K S Mohindra

Can microcredit help improve the health of poor women? Some findings from a cross-sectional study in Kerala, India

BackgroundThis study examines associations between female participation in a microcredit program in India, known as self help groups (SHGs), and womens health in the south Indian state of Kerala. Because SHGs do not have a formal health program, this provides a unique opportunity to assess whether SHG participation influences womens health via the social determinants of health.MethodsThis cross-sectional study used special survey data collected in 2003 from one Panchayat (territorial decentralized unit). Information was collected on womens characteristics, health determinants (exclusion to health care, exposure to health risks, decision-making agency), and health achievements (self assessed health, markers of mental health). The study sample included 928 non elderly poor women.ResultsThe primary finding is that compared to non-participants living in a household without a SHG member, the odds of facing exclusion is significantly lower among early joiners, women who were members for more than 2 years (OR = 0.58, CI = 0.41–0.80), late joiners, members for 2 years and less (OR = 0.60, CI = 0.39–0.94), and non-participants who live in a household with a SHG member (OR = 0.53, CI = 0.32–0.90). We also found that after controlling for key womens characteristics, early joiners of a SHG are less likely to report emotional stress and poor life satisfaction compared to non-members (OR = 0.52, CI = 0.30–0.93; OR = 0.32, CI = 0.14–0.71). No associations were found between SHG participation and self assessed health or exposure to health risks. The relationship between SHG participation and decision-making agency is unclear.ConclusionMicrocredit is not a panacea, but could help to improve the health of poor women by addressing certain issues relevant to the context. In Kerala, SHG participation can help protect poor women against exclusion to health care and possibly aid in promoting their mental health.

Women’s health in a rural community in Kerala, India: do caste and socioeconomic position matter?

Objectives: To examine the social patterning of women’s self-reported health status in India and the validity of the two hypotheses: (1) low caste and lower socioeconomic position is associated with worse reported health status, and (2) associations between socioeconomic position and reported health status vary across castes. Design: Cross-sectional household survey, age-adjusted percentages and odds ratios, and multilevel multinomial logistic regression models were used for analysis. Setting: A panchayat (territorial decentralised unit) in Kerala, India, in 2003. Participants: 4196 non-elderly women. Outcome measures: Self-perceived health status and reported limitations in activities in daily living. Results: Women from lower castes (scheduled castes/scheduled tribes (SC/ST) and other backward castes (OBC) reported a higher prevalence of poor health than women from forward castes. Socioeconomic inequalities were observed in health regardless of the indicators, education, women’s employment status or household landholdings. The multilevel multinomial models indicate that the associations between socioeconomic indicators and health vary across caste. Among SC/ST and OBC women, the influence of socioeconomic variables led to a “magnifying” effect, whereas among forward caste women, a “buffering” effect was found. Among lower caste women, the associations between socioeconomic factors and self-assessed health are graded; the associations are strongest when comparing the lowest and highest ratings of health. Conclusions: Even in a relatively egalitarian state in India, there are caste and socioeconomic inequalities in women’s health. Implementing interventions that concomitantly deal with caste and socioeconomic disparities will likely produce more equitable results than targeting either type of inequality in isolation.

Women's Interlaced Freedoms: A Framework Linking Microcredit Participation and Health*

Improving the health of poor women is a public health priority worldwide. In this paper, we focus on microcredit — an intervention not explicitly designed to have an impact on health. Microcredit programmes aim to provide the poor with access to credit, thereby improving their opportunities to engage in productive activities. This paper presents a conceptual framework, inspired by Sens capability approach, Michael Grossmans health production theory, and models of the determinants and pathways of population health, to assess how participation in microcredit can lead to improvement in the health of poor women. We explore how womens health capabilities (i.e. opportunities to achieve good health), and ultimately their health functionings (e.g. being healthy), can be expanded via key determinants of population health, such as access to resources and autonomy. *This is a revised version of ‘Expanding Female Health Capabilities in the South: Linking Microcredit Participation and Womens Health’, a paper presented at the 4th International Conference on the Capability Approach, Pavia, Italy, 5–7 September 2004.

My Story is Like a Goat Tied to A Hook. Views from a Marginalised Tribal Group in Kerala (India) On the Consequences of Falling Ill: A Participatory Poverty and Health Assessment

Background Indigenous populations tend to have the poorest health outcomes worldwide and they have limited opportunities to present their own perspectives of their situation and shape priorities in research and policy. This study aims to explain low healthcare utilisation rates and opportunities to cope with illness among a deprived indigenous group - based on their own experiences and views. Methods A participatory poverty and health assessment (PPHA) was conducted among the Paniyas, a previously enslaved tribal population of South India in a Gram Panchayat in Kerala, India in 2008. Purposive sampling was used to select five Paniya colonies, involving 66 households. Results There were four key findings. First, Paniyas perception that the quality of the public healthcare system is poor leads them to seek suboptimal care or deters them from using services. Second, there are significant costs of care unrelated to service use or purchase of medicines, such as travel costs, which the Paniyas lack the ability to pay. Third, illness can lead to loss of productive opportunities among those who fall ill and those who provide informal care. Fourth, the Paniyas lack a ‘range’ of coping strategies as they are wage labourers without diverse sources of income. They rely on a single strategy: borrowing from outside their community, often from landowners and employers, to whom they become indebted with their labour. Conclusions Improving the capacity of tribal populations to present their own perspectives is likely to lead to more effective tribal development policies and consequently better health.

Women's health in developing countries: beyond an investment?

Most international programs and policies devised to improve womens health in developing countries have been shaped by powerful agencies and development ideologies, including the tendency to view women solely through the lens of instrumentalism (i.e., as a means to an end). In a literature review, the authors followed the trail of instrumentalism by reviewing the different approaches and paradigms that have guided international development initiatives over the past 50 years. The analysis focuses on three key approaches to international development: the economic development, public health, and women-gender approaches. The findings indicate that progressive changes have adopted a more inclusive development perspective that is potentially beneficial to womens health. On the other hand, most paradigms have largely viewed improving womens lives in general, and their health in particular, as an investment or a means to development rather than an end in itself. Public health strategies did not escape the instrumentalism entrenched in the broader development paradigms. Although there was an opportunity for progress in the 1990s with the emergence of the human development and human rights paradigms and critical advances in Cairo and Beijing promoting womens agency, the current Millennium Development Goals project seems to have relapsed into instrumentalism.

Alcohol use and its consequences in South India: Views from a marginalised tribal population

BACKGROUNDnAlcohol consumption in India is disproportionately higher among poorer and socially marginalised groups, notably Scheduled Tribes (STs). We lack an understanding of STs own views with regard to alcohol, which is important for implementing appropriate interventions.nnnMETHODSnThis study was undertaken with the Paniyas (a previously enslaved ST) in a rural community in Kerala, South India. The study, nested in a participatory poverty and health assessment (PPHA). PPHA aims to enable marginalized groups to define, describe, analyze, and express their own perceptions through a combination of qualitative methods and participatory approaches (e.g. participatory mapping and ranking exercises). We worked with 5 Paniya colonies between January and June 2008.nnnRESULTSnAlcohol is viewed as a problem among the Paniyas who reported that consumption is increasing, notably among younger men. Alcohol is easily available in licensed shops and is produced illicitly in some colonies. There is evidence that local employers are using alcohol to attract Paniyas for work. Male alcohol consumption is associated with a range of social and economic consequences that are rooted in historical oppression and social discrimination.nnnCONCLUSIONnFuture research should examine the views of alcohol use among a variety of marginalised groups in developing countries and the different policy options available for these populations. In addition, there is a need for studies that untangle the potential linkages between both historical and current exploitation of marginalized populations and alcohol use.

Paniya Voices: A Participatory Poverty and Health Assessment among a marginalized South Indian tribal population

BackgroundIn India, indigenous populations, known as Adivasi or Scheduled Tribes (STs), are among the poorest and most marginalized groups. Deprived ST groups tend to display high levels of resignation and to lack the capacity to aspire; consequently their health perceptions often do not adequately correspond to their real health needs. Moreover, similar to indigenous populations elsewhere, STs often have little opportunity to voice perspectives framed within their own cultural worldviews. We undertook a study to gather policy-relevant data on the views, experiences, and priorities of a marginalized and previously enslaved tribal group in South India, the Paniyas, who have little voice or power over their own situation.Methods/designWe implemented a Participatory Poverty and Health Assessment (PPHA). We adopted guiding principles and an ethical code that promote respect for Paniya culture and values. The PPHA, informed by a vulnerability framework, addressed five key themes (health and illness, well-being, institutions, education, gender) using participatory approaches and qualitative methods. We implemented the PPHA in five Paniya colonies (clusters of houses in a small geographical area) in a gram panchayat (lowest level decentralized territorial unit) to generate data that can be quickly disseminated to decision-makers through interactive workshops and public forums.Preliminary findingsFindings indicated that the Paniyas are caught in multiple vulnerability traps, that is, they view their situation as vicious cycles from which it is difficult to break free.ConclusionThe PPHA is a potentially useful approach for global health researchers working with marginalized communities to implement research initiatives that will address those communities health needs in an ethical and culturally appropriate manner.

The value of presenting at scientific conferences: reflections by a couple of early career researchers

Homo academicus , to use a term coined by Pierre Bourdieu, is a special species and for those of us embarking on our careers, we must be able to demonstrate our potential ability to not only survive but to excel in the academic jungle if we hope to secure our first post as an assistant professor or a junior researcher. The selection criteria include a lengthy list of publications in journals with the highest possible impact factor, an established research programme demonstrating the capacity to be an independent researcher, and extensive experience as communicators, both as invited speakers and as presenters at scientific conferences. Although there is much to be said on all of these aspects, our commentary focuses on this last point, as we should not forget the words of Max Weber:1 “of all of the pedagogical tasks, the most difficult is that of communicating scientific problems in such a way that an unprepared yet gifted individual will be able to understand and …

Towards the next generation of public health research in India: a call for a health equity lens

Background Public health research is at a cross road in India. Despite a high level of health needs and new public health challenges arising in the context of rapid economic growth and social change, public health research is not keeping up with the needs of Indian society. There are, however, new initiatives creating opportunities to increase public health research, thereby raising debates about public health research priorities. Objective In this paper, the authors offer their own view on an agenda for the next generation of public health research in India. Findings The authors first outline the main reasons why they believe that public health research has been sidelined in India. Then, the authors argue that health equity should be the overarching principle guiding a public health research agenda. The authors suggest how to integrate equity-oriented strategies into the public health research agenda and propose some key research questions that require urgent attention from their respective disciplines.

Can Short-term Economic Policies Hurt the Health of the Poor? Demonetization in India

In November 2016, the Government of India (GOI) demonetized the commonly used Rs500 and Rs1,000 denominations. This was a short-term economic policy, known as notebandi, implemented as a means to address black money, counterfeit currencies, and terrorist activities. Notebandi was unrolled in a chaotic, confusing, and complex manner, leaving many people with limited access to cash in their daily activities. And the poor, who tend to earn their livelihoods from cash, were faced with economic exclusion and even destitution. In this paper, we argue that demonetization had disproportionately negative consequences on the poor and trace the main pathways between demonetization and the health of the poor. We conclude by calling on public health researchers to monitor and evaluate the health consequences of India’s latest demonetization and to rapidly assess future policy initiatives in order to help advise governments in devising and implementing economic policies that does not harm the health of people, especially the poor.