Table 3 Key findings from Phase II
Social inequalities in health • There is a large health divide between social groups. The category of SC/ST (targeted by positive discrimination) is heterogeneous: one ST group, the Paniyas, are particularly disadvantaged. The divide between ST and non-ST populations persists even after controlling for poverty and education. These results illustrate that STs’ vulnerability in the social structure goes well beyond material deprivation [18]. |
Health of Paniyas ■Paniyas have high levels of health needs; their prevalences of underweight, anaemia, and goitre are 60%, 15%, and 11% respectively [18]. Inequalities in health exist across generations. Young adults are particularly disadvantaged with respect to hypertension. Paniyas reported that they are caught in multiple “vulnerability traps”, that is, they view their situation as vicious cycles from which it is difficult to break away [13;19]. ■Alcohol is viewed as a problem among the Paniyas who reported that: 1) its consumption is increasing, notably among younger men; 2) it is easily available in licensed shops and is produced illicitly in some colonies; 3) it is used to attract Paniyas for work by some local employers; and 4) it is associated with a range of social and economic consequences that are rooted in historical oppression and social discrimination [16]. |
Population health interventions â– Women office bearers of SNEHA have proven themselves capable of decisionmaking and tackling challenges proactively (see, for instance, the change of insurance company). They have developed their negotiating power (see the negotiation with the insurance company that took over the scheme), have gained a profound knowledge of health insurance and of inclusion issues (see the revision of eligibility criteria for enrolling in the CBHI), have shown leadership and have overcome political pressure (SNEHA at present is not ruled by its governing body but by informal leadership). Today the CBHI is still functional with about 1,000 members. |