Skip to main content

Advertisement

SpringerLink
Log in

Socioeconomic Determinants of Health Inequalities Among the Older Population in India: A Decomposition Analysis

  • ORIGINAL ARTICLE
  • Published:
Journal of Cross-Cultural Gerontology Aims and scope Submit manuscript

Abstract

This study quantified and decomposed health inequalities among the older population in India and analyzes how health status varies for populations between 60 to 69 years and 70 years and above. Data from the 60th round of the National Sample Survey (NSS) was used for the analyses. Socioeconomic inequalities in health status were measured by using Concentration Index (CI) and further decomposed to find critical determinants and their relative contributions to total health inequality. Overall, CI estimates were negative for the older population as a whole (CI = −0.1156), as well as for two disaggregated groups, 60 to 69 years (CI = −0.0943) and 70 years and above (CI = −0.08198). This suggests that poor health status is more concentrated among the socioeconomically disadvantaged older population. Decomposition analyses revealed that poor economic status (54 %) is the dominant contributor to total health inequalities in the older population, followed by illiteracy (24 %) and rural place of residence (20 %). Other indicators, such as religion, gender and marital status were positive, while Caste was negatively associated with health inequality in the older populations. Finally, a comparative assessment of decomposition results suggest that critical contributors for health inequality vary for the older population of 60 to 69 years and 70 years and above. These findings provide important insights on health inequalities among the older population in India. Implications are advanced.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Alam, M., & Mukherjee, M. (2005). Aging, activities of daily living disabilities and the need for public health initiatives: some evidences from a household survey in Delhi. Asia Pacific Population Journal, 20(2), 47–77.

    Google Scholar 

  • Arokiasamy, P., Jain, K., Goli, S., & Pradhan, J. (2012). Health inequalities among urban children in India: a comparative assessment of Empowered Action Group (EAG) and South Indian States. Journal Biosocial Science, 45, 167–185.

    Article  Google Scholar 

  • Basant, R. (2007). Social, economic and educational conditions of Indian Muslims. Economic and Political Weekly, 42(10), 828–832.

    Google Scholar 

  • Bassuk, S. S., Berkman, L. F., & Amick, B. C. (2002). Socioeconomic status and mortality among the older: findings from four US communities. American Journal of Epidemiology, 155, 520–533.

    Article  Google Scholar 

  • Berkman, C., & Gurland, B. J. (1998). The relationship among income, other socioeconomic indicators, and functional level in older persons. Journal of Aging and Health, 10, 81–98.

    Article  Google Scholar 

  • Chen, B., & Mahal, A. (2010). Measuring the health of the Indian older: evidence from National Sample Survey data. Population Health Metrics, 8, 30.

    Article  Google Scholar 

  • Cockerhama, W. C., Hattorib, H., & Yamorib, Y. (2000). The social gradient in life expectancy: the contrary case of Okinawa in Japan. Social Science and Medicine, 51(2000), 115–122.

    Article  Google Scholar 

  • Deaton, A. S. (2002). Policy implications of the gradient of health and wealth. Health Affairs, 21, 13–30.

    Article  Google Scholar 

  • Deaton, A. (2003). Health, inequality, and economic development. Journal of Economic Literature, 41, 113–158.

    Article  Google Scholar 

  • Deaton, A. S., & Paxson, C. (2001). Mortality, education, income and inequality among American cohorts. In D. A. Wise (Ed.), Themes in the economics of aging (pp. 129–165). Chicago: University of Chicago Press.

    Chapter  Google Scholar 

  • Desai, S. (2008). Caste in 21st century India: competing narratives. Economic and Political Weekly, 46(11), 41–49.

    Google Scholar 

  • Devi, S. B. (2005). Challenges and issues in formal care giving. Indian Journal of Gerontology, 19(4), 447–456.

    Google Scholar 

  • Drèze, J., & Sen, A. K. (2013). An uncertain glory, india and its contradictions. New Delhi: Penguin.

    Google Scholar 

  • Duda, R. B., Anarfi, J. K., Adanu, R. M. K., Seffah, J., Darko, R., & Hill, A. G. (2011). The health of the “older women” in Accra, Ghana: results of the women’s health study of Accra. Journal of Cross Cultural Gerontology, 26, 299–314.

    Article  Google Scholar 

  • Dumont, L. (1970). Homo hierarchicus: The caste system and its implications. London: England Weidenfeld and Nicholson.

    Google Scholar 

  • Evans, R. G., Barer, M. L., & Marmor, T. R. (Eds.). (1994). Why are some people healthy and others not? The determinants of health of populations. New York: Aldine de Gruyter.

    Google Scholar 

  • Gakidou, E. E., Murray, C. J., & Frenk, J. (2000). Defining and measuring health inequality: an approach based on the distribution of health expectancy. Bulletin of the World Health Organization, 78(1), 42–54.

    Google Scholar 

  • Garfein, A. J. (1995a). Robust aging among the young-old, old-old, and oldest-old. Journal of Gerontology Series B: Psychological Science and Social Science, 50B(2), S77–S87.

    Article  Google Scholar 

  • Garfein, A. J. (1995b). Robust aging among the young-old, old-old, and oldest-old. Journal Gerontology B Psychological Science Social Science, 50B(2), S77–S87.

    Article  Google Scholar 

  • Golandaj, J. A., Goli, S., & Das, K. C. (2013). Living arrangements among older population and perceptions on old age assistance among adult population in India. International Journal of Sociology and Social Policy, 33(5/6), 367–379.

    Article  Google Scholar 

  • Goli, S., & Arokiasamy, P. (2013). Trends in health and health inequalities among major states of India: assessing progress through convergence models. Health Economics, Policy, and Law, 26, 1–26.

    Google Scholar 

  • Goli, S. & Pandey, A. (2010). Challenges of twenty-first century-A trans disciplinary perspective. Macmillan Advanced Research Series.

  • Goli, S., Riddhi, D., & Arokiasamy, P. (2013). Pathways of economic inequalities in maternal and child health in urban India: a decomposition analysis. PLoS One, 8(3), e58573.

    Article  Google Scholar 

  • Government of India. (2006). Social, economic and educational status of the Muslim community of India. A report. Prime Minister’s high level committee. New Delhi

  • Grundy, E., & Sloggett, A. (2002). Health inequalities in the older population: the role of personal capital, social resources, and socio-economic circumstances. Social Sciences and Medicine, 56, 935–947.

    Article  Google Scholar 

  • Gwatkin, D. R. (2000). Health inequalities and the health of the poor: what do we know? What can we do? Bulletin of the World Health Organization, 78(1), 3–17.

    Google Scholar 

  • Hosseinpoor, A. R., Doorslaer, V. E., Ahmad Speybroeck, N., Hosseinpoor, R., Van Doorslaer, E., Speybroeck, N., Naghavi, M., Mohammad, K., Majdzadeh, R., Delavar, B., Jamshidi, H., & Vega, J. (2006). Decomposing socioeconomic inequality in infant mortality in Iran. International Journal of Epidemiology, 35, 1211–1219.

    Article  Google Scholar 

  • Huguet, N., Kaplan, M. S., & Feeny, D. (2008). Socioeconomic status and health-related quality of life among older people: Results from the Joint Canada/United States Survey of Health. Social Science and Medicine, 66, 803–810.

    Article  Google Scholar 

  • Huisman, M., Kunst, A. E., & Mackenbach, J. P. (2004). Socioeconomic inequalities in morbidity among the older: a European overview. Social Science and Medicine, 57, 861–873.

    Article  Google Scholar 

  • IIPS and Macro International. (1992–2006). National Family Health Survey (NFHS-3), India 2005–06. International Institute for Population Sciences (IIPS), Mumbai.

  • Jain, K., Goli, S., & Arokiasamy, P. (2012). Are self-reported morbidities deceptive in measuring socio-economic inequalities in India: a case of obstetric morbidity in EAG states. Indian Journal of Medical Research, 136, 35–42.

    Google Scholar 

  • Kitagawa, E. M., & Hauser, P. M. (1973). Differential mortality in the United States: A study of socioeconomic epidemiology. Cambridge: Harvard University Press.

    Book  Google Scholar 

  • Kumar, V. S. (2003). Economic security for the older in India: an overview. Journal of Aging and Social Policy, 15(2–3), 45–65.

    Article  Google Scholar 

  • Matthews, R. J., Jagger, C., & Hancock, R. M. (2006). Does socio-economic advantage lead to a longer, healthier old age? Social Science and Medicine, 62, 2489–2499.

    Article  Google Scholar 

  • Mini, G. K. (2009). Socioeconomic and demographic diversity in the health status of older people in a transitional society, Kerala, India. Journal of Biosocial Science, 41(4), 457–467.

    Article  Google Scholar 

  • Mishra, A. J. (2005). Is a social security for the older enough? A study of the perception of old age home residents of Orissa. Indian Journal of Gerontology, 19(4), 373–380.

    Google Scholar 

  • National Research Council. (2012). Ageing in Asia: Finding from the new and emerging data Initiatives. In J. P. Smith & M. Majumdar (Eds.), Panel on policy research and data needs to meet the challenge of ageing in Asia. Committee on Population, Division of Behavioural and Social Sciences and Education. Washington, DC: The National Academies Press.

    Google Scholar 

  • National Research Council of the National Academies. (2011). Preparing for the challenges of population aging in Asia: Strengthening the scientific basis of policy development. Washington DC: National Academies Press.

    Google Scholar 

  • National Sample Survey Organization (2006). Morbidity, Health Care and the Condition of the Aged. Report No. 507 (60/25.0/1), Department of Statistics, Government of India, New Delhi.

  • Nawal, D., & Goli, S. (2013). Inequality in utilization of maternal health care services in Nepal. Ethnicity and Inequalities in Health and Social Care, 6(1), 3–15.

    Article  Google Scholar 

  • Nedjat, S., Hosseinpoor, A. R., et al. (2012). Decomposing socioeconomic inequality in self-rated health in Tehran. Journal of Epidemiology Community Health, 66(6), 495–500.

    Article  Google Scholar 

  • O’Donnell, O., Van Doorslaer, E., Wagstaff, A., & Lindelow, M. (2008). Analyzing health equity using household survey data. A guide to techniques and their implementation. Washington D. C: World Bank Institute.

    Google Scholar 

  • Pou, L. M. A., & Goli, S. (2012). Burden of multiple disabilities among the older population in India: an assessment of socioeconomic differentials. International Journal of Sociology Social Policy, 33(1/2), 63–76.

    Google Scholar 

  • Rajan, S. I. (2006). Population aging and health in India. Mumbai: The Centre for Enquiry into Health and Allied Themes (CEHAT).

    Google Scholar 

  • Schoenbaum, M., & Waidmann, T. (1997). Race, socioeconomic status, and health: accounting for race differences in health. The Journals of Gerontology Series B 1997, 52B(Special Issue), 61–73.

    Article  Google Scholar 

  • Smith, J., Borchelt, M., Maier, H., & Jopp, D. (1995). Health and well–being in the young old and oldest old. Journal of Social Issues, 58(4), 715–732.

    Article  Google Scholar 

  • Srinivasan, M. N. (1957). Caste in modern India. Journal of South Asian Studies, 16(4), 529–548.

    Article  Google Scholar 

  • Subramanian, S. V., et al. (2006). The mortality divide in India: the differential contributions of gender, caste, and standard of living across the life course. American Journal of Public Health, 96(5), 818–825.

    Article  Google Scholar 

  • Subramanian, S. V., Leland, K. A., Malavika, A. S., & Sivaramakrishnan, K. (2008). Health inequalities in India: the axes of stratification. Brown Journal of World Affairs, 14(2), 127–138.

    Google Scholar 

  • Sun, R., & Liu, Y. (2006). Mortality of the oldest old in China: the role of social and solitary customary activities. Journal of Aging and Health, 18, 37–55.

    Article  Google Scholar 

  • Sundmacher, L., Scheller-Kreinsen, D., & Busse, R. (2011). The wider determinants of inequalities in health: a decomposition analysis. International Journal for Equity in Health, 10(30), 5–13.

    Google Scholar 

  • Von dem Knesebeck, O., Uschen, G. L., Cockerham, W. C., & Siegrist, J. (2003). Socioeconomic status and health among the aged in the United States and Germany: a comparative cross-sectional study. Social Science and Medicine, 57(2003), 1643–1652.

    Article  Google Scholar 

  • Wagstaff, A. (1991). QALYs and the equity-efficiency trade-off. Journal of Health Economics, 10(1), 21–41.

    Article  Google Scholar 

  • Wagstaff, A. (2002). Poverty and health sector inequalities. Bulletin of the World Health Organization, 80(2), 97–105.

    Google Scholar 

  • Wagstaff, A., & van Doorslaer, E. (1991). On the measurement of inequalities in health. Social Sciences and Medicines, 33, 545–557.

    Article  Google Scholar 

  • Wagstaff, A., Van Doorslaer, E., & Wantanbe, N. (2003). On decomposing the causes of Health sector inequalities, with an application to malnutrition inequalities in Vietnam. Journal of Econometrics, 112(1), 219–227.

    Article  Google Scholar 

  • Wilkins, R., Marmot, M. (ed). (2003). The social determinants of health: The solid facts, 2nd edition. World Health Organization Europe. Retrieved 2013-03-27.

  • Wilkinson, R. G. (1996). Unhealthy societies: The afflictions of inequality. New York: Routledge.

    Book  Google Scholar 

  • Zhang, W. (2008). Religious participation and mortality risk among the oldest old in China. The Journals of Gerontology: Social Sciences, 63B, S293–S297.

    Article  Google Scholar 

  • Zimmer, Z., & Amorbsirisomboon, P. (2001). Socioeconomic status and health among older adults in Thailand: an examination using multiple indicators. Social Science and Medicine, 52(8), 1297–1311.

    Article  Google Scholar 

  • Zimmer, Z., & House, J. S. (2003). Education, income, and functional limitation transitions among American adults: contrasting onset and progression. International Journal of Epidemiology, 32, 1089–1097.

    Article  Google Scholar 

  • Zimmer, Z., & Kwong, J. (2003). Family size and support of older adults in rural and urban China: current effects and future implications. Demography, 40(1), 23–44.

    Article  Google Scholar 

  • Zimmer, Z., & Kwong, J. (2004). Socioeconomic status and health among older adults in rural and urban China. Journal of Aging and Health, 16, 44–70.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Development Studies, Giri Institute of Development Studies, Sector ‘0’Aliganj Housing Scheme, Lucknow, 226024, Uttar Pradesh, India

    Srinivas Goli

  2. School of Health Systems Studies, Tata Institute of Social Sciences (TISS), Mumbai, 400088,, Maharashtra, India

    Lucky Singh

  3. International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India

    Kshipra Jain & Ladumai Maikho Apollo Pou

Authors
  1. Srinivas Goli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lucky Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kshipra Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ladumai Maikho Apollo Pou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Srinivas Goli.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goli, S., Singh, L., Jain, K. et al. Socioeconomic Determinants of Health Inequalities Among the Older Population in India: A Decomposition Analysis. J Cross Cult Gerontol 29, 353–369 (2014). https://doi.org/10.1007/s10823-014-9251-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10823-014-9251-8

Keywords

Search

Navigation