Inverse care and the role of the state: the health of the urban poor

Nambiar, Devaki; Mander, Harsh

doi:10.2471/blt.16.179325

Cited by 18 publications

(17 citation statements)

References 5 publications

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“…First, most studies on the association between green space exposure and health are based in high income countries. It is unknown whether green space exposure impacts physical and mental health in large urban metropolises of low and middle income countries (LMICs) like India, whose socio-cultural and socio-economic milieus are very distinct and diverse, currently experiencing rapid rates of unplanned urbanization and shrinking green space, and where urban stressors (crowding, noise, traffic), the burden of disease and related risk factors, as well as health inequalities are more severe than in high income countries (Glaeser, 2014; Nambiar, Mander, & Mander, 2017). …”

Section: Introductionmentioning

confidence: 99%

Park availability and major depression in individuals with chronic conditions: Is there an association in urban India?

et al. 2017

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Green space exposure has been positively correlated with better mental-health indicators in several high income countries, but has not been examined in low- and middle-income countries undergoing rapid urbanization. Building on a study of mental health in adults with a pre-existing chronic condition, we examined the association between park availability and major depression among 1208 adults surveyed in Delhi, India. Major depression was measured using the Mini International Neuropsychiatric Interview. The ArcGIS platform was used to quantify park availability indexed as (i) park distance from households, (ii) area of the nearest park; and within one km buffer area around households - the (iii) number and (iv) total area of all parks. Mixed-effects logistic regression models adjusted for socio-demographic characteristics indicated that relative to residents exposed to the largest nearest park areas (tertile 3), the odds [95% confidence interval] of major depression was 3.1 [1.4-7.0] times higher among residents exposed to the smallest nearest park areas (tertile 1) and 2.1 [0.9-4.8] times higher in residents with mid-level exposure (tertile 2). There was no statistically significant association between other park variables tested and major depression. We hypothesized that physical activity in the form of walking, perceived stress levels and satisfaction with the neighbourhood environment may have mediating effects on the association between nearest park area and major depression. We found no significant mediation effects for any of our hypothesized variables. In conclusion, our results provide preliminary and novel evidence from India that availability of large parks in the immediate neighborhood positively impacts mental well-being of individuals with pre-existing chronic conditions, at the opportune time when India is embarking on the development of sustainable cities that aim to promote health through smart urban design – one of the key elements of which is the inclusion of urban green spaces.

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Section: Introductionmentioning

confidence: 99%

Park availability and major depression in individuals with chronic conditions: Is there an association in urban India?

et al. 2017

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“…However, in practice, urban governance for health is distributed unevenly across national, regional, and municipal governments 57. It spans public, private for-profit, and not-for-profit providers of various types,1213 and is characterised by internal politics at various levels,141516 and almost systemic exclusion of vulnerable populations 17…”

Section: Urban Health Governancementioning

confidence: 99%

Advancing universal health coverage in South Asian cities: a framework

Adams

Nambiar

Siddiqi

et al. 2018

BMJ

Self Cite

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“…In most instances in rural India, decision-making among households during maternal emergencies is in uenced by past experiences with the health system and a tendency to follow traditional cultural beliefs (29,31,32). Previously delays in care-seeking have been explained using the widely validated three-delays framework as an approach to develop interventions to improve care-seeking steps (19,24,31,(33)(34)(35). The framework identi es the recognition of danger signs in the household as the rst type of delay, delays in reaching an appropriate facility as the second delay and lastly, delays in receiving adequate care in the health facility (35).…”

Section: Introductionmentioning

confidence: 99%

Improving Birth Preparedness and Complication Readiness Through an Integrated Microfinance and Health Literacy Program:Evidence From Rural India

Ahmad¹,

Mohanty²,

Niyonsenga³

2020

Preprint

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Background:Despite maternal mortality rate almost halving over the past two decades, approximately 295,000 deaths occurred annually in 2017 globally. They occur in high burden regions where most preventable deaths are precipitated by delays in maternal care provision. Recently, a novel rapidly scalable community-based program combining maternal health literacy delivery through microfinance-based women-only self-help groups (SHG) was implemented in rural India. We evaluated the impact of the IMFHL program on BPCR practice by women in one of India’s poorest states-Uttar Pradesh, adjusting for community, household and individual variables. We also investigated if there is a diffusion of knowledge of BPCR from SHG members receiving the health literacy intervention to non-members in program villages.Method: Using secondary survey data from the IMFHL project, we analysed data from 17,244 women across SHG and non-member households in Uttar Pradesh. We performed multivariable logistic regressions to estimate adjusted IMFHL program’s effects on maternal BPCR practice.Results: Membership in SHG alone is positively associated with BPCR practice with 17 percent higher odds compared to women in villages without the programs. Furthermore, the odds of practising complete BPCR increases by almost fifty percent when a maternal health literacy component is added to the SHGs. A diffusion effect was found for BPCR practice from SHG members to non-members only when an added health literacy component was integrated into the SHG model. The main effect of the IMFHL program on BPCR practice remained stable in the presence of confounders suggesting that the delivery of health messages is undiluted by other non-programmatic factors at the individual, household and community level. Among confounders, only the poorest households as captured by the wealth quintile were significantly negatively associated with BPCR practice.Conclusion: The public health literature promotes the adoption of BPCR practices to improve maternal health outcomes. This study shows that SHGs exert both a dissemination effect of planned health behaviour within members, as well as facilitate a diffusion effect of the natural transfer of BPCR from members to non-members when SHGs are enriched with a health literacy component

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Inverse care and the role of the state: the health of the urban poor

Cited by 18 publications

References 5 publications

Park availability and major depression in individuals with chronic conditions: Is there an association in urban India?

Park availability and major depression in individuals with chronic conditions: Is there an association in urban India?

Advancing universal health coverage in South Asian cities: a framework

Improving Birth Preparedness and Complication Readiness Through an Integrated Microfinance and Health Literacy Program:Evidence From Rural India

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