Health Inequalities in Kerela

The Sustainable Development Goals (SDGs), which were published in 2015,recognised Non-Communicable Diseases (NCDs) are a serious threat to sustainable development and set a global goal to cut premature death by a third in the next 15 years. Kerala, in southern India, topped the country's Sustainable Development Goal India Index in 2019, outperforming other states in terms of life expectancy, mortality, and death rates. However, when compared to other Indian states, the state's morbidity rates are substantially greater, owing largely to the prevalence of NCDs. According to a recent study, roughly 61 percent of NCD-affected households in Kerala suffered catastrophic health expenses, and in fact, absolute impoverishment as a result of the disease's burden in kerela was the highest of any state in the country.

In light of this, the Kerala government has established state-specific SDGs, one of which is to lower the prevalence of high blood pressure (HBP) by 30–40% and high blood glucose (HBG) by 18–20% among people aged 30 and up. Kerala has established the Aardram mission to fulfil these state-specific goals, with the purpose of transforming public health systems, with a focus on expanding the scope and quality of primary care services. Starting in 2017, a number of the state's Primary Health Centres (PHC) were upgraded to Family Health Centres (FHC) by boosting staff, training, infrastructure, and working hours as part of this aim. In addition, the state has updated its NCD guidelines to include opportunistic screening for persons over the age of 30 for diabetes and above 18 years for hypertension.

Given these reforms, it was necessary to establish population coverage as a baseline at this early stage. There was already signs of inequities as the FHC programme was being implemented: According to the Kerala Economic Review 2018, there were sex inequalities in diabetes prevalence, with 27 percent of adult males and 19 percent of adult females having diabetes.

Literature reveals that the frequency of self-reported NCDs differs across men and women in different countries, as well as in India and Kerala.

The frequency of NCDs and related risk factors are linked to sex, education, and income, resulting in catastrophic disease burden among vulnerable groups. According to a 2012 study, diabetes prevalence was connected with Scheduled Caste (SC) and Scheduled Tribe (ST) status, better education, higher financial level, and rising age. In Kerala, studies have found that people living below the poverty line in rural areas are less likely to have diabetes, hypertension, or dyslipidemia than those living above the poverty line, as well as that sex differences exist in self-reported diabetes, with higher socioeconomic groups having more diabetes. While self-reported prevalence of cardiometabolic risk variables has limits for inferring NCD outcomes, this indicator can serve as a surrogate for early programme outreach from a health systems viewpoint.

Few of the aforementioned clinical measuring studies were also competent to examine NCD testing and risk factor prevalence in intersectional population groupings (i.e. men and women across socio-economic, social, and other groups). Intersectional analyses have offered key insights into the populations most affected by morbidity, as well as the health system's reach and activities. To close this gap, we need to look at differences in testing and self-reported prevalence of HBP and HBG among men and women in Kerala, based on education, wealth, caste and tribe, and religion.

In both testing indicators and self-reported prevalence indicators for blood pressure and blood glucose, the NFHS sheet discovered sex-related differences by wealth and education. High-income groups reported more testing and a higher prevalence of high blood pressure and blood glucose as determined by providers. Except for the frequency of high blood pressure, where relative differences were greater among women, the magnitude of wealth-related inequalities was bigger among men than women overall. In terms of relative prevalence, more educational attainment and affluence appear to be linked to more testing, although self-reported prevalence appears to differ by religious groupings. To guarantee that programme design does not leave anyone behind, further research is needed to understand contexts and paths.