Written by Swagata Bhattacharya, Head of Marketing Operations & Brand at Medix India

Addressing SDH is vital for achieving health equity. This article examines the primary SDH in India, their effect on health outcomes, plus government interventions and impact to mitigate health disparities.

How Do SDH Adversely Impact Overall Health in India?

Health disparities in India are largely driven by socio-economic factors, particularly in underdeveloped states like Uttar Pradesh and Jharkhand. Low-income communities often face limited access to healthcare, leading to high rates of preventable diseases, malnutrition, and distress migration. Poor education and low health literacy—especially among marginalised groups and women—further impact health-seeking and sanitation behaviours.

The lack of access to clean water and sanitation contributes significantly to disease burden, causing nearly two lakh deaths annually. Additionally, a large segment of India’s workforce is employed in low-paid, insecure jobs with hazardous conditions, lacking both healthcare access and financial protection. These vulnerabilities are worsened by deep-rooted caste, gender, and cultural inequalities that limit healthcare access, particularly for women’s reproductive and maternal needs.

Nutrition and food security are also pressing concerns, especially among women and children in impoverished areas. Undernutrition leads to serious deficiencies and developmental issues, while rising overnutrition contributes to a rise in non-communicable diseases like diabetes, with a study showing a 16.1% prevalence but low rates of awareness, treatment, and control. Rapid urbanisation, though improving healthcare accessibility in cities, brings challenges such as overcrowding, inadequate infrastructure, and poor sanitation—particularly in slums. Rural areas, on the other hand, suffer from insufficient healthcare infrastructure, widening the urban–rural gap.

Mental health remains neglected, especially for vulnerable groups, due to stigma and limited services. Climate change further compounds these issues, intensifying disease risks through pollution, heatwaves, and extreme weather events. Migrant and displaced populations are particularly at risk, often lacking consistent access to healthcare. Addressing these disparities requires integrated, inclusive policies that combine healthcare reform, social support, and environmental resilience.

Governmental Policies Aimed at Mitigating the Adverse Effects of SDH

To address the impact of socioeconomic disparities on health, key policies such as the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA, 2005) have provided wage employment to over 7.5 crore households in 2020–21, reducing rural poverty, distress migration, and improving nutrition. The act has also led to increased female workforce participation. Ayushman Bharat (2018) further tackles health access inequality by offering insurance to 500 million individuals, significantly lowering out-of-pocket healthcare expenses.

The Right to Education Act (2009) and the National Policy for Skill Development & Entrepreneurship (2015) target education-driven health disparities, especially among rural and marginalised communities. These initiatives cover over 1.5 million schools and thousands of institutions nationwide, aiming to close the health literacy gap reflected in India’s literacy rates—rural literacy stood at 73.5% compared to 87.7% in urban areas, and male literacy in India was 82% while female literacy was 65%. On the environmental front, the Swachh Bharat Mission declared 6 lakh villages “open defecation free” and built 100 million toilets by 2019. Complementing this, the Jal Jeevan Mission raised rural tap water access to 77.87% by August 2024, while the National Water Mission aimed to improve water-use efficiency by 20%.

India’s uneven healthcare infrastructure has seen improvements through the National Health Mission, which engaged 12 lakh health workers from 2021 to 2024 and helped reduce the Maternal Mortality Ratio by 83% since 1990. Despite this, rural areas continue to face service shortages. Urban challenges tied to overcrowding and poor sanitation are addressed via the National Urban Housing and Habitat Policy (2007), while the National Policy for Farmers (2007) supports rural populations, indirectly easing urban migration. Cultural and gender disparities are targeted through the National Policy on Empowerment of Women (2001) and e-Shram, which registered 29.2 crore informal workers—53% women.

The Labour Codes (2019–2020) extended protections to 50 crore workers. Nutrition interventions under the National Food Security Act (2013) align with modest health gains seen in the National Family Health Survey (2019–21), including declines in child malnutrition. Improvements—stunting (7%), wasting (8%), and underweight rates (10.3%) in children under five have declined slightly, as has malnutrition among women (18.3%). Meanwhile, the National Health Policy (2017) and Ayushman Bharat push for universal coverage. By 2022, government healthcare spending rose from 3.94% to 6.12%, reducing out-of-pocket expenses.

The Niti Aayog Health Index Provides a State-Wide Assessment of the Health Situation in India

The Niti Aayog (National Institution for Transforming India, a government policy think tank), in collaboration with the World Bank and the Ministry of Health and Family Welfare, launched a report on “Healthy States and Progressive India”. This report assesses health performance across Indian states using 23 indicators grouped into health outcomes, governance, and key inputs.

Kerala ranked highest but saw a decline from 2014 to 2018. Nagaland and Uttar Pradesh showed minimal progress.

These rankings highlight the regional disparities in health access and outcomes and call for continuous and focused interventions.

Conclusion: Addressing Health Disparities in India Through Social Determinants

Health disparities in India are deeply influenced by a range of socioeconomic, cultural, and environmental factors. To address these inequalities, India must adopt a comprehensive approach that focuses on education, economic empowerment, infrastructure development, and social justice reforms. Policies such as MGNREGA, the National Health Policy, and Ayushman Bharat, represent the first steps in the right direction, but more effort is needed to:

• Strengthen rural health systems & sanitation
• Integrate mental health services
• Promote climate-resilient healthcare & rural development
• Expand impact of insurance coverage
• Improve infrastructure in underserved regions & arrest distress migration

The path to a healthier India begins not only in hospitals but also in classrooms, homes, workplaces, and communities. Raising awareness is essential to maximise the impact of government policies, NGO efforts, and other stakeholder initiatives. Stakeholders across government, civil society, and the private sector must collaborate to address the root causes of health disparities.

Communities most affected by these social determinants of health (SDH) must be informed and guided to access the benefits of government schemes. Furthermore, government authorities need to reduce red tape and streamline lengthy processes that hinder citizens from fully benefiting from these policies and acts.

Greater individual effort is also needed; citizens can contribute by staying informed, advocating for change, and supporting community programs that positively influence social determinants of health. Everyone has a role to play in building a healthier, more informed, and equitable India.