title: Social determinants of health in India: progress and inequities across states.
abstract: BACKGROUND
  Despite the recognized importance of social determinants of health (SDH) in India, no compilation of the status of and inequities in SDH across India has been published. To address this gap, we assessed the levels and trends in major SDH in India from 1990 onwards and explored inequities by state, gender, caste, and urbanicity.
  
  
  METHODS
  Household- and individual-level SDH indicators were extracted from national household surveys conducted between 1990 and 2011 and means were computed across population subgroups and over time. The multidimensional poverty index (MPI), a composite measure of health, education, and standard of living, was calculated for all three rounds of the National Family Health Survey, adjusting the methodology to generate comparable findings from the three datasets. Data from government agencies were analyzed to assess voting patterns, political participation, and air and water pollution.
  
  
  RESULTS
  Changes in the MPI demonstrate progress in each domain over time, but high rates persist in important areas: the majority of households in India use indoor biomass fuel and have unimproved sanitation, and over one-third of households with a child under the age of 3 years have undernourished children. There are large, but narrowing, gender gaps in education indicators, but no measurable change in women's participation in governance or the labor force. Less than 25% of workers have job security and fewer than 15% have any social security benefit. Alarming rates of air pollution are observed, with particulate matter concentrations persistently above the critical level at over 50% of monitoring stations.
  
  
  CONCLUSIONS
  This assessment indicates that air pollution (indoor and outdoor), child undernutrition, unimproved sanitation, employment conditions, and gender inequality are priority areas for public policy related to SDH in India.
authors.affiliation: Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, New Delhi, India. kcowlin1@jhu.edu.
authors.forename: Krycia
authors.initials: K
authors.lastname: Cowling
authors.affiliation: Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, New Delhi, India. rakhi.dandona@phfi.org.
authors.forename: Rakhi
authors.initials: R
authors.lastname: Dandona
authors.affiliation: Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, New Delhi, India. lalit.dandona@phfi.org.|Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA. lalit.dandona@phfi.org.
authors.forename: Lalit
authors.initials: L
authors.lastname: Dandona
mesh_terms: D000397:Air Pollution; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology; D003296:Cooking / Q000379:methods; D054624:Health Status Disparities; D006801:Humans; D007194:India / Q000453:epidemiology; D011057:Politics; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012499:Sanitation / Q000706:statistics & numerical data; D012737:Sex Factors; D064890:Social Determinants of Health / Q000706:statistics & numerical data* / Q000639:trends*; D012959:Socioeconomic Factors; D014876:Water Pollution