Here is an advocacy document that Kerala University of Health Science (KUHS) has made following intense brainstorming. The document was submitted to the Government of Kerala; but any follow-up action is yet to be taken, even though Social determinants has been mentioned in the State’s draft health policy.
KUHS is planning to start acting, in collaboration with the Kerala Institute of Local Administration (KILA). We hope that we will be able to implement a scheme as a pilot project in a couple of selected Panchayats, and create models. It is hoped that we will be able to rope in the Dept. of Self Government in due course (KILA, an autonomous Institute, is under this Dept.
Kerala State has attained excellent health indicators as compared to the other states of India but faces major challenges of health inequalities. It is high time that the State of Kerala takes initiatives in main-streaming social determinants of health while it still has the potential to be a model for other states. Government policies have to be sensitive in this area and programs should factor in the social determinants and promote intersectoral activities that promote health and tackle health inequalities.
Research in health should look into these social determinants and their interactions to plan programs and mechanisms of implementation. There is a need to evaluate the Kerala model of health and the challenges it faces from a SDH perspective. This will help planning the future better.
Kerala University of Health Sciences believe that it is its responsibility to collect, synthesise and disseminate evidence in this area which will help equip the State in dealing with the challenges in the coming years.
We recognise there is paucity of discussion on social determinants of health in Kerala and there is a requirement of greater emphasis on generating information according to social group divide, there has to be some discussion as regard defining social group identities in the state. The conventional socio-economic classification need to be directly applicable in Kerala where there is a swelling of the middle class (in economic erms) over time.
Probably there is a need for alternative formulation of social group identity to bring to the real extent of inequities to the fore in health care prevalent in the state. Another significant aspect that needs to be studied is the behavioural divide in consumption, the unusual pattern of lifestyle adoption that feeds into the kind of epidemiological profile.
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