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I. Background

Despite India’s rapid economic progress in recent years, social and economic inequalities in India by class, caste/ethnicity, and gender and location (among others) remain entrenched. Significant differences have been found to exist also in health status and in utilization of health care services across class, caste/ethnicity, gender and other axes of deprivation and combinations of many of these.
Effective policy action calls for robust evidence. It is for this reason that Achutha Menon Centre for Health Science Studies, the Public Health Wing of Sree Chitra Tirunal Institute for Medical Sciences and Technology, embarked in 2014 on a research initiative “Closing the Gap: Health Equity Research Initiative in India”. The overall objective of this research initiative, supported by the International Development Research Centre (IDRC) Canada, is to

“contribute to the advancement of a sound, actionable and measurable evidence- base on inequities in health in India with a view to influencing government and civil society initiatives to prioritize the reduction of health inequities”.  

Its activities include synthesis of current knowledge, identifying research priorities, creation of new knowledge, and transfer and translation of knowledge to influence policy towards reduction in health inequities in India.


II. Outline of the present exercise to identify priority research areas and research questions

This is an invitation to you to participate in an exercise to identify priority research areas and research questions on health inequities in India.

  • We have presented in the next section summary information on major research gaps identified through a synthesis exercise identified as a part of this project.
  • You are requested to list up to two priority areas for research, either from the gaps identified, or based on your own experiences.
  • Following this, kindly generate up to five research questions that will address the gaps, in the priority areas that you have identified.
  • Enter your responses in the template provided at the end of this document.

All the research questions generated through this process (and through other processes in the Closing the Gap initiative), will be pooled. Scoring and ranking of research questions will be done on the basis of specific criteria by a team of experts from multiple disciplines. The results will be used for advocacy to influence future research in this field.


III.     Research gaps

The following are research gaps in health equity research identified through the mapping and syntheses exercises carried out as part of the ‘Closing the gap’ project:

1. Axes and major drivers of health inequities

  • Class/ socio-economic status: The vast majority of studies on health inequities have examined variations by consumption expenditure class or by standard of living index or wealth index. However, they have been focused mainly on maternal health and health of children under five years of age. Studies on inequities by socio-economic status in incidence/ prevalence of communicable and non-communicable diseases, mental health or injuries are very few.
  • Caste/ethnicity: There is a major gap in studies examining caste and tribe based inequities in health outcomes, health seeking behaviour and access to and affordability of health care services. The small number of studies is focused on maternal health and health of children under five.  
  • Gender: There are almost no studies examining gender-based differentials between women and men and boys and girls above age 5 in health status and in health seeking behaviour for health conditions common to both.
  • “Socially constructed” vulnerabilities:  A generally neglected area is inequities in health, experienced by specific population groups subject to discrimination and stigma in different contexts. This includes for example persons living with disabilities (physical and mental); persons living with specific stigmatised health conditions; migrant workers. The exception is Persons living with HIV/AIDS, a relatively better studied group.
  • Health systems: Almost no studies examining how health systems as social institutions contribute to health inequities
  • A big gap exists in terms of studies simultaneously examining multiple axes of social inequalities (e.g. urban and female and poor)

2. Inequities in health conditions

  • Inequities in all reproductive health conditions besides pregnancy and delivery have remained little studied
  • Few studies exist on inequities in communicable and non-communicable diseases, mental health, injuries and inequities in disabilities

3. Inequities across specific population groups

Missing from most studies are

  • Girls above 5 years of age and women outside the reproductive age group – above 45 years of age  
  • Boys above 5 years of age and men of all ages
  • Urban populations (as compared to rural)
  • Occupational groups
  • North Eastern states of India and relatively “developed” states such as Kerala, Tamil Nadu and Goa (as compared to other states) and Jammu and Kashmir.

4. Gaps in types of studies

  • Very few studies are based on primary data
  • Very few studies using qualitative methods or mixed methods
  • Almost non-existent are studies examining the processes through which health disparities are created; or the processes through which social inequalities translate into health inequities
  • Another major gap is in terms of studies on interventions or policies that aim to close the gap in health status or access to health care services    

Click here to Identify Priority research areas and research questions