La significación cultural

1- Disfruta el siguiente video:



2- Complementándolo con  lo trabajado en clase , reflexiona  :

a -¿Qué relación encuentras entre la significación de los gestos en una cultura y el proceso de socialización.

b-En relación al mismo, y desde la importancia del valor que se le atribuye  a un mismo gesto o una misma palabra, en  culturas distintas,¿ podrías dar dos instancias en que  una persona  adopta pautas de socializacion nuevas ?

c-  ¿Y dos instancias en las que nos adaptamos a pautas de socializacion nuevas ,pero en nuestro mismo lugar originario?

3- Averigua :
Tres gestos que hayan sido ´´heredados´´´de otras culturas y adoptados por la nuestra.

ORGANIGRAMA

 

Preguntas con Scanning y Skimming

Preguntas sobre el Texto: "Mediación de Seguridad en Programas de Entretenimiento"

1.   Escribe  4 palabras claves que identifique el artículo elegido

2.  ¿ De que se trata el artículo?

MEDIACIÓN DE SEGURIDAD EN LOS PROGRAMAS DE ENTRETENIMIENTO

Inner Security in Media from the perspective of social science and media studies

Oliver Bidlo, Carina Jasmin Englert

Universität Duisburg-Essen

Fachbereich Geisteswissenschaften - Kommunikationswissenschaft

Abstract:

Security and entertainment are moving closer together. The term Securitainment

expresses in this context, the mediation of security through entertainment formats. This will

open a new space for Internal Security, which includes its own actors and patterns of

interpretation. This space is portrayed in the media and follows the logic of media for attention

but is also part of the process of social control. The mass media are therefore an instance of the design of internal security, social control and an interpretation producer. Mass media become actors of the internal security. They provide a symbolic representation of security.

Keywords: Internal Security, sociology of knowledge, Media, Securitainment, Entertainment,

Television, Actor.

3. Entertainment as a Total Social Phenomenon

Entertainment in the mass media is a ubiquitous part of contemporary society, with television

very much taking the lead role. Consequently, entertainment has attracted the interest not only

of psychology, literary, media and communication sciences, but has also increasingly become an established part of other scientific disciplines such as politology and criminology. In this way,

entertainment has evolved into a “soziales Totalphänomen” (cf. Saxer 2007: 19) (“total social

phenomenon”), and not only in the everyday sense. But what is entertainment? Here it is

understood more as ‘transience’, ‘time-killing’ or ‘distraction’ than as an exchange of thoughts,

and in these contexts it can have various manifestations. It is about practising values and not

least about emotionally reinforcing certain views of the world (cf. Schicha, Brosda 2002: 10).

Schicha and Brosda make a further distinction between formal categories of entertaining

presentation and entertaining content. While the former call to mind comfort, stimulation,

respite and relaxation, the latter have associations with escapism from the real world, banality,

vacuity and triviality (cf. Schicha, Brosda 2002: 10f). Yet this does not answer the question of

how entertainment or “Entertainization” (Saxer 2007: 21) are combined with information in

television formats and what role entertainment actually plays in the process. So far, it has only

become clear that sciences previously dedicated to “serious issues”, like politology or

criminology, can no longer ignore the topic of ‘entertainment’ in connection with the media.

This is confirmed by Kamps, who explains that ‘entertainization’ is shifting the orientation

towards entertaining formats for communication purposes, and original (television) formats are

switching from information to entertainment mode (cf. Kamps 2007: 149). Television formats

tagged as documentary or news programmes already enhance their information content with

dramatic images and ‘stage’ eventful stories (cf. Englert/Roslon Chapter XY in this edition).

Increasingly, the “Hybridformen (Hickethier 2007: 176) (“hybrid forms”) and the hybrid genres

of television, such as semi-documentary or semi-fictional programmes, are attracting the interest of the viewing public (cf. Schicha, Brodsa 2002: 7), as the rise of reality TV programmes in German television alone can testify (cf. also Reichertz Chapter XY in this edition). The “mediale Erlebnisgesellschaft” (Dörner 2001: 40) (“media experience society”) or the “Fernsehgeneration” (Peiser 1996) (“TV generation”) increasingly wants information packaged in a gripping format, and increasing numbers of viewers are placing entertainment value over information value (cf. Corsa 2005). Yet it is not the case here that information and entertainment are mutually exclusive, but rather that they come together in hybrid television formats. This is another indication of the ongoing entertainization and “Boulevardisierung”2 (Kleiner, Nieland 2004) (“tabloidization”) of information, resulting in increased “fictionalization” of information culture or what Leder also defines as “Infotainisierung” (Leder 1996: 92) (“infotainization”).

Other terms include “Infotainment” (Wittwen 1995), “Politainment” (Dörner 2001) and

“Edutainment” (Mangold 2004). The feel good factor, in other words the presentation of

information in an attractive format, takes top priority, as the example of the semi-documentary

formats surrounding the subject of internal security (e.g. Schneller als die Polizei erlaubt or

Recht & Ordnung) goes to show. This can be attributed to the fact that entertainment is an

emotional event that leads to various gratifications (cf. Saxer 2007: 19). It is not without reason

that viewing figures climb as TV content becomes more personalized, emotional and dramatic,

particularly if it is presented as closely as possible to the viewer (cf. Englert/Roslon in Chapter

2 “Boulevardisierung zeichnet sich durch einen allgemeinen Verfall journalistischer Standards (etwa Objektivität, umfassende Recherche, Wahrung ethischer Grundsätze etc.) aus; durch einen Rückgang räsonierender (z.B. Politik und Wirtschaft) und einen gleichzeitigen Anstieg unterhaltender Themen (u.a. Skandale, Sensationsmeldungen, Sex, Lifestyle), durch die der Massengeschmack bedient werden soll; eine Zunahme von Serviceleistungen; starke Personalisierungen und Emotionalisierungen sowie zynische und ironisierende Kommentare, die eine bestimmte Diskurs-Hippness unterstreichen wollen. Diese inhaltlichen Boulevardisierungstendenzen werden zudem sprachlich und optisch unterstützt, etwa durch die Annäherung an die Umgangssprache, Verwendung vieler Photos, vergrößerte Überschriften sowie plakative Aufmacher und Eye-Catcher.” (Kleiner, Nieland 2004: 2). (“Features of ‘Boulevardisierung’ (tabloidization) are a general decline in journalistic standards (such as objectivity, detailed research, observing ethical principles, etc.) resulting from a reduced number of serious subjects (e.g. politics and economics) and simultaneous rise in entertaining ones (including scandals, sensationalized stories, sex, lifestyle) geared to appeal to the masses; an increase in services; strong personalization and emotionalization and cynical and ironic commentary, which are aimed at underscoring a certain discourse hipness. These tendencies towards dumbing down or tabloidizing content are also supported linguistically and visually, for example by the use of slang and photos, oversized headlines, striking openers and eyecatchers.”XY of this edition).

The trend towards ‘staging’ informative content is nothing new. In 2002, Thomas Meyer and

Christian Schicha described the trend towards staging politics on the television and its

increasing relevance (cf. Meyer, Schicha 2002: 53). Further, Erika Fischer-Lichte points out that nothing in the world is entirely free of ‘stage management’, making it an inherent part of our

world (cf. Fischer-Lichte 1998: 88f). Fischer-Lichte defines the term ‘Inszenierung’ (‘staging’,

‘stage management’, ‘scene setting’) in its theatrical sense as a creative process to connect the imaginary and fictitious with the real and empirical (cf. Fischer-Lichte 1998: 88). Meyer and

Schicha reinforce Fischer-Lichte’s thinking and explain that “Infotainment […] in hohem Maße

informieren [kann und dass] [p]rinzipiell […] alle Inszenierungsformen und Inszenierungsgrade

für der Sache angemessene Informationen offen [sind]” (Meyer, Schicha 2002: 57)

(“Infotainment [… can] be highly informative [and that] in principle […] all forms and degrees

of stage management are open to information that is appropriate to the subject matter”). The

important question is therefore how and to what extent elements of the fictional-imaginary and

the real-empirical are used to stage a situation and its intended purpose (cf. Meyer, Schicha

2002: 53).

The example of fictional series relating to internal security shows that elements of staging and

theatricality are usually quite evident in the use of scripted characters, action scenes or coherent action sequences. The question is, however, how documentary or semi-documentary formats go about reproducing uncontrived, or unstaged, reality. On the surface, accompanying the highway police as they inspect truck drivers on the German-Czech border may not seem that interesting.

However, as soon as a truck driver refuses a fine that he feels is unjustified, the action becomes much more interesting. If the apparently ‘boring’ scenes involving uneventful spot checks on various truck drivers are cut from the actual programme, and music or voice-overs are used to imply certain interpretations, the entertainment factor begins to rise. Clearly, there is a difference between the portrayal of a highway police officer who is going about his work,

catches an exhausted truck driver at the wheel and, according to the off-screen voice ‘quite

rightly, given the potential danger of an overtired driver’, takes him off the road, and the

portrayal of a highway police officer encountering the same situation but with background

circus music and a voice-over commenting that he ‘is overreacting; the truck drivers are only

doing their job after all’. If the camera perspective is switched from long to full shot allowing

television viewers to feel that they are live on the scene and can empathize, the work of the

highway police is transformed into an entertaining format for late evening viewing. All this falls

under the term Inszenierung, which means employing theatrical elements and quite literally

setting a scene (cf. Hickethier, Bleicher 1998: 369).

If this concept extends to the technical media, the effect becomes twofold (doppelte

Inszenierung): the characters in front of the camera and the technical modifications, editing,

montage and the narrator’s voice combine to produce an electronic version or a final staged

product (cf. Hickethier, Bleicher 1998: 369). It can be taken even further in connection with

hyper-ritualization as defined by Goffman (Goffman 1981: 328). Beyond the scene set in front

of, that is, for the camera, the actors are also portraying themselves. They are members of

society who play a particular role in their everyday lives and are now playing another role

within that role before the camera. As the example of the highway officers shows, they are keen

to portray themselves and their work as correct and legitimate. This portrayal then enters a third

stage and another level of production when the recorded scenes are edited and given a narrative structure. In many cases, this leads to increased standardization, exaggeration and simplification of rituals (cf. Goffman 1981). According to Goffman’s definition, rituals are heavily emphasized or over-emphasized actions or behaviours and have little to do with the everyday ceremonial meaning. This raises the question of whether it would be possible to talk about

‘Hyperinszenierung’ (‘hyper-staging’) in this context. Here we see that what we encounter on a

daily basis in reality often appears out of focus and ambivalent, and it is only staging by the

media that makes an event clearly structured and easy to understand (cf. Hickethier, Bleicher

1998: 369). Relationships and connections quickly become apparent and comprehensible,

without the need for further explanation of the facts. In this way, a new order, a beautiful new

world, is created which strives to - and actually does - appear real (cf. Thomas’ theory). This

world is constructed by ‘incorporated actors’ (cf. also the article by Englert/Roslon Chapter XY

of this edition) according to certain socially valid ideals. In this context, Siegfried Kracauer

talks about the “Errettung der äußeren Wirklichkeit” (“redemption of physical reality”) and the

“Affinität zur ungestellten Realität” (“affinity for unstaged reality”) (Kracauer 2003: 95ff). That

television content virtually never achieves these goals is clear from the first American

documentary film of any length, Nanook of the North, by Robert Flaherty in 1922. The film

attempts to stage reality almost to perfection, with the result that the audience automatically

becomes distanced from unstaged reality (cf. Hickethier, Bleicher 1998: 370). This is also true

of almost all documentary formats on the subject of internal security today. This process of

staging reality has a critical effect on contemporary social culture (cf. Fischer-Lichte 2000: 11),

since the way an officer’s work is staged by the media conveys to viewers a specific picture and an understanding of what internal security is all about.

This development forms the basis for terms like the aforementioned ‘Infotainment’ (Wittwen

1995), ‘Politainment’ (Dörner 2001) or ‘Edutainment’ (Mangold 2004), which attempt to

capture the entirely new circumstances associated with ongoing entertainization. It has, in fact,

prompted the emergence of a whole ‘family’ of ‘…-tainments’ (cf. Mattusch 1997: 124).

While infotainment refers to a genre in which all knowledge transfer is interwoven with entertaining and often emotional elements, and imparting knowledge and integrity thereby become secondary (cf. Mangold 2004: 536), edutainment sets out to reinforce learning motivation and success with elements of fun and entertainment (cf. ebd.). Another new term may seem superfluous to requirements under these circumstances, yet closer inspection shows that securitainment belongs neither to infotainment nor edutainment, and certainly not politainment (given its thematic focus on politics). Firstly, knowledge transfer cannot be said to play a secondary role from the very beginning in securitainment, as is the case in infotainment. Even in everyday situations – traffic for example – many followers of securitainment series will recall the last episode of Schneller als die Polizei erlaubt and remember that speeding is not worth the risk of a fine and points on your driving license. Equally, it is not easier to class securitainment as edutainment, since that would require the programmes to be clearly geared towards successful teaching and learning on the part of the programme makers. This is not generally the case in securitainment, where the success of a programme is much more likely to be judged by the viewing figures. The fact that a programme ultimately has an effect on the viewers’ understanding of internal security does not necessarily mean that that was the original intention of the TV programme (including the ‘incorporated actors’ such as the producers and series scriptwriters). In the end, it is the viewing figures and the associated interest in certain content and its application that determine the success or failure of knowledge transfer or modulation. In other words, the recipients’ interpretation of Schneller als die Polizei erlaubt or Recht & Ordnung and what they do with this knowledge in everyday interactions plays a decisive role in building their understanding of internal security. It is not dictated solely by the incorporated actors’ intention and goal, if in fact there is one at all. This is how a medium (intentionally or unintentionally) itself becomes an actor in the social construction of internal security (cf. Feltes 2008: 105). Even though we do not obtain all our knowledge through the media (cf. Reichertz 2007: 17), it is nevertheless true that “Kommunikation und Medien haben die Welt verändert und werden sie auch weiterhin verändern” (Reichertz 2007: 11) (“communication and media have changed the world and will go on changing it”), which also applies to the discourse on internal security in Germany.

PENSANDO SOBRE EL BULLYING

REALIZA LA SIGUIENTE SOPA DE LETRAS EN FUNCIÓN DEL TEXTO GRÁFICO ANTERIOR...

La Multiculturalidad: un asunto de todos...

Lee las siguientes imágenes, y responde:

1-¿Crees posible que lo transmitido en esta  imagen pueda darse en la realidad?

2- ¿Desde tu cotidianeidad, como podrías contribuir a que se consolide este tipo de convivencia?

 

3-¿Qué crees que puede significar para una sociedad, el hecho de que existan diferentes miradas ante una misma realidad?

4-¿Qué se construye a partir de esas miradas?

WEBQUEST SOBRE CULTURA

ACTIVIDADES

1   Lectura

Hacer click  aquí y lea el texto correspondiente

2   Responde

a. Qué hecho histórico mundial se menciona en la lectura como punto de quiebre para adoptar una    concepción diferente al "relativismo cultural".

b. Fundamente si la  cultura mencionada  es o no afectada en su dignidad humana.

c. ¿ Se debe respetar la diversidad cultural? . ¿Por qué?

d.  Plantee una conclusión sobre la situación planteada.

3- Analiza el siguiente  Video , y  relacionándolo con la lectura del punto 1 ,   elabora  un texto argumentativo, que de cuenta de tu posición personal sobre el tema de la multiculturalidad en nuestro mundo posmoderno.

4- Lee la siguiente frase de Galeano y a modo de reflexión:
¿Qué aspectos deberíamos valorizar y tener en cuenta a la hora de observar una cultura diferente a la nuestra?

¿QUÉ ES UNA WEBQUEST?

A WebQuest is an inquiry-oriented lesson format in which most or all the information that learners work with comes from the web. The model was developed by Bernie Dodge at San Diego State University in February, 1995 with early input from SDSU/Pacific Bell Fellow Tom March, the Educational Technology staff at San Diego Unified School District, and waves of participants each summer at the Teach the Teachers Consortium.
Since those beginning days, tens of thousands of teachers have embraced WebQuests as a way to make good use of the internet while engaging their students in the kinds of thinking that the 21st century requires. The model has spread around the world, with special enthusiasm in Brazil, Spain, China, Australia and Holland.
To find out more, explore the links to the left of this page.

http://webquest.org/

Escultura e imágenes representativas del texto

CROSSWORD

Tras leer el texto anterior, intenta completar el 

siguiente crucigrama. IMPORTANTE: Si bien, las pistas 

están en español, ya sean algunas de ellas textos 

lingüísticos, y otras icónicos, las palabras a descubrir 

están en inglés. GOOD LUCK!!!

Electronical Journal of Sociology (2004)   ISSN: 1198 3655

Socio-economic inequality and its effect on healthcare delivery in India: Inequality and healthcare

Milind Deogaonkar, MD  Department of Neurosciences  Cleveland Clinic Foundation  Cleveland, OH USA deoganm@ccf.org

Abstract Social and economic inequality is detrimental to the health of any society. Especially when the society is diverse, multicultural, overpopulated and undergoing rapid but unequal economic growth. This paper attempts to review the effects of growing socio-economic inequality in Indian population and its effect on the healthcare system. It tries to identify the factors responsible for the difficulties in healthcare delivery in an unequal society and its effect on the health of a society.

Background

“In the beginning, there was desire which was the first seed of mind,” says Rig-Veda, which probably is the earliest piece of literature known to mankind. This desire for a healthy family, healthy society and a healthy country drives individuals and governments alike. The government is supposed to create settings that will provide equal opportunity for an individual to fulfill these desires. There is an undisputed association between this social equality, social integration and health. The effect of social integration on health is conclusively documented in the theory of ‘social support’ [Cassel, 1976]1. The effect of social and economic inequality on health is profound too. Poverty, which is a result of social and economic inequality in a society, is detrimental to the health of population. The outcome indicators of health (mortality, morbidity and life expectancy) are all directly influenced by the standards of living of a given population. More so, it is not the absolute deprivation of income that matters, but the relative distribution of income [Wilkinson, 1992]2. Various international studies have documented a strong association between income inequality and excess mortality3 4. In a study by Kennedy et al, income inequality was shown to directly affect the total mortality in a given population [p<0.05]5. The same study measure income inequality by ‘Robin Hood Index’, which is the part of income that needs to be redistributed from the rich to the poor to achieve economic equality. 1% rise in this index led to 21.7 excess deaths per 100,000 populations. This shows the profound effect income inequality has on the health of a population.

When applied to Indian context these social theories translate into millions of lives that perish due to a lack of socio-economic equality. Since the emergence of free India in 1947, economic egalitarianism dominated the economic policies. Socialism and government-centered economic policies were favored over the profit-making private enterprise and capitalism. Though admirable for its motives, these policies led to over-dependence on the bureaucracy and stifled the growth of free enterprise. Slow and unequal social mobilization in various parts of India led to an uneven economic growth. Caste and social polarization, literacy and educational levels, natural resources, levels of corruption and role of political leadership has resulted in some Indian states doing better than others on the economic front6. This basic inequality was magnified by the rapid but unequal economic growth that India has witnessed in the last two decades. Amidst the rising standards of living, lie pockets of terrible poverty and deprivation.

Unequal Distribution of Healthcare Resources India.

Healthcare resources in India though not adequate, are ample. There has been a definite growth in the overall healthcare resources and health related manpower in the last decade. The number of hospitals grew from 11,174 hospitals in 1991 (57% private) to 18,218 (75% private) in 20007. In 2000, the country had 1.25 million doctors and 0.8 million nurses. That translates into one doctor for every 1800 people. If other systems including Indigenous System of Medicine (ISM) and homeopathic medicine are considered, there is one doctor per 800 people. It not only satisfies but also betters the required estimate of one doctor for 1500 population8. Approximately 15,000 new graduate doctors and 5,000 postgraduate doctors are trained every year. The country has an annual pharmaceutical production of about 260 billion (INR) and a large proportion of these medicines are exported9.

To a casual observer this looks like a good proportion, however on further study, unequal distribution of resources becomes apparent. The ratio of hospital beds to population in rural areas is fifteen times lower than that for urban areas7. The ratio of doctors to population in rural areas is almost six times lower than that in the urban population7. Per capita expenditure on public health is seven times lower in rural areas, compared to government health spending for urban areas. Though the spending on healthcare is 6% of gross domestic product (GDP), the state expenditure is only 0.9% of the total spending. People using their own resources spend rest of it. Thus only 17% of all health expenditure in the country is borne by the state, and 82% comes as ‘out of pocket payments’ by the people. This makes the Indian public health system grossly inadequate and under-funded. Only five other countries in the world are worse off than India regarding public health spending (Burundi, Myanmar, Pakistan, Sudan, Cambodia)10. As a result of this dismal and unequal spending on public health, the infrastructure of health system itself is becoming ineffective. The most peripheral and most vital unit of India’s public health infrastructure is a primary health centre (PHC). In a recent survey it was noticed that only 38% of all PHCs have all the essential manpower and only 31% have all the essential supplies (defined as 60% of critical inputs), with only 3% of PHCs having 80% of all critical inputs.

The reduction on public health spending and the growing inequalities in health and health care are taking its toll on the marginalized and socially disadvantaged population. The Infant Mortality Rate in the poorest 20% of the population is 2.5 times higher than that in the richest 20% of the population. In other words, an infant born in a poor family is two and half times more likely to die in infancy, than an infant in a better off family11. A child in the ‘Low standard of living’ economic group is almost four times more likely to die in childhood than a child in the ‘High standard of living’ group. Child born in the tribal belt is one and half times more likely to die before the fifth birthday than children of other groups. Female child is 1.5 times more likely to die before reaching her fifth birthday as compared to a male child 11. The female to male ratios for children are rapidly declining, from 945 girls per 1000 boys in 1991, to just 927 girls per 1000 boys in 200112. Children below 3 years of age in scheduled tribes and scheduled castes are twice as likely to be malnourished than children in other groups. A person from the poorest quintile of the population, despite more health problems, is six times less likely to access hospitalization than a person from the richest quintile. This means that the poor are unable to afford and access hospitalization in a very large proportion of illness episodes, even when it is required. The delivery of a mother, from the poorest quintile of the population is over six times less likely to be attended by a medically trained person than the delivery of a well off mother, from the richest quintile of the population. A tribal mother is over 12 times less likely to be delivered by a medically trained person 11. A tribal woman is one and a half times more likely to suffer the consequences of chronic malnutrition as compared to women from other social categories. These figures speak for themselves and bring to the fore unequal distribution of resources and the effect of it on public health parameters. This unequal distribution of resources is further complimented by inability of universal access to healthcare due to various access difficulties.

Access Difficulties to Health Care.

Universal access to healthcare is a norm in most of the developed countries and some developing countries (Cuba, Thailand and others). In India though, pre-existing inequality in the healthcare provisions is further enhanced by difficulties in accessing it. These access difficulties can be either due to Geographical distance, Socio-economic distance, Gender distance.

The issue of geographic distance is important in a large country like India with limited means of communication. Direct effect of distance of a given population from primary healthcare centre on the childhood mortality is well documented13. It has been shown that the effect of difficult access to health centers is more pronounced for mothers with less education14. The same study also states that distance from private hospitals does not affect the health parameters but the distance from public health centre does. Those who live in remote areas with poor transportation facilities are often removed from the reach of health systems. Incentives for doctors and nurses to move to rural locations are generally insufficient and ineffective. Equipping and re-supply of remote healthcare facilities is difficult and inadequacies due to poor supply deter people from using the existent facilities. Maternal mortality is clearly much higher in rural areas15 as trained medical or paramedical staff attends fewer births and transport in case of pregnancy complications is difficult. Geographical difficulties in accessing healthcare facilities thus is an important factor, along with gender discrimination, that contributes to higher maternal mortality in women who live in remote areas especially the tribal women in India16.

A different aspect of healthcare access problem is noticed in cases of ‘urban poor’. Data from urban slums show that infant and under-five mortality rates for the poorest 40% of the urban population are as high as the rural areas. Urban residents are extremely vulnerable to macroeconomic shocks that undermine their earning capacity and lead to substitution towards less nutritious, cheaper foods. People in urban slums are particularly affected due to lack of good housing, proper sanitation, and proper education. Economically they do not have back-up savings, large food stocks that they can draw down over time. Urban slums are also home to a wide array of infectious diseases (including HIV/AIDS, tuberculosis, hepatitis, dengue fever, pneumonia, cholera, and malaria) that easily spread in highly concentrated populations where water and sanitation services are non-existent.17 Poor housing conditions, exposure to excessive heat or cold, diseases, air, soil and water pollution along with industrial and commercial occupational risks, exacerbate the already high environmental health risks for the urban poor. Lack of safety nets and social support systems, such as health insurance, as well as lack of property rights and tenure, further contribute to the health vulnerability of the urban poor. Though the healthcare facilities are overwhelmingly concentrated in urban areas, the ‘socio-economic distance’ prevents access for the urban poor. These socio-economic barriers include cost of healthcare, social factors, such as the lack of culturally appropriate services, language/ethnic barriers, and prejudices on the part of providers. There is also significant lack of health education in slums. All these factors lead to an inability to identify symptoms and seek appropriate care on the part of the poor18.

The third most important access difficulty is due to gender related distance. It is said that health of society is reflected from the health of its female population. That is completely disregarded in many of the south Asian countries including India. Gender discrimination makes women more vulnerable to various diseases and associated morbidity and mortality. From socio-cultural and economic perspectives women in India find themselves in subordinate positions to men. They are socially, culturally, and economically dependent on men19. Women are largely excluded from making decisions, have limited access to and control over resources, are restricted in their mobility, and are often under threat of violence from male relatives20. Sons are perceived to have economic, social, or religious utility; daughters are often felt to be an economic liability because of the dowry system. In general an Indian woman is less likely to seek appropriate and early care for disease, whatever the socio-economic status of family might be. This gender discrimination in healthcare access becomes more obvious when the women are illiterate, unemployed, widowed or dependent on others21. The combination of perceived ill health and lack of support mechanisms contributes to a poor quality of life.

Effect on Health Outcome Indicators Due to Economic Inequalit

Health standards of a country reflect the social, economic, political and moral well being of its ordinary citizen. Economic and social growth of a society and country is directly dependant on the health of its constituents. Healthy living conditions and access to good quality health care for all citizens are not only basic human rights, but also essential prerequisites for social and economic development. Any inequality in social, economical or political context between various population groups in a given society will affect the health indicators of that particular society. The most sensitive indicators of health of the society are infant and maternal mortality rates (IMR and MMR). IMR is still significantly high in India. Around 2.2 million infants die every year22. In fact the National Health Policy 1983 target to reduce Infant Mortality Rate to less than 60 per 1000 live births has still not been achieved23. The National Health Policy had also set a target for 2000 to reduce Maternal Mortality Rate to less than 200 per 100,000 live births. However, 407 mothers die due to pregnancy related causes, for every 100,000 live births even today. In fact, as per the NFHS surveys in the last decade Maternal Mortality Rate has increased from 424 maternal deaths per 100,000 live births to 540 maternal deaths per 100,000 live births24. Apart from these avoidable deaths, India has seen persistence and resurgence of many infectious diseases. About 0.5 million people die from tuberculosis every year in India and this number has hardly changed in last five decades25. Other communicable diseases like Malaria, Encephalitis, Kala Azar, Dengue and Leptospirosis to name a few, are far from being eradicated. The number of reported cases of Malaria has remained at a high level of around 2 million cases annually since the mid eighties. The outbreak of Dengue in India in 1996-97 saw 16,517 cases and claimed 545 lives26. Simple curable diseases like diarrhea, dysentery, acute respiratory infections and asthma also take their toll due to weak public health system and lack of awareness. Around 0.6 million children die each year from an ordinary illness like diarrhea. While diarrhea itself could be largely prevented by universal provision of safe drinking water and sanitary conditions, these deaths can be prevented by timely administration of Oral Re-hydration Solution (ORS), which is presently administered in only 27% of cases 24. Cancer claims over 0.3 million lives per year and tobacco related cancers contribute to 50% of the overall cancer burden, which means that such deaths might be prevented by tobacco control measures 23.

These health outcome indicators reflect a very disappointing state of public healthcare. The unfortunate fact is, these indicators have failed to improve in spite of various state run programs, mushrooming of private healthcare and a perceptible increase in the GDP. This underscores the importance of social and economic inequality as the stumbling block.

Private Healthcare and Economic Inequalit

The growth of private healthcare sector has been largely seen as a boon, however it adds to ever-increasing social dichotomy. The dominance of the private sector not only denies access to poorer sections of society, but also skews the balance towards urban-biased, tertiary level health services with profitability overriding equality, and rationality of care often taking a back seat. The increasing cost of healthcare that is paid by ‘out of pocket’ payments is making healthcare unaffordable for a growing number of people. The number of people who could not seek medical care because of lack of money has increased significantly between 1986 and 199527. The proportion of people unable to afford basic healthcare has doubled in last decade. One in three people who need hospitalization and are paying out of pocket are forced to borrow money or sell assets to cover expenses 27. Over 20 million Indians are pushed below the poverty line every year because of the effect of out of pocket spending on health care. In the absence of an effective regulatory authority over the private healthcare sector the quality of medical care is constantly deteriorating28. Powerful medical lobbies prevent government from formulating effective legislation or enforcing the existing ones. A recent World Bank report acknowledges the facts that doctors over-prescribe drugs, recommend unnecessary investigations and treatment and fail to provide appropriate information for patients even in private healthcare sector 28. The same report also states the relation between quality and price that exists in the private healthcare system. The services offered at a very high price are excellent but are unaffordable for a common man. This re-emphasizes the role socio-economic inequality plays in healthcare delivery.
                                                                                                                  

Conclusions

Effects of social and economic inequality on health of a society are profound. In a large, overpopulated country like India with its complex social architecture and economic extremes, the effect on health system is multifold. Unequal distribution of resources is a reflection of this inequality and adversely affects the health of under-privileged population. The socially under-privileged are unable to access the healthcare due to geographical, social, economic or gender related distances. Burgeoning but unregulated private healthcare sector makes the gap between rich and poor more apparent.

Endnotes

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