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First published online January 24, 2020

Intersectional Effects of Gender, Education, and Geographic Region on Functional Health Disparities Among Older Adults in India

Abstract

Objective: Research on social determinants of health in India has focused largely on the independent influence of education, gender, and region. Using an intersectionality framework in this study, we examine the combined effects of these three key social locators on the critical, yet underexamined outcome of later life functional health. Method: We use data from Wave 1 (2007–2010) of the Study of Global Ageing and Adult Health (SAGE) (N = 7,150) to examine whether the effects of education on functional limitations differ by gender in six highly heterogenous regions of India. Results: The effects of education on functional limitations were significantly greater (β = .026, p < .001) for men than women. Consistent with established regional differences in economic development, cultural practices, and political context, this relationship varied across locales. Discussion: Our findings highlight the need to move beyond independent sources of heterogeneity in examining later life functional health in the global South.

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References

Anson O., Sun S. (2002). Gender and health in rural China: Evidence from HeBei province. Social Science & Medicine, 55(6), 1039–1054. https://doi.org/10.1016/S0277-9536(01)00227-1
Arokiasamy P. (2004). Regional patterns of sex bias and excess female child mortality in India. Population, 59(6), 831–863. https://doi.org/10.2307/3654897
Arokiasamy P., Uttamacharya K. J. (2015). Multi-morbidity, functional limitations, and self-rated health among older adults in India: Cross-sectional analysis of LASI pilot survey, 2010. SAGE Open, 5(1). https://doi.org/10.1177/2158244015571640
Barooah V. K. (2016). Gender disparities in health outcomes of elderly persons in India. Journal of South Asian Development, 11(3), 328–359. https://doi.org/10.1177/0973174116666445
Bauer G. R. (2014). Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity. Social Science & Medicine, 110, 10–17. https://doi.org/10.1016/j.socscimed.2014.03.022
Bhatta T. R., Albert J. M., Kahana E., Lekhak N. (2017). Early origins of later life psychological well-being? A novel application of causal mediation analysis to life course research. The Journals of Gerontology: Series B, 73(1), 160–170. https://doi.org/10.1093/geronb/gbx022
Bora J. K., Saikia N. (2015). Gender differentials in self-rated health and self-reported disability among adults in India. PLOS ONE, 10(11), e0141953. https://doi.org/10.1371/journal.pone.0141953
Borthwick M. (1984). The changing role of women in Bengal, 1849-1905. Princeton University Press.
Brinda E. M., Attermann J., Ulf-Göran U. G., Enemark U. (2016). Socio-economic inequalities in health and health service use among older adults in India: Results from the WHO Study on Global AGEing and adult health survey. Public Health, 141, 32–41. https://doi.org/10.1016/j.puhe.2016.08.005
Choo H. Y., Ferree M. M. (2010). Practicing intersectionality in sociological research: A critical analysis of inclusions, interactions, and institutions in the study of inequalities. Sociological Theory, 28(2), 129–149. https://doi.org/10.1111/j.1467-9558.2010.01370.x
Crenshaw K. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 139, 139–167.
Dey S., Nambiar D., Lakshmi J. K., Sheikh K., Reddy S. K. (2012). Health of the elderly in India: Challenges of access and affordability. In Smith J.P., Majmundar M. (Eds.), Aging in Asia: Findings from new and emerging data initiatives (pp. 371–383). National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK92618/
Dhamoon R. K. (2010). Considerations on mainstreaming intersectionality. Political Research Quarterly, 64(1), 230–243. https://doi.org/10.1177/1065912910379227
Duraisamy P. (2002). Changes in returns to education in India, 1983–94: By gender, age-cohort and location. Economics of Education Review, 21(6), 609–622.
Evans C. R., Williams D. R., Onnela J.-P., Subramanian S. V. (2018). A multilevel approach to modeling health inequalities at the intersection of multiple social identities. Social Science & Medicine, 203, 64–73. https://doi.org/10.1016/j.socscimed.2017.11.011
Fikree F. F., Pasha O. (2004). Role of gender in health disparity: The south Asian context. British Medical Journal, 328(7443), Article 823.
Goli S., Singh L., Jain K., Pou L. M. (2014). Socioeconomic determinants of health inequalities among the older population in India: A decomposition analysis. Journal of Cross-cultural Gerontology, 29(4), 353–369. https://doi.org/10.1007/s10823-014-9251-8
Government of India. (2016). Elderly in India: Profiles and programs. Central Statistics Office Ministry of Statistics and Programme Implementation. www.mospi.gov.in
Green M. A., Evans C. R., Subramanian S. V. (2017). Can intersectionality theory enrich population health research? Social Science & Medicine, 178, 214–216. https://doi.org/10.1016/j.socscimed.2017.02.029
Holston J., Appadurai A. (1996). Cities and Citizenship. Public Culture, 8(2), 187–204. https://doi.org/10.1215/08992363-8-2-187
Hopkins P. (2017). Social geography I: Intersectionality. Progress in Human Geography, 43(5), 937–947. https://doi.org/10.1177/0309132517743677
Iyer A., Sen G., George A. (2007). The dynamics of gender and class in access to health care: Evidence from rural Karnataka, India. International Journal of Health Services, 37(3), 537–554. https://doi/10.2190/1146-7828-5L5H-7757
Jejeebhoy S. J., Sathar Z. A. (2001). Women’s autonomy in India and Pakistan: The influence of religion and region. Population and Development Review, 27(4), 687–712.
Kastor A., Mohanty S. K. (2016). Associated covariates of functional limitation among older adults in India: An exploration. Ageing International, 41(2), 178–192. https://doi.org/10.1007/s12126-016-9241-y
Kowal P., Chatterji S., Naidoo N., Biritwum R., Fan W., Ridaura R. L., Maximova T., Arokiasamy P., Phaswana-Mafuya N., Williams S., Snodgrass J. J., Minicuci N., D’Este K., Peltzer K., Boerma J. T., & The SAGE Collaborators. (2012). Data resource profile: The World Health Organization study on Global AGEing and Adult Health (SAGE). International Journal of Epidemiology, 41(6), 1639–1649. https://doi.org/10.1093/ije/dys210
Kundu A., Mohanan P. C., Varghese K. (2013). Spatial and social inequalities in human development: India in the global context. United Nations Development Program. https://www.undp.org/content/dam/india/docs/human-development/spatial-and-social-inequalities-in-human-development–india-in-t.pdf
Lee J., McGovern M. E., Bloom D. E., Arokiasamy P., Risbud A., O’Brien J., Kale V., Hu P. (2015). Education, gender, and state-level disparities in the health of older Indians: Evidence from biomarker data. Economics & Human Biology, 19, 145–156. https://doi.org/10.1016/j.ehb.2015.09.003
Lee J., Smith J. P. (2014). Regional disparities in adult height, educational attainment, and late-life cognition: Findings from the Longitudinal Aging Study in India (LASI). The Journal of the Economics of Ageing, 4, 26–34. https://doi.org/10.1016/j.jeoa.2014.02.002
Leveille S. G., Penninx B. W., Melzer D., Izmirlian G., Guralnik J. M. (2000). Sex differences in the prevalence of mobility disability in old age: The dynamics of incidence, recovery, and mortality. Journals of Gerontology Series B, 55(1), S41–S50. https://doi.org/10.1093/geronb/55.1.S41
Liberatos P., Link B. G., Kelsey J. L. (1988). The measurement of social class in epidemiology. Epidemiological Review, 10(1), 87–121.
Link B., Phelan J. (1995). Social Conditions As Fundamental Causes of Disease. Journal of Health and Social Behavior, 80–94. https://doi.org/10.2307/2626958
Long S. J., Pavalko E. (2004). Comparing alternative measures of functional limitation. Medical Care, 42(1), 19–27. https://doi.org/10.1097/01.mlr.0000102293.37107.c5
Medhi G. K., Hazarika N. C., Borah P. K., Mahanta J. (2006). Health problems and disability of elderly individuals in two population groups from same geographical location. Journal of the Associations of Physicians, India, 54, 539–544.
Montez J. K., Zajacova A., Hayward M. D. (2016). Explaining inequalities in women’s mortality between U.S. States. Social Science and Medicine: Population Health, 2, 561–571. https://doi.org/10.1016/j.ssmph.2016.07.004
Mukhopadhyay S. (2015). The intersection of gender, caste and class inequalities in child nutrition in rural India. Asian Population Studies, 11(1), 17–31. https://doi.org/10.1080/17441730.2015.995150
Mullings L., Schulz A. J. (2006). Intersectionality and health: An introduction. In Mullings L., Schulz A. J. (Eds.), Gender, race, class, and health: An intersectional approach (pp. 3–17). John Wiley & Sons.
Murray C. J., Feachem R. G., Phillips M., Willis C. (1992). Adult morbidity: Limited data and methodological uncertainty. In Feachem R. G. A., Kjellstrom M. T., Murray C. J. L., Over M., Phillips M.A. (Eds.), The health of adults in the developing world (pp. 113–155). Oxford University Press.
Mwangi E. W., Constance-Huggins M. (2019). Intersectionality and black women’s health: Making room for rurality. Journal of Progressive Human Services, 30(1), 11–24.
Nagarkar A., Kashikar Y. (2016). Predictors of functional disability with focus on activities of daily living: A community based follow-up study in older adults in India. Archives of Gerontology and Geriatrics, 69, 151–155. https://doi.org/10.1016/j.archger.2016.11.015
Nagi S. Z. (1976). An epidemiology of disability among adults in the United States. The Milbank Memorial Fund Quarterly: Health and Society, 54(4), 439–467. https://doi.org/10.2307/3349677
Nathanson C. A., Lopez A. D. (1987). The future of sex mortality differentials in industrialized countries: A structural hypothesis. Population Research and Policy Review, 6(2), 123–136.
Pandey M. K. (2012). Poverty and disability among Indian elderly: Evidence from household survey. Journal of Disability Policy Studies, 23(1), 39–49. https://doi.org/10.1177/1044207311411299
Peacock S. (2009). The “education” of the Indian woman against the backdrop of the education of the European woman in the nineteenth century. In Forum on public policy online (Vol. 2009, No. 2). Oxford Round Table. https://files.eric.ed.gov/fulltext/EJ870098.pdf
Ramachandra S. S., Allagh K. P., Kumar H., Grills N., Marella M., Pant H., Murthy G. V. S. (2016). Prevalence of disability among adults using rapid assessment of disability tool in a rural district of south India. Disability and Health Journal, 9(4), 624–631. https://doi.org/10.1016/j.dhjo.2016.05.010
Reuben D. B., Seeman T. E., Keeler E., Hayes R. P., Bowman L., Sewall A., Hirsch S. H., Wallace R. B., Guralnik J. M. (2004). Refining the categorization of physical functional status: The added value of combining self-reported and performance-based measures. The Journals of Gerontology: Series A, 59(10), M1056–M1061. https://doi.org/10.1093/gerona/59.10.M1056
Roy K., Chaudhuri A. (2008). Influence of socioeconomic status, wealth and financial empowerment on gender differences in health and healthcare utilization in later life: Evidence from India. Social Science & Medicine, 66(9), 1951–1962. https://doi.org/10.1016/j.socscimed.2008.01.015
Saikia N., Bora J. K., Jasilionis D., Shkolnikov V. M. (2016). Disability divides in India: Evidence from the 2011 census. PLOS ONE, 11(8), e0159809. https://doi.org/10.1371/journal.pone.0159809
Sen A. (2002). Health: Perception versus observation. British Medical Journal, 324(7342), Article 860. https://doi.org/10.1136/bmj.324.7342.860
Sen G., Iyer A. (2012). Who gains, who loses and how: Leveraging gender and class intersections to secure health entitlements. Social Science & Medicine, 74(11), 1802–1811. https://doi.org/10.1016/j.socscimed.2011.05.035
Sen G., Iyer A., Mukherjee C. (2009). A methodology to analyse the intersections of social inequalities in health. Journal of Human Development and Capabilities, 10(3), 397–415. https://doi.org/10.1080/19452820903048894
Sengupta M., Agree E. M. (2002). Gender and disability among older adults in North and South India: Differences associated with coresidence and marriage. Journal of Cross-Cultural Gerontology, 17(4), 313–336.
Subramanian S. V., Smith G. D. (2006). Patterns, distribution, and determinants of under- and overnutrition: A population-based study of women in India. The American Journal of Clinical Nutrition, 84(3), 633–640. https://doi.org/10.1093/ajcn/84.3.633
Sulania A., Khandekar J., Nagesh S. (2015). Burden and correlates of disability and functional impairment in an urban community. International Journal of Medicine and Public Health, 5(1), 82–85. https://doi.org/10.4103/2230-8598.151268
Tomey K. M., Sowers M. R. (2009). Assessment of physical functioning: A conceptual model encompassing environmental factors and individual compensation strategies. Physical Therapy, 89(7), 705–714. https://doi.org/10.2522/ptj.20080213
United Nations Department of Economic and Social Affairs, Population Division. (2017). World population ageing 2017highlights. http://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdf
Verbrugge L. M., Jette A. M. (1994). The disablement process. Social Science & Medicine, 38(1), 1–14.
Warner D. F., Brown T. J. (2011). Understanding how race/ethnicity and gender define age-trajectories of disability: An intersectionality approach. Social Science & Medicine, 72(8), 1236–1248. https://doi.org/10.1016/j.socscimed.2011.02.034
Weber L., Parra-Medina D. (2003). Intersectionality and women’s health: Charting a path to eliminating health disparities. Advances in Gender Research, 7, 181–230. https://doi.org/10.1016/S1529-2126(03)07006-1
Whittle K. L., Inhorn M. C. (2001). Rethinking difference: A feminist reframing of gender/race/class for the improvement of women’s health research. International Journal of Health Services, 31(1), 147–165. https://doi.org/10.2190/FKJA-CXD7-V4G6-U4W9
Williams J. S., Norström F., Ng N. (2017). Disability and ageing in China and India: Decomposing the effects of gender and residence—Results from the WHO study on global AGEing and adult health (SAGE). BMC Geriatrics, 17(1). Article 197. https://doi.org/10.1186/s12877-017-0589-y
World Bank. (2018). Rural population (% of total population): India. https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS?locations=IN

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Article first published online: January 24, 2020
Issue published: October 2020

Keywords

  1. India
  2. social factors
  3. intersectionality
  4. functional limitations
  5. geographic locale

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PubMed: 31976791

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Moushumi Roy, PhD
Tirth Bhatta, PhD
J. Denise Burnette, PhD
Virginia Commonwealth University, Richmond, USA

Notes

Moushumi Roy, Social Sciences Division, Delta College, University Center, MI 48710, USA. Email: [email protected]

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