Academic journal article Demographic Research

Exploring the Meaning of Context for Health: Community Influences on Child Health in South India

Academic journal article Demographic Research

Exploring the Meaning of Context for Health: Community Influences on Child Health in South India

Article excerpt

Abstract

Much research attention has been devoted to community context and health. Communities are often defined as residential spaces, such as neighborhoods, or as social groupings, such as caste in India. Using data from a group of tea estates in South India, we attempt to address important methodological challenges in the identification of neighborhood effects on child health. We find significant neighborhood effects for weight for age at age one, including a protective role for community-level women's education, but none for birth weight. In contrast to the usual pattern in rural India, caste disparities in child health are also eliminated in this setting.

1. Introduction

A great deal of research attention has been devoted to the connection between community context and health. A large body of work concerns neighborhood effects, which views community as a geographically defined space in which individuals reside and interact. Residential communities have been variously defined in the literature, including by census tracks, zip code areas, villages, districts, or regions of countries (e.g., Browning and Cagney 2002; Wen, Cagney, and Christakis 2005; Kandala, Magadi, and Madise 2006; Shin 2007; Linnemayr, Alderman, and Ka 2008). This work recognizes that the ideas and behavior of people living in close proximity can affect health outcomes independent of individual characteristics (Sampson, Raudenbush, and Earls 1997). Much of the recent theoretical and empirical research on neighborhood effects is based in urban areas in the United States, where the neighborhood is a prominent social unit (e.g., Sampson, Raudenbush, and Earls 1997; Malmstrom, Sundquist, and Johansson 1999; Sampson, Morenoff, and Gannon-Rowley 2002; Wen, Cagney, and Christakis 2005; Cohen et al. 2006).

Community affiliations can also be defined in relational terms, where individuals are categorized according to shared histories, identities, and interests regardless of space or residential patterns (Cornish and Ghosh 2007; Abbott and Luke forthcoming). These relational types of community include race, ethnicity, and the kinship group or clan, and a wealth of research has examined health disparities across these social groupings. These studies share their theoretical underpinnings with those of neighborhood effects research, and contend that social interactions between group members can influence health behaviors and outcomes, regardless of individual attributes. In India, the endogamous sub-caste, or jati, continues to be the major locus of social contact and source of social and economic support for most individuals, even though sub-caste groups are often spread over large areas, such as an entire Indian state (Munshi and Rosenzweig 2009). The caste hierarchy was based on traditional occupations assigned across sub-castes, with the lowest caste groups undertaking the most menial and ritually polluting tasks (Milner 1994). These historical divisions form the basis of persistent symbolic and material inequalities today, including poorer maternal and child health outcomes among the lower castes (Pal 1999; Bonu, Ramin, and Baker 2003; Som et al. 2006; Dommaraju, Agadjanian, and Yabiku 2008).

In many settings worldwide, community affiliations intersect. For example, neighborhoods in urban America are often segregated to a large extent by race and ethnicity. In rural areas of India, sub-castes usually reside in separate streets or hamlets within the village, and the lowest castes are often relegated to land on the village outskirts (Kapadia 1995; Navaneetham and Dharmalingam 2002). In these contexts of strong correlation between the neighborhood and the race or caste, it is difficult to attribute observed effects to either type of community (Rosenzweig and Wolpin 1986; Oakes 2004; Subramanian 2004; Acevedo-Garcia and Osypuk 2008).

Identifying the influential domains of social interaction-the caste, the neighborhood, or both-and the processes by which they affect health could help eliminate the underlying causes of disparities in India. …

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