SPECIAL ARTICLE Economic & Political Weekly EPW august 2, 2008 41 Health Inequality in India: Evidence from NFHS 3 William Joe, U S Mishra, K Navaneetham R ecent research has witnessed considerable engagement with the task of comprehending the crucial determinants of health outcomes. It is observed that the burden of ill health is borne disproportionately by different population subgroups and that people of lower socio-economic status consist- ently experience poor health outcomes [Macinko et al 2003]. Several empirical studies have also acknowledged such income- related inequalities in health, propounded as the absolute income hypothesis [Kakwani et al 1997; van Doorslaer et al 1997: Humphries and van Doorslaer 2000]. In view of such findings, health promotion of the poor has emerged worldwide as a vital area for policy research and action. Policy initiatives and programmes strongly perceive that inequalities in the health outcomes of different population subgroups are characterised by certain systematic deprivations (such as poverty). Apparently, some of the Indian health policies and program- mes also attempt to eliminate deprivation in the provisioning of healthcare and achieve the objective of health equity. 1 In order to achieve this objective, it is important to steer policymaking through timely and systematic assessment of prevailing health inequality, 2 a task that so far does not seem to have received serious attention. Although a few studies have presented region- specific or population-subgroup-related health profiles for India, they are at best able only to reflect on disparities and not inequa- lities. While disparities are evaluated based on the positioning around aggregate outcome, inequalities have to be adjudged according to specific ethical or economic ideals. Moreover, for ensuring equitable and efficient allocation of public health resources, it is imperative to unravel the depth and the varied dimensions of health outcomes, especially through measures sensitised for equity concerns. Apart from these considerations, it is also of analytical interest to examine whether income inequa- lity itself poses as a public health hazard. This question has gained much academic attention but most of the findings of studies 3 on the topic have remained inconclusive. The literature on health economics, which identifies this question as the relative income hypothesis states that the distribution of income in a society has a larger impact on population’s health than absolute income. Since most of the studies on relative income hypothesis are undertaken in the context of developed countries, it would be worthwhile to gather some insights from the Indian experience to further our understanding of the income-health nexus. In this article, we employ widely accepted measurement techniques to assess inequities in child health across different Indian states and draw some interesting conclusions on the relationship between income inequality and health inequality in the country. As we all know, health of children assumes The authors appreciate the editorial effort of P R G Nair towards making the manuscript read better. William Joe (william@cds.ac.in), U S Mishra (mishra@cds.ac.in) and K Navaneetham (nava@cds.ac.in) are at the Centre for Development Studies, Thiruvananthapuram, Kerala. This article utilises the National Family Health Survey-3 data and presents an empirical assessment of income-related health inequality in India. It undertakes a state-level analysis of inequities in child health by employing the widely accepted measures of concentration curves and concentration indices. It finds that the poorer sections of the population are beleaguered with ill health whether in the quest for child survival or due to anxieties pertaining to child nutrition. Further, an attempt is made to comprehend the relationship between income inequality and health status in the Indian context. The analysis reveals that the degree of health inequalities escalates when the rising average income levels of the population are accompanied by rising income inequalities. The income-poor sections have different needs and therefore, planning and intervention necessitates an understanding of the sources of inequality and recognition of the vulnerable groups to arrive at efficient resource allocation and policy decisions.