Social evils, poverty & health.

There is a close association between social circumstances and health. In India, there is a significant burden of both communicable and non communicable diseases. Risk factors responsible for these conditions are underweight, unsafe sex, unsafe water, poor sanitation and hygiene, indoor smoke pollution, zinc, iron and vitamin A deficiency, tobacco use, high blood pressure, and high cholesterol. All these risk factors are influenced by social factors and in India the more important factors are poverty and illiteracy. Changing lifestyles as a result of rising incomes are significant risk factors for non communicable diseases. The social evils that influence poverty and health are macrolevel national and regional issues such as physical geography, governance patterns and failures, geopolitics, economic policy, natural resources decline, population growth, the demographic trap and the fiscal trap. Household and microlevel factors include the poverty trap, cultural barriers, lack of innovation and saving, absence of trade or business, unemployment, technological reversal, adverse productivity shock, social issues related to females, and adolescent social issues. Social determinants important for non communicable diseases, defined by the World Health Organization include the social gradient, stress, early life events, social exclusion, improper work conditions, unemployment, lack of social support, addiction, food scarcity or excess and uneven distribution, lack of proper transport, and illiteracy or low educational status. There are multiple pathways through which social factors influence health, and pathophysiological mechanisms involve homeostatic and allostatic changes in response to stress, neuroendocrine changes and altered autonomic functions, and abnormal inflammatory and immune responses. A concerted action to eradicate these social evils shall have to focus on reducing poverty, improving educational status and providing equitable and accessible healthcare to all.