A Tale of Two States: A Comparative Analysis of the Health Outcomes in Haryana and Kerala, with Focus on Women's Capability and Health Literacy

Abstract

The improvement in health outcomes in India post-independence has been steady, but substantial progress still needs to be made before India produces indicators that are on par with countries that have a similar GDP. In comparison to those countries, however, the average per capita income in India is much lower, which partially explains the poorer health outcomes. An article on the importance of education on health outcomes specified health literacy as an important indicator of health in a population. Additionally, Indian economist and philanthropist Amartya Sen described the positive correlation between education and health. He also developed the Capability Approach, which recognizes ‘poverty’ as the deprivation of the ability to live a good life either due to lack of functioning or freedom. Because Sen considered education, and thus literacy rates, important in understanding health outcomes and building capability, this thesis applies the same rationale in utilizing health literacy to understand health outcomes and build capability. This thesis first performs a qualitative review of the existing literature on educational institutions and healthcare infrastructure in both Haryana and Kerala. Next, this thesis employs regression analysis to identify the relationships between the five independent variables of interest and infant mortality rate. The analysis also helped to determine which of the variables had the greatest association to lower infant mortality rates. The analyses displaying the correlation of literacy rate to infant mortality rant and of the density of nurses and midwives per lakh population to infant mortality rate were the most statistically significant correlations. According to the analysis a 1% increase in the literacy rate decreases infant mortality rate by 0.9981. A 1 unit increase in the density of nurses and midwives per lakh population is only correlated to a decrease in infant mortality rate by 0.13017. However, this reduction is more than that offered by a 1 unit increase in the density of allopathic doctors per lakh population, which is correlated to a reduction in infant mortality rate by 0.10517. The corrected ratio of nurses and midwives to allopathic doctors, which does not include outliers, offered results that indicated a 1 unit increase in the number of nurses and midwives while holding the number of allopathic doctors constant is correlated to a reduction in infant mortality rate by 5.885. This thesis continues while analyzing the findings of the regression analyses through both a cultural and theoretical lens. This thesis concludes by offering policy guidance that India should increase its investment in female health professionals, as they are largely responsible for spreading health literacy among females. In turn, capability also increases and enables individuals to make more informed decisions healthcare, which presumably positively impacts health outcomes