Glorifying Virchow: Current Debate on Neoliberal Policies and Health Inequalities in India

This paper explores the theoretical basis and empirical evidence for understanding the links between neoliberal policies and health inequalities in the Indian context. The pathways in which inequality generates population health outcomes remain a major source of dispute within social epidemiology and health economics. Virchow’s philosophy, which undoubtedly galvanised thinking across the disciplines, emphasises how political–economic ideologies and income inequality shape the distribution of health and social problems. In this paper, we argue that the focus on health inequality, while important, understates the role of neoliberal discourses and practices in making sense of contemporary debates on health inequality. Many quantitative studies have demonstrated that more neoliberal countries have poorer health than do fewer neoliberal countries, but we rarely find comprehensive documentation of evidence in the Indian context. In light of the fast-changing political and social environment and policy priorities post-1990s in general and post-2014, this paper examines the impact of a rising share of private healthcare delivery on health inequalities. Using inequality in the under-five mortality rate (U5MR) as a health outcome and per capita NSDP, per capita public health expenditure, the share of private health care spending and the poverty ratio as indicators of neoliberal policies, through robust econometric assessment, we find that economic growth without poverty reduction and public health care spending increase health inequalities. The fixed effects model plots depicting the interaction effects of PCPHE and time on health inequality suggest that public health spending consistently has a negative association with health inequality. However, the period impact of PCPHE on reducing health inequality is declined over time. Random effects model plots that show the interaction effects of the share of private health care utilisation and time consistently show a positive association with health inequality. Our findings also suggest that a positive association exists between the poverty ratio and health inequality. We conclude that integrating understandings of neoliberalism into theorising about health inequality enriches the political economic and political demographic perspective of health. India must implement “post neoliberal” social and political economic policies to counter neoliberal models that emerged in the 1990s and rising social and health inequalities. Ending poverty and austerity towards public health spending are two key steps for reducing health inequalities.