Health, Environment, And Inequality In India

Aashish Gupta, University of Pennsylvania


This dissertation makes three scientific contributions to understand the ongoing epidemiological transition in India. The first chapter documents local externalities of solid fuel use for adult lung function. The use of solid fuels for cooking and heating is rooted in poverty and gender inequality within households. However, harms from solid fuel use are more widespread. In neighborhoods with high solid fuel use, the lungs of those who do not use solid fuels can be as obstructed as the lungs of those who use solid fuels. Because it contributes to both infectious disease among children and chronic diseases among adults, the use of solid fuels complicates the epidemiological transition in India. The second chapter observes that Indian infants face higher mortality risks in the summer, monsoon, and winter months compared to the spring months. Using birth history data, the chapter develops an innovative demographic approach which estimates and adjusts infant mortality by calendar month. The chapter highlights that Indian infants face multiple environmental threats that are less salient for a limited period within a year. It finds that although seasonal variation has declined, it remains a concern in rural areas and among more disadvantaged households. The last chapter provides the first estimates of life expectancy by social class in India for the period 1990-2016. It develops methods to directly estimate life tables from survey data. The chapter documents persistent and stark mortality disparities in a period of robust economic growth and changing disease profiles. It finds progress in reducing levels and differentials in child mortality. However, patterns in the working ages are concerning, with slower progress and little reduction in inequality. The three chapters make both substantive and methodological contributions to the study of health and mortality in low- and middle-income countries. They show that addressing social inequalities and environmental risks are essential for population health improvements in India.