Health disparities in India : the role of gender, family, and culture.

This dissertation examines how cultural contexts play a role in gender differences in health in India. After an introductory chapter, chapter two asks whether the extent of dowry practice perception in local communities is linked to wider gender gaps in illness. Hierarchical regression models indicate that increases in community dowry practice are associated with increases in three morbidity outcomes for women and also greater gender gaps in health. Unexpectedly, two morbidity outcomes also increase for men in dowry communities. Chapter three focuses on the multidimensionality of gender and examines how different dimensions of gender at the community level are related to women’s self-rated health. Results show that marriage and gender segregation dimensions of gender are associated with poor health. The most variance is explained by a measure of gender segregation, male-first eating order. This finding suggests that cultural practices deeply embedded in the intimate relationships within families and day-to-day life are the ones which most accurately reveal the degree to which culture is ingrained. It also implies that such deep cultural practices of gender segregation are more important than other forms of gender segregation for women’s health. The fourth chapter analyzes gender differences in hypertension using individual-level and household-level variables and also focusing on the multidimensionality of gender (economic, segregation, and empowerment dimensions). The moderating roles of different dimensions of gender and differences in men’s and women’s hypertension are tested. Support is found in the case of gender segregation and empowerment. Specifically, gender differences in hypertension are exacerbated in households that seclude women and restrict women’s household decision making. These measures are associated with greater hypertension for women, but in the case of women’s seclusion, reduced hypertension for men. Chapter five, considers the utility of the theoretical approach taken in the dissertation, especially its utility in related areas of population health research. This chapter explores implications of the empirical chapters for research that extends beyond the Indian context and sets out potentially fruitful directions for future research.Ph.D