Unveiling Healthcare Disparities: Social Exclusion and Public Health Challenges in Rural Ganderbal, Kashmir

Main Article Content

Snober Hamid
Aasif Hussain Sheikh
Amreen

Abstract

This study explores the dynamics of social exclusion in healthcare settings within the rural Ganderbal district of Kashmir, focusing on the availability of health facilities and the health-seeking behaviors of socially disadvantaged populations. Through a mixed-methods approach, combining quantitative data from interviews and qualitative insights from observation, the research reveals significant disparities in healthcare access between rural and urban areas. Key findings indicate that rural residents face exclusion due to a scarcity of hospitals, unavailability of 24-hour medical staff, inadequate infrastructure, staffing shortages, and systemic biases, compounded by environmental and occupational challenges. Communicable diseases predominate, with majority of respondents affected, and traditional healers and medical shops serve as primary care sources over formal institutions like government hospitals. Socio-economic factors, including low literacy, reliance on agriculture, and poverty, exacerbate these issues. The study highlights higher infant mortality and malnutrition rates in rural areas compared to urban centers, underscoring the need for attitudinal shifts among healthcare providers and systemic improvements in infrastructure and policy to enhance health equity. By addressing an underexplored gap in rural health research in India, this work aims to inform strategies for inclusive healthcare delivery, potentially yielding broader societal benefits through improved well-being and demographic dividends.

Article Details

Hamid, S., Hussain Sheikh, A., & Amreen, A. (2025). Unveiling Healthcare Disparities: Social Exclusion and Public Health Challenges in Rural Ganderbal, Kashmir. Journal of Community Medicine and Health Solutions, 6(1), 039–047. https://doi.org/10.29328/journal.jcmhs.1001056
Research Articles

Copyright (c) 2025 Hamid S, et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Piachaud D, Bennett F, Nazroo J, Popay J. Report of task group 9: social inclusion and social mobility [Internet]. London: Institute of Health Equity; 2009. Available from: https://www.instituteofhealthequity.org/resources-reports/social-inclusion-and-social-mobility-task-group-report/task-group-9-social-inclusion-and-social-mobility-full.pdf

Lenoir R. Les Exclus: Un Francais sur Dix. Paris: du Seuil; 1974 [cited 2025 May 21]. Available from: https://www.scirp.org/reference/referencespapers?referenceid=2282336

Daly M. Social exclusion as concept and policy template in the European Union. Centre for European Studies Working Paper. 2006;(135). Available from: https://www.researchgate.net/publication/29998617_Social_Exclusion_as_Concept_and_Policy_Templatein_the_European_Union_CES_Working_Paper_no_135_2006

Atkinson AB. Poverty in Europe [Internet]. Oxford: Wiley-Blackwell; 1998 [cited 2025 May 21]. Available from: https://books.google.co.in/books/about/Poverty_in_Europe.html?id=BOu_QgAACAAJ&redir_esc=y

Burchardt T, Le Grand J, Piachaud D. Degrees of exclusion: developing a dynamic, multidimensional measure. In: Hills J, Le Grand J, Piachaud D, editors. Understanding social exclusion. Oxford: Oxford University Press; 2002. p. 30–43. Available from: https://www.scirp.org/reference/referencespapers?referenceid=2282319

Farmer J, Muñoz SA, Threlkeld G. Theorizing rural health: a social determinants approach. Health Place. 2010 Sep;16(5):1055–62.

Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Rahman MH. Poverty and access to health care in developing countries. Ann N Y Acad Sci. 2008 Jul;1136(1):161–71. Available from: https://doi.org/10.1196/annals.1425.011

Commission on Social Determinants of Health (CSDH). Closing the gap in a generation: health equity through action on the social determinants of health [Internet]. Geneva: World Health Organization; 2008. Available from: https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1

International Institute for Population Sciences (IIPS). National Family Health Survey-4 (NFHS-4), 2015-16: India [Internet]. Mumbai: IIPS; 2017. Available from: https://www.dhsprogram.com/pubs/pdf/fr339/fr339.pdf

Baru R, Acharya A, Acharya S, Kumar AKS, Nagaraj K. Inequities in access to health services in India: caste, class and region. Econ Polit Wkly. 2010 Sep 18;45(38):49–58. Available from: http://www.indiaenvironmentportal.org.in/files/Inequities%20in%20access%20to%20health%20services.pdf

Kaul N, Chopra S. Health and conflict: A study of healthcare challenges in Jammu and Kashmir. J Peace Stud. 2019;26(3):45–60.

Reddy KS, Patel V, Jha P, Paul VK, Kumar AKS, Dandona L. Towards achievement of universal health care in India by 2020: A call to action. Lancet. 2011 Feb 19;377(9767):760–8. Available from: https://doi.org/10.1016/s0140-6736(10)61960-5

Boulle A. Rural health care and rural poverty inextricably linked policy in progress. Health Syst Trust Up. 1997;28:6–7.

Strasser RP, Harvey D, Burley M. The health service needs of small rural communities. Aust J Rural Health. 1994;2(2):7–13. Available from: https://doi.org/10.1111/j.1440-1584.1994.tb00102.x

Lawrence GA, Williams CJ. The dynamics of decline: implications for social welfare delivery in rural Australia. In: Cullen T, Dunn P, Lawrence GA, editors. Rural Health and Welfare in Australia. Wagga Wagga, NSW: Centre for Rural Welfare Research, Charles Sturt University-Riverina; 1990;38–59. Available from: https://www.nintione.com.au/resources/rao/the-dynamics-of-decline-implications-for-social-welfare-in-rural-australia/

Birrell B, Dibden J, Wainer J. Regional Victoria: Why the Bush is Hurting [Internet]. Melbourne: Centre for Population and Urban Research, Monash University; 2000. Available from: https://www.researchgate.net/publication/237634313_Regional_Victoria_Why_the_Bush_Is_Hurting

World Organization of Family Doctors (WONCA). Policy on Training for Rural Practice. Hong Kong: WONCA; 1995.

Campbell J, Dussault G, Buchan J, Pozo-Martin F, Guerra AM. A Universal Truth: No Health without a Workforce [Internet]. Geneva: WHO, Global Health Workforce Alliance; 2013. Available from: https://www.who.int/publications/m/item/hrh_universal_truth

Awofeso N. Improving health workforce recruitment and retention in rural and remote regions of Nigeria. Rural Remote Health. 2010;10(1):1319–29. Available from: https://pubmed.ncbi.nlm.nih.gov/20136347/

Ministry of Health and Family Welfare. National Family Health Survey-4: 2015–16. Mumbai: International Institute for Population Sciences. Available from: https://www.epw.in/journal/2015/25/web-exclusives/national-family-health-survey-4.html

Government of Jammu and Kashmir. Draft Master Plan. Gurgaon: M/S Feedback Infra Private Limited; 2013.

Census of India. District Census Handbook Ganderbal: Village and Town Wise Primary Census Abstract (PCA). Vol. 02. New Delhi: Directorate of Census Operations; 2011.

Ahmad S. Impact of weather on public health in Kashmir: A seasonal analysis. J Environ Health Stud. 2019;12(3):45–56.

Sharma P. Traditional occupations and their health implications in the Kashmir Valley. Rural Dev Rev. 2021;8(4):112–25.

Khan A, Mir R. Economic patterns and health expenditure in rural Kashmir. South Asian J Public Health. 2020;15(2):78–89.

Hussain M. Occupational health risks in traditional Kashmiri crafts. J Rural Health Stud. 2022;19(1):23–34.

Rather S, Qureshi N. Economic and health disparities in Kashmir’s rural workforce. Asian Public Health Rev. 2021;10(3):56–67.

Gartner A, Gibbon R, Riley N. A profile of rural health in Wales [Internet]. Wales Centre for Health: Canolfan Lechyd Cymru; 2007 [cited 2025 May 21]. Available from: https://phw.nhs.wales/services-and-teams/observatory/data-and-analysis/ad-hoc-publications/a-profile-of-rural-health-in-wales-pdf/

Hussain M. Rural development and health - a case study of the Ganderbal block. J Exclusion Stud [Internet]. 2012;2(1):63. Available from: http://dx.doi.org/10.5958/j.2231-4547.2.1.008

Mukherjee S, Levesque JF. Changing inequalities in utilisation of inpatient care in rural India: Evidence from the NSS. Econ Polit Wkly [Internet]. 2010;55(46):84–91. Available from: https://www.epw.in/journal/2010/46/special-articles/changing-inequalities-utilisation-inpatient-care-rural-india

O'Donnell P, O'Donovan D, Elmusharaf K. Measuring social exclusion in health-care settings: a scoping review. Int J Equity Health [Internet]. 2018;17(1):1–16. Available from: https://doi.org/10.1186/s12939-018-0732-1

Peace R. Social exclusion: a concept in need of definition? Soc Policy J N Z. 2011;16:17–35.

Rafiq M, Yasmeen, Ashfaq, Shalinder, Rifat. Health problems of the elderly in Budgam district (J&K): a cross-sectional study. Int J Contemp Med Res. 2016;3(12):3456–8.

Strasser R. Rural health around the world: challenges and solutions. Fam Pract [Internet]. 2003 Aug;20(4):457–63 [cited 2025 May 21]. Available from: https://doi.org/10.1093/fampra/cmg422

The World Bank. Social exclusion and the EU's social inclusion agenda: papers prepared for the EU8 social inclusion study. Washington (DC): The World Bank; 2007.

Thukral DR. Jammu and Kashmir District Factbook: Ganderbal District. 2nd ed. New Delhi: Datanet India Pvt. Ltd.; 2018.

Wani RT, Khan S, Dar H. Assessment of facilities available at primary health care centers in Kashmir: a cross-sectional study. Int J Sci Res. 2017;6(6):1–2.

Wood J. Rural health and healthcare: A North West perspective. Lancaster (UK): Institute for Health Research, Lancaster University; 2004.