“CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION”

Submission made by Andlib Imrose

Roll-1915 B.A.LL. B (Hons.)

Submission submitted to DR. SHIVANI MOHAN

A research paper submitted in fulfilment for the course (Money Banking and Public Finance) for
obtaining the degree B.A.LL. B(Hons.) during the Academic year 2020-21.

March,2021

Chanakya National Law University, Nyaya nagar, Mithapur Patna-800001

CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

ACKNOWLEDGEMENT
Writing a project is one of the most significant academic challenges, I have ever faced. Though
this project has been presented by me but there are many people who remained in veil, who gave
their all support and helped me to complete this project.

First of all, I am very grateful to my subject teacher Dr. Shivani Mohan the kind support and
help of whom the completion of the project was a herculean task for me. She donated his
valuable time from his busy schedule to help me to complete this project and suggested me from
where and how to collect data. I am very thankful to the librarian who provided me several books
on this topic which proved beneficial in completing this project.

I acknowledge my friends who gave their valuable and meticulous advice which was very useful
and could not be ignored in writing the project.

Last but not the least, I am very much thankful to my parents and family, who always stand aside
me and helped me a lot in accessing all sorts of resources.

I thank all of them!

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

DECLARATION BY THE CANDIDATE

I hereby declare that the work reported in the B.A., LL.B. (Hons.) Project Report entitles
“Money Banking and Public Finance” Submitted at Chanakya National Law University, Patna
is an authentic record of my work carried out under the supervision of Dr. Shivani Mohan. I
have not submitted this work elsewhere for any other degree or diploma. I am fully responsible
for the contents of my Project Report.

(Signature of the Candidate)

Andlib Imrose

Chanakya National Law University, Patna

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

INTRODUCTION

‘There can be no contentment for any of us when there are children, millions of children, who do
not receive an education that provides them with dignity and honor and allows them to live their
lives to the full.’- Nelson Mandela1

Essentiality of education in people’s lives is being increasingly acknowledged in today’s

globalized world. Education is indispensable for empowering individuals and for economic
change. It has a key role in constructing children for democratic citizenship and responsibilities
of future. Education is also central to poverty removal strategies and the attainment of global
commitments for sustainable development. It is elementary building block for human
development. As the Human Development Report 2012 mentions, the growth in Human
Development Index is related with growth in public spending on education. 2 As such, a central
place must be granted to the right to education in development thinking. One witnesses
unmatched disparities in access to education, as well as in terms of educational fulfillment of
those in schools. Extreme inequality persists and, in some cases, has broadened. This must be
seen in the context of persistent and significant disparities between rich and poor, both inside and
among countries, and about the unfavorable implications of these inequality for the promotion of
human development all over the world.”

A growing body of proof has shown that extreme income inequality is treatable through
expenditure in quality and equitable education. 3 Increased expenditure on education is, as the
IMF has pointed, an element of the ‘right policies’ to deal with inequality. 4 The OECD has made
1
Nelson Mandela speech at the launch of the Nelson Mandela Institute for Education and Rural Development,
November 2007
2
UNDP. (2012). Human Development Report 2012: The Rise of the South: Human Progress in
3
See, for example, E. Dabla-Norris, et al. (2015). Causes and consequences of income inequality: a global
perspective. IMF. https://www.imf.org/en/Publications/Staff-DiscussionNotes/Issues/2016/12/31/Causes-and-
Consequences-of-Income-Inequality-A-GlobalPerspective-42986; E. Gould and A. Hijzen. (2017). In equality, we
trust. Finance & Development, March 2017, Vol. 54, No. 1. IMF. (Accessed on 18 th February 2021)
https://www.imf.org/external/pubs/ft/fandd/2017/03/gould.htm (Accessed on 18th February 2021) (on cohesion and
democratic functioning); and J. Kunst, et al. (2017). Preferences for group dominance track and mediate the effects
of macro-level social inequality and violence across societies. Proceedings of the National Academy of Sciences of
the USA, vol. 114 no. 21. DOI: 10.1073/pnas.1616572114.https://www.ncbi.nlm.nih.gov/pubmed/28484013
(Accessed on 18th February 2021)
4
IMF. Inequality: we can do something about it? [video].
http://www.imf.org/external/spring/2017/mmedia/view.aspx?vid=5406736503001 (Accessed on 19th February 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

education central to its policy agenda for addressing rising income inequalities in both developed
and rising economics.5

New survey by Oxfam, using data from UNESCO, manifest that in developing countries, a child
from a poor family is seven times less probable to finish secondary school than a child from a
rich family.6

The world has not at all been as rich as it is today. Yet considerable proportions of the global
population live short and brutal lives, ghosted by hunger, ill-health and disease. The average life
expectancy in Sweden countries in 2015 was 82.4 years; that in Swaziland was 58.9.7

Fifty-three years ago, speaking about justice in access to health and healthcare, Dr. Martin
Luther King Jr. said: Of all the forms of inequality, injustice in health is the most shocking and
the most inhuman because it often results in physical death.8

Over the last 30-odd years, as the world sets in a neo-liberal turn to economic growth, along with
a expanding wealth gap allying rich countries and poor countries, and allying the rich and poor
within countries, there is also a increasing health gap. For example, the maternal mortality rate in
the black population in the United States is three times excessive than that in the white and is
rising. In India masses, a person born in Kerala can expect to live 18 years more than one born in
Jharkhand or Bihar.

RESEARCH QUESTIONS

 What are the positive effects of income inequality on population health?

 How does healthcare spending in the United States compare with spending in India?

 Is India a low inequality country in terms of education and health?

5
Special Focus: Inequality in Emerging Economies (EEs). https://www.oecd.org/els/soc/49170475.pdf (Accessed on
19th February 2021)
6
Data from UNESCO Education Inequalities Database:
https://www.educationinequalities.org/indicators/comp_upsec_v2#?
sort=mean&dimension=all&group=all&age_grou p=comp_upsec_v2&countries=all for details, see methodology
note (Accessed on 19th February 2021)
7
https://apps.who.int/iris/bitstream/handle/10665/255336/9789241565486-eng.pdf?sequence=1 (Accessed on 19th
February 2021)
8
https://www.forbes.com/sites/ danmunro/2016/03/25/the-50th-anniversary-of-dr-kings-healthcare-
quote/#54e85ec730b5. (Accessed on 20th February 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

AIMS AND OBJECTIVES

This study attempts to trace inequalities by measuring some basic parameters pertaining to
general consumption levels, food intake, education and health. The analysis also tries to take into
account the various economic factors that determine inequalities in India.

HYPOTHESES

 Segregated patterns of schooling build segregated communities, driving a wedge between

the haves and the have-nots, right at the start of life.

 Privatization of education drives inequality

 Poor health leads to low income

RESEARCH METHODOLOGY

In this project, the researcher has developed doctrine type of research. This research is totally
based on library and other online sources. Various types of books were to get adequate data
essential for the project. Computer library was also used to get important data and facts released
to this topic. Several websites found to be very useful to better understand this topic.

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

Defining quality, equity and equality in education and health

When talking inequality in education, we discuss both ‘inequality of opportunity’ and ‘inequality
in outcomes. We often use the word ‘inequity’ and ‘inequality’ synonymously. Oxfam perceive
that these are contested terms applied differently by different people. Oxfam has chosen, in the
main, to talk about equality in education to greater mirror the advantage of the broader struggle
towards greater equality in societies. Oxfam perceive that the education sector has often used the
term ‘equity’ to signify an approach that considers the social justice consequences of education –
i.e., the justness or fairness of education. I, recognize the fundamental importance of social
justice, and apply the same principles to the term ‘equal education’. Oxfam’s interpretation of
equal education also includes the important role of education as a public good, in fighting for
equality and other social goods. In some occasion, however, the word ‘equity’ is intentionally
used9 because equality in education is not always achieved through equal policy interventions for
all, i.e., the poorest children often require more resources to catch up, and eventually close the
achievement gap, or children with a disability may need additional help. This is at the heart of
equitable policy framing in educational provision. When talking about ‘quality’, it should be
unambiguous that this is not concentrated only on equipping children with basic skills such
foundations are serious but inadequate to release the equity-enhancing and life changing role of
education. Rather, Oxfam believes that a good-quality education supports the cognitive, creative
and emotional development of all learners. Education should be transformative for learners.

According to the World Health Organization (WHO), equity is defined 10 as "the absence of

avoidable or remediable differences among groups of people, whether those groups are defined
socially, economically, demographically or geographically." Hence, as the WHO notes, health
inequities involve more than lack of equal access to required resources to sustain or improve
health outcomes. They also refer to perplexity when it comes to "inequalities that infringe on
fairness and human rights norms."

9
OECD. (2017). Educational Opportunity for All: Overcoming Inequality throughout the Life Course.
https://www.oecd.org/publications/educational-opportunity-for-all-9789264287457- en.htm (Accessed on 6th March,
2021)
10
https://www.who.int/healthsystems/topics/equity/en/ (Accessed on 6th March, 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

The difference between health equality and health equity 11 is crucial to public health to ensure
that resources are directed aptly as well as supporting the continuing process of meeting people
where they are. Unalienable to this process is the advancement of diversity in teams and
personnel, public health practice, research methods and other pertinent factors. For these reasons,
providing the same type and number of resources to all is not satisfactory. In order to reduce the
health disparities gap, the vital issues and individual needs of underserved and vulnerable
populations must be adequately addressed.

11
https://www.amwa-doc.org/health-equality-vs-health-equity/ (Accessed on 7th March, 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

THE CAUSES OF EDUCATIONAL INEQUALITY

Chart Title

Europe and Northern America

Cascusus and Central Asia

Eastern and South -Eastern Asia

Latin America and the Carribean

Northern Africa and Western Africa

Sourthern Asia

Sub-Saharan Africa

0% 20% 40% 60% 80% 100% 120%

2011
2018

Source: Data taken from the World Inequality Database on Education (WIDE).12

The causes of educational inequality vary between countries positioned on historical,

geographical or economic factors; common bases of inequality include:

 rural/urban divides;

 gender;

 disability;

 family income poverty;

 ethnic, religious or language identity; and

 location

12
https://www.education-inequalities.org/ (Accessed on 9th March, 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

There has been huge progress since the 1990s in getting more children into primary school.
However, there are still gaps in improvement across primary school, and many of the most
marginalized and often girls’ poorest children, remain out of school. An average level of primary
school completion of 74% across low- and lower-middle income countries 13 masks large and
often endless inequality gaps. These gaps are broadly between children from the poorest and
wealthiest backgrounds. In Pakistan, for instance, more than 75% of the richest children
complete primary school, but fewer than 30% of the very poorest do. 14 In Denmark, 9th grade
students from the upper middle-class score 30% better in exams than children from impoverished
households.15

These gaps broaden further after primary school. In a large majority of developing countries, the
poorest children have less than 10% of the chances of rich children to attend higher education.
For example, in Malawi, a poor child has about 30% of a wealthier child’s chance of enlisting in
secondary school, and less than 1% of a wealthier child’s chance of enrolling in higher
education.16

Location is another prevailing source of inequality. In most developing countries, rural children
are at a observable disadvantage. In Senegal, urban children are twice as likely to be in school as
rural children.17 In most low- and middle-income countries, children with disabilities are more
normal to be out of school than any another group of children.18

Some of the causes of health inequalities are gender discrimination, $$$, facilities, policies,
education, shelter security etc.

13
In the 67 such countries for which data is available. See: Rose, P. Sabates, R. Alcott, B and Ilie, S. (2017).
Overcoming Inequalities Within Countries to Achieve Global Convergence in Learning. University of Cambridge.
https://doi.org/10.17863/CAM.7673 (Accessed on 9th March, 2021)
14
This refers to the richest quintiles and the poorest quintiles. Ibid.
15
Arbejderbevægelsens Erhvervsråd. (2018). Den sociale arv afspejler sig tydeligt i børns karakterer.
https://www.ae.dk/sites/www.ae.dk/files/dokumenter/analyse/ae_den-sociale-arvafspejler-sig-tydeligt-i-boerns-
karakterer.pdf (Accessed on 9th March, 2021)
16
Ibid.
17
According to the World Inequality Database on Education (WIDE) (op. cit.), 59% of rural children are out of
school, compared to 30% of urban children. The gap is wider for children who have never attended school: 47% of
rural children have not, compared to 14% of urban children. See:
https://www.educationinequalities.org/countries/senegal#?dimension=community&group=|Urban|Rural&year=lates
(Accessed on 9th March, 2021)
18
J. Walker. (2014). Equal Right, Equal Opportunity: Inclusive Education for Children with Disabilities. Global
Campaign for Education. http://campaignforeducation.org/docs/reports/Equal%20Right,%20Equal
%20Opportunity_WE B.pdf (Accessed on 9th March, 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

Health inequity refers to arranged disparities in health or their social determinants based on
defining human characteristics such as ethnicity, wealth, or social standing.19 There is ample
evidence that social factors, including education, employment status, income level, gender and
ethnicity have a marked leverage on how healthy a person is. In all countries whether low-,
middle- or high-income there are wide inequalities in the health status of different social groups.
The lower an individual’s socio-economic position, the higher their danger of poor health.

Symbolic inequities in health exist in all nations and are a direct consequence of poverty,
indifference (political and societal) and the inability to apply or impose global declarations
addressing the right to health on individual nation states. There is a strong relation between
socioeconomic and health disparities.20

Causes of health inequality are multidate. These include, amongst others, an individual's
conception of "health", environment, water supply and poverty. In daily life all other factors -
education, jobs, skill - being equal poverty depends on number of children in the family. It is
common sense that a disposable income of X pounds would go much further in improving the
health of smaller family than a larger one. The smaller family can sustain better education, better
housing and better access to health care if it has to be paid for as in India.21

The Consequences of unequal education and health

It has long been suspected that the takeoff in income inequality has made the good luck of an
advantaged birth ever more important for accessing opportunities and getting ahead. 

In spite of the vast potential of education to tackle inequality in society, at present, education
systems in many developing countries are largely emulating inequalities. Vast disparities in
educational opportunities are a mirror image of pre-existing inequalities in wider society.

 The education accessible to the majority is letting children down, because it is often very
poor quality; not free; or biased against people who are poor, disabled or the most

19
Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health. 2003; 57:254-8
20
Houweling TAJ, Kunst AE. Socio-economic inequities in childhood mortality in low- and middle-income
countries: a review of the international evidence. Br Med Bull. 2010; 93:7-26
21
https://www.bmj.com/rapid-response/2011/10/28/causes-health-inequalities (Accessed on 30th March, 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

marginalized. Many girls continue to struggle to go to school; when in school, they have
to fight against powerful patriarchal presumption of their roles. This gets in the way of
these children actualizing their potential, and limits education in its power to change lives
and promote meaningful opportunity.22 Put simply, right now education is not doing
enough to help bring societies closer together.

 Unequal education has serious signification for our societies, as well as individuals. A
segregated and stratified system in which a low-quality education is accessible to the
majority, while the more privileged can pay for a better education, does little to facilitate
social adherence or build a public sense of a assemblance.

 Inequality in education is also furnishing to a sense of social mobility being jammed, and
the game being well-developed in favor of the privileged. ‘Mobility has stalled in recent
years’,23 is the conclusion of a recent World Bank report using a new Global Database for
Intergenerational Mobility24 that covers 96% of the world’s population. The report looks
at both economic and educational mobility. Both are much lower on average in
developing economies than high-income economies 46 of the bottoms 50 are developing
countries.25 Africa and South Asia, the regions with majority of the world’s poorest
people, have the lowest average mobility. In few low-income and weak African
countries, only 12% of today’s young adults have more education than their
parents.26This manifest that the prospects of too many people across the world are still too
firmly tied to their parents’ social status readily than their own potential and that
education is doing very small amount of work unleash the opportunity and talent of the
22
Education for All Global Education Monitoring Report. (2015). Education for All 2000–2015: Achievements and
challenges https://www.unite4education.org/global-response/recovering-the-political-in-the-idea-ofeducation-as-a-
public-good-and-why-this-matters/ (Accessed on 30th March, 2021)
23
Narayan, A., et al. (2018). Fair Progress? Economic Mobility Across Generations Around the World. Equity and
Development. World Bank. https://openknowledge.worldbank.org/handle/10986/28428 (Accessed on 30th March,
2021)

24
GDIM. (2018). Global Database on Intergenerational Mobility. World Bank.
https://www.worldbank.org/en/topic/poverty/brief/what-is-the-global-database-onintergenerational-mobility-gdim
(Accessed on 30th March, 2021)
25
The database ranks countries on two aspects of economic mobility: absolute, which measures the share of people
who exceed their parents’ standard of living or educational attainment; and relative, which measures the extent to
which a person’s position on the economic scale is independent of his or her parents’ position.
https://www.worldbank.org/en/topic/poverty/brief/what-is-the-global-database-on-intergenerational-mobility-gdim
(Accessed on 30th March, 2021)
26
Ibid.

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

many. Educational and economic mobility are most static where substantial learning gaps
exist between students at diverging ends of the socio-economic scale, i.e., where
education systems are highly unbalanced.27

 Analyses of contemporary social mobility tendency by both the OECD and the World
Bank have come to very alike conclusions: to help lower income inequality and increase
social mobility, countries must invest in good-quality and equitable education. This is
mainly important in situation in which a good education is only accessible to those who
can pay for it, as this leads to opportunity being bought up by the wealthy. Researchers
express this phenomenon as the ‘commodification of opportunity’, whereby rather than
accessing the opportunities that come with a good education by right as a citizen, through
a free public system, individuals must buy their way into opportunity by procuring
services privately.28 This creates a position in which the chance to enter more main line
professions or earn higher incomes is passed on within families, and inequality extends
with each generation.29

 Economists and health experts have well known for years that people who live in poorer
societies live shorter lives. But research also enumerates to another factor in explaining
life expectancy: a society’s level of inequality. People live longer, according to World
Health Organization30 and World Bank data,31 in nations with lower levels of inequality.

 Extreme inequality come out to affect how people apperceive their well-being. In nations
where the top 1 percent hold a larger share of national income, people tend to have a
lower sense of personal well-being, acceded to University of Oxford Saïd Business
School research.32

27
Narayan, A., et al. (2018). Fair Progress? Economic Mobility Across Generations Around the World.
28
Z. Faircloth. (15 September 2015). David Grusky on Social Mobility. The Samuel Dubois Cook Center on Social
Equity at Duke University. https://socialequity.duke.edu/news/davidgrusky-social-mobility (Accessed on 30th
March, 2021)
29
Greenstone, M., et al. (2013). Thirteen Economic Facts About Social Mobility and the Role of Education.
Brookings. The Hamilton Project. https://www.brookings.edu/research/thirteeneconomic-facts-about-social-
mobility-and-the-role-of-education/ (Accessed on 31st March, 2021)
30
Life expectancy and Healthy life expectancy Data by country https://apps.who.int/gho/data/node.main.688?
lang=en (Accessed on 631 March, 2021)
31
https://data.worldbank.org/indicator/SI.POV.GINI/?year_high_desc=false
32
eureka.sbs.ox.ac.uk/5875/1/2015-25.pdf (Accessed on 1st April, 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

Evidences on Inequalities in India in health and education

Health system elements like Human resources, Financing, Technologies Governance/Leadership,

Service delivery, Information systems subject to multiple social determinants which are Gender
discrimination, Facilities, Shelter, Security, $$$, Education, Policies drive health outcomes of
Disease burden.
Inequalities in Calorie Intake

Food being the important basic need gets the preference in the pattern of expenditure of people,
especially the poor class. Access to food demands to be economical, which are majorly build
upon the twin criteria, namely, income of the people and prices operating in the country. Slower
growth in income than prices would undermine the purchasing power, resulting in insubstantial
access to food and calorie consumption. Food grains account for about four-fifth of the calorie
intake of the poor and an increase in cereal prices could consequently reduce the calorie intake of
the poor, as it is unstable to cereal prices.

% of Intake of
Calorie from Cereals and Other Food
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Cereals Other Foods

Rural Series 3 33

The disparity between the bottom class (poorest 5% of population ranked by per capita
expenditure level) and the richest top 5% class consume all most double the calorie both in rural
and urban,34
33
Nutritional Intake in India: Based on 68 Round of NSSO available at http://www.communityresearch.org.nz/wp-
content/uploads/formidable/Nutrion-Intake-of-Idian-Population.pdf (Accessed on 1st April, 2021)
34
http://www.communityresearch.org.nz/wp-content/uploads/formidable/Nutrion-Intake-of-Idian-Population.pdf
(Accessed on 1st April, 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

Online educational outcomes

It has been pointed out that the percentage of enlisted children from government and
private schools owning a smartphone increased from 36.5% in 2018 to 61.8% in 2020 in
rural India.

Online schooling, which has taken off in a big way during the COVID-19 pandemic, can help
reduce inequalities in educational outcomes if it is taken advantage of, the Pre-Budget
Economic Survey35.

Quoting the Annual Status of Education Report (ASER) 2020 Wave-1 (Rural), the Survey
enumerated that the percentage of enlisted children from government and private schools having
a smartphone rised from 36.5% in 2018 to 61.8% in 2020 in rural India.

if applied well, the resultant reduction in the digital divide between rural and urban, gender, age
and income groups is most likely to curtail inequalities in educational outcomes.36

India’s education system is underfunded and unequal

India’s education system is unequal. The median no. of years of education girls belonging to rich
family’s gain is nine, while the equivalent median number for girls from poor families is zero. 37
Girls are 20% less expected than boys to study in technical streams, science or commerce
compared with arts or humanities, blocking their access to better paying jobs in life. Having
studied in a technical stream comparatively than arts reduce the gender gap in earnings by
28.2%.38 India’s marginalized social groups also tend to have reduced the learning outcomes.39

35
https://www.thehindu.com/business/economic-survey-2021-updates/article33694041.ece Economic Survey 2021
updates | India’s GDP is estimated to contract by 7.7% JANUARY 29, 2021 14:12 IST (Accessed on 1st April, 2021)
36
E-education, if well utilised, can reduce inequalities in educational outcomes: Economic Survey
https://www.thehindu.com/education/e-education-if-well-utilised-can-reduce-inequalities-in-educational-outcomes-
economic-survey/article33695704.ece (Accessed on 1st April, 2021)
37
Data on the 20% richest families vs. the 20% poorest families. National Family Health Survey India.
38
Sahoo, S. and S. Klasen. (2018). Gender segregation in education and its implications for labour market outcomes:
Evidence from India. https://www.econstor.eu/bitstream/10419/179967/1/1025479432.pdf (Accessed on 1st April,
2021)
39
Borooah, V. K. (2012). Social Identity and Educational Attainment: The Role of Caste and Religion in Explaining
Differences between Children in India. The Journal of Development Studies, 48(7), 887–903.
https://doi.org/10.1080/00220388.2011.621945

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

While improved public education provision reduces inequality a lack of schools and health
Centre’s has been found to be obliged for an approximately 30% increase in inequality in
ethnically disintegrated districts in India.40 However, much of the education system in India is
under-funded. Barely 12.7% of India’s schools is in compliance with the minimum yardsticks
under the Right of Children to Free and Compulsory Education Act (RTE). There are big
differences between states: while almost all teachers in schools in Gujarat, Delhi and Puducherry
have the required academic qualifications, 70% of teachers in Meghalaya continue to be in not
conformity. The comprehensive poor quality of education is accompanied by the on-going
discrimination in classrooms.41 Lower caste children also struggle with the longer travel time to
school since they are more likely to reside at the outskirts of their villages, 42 and schools with
tribal populations often lack guidance in their mother tongue.

When private schools administer spaces for rich and poor students to mix, as has been
externalized under the RTE Act in India, this makes rich students more pro-social, egalitarian
and generous , less likely to discriminate against poor students, and more willing to socialize
with them.43 However, the growth of private schooling has instead led to social seclusion as,
unfortunately, private schools often create hurdles to avoid enlisting children with disabilities
and from marginalized communities.44 Girls are at a particular disadvantage in the broadening
private education market. The gender gap in private school enrolment in India is growing, even
as it is shutting down the government schools.45

40
Chadha, N. and Nandwani, B. (2018). Ethnic fragmentation, public good provision and inequality in India, 1988–
2012. Oxford Development Studies. Volume 46, 2018, Issue 3, pp 363–367.
https://doi.org/10.1080/13600818.2018.1434498 (Accessed on 3rd April, 2021)
41
The Probe Team. (1999). PROBE: The Public Report on Basic Education in India. Oxford University Press.
https://www.undp.org/content/dam/india/docs/public_report_basic_education_india.pdf (Accessed on 3rd April,
2021)
42
Nambissan GB and Sedwal, M. Education for All: The Situation of Dalit Children in India. In: Govinda R. (ed).
(2002). India Education Report. New Delhi: Oxford University Press, pp. 72–86.
43
Rao, G. (2018). Familiarity Does Not Breed Contempt: Generosity, Discrimination and Diversity in Delhi schools.
https://scholar.harvard.edu/rao/publications/familiarity-does-notbreed-contempt-diversity-discrimination-and-
generosity-delhi (Accessed on 3rd April, 2021)
44
S. Chettri. (23 December 2018). With just 3 months left in session, DoE yet to fill over 1,200 seats for children
with special needs. Times of India. https://timesofindia.indiatimes.com/city/delhi/with-just-3-monthsleft-in-session-
doe-yet-to-fillover-1200-seats-for-children-withspecial-needs/articleshow/67222271.cms (Accessed on 3rd April,
2021)
45
T. Kumar. Household-level effects of affordable housing: Evidence from Mumbai. Ideas for India.
https://www.ideasforindia.in/topics/human-development/india-seducation-quandarylearning-from-learning-
outcomes.html (Accessed on 3rd April, 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

India also presently faces a public health crisis. The country has the largest no. of people without
effective and efficient healthcare coverage in the world. WHO evaluates average coverage of
basic services is around 56% of the population 46 meaning 600 million people fail to afford the
healthcare they need

This is not only a worsening health risk to the particular individuals and their communities; it is a
significant barrier to further social development and economic development.

India has also been ranked 145th out of 180 countries (Global Burden of Disease Study 2018) on
the quality and access of healthcare. Only some sub-Saharan countries, few pacific islands,
Pakistan and Nepal were ranked below India.47

Looking on the other side in positive manner it has also recorded some notable milestone
achievements in improving health indicators. For instance, WHO declared India free of polio in
2014.

Despite its remarkable economic growth, India has the second lowest life expectancy in South
Asia. Average life expectancy for people in India is now relatively eight years lower than in
China.48

Education and Health Expenditure by the Centre: Union Budget 2021

46
https://www.who.int/data/gho/data/major-themes/universal-health-coverage-major (Accessed on 3rd April, 2021)
47
Global Burden of Disease Study 2018 (GBD 2018) Incidence, Prevalence, and Years Lived with Disability 1990-
2016 Global Burden of Disease Study 2016 (GBD 2018) Incidence ...http://ghdx.healthdata.org (Accessed on 3rd
April, 2021)

48
https://data.worldbank.org/indicator/SP.DYN.LE00.IN (Accessed on 4th April, 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

E D U C A T I ON E X P E N D I T U R E B Y T HE C E N T R E (in c r o r e )
1,200

1,000

800

600

400

200

0
2014-2015 2015-2016 2016-2017 2017-2018 2018-2019 2019-2020 2020-2021 2021-2022

49

Holistically, we are failing to keep our promises to our children also. In the financial year 2019-
20, only 2.99 per cent (Rs 80.44 thousand crore) of the total government expenditure (Rs. 26.86
lakh crore) was dedicated to children, who make up to 42 per cent of the country’s population.

In 2020-21, Rs 96,040 crore (3.17 per cent) were allocated for children from the total
expenditure of the Government of India (30.42 lakh crore), but in reality actual expenditure was
only 80,500 crores. The total central government spending has gone up almost by Rs four lakh
crore (Rs. 34.50 lakh crore from Rs. 30.42 lakh crore), but the expenditure on children has come
down by almost Rs 16,000 crore (16 per cent).

It is a matter of priority and empathy towards the young and adolescent population. In FY 2021-
22, only Rs 85,710 crore (2.46 per cent) of the country’s budget was allocated for 550 million
children. It comes to Rs 4.20 per day.50

49
https://www.indiabudget.gov.in/ (Accessed on 4th April, 2021)

50
https://www.downtoearth.org.in/blog/governance/what-is-in-the-union-budget-2021-22-for-children-not-much-
75329 (Accessed on 4th April, 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

It is with disheartening that one sees the budget for the Department of Education and Literacy
being slashed to Rs 53,600 crore from 59, 370 crores. The budgetary allocation for child
protection was cut down 40 per cent from Rs 1,500 crore to Rs 900 crore.

HEALTH EXPENDITURE BY THE CENTRE (In crore)

250000

200000

150000

100000

50000

0
2019-2020 2020-2021 2021-2022 51

India’s
public health expenditure has been uncaringly rising over the last decade in order to cater the
needs of its growing population. In fiscal year 2018, the value of public health expenditure by
states and union territories together amounted to around 1.58 trillion Indian rupees. This was
estimated to be around 1.28 percent of the country’s GDP.52 In contrast, the United States’
budget estimates showed an expenditure of over 17 percent of the GDP to public health
outlay53 in its fiscal year 2018.

Due to the coronavirus pandemic, the sector which is the biggest discussing point this year is
healthcare. The pandemic completely disclosed India’s underfunded healthcare system. Critical
patients all over the country were making efforts to get ICU beds. Some lost their lives as the
ambulance reached late, while some died outside the hospitals waiting to get admitted in the

51
https://www.indiabudget.gov.in/ (Accessed on 4th April, 2021)
52
https://www.statista.com/statistics/953163/india-public-expenditure-on-health-as-a-share-of-gdp/ (Accessed on 4th
April, 2021)
53
https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/ (Accessed on 4th
April, 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

hospital. The pandemic disclosed fundamental problems bothering the Indian healthcare system,
be it infrastructure, manpower, etc.

In the union budget 2021-2022 health spending is up by 137%. 54 At just over $30bn (£21bn),
India's overall health budget has more than multiplied by two. This is a massive boost for India's
health sector, which has from long time been under-funded, getting just about 1.3% of GDP.

However, a closer analysis reveals that this figure is the outcome of sapping the allocations for
the Ministry of AYUSH, drinking water and sanitation and nutrition all under the single category
of ‘health’.55

Also at the same time there has been a complete silence on the nutrition security of women and
children during the pre-budget consultations. The private sector think tanks have sustained the
deafening silence through the ongoing novel coronavirus disease (COVID-19) pandemic.

In effect, the link of economic policy makers and the ‘big-bull market’ have used the pandemic
as an evasion to push for laws and policies directed at selling out public sector resources and
capital.

Even as the Union government is aware of the terror, challenge and crisis of malnutrition and its
concomitant explanation56in the vicious intergenerational cycle of mortality maternal and child
morbidity, it was mute on this angle while preparing the Union Budget 2021-22.

The government has allowed itself to deprive pregnant women, children and lactating mothers
from the important benefits of schemes and interruptions that are time and evidence-tested. It
looks crystal clear that the collusion of the corporate lobby and policy makers ensured that the
resource base of nutrition programming is slashed.

54
Union Budget 2021 Explained: Decoding The 137 Per Cent Increase In Health Expenditure; available at
https://swachhindia.ndtv.com/union-budget-2021-explained-decoding-the-137-per-cent-increase-in-health-
expenditure-56568/ (Accessed on 4th April, 2021)
55
Why 137% Increase in Budget Outlay for ‘Health and Wellbeing’ Is Misleading available at
https://science.thewire.in/health/union-budget-why-137-percent-increase-in-budget-outlay-for-health-and-wellbeing-
is-misleading/ (Accessed on 4th April, 2021)

56
Union Budget 2021-22: India's nutrition programme put on a diet (downtoearth.org.in) (Accessed on 5th April,
2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

A question also arises whether the government’s stated concern on the ‘bothersome results’ of
National Family Health Survey-5 released in November 2020 was only a lip service.

It was widely claimed time and again that the package of more than Rs 21 lakh crore is meant to
protect the country from the ill effects of the COVID-19 pandemic and that it was being
demanded that additional allocations for the nutrition of children,57 pregnant and lactating
women and adolescent girls be made in the wake of growing unemployment and food urgency.

Case Study
Union Budget 2021-22: Time to step up public investment in nutrition (downtoearth.org.in) (Accessed on 5th
57

April, 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

How United States is spending on education to improve equality and quality?

‘Life should be better and richer and fuller for everyone, with opportunity for each according to
ability or achievement regardless of the fortuitous circumstances of birth or position.’

This is the terminology of the ‘American Dream’ by James Truslow Adams in his book The Epic
of America, published in 1931.58

However, as the OECD has newly noted, in the United States: ‘this concept of equal
opportunities for all, however, has become a mere dream for some, while a privileged few enjoy
abundant opportunities to succeed in life.’59

Recent research shows that there can be an excessive gap between the public discourse about
equal opportunity and the reality of unequal access to education in the United States. For
example, out of 100 children whose parents are among the bottom 10% of income earners, only
20 to 30 go to college. Nonetheless, that figure reaches 90 when parents are in reach the top 10%
of earners.60

This appears to be linked to increasing gaps in education: over the past three decades, increasing
wage gaps between secondary school graduates and secondary school dropouts has been a major
source of rising inequality.61

58
Nevins, A. (1968). James Truslow Adams: Historian of the American Dream. Urbana: University of Illinois Press
59
OECD. (2017). Educational Opportunity for All: Overcoming Inequality throughout the Life Course.
oecd.org/social/broken-elevator-how-to-promote-social-mobility-9789264301085-en.htm (Accessed on 5th April,
2021)
60
See, for example, F. Alvaredo, L. Chancel, T. Piketty, E. Saez and G. Zucman. (2017). The World Inequality
Report 2018, op. cit.
61
Education for All Global Education Monitoring Report. (2009). Overcoming Inequality: why governance matters.
UNESCO. https://en.unesco.org/gem-report/report/2009/overcominginequality-why-governance-matters (Accessed
on 5th April, 2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

Historical intergenerational social mobility in the United States has been shown to be very
strongly correlated to education. In one study of social mobility in the US, the vigorous
predictors of social mobility later in life were learning and educational quality, both individually
and within the community in which a child lives (adjusted for the income of that community).
Secondary predictors of social mobility were based on spending inputs, class sizes.62

In other words, education was a major part of the American dream. It is now part of its
unravelling.

Struggle of Bihar due to lack of investment in health infrastructure

BACKGROUND

In the last few years, Bihar has shown improvement on some important family health indicators,
driven by accumulative efforts of the national and the state government to enhance the state
public health system’s quality.

However, Bihar still finds itself encumbered by daunting public health challenges on multiple
fronts. The state endures to struggle on the nutritional status of children, with a huge share of
underweight and dwarfed children. Further, over two-thirds of the children are anaemic.

PHC, Pandaul, Madhubani district63

PHC, Pandaul caters to a population of 2,86,534.

In compliance with NQAS standards,64 PHC, Pandaul has thrivingly put in place amenities in the
labour room, OPD registration and OPD medicine counters, and sitting arrangements/shade for
patients.

The hospital provides 14 tests free of cost. An emergency unit has been developed with adequate
supply of medicines and emergency articles. The health facility has also evolved an effective
feedback mechanism for building up delivery room facilities.

62
Raj, C., Hendren, N., Kline, P. and Saez, E. (2014). Where Is the Land of Opportunity? The Geography of
Intergenerational Mobility in the United States. Quarterly Journal of Economics 129 (4): 1553–1623.
https://doi.org/10.1093/qje/qju022 (Accessed on 5th April, 2021)
63
Services Record of Primary Health Centre, Pandaul, Madhubani, 2014–2015, (NQAS facility)
64
National Quality Assurance Standards | National ... – NHSRC Available at ; http://qi.nhsrcindia.org (last accessed
on 5th April,2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

The NQAS checklist has also supported the facility in guiding the staff on proper storage of
medicines. For example, oxytocin, a vital drug for the labour room, should be procured in the
refrigerator.

Improved facilities and services seem to be alluring many more people to avail services at PHC,
Pandaul.

Supportive supervision by SHSB65 also helped the facility identify gaps and procure special
funds to set up the labour room. These actions, a few of the many, have helped PHC, Pandaul
raise patient experience and welfare and heightened the uptake of services despite the presence
of many private players.

Handholding by BTAST in compliance 66 with NQAS norms has helped develop some skills in
the nursing staff. The hospital authorities acknowledge the important support BTAST has lent in
improving their health facility.

RH, Shahpur, Bhojpur district67

The referral hospital (RH) in Shahpur, Bhojpur district, is also an illustration of a facility
struggling due to lack of a concerted attention on quality assurance. The facility’s efforts toward
quality assurance under FFHI68 appear to have addressed only a few of the various gaps. Even
though the nurses at RH, Shahpur were trained through FFHI and improvements ensured on
many fronts, including enhancement of labour rooms with different equipment and sterilization
facilities, a lot is left to be improved and achieved in terms of hospital infrastructure. Labour
room is important like the suction machine (neonatal) and oxygen concentrators need
upgradation and partographs stocks need to be repleted. Other upgradations needed include
better lighting and handwashing facilities in the labour room.

Doctors at the facility also feel that a number of nurses would get advantage from training on
how to tackle emergencies in the labour room. Physical infrastructure such as beds in the
maternity ward, as well as well-stocked important drugs such as misoprostol and oxytocin, can

65
http://statehealthsocietybihar.org/ (last accessed on 5th April,2021)
66
https://www.devex.com/jobs/team-leader-bihar-technical-assistance-and-support-team-btast-305079 (last
accessed on 5th April,2021)
67
https://bhojpur.nic.in/public-utility/rh-shahpur/ (last accessed on 5th April,2021)
68
https://abhipedia.abhimanu.com/Article/State/NTI0NgEEQQVVEEQQVV/Health-Policy-in-Bihar-Bihar-State
(last accessed on 5th April,2021)

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

make maternity services safer. Eventhough many of the staff, including senior nurses and doctors
were conscious of the need for quality improvements, they felt they were too constrained to
make any improvements.

Conclusion

Barriers to quality of care became evident. Manpower shortage, especially of nursing staff and
specialists; lack of training; persistent infrastructural problem; and shortage of emergency
medicines and instruments and labor room essentials are the key gaps in some of the facilities.
Along with addressing these longstanding problems, any sustainable solution for ensuring
continued delivery of quality care must also address the critical urgency for regular monitoring
and corrective measures and securing the buy-in and motivation of healthcare staff.

Conclusion & Recommendations

As aforesaid, there is no doubt that some measure of equality is fundamental and actually
desirable. Coming up with a way to reduce and eradicate current days inequalities would be

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important. Education, healthcare should be developed such that everyone can equally have
access without discrimination. Because of the inequalities in the society, the people at the upper
classes would be always ahead of those in the lower-class. Those at the lower-class will hence
find it hard to curtail the wide gap between the classes.

Inequalities in health care access are widening, and rural residents, children, seniors, and low-
income families are essentially vulnerable. Improvements in the health of the Indian population
will likely yield a range of social and economic benefits, including increased productivity,
improved performance in competitive sports, and inter-sectoral convergence, gains in human
security overall and greater social solidarity. According to several analysts, the burden for the
lethargic progress on key health indicators and outcomes lies, to a great extent, on the country’s
health system, which has been afflicted with decades of inadequacy in governance and
management and also in financing

There is growing attention to the problem of equity in education. Mass expansion in education
systems was linked to a wave of positivism that it would enable young people, regardless of
background, to accomplish their full potential. If much has been accomplished, there has also
been so much of setbacks. Indian society struggles from substantial inequalities in education,
employment, and income based on ethnicity and caste.

Recommendations:

 In build national education plans that focus comprehensively and coherently on analyzing
pre-existing inequalities in education, producing data on gaps and needs, and developing
correct strategies.
 Ensure equitable teacher deployment, brought together with equitable spending on
school infrastructure and learning inputs, to help restore disadvantage. This may need
affirmative action in poorer or more marginalized districts or regions.
 Ensure further spending targeted at restoring disadvantage for marginalized or poor
children in ways with proven impact.
 Ensure schools and teachers are supported to address the unique learning demands of all
students, including children with disabilities. This will further need training teachers on
differentiated instruction as well as proper diagnosis and data collection.

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

Food being the foremost basic essential gets the priority in the pattern of expenditure of people,
notably the poor class. Access to food demands affordability, which depends upon the two
factors, that is, income of the people and prices prevailing in the country. Slower growth in
income than prices would sabotage the purchasing power, resulting in insubstantial access to
food and calorie consumption. Food grains account for about four-fifth of the calorie intake of
the poor and an increase in cereal prices could majorly reduce the calorie intake of the poor, as it
is hypersensitive to cereal prices.

 So, focus on achieving full population coverage and giving importance to the needs of the
poor and vulnerable
 Focus additional resources on primary healthcare services along with vital public health
services
 Assurance of universal access to free basic medicines and diagnostic services.

Now Coming to my first hypothesis which is “segregated patterns of schooling build segregated
communities, driving a wedge between the haves and the have-nots, right at the start of life” is
proved because when good education can only be afforded by families with money, it sabotages
social mobility; it guarantees that if you are born poor, you and your children will die poor,
no matter how hard you work. It also sabotages our societies, as the children of the wealthy are
segregated from the children of ordinary families from an early age. While schooling remains
segregated by class, ethnicity, wealth, gender or other signifiers of privilege and exclusion, this
roots inequality. Segregated patterns of schooling build segregated communities, activating a
nugget between the haves and the have-nots, right at the beginning of life.

My second hypothesis which is “Privatization of education drives inequality” is also proved

because privatization in education is often linked to higher academic performance but larger
social inequality on it, whereas standardization of school systems is linked to equalization of
opportunities, at the cost of lower performance. Through my research I find that there is higher
level of inequality in countries with there is higher level of privatization of school system, which
also commute the level of inequality between higher and lower student’s socioeconomic
background for various levels of standardization in Latin America’s school systems. 

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

With the analysis of my whole research, I can also conclude that poverty and low-income status
are linked with a variety of adverse health outcomes, including higher rates of infant mortality,
shorter life expectancy, and higher death rates for the 14 leading reasons of death. These things
are mediated through individual and community-level machinery. For individuals, poverty
curtails the resources used to bypass risks and inculcate healthy behaviors. Hence my third
hypothesis that is poor health leads to low income is proved.

At last, I also want to conclude that Good education has substantial power to increase
equality between women and men. Education can help tackle gender gap in wages, poverty,
reproductive sovereignty and political power. It can drastically improve the health outcomes
for children and women.

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

ARTICLES

 Adams, Peter; Michael D. Hurd, Daniel McFadden, Angela Merrill and Tiago Ribeiro.
2003. “Healthy, Wealthy, and Wise?” J. Econometrics, 112, pp. 3–56.

 Aghion, Philippe; Eve Caroli and Cecilia GarcíaPeñalosa. 1999. “Inequality and
Economic Growth: The Perspective of the New Growth Theories,” J. Econ. Lit. 37:4, pp.
1615–60.

 Cohen, Sheldon. 1999. “Social Status and Upper Respiratory Infection,” in

Socioeconomic Status and Health in Industrialized Nations: Social, Psychological, and
Biological Pathways. Nancy Adler et al., eds. Annals NY Academy Science 896, pp.
246–53.

 Kennedy, Bruce P.; Ichiro Kawachi and Deborah Prothrow-Smith. 1996b. “Important
Correction,” Brit. Med. J. 312, pp. 1194.

 Strauss, John and Duncan Thomas. 1998. “Health, Nutrition, and Economic
Development,” J. Econ. Lit. 36:2, pp. 766–817

 Tara, N, S Kumar and S Ramaswamy (2010), ‘Study of Effectiveness of BRCs and CRCs
in Providing Academic Support to Elementary Schools’, Commissioned by EdCIL’s
Technical Support Group for SSA, on behalf of Department of School Education and
Literacy, Ministry of Human Resource Development, Government of India.

BOOKS

 Economics of Education and Health in India by Anil Kumar

 Priced Out: The Economic and Ethical Costs of American Health Care Uwe E. Reinhardt

 The Economics of Education by Steve Bradley Colin Green

 Economic Development and Policy in India by T R Jain, V K Ohri, B D Majhi (Author)

 Economics of health sector reforms in India by Pardeep Kumar

WEB SOURCES

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CAUSES AND CONSEQUENCES OF INEQUALITY IN HEALTH AND EDUCATION

 https://www.indiabudget.gov.in/

  http://www.educationforallinindia.com/report_on_block_cluster_resource_centres-
providing-academic_support-2010.pdf

 https://www.unicef.org/education

 http://www.healthscotland.scot/health-inequalities/what-are-health-inequalities

 https://ourworldindata.org/global-education

 https://www.unicef-irc.org/publications/995-an-unfair-start-education-inequality-
children.html

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