Non-health determinants of health and healthcare in Delhi

With only 0.05% of the total area of the country, Delhi is home to 1.34% of India's population. This creates enormous pressure on natural and man-made resources, and generates situations in which non-health determinants may take precedence over the conventional determinants directly associated with health and healthcare. With the rising advocacy on social determinants of health, several of these factors may rightly seem to be part of the broader territory of health-related variables, and in that context, they may be designated as conventional non-medical determinants. We discuss some more visible domains, such as demography, migration and floating population; the physical and biological environment; economic determinants; social determinants; legislation and enforcement, and underscore some less explored yet critical domains of the determinants related to culture, governance and politics. What emerges as a compelling reality is a wide differential in physical environment, urban planning and access to infrastructural inputs between the privileged and marginalized areas of Delhi. Inequities in physical quality of life are so gross that even a value-neutral, official narrative betrays them helplessly. We propose actionable areas to address some of the pressing non-health determinants of health and healthcare.