Introduction

The aim of this chapter is to examine the differentials in chronic diseases among occupational classes in India. Our rationale for this study is as follows. Firstly, the Indian economy has become increasingly diversified with the growth of new forms of occupation, notably in the rapidly growing service sector. This raises questions about whether this change in employment structure is associated with a change in the nature of chronic illness among those in work. The nature of employment is increasingly contractual and less stable. There is evidence from small-scale studies that there has been an increase in work-related stress at work. This has a direct impact on the health and well-being of the working population. However, these studies are unrepresentative and therefore it is crucial that we use nationally representative data from large-scale surveys to test these findings. Secondly there is evidence that non-communicable diseases (NCDs) are on the rise and that work-related morbidity is also increasing. Third, though some attempts have been made in identifying the risk factors of NCDs, no study has examined the links between occupation and diseases pattern in India. Thus, understanding the role of occupational differentials in NCDs is essential for reducing inequalities in health.

In Chapter 6, Dr Sahoo examined the association between activity status, morbidity patterns and hospitalisation in India. He found differences in disease patterns and rates of hospitalisation across regions and by economic activity status using the 60th round of National Sample Survey (NSS) data. One of his key findings is that there is a higher burden of poor health among the socially and economically better off groups. In this chapter, we further examine the association of occupational class with chronic diseases using the second round of India Human Development Survey, 2011–12.

According to Omran (1971) as countries develop they pass through a series of epidemiological transitions. In the third of these transitions mortality due to infectious diseases declines and is replaced by chronic NCDs such as cardiovascular diseases, cancer and dementia as the main killers. Evidence from a wide number of countries has shown that industrialisation brought with it new threats to health, such as occupational hazards and psychosocial factors. Yet the eradication of infectious diseases and the reduction of mortality in infancy and mid-life have allowed many more people to survive into older ages (Horiuchi and Wilmoth, 1998).