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• Caste is an important and unique axis of inequality in India. Caste based digital divide can exacerbate the existing socioeconomic divisions between different caste groups. • Using non-linear decomposition method, the present paper explains the digital divide between disadvantaged and other caste groups. • We find that there is a considerable first level and second level digital divide between the disadvantaged caste groups and Others in India. • The caste-based digital divide is largely explained by the differences in education and income between the caste groups. • The study foregrounds the importance of bridging the caste-based digital gap by closing the gap between the educational attainments of the disadvantaged and other caste groups. With the increasing importance of information and communication technologies in access to basic services like education and health, the question of digital divide based on caste assumes importance in India where large socioeconomic disparities persist between different caste groups. Studies on caste-based digital inequality are still scanty in India. Using nationally representative survey data, this paper analyzes the first-level digital divide (ownership of computer and access to the Internet) and the second-level digital divide (individuals skills to use computer and the Internet) between the disadvantaged caste groups and Others. Further, this paper identifies the caste-based differences in socioeconomic factors that contribute to the digital divide between these groups using a non-linear decomposition method. The results show that there exists large first-level and second-level digital divide between the disadvantaged caste groups and Others in India. The non-linear decomposition results indicate that caste-based digital divide in India is rooted in historical socioeconomic deprivation of disadvantaged caste groups. More than half of the caste-based digital gap is attributable to differences in educational attainment and income between the disadvantaged caste groups and Others. Findings of this study highlight the urgent need for addressing educational and income inequality between the different caste groups in India in order to bridge the digital divide. [ABSTRACT FROM AUTHOR]

This paper empirically examines the applicability of the planetary urbanization concept to understand the complexities associated with the rural-to-urban transformation process unfolding in India. It contributes to the rural-urban debate by investigating the role of non-urban spaces – here census towns – in accelerating India's process of urbanization. The Capital Region of India is taken as a study area and a mixed methods approach is used to establish concentrated and extended urbanization as interlinked processes in relation to the growth of census towns. The applied mixed methods approach helps to overcome the critiques of deploying Global North theories, here planetary urbanization, on the Global South context by not only establishing a general pattern and dynamics of growth but also by contextualizing the local characteristics of rural to urban transformation as census towns. The analysis established a dense network of transport and a high level of commuting for work between statutory towns and census towns in the urban periphery and hinterland overcoming the traditional urban and rural divide. This paper makes a methodological and analytical contribution to the concept of planetary urbanization, whereby growth of census towns can be explained as an interlinked process of concentrated, extended and differential urbanization. The political economy analyses established that the differences between statutory and census towns can be traced back to state rescaling and investment policies. In this process, rural areas are rapidly acquiring urban characteristics as census towns and to some extent perform better on socioeconomic and infrastructural aspects compared to statutory towns (official urban areas). • Concept of planetary urbanization applied to India's rural to urban transformation. • Concentrated and extended urbanization established as interlinked processes. • Rural areas are rapidly acquiring urban characteristics as census towns. • Mixed methods help overcome the critique of planetary urbanization concept. [ABSTRACT FROM AUTHOR]

Routine childhood immunizations against measles and DPT are part of the World Health Organization's (WHO) Expanded Program on Immunization (EPI) set up in 1974, with the aim of reducing childhood morbidity and mortality. Despite this, immunization rates are sub-optimal in developing countries such as India, with wide heterogeneity observed across districts and socio-economic characteristics. The aim of this paper is to examine district-level variations in the propensity to vaccinate a child in India for measles and DPT3, and analyse the extent to which these immunizations are given age-inappropriately, either prematurely or delayed. The present study uses data from the Indian District Level Household Survey (DLHS-3) collected in 2008, and the final sample contains detailed information on 42157 children aged between 12 and 60 months, across 549 Indian districts for whom we have complete information on immunization history. Our empirical study analyses: (i) the district-level average immunization rates for measles and DPT3, and (ii) the extent to which these immunizations have been given age-appropriately. A key contribution of this paper is that we link the household-level data at the district level to data on availability and proximity to health infrastructure and district-level socio-economic factors. Our results show that after controlling for an array of socio-economic characteristics, across all our models, the district's income per capita is a strong predictor of better immunization outcomes for children. Mother's education level at the district-level has a statistically significant and positive influence on immunization outcomes across all our models. [ABSTRACT FROM AUTHOR]

Abstract: Diffusion of new technology is an important driver of economic growth. In this paper, diffusion of mobile telephony in India is studied. There is a vast diffusion potential in this country which needs to be exploited efficiently and in a rational way. This paper investigates the social, technological, economical and political (STEP) factors that have influenced the diffusion process of mobile telephony especially the diffusion speed. The epidemic model, which is widely employed in the diffusion studies of mobile telephony, is used for the study. The data is fitted into logistic, gompertz, and bass models by nonlinear least squares and it is found that gompertz model best describes the diffusion process of mobile telephony in India. The study reveals that competition and government intervention played a significant role in accelerating the diffusion speed of mobile telephony by making the technology affordable. It is found that mobile telephony is a substitute for fixed line telephony in India. The findings will be useful in taking managerial decisions with respect to factors in forecasting and controlling the diffusion process of emerging technologies. [Copyright &y& Elsevier]

Individuals in developing countries often engage in paid and unpaid work till late in life due to low household savings and limited welfare provisions. Yet, physical disabilities associated with aging can limit their ability to work. While work can be beneficial for economic and psychological well-being, this paper investigates whether engagement in paid and unpaid work mediates the impact of physical disabilities on quality of life for older adults. We exploit the different levels of health services and social security in rural and urban China and India to examine the effect of public provisions in the process. We use nationally representative data of individuals aged 50 and above from the World Health Organization Study on Global Ageing and Adult Health Wave 1, conducted in 2008–10 in China and in 2007–08 in India. Using a causal mediation analysis framework, we find that paid work plays a minor role in mediating the effect of physical disabilities on quality of life in all societies, and the mediated effect is smaller in urban China than in other societies. Unpaid work is beneficial only in urban China, and it does not mediate the impact of physical disabilities on quality of life elsewhere. The findings indicate that promoting productive engagement alone, without improving basic public provisions, will have limited impact on improving quality of life of the aging population in developing countries. • In developing countries, both paid and unpaid work is common out of necessity. • Older adults bear a double burden of paid and unpaid work in rural China and India. • Productive aging has limited impact on quality of life in developing countries. • Impact of productive aging on quality of life varies with public provisions. • Physical disabilities associated with aging is less consequential in urban China. [ABSTRACT FROM AUTHOR]

With its sociocultural, institutional, and demographic contexts, India offers a unique opportunity to study the dynamics and experiences of aging, especially as it is poised to have a large increase in the number of persons aged 60 and above in the next half a century. In this paper, we focus on the concept of productive aging that emphasizes the active participation of older persons in society. We examine the correlates of productive aging in India, drawing on data from the Building Knowledge Base on Population Aging (BKPAI) survey of 9852 men and women aged 60 years and above in seven states of India in 2011. The productive activities that we examine pertain to four domains: work, contribution to household financial matters, grandparenting, and social engagement. The findings highlight the importance of gender, family structure, and socio-economic status in these different aspects of productive aging. Importantly, the findings show that the effect of the correlates is not the same across the different measures of productive aging. We find that women are less likely than men to engage in all productive activities except for grandparenting, and that living with children and adverse health reduce the likelihood of current employment or financial contributions, but not of social engagement or grandparenting. Greater wealth at older ages reduces the likelihood of employment but increases the likelihood of social engagement and ties. The study contributes to the understanding of opportunities and constraints of productive aging in India and has implications for intergenerational relationships, support and dependencies in old age. • We examined economic, care, and social engagement aspects of productive ageing. • Older women engage less than men in productive activities except for grandparenting. • Intergenerational coresidence neither boosts nor harms later life social engagement. • Greater wealth reduces the likelihood of working and increases social engagement. • Functional disability but not chronic ailments adversely affect productive ageing. [ABSTRACT FROM AUTHOR]

Abstract Increasing caesarean births is a global trend and of recent origin in India. Besides its utility and disutility, increasing caesarean births exert higher economic burden on households and the nation. Using 148,746 births from the National Family Health Survey, 2015–16, this paper examines the correlates and provides comparable estimates of out of pocket expenditure (OOPE) on caesarean births in public and private health centres in India. The monthly state specific rural-urban consumer price index and the OOPE on births over seven years are used to derive comparable OOPE estimate at 2016 prices. A composite variable combining type of birth and place of delivery is computed and classified as private and caesarean, public and caesarean, private and non-caesarean, public and non-caesarean. Descriptive statistics, logistic and tobit regression model were used to understand the differentials and determinants of OOPE on caesarean births. Caesarean births were significantly higher among mothers belonging to higher socioeconomic status, first order births, mothers with high BMI, pregnancy complications, repeat caesarean and in private health centres confirming that both maternal demand and institutional factors are leading to the increasing in caesarean rates in India. The mean OOPE of caesarean births in public health centres of poorer states was higher than that in the richer states of India (US$107 in low performing states compared to US$88 in high performing states) while such differentials across private health centres are small. The marginal effect of a caesarean birth in private health centres in low performing states was US$296 dollar higher than that of non-caesarean births. Improving the public health centres for conducting caesarean births, developing standard guideline for clinical practices in conducting caesarean births and creating awareness on comprehensive pregnancy care can reduce the caesarean rates and OOPE on caesarean birth in India. Highlights • Incraese in caesarean births are due to both maternal and clinical factors. • Three of ten first-order births were caesarean; higher than any subsequent order. • Caesarean rate among mothers with prior caesarean births was above 90 percent. • OOPE of a caesarean birth in public health centre of poorer states was high. • Medicine and test accounts larger share of OOPE in public health centers in India. [ABSTRACT FROM AUTHOR]

Empirical studies of social capital rarely take into account the socioeconomic context of the region in which it operates, indeed as most of this research has been located in high income countries. It is imperative to investigate how development may influence the impact of social capital, especially in developing countries. This paper examines the relationship between social capital and child nutrition using the India Human Development Survey, 2005-2006. Using a multilevel framework and a sample of 6770 rural children under the age of five, it finds that household based bridging social capital, expressed as connections with development based organizations, is positively associated with child nutrition. Bonding social capital, expressed as ties with caste and religious based organizations, has the opposite impact. At the village level, contextual measures of social capital are associated with nutritional status of children, but their influence is conditional on local development. [ABSTRACT FROM AUTHOR]

Demographers have carefully analyzed intersecting aspects of identity beyond religious category that influence fertility patterns in India, such as region, access to wealth, sex ratios, and gender dynamics (Padmanabhan, 2015). Drawing on interviews and participant-observation conducted during 15 months of field research on infertility in Lucknow, Uttar Pradesh, north India, between 2005-07 and 2016–17, this study shows how nuances of demographic change categorized by religion, such as changes in fertility and mortality rates, ripple through public discourse and imagination less powerfully than overall shifts in population percentages. This paper connects media and political discourse about religion, demography, and fertility in large-scale reports, such as the 2011 Census of India and the Sachar Committee Report on status of Muslims in India (Sachar et al., 2006), to the health care services and advice provided to Muslim women and children. While the Sachar Report drew attention to economic and social disadvantage among Muslims, political discourse in response to the 2011 Census continues a trend of labeling disparities in fertility rates across religious categories as a social problem. Such discourse renders individual fertility and infertility experiences invisible and reinforces longstanding negative representations of Muslims' fertility, with important implications for health, identity, and ultimately, governance (Sangamoorthy and Benton, 2012). Ethnographic data from health outreach efforts led by and serving Muslim women in Lucknow demonstrate the diversity of Muslim women's positions relative to health and fertility services as well as the intersections of various aspects of identity with fertility management experiences. By bringing these perspectives together, the paper shows how ethnographic work matters for making sense of quantitative population data. The political uses of large-scale quantitative data demonstrate how social science analysis can be used both to create "Others" and argue for neo-eugenics, and to bolster arguments for resources and reform that benefit the disadvantaged. • Large-scale research on population in India leaves out experiences of infertility. • Qualitative research can bring perspectives on infertility to light. • Political uses of religious demography of fertility show up in clinical encounters. • Situating infertility requires mixed methods and interdisciplinary inquiry. [ABSTRACT FROM AUTHOR]

This study investigates the significance of rural unorganized retailers to the Indian rural society, providing specific attention to the social and economic roles performed by unorganized retailers in Indian villages. The present study argues that rural unorganized retailers serve as an economic engine driving the Indian rural society. At the same time, these retailers also serve multiple social functions. A content analysis method is used in this study, following a theoretical review of existing literature, to identify the existing themes in the study of rural unorganized retailers in India. Building upon these identified themes, a detailed discussion on the reasons for the significance of this entity is presented. By identifying the reasons for the influence of rural unorganized retailers along with a converse theorization on rural consumers' dependency on these retailers, this paper suggests a framework to explain why rural unorganized retailers are socially and economically important for Indian rural societies. This study is aimed at drawing the attention of policy-makers and marketers to the significant socio-economic role played by rural unorganized retailers, so that relevant steps may be taken towards sustenance and growth of this important entity. [ABSTRACT FROM AUTHOR]

Municipal solid waste management is a major environmental issue in India. Due to rapid increase in urbanization, industrialization and population, the generation rate of municipal solid waste in Indian cities and towns is also increased. Mismanagement of municipal solid waste can cause adverse environmental impacts, public health risk and other socio-economic problem. This paper presents an overview of current status of solid waste management in India which can help the competent authorities responsible for municipal solid waste management and researchers to prepare more efficient plans. [ABSTRACT FROM AUTHOR]

Evidence from developing countries demonstrates a mixed relationship of overweight/obesity with socioeconomic status (SES) and place of residence. Theory of nutrition transition suggests that over the course of development, overweight first emerges among rich and urban people before spreading among rural and poor people. India is currently experiencing a rapid rise in the proportion of overweight and obese population especially among adult women. Under the backdrop of huge socio-economic heterogeneity across the states of India, the inter-state scenario of overweight and obesity differs considerably. Hence, this paper investigates the evolution over time of overweight and obesity among ever-married Indian women (15–49 years) from selected ‘underweight states’ (Bihar, Orissa and Madhya Pradesh, where underweight proportion is predominant) and ‘overweight states’ (Kerala, Delhi and Punjab, where overweight is the prime concern), in relation to a few selected socio-economic and demographic indicators. This study analysed National Family Health Surveys- NFHS-2 (1998–99) and NFHS-3 (2005–06) following Asian population specific BMI cut-offs for overweight and obesity. The results confirm that within India itself the relationship of overweight and obesity with place of residence and SES cannot be generalized. Results from ‘overweight states’ show that the overweight problem has started expanding from urban and well-off women to the poor and rural people, while the rural-urban and rich-poor difference has disappeared. On the other hand in ‘underweight states’ overweight and obesity have remained socially segregated and increasing strongly among urban and richer section of the population. The rate of rise of overweight and obesity has been higher in rural areas of ‘OW states’ and in urban areas of ‘UW states’. Indian policymakers thus need to design state-specific approaches to arrest the rapid growth of overweight and its penetration especially towards under-privileged section of the society. [ABSTRACT FROM AUTHOR]

Stigma contributes greatly to the burden of schizophrenia and is a major obstacle to recovery, yet, little is known about the subjective experiences of those directly affected in low and middle income countries. This paper aims to describe the experiences of stigma and discrimination of people living with schizophrenia (PLS) in three sites in India and to identify factors influencing negative discrimination. The study used mixed methods and was nested in a randomised controlled trial of community care for schizophrenia. Between November 2009 and October 2010, data on four aspects of stigma experienced by PLS and several clinical variables were collected from 282 PLS and 282 caregivers and analysed using multivariate regression. In addition, in-depth-interviews with PLS and caregivers (36 each) were carried out and analysed using thematic analysis. Quantitative findings indicate that experiences of negative discrimination were reported less commonly (42%) than more internalised forms of stigma experience such as a sense of alienation (79%) and significantly less often than in studies carried out elsewhere. Experiences of negative discrimination were independently predicted by higher levels of positive symptoms of schizophrenia, lower levels of negative symptoms of schizophrenia, higher caregiver knowledge about symptomatology, lower PLS age and not having a source of drinking water in the home. Qualitative findings illustrate the major impact of stigma on ‘what matters most’ in the lives of PLS and highlight three key domains influencing the themes of 'negative reactions' and ‘negative views and feelings about the self’, i.e., ‘others finding out’, ‘behaviours and manifestations of the illness’ and ‘reduced ability to meet role expectations’. Findings have implications for conceptualising and measuring stigma and add to the rationale for enhancing psycho-social interventions to support those facing discrimination. Findings also highlight the importance of addressing public stigma and achieving higher level social and political structural change. [ABSTRACT FROM AUTHOR]

Abstract: Standard policy prescriptions for improving public health in less developed countries (LDCs) prioritise raising average income levels over redistributive policies since it is widely accepted that ‘wealthier is healthier’. It is argued that income inequality becomes a significant predictor of public health only after the ‘epidemiological transition’. This paper tests this theory in India, where rising income levels have not been matched by improvements in public health. We use state-, district-, and individual-level data to investigate the relationship between infant and under-five mortality, and average income, poverty, income inequality, and literacy. Our analysis shows that at both state- and district-level public health is negatively associated with average income and positively associated with poverty. But, at both levels, controlling for poverty and literacy renders average income statistically insignificant. At state-level, only literacy remains a significant and negative predictor. At the less aggregated district-level, both poverty and literacy predict public health but literacy has a stronger effect than poverty. Inequality does not predict public health at state- or district-levels. At the individual-level, however, it is a strong predictor of self-reported ailment, even after we control for district average income, individual income, and individual education. Our analysis suggests that wealthier is indeed healthier in India – but only to the extent that high average incomes reflect low poverty and high literacy. Furthermore, inequality has a strong effect on self-reported health. Standard policy prescriptions, then, need revision: first, alleviating poverty may be more effective than raising average income levels; second, non-income goods like literacy may make an important contribution to public health; and third, policy should be based on a broader understanding of societal well-being and the factors that promote it. [Copyright &y& Elsevier]

Abstract: There is growing concern that climate change will lead to more frequent natural disasters that may adversely affect short- and long-term health outcomes in developing countries. Prior research has primarily focused on the impact of single, large disaster events but very little is known about how small and moderate disasters, which are more typical, affect population health. In this paper, we present one of the first investigations of the impact of small and moderate disasters on childhood morbidity, physical growth, and immunizations by combining household data on over 80,000 children from three waves of the Indian National Family and Health Survey with an international database of natural disasters (EM-DAT). We find that exposure to a natural disaster in the past month increases the likelihood of acute illnesses such as diarrhea, fever, and acute respiratory illness in children under 5 year by 9–18%. Exposure to a disaster in the past year reduces height-for-age and weight-for-age z-scores by 0.12–0.15 units, increases the likelihood of stunting and underweight by 7%, and reduces the likelihood of having full age-appropriate immunization coverage by nearly 18%. We also find that disasters'' effects vary significantly by gender, age, and socioeconomic characteristics. Most notably, the adverse effects on growth outcomes are much smaller among boys, infants, and families with more socioeconomic resources. [Copyright &y& Elsevier]

Abstract: This paper informs debates about the potential role for low-fee private schooling in achieving Education for All goals in India. It reports Young Lives’ longitudinal data for two cohorts (2906 children) in the state of Andhra Pradesh. Eight year olds uptake of private schooling increased from 24 per cent (children born in 1994–5) to 44 per cent (children born in 2001–2). Children from rural areas, lower socioeconomic backgrounds and girls continue to be under represented. While some access gaps decreased, the gender gap seems to be widening. Evidence on risks to equity strengthen the case for an effectively regulated private sector, along with reforms to government sector schools. [Copyright &y& Elsevier]

Abstract: India experienced tremendous economic growth since the mid-1980s but this growth was paralleled by sharp rises in economic inequality. Urban areas experienced greater economic growth as well as greater increases in economic inequality than rural areas. During the same period, child health improved on average but socioeconomic differentials in child health persisted. This paper attempts to explain wealth-based inequalities in child mortality and malnutrition using a regression-based decomposition approach. Data for the analysis come from the 1992/93, 1998/99, and 2005/06 Indian National Family Health Surveys. Inequalities in child health are measured using the concentration index. The concentration index for each outcome is then decomposed into the contributions of wealth-based inequality in the observed determinants of child health. Results indicate that mortality inequality declined in urban areas but remained unchanged or increased in rural areas. Malnutrition inequality increased dramatically both in urban and rural areas. The two largest individual/household-level sources of disparities in child health are (i) inequality in the distribution of wealth itself, and (ii) inequality in maternal education. The contributions of observed determinants (i) to neonatal mortality inequality remained unchanged, (ii) to child mortality inequality increased, and (ii) to malnutrition inequality increased. It is possible that the increases in child health inequality reflect urban biases in economic growth, and the mixed performance of public programs that could have otherwise offset the impacts of unequal growth. [Copyright &y& Elsevier]

Abstract: In India inclusive innovation through social entrepreneurs is currently booming. However, these entrepreneurs suffer from a lack of finance since the bank system as well as the microfinance sector are unwilling or unable to finance them. However, pioneering finance initiatives have been emerging recently to bridge this gap. This paper discusses these emerging alternative financing initiatives which are forming an innovation eco-system of support for inclusive innovation and social entrepreneurship. It highlights two instruments in particular that are used in conventional innovation support: business incubation and venture capital. Two case studies are undertaken in order to provide evidence on how such instruments can operate with a ‘dual bottom line’ in supporting inclusive innovation and social entrepreneurship. [Copyright &y& Elsevier]

Abstract: This paper examines the trends and patterns of economic inequalities with respect to child malnutrition by wealth status of population across major regions and states of India. Data from three rounds of National Family and Health Survey (NFHS) conducted during 1992–2006 were analyzed. The proportion of underweight children (measure of both acute and chronic malnutrition) has been used as a dependent variable. The wealth index is used as proxy for economic status of the population, and was estimated through principal component analysis by employing a set of variables representing durable asset ownership, access to utilities and infrastructure, and housing characteristics of respondents for all the three survey rounds. Bivariate analyses, poor-rich ratio and concentration indices were used to understand the trends in economic inequalities with respect to child malnutrition. Pooled logistic regression models were fitted to estimate the adjusted effect of economic status on the likelihood of child malnutrition over time. Results indicate sluggish change coupled with concomitant rise in economic inequalities with respect to child malnutrition in India during 1992–2006. The burden of malnutrition was disproportionately concentrated among poor children. In addition, average decline in malnutrition concealed large economic disparities across space and time. [Copyright &y& Elsevier]

• We show that the rise in rural obesity in India is closely associated with urbanization of its rural spaces. • These risks have increased disproportionately among lower socio-economic classes. • Those living near towns with a population of 50,000 & those living in more economically developed states are at greater risk. • Greater diet diversity alleviates the urban effect of the rural obesity pandemic. While obesity across rural India has doubled in the last decade, research explaining such an unprecedented change is sparse. This paper shows that the rise in the incidence of rural obesity is associated with the process of structural transformation, especially within rural spaces. As the distance to nearby towns from the villages has reduced, urban proximity not only leads to improved livelihoods but also a change in dietary practices and access to processed food. Combining the rural sample of India's latest National Family Health Survey (2015–16) with the estimates for town distance from the village clusters, we show that an additional kilometer of reduction in rural–urban distance increases the risk of obesity among women by 0.06 percent. Our estimates imply that for every kilometer of reduction in rural–urban proximity 3000 rural women become at-risk for obesity. Heterogeneity analysis shows that this burden is higher in towns with a population of over 50,000. We also find that the risk has increased disproportionately among the lower socio-economic classes. Similarly, states at a more mature stage of structural transformation face higher risk of obesity. Finally, we find that higher dietary diversity reduces the influence of urban growth on rural obesity. Our findings underscore the looming dual burden of malnutrition among developing countries and suggest that nutrition policies that promote diet diversity could be a panacea. [ABSTRACT FROM AUTHOR]

Rationale and objective Fewer than 15% of adults who meet criteria for a depression diagnosis in India seek treatment for these symptoms. It is unclear whether this reflects limited supply of mental health services or lack of demand for medical intervention for these experiences. This paper aims to identify and describe self-reported barriers that contribute to this "treatment gap" in a rural district in central India, where depression treatment had recently become available in primary care facilities. In this qualitative study we conducted in-depth interviews with 35 adults who screened positive for depression and who had not sought treatment for their condition, and 15 of their relatives. We analysed the data using the framework approach. A key barrier to seeking health care for psychological symptoms was lack of perceived need for treatment for these symptoms. Low perceived need for health interventions arose because participants frequently attributed depression-like symptoms to their socio-economic circumstances, or to the stress of physical illness, which conflicted with the biomedical approach associated with health services. Despite widespread recognition of the links between psychological symptoms, social circumstances and physical health, it was believed that health care providers are equipped to treat only somatic symptoms, which were commonly reported. Low demand for depression treatment reflected discrepancies between the community's perceived needs and a narrow biomedical model of mental health. Meeting their needs may require a radical change in approach that acknowledges the social determinants of distress, and the interactions between mental and physical health. The capabilities approach may provide a framework for more holistically conceptualising people's needs. • Participants conceptualised their depressive symptoms as "tension" (stress). • "Tension" is seen as a natural response to poverty/physical illness/family problems. • Most participants consulted health workers but only reported somatic symptoms. • Participants did not believe that health workers could treat "tension". • Conceptualisations of health must recognise psychological, physiological and social needs. [ABSTRACT FROM AUTHOR]