CHAPTER IV
HEALTH STATUS IN TAMIL NADU AND
TIRUNELVELI DISTRICT – AN EVALUATION
4.1 INTRODUCTION
The main focus of this chapter is to evaluate the health status in Tamil
Nadu as well as in Tirunelveli district. For the purpose of analysis, health
indicators and its determinants were chosen for the period from 1995-96 to
2009-10. The indicators are determined by numerous factors such as per capita
income, way of life, marital status, housing, sanitation, water supply, health
infrastructure, social organisation, the structure of the economy, nutrition,
education, health services provided by the government, political and
administrative set up, geography climate, religious belief etc.1
Thus it is realised that no universally accepted determinants of health status
have emerged satisfactorily. The most worrying aspect of it is that not all the
determinants are quantifiable and different empirical investigation have resulted
1 K.N. Reddy and V. Selvaraju, “Determinants of Health Status in India - An
Empirical Verification”, 1EA 76th
Annual Conference Volume, 1994, pp.31-33.
141
in different generalisations.2 (Adelman, 1963; Auster, Leveson and Sarachek,
1969; Grossman, 1972; Fuch 1974 and 1982; Benham and Benham, 1975;
2Adelman O., “An Econometric Analysis of Population Growth “, American
Economic Review, Vol. 53 (3), June, 1963. pp. 314-339.
-Auster, R.,I. Leveson and D. Saracheck , “The Production of Health,
AnExploratory Study”, Journal of Human Resources, Vol IV, Fall, 1969, pp.411-436
- Benham, L and A. Benham, “The Impact of Incremental Medical services on
Health statues 1963-1970” in R. Andersen, J. Kravitz and O Andersons (eds) Equity in
Health Services: Empirical analysis of Social Policy, Cambridge, 1975.
- Carrin, Guy, Economic Evaluation of Health Care in Developing Countries,
Croom Helm, London, 1984.
Culyer, Economics of Health, Edward Elgar, England, 1991.
Fuchs V.R., Who shall live? Health Economics and Social Choice, Basic Books
Inc, New York, 1974.
Fuch V.R., Economic Aspects of Health, Chicago University, Chicago. 1982.
Grossman, M., “On the Concept of Health Capital and the Demand for Health”,
Journal of Political Economy, March-April, 1972.
Hadley J., More Medical Care, Better Health?, The Urban. Institute,
Washington D.C., 1982.
Panikar PGK and C.R. Soman, “Health status of Kerela - The Paradox of
Economic Backwardness and Health Development, Centre for Development Studies,
Trivandrum, 1984.
Payer L, Medicine and Culture: varieties of Treatment in the United States,
England, West Germany and Frace, Holt Rinchant and Winston, New York, 1988.
142
Hadley, 1982; Panikar and Soman, 1984; Garrin Guy, 1984; Payer, 1988; Cuyler,
1991 and the World Bank, 1993). The World Bank in its World Development.
Report, 1993 observed that (1) pursuit of economic growth strategies that reduce
poverty, (2) implementation of public health and essential clinical care packages
and (3) increased investment in schooling for girls would enormously improve
health status in developing countries.
4.2. THE ANALYTICAL FRAMEWORK
In order to analyse the trend and growth of health indicators, the following
semi-log trend equation was fitted.3
Y = a + bt .......................... (4.1)
Where,
Y = Value of variable,
t = Time variable.
The above model was computed by the method of least squares.
To analyse the influence of first six determinants on health status namely
life expectancy and birth rate in the study area, a multiple regression model of the
following formula has been used.
3Domodar Gujarati, Essentials of Econometrics, McGraw Hill Inc., International
Edition, New York, 1992, pp.228-229.
143
Y = β0+ β1 X1 + β2 X2 + β3 X3 + β4 X4 + β5 X5 + β6 X6 + U
where,
Y = Life Expectancy / Birth Rate,
X1 = Number of PHCs and health sub-centres,
X2 = Population per bed ratio,
X3 = Number of doctors and nurses in PHCs,
X4 = Population per doctor ratio,
X5 = Female literacy rate,
X6 = Per capita food availability,
U = Disturbance term.
β0, β1 to β6 regression parameters to be estimated and
In order to analyse the influence of the health status namely Death Rate and
Infant Mortality Rate, the following multiple regression model was used.
Y = β0+ β1 X1 + β2 X2 + β3 X3 + β4 X4 + U
where,
X1 = PHC per million population,
X2 = Per capita income,
X3 = Public health expenditure
X4 = Employment in organized sector,
144
U = Disturbance term.
β0, β1 to β4 regression parameters to be estimated and
The correlation coefficient ‘r’ has been computed and t-test was used to
verify the formulated null hypothesis.
4.3. TRENDS IN INDICATORS OF HEALTH
In the present study four health variables, namely, life expectancy at birth,
birth rate, death rate and Infant mortality Rate are used for measuring the levels of
health status in Tamil Nadu State and Tirunelveli district separately so to make a
comparative analysis. These health variables are known as health indicators. The
health indicators are influenced by many determinants. In this study eighteen
determinants, namely number of Primary Health Centres, population per bed ratio,
number of doctors and nurses in primary health centre, population per doctor
ratio, female literacy rate, per capita food availability, PHC per million
population, per capita income at current prices, public health expenditure, literacy
rate, employment in organised sector, provision of drinking water – villages
covered, couple protection rate, fertility rate, sex ratio, density of population, beds
and hospitals are taken as determinants of health status in Tamil Nadu State as
well as in Tirunelveli district. The study period is 15 years from 1995-96 to
2009-10. The first objective of the present study, namely, to study the levels of
health in the study area is based entirely on secondary statistics. They are
collected from various statistical reports, published by Government of Tamil
145
Nadu, Directorate of Medical and Rural Services, Chennai, Directorate of Public
Health and Preventive Medicine, Chennai, Directorate of Family Welfare,
Chennai Department of Economics and Statistics, Chennai Joint Directorate of
Health and Medical Services, Tirunelveli, Deputy Directorates of Public Health,
Tirunelveli, and Assistant Directorate of Statistics, Tirunelveli.
To attempt to answer the question ‘how healthy’ is the study area (Tamil
Nadu State and Tirunelveli District,) with existing health care services available to
people in these areas, the first objective namely the movements of health
indicators and determinants are analysed. The present study is aimed at,
evaluating the health situation in the study area and suggesting possible lines of
approach in the formulation of health policy and programmes that help to promote
the health status in the coming years.
To study the first objective, movements of health indicators life
expectancy, birth rate, death rate and infant mortality rate in the case of Tamil
Nadu and in the case of Tirunelveli district are examined by fitting a trend relation
Yt = a + bt where t is the time, yt is the value of indicator at time ‘t’ and ‘a’ and
‘b’ are parameters; ‘b’ is giving the trend. The trend is estimated for four chosen
indicators. Moreover the trends in the eighteen chosen determinants are also
obtained to know their movements.
146
4.3.1. Indicators of Heath in Tamil Nadu
Table 4.1 reveals various data related to life expectancy, birth rate, death
rate and infant mortality rate in Tamil Nadu for the period from 1995-96 to
2009-10.
TABLE 4.1
INDICATORS OF HEALTH IN TAMIL NADU
FOR THE PERIOD FROM 1995-96 TO 2009-10
Year Life Expectancy Birth Rate Death Rate IMR
1995-96 64.09 20.3 8.0 54
1996-97 64.10 19.5 8.0 53
1997-98 64.14 19.0 8.0 53
1998-99 64.29 19.2 8.5 53
1999-00 65.31 19.3 8.0 52
2000-01 65.41 19.3 7.9 51
2001-02 65.09 19.1 7.6 49
2002-03 65.11 18.5 7.7 44
2003-04 65.15 18.3 7.6 43
2004-05 66.22 17.1 7.5 41
2005-06 67.11 16.5 7.4 37
2006-07 67.21 16.2 7.5 37
2007-08 67.31 15.8 7.2 35
2008-09 67.75 16.0 7.4 31
2009-10 67.98 16.3 7.6 28
Source: (i) Directorate of Medical and Rural Services, Chennai
(ii) 1991 Census of India
(iii) 2001 Census of India
147
Figure 4.1
Indicators of Health in Tamil Nadu for the Period from
1995-96 to 2009-10
0
10
20
30
40
50
60
70
80
1995-9
6
1996-9
7
1997-9
8
1998-9
9
1999-0
0
2000-0
1
2001-0
2
2002-0
3
2003-0
4
2004-0
5
2005-0
6
2006-0
7
2007-0
8
2008-0
9
2009-1
0
Year
Ind
icato
rs
Life Expectancy Birth Rate Death Rate IMR
148
TABLE 4.2
THE RESULTS OF TRENDS IN THE INDICATORS OF HEALTH IN
TAMIL NADU FOR THE PERIOD FROM 1995-96 TO 2009-10
Model: Yt = a + bt
Sl.
No Health Indicators
Coefficients R
2
a b
1. Life Expectancy at birth 63.3587 0.661*
(11.948) 0.917
2. Birth rate 20.6152 -0.3235*
(-10.269) 0.890
3. Death rate 8.2123 -0.0607*
(-4.998) 0.657
4. Infant Mortality Rate 66.7430 -1.1034*
(-4.257)* 0.582
Source: Computed from secondary data.
: Figures in parentheses are ‘t’ values
* Significant at 5 per cent level.
From Table 4.2 the trend and the annual rate of change of four health
indicators have been observed. Life expectancy at birth has registered an
increasing trend and its annual rate of changes is, 0.661. The birth rate, death rate
and infant mortality rate have shown a declining trend, with the annual rate of
changes being -0.3235, -0.0607 and -1.1034 respectively. All these rates are
significant statistically.
149
Tables 4.1 and 4.2 clearly reveal the following inferences about Tamil
Nadu state:
During the study period, Life expectancy had increased from 64.09 to
67.98 in the state. It had increased at the rate of 0.299 per annum. Among the
four health indicators, Infant mortality rate had undergone the largest change. It
had decreased from 54 to 28 and its higher annual rate of change was -1.1034.
The birth rate had decreased from 20.30 to 16.30 during the study period and the
annual rate of change was -0.3235. The death rate had also declined from 8.00 to
7.60 in the state and the rate of change per annum was –0.0607. The birth rate
increased and death rate had declined but annual rate of the decline in birth rate
(- 0.3235) was higher than the decline in death rate (-0.0607). These trends imply
remarkable enhancement in the health status of Tamil Nadu for the period from
1995-96 to 2009-10.
4.3.2. Indicators of Health in Tirunelveli District
The trend in health indicators in Tirunelveli district has been shown in
Tables 4.3 and 4.4.
150
TABLE 4.3
INDICATORS OF HEALTH IN TIRUNELVELI DISTRICT
FOR THE PERIOD FROM 1995-96 TO 2009-10
Year Life Expectancy Birth Rate Death Rate IMR
1995-96 60.22 21.3 8.5 71.21
1996-97 60.21 20.5 8.4 67.15
1997-98 61.11 20.1 8.2 68.91
1998-99 62.21 19.8 8.6 57.61
1999-00 63.15 19.9 8.0 56.15
2000-01 64.11 19.3 8.0 50.21
2001-02 64.21 19.1 7.6 44.61
2002-03 64.11 18.5 7.9 43.15
2003-04 65.31 18.3 7.7 40.21
2004-05 65.81 17.9 7.5 38.09
2005-06 65.90 17.6 7.8 38.10
2006-07 66.53 17.4 7.5 38.15
2007-08 66.61 17.6 7.4 38.61
2008-09 66.65 17.1 7.6 39.15
2009-10 66.91 16.9 7.3 39.21
Source: (i) Joint Directorate of Health and Medical Services, Tirunelveli..
(ii) Deputy Directorates of Public Health, Tirunelveli..
151
Figure 4.2
Indicators of Health in Tirunelveli District for the Period from
1995-96 to 2009-10
0
10
20
30
40
50
60
70
80
1995-9
6
1996-9
7
1997-9
8
1998-9
9
1999-0
0
2000-0
1
2001-0
2
2002-0
3
2003-0
4
2004-0
5
2005-0
6
2006-0
7
2007-0
8
2008-0
9
2009-1
0Year
Ind
ica
tors
Life Expectancy Birth Rate Death Rate IMR
152
TABLE 4.4
THE RESULTS OF TRENDS IN THE HEALTH INDICATORS IN
TIRUNELVELI DISTRICT FROM 1995-96 TO 2009-10
Model: Yt = a + bt
Sl.
No. Health Indicator
Coefficients R
2
a b
1. Life expectancy at birth 60.117 0.510*
(14.284) 0.940
2. Birth rate 21.1476 -0.2992*
(-20.751) 0.970
3. Death rate 8.5266 -0.0825*
(-7.440) 0.809
4. Infant mortality rate 68.8193 -2.514*
(-7.986)
0.830
Source: Computed from the secondary data.
Note : Figures in Parentheses denote ‘t’ values
* Significant at 5 per cent level.
From Tables 4.3 and 4.4, it has been inferred that the Life expectancy at
birth in the district was 60.22 in 1995-96 and it had risen to 66.91 in 2009-10.
Life expectancy at birth in Tirunelveli district had shown increasing trend and its
annual rate of change was 0.510. During the study period, the birth rate had
decreased from 21.30 to 16.90; the death rate had decreased from 8.50 to 7.30 and
the infant mortality rate had fallen from 71.21 to 39.21. Birth rate, death rate and
infant mortality had shown a declining trend with the annual rates of change being
-0.2992, -0.0825 and –2.514 respectively. Infant mortality rate had declined
largely (-2.514) in the district. The annual rate of change in birth rate and death
rate is more or less equal. The annual rate of change in all the health indicators is
153
statistically significant. These trends highlight the spectacular increase in the
health status of the people in the district during the study period.
The health profiles of Tamil Nadu State and Tirunelveli district are
compared, because the comparative study could be an effective and certain
conclusion could be drawn for policy implications.
Regarding the first health indicator, namely life expectancy at birth, the
annual growth rate had shown an increasing trend both in Tamil Nadu State and
Tirunelveli district. The life expectancy at birth had increased from 64.09 to
67.98 in Tamil Nadu and from 60.22 to 66.91 in Tirunelveli district. The average
life span had increased by 7.20 years both in Tamil Nadu and Tirunelveli district
during the study period. The birth rate had decreased from 20.30 to 16.30 in
Tamil Nadu and in Tirunelveli district it had decreased from 21.30 to 16.90. The
death rate had declined from 8.00 to 7.60 in Tamil Nadu and it had come down
from 8.50 to 7.30 in Tirunelveli district. The infant mortality rate in Tamil Nadu
had declined from 72.11 to 55.21 whereas it had come down from 71.21 to 39.21
in Tirunelveli district. This shows the overall health development in Tirunelveli
district despite its economic development. Health status of Tamil Nadu is better
off than that of Tirunelveli district as per the health indicator, namely life
expectancy at birth. Its annual growth rate was 0.661 in Tamil Nadu whereas it
was 0.510 in Tirunelveli district. Infant mortality rate, birth rate and death rate in
Tamil Nadu state as well as in Tirunelveli district were experiencing a declining
154
trend. The declining trend in infant mortality rate was stronger than that of birth
rate and death rate. The annual rate of decline in death rate and IMR was higher in
Tirunelveli district than in Tamil Nadu. The annual rate of decline in IMR was –
2.514 in the district and –1.1034 in the state. The health status of the district is
better than the state, as far as IMR is concerned. Among the four health
indicators, life expectancy at birth and infant mortality rate were decisive and
dominant in indicating the health status of any region.
Almas Ali and Pratap Sisodia (1995)4 confirmed that the primary
determinants of improved health status of the population had been general
mortality, infant mortality and life expectation at birth. They further stated that
studies on fertility and morbidity and also on the impact of health programmes
and use of health services had been introduced as secondary health indicators.
Nevertheless, the analysis of mortality data was still very much an indispensable
part of the health situation analysis.
The annual growth rate of infant mortality rate in Tirunelveli District was
–2.514, and in Tamil Nadu State it was -1.1034. There was a good sign of health
improvement in Tirunelveli district. The decline in birth rate was higher in Tamil
Nadu whereas the decline in death rate was higher in Tirunelveli District.
Therefore Government of Tamil Nadu has to concentrate on taking steps to reduce
infant mortality rate further in the state. Moreover Tirunelveli district
4 Almas Ali and Pratap Sisodia, “Health Profile of India: An Overview”, Health
for Millions, Souvenir Number, Vol. 21, October 1995, p. 48.
155
administration has to concentrate on multifarious measures to bring down the
birth rate thereby controlling the growth of population and elevating the level of
health status.
4.4 TRENDS IN DETERMINANTS OF HEALTH
Health, economic, demographic, social and educational variables are
among the several factors, which determine the status of health. Table 4.5
explicitly demonstrates the trends in various health determinants in the state of
Tamil Nadu.
TABLE 4.5
HEALTH DETERMINANTS IN TAMIL NADU FOR THE PERIOD
FROM 1995-96 TO 2009-10
Year
Number
of PHCs
+ HSCs
Population
per Bed
ratio
Number of
Doctors +
Nurses
Population
per Doctor
Ratio
Female
Literacy
Rate
Per capita
food
availability
(in Kgs)
1995-96 10106 1926 22262 20511 55.41 143.00
1996-97 10102 1954 23354 20698 56.77 167.20
1997-98 10099 1977 22416 20784 58.12 107.40
1998-99 10090 1995 22470 20853 59.48 114.90
1999-00 10091 2031 22504 20978 60.84 133.00
2000-01 10096 2015 22608 21010 62.20 126.50
2001-02 10099 2017 22664 21018 63.36 135.00
2002-03 10100 2018 22700 21025 64.55 146.60
2003-04 10103 2019 22761 21034 65.31 147.21
2004-05 10106 2021 22799 21045 67.91 149.24
2005-06 10109 2023 22816 21051 68.21 150.15
2006-07 10110 2025 22861 21063 68.31 151.21
2007-08 10113 2027 22893 21065 68.43 152.14
2008-09 10115 2079 22909 21068 68.54 152.31
2009-10 10117 2030 22968 21069 68.91 152.43
Source: (i) ‘Tamil Nadu – An Economic Appraisal’ for various years, Published
by Department of Evaluation and Applied Research, Chennai.
(ii) Statistical Hand Book of Tamil Nadu for various years.
(iii) 1991 Census of India, 2001 Census of India.
156
TABLE 4.5 CONTD.
Year PHC per
million
population
Per capita
income at
current
prices
( in Rs.)
Public
health
Expedition
(Rs in
lakhs)
Literacy
Rate
Employment
in Organised
Sector
(in ‘000)
Number of
Villages
with Safe
Drinking
Water
1995-96 0.040 7352 13071.34 65.66 2898.80 8134
1996-97 0.040 8282 25842.28 66.73 2412.70 9439
1997-98 0.042 11573 29955.36 67.81 2563.20 10541
1998-99 0.042 13985 36419.21 68.90 2571.10 11627
1999-00 0.043 15798 42399.00 69.93 2584.30 12431
2000-01 0.043 16114 48080.93 73.50 2592.60 13382
2001-02 0.043 17008 47807.58 72.30 2596.20 14463
2002-03 0.044 17893 50100.92 73.47 2611.70 15676
2003-04 0.045 17914 52114.15 74.15 2761.15 16211
2004-05 0.045 17924 53211.41 75.21 2863.43 17621
2005-06 0.045 17931 53421.11 77.14 2961.43 18341
2006-07 0.046 17943 54561.25 77.21 2998.64 18462
2007-08 0.046 17961 56241.15 77.61 3024.69 18499
2008-09 0.046 18291 57319.21 78.62 3036.15 19211
2009-10 0.047 18314 58624.19 79.41 314125 19341
Source: (i) ‘Tamil Nadu – An Economic Appraisal’ for various years, Published
by Department of Evaluation and Applied Research, Chennai.
(iv) Statistical Hand Book of Tamil Nadu for various years.
(v) 1991 Census of India.
(vi) 2001 Census of India.
157
TABLE 4.5 CONTD.
Year
Couple
protect
Rate
Fertility
rate
Sex
ratio
Density of
population
per sq.km.
Number of
Beds in
PHCs
Number
of
Hospital
1995-96 50.90 2.2 981.00 445.00 29812 306
1996-97 51.80 2.1 981.00 451.00 30108 306
1997-98 53.00 2.0 982.00 456.00 30397 314
1998-99 54.90 2.0 982.00 462.00 30503 314
1999-00 54.60 2.0 984.00 468.00 30641 314
2000-01 56.20 2.0 984.00 473.00 30716 314
2001-02 57.30 2.0 980.00 475.00 30769 314
2002-03 58.70 2.0 986.00 478.00 30791 314
2003-04 59.21 2.0 991.00 479.00 30821 321
2004-05 61.21 1.9 991.00 479.00 30845 321
2005-06 61.25 1.7 991.00 479.00 30859 321
2006-07 62.24 1.7 993.00 481.00 30877 321
2007-08 62.31 1.7 993.00 481.00 30899 321
2008-09 65.21 1.7 993.00 481.00 30905 321
2009-10 65.20 1.6 993.00 481.00 30935 321
Source: (i) ‘Tamil Nadu – An Economic Appraisal’ for various years, Published
by Department of Evaluation and Applied Research, Chennai.
(vii) Statistical Hand Book of Tamil Nadu for various years.
(viii) 1991 Census of India.
(ix) 2001 Census of India.
158
TABLE 4.6
RESULTS OF TRENDS IN HEALTH DETERMINANTS IN TAMIL NADU STATE FOR
THE PERIOD FROM 1995-96 TO 2009-10 Model: Yt = a + bt
Sl.
No Determinants of Health
Coefficients R
2
a b
1. PHCs and HSCs (X1) 10092.79 1.3678*
(4.051) 0.558
2. Population per bed ratio (X2) 1957.95 6.5642* (5.086)
0.666
3. Doctors and Nurses (X3) 22514.16 27.2714*
(1.859) 0.210
4. Population per doctor ratio(X4) 20703.58 30.986*
(5.412)* 0.693
5. Female literacy rate (X5) 55.543 1.026*
(15.192) 0.947
6. Per capita food availability (X6) 128.893 1.624
(1.862) 0.210
7. PHC per million population (X7) 0.040 0.0047*
(15.958) 0.951
8. Per capita income (X8) 10033.58 698.16*
(5.768) 0.719
9. Public Health expenditure (X9) 23581.867 2712.008*
(7.983) 0.830
10. Literacy rate (X10) 64.972 1.005*
(37.601) 0.991
11. Employment in organised Sector (X11) -39012.68 7814.92
(1.740) 0.1889
12. Provision of drinking water
– Villages Covered (X12) 8258.590
829.167*
(19.027) 0.9653
13. Couple protection rate (X13) 50.03009 1.0298* (31.394)
0.9869
14. Fertility rate (X14) 2.20381 -0.0371*
(-8.925) 0.8596
15. Sex rate (X15) 978.971 1.053*
(13.939) 0.9372
16. Density of population (X16) 451.780 2.4357*
(7.443)* 0.8099
17. Beds (X17) 30155.304 62.903*
(6.1427) 0.7437
18. Hospitals (X18) 307.628 1.0714*
(7.368)* 0.8068
Source: Computed from secondary data
Note : Figures in parentheses denote ‘t’ values
*Significant at 5 per cent level
159
4.4.1 Determinants of Health in Tamil Nadu
From the Table 4.5 and 4.6 it has been revealed that in terms of
determinants in Tamil Nadu, all the determinants were significant except one
determinant namely per capita food availability which has not recorded any
significant trend. All others have shown significant and positive trends except
PHC per million population and the fertility rate which are favourable to improve
the health status. Among the 18 selected determinants, 15 determinants have
significant and positive trends. Per capita income at current prices, public health
expenditure, and provision of drinking water villages covered, have shown the
highest growth rate; whereas female literacy rate, literacy rate, couple protection
rate, sex ratio and number of hospitals have shown the lowest growth rate. The
growth rate of other determinants was moderate during the study period in the
state. The favourable and unfavourable monsoons during the study period
resulted in fluctuations in food production and output. This was the reason for
insignificant and negative trend in per capita food availability in the state.
Secondly, PHC per million population was statistically significant and its growth
was marginally negative. Thirdly the fertility rate had also negative trend which
exhibited the awareness of people in small family norms.
Per capita income at current prices in the state had increased from Rs.7352
to Rs.18314 that is, a two fold increase during the study period. Public health
160
expenditure had risen from Rs.13071.34 lakhs to Rs.58624.19 lakhs, a three fold
increase. The inflationary effect might have partly contributed to this huge
income in public health expenditure. Villages covered for provision of safe
drinking water, increased from 8134 to 19341. The female literacy rate had been
accelerated from 54.35 to 71.99 in the state, thanks to Total Literacy Campaign
launched by the National Literacy Mission, New Delhi between 1991 and 1995.
The per capita food availability in the state increased from 117.30 kilograms to
146.60 kilograms during the study period. PHC per million was 0.082 in 1994-95
and it had declined to 0.044 due to growing population, low commitment to open
up new additional PHCs and cut in health budget during the last decade, owing to
the impact of globalisation and New Economic Policy of 1991.
Panikar and Soman5 analysed the health status of Kerala and found out
that a mere linear expansion of curative medical care facilities could not take the
state anywhere to the goal of heath for all; already public and private expenditure
together were absorbing a high and increasing proportion of the state income,
without any visible impact on the incidence of diseases. Therefore, the goal of
better health had to be sought through development of the non-health care sectors
including food, housing, water supply and sanitation, as suggested by Panikar and
Soman.
5P.G.K. Panikar and C.R. Soman, “Health Status of Kerala – Paradox of
Economic Backwardness and Health Development”, Centre for Development Studies,
Thiruvananthapuram, 1984, p. 147.
161
As per the documents of National health Policy, 2002, prepared by
Ministry of Health and Family Welfare, New Delhi, Tamil Nadu fits in the
category of better performing states in health sector in India.
• Health determinants namely number of PHCs and HSCs, female literacy
rate, per capita income, employment in organised sector and provision of
safe drinking water do play an influencing role in enhancing the health
status of the state.
• Government may pay attention to improving these determinants so that the
outcome will be productive further in improving the health status vis-à-vis
standard of living.
The trends in the determinants of health in Tirunelveli district for the
period 1994-95 to 2008-09 is presented in Table 4.7.
162
TABLE 4.7
DETERMINANTS OF HEALTH IN TIRUNELVELI DISTRICT FOR THE
PERIOD 1995-96 TO 2009-10
Year
Number
of
PHCs
+HSCs
Population
per Bed
ratio
Number
of
Doctors+
Nurses
Population
per Doctor
ratio
Female
literacy
rate
Per capita
food
availability
(in Kgs)
1995-96 211 2066 214 16174 54.35 70.50
1996-97 224 2071 220 16098 55.61 71.10
1997-98 231 2076 224 16043 60.21 70.60
1998-99 245 2082 226 16091 61.41 70.10
1999-00 261 2087 231 16041 63.15 85.20
2000-01 271 2091 243 15933 64.21 80.40
2001-02 278 2093 254 15896 66.41 85.40
2002-03 284 2095 261 15809 67.29 83.90
2003-04 289 2099 273 15754 69.45 85.61
2004-05 290 2117 281 15702 70.65 86.43
2005-06 295 2118 285 15691 70.91 87.91
2006-07 299 2119 291 15673 71.51 88.21
2007-08 303 2121 311 15521 71.91 89.11
2008-09 307 2129 324 15541 71.93 89.21
2009-10 310 2133 343 15521 71.99 89.41
Source: (i) Joint Directorate of Health and Medical Services, Tirunelveli.
(ii) Deputy Directorates of Public Health, Tirunelveli.
163
TABLE 4.7 CONTD.
Year
PHC
Per million
population
Per
capita
Income
(in Rs.)
Public health
Expenditure
(Rs.in lakhs)
Literacy
Rate
Employment
in Organised
Sector
(in ‘000)
Number
of
Villages
with Safe
Drinking
Water
1995-96 0.043 4450 603.15 66.10 554 592
1996-97 0.044 5761 1110.50 67.21 528 599
1997-98 0.047 6186 1365.21 68.32 506 599
1998-99 0.045 6993 1400.11 69.44 499 611
1999-00 0.047 7899 1500.10 70.58 472 611
2000-01 0.047 8057 18991.15 71.80 473 611
2001-02 0.048 8508 21411.51 73.12 481 623
2002-03 0.048 9849 22611.55 74.23 493 623
2003-04 0.049 9921 23451.65 79.15 499 623
2004-05 0.049 9934 24691.22 81.61 511 631
2005-06 0.049 9945 25641.24 82.15 524 631
2006-07 0.051 9953 27999.15 82.19 539 631
2007-08 0.051 9964 28981.15 82.61 549 631
2008-09 0.051 9966 29908.61 83.14 561 631
2009-10 0.030 9977 29915.15 83.15 574 649
Source: (i) Joint Directorate of Health and Medical Services, Tirunelveli.
(ii) Deputy Directorates of Public Health, Tirunelveli.
164
TABLE 4.7 CONTD.
Year
Couple
protection
Rate
Fertility
rate Sex ratio
Density of
population
Number of
Beds in
PHCs
Number
of
Hospital
1995-96 45.15 2.5 997 379 784 15
1996-97 46.21 2.5 998 385 792 15
1997-98 49.15 2.3 999 389 799 15
1998-99 51.21 2.2 1001 391 816 15
1999-00 53.43 2.2 1004 394 819 15
2000-01 56.24 2.1 1006 412 822 15
2001-02 59.61 2.2 1009 414 831 15
2002-03 61.21 2.1 1013 416 843 17
2003-04 62.15 2.0 1015 418 849 17
2004-05 63.24 2.0 1017 419 853 17
2005-06 64.15 2.0 1018 422 861 21
2006-07 65.11 1.9 1019 424 871 21
2007-08 65.41 1.9 1022 433 874 21
2008-09 65.49 1.9 1024 435 879 21
2009-10 65.51 1.9 1026 439 884 21
Source: (i) Joint Directorate of Health and Medical Services, Tirunelveli.
(ii) Deputy Directorates of Public Health, Tirunelveli.
165
TABLE 4.8
RESULTS OF TRENDS IN HEALTH DETERMINANTS IN
TIRUNELVELI DISTRICT FOR THE PERIOD FROM
1995-96 TO 2009-10 Model: Yt = a + bt
Sl.
No Health Determinants
Coefficients R
2
a b
1. PHCs and HSCs (X1.1) 250.933 9.6750*
(12.918) 0.9277
2. Population per bed ratio (X2.1) 2061.485 4.7892* (24.082)
0.9780
3. Doctors and Nurses (X3.1) 194.571 8.8535*
(19.748) 0.967
4. Population per doctor ratio (X4.1) 16228.219 -49.466*
(-21.585) 0.9728
5. Female literacy rate (X5.1) 55.794 1.2839*
(11.711) 0.9134
6. Per capita food availability (X6.1) 70.0225 1.522*
(7.172) 0.7982
7. PHC per million population (X7.1) 0.0436 0.0054*
(11.377) 0.9087
8. Per capita income (X8.1) 5463.609 378.407*
(7.803) 0.8240
9. Public health expenditure (X9.1) -2932.062 2529.686*
(9.048) 0.8629
10. Literacy rate (X10.1) 64.2893 1.4205*
(15.087) 0.9459
11. Employment in Organised sector (X11.1) 490.019 3.4392
(1.930) 0.222
12. Provision of drinking water –
Villages covered (X12.1) 593.133
3.3250*
(11.875) 0.9156
13. Couple protection rate (X13.1) 45.5380 1.5850* (12.168)
0.9192
14. Fertility rate (X14.1) 2.45619 -0.0428*
(-10.298) 0.8908
15. Sex ratio (X15.1) 993.6000 2.2000*
(34.045) 0.9889
16. Density of population (X16.1) 377.790 4.1928*
(16.647) 0.9551
17. Beds (X17.1) 780.666 7.225*
(33.878) 0.9888
18. Hospitals (X18.1) 12.9428 0.5571*
(7.776) 0.8230
Source: Computed from Secondary data.
Figures in parentheses denote ‘t’ values.
* Significant at 5 per cent level.
166
4.4.2. Health Determinants in Tirunelveli District
It has been observed from Tables 4.7 and 4.8 that the health profile of
Tirunelveli district is substantiated and supplemented by secondary data for the
period of 15 years between 1993-94 and 2007-08. Regarding the trends in the 18
health determinants, only PHC per million population has no significant trend and
the remaining determinants are significant and all are positive except population
per doctor ratio. Per capita incase and public health expenditure have shown the
highest annual growth rate. Female literacy rate, per capita food availability,
literacy rate, Sex ratio and number of hospitals have shown the lowest annual
growth rate. The growth rate of remaining determinates was moderate during the
study period in the district. Population per doctor ratio showed a declining trend.
It is a welcome feature. A doctor could render qualitative health service only if
the number of patients to be attended, would be minimum. The female literacy
rate in the district had shown an increasing trend and this would reduce infant
mortality rate as tested statistically and proved empirically.
While comparing the trends of health determinants at state level and district
level, it is found that the growth rate of female literacy level (1.28) is higher in
Tirunelveli than that of Tamil Nadu (1.03). Consequently infant mortality rate is
less in Tirunelveli district than that of Tamil Nadu. Population per doctor ratio
(30.986) and population per bed ratio (6.5642) have higher growth rate at the state
167
level than that of district level. The growth rate of per capita income is less in
Tirunelveli district (378.407) than that of Tamil Nadu State (698.160).
Among 29 districts in Tamil Nadu, Tirunelveli district is economically in
the forefront. The health profiles and literacy profile are encouraging in this
district. The number of PHCs in Tamil Nadu increased from 10106 to 10117 and
in Tirunelveli district it increased from 282 to 403 during the study period. The
female literacy increased in Tamil Nadu from 55.41 to 68.91 and in Tirunelveli
district it increased from 54.35 to 71.99. The per capita food availability
increased in Tamil Nadu from 143.00 kilograms to 152.43 kilograms, whereas in
Tirunelveli district it increased from 70.50 kilograms to 89.41 kilograms. The
fertility rate in Tamil Nadu had decreased from 2.20 to 1.606 whereas in
Tirunelveli district it had decreased from 2.50 to 1.90. The per capita income in
Tamil Nadu had increased from Rs.7352 to Rs.18314 but in Tirunelveli district it
was Rs.4450 in 1995-96 and it increased to Rs.9977 in 2009-10.
Overall analysis reveals that Primary Health Centres and Health Sub-
Centres, female literacy rate and per capita income are having the highest growth
rate and they are vital factors to determine the health status in the district.
168
4.5. DETERMINANTS OF HEALTH STATUS
In this section, an attempt has been made to analyse the influence of the
determinants on the health indicators, in the study area from 1995-96 to 2009-10,
using secondary data collected for Tamil Nadu State and Tirunelveli District.
Four important health indicators are selected to evaluate the health status.
They are (i) life expectancy at birth, (ii) birth rate, (iii) death rate and (iv) infant
mortality rate. Secondary data were collected for the selected 18 health
determinants. Several combinations of determinants were tried, taking into
consideration, the interrelation among the determinants and suitable models were
arrived at. Hence out of 18 determinants, only 10 health determinants are used for
the purpose of analysis. The selected determinants are
(i) Number of PHCs and Health Sub-Centres
(ii) Population per bed ratio
(iii) Number of doctors and nurses in PHCs
(iv) Population per doctor ratio
(v) Female literacy rate
(vi) Per capita food availability
(vii) PHC per million population
(viii) Per capita income
(ix) Public health expenditure
(x) Employment in organised sector
169
To analyse the influence of first six determinants on health status namely
life expectancy and birth rate in the study area, a multiple regression model of the
following formula has been used.
Y = β0+ β1 X1 + β2 X2 + β3 X3 + β4 X4 + β5 X5 + β6 X6 + U
where,
Y = Life Expectancy / Birth Rate,
X1 = Number of PHCs and health sub-centres,
X2 = Population per bed ratio,
X3 = Number of doctors and nurses in PHCs,
X4 = Population per doctor ratio,
X5 = Female literacy rate,
X6 = Per capita food availability,
U = Disturbance term.
β0, β1 to β6 regression parameters to be estimated and
It is estimated by the method of least squares separately for Tamil Nadu
and Tirunelveli district. The study period is about 15 years from 1995-96 to
2009-10. The computed results are in the Table 4.9 for life expectancy.
170
TABLE 4.9
RESULTS OF MULTIPLE REGRESSION ANALYSIS FOR TAMIL NADU
AND TIRUNELVELI DISTRICT – LIFE EXPECTANCY AT BIRTH
Variables Parameter Estimates
Tamil Nadu Tirunelveli District
Intercept 0.781 23.32
X1 -2.941*
(-3.110)
0.041*
(3.211)
X2 0.048
(0.101)
-0.016
(-1.03)
X3 1.214
(1.018)
-0.110*
(-2.951)
X4 0.162
(0.311)
-0.005
(-0.792)
X5 0.241
(1.041)
0.371
(1.4217)
X6 -5.271
(-0.816)
0.051*
(2.671)
R2 0.939 0.991
No. of observations 15 15
Figures in bracket represent t- value.
* Indicates that the co-efficients are statistically significant at 5 per cent level.
From Table 4.9 it has been inferred that the number of PHCs and HSCs
was significant and influencing the life expectancy at birth at state level. The
number of PHCs and HSCs, the number of doctors and nurses, and per capita food
availability were significant with marked influence on the life expectancy at birth
at District level.
171
Seeta Prabhu (1994)6 made a study on the financing of health sector in
Maharashtra and she concluded in her work that the health infrastructure
especially PHC was significant in influencing life expectancy at birth. She
suggested that concerted actions on the part of the government to improve the
access to public health facilities to be taken to improve the health status in
Maharashtra.
Sarma (1994)7 studied the relationship between poverty, nutrition and
infant mortality among the Kandha tribes of Orissa state and found that changes in
food intake material and low per capita food availability were responsible for the
poor health status of tribes in Orissa. Per capita food availability is a dominant
factor, influencing the longevity of life in any region.
The computed regression results for Birth rate separately for Tamil Nadu
and Tirunelveli district are given in Table 4.10.
6K. Seeta Prabhu, “Financing of Health Sector in Maharashtra”, Conference
Volume, Indian Economic Association, Bombay, 19-21 February, 1994.
7R.P. Sarma, “Poverty Nutrition and Infant Mortality among the Kandha Tribes of
Orissa “, Conference Volume, Indian Economic Association, Bombay, 1994, p. 54.
172
TABLE 4.10
RESULTS OF MULTIPLE REGRESSION ANALYSIS FOR TAMIL NADU
AND TIRUNELVELI DISTRICT – BIRTH RATE
Variables Parameter Estimates
Tamil Nadu Tirunelveli District
Intercept 68.631 36.41
X1 0.004
( 0.381)
-0.042
(-1.061)
X2 0.021
(1.091)
0.056
(1.121)
X3 -0.004
(-0.691)
0.272*
(3.711)
X4 -0.014*
(-2.911)
-0.018
(-1.241)
X5 -0.012
(-0.101)
-2.161*
(-2.341)
X6 0.004
(0.612)
0.196*
(2.450)
R2 0.912 0.874
Number of Observations 15 15
Figures in bracket represent t- value.
* Indicates that the co-efficients are statistically significant at 5 per cent level.
Table 4.10 revealed that birth rate was influenced by the following
determinants. At state level, birth rate was influenced by population per doctor
ratio. At district level, female literacy rate and per capita food availability played
a major role in determining the birth rate. As female literacy increased, birth rate
decreased. There was a positive relationship between per capita food availability
and birth rate.
173
Bhattacharya (1982)8 was of the opinion that continued progress in health
care would lower the rate of population growth. Health status would not change
as long as the population remained below subsistence level. The relationship
between health status and birth rates was mutual. It implied that enhancing the
health status would lower the birth rate and increasing the birth rate would not
enhance health status.
Rajalakshmi and Hepzi (1993)9 had observed a similar relationship that a
cross sectional analysis of birth rate and female literacy rate revealed a strong
tendency towards lower birth rate. Education of women was found to have a
positive influence on the practice of family planning. The study concluded that
substantial reduction in the birth rate could be achieved by increasing female
literacy rate.
Gopalan et al., (1971)10 had also the same inference that there was a
positive correlation between per capita food availability and birth rate.
Reproduction was normal between 15 and 45 years of the woman. The food
availability was an important factor for reproduction.
8N. Bhattacharya, “Health Care and Its Problem in West Bengal”, Conference
Volume, 25th
Annual Conference of the Indian Public Health Association, Washington,
D.C., Vol. 19-24, 1982. 9N. Rajalakshmi and J. Hepzi, “Linkage Effect of Female Literacy on
Demographic Structure”, Women and Economy, Nancy David and V. Loganathan
(Eds.), Mother Theresa Women’s University, Madras, 1993, pp. 366-378. 10C. Gopalan, S.C. Balasubramanian, B.V. Ramasri and Visweswara Rao, “Diet
of Pregnant Women”, Diet Atlas of India, ICMR, Hydrabad, 1971, p. 60.
174
In order to analyse the influence of the health status namely Death Rate and
Infant Mortality Rate, the following multiple regression model was used.
Y = β0+ β1 X1 + β2 X2 + β3 X3 + β4 X4 + U
where,
X1 = PHC per million population,
X2 = Per capita income,
X3 = Public health expenditure
X4 = Employment in organized sector,
U = Disturbance term.
β0, β1 to β4 regression parameters to be estimated and
The above model was estimated by method of least squares separately for
Tamil Nadu and Tirunelveli district.
The computed results are given in Table 4.11 for Death Rate.
175
TABLE 4.11
RESULTS OF MULTIPLE REGRESSION ANALYSIS FOR TAMIL NADU
AND TIRUNELVELI DISTRICT – DEATH RATE
Variables Parameter Estimates
Tamil Nadu Tirunelveli District
Intercept 7.823 -14.781
X1 18.621*
(3.124)
116.84*
(5.627)
X2 -1.512
(-0.211)
-0.001
(-0.048)
X3 1.048
(0.371)
-2.671
(-0.048)
X4 -0.007
(-0.711)
0.006
(1.421)
R2 0.867 0.851
Number of Observations 15 15
Figures in bracket represent t- value.
* Indicates that the co-efficients are statistically significant at 5 per cent level.
Table 4.11 shows that the results of multiple regression analysis at state
level as well as at district level. PHC per million populations did play a vital role
in minimising the death rate. In rural area, PHC was easily accessible for medical
intervention and death could be avoided.
Chitra (1994)11 pointed out that PHCs were playing a major role in bringing
down the death rate. She also suggested that health services should be expanded
11Chitra, “Women Campaign for New Plan to Curb the World’s Population”, New
York Times, April 13, 1994, pp. A1-A12.
176
to include parental care, child survival efforts, educating girls, promoting
women’s equality and finally reducing the death rate.
The computed results for infant mortality rate are given in Table 4.12.
TABLE 4.12
RESULTS OF MULTIPLE REGRESSION ANALYSIS FOR TAMIL NADU
AND TIRUNELVELI DISTRICT – INFANT MORTALITY RATE
Variables Parameter Estimates
Tamil Nadu Tirunelveli District
Intercept -4.381 -3791.12
X1 2.632
(0.711)
0.381
(1.211)
X2 -3.412*
(-2.789)
9.411
(1.021)
X3 -0.004
(-1.941)
0.642
(0.471)
X4 0.801
(0.414)
1742.13*
(2.971)
R2 0.912 0.721
Number of observations 15 15
Figures in bracket represent t- value.
* Indicates that the co-efficients are statistically significant at 5 per cent level.
Table 4.12 clearly reveals the influence of health determinants of infant
mortality rate. At the state level, female literacy rate was found to strongly
influence the infant mortality rate. At the district level, PHC per million
populations was playing a vital role in reducing infant mortality rate.
177
Similar inference was drawn by Manonmoney (1994)12 in her research
paper that among all the determinants of ‘health status’ in Tamil Nadu from 1981-
82 to 1990-91, services of PHC had been the most important variable in reducing
the infant mortality rate and thereby increasing the health status of the state.
Reddy and Selvaraju (1994)13 concluded that female literacy had a
significant bearing on health status, since female health education reduced infant
mortality rate. The authors viewed that there was an urgent need to step up
expenditure on women’s education. It might not help improve health status in the
short run, but may help increase human capital and productivity and thereby
economic growth.
4.6. COMPARATIVE ANALYSIS
The comparative analysis between Tamil Nadu State and Tirunelveli
district has resulted in the following conclusion:
Both at the state level and the district level, PHC’s are important
determinants to maintain and enhance health status. So the government of Tamil
12N. Manonmoney, “An Economic Analysis of Health Status in Tamil Nadu”,
Conference Volume, Indian Economic Association, 76th
Annual Conference, Bombay,
19-21 February, 1994.
13K.N. Reddy and V. Selvaraju, “Determinants of Health Status in India: An
Empirical Verification”, Conference Volume, Indian Economic Association, Bombay,
19-21 February, 1994, pp. 31-33.
178
Nadu and the District Health Administration have to concentrate on equipping
PHC’s further with infrastructural facilities and imparting periodical training to
the medical and paramedical staff. Female literacy rate in Tamil Nadu (68.91 per
cent) and in Tirunelveli district (71.99 per cent) is helpful in reducing the infant
mortality rate to 55.21 per 1000 in the former case and to 39.21 per 1000 in the
latter case. Per capita food availability in the study area increases nutritional
status and thereby augments the health status. The number of doctors and the
nurses are instrumental in reducing the mortality rate and morbidity rate in the
study area.
It is clearly evident from the above analysis that there was gradual increase
in health status not only in Tamil Nadu State but also in Tirunelveli District
Government has to make arrangement to open up new additional PHCs, where the
coverage of population exceeded 30,000 population in community development
blocks in Tamil Nadu.
4.7. TESTING OF HYPOTHESIS
“A hypothesis is testable if other deductions can be made from it which in
turn, can be confirmed or disproved by observation”.14
In this section two
hypotheses are framed based on the secondary data collected at the level of
government offices, in Tirunelveli District.
14C. William Emory, Business Research Methods, p. 33.
179
Null Hypothesis
H0 : The first hypothesis states that infant mortality rate
is independent of female literacy rate.
This hypothesis have emerged from the second objective of the study
namely analysing the influence of health indicators on the health status of the
study area. The movement of female literacy rate and infant mortality rate in
Tirunelveli district for the study period has been presented in Table 4.13.
180
TABLE 4.13
FEMALE LITERACY RATE AND INFANT MORTALITY RATE IN
TIRUNELVELI DISTRICT FOR THE PERIOD 1995-96 TO 2009-10
Year Female literacy rate Infant mortality rate
1994-95 54.35 71.21
1995-96 55.61 67.15
1996-97 60.21 68.91
1997-98 61.41 57.61
1998-99 63.15 56.15
1999-00 64.21 50.21
2000-01 66.41 44.61
2001-02 67.29 43.15
2002-03 69.45 40.21
2003-04 70.65 38.09
2004-05 70.91 38.10
2005-06 71.51 38.15
2006-07 71.91 38.61
2007-08 71.93 39.15
2008-09 71.99 39.21
Source: 1. Deputy Directorates of Public Health, Tirunelveli..
2. Assistant Directorate of Statistics, Tirunelveli.
181
TABLE 4.14
CORRELATION BETWEEN FEMALE LITERACY RATE AND INFANT
MORTALITY RATE IN TIRUNELVELI DISTRICT
Variables Coefficient ‘r’ t-values
Calculated Tabulated
Female literacy
rate and Infant
mortality rate
-0.8753 3.671* 2.120
Source: Computed from Secondary data
*Significant at 5 per cent level
Table 4.14 shows the negative correlation between female literacy rate and
infant mortality rate. The value of correlation coefficient is –0.8753. It is
observed that infant mortality rate goes on decreasing as the female literacy rate
increases in the district.
The calculated ‘t’ value is 3.671, which is significant at 5 per cent level.
Since the calculated value is greater than the tabulated value (2.120), the null
hypothesis is rejected. Thus, it may be concluded that the infant mortality rate is
highly influenced by female literacy rate in Tirunelveli district. It is statistically
tested and empirically verified.
182
Suman Jain (1994)15 also drew similar conclusion from his study that
women’s education resulted in lower child mortality by improving child health
and survival by improving hygiene, nutrition and feeding practice and timely
medical intervention. Female literacy had been instrumental in lowering the
infant mortality rate.
Null Hypothesis
H0: The second hypothesis states that total government
spending for health care has not improved the life
expectancy at birth of the people.
The nature of public health expenditure and life expectancy at birth in
Tirunelveli district between 1994-95 and 2008-09 is shown in Table 4.15.
15Suman Jain, “Gender and Survival – A Comparative Analysis of Kerala and
Karyana”, Conference Volume, Indian Economic Association, February 19-21, 1994,
pp. 37-41.
183
TABLE 4.15
PUBLIC HEALTH EXPENDITURE AND LIFE EXPECTANCY AT
BIRTH IN TIRUNELVELI DISTRICT
Year Public Health Expenditure
(Rs. in Lakhs) Life Expectancy at Birth
1995-96 603.15 66.22
1996-97 1110.50 60.21
1997-98 1365.21 61.11
1998-99 1400.11 62.21
1999-00 1500.10 63.15
2000-01 18991.15 64.11
2001-02 21411.51 64.21
2002-03 22611.55 64.31
2003-04 23451.55 65.31
2004-05 24691.22 65.81
2005-06 25641.24 65.90
2006-07 27999.15 66.53
2007-08 28981.15 66.61
2008-09 29908.61 66.65
2009-10 29915.15 66.91
Source: (i) Deputy Directorate of Public Health, Tirunelveli.
(ii) Assistant Directorate of Statistics, Collectorate, Tirunelveli.
184
TABLE 4.16
CORRELATION BETWEEN PUBLIC HEALTH EXPENDITURE
AND LIFE EXPECTANCY AT BIRTH IN TIRUNELVELI
DISTRICT
Variables Coefficient ‘r’ t-values
Calculated Tabulated
Public health
expenditure and
life expectancy at
birth
0.8837 12.61* 2.120
Source: Computed from secondary data.
* Significant at 5 per cent level.
From Table 4.15 it has been observed that the life expectancy at birth goes
on increasing as public health expenditure has increasing trend. It is understood
from Table 4.16 that there is positive correlation between public health
expenditure and life expectancy at birth. In Table 4.16 the value of ‘r’ is 0.8837.
The calculated ‘t’ value is significant and greater than the tabulated ‘t’ value.
Hence the null hypotheses is rejected. Thus, it may be concluded that total
government spending for health care has improved the life expectancy at birth of
the people in the district.