INTRODUCTION The tea estate sector of India is one of the oldest and largest formal private employers. Workers are dependent on plantation estates for a range of basic services under the 1951 Plantation Labour Act and have been subject to human rights violations. Ad hoc reports related to poor health outcomes exist, yet their determinants have not been systematically studied. This study in Assam, situated in Northeast India, sought to understand the Social Determinants of Health (SDH) of women plantation workers with an aim to offer directions for policy action. METHODS As part of a larger qualitative study, 16 FGDs were carried out with women workers in three plantations of Jorhat district covering permanent and non-permanent workers. Informed consent procedures were carried out with all participants individually. Data were analyzed thematically using Ritchie and Spencer's framework based on an adapted conceptual framework drawing from existing global conceptual models and frameworks related to the SDH. RESULTS Determinants at structural, intermediary and individual levels were associated with health. Poverty and poor labour conditions, compounded by the low social position of women in their communities, precluded their ability to improve their economic situation. The poor quality of housing and sanitation, inadequate food and rations, all hampered daily living. Health services were found wanting and social networks were strained even as women were a critical support to each other. These factors impinged on use of health services, diet and nutrition as well as psychosocial stress at the individual level. CONCLUSION Years of subjugation of workers have led to their deep distrust in the system of which they are part. Acting on SDH will take time, deeper understanding of their relative and/or synergistic contribution, and require the building of stakeholdership. Notwithstanding this, to have heard from women workers themselves has been an important step in visibilizing and building accountability for action on the health and SDH of women in plantation estates.

中文翻译：

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“谁来为我们站起来？” 印度茶园女工健康的社会决定因素。

简介印度的茶产业是历史最悠久，规模最大的正式私营雇主之一。根据1951年《种植园劳工法》，工人必须依靠种植园提供一系列基本服务，并遭受侵犯人权的行为。存在与健康状况差有关的临时报告，但尚未对其决定因素进行系统的研究。这项位于印度东北部阿萨姆邦的研究旨在了解女性种植园工人的健康社会决定因素（SDH），旨在为政策行动提供指导。方法作为一项较大的定性研究的一部分，在乔哈特（Jorhat）地区的三个种植园中，对女工进行了16次烟气脱硫，其中包括长期工和非常工。对所有参与者分别进行知情同意程序。使用Ritchie和Spencer的框架，根据从现有的全球概念模型和与SDH相关的框架中提取的适应性概念框架，对数据进行主题分析。结果在结构，中介和个人层面的决定因素与健康相关。贫穷和恶劣的劳动条件，加上妇女在社区中的社会地位低下，使她们无法改善经济状况。住房和卫生条件差，食物和口粮不足，都阻碍了日常生活。即使妇女相互支持，人们发现医疗服务匮乏，社会网络也很紧张。这些因素影响了个人卫生保健，饮食和营养的使用以及社会心理压力。结论多年的服从工人已经导致他们对自己所隶属的制度深表不信任。采取SDH行动将需要时间，需要更深入地了解其相对和/或协同作用，并需要建立利益相关方能力。尽管如此，征求女工本人的意见是在种植园中提高对妇女的健康和SDH采取行动并建立责任制的重要一步。