Saturday, 31 December 2016

India: Promoting healthy life for Human Development

Dr. Devendra Kothari
Population and Development Analyst
Forum for Population Action

Wishing you a Happy New Year

The positive health outcomes ultimately contribute to better educational outcomes and a more productive and higher-skilled labor force. India, therefore, must convert its young population to a competitive advantage, and general health, nutrition and children by choice are foundational to that outcome which promotes healthy life.

This post discusses the state of general health.

India’s current state of health is alarming. Recently, the world's most revered medical journal - The Lancet - has censured severely Government of India for ignoring health sector and has warned that India is on the “verge of a collapse under the weight of its own ill health”. In an exclusive interview to Times of India, Lancet's editor-in-chief Richard Horton said that failing to combat non communicable and communicable diseases will cost India's health system and social care "enormously making India collapse”. [1]

The World health organization has identified India as one of the nations that is going to have most of the lifestyle disorders in the near future. [2]  Nowadays, not only are lifestyle disorders becoming more common, but they are also affecting younger population. The population at risk shifts from 40+ to may be 30+ or even younger. Already considered the diabetes capital of the world, India now appears headed towards gaining another dubious distinction of becoming the lifestyle-related disease capital as well. These include obesity, diabetes, cardiovascular diseases, cancer, and osteoporosis, among others.  A study conducted jointly by the All India Institute of Medical Sciences and Max Hospital shows the incidence of these diseases is increasing at an alarming rate, especially in the young population.

Modern science through improved sanitation, vaccination, and antibiotics, and medical attention has eliminated the threat of death from most infectious diseases. However, communicable diseases are still a major cause of deaths in India.

The  data, released by the office of the Census Commissioner, reveals that one in two deaths in the country, estimated in the period 2010-13, are due to non-communicable  or lifestyle diseases. However, for urban areas, NCDs account for nearly 60 per cent of deaths. Communicable diseases in the top 10 include lower respiratory tract diseases like bronchitis and pneumonia, diarrhea, TB and diseases occurring to prematurely born babies. Road injuries are the tenth most prevalent cause of death. Together, these 10 make up 60 per cent of the 10.3 million deaths in India every year. The top 10 causes of deaths in India have remained the same since 2004-06, with a slight change in order.

As such, one can draw the conclusion that India at present faces a combination of communicable diseases and non-communicable, with the burden of chronic diseases has exceeded that of communicable diseases. Projections nevertheless indicate that communicable diseases will still occupy a critically important position up to 2020.

India's position in the middle of the transition from a poor, healthcare-deficient country to an advanced country is brought out starkly when compared with examples from other countries. In Niger, one of the poorest countries in the world, with a per capita gross domestic product less than one-fifth of India's, eight of the top ten causes of death are communicable diseases. At the other extreme, Norway, with per capita gross domestic product over ten times that of India, has just one communicable disease — lower respiratory tract infections — among its top ten, with the other nine being non-communicable diseases.

China, which started off from conditions similar to India, has moved much further towards the advanced end of the transition. It too has only one infectious disease among its top ten causes of death.

These are disturbing statistics. India needs to dramatically improve the quality of life for its citizens in terms of cleaner environment; better citizen amenities and preventive healthcare measures to improve the health of people; and to bring under control the seasonal diseases like Chikungunya and Dengue, the dreaded vector-borne diseases, quickly and effectively. The prologue resultant debility is seriously affecting the productivity of the sufferers and thus, economics of their families and organizations. People of this country should not be made suffer every year when preventive measures are already known.

In addition to better sanitation and sports, yoga needs to be promoted as a non-sectarian wellness initiative to control communicable and non-communicable diseases. On the occasion of the second International Yoga Day, Prime Minister Narendra Modi has done well to highlight the non-sectarian character of yoga. Emphasizing that yoga was not religious in nature; he asserted that the traditional practice was even meant for atheists. Moreover, he described yoga as an instrument that provided health assurance with zero spending. A mass movement that promotes yoga can be one way of following the dictum that prevention of ill health is better than cure. Further, the Government of India must rethink about reintroducing The National Cadet Corps in all the   schools and colleges on the voluntary basis. 

Most of the challenges facing India’s health system can be attributed to under investment and the inefficient use of resources, as argued by Dr. Prabhat Jha of the Centre for Global Health Research, University of Toronto.   Further, the promise of universal health coverage will remain unfulfilled unless health is prioritized, as noted by Dr.  K. Srinath Reddy, President of the Public Health Foundation of India.  In addition, an inadequate number of doctors and a poor network of public hospitals, coupled with bureaucratic bungling, means India often struggles to spend even its allocated budgets. 

Asia's third-largest economy spends around 1 per cent of its gross domestic product (GDP) on public health, compared with 3 per cent in China and 8.3 per cent in the United States. (Indian states manage their health budgets separately.) As a result, the per capita spending rates are extremely low at US $ 109 (in Purchase Power Parity terms) as compared to the USA ($7,285) and Brazil ($837). The global figure is US$ 863 (WHO World Health Statistics 2010). As such, there is an urgent need to increase the budgetary allocation for health.

There is an urgent need to develop an effective healthcare delivery system, which addresses both communicable and non-communicable healthcare needs. For this, India needs to adopt an integrated national healthcare system built around a strong public-primary care system with a clearly articulated supportive role for the private and indigenous sectors. [3]

The draft National Health Policy 2015, which provides a broad roadmap for health system reforms, calls for strengthening primary care services to provide comprehensive care for several health conditions including non-communicable diseases.  Further, continuity of care would be ensured through linkages with secondary and tertiary care facilities. Both public and private sector providers would be engaged to deliver the service package, which would be paid for by the government-funded health insurance schemes, as noted by the draft NHP. 

In addition, there is an urgent need to enhance the standard of medical education/training in India. Medical education and its subsequent impact on medical care has been adversely affected by Medical Council of India (MCI), which regulates medical education and licenses doctors, MCI’s emphasis on infrastructure in colleges and not quality of students. Niti Aayog’s (formerly Planning Commission) draft legislation wants to replace the current system with a common entrance exam as well as a common exit test to make sure doctors meet minimum standards prior to practice. It is important to end the vested interest medical colleges have in churning out substandard doctors.

Furthermore, for India to be healthy, we have to focus on the nutrition.

The next post discusses the state of nutrition.

[1] Refer at:

[2] Refer WHO at: 

[3] Refer author’s article: India needs efficient healthcare system for overall development at: