Dr. Devendra
Kothari
Population and
Development Analyst
Forum for
Population Action
Wishing you a Happy
New Year
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.
