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Illustration: Jayachandran/Mint
Illustration: Jayachandran/Mint

Diagnosing India’s growing health problem

The reasons for India's poor health are both resource-related and systemic

The Indian health story has trended upwards going by the standard indicators of health. Besides significantly increasing the longevity of its citizens and keeping a check on its population, since independence, India has managed to rid itself of some major illnesses—small pox in 1975, polio in 2014, and maternal and neonatal tetanus in 2015. However, with respect to meeting its potential health outcomes and relative performance, the country has faltered.

The World Health Report of 2016 recently released by the World Health Organization (WHO) shows that despite being placed roughly in the middle of the South-East Asian Region (SEAR)—one of the worst performing regions in health after Africa—in terms of gross national income per capita, India figures in the bottom slots for most health-related parameters within the group. For instance, among SEAR nations, it ranks the worst in the relative inequality score—the ratio of mean coverage among the poorest populations to national average—for reproductive, maternal, newborn and child health intervention. Child stunting, non-communicable diseases and mortality due to air pollution are other areas where the country fares poorly.

The reasons for this state of affairs are both resource-related and systemic. Tackling the former requires, of course, an increase in the centre’s current health spending of 1% to at least 2.5% of the gross domestic product as recommended by the National Health Policy of 2015. However, it isn’t simply a matter of the centre throwing more money at the problem. A look at the systemic issues will show that the current situation could be improved even with the available resource allocations.

First, India’s health services and health personnel, besides being grossly inadequate, are inequitably distributed across and within states. Rural-urban inequalities inevitably translate into differences in health outputs. For example, there is a 63% difference in infant mortality rates and 44% difference in total fertility rates of rural and urban areas in India.

Second, despite the considerable shift in the disease burden of India from communicable to non-communicable diseases, policy plans and funding have not altered in tandem with this paradigm shift. A growing urban population of overweight and obese citizens co-existing with those suffering nutrient deficiency; diseases like diabetes which have a cascading effect on cardiovascular diseases; climate change-triggered bronchial disorders and mental disorders, have now become areas of increasing concern.

As far as the latter goes, a recently released Lancet report on adolescent health cites suicide as the leading cause of death among youngsters aged 10-24 in the country. This is alarming since around 30% of India’s population falls within this group and India accounts for 15% of the global mental, neurological and substance use disorders in the world. The stigma associated with these issues coupled with a severe shortage of medical professionals in the field leads to sub-optimal health outcomes.

Third, the quality of our healthcare is in serious jeopardy due to a lack of regulation as well as well-trained medical professionals. The National Eligibility cum Entrance Test controversy shows that policymakers after due consultation with states, must seriously reconsider improving the field of medicine and health sciences. There is also an urgent need to upgrade the curriculum in keeping with the changing disease spectrum and technological advances.

The nature, scope and incidence of these problems naturally vary widely across the country depending on economic conditions and development indicators. Eighty per cent of the 1% of GDP health allocation is raised and spent by states. In keeping with the Narendra Modi administration’s shift towards greater fiscal devolution, there must be a dialogue about how health-spending programmes can give state governments the greatest possible control in fine-tuning their approach, based on local needs.

The biggest reason for the slow improvement in health parameters in the country, however, is the huge out-of-pocket (OOP) health expenditure incurred by Indian households. Private expenditure on health also includes insurance, donations and direct service payments by corporations. In India, 85.9% of private expenditure on health is OOP. The Rashtriya Swasthya Bima Yojana, 2014, aims to redress this by expanding the health insurance cover—currently, only 17% of the total population—but its effectiveness remains to be seen.

India’s demographic dividend is expected to last for another 25 years. But if the youth are restrained from achieving their potential due to illnesses, old and new, the dividend will remain theoretical. The Indian health story needs a rewrite. A bigger budget that irons out creases such as regional inequalities and accounts for a shifting disease spectrum might be a good storyline to begin with.

In what other ways can India improve the health of its citizens? Tell us at views@livemint.com

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