With October, another Swacch Bharat day goes by, and the status of the health of Indians has come under the scanner once again. India is not only one of the fastest growing economies in the world, it is also home to millions of people who battle with some of the worst health problems known to mankind- cancer, HIV, heart diseases, tuberculosis, malaria and malnutrition, among others. Topics that rank high on the Swacch Bharat Abhiyan agenda- open defecation and cleanliness- cause serious health crises, particularly among children.
The latest shocker is obviously the Global Hunger Index, which puts India at the 100th position in a list of 119 countries. Although it is not true that the ranking indicates decrease in India’s number of under-nourished people as the ranking has dropped about 45 places compared to 2013 (this is actually due to a change in calculation methods), the number is still much higher than the global average.
In September 2016, the UN General Assembly released its first global health index to analyse the progress countries had made towards achieving the health-related targets under Sustainable Development Goals (SDG) as laid down by the organisation. It examined and graded the performance of individual countries under various health parameters and awarded overall grades for each country. Out of 188 countries, India was ranked at 143, with a total score of 42 out of 100.
Health problems like malaria, child mortality and lack of safe hygienic practices contributed to India’s low ranking, which was worse than countries like Iraq, Syria and Palestine, which have been grappling with war or war-like conditions for several years. In fact, India’s saving graces were parameters like deaths due to war (although it scored poorly in the area of deaths due to violence), alcohol consumption and overweight people.
According to World Health Organisation statistics, heart diseases are the leading cause of death among adults in the country, while premature births killed the most number of children less than five years of age.
Serious health problems can be found extensively among children and women. Almost 48% of children younger than five years are stunted, which amounts to around 62 million children. Stunting, which can be moderate or severe according to the rate of reduction from ideal height of the child, is caused by undernourishment in the mother when she is pregnant and in the child during his/her first two years of life. It becomes irreversible after the child has become two years old. It leads to severe health problems in later stages of life, including obesity, diabetes and hypertension. In its worst form, stunting becomes ‘wasting’, which had affected 15.1% of children in the country in 2013-14. In addition, neonatal and infant mortality rates remain high.
Severe malnourishment, anaemia, breast cancer, mental health problems and domestic violence, among other problems, haunt the women of this country. Deep-rooted gender bias has led to widespread discrimination against women of all ages and categories. Even before she is born, a girl child in India is at the risk of dying. Infanticide, foeticide, discrimination in provision of nourishment, early marriages and pregnancy, poor nourishment during pregnancy, poor maternal care, abuse- the list of potential threats to the wellbeing of women is endless.
Public health crises arising from pollution, unclean water and food and poor sanitation practices loom large. Some of Indian cities, including the capital, have the poorest air quality in the world and have severe noise pollution issues. Unregulated industries, corporate plunder, unscientific agricultural practices and urbanisation have eroded the quality of water and soil.
As a tropical country, it is true that communicable diseases like malaria, dengue, leprosy and cholera can easily spread here. However, statistics point out that non-communicable diseases cause more deaths (61.8%) in India than communicable diseases(27.49%). The rest are caused by natural causes. Moreover, many of our neighbouring countries have performed better than us in dealing with these problems. This shows that the health problems that we face are intrinsically linked to the way we live, and not just to our environment.
To combat these problems, the government has announced many health-related schemes over the years, including the National Health Mission, Janani Suraksha Yojana, Navajat Shishu Suraksha Karyakram and Home Based New Born Care, besides National Strategic Programme for TB Control, National Leprosy Eradication Programme and National Mental Health Programme. One of our biggest success stories in the health sector has been the eradication of polio. For a country which used to lead the world in the number of polio cases reported as late as 2009, this feat has been remarkable. It shows what we are capable of if our government and health bodies put their mind to it. The same is true of small pox and malaria, both of which we have been able to eradicate or reduce significantly.
However, we still have too much left to do. To begin with, the country does not have the infrastructure or manpower required to promote healthy habits or deal with the existing health problems among all its citizens. India spends much less on health than many developed and developing countries, although the government has hiked spending on health in the 2017 budget. However, in India, increased allocation does not always translate to change on ground. The stakeholders have to wake up and work for change.
The indifference of the government bodies is one of the biggest obstacles standing in the way of a health revolution. This year in Gorakhpur in Uttar Pradesh, more than 60 children admitted at a government hospital died a painful death due to the lack of something as basic as oxygen cylinders. The state government, instead of admitting its mistake and taking measures to avoid future catastrophes, resorted to playing the blame game and pointed fingers against the hospital staff and the families. Gorakhpur has been the constituency of the chief minister himself for the last 20 years.
Corrupt practices abound in government medical centres, where doctors are forced to work ungodly hours for a pittance. Medical negligence has caused too many deaths in this country.
While the public healthcare system is largely in shambles, high costs prevent a large section of the population from accessing private healthcare. Ironically, the excellent quality of our doctors and private hospitals attract patients from all over the world, while a majority of our countrymen lead a life of misery due to treatable diseases. The government needs to work hard to make this army of well-qualified medical professionals available to the common man of India, besides striving to improve the quality of healthcare provided in its own centres. For this, it has to spend more, spend wisely and strike deeply at the roots of the problem.