Need to spend more

A degraded environment infested with air and water pollution continues to affect the health of people in India, according to the National Health Report (NHP) released on October 31, 2019.

Air pollution-linked acute respiratory infections contributed 68.47 per cent to the morbidity burden in the country and also to the highest mortality rate after pneumonia.

Acute diarrhoeal diseases, caused due to drinking contaminated water, added to the second-highest morbidity at 21.83 per cent.

Cholera cases went up to 651 in 2018 from 508 in 2017, the report showed. Uttar Pradesh followed by Delhi and West Bengal had the highest cases. Cases of typhoid went up to 23,08,537 in 2018 from 22,64,453 in 2017. The data for 2018 is provisional.

Even vector-borne diseases or zoonotic disease showed a high morbidity and mortality rate in the country.

While there has been a decrease in both mortality and morbidity due to malaria in the country, Chattisgarh reported 77,140 cases and 26 deaths and had the maximum number of cases and deaths due to malaria. Bihar suffered the most from Kala-azar with 3,423 cases.

Dengue outbreaks have increased, while Chikungunya has gone down to 57,813 in 2018 from 67,769 in 2017. Karnataka had as many as 20,411 suspected cases in 2018.

Contagious but vaccine-preventable diseases like diphtheria also showed an increase to 11,720 in 2018 from 5,421 in 2017. Assam reported the highest number of cases in both 2017 and 2018. Cases of measles also spiked to 20,895 in 2018 from 18,618 in 2017, the report noted.

The 14th National Health Profile 2019, released by Harsh Vardhan, Union minister of health and family welfare, has been prepared by the Central Bureau of Health Intelligence. It provides information on demographics, socio-economic health status, health finance indicators, health infrastructure and health of human resources in the country.

"Data helps us to navigate health needs and issues, and helps devise area-specific programme strategies," Vardhan said, in a press statement.

Despite the increasing burden of diseases in the country, the budgetary allowance for controlling diseases has been steadily dipping in the last few years.

India spends only 1.28 per cent of its gross domestic product (according to 2017-18 budget estimates) as public expenditure on health.

For example, for schemes that strengthen the Inter-Sectoral coordination for Prevention and Control of Zoonotic Diseases programme, Rs 0.75 crore was allotted (approved outlay) in 2016-17. But, this was reduced to Rs 0.33 crore in the budget of 2017-18 and 2018-19.

The impact of a budget-cut was particularly seen in the case of Kala-azar, which should have been eliminated from the country by 2017.

Of the 633 endemic blocks, 559 blocks have achieved the elimination target but 74 remaining blocks could not achieve elimination target, which is having less than one case of Kala-azar per 10,000 population, said Ashwini Kumar Choubey, minister of state (health and family welfare), in a reply to a Lok Sabha question in March 2018.

Further, the NHP report pointed out that per capita public expenditure on health has gone up to Rs 1,657 in 2017-18 from Rs 621 in 2009-10. While states are bearing 63 per cent of this expenditure, out of pocket expenditure by the patients are not included in this estimate — known to be the biggest reason behind increasing debt in the population, according to the report.

While the Indian Council of Medical Research in 2017 stated that communicable diseases are the biggest reason for poor health in India, data on these are limited compared to those from the non-communicable diseases (NCD).

This data shows that out of 6,51,94,599 patients who attended NCD clinics, 4.75 per cent people suffered from diabetes, 6.19 per cent were diagnosed with hypertension, 0.30 per cent had cardiovascular diseases, 0.10 per cent

were diagnosed with stroke and 0.26 per cent had common cancers. These diseases too are linked to poor environment and lifestyle.

Vibha Varshney is Associate Editor, Down To Earth. She is a biologist by training and holds a PhD in Botany. Views expressed are strictly personal