Heeding the clarion call

The current pandemic has revealed major gaps in India’s healthcare system — requiring dedicated effort to shore up shortfalls in the healthcare budget

Amidst the ongoing crisis, the debate has already begun over the strategies for post-COVID-19 economic growth. The discussion is centred around how to restart the industry and other work which have been on standstill since the lockdown. One opinion is to carry forward the same old corporate-driven development model which talks only of wealth generation but ignores the needs of the vast majority of our people and breeds inequality while catering to the interests of a few. It is this model which is responsible for the degradation of the environment and climate change. There is another opinion which quotes Gandhiji and his ideas of rural-based development model. Another viewpoint is scientifically-based inclusive growth. What will ultimately happen, only time will tell? But one thing most essential is that we need growth which cares for the needs of all sections of the people and puts the human factor as primary.

Development, progress and economic growth of a society and country are proportional to the participation of the workforce in these activities. Only a disease-free healthy person can contribute effectively in this process and disease scenario in our country is very dismal. India accounts for a relatively large share of the world's disease burden. The National Sample Survey Office's (NSSO) 71st round report on 'Health in India', has brought out certain facts which need serious consideration.

About 9 per cent of the rural population and 12 per cent of the urban population reported ailment during a 15 day reference period. Proportion (number per 1000) of ailing persons (PAP) was highest for the age group of 60 and above (276 in rural, 362 in urban) followed by that among children (103 in rural, 114 in urban). About 4.4 per cent of the urban population was hospitalised (excluding childbirth) at any time during a reference period of 365 days. The proportion of persons hospitalised in the rural areas was lower (3.5 per cent). When such a large number is unwell at any time of the year, their participation in the nation's building is bound to be affected.

The COVID-19 crisis has brought to the fore, shortcomings of our system to meet the challenge of the health crisis. It appears the lockdown has worked only for about 20 per cent population who own their house, have sufficient income to feed themselves for a few months and have education level to understand the importance of steps for prevention. But for a majority of the population, it has been a cause of misery. They do not have sufficient income to feed themselves even for a few days if they do not work. Physical distancing is not possible as many live in the shanty areas with 7-8 persons sharing a 8 x 8 feet room. Nor do they have android mobile phones to download apps to understand the intricacies of the preventive measures from COVID-19. Availability of healthcare for routine illnesses in this crisis situation is a dream for them as OPD care in several state-run hospitals is closed and they are unable to afford expenditure in private setups.

India is always in an emergency situation for health. Tuberculosis is the cause of death for about 1,400 persons per day in our country. Over 900 people in India die due to Respiratory Tract Infection (RTI) every day. Despite a decline, the current infant mortality rate for India in 2019 stands at 29.848 deaths per 1,000 live births.

A study by Lancet, one of the most credible medical journals, points out the death of hundreds in India due to poor nutrition. The study estimates that one in five deaths globally are due to poor dietary intake. This contributes to a range of chronic diseases in people around the world.

The World Bank estimates that 21 per cent of communicable diseases in India are linked to unsafe water and the lack of hygiene practices. Further, more than 500 children under the age of five die each day from diarrhoea in India alone.

The Lancet had formed a 37 member EAT-Lancet Commission for the purpose including Dr K Srinath Reddy, a renowned Cardiologist and President of Public Health Foundation of India and Sunita Narayan, Director General, Centre for Science and Environment and the Editor of 'Down to Earth'. It had recommended for a healthy adult, an average daily intake of 232 grams of whole grain (rice, wheat, corn etc.), 50 grams of starchy vegetables (potatoes and cassava), 300 grams of all other vegetables, 200 grams of fruits, 250 grams of dairy foods (milk or equivalents), about 200 grams of protein sources from non-vegetarian food, about 50 grams of added fats (unsaturated oils and saturated oils) and 30 grams of added sugar to meet the requirement of our balanced diet.

The average approximate cost of this diet at the present market price was found to be around Rs 130 per person per day. For a family of 5 members, this comes out to be Rs 650 per day or Rs 19,500 per month. This is impossible to be met within the present-day socio-economic structure of our country particularly in the present day context when many people have lost their jobs and in the absence of provision of a nutritional diet to such persons by the state, several of them are at the mercy of others to get food/ration.

Under the present circumstances when a large percentage of the population is away from their families as a result of the lockdown, their mental health is at great risk. Lack of food, distance from kith and kin, the uncertainty of their future and walking hundreds of kilometres on foot to reach their native place is a grave issue. Unfortunately, this does not come under any discussion in our country, while it can have a far-reaching impact on people's health in the times to come.

Therefore, steps need to be taken and strategy evolved to meet the nutritional needs of our population as a whole, provide clean drinking water and sanitation facilities to all the population, ensure healthy housing for all the people including the workers at their workplaces as well as in their native places while also strengthening the state healthcare system to provide adequate healthcare facilities to low-income groups. There is also a need to have hospital care for already prevalent diseases in emergency situations as is the case today. It is however commendable in the present crises that the state sector, despite the extremely poor infrastructure, is doing a yeoman's job right by giving medical aid in the healthcare facilities and public education through field workers.

Unfortunately, our public health spending is very poor, hovering around 1.02 per cent of the GDP. This must be increased minimum to 6 per cent. Growth with mere wealth generation producing inequities will not meet the above needs. There is need for urgent policy evaluation to develop growth strategies centred around health. Otherwise, the times to come will be very hard for working people with low wages.

Views expressed are strictly personal

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