India’s Growing Disease Burden… Will Healthcare Budget Suffice?

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The global health emergency that jolted the world from its slumber made us realize the value and importance of health, probably the only positive outcome of the pandemic. Baring few nations, others struggled hard to cope with their crumbling health infrastructure. In India too, Health sector which had long been overshadowed and ignored in both priority and fund’s in the race of development came under pressure and scrutiny. Our healthcare spending of GDP has been measly in the last seven decades of independence. The Modi government aims to increase the public health spending to 2.5% of GDP by 2025, which is way too low for a country of 1.3 billion. Whereas, countries with much smaller populations like US are spending 16.9% of GDP (2018), Switzerland 12.2% (2018), France and Germany spending11.2% respectively.

The disease situation in India has been in a consistent state of deterioration with little improvement over the decades. The ailing health of our population has hardly ever been a priority with state authorities or a cause of concern for health experts. Till the time pandemic decided to hit us -Health ministers were neither heard nor seemed worried for the persistent health issues gripping our people and eroding the human capital of our country.

Even though the Healthcare allocation in the budget has surged by 137% from Rs 94,452 crore to 223,846 crores in 2021 (Economic Times), But is this budget enough for a perpetually ailing population marred by burden of disease. What needs to be understood is that mere pumping of money in the under resourced and up till now ignored sector will only marginally help at a superficial level in regaining the lost health of our population. We have been quick to applaud ourselves over the unearned victory in tackling the COVID-19 crisis and conveniently ignoring the real pandemic looming large.

India ranked 94th on the Global Hunger Index (2020) among 107 countries. The score based on four indicators of undernourishment, child wasting, child stunting and child mortality makes it all the more crucial to recognize the grim reality. The ‘Serious Category’ tag exposes the irreparable damage being done to our young population.  As per the National Health Survey (2015-16) conducted by Ministry of Health and Family Welfare-35.7% children under 5 years of age are under weight, 38.4% are stunted and 21% are wasted. What is even more alarming is the prevalence of hunger in our country over the decades, with 8,82000 reported malnutrition deaths in 2018, of children below 5 years of age as reported by UNICEF. Though, these staggering figures are slowly declining but they still continue to impact the lives of our young population. Malnutrition impairs cognitive ability and reduces work performance in school. The burden of the disease in childhood also leads to detrimental effects that persist throughout the course of life. Surprisingly, India is not only a self sufficient but a surplus food grain country, the hunger pangs of the deprived population failing to find a voice.

Rabies, a completely preventable disease has shown no obvious decline for almost a decade, the reported incidents are probably only an understatement of actual incidence of the disease, since Rabies is still not a notified disease in our country. According to World Health Organisation (WHO) Bulletin released in 2014, the annual reported deaths due to the disease were as high as 18,000 to 20,000 and India accounts for 36% of the total deaths across the world.

Most of the infected people are from lower socio-economic background. Thus, these depressing statistics fail to find any mention in government Health Schemes or awareness programs.

Communicable disease remains a major threat for crippling India’s population, with Tuberculosis (TB) being the biggest challenge. The elimination of TB by 2025 as proclaimed by the National TB Elimination Program seems unrealistic with its extremely high prevalence across the country. WHO has categorized India as a ‘High Burden’ country as it accounts for 27% of total worldwide deaths. The absolute figures for total infected and notified cases is even more shocking with a total 24 lakh positive cases and 79,000 reported deaths in 2019, TB being a bigger killer than covid.

Moreover, most of the TB cases in India are also drug resistant posing major hurdles to its elimination. Worse, the TB infected population shows higher incidence of also being HIV positive making it a lethal combination.

The HIV positive status of our country is even more disconcerting as we are home to second largest population living with HIV infection in the world. In 2019, 23.49 lakh people were suffering from AIDS and 69,000 had died due to the unforgiving illness(Ministry of Health and Welfare). The extent of prevalence of the disease is equivalent to any scary epidemic.

The burden of Malaria has also not eased much in the last several years, with consistent break outs every year. India accounts for a whopping 77% of total Malaria cases in South Asia. There are glaring discrepancies in the reported cases and recorded deaths as far as statistics provided by Indian authorities and data reported by World Health Organisation is concerned. The estimated figures for the disease as reported by WHO in 2019 were as high as 6,737,000 confirmed cases and 9620 recorded deaths. The impact for Malaria is more profound in case of pregnant women causing severe anemia, abortions, still birth, and maternal mortality. Unfortunately, data for these lost lives does not find any reference.

According to a report released by the United Nations Development Programme (UNDP) for 2020, India ranked 131 on Human Development Index among 189 countries. Health being one of the prime parameter’s in measuring Human Development Index. The life expectancy of Indian’s at birth is worse (69.7 years) than even developing countries like Bangladesh (72.6 years). This clearly substantiates the growing disease burden in India, making it pertinent to recognize several factors that accelerate the spread of diseases. The link between poverty and disease is obvious and indisputable. Hence, lack of clean drinking water, poor sanitation conditions, absence of adequate food, rising pollution levels are major risk factors, with air pollution being the biggest contributor in rampant spread of Pneumonia and other respiratory illnesses.

The prevalence of disease dampens and depresses human development and is detrimental to its progress. It is common knowledge that poor countries tend to be unhealthy and diseased nations tend to be poor. Human capital itself is a prime resource for economic development as ill health and disease reduce lifetime incomes.  Human-resource being the driving force behind nation building, makes investment in Health sector imperative and crucial.

The threat posed by disease burden in our country needs to be understood and addressed at the micro level by revisiting the numerous health schemes started by the government. There is an urgent need to make healthcare affordable and available for the poor and deprived population. Awareness drives need to broaden their spectrum. COVID-19 pandemic with less than 2 lakh deaths should not become the only top priority in allocation of funds. Therefore, to raise the health status of our population healthcare policies, need to be all inclusive and comprehensive, rather being inclined to a particular population group or a particular disease. Health of a nation should be a collective responsibility carried out in a cooperative manner towards a common goal.

Dr Harleen  Shergill PhD in Economics Freelance author and Researcher.



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