Neglect of public health leaves millions of Indians vulnerable to non-communicable diseases

The recent release of National Health Profile (NHP) 2019 is once again a dismal reminder of India’s neglect of public health even by the standards of other neighbourhood and low-middle income countries. Its public health expenditure, at just 1.28 per cent of GDP, is way below that of Maldives, Thailand, Bhutan, Sri Lanka and Indonesia. The NHP has chosen to overlook a globally accepted indicator of health access — direct out-of-pocket expenditure (OOPE). The OOPE accounts for 62.5 per cent of total health expenditure in India. In France, the government’s share is 78.2 per cent while in China, it is above 56 per cent. Such expenditure pushes a staggering eight crore Indians below the poverty line every year.

To bridge the public funding gap, governments past and present have opted for an insurance-based model of financing. While Ayushman Bharat and its State-level equivalents such as Arogyashree have helped reduce OOP, it would be a mistake to assume, as the NITI Aayog has done in an earlier policy paper advocating a PPP approach to healthcare, that publicly funded health infrastructure is not crucial. In health, it is State-run models that have worked, from Scandinavian countries and Sri Lanka, to Costa Rica and Cuba. Even if India’s healthcare systems cannot be fully run by the government, there is certainly a great scope for expanding the State’s footprint — not just in healthcare infrastructure, but also in medical education, the root cause of unaffordable private healthcare in India. In India, inclusive health is a contradiction in terms. The health infrastructure — divided into primary, secondary and tertiary, where primary care is State-managed and tertiary care privately controlled — is based on an outmoded notion of morbidity. For instance, non-communicable diseases such as diabetes, cardiac ailments and cancer are not elite, lifestyle disorders, but are increasingly claiming their victims among the poor as well; yet their treatment falls in the domain of expensive tertiary care. NCDs account for 63 per cent of all deaths in India, and their effects on the poor, underweight and malnourished, in the form of low weight diabetes, for instance, can be lethal. Recent Global Burden of Disease data shows that a rise in NCDs is related to inadequate intake of fruit and vegetables.

The effects of India’s poor emphasis on State-run healthcare are quite evident: even Bangladesh has done better. If Bangladesh’s per capita income is fast closing up with India’s, it is because it has focussed on the basics. India has pursued growth in isolation of developing its human capital.

COMMENT NOW