As the fiery headlines of million-dollar scams, political mud-slinging, terrorism, intolerance and sedition burn volumes of newsprint, the countless horrifying stories of innumerable deaths due to malnutrition, infant mortality, poor hygiene and communicable & non-communicable diseases get buried under the ashes and fail to stir our gossip-and-violence-addict consciousness. We have still not acknowledged the fact that health related casualties outnumber those brought about by terrorism, accidents and catastrophes, at least in our country.
How healthy is India? How do we fare on public health indices? Are Indian kids, adults and mothers physically and mentally fit? We need to have a thorough check on our health, which is our priciest possession. We need to look closely at issues and challenges that have impeded India’s growth and threatened her well-being.
World Health Organization (WHO) defines Health as a state of complete physical, mental and social well being and not merely the absence of disease. It is determined not only by medicine and curative services alone. There are many other factors that lie outside medical sector. Public Health Management is art and science of dealing with all these determinants which calls for cohesive and coordinated efforts from many sectors and disciplines.
Our Constitution has rested the responsibility of public health with the state governments. It is one of the primary duties of all Indian states to raise the level of nutrition, improved health and standards of living of their people. Although India’s public health has seen major improvement post-1950 era, there has been a drastic demographic and environmental transition that has added a triple burden in form of communicable, non-communicable and emerging infectious diseases. Combating this extra burden necessitates an effective public health system. However in India, the growth of public health has been painfully slow due to inadequate public expenditure on health, very few public healthcare institutes and sub-standard health education. Of late, there have been some concrete efforts in form of National Rural health Mission (NRHM), improvement in healthcare infrastructure as per Indian Public Health Standards (IPHS) Guidelines and increase in number of public healthcare courses and institutions. Still, there are some basic factors that have risen above the danger threshold and invite our immediate attention.
According to a study, every third Indian is malnourished. Over 40% of our children get food that is just insufficient for optimum growth and physical development. Although the government has been raising food subsidies to combat this situation, the ever rising population poses constant challenges. A great number of malnutrition related illnesses still prevails in India that have created a situation which is none less than a medical emergency. The Rapid Survey on Children (RSoC), perform in 2013-2014 reveal
- 7% children to be stunted (low height for age)
- 4% children to be underweight (low weight for age)
- 15% children to be wasted (low weight for height)
Malnourished children are an easy prey to various illnesses which are potential killers. Hunger remains the No.1 killer in the world and in India. Aids, Cancer or any other disease only follow. How would you respond if you are told that over 7000 Indians (mostly children) die of hunger (read malnourishment) every day?
High Infant Mortality
Infant mortality rate is defined as the number of infants dying before reaching one year of age, per 1,000 live births in a given year. Indian figure at present is 38 which is marginally lower than previous years. Even today, India suffers from high neonatal and infant mortality. Despite improved healthcare in past three decades, casualties have risen due to early childhood diseases, inadequate newborn care and birth related complications. Consider this:
- More than 2 million children die every year from preventable infections
- About 1.72 million children die before reaching their first birthday
- Over 400,000 newborns die within the first 24 hours of their birth every year, the highest anywhere in the world.
- As per United Nations Department of Economic and Social Affairs (UN-DESA) data for 150 countries over 40 years, India was reckoned as the most dangerous place in the world to be a baby girl. An Indian girl in age 1-5 years is 75% more likely to die than an Indian boy. This is a case of worst gender differential in child mortality in the world.
- Studies alsoreveal health-related neglect that makes a sick girl wait for long before she is taken to the doctor as compared to a sick boy. Immunization rates in girls are also way too low as compared to those among boys.
Although mortality rate is declining, it is still way behind to meet the Millennium Development Goals.
Indian population dies more from infections than from heart diseases, diabetes and cancers. Every fifth new tuberculosis case is detected in Indian subcontinent according to the Deutsche Lepra-und-Tuberkulosehilfe (the German Leprosy and Tuberculosis Relief Association). Many regions in our country have presence of Japanese Encephalitis that has caused severe epidemics in recent years. India might be less affected by HIV epidemic than many countries, but still 3 million Indians live with this virus. The widespread misuse of broad-spectrum antibiotics in India has posed a great threat of most bacteria going resistant to them.
Our hospitals have super luxurious specialty facilities to manage cardiology, nephrology and pulmonary cases, but most of these healthcare centres lack the specialty of infectious diseases, which is probably much less profitable business avenue. Here are some more disturbing facts to ponder:
- 40% of Indian population carries a form of TB strain. We had the highest number of TB cases in 2014, followed by Indonesia and China. Cases of Extensively Drug Resistant and Multi Drug Resistant Tuberculosis (XDR TB and MDR TB) are on rise in India.
- Although prevalence of AIDS/HIV in India has declined over past few years, there are still 1.4 to 1.6 million people in our country who suffer from this deadly infection. India stands at No.3 globally, in terms of total number of HIV/AIDS patients.
- Viral hepatitis claims 2.50 lakh lives in India every year according to health experts.
- With Malaria still a major threat in India, we also lead the world in terms of dengue cases.
- About 250,000 people die of viral hepatitis in India every year.
- In 2010, India accounted for 47% of total deaths occurred due to measles globally.
- Diseases like Typhoid, Diarrhea, Hepatitis A, B and C and other infectious illnesses are creating havoc as most BPL population does not have access to proper treatment.
Non Communicable Diseases
A combination of genetic determinants and modified demographic factors has long since exposed Indian population to non communicable diseases like hypertension, diabetes and cardiovascular complications. According to a study in Tamil Nadu a few years back, every one out of ten Tamilians was a diabetic. Cardiovascular ailments are competing with infectious diseases as the biggest killer in India. In fact, among middle aged male population in India, the heart problems have become the leading cause of deaths. Some saddening facts are as under:
- Indian population is transiting swiftly towards lifestyle diseases as killers.
- While global rise in diabetes has been around 45% during 1990-2013, in India the ailment has galloped at whopping 123%. Diabetes has emerged as the new epidemic in our country.
- A study has revealed that nearly 6 lakh Indians die of Cancer every year, with 70% of these deaths coming to people in age group 30-69 years.
- A report suggests that by 2050, there shall be 12 million dementia patients in India. We are likely to be global No.2 on this scale behind only China.
Female Health Issues And Skewed Sex Ratio
In India maternal deaths have traditionally been very high. In rural India, the maternal death rates are among the highest in the world. The main factors behind maternal mortality include lack of access to skilled birth attendants and medical care. Our females also suffer from malnutrition before, during and after pregnancy. Iron and calcium deficiencies are rampant among rural women. Cancers – of breast and reproductive organs, are big killers in Indian females.
Another factor that blemishes our national health is our skewed sex ratio. As per latest figures, we have 944 females for every 1000 males. This ratio point towards some ugly facts that include female infanticide, unhealthy biases against girl children and disadvantageous status granted to grown up women in our social orders.
There are more households in India with a mobile phone than with a toilet. The data released by national Sample Survey Office (NSSO) in 2012, only 32% of rural Indian households have their own toilets. Of total billion people defecating in the open, more than half reside in India. Poor sanitation leads to malnutrition and low productivity among masses. Children exposed to poor sanitation are unable to absorb adequate nutrients resulting in stunted growth. The recently launched Swachch Bharat Abhiyaan aims to improve the sanitation and hygiene deficits in India. But it needs immense public support to gather momentum.
Inadequate Safe Drinking Water
Although access to drinkable water in India has increased manifold over last few years, it remains a fact that no major Indian city distributes clean, potable water more than a few hours. A rapid depletion of ground water in cities and contamination of rivers and wells in rural areas pose a threat of severe water crisis in near future. The quality of drinking water is also questionable. Millions suffer from water-borne diseases like diarrhea, Hepatitis A, enteric fever, intestinal worms and infections of eye and skin. Poor drainage systems in cities and towns also pose major problems during monsoons and become issues for public health departments.
In view of above sad facts, We Indians need to refresh our view towards our real problems. We should learn to see through the vested interests of power mongers who sit in governments, media and business houses, who only want us to believe in fake issues and fight for them. Remember, health is the greatest wealth – be it our own or of our motherland.