The future of health in India

September 21, 2015

(Any opinions expressed here are those of the author and not of Thomson Reuters)

Is India a healthy nation? It is an uncomfortable question, particularly so when it is directed at a nation known for its back-breaking burden of diseases. The question might even be dismissed as an irrelevant one, but that would be a mistake. The issue it raises is very real, but the search to answer that question leads us to the revelation that India is ready to develop an acceptable answer regarding population health.

So perhaps we should rephrase the question: Is India making a determined bid to tear down restrictive, conventional barriers and emerge as a healthier nation? The answer to that question is an unequivocal “yes”.

What should be the focal point of India’s future health strategy? As a starting point, it is absolutely imperative to address a health issue that has been escalating for some time and cannot be ignored any longer. India, along with most other nations on the planet, has fallen victim to a modern-day health threat – non-communicable diseases (NCDs). These are an array of debilitating and deadly afflictions – cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, to name a few – that could cost the world $47 trillion in lost economic output from 2010 to 2030 if urgent action is not taken to prevent and treat them, say experts.

And India’s condition is particularly serious. NCDs are estimated to account for a disturbing 60 percent of all deaths in India, making them the leading cause of mortality ahead of injuries and communicable diseases as well as maternal, prenatal, and nutritional conditions. Furthermore, NCDs account for about 40 percent of all hospital stays and roughly 35 percent of all recorded outpatient visits.

NCDs not only affect health, but also productivity and economic growth. The probability of dying during the most productive years (ages 30-70) of one’s life from one of the four main NCDs is a staggering 26 percent. Moreover, an ageing India whose population is growing more susceptible to NCDs is likely to find the burden even heavier and more destructive than is the case with other nations.

The situation, however, doesn’t have to be as bleak as it looks right now. NCDs are preventable.

Overconsumption of salt, sugar and trans fats combined with lack of physical activity are contributing factors to many NCDs. Increased production of processed food, rapid urbanization and changing lifestyles have led to a shift in dietary patterns. People are consuming foods high in energy, saturated fats, trans fats, free sugars or salt/sodium, while not eating enough fruit, vegetables and dietary fibre such as whole grains. There is sufficient global evidence suggesting reducing salt, sugar and trans fat in the diet can prevent major NCDs and lower disability and mortality rates.

Options exist for actions that policy makers can take today. Businesses may contribute as well through workplace health programmes aimed at prevention, early detection, treatment, and care. Are we prepared to take up this challenge? This is an important question, given India’s healthcare track record.

The clear warnings regarding population health that are resonating across the country have not been able to shake off the indifference of the policymakers vis-a-vis NCDs. They remain heavily focused on communicable diseases and classic “diseases of poverty”, paying scant attention to these emerging health threats, even the most virulent ones. So while NCDs now constitute the bulk of the country’s disease burden, national health programmes to tackle and treat these are very limited in coverage and scope.

India needs a smartly planned, adequately financed and efficiently administered public healthcare system, one that earmarks a major portion of the annual healthcare budget towards addressing NCDs. This will mobilise adequate funds for the delivery of public health interventions, medical services, and counseling of patients.

This system should also explore public and private collaboration to develop innovative financing models, including both public and private insurance that can reduce individuals’ out-of-pocket expenses.

It is imperative to increase spending on preventive care and encourage individual interventions including regular health check-ups, curbing tobacco and harmful alcohol use, reduction of salt/sugar intake and promoting physical activity. All this will limit disease progression and the need to spend significant resources on expensive treatments. Efficient health teams, including nurses and paramedical professionals, also play a critical role here and would respond to the needs of patients with chronic diseases. Investment should, therefore, be made in training of paramedical staff and physicians to detect early signs of illnesses.

Based on latest reports, we are seeing promise for positive change on this subject. The National Democratic Alliance (NDA) government, as of this writing, plans to increase public investment in health from 1 percent of GDP (gross domestic product) to 2.5 percent by 2020, with 70 percent of this being dedicated to primary healthcare.

In other words, under this new national health policy document that is being drafted, the government will ensure that it spends an average 3,800 rupees per capita annually on health as compared to less than 1,000 rupees being spent at the moment at current prices.

This latest draft health policy may not be fully what the doctors and the medical community ordered, or hoped for. Not by far. But it has managed to reach closer to the target than ever before and demonstrates considerable progress. One can hope that these decisions are an indicator that the government is listening to our concerns about India’s greatest health challenge.

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