On New Year’s Day, the Prime Minister gave an interview
to ANI, wherein he touched upon various matters of interest to the country.
But, a subject that was glaringly missing in his 90 minute conversation was
that of Health.
The questions dealt more with current political issues,
which will invariably crop up in the coming parliamentary election and the
answers seemed to be aimed at reassuring the electorate.
The Prime Minister talked about political violence and
also strongly condemned it.
It would have been indeed heartening to further know his
views also on violence against doctors and how his government plans to tackle
the escalating incidents of violence against doctors across the country.
He also spoke about “economic health” but not “health”,
despite several prevailing health issues in the country.
Pollution has become a major public health problem and
there seems to be no respite from it. Evidence has documented an association
between air pollution and many acute health events such as heart attack,
stroke, acute asthma and chronic diseases such as cancer, heart disease, lung
diseases (asthma, COPD). But neither harm prevention nor harm reduction due to
pollution was addressed by the PM.
There is a wide gap in the availability of healthcare
service in the country. On one hand, India is fast becoming the hub of medial
tourism, but in a sharp contrast, healthcare including essential healthcare is
still out of reach for many people.
India is far from attaining universal health coverage,
which is affordable, accessible, available, appropriate and accountable. This
is because the public expenditure on health is very less.
Currently, India spends just 1% of its gross domestic
product (GDP) on health. Without spending at least 5-6% of the GDP on health,
the basic healthcare needs of the population cannot be fulfilled. Although the
National Health Policy 2017 has provided for increasing public expenditure on
health to 2.5% of GDP from the current ~1% by 2025, it is still very inadequate
to provide universal healthcare.
The budgetary allocation of Rs 52,800 crore for health in
2018/19 was merely 5% higher than the revised estimate of Rs 50,079.6 crore, in
2017/18 (Business Today, Feb 19, 2018).
Also, very few people in the country have health
insurance coverage. At more than 60%, India has one of the highest
out of expenditures on health globally. Poverty arising out of exorbitant
health expenses further contributes to the widening inequity in health
services. Ayushman Bharat scheme was launched last year as an answer to reduce
this gap. We hope that it will be implemented across the country.
India faces a twin burden of diseases: Communicable
diseases (endemic + emerging and re-emerging) and non-communicable diseases
(NCDs). Diseases that are endemic in the country rear up every year.
The Gorakhpur tragedy last year, where several children
lost their lives due to acute encephalitis syndrome (AES) had stirred a debate
in the country. But this was not the first AES outbreak in this area. Many such
outbreaks have been occurring for several years now and each epidemic has taken
a heavy toll of lives.
Similarly, flaring up of Dengue and Chikungunya is an
annual feature now. Last year, outbreaks of Nipah virus and Zika virus – both
emerging infectious diseases - were reported from Kerala and Rajasthan,
respectively. They are now here to stay.
The huge population in the country, lack of education and
awareness as well as global travel leave us vulnerable to many such outbreaks.
We need to be in a state of constant alert and preparedness to prevent an
epidemic in advance instead of responding once an epidemic has occurred. We
need to find answers to such continuing epidemics.
Doctors should have been involved in the efforts to
address the health issues; but, their autonomy has been dissolved.
Doctors across the country see more than 2 crores of
patients every day. Hence, they represent the collective consciousness of
people, so they should be part of the solutions for the prevailing health
problems and concerns in the country.
India continues to bear the highest burden of
tuberculosis (TB) cases globally, including MDR-TB. Many of India’s citizens
continue to grapple with lack of adequate sanitation and safe drinking water.
The Prime Minister spoke about Ayushman Bharat as his
“biggest achievement”. But, aside from this it was disheartening to note that
health appears to be a low priority issue for the government as well as ANI.
If in a 90-minute interview, health could not be a part
of the agenda, it’s a sorry state of affairs. Apparently, health will not
feature in the manifesto of the upcoming elections.
If India aspires to be a global superpower and become one
of the largest economies in the world, health of her citizens needs to be
improved. Healthy citizens can contribute much more to the growth of a nation.
We hope the Prime Minister will take up these issues in
his next “Mann ki Baat” and allay these concerns.
Dr KK Aggarwal
Padma
Shri Awardee
President Elect Confederation of Medical Associations in Asia and
Oceania (CMAAO)
Group
Editor-in-Chief IJCP Publications
President
Heart Care Foundation of India
Past National President IMA
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