Thursday, January 3, 2019

Health should be one of the topmost priorities for the government

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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