Data from the health ministry shows that nearly half the people who have died of Covid in India had previously existing health conditions, diabetes and hypertension being among the top few. The pandemic not only highlighted the country's dire need for more healthcare workers and better public health infrastructure but also showed how the prevalence rate of lifestyle diseases is a growing cause for concern.
While several critical diseases such as polio, measles, TB, HIV and now Covid-19 have seen concentrated efforts to combat them, diabetes and heart disease aren't even listed in the top 10 major diseases of the country. Yet, India is the diabetes capital of the world (69.9 million cases by 2025), with the number of cases doubling in the past 30 years as for heart diseases. These 'lifestyle' diseases are of even more concern as they are spreading at a fast pace amongst the young in both urban and rural settings. Cardiovascular diseases and diabetes are also estimated to have an economic cost for the country-$6.2 trillion by 2030-as they reduce the productivity of patients and add to the growing cost of healthcare. "Covid showed us how vulnerable poor health can make us. Urbanisation has led to a more sedentary lifestyle and poor eating habits. What we need is more awareness on long-term health and immunity. There is no quick-fix pill for good health," says Dr V.K. Bahl, head of cardiology at Max Healthcare.
Health experts are also worried about the growing rate of out-of-pocket spending in the country. Only 15 per cent of the population is covered by insurance, according to NSS (National Sample Survey), 2014. In 2015, an estimated 8 per cent of the population had been pushed into poverty by high out-of-pocket payments for healthcare. Medicines for cancer remain among the costliest purchases in the country. "Now that we are digitising health insurance, the process of claiming returns will be simpler and faster. We are also spreading more awareness on the benefits of insurance," says Ayushman Bharat CEO Indu Bhushan.
Blast from the past: A roadside vaccination post in Calcutta, Sepember 1964 (Photo: Keystone-France/ Getty Images)
There have also been many gains in the past few decades. Our life expectancy has significantly improved since Independence. Under-5 mortality and infant mortality rates have both reduced. However, neonatal mortality remains a problem with 600,000 newborns dying every year within 28 days of birth. "Neonatal health is the highest priority for our government because almost 60 per cent of our infant deaths [when a child dies within the first year] happen in the first 28 days of life," says Dr Ajay Khera, commissioner for child health at the Ministry of Health and Family Welfare (MoHFW). "This is the period when a child is the most vulnerable. They have almost no immunity. Quick and quality care is needed. Through our National Health Policy (NHP) 2017, we have made a commitment to ensure India reaches a Neonatal Mortality Rate (NMR) of less than 16 by 2025 and 12 by 2030. No other country has made such a commitment for newborn deaths at a policy level before."
One of the biggest reasons for the neonatal deaths is poor accessibility to healthcare facilities. While the number of primary healthcare centres (PHCs) in India have increased from 23,887 in 2011 to 30,045 now, the average distance to a PHC is around 8 km while that for a district hospital is 34 km. In many places, this is through poor roads and where public transport is limited. Additionally, there continues to be a shortfall of doctors at the primary healthcare level-as of 2018, 1,974 PHCs had no doctors at all. The country also has an 82 per cent shortage of specialised doctors at all levels of healthcare. Even though medical colleges have significantly increased from 86 in 1965 to over 400 today, the number of doctors per 1,000 patients is yet to reach the WHO (World Health Organization) recommended level (it is currently 0.8 per 1,000 people, while WHO norms are a minimum 1 per 1,000).
Graphic & Illustration by Raj Verma (Source: Census of India, National Health Survey, World Bank, WHO, MoHFW)
This is largely due to doctors preferring to go abroad to work or many going into private practice. "The only way in which you can really improve healthcare services is to put investment into it. Our budget allocation is still one of the lowest in the world for health. If you want more doctors and better facilities, then you need money for it. Why do we have to wait for a pandemic to realise the importance of the sector? Costs and access to health will be one of the biggest problems for the country in the coming decade," says healthcare expert Dr Mira Shiva. While we might have won the battle against Covid, the war it seems has only just begun.