| In Focus |
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 The Burden of Disease
Public health remains a major challenge in India
India’s fast-growing population provides a daunting challenge in many areas of development. One of the most important of these is public health. Burdened by high rates of communicable and non-communicable diseases, India is struggling to keep up with the health needs of its population. While the private healthcare industry is booming – to the extent that medical tourism is being viewed as the next big opportunity – the public healthcare system leaves much to be desired. For those who cannot afford the exorbitant costs of a private hospital, there are few options. Major cities do have public hospitals but they are clearly unable to cope with the tremendous numbers of people that knock on their doors. Often, these centres are inadequately equipped with dingy wards and obsolete machines and to make matters worse, corruption is rampant.
In remote rural areas, there is a desperate lack of public health centres and shortage of public health professionals. Consider the figures: we need 7,415 community health centres per 100,000 population. We have about half the number. Even when facilities exist, the basic staff is not in place. Only 38% of primary health centres have all the required medical personnel. As a result, the poor who live in rural villages and urban slums are unable to access healthcare systems.
And yet, they remain the most vulnerable to disease because of their living conditions or the nature of their environment. Firstly, substandard living conditions, including lack of access to clean water or proper sanitation, contribute to a high prevalence of disease among them. The World Bank estimates 21% of communicable diseases in India are water related. Of these diseases, diarrhoea alone killed over 700,000 Indians in 1999 (estimated) – over 1,600 deaths each day. The highest mortality from diarrhoea is in children under the age of five, highlighting an urgent need for focused interventions to prevent diarrhoeal disease in this age group. Despite investments in water and sanitation infrastructure, many low-income communities continue to be deprived of access to safe drinking water. Unhygienic practices during water collection and storage, poor hand washing and limited access to sanitation facilities perpetuate the transmission of diarrhoea-causing germs. Also, only 33 percent of the population have access to adequate sanitation facilities. People are cramped together in unventilated living quarters in slums where open sewers, garbage pits and drains serve as breeding ground for diseases. The poor are also more likely consume adulterated food and drink because they are cheaper.
Because the poor are largely uneducated, their lack of awareness about health issues and preventive methods is an important factor that needs to be addressed. Many people living in villages or slums are subject to superstitious beliefs and rely on local mendicants, herbal condiments or faith healing even when there is a public health centre available. Women are expectedly the most neglected because of social conditioning that encourages an attitude of silent suffering. In villages, the widespread prevalence of the caste system complicates issues. Members of lower castes who have traditionally been discriminated or ostracised by others are often frightened of people outside the community; often, they refuse to visit public health centres unless persuaded otherwise. There is also little awareness about immunization, family planning and methods of disease prevention.
Without adequate knowledge of symptoms of diseases, people living in slums often ignore illnesses in the early stages. Chronic non-communicable and communicable diseases like hypertension, diabetes, intentional and unintentional injuries, tuberculosis, rheumatic heart disease, and HIV infection are usually diagnosed by the formal health sector only when there are late-stage complications. Little is known about the magnitude, distribution, and risk factors for these illnesses before they manifest as stroke, myocardial infarction, kidney failure, suicide, multidrug-resistant TB, heart valve disease, and AIDS. Often, by the time, these diseases are diagnosed, handling them is both difficult and expensive. This also increases the risk factors in the case of communicable diseases.
While improving public healthcare systems remains a key imperative for the government, it is essential that development organisations work within communities to enable them to make better use of existing facilities. Creating awareness about simple measures of disease prevention and hygiene improvement is also necessary. A comprehensive approach that successfully integrates policy with grass roots-level prevention is the only way towards a healthier future.
‘Public health infrastructure: What we need and what we have’, Infochange India News, June 2005 | Retrieved online from http://www.infochangeindia.org/agenda2_14.jsp
‘Slum health: Diseases of neglected populations’, BMC International Health and Human Rights, 7 March 2007 | Retrieved online from http://www.biomedcentral.com/1472-698X/7/2
‘Combating diarrhoeal disease in India through safe drinking water’, World Health Organisation, November 2002 | Retrieved online from http://www.who.int/mediacentre/multimedia/2002/ind_sanitation/en/index.html
UNICEF India Statistics | Retrieved online from http://www.unicef.org/infobycountry/india_india_statistics.html#29
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