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Way Too Many Adults Are Dying Prematurely In India And The Govt Must Act Now

30/06/2016 8:28 AM IST | Updated 15/07/2016 8:27 AM IST
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Adnan Abidi / Reuters
A laboratory staff member holds a patient's blood sample inside a laboratory at Janakpuri Super Speciality Hospital in New Delhi January 19, 2015. The empty hospitals in the heart of the Indian capital are emblematic of the paralysis gripping a public health system that is responsible for some of the world's worst health indicators. Many of the country's 1.2 billion people have a choice between expensive private care, or no care at all. Prime Minister Narendra Modi faces many challenges to his stated goal of providing universal public health coverage, but one of the most daunting is ending the logjams that mean officials consistently fail to use their budgets. Picture taken January 19, 2015. To match Insight INDIA-HEALTHCARE/HOSPITALS REUTERS/Adnan Abidi (INDIA - Tags: HEALTH POLITICS)

It is estimated that 31 million adult people died prematurely (death below 70 years of age) in India during 2010-2015; accounting for 21% of the total global premature deaths, the highest in the world. An important trend observed by health organizations is the shift of the premature mortality burden from the child (0-5 years) to the adult (15-60 years) level. While it is true that India has shown remarkable progress in declining child mortality from 48 to 15% over the last four decades, it is also important to bring to notice the transition to adult premature mortality - 65% of the premature deaths in India are at the adult level.

With non-communicable diseases (NCDs) and the double burden of mortality weighing down the country, there cannot be any more indicative factors urging the government to prioritize healthcare as its fundamental agenda to secure its people. Additionally, India's health system, which for decades has focused on child mortality, also needs to give immediate attention and work on prevention of morbidity, mortality and risk factors attributable to NCDs.

Equal Focus On Adult And Child Mortality

Close to 50% of India's people are in the age group of 20-59 years, accounting for a large percentage of the country's working population. According to a UN report, India is projected to dominate the working-age population growth in Asia-Pacific by 2050. The numbers seem impressive and also raise hopes for better economic prospects for the country in the years to come. But how much financial, economic or social progress can a country make with a large proportion of its working population not being optimally healthy?

The working-age population plays a critical role in economic growth, not only at the national level, but also at the household level.

The working-age population plays a critical role in economic growth, not only at the national level, but also at the household level. Adults, the breadwinners of the family, are the key component of the growth pyramid. On the other hand, children (from 0-9 years), considered the dependent population, rely on adults for the fulfillment of not only their basic physiological needs (food, shelter, water) but also for provision, protection and participation (education, recreation, activities, behavioural growth, constructive development through community programmes). Hence, the well-being of children is bound to the welfare of the adults. The economic status of the employed members of the family determines the prosperity and security of the dependents.

An all-encompassing health system -- child-focused strategies and health interventions that enhance adult health -- will step up the process of poverty mitigation. By strengthening potential, effective health programmes will make the working population contributors instead of reliant collectors. A healthy population will also help reduce burden on public welfare.

Need For Prevention

As the first point of contact for patients, Primary Health Centres (PHCs) play a leading role in reducing the premature mortality burden. Primary health systems are the cornerstone for prevention of chronic diseases. Chronic or non-communicable diseases such as cancer, diabetes and cardiovascular diseases that are taking more than 60% lives in India each year are all preventable medical conditions. Prevention of NCDs, a vital mechanism to manage chronic diseases, is one of the most cost-effective action plans to tackle the growing disease burden. In the short-term, it helps patients cut down and save on treatment costs, in the long-term; it helps avert direct and indirect economic implications of NCDs.

Immediate attention should be concentrated on empowering India's health system and centres to prevent diseases, identifying persons at risk and giving appropriate healthcare to those who need it.

Health systems in India lack the will to implement functions, and so they fall short of providing the medical and preventive care they are supposed to. The healthcare system needs strict, robust governance that will ensure effective and timely delivery of healthcare services to the large unhealthy population of India. Through its political will and collaborative, multi-sectoral schemes, the government and the private sector should prioritize healthcare in order to cater to India's increasingly urgent needs. The government, aided by support from NGOs and the private sector, can advance its proposals, schemes and services across the country. While the metros in India are becoming medical tourism destinations, the tier 2 and tier 3 cities require support to strengthen their health system. Public-private-partnerships can be one of the ways to help replicate successful health models in the far ends of the country.

Health should be the primary agenda for every government. An ideal comprehensive health policy, which also includes strategies for health promotion and prevention, should aspire to reduce the need for medical care. Immediate attention should be concentrated on empowering India's health system and centres to prevent diseases, identifying persons at risk and giving appropriate healthcare to those who need it, thereby reducing the rate of premature mortality, which also has detrimental effects on the economic prospects of the country.

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