Ill health deaths: 97 percent.
Terror deaths: 0.007 percent.
Let us first take a moment to digest the headline.
“The two issues that took significance and helped the BJP return to power were national security and Hindu nationalism, with claims that both are under threat by unforeseen powers. The reality is different: people are dying of ill health 8000 times more than terror.”
Even though this shocking figure may be a hard fact out there, staring at us, somehow the policymakers and the media have turned a blind eye. You may agree to what I am saying if you were following the media debates, campaign speeches, and manifestoes of the political parties. The two issues that took significance and helped the BJP return to power were national security and Hindu nationalism, with claims that both are under threat by unforeseen powers.
The reality is different: people are dying of ill-health 8000 times more than terror.According to a report by India Spend, in 2017 766 Indians died, due to terror-related incidents as compared to 6.6 million deaths due to ill health. As such, terror deaths accounted for 0.07 percent of total deaths that year. Health reasons accounted for ninety percent.
This clearly should position health at a higher priority than terror. Notwithstanding this overwhelming gap, the government’s priority was reflected in spending levels. India’s defence spending that year was 2.5 percent of GDP. By comparison, government spending on health, was close to half, a mere 1.4 percent in the 2017-18 fiscal year.
If you are an ardent follower of the Indian news debates and opinion pieces, defence stories supersede interest in health. Indian media prefers to talk about details of fighter aircraft deal but would not indulge in brainstorming over the growing burden of noncommunicable diseases; the continued burden of infectious conditions such as tuberculosis and malaria; the ill effects of pollution; and the escalating water crisis.
Former Health Secretary, Sujata Rao, questioned this misplaced priority during the election season. “India has high levels of premature deaths & more die of diabetes, suicides, infectious diseases & NCD’s [sic] than terrorism,” she tweeted. “Yet, election debates are more about nationalism & terror & not health. One needs to be alive to be a patriot. Health & education need to be top & at least eight percent GDP allocated to them.”
India’s public health spending is among the world’s lowest, despite having a fifth of the world’s population and topping several categories of global disease burden. India is home to a third of the world’s stunted children; accounts for 23 percent of the world’s tuberculosis cases; loses 1.2 million lives to air pollution every year; and reports one of the world’s highest rates of out-of-pocket expenditure, an indicator of public healthcare failures.
“According to a Lancet study, “Until federal government in India takes health as seriously as many other nations do, India will not fulfil either its national or global potential.””
These health crises aside, India is the fifth largest defence spender in the world. The defence budget in 2017-18 was Rs 4.31 lakh crore ($72.1 billion, using 2017 rates), as per Institute of Defence Studies and Analyses, a think-tank. This was double the health budget that year, which stood at Rs 2.1 lakh crore.
“It is believed that countries with more accountable democratic institutions are more likely to invest in improving health outcomes for its people, because democracy plays a bigger role in health for the people than GDP alone,” Meenakshi Dutta Ghosh, former special secretary at the Ministry of Health Affairs, told Health Issues India. “However, in India, political parties and politicians have not been held to account in this manner.”
During this year’s election campaign, Health Issues India asked Rajeev Gowda, a Congress MP, why is healthcare not a priority for Indian politicians, in reference to the low healthcare budget. He stated, “There are other priorities overtaking healthcare. A lot of budget healthcare is out of pocket in India as compared to several other countries, and the catastrophic impact is so severe that one severe illness in a family can drive them below the poverty line. So yes, every political party is very concerned about this, but other priorities end up being more urgent.”
Amidst political posturing over the public interest, it is important for both the media and the government to cast the spotlight on India’s growing disease burden and implement imperative healthcare policy changes that are prerequisite for fulfilling Sustainable Development Goals (SDG) target by 2025.
According to a Lancet study, “Until federal government in India takes health as seriously as many other nations do, India will not fulfil either its national or global potential.” So is health the neglected GDP driver that India needs to help the economy back on track? If given due focus, the sector has the ability to propel GDP growth via multiple spokes, both directly and indirectly.
A KPMG report, dated 2015, explains why: “It aims to provide a view to help envision investment into the health of citizens, as an investment to improve the economic growth of the nation, and not as a social expenditure.”
“Only a healthy nation can become an economic power. A healthy workforce has enhanced labour productivity, good physical capacities (such as endurance and strength), and augmented mental capacities.”
Healthcare needs have made the sector one of the largest, in terms of revenue and employment. India is battling a severe job crisis, with unemployment figures at a 45-year high. Being the fifth largest employer among all sectors, both in terms of direct and indirect employment, the health sector offers direct employment to nearly five million citizens in India and has the potential to generate close to 7.5 million direct opportunities by 2022.
With a shift in focus towards increasing accessibility and quality of service, the industry requires specialised and highly skilled resources. Only three percent doctors cater to rural areas despite such regions being home to seventy percent of Indians, as reported by Health Issues India recently. This is partly because India has only one doctor for every 11,000 people, as compared to the World Health Organization (WHO) standard of one for every 1,000 people.
The KPMG report states that only a healthy nation can become an economic power. A healthy workforce has enhanced labour productivity, good physical capacities (such as endurance and strength), and augmented mental capacities. However, the report estimates that the increasing noncommunicable (NCD) disease burden will cost India close to US$5 trillion due to loss of productivity. This emphasises the need of robust healthcare infrastructure to enable Indians living with NCDs to manage their conditions and live as healthily as possible.
A healthy India is important, necessary to win elections, to win wars (both economic and defence) and to prosper. To stand up against the global challenges it faces, India needs to ensure first that it strengthens its healthcare sector. It is important for both the policymakers and the media to understand the significance of a narrative in favour of strengthening the public health system. India needs to prepare itself to fight a bigger war against health challenges – than its fighting against terror.