India’s progress in achieving health goals has been deemed “dismal” by the 2018 global Multidimensional Poverty Index (MPI), released by the United Nations Development Programme (UNDP).
India has made huge strides towards some health goals within the last few decades. The eradication of polio is perhaps the most notable of India’s health success stories. However, lack of funding has led to progress on many health parameters entirely stalled.
The MPI acknowledges there has been an improvement in poverty rates within India in the last decade. However, many health conditions that often coincide with high poverty rates are still prevalent within India. The report focuses on two primary parameters for India’s health, stunting and childhood mortality.
Stunting and poverty typically go hand in hand
Stunting refers to when a child is not tall enough for their age. Stunting during infancy is linked to a range of poor health indicators in later life, including poor educational performance. Statistics indicate that 66 percent of working Indians who suffered from stunting during childhood experience lower wages.
Workers who were stunted as children earn, on average, thirteen percent less than they should. This may be from a myriad of side-effects. Poor educational performance is directly tied to lower earnings later in life. The long-term effects of stunting may also cause a person to be predisposed to many noncommunicable diseases (NCDs), or even make them more prone to infections.
Stunting is most often developed as a result of prolonged malnutrition. While this is often the result of being underweight, it is also possible for a person considered obese to also be malnourished due to a diet high in calories, yet lacking in certain vitamins and minerals. Repeated infections during childhood are also a common cause of stunting.
Prevalence of the condition in India is high, affecting 38.4 percent of children on average. This figure varies considerably, with states at lower levels of economic development showing prevalences as high as 65.1 percent).
Health goals, does the budget meet the need?
The MPI report states that major reductions are needed in India’s stunting rates to meet health goals, “The trajectories to achieve targets in reducing stunting suggest that a rate of reduction of 4.9 percent is required to achieve the World Health Summit targets (forty percent reduction in stunting prevalence till 2025) or the targets set by UN-mandated Sustainable Development Goal by 2030,” it states.
Health programmes — with the exception of Ayushman Bharat — appear to have fallen down the list of priorities in the Union Budget 2019. With a focus on job creation, infrastructure, economic slowdown and ease of living, issues such as malnutrition and healthcare infrastructure expansion have been sidelined.
Healthcare spending has been marginally increased from Rs 54,302.50 crore in 2018-19 to Rs 62,659.12 crore in 2019-20. This increase is far below previous promises of a rise to 2.5 percent of GDP, a target the Centre intends to achieve by 2025. Healthcare budgets are likely to be stretched across the coming years as a rising tide of NCDs is placing ever more strain on the healthcare system.
The MPI report highlighted considerable gaps in nutrition programmes in India. These gaps in the system have left many impoverished children and families struggling to afford enough for food. This has left malnutrition rates stagnant in the last few years, with only marginal reductions.
Nothing has epitomised India’s struggle with malnutrition more than the recent spate of child deaths due to encephalitis in Bihar recently. More than 100 children have died — the suspected cause of which is encephalitis or hypoglycemia linked to unripened lychees. Two common factors link almost all of the encephalitis deaths: children who have recently eaten a large volume of lychees, and malnutrition. Toxins within the lychees have been implicated as the cause, an issue that tends to affect the children already weakened through malnutrition.
Child mortality, a largely preventable issue?
The other metric in which the report found India to be lacking was the handling of the issue of child mortality. The under-five mortality rate in India still stands at 43 per 1,000 live births. Some neighbouring countries such as Myanmar, Pakistan have also shown no improvement. Though Nepal and Bangladesh have been successful in bringing down their respective rates to 34 per 1,000 live births each.
The report pointed towards a particularly damning study which found that the majority of child deaths occurring within India could have been prevented. Many of the responsible conditions were relatively easily treatable, though it was found that in many cases medical attention had not been sought out prior to the child’s death.
The study found that neonatal etiologies, acute respiratory infection (ARI), and diarrhoea accounted for approximately 63.1 percent of all deaths in the under-five age group. It was also found that care providers of 52.6 percent of the neonates and 21.7 percent of infants and under-five children did not seek any medical care before the death of the child.
The implications of the study are that simple infections are the cause of the majority of infant mortality within India. In many cases medical attention is not sought out. This may be caused by a number of reasons. Firstly, a lack of healthcare infrastructure means those in rural India are unlikely to have easy access to government-run hospitals in which many medical procedures are provided either at a considerably reduced price or for free. This in many cases necessitates the use of private healthcare, leading to sometimes considerable out-of-pocket bills.
For many in poverty — in particular those in rural environments — this means that access to healthcare is all but cut off. India could avert a considerable number of these child deaths if access to affordable healthcare and effective healthcare infrastructure were extended. However, with such a strained healthcare budget and no signs of a major increase in the coming years, India’s health metrics will continue to stagnate.