On April 5th, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic. Two days later marked World Health Day.
In 2021, World Health Day occurs once more against the backdrop of the COVID-19 pandemic. At the time Health Issues India covered World Health Day last year, I wrote “India [had] reported thousands of infections and well in excess of 100 deaths.” One year on, the situation is markedly more severe with India ranking as the third-most-affected country by the pandemic in terms of confirmed cases thus far; the fifth-most-affected country in terms of active cases; and the fourth-most-affected in terms of death. That World Health Day comes at a period when India is witnessing a second COVID-19 wave underscores the disparities between where we were this time last year and where we are now.
But it is key to remember that COVID-19 – while an overwhelming crisis – is not the sole health issue we are grappling with. Nothing could be further from the truth. We contend with a broad spectrum of health issues. Noncommunicable diseases, often chronic in nature, loom large. Meanwhile, we also experience the infectious diseases exclusive of COVID-19. India, with its dual burden of disease, faces many challenges exacerbated by systemic issues relating to its healthcare infrastructure and its chronic underspending on health as it relates to the country’s gross domestic product (GDP) – although the country did make gains in this year’s Union Budget.
As Health Issues India reported at the time, “healthcare and wellness initiatives enjoyed a boost of Rs 2.23 lakh crore during the budget…With this increase in outlays, per the report, allocation for health and wellbeing increased by 137 percent compared to the previous year.” Nonetheless, we noted, “India’s spending on healthcare has long been a bane. The government’s arguably inadequate outlays for healthcare has been accredited with driving up out-of-pocket spending on healthcare by families, plunging many into poverty….The new budget may not be what all have hoped for, but it is the first budget enacted in the era of a pandemic that has underscored why healthcare is an investment vital as a public and moral imperative.”
The COVID-19 pandemic struck each and every nation without warning, but the health crises it highlighted did not – ranging from shortages of medicines and essential equipment to vaccine hesitancy to underinvestment in public health. The WHO has emphasised the need to avoid returning to normalcy in a post-COVID-19 world – an equitable approach being the need of the hour
“Within countries, illness and death from COVID-19 have been higher among groups who face discrimination, poverty, social exclusion, and adverse daily living and working conditions – including humanitarian crises. The pandemic is estimated to have driven between 119 and 124 million more people into extreme poverty last year. And there is convincing evidence that it has widened gender gaps in employment, with women exiting the labour force in greater numbers than men over the past twelve months.
“These inequities in people’s living conditions, health services, and access to power, money and resources are long-standing. The result: under-5 mortality rates among children from the poorest households are double that of children from the richest households. Life expectancy for people in low-income countries is sixteen years lower than for people in high-income countries. For example, nine out of ten deaths globally from cervical cancer occur in low- and middle-income countries.”
To quote WHO Director-General Dr Tedros Adhanom Ghebreyesus “the COVID-19 pandemic has thrived amid the inequalities in our societies and the gaps in our health systems. It is vital for all governments to invest in strengthening their health services and to remove the barriers that prevent so many people from using them, so more people have the chance to live healthy lives.” India is no stranger to inequity when it comes to health, with significant inequalities between its states and union territories in terms of health outcomes and access to care. For example, as reported by Health Issues India in 2019 regarding life expectancy
“Disparities do remain, however, with varying estimates of life expectancies between states. Women born in Kerala, for example, live for 77.8 years on average. Women in Uttar Pradesh live for 65.6 years on average. Similarly, men born in Delhi live for 73.3 years on average, compared to just 63.8 years for men born in Chhattisgarh.”
With inequality in mind, the WHO has called for action on five fronts: “[accelerating] equitable access to COVID-19 technologies between and within countries” (of heightened relevance due to vaccine nationalism); “[investing] in primary health care”; “[prioritising] health and social protection”; “[building] safe, healthy and inclusive neighbourhoods”; and “[strengthening] data and health information systems.” Such actions are imperative, for India and for the world at large. World Health Day is a once-a-year event – but the lessons we take from it must be applied universally and with consistency.
“The positioning of World Health Day 2020 in the midst of the COVID-19 crisis reinforces why strong health systems are the need of the hour,” I wrote last year. “COVID-19 is not the sole health issue the world faces. The pandemic notwithstanding, World Health Day provides a chance for nations to appraise their public landscape and look to solutions to the challenges they face. COVID-19 underscores why this is of such importance. When World Health Day is observed next year, will countries have heeded its call?”
As I questioned then, when World Health Day is observed next year, will countries have heeded its call?