Sumita Kale: Prescription for health

India is well-known for its distressing record on health provision. Though life expectancy has increased, other indicators of a healthy population have not improved substantially. Over the past 15 years, India reduced its infant mortality rate from 84 to 62 per 1,000, even as Bangladesh's achievement was from 100 to 56 over the same period. While it is clear that the government has failed in its role as primary health provider, it now has to deal with fresh challenges.

Last October, the World Health Organisation (WHO) raised an alert of the alarming rise in non-communicable chronic diseases (cardio-vascular diseases, cancer and diabetes and so on) as the "latest largest killer", giving special emphasis to India and China. It estimated that in 2005 alone, India would lose 9 billion dollars (in PPP terms) in national income from premature deaths due to heart disease, stroke and diabetes. Chronic diseases are currently estimated to account for 53 per cent of all deaths, with this share projected to touch 66.7 per cent by 2020. Even more disturbing data emerge for those who believe that these are lifestyle diseases that typically affect the urban rich "" 53 per cent of the 29.8 million Indians suffering from coronary heart disease in 2003, came from rural areas. Further, India has the largest number of oral cancers in the world due to the widespread habit of chewing tobacco, a habit that ignores all class boundaries.

The impact on economic growth and productivity can be substantial as the age group of 35-64 years is the one most severely hit by these diseases. The issue will grow more acute over time as the proportion of this age group is slated to grow to 42 per cent of population by 2021. Apart from loss of lives, the associated impact on productivity as people grapple with these diseases is a matter of serious concern.

Better income levels, unfortunately, do not automatically lead to healthier lives; rather a tendency towards higher tobacco consumption is one predictable outcome of more income. For the poor and disadvantaged, the problem is compounded as there is a lack of awareness of these diseases and access to health care is woefully inadequate. Not only is the provision of health-care skewed in favour of private centres in urban areas, small towns and cities lack specialised hospitals.

While the government has started some national campaigns and states such as Tamil Nadu and Kerala have prioritised this issue, there has to be an integrated approach across departments. Programmes with single focus, for instance, the National Cancer Control Programme, National Tobacco Control Cell and so on have to be modified to combine treatment plans across different diseases. Needless to say, primary health care centres in rural areas and small towns need to be upgraded to prepare health-care workers to deal with the challenge "" an aim of the National Rural Health Mission.

As WHO points out, dealing with infectious as well as chronic diseases is a double burden for developing countries with limited resources. Yet, countries such as Indonesia and Philippines have shown this is possible by adopting the WHO approach, which essentially covers nationwide co-ordination, planning and communication strategies. Time will tell whether India becomes another success story or whether a programme like the National Rural Health Mission will remain yet another missed opportunity.

The writer is Advisor, Indicus Analytics