What precisely does India's demographic dividend amount to? In 2026, to pick a random year from the near future, 573 million Indians will be aged between 15 and 30, out of a total population of close to 1.5 billion. Well-equipped and skilled, a young population can be a boon. Ill-equipped and poorly-skilled, it can be a disaster. The challenge before us is an economic one - providing education, vocational skills and jobs. Yet, it is also a social one, related to health and nutrition.
Not that this has gone unrecognised. After all, among the points raised during the recent debate on the Food Security Bill was the need to ensure timely and adequate food for our children. It has been scientifically established that nutrition is directly linked to cognitive development and learning abilities and is therefore essential for young children.
Rearing a child cannot, however, be broken into separate parts and silos. It represents a continuum where education, social and physical environment, food security and public health all play a part. As such, in acknowledging the food security provisions, let us not forget the challenge India faces from childhood diseases.
Each year, 6.6 million children around the world die before the age of five. India accounts for an astonishing and shaming one-fifth of this number. What is particularly tragic is the vast majority of these children die of eminently preventable diseases. As a signatory to the United Nations Millennium Development Goals (MDGs), India is internationally committed to act on this. MDG 4, after all, holds India to the promise of reducing under-five mortality by two-thirds by the year 2015. This goal cannot be met if diarrhoea and pneumonia, the two primary killers of children in India, are not tackled.
Diarrhoea kills more than 200,000 children in India before they reach their fifth birthday (Unicef). Even if a child survives, the costs related to treatment, hospitalisation and other suffering can be guessed. Rotavirus, the leading cause of diarrhoea in India, is responsible for an estimated 75,000 deaths, 450,000-800,000 hospitalisations and two million outpatient visits per year. Do remember, diarrhoea is much more likely to strike a child from a poor family, living in an unhygienic neighbourhood.
The corresponding figures for pneumonia are no less depressing. Caused by Streptococcus pneumoniae and Haemophilus influenzae type B (Hib), pneumonia is the leading killer of children under five in India and globally. To give you an idea, pneumonia accounts for more deaths than HIV-AIDS, malaria and measles combined. Yet, it gets only a fraction of the media coverage and public and policymaker attention.
In 2010, just over 30 per cent of deaths of Indian children in the one to 59 months cohort occurred due to pneumonia. This came to some 250,000 deaths. An additional 142,000 neonatal deaths were caused by pneumonia that killed new-born infants before they completed their first month.
What is the way out? Can India even hope to meet the aspirations of MDG 4? Public health specialists increasingly stress the relevance of what may be called the PPT model - Protect; Prevent; Treat.
Of these, protection is ideal - but the conditions for it, social and economic, are not always optimal in a developing country such as India. Protection calls for promoting breast-feeding and hand-washing, both of which are the first line of defence against pneumonia and diarrhoea. Adequate nutrition and supplementation - zinc in the case of pneumonia and zinc and vitamin A in the case of diarrhoea - are also recommended.
Finally, reducing indoor air pollution - difficult in crammed Indian homes, where a coal-based stove may be functional in the same room as a child - is vital to guarding against pneumonia. In the case of diarrhoea, safe water and sanitation are required. How easily are these available? Our sanitation statistics are there for all to see.
Treatment is the last-ditch stand, often a desperate attempt to stave off death. Even if successful, it need not be without consequences. Take the example of pneumococcus, which causes both pneumonia and meningitis. Detected early, it can be treated with antibiotics. However, India has a longstanding problem related to antibiotic misuse, leading to resistance. As such the efficacy of this mode of treatment may be less than expected in serious cases.
That aside, access to treatment and care is unpredictable and depends on which state or even town or village you live in. Only 13 per cent of Indian children suspected to have pneumonia receive potentially life-saving treatment. Even when treatment works and saves the patient, there can be long-term implications. Meningitis survivors often complain of hearing loss, seizures, motor impairment and mental retardation. Naturally, scholastic outcomes in the classroom suffer.
All this makes the second P - prevention - key to India's MDG 4 campaign. In turn, this calls for use of the most cost-effective and technologically-adept tools of prevention. Within such a matrix, the choice of vaccines is inevitable and unavoidable. As the development economist Jeffrey Sachs once put it, vaccines are "weapons of mass salvation".
Vaccines that are already part of our routine immunisation system and promised to every Indian child assist us in taking on diarrhoea and pneumonia. The measles vaccine helps prevent both afflictions and the pertussis vaccine provides collateral immunity against pneumonia. However new vaccines are also available and increasingly used in the private sector in India and of course in other countries. These are the rotavirus vaccine (which protects against the most lethal form of diarrhoea) and the pneumococcal and Hib vaccines that fight the pneumonia family of diseases.
It is time to get these vaccines to those who need them most: vulnerable children from India's poorest districts and most economically-stricken households. We owe it to our MDG commitment before the United Nations. More than that, we owe it to the legatees of our demographic dividend.
The writer is Member of Parliament for East Champaran, Bihar. He is also a member of Parliament's standing committee on health
Disclaimer: These are personal views of the writer. They do not necessarily reflect the opinion of www.business-standard.com or the Business Standard newspaper
