World Health Day 2024 and Health Equity in India

Context

World Health Day which is observed every year on April 7 emphasizing on the issue of health equity for global health and justice. 

World Health Day 2024 & World Health Organization (WHO)

• World Health Day is observed annually on April 7th.
  • World Health Day 2024 theme is “My Health, My Right”.
• WHO was established on October 24, 1945.
• The WHO Constitution came into effect on April 7, 1948.
• WHO began functioning in 1951 after acquiring sufficient resources, emerging from the merger of the Health Organisation of the League of Nations and other entities.
• India became a member of WHO on January 12, 1948.

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Human Health

• Human Health as Fundamental Right: The World Health Organization (WHO) has declared health to be a fundamental human right.
• Disparity in Healthcare Access: However, there is an alarming gap in health-care access, highlighted by the COVID-19 epidemic, environmental crises, and growing socio-economic gaps. 
• Even though over 140 nations recognise health as a constitutional right, the WHO Council on the Economics of Health for All reports that more than half the world’s population needs complete access to essential health services.

What is Health Equity?

• About: It ensures that every person has an equal opportunity to achieve their highest health potential, no matter what their circumstances. 
• Addressing Root Cause of Health Inequity: It addresses the root causes of health inequities such as poverty, discrimination, limited access to high-quality education, a healthy diet, clean water, fresh air, and housing, and merely grants equal access to health care. 
  • For example, a child born into poverty in a rural area has no access to clean water, wholesome food, or immunisations, which lays the foundation for chronic health problems.
  • These differences are made worse by pandemics, climate change, and sociopolitical unrest. 
• Health as a Human Right: Health as a human right must be seen as the freedom, where every citizen has the possibility to achieve health and wellness as part of their rights to access to public health.

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India’s Health Equity Challenge

• Poor Budgetary Funding: 

  • The combined budget for the Ministry of Health and Family Welfare and the Ministry of AYUSH) is a meagre 0.27% of the gross domestic product (GDP) estimate for 2024–25.
    • Experts have suggested the health budget should be at least 3 percent of GDP.
    • The National Health Policy 2017 put the target for increasing the budget to at least 2.5 percent of GDP by 2025. 

• Infrastructure Gaps: 

• • India’s hospital bed density is 1.3 beds/1,000 population, which is significantly below the recommended 3 beds/1,000 population mark — a deficit of nearly 24 lakh beds. 
    • In urban areas, more than 70 per cent of the bed capacity expansion in the last decade has been by the private sector. Moreover, there is a slowdown in fresh investments, especially in tier 2, 3 cities and beyond.

• Disparities in Healthcare Sector: 

  • Rural-Urban Divide: Access to health care in rural areas is significantly less than in metropolitan areas. Social and economic barriers exacerbate this disparity.
    • A study titled Bharat Health Index (BHI) 2023 stated that only 25 per cent of the semi-rural and rural population in India have access to modern healthcare within their localities. 
  • Disparities across caste and gender: National Family Health Survey (NFHS)-5 (2019-21) data indicates that Scheduled Castes and Scheduled Tribes experience higher child mortality and lower immunisation rates. 
    • Moreover, 59% of women in the lowest wealth bracket suffer from anaemia, almost double the rate in the highest quintile.
  • Health Disparities in Urban Slums: According to the 2011 Census, urban slums make up over 17% of India’s metropolitan areas, and exhibit serious health disparities. 
    • Health risks are increased by overcrowding, poor sanitation, and restricted access to clean water. 
    • According to the Indian Council of Medical Research, infectious diseases, such as tuberculosis, are 1.5 times more common in slums than in non-slum areas.
    • India has a large migrant population: the total number of inter-State migrant workers was about 41 million (Census 2011), and the total migration rate was 28.9% (Periodic Labour Force Survey, 2020-21). 

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• Shortage of Healthcare Personnel: 

  • There is a large number of vacancies against sanctioned posts at various levels of the public health system.
    • Over 75% of health-care professionals work in metropolitan regions, which only account for 27% of the population; the shortage is particularly severe in rural areas. 
    • A critical shortage of doctors exacerbates these issues, with WHO data indicating only 0.8 doctors per 1,000 people, which is below the advised ratio. 

• Inadequate Regulation of Private Sector: 

  • Private healthcare accounts for around 70% of healthcare utilization in the country and is allowed to make high profits, because it is inadequately regulated and often charges patients exorbitant rates.
  • The Clinical Establishments (Central Government) Rules, 2012 specify that all healthcare providers must display their rates and should charge standard rates as determined by the government from time to time. 
  • However, these legal provisions are yet to be implemented.

• Mental Health Issues: 

• • Suicide in the young is a major public health problem in India. 1% of all suicides are by young people below the age of 30. 
    • India has the highest number of suicides in the world. The National Crime Records Bureau (NCRB) reports that 1.71 lakh people died by suicide in 2022.

• Issue of Hidden Hunger: 

  • As per the Ministry of Health and Family Welfare, there is prevalence of anaemia in:
    • 58.6  per cent among children aged 6-59 months
    • 53.1 per cent in women aged 15-49 years
    • 50.4 per cent in pregnant women aged 15-49 years
    • 22.7 per cent in men aged 15-49 years.

Government Initiatives to Public Health

• Ayushman Bharat Programme:  It provides for holistic and integrated health care and is the principal vehicle for achieving Universal Health Coverage (UHC). Components include:
  • Health and Wellness Centre component (AB-HWC): It provides essential primary and community health services such as maternal, neonatal and child health services including immunization and nutrition.
  • AB-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): It provides free and cashless care to about 500 million poor and deprived people for secondary and tertiary hospitalization care.
• Strengthening of Tertiary Care for Cancer Scheme: It is being implemented to support setting up of State Cancer Institutes (SCI) and Tertiary Care Cancer Centres (TCCC) in different parts of the country. 
• Financial assistance: Financial assistance to patients living below poverty line for life threatening diseases under the schemes such as Rashtriya Arogya Nidhi (RAN), Health Minister’s Cancer Patient Fund (HMCPF) and Health Minister’s Discretionary Grant (HMDG) is provided.
• Affordable Medicines and Reliable Implants for Treatment (AMRIT) Deendayal outlets: These have been opened to make available drugs and implants for Cardiovascular Diseases (CVDs), Cancer and Diabetes at discounted prices to the patients.
• Janani Shishu Suraksha Karyakram (JSSK): Under this,  free drugs, free diagnostics, free blood and diet, free transport from home to institution is provided.
• Rashtriya Bal Swasthya Karyakram (RBSK): It provides newborn and child health screening and early interventions services free of cost for birth defects, diseases, deficiencies and developmental delays.
• National Suicide Prevention Strategy for India: It aims to reduce suicide by 10% by 2030 by leveraging educational institutions and youth organisations to promote mental health.

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Role of Technology in Improving Health Outcomes

• Tracking Health Metrics: With the use of mobile apps and remote monitoring devices, individuals can easily track their health metrics and receive personalised recommendations without having to visit a doctor. 
  • This saves time and money and allows for better management of chronic conditions.
• Promote preventive care through data analysis: By collecting real-time data from various sources like fitness trackers, smart scales, and blood glucose monitors, and with the use of Artificial Intelligence and Machine Learning, the patterns can be identified that indicate potential health risks. 
  • This information can then be used by individuals to make necessary lifestyle changes or it can be shared with healthcare professionals for more targeted treatment plans.
• Diagnosis and treatment: For instance, imaging technologies such as MRI and CT scans allow for earlier detection of illnesses with higher precision than ever before. 
  • Robotic surgery techniques have improved surgical outcomes by increasing accuracy while minimising invasiveness.

Way Forward

• Implementation of Universal Health Coverage (UHC): Given that health is a state subject and the Universal Health Coverage (UHC) policy is envisaged at the national level, there is a necessity for discussions on implementation strategies.
  • Reducing out-of-pocket expenditure: The reimbursement processes for reducing out-of-pocket expenditure needs to be simplified. 
    • The design of cash transfers and reimbursement in India’s public healthcare system needs adaptation for migrant and marginalised communities.
• Robust healthcare infrastructure: This includes building state-of-the-art hospitals, expanding healthcare networks, and ensuring that healthcare services are accessible to all citizens. 
• Raising Health Literacy: Achieving health equity requires raising health literacy. India should turn health equality into a shared, community-driven goal by including health education in the NHM, enabling its people to seek equitable care and make educated health decisions.
• Investment in Preventive Care: Preventive care and public health initiatives should be prioritised to reduce the burden of diseases and promote overall wellness. 
  • These initiatives include vaccination drives, disease surveillance, and health education campaigns that target various age groups and communities.
• Ensuring transparency of Healthcare Rates:   It is high time that transparency of healthcare rates be ensured, and standardisation of rates be implemented in an appropriate manner. 
  • This can be ensured when the Clinical Establishment Rules are implemented or when State governments adopt improved Acts of their own.
• Standard Protocols to check irrational healthcare interventions: Standard protocols are needed to check irrational healthcare interventions, which are currently promoted on a wide scale due to commercial considerations. 
  • For example, the proportion of caesarean deliveries in India in private hospitals (48%) is three times higher compared to public hospitals (14%).
  • In private hospitals, the share is far in excess of the medically recommended norm for caesarean sections (10-15% of all deliveries).
• Enforcement of Patient Rights Charter: The complete Patient Rights Charter (not a diluted version as observed in some hospitals) must be effectively enforced in all healthcare facilities across the country, so that patients and their caregivers can obtain care in a conducive environment. 
• Community-based primary healthcare: The community-based primary health care should be implemented in urban and peri-urban areas with seamless referral systems. It may include:
  • Strengthening primary healthcare through the 1.7 lakh Health and Wellness Centres (now renamed as Ayushman Arogya Mandirs).
  • Creating a mechanism to cover OPD care under health insurance.
• Grievance redressal systems: User-friendly grievance redressal systems should be operationalised from district level upwards to ensure justice for patients with serious complaints related to private hospitals.

Conclusion

Prioritising good health and well-being is critical for achieving sustainable development goals at both the local and global levels. It not only improves the quality of life for individuals but also contributes to creating more equitable, resilient, and sustainable communities. In an interconnected world, it is essential to recognise the importance of global collaboration in healthcare. With the collective knowledge, resources, and best practices of various nations, we can achieve a sustainable future for all.

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