Shaping India’s path to inclusive health care
Relevance: GS Paper I
Why in News?
India's health equity challenges demand a comprehensive strategy that extends beyond mere enhancements in healthcare infrastructure.
More about the news:
Each year, on April 7th, World Health Day brings us together to address health equity, a crucial issue in global health and justice. According to the World Health Organization (WHO), health is a fundamental human right, with this year's theme being "My Health, My Right".
- Understanding Health Equity: The concept of health equity revolves around ensuring that every individual has an equal opportunity to achieve their optimal health regardless of their circumstances. It acknowledges that various social, economic, and environmental factors influence health outcomes, extending beyond genetic predispositions. The World Health Organization (WHO) aims to eliminate unjust and avoidable health disparities among different social and economic groups. Genuine health equity delves into the underlying causes of health inequalities, such as poverty, discrimination, limited access to quality education, nutritious food, clean water, fresh air, and adequate housing, rather than solely focusing on equal access to healthcare.
- Why there is need for Health Equity: A child born into poverty in a rural setting may lack access to clean water, nutritious food, or vaccinations, leading to chronic health issues later in life. These disparities are exacerbated by pandemics, climate change, and socio-political unrest. India, with its diverse population and wide socioeconomic gaps, particularly resonates with this dilemma.
- Access to healthcare in rural areas significantly lags behind that in urban areas, with social and economic barriers exacerbating the divide.
- Diverse populations require assistance in accessing high-quality healthcare in such contexts. At a global level, the fight for health equity encounters challenges that defy national borders and demand collective international action.
- The COVID-19 pandemic has starkly highlighted how infectious diseases disproportionately affect marginalized and vulnerable groups, widening the health equity gap.
- Climate change poses a significant health risk, especially for low-income and vulnerable populations.
- Conflicts further impede healthcare provision by destroying infrastructure, displacing communities, and obstructing access to essential medical services.
- The Global Challenge: The COVID-19 pandemic, environmental crises, and increasing socio-economic gaps have worsened the already significant discrepancies in healthcare access. Even though more than 140 nations recognize health as a constitutional entitlement, the WHO Council on the Economics of Health for All indicates that over half of the world's population does not have full access to vital health services. As World Health Day 2024 concludes, it is apparent that the advancement of health equity provides optimism for millions, going beyond simple social justice or legislative changes.
How to Achieve Health Equity:
- Achieving health equity requires a holistic approach that transcends legislative reforms to address the social and economic determinants of health.
- It necessitates concerted efforts by governments, communities, and individuals to dismantle these barriers and ensure that everyone can lead a healthy life.
- However, the path to health equity is rife with challenges, ranging from deeply entrenched social injustices to global systemic health issues, particularly in multicultural countries like India.
India’s Health Equity Challenge:
- Population Factor: India faces significant challenges in achieving health equity due to its large and diverse population, leading to disparities in healthcare outcomes and access. While there have been improvements in healthcare access over the past two decades, rural areas still require substantial attention. Urban slums, constituting over 17% of metropolitan areas according to the 2011 Census, exhibit serious health disparities due to factors like overcrowding, poor sanitation, and limited access to clean water, leading to increased health risks, including higher rates of infectious diseases like tuberculosis.
- Social Disparities: Profound disparities also exist across caste and gender lines, as evidenced by data from the National Family Health Survey (NFHS)-5 (2019-21), which shows higher child mortality and lower immunization rates among Scheduled Castes and Scheduled Tribes. Additionally, there's a significant discrepancy in health outcomes related to economic status, with anemia rates among women in the lowest wealth quintile nearly double that of the highest quintile, highlighting the intersection of caste, gender, and economic status in health outcomes.
- Non-communicable diseases (NCDs): Non-communicable diseases (NCDs) are a major concern, accounting for over 60% of all deaths in India. The Public Health Foundation of India underscores the importance of equitable access to treatment and preventive healthcare, warning of the substantial economic impact of NCDs, projected to exceed $6 trillion by 2030.
- Shortage of Professionals: A critical shortage of doctors exacerbates these challenges, with WHO data indicating a doctor-to-population ratio below the recommended level. While the majority of healthcare professionals are concentrated in urban areas, which serve only a fraction of the population, rural areas face severe shortages. Expanding the definition to include other medical practitioners might balance the ratio.
Government Initiatives:
- Government initiatives like Ayushman Bharat, offering free health coverage to the bottom 40% economically, demonstrate a commitment to reducing health disparities.
- The National Health Mission (NHM), encompassing the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), aims to bridge the healthcare gap between rural and urban India through expanding access, strengthening infrastructure, and providing essential services to vulnerable populations.
Strategies for Progress:
- Addressing India's health equity issues requires a comprehensive approach that goes beyond mere improvements in healthcare facilities to tackle broader socioeconomic determinants of health. Collaboration between government, civil society, healthcare providers, and communities is essential to move towards universal health coverage and a more equitable future.
- Health Literacy: Raising health literacy is crucial, with efforts needed to incorporate health education into initiatives like the NHM to empower individuals to seek equitable care and make informed health decisions.
- Collaboration: Public and private healthcare sectors collaborate to provide services to underprivileged communities, focusing on preventive education, workforce development, and infrastructure enhancement.
- Non-governmental organizations and civic societies engage in community outreach to address regional health concerns, often collaborating with international and governmental organizations to tailor culturally sensitive health initiatives.
- Strongly rooted local organizations are vital for promoting health equity. They actively engage in all phases of health program implementation, ensuring that initiatives are relevant and effective. With a deep understanding of their community's needs, these organizations tailor their efforts accordingly.
- Successful collaborations, crucial for achieving health equity, rely on open communication, mutual respect, and shared objectives. These partnerships are flexible, adapting to evolving health concerns and community needs, while prioritizing community empowerment, knowledge sharing, and capacity building.
- Effective collaboration across various sectors, from policymakers to grassroots organizations, holds significant potential for enhancing health equity and ultimately making access to high-quality healthcare a universal reality rather than a privilege.
- International Collaboration: International institutions such as WHO, the Global Fund, and Gavi support health initiatives in resource-limited settings and facilitate information and resource-sharing to strengthen healthcare systems, particularly in countries like India.
- Accessibility: The commercial sector and charitable organizations drive accessibility and affordability through innovation and technological advancements, especially in digital health, to extend reach and effectiveness.
- Research: Research institutes and academic institutions play a vital role in understanding health inequalities and evaluating intervention efficacy, contributing to evidence-based practices and policies supported by scientific research.
Conclusion:
There is need for a concerted effort from all sectors of society to tackle health equity issues and ensure that access to healthcare becomes a shared reality rather than a privilege. Also we need to have an inclusive and collaborative approach to address the root causes of health disparities and promote equitable health outcomes for all.
