The Indian government launched the Pradhan Mantri Atmanirbhar Swasth Bharat Yojana with an allocation of ₹65,560.99 crore to proactively identify gaps in dealing with challenges posed by Covid-19-like pandemics, epidemics and disasters in future. The Yojana, said Health Minister Harsh Vardhan, will focus on pandemic management through investments in research, healthcare and public health infrastructure. He announced this on the first day of the Monsoon Session of the Lok Sabha on 14 September 2020.
Following the onset of Covid-19, the world is much more dynamic and unpredictable. India, the second-most populated and home to nearly a fifth of the world’s population has been experiencing rapid changes in her socio-economic segments.
It’s imperative that all sections of the society stay healthy and policies and laws focus on public health issues to benefit all segments of the society. It is a given that India won’t be able to realise its true growth potential if its youth – about 65 crore below the age of 25 – is unable to contribute adequately and participate productively in nation building.
The challenges are immense but not unsurmountable as India braces to meet them with panache and grit in the years ahead.
India’s public health issues
In the public health space, India faces several unique challenges and innumerable new opportunities too to boot. In the decade gone by, India has fared much better in the various markers of development due to economic growth and simultaneous reduction in poverty.
In the public health sphere, World Bank data reveals, in the period from 2000 to 2015, ‘infant mortality in India fell from 66 to 38 per 1,000 live births; life expectancy at birth increased from 63 to 68 years; and maternal mortality ratio fell from 374 to 174 per 100,000 live births.’ The health sector in India has made significant improvements in the last few decades. Life expectancy has crossed 67 years and the rate of disease incidence too has been declining. Several dreaded diseases such as polio, guinea worm disease, tetanus, etc., have been successfully eradicated.
Certain diseases continue to pose challenges in India and remain major public health problems. These include communicable diseases; endemic diseases such as HIV/AIDS, tuberculosis, malaria; and vector-borne diseases such as dengue and acute encephalitis syndrome. Sadly, with the thrust restricted to COVID-19 related issues, most of these diseases have not been addressed in the last six months leading to a spike in numbers.
Lifestyle-related diseases need to be checked
India, however, is bracing for a different public health crisis today. Even amidst the entire COVID-19 pandemic, ironically it’s the non-communicable diseases that are the leading cause of death in the country — 60 per cent of deaths in India. Of these, heart diseases, diabetes, cancers and chronic pulmonary diseases make up for nearly 80 per cent of the deaths.
All these four major causes of death due to non-communicable diseases share common lifestyle-related health risk factors: tobacco, alcohol, unhealthy diet and lack of physical activity. In the years to come India, just like the rest of the developing and developed countries will have to tackle these major national health security threats.
Another disease that’s crippling the nation is obesity. Sedentary lifestyle, unhealthy food habits, lack of physical activity are the major cause of obesity. Latest studies have revealed ‘the prevalence of overweight and obesity has increased rapidly in recent decades in India’. There is a direct correlation between obesity and many non-communicable diseases like coronary heart diseases, diabetes, etc.
Obesity is an urban phenomenon. Given, more than 31 per cent of the country’s 1.3 billion population resides in cities, time has come for a national health policy to curb the increase in such non-communicable diseases.
India’s COVID-19 crisis
India is also faring much better than most countries, including many western nations. Till mid-September 2020, India stood at 61st position and reported 58.94 deaths per million. Compare this with Germany’s 112.81 deaths per million, Russia’s 128.16 deaths per million, Canada’s 248.79 deaths per million, France’s 459.19 deaths per million, Italy’s 589.26 deaths per million, USA’s 591.43 per million and the UK’s 626.09 deaths per million.
India has managed to keep COVID-related recovery rates higher and the fatality rates lower than most countries in the world. Still, the COVID-19 crisis has exposed Indians to the vulnerability and fragility of the human body. Preventive healthcare has taken precedence and Indians are now opting for healthier lifestyles.
Pandemic exposed malpractices
The COVID-19 crisis also exposed certain malpractices in the healthcare industry. Even as the nation celebrated the frontline medical workers i.e. the doctors who were risking their lives to protect the country, there were far many medical practitioners who chose to shut shop and stay back at home instead.
For the entire duration of the lockdown, many doctors shut down their clinics and stayed at home, depriving patients of medical care and evading their primary duty as a doctor. This, despite the State constantly cajoling them to attend to the crisis, even paying them well. Many senior citizens, those with serious illnesses and with emergency needs were left unattended and in need of medical attention.
Not only that, at a time when the country was facing a shortage of face masks and hand sanitisers, many chemists and pharmacies resorted to selling these essential items at hiked prices taking advantage of the situation. The government had to issue notifications to cap the prices even crack down on the offenders.
Similarly, there were many pathology labs and diagnostic centres that remained shut during the lockdown. Diagnostics is an essential part of healthcare and plays a crucial role in the management of diseases, even critical ones. Depriving the patient of access to diagnostics especially at such trying times is nothing short of medical negligence.
Lessons learnt from COVID-19 outbreak
“In our country about 92 per cent of the cases are reported to be having mild disease. In only about 5.8 per cent of cases oxygen therapy is required, and the disease may be severe enough to require intensive care in only 1.7 per cent cases,” stated Health Minister Harsh Vardhan. The going for India doesn’t seem to be as bad as has been for the rest of the world. It was at the very onset of the COVID-19 outbreak that India went into an immediate and total lockdown. The essential service providers were stepping out to ensure life for the remaining population was not disrupted and supply of essential items and services continued unabated.
At the same time, healthcare providers, civic health workers, government health officials, scientists and researchers worked endlessly to tend to COVID-affected patients. The most important lesson learnt being: In the absence of a vaccine and to prevent one from unknown ‘deadly’ infections in the future, the best remedy remained a strong immune system.
“I keep telling my patients that prevention is the best cure when it comes to diseases like COVID-19. It’s so difficult to understand this virus and the symptoms keep changing. We may get a vaccine sooner than later but the fear of another outbreak looms large and the best defence is that as a nation we work towards improving individual health and immunity,” says Mumbai-based general physician Dr. Sneha Shetty.
During the lockdown, many Indians quickly resorted to home remedies and the good ol’ grandmother’s kadha (decoction) to boost their immunity. “It was extremely scary to see the news every day. Cases of infections were increasing like wildfire and in some countries, people were dropping dead as if it were the apocalypse. It was then I started preparing the herbal decoction with tulsi, turmeric, cinnamon, pepper and dry ginger for my family to strengthen their immunity,” says Bengaluru-based homemaker Meenakshi Moudgil.
India has learnt her lessons and a new India is making significant changes in healthcare. Indians are changing their lifestyle and adopting healthy practices such as more physical activity, healthy eating, meditation, pranayama, and yoga. It’s like a home-coming of sorts for them all.