Ibu Sanjeeb Garg
Beating the Rhetoric
The day after Diwali, Delhi woke up to a rude shock. Smog had enveloped the whole city making it difficult to breathe. The PM 2.5 particles were almost three to four times more than the accepted levels. Experts envisage that if Delhi does not get its act together soon it could see a situation akin to the Great London Smog that took the lives of thousands. The presence of the PM 2.5 particles is particularly harmful for children and the elderly. These particles enter the lungs and can result in a number of respiratory problems which increases the mortality factor quite considerably. While environmental concerns are being discussed in a broad manner, an issue that remains out of the limelight is India’s new emerging health challenges.
A globalised world has also become a more connected world where events affect a large number of human beings. While boundaries are transcended there is also cross border exchange of diseases and emergence of new forms of disease. And it is this threat that India is facing that challenges the traditional paradigm of health and disease. While Indian health infrastructure grapples with the basic issue of access and facilities, new challenges are emerging that policymakers have to face.
Today the Indian health profile is changing rapidly. As a large part of India moves to the urban areas, new challenges have emerged. Slowly, two different paradigms of health concerns are manifesting themselves. The rural populace of the country still grapples with the issue of malnutrition, arsenic mixed in water, anaemia among others. Nutritional issues concerning health are a major problem in the rural areas. In the urban areas the profile is slightly different. Urban India is beginning to see a rise in cardiovascular diseases, diabetes, respiratory problems among others. A large part of health problems in urban India can be attributed to the `lifestyle choices’ that are made and hence are non communicable in nature. Thus the health sector in India has to effectively combat this rising “Health Divide”.
Today the global boundaries have disappeared and so have boundaries that contained disease. Bird Flu, for example, was a disease that was hitherto unknown to India but has become a much focussed area in the past few years. During the past three decades more than 30 new organisms have been identified worldwide including HIV, Vibrio cholera O139, SARS, corona virus, highly pathogenic avian influenza virus A, and novel H1N1 influenza virus. Many of these organisms emerged in the developing countries of Asia. Every global outbreak of Bird Flu or Bovine Flu poses new challenges for the Indian health sector. While they have been effective in this fight till recent times, there is no guarantee that this resilience will sustain in the future. Hence there is urgent need to keep an eye on each emerging global health concern and prepare a roadmap to combat each disease effectively. India, which boasts of a phenomenal pharmaceutical industry, must also offer its expertise to global drug makers in times of need, even before a particular disease hits the Indian shores. This would ensure that should a disease or a health concern hit the boundary our drug makers are prepared to the extent possible to handle any eventuality.
While India has been able to effectively curb malaria, new forms of vector borne diseases have emerged that have posed new challenges to the health sector. Dengue and Chikungunya which were previously unknown in the Indian medical history have become major headache in the past few years. Dengue, for example, is witnessing a rapid increase in its profile. While a decade back dengue was restricted only to parts of Northern India, in recent times it has spread to the Eastern part of the country as well. In 2015, according to the WHO website, India reported close to 15,000 cases of dengue, the highest in a decade. On September 6, 2016 this figure stood at 19,704. This undoubtedly proves that newer diseases are posing newer challenges to the policymakers that they must address effectively.
As argued above, non communicable diseases pose a special challenge to the health of urban India. Today obesity and diabetes has become a regular occurrence in almost every major urban Indian household. If a person steps outside in order to break the monotony of a sedentary lifestyle, the polluted air increases the chance of respiratory diseases. Lifestyle habits have also increased the chances of cardiovascular diseases. Non communicable diseases account for 56% of deaths in urban areas. If we were to factor in other factors like road accidents, for example, this number would climb still higher. To counter threat of non communicable diseases however, infrastructure and doctors wouldn’t be able to provide the solution again. Awareness is one of the most vital weapons in the fight against urban non communicable diseases. Mental health for example is still an unexplored area. The people have to be made aware that mental health is of equal importance as physical health in the life of an individual. Sanitisation campaigns should be unveiled about food habits and the need for physical activities in a person’s life while setting up measures that would dissuade people especially children from certain kind of food should be encouraged. These steps would go a long way in improving the results of the fight against non communicable diseases.
Antimicrobial resistance demands a special mention in the fight to better India’s health profile. India’s global reputation took a major beating when in 2008 India’s name was attached to a super bug, the NDM-1. The New Delhi Metallo-beta-lactamase-1 was an enzyme that rendered bacteria resistant to a broad spectrum of antibiotics. A strain of the NDM-1 had crossed the shores and spread resistance to other countries as well. And slowly India woke up to this new challenge. In 2010 India was the largest consumer of antibiotics in the world. Years of over the counter prescription and medication without proper consultation had resulted in disastrous consequences rendering many drugs useless. Attempts are however being made to control this aspect, new bills have been introduced which have made procurements of certain kinds of drugs harder. New regulations have come in place which make the availability of Schedule –H drugs over the counter almost impossible. Further steps have to be taken in this regard while consistently evolving newer strategies to counter over the counter sell of antibiotics.
Despite the obvious challenges there is however no doubt that India has performed remarkably in the health sector. Diseases like polio have been wiped clean from the country through sustained efforts and people’s participation. Diseases like Smallpox and guinea worm have been eradicated; their last cases occurred in the country in May 1975 and July 1996 respectively. Yaws, which mainly occurs in remote tribal areas, has been eliminated. The average life expectancy in India has risen from 36.5 years in 1951 to 63.5 in 2011. Maternal Mortality Rates and Infant mortality rates have improved considerably as well. Today India boasts or world class medical education. Indian doctors and India’s medical facilities are recognised amongst the best in the world in affordable prices on a global level. In the past sixty years, India has demonstrated remarkable will in responding to the challenges of the health sector. In a similar spirit, it must focus itself towards combating the new forms of health concerns grappling its people.
(Views expressed by the author are entirely personal)