Common Man Uncommon

Problems

Ratan JalanFeb 4, 2011

Common Man

Common Man

His 'Common Man' with his unchanging dhoti and checkered shirt and a perpetually bewildered expression symbolizes the mute millions of India.

The 'Common Man' who finds that the leaky tap in the bathroom is of greater concern to him than the failure of the summit, or the rise in the cost of toothpaste and tomatoes is more bothersome than the deficit in our foreign exchange reserves.

Laxman says that like most Indians, the Common Man sees his country being forced through endless indignities by its leaders and yet doesn't even whimper in protest. He has perfected being docile as a survival strategy.

Common Man

poor not so poor very poor not so rich middle class lower middle class middle-middle class rural urban semi-urban literate illiterate scholar modern traditional in Bihar in Kerala public servant servant public has a two wheeler has a Nano

Needs health needs healthcare needs care

Indian Healthcare : Golden Era

Estimates of the value of medical tourism to India go as high as $2 billion a year by 2012. Today, leading hospitals in India get patients from developed countries such as US, Canada and UK, who demand world-class clinical outcome.

The Indian government is taking steps to address infrastructure issues that hinder the country's growth in medical tourism.

Dr Sanjay Gupta : Surgeon General of the United States

Problems. Problems. And Problems.

“Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane", said Martin Luther King.

Sanitation

Some 665 million Indians practice open defecation, more than half the global total. More unsettling, 17 percent of city residents, or 50 million people, don’t have toilets.

“India cannot reach its full economic potential unless they do something about this sanitation crisis,” says Clarissa Brocklehurst, Unicef.

Drinking Water

Over 21% of transmissible diseases in India are related to unsafe water. In India, 1600 children will die today from lack of clean water.

The New Delhi Jal Board supplies just over 30 million cubic meters per day, but only 17 million cubic meters actually reach consumers due to infrastructure problems, such as leaking pipes.

“If the country continues with a business as usual mentality the consequences will be drastic. India could become the stage for major international water wars because so many rivers that originate in India supply water to other countries.”, Nina Brooks, The Arlington Institute.

Nutrition

Under-nutrition is insidious — it sucks the life out of kids before clinical signs show. Moreover, malnourished children are more susceptible to diarrheal disease, and with more diarrheal disease they become more malnourished.

It is such a huge burden : 43 per cent of children are malnourished.

“If current rates of progress in reducing under-nutrition are not improved upon, India will reach the U.N. Millennium Development Goal of halving under-nutrition by 2043. The target date is 2015.”, says Prof Lawrence Haddad.

Immunization

On an average, 35% of infants are not fully immunized, but this is as high as 90% in Bihar and 81% in Uttar Pradesh.

Nationally, almost 6.5 million infants drop out between BCG and measles annually. Of these, 57% are in five states: Andhra Pradesh, Bihar, Rajasthan, Uttar Pradesh and West Bengal.

When it comes to adult Immunization, it is widely known that 90% of Delhi population still needs to be vaccinated against Hepatitis B Virus.

Public Health Infrastructure

Delhi health minister’s statement that hospitals need to be stricter to prevent patients from fleeing misses the point entirely.

40% of nurses and doctors in public health centers are absent from their posts . And patients who usually come here are too needy and too ignorant to complain about the lack of facilities.

"We have found health centre staff in Uttar Pradesh demanding money from poor women for delivery. Many were turned away from the centres and were forced to give birth on the road or the hospital compound," said JashodharaDasgupta of Health Watch, a network of activists.

Medical Education

With people-doctor ratio six times lower in rural India in comparison to cities, the central government on Thursday said it will produce 145,000 rural doctors through a truncated medical course designed after the Chinese "barefoot doctors".

India has one doctor for 1,700 people. The US has one doctor for 324 persons.

Even if 5,000 new doctors come up every year, it will take 19 years before we can bring the number up to one doctor per thousand population. What is worse, we have very few specialists.”, said Dr S K Sarin, Chairman, the Board of Governors , MCI

Pharmaceuticals

One in every four medicinal drugs that you buy in the country is spurious or fake or substandard. The size of the fake pharma industry is about Rs 4,000 crore, or 20 per cent the size of the legitimate one.

Worse, India has emerged as a major global producer of spurious drugs, accounting for a third of the world's fakes.

“Today we have a range of fake medicines. The rate at which fake drugs is flooding our markets, diseases will never get cured.“, says Dr PremAggarwal, IMA General Secretary

Obesity

Currently, almost 1 in 5 men and over 1 in 6 women are overweight. In urban areas, the rates are as high as 40%.

Obesity is the root for several non-communicable diseases. Nearly 70% of all deaths will be from non-communicable diseases like cancer, diabetes, and respiratory and heart disease.

“Five years ago obesity and diabetes were limited to India's most affluent. But, now poor Indians also are getting fatter. It is such a paradox”. says Dr Anoop MisraDirector of diabetes and metabolic disease at Fortis Hospital.

Every sixth diabetic in the world is an Indian, making the country the world's diabetes capital. It is expected to reach 73.5 million by 2025. In cities such as Chennai and Hyderabad,about 16% of the population is diabetic.

The total annual cost to treat India’s diabetic patients is estimated at Rs 20,000 per person.

Diabetes

“The diabetes time bomb has been ticking for 50 years. Despite the warning, successive generations of world leaders have largely ignored the threat. Diabetes has now exploded with the force felt greatest in the India,”, says Martin Silink, President-Elect, International Diabetes Federation.

Geriatric Care

The likely number of the elderly by 2016 will be around 113 million, approx 10-12 percent of entire population.

Diseases in this age group are frequently under identified and under treated, until the condition has progressed to advanced stages. Therefore, the aged often have multiple medical disorders to contend with.

“A proper healthcare system for the elderly remains largely non-existent in India, where healthcare spend is one of the lowest in the world and priority would be given to patients from other 'more productive' age groups.”, says Ranjit Kapadia, Head Research (PCG), Prabhudas Lilladher

Mental Health

Experts say In more than 70 per cent of the cases, mental disorders, particularly depression, lead to suicides.

Every year 1.25 lakh people in the country commit suicide. Some 4 lakh who attempt to end their life survive to tell the sorry tale.

We have to address the issues of stigma attached to the mental illnesses and the rights of mentally ill people in society. Equally worrying is the fact that the mental health trained personnel are quite limited, and these are mostly based in urban areas., says Dr S K Khandelwal, AIIMS

Emergency Services

About 1.15 lakh people died in accidents on Indian roads in 2007 alone, which equates to more than 13 deaths an hour. The WHO report calls this an epidemic and rightly so!

Death Rate per Ten Thousand Vehicles is 2 persons in USA, 32.5 persons in Pakistan, 140 persons in India. Delayed availability of care is one of the leading causes for maternal and cardio vascular deaths.

“Available emergency services are not sufficient to meet the demand. The state of trauma care in the country requires trauma care.” says Mr Venkat Changavalli, former CEO, EMRI

Ayurveda

Association of AyurvedicProfessionals of North America has a vision to bring the healing science of Ayurveda and its modalities to the forefront of integrative medicine in the West.

The German translation of an ayurvedic text that dates back to less than 1000 B.C.E., the Susruta Samhita, contributed to modern medicine the discipline of plastic surgery.

Only 11% of the population has any form of health insurance coverage. Health insurance industry is growing at 50 per cent and is projected to grow to over Rs 40,000 crore in five years.

Arogyasri in Andhra Pradesh, Yeshasvini in Karnataka and Chiranjeevi in Gujarat are some of the state run insurance schemes for the common man

Insurance

“RSBY is a truly unique model. As the insurance company's money is up for liability, this scheme is free from the moral hazards of corruption that government policies usually comprise.“, says Gurcharan Das, a noted thought leader.

Ethics in Healthcare

“In the lab diagnostics business, referral fee is the biggest cost component for a lab.”, says Dr Om Manchanda, CEO, Dr Lal’s Lab

Indians pay bribes worth Rs 2,728 crore annually. The report finds that the of the public sectors surveyed the health and education sectors were the most corrupt.

The popularly known ‘cut practice’ is perhaps as common as practice itself.

Prevention

Quite frankly, prevention is no one’s business. For the vast majority, it is evident that ‘if the disease does not kill them, the treatment will.”

Even richer nations today are finding that they cannot bear the burden of healthcare expenditure. Prevention is the only viable route.

“Wealth is health.”, seems to be the mantra for today’s generation.

The Road Ahead

It will take time but as was said years ago, “A journey of a thousand miles begins with a single step.”

My idealism continues.