Recently, I witnessed an animated conversation between parents. The cost of everything has gone up, exclaimed one parent, referring to increasing costs of clothes, sweets and firework during Diwali. In a minute, however, the conversation moved to health, as another spoke about her child being at risk of an asthmatic attack during the festival season. Disconnected as it seems at first glance, these have something in common. And that is the ‘price’; one where the transaction is visible — where one buys things at a certain cost — and the other invisible — ill-health due to societal practices.
I want to elaborate on the second aspect. The survival needs of children include the ‘Right to health’, which is fundamental to their growth, development and progress. In the absence of reasonably good health and nutrition, a child’s cognitive development is impaired. The Indian progress card in child health is not something to be proud of. Disproportionate numbers of our children are underweight, not adequately immunised for age, suffer from malnutrition and take longer to get to a health facility when ill. Our track record in health should have been much better given the improvements in literacy and income. Social inequities and asymmetry of information has not only interfered with access to health services but also in the way we have shaped the wellbeing of India’s children and the future of our economy.
While measurements of morbidity and mortality are key considerations in estimating the burden of disease in populations, they provide an incomplete picture of the adverse impact of ill-health on human welfare. In particular, the economic consequences of poor health can be substantial. Analysis of the economic impact of ill-health addresses a number of policy questions concerning the consequences of disease or injury. Some of these relate to the microeconomic level of households, industry or government — such as the impact of ill-health on a household’s income or a industry’s profits — while others relate to the macroeconomic level, including the aggregate impact of a disease on a country’s current and future gross domestic product (GDP).
There is a price attached to realising ‘health for all’. It will be unrealistic to expect individual families alone to meet this resource need especially in a country where significant sections of society live in poverty. India, like most countries, has affirmed children’s fundamental right to health by signing the UN convention on the right of the child. Can this goal of giving a healthy start to life to all children be realised?
It can, but it won’t happen by itself. Reaching the excluded and most vulnerable children will be critical in building healthy communities. We are living in a time of unprecedented opportunities for health. Despite many challenges, technology has made important advances and international investment in health has at last begun to flow a little. In 2009, the WHO coordinated an effort to estimate the costs of strengthening health systems in 49 low-income countries in order to scale up service provision to move more rapidly towards the health MDGs. The estimated cost suggests that average health expenditures should reach at least $54 per capita. Investments could then reach a total of 21 hospital beds per 10,000 population and 1.9 nurses and midwives per 1,000 population, with significant mortality reductions of 23 million deaths from 2009 to 2015. The estimated price tag to ensure that a child is healthy in India is $ 54 or around Rs. 3500 a child a year, Rs.300 a month, Rs.10 a day.
I would like our collective voices to be amplified in asking our government, industry and communities: To take a step in the right direction by investing more in the health of all children.
Kezevino Aram is Director, Shanti Ashram