Shaping India’s path to inclusive health care

India’s health equity issues require a comprehensive approach that go beyond improvements in health-care facilities

Updated - April 08, 2024 09:18 pm IST

Published - April 08, 2024 01:36 am IST

‘With a large and diversified population, India faces persistent obstacles to health equity’

‘With a large and diversified population, India faces persistent obstacles to health equity’ | Photo Credit: Getty Images

World Health Day, which is observed every year on April 7, unites us around health equity, an essential topic at the heart of global health and justice. The World Health Organization (WHO) has declared health to be a fundamental human right. The theme this year is “My Health, My Right”.

There is an alarming gap in health-care access, highlighted by the COVID-19 epidemic, environmental crises, and growing socio-economic gaps. Even though over 140 nations recognise health as a constitutional right, the WHO Council on the Economics of Health for All reports that more than half the world’s population needs complete access to essential health services. With the passage of World Health Day 2024, it is clear that promoting health equity is a source of optimism for millions of people, going beyond social justice or legislative change.

The meaning of health equity

Health equity ensures that every person has an equal opportunity to achieve their highest health potential, no matter what their circumstances. Recognising that social, economic, and environmental factors impact health outcomes, this idea goes beyond genetics. WHO’s mission is to eliminate unfair and preventable disparities in health among different social and economic categories.

True health equity addresses the root causes of health inequities such as poverty, discrimination, limited access to high-quality education, a healthy diet, clean water, fresh air, and housing, and merely grants equal access to health care. For example, a child born into poverty in a rural area has no access to clean water, wholesome food, or immunisations, which lays the foundation for chronic health problems.

These differences are made worse by pandemics, climate change, and sociopolitical unrest. India is diverse and has wide socioeconomic gaps. Thus this predicament strikes a chord. Access to health care in rural areas is significantly less than in metropolitan areas. Social and economic barriers exacerbate this disparity.

To guarantee that everyone may live a healthy life, attaining health equity necessitates a comprehensive strategy that goes beyond legislative reform to address the socioeconomic determinants of health. Realising each person’s potential for health demands a concerted effort by governments, communities, and individuals to tear down these obstacles.

The road to health equity is fraught with difficulties, ranging from deeply ingrained social injustices to global systemic health concerns, particularly in multicultural countries such as India. Diverse populations need help to get access to high-quality health care in this place.

The global challenges are: The fight for health equity confronts global challenges that transcend borders and call for collective international action. The COVID-19 pandemic has starkly revealed that infectious diseases target marginalised and vulnerable groups the most, thus widening the health equity gap. Climate change poses a serious health risk since it disproportionately impacts low-income and vulnerable people. The health-care provision is severely hampered by conflicts, which destroy infrastructure, uproot communities, and shut off access to vital medical services.

India’s health equity challenge

With a large and diversified population, India faces persistent obstacles to health equity, including notable differences in health-care outcomes and access. Even though access to health care has improved over the past 20 years, there is still much work to be done in rural India. According to the 2011 Census, urban slums make up over 17% of India’s metropolitan areas, and exhibit serious health disparities. Health risks are increased by overcrowding, poor sanitation, and restricted access to clean water. Infectious diseases, such as tuberculosis, are 1.5 times more common in slums than in non-slum areas, according to the Indian Council of Medical Research.

Disparities across caste and gender are profound. National Family Health Survey (NFHS)-5 (2019-21) data indicates that Scheduled Castes and Scheduled Tribes experience higher child mortality and lower immunisation rates. Additionally, 59% of women in the lowest wealth quintile suffer from anaemia, almost double the rate in the highest quintile, demonstrating the intersection of caste, gender, and economic status in health outcomes.

Non-communicable diseases (NCDs) account for more than 60% of all fatalities in India. The Public Health Foundation of India points out the necessity for equitable treatment access and preventive health care, stating that the economic effect of NCDs could surpass $6 trillion by 2030.

A critical shortage of doctors exacerbates these issues, with WHO data indicating only 0.8 doctors per 1,000 people, which is below the advised ratio. Even though over 75% of health-care professionals work in metropolitan regions, which only account for 27% of the population, the shortage is particularly severe in rural areas. If other medical practitioners are considered, the ratio might be balanced.

India’s health equity issues require a comprehensive approach beyond improvements in health-care facilities to address more extensive socioeconomic determinants of health. To move India toward universal health coverage and a more equitable future, the government, civil society, health-care providers, and communities need to work together.

Governments and officials may influence the state of health through funding, creative policies, and laws. For instance, India’s Ayushman Bharat initiative provides free health coverage to the bottom 40% economically, demonstrating a commitment to reducing health disparities.

The National Health Mission (NHM), which includes both the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), reduces the health-care gap between rural and urban India by expanding access, strengthening infrastructure, and providing essential services to vulnerable populations.

Achieving health equity requires raising health literacy. India should turn health equality into a shared, community-driven goal by including health education in the NHM, enabling its people to seek equitable care and make educated health decisions.

Together with the government, the public and private health-care sectors provide services to underprivileged communities, emphasising preventive education, workforce development, and infrastructure enhancement.

Non-governmental organisations and civic societies engage in direct community outreach to draw attention to and resolve regional health concerns. Their collaboration with international and governmental organisations allows them to tailor health initiatives that are culturally sensitive to the community’s unique needs.

International institutions such as WHO, the Global Fund, and Gavi support health initiatives in places with limited resources and promote sharing information and resources to enhance health-care systems, especially in countries such as India.

Through innovation and technical growth, particularly in digital health, the commercial sector and charitable organisations advance accessibility and affordability while extending reach and efficacy.

Research institutes and academic institutions offer crucial insights into health inequalities and the efficacy of interventions, assisting in creating evidence-based practices and policies supported by scientific studies.

Tap these organisations

Organisations with a strong local presence are essential for health equity. They actively participate in every phase, from planning to evaluation, to guarantee the relevance and effectiveness of health programmes. They also have a thorough understanding of their community’s requirements.

Successful collaborations, essential for achieving health equity, depend on open communication, respect for one another, and common goals. They are prepared to adapt to shifting health concerns and community demands because they strongly emphasise empowering communities, sharing knowledge, and building capacity.

Effective collaboration among many sectors, ranging from policymakers to grassroots organisations, may significantly enhance health equity and pave the path for a time when access to high-quality health care would be a shared reality rather than a privilege.

Dr. K. Madan Gopal is an Adviser in Public Health Administration, National Health Systems Resource Centre and a former Senior Consultant with NITI Aayog. Professor Dr. Suneela Garg is Chair of the Programme Advisory Committee, National Institute of Health and Family Welfare, Ministry of Health and Family Welfare, New Delhi. Dr. K.S. Uplabdh Gopal is a health-care professional. The views expressed are personal.

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