Health in India
![](http://upload.wikimedia.org/wikipedia/commons/thumb/b/bf/Life_expectancy_development_in_India.svg/220px-Life_expectancy_development_in_India.svg.png)
![](http://upload.wikimedia.org/wikipedia/commons/thumb/2/22/Child_mortality_rate_in_India.png/220px-Child_mortality_rate_in_India.png)
India's population in 2021 as per World Bank is 1.39 billion.[1] Being the world's most populous country and one of its fastest-growing economies, India experiences both challenges and opportunities in context of public health. India is a hub for pharmaceutical and biotechnology industries; world-class scientists, clinical trials and hospitals yet country faces daunting public health challenges like child undernutrition, high rates of neonatal and maternal mortality, growth in noncommunicable diseases, high rates of road traffic accidents and other health related issues.
The Human Rights Measurement Initiative[2] finds that India is fulfilling 80.5% of what it should be fulfilling for the right to health based on its level of income.[3] When looking at the right to health with respect to children, India achieves 92.1% of what is expected based on its current income.[3] In regards to the right to health amongst the adult population, the country achieves only 85.6% of what is expected based on the nation's level of income.[3] India falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 63.7% of what the nation is expected to achieve based on the resources (income) it has available.[3]
Major health indicators
The life expectancy at birth has increased from 49.7 years in 1970–1975 to 67.9 years in 2010–2014. For the same period, the life expectancy for females is 69.6 year and 66.4 years for males. In 2018, the life expectancy at birth is said to be 69.1 years.[4]
The infant mortality rate has declined from 74 per 1,000 live births in 1994 to 37 per 1,000 live births in 2015. However, the differentials of rural (41) and urban (25) as of 2015 are still high. In 2016, the infant mortality rate was estimated to be 34.6 per 1,000 live births.[4]
The under-five mortality rate for the country was 113 per 1,000 live births in 1994 whereas in 2018 it reduced to 41.1 per 1,000 live births.[4]
The maternal mortality ratio has declined from 212 per 100 000 live births in 2007–2009 to 167 per 100 000 live births in 2011–2013. However, the differentials for state Kerala (61) and Assam (300) as of 2011–2013 are still high. In 2013, the maternal mortality ratio was estimated to be 190 per 100 000 live births.[4]
The total fertility rate for the country was 2.3 in rural areas whereas it has been 1.8 in urban areas during 2015.
The most common cause of disability adjusted life years lost for Indian citizens as of 2016 for all ages and sexes was ischemic heart disease (accounting for 8.66% of total DALYs ), 2nd chronic obstructive pulmonary disease (accounting for 4.81% of total DALYs), 3rd diarrhea (accounting for 4.64% of total DALYs) and 4th lower respiratory infections (accounting for 4.35% of total DALYs).[5]
As per the figures about the child mortality rate which is quite a big hurdle for the government, the 2nd most common cause of DALYs lost for children under 5 years of age was diseases like diarrhea, lower respiratory tract infections and other communicable diseases (accounting for 22,598.71 DALYs per 100 000 population) as of 2016 which can be preventable.[5]
Health issues
Oral Health in India
Oral health refers to optimum functioning of mouth (smile, swallow, chew, taste, etc.), proper dentition and ability to perform various movements of facial muscles, jaws and other orofacial structures without pain and discomfort.
Status of oral health both affects and gets affected by specific systemic health conditions. Many systemic diseases, such as; diabetes, can be suspected by examining oral signs and symptoms. Poor oral health is also a risk factor of cardio-vascular diseases, stroke, digestive issues, pre-term birth, low birth weight, preeclampsia etc. [6]
According to Global Oral Health Status Report: Towards Universal Health Coverage for Oral Health by 2030 (WHO report), Globally, oral diseases affect 3.5 billion people and every three out of four people lives in middle-income countries. In India, there has been a steady increase in the burden of oral diseases since last two decades.[7] High prevalence of dental caries is notable among children and adults, due to high sugar consumption. It subsequently leads to high prevalence of periodontal diseases and edentulism.
Squamous cell carcinoma is the most usual form of oral cancer in India and primarily affects middle age population (31–50 years). Epidemiologically, Kerala has the lowest and West Bengal has the highest incidence of oral cancer. For India, self-examination is the most effective method for early diagnosis of oral cancer.[8]
Risk factors for all kind of dental diseases includes; High dietary sugar, areca nut, alcohol and tobacco (gutkha, khaini, mawa, etc.) consumption, smoking, etc.[9]
![](http://upload.wikimedia.org/wikipedia/commons/thumb/b/b4/Desolater_Gebisszustand%2C_2020-2.jpg/220px-Desolater_Gebisszustand%2C_2020-2.jpg)
![](http://upload.wikimedia.org/wikipedia/commons/thumb/a/a1/Lower_lip_cancer.jpg/220px-Lower_lip_cancer.jpg)
According to the WHO 'oral health country profile' below is the prevalence of main oral health issues:[10]
Oral Health Issue | Prevalence (%) |
---|---|
Untreated caries of deciduous teeth in children (1–9 years) | 43.3 |
Untreated caries of permanent teeth in people (5+ years) | 28.8 |
Severe periodontal disease in people (15+ years) | 21.8 |
Edentulism in people (20+ years) | 4 |
Header text | Male | Female | Total |
---|---|---|---|
Number of new cases | 104,661 | 31,268 | 135,929 |
Incidence rate (%) | 14.8 | 4.6 | 9.8 |
Risk Factor | Male | Female | Total |
---|---|---|---|
Per capita availability of sugar (g/day) | .... | .... | 53.8 |
Prevalence of current tobacco use, 15+ years (%) | 42.4 | 13.7 | 28.1 |
Per capita alcohol consumption, 15+ years (litres of pure alcohol/year) | 9.1 | 1.9 | 5.6 |
Root Issues
However, the number of dentists in 2011 was 117,825 and approximate number for 2020 is 309,700, but still, majority people are devoid of proper dental treatment. Reasons for this gap, 1) unequal distribution of dentists in urban (70%) and rural (30%) areas, 2) 90% services provided by private practitioners and only 10% through the government settings, and 3) Negligeable % of insurance coverage for dental treatments. As a result, oral diseases cause high economic burden.[11]
Possible solutions[6]
- Limit sugar, tobacco, alcohol and araca nut consumption through awareness programs
- Promotion of the use of fluoride containing toothpaste
- Oral health promotion programs
- Public-Private partnership
- Well-structured oral health surveys
- Integration of oral health with medical health
Malnutrition
Malnutrition refers to deficiencies, excesses or imbalances in a person's intake of energy and/or nutrients. The term malnutrition covers 2 broad groups of conditions. One is undernutrition – which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). The other is overweight – overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and cancer).[12]
According to a 2005 report, 60% of India's children below the age of three were malnourished, which was greater than the statistics of sub-Saharan African of 28%.[13] World Bank data indicates that India has one of the world's highest demographics of children suffering from malnutrition – said to be double that of sub-Saharan Africa with dire consequences. India's Global Hunger Index India ranking of 67, the 80 nations with the worst hunger situation places it even below North Korea or Sudan. 44% of children under the age of 5 are underweight, while 72% of infants have anemia.[14] It is considered that one in three malnourished children live in India.
States where malnutrition is prominent:[14]
- Uttar Pradesh: Most children here, in India's densest state by population, under the age of 5 are stunted due to malnutrition.
- Tamil Nadu: The state, despite high education, has a prominent child malnutrition problem. A National Family Health Survey reveals that 23% of children here are underweight, while 25% of Chennai children show moderately stunted growth.
- Madhya Pradesh: 2015 data reveals that Madhya Pradesh has India's highest number of malnourished children – 74.1% of them under 6 suffer from anemia, and 60% have to deal with malnutrition.
- Jharkhand and Bihar: At 56.5%, Jharkhand has India's second highest number of malnourished children. This is followed by Bihar, at 55.9%.
Forms
- Protein–energy malnutrition (PEM): also known as protein-calorie malnutrition
- Iron-deficiency: nutritional anemia which can lead to lessened productivity, sometimes becoming terminal
- Vitamin A deficiency: which can lead to blindness or a weakened immune system
- Iodine deficiency: which can lead to serious mental or physical complaints
- Vitamin B complex deficiency: can lead to insufficient birth weight or congenital anomalies such as spina bifida.[15][16]
In children
Condition | Prevalence % |
---|---|
Low birth weight | 22 |
Kwashiorkor/Marasmus# | <1 |
Bitot's spots# | 0.8–1.0 |
Iron deficiency anaemia (6–59 months) | 70.0 |
Underweight (weight for age)* (<5 years)# | 42.6 |
Stunting (height for age)* (<5 years)# | 48.0 |
Wasting (weight for height)*# | 20.0 |
Childhood overweight/obesity | 6–30 |
* : <Median -2SD of WHO Child Growth Standards
# : NNMB Rural Survey – 2005–06
A well-nourished child is one whose weight and height measurements compare very well within the standard normal distribution of heights and weights of healthy children of same age and sex.[17] A child without sufficient nutrients in its daily intake is not only exposed to physical and motor growth delays, but also to heightened risk of mortality, reduced immune defenses and decreased cognitive and learning capacities. Malnutrition limits the productivity of all those who are its victims, and thus serves to perpetuate poverty. As with serious malnutrition, growth delays also hinder a child's intellectual development. Sick children with chronic malnutrition, especially when accompanied by anemia, often have a lower learning capacity during the crucial first years of attending school.[15]
In adults
Condition | Unit | Males | Females | ||||
---|---|---|---|---|---|---|---|
Urban | Rural# | Tribal^ | Urban | Rural# | Tribal^ | ||
Chronic energy deficiency (BMI <18.5) | % | 33.2 | 40.0 | 36.0 | 49.0 | ||
Anaemia in women (including pregnant women) | % | 75 | |||||
Iodine deficiency - Goitre | millions | 54 | |||||
Iodine deficiency – Cretinism | millions | 2.2 | |||||
Iodine deficiency – Still births (includes neo-natal deaths) | 90,000 | ||||||
Obesity related chronic diseases (BMI >25) | % | 36.0 | 7.8 | 2.4 | 40.0 | 10.9 | 3.2 |
Hypertension | % | 35.0 | 25.0 | 25.0 | 35.0 | 24.0 | 23.0 |
Diabetes mellitus (year 2006) | % | 16.0 | 5.0 | 16 | 5.0 | ||
Coronary heart disease | % | 7–9 | 3–5 | 7–9 | 3–5 | ||
Cancer incidence rate | per million | 113 | 123 |
* : <Median -2SD of WHO Child Growth Standards
# : NNMB Rural Survey – 2005–06
^ : NNMB Tribal Survey – 2008–09
Due to their lower social status, girls are far more at risk of malnutrition than boys of their age. Partly as a result of this cultural bias, up to one third of all adult women in India are underweight. Inadequate care of these women already underdeveloped, especially during pregnancy, leads them in turn to deliver underweight babies who are vulnerable to further malnutrition and disease.[18]
Obesity
Obesity in India has grown to epidemic levels in India in the 21st century, with morbid obesity affecting 5% of the population.
One factor that may impact the rise of obesity in India is the growing establishment of fast-food and mithai shops within India. Fast-food is among one of India's largest growing markets, especially amid the COVID-19 pandemic where it saw tremendous growth due to the speed of service and no-contact model. Moreover, the rise of food-delivery apps such as Zomato and Swiggy in India has allowed access to fast-foods on an unparalleled level in India. By increasing the ease of access to such unhealthy foods, Indians are more likely than ever before to choose such options rather than cooking at home. In 2021, the most ordered-foods on Swiggy were biryani and paneer butter masala, both of which are highly fattening when ordered from restaurants.[19] Such delivery apps also use what some may consider predatory business tactics to hook customers on to their services. First time customers are offered a month's worth of free delivery and discounts to build their reliance on delivery apps, so even after the trial ends the customers continue paying and ordering food. Even prior to COVID and online food ordering services, fast food has been readily available around the streets of Indian cities, just minutes away from most residential areas. Ever since McDonalds entered India in 1996, numerous fast food chains have followed suit including Dominos, Pizza Hut, Burger King, and KFC.[citation needed]
Communicable diseases
Diseases such as dengue fever, hepatitis, tuberculosis, malaria and pneumonia continue to plague India due to increased resistance to drugs.[20]
![](http://upload.wikimedia.org/wikipedia/commons/thumb/1/16/Morbidity_Communicable_Diseases_-_2016.jpg/440px-Morbidity_Communicable_Diseases_-_2016.jpg)
![](http://upload.wikimedia.org/wikipedia/commons/thumb/b/bc/Mortality_Communicable_Diseases_-_2016.jpg/440px-Mortality_Communicable_Diseases_-_2016.jpg)
In 2011, India reported a 'totally drug-resistant' form of tuberculosis .[21] India is the highest TB burden country in the world in terms of absolute number of incident cases that occur each year.[22] TB primarily affects people in their most productive years of life. While two-thirds of the cases are male, TB takes disproportionately larger toll among young females, with more than 60 per cent of female cases occurring by the age of 34 years. In 2018, the TrueNat test, an indigenously developed technology under the "Make in India" initiative, was deployed in about 350 PHCs. This led to marked increase in access to highly sensitive molecular tests with augmented capacity for resistance testing at the peripheral level.[23]
HIV/AIDS in India is ranked third highest among countries with HIV-infected patients. National AIDS Control Organisation, a government apex body is making efforts for managing the HIV/AIDS epidemic in India.[24] Diarrheal diseases are the primary causes of early childhood mortality.[25] These diseases can be attributed to poor sanitation and inadequate safe drinking water.[26] India has the world's highest incidence of rabies. Malaria has been a seasonal health problem in India from a very long time. The maximum number of malaria cases and deaths have been reported mostly form the rural parts of Orissa. The overall prevalence of the disease has diminished in 2012 and 2013 however there is a slight increase in 2014 and again started decreasing from 2015. WHO (World Health Organization) adopted a strategy in May-2015, that provides a technical guidance to countries emphasizing the importance of scaling up malaria responses and moving towards elimination of malaria. This is known as The Global Technical Strategy for Malaria (2016-2030) [27]. A major scale-up of malaria responses will not only help countries reach the health-related targets for 2030, but will contribute to poverty reduction and other development goals.
Kala-azar is the second largest parasitic killer in the world. Most of the cases (76%) were found in Bihar in 2016. Dengue and chikungunya transmitted by Aedes mosquitoes, is another problem of concern in India. Dengue outbreaks have continued since the 1950s but severity of disease has increased in the last two decades. In 2016, India reported a total of 58,264 cases of chikungunya. Chicken pox is a highly contagious and a viral infection which breaks out in many parts of India.[28] Cases were reported to be 61,118 & deaths to be 60 in 2016.
In 2012, India was polio-free for the first time in its history.[29] This was achieved because of the Pulse Polio programme started in 1995–96 by the government.[30]
![](http://upload.wikimedia.org/wikipedia/commons/thumb/a/ab/IHME_NCD_India_Incidence.jpg/440px-IHME_NCD_India_Incidence.jpg)
Non-communicable diseases
India has witnessed huge progress in the health status of its population since independence. The transition has been seen in economic development, nutritional status, fertility and mortality rates and consequently, the disease profile has changed considerably. Although great efforts have been done to control the communicable diseases, but they still contribute significantly to disease burden of the country. Decline in disability and death from communicable diseases has been accompanied by a gradual shift to, and accelerated rise in the prevalence of chronic non-communicable diseases such as cardiovascular disease, diabetes, chronic obstructive pulmonary disease, cancers, mental health disorders and injuries. Indians are at particularly high risk for atherosclerosis and coronary artery disease. This may be attributed to a genetic predisposition to metabolic syndrome and adverse changes in coronary artery vasodilation.
![](http://upload.wikimedia.org/wikipedia/commons/thumb/2/25/IHME_NCD_India_Mortality.jpg/440px-IHME_NCD_India_Mortality.jpg)
The burden of the Non-Communicable Diseases (NCD) in India with a population of the over 1.3 billion is huge. NCDs in India contributed to 6.8 million deaths in 2019, which is about 67.6% percent of overall deaths. In the same year Ischemic heart disease accounted for highest mortality followed by COPD, Stroke and Diabetes among all NCD related deaths.[31]
Starting in early 1990s, there have been wide disparities in terms of NCD burden on Indian diaspora. While life expectancy has increased it is the number of years lost due to ill-health, disability or early death (DALY) rate that is almost doubled. It was 29.17% in 1990 and reached 57.92% in 2019 according to IHME. Also NCDs are accounting for more than 90% of total prevalent cases in India at any given point of time. Between ages 15–49 NCDs mortality share was 35.56% in 1990 while the share is increased to 48.95% in 2019[32]
A 2021 report on NCD status in India
Source:[33]
Through Arbitrage Research Institute (TARI) a private not for profit market research firm has developed a report for ASSOCHAM regarding NCD status in India. This study highlighted the burden of NCDs among Indians and has highlighted that the prevalence of having any NCDs among the Indian population is 116 per 1000 population.
Key findings
- High blood pressure, intestinal disorders related to digestion, diabetes, respiratory disorders, neurological disorders, cardiovascular diseases, renal disorders, and cancers are top NCDs among Indians
- Major risk factors for NCDs include air pollution (76%), low physical activity (67%), imbalanced diet (55%), stress (44%) and obesity (24%)
- Among states Odisha has the highest prevalence of NCDs, with every 272 per 1,000 population with any NCD and Gujarat has the lowest prevalence — 60 per 1,000.
- More than two-thirds of people with non-communicable disease (NCDs) in India are in the 26-59 age group
- Prevalence of NCD has shown to be increasing after 18 years and makes a quantum leap when an individual crosses the age of 35
- Diabetes and hypertension showed higher prevalence in those who are 50 years and above while brain/neurological disorders showed higher prevalence in the age group 35 years and below
In 2018 chronic obstructive pulmonary disease was the leading cause of death after heart disease. The 10 most polluted cities in the world are all in northern India with more than 140 million people breathing air 10 times or more over the WHO safe limit. In 2017, pollution levels forced schools to close for several days and air pollution killed 1.24 million Indians.[34]
A statewide STEPS survey done in Madhya Pradesh estimated 22.3 percent had hypertension and 6.8 percent had diabetes.[35]
High infant mortality rate
Despite health improvements over the last thirty years, lives continue to be lost to early childhood diseases, inadequate newborn care and childbirth-related causes. More than two million children die every year from preventable infections.[36]
Approximately 1.72 million children die each year before turning one.[37] The under five mortality and infant mortality rates have been declining, from 202 and 190 deaths per thousand live births respectively in 1970 to 64 and 50 deaths per thousand live births respectively in 2009 and to 41.1 (in 2018) and 34.6 (in 2016) deaths per thousand live births respectively.[37][38][4] However, this decline is slowing. Reduced funding for immunization leaves only 43.5% of the young fully immunized.[39] A study conducted by the Future Health Systems Consortium in Murshidabad, West Bengal indicates that barriers to immunization coverage are adverse geographic location, absent or inadequately trained health workers and low perceived need for immunization.[40] Infrastructure like hospitals, roads, water and sanitation are lacking in rural areas.[41] Shortages of healthcare providers, poor intrapartum and newborn care, diarrheal diseases and acute respiratory infections also contribute to the high infant mortality rate.[37]
Sanitation
In 2008 there were more than 122 million households that had no toilets, and 33% lacked access to toilets, over 50% of the population (638 million) defecated in the open.[42] This was relatively higher than Bangladesh and Brazil (7%) and China (4%).[42] 211 million people gained access to improved sanitation from 1990 to 2008.[42] A huge portion of Indian Population lacked access to toilets prior to the 2014, and open defecation on roads and railway tracks were very common.[42] However, due to the success of "Swacch Bharat Mission" initiative of the government of India, launched in 2014, India constructed 110 million toilets in the country on the cost of $28 billion. As of 2018 about 95.76% of Indian households have toilet access and in 2019 the Government of India declared the country "Open Defecation Free" (ODF).[43]
Several million more have multiple episodes of diarrhea and still others fall ill on account of Hepatitis A, enteric fever, intestinal worms and eye and skin infections caused by poor hygiene and unsafe drinking water.[44]
Access to protected sources of drinking water improved from 68% of the population in 1990 to 88% in 2008.[42] However, only 26% of the slum population has access to safe drinking water,[43] and 25% of the total population has drinking water on their premises.[42] This problem is exacerbated by falling levels of groundwater caused mainly by increasing extraction for irrigation.[42] Insufficient maintenance of the environment around water sources, groundwater pollution, excessive arsenic and fluoride in drinking water pose a major threat to India's health.[42]
Female health issues
A major issue for women in India is that few have access to skilled birth attendants and fewer still to quality emergency obstetric care. In addition, only 15 per cent of mothers receive complete antenatal care and only 58 per cent receive iron or folate tablets or syrup.[36] Women's health in India involves numerous issues. Some of them include the following:
- Malnutrition : The main cause of female malnutrition in India is the tradition requiring women to eat last, even during pregnancy and when they are lactating.[45]
- Breast cancer : One of the most severe and increasing problems among women in India, resulting in higher mortality rates.
- Maternal mortality : Indian maternal mortality rates in rural areas are one of the highest in the world.[45]
Rural health
Rural India contains over 68% of India's total population,[46] and half of all residents of rural areas live below the poverty line, struggling for better and easy access to health care and services.[47] Health issues confronted by rural people are many and diverse – from severe malaria to uncontrolled diabetes, from a badly infected wound to cancer.[48] Postpartum maternal illness is a serious problem in resource-poor settings and contributes to maternal mortality, particularly in rural India.[49] A study conducted in 2009 found that 43.9% of mothers reported they experienced postpartum illnesses six weeks after delivery.[50] Furthermore, because of limited government resources, much of the health care provided comes from non profits such as The MINDS Foundation.[51]
Urban health
Rapid urbanization and disparities in urban India
India's urban population has increased from 285 million in 2001 to 377 million (31%) in 2011. It is expected to increase to 535 million (38%) by 2026 (4). The United Nations estimates that 875 million people will live in Indian cities and towns by 2050. If urban India were a separate country, it would be the world's fourth largest country after China, India and the United States of America. According to data from Census 2011, close to 50% of urban dwellers in India live in towns and cities with a population of less than 0.5 million. The four largest urban agglomerations Greater Mumbai, Kolkata, Delhi and Chennai are home to 15% of India's urban population.[52]
![](http://upload.wikimedia.org/wikipedia/commons/thumb/3/37/Changing_lives_Ante_and_post_natal_care_for_mums_and_babies_in_Orissa_%286835364123%29.jpg/332px-Changing_lives_Ante_and_post_natal_care_for_mums_and_babies_in_Orissa_%286835364123%29.jpg)
Child health and survival disparities in urban India
Analysis of National Family Health Survey Data for 2005–06 (the most recent available dataset for analysis) shows that within India's urban population – the under-five mortality rate for the poorest quartile eight states, the highest under-five mortality rate in the poorest quartile occurred in UttarPradesh (110 per 1,000 live births), India's most populous state, which had 44.4 million urban dwellers in the 2011 census[53] followed by Rajasthan (102), Madhya Pradesh (98), Jharkhand (90) and Bihar (85), Delhi (74), and Maharashtra (50). The sample for West Bengal was too small for analysis of under-five mortality rate. In Uttar Pradesh was four times that of the rest of the urban populations in Maharashtra and Madhya Pradesh. In Madhya Pradesh, the under-five mortality rate among its poorest quartile was more than three times that of the rest of its urban population.[54]
Maternal healthcare disparities in urban India
Among India's urban population there is a much lower proportion of mothers receiving maternity care among the poorest quartile; only 54 per cent of pregnant women had at least three ante-natal care visits compared to 83 per cent for the rest of the urban population. Less than a quarter of mothers within the poorest quartile received adequate maternity care in Bihar (12 percent), and Uttar Pradesh (20 percent),and less than half in Madhya Pradesh (38 percent), Delhi (41 percent), Rajasthan (42 percent), and Jharkhand (48 percent). Availing three or more ante-natal check-ups during pregnancy among the poorest quartile was better in West Bengal (71 percent), Maharashtra (73 percent).[54]
High levels of undernutrition among the urban poor
For India's urban population in 2005–06, 54 percent of children were stunted, and 47 percent underweight in the poorest urban quartile, compared to 33 percent and 26 percent, respectively, for the rest of the urban population. Stunted growth in children under five years of age was particularly high among the poorest quartile of the urban populations in Uttar Pradesh (64 percent), Maharashtra (63 percent), Bihar (58 percent), Delhi(58 percent), Madhya Pradesh (55 percent), Rajasthan (53 percent), and slightly better in Jharkhand (49 percent). Even in the better-performing states close to half of the children under-five were stunted among the poorest quartile, being 48 percent in West Bengal respectively.[54]
High levels of stunted growth and underweight issues among the urban poor in India points to repeated infections, depleting the child's nutritional reserves, owing to sub-optimal physical environment. It is also indicative of high levels of food insecurity among this segment of the population. A study carried out in the slums of Delhi showed that 51% of slum families were food insecure.[55]
Initiatives
Health education programs
The Indian government has implemented several initiatives over the past few decades to boost healthcare opportunities and access in both rural areas and urban slums. International researchers and organizations have cited the need to implement more long-term solutions to permanently improve slum health; they argue that government-funded programs like the National Rural Health Mission (NRHM) or the National Urban Health Mission (NUHM) have a short-lived impact.[56] The National Immunization Programme, a notable example, prioritized providing vaccinations to slum-dwellers to reduce spread of infectious disease, but research suggests that the efficacy of this program was limited because slum residents remain unaware of the significance of being immunized.[57] This finding demonstrated the need to implement health education programs to work towards long-term solutions to the slum health crisis.[58] Non-profit organizations have approached this problem in a multitude of different ways.
While some organizations continue to provide service through opening medical facilities in inner city areas or advocating for infrastructural change (e.g. improving water sanitation), other newer organizations are increasingly focusing on educating the population on health care resources through community-based health education programs.[59] Factors like fear of consequence, gender, individual agency, and overall socioeconomic environment have an effect on the ability and willingness of patients to seek healthcare resources.[60] Implementing health awareness programs and focusing on improving the population's knowledge of healthcare resources has a significant effect on their ability to access affordable care, prevent illness, and prevent job loss.[61] For example, in parts of India, public facilities offer free treatment for tuberculosis, yet many slum residents choose to visit expensive private healthcare facilities due to lack of awareness of this program. After an initiative involving conversations between health experts and slum households, a significant number of residents turned to public facilities rather than private hospitals to receive effective treatment at no cost.[62]
Organizations have implemented a similar method of health education within urban schools to combat nutritional deficiency and malnutrition among children.[63] Through use of informational videos and posters and curriculum changes, all implemented within a school setting, adolescents had an increased awareness of their nutritional needs and the resources they could utilize.[64] Overall, health education programs have proven to be an effective strategy in addressing the root causes of health disparities and promoting long-term change in underserved communities.
Preventive and Promotive Healthcare
Programmes for Communicable Diseases
- National Viral Hepatitis Control Program
- Integrated Disease Surveillance Programme
- Revised National Tuberculosis Control Programme
- National Leprosy Eradication Programme
- National Vector Borne Disease Control Programme
- National AIDS Control Programme
- Pulse Polio Programme
Programmes Non-communicable Diseases
Program | Launch Year |
---|---|
NATIONAL PROGRAM FOR CONTROL OF BLINDNESS AND VISUAL IMPAIRMENT (NPCBVI) | 1976 |
NATIONAL MENTAL HEALTH PROGRAM (NMHP) | 1982 |
NATIONAL PROGRAM FOR THE PREVENTION AND CONTROL OF DEAFNESS (NPPCD) | 2007 |
NATIONAL TOBACCO CONTROL PROGRAM (NTCP) | 2007 |
NATIONAL PROGRAM FOR HEALTHCARE OF ELDERLY (NPHCE) | 2010 |
NATIONAL PROGRAMME FOR PREVENTION & CONTROL OF CANCER, DIABETES, CARDIOVASCULAR DISEASES & STROKE (NPCDCS) | 2010 |
NATIONAL PROGRAM FOR PREVENTION AND MANAGEMENT OF BURN INJURIES (NPPMBI) | 2010 (Initial pilot program) |
NATIONAL PROGRAM FOR PALLIATIVE CARE (NPPC) | 2012 |
NATIONAL ORAL HEALTH PROGRAM (NOHP) | 2014 |
National Nutritional Programmes
- Integrated Child Development Services
- National Iodine Deficiency Disorders Control Programme
- Mid-Day Meal Programme
Programmes Related to System Strengthening / Welfare
- Ayushman Bharat Yojana
- National Program of Health Care for the Elderly
- Reproductive, Maternal, Newborn, Child and Adolescent Health
- National Rural Health Mission
- National Urban Health Mission
Miscellaneous
- Voluntary Blood Donation Programme
- Universal Immunization Programme
- Pradhan Mantri Swasthya Suraksha Yojana
- Janani Shishu Suraksha Yojana
- Rashtriya Kishor Swasthya Karyakram
Other issues
According to Huffington Post, doctors spoke about the problems with "corporate hospitals" and senior surgeons being told to sell surgeries to their patients even if they weren't needed. In one instance, a doctor was told he would be sacked if he didn't have enough patients to operate on.[66] The majority of India's private, for-profit hospitals charge exorbitant costs for medical services and supplies, which has put a strain on the country's public finances.[66][67][68][69]
See also
- Environment of India
- HIV/AIDS in India
- Indian states ranking by institutional delivery
- National Centre for Disease Control
- Poverty in India
- Healthcare in India
- Timeline of healthcare in India
- Tobacco control law in India
- Mental health in India
- National Commission for Indian System of Medicine
References
- ^ "Population, total - India | Data". data.worldbank.org. Archived from the original on 3 November 2021. Retrieved 16 September 2021.
- ^ "Human Rights Measurement Initiative – The first global initiative to track the human rights performance of countries". humanrightsmeasurement.org. Archived from the original on 29 March 2023. Retrieved 18 March 2022.
- ^ a b c d "India - HRMI Rights Tracker". rightstracker.org. Archived from the original on 29 March 2023. Retrieved 18 March 2022.
- ^ a b c d e Rosling. "Gapminder". Archived from the original on 4 September 2018. Retrieved 5 September 2018.
- ^ a b "GBD Compare". Institute for Health Metrics and Evaluation. Archived from the original on 26 September 2019. Retrieved 15 September 2021.
- ^ a b Batra, P., Saini, P., & Yadav, V. (2020). Oral health concerns in India. Journal of oral biology and craniofacial research, 10(2), 171–174. https://doi.org/10.1016/j.jobcr.2020.04.011 Archived 6 July 2024 at the Wayback Machine
- ^ Ramanarayanan, V., Janakiram, C., Joseph, J., & Krishnakumar, K. (2020). Oral health care system analysis: A case study from India. Journal of family medicine and primary care, 9(4), 1950–1957. https://doi.org/10.4103/jfmpc.jfmpc_1191_19 Archived 6 July 2024 at the Wayback Machine
- ^ "Global oral health status report: Towards universal health coverage for oral health by 2030". Archived from the original on 23 September 2023. Retrieved 19 September 2023.
- ^ Ramanarayanan, V., Janakiram, C., Joseph, J., & Krishnakumar, K. (2020). Oral health care system analysis: A case study from India. Journal of family medicine and primary care, 9(4), 1950–1957. https://doi.org/10.4103/jfmpc.jfmpc_1191_19'
- ^ "Archived copy" (PDF). Archived (PDF) from the original on 27 December 2023. Retrieved 18 September 2023.
{{cite web}}
: CS1 maint: archived copy as title (link) - ^ Vundavalli S. (2014). Dental manpower planning in India: current scenario and future projections for the year 2020. International dental journal, 64(2), 62–67. https://doi.org/10.1111/idj.12063 Archived 6 July 2024 at the Wayback Machine
- ^ "WHO – Malnutrition". WHO. Archived from the original on 18 October 2019. Retrieved 4 October 2020.
- ^ Rieff, David (11 October 2009). "India's Malnutrition Dilemma". Source: The New York Times 2009. Archived from the original on 29 August 2019. Retrieved 20 September 2011.
- ^ a b "Malnutrition in India Statistics State Wise". Save the Children. Archived from the original on 6 July 2019. Retrieved 2 September 2018.
- ^ a b "Child malnutrition". Archived from the original on 7 September 2014.
- ^ a b c http://ninindia.org/DietaryGuidelinesforNINwebsite.pdf Archived 27 November 2019 at the Wayback Machine Dietary Guidelines for NIN
- ^ "Factors affecting prevalence of malnutrition among children under three year of age in Botswana" (PDF). Archived (PDF) from the original on 18 November 2017. Retrieved 5 September 2014.
- ^ "UNICEF India - the children - MPS stage a Candlelight Vigil to highlight Child Malnutrition in India". Archived from the original on 11 October 2014. Retrieved 4 September 2014.
- ^ "Swiggy releases annual list of what Indians ordered most, Bengaluru man orders groceries worth Rs 16 Lakh". The Economic Times. 18 December 2022. ISSN 0013-0389. Archived from the original on 6 July 2024. Retrieved 13 May 2023.
- ^ "Dengue". Source: Centers for Disease Control and Prevention US. Archived from the original on 27 July 2011. Retrieved 20 September 2011.
- ^ Goldwert, Lindsay. "'Totally drug-resistant' tuberculosis reported in India; 12 patients have not responded to TB medication." Archived 17 May 2013 at the Wayback Machine New York Daily News 16 January 2012.
- ^ "Country profiles FOR 30 HIGH TB BURDEN COUNTRIES" (PDF). Archived (PDF) from the original on 29 November 2020. Retrieved 30 September 2020.
- ^ "India TB report 2019" (PDF). June 2019. Archived (PDF) from the original on 9 September 2023. Retrieved 30 September 2020.
- ^ "HIV/AIDS". Source: UNICEF India. Archived from the original on 3 September 2011. Retrieved 20 September 2011.
- ^ "Life Expectancy and Mortality in India". Source: The Prajnopaya Foundation. Archived from the original on 6 July 2010. Retrieved 20 September 2011.
- ^ "Health Conditions". Source: US Library of Congress. Archived from the original on 19 September 2011. Retrieved 20 September 2011.
- ^ "Global Technical Strategy for Malaria 2016–2030". World Health Organization. Archived from the original on 28 June 2015.
- ^ "Chickenpox | National Health Portal Of India". www.nhp.gov.in. Retrieved 14 April 2022.
- ^ "India marks one year since last polio case." Archived 8 June 2020 at the Wayback Machine Al Jazeera, 13 January 2012.
- ^ "National Portal of India". Archived from the original on 10 May 2012. Retrieved 6 July 2024.
- ^ "GBD Compare | IHME Viz Hub". vizhub.healthdata.org. Archived from the original on 26 September 2019. Retrieved 15 September 2021.
- ^ "GBD Compare | IHME Viz Hub". vizhub.healthdata.org. Archived from the original on 26 September 2019. Retrieved 16 September 2021.
- ^ "Non-Communicable diseases in India" (PDF). Archived (PDF) from the original on 15 September 2021. Retrieved 15 September 2021.
- ^ "Dirty air: how India became the most polluted country on earth". Financial Times. 11 December 2018. Archived from the original on 30 September 2019. Retrieved 22 January 2019.
- ^ Kokane, Arun M.; Joshi, Rajnish; Kotnis, Ashwin; Chatterjee, Anirban; Yadav, Kriti; Revadi, G.; Joshi, Ankur; Pakhare, Abhijit P. (2020). "Descriptive profile of risk factors for cardiovascular diseases using WHO STEP wise approach in Madhya Pradesh". PeerJ. 8: –9568. doi:10.7717/peerj.9568. ISSN 2167-8359. PMC 7415222. PMID 32844055.
- ^ a b "FAQs – UNICEF". Archived from the original on 19 February 2015. Retrieved 7 September 2014.
- ^ a b c "Childhood Mortality and Health in India" (PDF). Source: Institute of Economic Growth University of Delhi Enclave North Campus India by Suresh Sharma. Archived from the original (PDF) on 2 April 2012. Retrieved 20 September 2011.
- ^ "Maternal & Child Mortality and Total Fertility Rates" (PDF). Archived (PDF) from the original on 19 March 2013. Retrieved 13 February 2012.
- ^ Robinson, Simon (1 May 2008). "India's Medical Emergency". Source: Time US. Archived from the original on 19 May 2008. Retrieved 20 September 2011.
- ^ Kanjilal, Barun; Debjani Barman; Swadhin Mondal; Sneha Singh; Moumita Mukherjee; Arnab Mandal; Nilanjan Bhor (September 2008). "Barriers to access immunisation services: a study in Murshidabad, West Bengal". FHS Research Brief (3). Archived from the original on 30 April 2013. Retrieved 6 July 2024.
- ^ "Medical and Healthcare Facility Plagued". Source: Abhinandan S, Dr Ramadoss. 22 May 2008. Archived from the original on 17 April 2023. Retrieved 20 September 2011.
- ^ a b c d e f g h "Water, Environment and Sanitation". Source: UNICEF India. Archived from the original on 16 October 2011. Retrieved 20 September 2011.
- ^ a b "Initiatives: Hygiene and Sanitation". Source: Sangam Unity in Action. Archived from the original on 21 December 2012. Retrieved 20 September 2011.
- ^ "What We Do – UNICEF". Archived from the original on 2 March 2015. Retrieved 7 September 2014.
- ^ a b "Chronic hunger and the status of women in India". Archived from the original on 10 September 2014.
- ^ "RURAL URBAN DISTRIBUTION OF POPULATION" (PDF). Archived (PDF) from the original on 26 January 2021. Retrieved 6 May 2015.
- ^ Urban Rural Population of India Archived 15 March 2012 at the Wayback Machine. Indiafacts.in. Retrieved on 2012-07-17.
- ^ JSS – The Bitter Truth About Rural Health Archived 25 April 2012 at the Wayback Machine. Jssbilaspur.org. Retrieved on 2012-07-17.
- ^ Sutherland, T; DM Bishai (2008). "Cost-Effectiveness Of Misoprostol And Prenatal Iron Supplementation As Maternal Mortality Interventions In Home Births In Rural India". International Journal of Gynecology & Obstetrics. 104 (3): 189–93. doi:10.1016/j.ijgo.2008.10.011. PMID 19081564. S2CID 38055632. Archived from the original on 30 August 2012. Retrieved 26 May 2012.
- ^ Tuddenham, S A; et al. (February 2010). "Care seeking for postpartum morbidities in Murshidabad, rural India". International Journal of Gynecology & Obstetrics. 109 (3): 245–246. doi:10.1016/j.ijgo.2010.01.016. PMID 20207357. S2CID 32417177. Archived from the original on 10 November 2012. Retrieved 26 May 2012.
- ^ "What We Do: Our Purpose". The MINDS Foundation. Archived from the original on 10 September 2019. Retrieved 29 July 2014.
- ^ Agarwal, Siddharth (31 October 2014). "Making the Invisible Visible". SSRN 2769027.
{{cite journal}}
: Cite journal requires|journal=
(help) - ^ Office of the Registrar General and Census Commissioner (2011). Population Census of India 2011 Accessed 9-10-016 http://www.census2011.co.in/census/state/uttar+pradesh.html Archived 30 April 2011 at the Wayback Machine
- ^ a b c Agarwal, Siddharth (1 April 2011). "The state of urban health in India; comparing the poorest quartile to the rest of the urban population in selected states and cities". Environment and Urbanization. 23 (1): 13–28. Bibcode:2011EnUrb..23...13A. doi:10.1177/0956247811398589. ISSN 0956-2478. S2CID 154216003.
- ^ Agarwal, Siddharth; Sethi, Vani; Gupta, Palak; Jha, Meenakshi; Agnihotri, Ayushi; Nord, Mark (4 August 2009). "Experiential household food insecurity in an urban underserved slum of North India". Food Security. 1 (3): 239–250. doi:10.1007/s12571-009-0034-y. ISSN 1876-4517. S2CID 17151198.
- ^ Nolan, Laura B. (March 2015). "Slum Definitions in Urban India: Implications for the Measurement of Health Inequalities". Population and Development Review. 41 (1): 59–84. doi:10.1111/j.1728-4457.2015.00026.x. PMC 4746497. PMID 26877568.
- ^ Singh, Sanjeev; Sahu, Damodar; Agrawal, Ashish; Vashi, Meeta Dhaval (July 2018). "Ensuring childhood vaccination among slums dwellers under the National Immunization Program in India – Challenges and opportunities". Preventive Medicine. 112: 54–60. doi:10.1016/j.ypmed.2018.04.002. PMID 29626558. S2CID 4879865.
- ^ Lilford, Richard J; Oyebode, Oyinlola; Satterthwaite, David; Melendez-Torres, G J; Chen, Yen-Fu; Mberu, Blessing; Watson, Samuel I; Sartori, Jo; Ndugwa, Robert (February 2017). "Improving the health and welfare of people who live in slums" (PDF). The Lancet. 389 (10068): 559–570. doi:10.1016/S0140-6736(16)31848-7. PMID 27760702. S2CID 3511402. Archived (PDF) from the original on 19 July 2018. Retrieved 24 September 2019.
- ^ Lilford, Richard J; Oyebode, Oyinlola; Satterthwaite, David; Melendez-Torres, G J; Chen, Yen-Fu; Mberu, Blessing; Watson, Samuel I; Sartori, Jo; Ndugwa, Robert (February 2017). "Improving the health and welfare of people who live in slums" (PDF). The Lancet. 389 (10068): 559–570. doi:10.1016/s0140-6736(16)31848-7. ISSN 0140-6736. PMID 27760702. S2CID 3511402. Archived (PDF) from the original on 19 July 2018. Retrieved 24 September 2019.
- ^ Das, Moumita; Angeli, Federica; Krumeich, Anja J. S. M.; van Schayck, Onno C. P. (December 2018). "Patterns of illness disclosure among Indian slum dwellers: a qualitative study". BMC International Health and Human Rights. 18 (1): 3. doi:10.1186/s12914-018-0142-x. ISSN 1472-698X. PMC 5771001. PMID 29338708.
- ^ Yang, Li; Zhao, Qiuli; Zhu, Xuemei; Shen, Xiaoying; Zhu, Yulan; Yang, Liu; Gao, Wei; Li, Minghui (August 2017). "Effect of a comprehensive health education program on pre-hospital delay intentions in high-risk stroke population and caregivers". Quality of Life Research. 26 (8): 2153–2160. doi:10.1007/s11136-017-1550-4. ISSN 0962-9343. PMID 28401417. S2CID 4587634.
- ^ Samal, Janmejaya (2017). "Impact of a Structured Tuberculosis Awareness Strategy on the Knowledge and Behaviour of the Families in a Slum Area in Chhattisgarh, India". Journal of Clinical and Diagnostic Research. 11 (3): LC11–LC15. doi:10.7860/JCDR/2017/24107.9489. PMC 5427341. PMID 28511415.
- ^ Pörtner, Claus C.; Su, Yu-hsuan (February 2018). "Differences in Child Health Across Rural, Urban, and Slum Areas: Evidence From India". Demography. 55 (1): 223–247. doi:10.1007/s13524-017-0634-7. ISSN 0070-3370. PMID 29192387. S2CID 3708575.
- ^ Rao, D. Raghunatha; Vijayapushpam, T.; Rao, N. Amulya; Dube, Anilkumar; Venkaiah, K. (1 December 2016). "Assessment of an Integrated Nutrition Communication Approach to Educate the School Going Adolescent Girls Living In Urban Slums of Hyderabad, Telangana State, India". Asian Journal of Education and Training. 2 (2): 70–77. doi:10.20448/journal.522/2016.2.2/522.2.70.77. S2CID 53395280.
- ^ "Non Communicable Disease Control Programmes :: National Health Mission". nhm.gov.in. Archived from the original on 21 September 2021. Retrieved 15 September 2021.
- ^ a b Chandran, Prabha (15 July 2016). "Exclusive: Doctors And Hospitals Are Playing With Lives For Profit, Say Authors Of Medical Exposé". Huffington Post. Archived from the original on 30 January 2024. Retrieved 31 January 2024.
- ^ Prabhakar, BinoyY (24 September 2022). "Max, Fortis, Apollo and other big hospital chains have been overcharging patients: CCI investigation". Moneycontrol.com. Archived from the original on 30 January 2024. Retrieved 31 January 2024.
- ^ Krishnan, Murali (22 November 2017). "The problem of expensive hospitals in India". Deutsche Welle. Archived from the original on 30 January 2024. Retrieved 31 January 2024.
- ^ Singh, Kavaljit (11 June 2021). "COVID-19 Killed My Wife. Then Came a 19 Lakh Bill From a Hospital That Didn't Have a CT Scanner". The Wire (India). Archived from the original on 30 January 2024. Retrieved 31 January 2024.
This article incorporates text from this source, which is in the public domain. Country Studies. Federal Research Division.
External links
- The State of the World's Midwifery – India Country Profile
- Lancet -India: Towards Universal Health Coverage
- Indian Healthcare Industry, November 2012 – Dinodia Capital Advisors