Life expectancy lower for urban poor: Study

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    • Recently, Azim Premji University (APU) released the report on ‘Health Care Equity in Urban India’ in collaboration with 17 regional NGOs across India.

    About the report

    • It explores health vulnerabilities and inequalities in cities in India. 
    • It also looks at the availability, accessibility and cost of healthcare facilities, and possibilities in future-proofing services in the next decade.
    • Data Sources: The study also draws insights from data collected through detailed interactions with civil society organisations in cities and towns across Mumbai, Bengaluru, Surat, Lucknow, Guwahati, Ranchi, and Delhi. 
      • This also included an analysis of the National Family and Health Surveys (NHFS), the Census of India, and inputs from State-level health officials on the provision of health care.

    Major Findings 

    • Disproportionate disease burden: Life expectancy among the poorest is lower by 9.1 years and 6.2 years among men and women, respectively, compared to the richest in urban areas.

    Image Courtsey: TH

    • Third of India’s people now live in urban areas, with this segment seeing rapid growth from about 18% (1960) to 28.53% (2001) to 34% (in 2019).
      •  Close to 30% of people living in urban areas are poor.
    • Chaotic urban health governance: 
      • The report, besides finding disproportionate disease burden on the poor, also pointed to chaotic urban health governance, where the multiplicity of healthcare providers both within and outside the government without coordination challenges urban health governance.
    • Financial burden:
      • The other key findings include a heavy financial burden on the poor and less investment in healthcare by urban local bodies.
        • For example, 30 per cent of even the poorest quintile in India seek delivery care from private sources, resulting in high out-of-pocket expenditure.
    • Other Issues: 
    • “For some health conditions, the disease burden is higher among the urban poor even when compared to the rural poor, such as underweight, obesity and tuberculosis among children. 
    • Lack of sufficient health personnel in government facilities, including doctors, nurses, and other paramedics, as well as poor infrastructure and lack of essentials such as drugs and consumables, are a direct result of abysmally low budget allocations to urban health.
    • Recommendations: It calls for 
      • Strengthening community participation and governance.
      • Building a comprehensive and dynamic database on the health and nutrition status, including co-morbidities of the diverse, vulnerable populations.
      • Strengthening healthcare provisioning through the National Urban Health Mission, especially for primary healthcare services; and putting in place policy measures to reduce the financial burden of the poor. 
      • It also advocates for a better mechanism for coordinated public healthcare services and better governed private healthcare institutions.

    Overview of India’s healthcare sector

    • Healthcare has become one of the largest sectors of the Indian economy, in terms of both revenue and employment.
    • India’s healthcare industry has been growing at a Compound Annual Growth Rate of around 22% since 2016. 
    • At this rate, it is expected to reach USD 372 billion in 2022. Healthcare has become one of the largest sectors of the Indian economy, in terms of both revenue and employment.
    • India’s healthcare sector has the potential to generate 27 lakh jobs in India between 2017 and 2022.

    Steps were taken by India for improving the health sector

    • National Health Mission: The mission was launched by the Government of India in 2013 subsuming the National Rural Health Mission and the National Urban Health Mission. It was further extended in March 2018, to continue till 2020.
    • Ayushman Bharat: It is a flagship scheme of the Government of India that was launched in September 2018 on the recommendations of the National Health Policy 2017 for achieving the vision of Universal Health Coverage (UHC). 
      • This programme will help in meeting the  Sustainable Development Goals (SDGs) and its underlying commitment.
    • National Nutrition Mission: It is the government’s flagship programme to improve nutritional outcomes for children, pregnant women and lactating mothers.
      • The Ministry of Women and Child Development (MWCD) is the nodal ministry for implementation.
    • Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): It was announced in 2003 with the objectives of correcting regional imbalances in the availability of affordable/ reliable tertiary healthcare services and also augmenting facilities for quality medical education in the country.
    • National Digital Health Mission (NDHM): It aims to develop the necessary to support the integrated digital health infrastructure of the country. 
    • It will bridge the existing gap amongst different stakeholders of the Healthcare ecosystem through digital highways.
    • Poshan Abhiyan: It is the flagship programme that aims at improving nutritional outcomes among pregnant women, lactating mothers and children by reducing the level of stunting, underweight, anaemia and low birth weight by 2022. 

    Challenges in Health Sector 

    • Poor expenditure on the health sector i.e India spends a mere 1.13% of GDP on health.
    • India lacks affordable health care services for the marginalised sections.
    • Lack of robust public health infrastructures like hospitals, primary health centres.
    • Lack of number of Doctors and Specialists as per the population of the country.
    • Lack of awareness among the people.

    Way Forward

    • More emphasis should be on quick and hassle-free delivery of medical services to the marginal section. 
    • There is a need for an increase in expenditure on health so that India can improve existing facilities as well as add more of them.
    • The focus should be on healthcare infrastructure and healthcare R&D 

    Source: TH

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