Over the years, the Indian health system has overcome seemingly insurmountable problems, long considered hopeless. At a time when we are the envy of the world for having the youngest population for more than three decades to come and if we are to redeem that advantage fully, some tough health challenges will need to be confronted.
Nothing is impossible, as the recent National Family Health Survey (NFHS-5) results have shown. In 2007, national and international demographers concluded that even under the best-case scenario, India would achieve a total fertility rate of 2.1 (replacement level) only by 2041. India achieved this by 2020. Likewise, high maternal and infant mortality seemed destined to persist as late as 2010. Despite evidence showing the crying need for women to deliver in a hospital, the reaction was always the same — “sadiyon se humare dai yeh kaam karti arahi hai. Isse hum badal nahi sakte.” (For centuries, the traditional dais have delivered babies and we cannot change that.) Ten years later, the latest NFHS-5 findings show how even in the so-called BIMARU states, hospital deliveries have soared to 89 per cent.
Today’s macro picture shows at least five interrelated challenges which are pervading the population. Cardiovascular diseases (CVDs), cancers, chronic respiratory diseases (CRDs) and diabetes are spiralling and they all share four behavioural risk factors — an unhealthy diet, lack of physical activity and use of tobacco and alcohol. A report, ‘India: Health of the nation’s states’, estimated that the proportion of deaths due to non-communicable diseases (NCDs) has increased from around 38 per cent in 1990 to 62 per cent in 2016. Obesity has increased from 19 per cent to 23 per cent between NFHS-4 and NFHS-5, in both urban and rural areas. Among Delhi’s citizens, 38 per cent were found to be obese, followed by Tamil Nadu and Kerala. People in Punjab, Telangana, Andhra Pradesh, and Karnataka also have large sections of the population that are obese. This increases the risk of diabetes, hypertension, and CVD. Building awareness and exhorting people to lead healthy lives will save millions from illness and decelerate premature death. Unspectacular as it sounds, governments must keep millions away from ill health — more cost-effective than eventually treating chronic medical conditions in hospitals.