|Public Health in India|
and morbidity patterns that have been drawing global attention in recent years. Despite several growth orientated policies adopted by the government, the widening economic, regional and gender disparities are posing challenges for the health sector. About 69% of health infrastructure, medical man power and other health resources are concentrated in urban areas where 31% of the population live. Contagious, infectious and waterborne diseases such as diarrhoea, amoebiasis, typhoid, infectious hepatitis, worm infestations, measles, malaria, tuberculosis, whooping cough, respiratory infections, pneumonia and reproductive tract infections dominate the morbidity pattern, especially in rural areas. However, non-communicable diseases such as cancer, blindness, mental illness, hypertension, diabetes, HIV/AIDS, accidents and injuries are also on the rise. The health status of Indians, is still a cause for grave concern, especially that of the rural population. This is reflected in the life expectancy (67 years), infant mortality rate (47/1000 live births), maternal mortality rate (212/100 000 live births); however, over a period of time some progress has been made. To improve the prevailing situation, the problem of rural health is to be addressed both at macro (national and state) and micro (district and regional) levels. This is to be done in an holistic way, with a genuine effort to bring the poorest of the population to the centre of the fiscal policies. A paradigm shift from the current ‘biomedical model’ to a ‘sociocultural model’, which should bridge the gaps and improve quality of rural life, is the current need. A revised National Health Policy addressing the prevailing inequalities, and working towards promoting a long-term perspective plan, mainly for rural health, is imperative.
HEALTH PRACTICES AND PROBLEMS IN RURAL INDIA
Rural people in India in general, and tribal populations in particular, have their own beliefs and practices regarding health. Some tribal groups still believe that a disease is always caused by hostile spirits or by the breach of some taboo. They therefore seek remedies through magicoreligious practices. On the other hand, some rural people have continued to follow rich, undocumented, traditional medicine systems, in addition to the recognised cultural systems of medicine such Ayurveda, unani, siddha and naturopathy, to maintain positive health and to prevent disease. However, the socioeconomic, cultural and political onslaughts, arising partly from the erratic exploitation of human and material resources, have endangered the naturally healthy environment (e.g. access to healthy and nutritious food, clean air and water, nutitious vegetation, healthy life styles, and advantageous value systems and community harmony). The basic nature of rural health problems is attributed also to lack of health literature and health consciousness, poor maternal and child health services and occupational hazards.
The disillusionment and frustration with the growing ineffectiveness of the government sector is gradually
driving poor people to seek help of the private sector, thus forcing them to spend huge sums of money on credit, or they are left to the mercy of ‘quacks’. While estimates vary, the government probably accounts for no more than 20–30% of total health spending. The share of the private sector has grown from 14% in 1976 to 67% in 1993. About 67% of all hospitals, 63% of all dispensaries and 78% of all doctors in India are in the private/corporate sector. Much has been experienced and written on the growing privatization and commercialisation of the medical practices and their links with drug and medical instrument manufacturers. While WHO recommends about 130 essential drugs, as many as 4000 drugs are available on the
Indian market. Due to this, ‘buying’ healthcare has gone beyond the reach of the rural poor.
1. 70% of families spend 60% of their annual income on health.
2. 93% of the amount spent on health is on curative and emergency care.
3. Invariably, men receive preferential treatment (56% of the expenditure).
4. Adolescents and the elderly are neglected (14% of expenditure).
5. Poor families spend a higher percentage of their income on health than do the rich, as they are forced to use the services of the private sector because the public sector is ill-equipped and unaccountable. While a number of health insurance schemes are available to the urban sector, the unorganized rural masses that do not have insurance coverage are driven into the arms of the exploitative private sector.