A single question to assess the health of India?

To say that the current healthcare situation in India is complex is an understatement.

A dual burden of infectious disease and non-communicable diseases is leaving the healthcare system strained. Infrastructure disparities see the poor and those in rural communities almost entirely overlooked by the medical system in many cases.

Would it be possible, then, to assess the health of the nation using a single question? Researchers at the University of Geneva (UNIGE), Switzerland, began to wonder whether it was possible to use this single question — “What would you say about your health status?” — to assess public perception of health.

India, a far more complex health situation?

The question is more common in wealthier nations, such as Europe and the United States. There, infectious diseases are far less common and the question may produce simpler outcomes. With a far more limited list of potential infectious diseases, as well as widely known risk factors for chronic conditions, the reporting of feeling generally unwell could indeed lead to a specific diagnosis by the doctor.

Difficulty breathing for example may lead to a diagnosis of lung cancer, asthma, or influenza in a western nation. In India, this symptom may be caused a whole host of conditions. It may be numerous infectious diseases may cause the condition. It could be environmental factors such as heightened pollution levels. Even illnesses contracted in the workplace such as silicosis or asbestosis may be the cause.

Stéphane Cullati, a researcher at UNIGE’s Institute of Sociological Research, explains “the possible answers are: ‘Very good’, ‘Good’, ‘Average’, ‘Bad’, or ‘Very bad’. She said, “We wanted to know whether this same question would be suitable for a country as socially diverse as India. Initially at least, our Indian colleagues were sceptical.”

The researchers note that in addition to the more diverse range of diseases that are native to the subtropical climate of India, socioeconomic factors play a major role. Unlike in Switzerland (or, indeed, the majority of European nations), extreme poverty is rife in India. With this come additional factors such as malnutrition, a complication which have more far-reaching effects across a person’s life, leaving them more vulnerable to many diseases.

This concept is supported by further studies which state that, even if a child who is in poor health resulting from a poor economic background in their early years improves in socioeconomic status later in life, they are likely to continue to suffer health effects. In addition to the potential for malnutrition, researchers have proposed that chronic stress in a person’s youth may have detrimental effects later in life. Numerous untreated illnesses  may also have further consequences across a person’s lifetime.

“In some of the poorest states in India, people are sometimes inclined to think that diseases are ‘normal’, even though they are actually preventable”, says Claudine Burton-Jeangros, a professor in UNIGE’s Faculty of Science. “This is because diseases can be common and medical facilities rare. Likewise, illiteracy restricts the access of a certain section of the population to medical expertise, sometimes preventing them from establishing that their pains are due to chronic diseases, such as diabetes.”

The results of just one simple question could give effective guidance to India’s healthcare system

The UNIGE researchers compared the data from 2003 gathered by the World Health Organization (WHO) in India with Swiss data from 2007. The study used around twenty comparable indicators between the two databases and measuring four key health factors: physical (heart problems, breathing difficulties and chronic diseases), mental (depression, anxiety, etc.), functional (walking, self-care, etc.) and health behaviours (physical activity, vegetable consumption).

The results of the study indicated that the one line question may be of even more benefit than to India than in a Western nation. It was noted that, in Switzerland, about eighty percent of the population considered themselves to be in good or very good health.  Fewer than one percent rated themselves as being ‘in very bad health’. In India the responses were far more varied, with around fifteen percent reporting their health as ‘very poor’ and 21 percent responding ‘very good’.

More varied results means that the information may be far more useful to India. For example, identifying areas where respondents consistently report worse states of health may allow for the healthcare system to better target improvements in healthcare infrastructure.

Where infrastructure is lacking, mobile surgeries could allow for groups of doctors to perform diagnostics in areas where respondents are reporting worse states of health. This could allow for the root cause of the issue to be identified. In the case of infectious disease this may warrant targeted vaccination campaigns or the provision of antibiotics to an area.

Cullati notes that one of the biggest advantages of the use of this question is the speed of delivery. While an individual may not bother to fill out an in-depth questionnaire, they are likely to be more than happy to answer a single sentence with a brief response. As the information from this response can be extrapolated to identify those needing further investigation into health concerns, it is a simple measure that may vastly improve efficiency within India’s healthcare system.