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Public health investment: The way to economic prosperity?

The Indian economy is currently perceived by many to be in a state of stagnation and employment opportunities are few and far between for many, leaving a significant portion of India’s working age population trapped in a cycle of poverty. Could a greater degree of investment into public health act as a kickstarter to spur India’s economic growth?

Some experts have pointed towards factors such as weak performance in terms of maternal and child health that are holding the country back. This fact is exacerbated by the considerable disparities on health indicators between states. Some vastly outperform others, with the states at lower levels of economic development often displaying health indicators which could conceivably come from an entirely different nation.

public health Copyright: waelkhalil / 123RF Stock Photo

Public health figures summarised

The Hindustan Times cites a number of figures, each underlining the role which health parameters plays in determining economic performance. For example, Professors D. Bloom and J.P. Sevilla of Harvard TH Chan School of Public Health and D. Canning of Queen’s University studied the health parameters of more than 100 countries, finding that a one-year improvement in life expectancy of a population increases economic output by four percent. 

India has seen life expectancy rise from roughly 41 in 1960 to 69 in 2017. Such a rise is an astonishing achievement. It coincides with massive reductions in the rates of infectious diseases across the country, as well as expanded access to healthcare and vaccination. Yet inequalities persist between states on life expectancy. Women born in Kerala live 77.8 years on average compared to a life expectancy of 65.6 years for women born in Uttar Pradesh.

The rise in life expectancy has been linked in part to a reduction in infectious diseases. However, such conditions have largely been supplanted by new health issues. Noncommunicable diseases are now by far the most common causes of death in India, responsible for 61 percent of deaths in the country. 

These often chronic conditions are now placing a considerable burden on the Indian economy. As treatment often takes place over the course of many years, funding is necessary — whether this be from the individual or the state. Patients may see the burden of their healthcare expenses alleviated through government programmes such as Ayushman Bharat. However, even in the presence of such schemes, out-of-pocket expenditure is still rampant, driving millions into poverty and perpetuating the cycle of poverty ensnaring many Indians.

Researchers Amiri Shiraz and U. G. Gerdtham of Lund University, Sweden note that changes in under-five mortality impacted economic growth in over 85 percent of 180 countries studied. Maternal, as well as child mortality are often linked to malnutrition. This is particularly the case in India, in which a vast number of children suffer from malnourishment, most commonly those from impoverished backgrounds.


India must stave off malnourishment to set its children up for life

Malnourished children reportedly earn twenty percent less as adults than other children, according to research by Save the Children. Micronutrient deficiencies alone cost India 0.4 percent of its GDP each year, according to the World Bank. Severe malnourishment as a child can result in conditions such as stunting or, in its most severe form, wasting.

Stunting refers to when a child is not tall enough for their age. The condition is generally caused by malnutrition or repeated infections impacting the natural growth of the child. Prevalence of the condition in India is high, affecting 38.4 percent of children (though in some districts the figure can be as high as 65.1 percent).

Stunting during infancy is linked to a range of poor health indicators in later life, including poor educational performance. This may account for the newly released statistic that 66 percent of working Indians experience lower wages because of stunting.

Poor educational performance results in a child’s earning capacity in later life being massively limited. This has an immediate effect on the Indian economy, as due to the widespread nature of stunting there are fewer available highly skilled workers. Many children in poorer areas may even forsake their education in favour of helping their family in sectors such as farming. 

This, in turn, often leaves the child impoverished in their own adult life, making it all the more likely that their own children are impoverished. This results in a cycle of poverty in which both the Indian economy and the lives of individuals, are impacted to a severe degree.

Investment into public health, as well as nutritional schemes aimed towards those in impoverished communities (both in rural and urban areas), could be a major stepping stone to reducing child malnutrition rates. This, in turn, would improve the educational performance of many of India’s youth, giving them greater opportunity in later life — and in the process, driving the economy. 


Funding required to continue the fight against infectious disease

Infectious disease has perhaps been the area in which India has had its most notable public health success stories. Rates of malaria and HIV have fallen in recent years. These were among some of the diseases with the greatest impact on the health of the nation, and, therefore, the economy.

However, the greatest success stories have been those of polio and smallpox. Through sustained vaccination campaigns, these diseases have been entirely eradicated from India. This is a testament to both the efficacy of vaccination as a public health tool, and the drive behind India’s medical community down to the grassroot levels.

Without adequate funding, the initiatives that eradicated these diseases could never have taken place. While India has witnessed a considerable reduction in other infectious diseases, they remain considerable public health challenges and new challenges are emerging.

In the example of malaria, India still accounts for 45 percent of the world’s cases. While cases are falling, progress on elimination is losing traction. As with many other diseases rural, hard to reach areas are acting as bastions for the infection to spread. Within densely packed urban metros, there are ample opportunities for vector-borne diseases such as malaria to resurge even after an area has seen cases fall. Surveillance systems must be improved to allow rapid diagnosis and treatment. Such improvements to infrastructure cannot be made without ample funding. 

Drug resistance is also likely to become a major issue unless the problem is addressed rapidly. Nowhere is this more evident than in the growing threat of drug-resistant tuberculosis (TB). Should first-line therapies become ineffective, the more expensive second- and third-line therapies become a necessity to curb disease outbreaks. Without ample funding, drug-resistant strains could see infectious disease rates rise to rival NCDs once more.

In order to cope with its dual burden of infectious diseases and NCDs, India must invest more into its health system, or risk it being overwhelmed. Currently, public health expenditure lingers at around 1.4 percent. This is despite promises by the Centre to increase funding for healthcare to 2.5 percent. 

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