In the heart of India’s bustling cities and tranquil villages, there is a silent but significant fight raging on the public health front. It is not the dramatic triumphs of curative medicine that dominate this story but the quiet victories of preventing diseases such as smallpox (though eradicated, it is still under surveillance), polio, neonatal tetanus, and measles, through improved sanitation and vaccines. These are unsung wins where the absence of illness speaks volumes.
In particular, political leaders across the spectrum have leaned towards initiatives that promise immediate results, such as new hospitals, subsidised treatments in private hospitals, emergency response (over preventive response), and populist health policies. Many of these measures do not have much of an impact because of a lack of action beyond public announcements, which is almost always due to budgetary constraints.
The case of dengue- Consider the story of dengue, a disease that has only symptomatic treatments, and no definitive cure. When cases surge, political leaders often mobilise the State machinery to set up immediate relief camps at the expense of long-term strategies such as understanding vector bionomics or developing effective vaccines. The focus on providing emergency relief also sidelines the availability of public attention for the root causes of dengue and its long-term prevention, and the research required in vector control, vaccine development, and improvement in public health infrastructure. As a result, the current approach fails to prevent future outbreaks and strains the health-care system.
Investments in nutrition programmes, while not immediately visible, have far-reaching implications for health and productivity.
The contemporary Prime Minister’s Overarching Scheme For Holistic Nourishment (POSHAN) Abhiyan Scheme plans to reduce stunting by 2%, undernutrition by 2%, anaemia by 3%, and low birth weight by 2% every year. But the fifth National Family Health Survey found 35.5% of children under five were stunted and 32.1% were underweight in 2019-21. The prevalence of anaemic children aged 6-59 months increased from 58.6% to 67.1%, and 54.1% to 59.1% among women aged 15-19 years. This disparity between prevalence and policy targets highlights a significant gap in public health efforts.
Indian dilemma: Despite having the same medicines to fight tuberculosis (TB), India reported 21.4 lakh TB cases in 2021, an 18% increase from 2020, translating to an incidence of 210 cases per 1,00,000 population. In contrast, the United States reported only 8,331 TB cases in 2022, about 2.5 cases per 1,00,000 persons. This disparity is not merely a matter of the availability of medical treatment but is deeply linked to socio-economic factors such as poverty, sanitation, and overcrowding (as a result of poorly organised urban housing) prevalent in India.
A degree of autonomy is needed-To address this, an ideal solution would be to place Health Ministries directly under the leadership of elected officials, such as the Chief Minister or the Prime Minister, similar to the management of the space and the atomic energy departments. This structure would not only provide a degree of autonomy but also ensure that health policies are aligned with the people’s immediate and practical needs, striking a balance between expert-driven decisions and public aspirations.
World Economic Forum : the laudatory statement by the WEF’s President that India was a $10 trillion economy in the making. This is only the most recent of a spate of predictions on the future size of India’s economy. At least it can be said for them that it is India’s own leaders who were the first to make these. Thus, in 2019, upon returning to office, Prime Minister Narendra Modi said that India aimed to become a $5 trillion economy by 2024, which would have been the end of his current term.
A $1 trillion economy for their States- This includes the Chief Ministers of Uttar Pradesh and Tamil Nadu.
Growth is a legitimate aspiration in India where the majority of the population is yet to attain a reasonable standard of living.
Growth plus rising inequality- The first thing to note about the recent growth in India is that it has been accompanied by growing inequality. It is important to recognise that this trend is not new.
the world’s leading inequality researchers are very likely right in describing India as “a poor country with an affluent elite” (‘World Inequality Report’, 2022).
To be precise, the real wage rate has grown by 4.6% over the nine years from 2014 to 2022-23. However, even this bare movement is truncated. The real wage rate peaks midway through the period and has remained stagnant since.
Compared to the wages of the agricultural workers, the real wage rate of non-agricultural and construction workers, respectively, is actually lower at the end of the period studied. The Sixth Economic Census of India (2013-14) reports that 51.7% of the employed are in rural India, and, of these, the overwhelming majority (68.9%) are non-agricultural workers.
Why inequality does matter- First, unequal societies are subject to the worst forms of social pathology. These range from violence to disease and mental health disorder. Second, inequality stands in the way of achieving collective action at a time when it is most needed.
Conclusion: India is a democracy, as the Prime Minister constantly reminds us, and it is not in the spirit of democracy to have such divergent economic outcomes. India has not, historically, given enough space in its economic policy to the gross inequality of opportunity across its population.
Stunting irreversibly affects not just the height, but also the cognitive development of a child. While the long-term impact of early childhood stunting on educational levels is recognised, the processes by which it results in lower educational achievements, particularly in low- and middle-income countries, are not well understood.
However, a recent study in ‘World Development’ examines the link between early under-nutrition and four key cognitive skills developed later in childhood: working memory, inhibitory control, long-term memory, and implicit learning.
Three key strategies -
First, promoting early breastfeeding, along with continued breastfeeding for two years, coupled with appropriate complementary feeding starting at six months, is essential.
Second as children grow, diversifying their diet becomes crucial. India should implement and scale up community-based complementary feeding programmes. These can educate parents about the importance of adding a variety of foods to their child’s diet after six months of age, focusing on locally available, nutrient-rich food options.
Finally, adding an extra Anganwadi worker to each Anganwadi centre could help.
