This is a fact that is often overlooked when we consider health care in India and the state of health in the country yet the medicines for the millions of poor and the lower middle class families still remains a luxury. Million of people are trapped.
In the vicious circle of poverty, malnutrition and diseases. Lakhs of people suffer from T.B. and many succumbing to it. The incidence of infant mortality and maternal mortality still remains high.
Where illiteracy and poverty reign supreme, people pay little heed to hygiene, personal cleanliness and environmental sanitation leading to problem of health. There is hundreds of habitation which have medical facilities.
If there is health centre there are no doctors, if there are doctors there are no medicines and those who need special care they don’t have the money to buy medicines and pay the doctor’s bills. For the bulk of the poor health and survival still remains a luxury.
No doubt, we have achieved a lot on the health front. But we are yet to attain the level of health care reached by developed countries like America and France. Prior to independence the average life expectancy at birth was under 30 years.
A baby born in India today can expect to live an average of twice as long. Out of 1000 born in India in 1945, 161 would be dead before reaching their first birthday. Today the infant mortality has been more than halved and is less than 70 per 1000 live birth.
In parts of India the rate has been reduced to levels approaching those in some western countries. The story is similar in regard to other health indices. One of the common causes of infant death was tetanus of the new born.
About 20-30 per cent of infant deaths were due to this infection. Today tetanus is almost eliminated as a cause of death. Smallpox has been eradicated. An epidemic of cholera rarely occurs today. Many of these changes have taken place because of a combination of factors.
Basic public health services such as immunisation, control of epidemic disease and better water supply have played a role. But so have been played the role of overall development, better food availability nutrition and education.
The change in the death rate has resulted in the average Indian living longer. In demographic terms we can say that more persons are living not only to adulthood, but also surviving into old age. Today there are more than 67 million old people in India.
This has serious implication for the health system in India, when few persons lived to older age, the disease that are common in older persons were uncommon in India. Now that there are older persons in India than there are people in most countries in the would.
The health system will increasingly have to cope with condition such as cancer, hypertension and health disease.
This epidemiologic change in disease pattern is the result of the demographic transition that is taking place with improved health services and better living conditions in the country together with the reduction in infant and childhood disease and the noninfectious disease.
Unfortunately this has not meant that infectious diseases have become less important. Childhood continue to be shadowed by respiratory infections. There are parts of India where quality of life has not improved with the rest of the country.
In addition some old diseases such as malaria are making comeback and new ones are emerging. HIV infection and AIDS is a prominent example of new infectious disease.
India has recently estimated that there are over three million persons already infected with the virus that causes AIDS and new infections are occurring every day. With the advent HIV/AIDS, tuberculosis will become an increasingly common infection.
There are national health programmes for malaria. TB, leprosy, blindness, AIDS, cancer etc the National Anti Malaria programme is the world’s biggest health programme against a single communicable disease.
Deaths due to malaria were totally eliminated but unfortunately due to several other factors malaria has staged a come back.
India accounts for nearly one third of the global cases of tuberculosis. Every year 20 lakh people fall victim to TB and eight lakh becomes highly infectious about five lakh die of TB every year.
Though the incidence of leprosy has come down India still holds the dubious distinction of having 60 per cent of the globally recorded leprosy case. As regards cancer, in all, there are 20 to 25 lakh cases of cancer in the country and about seven lakh new cases emerge every year.
As cancer has high rate of mortality unless detected and treated early. The emphasis is on prevention, early detection of cause and augmentation of treatment facilities in the country.
The government must realise at the same time the need for preventive medicine. The area of concern for patient is the cost of medicine which is going up day by day. The doctor and para-medical staff are hands in glove to pilfer away costly medicines from hospitals and dispensaries.
The latter don’t have bandages or cotton for dressing, where all these supplies go? Visit any dispensary in rural or semi urban areas there is hardly medicine except the common paracetamol for fever or allergy.
All the more, regretfully public health as a discipline has steadily diminished in importance and today it is the low status poor cousin of health care. So we continue to react to health emergencies rather than proactively anticipate and prevent them.
Today most states in the country do not feel it necessary that the chief medical officer has any training in public health. The district health system is therefore supposed to be managed by a person chosen not for his/her training but the person who happens to be the most senior and due for a promotion.
Above all, prevention is better than cure. Health is not just hospitals, doctors or drugs. It is the duty of the government and the society to create the ideal conditions for basic health.
These ideal conditions include steps to reduce poverty, promote education and awareness, provide safe drinking water and sanitation, including habits of hygiene and personal cleanliness and educate the masses on fundamentals of health through inter personal contact group discussions, traditional media newspapers and TV.