One size won't fit all

Health of the nation survey confirms India lives in multiple worlds simultaneously

It was a long time coming but the first ever properly authenticated ‘health of the nation' survey or, more accurately, the State-wise disease burden and risk factors survey for India conducted jointly by the Indian Council for Medical Research, Health Foundation of India and Institute for Health Metrics and Evaluation under the aegis of the Union Health Ministry has underlined the fact that while India's war against disease and ill-health must be fought collectively as a nation, the priority battles differ from State to State. According to the findings of the survey based on data collected between 1990 and 2016, every State in the country now bears a greater burden from non-communicable diseases and injuries as opposed to from infectious diseases the extent of which varies widely from State to State. So, for example, the Government's Empowered Action Group of States (Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan, Jharkhand, Chhattisgarh, Odisha and Uttarakhand) plus Assam continue to battle maternal/child malnutrition the incidence of which, while having dropped significantly from 1990, is still the single largest risk factor nationwide and was responsible for 15 per cent of India's total disease burden in 2016. But in more developed and prosperous States comprising the southern States plus Punjab, Haryana, Gujarat, Maharashtra and Goa, the disease burden of the aforementioned are proportionately less while at the same time these States are seeing a much higher incidence of non-communicable diseases including cancer and lifestyle-related ailments such as heart disease and diabetes.

In a sense, the survey provides us with reliable data for the first time that would indicate that while the erstwhile BIMARU States are still battling maternal/child malnutrition and diarrhoea epidemics, the better governed States have — thanks to the national focus on maternal and child health by successive regimes over the past 30 years and despite the criminal leakages from and negligence of the public-sector healthcare system — worked to reduce the incidence of such diseases. The bad news for the latter group of States, however, is that prevention of, and spreading awareness about, lifestyles and dietary habits that have contributed to the spike in non-communicable diseases has not been a focus of, say, the National Rural Health Mission or the effort in meeting the UN-mandated Millennium Development Goals which have focused on reproductive, maternal and child health. Add to the mix the fact that road accident and pollution-related disease burdens also figure in the survey and vary from State to State, and the argument for State-specific budgetary estimates and focus areas for action becomes irrefutable. The mapping of severe inequalities between States is a wake-up call to planners and policy-makers at the Centre to ensure that healthcare becomes as governance-agnostic as it can be at the State-level because the systemic issues in poorly governed States are not going to be solved overnight. So, even at the risk of treading on the toes of duly elected State Governments, the Centre needs to take the initiative in the spirit of cooperative federalism, as it were, to work out a joint plan of action with and for specific States. This would also need a joint monitoring mechanism with third-party, expert participation, to ensure accountability. At the same time, both Centre and States must ensure, especially in cases where opposing political allegiances are in play, that at least on an issue as vital as the health of the nation absolutely no discrimination is countenanced. If Centre and States could work together to get GST though, they can certainly do so to give Indians a fighting chance to live a disease-free, healthy life.