Has distorted development brought about a change in the environment which, in turn, has led to the recent epidemics in India? This question is but natural when one thinks of the relation between environment and health. Though the idea is not novel, it is a reminder that in today's world, where medical view borders on curative formulae rather than preventive steps, the need of the hour is a relook at the relation of environment and health so as to put things in perspective.
The dreaded Plague which spread terror in India, and caused havoc especially in Surat and Latur (remember the earthquake-struck villages?), was followed by the recent outbreaks of Dengue and malaria. It appears that India has woken up only after these tragedies, and realised that garbage, pollution (air, water, noise, etc.) and the like are indeed forces to reckon with.
The health status of Indian people and the factors affecting the status and health care services in India are fast becoming issues of great concern in the changing national and international social and economic scenario.
Health is very sensitive to changes in economic policies, environment, standard of living, working conditions, conflicts and violence, and the like. In fact, there is not a single broad social action which does not have a direct or indirect effect on people's health.
India is a country of almost one billion people, and given its diversity of languages, culture, religion, castes, etc. it is like a sub-continent. In half-a-century since its independence from colonial rule, India has made great progress in improving the people's health status and in establishing health care services. For instance, the Infant Mortality Rate (IMR) has come down from 161 in 1946 to 82 in 1993 per thousand live births, the policy makers are feeling confident about eradicating leprosy in the next few years, and that we now have one properly trained doctor for 800 people.
However, averages are often deceptive, they do not tell us about the millions of people still are at greater risk of communicable diseases than the averages suggest or that doctors are so grossly maldistributed that the doctor-population ratio is two to three times higher in the rural areas than in the urban areas. Or that there are areas in India (eg. Kerala) where the health status indicators compare favourably with the achievement in the developed world, but there are areas where the developments of last half-a-century not made any difference at all.
Further, many of the developments have made some regions of India highly prosperous but at the same time displaced people, degraded environment, introduced new diseases, encouraged large-scale migrations, adversely affected traditional economy and made people unemployed, increased income disparities and forced people into poverty, and so on. Thus, while new developments and technologies have reduced mortality rates, they have also contributed in lowering quality of life and in increasing morbidity.
We have been endevouring to understand such multiple dimensions of contraditions of health and health care, and their regional variations for the last two decades. From the beginning we faced great hurdles in having national and region specific reliable information. We remember our initial astonishment reading data given in the late 1970s by international organisations and journals that in India only 20% of people use modern medical care while to the rest, modern pharmaceuticals are not accessible and that they still use indigenous medicine. But all surveys we conducted at the community level did not confirm to such assertion, on the contrary we found that people were desiring modern medicine more that the indigenous.
Now, of course, more substantial data are available from large national surveys to show that our observation was correct and that Indian systems of medicine are suffering from such a crisis that there was a need to make special effort to survive and revive them.
NSS data shows that next to dowry, expenditure on health care constitutes the commonest cause of rural indebtedness.
Head, Public Policy Division, Voluntary Health Association of India, New Delhi, Mira Shiva, points out that India's situation in terms of spending of health care is different from most countries in the third world on two counts. At 6% of the GDP spent on health care (including both government and private expenditure), India spends more on health care in per cent terms than most developing countries -- almost on par with developed countries. Simultaneously, the state funding of health care is only 22% -- one of the lowest in the world, developed or developing.
What kind of information will be available on this page?
- Rigorously researched articles and papers various health issues.
Initially we will be providing more information on the following four
areas of health and health care in India :
- Health services and their financing
- Health laws, ethics and regulation
- Women's health
- Health, human rights and violence
- Statistical information -- partly as a part of the researched articles/papers/comments, and partly as tables providing data for those who are interested in using such information for their research, advocacy, action, education works. Some of such data will be available time-series (1952 to 1995) and for each state in Indian union.
- Information on various health related events - meetings, conferences, etc.
- Analysis of current events in the field of health.
Its priorities include documenting information, developing databases, undertaking research, including filed based research to collect primary data, and feeding the information to activist groups involved in various movements such as environment, health, womens', human rights, trade unions etc., and also making use of them for advocacy with the official government agencies. Using the print media -- popular newspapers and magazines, scientific journals, publications of books, reports etc. - we have so far made efforts to take information to all interested individuals and groups. This webpage is a new media we will be using to reach out people with Indian health information and will also endeavour to respond to queries of users.
CEHAT, Research Centre of Anusandhan Trust, 519 Prabhu Darshan, 31 S. Sainik Nagar, Amboli, Andheri (West), Mumbai 400058, Maharashtra, India. Tel: (91)(22) 625 0363, Fax: (91)(22) 620 9203.