Addressing Health Equity in India

General Studies Paper -2

Context: With a large and diversified population, India faces persistent obstacles to health equity.

Health Equity

• Equity is the absence of avoidable, unfair or remediable differences among groups of people due to their social, economic, demographic or geographic circumstances.
• Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health.

Importance of Health equity

• It ensures that every person has an equal opportunity to achieve their highest health potential, no matter what their circumstances.
• It addresses the root causes of inequities such as poverty, discrimination, limited access to high-quality education, a healthy diet, clean water, fresh air, and housing, and merely grants equal access to health care.
• It is a fundamental component of social justice.
• Health and development :They are interlinked. The health of a population is a fundamental need for economic and social well-being. Thus, the developmental trajectory of a nation hinges significantly on its capacity to furnish top-tier healthcare services to its populace.
  • Doing so enhances productivity, encourages better lifestyles, and creates a more informed and mature labour force, thereby enriching the overall standard of living.

Initiatives

• “Public Health and Hospitals” being a state subject, the primary responsibility of strengthening the public healthcare system lies with the respective State Governments.
  • However, under the National Health Mission (NHM), technical and financial support is provided to the States/UTs to strengthen the public healthcare system at public healthcare facilities.
• Ayushman Bharat initiative: Ayushman Bharat was recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC).
  • This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlying commitment, which is to “leave no one behind.“
• The National Health Mission (NHM), which includes both the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), reduces the health-care gap between rural and urban India by expanding access, strengthening infrastructure, and providing essential services to vulnerable populations.

Existing Issues

• Global: The COVID-19 pandemic has revealed that infectious diseases target marginalised and vulnerable groups the most, thus widening the health equity gap.
  • Climate change poses a serious health risk since it disproportionately impacts low-income and vulnerable people.
  • The health-care provision is severely hampered by conflicts, which destroy infrastructure, uproot communities, and shut off access to vital medical services.
• Indian Scenario: India is diverse and has wide socioeconomic gaps.
  • Access to health care in rural areas is significantly less than in metropolitan areas.
    • Social and economic barriers exacerbate this disparity.
    • According to the 2011 Census, urban slums make up over 17% of India’s metropolitan areas, and exhibit serious health disparities.
    • Health risks are increased by overcrowding, poor sanitation, and restricted access to clean water.
    • Infectious diseases, such as tuberculosis, are 1.5 times more common in slums than in non-slum areas
  • Disparities across caste and gender are profound.
    • NFHS-5 (2019-21) data indicates that Scheduled Castes and Scheduled Tribes experience higher child mortality and lower immunisation rates.
    • Additionally, 59% of women in the lowest wealth quintile suffer from anaemia, almost double the rate in the highest quintile, demonstrating the intersection of caste, gender, and economic status in health outcomes.
  • Non-communicable diseases (NCDs) account for more than 60% of all fatalities in India.
• A critical shortage of doctors exacerbates these issues, with WHO data indicating only 0.8 doctors per 1,000 people, which is below the advised ratio.
• Even though over 75% of health-care professionals work in metropolitan regions, which only account for 27% of the population, the shortage is particularly severe in rural areas.

Suggestions and Way Forward

• Even though access to health care has improved over the past 20 years, there is still much work to be done in rural India.
• India’s health equity issues require a comprehensive approach beyond improvements in health-care facilities to address more extensive socioeconomic determinants of health.
• To move India toward universal health coverage and a more equitable future, the government, civil society, health-care providers, and communities need to work together.
• Governments and officials may influence the state of health through funding, creative policies, and laws.
• Achieving health equity also requires addressing social determinants of health and health disparities.

It involves acknowledging and addressing racism as a threat to public health and the history of unethical practices in public health that lead to inequitable health outcomes.