Across the economic strata, barring the extremely rich, health and prosperity are highly correlated. A thumb rule says that a patient suffering from malignancy requiring treatment spaced out over a period of ten years would require Rs 50 lakhs at the least. An extreme example but is a pointer as to what a healthcare cost may do to a family’s economic situation. Insurance helps but how many people can afford the premium required to sustain this degree of coverage?
Now as we go down the economic pyramid the situation becomes even more critical. According to an assessment made by the Public Health Foundation of India it is found that between 1993-94 and 2011-12 more than 5.5 crore people were pushed below poverty line due to out of pocket expenditure on heatlthcare.
The enormity of the issue becomes even more glaring if we compare the South Korean population of 5.15 crore with the number of people pushed down below the poverty line as assessed by the Public Health Foundation of India. Ayushman Bharat scheme is expected to chip in substantially in alleviating the situation. But considering the fact that we have just about one doctor per 1000 population the problem in the healthcare sector becomes even more glaring.
Illness therefore tends not only to have a debilitating impact on health but also tends to take a heavy toll on the economic well being as well. Because illness prevents one to be an active participant in the labour force. This in turn takes away the person concerned ability to earn denting heavily the wherewithal of his or her family. The chain however doesn’t stop here. Being ill necessitates a flow of care services. At the lower stratum this flow is sustained by family members. The necessity of providing care further dents a family’s ability to earn further as the care giver also needs to withdraw himself or herself from whatever economic services that he or she may have been engaged in. Understanding of this dynamics doesn’t require a lot of theoretical inputs and by extending this understanding we can easily grasp the implications of the results of the survey that I stated at the beginning.
The point to note here is that if the illness were not to claim such a huge casualty in terms of economic well being all these families would have retained their prosperity at the least if not would have prospered further. In the context of the Indian poverty alleviation dynamics therefore preventive healthcare takes up an importance of serious proportion. A creation of a preventive healthcare infrastructure could lead to creation of higher prospects for prosperity among families not only at the base of the pyramid but also among families occupying various higher strata of economic well being.
Completely agree with your point of view. Very pertinent and timely article. While preventive healthcare is very important and conspicuous by absence in poor people, another issue which needs to be taken care is nutrition in the segment and an organised intervention is required. Task is too big and only state may not be able to do it alone, all of privileged citizens need to chip in.
ReplyDeleteCorrect. I have an interesting anecdote to share. Once I was trying to do an agriculture training under which I was suggesting backyard cultivation for family nourishment which can also go as far as to an income of a lakh or more. I was asking to assess the income of the family. Many could not do it. So I asked the expenses of the family. And somehow the expenses related to health engaged people more. They started counting how many times they have to spend, in medicine, checkup, travel, follow ups and the altered diet suggested by a doctor, and his fees. When I wrote it down one by one, everybody was looking at the chart with lot of interest. My point was to tell them that since they were spending so much, it must have come from the family income; because nobody does stealing to pay for this. They were laughing. When I summed it up, it was well over a lakh per year. One of them quipped " you have already made us feel like lakhpatis"! This was in Khunti district of Jharkhand in the year 2015-2016. In Manpur block of Umaria district in Madhya Pradesh, during 2011-2015, I was promoting a SHG federation, and had the women save little every month, and were trained to consume leafy vgetables more, and have 5 coloured food daily. In 2011, ony 4 girlsd were going to school. By 20115, 80% of the girls were attending school, and at lest 40% of them reached to 10th standard, and almost 80% of them passed out of school. With the then chief minister Mr. Shivraj Chouhan's girl education iniitiative to give a bicycle to whoever attended school in those areas, it was quite a transformed scenario looking at the rows and rows of girls returning from school in the evening. Way back in 2005-2007, this same experiemnet was done in the Sadar block of Dhenkanal district in Odisha; where particularly in one village there was a vicious cycle of Malaria, chicken pox and typhoid. In addition to the leafy vegetables,We promoted mushroom cultivation and asked them to cook a mushroom dish everyday for their own lunch. Surprisingly the diseases disappeared, and the once almost impoverished village was transformed to a prosperous village with average monthly income of Rs. 45 per kg x 25 days x 5 kg per family, for 8 months in a year. They supplied this mushroom to the industrial town of Talcher just 45 kms away. Important supply chain intervention...
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