Saturday, March 6, 2010

Health Care In The Country Of India (Poor Now But Signs of Progress)

"Economistsforum" blog of Financial Times has an interesting story on India.  Mainly focusing on public health services in the country.  Written by Shankar Ankarya who was chief economic adviser to India for 8 years.  India is very similar to China in that it is an emerging economy, so if you plan to make some investment there, maybe with an ETF or mutual fund, you need to know clearly before you invest what is the situation there on many levels.

One factor to consider is the general health of the citizens/workers of the country.  A healthy worker is an efficient worker, so we need to consider the current health situation and the steps being taken to improve it.

Currently people in India must tolerate very poor health.  Roughly 40% of Indian children under three are stunted (short, not growing properly for their age). Nearly 80% of Indian children under age 3 are anaemic. Greater than 50% of married women (age 15-49) are anaemic.  Even it's relatively common that affluent Indians will get diseases like hepatitis, malaria, diarrhea, and dengue or less commonly swine flu.

The economic costs of poor health of a country's general population can be enormous.  Government spending on health in India accounts for just barely 1% of gross domestic product (GDP).  The article goes on to point out the high importance of differentiating between "public health services" and "medical services".  It breaks it up into 3 parts, the first 2 called "public health services" the 3rd called "medical services" and here I lift directly from Shankar Ankarya's article:

  1. Population-wide preventive services to reduce exposure to disease through sanitary and health regulations and monitoring and averting health threats;
  2. Clinical preventive services provided to individuals such as vaccination and screening; and
  3. Medical services to care for and treat individuals with injuries and diseases.
The first of the three numbered above, which can also be called "environmental health services" is the most important, and is really what demarcates the success in health rates of developed countries in comparison to countries such as India.  Unfortunately, due to past policy errors "environmental health services" (number 1 above) has become the neglected ugly red-haired stepchild in most Indian states' health system.

Public health and medical health used to be separate bureaucracies in the government, but around 1947 they started to become unified. After they combined, medical services started to dominate the battle for talent and resources in the Indian states.

As the Financial Times article spells out, there was one very important exception to this herd mentality in the Indian health care system and that was the state Tamil Nadu.  Tamil Nadu put more effort and resources into the public health services aspect.  Things such as immunization for children, postnatal care for mothers.  There were other variables which might have helped Tamil Nadu's superior health results to other Indian states, but there is no doubt that the different approach to the problem was a positive factor.

You can compare the results between Tamil Nadu and India in general in the 3 graphs at the links here, here, and here.  The graphs are very enlightening, and many lessons for India in this paper and lessons for other countries in similar situation as India.  Much of the findings were found in a paper Shankar Ankarya references in his article here:  How might India’s public health systems be strengthened?” by Monica DasGupta, Rajendra Shukla, T V Somanathan and  K K Datta, World Bank Policy Research Working Paper 5140, November 2009; and “How to improve public health systems: the lessons from Tamil Nadu”, by Monica DasGupta, B R Desikachari, T V Somanathan and P Padmanaban, World Bank Policy Research Working Paper 5073, October 2009.

I encourage all to read Shankar Ankarya's article and the referenced paper.

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