Health status and Health problems of India
Health status and Health problems of India:
An assessment of the health status and health problems is the first requisite for any planned effort to develop health care services. This is also known as community diagnosis. Healthcare in India features a universal health care system run by the constituent states and territories of India. The Constitution charges every state with "raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties" The data required for analysing the health situation and for defining the health problems comprise as of following.
Current systems of health care
Many diseases can be prevented, yet health care systems do not make the best use of their available resources to support this process. All too often, health care workers fail to seize patient interactions as opportunities to inform patients about health promotion and disease prevention strategies.
Most current health care systems are based on responding to acute problems, urgent needs of patients, and pressing concerns. Testing, diagnosing, relieving symptoms, and expecting a cure are hallmarks of contemporary health care. While these functions are appropriate for acute and episodic health problems, a notable disparity occurs when applying this model of care to the prevention and management of chronic conditions. Preventive health care is inherently different from health care for acute problems, and in this regard, current health care systems worldwide fall remarkably short.
Health Problems: The health problems of India may be conveniently grouped under the following heads:
Communicable disease problems:
India is undergoing an epidemiologic, demo-graphic and health transition. The expectancy of life has increased, with consequent rise in degenerative diseases of aging and life-styles. Nevertheless, communicable diseases are still dominant and constitute major public health issues.
MALARIA
The emergence of chloroquin resistance in P.falciparum and vector resistance to commonly used insecticides are the main obstacles in the control of malaria in the country. New technologies are being introduced for malaria control under Enhanced Malaria Control Programme. The roll back malaria programme has been launched simultaneously in all malaria endemic countries. These have thrown new challenges in malaria research. The Council's institutes viz. Malaria Research Centre (MRC), Vector Control Research Centre (VCRC) and other institutes are making efforts to address these problems through focused research in vector and parasite biology and ecology, development of malaria control tools, drug development, testing and validation of new technologies.
FILARIASIS
The Council's Vector Control Research Centre (VCRC) at Pondicherry and RMRC, Bhubaneswar have focused their research in the field of vector biology and control, clinical epidemiology and chemotherapy, applied field research and product development. It is identified in the 13 districts of 7 endemic states, namely, AP, Bihar, Kerala, Orissa, TN, UP, WB, covering about 41 million infected persons. The Centre has geared its activity towards transferring the technical know-how to the field for optimum and appropriate application for elimination of filariasis so that latest technical knowledge is absorbed into the Programme.
TUBERCULOSIS
Tuberculosis accounts for a loss of approximately 11 million disability adjusted life years (DALYs). The burden of disease may increase further with the emergence of the HIV epidemic. Approximately 1.8 million new cases of which about 0.8 million are highly infectious smear positive are reported every year. About 4.17 lakh persons die of TB every year in the country.
The Revised National TB Control Programme (RNTCP) which covers more than 120 million population has successfully treated approximately 80% of patients in 48 districts of 16 states and Union Territories. Treatment success rates have more than doubled and death rates have decreased by 75 per cent. The ICMR's Tuberculosis Research Centre (TRC) at Chennai is providing research support to the RNTCP through the conduct of basic, applied and operational research to develop better tools and training strategies for tuberculosis control.
LEPROSY
As a result of the introduction of multidrug therapy (MDT) in the national disease control programme, 98 of 122 countries have reached the goal of elimination of leprosy as a public health problem. However, the prevalence of leprosy in India is still around 5/10,000 population. Leprosy : The leprosy prevalence rate for the country as a whole is estimated at 2.4 per 10,000 population during 2004.
LEISHMANIASIS
Kala-azar is a major public health problem in the states of Bihar, West Bengal and Uttar Pradesh. Cases have also been reported in Delhi. It is serious public health problem in Bihar and West Bengal. Kala-Azar cases reported- 17,806 cases with 72 deaths ('86); 14,753 with 150 deaths (2000); 12,120 cases with 212 deaths in 2001 ;) and 11845 cases with 164 deaths in 2002. However, up to April 2003, 4161 cases and 49 deaths were reported. Research on various aspects of kala-azar is being conducted mainly through the Council's Rajendra Memorial Research Institute of Medical Sciences (RMRI) at Patna and various extramural projects. New research areas such as development of DNA/RNA diagnostic probes and their use in mapping of the distribution of the parasite in kala-azar endemic areas and epidemiological modelling have been identified recently. A Leishmania parasite bank has been established. Clinical trials of different combinations of existing drugs for the treatment of kala-azar are being undertaken to optimize the drug dosages and minimize the associated side reactions.
DIARRHOEAL DISEASES
The National Institute of Cholera and Enteric Diseases (NICED), Calcutta and RMRC, Bhuban-eswar continued to pursue their research goals on different facets of diarrhoeal diseases. The NICED, Calcutta has earned an important affiliation with the Japanese International Collaborating Programme. Its active surveillance programme continues to monitor the newly emerging diarrhoeal pathogens and addresses unknown frontiers in clinical diagnosis and disease management.
Poliovirus:
The four metro cities (Delhi, Mumbai, Calcutta and Chennai) have a high incidence of paralytic poliomyelitis. Urban slums are the main breeding ground of the poliovirus. Eradication of poliomyelitis from these cities is considered difficult because of the high population density, large slum population and also because these cities attract patients from all over the country for treatment.
HIV INFECTION / ACQUIRED IMMUNE DEFICIENCY SYNDROME
The human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) is increasing in India. ICMR's research activities have helped to understand the problem of HIV/AIDS and have contributed in formulating strategies for the control and management of the disease. A prospective cohort of HIV seronegative persons attending STD clinics gave the first reliable estimates of incidence of HIV infection in this highrisk population and identified the behavioural and biological risk factors associated with acquiring HIV infection. Presently this cohort is being used for studies on acute pathogenesis and intervention of HIV/AIDS. Basic research including developmental research has been given special importance. High in the priorities are vaccine related virological and immunological studies, development of diagnostic tests for opportunistic infections, testing of drugs for anti-retroviral and immunopotentiating activity and generation of reagent and virus repositories for use in HIV research. HIV infection is unique due to its social aspects. Studies in the social and behavioural sciences have been continuing specially in areas related to women and education, awareness, reproductive health and treatment seeking behaviour. India accounts for 10 percent of the global HIV burden. An estimated 4.58 million men, women and children were living with HIV/AIDS in the country at the end of 2002, with an adult (15-49 years) prevalence rate of 0.8 percent.
Blindness: Government is implementing the National Blindness Control Programme. About 4.5 million cataracts operation per year up to 2007 are envisaged.
Cancer : There are about 20-25 lakh cases of cancer and approximately 7-9 lakh cases come up every year. During the Tenth plan, the National Caner Control Programme has been made a Centrally Sponsored Scheme.
Environmental Sanitation Problems: Presently, 85 % of rural and 95% of the urban population has access to safe drinking water.
Dengue (Haemorrhagic) fever: It is a fatal viral disease caused by female Aedes aegypti mosquitoes. First reported in Delhi in 1996 with 10,252 infected cases and 423 deaths. In 2001, 3,188 cases reported and 53 deaths. It is spreading to new areas.
Japanse Encephalitis : It caused by flavivirus group. In the last five years, it has acquired serious magnitude in 11 states. In 1995, 2974 cases with 942 deaths and in 2002, out of 1464 cases 361 deaths, were reported.
Nutritional problems
From the nutritional point of view, the Indian society is a dual society, consisting of a small group of well fed and a very large group of undernourished. The high income groups are showing diseases of affluence which one finds in developed countries.
The major problems such as Protein Energy Malnutrition, Nutritional Anemia, and Vitamin A deficiency disorder cases great morbidity and mortality amongst the children and young. 47% of India's children below the age of three are malnourished, almost twice the statistics of sub-Saharan African region of 28%. World Bank estimates this figure to be 60 million children out of a global estimated total of 146 million. Although India's economy grew 50% from 2001-2006, its child-malnutrition rate only dropped 1%, lagging behind countries of similar growth rate. Malnutrition impedes the social and cognitive development of a child, reducing his educational attainment and income as an adult. These irreversible damages result in lower productivity.
Environmental sanitation:
Sanitation includes water supply, safe disposal of human waste, waste water and solid waste management, control of vectors of diseases, domestic and personal hygiene, food, sanitation, housing etc. The US National Sanitation Foundation defines sanitation thus: "It is the quality of living expressed in clean homes, clean farms, clean neighbourhoods and clean ommunity. Being a way of life, it must come from people, nourished as it is by knowledge and it grows as obligation and ideal in human relations".
Adequate supply of safe water and sanitation is vital for sustainable development and for improving the quality of life no less than alleviating poverty. Sustainable development is the result of a political order in which a society is so structured that it learns fast from its mistakes in the use of its natural resources and rapidly rectifies its human-nature relationships in accordance with the knowledge it has gained. In rural area percentage coverage is only 22%, however it is 59% in urban areas. (WHO/UNICEF Sanitation Assessment Report 2004). In recent years there is continuous progress in the sector, however a lot is required to meet the Millennium Development Goal on sanitation. Majority of the people defecate in the open. Open defecation defiles ecology, fouls water resources and causes stink in inhabitated areas.
Of the estimated 2 million children who die from diarrhoeal diseases each year in developing countries, almost 600,000 die from sanitationrelated ailments alone. This disease is endemic throughout the world. Refugee populations and children suffering from malnutrition are among the worst affected. Sustainability thus demands the creation of a political order in which, firstly, control of natural resources rests, to the maximum extent possible, with local communities which are dependent on those resources; and, secondly, decision-making within the community is as participatory, open and democratic as possible. The bedrock of sustainable development is composed of freedom and democracy.
Medical care problems
India has a national health policy. It does not have a national health service. The financial resources are considered to furnish the costs of running such a service. The existing hospital based, disease oriented health care model has provided health benefits mainly to the urban elite. Approximately 80 percent of health facilities are concentrated in urban areas. Even in Urban areas, there is an uneven distribution of doctors. With large migrations occurring from rural to urban areas, urban health problems have been aggravated and include overcrowding in hospitals, inadequate staffing and scarcity of certain essential drugs and medicines. The rural areas where nearly 74 percent of the population live, do not enjoy the benefits of the modern curative and preventive health services. Many villages rely on indigenous system of medicine. Thus the major medical care problem in India is in equable distribution of available health resources between urban and rural areas, and lack of penetration of health services to the social periphery.
Population problem:
The population problem is one of the biggest problems facing the country, with its inevitable consequences on all aspects of development, especially employment, education, health care, housing, sanitation and environment. The country's population has already reached more one billion mark.
An assessment of the health status and health problems is the first requisite for any planned effort to develop health care services. This is also known as community diagnosis. Healthcare in India features a universal health care system run by the constituent states and territories of India. The Constitution charges every state with "raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties" The data required for analysing the health situation and for defining the health problems comprise as of following.
- Morbidity and mortality statistics
- Demographic conditions of the population
- Environmental conditions which have a bearing on health
- Socio-economic factors which have a direct effect on health
- Cultural background, attitudes, beliefs and practices which affect health
- Medical and health services available
Current systems of health care
Many diseases can be prevented, yet health care systems do not make the best use of their available resources to support this process. All too often, health care workers fail to seize patient interactions as opportunities to inform patients about health promotion and disease prevention strategies.
Most current health care systems are based on responding to acute problems, urgent needs of patients, and pressing concerns. Testing, diagnosing, relieving symptoms, and expecting a cure are hallmarks of contemporary health care. While these functions are appropriate for acute and episodic health problems, a notable disparity occurs when applying this model of care to the prevention and management of chronic conditions. Preventive health care is inherently different from health care for acute problems, and in this regard, current health care systems worldwide fall remarkably short.
Health Problems: The health problems of India may be conveniently grouped under the following heads:
- Communicable disease problems
- Nutritional problems
- Environmental sanitation problems
- Medical care problems
- Population problems
Communicable disease problems:
India is undergoing an epidemiologic, demo-graphic and health transition. The expectancy of life has increased, with consequent rise in degenerative diseases of aging and life-styles. Nevertheless, communicable diseases are still dominant and constitute major public health issues.
MALARIA
The emergence of chloroquin resistance in P.falciparum and vector resistance to commonly used insecticides are the main obstacles in the control of malaria in the country. New technologies are being introduced for malaria control under Enhanced Malaria Control Programme. The roll back malaria programme has been launched simultaneously in all malaria endemic countries. These have thrown new challenges in malaria research. The Council's institutes viz. Malaria Research Centre (MRC), Vector Control Research Centre (VCRC) and other institutes are making efforts to address these problems through focused research in vector and parasite biology and ecology, development of malaria control tools, drug development, testing and validation of new technologies.
FILARIASIS
The Council's Vector Control Research Centre (VCRC) at Pondicherry and RMRC, Bhubaneswar have focused their research in the field of vector biology and control, clinical epidemiology and chemotherapy, applied field research and product development. It is identified in the 13 districts of 7 endemic states, namely, AP, Bihar, Kerala, Orissa, TN, UP, WB, covering about 41 million infected persons. The Centre has geared its activity towards transferring the technical know-how to the field for optimum and appropriate application for elimination of filariasis so that latest technical knowledge is absorbed into the Programme.
TUBERCULOSIS
Tuberculosis accounts for a loss of approximately 11 million disability adjusted life years (DALYs). The burden of disease may increase further with the emergence of the HIV epidemic. Approximately 1.8 million new cases of which about 0.8 million are highly infectious smear positive are reported every year. About 4.17 lakh persons die of TB every year in the country.
The Revised National TB Control Programme (RNTCP) which covers more than 120 million population has successfully treated approximately 80% of patients in 48 districts of 16 states and Union Territories. Treatment success rates have more than doubled and death rates have decreased by 75 per cent. The ICMR's Tuberculosis Research Centre (TRC) at Chennai is providing research support to the RNTCP through the conduct of basic, applied and operational research to develop better tools and training strategies for tuberculosis control.
LEPROSY
As a result of the introduction of multidrug therapy (MDT) in the national disease control programme, 98 of 122 countries have reached the goal of elimination of leprosy as a public health problem. However, the prevalence of leprosy in India is still around 5/10,000 population. Leprosy : The leprosy prevalence rate for the country as a whole is estimated at 2.4 per 10,000 population during 2004.
LEISHMANIASIS
Kala-azar is a major public health problem in the states of Bihar, West Bengal and Uttar Pradesh. Cases have also been reported in Delhi. It is serious public health problem in Bihar and West Bengal. Kala-Azar cases reported- 17,806 cases with 72 deaths ('86); 14,753 with 150 deaths (2000); 12,120 cases with 212 deaths in 2001 ;) and 11845 cases with 164 deaths in 2002. However, up to April 2003, 4161 cases and 49 deaths were reported. Research on various aspects of kala-azar is being conducted mainly through the Council's Rajendra Memorial Research Institute of Medical Sciences (RMRI) at Patna and various extramural projects. New research areas such as development of DNA/RNA diagnostic probes and their use in mapping of the distribution of the parasite in kala-azar endemic areas and epidemiological modelling have been identified recently. A Leishmania parasite bank has been established. Clinical trials of different combinations of existing drugs for the treatment of kala-azar are being undertaken to optimize the drug dosages and minimize the associated side reactions.
DIARRHOEAL DISEASES
The National Institute of Cholera and Enteric Diseases (NICED), Calcutta and RMRC, Bhuban-eswar continued to pursue their research goals on different facets of diarrhoeal diseases. The NICED, Calcutta has earned an important affiliation with the Japanese International Collaborating Programme. Its active surveillance programme continues to monitor the newly emerging diarrhoeal pathogens and addresses unknown frontiers in clinical diagnosis and disease management.
Poliovirus:
The four metro cities (Delhi, Mumbai, Calcutta and Chennai) have a high incidence of paralytic poliomyelitis. Urban slums are the main breeding ground of the poliovirus. Eradication of poliomyelitis from these cities is considered difficult because of the high population density, large slum population and also because these cities attract patients from all over the country for treatment.
HIV INFECTION / ACQUIRED IMMUNE DEFICIENCY SYNDROME
The human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) is increasing in India. ICMR's research activities have helped to understand the problem of HIV/AIDS and have contributed in formulating strategies for the control and management of the disease. A prospective cohort of HIV seronegative persons attending STD clinics gave the first reliable estimates of incidence of HIV infection in this highrisk population and identified the behavioural and biological risk factors associated with acquiring HIV infection. Presently this cohort is being used for studies on acute pathogenesis and intervention of HIV/AIDS. Basic research including developmental research has been given special importance. High in the priorities are vaccine related virological and immunological studies, development of diagnostic tests for opportunistic infections, testing of drugs for anti-retroviral and immunopotentiating activity and generation of reagent and virus repositories for use in HIV research. HIV infection is unique due to its social aspects. Studies in the social and behavioural sciences have been continuing specially in areas related to women and education, awareness, reproductive health and treatment seeking behaviour. India accounts for 10 percent of the global HIV burden. An estimated 4.58 million men, women and children were living with HIV/AIDS in the country at the end of 2002, with an adult (15-49 years) prevalence rate of 0.8 percent.
Blindness: Government is implementing the National Blindness Control Programme. About 4.5 million cataracts operation per year up to 2007 are envisaged.
Cancer : There are about 20-25 lakh cases of cancer and approximately 7-9 lakh cases come up every year. During the Tenth plan, the National Caner Control Programme has been made a Centrally Sponsored Scheme.
Environmental Sanitation Problems: Presently, 85 % of rural and 95% of the urban population has access to safe drinking water.
Dengue (Haemorrhagic) fever: It is a fatal viral disease caused by female Aedes aegypti mosquitoes. First reported in Delhi in 1996 with 10,252 infected cases and 423 deaths. In 2001, 3,188 cases reported and 53 deaths. It is spreading to new areas.
Japanse Encephalitis : It caused by flavivirus group. In the last five years, it has acquired serious magnitude in 11 states. In 1995, 2974 cases with 942 deaths and in 2002, out of 1464 cases 361 deaths, were reported.
Nutritional problems
From the nutritional point of view, the Indian society is a dual society, consisting of a small group of well fed and a very large group of undernourished. The high income groups are showing diseases of affluence which one finds in developed countries.
The major problems such as Protein Energy Malnutrition, Nutritional Anemia, and Vitamin A deficiency disorder cases great morbidity and mortality amongst the children and young. 47% of India's children below the age of three are malnourished, almost twice the statistics of sub-Saharan African region of 28%. World Bank estimates this figure to be 60 million children out of a global estimated total of 146 million. Although India's economy grew 50% from 2001-2006, its child-malnutrition rate only dropped 1%, lagging behind countries of similar growth rate. Malnutrition impedes the social and cognitive development of a child, reducing his educational attainment and income as an adult. These irreversible damages result in lower productivity.
Environmental sanitation:
Sanitation includes water supply, safe disposal of human waste, waste water and solid waste management, control of vectors of diseases, domestic and personal hygiene, food, sanitation, housing etc. The US National Sanitation Foundation defines sanitation thus: "It is the quality of living expressed in clean homes, clean farms, clean neighbourhoods and clean ommunity. Being a way of life, it must come from people, nourished as it is by knowledge and it grows as obligation and ideal in human relations".
Adequate supply of safe water and sanitation is vital for sustainable development and for improving the quality of life no less than alleviating poverty. Sustainable development is the result of a political order in which a society is so structured that it learns fast from its mistakes in the use of its natural resources and rapidly rectifies its human-nature relationships in accordance with the knowledge it has gained. In rural area percentage coverage is only 22%, however it is 59% in urban areas. (WHO/UNICEF Sanitation Assessment Report 2004). In recent years there is continuous progress in the sector, however a lot is required to meet the Millennium Development Goal on sanitation. Majority of the people defecate in the open. Open defecation defiles ecology, fouls water resources and causes stink in inhabitated areas.
Of the estimated 2 million children who die from diarrhoeal diseases each year in developing countries, almost 600,000 die from sanitationrelated ailments alone. This disease is endemic throughout the world. Refugee populations and children suffering from malnutrition are among the worst affected. Sustainability thus demands the creation of a political order in which, firstly, control of natural resources rests, to the maximum extent possible, with local communities which are dependent on those resources; and, secondly, decision-making within the community is as participatory, open and democratic as possible. The bedrock of sustainable development is composed of freedom and democracy.
Medical care problems
India has a national health policy. It does not have a national health service. The financial resources are considered to furnish the costs of running such a service. The existing hospital based, disease oriented health care model has provided health benefits mainly to the urban elite. Approximately 80 percent of health facilities are concentrated in urban areas. Even in Urban areas, there is an uneven distribution of doctors. With large migrations occurring from rural to urban areas, urban health problems have been aggravated and include overcrowding in hospitals, inadequate staffing and scarcity of certain essential drugs and medicines. The rural areas where nearly 74 percent of the population live, do not enjoy the benefits of the modern curative and preventive health services. Many villages rely on indigenous system of medicine. Thus the major medical care problem in India is in equable distribution of available health resources between urban and rural areas, and lack of penetration of health services to the social periphery.
Population problem:
The population problem is one of the biggest problems facing the country, with its inevitable consequences on all aspects of development, especially employment, education, health care, housing, sanitation and environment. The country's population has already reached more one billion mark.
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