World Population Day: Population and Healthcare in India

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“We live in a finite universe with finite resources.” ~ Thannos, MCU.

The most famous villain from the Marvel Comics Universe probably had the most profound insight into the finiteness of the world we live in. The uninhibited pillage of finite resources, with an ever burgeoning population is like a ticking time bomb waiting to go off.

The WHO population report stipulated that India with its current fertility rate would bypass China’s population in the next seven years. Those seven years are far too close for comfort, especially when other reports are talking about the rapid depletion of India’s resources. Shimla, the holiday haven for most, had lost its ground water supply and was declared as having gone dry. Pictures of hapless citizens of Shimla, standing in long lines for a bucket of water is an indication of a national crisis waiting to happen. Several large cities in India have already been warned of a loss of ground water by 2020. So far we have talked about limited resources but what is the impact of population on healthcare?

World Population Day Special: Population and Healthcare in India

Population and Healthcare in India:

As we have mentioned above, the WHO population report has given India mere seven years to get its act together before it becomes the single most populous country in the world with a smaller geographical share than China. Be that as it may, an uncontrolled population has severe effects on health care systems in developing countries. India is gradually turning into a country with a rapidly aging population, with the mean age in India going upto 31 years. Well, as is generally argued, family planning is a human right. Each family has the legitimate human right to determine how big a family makes them happy. This human right to determination while being true for developed countries, holds little grounds in India.

In developing the choice to have more children is an indication of economic and health care crisis. The vicious circle of population, economics and healthcare is explained in the following section. However, one needs to remember that as of 2015, India showed a gradual decline in average TFR rates, which was recorded at 2.40 births per woman. It is believed that if India brings the average down to the range of 2.10 births per woman, it would reach an ideal situation where the population would regenerate itself. Now, let’s proceed to understand why India’s health care system is in a crisis.

Population Density and Availability of Clinics and Hospitals:

India is probably one of the most favourite destinations for a healing vacation, with Kerala booming in quality healthcare practices. Then why do we hear of events like the death of many children in UP because of lack of oxygen, or that a person with 8th grade qualification performed operation on someone? Why is it always stressed that even basic healthcare is not available with people living in fringe villages, or that the government hospitals and doctors are overwhelmed, understaffed and underpaid?

The answer lies in demographics. For a population of over 100 crore people, there are a few lakh doctors, in fact according to some estimates, there is one doctor per 1700 people. This figure in itself puts an excess pressure on any doctor. Now add the density of hospitals, and availability of hospitals to the list and we will have a dismal picture.

70% of Indian population is rural, several of which are lacking access to Primary Health Centres, on the other hand, nearly 80% of doctors live in urban India, working for private hospitals, making quality healthcare almost inaccessible to a large chunk of the population.

How is Demography Impacting Quality Healthcare:

When healthcare providers are absent from vital positions of availability, especially for a population which does not have the means to afford healthcare in private healthcare, it leads to the menacing spread of diseases and deaths which could have been avoided. As mentioned, if there is one doctor per 1700 people, the doctor is under immense pressure to provide timely care to as many people as he/she possibly could. This means, that the time dedicated to one patient, is less than ideal, most of the times, it means that adequate healthcare is delayed on the grounds of lack of time and priority of cases.

There is also the fact, that a communicable disease can easily become an epidemic because of the proximity and conditions a large number of people live in, increasing the load of an overburdened healthcare system.

Population Density and Social and Economic Causes:

Infant Mortality Rate have been on a steady decline because of the government’s efforts. However, we need to understand, why we even had a high TFR and IMR in the first place. The reason for a high TFR has a lot to do with malnutrition, lack of timely care and economy. Economists and sociologists have argued that the “Hum do, Hamare do” campaign failed to take into account some critical factors.

One being high infant mortality rate, the high infant mortality rate was a direct result of which would be that the poor took a gamble. They would have several children in the hope that some would survive the conditions they were born in.

For the rich the causes have been more social, lack of gender equality and preference for a son, meant that families with two or more daughters would keep trying till the woman was in no condition to go through another pregnancy or a son was born.

If we look at communities, the popular belief and theory is that some communities have increased their numbers to protect themselves and their numbers from the threats of the dominant identity groups. How true, any of these beliefs is not clear but it is true that population has risen to threatening levels in the 70 years since independence.

Healthcare: Contribution to GDP and Share from the Union Budget

Healthcare sector contributes to nearly 4.2% of the total GDP of India, however, the union budget’s health expenditure is less than 2%. This inequity means that doctors serving in government hospitals are working for a comparatively lower salary in highly stressful situations. It is this dissatisfaction with government salaries that has driven several doctors to join the well paying private sector, creating a shortage of doctors and healthcare professionals in rural India, where there is a genuine need of doctors. This has at times lead to deaths could have been avoided with timely intervention.

It has also led to the demographic imbalance, forcing families in need to move to cities, contributing to its slum population, where living conditions are deplorable in the least.

Impact of Population on Mental Health Care:

Apart from facing a physical healthcare crisis, India is also facing a mental health crisis. Till very recent times, mental health issues were highly tabooed topics and confirmation of a mental condition led to more trauma than support. The scene around mental health issues have only started changing with continuous efforts by various bodies on creating awareness. Such awareness drives however, are limited only to urban zones.

There is also the fact, that mental health was not considered to have physical impacts, and in any case, in a country where urgent cases are not receiving adequate support, mental health related issues, take a backseat priority wise.

Population and Awareness of Diseases and Policies:

A large population is difficult to track and manage. It is even more difficult to employ resources specifically for the purpose of creating awareness diseases, their causes and treatment options. This also means that effective communication on family planning is also difficult to put across.

Crisis in India’s Healthcare Sector:

India is now an aging population, which means that it faces a triple national health care crisis:

  1. Development of chronic diseases in geriatric population. These chronic diseases may be disabling and may require more medical attention, which would put more burden on healthcare system, as well as burden the patients as medical bills rise.
  2. The other crisis comes from communicable and acute diseases, which require high priority and immediate care and most deaths caused are avoidable but happen because of lack of adequate numbers of medical practitioners.
  3. Mental health illnesses, in India, while it is still a hushed up, a considerable population suffers from a range of psychological health issues, that do not see any priority.

India’s Population Crisis Can Be Averted:

Yes, India’s burgeoning population and subsequent issues arising from it. These measures can also lead to more organized and sanitized communities, promote community health and make access to public health policies more robust.

1. Incentivise Family Planning:

Even the size of family is a basic human right, the government should at least create policies where a family is given incentives for affirming with the two child policy. Monetary incentives go a long way in spreading the message as well as motivating individuals in opting for a policy.

2. Health Insurance:

Many people living in both rural and urban India do not understand the importance of medical insurance and how it helps the family in accessing quality health care. More awareness drives as well as better health insurance policies for the poor are required to contain the current crisis in healthcare system.

3. Promote Gender Equality:

More often than not, the moderately affluent class generally prefer sons and thus, keep on planning children till either a son is born or the woman’s life is threatened with another pregnancy. This mindset requires a social discourse, which could only be effective, if the government promotes gender equality.

4. Promote Use of Contraceptives:

To this day, many people in rural as well as urban India do not know about the different types of contraceptives available in the market. Yes, it is true that contraceptive pills are highly controversial and famous for causing other health issues, but there are several natural contraceptives that are indigenous and available in our backyards that people have stopped using or whose properties they are not aware of. Some such contraceptive herbs namely, Moringa (Drumsticks), and Neem have been made into a health supplement by Medlife Essentials. These herbs and their supplements are natural and safe and can be used without any reported side effects to date. However, for throwing caution to the winds, we would suggest all users to consult a physician before taking any supplements. It is also important to remember that herbal supplements also go through a series of detox and reuse, thus, one must be aware of the proper ways of ingesting herbal medicines. Ideally, one must opt for a detox of one month after using herbal supplement for 3 months at most.

5. Promote Adoption:

Adoption is a healthy option to curtailing the population pressure as well complete families. The hesitance to adopt a child is more social than biological and these can be countered through proper awareness campaigns. Adoption laws in India are also very rigid and thorough, which makes sure that children and families adopting are compatible with each other. Young couples who have started their families can be encouraged to adopt, especially if there are more incentives attached.

7. Awareness on Importance of Population Issues:

The most important task for the current government is to hold awareness sessions with young couples as well as couples who are planning more than two children. The more people know of and appreciate the importance of population issues, the more keen they would be to create a better future for their children and grandchildren.

In the end it should be remembered that a strict one child or two children policy, violently enforced by the government is an encroachment on the human right to self determination and such state led, short sighted population control may at some point lead to another crisis of a larger dependent population, something, that China has been facing for some time and may continue to do so for some more time. Thus, it is more important to encourage individuals to make this choice on their own.

When and Why is the World Population Day Celebrated?

The World Population Day is celebrated on July 11 of every year. This day was declared as the International Population Day by the governing council of the United Nations Development Programme (UNDP) in 1989. It is believed that this date was selected to commemorate the five billion day which fell on July 11, 1987. On the five billion day, the world population was believed to have reached five billion living souls. This day is observed to create awareness among the people of the world about population related issues, gender parity, family planning, health of the mother, human rights and poverty. It has been estimated that the world population increases by 100 million people every 14 months. As of April 24, 2017, the world population stood at 750,00,00,000 of which India amounts to over 120,00,00,000.

News on World Population Day:

1. Healthcare Crisis in Odisha:

– 26th July 2018

We have discussed this in previous sections, healthcare in rural India is facing a crisis. The sharp divide between urbanized and private sector earning and privileges made available to doctors and the poor pay offered to government doctors. Couple this divide with the pressure of patients on a particular doctor in a rural setting and this would explain why Odisha has over 60 vacant seats to be filled. This lack is now posing an even greater threat for the poor citizens of Odisha, who are now being hoodwinked by quacks. This is not the only threat to healthcare, villages and other centres are now full of quack or unqualified chemists, who have been known to give patients wrong patients.

In the past two years, children, teenagers and adults alike have had to face the extreme consequences of incorrect treatment, with almost 3 reported deaths in the past two years. The healthcare department and police department are trying hard to crack down on these quack doctors but it is believed that the two most notorious districts of Odisha have over 100 quack doctors, a real estimate for the state is yet unknown. This remains the case with only one state, a national level data is yet unknown.

2. Government of India is Committed to Population Control:

11th July 2018

With the United Nations report warning India about its impending population boom which would make it a more populous country than China in the next 7 years, the government of India is on a high alert. The Ministry of Health and Family Welfare has focused all its efforts in promoting family planning, contraception and awareness on gender related issues. In the past few years, the government’s efforts have been successful in bringing down the Total Fertility Rate (TFR) to 2.1% in 24 states and union territories. The government however has identified 146 districts in seven states namely, Assam, Bihar, Uttar Pradesh, Chhattisgarh, Madhya Pradesh, Jharkhand and Rajasthan where the TFR is still over 3%. Incidentally, the 2011 census revealed that nearly 44% of India’s population resided in these seven states.

The government plans to launch an intensive program focusing on educating the residents of these states about all options of contraception available to men and women, the benefits of family planning as well as the correct way to plan a family, as well as counselling to reach favourable outcomes. The government is also planning to create institutions which could help clear all residual doubts and conflict. With the change in strategy, the government is trying to minimize instances of forced sterilization in the efforts of controlling population.

If you are wondering about government’s focus on bringing down the TFR levels to 2% or below then it important to understand that globally, 2% TFR is considered ideal as at this TFR level the population regenerates itself.

In Assam, the state assembly has also declared sanctions against in the form of barring individuals with more than two children from holding any official post in any government office, or even participate in gram panchayat elections.

The Ministry of Health and Family Welfare however refuses to comment on the success of these sanctions, as the effects would take a little longer on revealing themselves.

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