It’s not hard to find people caught in the gap between India’s dreams of greatness and the awful reality of its broken health system. Most of the country lives there. Take Abhishek Khushwa. He would be a normal kid but for the fact that nine years after his birth with a bladder defect, his family is still struggling to get him what should be a simple and relatively cheap operation. Like many sick Indians, Abhishek is both symptom and cause. His lack of proper treatment is reason enough for national shame but his ill health hurts the country in turn, not only forcing the frail-looking boy to miss school for a week or two every few months while he searches hospital by hospital for some relief, but dragging his uninsured family into debt when they should be benefiting from India’s economic boom. Together, Abhishek’s parents — his mother Sunita is a clerk in a local government office in the northern city of Farrukhabad, his father Sunil works in a small clothes shop — make just under $200 a month, no fortune but enough to buy a small TV for their modest home. They would have bought a motorbike too, Sunil says, perhaps even a patch of land somewhere, were it were not for the hospital bills that never seem to end.
Standing in the crowded entrance hall in the outpatients department of New Delhi’s All India Institute of Medical Sciences , one of India’s best public hospitals, Sunil explains that because there are no decent public hospitals in Farrukhabad, he and his wife take Abhishek to New Delhi about three times a year for checkups and to try to get him the operation he needs. Last year, after years bouncing between hospitals and clinics, their son got an appointment to have the vital tests he needs before an operation. The family scraped together the $120 fee and traveled the 180 miles to India’s capital by train. But when they arrived they discovered the machine at the government hospital they had been visiting was broken and unlikely to be working anytime soon. Which is how the family came to be at AIIMS one morning late last year, hoping, cajoling, pleading for an appointment at the better-equipped hospital, and praying that one day they could make the system work for them. “Nine years is a very long time,” says Sunil. “My son should have been operated on and recovered years ago.”
A Paradoxical State
The same could be said of india’s health system. Sixty years after independence, India remains one of the unhealthiest places on earth. Millions of people still suffer from diseases and ailments that simply no longer exist almost anywhere else on the planet. Four out of five children are anemic. Almost one in four women who give birth receives no antenatal care. What makes the picture even bleaker is the fact that India’s economic boom has had, so far at least, little impact on health standards. Think of it this way: in the five years between 2001 and 2006 India’s economy grew almost 50%, the country’s biggest expansion in decades. Meantime, its child-malnutrition rate, a number that measures the percentage of children under 3 who are moderately or severely underweight, dropped just a single percentage point, to 46%. That’s worse than in most African countries, and means almost half India’s children remain at risk of “health problems such as stunted growth, mental retardation, and increased susceptibility to infectious diseases,” according to the most recent National Family Health Survey, a study of more than 230,000 people, from which the figures are taken.
Perversely, the incredible economic growth is having an impact in other ways, driving up rates of rich-world diseases such as obesity and diabetes and encouraging high-end health services, some of which offer world-class care but remain far beyond the reach of the vast majority of Indians. It’s these services — think of last year’s surgery to save an Indian girl born with four arms and four legs — and the skill of India’s world-class doctors that the country brags about when its marketers sell India as a medical-tourism destination and an emerging health-services giant. The truth behind the glossy advertising is less incredible: India remains the sick man of Asia, malnourished and obese at the same time, beset by epidemics of AIDS and diabetes, and with spending levels on public health that even Prime Minister Manmohan Singh has conceded “are seriously lagging behind other developing countries in Asia.”
The sorry state of India’s medical services might not matter so much if tens of millions of Indians weren’t already so sick. Part of the problem is the lack of infrastructure — not fancy hospitals or equipment but basic services such as clean water, a functioning sewage system, power. The World Health Organization estimates that more than 900,000 Indians die every year from drinking bad water and breathing bad air. The Indian government says that 55% of households have no toilet facilities. Many cities lack sewers. The missing infrastructure is not unique to India. Parts of Africa face similar underdevelopment. But some public-health experts believe that India’s massive population adds to the burden, overloading systems where they do exist and aiding the spread of disease in the many places they don’t.
There are other reasons for India’s ill health. Over the past decade or so, funding for public-health initiatives such as immunization drives and programs to control the spread of communicable diseases has been cut; some critics blame shifting government priorities. One of the best ways a country can improve its health, for instance, is by making sure its children are immunized against measles, polio and other life-threatening illnesses. But immunization rates in India are significantly lower than in other developing nations such as Bangladesh, China and Indonesia. Just 43.5% of very young children are fully immunized. “It’s shameful,” says A.K. Shiva Kumar, an economist and public-health expert who consults to the United Nations Children Fund in India and was a member of the government’s recently disbanded National Advisory Council. “All this high income, this growth of the past few years is well and good, but numbers like this show you can’t get complacent about health or you’ll go nowhere.”
