Editorial 1 : Shaping India’s path to inclusive health care
Context
World Health Day, which is observed every year on April 7, unites us around health equity, an essential topic at the heart of global health and justice. The World Health Organization (WHO) has declared health to be a fundamental human right. The theme this year is “My Health, My Right”.
The meaning of health equity
- There is an alarming gap in health-care access, highlighted by the COVID-19 epidemic, environmental crises, and growing socio-economic gaps.
- Health equity ensures that every person has an equal opportunity to achieve their highest health potential, no matter what their circumstances.
- True health equity addresses the root causes of health inequities such as poverty, discrimination, limited access to high-quality education, a healthy diet, clean water, fresh air, and housing, and merely grants equal access to health care.
- These differences are made worse by pandemics, climate change, and sociopolitical unrest.
India’s health equity challenge
- With a large and diversified population, India faces persistent obstacles to health equity, including notable differences in health-care outcomes and access.
- According to the 2011 Census, urban slums make up over 17% of India’s metropolitan areas, and exhibit serious health disparities.
- Health risks are increased by overcrowding, poor sanitation, and restricted access to clean water.
- Infectious diseases, such as tuberculosis, are 1.5 times more common in slums than in non-slum areas, according to the Indian Council of Medical Research.
- Disparities across caste and gender are profound. National Family Health Survey (NFHS)-5 (2019-21) data indicates that Scheduled Castes and Scheduled Tribes experience higher child mortality and lower immunisation rates.
- Additionally, 59% of women in the lowest wealth quintile suffer from anaemia, almost double the rate in the highest quintile, demonstrating the intersection of caste, gender, and economic status in health outcomes.
- Non-communicable diseases (NCDs) account for more than 60% of all fatalities in India.
- A critical shortage of doctors exacerbates these issues, with WHO data indicating only 0.8 doctors per 1,000 people and the shortage is particularly severe in rural areas.
Suggestions
- India’s health equity issues require a comprehensive approach beyond improvements in health-care facilities to address more extensive socioeconomic determinants of health.
- To move India toward universal health coverage and a more equitable future, the government, civil society, health-care providers, and communities need to work together.
- Governments and officials may influence the state of health through funding, creative policies, and laws.
- For instance, India’s Ayushman Bharat initiative provides free health coverage to the bottom 40% economically, demonstrating a commitment to reducing health disparities.
- The National Health Mission (NHM), which includes both the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), reduces the health-care gap between rural and urban India by expanding access, strengthening infrastructure, and providing essential services to vulnerable populations.
- Achieving health equity requires raising health literacy. India should turn health equality into a shared, community-driven goal by including health education in the NHM, enabling its people to seek equitable care and make educated health decisions.
- Organisations with a strong local presence are essential for health equity. They actively participate in every phase, from planning to evaluation, to guarantee the relevance and effectiveness of health programmes. They also have a thorough understanding of their community’s requirements.
Way forward
- Effective collaboration among many sectors, ranging from policymakers to grassroots organisations, may significantly enhance health equity and pave the path for a time when access to high-quality health care would be a shared reality rather than a privilege.
Editorial 2 : Gone too soon — the subject of youth suicide in India
Context
- No young lives should be lost by suicide in India due to silence and inaction.
Suicide – a tragic loss
- Suicide is the tragic and untimely loss of human life, all the more devastating and perplexing because it is a conscious volitional act.
- India has the dubious distinction of having the highest number of suicides in the world.
- The National Crime Records Bureau (NCRB) reports that 1.71 lakh people died by suicide in 2022.
- But these figures are underestimated due to an inadequate registration system, the lack of medical certification of death, stigma and other factors.
- Unfortunately, 41% of all suicides are by young people below the age of 30.
- A young Indian dies by suicide every eight minutes, which is a loss to family, society, the economy and future of the country.
There is no single factor
- Suicide in young people is best understood as multidetermined and the result of interaction between biological, psychological, familial, and social cultural factors.
- A current review of adolescent suicides in India shows that the most commonly reported risk factors were mental health problems (54%), negative or traumatic family issues (36%), academic stress (23%), social and lifestyle factors (20%), violence (22%), economic distress (9.1%) and relationship factors (9%).
- Physical and sexual abuse, examination failure, intergenerational conflicts, parental pressures and caste discrimination are associated with youth suicide.
- There are specific sociocultural factors for suicide among young girls and women. Arranged and early marriages, young motherhood, low social status, domestic violence and economic dependence are well documented.
- Failure in examinations drove 2,095 people to suicide in 2022.
- Enormous competition to get into colleges, media hype around results, the shame associated with failure, and months of pent-up pressures and emotions result in a highly emotionally wrought state.
- Competitive examinations have also pushed many students to the edge.
- Alcohol and substance use are known risk factors in youth suicides.
- A meta-analysis from 19 States of India revealed that almost 20% of college students are net addicts. One-third of young people are cyber-bullied. And of this sub-set, one third are suicidal.
- The media has a strong influence on vulnerable young people. Sensational reporting of suicide, particularly by a celebrity, is followed by increased suicidal behaviour.
There are solutions
- Young people can be taught problem solving, impulse control and emotional regulation skills along with improving help-seeking behaviour.
- Early identification of mental distress and provision of care in a youth-friendly environment are essential.
- Adopting a healthy lifestyle (a good diet, regular physical activity, moderate and appropriate use of the Internet, cultivating supportive friendships, yoga and meditation) improves mental health and reduces suicide in the young.
- Improving the family environment by reducing domestic violence and alcohol consumption, and providing economic assistance to the needy have been shown to reduce suicidal behaviour.
- Educational reforms such as alternative assessment methods and provisions to explore the potential of a young person are needed.
- Societal changes to reduce stigma and discrimination based on caste, religion and sexuality need to be addressed.
- Political will, intersectoral collaboration and commitment, and community participation are needed.
Way forward
- The Ministry of Health constituted a task force in November 2019 to develop a National Suicide Prevention Strategy for India with the objective of reducing suicide by 10% by 2030.
- The immediate task is to disseminate the strategy to all States in India and stakeholders. Budgetary allocations are necessary and the strategies need to be implemented at the earliest at the State, district and community levels.
