On Our Own

Healthcare and literacy

Censuses in India have defined the population growth as – 1891 – 1921, as Stagnant Population, 1921 – 1951, as Steady Growth, 1951 – 1981, as Rapid Growth, 1981 – 2011 High Growth with signs of Slowing down, 2011 – onward, as Controlled Growth which has been used as parameters of measuring many social sciences studies. Current census of 2011 clearly defines the Indian Population as the emerging Super Power in Manpower of the world by 2020 because of the largest segment of the young population, which is of course a transit advantage for the country. Like other censuses this current census 2011 has highlighted the issues like (CSR) declining Child Sex Ratio, higher level of (TFR) Total Fertility Rate, Increased Literacy Rate etc. as controllable measures for the nation.

All of the above classifications do not rule out the fact that the Indian population is growing at an ever expanding level. According to the CIS, world fact book, the Health expenditures in India are     2.4% of GDP (2009) and India ranks 185 in world rankings. Needless to say major Asian countries have moved in the direction of increasing their healthcare expenditures to greater than 2.5%.

The health sector challenges in India, like those in other low- and middle-income countries, are formidable. Public spending on medical, public health, and family welfare in India is much below what is required. Further, the gap between the actual spending and the required amount is larger in the relatively low-income states and this results in marked inter-state inequality. The low levels of spending have had an adverse impact on the creation of a preventative health infrastructure. With over 70 percent of the spending on health being OOP, the low level of public spending and its uneven distribution have been a major cause of the immiseration of the poor.

 Several state governments also have come up with their own insurance schemes. Despite these initiatives, the actual public spending on health has not shown much increase.

The second aspects of interest for the “reasonable lack of healthcare” in India are the low literacy levels.

Indian literacy rate grew to 74.04% in 2011 from 12% at the end of British rule in 1947. Although this was a greater than six fold improvement, the level is well below the world average literacy rate of 84 and India currently has the largest illiterate population of any nation on earth.

India, along with the Arab states and sub-Saharan Africa, has a literacy level below the threshold level of 75%, but efforts are on to achieve that level. The campaign to achieve at least the threshold literacy level represents the largest ever civil and military mobilization in the country.

Disease Prevalence and India

Based on the findings from the National Commission on Macroeconomics and Health in India:

There is a need to avert disease for enhancing the quality of life, neglect can have adverse consequences on the wellbeing of affected families—social, psychological as well as economic. Diseases that are heavily concentrated among working age adults or the poor, as is the case with HIV/ AIDS, cardiovascular disease (CVD), tuberculosis (TB), etc., can have a ruinous impact as such diseases are extremely expensive to treat, especially due to lack of insurance mechanisms. For example, in the case of HIV/AIDS, the out-of-pocket expenditure on treatment and services was reportedly Rs 6000 per HIV-positive person over a six-month reference period, while for clients on antiretroviral treatment (ART), the expenditures were markedly higher, nearly Rs 18,150 per person over a six-month period. Roughly 40%–70% of these expenditures are financed by borrowing. The devastating impact of TB, asthma, chronic obstructive pulmonary disease (COPD), heart diseases, etc. on individual household is similar, with children having to discontinue schooling and/or take up employment to provide an additional source of income.

The question now arises: What happens when a patient has an ailment for which he cannot afford a treatment and is left with no option to enroll for an industry sponsored clinical trial.

It is certainly no secret that many key cities are the domain of clinical trials which have particularly taken an aggressive increase /double digit growth since 2005.

In an analysis of more than 1100 registered clinical trials at the clinical trial registry in India, The Clinical Trials Registry- India (CTRI), http://ctri.nic.in/Clinicaltrials/sect.php, it was found that more than 30 % of the registered clinical trials were at unspecified or unknown sites.

It would be even more difficult to estimate the nature of the enrolled patients and their subsequent literacy levels.

Considering the diversity of the Indian Population in languages, culture, living patterns etc, it becomes even more difficult to understand to what extent the penetration of clinical research is actually possible.

Considering that novel fact that most of the risk remains largely “UN covered” remains with the patient, with very little government support in terms of compensation.

Although of late particularly in the last six months of 2012, the Indian Government has made clinical trial compensation mandatory for companies conducting clinical trials to all those patients suffering from adverse events or coming to the end of their life. The compensation criterion on the whole favors the younger patient. Details of compensation given have also to be shared with the regulatory authorities to be placed in the public domain.

Certainly not possible for any government to do so to do so at various levels of a large $ 1 billion population.

The disease and the patient are on a large extent on our own risk…………..