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BMJ. May 4, 2002; 324(7345): 1056.
PMCID: PMC1172146

India's health levels a mix of success and embarrassment, says report

A report on improvements in life expectancy and standards of health in India gives a mixed picture of the country's achievements in recent years.

"India's post-independence achievement in longevity and health of the population is a story of some successes and some embarrassments—perhaps in equal measures," says the first ever National Human Development Report , released last week by the Planning Commission.

The human development index, comprising eight key indicators—including incidence of poverty, access to safe drinking water, and infant mortality—improved by 26% nationally during the 1980s and by another 24% in the 1990s, says the report. But at the state level "there are wide disparities in the level of human development."

In the 1980s Bihar, Uttar Pradesh, Madhya Pradesh, Rajasthan, and Orissa had a human development index half that of southern Kerala. But only Uttar Pradesh, Madhya Pradesh, and Rajasthan managed to improve development in the 1990s.

"There is some evidence in the Indian context indicating that mortality and morbidity patterns may often run counter to each other," says the report. Despite having the lowest mortality, Kerala has the highest morbidity in India for acute as well as chronic ailments.

The incidence of poverty declined from 44% of the total population in 1983 to 26% in 1999-2000. In 1983 the poorest states with a large urban population were Madhya Pradesh, Uttar Pradesh, and—the poorest—Orissa, but in 1993 this order had changed. Orissa became the poorest, followed by Madhya Pradesh and Bihar.

The report highlights the millions of people in India who contract waterborne diseases because of a lack of safe drinking water—with poor people having a higher prevalence of disease than the rich. But the report also states that, curiously, drinking water is worst in Kerala—despite the state's top ranking on the human development index. Less than one fifth of Keralan households had access to safe water, which may be responsible for the high morbidity, the report suggests.

The report introduces the concept of "persons not expected to survive beyond the age of 40 years," to reflect the level of deprivation. In the most developed state, Kerala, the proportion of people not expected to live beyond 40 was roughly 5% in 1991, whereas in Assam, Uttar Pradesh, and Orissa it was more than 20% and in Madhya Pradesh it was 25.3%.

The proportion of public resources for health has declined in almost all states in the past two decades, the report says, whereas the central government's allocation has increased only marginally. Meanwhile private spending on health has increased, from 2% of total spending on health in the 1980s to 7.5% in the 1990s.

Other problems in India's healthcare system highlighted by the report are its substandard infrastructure, poor referral services, and an increasing dependence on private healthcare, often leading to indebtedness in rural areas.

Technological advances that broaden the scope of potential interventions are well beyond the reach of most people. There is a misplaced emphasis on the development of private health care at the expense of broadening the public system, says the report.

"Continuation of a universally free public health healthcare system—preventive and curative—is unsustainable in its present form," it adds.

The National Human Development Report 2001 is available at http://planningcommission.nic.in/http://planningcommission.nic.in/


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