A HEALTH SYSTEM TO MEET 21ST CENTURY NEEDS IN INDIA

The 14th-century world witnessed one of the worst health crises in the world bubonic plague. It killed nearly one-third of humanity. More than five centuries later the world again found itself in a similar situation - Spanish flu, which killed nearly 50 million people. Again after a century pandemic has not only disrupted the global economic system including that of India but also has threatened the very existence of Humankind.

Since our existence as an intelligent species, health has played a very important role. We have found bones of early humans which have surgery marks and have healing evidence showing some form of health exists.

India has a very rich history in healthcare and medicine. Traditional medicinal systems of India like Ayurveda are world-famous. The methods adopted by Sushruta and Charak like nose surgery still find resemblance with modern-day surgery.

Fast forward to the current time, India, on one hand, is leading in medical research, vaccine production, pharma industry et al while on the other hand is considered the ‘disease capital’ of the world. The recent pandemic has highlighted the importance of a strong, inclusive, and resilient healthcare system which India needs to meet 21st-century requirements.

The World health organization (WHO) defines health as physical, mental, and social well-being and just the absence of illness. Therefore health is a multidimensional concept. It includes being free from diseases both communicable and non-communicable, free from mental and psychological stress, and having the ability to constructively engage with people and society.

India in the 21st century faces a dual problem. First, traditional diseases like malaria, tuberculosis, pneumonia, etc cause a lot of mortality every year. Second emerging diseases like HIV, cancer, obesity, diabetes et al are increasingly becoming common.

Another area where India performs poorly is malnutrition. According to the global hunger index released by the World Economic Forum, India is the world's 94th hungry country. Also, it is home to over 40 million stunted and 17 million wasted children, putting the future of India at risk.

Moreover, India also lacks maternal and infant care. With a maternal mortality rate of 120 (approx) and an infant mortality rate of around 38, India still lags far behind the developed countries

The recent pandemic has highlighted the dismal picture of India’s healthcare. With a low doctor-to-patient ratio of 32 per lakh population severe scarcity of hospital beds and non-availability of necessary items like ventilators and oxygen cylinders etc, India is among the worst in several health indicators. Even basic primary health care is not reaching everybody.

The 21st century also poses newer threats to human health. Newer viruses and bacteria have been discovered in recent years. For example SARS outbreak in the middle east, the Swine flu outbreak in 2009-10, the ebola outbreak in 2014-15, and now the Covid-19 pandemic. These pandemics have the potential to threaten our social, political as well as economic setup.

Post world war 2, the world has seen tremendous economic growth. This has led to changes in lifestyles, working culture, and eating habits and has also led to a globalized world.

The above changes have caused certain unintended problems. For example, it has increased mental and psychological stress leading to an increase in mental health problems and suicides. Lifestyle diseases like obesity, diabetes, etc. are now becoming common in all countries including India.

A globalized world has also facilitated the spread of diseases like in the case of several viruses leading to pandemics. It also facilitates the spread of radical ideas disturbing peace and harmony all over the world. Mental health problems have increased like the blue whale challenge, which has put even our children at risk.

Newer technology is also acting like a dual-edged sword. On one hand, research and development in medical science like gene editing through CRISPR - Cas9 shows high potential in treating diseases, while on the other hand misuse of this niche, technology can be devastating reports have emerged from China about designer babies. If not regulated well, these can penetrate India as well.

India since post-independence tried to focus on public health and healthcare. Article 47 of the constitution states that the ‘state shall regard raising the level of nutrition and standard of living and improvement in public health among its primary duties’.

Subsequently, through five-year plans, public expenditure was focused on the delivery of healthcare facilities to every corner of India. Recently in 2017, India adopted a new national health policy that tries to meet the needs of 21st-century demands. Also, schemes like Ayushman Bharat, PCPNDT Act, National Nutrition Mission, and several state-level schemes try to bring quality healthcare to all.

India through the Indradhanush scheme (Mission Indradhanush 2.0), increased vaccination from around 40% to over 80% within a very short period. Similarly through Public Distribution System, Mid Day Meals, and focused attention on nutritious food, India is poised to end hunger and bring down malnutrition in the country.

Moreover, now through Eat Healthy Campaign (eat right movement), the government is trying to nudge people’s behavior. Making people shift to nutritious food is one of the greatest challenges which India faces in the 21st century.

NITI Ayog has recently come up with a digital health strategy. Covid has highlighted the importance of telemedicine, tele-consultancy, and e-health technologies. There is a need to increase the acceptance of these among people.

With rising internal migration due to many reasons like jobs, education, and better opportunities, it is high time that India adopts digital healthcare. Talks are going to set up national e-health authority and digitize all our public as well as private healthcare. This would enable a person to get healthcare facilities seamlessly. Also, digital health records would enable better diagnosis and treatment.

The war against corona has also highlighted the need for a suitable response to stress, fear, and apprehension. There is an increasing acceptance of Ypga which can decrease psychological stress, bring stability to the body and mind, and strengthens the immune response.

For emerging technology like gene therapy, India needs to invest more in research and development. Also, there is a need to collaborate with like-minded countries and global institutions like WHO. It has great potential to treat disease from its root, treat genetic disorders, and also permanent treatment to emerging diseases like Cancer. Proper regulation and setting ethical standards are the need of the hour.

Healthcare should also be inclusive. We are progressing in developing prosthetic arms, legs, and implants which can help a lot of people who are differently abled government should make sure that the benefits of these advancements reach the last man standing in the line.

The use of data and artificial intelligence for evidence-based policymaking and to predict and detect diseases is now becoming a reality. In covid only many countries including India used it. Government should make sure that its use doesn’t impinge on the privacy of individuals and people.

People should be the heart of any policy. Community participation in healthcare in the world like in Cuba and in India like Kerala has shown its relevance. It's the community that is the first responder to any disease or outbreak.

Therefore it is necessary to strengthen the healthcare system at the community level. India is upgrading its primary healthcare by 2.5 lakhs into a health and wellness center. Also, spreading awareness regarding preventive and promotive healthcare is a need of 21st-century India.

As Victor Hugo had said ‘there is no greater force than the idea whose time has come. I think government, people, and humanity as a whole cannot delay healthcare improvement.

The 21st century is regarded by many scholars as Asia’s century with a major role in India. India wants to be part of such a growth story and make this century as India led, we need to reinvent our approach towards health as the nation is made up of people and it is healthy people who make a healthy nation.