“Health is wealth.”

Indeed, we have all heard this quote, but is it really the truth? Let’s find out.

Health is the biggest asset we need every day to meet our goals. Earlier, the definition of health was “the state of being free from illness or injury”. However, as time passed, the definition changed. Health now includes the physical as well as mental well-being of a person. A person can be physically fit but mentally disturbed due to the difficult circumstances he is facing. The same can happen when someone is suffering from physical illnesses but is mentally strong.  Individuals and the general public are served by several segments of the healthcare industry. Globally, the healthcare industry will continue to grow as long as humans exist, contributing a significant amount to any country’s economy.

But does the health care system works the same for all, despite imposing several schemes by the government ?? No! Covid-19 highlighted the health inequality present all over the world. Rural areas witnessing a shortage of tests, oxygen, and hospital beds — especially during the second wave earlier this year. “Persistent underfunding of public health system especially primary health care and inadequate health infrastructure in India remain to be addressed by the government even after [the] devastating second wave,” Amitabh Behar, CEO of Oxfam India.  Health inequality, though our public health response—our modern Metropolitan Health Laws—must address more insidious causes and conditions of illness. There is robust literature linking income inequality to health disparities—and thus widening income inequality is cause for concern.

Oxfam India’s inequality report

According to data given by Oxfam India’s Inequality Report 2021: India’s Unequal Healthcare Story, 65.7 percent of General Category homes have access to upgraded, non-shared sanitation facilities, whereas just 25.9 percent of Scheduled Tribes (ST) households have access to improved, non-shared sanitation facilities. Stunting affects 12.6 percent more children in Scheduled Castes (SC) families than in general-category homes.

The risks of a youngster dying before his fifth birthday are three times higher in the bottom 20% of the population than in the top 20%. Oxfam India’s latest research presents a detailed examination of health outcomes across different socioeconomic categories to assess the country’s level of health disparity.

According to the survey, the general category outperforms SCs and STs. Hindus outperform Muslims, the wealthy outperform the poor, males outperform women, and the urban population outperforms the rural population on several health metrics.

The Oxfam India report shows the rich, on average, live seven and a half years more than the poor. Similarly, on average, a woman from the general category lives 15 years longer than a Dalit woman. The analysis further shows an overall improvement in infant mortality rate (IMR) is not equal across social groups. Dalits, Adivasis, and OBCs have higher IMR as compared to the general category. IMR for Adivasis is 44.4 which is 40 percent more than the general category and 10 percent more than the national average.

A strong public health sector is recommended to address these fundamental inequalities in the health system through Universal Health Coverage (UHC). OOPE(Out-of-Pocket expenditure) on health is also disproportionately high in marginalized communities. The government estimates that healthcare expenditures push six crores, of people, into poverty every year.

Failure of the government

India’s expenditure on healthcare has been found to be the lowest among BRICS countries (consisting of five emerging economies: Brazil, Russia, India, China, and South Africa)

However, there was some hope. Between 2015-2016, the number of institutional deliveries (or deliveries at medical facilities, or under supervision by skilled medical personnel) increased significantly in India. Which could bring down the infant mortality rate, besides ensuring better care for mothers. The rates of immunization, too, have gone up since 2015.

Unfortunately, the pandemic may have undone some of this progress. Compared to vaccination rates in pre-pandemic times. Additional 15 lakh children in India missed their routine vaccinations against diphtheria, tetanus, measles, and other preventable infections due to disruptions caused by the pandemic.

According to the World Health Organization children from Scheduled Castes, Tribes are likelier to Die Before Age 5. Studies document longer wait times for health care for scheduled castes and tribes at private hospitals. Compared to more privileged castes. Other studies record the health care provided to individuals of scheduled castes and tribes is of substandard quality. Sometimes, health care is denied entirely to people of scheduled castes and tribes, according to a report by LiveMint.

Failure of insurance models

As a way to reduce OOPE on health and move towards universal health coverage, both state and federal governments have implemented health insurance schemes. By 2015-16, the number of people living in poverty due to high OOPE stood at 5.5 crores as opposed to 3.25 crores in 1999-2000, and less than one-third of households were covered by a government insurance scheme.

It’s clear that the limited scope and coverage of the insurance schemes are insufficient to meet the requirements of UHC. Recently obtained data via Right to Information (RTI) showed that only 19 people got COVID-19 treatment under Union Government’s Ayushman Bharat in Bihar, one of the worst affected states in the second wave.

Sanitation is another aspect that contributes to this large gap in lifespans. Sanitation preserves human health, enhances lifespans, and boosts productivity by limiting people’s exposure to infections. However, much like access to great healthcare, access to quality sanitation is a luxury in India. “While 93.4% of households in the top 20% [of the country’s economic bracket] have access to improved sanitation, only 6% have access in the bottom 20%,” the report stated — highlighting a stark difference of more than 85%. So, not only do less-privileged groups in India have poorer access to healthcare, but they’re also more vulnerable to conditions that require healthcare. They do not have access to either cure or the means to prevent diseases.

As we work to repair the harm created by Covid19, it is critical to address the decades-long imbalances in healthcare, particularly in the aftermath of the epidemic that highlighted the discrepancies.

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