India needs state specific health policies: Soumya Swaminathan

Neelu Vyas

India’s state-level disease burden report launched recently is a wakeup call for the Indian health sector says Director General, Indian Council of Medical Research Soumya Swaminathan.

Emphasising on how India was facing a dual challenge because of the rising number of lifestyle diseases accounting for almost 62 percent coexisting along with the infectious diseases,  Swaminathan pointed out that there was an urgent need for the health policymakers to take this report as a starting point and customise policies varying from state to state.

She also reiterated that the only way to get the health quotient better was to increase the spending every year.

In an exclusive interview to Rajya Sabha TV, DG ICMR stressed that State level disease burden report was not only meant for the health sector but also to areas like urban planning which need to take into account the findings of the report before they make policies.

Q: How significant is India’s state-level disease burden report?

A: This is something we thought of two years ago. These are statistics which are state specific; data is heterogeneous, varying from state to state in terms of health performance. Every state would now know what would be their health problems. This is for the first time that we have come out with such an exhaustive report. We have used latest computational techniques

Q: Lack of data has always been a problem in the health sector, what kind of a challenge is it now for the policymakers?

A: We do not have an accurate civil registration process specially birth and death registration. Latest analysis shows we are at the bottom when it comes to civil registration. Our planners need to plan on this line to get the birth and death registration. That’s the top most priority. . We have had various surveys like family health survey, district health survey. All these surveys have been used.  Previous health surveys have looked at parameters which were eliminated.  For the first time this report has talked about risk factors.  It uses a metrics which can be compared easily what you call an epidemiological transition. India is facing a transition where we have moved towards non communicable diseases.  Kerala, Tamil Nadu affluent states have more number of deaths due to non communicable diseases.

Q: Does India face a dual challenge or a double whammy? 62 % deaths due to noncommunicable diseases and you also have infectious diseases

A: This report is a wakeup call. it’s not only a double burden but a triple burden as well. data on injuries is so exhaustive has come for the first time.  We have the burden of communicable diseases in the empowered action group states like MP, UP, Rajasthan but we have moved towards noncommunicable diseases.

Q: Why hasn’t India not been able to respond to these changes

A: We need to remember that as populations live longer life span has increased by 10 years . As you live longer you will get more non communicable diseases. That’s expected. What we have to focus on premature deaths.  The biggest risk factor is tuberculosis due to mal nutrition. Tb is linked directly to malnutrition and low immunity. Large part of our populations is suffering with TB.  People don’t take treatment properly. TB IS transmitted by air. We will be able to eliminate it by next ten years.

Q: What about urban planning, does this report send out a signal to the urban planners?

A: For non communicable diseases every sector of the govt and civil society has to think. We need open spaces, park etc. People living near green spaces are much healthier. There is a study on this. We need to reduce the amount of sugar and salt in our food.  Food processing industry needs to look at ways and, mean to reduce salt and sugar. 80 percent Indians don’t eat enough fruits and vegetables. Healthy diet and exercise is important.  The other risk factor is outdoor pollution.

Q: How will policy makers think about health insurance schemes

A: We have to think at several levels. Think about preventive health care. We have focused on cure. Our primary health care centers need to become hubs of primary and preventive care. They can teach people about keeping oneself healthy. Burden of diseases like cancer, cardio vascular diseases will increase in the coming years. Expense on these diseases is a financial burden. Now states have started thinking about providing services to people. Some states have already set up centre treating heart attacks. Dialysis at centers is another boost to government programs done through private Public partnership.

Q: Does this report send out a signal that every state will need separate health policy as data varies from states to states?

A: Yes policy can’t be uniform. It has to happen like that otherwise the entire exercise will be pointless. Universal health assurance program has been developed to cover the below the poverty line people gradually it will incorporate others

Q: India spends 2.5 percent of the GDP on health. How will you expand the services, bring out the affordability when you do not have money.

A: We need resources that are the only way out. We need a progressive increase in health spending. Govt is spending 1.4 percent. Most of the expenditure is coming from out of pocket expenditure. With GST states will have more resources. Both states and centre will have to work together.  Focus has to be state specific. Each state has to make informed decisions on spending resources.

Q: What about health infrastructure both physical and human?

A: Both will need additional allocations. More important is the human resources. At the sub centers which cater to people have an Ayush practitioner? He is able to treat the common diseases then you have a referral center. But we need more trained along with free drugs. For chronic diseases, we need free drugs. We need good counselors.  That’s the model we don’t have and we need to develop that large part of our country quacks is providing the first point of care. Govt has to focus on high-quality doctors. People will then go to the primary health centers and sub-centers. There have to be enough drugs. We have to ensure quality care. Until that happens quacks are available at a minutes’ notice they misuse antibiotics.

Q: Political parties never take up health as a natural narrative, be it the ruling parties or opposition parties health is never an issue?

A: Things are changing but we need to do more. Health literacy is an issue. ICMR is there to bring out facts and be very science-based. The first step is to accept the problem then only we can address the problem. Diseases burden report is not to name and shame; it’s a reality check on states health. There are positives also to look forward. But we need to look at the road ahead.