The new politics of health in India

Richard Horton
“There is a full-blown crisis in India.” So said Rahul Gandhi, President of the Indian National Congress Party, during a visit to the London School of Economics last month. He was talking about a “jobs crisis”. But there is also a health crisis, as five papers published across three Lancet specialty journals—Lancet Oncology, Global Health, and Public Health—set out this week. Now is the right moment to be debating the future health of the world’s largest democracy. In April, 2019, Indian voters will go to the polls in the most important general election since India achieved independence in 1947. The new Government will not only set a fresh course for health policy. It will also have the opportunity to redefine the idea of India for a new generation. Narendra Modi is India’s current Prime Minister and leads the centre-right Bharatiya Janata Party (BJP). His main rival is Rahul Gandhi who, since December, 2017, has led the Congress Party. In 2014, Modi won a landslide victory against Rahul Gandhi—the Modi wave.
A centre-right coalition, the National Democratic Alliance, won 336 seats in India’s Parliament, the Lok Sabha. The centre-left United Progressive Alliance, dominated by Congress, won only 60 seats (44 by Congress). Rahul Gandhi led his party to the worst electoral defeat in its history. He is now seeking to resurrect Congress and to prove that India’s greatest political dynasty still has something to offer. He might be hopeful. Recent byelections suggest discontent with the BJP. Indian voters are questioning Modi’s success in delivering economic growth and job creation.
* Health should be an important issue in India’s coming general election. The five Lancet papers reveal a dangerously rapid epidemiological transition. Ischaemic heart disease is the leading individual cause of disease burden in India. The contribution of cardiovascular diseases to total deaths has almost doubled since 1990.
The number of Indians living with diabetes has grown from 26 million in 1990 to 65 million in 2016. The incidence of all cancers increased by 28 percent between 1990 and 2016, with new cases of cancer reaching 1·1 million.
Those who suffer with chronic obstructive pulmonary disease have risen from 28 million (1990) to 55 million (2016). And while India is engulfed in this swirling epidemic of non-communicable diseases, the country is also in the grip of a mental health emergency. India could claim 18 percent of the world’s population in 2016, yet it accounted for 37 percent of global suicide deaths among women and 24 percent among men. The death rates from suicide in India were 2·1 times higher among women and 1·4 times higher among men than global averages in 2016. Suicide is the leading cause of death among 15–39-year-olds.
* After years of neglect, the Indian Government has at last recognised the perils of public discontent about health. Under a new initiative called Ayushman Bharat, launched this year, Prime Minister Modi has implemented two new flagship programmes. First, the creation of 150 000 health and wellness centres across the country.
These centres will provide a spine of primary care facilities to deliver universal health coverage. Second, the National Health Protection Mission (NHPM)—a system of health insurance that intends to cover 500 million people. The financial risk protection offered by the NHPM is equivalent to €6265 per person annually. It covers secondary and tertiary care for the poorest and most vulnerable families.
Together, these twin programmes should improve access to quality health services and reduce out-of-pocket health expenditures. Modi’s stated goal is to build a new India by 2022. Rahul Gandhi has spoken about a “modernising impulse” in India and the possibility of “a transformation of 1·3 billion people”. Modi has grasped the importance of health not only as a natural right for India’s citizens, but also as a political instrument to meet the growing expectations of India’s emerging middle class. Modi is the first Indian Prime Minister to prioritise universal health coverage as part of his political platform. Rahul Gandhi, despite his promises to help lower castes, tribal communities, and the rural poor, has yet to match Modicare. There is now every prospect that as the BJP and Congress set out competing and contrasting visions for India’s future, health will rightly become a decisive issue in next year’s general election.
Courtesy : www.thelancet.com

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