Indians are famous for our savings mentality. The 2014 Towers Watson Global Benefits Attitude Survey found that Indians had the second-highest savings rate, after the Chinese. We save for a variety of reasons, to create a safety net and to yield returns in future. While there is a time to save, there is also a time to invest. And for India’s government, that time is now.
World leaders — including the government of India — meet in Addis Ababa this week at the Third International Conference on Financing for Development to discuss how domestic and global development efforts may be sustained and financed. This marks an important opportunity for India to conclude that judicious investment in development, particularly in public health, is critical to the country’s future economic growth. Failing to proactively address significant and growing health challenges will increase our health costs and impede future development.
The scale of the problem is significant. India accounts for a third of the world’s poorest 1.2 billion people and 21 per cent of the world’s disease burden. Our poor health is making us poorer still.
India contends with a triple health threat — infectious diseases, violence/ injuries and non-communicable diseases (NCDs), like cardiovascular diseases, cancers, chronic respiratory disease and diabetes. According to the Institute for Health Metrics and Evaluation (IHME), the burden from infectious diseases reduced between 1990 and 2010 — but premature deaths and disability due to injuries and NCDs significantly increased.
India loses 6 per cent of its annual GDP to preventable illnesses and premature deaths. NCDs are responsible for 60 per cent of deaths in India, account for 40 per cent of hospital stays and 35 per cent of outpatient visits. Since public health expenditure in India is less than 1 per cent of GDP — among the lowest in the world — individuals and their families bear the brunt of the cost. The World Health Organisation (WHO) says this pushes an estimated 2.2 per cent of Indians into poverty each year.
The future outlook is even more bleak. Poor diets (including high caloric diets), household air pollution and tobacco use are the top three risk factors for NCDs in India, according to the IHME. The toll of NCDs is expected to rise further with increased urbanisation, which is associated with lower levels of physical activity and increased consumption of commercially processed, energy-dense (nutrient deficient) foods that fuel obesity. According to the Harvard School of Public Health, NCDs and mental health conditions will cost India $4.58 trillion in economic losses by 2030.
This anticipated escalation in cost is due to India’s demographic profile. Our population is among the youngest in the world, with a third aged between 10-24 years. The disease burden, particularly from NCDs, is borne by those in the most productive years of their life — aged between 30 and 70 years.
Fortunately, there are proven, cost-effective solutions. Investment in primary prevention — reducing the four big “behavioural risk factors” of tobacco and alcohol consumption, poor diet and physical inactivity — could halve the rate of NCDs. It would also improve the outcomes for patients suffering from infectious diseases like tuberculosis and HIV, which continue to be major killers in India.
This is highly feasible. Successful policy interventions require comparatively few resources but have population-wide reach. Increasing the prices of and taxes on unhealthy products (for example, tobacco taxes) is the most effective solution, reducing consumption and presenting government with a source of revenue for continued health programmes. Bans or restrictions on the advertising, marketing and promotion of unhealthy products, public education campaigns that warn about the harm they do health, clear labelling (pack warnings for tobacco) and smoking bans are all proven to be highly effective. Effective implementation of tobacco control alone could save five million lives from tobacco-related deaths in 23 low- and middle-income countries, including India.
Most importantly, this approach is highly affordable. As reported recently in the WHO’s Global Tobacco Control Report, the World Lung Foundation found that mass media campaigns successfully motivated smokeless tobacco users to attempt to quit, at the cost of just Rs 5 ($0.07) per person. The WHO estimates that the combined cost of implementing programmes on the four behavioural risk factors in India would cost $0.30 per person.
Reducing preventable disease should be a development priority, and now is the time to invest in a healthier, wealthier future for India.
The writer is Country Director, India and Director (Global), Research and Evaluation, World Lung Foundation