India has scored poorly in an index that ranks countries on their performance on a range of health-related indicators. It is placed 143 in a list of 188. India consistently ranks low in such surveys and the latest indictment may not mean much to the country’s policymakers. But the index that draws on a collaborative study by more than 1,700 researchers from around the world, under the aegis of the Washington-based Global Burden of Diseases, is significant for several reasons. Published in the medical journal, The Lancet, it brings together disparate targets under the Sustainable Development Goals (SDGs) to assess the performance of countries on health. Health is one of the core SDGs, but indicators germane to other SDGs also have a bearing on health.
Sanitation, hygiene and access to water, for example. The study draws on 47 indicators relevant to health to create a composite index. Many of these indicators are ostensibly policy priorities in India. On safe hygiene practices, for example. India scores an abysmal eight on a scale of 0 to 100. On sanitation, another high government priority, India scores 48, while it scores a lowly 22 in giving people access to water. India registers only 10 points on malaria eradication, while Sri Lanka and war-ravaged Iraq, Syria and Libya score the maximum on this yardstick: They have eradicated malaria.
For a country reeling under mosquito-borne diseases, Sri Lanka’s experience could well be instructive. India’s southern neighbour improved its public health system, created a network of free primary medical centres and mobilised health workers. Public health in India, in contrast, is vastly neglected. The country missed a good opportunity to direct public spending towards health in the last decade-and-a-half when its economy grew at a robust clip. Universal health coverage eludes Indians. At a little more than one per cent of the GDP, public spending on healthcare in India is among the lowest in the world. To put matters in perspective, public spending on healthcare in Sri Lanka is around two per cent of the country’s GDP, in China it’s three per cent, in the UK it’s eight per cent, and in Iceland, the top ranker in the Global Health Burden of Diseases study, nearly eight per cent.
Such neglect has economic bearings. In 2014, the OECD’s assessment of India’s economy warned that the country’s poor performance in healthcare was a major developmental challenge. This caution was issued just six months after the Narendra Modi government had taken over and there was hope that the new government would mend matters. As the ongoing viral epidemic shows and the Lancet article confirms, those hopes have been belied.