Saturday, April 08, 2017

Indians pay dearly for good health

The poor are forever pushed to extreme poverty owing to expenditure to meet their healthcare requirements. With rampant poverty and inequalities backed up by large rural and urban divide in our country, the state of India's health services requires urgent attention. 

The World Health Organisation (WHO) states that about 300 million people around the world live with depression. India stares at equally grim figures of 10 million people suffering from depression every year. One cannot see the issue of depression in isolation from various deprivations related to poverty and high pace of urbanisation, especially when looking at India. Unfortunately, India does not have the luxury of looking at depression solely, especially since the country’s huge populace is in constant deprivation of healthcare facilities. Ill health has taken its toll. But good health comes at a price. A price they and countless millions cannot pay. In the average Indian village, the poor cannot dream of getting a free medical check-up anywhere in their vicinity.

 The out-of-pocket expenditure (OOP) to meet their healthcare requirements is as high as 60% in India, even as it is only around 15-18% in the developed world.

In India, the health infrastructure still remains poor, where lack of manpower and dismal state of physical infrastructure in thousands of primary health centres (PHCs) tend to hinder the health of millions.

As millions of Indians are suffering from multiple health hazards and remain bereft from health services to deal with these problems, there are lofty expectations from the government’s initiatives, including Universal Health Coverage (UHC).  The public spending in the health sector till now accounts for a dismal 1.2% of total GDP - and while the present government is aiming to increase this to 2.5%, developed nations spend a whopping 4-5% of their GDP on the health sector.
More than 600 million Indians, including 300 million women, defecate daily in bushes, fields, rivers and gutters. Wwomen and girls in India relieve themselves only under the cover of darkness in order to avoid exposure, sexual harassment or rape. Some 30 percent of women from underprivileged classes are sexually assaulted, according to Dasra, a nonprofit organization based in Pune. On average, Dasra’s report says, women and girls in Indian cities hold their bladders for “13 hours a day, leaving them at risk of urinary and reproductive tract infections.” The report also highlights that in 2014, approximately 23 percent of adolescent girls dropped out of school due to lack of sanitation facilities. An often underreported fact about the consequences of not having proper sanitation are the 1.3 million Indians, mostly women from the Dalit caste (the lowest caste), who make a living by removing feces from latrines, sewers, defunct toilets, roads and streets. 

The 2017 Oxfam report shows that the richest 1 percent own 58 percent of India’s wealth. A few of the 57 billionaires in India have the same wealth ($216 billion) as the bottom 70 percent of the population of the country. The affluent 10 percent of India’s population own as much as 80 percent of India’s wealth. Instead of just attacking the symptom — the lack of toilets — the government must do more to eliminate the root of this inhumane set of conditions. Poverty and entrenched inequality are the causes of widespread open defecation in India.

India is home to 101 billionaires

Government of India’s National Sample Survey (NSS) figures show that the average value of assets held by urban households falling in the top 10% income category (identified as decile 10) in urban India is Rs 1.5 crore, which is 50,034 times the average value of assets held by an average urban household in the lowest 10% category, or decile 1. 
NSS divides household asset holding classes into 10 decile segments for rural and urban India. It means that decile 1 in comprises the poorest 10% of households in terms of their holding of assets, and the decile 10 denotes the richest tenth of households in terms of asset ownership. Almost all physical and financial assets are included.

Analysing latest available NSS urban figures, a recent report adds, those in the 10th decile have “18.7 times the average value of assets held by a household in the 6th decile” and “4.1 times the average value of assets held by a household in the ninth decile.”

“What’s more”, says the analyst, Manas Chakravarty, “these are just the official figures – God only knows how much more skewed these numbers would be if we found some way to include undeclared wealth in the data.”

In rupee terms, says the analyst, the household in the poorest decile – decile 1 – has Rs291 worth of assets, the one in decile 2 has assets worth Rs 9,565, as against the richest household (in the 10th decile), which has assets worth Rs 1.5 crore”
Worse, he adds, if one adds up the total value of assets held by the first nine assets, then, put together, their assets would be worth Rs 82,90,418, which is lower than the richest household’s assets.

Coming to the NSS’ consumption data, which show the monthly per capita expenditure of the different classes, from the poorest 5% to the richest 5%, the analyst says, “Differences in consumption are not as skewed as wealth or income, because there’s a limit to what a person can consume in many items.” 
Thus, he says, “Monthly per capita expenditure of the richest 5% in urban India is 14.7 times that of the poorest 5%. It is 4.7 times that of the lowest 50-60% bracket, who are India’s actual middle classes.”

Then, says the analyst, the “total medical expenditure per month of a person in the 50-60% group is Rs 119 and “for the top 5%, it’s Rs 658… For those in the 50-60% bracket, spending on education per month is a mere Rs 125. For the richest 5%, it’s Rs 908.” 
Pointing out that “it’s not just wealth that’s distributed unequally, so is opportunity”, the analyst says, “Durable goods consumption of the richest 5% is 23 times that of people in the 50-60% group. Spending on personal transport equipment of the richest 5% is 35 times that of the 50-60% group.” 

“Given these disparities, even if a disaster were to cut down the consumption of the lower half of the population by a third, it will be a tragedy for the poor, but it will make little difference to the overall spending”, comments the analyst.
He adds, “In short, the poor do not really matter as consumers. They do matter, however, as a reserve army of labour, keeping wages down in the overall economy and boosting profits, which bolsters the incomes of the rich.”

If you wish a healthy secure, stress-free and dignified future contact:
The World Socialist Party (India): 257 Baghajatin ‘E’ Block (East), Kolkata – 700086,
Tel: 2425-0208,

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