India's poor health

Each year, the cost of health care pushes some 39 million people back into poverty, according to a study published in the Lancet medical journal. Patients shoulder up to 80 percent of India's medical costs. Their share averages about $66 (3,000 rupees) annually per person — a crippling sum for the 800 million or so Indians living on less than $2 a day. A diagnosis of asthma, a broken leg or a complicated childbirth can mean having to choose between medicine or food, spending on treatment or relying on prayer. Many patients simply rely on traditional holistic medicine approaches such as ayurveda, or seek help from quacks. Hospital costs impoverish a quarter of all patients.

Uttar Pradesh, one of India's poorest states. Its infant mortality rate — 96 of every 1,000 newborns die — makes it one of the worst places on Earth to be born. The average Indian rate is better at 63 but still grim compared with China's 15 deaths out of every 1,000 births. The state's leader, Mayawati rose from India's lowest caste to power and prominence. She calls health care a top priority. Yet since taking office in 2007 she has spent just $224 million on medicines for the state's 195 million people, while spending $569 million to build memorial parks and statues of leading dalits — also known as untouchables — such as herself.

India's government spends comparatively little on health care: just 1.1 percent of the country's GDP, a figure that hasn't changed much since 2006 when China was spending 1.9 percent; Russia, 3.3 percent and Brazil, 3.5 percent, according to World Health Organization. India boasts an economic growth rate near 9 percent, the wealth has done little to help millions burdened by poverty and disease. The poor, aside from struggling to afford care, also face extreme shortages of doctors and medicines. The government says the nation needs tens of thousands of clinics and 700,000 more doctors. Chief Medical Officer Dr. Poonam Sharma said "We cannot give the patients good treatment," she said. "They won't get the quality time, most maybe just three minutes."

India boasts a thriving medical tourism industry with shiny private clinics luring tens of thousands of foreigners for everything from bargain tummy tucks to experimental stem-cell treatments in an industry estimated to be worth nearly 100 billion rupees ($2.3 billion). The pharmaceutical industry is making lifesaving drugs at cut-rate costs (yet India was short 35 million vaccine doses for diphtheria and 30 million for tetanus, a Health Ministry report said) , private hospitals are pioneering advances in open-heart surgery and medical schools are churning out physicians eager to work in the West. Yet on any given day, at least 40 percent of government doctors are absent — busy moonlighting for higher pay at the private clinics. At government hospitals practitioners will work for 20,000 rupees (about $450) a month but they can make at least double at a private clinic. Private health care is booming, with clinics and insurance schemes multiplying and driving up costs. For most Indians this is another world.

Ibne Hasan was diagnosed with HIV two years ago "They make all these promises, but they are only promises."

"What is the point of economic success if there is nothing in it for the population?" Lancet editor Richard Horton asks. But it is a point about which he can do little or nothing. It is an inescapable aspect of capitalism.