Fixing the broken bones of India’s health system

My father was born under the British Empire in the 1940s and grew up as a sugarcane and soybean farmer in rural India. Living was against all odds, as prospects for basic health and meaningful opportunity were grim. Any graph measuring India’s economic progress since then will show a drastic growth curve. However this curve tells an incomplete story. The promise of growth hasn’t been realized by improvements in many health outcomes. Nearly 70 years later, millions of India’s children continue to face the same dire circumstances my father did.       

The economic changes are mirrored by vastly changing demographics. India is set to surpass China to become the world’s most populous country as early as 2022. Soon, for the first time in history, a majority of people in India will be living in cities. India’s public health system, already fractured by resource constraints, will struggle to bear the added weight. Politicians would be wise to view these demographic trends as even more reason to prioritize the health of their citizens, particularly children. 

The timing is opportune. According to recent data released by the World Health Organization, India has some of the worst public health indicators in the world. It is home to a majority of the world’s most polluted cities, and Delhi, which tops the list, has levels of air pollution six times higher than levels considered safe. More resonant than the numbers, though, is the image of India’s urban-dwelling children choking on the exhaust of economic growth. And recently leaked data show that India has the highest rates of underweight children in the world and trails its neighboring countries in terms of infant mortality and child immunization rates. 

In his Sept. 25 address to the United Nations Sustainable Development Summit — a talk that noticeably eschewed the topic of health — Prime Minister Narendra Modi said, “There is no cause greater than shaping a world, in which every life that enters it can look to a future of security, opportunity and dignity.” It is exactly for this reason that Modi should prioritize the health of his people.

He can start in two simple ways. First, India’s public health expenditures should reflect global standards. Its national health spending dropped in this year’s national budget; it currently spends roughly 1 percent of GDP, a woeful underinvestment compared to the rest of the world. India's health expenditure not only falls short of the average allocation spent by other BRIC countries (3.6 percent), it’s also one of the world’s lowest, behind much lesser developed countries such as Sudan.

As India graduates from receiving development aid through bilateral assistance and multilateral development banks, there is even more of an onus on it to rely on domestic resource mobilization. Modi’s policies have thus far leaned hard on the private sector, by mandating businesses to designate 2 percent of pretax profits toward corporate social responsibility work. While perhaps helpful, such mandates are insufficient at best and dangerously irresponsible at worst if they give the government an excuse to stay idle. India needs basic investment in public health infrastructure and workforce training, especially as overburdened public hospitals reach their breaking point.  

The second way Modi can prioritize health is by embracing data transparency and setting standardized goals for environmental and public health outcomes. Possibly out of embarrassment, the federal government initially failed to publish its most recent nutritional survey data on child health, forcing researchers to use leaked data. In addition to publishing national health data, India’s government should set a timeline of targets based on the data, prioritizing the most urgent metrics, such as the nutritional status of girls. As many social protection programs are decentralized and under state jurisdiction, standardized core metrics will allow for coordination as well as shared responsibility at the local, state and national levels. Once policymakers and the public know where they stand, they will have a much better sense of how to move forward.

There are numerous reasons to prioritize public health, if the alleviation of suffering isn’t reason enough. For a business-minded leader such as Modi, here is one he can easily swallow: One of the best investments a country can make is in its own human capital. India already has the largest youth population in the world. Investing in and targeting health outcomes will yield dividends many times over, through increases in productivity and, in turn, economic growth. This is prudent policy, not only for India’s people but also for it’s future.