loomberg has just released the World Health Index – 2019. This London-based organisation focuses on building products and solutions that are needed for the 21st century and is known for providing quality data. The agency has ranked 169 countries and India stands at 120th position. While people may dispute the rankings, they offer an opportunity to introspect and learn from the best practices of the higher ranked countries.
Spain has been identified as the healthiest country in the world, while Japan from Asia is among the top ranked nations. Spain has moved up the ladder beating previous topper Italy to become the number one. Among the nations rated, Japan is positioned at 4th, an improvement from 7th in 2017. Singapore, which was ranked 4th in 2017, has slipped to the 10th position this year. India too has slipped marginally from 119th to120th during this period.
This analysis is based on World Health Organization (WHO), United Nations Population Division and World Bank data. The rankings are based on many factors, including life expectancy at birth and risk factors like tobacco use and obesity. There are two types of scores: health scores and risk scores. A country’s rank is determined after subtracting its risk score from health score. Healthcare score includes factors like life expectancy at birth, causes of death, death rate among different age groups, while consumption of tobacco, obesity, prevalence of diabetes and hypertension, immunisation coverage, access to clean water and sanitation contribute towards risk score. Spain’s score is 92.8 and it has the highest life expectancy at birth. It has been forecast that the country would have highest lifespan of 86 years by 2040 – highest among all nations.
In Spain, primary healthcare is provided by the government, which offers preventive care services to children, women and the elderly; as well as acute and chronic care. There are provisions of a family doctor and family nurse.
India’s public investment in healthcare has been consistently low over the years – about 1.3% of the GDP. The out of pocket expenditure is about 62% of the total healthcare expenditure, which is often catastrophic. In order help people who are largely affected by the high out of pocket expenditure; the government has launched the Ayushman Bharat covering more than 10 crore families under government-funded insurance to the tune of Rs 5 lakh each year for secondary and tertiary healthcare. While the scheme is innovative and projected as game-changer, the sustainability of such schemes is always a concern without contributing portion from the beneficiaries.
While significant strides have been made over the last two decades in providing quality healthcare, there are wide disparities among the states in terms of facilities and outcomes. ‘Healthy States and Progressive India’ report finds Kerala, Tamil Nadu and Punjab are on the top of the domestic health index, while Uttar Pradesh, Rajasthan and Bihar are at the bottom. The average life expectancy at birth has been raised to 67 years, infant and under-five mortality has declined and India is free of polio. In addition to continuing challenges posed by communicable diseases, non-communicable diseases like cancer, cardiovascular diseases and diabetes have emerged as new threats contributing to 60% deaths.
India is among the fasted growing economy and is likely to be one of the top economic powers of the world in the next 10 years or so. With GST in place, the country’s revenue has touched all-time high – Rs 95,000 crore collections in December 2018. Hence, there should be proportional investment for public health. It is important for the government to keep its promise as outlined in the Health Policy and increase public health spending to 2.5% of GDP by 2025. This would not only reduce disparities among the people, but also help in tackling the public health challenges the country is currently facing. To our surprise, our neighbours in South East Asia are have been ranked higher than us. Sri Lanka, Bangladesh and Nepal are at 66th, 91st, 110th positions respectively. The life expectancy in Sri Lanka (75 years), Bangladesh (72 years) and Nepal (70 years) is also much higher than ours despite Ayushman Bharat.
Guru Prasad Mohanta