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Making data drive health coverage


If the ICMR-PHFIIHME study can truly guide the implementation of Ayushman Bharat, there is hope that we will see more positive health outcomes

A recent study published recently in The Lancet provides hard numbers to back what health economists already know: that nations failing to invest in health and education are at risk of stagnating economies and lower per capita GDP. Positioned as the first-ever scientific study ranking countries for their levels of human capital, the study titled, “Measuring human capital: A systematic analysis of 195 countries and territories, 1990–2016” by the Institute for Health Metrics and Evaluation (IHME), University of Washington shows that India’s ranking of 158th in 2016 represents an improvement from its 1990 ranking of 162nd to go, considering that India is now ranked just behind Sudan (157th US has in fact shown a massive drop from 6th place to 27th.

The question is, will the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) improve these rankings? Undoubtedly so, given that there will be many easy wins in the initial days. But we will have to fix the weakest links. High on the list of cautionary messages was the fact that previous schemes have not had the desired success. For example, an analysis based on data from the last National Sample Survey Office health survey conducted in 2013-14, shows that access to a government health insurance scheme may have had uneven effects across income classes and regions.

The good news is that while previous health schemes may not have had the disease statistics to guide them, this time we have good data to guide policy makers and implementors. The data comes from the latest India State-level Disease Burden Initiative, which was released on September 12, just before the launch of AB-PMJAY. The findings, reported in five research papers, paint a very sorry picture of India’s health as a nation over the last 25 years.

As a joint initiative of the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI), and IHME in collaboration with the Ministry of Health and Family Welfare, Government of India, the initiative is reportedly based on an analysis of all identifiable epidemiological data from India since 1990 as part of the Global Burden of Disease study.

Thus the findings should be “quite useful for titrating the Ayushman Bharat effort according to the need of each state,” as Professor Vinod Paul, Member, NITI Aayog, said at the launch of the. No doubt, we still have a long way ), ahead of Namibia (159th). The report. He goes on to say that these findings will be utilised “in collaboration with the state decision makers to determine the appropriate balance of activities under the Health and Wellness Centres to strengthen comprehensive primary healthcare in each state.” If the ICMR-PHFI-IHME study can truly guide the implementation of Ayushman Bharat, there is hope that we will see more positive health outcomes.

Four diseases have the highest overall burden in India: ischemic heart disease, lower respiratory infections, chronic obstructive pulmonary diseases (COPD), and tuberculosis (TB). In the last quarter of a century, State-level Disease Burden Initiative shows that the prevalence of ischemic heart disease and stroke has increased by over 50 per cent, with an increase observed in every state.

The rate of increase in the burden of ischemic heart disease and diabetes has been the highest in the less developed states of India, where the burden of COPD and infectious conditions is already high.

The number of persons with diabetes in India has increased from 26 million in 1990 to 65 million in 2016. This jibes with the other estimates that put India as the country with the second largest number of diabetes cases (73 million in 2017). On the cancer front, the proportional contribution of cancers to the total health loss in India has doubled from 1990 to 2016, but the incidence of different types of cancers varies widely between the states.

The number of chronic obstructive lung disease cases in India has increased from 28 million to 55 million from 1990 to 2016, and death rate among these cases is twice as high in the less developed states than in the more developed states.

A worrying statistic is that suicide is presently the leading cause of death in the 15-39 year age group in India, 37 per cent of the total global suicide deaths among women occur in India, and suicide death rate among the elderly has increased over the past quarter century. This is also the most economically productive age group so policies need to be geared to analyse the root causes and take remedial action. Many of these issues will be discussed at the fourth edition of Healthcare Sabha, our public health focussed event, scheduled for this October 5-6 in Delhi. Do look out for a detailed report in November issue of Express Healthcare.

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