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The health policy of India aims at an integrated approach, which is to provide accessible, affordable and equitable quality health care to the marginalised and vulnerable sections. For a heavily populated country such as India, this is an uphill task.
However, the aim of good health and well-being for all is envisaged in the sustainable development goal (SDG) 3. To quote, it envisages to “ensure healthy lives and promote well-being for all at all ages”, which provides an impetus to the policies of India to synchronise all our health targets.
The top 4 improving health indices are:
1. Doubling of life expectancy and reducing crude death rate
India is seeing Life expectancy that has doubled coupled with infant mortality and crude death rates that have reduced sharply.
Life expectancy is understood to be a statistical measure of the average time one is expected to live, based on the year of their birth, their current age and other demographic factors including sex.
The crude death rate of mortality rate, on the other hand, is a measure of the number of deaths (in general, or due to a specific cause) in a particular population, scaled to the size of that population, per unit of time. The mortality rate is typically expressed in units of deaths per 1,000 individuals per year; thus, a mortality rate of 9.5 (out of 1,000) in a population of 1,000 would mean 9.5 deaths per year in that entire population or 0.95 percent out of the total.
As per the WHO’s World Statistics Report 2016, life expectancy at birth for the year 2015 was 68.3 years in India which breaks down to 66.9 years for men and 69.9 years for women.
On the other hand, as per the ministry of health and family welfare, Government of India, the crude death rate for India worked out to be 7.31 in 2015. India has seen its decadal crude death rate decline to 8.5 in 2001-2011 from 42.6 in 1901-1911. Though the death rates have come down, the rural-urban divide still remains – the death rate was 6 in urban areas and it was 8.2 in rural areas in 2001-2011.
2. Declining total fertility rate
India’s total fertility rate (TFR) has been steadily declining and was 2.3 (rural 2.5 and urban 1.8) during 2014. Total fertility rate can be understood as the number of children who would be born per woman (or per 1,000 women) if she/they were to pass through the childbearing years bearing children according to a current schedule of age-specific fertility rates.
3. Declining infant mortality rate
Infant mortality rate (IMR) has declined to 37 per 1000 live births in 2015 from 44 in 2011. The challenge lies in addressing the huge gap between IMR in rural (41 per 1000 live births) and urban (25 per 1000 live births) areas.
Infant mortality refers to deaths of young children, typically those less than one year of age. It is measured by the infant mortality rate (IMR), which is the number of deaths of children under one year of age per 1000 live births.
4. Declining maternal mortality ratio
The maternal mortality ratio (MMR) declined from 301 maternal deaths per 100,000 live births during 2001-03 to 167 maternal deaths per 100,000 live births during 2011-13. The maternal mortality rate (MMR) may be understood to be the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes).
There are wide regional disparities in MMR, with States like Assam, Uttar Pradesh, Rajasthan, Odisha, Madhya Pradesh and Bihar recording MMR well above all India MMR of 167. Therefore, in addition to reducing all India MMR in line with SDG 3 targets, by improving health policy and nutritional status of women, there is need to focus on States with MMR higher than the national average.
Conclusion:
Although the basic health parameters are showing an upward rise, there is a huge gap in access to quality health care in India and hence health policy may require some tweaking. There are chronic diseases that plague the population. Primary amongst these seem to be the prevalence of high levels of anaemia among women in the age group 15-49 leading to high levels of maternal mortality.
In Haryana and West Bengal more than 60 percent of women suffers from anaemia. Under the National Health Mission, Government of India has programmes to address the issue of anaemia through health policy and nutrition education to promote dietary diversification, the inclusion of iron foliate rich food as well as food items that promote iron absorption.

 

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  • Steve Ovett, the famous British middle-distance athlete, won the 800-metres gold medal at the Moscow Olympics of 1980. Just a few days later, he was about to win a 5,000-metres race at London’s Crystal Palace. Known for his burst of acceleration on the home stretch, he had supreme confidence in his ability to out-sprint rivals. With the final 100 metres remaining,

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    Ovett waved to the crowd and raised a hand in triumph. But he had celebrated a bit too early. At the finishing line, Ireland’s John Treacy edged past Ovett. For those few moments, Ovett had lost his sense of reality and ignored the possibility of a negative event.

    This analogy works well for the India story and our policy failures , including during the ongoing covid pandemic. While we have never been as well prepared or had significant successes in terms of growth stability as Ovett did in his illustrious running career, we tend to celebrate too early. Indeed, we have done so many times before.

    It is as if we’re convinced that India is destined for greater heights, come what may, and so we never run through the finish line. Do we and our policymakers suffer from a collective optimism bias, which, as the Nobel Prize winner Daniel Kahneman once wrote, “may well be the most significant of the cognitive biases”? The optimism bias arises from mistaken beliefs which form expectations that are better than the reality. It makes us underestimate chances of a negative outcome and ignore warnings repeatedly.

    The Indian economy had a dream run for five years from 2003-04 to 2007-08, with an average annual growth rate of around 9%. Many believed that India was on its way to clocking consistent double-digit growth and comparisons with China were rife. It was conveniently overlooked that this output expansion had come mainly came from a few sectors: automobiles, telecom and business services.

    Indians were made to believe that we could sprint without high-quality education, healthcare, infrastructure or banking sectors, which form the backbone of any stable economy. The plan was to build them as we went along, but then in the euphoria of short-term success, it got lost.

    India’s exports of goods grew from $20 billion in 1990-91 to over $310 billion in 2019-20. Looking at these absolute figures it would seem as if India has arrived on the world stage. However, India’s share of global trade has moved up only marginally. Even now, the country accounts for less than 2% of the world’s goods exports.

    More importantly, hidden behind this performance was the role played by one sector that should have never made it to India’s list of exports—refined petroleum. The share of refined petroleum exports in India’s goods exports increased from 1.4% in 1996-97 to over 18% in 2011-12.

    An import-intensive sector with low labour intensity, exports of refined petroleum zoomed because of the then policy regime of a retail price ceiling on petroleum products in the domestic market. While we have done well in the export of services, our share is still less than 4% of world exports.

    India seemed to emerge from the 2008 global financial crisis relatively unscathed. But, a temporary demand push had played a role in the revival—the incomes of many households, both rural and urban, had shot up. Fiscal stimulus to the rural economy and implementation of the Sixth Pay Commission scales had led to the salaries of around 20% of organized-sector employees jumping up. We celebrated, but once again, neither did we resolve the crisis brewing elsewhere in India’s banking sector, nor did we improve our capacity for healthcare or quality education.

    Employment saw little economy-wide growth in our boom years. Manufacturing jobs, if anything, shrank. But we continued to celebrate. Youth flocked to low-productivity service-sector jobs, such as those in hotels and restaurants, security and other services. The dependence on such jobs on one hand and high-skilled services on the other was bound to make Indian society more unequal.

    And then, there is agriculture, an elephant in the room. If and when farm-sector reforms get implemented, celebrations would once again be premature. The vast majority of India’s farmers have small plots of land, and though these farms are at least as productive as larger ones, net absolute incomes from small plots can only be meagre.

    A further rise in farm productivity and consequent increase in supply, if not matched by a demand rise, especially with access to export markets, would result in downward pressure on market prices for farm produce and a further decline in the net incomes of small farmers.

    We should learn from what John Treacy did right. He didn’t give up, and pushed for the finish line like it was his only chance at winning. Treacy had years of long-distance practice. The same goes for our economy. A long grind is required to build up its base before we can win and celebrate. And Ovett did not blame anyone for his loss. We play the blame game. Everyone else, right from China and the US to ‘greedy corporates’, seems to be responsible for our failures.

    We have lowered absolute poverty levels and had technology-based successes like Aadhaar and digital access to public services. But there are no short cuts to good quality and adequate healthcare and education services. We must remain optimistic but stay firmly away from the optimism bias.

    In the end, it is not about how we start, but how we finish. The disastrous second wave of covid and our inability to manage it is a ghastly reminder of this fact.