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Bringing down need for tertiary healthcare can catapult India’s demographic dividends

Dr. Shankar Narang
Tuesday, April 10, 2018, 08:00 Hrs  [IST]

The government of India has recently taken some proactive steps in healthcare field towards bringing down the costs of implants, stents and even medicines. The prices of knee implants were capped, bringing down their costs as much as 69 per cent for certain types. Earlier, the prices of stents were also capped, taking down their end price significantly. These measures will have the effect of bringing down the costs of these items for the patients and making healthcare more affordable for the common man.

However, the thrust of the government seems to be on bringing down these prices of these items that are used in tertiary care. How about enabling an environment where people do not need tertiary care or, in other words, putting in place measures where people do not fall sick and need to be admitted to hospitals?

France has taken a lead
France has taken a lead in these aspects and has come out with National Nutrition Policy where the thrust is on healthy food habits. The guidelines for general public clearly state that people should limit the consumption of fatty foods, increase the consumption of starchy food, fruits and vegetables, limit consumption of alcohol and consume only iodized salt. The guidelines were formulated by multiple-sectoral committee comprising of representatives of national health agencies, different ministries, public research institutes and other stakeholders. The attempt has been clearly to prevent obesity which is a major precursor for various ailments and medical conditions.

Going one step further, the authorizes in France also made it mandatory for all advertisements of food products to carry cautions telling the people to stop snacking, start exercising and eat more fruits and vegetables. All this when only about 9% French are obese.

Indian situation

In India, we are already have one in every five people who is obese, translating into about 20 per cent overweight population. This figure is only climbing up. If people are guided and enough safeguards are put in place by the government through its agencies to make sure that people do not fall ill and as a result do not need or very few people need tertiary care, it will be far more effective than just making tertiary care more affordable to them.

Containing obesity is definitely one step that the government can take in this regard for long term health benefits of the populace. For example, India has already been crowned as the world’s capital for heart related ailments. There are about 3 crore heart patients in India with about 2 lakh heart surgeries being performed every year and projections that this number will rise dramatically. Heart problems have a direct relation with obesity. If there is concerted effort to fight obesity, in which the government will have to play the pivoting role, the burden of diseases can be brought down in the country, instead of just reducing prices of stents and other devices which will have limited scope of benefit.

Policies for pharma dispensing
The government has also been asking doctors to prescribe only generic medicines to the patients. This may not produce the desired result as the pharmacist to which the patient will go to will stock 4-5 brands generic brands and all may not have the same efficacy. Here the government has to play an all the more active role than in items like stents and knee implants. This is because stents and implants are still used by far fewer people by medicines are consumed by almost the entire population. Government has to come out with really strong certifications and quality controls for the generics before doctors prescribing only generic medicines can bring about the desired results. The government has also increased the registration cost of foreign pharmaceutical companies for entering India and selling their medicines. All these measures will have more impact when there is s thriving generics market which has strong credentials and is trustworthy.

In a country like India which has a population of 1.2 billion with about half of the population under or about the age of 25, there is no reason we should be bogged down by the burden of diseases and not emerge as a winner in the global economic, military and scientific fields.

Calories become cheaper and nutrition expensive
India is urbanising. Double income couples are increasing. We are getting a richer country. People are moving towards convenience due to lack of time and packaged foods is cheaper and quicker for consumption. We worry more about our wallet than about our body. Unhealthy foods are easy on the pocket because they simply add any nutritional value. We are paying the companies of packaged foods for keeping us unhealthy. Though organic and probiotic food are expensive, they keep us hale and hearty for a longer duration of time. India is riddled with problems of diabetes, heart stroke and other non-communicable diseases. If we opt for healthier food choices, we would save on both life and money. A healthy body would reside in a healthy mind and healthy minds build a strong nation. India is set to become the youngest country in the world by 2030. How to ensure that our children eat healthy? Government needs to find pragmatic solutions for the declining health of India. One option could be making unhealthy food more expensive. This would directly result in the reduction of diseases as people would opt for cheaper and healthier food instead. All hope is not lost in the maze of consumer market of packaged foods. There are dietary choices which are easier on the pocket and are also healthy. But here, awareness plays a major role in regulating their prices. We forbid our children from consuming a bottle of carbonated drink and stop them from smoking. We as consumers also need to be more conscious of the food we feed our children from the beginning. Over thirty years, the obesity rates in India have shot up. This is not because Indians are eating more but because Indians are not eating right.

Unhealthy food items became popular because we demanded them. If the demand for unhealthy food choices goes down, the prices of healthy food would automatically reduce. As consumers, it is our responsibility to opt for healthier food choices. As many as 75% Indians lack fibre. Approximately 90% of Indians are protein deficient. We are the leading country in terms of production of fibre and protein rich elements. It is ironic that our people suffer from nutritional deficiency. We need to consume both macro and micronutrients. Packaged goods are not always bad but the ones who have nutritional value are lesser known in the consumer market. Chocolate has become cheaper and broccoli more expensive. We need to ask ourselves: Are we responsible for this trend? We need to stop associating calories with celebration. A can of soda and an apple contains the same amount of calories. But we tend to take the soda which is undoubtedly cheaper but has zero nutritional value. We need to change our mindset if we want to increase the longevity of our bodily health.

What can we do?
To thwart any possibility of the brilliant demographic advantage go waste, India has to take proactive steps in making healthy eating a must in schools, hospitals and also public places. Physical education has to made a must right up till class 12th and a robust system has to developed where people understand the benefit of keeping fit.

Incentivising health by earmarking weightage for healthy people in jobs, in public utilities and in public transport will go along way in reminding people of the need to keep fit.

An awareness campaign needs to be developed which can also include television commercials and celebrity endorsement with a fit personality to spread the message of weight control and keeping healthy.

(Author is Chief Operating Officer, Paras Healthcare)


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