Imagining India at 100: Where Health is recognised as being critical for human capital – The Indian Express

The sky over North India is blue and the air is clear and crisp on a winter morning. The multigenerational rural family lives in a well-ventilated pukka house with an attached bathroom and running water. All houses have solar panels and the energy generated is connected to a local grid. Gone are the days when wood and other solid fuel had to be used for cooking. The young mother of two cooks breakfast and lunch on an electric stove, while her husband gets the children ready for school. The family takes the local solar battery operated bus to the school and their places of work. The husband works as a teacher at a local school and the wife is a clinical nurse practitioner. She and a colleague run the family health and wellness centre catering to about 5,000 people. She knows all the families and has a full record of each individual’s health. Her tablet device tells her the visits she has to make, and a list of medicines and supplies she needs to carry.
First, she has a group tele-consultation with the diabetic specialist at the district hospital. She finds a group of patients waiting for her at the centre — they have done self-tests at the diagnostic kiosk and have their results in hand. Soon, the doctor is on the screen for a virtual care session. Each individual gets a chance to report on their health parameters (BP, blood sugar, weight) and ask questions. While some are doing well, others have poor control of their blood sugar and need tailored advice from a specialist. The nutritionist then comes online to discuss healthy and affordable recipes.
Next are the home visits — to check in on pregnant women and those who are breastfeeding their infants, check if immunisation records are up to date (people of all ages and not just children receive vaccines), see if all the children are in school or if there are any teenagers facing difficulties or appearing depressed and do the monthly blood pressure checks on all adults in one part of the village. She also has to screen for cancer using a portable ultrasonic device for solid tumours and a biomarker in urine for others. She never fails to marvel at the fact that she has detected many early cancer cases, all of which have been cured. And the best part — no family has to sell land or jewellery to get treatment. While tuberculosis is rare, she still screens anyone with a cough or fever. Her training in public health means that she is quick to pick up unusual events, like a cluster of fever or diarrhoea cases, and report them to the district epidemiologist. She rarely comes across a family that is reluctant to have a girl child; literacy is 100 per cent.
Older people, those with disabilities and dementia, all go to a community centre where a trained physiotherapist and two aides keep them engaged. The crèche is next door where working women can leave their children, knowing they will receive both physical care and cognitive stimulation and learning through play. Quite often, the children come to the elder care facility and there is a happy mixing of generations. While life expectancy in India now exceeds 80 years, people are healthier because of the focus on disease prevention and health promotion.
The concept of healthcare has changed and the government invests much more not just in the delivery of clinical care services but in the upstream determinants of health like clean water, air, green spaces, public transport and healthy diets. Health is recognised as being critical for human capital and, therefore, economic development.
Because of the tremendous improvements in agricultural productivity and diversification of crops, a variety of millets, cereals and pulses are available through the PDS. There are village nutrition gardens as well. So, all families can afford three healthy meals a day, with adequate portions of fruits, vegetables and protein. The primary health centre functions seven days a week and a lot of specialist advice is through tele-health. For patients on chronic disease treatment, the drugs arrive through the postman and patients need to complete a simple form on their mobile phones which updates their electronic health records.
India is not only self-sufficient in (most) drugs, diagnostics, vaccines and medical devices, but is part of several global and regional consortia that are focusing R&D efforts on diseases that disproportionately affect developing countries. Targeted, individualised treatments (monoclonal antibodies) for cancer based on genetic markers and CrispR gene therapy for hereditary diseases are now available at many centres. Thanks to the trust in government healthcare, most citizens are comfortable with sharing their health data with the government, so that real time analyses of data on disease burden and risk factors in different communities can inform policy making.
The national health assembly meets every year, with representatives from all states coming together to discuss priority health topics and find solutions. This participatory exercise started during the 75th year of India’s Independence and has since matured into a mutually respectful, beneficial and enriching dialogue.
The older generation would often talk about the pandemic years of 2020 and 2021, how frightening everything was then, and how the approach to health changed dramatically after that experience. After that big shock, health literacy improved — many of those who died of Covid had underlying high blood pressure, obesity or diabetes — and people became more conscious of the need for regular screening and prevention of non-communicable diseases. The realisation that the quality of our lives is intertwined with the health of our environment and all the species which inhabit the land and the water alongside us (one health), reminded us of the importance of living in harmony with nature. As the oldest book known to us, the Rig Veda, says: “Sweet blow the winds/Sweet flow the rivers/May the herbs be sweet to us/May the nights and days bring happiness/May the dust of the earth yield us happiness.”
The writer is chief scientist, WHO. Views are personal
India at 100 must be a nation without discrimination

Soumya SwaminathanThe writer is director at the National Institute of Research  in Tube… read more

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