In the health sector, India is
often associated with its accomplishments in promoting innovation in the
delivery of health services and production of pharmaceuticals and
At the same time, in comparison to other large middle-income
nations such as Brazil, Russia and China (BRIC), India has failed to
assure minimal standards of sanitation and public health. In a paper published by the Royal Society for Public Health
, Gusmano, Rodwin and Weisz document Delhi's health system exceptionalism.
‘India is unlikely to make substantial improvements in healthcare outcomes unless they substantially increase public health spending and implement a range of programs that address the causes of extreme deprivation.’
In spite of recent investments in health care and public
health in India's global capital city, this original research
contribution finds that the capacity to leverage these investments to
improve access to effective care have not been sufficient to overcome
the crushing poverty and inequalities within Delhi.
The Lancet reported,
in 2009, that more than half of Indian households have no toilets, over
200 million people have no access to safe drinking water and WHO
estimates that 900,000 people die from contaminated water and polluted
More recently (2013), the Planning Commission reports that progress
in meeting millennium development goals has been slow. In contrast to
other BRIC nations, public expenditure on health care as a percent of
GDP (1%), is the lowest. Total expenditure (public and private) is just 4% of GDP, which places India as the lowest spender. Moreover,
out-of-pocket expenditure as a share of total health care spending (58%)
places India as the BRIC nation that relies most heavily on patient
payment at the point of consumption.
Gusmano, Rodwin, and Weisz find
that large and growing numbers of residents die prematurely each year
due to causes that are amenable to public health and healthcare
Michael K Gusmano is associate professor at the Rutgers
School of Public Health and Research Scholar at the Hastings Center,
Victor Rodwin is professor at the Robert F. Wagner Graduate School of
Public Service, New York University, and Daniel Weisz is research
associate at the Butler Aging Institute, Columbia University. Gusmano
and Rodwin, co-direct the World Cities Project, a collaborative venture
of their respective institutions. More specifically, their article finds that:
- Between 2004 and 2013, a time when the economy of India
was growing rapidly, rates of premature deaths due to causes for which
there are effective treatments (amenable mortality), increased by about
25% in the capital city of Delhi. The leading causes of death were
septicemia and tuberculosis. Maternal mortality is well above the global
level for other middle-income countries.
- During this same time period, cities in other
middle income countries, including Moscow, Sao Paulo, and Shanghai
experienced a decrease in amenable mortality of at least 25%.
- Delhi, and the rest of India, is unlikely to make
substantial improvements in these outcomes unless they substantially
increase public health spending, monitor health system performance, and
improve government capacity to adopt policies and implement a range of
programs that address the causes of extreme deprivation.