INDIA NEEDS TO PRIORITISE PREVENTIVE CARE

THE CONTEXT: The prevalence of NCDs in India has risen dramatically, accounting for 63% of all deaths in the country as of 2018. Cardiovascular diseases lead to 27% of overall mortality, followed by chronic respiratory diseases (11%), cancers (9%), and diabetes (3%). This alarming trend represents a significant epidemiological transition from communicable to non-communicable diseases.

THE SEVERITY OF THE NCD CRISIS IN INDIA:

• • Mortality burden: The proportion of deaths due to NCDs increased from 37.9% in 1990 to 61.8% in 2016.
  • Economic impact: The economic output lost due to NCDs, excluding mental conditions, is estimated to be $3.55 trillion for India from 2012 to 2030.
  • Global Context: India contributed to 14.5% of global NCD-related deaths, highlighting its disproportionate share of the global burden.
  • Rising cancer incidence: India is witnessing the fastest rise in cancer cases globally, potentially becoming the “cancer capital of the world.”
  • Diabetes epidemic: An estimated 101 million people in India have diabetes, 36% higher than previous international estimates.
  • Hypertension prevalence: 35.5% of the adult population is affected by hypertension, significantly higher than earlier national surveys.
  • Cardiovascular Disease Mortality: Among cardiovascular deaths in the 30–69 age group, 68.4% were caused by ischemic heart disease, and 28% by stroke.
  • Pre-disease states: One in three Indians is pre-diabetic, and two in three are pre-hypertensive.
  • Stroke: Stroke prevalence has risen by over 50% between 1990 and 2016. It remains a major cause of disability-adjusted life years (DALYs) lost.
  • Mental health concerns: One in 10 Indians is reported to be depressed.
  • COVID-19 impact: The pandemic has exacerbated the NCD crisis, disrupting prevention and treatment services, particularly in rural areas.

ECONOMIC BURDEN OF NCDS IN INDIA:

• • Out-of-pocket expenditure (OOPE): India has one of the highest OOPE rates globally, with over 50% of total health expenditures borne by households. Approximately 62.7% of individuals face catastrophic health expenditures (CHE) due to NCD care. Median direct medical costs for NCD care range from ₹400 to ₹5,000, depending on disease severity and healthcare access.
  • Public Health Spending: Public health expenditure remains at 1.28% of GDP, far below the National Health Policy (2017) target of 2.5%. The National Health Mission (NHM) allocation for 2024-25 is ₹36,000 crore, a 14% increase from the previous year, but still insufficient to address the growing NCD burden.
  • Macroeconomic Impact: The economic output lost due to NCDs is projected at $4.58 trillion by 2030, including mental health conditions. The World Health Organization (WHO) estimates that NCDs will cost India approximately ₹280 lakh crore by 2030, equivalent to ₹2 lakh per household annually.
  • Productivity Losses: NCDs reduce workforce participation through premature mortality, absenteeism, and reduced work capacity. Each 10% increase in NCD mortality correlates with a 0.5% decline in annual economic growth.
  • Impact on Households and National Economy: Over 50 million households fall into poverty annually due to OOPE on healthcare. Families spend more than half their total expenditure on medications for NCDs, particularly in private healthcare settings. Women and elderly populations face disproportionate financial burdens due to higher dependency ratios and caregiving responsibilities.

CHALLENGES WITH THE GOVERNMENT INITIATIVES:

• • Budget Allocation for Healthcare: The healthcare budget for FY 2024-25 stands at ₹109,551.36 crore, marking a 13% increase from the revised estimates of FY 2023-24 (₹97,633 crore). Government health expenditure remains at 2% of GDP, falling short of the National Health Policy (2017) target.
  • Tax Incentives for Preventive Health Checks: Taxpayers can claim deductions of up to ₹5,000 annually for preventive health check-ups under Section 80D of the Income Tax Act. The ₹5,000 deduction limit has remained stagnant since its introduction in 2013 despite rising healthcare inflation (12-14% annually).
  • Urban-Rural Divide: Rural areas face shortages in diagnostic facilities and skilled personnel. Though promising, Ayushman Bharat Health and Wellness Centres (HWCs) have been slow to achieve full operational capacity.

THE WAY FORWARD:

• • Comprehensive Primary Healthcare (CPHC): Early intervention reduces NCD-related morbidity and mortality. The Ayushman Bharat Health and Wellness Centres (AB-HWCs) play a pivotal role by integrating NCD screening, diagnosis, and management into primary care. Over 1.5 lakh HWCs have been operationalized since 2023, providing population-based screening (PBS) for common NCDs like hypertension, diabetes, and cancers (oral, cervical, and breast).
  • AI-Enabled Imaging for Cost-Effective Screenings: Leveraging Artificial Intelligence (AI) in diagnostics can reduce the cost of screenings while enhancing accuracy. AI-based imaging tools for mammograms, low-dose CT scans for lung cancer, and echocardiography for heart diseases can be deployed at scale.
  • Collaboration with Insurers and Private Providers: To expand access to affordable screenings, private sector engagement is critical. Public-private partnerships (PPPs) can incentivize private hospitals to offer subsidized screening packages for individuals aged 40–60.
  • Subsidized Minimum Screening Programs: A standardized minimum screening package should be mandated for private providers, covering critical tests like mammograms, pap smears, and stress tests. Partially subsidize costs through proceeds from sin taxes on tobacco, alcohol, and sugar-sweetened beverages.
  • Incentivizing Preventive Care through Tax Reforms: To account for inflation and rising healthcare costs, increase the tax deduction limit for preventive health check-ups from ₹5,000 to ₹15,000 annually. Extend tax benefits to include outpatient diagnostics and wellness programs. The Economic Survey (2023) recommended incentivizing preventive care as a cost-effective strategy.

THE CONCLUSION:

By expanding diagnostic capabilities at AB-HWCs, mandating universal screenings, revising tax policies, fostering multi-sectoral coordination, ensuring sustainable funding sources, and promoting awareness campaigns, India can build a robust framework to combat its escalating NCD crisis. These measures align with global best practices and India’s commitment to Sustainable Development Goal (SDG) 3 (“Good Health and Well-being”).

UPSC PAST YEAR QUESTION:

Q. In a crucial domain like the public healthcare system, the Indian State should play a vital role in containing the adverse impact of marketization. Suggest some measures through which the State can enhance the reach of public healthcare at the grassroots level. 2024

MAINS PRACTICE QUESTION:

Q. “India’s healthcare system is transitioning from communicable diseases to a growing epidemic of lifestyle-related Non-Communicable Diseases (NCDs).” Discuss the limitations of current policies in combating NCDs and propose a multi-sectoral approach to address the issue effectively.

SOURCE:

https://www.thehindu.com/opinion/op-ed/india-needs-to-prioritise-preventive-care/article69065561.ece