Life expectancy in India on the rise, but quality health care services inadequate

Life expectancy in India has increased by more than 10 years in the past two decades, while globally children born in 2015 were expected on an average to live till 71.4 years, a new UN report revealed.

In 2015, life expectancy at birth was 68.3 years in India which breaks down to 66.9 years for men and 69.9 for women, the WHO’s World Statistics Report 2016 found. In 1990, Indians were expected to live on an average till 58 years. This rose to 66 years in 2013.

Globally, life expectancy increased by five years between 2000 and 2015, which is the fastest increase since the 1960s. This has reversed the declines of the 90s owing to the AIDS epidemic in Africa and other challenges after the fall of the Soviet Union in Eastern Europe.

“India must have had a lot of progress because it is such a driver of global progress (in pushing up life expectancy) because it is so big (in size),” Ties Boerma, Director of the Department of Health Statistics and Informatics at the WHO, told Firstpost. This could be attributed to the “massive progress” made around countering child mortality in the country.

The WHO’s World Health Statistics is an annual publication since 2005 containing data from 194 countries reporting on the status of health of the world’s people.

One of the more worrying finding is that India’s share in Non-Communicable Diseases (NCD) has increased — there is a 26.2 percent probability of dying from any of the four main NCDs between the ages of 30 and 70. This is one of the highest in South East Asia Region (SEAR) — higher than many African countries as well as most countries in the Americas, including the US.

“India has now moved considerably in the epidemiological transition or health transition where non-communicable diseases now have also become a very important cause of death,” Boerma told the reporter.

India is presented as country with particular challenges with maternal mortality and infectious diseases, but now it is grappling with newer challenges of heart strokes, obesity, cancer and diabetes.

In 2012, 68 percent of the deaths globally – 38 million deaths – were due to NCDs of which 52 percent were premature deaths — that are deaths of less than 70-year-olds. Over three quarters of these premature deaths were due to cardio vascular diseases, cancer, diabetes or chronic respiratory diseases.

Last year, Maternal Mortality Rate (MMR), defined as the number of maternal deaths per 1,00,000 live births, was estimated at 215 globally which translates to a whooping 813 women dying every single day due to childbirth. India’s MMR in 2015 was 174. Nepal was the highest in the SEAR group with a high of 258 deaths, while Sierra Leone topped the global list with an extremely high ratio of 1,360 mothers dying per 1,00,000 live children born. A related statistic shows that between 2006 and 2014, 74 percent of the Indian children were born through skilled personnel while the same percentage for Thailand is 100, while it is as high as 99 percent for Sri Lanka.

India has about 24 skilled health personnel to serve 10,000 people. This rate is globally comparable only with Latin American countries like Peru and Nicaragua.

An estimated 5.9 million children died under the age of five in India in 2015 with 45 percent of them being newborns. India’s mortality rate under five was 47.7 per 1,000 live births in 2015.

Only 40 percent of the Indian population used improved sanitation in 2015, compared to 61 percent in Bangladesh and Indonesia, 46 percent in Nepal, 95 percent in Sri Lanka and 98 percent in Maldives. Improved sanitation implies that a facility is not shared with other households and where the output is safely disposed off in situ or treated offsite. Lack of access to proper sanitation facilities continues to affect development goals in India with the country having the largest population without improved sanitation facilities among the SEAR countries. Globally, 946 million people defecate in the open.

Twenty three percent of the world’s children — 156 million of them — are affected by stunting. India had a prevalence of 38.7 for children under 5 years of age between 2005 and 2015.

In 2015, the proportion of India’s population using improved drinking water sources was 94 percent. Although only three countries in the world have a less than 50 percent of the population accessing improvised drinking water sources, it is important to note that globally about one-quarter of the improved water sources are faecally contaminated and approximately 1.8 billion people drink such contaminated water. The access to such sources is further complicated in developing countries because of the distances of their location from home.

Only 34 percent of the Indian population in 2014 relied on clean fuels compared to more than 95 percent in Maldives and 68 percent among the Bhutanese population. Reliance on polluting fuels and technologies in the home is closely linked to poverty and social inequity, states the WHO report. Part of the consequence of use of unclean fuels was that the country had a high of 73.6 μg/m3 mean concentration of PM2.5 in urban areas — one of the highest among the SEAR countries and higher than many African countries. As many as 4.3 million people in the world die due to air pollution caused by cooking fuels and another three million die from outdoor pollution.

The mortality rate due to intentional homicide in India is 4.3 per 1,00,000 population. The highest such rate is in Honduras of almost 104 deaths per 1,00,000 people.

“Health care in India is very unequal,” the WHO official said, adding that there is a “long way to go before there is quality service for everyone.” India scored 70 on relative inequality for accessing reproductive, maternal, newborn and child health interventions, according to data from 2005. The debate in India is around the challenge of providing quality health care without financial hardships, and social insurance that allow the poor to use private services and not just public services.

“It is a big challenge for the private sector being so big. And the Indian government is putting relatively little money in health…the debate (in India) was very lively but the answers were still few,” Boerma said.

There have been “great successes” in Mexico’s Seguro Popular scheme — a public health insurance that covers a wide range of services without co-pays for its affiliates — and some Chilean initiatives that could provide models for tailoring to India’s settings. The Chinese experience has a very high insurance coverage for its population but has not been so successful in addressing the supply side of health care, the UN health agency said.

Some states in India like Kerala could be an example for other states in terms of their health initiatives, Boerma said.

Overall, India has scored 94 on 13 core capacities that the WHO’s International Health Regulations (IHR) stipulate for member states — for instance, on preparedness, response and critical capacities and surveillance. Some countries like Japan, Cuba, Australia, Republic of Korea, South Africa score 100 while countries like China, Vietnam and Germany have a score of 99. The US scores 91.

However, most of this data is self-reported annually by countries as required by IHR. WHO is moving into more external assessments of core capacities of countries — something that is “evolving” at the moment.

“We also feel that we need more objective assessments of where countries stand,” Boerma said.

Some global findings

– Life expectancy for children born in 2015 was 71.4 years. However, this remains uneven. For 29 high-income countries, the average life expectancy was 80 years, for 22 other low-income African countries, the life expectancy was less than 60 years. People in Sierra Leone have the lowest life expectancy globally for both sexes.
– Healthy life expectancy stands at 63.1 years globally.
– Japanese women are expected to live the longest with an average life span of 86.8 years while Swiss men have the longest average survival at 81.3 years.
– The latest figures show that countries that traditionally perform well on the life expectancy scale like Japan, Switzerland, and Australia continue to make progress.
– Research has shown that life expectancy grew by 2-2.5 years per decade in high-income countries during the 20th century — whether such gains could be sustained over time is a huge debate among demographers.
– There are 2 million people newly affected by HIV, 9.6 million with tuberculosis, 214 new malaria cases and 1.4 billion people in need of treatment for neglected tropical diseases in the world. More than 10 million people die premature deaths before 70 years by cardiovascular diseases and cancer. As many as 8,00,000 people committed suicide across the world last year, while 80 percent of the 4,75,000 people intentionally killed in 2015 were men. Despite measures to curb tobacco consumption in many parts of the world, more than a billion people smoke tobacco.

Source: Firstpost

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