Volume 21, Number 3; Article by Arnab Mukherji, Anit N Mukherjee; September, 2009
Demographic Change and the Public Health System in India: Academic Perspective
Arnab Mukherji is Assistant Professor, Centre for Public Policy, Indian Institute of Management Bangalore.
Anit N Mukherjee is Fellow, National Institute of Public Finance and Policy, New Delhi.
How does the public health system respond to the challenges thrown up by demographic change? Using data from the National Sample Survey Organisation-NSSO's 52nd Round and 60th Round nationally representative survey, Arnab Mukherji and Anit Mukherjee outlined the emerging population and health trends in India from the period 1995 to 96 to 2004 to 05.
Discussing the implications of the changing demographic trends on the public health system was a panel of experts invited as part of the IMR Round Table Discussion on the subject.
Dr K S James, Professor and Head, Population Research Centre, Institute for Social and Economic Change, pointed out that the significant decline in the fertility and mortality rates in India in the last quarter of the twentieth century has led to an advantageous demographic dividend. However, this picture varies across states with the southern states in more advanced stages of demographic transition. The demographic transition has led to an epidemiological transition or a change in the disease burden, also migration of people within the country. Changes in the sex ratio, marriage, family and lifestyle, while not as pronounced as in the West, are anticipated.
Increase in old age (60+ years) population, as Dr M K Vasundhara, Professor Emeritus, Department of Community Medicine, B R Ambedkar Medical College, Bangalore, points out, calls for a review of our health policies. We need to deal with the dual and differing load of pediatric and geriatric care, with communicable diseases dominating in the former category and chronic diseases in the latter. The position of the elderly in India is also impacted by the changing family structure, the lack of adequate systems of social support, security and insurance, which must be recognised and repaired by policy. Measures to strengthen the existing healthcare infrastructure would include training of all health care manpower in geriatrics, convergence of the services available under various national health programmes, social insurance and pro-active steps for 'active ageing'.
Dr Debabar Banerji, Professor Emeritus, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, underscored the fact that public health policies are deeply influenced by socio-political forces. He stressed the need to reverse the dominance of bureaucrats in public health in India with the appointment of specialised 'managerial physicians' who should occupy key public health positions in the union and state governments.
Detailing the changing scenario of Indian healthcare, Mr Santosh Marathe, Acting COO and Vice President, Finance, Apollo Hospital, Bangalore, mentioned the increase in lifestyle related diseases, the recurrence of some infectious diseases, the increase in day care procedures and the emphasis on preventive medication. A new trend has been the simultaneous increase in the number of patients of over 55 years of age and those in the 15 to 30 years profile. While public private partnerships are important, government initiatives are much needed in the areas of infrastructure support, emergency networks, group insurance schemes, community health initiatives, and accreditation of healthcare providers. The areas with potential for development include preventive healthcare, telemedicine, IT enabled solutions and medical education and training. To be viable, healthcare providers must factor in new ways of talent and performance management and lean management tools.
The importance of community-driven development and a holistic approach to public health, and the need to integrate grassroot level requirements into health plans and policies came in for intense discussion.
Reprint No 09306a