Discuss the major health problems in India

The HEALTH PROBLEMS of India may be conveniently grouped under the following heads :

1. Communicable disease problems

2. Non-communicable disease problems

3. Nutritional problems

4. Environmental sanitation problems

5. Medical care problems

6. Population problems.

1. Communicable disease problems

Communicable diseases continue to be a major problem in India. Diseases considered to be of
great importance today are:
(a) Malaria: Malaria continues to be a major health problem in India. Although total malaria
cases has declined compared to previous years, the proportion of P. falciparum has increased.
Malaria cases have increased in North-East states, Madhya Pradesh, Chhattisgarh, Jharkhand,
Orissa, Andhra Pradesh, Maharashtra etc. During 2013 there were 0.8 million cases of malaria
(which included 0.44 million cases of Pf malaria) and 379 deaths.
(b) Tuberculosis: Tuberculosis remains a public health problem, with India accounting for one-
fifth of the world incidence. Every year about 2.6 million persons develop tuberculosis, of
which about 0.62 million are new smear positive highly infectious cases and about 0.24 million
people die of TB every year. The emergence of HIV-TB coinfection and multidrug resistant TB
has increased the severity and magnitude of the disease.
(c) Diarrhoeal diseases : Diarrhoeal diseases constitute one of the major causes of morbidity
and mortality, specially in children below 5 years of age. They are responsible for about 10.76
million cases of diarrhoea each year. Outbreaks of diarrhoeal diseases (including cholera)
continue to occur in India due to poor environmental conditions.
(d) ARI : Acute repiratory diseases are one of the major causes of mortality and morbidity in
children below 5 years of age. During 2013, approximately 31. 7 million episodes of ARI were
reported with 3,278 deaths.
(e) Leprosy : Leprosy is another important public health problem in India. During the year
2013-2014, total of 1.27 lakh new cases were detected, out of which child cases were 9.49%
and deformity grade II and above was 4.14%. 51.48 per cent of these cases are estimated to
be multibacillary. All the States and Union Territories report cases of leprosy. With the
prevalence rate of about 0.68 per 10,000 population, India has achieved the goal of leprosy
elimination at national level.
(f) Filaria : The problem of filaria remains endemic in about 250 districts in 20 States and UTs.
The population at risk is over 600 milHon. To achieve elimination of LF, the Govt. of India has
 launched nationwide Annual Mass Drug Administration (MDA) with annual single
recommended dose of diethylcar-bamazine citrate tablets in addition to scaling up home
based foot care and hydrocele operations.
(g) AIDS : The problem of AIDS is stable. It is estimated that by the end of year 2012 there
were about 2.08 million HIV positive cases in the country.
(h) Others : Kala-azar, meningitis, viral hepatitis, Japanese encephalitis, dengue fever, enteric
fever and helminthic infestations are among the other important communicable disease
problems in India.
The tragedy is that most of these diseases can be either easily prevented or treated with
minimum input of resources. In fact most of the developed countries of the world have
overcome many of these problems by such measures as. manipulation of environment,
practice of preventive medicine and improvement of standards of living.

2. Non-communicable diseases (NCDs) India is experiencing a rapid epidemiological transition

with a large and rising burden of chronic diseases, which were estimated to account for 53 per
cent of all deaths and 44 per cent of Disability Adjusted Life Years lost in 2005. NCDs,
especially diabetes mellitus, CVDs, cancer, stroke, and chronic lung diseases have emerged as
major public health problems due to an ageing population and environmentally-driven
changes in behaviour.
Cancer has become an important public health problem in India with an estimated 7 to 9 lakh
cases occurring every year. At any point of time, it is estimated that there are nearly 25 lakh
cases in the country.
In India, tobacco related cancers account for about half the total cancers among men and 20%
among women. About one million tobacco related deaths occur each year, making tobacco
related health issues a major public health concern.
In India, more then 12 million people are blind. Cataract (62.6 per cent) is the main cause of
blindness followed by Refractive Error (19.70 per cent). There has been a significant increase
in proportion of cataract surgeries with Intra Ocular Lens (IOL) implantation
Oral Health Care has not been given sufficient importance in our country. Most of the district
hospitals have a post of dental surgeon but they lack equipment, machinery, and material.
Even where the equipment exists, the maintenance is poor, hence service delivery is affected,

3. Nutritional problems From the nutritional point of view, the Indian society is a dual society,
consisting of a small group of well fed and a very large group of undernourished. The high income
groups are showing diseases of affluence which one finds in developed countries The specific
nutritional problems in the country are :

(a) Protein-energy malnutrition : Insufficiency of food - the so-called "food gap"- appears to be the
chief cause of PEM, which is a major health problem particularly in the first years of life. The great
majority of cases of PEM, nearly 80 per cent are mild and moderate cases. The incidence of severe
cases is 1 to 2 per cent in preschool age children. The problem exists in all the States and the
nutritional marasmus is more frequent than kwashiorkor.

(b) Nutritional anaemia : India has probably the highest prevalence of nutritional anaemia in
women and children. About one-half of non-pregnant women and young children are estimated to
 suffer from anaemia. 60 to 80 per cent of pregnant women are anaemic. 19 per cent of maternal
deaths are attributed to anaemia. By far the most frequent cause of anaemia is iron deficiency,
and less frequently folate and vitamin B12 deficiency.

( c) Low birth weight : This is a major public health problem in many developing countries. About
28 per cent of babies born are of low birth weight (less than 2.5 kg), as compared to about 4 per
cent in some developed countries. Maternal malnutrition and anaemia are mainly responsible for
this condition.

(d) Xerophthalmia (nutritional blindness) : About 0.04 per cent of total blindness in India is
attributed to nutritional deficiency of vitamin A. Keratomalacia has been the major cause of
nutritional blindness in children usually between 1-3 years of age. Subclinical deficiency of vitamin
A is also widespread and is associated with increased morbidity and mortality from respiratory and
gastro-intestinal infections.

(e) Iodine deficiency disorders: Goitre and other iodine deficiency disorders (IDD) have been
known to be highly endemic in sub-Himalayan regions. Reassessment of the magnitude of the
problem by the Indian Council of Medical Research showed that the problem is not restricted to
the "goitre belt" as was thought earlier, but is extremely prevalent in other parts of India as well. It
has been found that out of 324 districts surveyed in 29 states and all UTs, 263 districts are
endemic i.e. where the prevalence of IDD is more than 10 per cent. It is also estimated that more
than 71 million people are suffering from goitre and other IDD. (27).

(f) Others : Other nutritional problems of importance are lathyrism and endemic fluorosis in
certain parts of the country. To these must be added the widespread adulteration of foodstuffs.

4. Environmental sanitation: The most difficult problem to tackle in this country is perhaps the
environmental sanitation problem, which is multifaceted and multi factorial. The twin problems of
environmental sanitation are lack of safe water in many areas of the country and primitive methods of
excreta disposal. Besides these, there has been a growing concern about the impact of "new"
problems resulting from population explosion, urbanization and industrialization leading to hazards to
human health in the air, in water and in the food chain. As of year 2012 safe water is available to 96
per cent of the urban and 87 per cent of the rural population; and adequate facilities for waste
disposal to 54 per cent of the urban and 21 per cent of the rural population. The problem is gigantic.

5. Medical care problems

India has a national health policy. It does not have a national health service. The financial resources
are considered inadequate to furnish the costs of running such a service. The existing hospital-based,
disease-oriented health care model has provided health benefits mainly to the urban elite.
Approximately 80 per cent of health facilities are concentrated in urban areas. Even in urban areas,
there is an uneven distribution of doctors. With large migrations occurring from rural to urban areas,
urban health problems have been aggravated and include overcrowding in hospitals, inadequate
staffing and scarcity of certain essential drugs and medicines. The rural areas where nearly 72 per cent
of the population live, do not enjoy the benefits of the modern curative and preventive health
services. Many villages rely on indigenous systems of medicine. Thus the major medical care problem
in India is inequable distribution of available health resources between urban and rural areas, and lack
of penetration of health services to the soda! periphery. The HFN2000 movement and the primary
health care approach which lays stress on equity, intersectoral coordination and community
participation seek to redress these imbalances.

6. Population problem The population problem is one of the biggest problems facing the country, with
its inevitable consequences on all aspects of development, especially employment, education,
housing, health care, sanitation and environment. The country's population has already reached one
billion mark by the turn of the century. The Government has set a goal of 1 per cent population
growth rate by the year 2000 (which was not attained}; currently, the country's growth rate is 1.8 per
cent. This calls for the "two child family norm". The population size and structure represent the most
important single factor in health and manpower planning in India today where the law of diminishing
returns, among other factors, plays an important role in the economic development of the country.

Population Problem

Malnutrition,

Lack of Environmental Sanitation

High Prevalence of Communicable Diseases

Lack of Medical Care Facilities