Population differences in prevalence of respiratory diseases and access to healthcare in India
In previous posts we informed you about the double burden of respiratory diseases in India. We discussed the health care system and concluded that the double burden of respiratory diseases is a big problem in India. This is partly due to the wide diversity in an immense country like India, as can be read in our background post. Variation can be within cultural, social, economic, religious or many other aspects. Because of this diversity, it is very hard to map and tackle the double burden of respiratory diseases in India. In this post we are going to tell you more about the diversity in the Indian population, focussing on geographic, socio-economic and gender differences, and its relationship with the double burden of respiratory disease.
Geographical differences
First of all the geographical differences. The Indian population is spread over 36 entities, some as large as countries. This causes wide variation within the population, which affects respiratory health. Most states in India have higher rates of DALYs from COPD and asthma compared with locations elsewhere in the world. But within the country, there are big variations as well, especially between rural and urban areas.
This is visible in figure 1, which shows the prevalence of COPD and asthma in India. At a glance it is visible that the prevalence of both diseases increased between 1990 and 2016, especially the prevalence of COPD. The DALYs due to COPD are mainly caused by air pollution (54%), tobacco use (25%) and occupational risks (17%).
Figure 1. Asthma and COPD prevalence in India in 1990 and 2016
Besides these non-communicable diseases (NCDs), the prevalence of the communicable disease (CD) tuberculosis (TB) is also different between regions. The prevalence of TB is higher in the urban Indian population compared with the rural population. This can be explained by the high population density in cities, which allows TB to spread easily.
Important for both, NCDs and CDs, is the access to healthcare. This is not equal in India, in rural areas there are less healthcare facilities than in urban areas. People have to travel further, which lead to less visits. Therefore a lot of diseases are untreated in rural regions
Socio-economic differences
In addition, socio-economic status (SES) plays an important role in the access to healthcare in India. However, there are huge differences between individuals. In the previous blog post you have read about the health system in India, which is a mix of public and private healthcare. Most people use private healthcare because of better experiences. However, public healthcare is way cheaper and often used by people with a low SES. Therefore people with a low income have often less access to good healthcare. This presence of socio-economic disparities in the health system is a damage for human rights and the trust in the health system. Besides, because of the bad access and also the high economic costs a disease brings, a low SES is related to a higher burden of asthma or COPD, and TB.
Gender differences
Lastly the differences in gender. The prevalence of COPD increases rapidly after the age of 30 years, especially in men. Therefore the highest prevalence of COPD in India is in men who are 80 years old or older. For asthma it is the opposite, women are more likely to develop asthma, the reason for this can be, as you can read in the indoor pollution post, because they cook a lot inside and are exposed to higher rates of particular matters. For TB, the prevalence is higher among Indian men than women. This can be caused because men have more access to healthcare and therefore more cases of TB among men are registered.
Not only for TB, but for most diseases there is a big gender gap for access to healthcare in India. This gap increased in the last decades, in which men have more access than women. Especially the access to care for mothers is inadequate and an important determinant for maternal mortality. These disparities are often compounded by cultural norms and expectations imposed on women. For example, some women are not allowed to leave their home unaccompanied . They have to wait for a male relative, which makes it hard to receive healthcare in emergencies.
In summary, because of this diversity it is very hard to map and tackle the double burden of respiratory diseases in India. By mapping these factors we are one step closer to a solution for the double burden of respiratory disease problem in India!
