The double burden of respiratory diseases and the Indian HealthCare System
Our two previous blog posts focused on in- and outdoor pollution, and its effects on health for people in India. This week, we will focus on the double burden of our previously mentioned lung diseases and explore the healthcare system taking care of Indian patients.
Double burden of lung diseases
You may wonder why we first elaborated on in- and outdoor pollution, before explaining our double burden of disease. The reason is the role air pollution plays in the prevalence of lung diseases. As mentioned in previous posts, India experiences a relatively large disease burden from communicable as well as non-communicable lung diseases. This may be caused by the high levels of air pollution experienced in India. As you can see in the image below, the risk of lower respiratory infection and COPD increases with a higher PM2.5 (particulate matter, or particle pollution). India has a mean PM2.5 of 90.8, but in Delhi it can become as bad as 220. The WHO has set up guidelines, saying that the mean should not be higher than 10.
Although not in the picture, the level of air pollution is also accountable for a higher risk of asthma and the development of tuberculosis
The double burden between COPD and infectious respiratory diseases can be explained vice versa. A known risk factor for COPD is frequent lower respiratory infections during childhood. At the same time, people with COPD are more likely to develop respiratory infections (especially in the lungs), due to bronchial blockages and weaker lungs caused by COPD. That way, it is easier for bacteria to settle and multiply, causing infections.
There is also a double burden between COPD and tuberculosis. COPD patients have an increased risk of developing active tuberculosis, but this relation also works the other way around.
The healthcare system experiences a bigger burden due to the growing incidences of NCDs and CDs. But does India have the resources to take care of all its patients? For that answer, we have to look deeper into the Indian healthcare system.
The Indian healthcare system
Responsibility for Indian healthcare is divided between union and state governments. The Union Ministry (of Health and Family Welfare) makes programs on a national scale, which individual state governments can imply. The Ministry is also responsible for preventing and controlling the spread of infectious diseases, by supplying technical assistance to the states.
The state governments on the other hand are responsible for public health, such as hospitals and sanitation. India has a mixed health-care system, meaning it allows public and private healthcare providers.
The public healthcare centers in rural areas can be divided into three layers.
- Sub-center is the first and is accessible for around 5000 people. It is the first contact point between primary care and the community. It has to consist of at least one nurse and one male health worker. They are accountable for interpersonal communication, in order to bring out behavioral change and provide care in relation to family welfare.
- Primary health center (PHC), which is established for every 30.000 people. The PHC are single-physician or ‘officer of health’ clinics, with a staff existing of 14 other members. The team consists of nurses, paramedicals and other public health professionals. They provide curative and preventive care and have 4–6 beds for in-patient care.
- The last layer of the public healthcare system is the community health centers (CHC), which is accounting for every 120.000 people. This center is staffed by 4 medical specialists (surgeon, physician, gynecologist and pediatrician), supported by 21 other health care workers who take care of people referred by the PHC. It has 30 beds. an operating room, X-ray, laboratory facilities and a labor room.
Further specialized health care centers are mostly covered by the private healthcare system and are concentrated in urban areas. It remains the primary source of care for 63% of the rural households, and 70% of the urban households. As health insurance only pays for 5–10% and employers for 9% in the private sector, most of the expenditure has to come from out-of-pocket payments. Therefore, more than 40% of patients have to borrow money, or sell belongings in order to get treatment.
In conclusion, due to the few health care workers per group of people and the high bills most Indian civilians can’t easily pay, the Indian health system cannot take care of all patients.
