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For Those Living On The Edge
You cannot turn health into a consumer good in a country like India where thousands of women still die during childbirth. For people living on the edge, public health service is still the last hope
of treatment. This was the conclusion reached at a two-day seminar on, 'Health Sector Reforms in India - Impact on Vulnerable Population'.
The seminar, held at the Indian Statistical Institute (ISI), disclosed the outcome of a study done by the population studies unit of ISI in collaboration with Madras Medical College, University of Cambridge and Centre for Economic and Social Studies,
Hyderabad.
"The main objective of the study was to isolate vulnerable populations and probe their health status," Prof. Samir Guha Roy of
population studies unit, ISI. "In rural areas, families who cannot spend more than
Rs. 500 a month have been designated as vulnerable populations," said Prof. Biswanath Bhattacharya of population studies unit,
ISI. "For urban people, it is less than Rs. 750 and for cities like Calcutta and
Chennai, it is less than Rs. 1000," he added.
"From 1951 to the 1990s, the public health service has delivered the goods by increasing life expectancy and reducing infant mortality rate," Kasturi
Sen, a senior research associate from the department of public health of University of Cambridge, pointed out.
The striking result of the study is that West Bengal, the state that relies heavily upon public health service, has remarkably increased general fertility rate and has been able
to reduce infant mortality rate to a great extent.
"In rural areas of Tamil Nadu 94 per cent of the vulnerable population reaps benefit from the public distribution system," Subha Kumar, a clinical epidemiologist of the Madras Medical College, said. "While for the urban poor it is almost 93 per cent," she added.
"During the last two decades, there has been a massive cutback in the public health service, while the private health sector has flourished," Sen observed. Yet people in the state are opting for expensive private health services, in spite of their poverty, according to Sen.
Sanitation is a key aspect of an ideal health service. "In rural West Bengal 78 per cent of the vulnerable population do not have
any toilet," Prof. P. K. Majumdar of population studies unit, ISI, lamented. This explains why the villages of West Bengal are considered a hotbed of infectious diseases.
"Nutrition is a neglected area as it constitutes 0.03 per cent of the total state expenditure," Prof. Aditya Bagchi of computer science unit,
ISI, said. Which is why, deprived of government subsidies, poor rural people suffer from various eye and dental diseases. Poor health and malnutrition make them susceptible to tuberculosis. "The villagers suffer less from serious illness than the urban people," Majumdar confirmed. But the vulnerable rural population succumbs to relatively harmless ailments.
The research team studied 3,307 households comprising 13,820 persons in Tamil Nadu and 5,685 households comprising 28,000 persons in West Bengal.
Regarding the infant mortality rate, the researchers pointed out that the improper delivery system was to blame. "Sixty-five per cent of childbirths in rural areas take place at home," Majumdar said. Childbirth at home puts both the mother and the newborn at a great risk of developing unexpected physiological complications.
The situation is further complicated by the poor health of the mothers. In India, seven out of 10 women of childbearing age suffer from
anaemia.
At least 19 per cent of the population is without access to safe drinking water and 71 per cent without access to sanitation. Prof. Atish
Dasgupta, ISI, emphasised the importance of disseminating health awareness, if the scenario is to be improved.
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