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Health Equity, Role of Different Stakeholders and Challenges

What is Health Equity?

  • Definition: Everyone has an equal opportunity to achieve optimal health, regardless of background. Goes beyond access to healthcare, addressing social determinants of health like poverty, education, and environment
  • Example: A child in rural poverty lacks access to clean water, food, and immunizations, increasing risk of chronic health problems.

Challenges to Health Equity

Global Challenges

  • Deeply rooted social injustices and global health issues create roadblocks.
  • Diverse populations in multicultural countries like India need equitable healthcare access.
  • Specific challenges include:
    • Pandemics disproportionately affect marginalised groups, widening the health equity gap (e.g., COVID-19).
    • Climate change disproportionately impacts low-income and vulnerable populations.
    • Conflicts destroy infrastructure, displace communities, and limit access to vital medical services.

India Specific Challenges

  • A large and diverse population faces significant disparities in healthcare access and outcomes.
  • Rural India lags behind urban areas in healthcare access despite improvements in the past 20 years.
    • According to the 2011 Census, urban slums make up over 17% of India’s metropolitan areas, and exhibit serious health disparities.
  • Urban slums with overcrowding, poor sanitation, and limited clean water access exacerbate health risks.
    • Example: Infectious diseases like tuberculosis are 1.5 times more common in slums (source: Indian Council of Medical Research).
  • Deep caste and gender disparities exist:
    • Scheduled Castes/Tribes have higher child mortality and lower immunisation rates (source: NFHS-5).
    • Anaemia is almost double as common among women in the lowest wealth quintile (source: NFHS-5).
  • Non-communicable diseases (NCDs) cause over 60% of deaths in India.
    • The economic impact of NCDs is projected to exceed $6 trillion by 2030 (source: Public Health Foundation of India).
  • Doctor shortage is critical, with only 8 doctors per 1,000 people (below WHO’s recommended ratio).
    • The shortage is worse in rural areas, with over 75% of healthcare professionals concentrated in cities (27% of the population).
Fact
  • As per the National Medical Commission (NMC) India’s doctor-population ratio is 1:834, surpassing WHO’s recommended standard of 1:1000, with an 80% availability of allopathic doctors and 5.65 lakh AYUSH practitioners.
  • The National Mental Health Policy is being implemented through the District Mental Health Programme, providing training and manpower for mental health services.

The Road to Health Equity

  • Requires a multi-sectoral approach beyond just healthcare access
  • Collaboration is needed between governments, civil society, healthcare providers, and communities
  • Examples of initiatives in India:
    • Ayushman Bharat: Free health coverage for the bottom 40% economically
    • National Health Mission (NHM): Expanding access, strengthening infrastructure, providing services to vulnerable populations
    • Focus on health literacy through education
    • Collaboration between public/private sectors and NGOs to improve access, workforce development, and infrastructure

The Role of Different Stakeholders

  • Public and private health sectors can collaborate to:
    • Provide services to underserved communities
    • Focus on preventive education
    • Develop workforce
    • Improve infrastructure
  • NGOs and civil society can:
    • Conduct direct community outreach
    • Address local health concerns
    • Partner with international/government organisations for culturally sensitive health initiatives.
  • International organisations (WHO, Global Fund, Gavi) can:
    • Support health initiatives in resource-limited settings
    • Promote information and resource sharing to improve healthcare systems.
  • Private sector and philanthropies can leverage innovation and technological advancements (digital health) to:
    • Enhance accessibility and affordability
    • Increase reach and effectiveness of healthcare delivery.
  • Research institutions and academia can offer crucial insights into:
    • Health inequalities
    • Intervention effectiveness
    • Evidence-based practices and policies
  • The Importance of Local Organisations:
    • Organisations with a strong local presence are crucial for health equity.
    • They understand community needs and can ensure program relevance and effectiveness.
    • Successful collaborations require:
      • Open communication
      • Mutual respect
      • Shared goals
      • Emphasis on community empowerment, knowledge sharing, and capacity building
      • Adaptability to evolving health concerns and community demands.

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