India's Health Crisis: Sanitation, Nutrition, and Social Determinants

Overall the health status of India is lacking. India has an overwhelming sanitation problem. There about 72% of the cities in India still do not have proper sanitation (Kumar, Kar, & Jain, 2011). This lack of proper sanitation leads to an increase in diarrheal diseases and deaths (Kumar, Kar, & Jain, 2011). The most affected areas are the rural areas which have the highest rates of poverty and the poorest sanitation (Kumar, Kar, & Jain, 2011). The nutrition of the Indian population is worse in the poorer areas (Usmani & Ahmad, 2017).

These areas also have the highest rates of infant mortality (Nongkyrinh, Patro, & Pandav, 2014). This is mainly due to poor sanitation and a lack of food. Higher education for men and women increases the health of the population. Men and women who are more educated tend to seek more health care than those who are not (Kowsalya & Manoharan, 2017). Another contributing factor in the poor health status of India is the frequent natural disasters that plague India, the most common being floods (“Top 14 Worst”).

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The nutritional status of the Indian population varies by the family’s income and location. Location in India plays a huge role in a person’s life. For example, the majority of children who live in the rural areas are diagnosed with malnutrition in adolescent years (Rao). The past vice president of India, Hamid Ansari, also stated that the location of where a child is born affects their life expectancy (Usmani & Ahmad, 2017). Families in urban areas have “better education facilities, healthcare facilities, easily accessible healthcare centres, etc” (Usmani & Ahmad, 2017). Majority of the people suffer from undernutrition and infants have low birth weight.  Consequently, shorter gestation period follows with higher levels of undernutrition. Families who have a higher education statistically are wiser at providing their children with basic needs, immunizations, and overall good health (Rao). It is known that the more educated a person is, then the more responsible their decisions will be. Because of low life expectancy, young Indian girls marry at a young age following with having children at a young age (Rao). Indian people have less access to nutritional foods which affects both their health, and the health of their children.

Women with poor education will often refuse prenatal care, some are unaware this type of care even exists, which consequently leads to unfortunate events such as death of the mother, the child, or both (Kowsalya & Manoharan, 2017). They also are more likely suffer from nutritional deficiencies due to the low social status, poverty, and their reproductive biology. Nearly 80 percent of all pregnant Indian women “suffer from iron deficiency anaemia’s [sic]” (Kowsalya & Manoharan, 2017).  Pregnancy-related matters will often lead women to lose a lot of blood and receive blood transfusion infected with Human Immunodeficiency Virus (HIV) (Kowsalya & Manoharan, 2017). Indian women have a lot of discrimination towards them, including lack of rights and health care access and services. They are often raped, abused, and even suffer through domestic violence. This type of negativity affects both their mental status and physical well being leading them to develop depression, anxiety, and other, which often lead to suicide. In fact, more Indian women die from suicide than Indian men. Widowed women are “forced into prostitution to lead their life” (Kowsalya & Manoharan, 2017). Despite being the most populated country in the world, Indian women do not have many rights and are mistreated, and uneducated.

Whenever a malnourished woman gives birth, her children will face multiple struggles later in life such as immunodeficiency, short stature, cognitive impairments, and more (Kowsalya & Manoharan, 2017). Indian children are also often born with low birth weight (Kowsalya & Manoharan, 2017), which puts them at long term risk for developing heart and disease as well as type II diabetes (Rao). A study in 2012 found that over half of the children who are under five years of age fall under the neonatal category and almost 70 percent of those neonates do not survive. Majority of these deaths are the cause of preterm birth complication as well as the child becoming infected during the birthing process (Usmani & Ahmad, 2017). Other reasons for childhood mortality are diarrheal and acute respiratory infections (Nongkyrinh, Patro, & Pandav, 2014). However, according to Usmani and Ahmad (2017), “malnutrition is the major cause of mortality among children.” In 1990, the infant mortality rate was 80 per 1000 live births; after healthcare advances and access to health care took place, the infant mortality rate halved to 40 per 1000 live births in 2013 (Usmani & Ahmad, 2017). Nearly half (43%) of the children who are under five are underweight (Usmani & Ahmad, 2017). It is difficult for children to survive in Indian environment. However, if the child lives until past the age of 5, they are more than likely going live for quite a while longer. With healthcare advances and access to health services, the infant mortality rate halved from 80 per 1000 live births in 1990 to 40 per 1000 live births in 2013 (Usmani & Ahmad, 2017).

Like any other country, India fights a lot of communicable and non-communicable diseases, and although health services exist in India, they are very poor quality (Nongkyrinh, Patro, & Pandav, 2014). Overall, non-communicable diseases account for 32 percent of all deaths in the country, which adds up to around three million deaths per year. One of the diseases that India struggles with is stroke. There are about “one million cases of stoke occurring every year in the country”, and around 100,000 of those cases die. Cardiovascular diseases affect everyone but it is the number one killer of women (Nongkyrinh, Patro, & Pandav, 2014).  A study estimated there around 1.5 to 2 million cancer cases at any given time (Nongkyrinh, Patro, & Pandav, 2014). It is a scary thought knowing that India is the most populated country in the world which suggests that majority of cancer patients live in India. The control of infectious diseases is difficult to manage due to poverty, poor water supply, and sanitation India has been nationwide free from smallpox and guinea worm disease. Polio has almost left the country, while leprosy, kala alzar, and filariasis are soon to be eliminated. According to Nongkyrinh, Patro, & Pandav (2014), “diseases like yaws and plague have been under control.” Diseases that were originally under control, such as malaria, poliomyelitis, and dengue fever have resurfaced once and have become stronger. In order to help combat malaria, India announced June as the anti-malaria month. Also, there are approximately 2.2 million new tuberculosis cases each year and half a million of tuberculosis patients die (Nongkyrinh, Patro, & Pandav, 2014).  Diseases seem to take the most lives in India due to poor healthcare and management.

India has faced a lot of natural disasters most of which seem to be floods. In 2010, the Eastern Indian Storm swept through the nation; a severe storm which took at least 90 lives and destroyed over 91,000 buildings and houses (“Top 14 Worst”). It affected people not only physically, but also emotionally. Some families had to start their lives all over. In 2013 there was the Maharashtra Drought, affecting primarily the Maharashtra state in India and was the worst drought that India had in 40 years. The drought followed two years of low rainfall and put millions of residents of the state at high risk of famine (“Top 14 Worst”). One can only imagine what these people had gone through and what they had to sacrifice in order to feed themselves or their children. The year 2013 also brought the Indian nation the Uttarakhand Flash Floods. These floods were due to heavy rainfall and created massive landslides and flash floods flooding many homes and businesses. The death toll went up to 1,000 but officials presumed over 5,000 people dead due to missing persons being gone for a questionable amount of time. The Uttarakhand Flash Floods is “the most disastrous floods in the history of India” (“Top 14 Worst”). These floods and the Maharashtra Drought happened around the same time but in different parts of the country, therefore the floods and heavy rainfall did not affect the drought. India also suffered through Kashmir Floods in 2014. Continuous rainfall affected Kashmir and the surrounding regions. 390 villages were fully submerged in water. Hundreds of people were trapped in their home and over 500 have lost their lives (Phukan, 2017). These disasters are said to be the most damaging to India. It is clearly seen that floods are the most recurring and have the most impact.Taking into account that India is the most populated country in the world leads one to believe how many services need to available in order to take care of every citizen- it is extremely challenging, which is why other countries help out any way possible. One of those ways is to create a trust. The Humanitarian Aid Relief Trust Fund has successfully “lead to increase of performed surgeries and the creation of more hospitals in India” (Gibson, 2018). This helped the country by discovering new ways to save more patients as well as hospitalize those who desperately need it. Theoretically, the increase of hospitals should lead to less mortalities and possibly healthier people, that is assuming there are certified and trained doctors and staff. Due to high number of floods affecting India, there are clearly a lot of people who need help. The United Nations Humanitarian Agencies have greatly helped the victims of the flood by providing them with food, clean water, and shelter, medical attention. Not only does India accept aid from other countries, it is also able to provide help with development assistance in countries such as Afghanistan and Bangladesh (Gibson, 2018). Besides having its own problems with health care and emergency response, India is eager to help other countries whatever way it can.One of the health determinants that affect one’s health in India is gender inequality. Women have the worst case because they are often mistreated, abused, and neglected, which often takes a toll on their health. Some other determinants are nutrition, air quality, sanitation, and most importantly- location. Because India suffers through many natural disasters, it allows for the hospitals and other places of care to be filled with victims of those disasters. On average, households spend almost 70 percent on health related matters alone which makes this “a major component of the financing system” (Gupta & Bhatia). Even though “services at government facilities… are delivered free of charge,” they are of poor quality, and often experience lack of supplies and staff, which leads many families turn to private care which is very expensive and leads to high out-of-pocket payments, regardless of the fact that around “40 percent of private care is provided by unqualified providers” (Gupta & Bhatia). India provides its citizens with insurance that will cover most of the services and even hospitalization, up to a point. Patients who require medical services cannot always get it. It has been found that nearly 60 percent of all poor children who live in urban areas did not receive the “recommended immunizations before age 1” (Gupta & Bhatia). Another problems that India is facing is the shortage of medical staff. The doctor-to-population ratio is 1:1,674. That is 674 extra patients than the World Health Organization suggests (Gupta & Bhatia). It is clear to see that India requires a lot of doctors and other medical staff to help take care of the patients of most populated country. It also needs a bigger supply of medications and other medical necessities.According to Hockings, India heavily focuses on different types of treatments, such as herbs. The oldest and most used system is Ayuryeda, which means “long life.” Its primary focus is non invasive herbal treatments and has its own “hospitals, clinics, pharmaceutical factories, and medical textbooks” (Hockings). Sidda is another tradition followed by the Indians; it involves a precise reading of the pulse and uses herbal and psychological ways of treatment. They also adopted Unami, a medical tradition, from the Muslims. Its focus is on diagnosing and treating not just one part of the body, but the whole; the followers of this tradition also believe in a different human physiology as scientists. Ayuryed,  Sidda, and Unami “ attribute disease to an imbalance between underlying constituents” (Hockings). The most followed system of all is scientific medicine. It has been around for three centuries and is “practiced in the best hospitals and training colleges” (Hockings). India seems to be very open to other ways of treatment besides herbal medicine. Although Ayuryeda practice has its own hospitals and clinics, biomedicine is the number one way of treatment.

The Indian government makes it clear that the police are not to rule the public, but to guard them from harm they may encounter. It is important for the policing to be “efficient, lawful, and humane” (Mahendra, 2014). Police in India are taken seriously and are respected. They make sure that their actions are not inhumane or unlawful, and they abide by the human right regulations. Indians are constantly monitored by the government and legal institutions in order to keep the people safe (Mahendra, 2014). The police are expected to follow the human rights regulations and to ensure human dignity and the involvement of society in maintaining order (Mahendra, 2014). One of the things that needs to be done by the government is to change the laws as needed to ensure that any police officer who commits atrocities towards those in custody do not escape punishment due to a lack of evidence (Mahendra, 2014). India needs to take action to limit inordinate delays in trials, policing and investigation to ensure fair and correct judgements (Mahendra, 2014).    The increase in the wealth of India as a country is helping to increase the health of its people. After 1991, the per capita income of India increased by almost two-and-a-half times faster than the previous thirty five years. Due to this increase the poverty rate also fell at increased rates. The research of Dr. Datt and his team shows that the poor benefit more from urban growth than from rural growth. Previous to 1991 the lowering of the poverty rates were determined by the growth of the rural communities because of the reliance of the poor on these communities (Datt, 2016). However, this decrease in poverty only affects the poor in the urban areas and had very little effect on the national poverty levels. After 1991, urban growth became a driving force in the reduction of the national poverty level. Urban growth accounts for about 60-80 percent of the reduction in the national poverty level (Datt, 2016). Due to the changing of the Indian economy the relationship between economic growth and poverty reduction this change has caused structural transformations in the economy. This structural change is what is believed to have contributed to the change in the source of poverty reduction. As these changes continue, the country is expected to start putting more focus on the urban growth to increase the economy and decrease the poverty level (Datt, 2016).    India has extremely unsanitary conditions and is in need of new sanitation systems. Inadequate sanitation in India has cost 6.4 percent of its gross domestic product 2006.The health related cost accounts for over 70 percent of this economic impact (Kumar, Kar, & Jain, 2011). These health related costs include diarrhea followed by acute lower respiratory infections. These account for about 12 percent of the health related impacts. These facts suggest that it would be financially beneficial to improve sanitation because the costs to the people and government of India would be reduced with the reduction of illnesses. About 63 percent of the urban population of India still does not have proper sanitation. Demands for water are growing rapidly with the urbanization in India (Kumar, Kar, & Jain, 2011). India implemented the National Urban Sanitation Policy 2008 in order to promote sanitation rapidly in urban areas. For the rural areas it is not the national government, but the local that is incharge of operating and maintaining the sanitation functions and infrastructure. There are an estimated 72 percent of Indians without proper sanitation (Kumar, Kar, & Jain, 2011). India has a lot of issues that need to be resolved. One of those issues is girls getting married at a young age and bearing children at early age. This normally leads to short life span. One way to fix this issue is to delay the age of marriage at least until the bride and groom is at least 18 years of age. Statics have shown time and time again that people who get higher education delay marriage and having children. They have also proved that educated parents keep their children healthy and well off. Another great issue in India is a high number of communicable and non-communicable diseases. To lower the numbers of incidence, the government should provide counseling sessions and nationwide programs that educate Indians about health tips, safe sex practices, importance of immunizations, etc. However, the greatest issue in India is malnutrition. People cannot afford nutritious foods and many children and adults die because of it. One way this could be fixed is to provide people in need with healthy foods. Another way is to lower the prices of nutritious foods in stores and markets. Government could also provide free assistance with food resources to mothers until the children reach at least the age of 5.

India is the most populated country in the world. It has many problems such as poor and expensive health care, inadequate sanitation, as well as frequent natural disasters, such as flooding. Children are malnourished; women are mistreated, and poorly educated. India has high number of communicable and non-communicable diseases. Unlike the U.S., India is forced to combat Malaria, which is very difficult. India receives a lot of aid, especially from the United Nations when a tragedy such as a flood strikes; and helps other countries where it can. A lot of factors play a role in how long an Indian will live, but the biggest one is location. The government constantly monitors India to make sure they are safe. Indian economy is growing for the better and is expected to decrease poverty level. Despite its great population and many problems, India will progress toward a better future.