Determinants of Health Status in India

Development of a nation is crucially connected with the condition of health of its people, and health is now been accepted as an important determinant of economic development of a nation. It is only a nation with a healthy labour force who has the ability and the capability to undertake the task of expediting the growth and development of the economy. According to Development Economists, health condition of the people is also one of the important ends of all developmental efforts. Impressive achievement in the health sector has paved the way for excellent record not only in the level of economic development as revealed by the experience of most nations, but in human development as well. This has been the experience of the South East Asian nations as well as the Nordic nations. Inadequate and unplanned investment in the health sector results in frequent break out of epidemics and deaths, which can seriously retard the current and the future growth potentiality of those nations. Such has been the unfortunate experience of some of the African nations.

Though superficially viewed the study of health problems do not appear to be included within the realm of Economics, but is considered to be the concern of only the scientists and medical practitioner; yet in modern times no work on health sector is complete without the application of the knowledge of economics. This is not only because the complexity of the health sector has increased manifold with the complexities of the society, but also because over the last 50 years or so, most nations of the world have experienced rapid increase in health care spending. This has resulted in the emergence of health economics as an independent area of study.

A good number of studies on health economics has been conducted, mostly during the last 50 years. In the Indian context however, a lot more studies in this sector needs to be undertaken, in view of the dearth of adequate research work in this area. Most of the literature surveyed for the purpose of the present work relates to the workdone by health economists of the west. All the work reviewed has been divided broadly into four categories as represented in the diagram below (Diagram 3.1):

In view of the crucial role played by cost in determination of health status as examined in Chap. 2, health expenditure and investment in health sector assume significance for the present work. Expenditure on health is viewed more as a long-term investment, which benefits accrue more to the individual in the short run, but it is the society and the nation who ultimately reap the benefit of such expenditure in the long run. Expenditure on health, therefore, like expenditure on any other socioeconomic aspect, can be viewed as investment for enhancing the quality of life of the people. The expenditure incurred for bringing up children and providing them with good health contributes not only for his own self but for providing healthy labour force for the future development of the nation. The GDP of such nations will eventually be much higher and better in comparison to those nations burdened with malnourished children with high morbidity and mortality rates. Resources required for meeting the challenges of health-related problems of such nature has high opportunity costs. Such resources spent in less developed nations could otherwise have been spent more profitably for the purpose of development of the nation had they not been spent for meeting the challenges of poor health of the population. It is not only by way of monetary investment alone, but a nation characterised by high morbidity and mortality rates also loses much of its human resources from whose productive contribution the nation is deprived. Health expenditure is therefore considered as an investment because the benefits are directly in terms of number of lives saved, extent of disability prevented and the amount of monetary loss that can be reduced.

There is no single index for measuring the health status of a country or society, as it is a multidimensional concept. In the absence of such an index, we use a number of indicators to represent health status. Though the health status of an individual is diagnosed by a physician, for evaluating the health status of a society or population, aggregation of health data is the only way to assess the health status. There is, however, no comprehensive or absolute measure to assess the health status of a population. It may be mentioned here that most of the health indicators are actually negative aspects of health. These negative indicators in fact help us in estimating the status of health since a decline in these indicators implies an improvement in the health condition. Some of these indicators which have been selected for the present study are infant mortality, child mortality, maternal mortality, death rates, crude death rates, percentage of underweight children, percentage of stunted children and life expectancy as already discussed in the earlier sections. For most of these indicators, we have tried to segregate them into rural and urban sectors in an attempt to know the difference in health status between the two sectors.

The discussions and analysis of the preceding sections reveal the need for management skills in the health sector for the delivery of health-care services to the right people at the right time and even more importantly at affordable prices. Health economics focusses attention to the ways and means of utilising the scarce resources in the health sector in an optimum manner. Management skills in the health sector, on the other hand, ensure that the health-care system has a strong medical, operational and financial foundation so that the health needs of the consumers can be undertaken and delivered in a professional manner with optimum use of the resources allocated to the health sector. Professional management of the health system can also ensure minimum wastage, avoiding underutilisation of capacity in the health system. In a society dominated by health-care service consumers, it is necessary that the important communication relating to health issues are conveyed to the members of the society and their leaders, for which management can also play a crucial role.

Health has been accepted as an important determinant of economic development which is evident from numerous empirical works on the subject. This is true both for the developed and the less developed countries. Good health can save scarce resources, which is particularly crucial from the point of view of development for the poor countries. Good health is also an important determinant of regular and good education, good income, higher productivity and higher national growth. Planning for good health is an integral part of overall national planning. Good health status therefore increases both the quality and the quantity in terms of both the number of workforce and the number of hours of work put in by the workers. Investment in health sector cannot be ignored either by any developed or underdeveloped nation. Development economics assigns the responsibilities of the health sector to the state, so that the minimum requisite health standard can be assured even to the deprived and poverty-stricken people of the country.