How can India heal its healthcare debt?

The year 2014 is likely to be remembered as the year of the surgical mask and the quarantine sign. Over the past several months, the Ebola virus has caused thousands of deaths in Liberia, Guinea and Sierra Leone, and spawned widespread anxiety about the adequacy of emergency health responses.

Missteps and fatalities in the United States and Spain have reminded us that wealthy industrialized nations have not yet conquered infectious diseases. Just as high-income countries remain vulnerable, low- and middle-income economies must confront an increasing burden of non-communicable diseases (NCDs), such as cardiovascular disease, chronic respiratory disease, diabetes, cancer and mental illness.

A recent New York Times editorial highlighted the catastrophic consequences that might occur if Ebola made its way to India. It emphasized the emerging economy’s under-resourced health systems and the still high burden of infectious diseases.

India faces a staggering NCD burden: in 2010, non-communicable diseases accounted for 235 million disability-adjusted life years (DALYs) in India (each calculated as a year of healthy life), mostly from cardiovascular disease and chronic respiratory disease. This is 13 million more DALYs than were accounted for that year by communicable diseases such as dengue, malaria and tuberculosis.

This daunting burden stems from a complex web of factors that include an ageing population, increasingly sedentary lifestyles, starchy and fatty processed foods, high rates of tobacco use, and limited resources for health education and primary prevention. All in all, India stands to lose a staggering $4.58 trillion to NCDs by the year 2030.

Fortunately, with peril also comes promise, as outlined in a new report, Economics of Non-Communicable Diseases in India, produced jointly by researchers at the World Economic Forum and the Harvard School of Public Health. New interventions on the part of government agencies, hospitals and healthcare professionals, targeted at preventing NCDs at all stages of the life course, are already underway.

Just a few standouts include a school-based programme to discourage adolescent smoking, prospective expansion of HPV vaccinations for girls to prevent cervical cancer, and collaborative care by physicians and lay mental-health counsellors to address clinical depression and anxiety disorders.

The interventions highlighted in the report are all estimated to be highly economical: each has been estimated to generate at least a 15% return on investment over the next three decades when valuing each DALY at the conservative, WHO-recommended rate of GDP per capita. The challenge lies largely in the fact that the benefits of NCD-prevention programmes tend to accrue gradually.

The expansion of these promising interventions will require judicious and forward-thinking leadership from elected officials and policy-makers who will not see the benefits of a reduced NCD burden realized fully (or even predominantly) on their watch. This may be a particularly difficult pill to swallow for the world’s largest democracy, especially when the nature of electoral politics rewards quick turnarounds and simple solutions.

However, India is also hugely diverse and resourceful, and teems with energy, optimism and human capital. It is a country that has seen huge gains in longevity and reductions in child mortality over the past several decades; it is a country that successfully sent a spacecraft to orbit Mars, on a smaller budget than it takes to produce a Hollywood blockbuster. Despite formidable challenges posed by both infectious diseases and NCDs, India’s coming years may lend weight to the newfangled adage that healthier means wealthier.

More on India and health
What if Ebola spreads to India?
Improving the health of India’s poorest
Can we create a healthy future for India?

Authors: David Bloom is the Clarence James Gamble Professor of Economics and Demography at the Harvard School of Public Health, Harvard University. Alyssa Lubet is a research assistant at the Harvard School of Public Health. 

Image: A cancer patient participates in a therapy session for children suffering from cancer in Mumbai November 14, 2009. REUTERS/Arko Datta