Tag Archives: dividend

Covid-19: A Paradox: Impact On Demographic Dividend: Vaccine Rush

Posted on by
Reply

Not so long ago, on September 25, 2019, while delivering the keynote address at the Bloomberg Global Business Forum in New York, Prime Minister Modi talked about the future direction of India’s growth story. He emphasized, this story was built on four pillars, namely Democracy, Demography, Demand and Decisiveness. Today, except perhaps the first pillar – Democracy, all three other pillars have been greatly impacted, especially by Covid-19 pandemic, just round a year’s time. Interestingly, while delivering the 74th Independence Day speech on August 15, 2020, the Prime Minister indicated: ‘Covid-19 is not an obstacle big enough to hamper self-reliant India’s growth’

That said, out of those 3 pillars, ‘demography’ of the country, I reckon, offers a key differential economic advantage to the nation. According to the Prime Minister’s own words: “This growth is facilitated by India’s demographic dividend and young and talented people.” Alarmingly, the collateral damage of the new Coronavirus pandemic has significantly affected this critical growth pillar, as well. Thus, I would cite this ‘pillar’ as an example, to drive home the point – how Covid-19 is impacting the demographic dividend, impeding the economic growth of a country, like India.

At the same time, it is becoming increasingly clear today, the new Coronavirus ‘maze’ is refusing to signal any clear pathway to get back to the ‘old normal,’ while the ‘new normal’ is yet to crystallize.From this perspective, let me deliberate in this article, with examples from the following two important areas:

  • A paradox that is directly related to Covid-19 transmission in various countries.
  • The collateral damage on ‘demographic dividend’.

These illustrations will vindicate that there isn’t any other meaningful option – for an indefinite period, but to wait (or rush) for vaccines, in the prevailing quandary.

The paradox: 

As the world awaits scientifically proven, safe and effective vaccines, duly approved by the drug regulators, to come out of Covid-19’s lethal shackles, several paradoxes further add to the complexity of the problem. Many of these seem to be quite difficult to untangle. One such paradox, for example, the observed case-fatality ratio (CFR). It indicates, the number of deaths either per 100 confirmed Covid-19 cases or per 100,000 population. The latter represents a country’s general population, with both confirmed cases and healthy people.

As analyzed by the Johns Hopkins University - among the twenty countries most affected by COVID-19 worldwide as of August 09, 2020, the United Kingdom (UK) had over 300,000 confirmed cases along with 70.16 deaths per 100,000 of its inhabitants. Peru and Chile had the second and third highest total per 100,000 of the population with 64.55 and 53.45 respectively, while the U.S. followed – with 49.65.

Similarly, while India shows a CFR of 2.0, other countries – quite different, particularly in economic and demographic parameters, are also not doing too badly, some are doing even, better as far as the CFR is concerned. These nations include, Pakistan 2.1, Vietnam 1.8, Thailand 1.7, Myanmar 1.7, Philippines 1.7, Australia 1.6, Malaysia 1.4, Bangladesh 1.3, Sri Lanka 0.4, Maldives 0.4 and Nepal, to name a few.

From these numbers, it appears, the CFR has neither any bearing on the degree of overall economic development of a country, nor how robust is the nation’s health care infrastructure, beside others. In that case, in which areas a country should focus to keep Convid-19 death rate low? A specific answer to this question is awaited. Till then does it not remain a paradox?

Impact on demographic dividend:

Besides the direct impact of rapid transmission of the Coronavirus infection and its associated fall outs, the livelihoods of many and crippling blows on the national economy, Covid-19 pandemic is silently making serious collateral damages. One of these is a significant impact on the demographic dividend, especially for a country like India. As many would know, ‘demographic dividend’ broadly refers to the growth in an economy that is the result of a change in the age structure of a country’s population, where the proportion of the working population out of the total population is high.

This issue has been well-captured in the August 11, 2020 report – ‘Youth & COVID-19: Impacts on jobs, education, rights and mental well-being,’ of the International Labor Organization (ILO). The report captures the immediate effects of the pandemic on the lives of young people (aged 18–29) with regards to employment, education, mental well-being, rights and social activism. Over 12,000 responses were received from young people in 112 countries. A large proportion of these came from educated youths with access to the Internet. Some of the key findings of this survey may indeed be a cause of worry for many, such as:

  • The pandemic is inflicting a heavy toll on young workers, destroying their employment and undermining their career prospects.
  • 38 per cent of young population is uncertain of their future career prospects due to the pandemic. They expect COVID-19 crisis to create more obstacles for them, besides lengthening the transition from school to work.
  • Mental well-being is lowest for young women and younger youths between the ages of 18 and 24 years.
  • One in six young people (17 per cent) – employed before the outbreak, stopped working altogether, most notably they are younger workers – aged 18 to 24 years.
  • Among those who thought that their education would be delayed or might fail, 22 percent were likely to be affected by anxiety or depression, compared to 12 percent of students whose education remained on track.
  • Young people whose education or work was either disrupted or had stopped completely being most twice as likely to be affected by anxiety or depression as compared to those who continued to be employed or whose education was not affected.
  • The new Coronavirus has left one in eight young people (13 per cent) without any access to courses, teaching or training — a situation, particularly acute among the youth in low-income countries and one that serves to underline the sharp digital divide that exists between regions.

The paper acknowledged that even before the onset of this crisis, the social and economic integration of young people was an ongoing challenge. Nevertheless, COVID-19 pandemic has disrupted every aspect of peoples’ lives, adversely impacting the demographic dividend. The paper cautioned, unless urgent action is taken right now, young people are likely to suffer severe and long-lasting impacts from the pandemic. Intriguingly, not many remedial measures in this space are visible just yet, not even in India.

A global rush to cling on to vaccines as a ‘safety belt’:

Amid such grim scenario, there exists an understandable global rush to cling on to get Covid-19 vaccines at an unprecedented record time, despite huge safety concerns of their users, if the development process is rushed through. The reason being, any previous vaccine development process has typically taken a decade or longer. Just to give a feel of it, according to reports:

Name of Vaccine

Number of years to develop

Varicella

28

FluMist

28

Human papillomavirus

15

Rotavirus

15

Pediatric combination

11

Covid-19 goal

18 months

Some countries promised even sooner:

Let me give two recent examples – one from India and the other from Russia.

According to the media news, Indian Council of Medical Research (ICMR) was planning to launch the Covid-19 vaccine by August 15 this year. Another report also indicated that on July 2, ICMR wrote to all 12 trial sites for the Covid-19 vaccine candidate - Covaxin, that all clinical trials had to be completed by August 15, in time for a public launch.

However, bioethics experts have questioned how all three phases of testing for a vaccine candidate, yet to even begin human trials, can be crunched into a timeframe of a month. Be that as it may, The Ministry of Science and Technology has since clarified that none of the Coronavirus vaccine candidates, including India’s Covaxin and ZyCov-D, are likely to be ready for public use before 2021.

Meanwhile, on August 12, 2020, Russia launched the world’s first registered COVID-19 vaccine ‘Sputnik V’ – again amid huge safety concern, as all three phases of clinical trials are yet to be over. This vaccine, apparently, will be first given to doctors and teachers after which there will be a mass vaccination campaign in October 2020. However, according to the Russian Health Minister, “Clinical trials of a Coronavirus vaccine developed by the Gamaleya Centre are over, paperwork is underway for the vaccine’s registration.”

Amid this rush, there comes good news. On August 10, 2020, the USFDA Commissioner assuredphysicians and other healthcare providers that vaccine and therapeutics approvals for the COVID-19 pandemic will be “based on good science and sound data.” And: “Nothing else will be used to guide our decisions,” he reiterated. By the way, six Covid-19 vaccine candidates from around the world are now in phase three of human trials.

Conclusion:

Currently, India is recording the highest count of fresh Covid-19 cases in the world while also reporting the most daily deaths from the virus. As on August 16, 2020 morning, the recorded Coronavirus cases in the country reached 2,590,501 with 50,099 deaths, despite all measures that the country is taking. The steep ascending trend continues, unabated. As I wrote on July 13, 2020 in this blog – what will be the ultimate fallout of this global health crisis, it will ultimately assume what form, when and how long? Similarly, clear reasons are not still available as to why many Covid-19 related catastrophic impacts in different nations, neither have any bearing on the degree of overall economic development of a country, nor how robust is the nation’s health care infrastructure, and the likes.

The answer to the question – Why many Covid-19 related things are happening, the way these are happening, even in India, continues to remain a paradox. Some experts are trying to attribute reasons to these, though, almost on a daily basis, which are also subsequently changing, as days pass by. In tandem, many significant collateral damages caused by the pandemic, are also surfacing, such as, weakening of an important growth pillar – demographic dividend, of a large country like India.

In the midst of all, the rush for a new Covid-19 vaccine development in a near impossible timeframe of around a year is gaining momentum. However, as the reports indicate, ‘despite the unprecedented push for a vaccine, researchers caution that less than 10 percent of drugs that enter clinical trials are ever approved by the Food and Drug Administration. The rest fail in one way or another: They are not effective, don’t perform better than existing drugs or have too many side effects,’ the report emphasized.

Incidentally, there doesn’t seem to be any other robust solution, either. On August 15, 2020, while addressing the nation on its 74th Independence Day, Prime Minister Modi said, ‘three Coronavirus vaccines are at different stages of testing in India and the government has a plan to ensure that a vaccine, when approved, reaches every Indian.’ The takeaway message from various developments on the global fight against the new lethal Coronavirus remains somewhat paradoxical. With the efforts to save lives and the livelihoods becoming more and more challenging, and the economic growth retarding faster every day, as it were. Thus, vaccines have to come sooner – but, no matter what?

By: Tapan J. Ray 

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

 

 

Millennial Generation Doctors And Patients: Changing Mindset, Aspirations, And Expectations

Posted on by
Reply

The term ‘Millennial Generation’ normally refers to the generation, born from 1980 onward, brought up using digital technology and mass media. According to ‘Millennial Mindset’ – a website dedicated to helping businesses understand millennial employees and new ways of working, the key attributes of this generation are broadly considered as follows:

  1. Technology Driven:
  2. Socially Conscious
  3. Collaborative

The millennial mindset:

The publication also indicates that the overall mindset of the millennial generation is also vastly different from the previous generations, which can fall into four categories:

  1. Personal freedom, Non-hierarchical, Interdependent, Connected, Networked, Sharing
  2. Instant gratification, Wide Knowledge, Test and learn, Fast paced, Always on, Innovative
  3. Fairness, Narcissistic, Purpose driven
  4. Balance, Eco-friendly and Experience focused

Seeks different professional ecosystem:

In the professional arena too, this new generation’s expectations from the professional ecosystem are often seen to be distinctly different, as they are generally seen to be:

  • Willing to make a meaningful professional contribution, mostly through self-learning
  • Seek maintaining a reasonable balance between work and personal life
  • Prefer flexible work environment, unwilling to be rigidly bound by convention, tradition, or set rules
  • Impatient for fast both personal and organizational growth, often on the global canvas

The ‘Millennial Generation’ in India:

The millennium generation with a different mindset, aspirations and value system, already constitutes a major chunk of the Indian demography. According to the 2011 Census, out of estimated 1.2 billion population, around 701 million Indians (60 percent) are under 30 years of age, which also very often referred to as ‘demographic dividend’ of India.

Currently, a large number of Indians belonging to the millennial generation are entering into the work stream of both national and International companies operating in the country.

The challenge in healthcare arena:

In the healthcare sphere too, we now come across a fast increasing number of technology savvy and digitally inclined patients and doctors of this generation. Accurately gauging, and then meeting with their changing expectations has indeed been a challenging task for the pharma companies, and the related service providers.

Their expectations from the brands and other services, as provided by the pharma companies, don’t seem to be quite the same as before, either, so are the individually preferred communication formats, the way of processing, and quickly cross-verifying the product and other healthcare information. Before arriving at any decision, they were found to keenly observe the way brands are marketed, their intrinsic value, type and the quality of interface for engagement with them by the companies, whenever required.

Thus, from the pharma business perspective, qualitatively different strategic approaches, to both the millennial doctors and patients, would be of increasing importance and an ongoing exercise. The goal posts would also keep moving continuously. Achieving proficiency in this area with military precision, I reckon, would differentiate the men from the boys, in pursuit of business performance excellence.

In this article, I shall primarily discuss on the changing mindset and needs of the patients and doctors of the ‘millennial generation’.

A. Treating millennial patients differently:

Around 81 percent of millennial doctors, against 57 percent of older generation doctors think that millennial patients require a different relationship with their doctors than non-millennial patients. About 66 percent of millennial doctors actually act upon this and change their approach, as the survey reported.

The difference:

The key differences on millennial doctors’ treating millennial patients, are mainly in the following areas:

  • Expects more, doesn’t get swayed away: Millennial doctors are more likely to advise the millennial patients to do additional research on their own for discussion. 71 percent of millennial doctors believe it’s helpful for patients to do online research before their appointment. However, they don’t get swayed by requests from more-informed patients, as only 23 percent of millennial doctors say they are influenced by patient requests when it comes to prescribing a treatment, whereas 41 percent of non-millennial doctors report finding those requests influential.
  • Gets into the details: The millennial doctors are more likely to simplify and streamline explanations for older patients, whereas non- millennial doctors were more likely to simplify explanations for millennial patients too, treating them exactly the same way.
  • Relies on digital resources: Millennial doctors rely mostly on using digital resources for treating millennial patients, but only around 56.5 percent of them do so for non-millennial patients.

B. Treating millennial doctors differently:

For effective business engagement and ensure commensurate financial outcomes, pharma companies will first require to know and deeply understand the changing mindset, expectations, and aspirations of the millennial doctors, then work out tailor-made strategic approaches, accordingly, to achieve the set objectives.

Top 3 expectations from the pharma industry:

According to a June 2016 special survey report on Healthcare Marketing to Millennials, released by inVentive Health agencies, the top 3 expectations of millennial and non-millennial doctors from the pharma industry, are as follows:

Rank Millennial Doctors % Rank Non- Millennial Doctors %
1. Unbranded Disease Information 67 1. Unbranded Disease Information 58
2. Discussion Guides 48 2. Latest Specific News 46
3. Adherence Support 40 3. Healthy Life Style Information 42

Pharma players, therefore, can provide customized offerings and services, in various innovative platforms, based on these top 3 different expectations of millennial and non-millennial doctors, to achieve much needed critical competitive edge for a sustainable business performance.

Brand communication process needs a relook:

The above report also noted a number of the interesting trends related to the millennial doctors. I am quoting below just a few of those:

  • Only 16 percent of millennial doctors found pharma promotional materials to be influential when considering a new treatment compared to 48 percent of non-millennial doctors who do.
  • 79 percent of them refer to information from pharmaceutical companies only after they’ve found that information elsewhere.
  • 65 percent of these doctors indicated, they did not trust information from pharmaceutical companies to be fair and balanced, while only 48 percent of their older peers shared that sentiment.
  • 50 percent found educational experiences that are driven by their peers to be the most relevant for learning and considering about new treatments, against 18 percent of non-millennial physicians.
  • 52 percent of them, when learning about new treatment options, favor peers as their conversation partners.
  • They are much more likely to rely on a third-party website for requisite product or treatment information
  • 60 percent of millennial doctors are more likely to see a pharma rep, if they offer important programs for their patients, compared to only 47 percent of non-millennial doctors. This also reflects greater patient centric values of the millennial doctors.
  • However, an overwhelming 81percent of millennial doctors believe that any type of ‘Direct To Consumer (DTC)’ promotion makes their job harder, because patients ask for medications they don’t need.
  • 41 percent of millennial doctors prefer a two-way and an in-person interaction, against just 11 percent of them with online reps. Here, it should be noted that this has to be an ‘interaction’, not just predominantly a monologue, even while using an iPad or any other android tablets.

Redesigning processes to meet changing expectations and needs:

Thus, to create requisite value, and ensure effective engagement with millennial doctors, the pharma companies may consider exploring the possibility of specifically designing their entire chain of interface with Millennials, right from promotional outreach to adherence tools, and from medical communications to detailing, as the survey report highlights. I shall mention below just a few of those as examples:

Communication platforms:

For personal, more dynamic and effective engagement, non-personal digital platforms – driving towards personal interactions with company reps, together with facilitating collaboration between their professional peer groups, came out as of immense importance to them.

Adherence and outcomes:

There is a need for the pharma companies to move the strategic engagement needle more towards patient outcomes. This is mainly because, medication adherence is a large part of the patient outcome equation. It involves a wide range of partnerships, such as, between patients and physicians, and also the physicians and pharma players. This particular need can be best met by offering exactly the type of collaborative approach that millennial doctors favor.

Medical communication:

Redesigning the core narrative of medical communication around a disease state and product, engaging the wisdom and enthusiasm of scientific, clinical, and educational leaders primarily to serve a well-articulated noble cause, are likely to fetch desired results, allaying the general distrust of millennial doctors on the pharma companies, in general.

Medical representative:

Earning the trust of the millennial doctors by respecting, accepting, and appealing to their value systems, is of utmost importance for the medical reps. To achieve this, drug companies would require to equip their reps with tools and programs that offer value in terms of patient support and adherence, while demonstrating compelling outcomes with a positive patient experience, and greater efficiency in treatment decisions.

Building reputation:

The “Purpose Generation” – that’s how millennials are often referred to. In that sense, to build a long lasting business reputation among them, pharma companies need to be in sync with this new generation.

Weaving a trusting relationship with them involves meeting all those needs that these doctors value, such as, adherence solutions, innovative patient support programs, and creating shared value for communities. This would mean, for many drug companies, charting an almost uncharted frontier, where there aren’t many footsteps to follow.

Need to induct younger generation to top leadership positions faster:

To capture these changes with precision, and designing effective engagement strategies for millennial patients and doctors accordingly, an open, innovative and virtually contemporary mindset with a pair of fresh eyes, are essential. As against this, even today, many ‘Baby Boomers’ (born approximately between 1946 and 1956), who have already earned the status of senior citizens, meticulously nursing a not so flexible mind with traditional views, still keep clutching on to the key top leadership positions in the pharma industry, both global and local.

This prevailing trend encompasses even those who are occupying just ornamental corporate leadership positions, mostly for PR purpose, besides being the public face of the organization, sans any significant and direct operational or financial responsibilities. Nevertheless, by pulling all available corporate levers and tricks, they hang-on to the job. In that way, these senior citizens delay the process of change in the key leadership positions with younger generation of professionals, who understand not just the growing Millennials much better, but also the ever changing market dynamics, and intricate customer behavior, to lead the organization to a greater height of all round success.

I hasten to add, a few of the younger global head honcho have now started articulating a different vision altogether, which is so relevant by being a community benefit oriented and patient centric, in true sense. These icons include the outgoing GSK chief Sir Andrew Witty, who explains how ‘Big Pharma’ can help the poor and still make money, and the Allergan CEO Brent Saunders promising to keep drug prices affordable. Being rather small in number, these sane voices get easily drowned in the din of other global head honchos, curling their lips at any other view point of less self-serving in nature. Quite understandably, their local or surrounding poodles, toe exactly the same line, often displaying more gusto, as many believe.

Conclusion:

The triumph of outdated colonial mindset within the drug industry appears to be all pervasive, even today. It keeps striving hard to implement the self-serving corporate agenda, behind the façade of ‘Patient Centricity’. When the demography is changing at a faster pace in many important countries, such as India, a sizeable number of the critical decision makers don’t seem to understand, and can’t possibly fathom with finesse and precision, the changing mindset, aspirations and expectations of the millennial generation doctors and patients.

Expectedly, this approach is increasingly proving to be self-defeating, if not demeaning to many. It’s affecting the long term corporate performance, continually inviting the ire of the stakeholders, including Governments in various countries.

From this perspective, as the above survey results unravel, the millennial doctors and patients, with their changing mindset, aspirations, expectations and demands, look forward to an environment that matches up with the unique characteristics and values of their own generation.

To excel in this evolving scenario, especially in India – with one of the youngest demographic profiles, proper understanding of the nuances that’s driving this change, by the top echelon of the pharma management, is of utmost importance. Only then, can any strategic alignment of corporate business interests with the expectations of fast growing Millennials take shape, bridging the ongoing trust deficit of the stakeholders, as the pharma industry moves ahead with an accelerated pace.

By: Tapan J. Ray   

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

 

With Highest Billionaire Wealth Concentration, India Tops Malnutrition Chart in South Asia: “What Future Do You Want?”

Posted on by
Reply

Two recent global research reports, though on different spheres, place India at the top of the respective blocks. However, the take away messages that the studies offer are indeed poles apart in qualitative terms and worth pondering over collectively.

On January 20, 2014, just before the World Economic Forum (WEF) at Davos in Switzerland, Oxfam International released a report warning that by 2016, the world’s wealthiest 1 percent will control almost half of the global assets. Since 2009, the world’s billionaires have seen their share of the asset pie grow from 44 percent to 48 percent.

Before that, a World Bank Report of October 2014 titled, “Addressing Inequality in South Asia”, highlighted that India has the highest billionaire wealth concentration in South Asia.

Billionaire wealth to gross domestic product ratio in India was 12 percent in 2012. This was was higher than other economies with similar development level, namely, Vietnam with its ratio at less than two percent, and China with less than five percent.

This report also clarifies that inequality in South Asia appears to be moderate when looking at standard indicators such as the Gini index, which are based on consumption expenditures per capita. But other pieces of evidence reveal enormous gaps, from extravagant wealth at one end to lack of access to the most basic services at the other.

Stark realities: 

Wealth creation by no means is bad and in fact, is essential for economic growth of any nation, if read in isolation. This is mainly because, as the Oxfam report says, some economic inequality is essential to drive growth and progress, rewarding those with talent, hard earned skills, and the ambition to innovate and take entrepreneurial risks.

Unfortunately, at the same time, as the same World Bank report highlights, the stunted growth of children under fiver years of age, due to malnutrition, has been 60 percent of the total number of children born in the poorest households of India, as compared to 50 per cent in Bangladesh and Nepal.

Moreover, According to UNICEF, every year 1 million children again below the age of five years die due to malnutrition related causes in India. This number is worrisome as it is far higher than the emergency threshold, according to W.H.O classification of the severity of malnutrition.

Highlighting stark inequality in India, the report says, “The net worth of a household that is among the top 10 per cent can support its consumption for more than 23 years, while the net worth of a household in the bottom 10 per cent can support its consumption for less than three months.”

Some poor moved above the poverty line, though grossly inadequate:

According to the same report, from 2004-05 to 2009-10 when India’s GDP registered the highest ever average growth, about 40 percent of poor households moved above the poverty line and around 11 percent of poor population even moved into the middle class. Unfortunately, during the same period around 14 percent of the non-poor population also slipped below the poverty line.

Thus, what needs to be addressed soonest is the issue of vast difference in income between the richest and the poorest leading to an equally huge difference in the access to basic human developmental needs such as, education, healthcare and nutrition.

Adverse impact on expected ‘demographic dividend’ of India:

As legendary Bill Gates said in a recent media interview, “India has got far more kids that are malnourished and whose brains are not developed, way more than any other country. That’s really the crisis.”

If this trend of inequality continues, the ‘demographic dividend’ of India that the country has factored in so intimately in its future GDP growth narrative, could well be no more than a myth.

As US Supreme Court Justice Louis Brandeis once famously said, “We may have democracy, or we may have wealth concentrated in the hands of the few, but we cannot have both.”

The Oxfam report also emphasizes, the extreme levels of wealth concentration occurring today threaten to exclude hundreds of millions of people from realizing the benefits of their talents and hard work.

Social inequality and healthcare challenges:

Health of an individual is as much an integral contituent of the socio-economic factors as it is influenced by a person’s life style and genomic configurations. Important research studies indicate that socio-economic disparities, including the educational status, lead to huge disparity in the space of healthcare.

As stated in another report, ‘About 38 million people in India (which is more than Canada’s population) fall below the poverty line every year due to healthcare expenses, of which 70 percent is on purchase of drugs’.

Thus, reduction of social inequalities ultimately helps to effectively resolve many important healthcare issues. Otherwise, mostly the minority population with adequate access to knowledge, social and monetary power will continue to have necessary resources available to address their healthcare needs, appropriately.

Regular flow of newer and path breaking medicines to cure and effectively treat many diseases has not been able to eliminate either trivial or dreaded diseases alike. Otherwise, despite having effective curative therapy for malaria, typhoid, cholera, diarrhea/dysentery and venereal diseases, why will people still suffer from such illnesses? Similarly, despite having adequate preventive therapy, like vaccines for diphtheria, tuberculosis, hepatitis and measles, our children still suffer from such diseases. All these continue to happen mainly because of socio-economic inequalities related considerations, including poor level of awareness.

A paper titled, “Healthcare and equity in India”, published in The Lancet (February, 2011) identifies key challenges to equity in service delivery, healthcare financing and financial risk protection in India.

These include: 

- Imbalanced resource allocation

- Limited physical access to quality health services and inadequate human resources for health

- High out-of-pocket health expenditures

- High health spending inflation

- Behavioral factors that affect the demand for appropriate healthcare

Research studies vindicate the point:

Following are some research studies, which I am using just as examples to vindicate the above argument on inequality adversely impacting healthcare:

• HIV/AIDs initially struck people across the socio-economic divide. However, people from higher socio-economic strata responded more positively to the disease awareness campaign and at the same time more effective and expensive drugs started becoming available to treat the disease, which everybody cannot afford. As a result, HIV/AIDS are now more prevalent within the lower socio-economic strata of the society.

• Not very long ago, people across the socio-economic strata used to consume tobacco in many form. However, when tobacco smoking and chewing were medically established as causative factors for lung and oral cancers, those coming predominantly from higher/middle echelon of the society started giving up smoking and chewing of tobacco, as they accepted the medical rationale with their power of knowledge. Unfortunately the same has not happened with the poor people of lower socio-economic status. As a consequence of which, ‘Bidi’ smoking and ‘Gutka’/tobacco chewing have not come down significantly among the population belonging to such class, with more number of them falling victim of lung and oral cancers.

Thus, in future, to meet the unmet needs when more and more sophisticated and high cost disease treatment options will be available, mostly people with higher socio-economic background will be benefitted more due to their education, knowledge, social and monetary power. This widening socio-economic inequality will consequently widen the disparity in the healthcare scenario of the country.

Phelan and Link in their research study on this subject had articulated as under:

“Breakthroughs in medical science can do a lot to improve public health, but history has shown that, more often than not, information about and access to important new interventions are enjoyed primarily by people at the upper end of the socioeconomic ladder. As a result, the wealthy and powerful get healthier, and the gap widens between them and people who are poor and less powerful.”

Recent deliberations at Davos:

In the last two decades, socio-economic inequality in India has been fuelled by rapid, but unequal economic growth of the nation. Though the overall standard of living has been rising, there still remain a large number of populations living in pockets of intense deprivation and abject poverty.

One of the Davos sessions of this year deliberated on “What Future Do You Want?” The session, among others, reportedly felt the important need to ensure people’s well being and put in place effective measures such as a social safety net and universal healthcare.

At the same WEF annual meet at Davos, United Nation’s Secretary General Ban Ki-Moon also reiterated, “All policies must be people centric. We should make a world where nobody is left behind.”

Conclusion:

Assuming the above approach as a sincere realization of the current policy makers and more importantly the powerful influencers of those policies, the key question that comes up is: In which direction would India now chart its course to address this critical issue?

One may possibly hazard a guess on the shape of the future policies to come in India from the BJP party President Amit Shah’s recent address to crème de la crème of Mumbai businessmen in a function organized by a business news channel. In this event Mr. Shah reportedly said to them that the BJP does not agree with their definition of “reforms” and will strive to build a welfare state.

Will this approach of the new political dispensation get reflected in the forthcoming union budget as well, to effectively translate the new National Health Policy of India into reality, at least this time?

I deliberated on the National Health Policy of India in my Blog Post of January 12, 2015, titled “India’s National Health Policy 2015 Needs Wings To Fly”

That said, if it really so happens, a strong signal would go to all stakeholders that India is now well poised to chart on an uncharted frontier to significantly reduce the impact of inequality, particularly in the space of healthcare.

In that process, despite the highest billionaire wealth concentration, India would set a pragmatic course to place itself at the top of the healthcare chart, not just in South Asia, but probably also within the BRIC countries, to expect the least.

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.