Inequality is pertinent to every economy, be it a developed or developing economy. As Warren Buffet once said, “There is class warfare, all right, but it is my class, the rich class, that is making war, and we are winning”. Inequality is undoubtedly multi-dimensional; they are structured around class, gender, race and ultimately are a genesis of social diversion and conflict (Economic Survey, 2021).
Health inequality magnifies socioeconomic inequality. The global pandemic made us realise that we lack proper healthcare infrastructure to cope with a major health crisis and have failed to provide health care services to economically backward communities. They get infected and cannot afford the proper prescribed treatment in hospitals (Dutta & Sardar, 2021).
Poor healthcare infrastructure leads to shedding light on the fact that an individual’s health status is subject to the socioeconomic position it holds in society.
Graph 1
Several studies have shown that the population’s health status also impacts the country’s economy: increased inequality in health leads to increased income and wealth inequality and a decline in labour productivity (Singer & Ryff, 2011). The fall of labour productivity further increases the economic burden on the healthcare system. On the contrary, good nutrition and access to healthcare boosts economic growth and reduces inequality.
Inequality in healthcare is primarily attributed to the weak public healthcare system, exploitative corporate hospitals, and limited government intervention to tackle these problems (Dutta & Sardar).
During the Covid-19 pandemic, the healthcare inequality was magnified- the public healthcare was underprepared while cases were dramatically rising, and the corporate hospitals, on the other hand, were charging exorbitant prices, letting only the wealthy getting treated until the government capped the prices. Still, the poor were affected as they were dependent only on public healthcare facilities. The inflow of patients exceeded the number of hospital beds, human resources (doctors and nurses) and medical resources such as oxygen cylinders and ventilators (Dutta & Sardar, 2021).
Even if the poor did manage to get a bed without drugs and oxygen supplies that were in shortage, they ultimately succumbed to death while the rich could afford to buy medicines and oxygen supplies from the black market. It indicated that there wasn't an equal shot given to the poor and rich at surviving coronavirus.
While priority was given to only covid illness and non-covid medical services were put to hold, rural areas suffered more than the urban areas. Since urban areas could have access to teleconsultations/ e-health while rural areas didn’t, people without a smartphone and internet couldn’t access the telehealth services (Onmanorama, 2020).
India’s inadequate investment in public healthcare has left the poor to depend on private healthcare services; according to government estimates, over 63 million people are pushed below the poverty line due to healthcare costs alone. (Dutta & Sardar)
Role of female education
Education plays a vital role in our health and well being. Education enables us to create a decent standard of living, giving us access to proper healthcare at an affordable price. A person with higher education will be able to understand their and their families healthcare needs (Mahendra & Khan, 2021).
Educated women will play a vital role in the households as she assumes the responsibility for her child’s immunisation, nutrition, education, and healthcare. She will also seek healthcare services when needed for herself and her family.
Figure 1
Graph 2
Literacy levels in rural areas are low for girls than boys.
Literacy rate among SC-ST still lags behind the general category.
Literacy rate of Christians and Sikhs is over 80%, and Hindus and Muslims range between 60% - 70%.
In rural areas, women’s share in higher secondary and higher education is low. A study conducted by NSSO and OXFAM report of 2021 found that in 2015-16 there was a gap of 51.1% in the literacy rate between the top and bottom 20% of the population.
Water and sanitation
Unsafe drinking water and inadequate sanitation expose communities and individuals to several communicable waterborne diseases like diarrhoea and dengue.
Graph 3
Access to improved water sources is more in urban areas than in rural areas by 1.8%.
The general category has access to improved sanitation and does not share access to sanitation larger than STs and SCs.
Sikhs have access to improved sanitation then followed by Christians, Muslims and finally Hindus.
A study conducted by OXFAM report 2021 found that 93.4% of households in the top 20% have access to improved sanitation, while only 6% have access in the bottom 20%.
Immunisation
Immunisation plays a vital role in child mortality by protecting a child from getting infected by various diseases (Mishra, 2021).
Figure 2
Graph 4
The rate of female immunisation is low compared to males though this inequality gap has fallen over the years.
Immunisation of children in urban areas is higher than in rural areas, while the inequality gap has declined over the years.
Immunisation of SC and STs are still below compared to other caste groups
Inequality in child immunisation exists across wealth categories as well
Maternal health
Good maternal health ensures improved health outcomes for the baby and mother. Thus, it becomes crucial to ensure that the mother isn’t suffering from malnutrition and anaemia (Mishra, 2021).
Graph 5
There are more anaemic women in rural areas than urban areas
In 2005-06 over 57-9% of women were anaemic, and it was declined to only 50.5% in 2015-16
Antenatal care has been falling from 37% in 2005-06 to 21% 2015-16.
Healthcare expenditure
As healthcare expenditure grows, it may push the household to the brink of falling into poverty. While healthcare expenditure becomes expensive, the poor suffer since they can not access these services (Mahendru & Khan, 2021).
Graph 6
Expenditure of hospitalisation increases in both urban and rural areas between 2004 and 2017-18
A study conducted by OXFAM 2021 found that medical expenses incurred for the general category were 2.5 times higher than the STs and 1.7 times higher than SCs (Mahendru & Khan, 2021)
Urban areas depend more on savings to cover medical expenditure, while rural regions depend more on lenders to finance their medical spending. There has been a declining share of borrowing and sale of physical assets as a source of financing medical expenditure that is brought to light.
Challenges of reducing health inequality
Health inequality is triggered by multiple factors not just limited to income but also education, insurance coverage provided by schemes, education of the households and the background from which they come.
The government will have to play a crucial role in providing equitable access to healthcare services to every individual in the country. The government will have to build institutions and frameworks that align with one of the 10 Sustainable Development Goals- equitable access to healthcare (Mishra, 2021).
Conclusion: Policy measures
India being a developing economy, has a large chunk of the population living in poverty. These people are burdened with poor health conditions and lack access to good public healthcare services. The government should direct more funds towards developing quality and an equitable healthcare system that would cater to people, especially from marginalised socioeconomic groups.
The Indian constitution does not guarantee the ‘right to health’ as a fundamental right (Mahendru & Khan, 2021). Since there is no proper public healthcare system established and private corporate hospitals charge outrageous amounts of money for their medical services. The government should enact the ‘right to health’ as a fundamental right to decrease health inequality.
The ravages of the Covid-19 pandemic pushed a large sum of households into poverty with its medical expenses. Since the government healthcare system lacked the infrastructure and resources to battle the health crisis, most people were forced to go to private corporate hospitals for treatment. Due to a lack of supply of medical resources, these hospitals charged exorbitant amounts of money for treatments that most people could not afford. Excessive medical bills pushed a significant portion of the population into poverty in the pandemic. Government should intervene in the private healthcare sector to regulate the prices charged by private hospitals (Mahendru & Khan, 2021).
The government should make the policies more inclusive. Quality health is directly attributed to our well being. Quality health outcomes result from various aspects. Aside from ensuring that people have access to affordable quality healthcare services, the government should also ensure that they have access to literacy, proper sanitation, access to clean water, and needs to ensure that people are immunised and vaccinated adequately. This includes all the aspects of human well being.
The fate of India’s future growth will ultimately depend on how healthy its population is. This will only be seen when the inequality gap in health care declines and benefits all.
References
Dutta, M., & Sardar, S. (2021). The need to examine health inequalities. Retrieved August 16, 2021, from https://www.oxfamindia.org/knowledgehub/workingpaper/inequality-report-2021-indias-unequal-healthcare-story
Economic Survey (2020-21). Inequality & Growth: Conflict or Convergence?. Retrieved August 16, 2021, from
https://www.indiabudget.gov.in/economicsurvey/doc/vol1chapter/echap04_vol1.pdf
Mahendru, A., & Khan, K. (2021). Determinants of health: Analysing the contributing factors. Retrieved August 16, 2021, from https://www.oxfamindia.org/knowledgehub/workingpaper/inequality-report-2021-indias-unequal-healthcare-story
Mishra, P. R. (2021). Impact of health interventions in India. Retrieved August 16, 2021, from https://www.oxfamindia.org/knowledgehub/workingpaper/inequality-report-2021-indias-unequal-healthcare-story
Onmanorama. (2021). Kerala reels under shortage of essential drugs for critically ILL, organ transplant recipients. Retrieved August 16, 2021, from https://www.onmanorama.com/news/kerala/2020/04/05/essential-drugs-kerala-lockdown-shortage-insulin-critically-ill.html
Singer, B., & Ryff, C. (2020, January 01). The influence of inequality on health outcomes. Retrieved August 16, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK43780/
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