Any health shock causes entry into poverty for most of those who suffer from it
We are living through a time of extreme adversity. The entire country is in lockdown in an attempt to survive the threat of the novel coronavirus disease (COVID-19) pandemic.
Economic activity is at a standstill. All plans and goals, whether related to sustainable development or otherwise, have gone for a toss.
There is simply no chance of our being able to achieve either sustainable development goal (SDG) one, that is, ending poverty in all its forms everywhere or SDG three, that is, ensuring healthy lives and promoting the well-being of all.
The likelihood of achieving these goals was bleak, however, even before the onset of COVID-19.
The present pandemic brought two serious errors we made, to the forefront.
The first is with regard to understanding the nature and extent of poverty. The second is our low investment in publicly funded provisioning of quality healthcare.
These have to be absolute priorities in post-pandemic India.
Poverty estimates mess
The fact is that the number of people in poverty in India has always been massive.
The proportion of the population in poverty increased to 37.2 per cent from 27.5 per cent when the Tendulkar Committee, in 2004-05, raised the poverty line from Rs 356 to Rs 447 per capita month in rural areas and from Rs 539 to Rs 579 in urban areas.
These were small increases in a deprivation-level poverty line and yet the numbers escalated sharply.
Similarly, in 2009-10, a whopping 100 million additional people were counted as poor (455 million poor instead of 355 million poor), if the Rangarajan Committee’s poverty lines were used (Rs 801 and Rs 1,198 per capita per month in rural and urban areas respectively, instead of the Tendulkar Committee’s Rs 673 and Rs 860).
The fact that we stopped estimating poverty after 2011-12 didn’t make the poverty problem go away.
All it meant was that it was no longer a priority. However, whether measured or not, poverty, chronic poverty and the dynamics of poverty remain the biggest development challenge since independence.
The commitment to give free cereals to 800 million people in a Rs 1.7 lakh crore relief package announced by the Union finance minister is a sign that the government realised the gravity of the poverty situation in India and the severe distress unleashed by the lockdown.
Morbidity estimates
The National Sample Survey Office estimated the prevalence of morbidity in India (those reporting ailments during the last 15 days) to be only 7.5 per cent in 2017-18 (8.3 per cent females and 6.7 per cent males).
Morbidity is reportedly less than 3 per cent in Assam and Bihar and as high as 24.5 per cent in Kerala. The reported 7.5 per cent morbidity in India, clearly, is grossly inaccurate.
The result is that budgetary allocations to healthcare are abysmal.
The disease burden and out-of-pocket spending at times of ill-health are very high in India.
Hence, health shocks cause entry into poverty. There is a rapid epidemiological shift in disease burden to non-communicable diseases (NCDs). The World Health Organization, in 2015, estimated one in four Indians have a risk of dying from an NCD before they reach the age of 70.
The Union Ministry of Health and Family Welfare, in 2017, was candid in pointing out that government spending on healthcare in India was only 1.15 per cent of the GDP and “it is unrealistic to expect achieving key goals in a five-year plan on half the estimated and sanctioned budget”.
Based on global evidence, “unless a country spends at least five to six per cent of its GDP on health, with government expenditure being a major part, basic healthcare needs are seldom met”.
Health shocks
Any health shock causes entry into poverty for most of those who suffer from it.
COVID-19 is contagious. The lockdown led to closure of businesses, job losses and extreme distress, exposing the vulnerability of a large proportion of the population.
Most of them depend on money earned today, or at most, this month, to survive. There are no savings to help tide over the lockdown.
Except for those with an assured source of income and those exempted from the lockdown — because they provide essential services — everyone else is either already poor or is vulnerable to poverty.
This has exacerbated and placed the poverty problem center-stage and denial is no longer possible.
Increasing life chances by raising immunity
Children in households that are poor, face inter-generational transmission of poverty. The science of the first 1,000 days is well known: The most crucial period for a child is from conception to completion of two years of life.
Physical growth and most of the brain development occurs during this time.
Low birth weight, poor dietary intake, malnutrition and high disease load lead to lower cognitive development.
Poor learning environments combine with poor cognitive development to trap them in low skill-low income jobs.
Hence, pregnant or lactating mothers, infants and young children need protection not just from the virus, but from a lack of healthcare, inadequate diet and ineffective breastfeeding.
Failure to pay attention to these issues will result in underweight, stunting and poor cognitive development in children and decrease their future earning potential.
Additional risks are due to pregnant mothers in labour not being admitted in many hospitals, untrained staff unable or unwilling to support, protect and promote breastfeeding at the time of birth and a lack of proper guidance on effective latching and skin-to-skin care at birth.
While the health ministry has just ordered state departments to start all essential healthcare services, including antenatal care (ANC), the pandemic has already led to severe adverse consequences for children just born or yet-to-be born.
Protein-rich foods are not available to mothers either due to poverty or due to a break in the supply chain link due to the lockdown.
If we want to prevent malnutrition and low immunity among children, it is crucial that special rations — including nutrients like protein, good fats, vitamins, essential minerals with less sugar — are provided to mothers urgently, with their ANC restored.
Immunisation prevents dreadful infections like measles, diphtheria and pertussis in babies and needs to be restarted at the earliest. We are risking the health of newborn children if we do not make these facilities available at this critical time.
The risk of poor outcomes during the pandemic is far higher among those with comorbidities. India is the diabetes capital of the world.
Rice and wheat have a high glycemic index. Sugar is the root cause of insulin resistance. Millets are high in fiber, protein and minerals and are far more nutritious than rice and wheat.
At this time, when face to face meetings are difficult due to the lockdown, mothers, caretakers and health care team can get online health and nutrition content that can prevent IGT Poverty and enable survival.
Inputs such as free health spoken tutorials developed by IIT Bombay are readily available and can reach and improve the life chances of our population and reduce the onset of obesity, diabetes and other co-morbidities by encouraging the consumption of millets and nutrient-dense foods based on locally available products.
These free online health spoken tutorials in 15 Indian constitutional languages provide health and nutrition content that can help mothers, caretakers and health care team to gain the right information during the critical phase of first 1000 days and thereafter.
Some of the items that can be included in their rations are eggs, beans, pulses, peanuts, seeds, dried or fresh vegetables.
Integrated child development services can provide locally made sprout powders, nut-seeds powder, daily eggs, dry drumstick leaf or curry leaf powders.
It is important to follow the latest junk food guidelines by the Indian Academy of Pediatrics on zero sugar or jaggery under two years of age to prevent NCDs in the future.
This will help create the immunity required to fight the threat of COVID-19 as well as potential threats that may emerge in the future.
Post-COVID-19 India must, however, prioritise decent work, livelihoods and free public provisioning of quality healthcare.
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