Budget 2024: Health for wealth, not welfare

We cherish the age-old wisdom that health is wealth, yet India paradoxically treats it as an afterthought. A mere 2% of the central budget has been allocated to healthcare. While overall health expenditure has increased by 12%, experts contend that this growth disproportionately favors the private sector. Further, the government’s own Economic Survey underscores the looming threats of obesity and mental health, which could undermine India’s demographic dividend. Yet, current healthcare allocations fall short of addressing these challenges.

The Economic Survey reveals a staggering 70-92% treatment gap for mental disorders, affecting 10.6% of adults. The World Health Organization estimates a mental health burden of 2,443 DALYs per 100,000 population and an age-adjusted suicide rate of 21.1 per 100,000. Mental health conditions are projected to incur economic losses of USD 1.03 trillion (approx ₹87,120,000 crores) between 2012 and 2030.

The survey also highlights the alarming rise of obesity, with the Indian Council for Medical Research attributing 56.4% of India’s disease burden to unhealthy diets. Increased consumption of processed foods high in sugar and fat, coupled with declining physical activity, is fueling micronutrient deficiencies and obesity.  India’s adult obesity rate has tripled, and the annual rise in childhood obesity is the world’s steepest after Vietnam and Namibia. The National Family Health Survey 2019-2021 underscores the urgency of promoting balanced and diverse diets to capitalize on India’s demographic dividend.

The survey ironically shifts focus to private entities as a potential solution, despite their role in creating the obesogenic environment through processed foods, excessive work hours, and screen addiction. The proposed solution cynically exploits the traditional Indian lifestyle as a commercial venture – “It makes commercial sense for Indian businesses to learn about and embrace them, for they have a global market waiting to be led rather than tapped.” – while neglecting to address the root causes of the health crisis or outline a comprehensive public health strategy.

This appears to be a ploy to transform a public health crisis into a lucrative business opportunity. The rapidly expanding, yet largely unregulated, weight management, nutraceutical, and wellness industries exemplify this trend.

The weight management market in India reached Rs 1.72 lakh crore in 2022 and is expected to grow to Rs 3.15 lakh crore by 2028. The diabetes and pre-diabetes care market, worth $17 billion (approx ₹1,42,800 crores )in 2021, and the burgeoning Ayurveda-wellness and nutraceuticals sector, growing at a CAGR of 11.39% until 2029, further underscore the commercialization of health. This market-driven approach has led to questionable practices, such as the promotion of unverified ayurvedic remedies like Baba Ramdev’s Covid cure, with government endorsement. Experts believe that every aspect of the nutraceutical industry must be overseen very closely and regulated.

India of course is a country of dichotomies. We make lofty talks about “micronutrients” in our policy papers while offering empty calories to our impoverished population through the Public Distribution System. The nation simultaneously grapples with a dual burden of disease. On one hand, over 80 crore people receive free grains, yet child wasting and stunting rates remain alarmingly high. On the other, the prevalence of non-communicable diseases (NCDs) has surged from 30% to 55% of the total disease burden between 1990 to 2016.

This epidemiological shift, driven by factors highlighted in the Economic Survey, places an immense financial burden on individuals. India’s challenge lies in addressing both ends: ensuring nutritional security while preventing lifestyle diseases and reducing the increasing out-of-pocket expenditure.

A research paper by Indrani Gupta and Avantika Ranjan says “The total spending on non-communicable diseases and injuries (NCDI) by the government is low at less than 0.5% of GDP.” The paper notes, “Studies have found that India is ill-prepared at the primary care level to tackle diseases like diabetes and hypertension. In the absence of volume and quality of NCDI care, out-of-pocket expenditures would continue to rise rapidly due to the high costs of treatment of NCDI and their chronic nature.”

Ayushman Bharat and PMJAY, the government’s flagship health schemes, have proven to be largely ineffective in curbing out-of-pocket healthcare expenditures. Indranil Mukhopadhyay of OP Jindal Global University criticizes the government’s excessive allocation to PM-JAY despite its shortcomings. He argues that the scheme, while a favored child of the current administration, consistently fails to deliver on its promises, primarily benefits the private sector, and neglects the most vulnerable.

Such inadequacies in the healthcare sector leave a burgeoning, unregulated wellness industry free to exploit the middle class’s anxieties and insecurities.

It’s time for a radical overhaul. We need massive investments in public health infrastructure, mental health services, and nutrition programs. We must regulate the wellness industry with an iron fist. And most importantly, we need to prioritize prevention over cure.

The health of a nation is not a business opportunity; it’s a moral imperative. Until we truly invest in the well-being of our people, public health will remain merely a means to generate wealth for private interests.