The latest edition of ‘Chat with BioVoice’ features Dr Kenneth E Thorpe, Chairman of Partnership to Fight Chronic Disease who is an authority on the health policy issues. As an academic, Dr Thorpe has testified before several committees in the U.S. Congress and advised governments around the world including India on healthcare reform and insurance issues. Here he responded to various burning questions from Rahul Koul, Chief Editor, BioVoice News.
What is your opinion on the overall healthcare scenario in India? What are the key challenges that need to be addressed on priority basis?
Dr Thorpe: India’s healthcare scenario is undergoing a striking transition due to the changing lifestyles, urbanization as well as environmental conditions which have given chronic diseases the centre stage. The focus of the government has shifted from women and child health to diabetes, cardiovascular disease, chronic respiratory diseases and cancer – the four leading non-communicable diseases that account for 53 per cent of India’s disease burden and 60 per cent of the total deaths in the country. That India is facing a dual disease burden of communicable and non-communicable diseases is a fact that health experts, policy makers and industry leaders have been reiterating time and again.
Some of the key challenges India is facing today are: low public spend on health, a disease-centric approach over patient-centric approach, and a method of treatment that focuses on curative care rather than preventive care. India’s low public spend on health and low prevalence of insurance coverage are driving a large number of Indians to poverty as they have to bear high out-of-pocket expenses. If the government makes a policy shift to preventive care, long-term impact of diseases such as diabetes, cardiovascular disease and cancer can be checked at the primary stage of onset by ensuring timely diagnosis of patients. A patient-centric approach will help the government create a conducive environment for patients wherein medical experts and healthcare professionals can focus on specific diseases, thus providing better facilities and services to patients.
“I think India has an immediate need to adopt a multi-sectoral approach to address the challenges in healthcare.”
Having worked closely with policy makers from the Union Ministry of Health and Family Welfare and the state health departments, public health experts and policy analysts, senior doctors, patient groups, and pharmaceutical and diagnostic companies, I think India has an immediate need to adopt a multi-sectoral approach to address the challenges in healthcare. Concerted, collaborative efforts by the central and state governments as well as public-private partnerships can lead the way in strengthening India’s healthcare system. In my experience over the last several years in India, an evidence-based action plan will help prevent, control and manage the growing disease burden, especially focusing on the escalating NCDs. India has been one of the early adopters in developing a policy framework towards addressing NCDs. At this crucial juncture for a developing country like India, it has immense opportunity to improve the quality of life for its citizens pave the way for a healthier future.
How can we control the rising incidents of non communicable disease (NCDs) like diabetes and heart attacks in India?
There have been detailed deliberations on the increasing burden of NCDs. Experts have repeatedly outlined the need for India to systematically increase the current overall expenditure on health, with a special focus to increase public spend for NCDs which account for more 60 per cent of deaths in the country. – A policy shift from curative to preventive care can be the first step to check the rapidly growing numbers of diabetes and CVD patients in India – Adopting ‘Healthy Living’ as a social norm in the present scenario where unhealthy lifestyle and dietary habits prevail will help check diseases like diabetes and heart attack at the primary stage of onset.
Some recommendations include introduction of behavioral changes at workplace. For instance, ban use of tobacco within office premises, provide gyms at workplaces or subsidize memberships at local gyms. Apert from that defined target for reduction of salt, sugar and transfat in mean population intake and devise an effective monitoring and surveillance framework. Healthy lifestyle can by promoted by introducing necessary shift in social behavior by encouraging voluntary exercise or yoga across all educational institutions.
What are the various initiatives that PFCD is spearheading in India? Any partnerships with various government agencies or other organizations?
We have been working in India to act as a catalyst to bring together all the relevant stakeholders in order to find sustainable solutions and advocating the need for a holistic approach to address the growing disease burden. PFCD’s objective is to draw the attention of relevant stakeholders towards developing an innovative policy framework to effectively address and manage NCDs. We hosted four multi-stakeholder discussions in Ahmedabad, Chennai, New Delhi and Mumbai in 2014. The events saw participation from top-level officials from the Ministry of Health & Family Welfare (MoH&FW) and the states. We have seen increasing participation and engagement from public health experts and policy analysts, senior doctors, patient groups, and pharmaceutical and diagnostic companies as well.
A separate multi-stakeholder discussion on healthcare financing was also hosted in New Delhi in April 2015 to identify key challenges in terms of lack of adequate healthcare protection to the population, and find solutions to address these gaps.
The recommendations made by the experts at these roundtables were summarized in two Consultation Papers ‘Addressing NCDs in India Through Innovation and Multi-Sectoral Response’ and ‘Innovative Models of Healthcare Financing for a Healthier India’ and presented to several key policy makers and others during the subsequent one-on-one meetings.
“India spends a little over one per cent of its GDP, a meager figure which has led the majority of Indians to pay almost 60-70 per cent of healthcare expenses out-of-pocket.”
A significant part of PFCD’s work in India has been on policy recommendations to the Draft National Health Policy. Encouraged by the responses from the stakeholders to move towards an evidence-based action plan, PFCD started work on a National Blueprint in early 2015. SANKALP – DishaSwastha Bharat Ki was released in October 2015 in New Delhi. This evidence-based document was an attempt to facilitate the government, healthcare implementers – both at the public as well as private establishments – to adopt innovative programs for prevention and control of NCDs in India and advance the momentum for reforms at the state level. In the coming months, we are looking to build momentum for health reform efforts at the state level and build capacity through sharing of best practices, and alliance building with organizations, both public as well as private. We plan to sharpen the focus on states in India which are heavily burdened by NCDs. Further, we plan to undertake a comparative impact assessment of NCDs on the socio-economic well-being of a community, before and after an inclusive and sustained programme implementation to control the growth of NCDs.
Should the government increase its health spending or the big corporate should chip in their support for health initiatives?
Increasing investments in healthcare is the need of the hour for India to overcome its high disease burden. Global evidence suggests that unless a country spends at least six per cent of its GDP on healthcare, basic healthcare needs are seldom met. India spends a little over one per cent of its GDP, a meager figure which has led the majority of Indians to pay almost 60-70 per cent of healthcare expenses out-of-pocket. India’s public spending on health is one of the lowest in the world.
There are close to 12 million people in India’s workforce. The probability of death during the most productive years (ages 30-70) from one of the four main NCDs is a staggering 26 per cent, hampering not only health but also the productivity and work output. A disproportionate people in India are suffering from poor health and frequent illness, leading to absenteeism at workplace, lack of attention and lower productivity. All these factors are inversely proportional to the country’s growth.
The corporates can contribute towards building healthy workplaces. They can introduce annual medical check-up camps for employees, construct adequate pathway within the campus to encourage walking, providing healthy eating options and refrain from providing aerated beverages and junk food during official meetings. These efforts will not only help the employees, but also the companies in enhancing productivity and reducing time spent on medical leave.
Public funding and adequate allocation of resources in the healthcare system are vital in providing affordable access to healthcare services and facilities. Models of public and private healthcare financing can work in collaboration to cater to the unique needs of the diverse population in India. PPP will help the government ensure greater healthcare coverage. Through a mix of public and private initiatives, the government can promote an efficient use of resources for training, medical education, diagnostic equipment and preventive care delivery requirements.
India needs to work on increasing investment in healthcare at the federal as well as state levels. The National Blueprint, SANKALP has already outlined the need for India to increase the current expenditure on healthcare from 1.1 per cent of the GDP to at least 2.5-3 per cent, with an increased focus on preventing and treating NCDs.
In 1991, Dr Kenneth E Thorpe was awarded the Young Investigator Award, presented to the most promising health services researcher in the country under age 40 by the Association for Health Services Research. He also received the Hettleman Award for academic and scholarly research at the University of North Carolina and was provided an “Up and Comers” award by Modern Healthcare.