What is it that prevents us from being healthy?

During the last decade, vibrant economic climate has propelled India from low income economies to the ranks of middle-income countries, Life expectancy of Indian people has increased from 50 to 60/80 years. And India is currently having highest younger population.

“Ironically, even after long years of independence and positive economic trajectory, “The Indian dream of health is wealth and national health is national wealth” is not only still in dismal state but Indian population today is living in a state of paradox”. Let us examine the following four situations that presently we observe in India.

Present health condition of Indian people can be summed up in following four situations: The overall health condition of Indian healthcare is thus – on one side scarcity of income leading to ill health – on the other side abundance is also resulting to ill health. Thirdly, a situation seen very typically in poor countries - where the adaptation to wrong social values also leading to ill health of particular class of a society. Fourthly, most people want more income to be healthy and strive for it. Yet as Western Societies have got richer, their people have become no healthier.

So, having known that more and more spending on medical care is not going to improve the health of the people (though it is definitely going to be a profitable dealing!), we need to look at this problem differently. We need to ask different questions to get a correct answer to this burning health problem faced by our country.

Which pays much bigger dividends?

• treating malaria/dengue or killing mosquitoes
• treating TB/swine flu or using mask/not spitting in public places
• treating polio/diphtheria/whooping cough or vaccination
• treating rabies or vaccinating dogs
• treating malaria/dengue or killing mosquitoes

To come out of this fix, we need to consider a “ Totally new approach” which is advocated by Nobel laureate Amartya Sen. What does it says? There are basically two types of handicap which prevent people from converting their resources into desired positive outcomes.

1. Economic handicap
2. Conversion handicap

Now, let us look at the above mentioned “four Indian situations”.

Situation 1

• People lack “earning capability” and therefore fail to even fulfill minimum needs of their life like food and good shelter to live in. This is “economic handicap”. What are the overall effects of economic handicap on health in India? In India, there is more than 25 per cent population living below poverty line, (77 per cent of which live on less than Rs. 20 a day) without sufficient food supply resulting in 70 per cent children anemic and 56.2 per cent women having lower body mass index.

Lack of health education resulting in high infant and maternal mortality rates, poor living conditions with lack of safe water, sanitation and personal hygiene resulting in about 7,80,000 deaths per year.

Who is responsible for this? State has to provide all basic necessary resources so as to come out of “Economic Handicap”, State has to provide the skills and opportunities for earning, State also has to provide clean water, food, air and environment to live in.

Situation 2 and 3
Having provided with basic needs still people lack the capability to covert the primary resources into positive health. This is conversion handicap, because of which – people lack the capacity.

1. to get proper information on different options
2. having proper information and known options, they lack the capacity to attach correct value to each option and  
3. also lack capacity of proper reasoning before choosing a particular option.

Situation 4
The hopelessly deprived people lack the courage to desire any radical change and typically tend to adjust their desires and expectations to what little they see as feasible. They train themselves to take pleasure in small mercies and adapt to wrong social values - e.g. subdued housewives in deeply sexist cultures ,  Workers in exploitative industries and oppressed minorities. This is “social adaptation handicap”. What are the effects of this handicap in India?

• Skewed sex ratio of 914: 1000       
• 56% children still not fully immunized
• High maternal mortality rate & high infant (girl) mortality rate.

Conclusion
Rich people are not necessarily healthy because they lack the capacity to convert the available resources into healthy life. They are conversion handicapped. Poor people are not healthy because they lack the capacity to earn sufficient income (economic handicapped) to be healthy and also lack capacity to convert that income into healthy life because of conversion handicap & some by additional social handicap.

“Globally, all over the world, life expectancy has increased, but at the same time, the number of healthy years lost to disability has also increased in most countries, That is to say, ” “ Life expectancy has increased but, Healthy Life Expectancy” (HALE)  has decreased. Fewer people are dying but more live with disability. Essentially, what ails you isn’t necessarily what kills you. “We are finding that very few people are walking around with perfect health and that, as people age, they accumulate unhealthy conditions,”

Having known all these startling facts, and concepts, now, we need to ask ourselves totally different, basic and fundamental questions about our health.

What is today’s concept of health?
Today's definition of health is “Absence of Diseases or disorder is health”. But most of the time, the diseases or disorder is an “End Point” or an “outcome” of long time neglected health, e.g. Anemia is outcome of long standing Malnutrition or Obesity is outcome of long standing overeating . As against this there is another concept of health.

That is called as - “Life-Course Theory of Health”.It says that events that happen earlier in life, whether they are stress or chronic disease, impact the course of an outcome”.

For example, only prenatal care doesn't necessarily improve birth outcomes. By the time a woman is pregnant, issues such as malnutrition and obesity leading to anaemia and chronic diseases respectively, impact the physical health of both mother and baby. Therefore, thinking about being healthy prior to pregnancy pays much bigger dividends than treating acute conditions once they occur.  "The choices women make about their health -- whether about diet, exercise or even whether to breastfeed - have profound impacts later on, not one but on two lives,"

Similarly, only spending on highly technological interventions like heart stents, valves, implants is not going to improve quality of health.

Thus spending time and money on preventive healthcare pays bigger dividends than spending on medicalcare.

Present is an information era. People are well aware of the health hazards like stress, irregular eating habits, irregular routines, and exposure to pollution, chemicals, however, they are not aware of “how to get rid of it & have good healthy life”. So the end result is that - they are taking health by default.

They have sufficient “primary resources” like money, time, health info, different options of making oneself happy, many friends, relations but don’t know how to convert all these resources in to healthy, happy and peaceful life. So what is that prevents us from being healthy?. And who is going to help us to come out of this handicap? None other than ourselves. We have to take the rein of our health in our own hands.