Jago India, Jago !!!
The recently conducted Economic Survey for 2007-08 shows that India still lags behind countries like Sri Lanka, China and even Bangladesh on several key parameters in the healthcare sector
India’s position on health parameters compared to even some of its neighbours continues to be unsatisfactory. While India has improved with respect to some important health indicators over the years, it compares poorly with countries like China and Sri Lanka,” the survey said.
While India’s maternal mortality rate per 100,000 live births remains a high 450, it is 45 in China, 58 in Sri Lanka and 320 in Pakistan. Similarly, infant mortality rate (IMR) in India is 56 per 1,000 live births against 12 in Sri Lanka and 23 in China.
Even Bangladesh fares better than India in infant mortality with 54 children dying per 1,000 live births. India shares its IMR with the landlocked country of Nepal and fares better than Pakistan (79). The survey has revealed that 74 Indian children per 1,000 die before attending their fifth birthday as against 14 in Sri Lanka, 27 in China and 73 in Bangladesh.
Giving a comparative study of life expectancy in south Asian countries, the survey underlines that the average life expectancy in India is 62.9 years. It is 72 years in China, 63.6 in Pakistan and 70.8 years in Sri Lanka. Only Nepal (61.3 years) and Bangladesh (62 years) are behind India.
There has been some improvement in the quality of healthcare but wide inter-state, male-female, and rural urban disparities in outcomes and impacts continue. Reproductive and child health services reach communities and households through the primary healthcare infrastructure in the country. Inadequacies in the existing health infrastructure have led to gaps in coverage and outreach services in rural areas,” the survey noted.
However, it praised the National Rural Health Mission (NRHM), a flagship programme of the health ministry, for improving rural health. NRHM has successfully provided platform for community health action at all levels. Through united and flexible financing, NRHM is trying to drive reforms that empower local communities to make their own decisions.
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Structuring Personal Health Information
In an interesting paper, researchers present critical issues concerning the community sensitive personal health information system in rural India. Current research points to limited acceptance of personal health information dissemination at community level among rural population. This is probably due to limited understanding of community sensitive information needs, societal structure and user beliefs of the rural community. To understand the underlying social values and users beliefs related to personal health information (PHI), a preliminary study including field interviews and review of currently deployed ICT projects was conducted. This paper presents the preliminary results, indicating several social and design challenges towards the development of a PHI system. Further the paper proposes a design framework, which includes design as a primary tool to shape existing user beliefs to positively influence the technology acceptance process of PHI system.
Personal Health Records : Do they work?
A study funded by the Federal Agency for Healthcare Research and Quality conducted by the Medical College of Georgia Center for Patient and Family Centered Care will work with hypertensive patients in the family medicine and internal medicine practices at MCGHealth to see if the electronic personal health record enhances patient involvement.A year-long study of 720 patients with hypertension will see half the participants use the newly-refined electronic personal health record and the remainder will receive standard treatment for a condition that affects about one quarter of the population or 65 million Americans.
Earlier the MCG Center for Patient and Family Centered Care, received a $30,000 grant from the Institute for Healthcare Improvement/Robert Wood Johnson Foundation in 2005 to test the Cerner system, used under the brand name My HealthLink at MCGHealth, in patients with multiple sclerosis. The 12-month study found that patients liked having a secure electronic link to care givers and that the electronic personal health record is an effective tool in helping battle chronic disease.
“This project will help demonstrate that when we partner with patients to really redesign the system of care, we will build the system in a way that works best for the people we serve,” says Beverley H. Johnson, the institute’s president and CEO. “I think the project creates a way to look over the next couple of years at how you get effective, sustained partnerships with families in place to make the care of higher quality which will lead to better outcomes.”
Study participants don’t have to have a computer; study coordinators will help those who don’t find where they can use one. However one of the many questions being asked is whether or not having a computer affects use of the electronic personal health record.
They will learn how to use the electronic record then have follow up visits at three, six and 12 months. Researchers will measure what they call patient activation or just how involved patients are in their own health, gather pertinent biological data such as blood pressure and waist circumference and use a widely accepted test to assess their relationship with their physician.
PHRs
In an interesting report, six experts share their views on the future of PHRs, from the perspective of the technologist, informed patient, physician, employer, and public health professional. The ideal PHR holds tremendous potential. It could receive and evaluate information from a patient’s lab results or monitoring devices; store a patient’s observations about physical and social environment; link with a clinician’s electronic health record; and much more. On a grander scale, PHRs could also make health care more affordable by urging prevention and wellness, and by streamlining care delivery.
Challenges of the 21st Century
The US National Academy of Engineering (NAE) has revealed that the panels choices fall into four themes that are essential for humanity to flourish namely sustainability, health, reducing vulnerability, and joy of living.
While the challenges have not been ranked, voting by the public is on, one among them is to Advance health informatics – with a view to develop stronger health information systems not only improve everyday medical visits, but they are essential to counter pandemics and biological or chemical attacks.
The academy has chosen these engineering challenges that they feel can be realistically met, most of them early in this century.
Health and Emerging Technologies
In an interesting use of Web technology in the field of health, InSpot.org, a website is enabling people with sexually transmitted diseases (STDs) to send anonymous email warnings to their partners in an attempt to slow a rise in new infections.
The site uses the ecard model to send messages like “I’m So Sorry” to notify people that they may have been exposed to a disease. It also offers information about getting tested and treatment. Users of the site, which went online in San Francisco in 2004, can choose from a selection of messages providing a convenient and anonymous avenue for people to be responsible about notifying their partners about a possible exposure to an STD.
Health And The Indian Economy
In an interesting article, an IT veteran points out the health ills that are plaguing the Indian IT/BPO industry and makes a case for investment in healthcare for employees wondering if it not already too late…
Excerpts Below…
To many around the world, the Indian IT and BPO industry is the face of the current boom time, of India Rising or of whatever shorthand appeals to the reader or the writer. The industry is represented by NASSCOM, which has lost, through unfortunate coincidence, two of its leaders in their prime. First there was Dewang Mehta, who died at the relatively young age of 40. Dewang Mehta was at the helm of NASSCOM when I worked with a leading IT services provider first in India and then in Europe. He was energetic, enthusiastic and apparently in good health, a description which has also been applied by commentators to Sunil Mehta, a former head of research at NASSCOM whom I never met. Sunil Mehta also was by all accounts in his 40s, when he passed away in late 2006.
To an observer with experience in the nascent heady days of the Indian IT industry, but now with a health hat on, these two untimely demises appear to be more than coincidental. They are probably indicators of the general working practices of the industry, and their long-term health consequences. Such is my interest in the matter that recently a consulting prospect in the IT industry told me, jokingly I was assured, that if I were to get any consulting projects with Indian IT firms, I should keep a firm rein on my desire to make their employees aware of their rights as human beings and as employees, and the need to take stock of their health periodically. Not a good sign of management commitment, is it? But since one swallow does not make a summer, lets examine some trends.
In the 1990s, the industry was characterised by long work hours, even longer during industry jamborees, fuelled by a lot of testosterone and alcohol, never punctuated by exercise or recharge time. Those who left work at 6 or 7 pm were described as part-timers, albeit jokingly and most found it hard to take days off. Women in management roles in the IT industry – not including HR, accounting and software development – were few and far in between, some of whom are now at the helm of leading technology firms in India and elsewhere. Either we played the game by these rules, or we didn’t; but some of us struck hard bargains about working to different rules and were supported by our managers. Many of my colleagues from that time are still in the industry but experiencing, despite being relatively young, chronic problems such as overweight, neck and back pains, high blood pressure and cholesterol, and in some cases, the need for untimely bypasses.
Through the noughties however, with India being described as the world’s back office and increasingly the front office, the nature of work has changed slightly. And to already well-ensconced bad health habits – including lack of exercise, lack of regular health check ups, regular consumption of scrumptious but artery clogging foods – some new culprits have been added. To long work hours, we have added irregular work times, including night shifts, and an upward trend in eating out. The former does a lot more damage than just interfere with the normal circadian rhythm of the body. These ill effects are widely studied and well-documented. The latter, while almost always foods rich in sugar and fats, is made possible by good monies being made by young people too tired to cook or to relax otherwise after long work hours. There are some signs that more and more young people in urban areas are now taking to gyms, but with a greater focus on trendiness and appearance than on health and in the absence of solid data, it is moot whether actual exercise taking has increased.
Statistical data about India, that allow the examination of a correlation between working hours and chronic health problems, or even comparisons with data from other countries, are hard to come by. But the link itself is well understood.
In the interest of ensuring that the Indian economic boom does not become a one-time burst but remains sustainable in its growth, it is well-worth asking whether it is time we started investing in the health of the workforce today. Awareness, capacity and delivery mechanisms are all essential, but in a corporate context, what is required above all is management commitment. And to that end, I hope NASSCOM – and the Indian IT industry – bosses are listening.
$237 billion : Why do we not care
In a recent article, Indra Nooyi, chairman and chief executive officer, PepsiCo Klaus Schwab, founder and executive chairman, World Economic Forum have covered the impact of companies commitment to employee wellness in the workplace on a global scale.
The WHO estimates that China will lose $558 billion, India $237 billion and Russia $303 billion in national income from 2005-2015 due to heart disease, stroke and diabetes.
Professor K. Srinath Reddy, president of the Public Health Foundation of India, has said that “heart disease is the number one killer throughout India. By 2030, 18 million potentially productive years of life will be lost.”. Recent studies show economic losses in developing countries will threaten the stability of social security systems in the Organization for Economic Cooperation and Development nations. So while the problem is local, the impact will be increasingly global.
Yet, there are practical, tangible steps, which can be taken now. The role of the workplace, as integral to addressing the major causes of death and disease in adults, was first recognized by the international AIDS community. Their energy and expertise propelled workplace AIDS programs to the highest levels of government and corporate attention.
There is incredible potential for nearly 3 billion productive people in labor markets around the world to affect change in the workplace. We must now ensure that heart disease, diabetes and cancers – by far the largest contributors to ill health and premature death at work – receive the same attention as the AIDS epidemic.
The private sector has the tools and knowledge to address most major health problems in the workplace. Tobacco cessation programs and smoke free workplaces work; screening and treatment for high blood pressure and cholesterol works; stress management programs work.
The recently completed WHO/World Economic Forum joint report on workplace wellness indicates that workplace programs targeting physical inactivity and unhealthy dietary habits, are effective in reducing the risks for major non-communicable diseases in a cost-effective manner. Further, it highlights key elements for the development of sustainable wellness programs and includes examples of successful programs implemented in countries as diverse as India, Malaysia and the US.
Some steps are simple – such as providing affordable, nutritious foods and access to physical activity – but there are tough problems still to solve and answers will only come through collaborative innovation. For example, a relatively new frontier for wellness is obesity. There is no major success story of reducing obesity levels in a large workplace setting and sustaining it over time. We have yet to pull together our best efforts to simultaneously address the input of calories and working to drive calories out by engaging employees in becoming more physical.
A good company does more than focus only on short term profits – it makes products that responsibly nourish people and societies, minimizes the impact on the environment in which it operates and cherishes its employees. A work environment which enhances health and wellness demonstrates to employees their importance to the company by enabling them to live life to its fullest.
This is a challenge that cannot be tackled just by medical and health services. It will take a companywide effort to make a difference. And for us to sustain the impact it will demand full involvement of the community.
Employee Wellness: An Indian Survey
Indian Council For Research on International Economic Relations (ICRIER) in its study based on a survey of disparate companies across 15 states of India, showed 12% of blue-collar workers were at a high risk of getting a debilitating disease compared to 4% of the medium and senior-level employees.
While blue-collar workers are generally afflicted with acute as well as chronic infectious diseases like tuberculosis and AIDS, senior executives are more prone to lifestyle diseases, owing to lack of exercise and dietary control.
ICRIER’s survey corroborates what Apollo Hospitals found in its study ‘Health and Wellness Survey (2003)’. The study said more than half of the executives were prone to lifestyle diseases. And nearly 71% of the employees and 82% of CEOs were overweight. It had also found nearly 48% of the employees and 69% of CEOs were physically unfit.
The direct impact of employee sickness is reflected in man days lost. ICRIER’s survey shows almost a quarter of the companies lose approximately 50 man days in a year due to sickness. Another 34% companies lose between 10 to 50 man days. This translates into an equal percentage of loss in their productivity and bottomlines.
The survey notes that companies are aware of how employee sickness affects their bottomlines. To mitigate some of the cost, two-thirds of respondent firms have introduced preventive healthcare as part of their corporate governance strategy.
However, less than one-third make provision for the whole range of preventive healthcare measures for their staff. Many of them feel providing health insurance is good enough.
The report also suggests a well-designed employee wellness programme by companies could lead to 25% reduction in their health-plan costs, sick leave, disability pay and workers compensation. Reducing just one health risk increases an employee’s on-the-job productivity by 9% and cuts absenteeism by 2%.
The report sums up with some suggestions both for the government and India Inc. These include conducting a health audit of all employees at regular intervals, introduction of preventive healthcare benefits and vouchers.
Techonology to make things easy
It is difficult at times to understand the reluctance of people to use technology when it will simplify matters and allow them to concentrate on more important activities.
In a recent study, by Sharma RC; Dutt SC presented at the World Health Forum 210 shows multipurpose workers and 47 supervisors at the peripheral level in seven states in India replied to a questionnaire requesting information on the amount of time spent maintaining registers and preparing elaborate monthly reports. More than two-thirds worked in Gujarat, while the rest worked in Himachal Pradesh, Karnataka, Kerala, Madhya Pradesh, Maharashtra, and Meghalaya. It was found that, on average, multipurpose health workers spend 1.5 hours per day updating their records and 15.1 hours preparing each monthly report. Assuming an eight-hour work day and 22 work days per month, they spend 28% of their working time recording and reporting. Supervisors spend an average of 1.6 hours daily and an additional 19 hours for monthly reporting, or 31% of their working time. Government-published statistics therefore indicate that approximately US$45 million are spent annually on record keeping and reporting at this level. An urgent need clearly exists to develop a health management information system to reduce the record-keeping workload of health workers at all levels. A computer-based system is specifically recommended.
We hope that something is done soon at this level to ensure that the focus of health workers remains health and not filing papers.
