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Insights into Editorial: Before the next health crisis



Two dangers in the time of COVID-19:

Stalking the efforts of the government and the private sector to revive the economy in the time of COVID-19 are two dangers to people’s health air pollution and greenhouse gases and a weak public health system.

The respite from the air pollution that blankets Indian cities is transitory. India must heed scientists’ warnings tying health disasters to air pollution as well as greenhouse gas (GHG) emissions causing global warming.

A noxious cocktail: Links between Pollution levels and COVID death rates:

Strikingly, the avoided number of early deaths from dirty air quality in recent months in China is estimated to have exceeded the number of those who have died from COVID-19.

In Europe, 11,000 air-pollution related deaths were estimated to have been averted since the start of lockdowns.

There is an association between pollution levels in cities (despite the improvements during the pandemic) and COVID-19 infections and death rates, a link observed in New York City and the northern provinces of Italy.

Delhi, Maharashtra, Gujarat, and Tamil Nadu, in the top tier of pollution concentration, have also seen high deaths and infections per thousand people.

Of course, other factors too decide morbidity and mortality.

COVID-19’s toll has differed considerably across States Kerala and Tamil Nadu, for example, have a lower COVID-19 mortality rate. These States stand out with good healthcare systems.

Link between global warming and the emergence of diseases:

  1. Globally some 9 million premature deaths a year are associated with air pollutants, such as fine particulate matter, known as PM 2.5.
  2. Regrettably, 14 of the world’s 20 most polluted cities are in India. The air in Ghaziabad, Delhi, and Noida is particularly hazardous.
  3. Last year, a public health emergency was declared as post-Diwali New Delhi’s air quality index approached 500, the “severe plus emergency” category.
  4. Adding to this noxious cocktail are GHGs like carbon dioxide, causing global warming and damaging health.
  5. Despite the plunge during the lockdown, atmospheric carbon emissions are a record high because of past accumulation.
  6. Ranked as the world’s fifth most vulnerable country to climate change, India must respond to alerts on communicable diseases linked to GHGs.
  7. Global warming intensifies heat waves and worsens respiratory illnesses. Locust swarms in Jaipur and Gurugram have been linked to climate change.
  8. Evidence is also emerging on a link between global warming and the emergence of diseases.
  9. Mosquito-borne diseases in India have been connected to global warming through both increased rainfall and heat waves. Europe reported its first local transmissions of dengue in 2010.

India’s Public Healthcare System:

The public healthcare system is made up of secondary and tertiary care institutions in key cities and provides basic healthcare facilities in the form of Primary Healthcare Centres in rural areas.

The private sector provides the majority of secondary, tertiary, quaternary care institutions with a major concentration in metros, Tier-1 and Tier-2 cities.

India’s healthcare industry is one of the fastest growing sectors and is expected to reach 280 billion by the year 2020.

India is also one of the leading destinations for high end diagnostics services with tremendous capital investment for advanced diagnostic facilities.

When it comes to world rankings, India was ranked 145th among 195 countries on Healthcare Access and Quality (HAQ) index in 2016.

The index is based on 32 causes of death considered preventable with effective medical care.

The comprehensive index released by Global Burden of Disease, funded by the Bill and Melinda Gates Foundation says that despite such low rankings, India has seen improvement in HAQ since the year 1990. India’s HAQ score 41.2 has improved from 24.7 score in the year 1990.

India lags way behind its BRICS peers Brazil, Russia, China and South Africa on the HAQ index.

Need of the hour: Inclusive Agenda for Health:

In order to ensure health services with special attention to the needs of marginalised sections of the population the following will be emphasised:

  1. Access to services: Barriers to access would be recognised and overcome especially for the disadvantaged and people located far from facilities.
  2. Medical and public health facilities would be accessible to the differently-abled. They would be gender sensitive and child friendly.
  3. Special services: Special services should be made available for the vulnerable and disadvantaged groups.
  4. For example, counselling of victims of mental trauma in areas of conflict.
  5. Monitoring and evaluation systems: Routine monitoring and concurrent impact evaluations should collect disaggregated information on disadvantaged segments of the population.
  6. Representation in community fora: Wherever community-level fora exist or are being planned for, such as Rogi Kalyan Samitis, VHSNC, representation of the marginalised should be mandatory.
  7. Also, every Village Health Sanitation and Nutrition Committee would strive to have 50 per cent representation of women.
  8. Training: Training of health and rehabilitation professionals should incorporate knowledge of disability rights, as also the skills to deal with differences in perspectives and expectations between members of disadvantaged segments and the general population that may arise out of different experiences.

Need for a new plan on reducing Air Pollution and GHGs:

India must not scramble to return to bad old ways of boosting short-term growth at any cost but capitalise on the tantalising glimpse of a healthier and cleaner world.

Spending on reducing air pollution and GHGs provides estimated health benefits of 1.4 to 2.5 times more than the cost of the actions.

Delhi, set to overtake Tokyo as the most populous city by 2030, needs to deal with transport, responsible for two-fifth of the PM 2.5 in the skies.

Reforms should encourage public transportation in place of the 10 million vehicles, expand electric vehicles, and provide inter-connectivity between the metro and buses.


In managing health risks, emission reduction should be coupled with a stronger public health system.

Right now, government spending on health is just 1.6% of GDP, low for a lower middle-income country.

Most countries, including India, fail the test of readiness for health disasters, according to the 2019 Global Health Security Index.

The cleaner air the country is still breathing during the pandemic should be a powerful motivation.

Scientific warnings do not indicate the time and place of calamities but do call for confronting air pollution and global warming and strengthening health systems before the next health emergency that is surely going to happen.

Insights Current Affairs Analysis (ICAN) by IAS Topper


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