India - Health Conditions

Diarrheal diseases, the primary cause of early childhood mortality, are linked to inadequate sewage disposal and lack of safe drinking water. Roughly 50 percent of all illness is attributed to poor sanitation; in rural areas, about 80 percent of all children are infected by parasitic worms. Estimates in the early 1980s suggested that although more than 80 percent of the urban population had access to reasonably safe water, fewer than 5 percent of rural dwellers did. Waterborne sewage systems were woefully overburdened; only around 30 percent of urban populations had adequate sewage disposal, but scarcely any populations outside cities did. In 1990, according to United States sources, only 3 percent of the rural population and 44 percent of the urban population had access to sanitation services, a level relatively low by developing nation standards. There were better findings for access to potable water: 69 percent in the rural areas and 86 percent in urban areas, relatively high percentages by developing nation standards. In the mid-1990s, about 1 million people die each year of diseases associated with diarrhea.

India is subject to outbreaks of various diseases. Among them is pneumonic plague, an episode of which spread quickly throughout India in 1994 killing hundreds before being brought under control. Tuberculosis, trachoma, and goiter are endemic. In the early 1980s, there were an estimated 10 million cases of tuberculosis, of which about 25 percent were infectious. During 1991 nearly 1.6 million new tuberculosis cases were detected. The functions of the Trachoma Control Programme, which started in 1968, have been subsumed by the National Programme for the Control of Blindness. Approximately 45 million Indians are vision-impaired; roughly 12 million are blind. The incidence of goiter is dominant throughout the sub-Himalayan states from Jammu and Kashmir to the northeast. There are some 170 million people who are exposed to iodine deficiency disorders. Starting in the late 1980s, the central government began a salt iodinization program for all edible salt, and by 1991 record production--2.5 million tons--of iodized salt had been achieved. There are as well anemias related to poor nutrition, a variety of diseases caused by vitamin and mineral deficiencies--beriberi, scurvy, osteomalacia, and rickets--and a high incidence of parasitic infection.

According to a 1989 National Nutrition Monitoring Bureau report, less than 15 percent of the population was adequately nourished, although 96 percent received an adequate number of calories per day. In 1986 daily average intake was 2,238 calories as compared with 2,630 calories in China. According to UN findings, caloric intake per day in India had fallen slightly to 2,229 in 1989, lending credence to the concerns of some experts who claimed that annual nutritional standards statistics cannot be relied on to show whether poverty is actually being reduced. Instead, such studies may actually pick up short-term amelioration of poverty as the result of a period of good crops rather than a long-term trend.

In the early 1990s, about 389 million people were at risk of infection from filaria parasites; 19 million showed symptoms of filariasis, and 25 million were deemed to be hosts to the parasites. Efforts at control, under the National Filaria Control Programme, which was established in 1955, have focused on eliminating the filaria larvae in urban locales, and by the early 1990s there were more than 200 filaria control units in operation.

Smallpox, formerly a significant source of mortality, was eradicated as part of the worldwide effort to eliminate that disease. India was declared smallpox-free in 1975. Malaria remains a serious health hazard; although the incidence of the disease declined sharply in the postindependence period, India remains one of the most heavily malarial countries in the world. Only the Himalaya region above 1,500 meters is spared. In 1965 government sources registered only 150,000 cases, a notable drop from the 75 million cases in the early postindependence years. This success was short-lived, however, as the malarial parasites became increasingly resistant to the insecticides and drugs used to combat the disease. By the mid-1970s, there were nearly 6.5 million cases on record. The situation again improved because of more conscientious efforts; by 1982 the number of cases had fallen by roughly two-thirds. This downward trend continued, and in 1987 slightly fewer than 1.7 million cases of malaria were reported.

The severity of the growing AIDS crisis in India is clear, according to statistics compiled during the mid-1990s. In Bombay, a city of 12.6 million inhabitants in 1991, the HIV infection rate among the estimated 80,000 prostitutes jumped from 1 percent in 1987 to 30 percent in 1991 to 53 percent in 1993. Migrant workers engaging in promiscuous and unprotected sexual relations in the big city carry the infection to other sexual partners on the road and then to their homes and families.

India's blood supply, despite official blood screening efforts, continues to become infected. In 1991 donated blood was screened for HIV in only four major cities: New Delhi, Calcutta, Madras, and Bombay. One of the leading factors in the contamination of the blood supply is that 30 percent of the blood required comes from private, profit-making banks whose practices are difficult to regulate. Furthermore, professional donors are an integral part of the Indian blood supply network, providing about 30 percent of the annual requirement nationally. These donors are generally poor and tend to engage in high-risk sex and use intravenous drugs more than the general population. Professional donors also tend to donate frequently at different centers and, in many cases, under different names. Reuse of improperly sterilized needles in health care and blood-collection facilities also is a factor. India's minister of health and family welfare reported in 1992 that only 138 out of 608 blood banks were equipped for HIV screening. A 1992 study conducted by the Indian Health Organisation revealed that 86 percent of commercial blood donors surveyed were HIV-positive.

Diseases

A number of endemic communicable diseases present a serious public health hazard in India. Over the years, the government has set up a variety of national programs aimed at controlling or eradicating these diseases, including the National Malaria Eradication Programme and the National Filaria Control Programme. Other initiatives seek to limit the incidence of respiratory infections, cholera, diarrheal diseases, trachoma, goiter, and sexually transmitted diseases.

AIDS

The incidence of AIDS cases in India is steadily rising amidst concerns that the nation faces the prospect of an AIDS epidemic. By June 1991, out of a total of more than 900,000 screened, some 5,130 people tested positive for the human immunodeficiency virus (HIV). However, the total number infected with HIV in 1992 was estimated by a New Delhi-based official of the World Health Organization (WHO) at 500,000, and more pessimistic estimates by the World Bank in 1995 suggested a figure of 2 million, the highest in Asia. Confirmed cases of AIDS numbered only 102 by 1991 but had jumped to 885 by 1994, the second highest reported number in Asia after Thailand. Suspected AIDS cases, according to WHO and the Indian government, may be in the area of 80,000 in 1995.

India has an estimated 1.5 million to 2 million cases of cancer, with 500,000 new cases added each year. Annual deaths from cancer total around 300,000. The most common malignancies are cancer of the oral cavity (mostly relating to tobacco use and pan chewing--about 35 percent of all cases), cervix, and breast. Cardiovascular diseases are a major health problem; men and women suffer from them in almost equal numbers (14 million versus 13 million in FY 1990).

Fear and ignorance have continued to compound the difficulty of controlling the spread of the virus, and discrimination against AIDS sufferers has surfaced. For example, in 1990 the All-India Institute of Medical Sciences, New Delhi's leading medical facility, reportedly turned away two people infected with HIV because its staff were too scared to treat them.

In 1987 the newly formed National AIDS Control Programme began limited screening of the blood supply and monitoring of high-risk groups. A national education program aimed at AIDS prevention and control began in 1990. The first AIDS prevention television campaign began in 1991. By the mid-1990s, AIDS awareness signs on public streets, condoms for sale near brothels, and media announcements were more in evidence. There was very negative publicity as well. Posters with the names and photographs of known HIV-positive persons have been seen in New Delhi, and there have been reports of HIV patients chained in medical facilities and deprived of treatment.

Health conditions

The average Indian male born in the 1990s can expect to live 58.5 years; women can expect to live only slightly longer (59.6 years), according to 1995 estimates. Life expectancy has risen dramatically throughout the century from a scant twenty years in the 1911-20 period. Although men enjoyed a slightly longer life expectancy throughout the first part of the twentieth century, by 1990 women had slightly surpassed men. The death rate declined from 48.6 per 1,000 in the 1910-20 period to fifteen per 1,000 in the 1970s, and improved thereafter, reaching ten per 1,000 by 1990, a rate that held steady through the mid-1990s. India's high infant mortality rate was estimated to exceed 76 per 1,000 live births in 1995 (see table 7, Appendix). Thirty percent of infants had low birth weights, and the death rate for children aged one to four years was around ten per 1,000 of the population.

A new program to control the spread of AIDS was launched in 1991 by the Indian Council of Medical Research. The council looked to ancient scriptures and religious books for traditional messages that preach moderation in sex and describe prostitution as a sin. The council considered that the great extent to which Indian life-styles are shaped by religion rather than by science would cause many people to be confused by foreign-modeled educational campaigns relying on television and printed booklets.

The main factors cited in the spread of the virus are heterosexual transmission, primarily by urban prostitutes and migrant workers, such as long-distance truck drivers; the use of unsterilized needles and syringes by physicians and intravenous drug users; and transfusions of blood from infected donors. Based on the HIV infection rate in 1991, and India's position as the second most populated country in the world, it was projected that by 1995 India would have more HIV and AIDS cases than any other country in the world. This prediction appeared true. By mid-1995 India had been labeled by the media as "ground zero" in the global AIDS epidemic, and new predictions for 2000 were that India would have 1 million AIDS cases and 5 million HIV-positive.

Leprosy, a major public health and social problem, is endemic, with all the states and union territories reporting cases. However, the prevalence of the disease varies. About 3 million leprosy cases are estimated to exist nationally, of which 15 to 20 percent are infectious. The National Leprosy Control Programme was started in 1955, but it only received high priority after 1980. In FY 1982, it was redesignated as the National Leprosy Eradication Programme. Its goal was to achieve eradication of the disease by 2000. To that end, 758 leprosy control units, 900 urban leprosy centers, 291 temporary hospitalization wards, 285 district leprosy units, and some 6,000 lower-level centers had been established by March 1990. By March 1992, nearly 1.7 million patients were receiving regular multidrug treatment, which is more effective than the standard single drug therapy (Dapsone monotherapy).

Official Indian estimates of the poverty level are based on a person's income and corresponding access to minimum nutritional needs (see Growth since 1980, ch. 6). There were 332 million people at or below the poverty level in FY 1991, most of whom lived in rural areas.

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