show me the money

Promoting yoga as a preventive health strategy is ok – if health budgets increase too

The health financing system in India defies the global trend. Out of every four rupees spent on health, only one comes from the government.

In his address on International Yoga Day last month, Prime Minister Narendra Modi asked everyone to think of yoga as “health assurance at zero budget”.

The prime minister also pitched the idea that countries with low health budgets should invest in yoga for preventive health measures as that would save them a lot of money.

During Modi’s 25-minute speech, India lost 62 children. The majority of these young lives could have been saved with investments in primary healthcare.

One in every five children who dies before reaching its fifth birthday is born in India. Similarly, millions of pregnant women in India do not receive basic healthcare while giving birth, with thousands of them dying in childbirth. Life expectancy in neighbouring Sri Lanka and Bangladesh is greater than that in India.

Health allocations

The benefits of yoga are well established, particularly in promoting health and well-being. But when yoga is invoked as a health assurance while, in reality, millions are denied the right to live a healthy life, projecting yoga as an alternative appears to be a cruel joke.

The prime minister's compulsion to find health assurance in yoga reiterates his government’s obsession with reducing the national health budget. During the ruling BJP-led National Democratic Alliance’s first budget in 2015-’16, budgetary allocation to health was cut to a historic low. Though there were some notional increases in the budget of 2016-’17, when adjusted for prices, the allocation was actually lower than that in 2014-’15.

The Union government allocations on health have not been able to keep pace with the rise in prices, even though stagflation has given way to a sober rise in prices recently. As a result, the Union government’s expenditure on health as a percentage of the country’s income – a globally acknowledged indicator to assess government commitment – is on a downward slope.

Cuts in the Union budget have been justified on the understanding that under the 14th Finance Commission more funds will be devolved to states directly as centralised planning is abandoned.

So, now the buck stops at states. The evidence so far suggest that states have lost rather than gained under this new fiscal arrangement. Health departments in states have not gained as much from the expanded tax kitty, as they have lost from the withdrawal of central plan funds.

During 2010-’11 to 2014-’15, when the Union government spending on health care declined, spending by states actually grew close to double-digit rates at 9.9%. The effects of this new fiscal arrangement might halt this much required expansion of healthcare services by states as they may face a new fiscal crisis.

State spending not enough

Public spending on health in India is among the lowest in the world when compared in terms of share in Gross Domestic Product and per capita spending. States should spend more on health, as health is a state subject. But it is unrealistic to expect that states alone will be in a position to step up public spending on health adequately to take it up to 2.5% of the Gross Domestic Product, as promised in several policy documents over last two decades.

The Centre not only complements spending by states, it also signals crucial policy directions for states to follow, as it did through the National Rural Health Mission. Not only did spending by states increase in tandem with the Centre, considerable expansion of rural healthcare infrastructure and services took place through the national mission.

National health missions stalling

Unfortunately, recent cuts in the Union budget will have perilous effects on the quality of health services delivered through government facilities. Progress on implementation of the National Health Mission has been halted across states. Salaries of doctors and nurses are overdue, National Health Mission staff are protesting indefinite delays in payment in several states, new mothers are being denied financial assistance after delivery, and crucial life-saving medicines and commodities are in short supply.

There is an unwritten embargo against any new intervention under the National Health Mission. Some of the health outcome impacts could be long term. For instance, budgetary cuts are impacting antenatal care and supplemental nutrition programs for a generation of children who are likely to face stunting and growth issues and a lifetime of illnesses.

Health for all

Worldwide, governments acknowledge their responsibility to pay for the healthcare needs of their citizens, and have have taken several paths to this goal of assuring health for all.

Most countries either provide care directly through public-funded health systems or through social insurance or a combination of the two. High income households often top up their healthcare needs through out-of-pocket payments or insurance mechanisms. As a result, the vast majority of people are protected from the financial consequences of seeking healthcare in developed and many developing countries.

But the health financing system in India defies the global trend. Out of every four rupees spent on health, only one comes from the government, and most healthcare expenses are borne by households.

Around 5.5 crore people are pushed to poverty just to meet the healthcare expenses of their near and dear ones. Many more die untimely deaths, or get delayed treatment because they can’t afford to pay for healthcare.

Compared to most developing nations and even some of our neighbours like Sri Lanka, Thailand and Malaysia or even our partners in BRICS, our record on public spending on health is abysmal

Note: National Health Accounts estimates being conducted currently might provide a refined estimate and bring India’s public spending on health down to near one percent of GDP.
Note: National Health Accounts estimates being conducted currently might provide a refined estimate and bring India’s public spending on health down to near one percent of GDP.

India’s health and development indicators hold the key to a healthier world. India is rapidly urbanising, social support systems are fading away, diseases related to work and lifestyle are on the rise. A recent National Sample Survey report shows the increasing burden of non-communicable diseases.

Needless to say, yoga has considerable potential when it is part of a holistic, integrated and comprehensive health system.

One of the immediate requirements for building that kind of system is to take up scientific research on yoga, to assess its effectiveness and limitations in an objective manner and apply that refined knowledge to the larger health sciences.

In 2015-’16 the total budgetary allocation to yoga research was merely Rs 42.5 crore. But while hype was created around World Yoga Day, allocations to yoga research were silently cut further to Rs 26 crore in the revised estimates.

Observing all this, it’s difficult not to wonder that the rhetoric around yoga is being invoked to allow the state to abdicate its responsibilities when it comes to health.

Indranil Mukhopadhyay and Nandita Bhan work with the Public Health Foundation of India. Views expressed here are personal.

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German expats talk about adapting to India, and the surprising similarities between the two cultures.

The cultural similarities between Germany and India are well known, especially with regards to the language. Linguists believe that Sanskrit and German share the same Indo-Germanic heritage of languages. A quick comparison indeed holds up theory - ratha in Sanskrit (chariot) is rad in German, aksha (axle) in Sanskrit is achse in German and so on. Germans have long held a fascination for Indology and Sanskrit. While Max Müller is still admired for his translation of ancient Indian scriptures, other German intellectuals such as Goethe, Herder and Schlegel were deeply influenced by Kalidasa. His poetry is said to have informed Goethe’s plays, and inspired Schlegel to eventually introduce formal Indology in Germany. Beyond the arts and academia, Indian influences even found their way into German fast food! Indians would recognise the famous German curry powder as a modification of the Indian masala mix. It’s most popular application is the currywurst - fried sausage covered in curried ketchup.

It is no wonder then that German travellers in India find a quite a lot in common between the two cultures, even today. Some, especially those who’ve settled here, even confess to Indian culture growing on them with time. Isabelle, like most travellers, first came to India to explore the country’s rich heritage. She returned the following year as an exchange student, and a couple of years later found herself working for an Indian consultancy firm. When asked what prompted her to stay on, Isabelle said, “I love the market dynamics here, working here is so much fun. Anywhere else would seem boring compared to India.” Having cofounded a company, she eventually realised her entrepreneurial dream here and now resides in Goa with her husband.

Isabelle says there are several aspects of life in India that remind her of home. “How we interact with our everyday life is similar in both Germany and India. Separate house slippers to wear at home, the celebration of food and festivals, the importance of friendship…” She feels Germany and India share the same spirit especially in terms of festivities. “We love food and we love celebrating food. There is an entire countdown to Christmas. Every day there is some dinner or get-together,” much like how Indians excitedly countdown to Navratri or Diwali. Franziska, who was born in India to German parents, adds that both the countries exhibit the same kind of passion for their favourite sport. “In India, they support cricket like anything while in Germany it would be football.”

Having lived in India for almost a decade, Isabelle has also noticed some broad similarities in the way children are brought up in the two countries. “We have a saying in South Germany ‘Schaffe Schaffe Hausle baue’ that loosely translates to ‘work, work, work and build a house’. I found that parents here have a similar outlook…to teach their children to work hard. They feel that they’ve fulfilled their duty only once the children have moved out or gotten married. Also, my mother never let me leave the house without a big breakfast. It’s the same here.” The importance given to the care of the family is one similarity that came up again and again in conversations with all German expats.

While most people wouldn’t draw parallels between German and Indian discipline (or lack thereof), Germans married to Indians have found a way to bridge the gap. Take for example, Ilka, who thinks that the famed differences of discipline between the two cultures actually works to her marital advantage. She sees the difference as Germans being highly planning-oriented; while Indians are more flexible in their approach. Ilka and her husband balance each other out in several ways. She says, like most Germans, she too tends to get stressed when her plans don’t work out, but her husband calms her down.

Consequently, Ilka feels India is “so full of life. The social life here is more happening; people smile at you, bond over food and are much more relaxed.” Isabelle, too, can attest to Indians’ friendliness. When asked about an Indian characteristic that makes her feel most at home, she quickly answers “humour.” “Whether it’s a taxi driver or someone I’m meeting professionally, I’ve learnt that it’s easy to lighten the mood here by just cracking a few jokes. Indians love to laugh,” she adds.

Indeed, these Germans-who-never-left as just diehard Indophiles are more Indian than you’d guess at first, having even developed some classic Indian skills with time. Ilka assures us that her husband can’t bargain as well as she does, and that she can even drape a saree on her own.

Isabelle, meanwhile, feels some amount of Indianness has seeped into her because “whenever its raining, my body instantly craves chai and samosa”.

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This article was produced by the Scroll marketing team on behalf of Lufthansa as part of their More Indian Than You Think initiative and not by the Scroll editorial team.