This article was originally published in Firstpost on 27.01.2023 in response to a query by them on our recommendations for the upcoming health budget.
The public healthcare budget in India continues to be extremely low at less than 2 percent of the GDP. Compare this to developed countries where spendings stands at 10-15 percent. Although the Ayushman Bharat program for public healthcare launched by the government is a good effort, this low percentage of spending on healthcare clearly shows health still being a low priority. There are also many reports of a shortage of doctors and nurses.
The most important requirement for the government’s healthcare plan still continues to be a lack of focus on preventive healthcare. Working on preventive healthcare would not only drastically reduce the national burden of disease which is rapidly increasing, but also lead to improvement in the quality of life of people(something that cannot be tracked by metrics). Preventive healthcare is something we focus on very strongly in functional medicine. Research on health markers shows that by tracking them and keeping them in optimal ranges, we can reduce disease risk significantly and track diseases in their early stages and prevent them from developing. We thus need to put more emphasis on diagnostics and regular testing. Besides tracking, there is a lot we can do through improving public nutrition, lifestyle, and the environment to reduce disease burden. The aim should be to focus on a model of promoting better health instead of blindly trying to tackle the burden of disease with no regard to why it is increasing in the first place. What we have at the moment in the name of healthcare is actually “sick”care to be precise.
So what can the government do to reduce the national disease burden?
One of the foremost steps would be to reduce the tax on health-promoting services. Nutrition and holistic health products are currently classified as wellness services and have to pay a full 18 percent GST as compared to conventional medical services, for which it is less than 3 percent. Granted, holistic health and wellness services are a very broad market and include a lot of treatments not necessarily supported by evidence. But we can at least selectively support treatments and supplements for which there is well-established evidence such as essential nutrients like vitamin D, B Complex,Magnesium, etc. On the contrary, the Indian government currently enforces a restriction of 100% RDA on supplements for these nutrients, making it impossible to manufacture products with effective therapeutic doses. The import duty on health supplements is also very high compared to other countries.
As stated above, diagnostics are important and should be supported by the government. Instead, we recently had an implementation of a 5% added tax on the import duty of diagnostic equipment. The place where we do actually need government regulation is in the monitoring of industries that contribute to toxin overload through pollution of air and water and soil. A lot of food and skincare products have been found to contain heavy metals and other toxins.
The government has been working on fortification of foods like grains and legumes in the past few decades and this has helped counter malnutrition to a good extent in our primarily vegetarian population. However, more work needs to be done here- the RDA limits really need to be updated. Key nutrients like Zinc, Vitamin D and Magnesium are still not being accounted for. There is a huge need for public education on eating more nutritious foods, especially animal foods and living healthier lifestyles. At present, even doctors are not well educated on nutrition with formal medical education hardly covering anything on clinical nutrition. Most nutritionists today also mostly only focus on food macros and weight loss, with no emphasis on the role of food in health and disease management.
Setting up of the AYUSH ministry was a revolutionary move because this is the first time a public health institution has been set up supporting alternative medicine on an official level. It’s a big step in standing up to the overbearing Big Pharma lobby that holds authoritative power globally. However, where AYUSH fails is through its focus on ancient treatment modalities like Ayurveda and Unani only. While these modalities do have a lot of value to them, they have been far outpaced by modern evidence-based alternative medicine modalities like functional medicine and integrative medicine. The latter make extensive use of modern medical scientific literature on holistic therapies including nutrition and supplements, plant medicine, genetic testing, gut microbiome treatment and toxin removal. This is what the government should focus on supporting to see effective change.
There is also still a heavy reliance on international organisations and programs such as the WHO and Bill Gates’s GAVI program. These organisations have huge conflicts of interest and are known to have nefarious agendas and we need to be very careful partnering with them. A 2018 paper which showed how the Gates foundations’ oral polio vaccine program in India most likely led to paralysis of half a million children in the past decade has been purported to be the reason why the government cut off funding from the Gates’ Foundation around the same time.
We need to be careful with projects like the Digital Health ID currently being implemented in partnership with the UN since these could enable surveillance and authoritarianism. We are already seeing this in China. We should be more self-reliant instead of blindly adopting our health and nutrition guidelines directly from those of the US.