Impact of Healthcare Disparities on Equity & Access in South Asia

Waasae Ayyaz, Princeton University

Introduction

Healthcare and medicine are the foundation in which the well-being of any society is formed all around the world. Every community needs stable, reliable, and high quality healthcare accessibility in order to flourish and maintain longevity. Without it, the overall health of a community will begin to deteriorate which can become detrimental to the individuals in need of medical assistance. For the 1.9 billion people (about 25% of the global population) living in South Asian countries such as India, Pakistan, Nepal, Bangladesh, and Afghanistan, healthcare is unreliable and of low quality.

Factors like the lack of proper education and conflicting socio-political agendas have led to the lack of proper attention given to the healthcare systems in the South Asian region. The education system, which is meant to prepare the future healthcare professionals, is embedded with internal issues that are reflected in the subpar healthcare systems. Furthermore, the political endeavors of these countries make public healthcare less accessible since it can conflict with their agenda to grow economically. As a result, those who are disadvantaged and in most need of support are also the ones most affected by the disparities in healthcare. The COVID-19 pandemic has only propagated these pre-existing flaws which can, and should, spark reason for some type of change.

Healthcare Access, Equity and Education in South Asia

The disparities within education for public health workforces is one factor that drives the healthcare disparities in South Asia. Medical education is focused on “student-centered learning approaches,... problem based learning,... early clinical training, opportunities for out-of-hospital postings, and student-selected electives” [1]. These methods of learning are simply teaching the future generation of healthcare professionals the basic, historically consistent knowledge needed to get into the field. This lacks an adaptation to present problems, and the education of what drives these issues, so that health workers in training are empowered to address problems that need solutions in real time. Public health issues specific to rural areas in South Asia are often overlooked, and people living in these areas are especially affected by the lack of attention given to their needs [2].

Incorporating a community-based medical education system that teaches students how to address current outstanding health problems can be more useful than the traditional ideology [2]. Factors such as climate change, the pharmaceutical industry, and disease mongering should all be topics of interest in healthcare education because they have the potential to produce challenges for the overall well being of South Asia [2]. Quality healthcare does not only come from professionals with high working knowledge of solutions that resolve health issues, but also from a strong foundation of interpersonal skills. A strong doctor-patient relationship is essential in providing healthcare because it can lead to higher satisfaction which results in better management of health problems [3]. Recently, there has been an increase in demand for patient autonomy and for more involvement in medical decisions [2]. Without considering this aspect of medicine, medical students will not develop the skills and habits to effectively connect to their patients, which leads to further dissatisfaction from the community in the quality of healthcare. There have been three core domains of public healthcare that have been identified as the foundations of a successful and high quality healthcare system: health protection, health services, and health improvement [4]. With emphasis on all three of these during the education of aspiring health professionals, students are able to form all the necessary skills that can address a wide range of problems, more than what the standard training currently allows for.

Political and Socioeconomic Factors Impacting Healthcare In South Asia

On average, people from an economically or socially disadvantaged background tend to suffer from worse health than their more well-off counterparts [5]. This is seen in low income and overly populated countries in South Asia, where there are elevated rates of illness, more exposure to infectious disease, more incidences of malnutrition, and a lower availability of food, clean water, sanitation and shelter, and medical care [5]. Due to these disparities, the life expectancy is significantly lower in this part of the world compared to other countries. In India, children that are born in the poorest 20% households are more than three times as likely to die before their fifth birthday compared to the children of the richest 20% households [5]. Two factors that contribute to the health inequities across socioeconomic groups are skilled birthattendance (the essential medical care given to women and newborns during pregnancy, childbirth and the postpartum period) and child malnutrition (pathological state resulting from inadequate nutrition, including undernutrition (protein-energy malnutrition) due to insufficient intake of energy and other nutrients) [5][6][11]. The results showed that disparities in health systems contribute to 19-25% of inequities in skilled birth attendance and 50% of such are accounted for by the socioeconomic position of women [5]. Furthermore, socioeconomic position contributes to about 36-68% of inequities regarding child malnutrition [5]. Routine child immunisations and family planning also differ between the lowest and highest socioeconomic quintiles in South Asia [7]. These differences result in lower life expectancy and higher morbidity rates for those with low socioeconomic status [7]. Socioeconomic status can also be directly related to regional disparities such as the differences in urban and rural areas [7]. Rural areas have less functional and less accessible health services with inadequate transportation services that are necessary to receive proper medical attention [7]. Usually, these types of areas are populated with people of low socioeconomic status which puts them at a further disadvantage from accessing proper healthcare services. There are also major policy implications that need addressing in order to improve the state of healthcare in South Asia [5]. Countries that are successful in eliminating health inequities have adopted an almost universal coverage of basic health services that allows anyone and everyone access to quality medical services without charge [5]. Two examples of this in play can be seen in Sri Lanka and Thailand where skilled birth attendance coverage is above 95% and the poorest populations have more than 90% coverage [5]. However, this universal coverage is hard to obtain because of inadequate government funding for healthcare services, forcing people to rely on the private sector to receive any type of health service that is necessary [7]. This puts people of low socioeconomic status at an even lower disadvantage because they do not have the resources that are necessary to receive medical attention because of the way the governments of these countries have structured their healthcare.

COVID-19 and Pandemic Preparedness In South Asia

The ongoing COVID-19 pandemic has posed many challenges to South Asian countries because of the low level of pandemic preparedness and the high levels of population density [8][9]. Almost all the countries in the region have overly dense populated areas which significantly increases the rate of transmission; although the region observed a strict lockdown for two months, a significant proportion of the population eventually broke social distancing guidelines, which caused an even higher infection rate [9]. Pairing the exponential growth of the virus with a low quality healthcare system only made the effects of the pandemic worse. With the pandemic taking thousands of lives everyday, the focus should have been to find ways to stop the spread and decrease the number of deaths, however, in India, the focus shifter to issues surrounding religious discrimination. On March 31st, a member of an Islamic missionary movement voluntarily informed the Indian police about the arrival of seven Indonesians at the local mosque [10]. This backfired on him and caused the Indian police to accuse him and other Muslims of bringing in people from different countries causing the spread of the infection in India [10]. The 201 million Muslim citizens in India were now blamed for the country’s COVID-19 outbreak and many were forced to quarantine even though they never got infected or had reasonable suspiscion to have the virus [10]. By reframing the pandemic as a religious struggle as opposed to a public health one, the Indian government (which is run by the Hindu nationalist party) succeeded in diverting the attention away from the infrastructural failings of the country, and continued to propagate Islamaphobic rhetoric.

Conclusion and Future Challenges

Evidently, healthcare in South Asia is not at the level that it needs to be; it is an under-supported and overwhelmed system which will continue to be challenged as the population of the subcontinent continues to grow. The countries in these regions can learn by increasing opportunities for exchange of beneficial information between other countries that currently have a working and efficient healthcare system [5]. The time is now to address these issues and begin to create solutions for the long standing problems that have been negatively affecting the people of South Asia for years.

Works Cited

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