Amidst the COVID-19 pandemic, environmental challenges, and widening socio-economic disparities, a glaring gap in healthcare access has come to the forefront. Despite health being acknowledged as a constitutional right in over 140 nations, the WHO Council on the Economics of Health for All has reported that more than half of the world's population lacks complete access to essential health services. As World Health Day 2024 is commemorated, it becomes evident that fostering health equity holds promise for millions, transcending mere social justice or legislative reform.

2. Health Equity

• Health equity refers to ensuring that every individual has an equal opportunity to attain their highest level of health, irrespective of their circumstances. It acknowledges that social, economic, and environmental factors play a crucial role in shaping health outcomes, surpassing the influence of genetics alone. The World Health Organization (WHO) is committed to eliminating unjust and preventable health disparities among various social and economic groups.
• Genuine health equity delves into the root causes of health inequalities, including poverty, discrimination, limited access to quality education, nutritious food, clean water, fresh air, and adequate housing, rather than merely providing equal access to healthcare services. For instance, a child born into poverty in a rural setting may lack access to clean water, proper nutrition, and vaccinations, setting the stage for long-term health challenges.
• These disparities are exacerbated by global crises such as pandemics, climate change, and socio-political unrest. India, with its vast socioeconomic disparities, mirrors this predicament, where access to healthcare in rural areas significantly lags behind urban centres. Social and economic barriers further compound this gap.
• Achieving health equity requires a comprehensive approach that extends beyond legislative measures to address the socioeconomic determinants of health. Ensuring that every individual can lead a healthy life necessitates concerted efforts from governments, communities, and individuals to dismantle these barriers.
• However, the journey toward health equity is riddled with challenges, ranging from entrenched social injustices to global systemic health issues, particularly in multicultural countries like India. Diverse populations require assistance in accessing high-quality healthcare services in such contexts.

Global Challenges in Pursuit of Health Equity

• The pursuit of health equity confronts formidable global challenges that transcend national borders and demand collective international action. The COVID-19 pandemic has starkly exposed how infectious diseases disproportionately affect marginalized and vulnerable groups, exacerbating health disparities.
• Climate change poses a significant health risk, especially to low-income and vulnerable populations. Conflicts around the world disrupt healthcare provision by damaging infrastructure, displacing communities and impeding access to essential medical services.

The National Family Health Survey (NFHS) is a large-scale, nationally representative survey conducted in India to assess various aspects of population and health. NFHS-5, conducted between 2019 and 2021, is the fifth round of this survey and provides comprehensive data on key indicators related to population, health, and nutrition.

Objectives

• Evaluate the demographic and health status of individuals and households across India.
• Assess trends in fertility, family planning, maternal and child health, nutrition, and other health-related indicators.
• Understand disparities in health outcomes across different socio-economic and demographic groups.
• Inform policymakers, program managers, researchers, and other stakeholders to develop evidence-based policies and interventions.

Key Indicators NFHS-5 collects data on various indicators, including but not limited to:

• Fertility and family planning practices
• Maternal and child health, including antenatal care, delivery care, and immunization coverage
• Nutrition status, including stunting, wasting, and anaemia among children and women
• Healthcare access and utilization
• HIV/AIDS prevalence and awareness
• Domestic violence and women's empowerment

Methodology: NFHS-5 follows a rigorous sampling methodology to ensure the representation of different regions, rural-urban areas, and demographic groups across India. Trained field investigators collect data through interviews with eligible respondents using standardized questionnaires. The survey covers a wide range of topics related to health, nutrition, and socio-economic status.

Significance: NFHS-5 provides critical data for policymakers, researchers, and development practitioners to understand the health and demographic landscape of India. The survey findings help identify areas of progress and areas needing intervention in various health and social sectors. By tracking changes over time, NFHS enables evidence-based decision-making and facilitates the formulation and evaluation of health programs and policies.

Utilization: The findings of NFHS-5 are widely used by government agencies, international organizations, NGOs, researchers, and policymakers to:

• Design and implement targeted interventions to address health and social challenges.
• Monitor progress towards national and international development goals, such as Sustainable Development Goals (SDGs).
• Advocate for resource allocation and policy reforms to improve health outcomes and reduce health disparities.
• Generate evidence for academic research, program evaluation, and advocacy efforts in the field of public health and development.

4. India's Health Equity Challenges

India faces significant hurdles in achieving health equity, driven by disparities in healthcare outcomes and access across its large and diverse population. Despite improvements in healthcare access in the last two decades, rural areas still lag. Urban slums, constituting over 17% of metropolitan areas, experience profound health disparities exacerbated by overcrowding, poor sanitation, and limited access to clean water. Infectious diseases, such as tuberculosis, are 1.5 times more prevalent in slums compared to non-slum areas.

Caste and Gender Disparities

Profound disparities persist across caste and gender lines, as evidenced by data from the National Family Health Survey (NFHS)-5. Scheduled Castes and Scheduled Tribes experience higher child mortality rates and lower immunization rates. Additionally, women in the lowest wealth quintile suffer from anaemia at a rate almost double that of women in the highest quintile, highlighting the intersection of caste, gender, and economic status in health outcomes.

Non-Communicable Diseases (NCDs) Burden

Non-communicable diseases (NCDs) account for over 60% of all fatalities in India. The Public Health Foundation of India underscores the urgent need for equitable access to treatment and preventive healthcare to mitigate the economic impact of NCDs, projected to exceed $6 trillion by 2030.

Healthcare Workforce Shortage

A critical shortage of doctors further exacerbates these challenges, with only 0.8 doctors per 1,000 people according to WHO data. While over 75% of healthcare professionals work in metropolitan regions, which house only 27% of the population, rural areas face severe shortages. Broadening the definition to include other medical practitioners may help balance the ratio.

Comprehensive Approach to Health Equity

Addressing India's health equity issues requires a multifaceted approach beyond healthcare facility improvements to tackle broader socioeconomic determinants of health. Collaboration among government, civil society, healthcare providers, and communities is essential.

Government Initiatives

Government initiatives such as Ayushman Bharat, offering free health coverage to the bottom 40% economically, demonstrate a commitment to reducing health disparities. The National Health Mission (NHM), encompassing the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), works to bridge the healthcare gap between rural and urban areas through expanded access, infrastructure strengthening, and essential service provision.

Health Literacy and Community Engagement

Raising health literacy and promoting community-driven goals are vital components of achieving health equity. Integrating health education into the NHM empowers individuals to seek equitable care and make informed health decisions. Public-private partnerships emphasize preventive education, workforce development, and infrastructure enhancement for underprivileged communities.

NGO and International Support

Non-governmental organizations (NGOs) and civil societies engage in direct community outreach to address regional health concerns, often collaborating with international and governmental organizations to tailor culturally sensitive health initiatives. International institutions like WHO, the Global Fund, and Gavi support health initiatives in resource-limited settings, promoting information sharing and resource allocation to strengthen healthcare systems.

Innovation and Research

The commercial sector, charitable organizations, research institutes, and academic institutions contribute to advancing accessibility, affordability, and efficacy in healthcare through innovation and technical growth, particularly in digital health. Research institutions play a crucial role in generating evidence-based practices and policies supported by scientific studies, contributing to reducing health inequalities.

5. Local Organizations

Local organizations play a crucial role in advancing health equity, as they possess a strong presence within their communities and actively engage in all stages of health program implementation, from planning to evaluation. With an in-depth understanding of their community's needs, these organizations ensure the relevance and effectiveness of health initiatives.

Key Characteristics of Successful Collaborations

Successful collaborations, which are essential for achieving health equity, are characterized by open communication, mutual respect, and shared objectives. These collaborations are adaptable to evolving health challenges and community needs, prioritizing community empowerment, knowledge sharing, and capacity building.

Multisectoral Collaboration for Health Equity

Effective collaboration across various sectors, including policymakers, grassroots organizations, healthcare providers, and community leaders, holds the potential to significantly enhance health equity. By working together, these diverse stakeholders can address systemic barriers to healthcare access and contribute to making high-quality healthcare accessible to all, transforming it from a privilege to a shared reality.

6. Conclusion

Achieving health equity requires sustained efforts at both the global and local levels, with a focus on addressing systemic barriers to healthcare access and ensuring that every individual has the opportunity to attain their highest level of health. Only through collective action can we transform the vision of health equity into a tangible reality for all individuals worldwide.