key: cord-1046328-dxd5shdm
authors: Gupta, Harish; Verma, Sudhir K.; Nigam, Nitu; Gautam, Medhavi
title: Health is wealth, but not vice versa
date: 2021-12-27
journal: J Family Med Prim Care
DOI: 10.4103/jfmpc.jfmpc_1616_21
sha: 96f1789713b50d49b2f4d8d321a9dca494b85b3a
doc_id: 1046328
cord_uid: dxd5shdm

nan

"Let hope be the antidote to fear. Let solidarity be the antidote to blame. Let our shared humanity be the antidote to our shared threat."-Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO, March 10, 2020

Vyas et al. [1] assessed repercussions of lockdown on primary health care (services) in India during the COVID-19 pandemic in the July 2021 issue of the journal. They mentioned pre-existing deficiencies in the system, overloading of the services due to deep impact caused by huge waves of the scourge, disruptions of all aspects of normal life, and what options we have as a rescue exercise. In their first paragraph, they wrote that the countries that spend up to 8 to 10% of their gross domestic product on health care services have also succumbed to the COVID-19 crisis, whereas India spends just 1.4% of its GDP on the health care sector and ranks 145 out of 195 countries in providing access to health care services to its people.

The data authors have provided are correct and is a well-known truth. However, what is also relevant here is that the health care outcomes do not necessarily have a linear correlation with monetary spending on a curve. The prime example in this context has been the United States of America (USA). The country spends the maximum amount in absolute terms on the management of the health of its people but lags severely behind in the pack with other nations that spend a comparable amount. [2] The reason is that outcomes are dependent not only on curative services but also on preventive ones. The preventive and promotive services consume astoundingly less amount to produce a similar effect on the health of a society. Hence, what emerges is that although there is no magical proportion of a nation's GDP that needs to be spent to produce the maximum benefit, wise utilization of finances is as well-or perhaps a more-important factor to achieve the desired goal.

Under the heading, "Problem Statement," the authors emphasized in the second paragraph that the Executive Director of Population Foundation of India showed concern that if there will be restricted (provision of) maternal and child health care (services), it will lead to a rise in unmet needs for contraception and unsafe abortions. However, the data obtained afterward did not confirm this fear. A report by the World Economic Forum indicates that in many countries, COVID-19 has suppressed population growth by causing a decline in births (and migration and life expectancy). [3] The fact of the matter is that when families witness mayhem caused due to pandemic around, visualize gory images of several pyres burning together, a long waiting list not only at hospitals but also at crematoriums [4] , and devastation that is unfolding at an unprecedented scale, they may decide to postpone their planned pregnancy because in their assessment antenatal services may not be available to a group who is in no position to exercise some decision making capacity.

Hence, at least two competing factors may be operating there, which may antagonize each other. Although the unmet need for contraception may have an effect to increase the population in near future, the conscious decision of others to postpone the pregnancy may have an opposite effect. Ultimately which factor, or other factors, have a larger effect size, perhaps we may know only retrospectively as several births go unregistered, and it is more likely to happen when more home deliveries are occurring than institutional ones. [5] Regarding the rise in unsafe abortions in India, again two competing forces operate concurrently. One of the factors that limits access to safe abortion services is that the Medical Termination of Pregnancy Act 1971 limits the duration of pregnancy when a woman could undergo the procedure legally. However, in March this year, the barrier was removed by our lawmakers and now the access to safe and legal abortion services on therapeutic, eugenic, humanitarian, and social grounds is widened. This amended law-The Medical Termination of Pregnancy (Amendment) Act 2021-is likely to reduce the prevalence of the potentially septic practice although the ongoing pandemic may be presenting its own set of challenges. [6] What we need to learn is that in real life, several factors operate concurrently many times to affect an outcome of interest and we should count each one of these to make better predictions and should look at these medical issues from other angles as well.

Repercussions of lockdown on primary health care in India during COVID 19

We can do better--improving the health of the American people

Birthrates are declining globally -here's why it matters

At India's funeral pyres, Covid sunders the rites of grief

Deaths up in city, birth certificates issued fall sharply. Times of India

World Health Organization. India's amended law makes abortion safer and more accessible

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