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Stanford journalist returns to old post in India – and finds health care still lagging

Three Stanford seniors and a second-year School of Medicine student spent their summer investigating India’s complicated health-care system — and I got to go along for part of the ride.

It had been a decade since I’d been back to India. I was the South Asia bureau chief for The Associated Press from 2000 to 2005, based in New Delhi. It was among the best assignments of my life.

The posting took me from the Himalayas to the valley of Kashmir, from the deserts of Rajasthan to the lush tea plantations of Sri Lanka. I traveled across Bangladesh with the director of the CDC to document the world’s last push against polio. I wrote about the medical horrors that still plagued those in Bhopal who had been poisoned by gas 20 years before.

And now I was back, this time as a journalist for Stanford Health Policy, comprised of the Center for Health Policy/Center for Primary Care and Outcomes Research and the Department of Medicine.

As I wrote in this story about the student’s research among the poor communities on the outskirts of Mumbai: India is a land of extremes.

I found that little had changed, on the surface, for the rich and the poor. The wealthy still live lavishly, which the students saw for themselves as they looked up at a billion-dollar home in the heart of Mumbai. And the poor remain among the unhealthiest in the world, as witnessed by the students who spent seven weeks in Mumbai’s surrounding slums.

The fellows of the Stanford India Health Policy Initiative ­— directed by Grant Miller, MD — talked with more than 100 patients and doctors, pharmacists and traditional health providers. They are charged with synthesizing their findings and providing a detailed analysis for their Indian partners, who are pushing for significant health policy improvements in their country.

Only 1.3 percent of India’s GDP was devoted to public health in 2014, according to the World Bank, and India still accounts for 21 percent of the world’s burden of disease. Most of the cost of health care falls to the patient in India, where 86 percent of the 1.2 billion must pay for health care and medications out of their own pockets, or through taxes and premiums. And then they often turn to services delivered by untrained, informal practitioners.

“I’m just trying to think about how some of this great prosperity can be applied to the health problems that are affecting some of the most disadvantaged members of Indian society,” said one of the fellows, Mark Walsh, an economics major just starting his senior year.

Poverty remains status quo for more than one-fifth of the world’s largest democracy, though the rate has dropped significantly, from 35 percent in 2001 to 20 percent in 2011. The middle-class continues to bounce up and down, along with the country’s rollercoaster economy.

Many analysts estimate that if India continues to grow at its current pace, average household incomes will triple over the next decade, making it the world’s fifth-largest consumer economy by 2025.

Some of the Indian friends I visited on a side trip to New Delhi appeared to back up those predictions. One friend has unwittingly become a millionaire as his family’s property value went sky high; another no longer takes an auto-rickshaw to work, but drives a foreign car and has just bought her own condo.

Houses in the neighborhood where I once rented a ground floor flat for $1,900 a month are now selling for tens of millions of dollars.

But no matter how well my middle-class friends — mostly journalists, and tech and service professionals — were faring, they all had the same key complaints: They had lousy or no health insurance, and the medical care that they could afford in the nation’s capital was lacking.

One had a sister who died from a brain tumor that had gone undetected; many were using their savings to help extended family members suffering from chronic diseases such as diabetes and hypertension. My flamboyant former yoga instructor — who once made a very good living catering to expats — had to sell his flat and move out of the city to pay for treatment of a serious illness. He has no health insurance.

“I’m now broke and alone,” he choked on the phone when he called to say he was too weak to come into the city and join me for tea.

These are the issues the fellows of the India Health Policy Initiative are tackling. And it’s an honor to be able to tell their story — as I like to believe their work could one day help the families of my friends.

Beth Duff-Brown is communications manager for the Center for Health Policy and Center for Primary and Outcomes Research (CHP/PCOR).

Previously: Stanford India Health Policy Initiative fellows are in Mumbai – come follow along
Video courtesy of CHP/PCOR

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