Household expenditure has increased over the years. What’s its impact on health?

The National Sample Survey Office (NSSO) under the Ministry of Statistics and Programme Implementation conducted the survey on household consumption expenditure, which aims to generate estimates of household Monthly Per Capita Consumption Expenditure (MPCE) and its distribution separately for the rural and urban sectors of the country, for states and Union Territories (UTs), and for different socio-economic groups.

In the country, out of ₹100, rural households spend ₹46.38 on food items and ₹53.62 on non-food items. Meanwhile, urban households spend ₹39.17 on food items while ₹60.83 on non-food items.

In 1999-2000, the spending pattern in rural households reflected a division of 59.40 percent on food and 40.60 percent on non-food items, while urban households allocated 48.06 percent to food and 51.94 percent to non-food items.

According to the HCES, a significant shift has occurred over time, with both rural and urban areas witnessing a notable transition from food to non-food expenditures.

This shift has introduced another dimension — a surge in expenditure on beverages and non-processed food.

In 1999-2000, rural residents allocated a mere 4.19 percent of their total expenditure to beverages and processed food, a figure that escalated to 9.62 percent in 2022-23.

In urban settings, the corresponding increase has been from 6.35 percent to 10.64 percent over the same period.

This uptick in spending on beverages and processed food, which encompasses purchased cooked meals, is causing alarms to go off among healthcare professionals and experts. They view it as an alarming trend, indicative of a shift towards an unhealthy lifestyle among the population.

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Expenditure on non-food items

Rural MPCE over the years. (MOSPI)

The observed trend indicates a notable shift towards an increase in spending on non-food items.

“Interestingly, within the realm of food items, the healthier options seem to be decreasing, while there is a significant rise in the consumption of beverages and processed foods, nearly tripling over the span of 23 years from 1999-00 to 2023,” Indian Medical Association Telangana unit spokesperson Dr Kiran Madala told South First.

“In 2000, healthier food options constituted 52 percent of the bought food, but this has now declined to almost 34 percent. This signifies a substantial decrease in people opting for healthier food choices,” he added.

In terms of expenditure, nearly every second rupee in 2000 was spent on healthier food options, but this has reduced significantly to one-third. Consequently, out of a total expenditure of ₹3, only ₹1 is now allocated to healthier food choices.

He pointed out that the connection between changing consumptive behaviour and health expenses, it’s plausible that alterations in food habits may be influencing health costs.

The expenditure on medical hospitalisation in rural areas, in 1999-2000 was 1.37 percent, which witnessed an increase to 2.36 percent in 2022-23.

For medical non-hospitalisation, the expenditure was 4.72 percent in 1999-2000, which saw a slight uptick to 4.77 percent in 2022-23.

In urban areas, medical hospitalisation expenditure stood at 1.44 percent in 1999-2000, which rose to 1.91 percent in 2022-23. Medical non-hospitalisation expenditure in 1999-2000 was 3.62 percent, but increased to 4 percent in 2022-23.

“This is particularly evident when analysing non-hospitalisation costs, such as outpatient (OP) services. Non-hospitalisation costs, which cover expenses for treatments on an outpatient basis, seem to be on the rise, possibly indicating an increase in lifestyle-related diseases that can be addressed through OP services,” said Madala.

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Food expenditure

Urban MPCE over the years. (MOSPI)

Senior interventional cardiologist and Pulse Heart Centre Managing Director Dr SS Mukharjee Madivada pointed out that there was a noticeable trend of increased spending on processed foods and beverages among people nowadays, posing a definite risk to their health.

“People are spending approximately 45-46 percent on food items, leaving the rest for non-food expenditures. Within the 45 percent dedicated to food expenditures, at least 10 percent is allocated to processed foods. It is crucial to understand this breakdown, revealing a high level of consumption that has notably increased over the past decade,” Madivada told South First.

“The percentage-wise surge in processed food consumption suggests not only its increased availability but also its enhanced accessibility,” he added.

He said that this surge in processed food consumption was linked to the alarming rise in non-communicable diseases (NCDs), as indicated by recent surveys.

Notably, diabetes has surged by almost 30 percent from before to after the Covid-19 pandemic, emphasising the concerning growth in NCDs.

The correlation between this increase and the rise in fast food and beverage consumption was evident.

“This phenomenon is particularly noteworthy in rural areas, where the consumption of fast food is unexpectedly high. Despite initial assumptions that rural consumption might be lower than consumption in urban areas, the report reveals that rural consumption of fast food is nearly on par with urban areas,” noted Madivada.

“This trend raises concerns due to the potential challenges it poses. Limited access to preventive healthcare in rural areas, coupled with a growing consumption of fast foods, can present a significant challenge for government health initiatives,” he added.

He also pointed out that the increasing prevalence of metabolic syndrome, characterised by insulin resistance, obesity, and hypertension, further underscored the potential health risks associated with the surge in processed food and beverage consumption.

Surprisingly, the medical expenditure, both in terms of hospitalisation and non-hospitalisation, appeared to be quite similar in both rural and urban areas, indicating that there was no significant difference between the two. This finding challenged the assumption that rural areas might have lower healthcare expenditures.

“The expenditure in rural areas is approximately 2.5 percent for hospitalisation and around 4 percent for non-hospitalisation, suggesting that healthcare expenses are on the rise in rural regions as well. The increase in NCDs is evident, contributing to the growing healthcare costs in both rural and urban settings,” said Madivada.

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Tobacco consumption

In rural areas, the expenditure on pan, tobacco, and intoxicants led to 2.87 percent of the total expenditure in 1999-2000, witnessing an increase to 3.79 percent in 2022-23.

In urban areas, consumption of pan, tobacco and intoxicants led to 1.9 percent of the total expenditure, which rose to 2.43 percent in 2022-23.

“It’s intriguing to note that, contrary to common belief, it’s not just hospitalisations that push people below the poverty line. According to a comprehensive survey conducted on 9 lakh people, tobacco and pan consumption expenses surpass hospitalisation expenditures,” said Madivada.

“This data sheds light on the priorities people are assigning to their healthcare, emphasising the significant expenditure on habits like tobacco and pan, potentially impacting overall health and financial well-being,” he noted.

“Understanding the exact relationship between increased healthcare expenses, especially in rural areas, and the consumption patterns will require further analysis over the coming years,” said Madivada.

“The significant increase to 3.79 percent in rural areas in pan consumption expenditure could indeed be connected to changing lifestyles, impacting the overall health scenario,” said Madala.

“One out of every eight rupees is now allocated towards processed food, pan, tobacco, intoxication, and beverages, marking an increase from one in every 14 rupees over the course of 23 years,” he added.

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The changing system of consumption

IMA Kerala’s public health advisory panel member Dr Rajeev Jayadevan said that this increase in consumption expenditure on tobacco and similar substances was possibly influenced by aggressive advertising.

He explained that the shift in consumption of processed food alongside durable goods, such as televisions and luxury or electronic items, underscored a shift in consumer behaviour.

“Two perspectives emerge regarding this rise in processed food expenditure. Firstly, it could signify economic progress and increased advertising, allowing individuals to indulge in snacks, order delivered food, or dine out – activities typically more expensive than home cooking. Secondly, there might be a shift in the workforce, with more women employed outside the home now compared to 15 or 20 years ago. Modern families could be leaning towards processed and ready-made foods for convenience and also because they could afford it,” Jayadevan told South First.

He pointed out that this called for a closer examination of the shrinking nuclear family structure, work responsibilities, and their evolution with economic progress — a well-documented phenomenon with various stages.

“Early economic progress in a country might lead to an initial decline in the female labour force as they were mainly involved as agricultural labourers. As financial stability is achieved, more women are able to stay at home and take care of the entire family. Subsequent stages involve increased education, employment opportunities, and urban migration, prompting more women to join the workforce predominantly doing desk jobs. This is described as a J-curve with a decline in women employment rates in the middle and subsequent rise,” he said.

Now, the country is navigating through this phase “where we have to look at the role of women in the workforce, changes in their job profiles, and the percentage engaged in office jobs versus those unable to spend time at home”, he said.

“These trends point towards evolving family structures, job descriptions, and economic situations. Another notable observation is the increase in spending on conveyance, a trend I personally witnessed,” noted Jayadevan.

“Also, the spending on conveyance is increasing. Women who used to incorporate more steps into their daily routines — such as walking to nearby bus stops and taking public transportation to work — have shifted to using their own two-wheelers,” he said.

“This shift has resulted in a decrease in their step count, leading to adverse effects on their health in two aspects,” he noted.

“Firstly, it contributes to the rise of NCDs, as highlighted in reports on increased abdominal obesity among women in India, with Kerala topping the list,” said Jayadevan.

“A study on the percentage of women with abdominal obesity, specifically fat accumulation around the belly area, reveals that 65 percent of women below the age of 50 in Kerala are affected. Other states, including Tamil Nadu, also approach similar statistics, while Madhya Pradesh appears to have lower rates of abdominal obesity among young women,” he added.

These trends strongly indicate the impact of changes in the women workforce on various health factors, including decreased physical activity, increased BMI, reliance on processed foods, and a preference for eating out — often involving oil-fried and salty street food.

This lifestyle, characterised by decreased exercise and poor dietary choices, is undoubtedly unfavourable.

Jayadevan also pointed out that the spending on salt and sugar has paradoxically decreased, possibly indicating heightened awareness of their negative health effects or a reduction in kitchen use.