Why experts support ‘Lancet’ editorial slamming Modi government’s fear of health data

The ability to make informed decisions at the polls has been compromised when voters lack access to reliable information about the outcomes of government policies, the journal said.

ByChetana Belagere

Published Apr 13, 2024 | 2:56 PMUpdatedApr 13, 2024 | 8:45 PM

The journal highlighted the abysmally low government spending on health — just 1.2% of GDP — and the high out-of-pocket expenses that continue to burden individuals.

Several Indian medical experts have been asking the questions — and they received a shot in the arm when the prestigious journal, The Lancet, raised them in an editorial in its 13 April edition.

The peer-reviewed medical journal succinctly put the questions across its cover: “Why is the (Indian) Government so afraid of showing the real state of health? And more importantly, how does the Government intend to measure progress when there are no data?”

The questions raised ahead of the general elections stirred a hornet’s nest in India. Several doctors, policymakers, and other stakeholders took to social media, responding to the editorial.

Many of them appreciated the journal’s “daring” editorial, highlighting the concerning state of healthcare and obscure data in India under the Modi government.

Some others felt the editorial was “unrelated to science and lacked objectivity”.

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Inadequate spending

Stakeholders who took part in the social media debate that followed underlined the need for a broader consensus on openness and accurate data in governance.

The journal highlighted the abysmally low government spending on health — just 1.2% of GDP — and the high out-of-pocket expenses that continue to burden individuals.

The strongly-worded editorial identified the challenges health professions have been facing routinely. The leader article’s emphasis on failed initiatives in primary healthcare and universal health coverage resonated with their firsthand experiences of systemic failings in delivering essential services to those in need.

“…Under Modi’s leadership, India has seen a remarkable, albeit unequal, economic boom. The economy is worth US$3·7 trillion and is expected to overtake Japan and Germany to become the third-largest economy in the world in the next three years,” the journal said.

Then came the downside. “However, when it comes to health, there is quite a different story to tell of the Modi Government,” it added.

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Data matters

It minced no words in saying that healthcare under Modi fared poorly, as described in the World Report.

The editorial also stressed the importance of accurate and timely health data, which has been lacking in India. For policymakers and economists, such incomplete data presented significant hurdles in planning and assessing the effectiveness of various health and economic policies.

The delay in census operations and the lack of clarity on critical health surveys hindered India’s ability to measure progress against national and global benchmarks.

“Persistent inequity in both access to and quality of healthcare are well recognised. But a major obstacle that India also faces, which many Indians might be unaware of, relates to health data and a lack of data transparency,” the editorial proclaimed.

“Accurate and up-to-date data are essential for health policy, planning, and management, but the collection and publication of such data in India have undergone serious setbacks and impediments,” it further said.

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Delayed census

The journal also spoke about the drawback of the delay in conducting the decadal census.

“For the first time in 150 years, a whole decade has gone by with no official comprehensive data on India or its people. A promise that the next census will be an electronic survey carried out in 2024 is yet to be fulfilled. The census is also the basis for all national and state-level health surveys,” the editorial said.

It also spoke about how the lack of data transparency would be detrimental to the democratic process itself. The ability to make informed decisions at the polls has been compromised when voters lack access to reliable information about the outcomes of government policies.

“The unpublished 2021 Civil Registration report would help to either confirm or refute the Government’s estimate. Publication of results from the latest Sample Registration System survey and the Million Death Study could address the major questions around
changes in mortality during 2020–21,” The Lancet opined.

“It would also provide updated evidence on potentially good news, such as ongoing declines in cancer, suicide, and child mortality,” it added.

The leader writer then questioned the dispensation at the Centre.

“Why is the Government so afraid of showing the real state of health? And more importantly, how does the Government intend to measure progress when there are no data? Without access to recent and reliable data, democratic choices are impoverished,” it contended.

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A must-read

Epidemiologist and researcher Dr Mamta Gupta said she has been expressing the same views. “The editorial published in Lancet has truly expressed my views. Punjabi mei bolte hain, “Thand Pai Gaye!!” Must-read editorial,” she said on LinkedIn, republishing her previous comment on the topic.

“NFHS (National Family Health Survey) data was suspended on 30th July, Census not done. Report on Civil Registration System delayed by three months!! Is it not an attempt towards prevailing the ‘scandal of invisibility’???? How conveniently the governments are bypassing their duties!!,” she exclaimed.

Public health activist Akhila Vasan subscribed to The Lancet‘s view on data forming the basis for health planning and programming. The lack of timely data caused immense harm to citizens.

“When we know that two-thirds of the women in the reproductive age group are anemic, the government’s decision not to gather data on anemia is going to reverse all the gains we made in reducing MMR, NMR, and IMR,” she told South First.

“It is India’s misfortune that the current political dispensation is only keen on divisive and hate politics. It has no concern for the well-being of the most marginalised and the vulnerable,” she added.

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Will go with the wind!

A public health doctor, Dr Sylvia Karpagam, felt The Lancet warning would soon disappear like many others.

“The government is hell-bent on doing away with any incriminating evidence. Rather than follow the arduous and often unflattering (to itself) path of having good quality data, the government is doing its best to avoid national data collection and dismiss any existing data,” she said.

Dr Karpagam felt that if the government had invested in the well-being of the country post-Covid, it would have conducted a survey to assess the degree of damage caused by the pandemic, and what should be done to prevent its recurrence in the future.

Citing instances of multitudes losing access to livelihood and education during and post-Covid she said, “Covid as well as non-Covid related health issues should be estimated. Instead, the government has been punishing anyone showing it in poor light.”

She referred to the Minister of Women and Child Development Smriti Irani dismissing data on hunger and malnutrition. “This is concerning because we can no longer have evidence-based planning,” she expressed her concern.

Dr Karpagam advocated identifying problems and putting in adequate resources as the first step to good healthcare.

“The government makes tall promises in its Budget speeches but they are left unfulfilled. We need to hold the government accountable for ensuring accurate and timely data, making data-based plans, and be open to monitoring and evaluation,” she said.

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Hampered policymaking

Dr Shakeeb Ahmed Khan, an independent consultant in disability and inclusion, stressed the need for conducting the decadal census.

The census data formed the cornerstone for the fair distribution of resources, infrastructure, and public amenities.

“Through the precise depiction of the population’s size, attributes, and requirements, census data guides decisions on resource allocation at national, regional, and local levels, ensuring optimal utilisation for maximum impact,” Dr Khan said.

“It would also help in policymaking and programme evaluation, furnishing policymakers with the evidence needed to gauge the efficacy of current policies and initiatives. In the absence of data, planning would get affected and hinder resource allocations,” Dr Khan added.

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The KS James experience

A renowned doctor who did not want to be named recalled the suspension and resignation of Professor KS James, former director of the International Institute of Population Sciences (IIPS).

“Prof. KS James, the country’s foremost researcher in the field of population studies, was asked to resign solely because he refused to compromise on the data collected during the NFHS-6 survey,” the doctor said.

“The survey, which influences India’s health policy, provides data on the success of the Union government’s health, welfare, and nutrition schemes. The government, not wanting this interference, first suspended him (James) on some allegations and then made him resign,” he added.

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The grey areas

Indian Medical Association Telangana chapter’s Dr Kiran Madhala was blunt.

“India is leading in malnutrition (stunting and wasting) at 3rd place among world countries; we are at 36th place among 194 countries in hypertension; we are in 100th place among 180 countries lacking physical activity; we top the world in tuberculosis, we are second in hepatitis B and C cases,” he explained where India has been standing.

Adding to the list, Dr Kiran said India ranked 140 among 190 countries in health expenditure and the government’s health expenditure was still one percent of the GDP, below the world average of 5.8 percent.

Quoting Parliament reports, he said people sold properties or raised loans to get medical treatment.

“Around 30-40 percent of inpatient care in India was financed by the sale of property and loans. While 20 to 28 percent of diseases in India were left untreated due to the lack of finances,” he said.

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Questioning the questions

Dr Cyriac Abby Philips aka TheLiverDoc was sarcastic. “Stop it Lancet,” he said on X. “We have our own grading system and we are number one in every aspect of health,” he added.

Replying, a user with the handle @PBNMC1964 suggested starting from the basics. “Do we even have reliable data on the number of doctors practicing in India,” the user questioned.

Several posts criticised The Lancet editorial. Gastroenterologist Dr Ashish Kumar wondered whether it was peer-reviewed.

“Why are there no citations and references to back their claims? Which WHO article have they cited to claim excess Covid deaths? Who is the author of this opinion piece,” he asked.

Editorials are normally unsigned and seldom carry bylines since they reflect the opinion of the publication.

(Edited by Majnu Babu).