From ‘healthcure’ to healthcare: why a single pill will not work in India.
The thing about healthcare is that it’s personal. We are all part of this giant, complex, healthcare machinery of our country and we need it to work for our families and for us.
For the most part, health is a fairly uncomplaining creature. It keeps us alive through all that we put it through, knowingly and unknowingly. When it does complain however, it has many voices, many diseases, many causes - some individual, some collective, some silent and some screaming out loud in pain. There is no single pill we can swallow that can bring a miracle solution to our own and our country’s healthcare gaps.
There is a pattern to the diseases we face, and it is rapidly evolving. We are more likely to stay one step ahead of emerging disease patterns only through deep, sustained innovation and collaboration.
A very pronounced shift in disease patterns
Over the last 26 years, disease patterns have undergone a dramatic shift across the country. Back in the 1990s, over half of the deaths were from communicable, maternal, neonatal, and nutritional diseases such as anaemia, tuberculosis, and diarrhoea. Although they have reduced over time, but they still account for about one-third of all deaths in the country.
On the other hand, there is an increasing incidence of non-communicable diseases. More than 50 percent of our population is at the risk of dying from heart diseases, obesity, cancer and diabetes. An increase of 25 percent in as many years.
These diseases result in significant lifestyle changes and require very different forms of treatment, care and adherence. With ageing population, increasing urbanisation and sedentary lifestyle this situation is only going to get worse putting an enormous burden on an already stretched system.
The cost of treating communicable diseases in a majority of cases is not high and results in one-time expenditure centred around specific incidence.
However, the cost and complexity of managing chronic diseases is very high resulting in abysmal screening and very poor adherence. For example, the recommended protocol for screening of Type 1 and 2 Diabetes is two-three times a day and three-four times a week respectively as against our national average of 70 days plus per test.
Negligible screening and low adherence for diabetic patients is likely to result in higher probability of kidney failure. Unless we make screening more affordable and accessible, higher proportion of patients are likely to go through more serious conditions during later years with lot of stress for families along with ruinous financial burden.
We need to do a lot more to prepare our people and healthcare system for this shift from nutritional deficiencies and communicable diseases to non-communicable diseases.
Increasing diversity of causes and diseases
It’s easy to say that the overall health profile of our country has tilted more towards non-communicable diseases. But when we dig deeper, we find some diseases that continue to remain deadly.
It seems astonishing that seemingly common problems like diarrhoea and respiratory infections have caused over 20 percent of deaths in India as recently as 1990!
Today heart and pulmonary diseases have emerged as the new silent killers. What is noteworthy is that diarrhoea and respiratory infections are still there, as third and fourth highest killers!
Most public policies, programmes and philanthropic funding are largely focused on disease pattern identified decades ago. However, increasing divergence is emerging in the causes, incidence and patterns of diseases. Public programmes are unlikely to evolve at that pace. Financial and human resources are insufficient for multi-pronged approach necessary to address so many different diseases.
Living longer, living sicker: disease diversity by levels
The fact is, we live longer today. Our life expectancy has improved by around 10 years since 1990. From 60 to 70 years for women, and from 58 to 67 years for men. Of course, there are huge variations due to unparalleled ethnic, genetic, geographic and socio-economic diversity that exists is in our country.
Each state has its own health profile that needs specific interventions. Southern states rank much higher in terms of life expectancy, but the prevalence of non-communicable diseases is disturbingly high. Northern states need to fast gear up for a multi-front war against nutritional, communicable and non-communicable diseases. Most states have enough diversity to understand pattern by districts and create targeted interventions.
There are clear gender variations. Many women suffer from nutritional deficiencies and pre-term birth complications while diabetes and accidents claim more men. Extremes of nutritional health showing up in the same family is increasingly common today with one person suffering from diabetes and another suffering from malnutrition.
With increased urbanisation and lifestyle changes, correlation of diseases with economic status is reducing. Air pollution, poor quality of drinking water, ground water contamination and adulterated food are affecting everyone, irrespective of economic status. We all are susceptible to them.
The key questions to ask today are – how many diseases are fatal, needing emergency treatment and cure? Can we prevent the obvious sicknesses and diseases? Will prevention help us live longer and healthier?
Building on our strengths to bring the “care” back in healthcare
We are leaders in generic drugs, medical tourism, and information technology. We have created a formidable unique identification platform. Much improved telecom infrastructure and data availability is helping rapid technology adoption. The pace of innovation and entrepreneurship has accelerated. Overall funding and support eco-system is getting deeper.
How can we use these strengths to deliver difficult trinity of increased access to high quality healthcare at an affordable cost to a large underserved population? Medical emergencies are expensive for everyone but catastrophic for those from lower economic strata.
Poor people spend years pulling themselves out of poverty in the hope that their children can enjoy a better quality of life and better health but out-of-pocket expenses for one single medical emergency can put them right back in a spiral of debt. Insurance penetration and government spending on healthcare remains low and is unlikely to increase overnight causing continued shortage of resources and infrastructure.
The irony is we call it 'healthcare’. But how do we get to the care when 100 percent cure is not possible once many of these diseases are triggered? The answer lies in the name - Health CARE. Preventive, point-of-care, portable, accurate diagnostics and affordable effective treatment might be an answer to trigger this difficult trinity of access, quality and cost.
Over the last seven years, we have had the opportunity to collaborate with many committed entrepreneurs. Everyone gets overwhelmed at the gaps and obstacles in the system. It is amazing to see them persevere with so much passion and continue to innovate and develop preventive care solutions despite the hindrances. We still have a long way to go before we get anywhere close to creating meaningful impact at large enough scale.
We need preventive healthcare
Solution lies in early point-of-care diagnosis that trigger and connect with treatment protocol before irreversible condition develops or a disease becomes fatal. We have invested in and supported entrepreneurs spanning the whole spectrum of communicable, maternal, neonatal, nutritional and non-communicable diseases.
Collaboration, not just products
Brilliant diagnostic products alone cannot make a difference. The products need to reach underserved population. Caregivers need to be trained and incentivized to use technology. This often requires long-term perspective and behaviour change. We may not want to know we are sick unless we are too sick.
Entrepreneurs with limited resources cannot do this alone. Funding from investors and their network can only go so far. Government and corporate collaboration is critical. In some areas CSR funds are required to show change at a small level through well-structured pilots before wider adoption.
Distribution and market expertise will help commercialize and scale faster as most of the entrepreneurs are from engineering and clinical background with limited market understanding.
Imagine if every healthcare and pharmaceutical company collaborates with at least one healthcare focused impact start-up trying to reduce the burden of these diseases, how much faster could we progress?
The data pill
Healthtech is a much-abused term. We believe that data and technology can go far beyond than just creating apps to collect information or schedule appointments. The real magic of data lies in harnessing the increasing power of cloud connectivity, geo connectivity and Aadhaar to meaningfully analyse the disease pattern by villages districts and states. That will help create specific, targeted public health campaigns and more efficient use of scarce resources. That is when real change will happen.
Now, more than ever, we need diagnostic and preventive care innovations in non-communicable diseases such as pulmonary, cardiovascular, glucose and oncology care and in communicable diseases.
Now more than ever we need collaboration with large companies and government. Twenty years from now, when we draw the ‘death from diseases’ graph again, we all want to see change. Real, positive change. Because each of us will be living that change in our lives.
We at Villgro and Menterra look forward to hearing from such innovative entrepreneurs and partners who are working towards a better, healthier India.