PassageTo

India

Jane Jue

Dept of Medicine

• 1,128,000,000 est population – (Second only to China, 1/6 of

world pop)

• Two thousand ethnic groups• 22 official languages – Hindi

most widely spoken• 82% Hindu (Muslim12%,

Sikh2%, Jain0.4%, Christian2%, Buddhists0.8%)

• Caste system – occupational and socio-religious hierarchies– Unequal social mobilization

and uneven economic growth

            

                  Breakup of India's religions: ██ Hinduism — 90.5% ██ Islam — 3.8% ██ Christianity — 2.3% ██ Sikhism — 1.9% ██ Buddhism, Jainism, others — 1.5%

Chaos

Vital Statistics

• Population 1.1 billion• Population growth rate: 1.38% (2006 est.)• Birth rate: 22.01 births/1,000 population (2006 est.)• Death rate: 8.18 deaths/1,000 population (2006 est.)• literacy rate: 79.9%• Percent of the population under the poverty line:

22%(2006 est.)• Unemployment Rate: 9.2%• Infant mortality rate: total: 54.63 deaths/1,000 live births • Life expectancy at birth:total population: 64.71 years• Gross national income per capita: $3,460

· Iron Age Kingdoms · 1200–700 BC

Maha Janapadas 700–300 BC

Magadha 1700 BC–550 AD

· Maurya Dynasty · 321–184 BC

Middle Kingdoms 230 BC–1279 AD

· Satavahana Empire · 230 BC–199 AD

· Kushan Empire · 60–240 AD

· Gupta Empire · 240–550

· Pala Empire · 750–1174

· Chola Empire · 848–1279

Islamic Sultanates 1206–1596

· Delhi Sultanate · 1206–1526

· Deccan Sultanates · 1490–1596

Hoysala Empire 1040–1346

Kakatiya Empire 1083–1323

Vijayanagara Empire 1336–1565

Mughal Era 1526–1707

Maratha Empire 1674–1818

Sikh Empire 1799–1849

Colonial Era 1757–1947

Modern States 1947 onwards

• India independent since 1947, after 150 yrs of rule by England– English put in much infrastructure (railroads, schools, roads,

health care system).

• Republic of India – collectively 29 states (elected gov’t) and 6 union territories (appointed administrator).

• Type of government – descriptions found in the Preamble “Sovereign,” “Socialist,” “Secular,” “Democratic,” “Republic”

• Central and State governments – similar division of power

Government

• Hospitals – 18,218 - 75% private – adds to social barriers• Healthcare spending by government is 6% of GDP. • Government covers 18% of healthcare costs, 72% out of

pocket• 1.25 million doctors (1:1800 people)• Medical tourism – Saudi Arabia & England• Religious and magical cures through priests and other

religious institutions, herbal and home remedies.• Strong pharmaceutical production with large proportion of

exportation

Healthcare

Barriers• Environmental factors – sanitation and safe drinking water,

toilet facilities, electricity

• BARRIERS TO ACCESS – Geography - Unequal distribution of resources- lower in rural

areas

– Socio-economic - Disparity in quality of care (public vs private hospitals)

– GENDER - Inequality of women • Patriarical society• 2/3 are illiterate

Disease Burden• Environmental factors – Higher burden of infectious diseases

• TB – 14 million cases• Malaria 2 million cases• HIV – 4 million• Leprosy

• Major causes of death:– Infectious diseases (TB, malaria, HIV)

– Cardiovascular disease (ischemic heart and stroke)

– Injury (1/3 suicide)

• Children:• Polio• Malnutrition• HIV

• December 2004 Tsunami struck southeast coast

HIV/AIDS

- Estimated 2.2-7.6 million cases

-Stigma is major barrier

- ARV’s available, but not affordable to common

- little research being done

- lack of funding

BBH

HIV testing at Bangalore Baptist Hospital in 2003-2006

Year Tot #

HIV test

HIV test Outpt

% OP HIV test

Total # HIV +

% HIV+ of tot tested

% HIV + dx from OP

2003 4415 2033 46% 59 1.34% 49%

2004 4491 2275 50% 77 1.7% 55%

2005 4680 2071 44% 106 2.3% 63%

2006 4107 2248 55% 87 2.1% 68%

EBM

HIV KAP

Ethics

Future opportunities