A healthy workforce is the backbone of an economy. No wonder Japan has an integrated ministry of health, labour and welfare’. On the other hand, our public health systems continue to focus on maternal and child health, hence we have a ministry of health and family welfare, despite the fact that 39% of deaths happened in the working-age population (15-64 years) compared to 15% among children aged 0-4 years during 2010-15. There should be zero tolerance for child deaths and they should be prioritised from an equity perspective. Nevertheless, health systems should also contribute to economic efficiency, especially in a country like India where public welfare support is limited and the dependent population (0-14 and 65+ years) is dependent on working members of the family. From this perspective, the health and welfare of our country’s workforce is critical not only for the health of the economy, but also for a family’s welfare and poverty reduction. The ministry of health would contribute better to family welfare if it starts focusing on the health of India’s workforce. It should be fully supported by ministries of finance and labour and employment.
But, what exactly ails India’s workforce? Death rate in our working-age population is catastrophic—during 2010-15, there were 19 million deaths in this age-group, not only more than China’s 13 million, but also the highest in the world. As part of our SDG commitment under, along with maternal and child mortality, we are obliged to reduce, by one-third, mortality due to non-communicable diseases (NCDs) among those aged 30-70 years until 2030. While NCDs accounted for 58% of deaths among the workforce, 23% also happened due to communicable diseases (CDs) and another 19% due to injuries in 2013. Therefore, Indian policymakers should not only aim at one-third reduction in NCD mortality, but similar levels of reductions in mortality due to CDs and injuries. Within NCDs, they should look out for six diseases in particular—cardiovascular diseases, cancers, chronic respiratory diseases, digestive diseases, cirrhosis as well as diabetes, urogenital, blood and endocrine diseases. Cardiovascular diseases are the primary reason for most deaths and that too by a huge margin, especially among males. In CDs, HIV/AIDS and tuberculosis should be of special concern since they account for more than half of CD-related workforce deaths. Moreover, we have to focus on transport and unintentional injuries caused due to fire, drowning and falls.
The health of survivors in the workforce isn’t great either—India lost 96 million years in 2013 due to disability caused by health conditions, second only to China’s 103 million. Earlier this month, Chinese president Xi Jinping ‘placed health at the heart of all policy making and called for full protection of every citizen’s health’ (The Lancet). I don’t think one could suggest this to any influential Indian policymaker or advisor without inviting contempt. If things stand where they are, the day is not far when we will overtake China in terms of disability, as we will in population. We can avoid such a scenario if we focus only on five disease areas that cause 75% of the disability in India’s workforce—all from the NCD category. Mental health, especially depression and anxiety, is one of the more serious concerns. Not just the policymakers, but society in general has to admit and deal with this challenge on a priority basis—we can no longer afford to ignore or hide it. Among musculoskeletal disorders, low back and neck pain is the biggest problem. Anyone who has experienced it even briefly—and there are too many of us now, even in the 20s—knows how disruptive it could be to one’s functionality. Neurological disorders, especially migraine, among females in particular, is another irritant that undermines our confidence and constantly pushes us to under-perform. Thankfully, there has been some focus on diabetes and respiratory diseases recently, but more than half of the disability in our workforce is due to factors that neither policymakers nor we as a society tend to take seriously.
Workforce mortality should be relatively straightforward, if not easier, to address with targeted screening in workplaces/community, followed by required treatment and monitoring on a regular basis. Given its nature, tackling the burden of disability is going to be much more complex. But just because it is complex it does not mean that we should simply ignore it, if we are committed to keeping our workforce healthy. There is a lot that employers could do in this regard and governments should partner with and incentivise them in various ways to deal with this challenge. The first step is to admit these challenges. Only then will we start thinking of ways to address them.
The author heads the Health Policy Initiative, ICRIER, New Delhi.
Views are personal