Dubious distinctions

Published January 13, 2023
The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC.
The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC.

PAKISTAN now has not only the fifth largest population in the world but it also bears a very heavy burden of disease. Also, negative determinants of health or risks to health abound and are on the rise.

The combined effect of these three factors is harrowing. At the cost of being dubbed a pessimistic naysayer, I present below a factual, tragic shortlist of our dubious distinctions in health.

At a time when nothing else is going right in national life, it is a strong reminder about the state of the health of the nation, to be taken into account as and when — and indeed if at all — we are prepared to fix it.

To start with, we are multiplying like rabbits. From around 36 million in 1947, we have increased to around 220m and at this high rate of growth we are projected to number 350m by the year 2050, ie in the next 27 years only. Aside from being the fifth largest population in the world, we rank fourth in Asia.

We have the second highest neonatal mortality rate (NMR) in the world, ie out of every 1,000 live births, 40 newborns die within 28 days of life. Only Lesotho with an NMR of 44 is ahead of us and we are in the company of South Sudan which also has an NMR of 40. The NMR of Finland is 1 and that of Iran 8.

A shocking 37.6 per cent of children less than five years of age in Pakistan are stunted. Globally, we rank an abysmal 13th in this regard; below us are only the poorest countries in sub-Saharan Africa.

Physical and mental stunting takes place due to malnutrition, and if not treated during the first 1,000 days of life, ie around three years of age, it becomes irreversible. This is an entirely preventable and treatable condition. In Iran the percentage of stunting is only 4.8.

Behind the shocking statistics on the health of Pakistanis is a tale of chronic negligence by the state.

In 2018, 42pc of women aged 15-49, ie women of reproductive age, had moderate iron deficiency anaemia which is a major reason for underweight children born to these mothers and also a risk factor for maternal mortality due to post-partum haemorrhage.

Many of these underweight babies tend to suffer later from stunted growth. Iron deficiency anaemia among women is entirely preventable and treatable.

There are only two countries in the world where transmission of wild poliovirus has not been completely disrupted, Pakistan and Afghanistan, and the disease continues to cripple our children. Despite billions of dollars that have been spent on eradication efforts, Pakistan and Afghanistan continue to hold back the world from becoming polio free. Iran, which neighbours both, eradicated polio in 2004 while India did so in 2014.

With an estimated 10m people living with hepatitis C, Pakistan is now home to the world’s largest population of patients infected by the virus, surpassing even China, India and Nigeria. This is a preventable disease and, once diagnosed, medicines to treat it are available cheaply with a cure rate of 97-98pc.

One of the causative factors for hepatitis C, and other blood-borne diseases, is the reuse of disposable syringes. Statistics for injections in Pakistan are mind-boggling: the highest number of injections the world over are given in Pakistan, ie 8-10 injections per person per year and 94pc of these are not needed at all. It speaks volumes for unethical prescribing behaviour, patient demand and state of regulation of unethical medical practices in the country.

Pakistan is also ranked fifth among countries with a high burden of tuberculosis. An estimated 510,000 new TB cases emerge every year and approximately 15,000 patients develop drug-resistant TB. It is estimated that we have the fourth highest prevalence of multidrug resistant TB globally.

Currently, an estimated 190,000 people are living with HIV in Pakistan. After the Philip­pines, we have the highest rate of increase in the number of HIV cases in Asia, ie more than 80pc increase between 2010 and 2020. Around 25,000 new cases are added to the pool every year.

These examples are reflective of the state of the health of people in Pakistan. All of these conditions and diseases are preventable in the first place and treatable once they develop.

Neither we are being able to prevent them nor we are treating them properly. Not only this, the risks to health are ubiquitous and on the rise. Access to proper nutrition, safe drinking water and clean air, we have serious problems in all these determinants of health.

Among environmental determinants of health, as an example, Pakistan has become the fourth most polluted country in the world, and Lahore now has the distinction of being the most polluted city on planet earth. Among behavioural determinants, the prevalence of tobacco consumption is very high in Pakistan.

We are among the top 15 countries in the world with widespread tobacco consumption and higher rates of tobacco-related health issues. According to 2019 estimates, 19.1pc of the population, ie around 42m adults, which includes 31.8pc of men and 5.8pc of women, consume tobacco in one form or the other.

Current life expectancy in Pakistan is 67.7 years. One hundred and forty-nine countries have higher life expectancy than us, including many poor African countries. An average Pakistani lives 17.3 years less than Hongkongers, who have the highest life expectancy, ie 85.2 years. An average Pakistani’s lifespan is almost 10 years less than a Sri Lankan, nine years less than an Iranian, seven years less than a Chinese and five years less than a Bangladeshi or a Vietnamese.

Why do we live less, and worse qualitatively? The answer is simple, though very tragic. As a state we have not prioritised the health of the people. We have not prevented what is preventable and we are not treating what is treatable. The catastrophe is all man-made.

The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC.

zedefar@gmail.com

Published in Dawn, January 13th, 2023

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