The right to health should be enacted as a fundamental right, demands Oxfam India in its Inequality Report 2021. The report analyses the country’s weak public healthcare system, health inequalities and the ongoing pandemic.

Titled India’s Unequal Healthcare Story, the report provides a comprehensive analysis of the health status across different socioeconomic groups such as marginalised communities that suffer from ill-health the most.

“The general category performs better than SCs and STs, Hindus perform better than Muslims, the rich perform better than the poor, men are better off than women, and the urban population is better off than the rural population on various health indicators,” said the report in its introduction.

Further in the report there is a closer look at health inequalities during the recent health emergency.

India’s healthcare and Covid 19

While analysing state performance in terms of the global pandemic, the report found that states that attempt to reduce social inequalities and spend more on health reported lower confirmed cases. However, states attempting to reduce inequalities showed lower recovery rate as well. 

According to contributor Apoorva Mahendru, this may be because the ‘Reduced Inequality Index’ used by the report does not take into account factors like social distancing, access to improved water and sanitation. Such access contributes greatly to recovery from Covid-19. These same factors are not easily available for marginalised communities.

Similarly, higher-income groups could easily arrange for transport to hospitals. Among the lowest income bracket, comprising households with a monthly income of Rs. 15,000, the report found that 30 percent had to arrange for transport themselves. In households with income of Rs. 30,000 or less, 14.8 percent and 22.2 percent faced issues of slow response and quality of food served, respectively.

“Percentage of respondents in low-income brackets facing discrimination in the community due to being Covid positive was five times than those in high-income brackets,” said the report.

Further, over 50 percent of people hailing from Scheduled Castes (SC) and Scheduled Tribes (ST) faced difficulties in accessing non-Covid medical facilities compared to 18.2 percent in the general category. In the same way, only 3.9 percent of general category respondents depended on springs or streams for water consumption. The figure for Scheduled Castes was four times that of the open category. This means that more SCs were forced to use unsafe sources of water.

In terms of gender disparity, 33.9 percent of female respondents experienced anxiety, irritation and anger, and sleep-deprivation during the lockdown compared to 18.2 percent males.

“This is because of an increase in women’s unpaid care work burden at home, increase in cases of domestic violence, and probability of re-employment of women lesser than that of men post-lockdown,” said the report.

Experts also pointed out that current vaccination drives are blind to the digital divide in India. At the beginning of the pandemic, only 15 percent rural households had internet connection, smartphone users in rural India were almost half of urban India. More than 60 percent of women across 12 states said they had never used the internet. SCs and STs with smartphones stood at 25 and 23 percent respectively, while 43 percent open category individuals had access to smartphones.

“The number of Covid cases doubled in the second wave. The second wave hit the middle class more with 90 percent of all cases in Mumbai concentrated in high-rise buildings, while 10 percent were in slums,” said the report.

Considering infrastructure, India ranks 155 out of 167 countries on bed availability. It has five beds and 8.6 doctors per 10,000 of its population. However, only 40 percent of beds are concentrated in rural India that houses 70 percent of the population.

Social inequalities and its impact on healthcare

Using National Family Health Survey (NFHS) 3 and 4 data, the report stated that literacy rate for general category women is 18.6 percent higher than SC women and 27.9 percent higher than ST women.

“Education, specifically of women, has a direct effect on improving the health outcome at the level of the household as educated women are known to take informed healthcare decisions,” said contributor Khalid Khan.

Thus, the health inequality is evident in the attainment of female literacy with a gap of 55.1 percent between the top and bottom 20 percent of population in 2015-16.

In case of water and sanitation, two out of three households have access to improved, non-shared sanitation facilities in the general category. Meanwhile, SC households are 28.5 percent behind the open category and ST are 39.8 percent behind them. It is worth noting that poor water, sanitation and hygiene conditions were responsible for 1,00,000 deaths from diarrhoeal diseases in under-five children in 2015 in India.

Moreover, while 93.4 percent of households in the top 20 percent have access to improved sanitation, only 6 percent have access in the bottom 20 percent, a difference of 87.4 percent.

Regarding household expenditure on health, one in every six rupees spent on hospitalization by households is financed through borrowings. Less than one-third of households were covered by a government insurance scheme in 2015-16.

Another indicator of health inequality are institutional and home births. Though the gap in the institutional delivery of rural-urban, caste, religion and income groups has been declining over the decade, inequality prevails across these categories.

Institutional births in ST households were 15 percent below general category births in 2015- 16. There is a 35 percent gap in institutional births between the lowest and highest 20 percent wealth quintile groups in 2015-16.

Further, despite improvement in child immunisation, female-child immunisation rate continues to be below that of the male child. Similarly, more children in urban areas are immunised compared to rural children. Immunisation of SCs and STs is behind that of other caste groups. The child immunisation of the high wealth quintile group is much higher than of low wealth quintile.

Even in terms of nutrition, the difference between stunted children in SC and ST households and those in general category households is 12.6 and 13.6 percent, respectively. One in every two children are anaemic, wherein 60 percent of anaemic children are from SC and ST households.

Efficacy of government intervention

In the last 10 years, around 18 percent Indians have begun seeking some form of healthcare when they report being sick. Still, the current health status is a testament to the unfulfilled dream of ‘Health for All’ said contributor Mayurakshi Datta.

“The right to the highest attainable health is far from being realized. This holds especially true for the socially and economically marginalised,” said Datta.

In the 2021-22 budget, the health ministry has been allocated Rs. 76,901 crore, 9.8 percent less than Rs. 85,250 crore reported from revised estimates of 2020-21. Moreover, public funds for health have also been invested specifically on secondary and tertiary care rather than primary healthcare. Meanwhile, private healthcare providers are thriving, widening inequalities along caste, class, gender and geography.

“Health insurance schemes are being promoted as a way to achieve UHC [Universal Health Coverage] and to reduce OOPE [Out-of-Pocket Expenditure]. But evidence shows that the limited scope and coverage of the insurance schemes cannot address the all-encompassing requirements of UHC,” said the report.

So what next?

Aside from a call for right to health and free vaccine policy, the report called for an increase in health spending to 2.5 percent of GDP at the union and state level.

They also called upon the government to ensure that union budgetary allocation in health for SCs and STs is proportionate to their population while dedicating two-thirds of the concerned budget to primary healthcare. The centre should provide financial support to states with low per capita health expenditure to reduce inter-state inequality in health.

Regions with higher concentration of marginalised population should be identified and public health facilities should be established, equipped and made fully functional as per Indian Public Health Standards (IPHS).

While the report does not endorse Government-financed Health Insurance Schemes (GFHIS) as a way to achieve UHC, it is imperative that GFHIS widens its ambit to include outpatient costs as a way to reduce out-of-pocket expenditure (OOPE).

Experts also called for a centrally-sponsored scheme that earmarks funds for free essential drugs and diagnostics at all public health facilities. Further, rights under the Patients’ Rights Charter should be made enforceable by law.

The private health sector must be regulated by ensuring that all state governments adopt and effectively implement Clinical Establishments Act. They also called for regularisation of women frontline health workers services especially Accredited Social Health Activists (ASHAs), establishing government medical colleges with district hospitals prioritising their establishment in hilly, tribal, rural and other hard-to-reach areas, enhancing medical infrastructure and establishing contingency plans for scenarios such as the second wave of the pandemic.

Report can be read here:

Related:

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Findings on India in Oxfam Inequality report “Reward Work, Not Wealth”: 

India added 17 new billionaires last year, raising the number to 101 billionaires. Indian billionaires’ wealth increased by INR 4891 billion — from INR 15,778 billion to over INR 20,676 billion. INR 4891 billion is sufficient to finance 85 per cent of the all states’ budget on Health and Education.

73 percent of the wealth generated last year went to the richest one percent, while 67 crore Indians who comprise the poorest half of the population saw one percent increase in their wealth. In the last 12 months the wealth of this elite group increased by Rs 20,913 billion. This amount is equivalent to total budget of Central Government in 2017-18.

India’s top 10% of population holds 73% of the wealth. 37% of India’s billionaires have inherited (family) wealth. They control 51 per cent of the total wealth of billionaires in the country. Only four women billionaires in India and three of them inherited family wealth. Between 2018 till 2022, India is estimated to produce 70 new millionaires every day. Number of billionaires has increased from only 9 in 2000 to 101 in 2017.

51 billionaires out of the total 101 are 65 years or above and own Rs 10,544 billion of total wealth. If we assume that in the next 20 years, at least Rs 10,544 billion will be passed on to the inheritors and on that if 30% inheritance tax is imposed, the Government can earn at least Rs 3176 billion.

Rs 3176 billion sufficient to finance 6 crucial services–Medical & Public Health, Family Welfare, Water & Sanitation, Housing, Urban Development and Labour & Labour Welfare in all States. Over the next 20 years, 500 of the world’s richest people will hand over $2.4 trillion to their heirs – a sum larger than the GDP of India, a country of 1.3 billion people.

In countries like India and the Philippines, at least one in every two workers in the garment sector are paid below the minimum wage. It would take 941 years for a minimum wage worker in rural India to earn what the top paid executive at a leading Indian garment company earns in a year.

It would take around 17.5 days for the best paid executive at a top Indian garment company to earn what a minimum wage worker in rural India will earn in their lifetime (presuming 50 years at work).

It would cost around Rs 326 million a year to ensure 14,764 minimum wage workers in rural India were paid a living wage. This is about half the amount paid out to wealth shareholders of a top Indian garment company.

Results of Oxfam Survey 

New research by Oxfam seeks to understand perceptions of inequality and support for redistribution policy options.137 Over 70,000 people were surveyed in 10 countries across five continents, representing over one-quarter of the world’s population and more than a third of the world’s GDP. These online surveys collected data from nationally representative samples in the United States, India, Nigeria, the United Kingdom, Mexico, South Africa, Spain, Morocco, the Netherlands and Denmark.

In India, specifically among people who think they are poor, seeing where they actually sit in the national income distribution resulted in almost 15% more respondents agreeing it is difficult for a person to increase the amount of money they have despite working hard. 84% Indians agree or strongly agree that the gap between the rich and poor in [country] is too large.

In terms of attitudes and beliefs about inequality, nearly two-thirds of all respondents think the gap between the rich and the poor needs to be addressed urgently or very urgently. And many have an even stronger sense of urgency: 73% in India, 79%in South Africa, 85% in Nigeria, and 93% in Mexico believe this.

There is also strong support for increasing the tax rate for the top 1% of income earners. When asked whether government deficits should be reduced by cutting public services or by increasing taxes on the 1%, over half of respondents selected higher taxes for the 1%. 52% Indians agree that income taxes on the richest 1% of people should be increased.

When respondents were asked to choose specific policy options to be put in place to tackle inequality, in nine out of the 10 countries, the four most selected options across countries were: 1) provide free and high-quality education and medical care; 2) fight corruption; 3) raise the minimum wage; and 4) provide jobs with decent wages.
 

Recommendations

Oxfam India is calling upon the Indian Government to act on growing inequality ans create an equal India. Following are the recommendations:
 

• Promote inclusive growth by ensuring that the income of the bottom 40% of the population grows faster than of the top 10% so that the gap between the two begins to close.  This can be done by encouraging labour-intensive sectors that will create more jobs; investing in agriculture; and effectively implementing the social protection schemes that exist.
• Seal the leaking wealth bucket by taking stringent measures against tax evasion and avoidance; taxing the super-rich by re-introducing inheritance tax, increasing wealth tax, reducing and eventually do away with corporate tax breaks; creating a more equal opportunity country by increasing public expenditure on health and education.
• Bring data transparency, produce and make available high quality data on income and wealth. Regularly monitor the measures the government takes to tackle the issue of rising inequality.

The post Reward Work Not Wealth: India’s Economic Inequality appeared first on SabrangIndia.

विश्व आर्थिक मंच की यहां होने वाली वाषिर्क बैठक से पहले अधिकार समूह ऑक्सफैम द्वारा जारी एक अध्ययन के अनुसार भारत के केवल 57 अरबपतियों के अब कुल 216 अरब डॉलर की संपत्ति है जो देश की करीब 70 प्रतिशत आबादी की कुल संपत्ति के बराबर है।

वैश्विक आधार पर यही स्थिति आठ अरबपतियों की है जिनके पास पूरे विश्व की 50 प्रतिशत आबादी के बराबर संपत्ति है।

अध्ययन में कहा गया है कि भारत में 84 अरबपति हैं जिनकी कुल संपत्ति 248 अरब डॉलर है। इनमें 19.3 अरब डॉलर की संपत्ति के साथ मुकेश अंबानी शीर्ष पर हैं। इसके बाद दिलीप सांघवी की संपत्ति 16.7 अरब डॉलर और अजीम प्रेमजी की संपत्ति 15 अरब डॉलर है। देश की कुल संपत्ति 3100 अरब डॉलर है।

इस वर्ष विश्व की कुल संपत्ति 2.56 लाख अरब डॉलर आंकी गई है और इसमें से करीब 6500 अरब डॉलर संपत्ति पर अरबपतियों का आधिपत्य है। इसमें 75 अरब डॉलर की संपत्ति के साथ बिल गेट्स शीर्ष पर हैं। इसके बाद 67 अरब डॉलर की संपत्ति वाले एमैनसियो ऑर्टेगा और 60.8 अरब डॉलर की संपत्ति वाले वारेन बफेट का नाम है।

ऑक्सफैम ने ‘99 प्रतिशत लोगों के लिए एक अर्थव्यवस्था’ शीषर्क से एक रपट में यह सारे आंकड़े पेश किए हैं।

The post भारत की 58 प्रतिशत संपत्ति पर एक प्रतिशत अमीरों का आधिपत्य : ऑक्सफैम appeared first on SabrangIndia.

Fifty-seven billionaires in India possess as much wealth as the poorest 70% of the country, according to a report on global inequality released on Monday by Oxfam, an international confederation of 18 non-governmental organisations.

By comparison, eight men across the world are as wealthy as the poorest 50% of the global population, the report said. A mere 500 people will bequeath wealth worth $2.1 trillion – more than the current gross domestic product of India – to their heirs over the next 20 years.

Drawing from news reports and its own studies, the Oxfam paper points to growing gaps in income inequality across the world. In India, for instance, the chief executive officer of a leading information technology company earns 416 times more than the firm’s average employee. This is reflected in India’s wealth distribution. The richest 10% in India own 80% of its wealth, while the richest 1% possess 58% of all wealth.

Note: Percentages in the first decile are negative because they represent negative wealth, that is debt. This amounts to -$21 billion, or -0.68% of India's wealth.

Even income growth has been uneven over the years. Between 1988 and 2011, incomes of the poorest 10% of Indians rose by $29, or around Rs 2,000, at an increase of 1% each year. For the richest 10% in the same period, incomes increased by almost Rs 40,000, with an annual increase of 25%.

Oxfam lists several reasons for this inequality, including crony capitalism and corporations that squeeze employees at lower rungs to maximise salaries and dividends for high-level executives and shareholders. This gets exacerbated in the current economic framework, Oxfam argues, since the surest way to grow wealth is to possess it. Those who are most rich can afford the best investment advice. Despite this growth of wealth, governments across the world lose taxes and valuable income with the super-rich depositing their wealth in tax havens abroad and manipulating political systems to do so without repercussion.

Oxfam’s report comes a week after HSBC released a study on social sector spending in India on January 10. The report, timed between demonetisation and the budget, notes that India’s expenditure on social sectors such as health and education is far lower than global and emerging market standards. However, this expenditure has far greater impact on growth than capital expenditure on infrastructure.

In this chart, EM stands for 'emerging markets'. Source: World Development Indicators, HSBC.

In this chart, EM stands for 'emerging markets'. Source: World Development Indicators, HSBC

Governments tend to ignore such expenditure, the report argues, because their political terms last five years, whereas it takes around six years for the clear benefits of social expenditure to show.

In this chart, EM stands for 'emerging markets'. Source: HSBC estimates

Courtesy: Scroll.in

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