Top two myths of Indian Healthcare

I often hear that in India poor people are being pushed deeper into poverty when they have to pay out of their own pockets for healthcare, especially when they avail of private healthcare.

We also often hear about the “high cost of healthcare” in the private sector in India which services 70% of India’s healthcare needs.

What are the solutions we hear being proposed by almost every stakeholder?

  1. Universal Medical Insurance 
  2. Increased Government spending on Healthcare

Let me try to explain why these are definitely not the best things that could happen to Indian healthcare


Whats wrong with Universal Medical Insurance [UMI]?

If there is one thing we know for sure from the experience of other countries, it is this: Universal Medical Insurance ensures in the long run that no middle class or poor person will be able to afford medical care without Medical Insurance. In a sense, UMI does everything to ensure its own survival!

Why does that happen? There are several factors:

Behavioral changes:

When people do not have to pay for their own healthcare: Have you thought through the way people approach their own health when they know they are covered by Medical Insurance and they believe they need not worry about taking care of their own health, especially in terms of the non communicable diseases NCD’s which are the leading causes of death? worldwide?

When people have medical insurance and do not have to spend for their own healthcare, it encourages a very casual approach to their own health, which is fueled by the media hype about how medical technology is able to treat every known disease on earth. So, the common attitude is, I have insurance, so no problem. If I fall sick, I am covered by insurance, and medical technology will make me alright. Wrong thinking, friend!

The incidence of NCD’s have skyrocketed in all developed countries and increasing even in the developing countries. There are multiple reasons for this rise but behavioral or lifestyle disorders are so called for a reason: Bad behavior causes bad health, and the false sense of security that insured persons have is a major cause for this behavior according to me. 

As a result of this increasing burden of NCD’s, Insurance companies keep increasing the premiums, and the overall burden on healthcare increases dramatically.

Where do you think Insurance companies get the money to pay your Medical bills?

[Read more on The Relation between Universal Health Insurance and Cost Control ]

Disruption of Free Market economics:

Mediclaim and other forms of Medical Insurance try to dictate pricing based not on actual costing studies but on a collective bargaining with providers. Paradoxically this has been shown to raise healthcare costs and lower healthcare quality, rather than bring them down as one would have hoped.

On the other hand, when people do not have medical insurance and must spend on healthcare out of their own pockets, they take all steps possible to avoid getting sick in the first place. They also behave more responsibly to take care of their own health and are very cost conscious.

This cost consciousness enables enabling free market economy forces in the private healthcare sector to keep costs low without unnecessary bureaucratic intervention. This is what has been happening till now in India to a large extent.

Whats wrong with Increased Government spending on Healthcare?

What really happens when the Government tries to step in to provide Healthcare?

The US spends 17% of its GDP on Healthcare. India barely 4%. Per capita annual Healthcare spending in the US is 8600 US Dollars which equals 551195.50 Indian Rupees, while in India and other such countries, annual average healthcare spending is 88 US Dollars which equals 5641.23 Indian Rupees.

Rising healthcare costs in the US force a major rethink on strategy

In the real world, healthcare costs skyrocket when the Government and Medical Insurance companies step in. All that they are concerned about is their own survival. 

When left to the economies of the free market as with any other industry or business, the price of healthcare will remain reasonable, access and quality will be determined by market forces, and there will be no opportunity for corrupt Governmental agencies to dictate their own often selfish agendas. I am not denying that there are several good people in the Government who sincerely believe that they are trying to do good, but the vast majority do not understand the realities and complexities of the healthcare system.

The Government, instead of wasting tax payers money in areas which are not its core competencies, should rather focus on providing basic things needed for health, starting with good infrastructure and a lot more! In these areas the Indian Government can do well to learn from the developed world!

Poverty and sickness:

But why do poor people in India find healthcare expensive?

Poverty is a big problem everywhere but more so in India. Is the healthcare industry responsible for poverty? A better question would be to ask, why are these people poor? And why are they falling sick?

Many poor people in India fall sick and die, because the environment and infrastructure essential for good health were not adequately provided for by the government and other agencies responsible for the same.

Poor people in India

The Government also did not provide a conducive environment for businesses to function transparently and efficiently, resulting in corruption and low wages for the workers. Of course there are diverse reasons for low wages, each of which is equally responsible for the poor person not being able to pay for healthcare.

The result: Poor people living in unhygienic conditions, getting underpaid for whatever work they do.

And when they fall sick, where do they go? Government healthcare, if available, is crowded and not free either. They lose days waiting in line, losing what little income they earned. So what alternative do they have? Private healthcare, that is fast, efficient, and much cheaper than any healthcare anywhere in the world. Why? Because when the pricing of healthcare is left to market forces, competition keeps costs low as in any business in the free market economy.

Warped Economics:

If this poor person cannot afford the fees at a private healthcare setup, something is drastically wrong in the economics. The poor person is not being paid adequately or unable to save enough.

So, who is really to blame for the poor sick man being pushed into poverty due to sickness? Who is responsible for him falling sick in the first place?

Is it not the Government, which has not provided him basic needs for good health like clean air, pure drinking water and good sanitation? Which has not ensured that he gets adequate opportunities to earn his reasonable livelihood?

Every person in India has a right to claim that the taxes he pays are adequately utilized, not to line the pockets of corrupt politicians through short sighted mega projects in ‘Government healthcare’, but to ensure a life of dignity to the poorest, with the basic needs for good health provided to every citizen of the land.

The WHO definition of Health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

The Government can do much more for the health of India if it focusses on what it is paid to do, govern impartially and without corruption, rather than try to enter into Healthcare and muddle it up.  In that way it would be doing a great favor to the health of its citizens.

The Government can mess up Healthcare even if it is relatively non-corrupt like in the developed nations. So one can only guess what is going to happen to Healthcare in India once the Government tries to do anything.

Private Healthcare Providers and the responsible Free Market:

I must salute the private healthcare provider, who despite the odds, is providing a reasonable level of service to large segments of society at a fraction of the cost worldwide. No doubt there are black sheep here also but the model is one that has a hope for a better future, bringing about Shalom Healing to people. 

Let us stop blaming those who are trying to do good, and focus on the real culprits. The people get the Government they deserve, an old saying goes.

I hope I have made myself clear. Neither increased Governmental spending on healthcare nor Universal Medical Insurance is the answer dear friend.

Instead, if it really cares for the health of its people, let our Government take serious steps to improve the basic essentials for good health. Let it restore and improve the quality of our air, water, food and soil.

Let the Government eradicate corruption and red tape within itself, help honest businesses to establish and grow, thus providing people with a reasonable standard of living. This will help to not only improve the health of our nation, but to transform India into a world class nation. Hope better sense prevails in our country. Please pass this on to those who care. Jai Hind!

Air pollution increases risk of childhood obesity and diabetes

A few days back I saw thick black smoke emanating from an illegal roadside garage and stopped to see what was happening.

Illegal roadside garage emitting carcinogenic fumes

I was shocked to see two men from a roadside garage burning wires made of copper and insulated with PVC, apparently to extract the copper.

In the bargain they were spreading carcinogenic fumes over a residential area housing thousands of citizens blissfully unaware of the deadly air they were breathing.
What are the dangers, you may wonder?
There is increasing evidence for the role of environment in pathogenesis in many diseases. Children below 5 years of age and adults older than 50 years are most at risk. A global assessment of the burden of disease from environmental risks by the WHO has shown that 23% of global deaths and 26% of deaths among children under five are due to modifiable environmental factors. The harmful effects of air pollution on respiratory health are well-known to us and well-established. Air pollution has been linked to many non communicable diseases such as cardiovascular diseases, obesity, cancers and type 2 diabetes.
A new study has again underscored the dire need for a healthier environment. This study has suggested that  exposure to ambient air pollution may contribute to development of type 2 diabetes through direct effects on insulin sensitivity and β-cell function. The study reported in the January 2017 issue of the journal Diabetes showed that exposure to elevated concentrations of nitrogen dioxide (NO2) and particulate matter (PM 2.5) had adverse effects on longitudinal measures of insulin sensitivity, β-cell function, and obesity in children at high risk for developing diabetes.
So what can you do?
Here is what I did.
I went to the people burning the wires and asked them what they were doing. They said they were burning wires to extract copper, and this was the first time they were doing this.
I told them the dangers of burning such things, not only on their own health but also on the health and lives of thousands of people staying around.
They immediately doused the flames with water.

Caught and educated

As a good steward of the environment, and a citizen of this nation, be alert and do your bit wherever you are. You will be blessed by the living God who sees everything and is no respecter of persons, dear reader.
Jesus would surely not approve of or tolerate any evil in the area where he lived. I consider myself to be an ambassador for Christ, and take responsibility for what is going on in the area where I live. So I do my bit to tackle any evil or injustice when I see it.
If each Indian were to do so I am sure India would be a much better place to live in, and future generations will be grateful.
God bless you and India.
Do post what you have done to encourage others.

Pigeon menace, what to do?


Mumbai runs for cover as an exploding population of pigeons, fed and fattened by easy availability of food, lays siege to the city. This was the headline in the Mumbai Mirror dated 20th April 2014 written by Virat Singh.



This is what I propose:


Figure 1 Pigeon Condo

A pigeon nesting condo from which their eggs can be safely harvested.


This was the article and also the feedback received from readers till today.

Virat A Singh | TWEETS @ singhvirat246

Mulund homemaker Preeti Wadhwa, 27, recently spent Rs 15,000 to cover her apartment windows with specialised netting to block pigeons that had become a nuisance and a health hazard, dropping huge quantity of “infections spreading” excrement on windowsills.

“But the problem has not been solved. They now sit on the ledge above the windows,” she said. The Wadhwa family presents a side of a growing debate in Mumbai over the impact of pigeons, whose numbers have multiplied exponentially in the past two decades.
To bird-lovers, they are hardy survivors in a concrete city; many feel that caring for pigeons is their religious duty and, more importantly, a humane thing to do. But to thousands of households, corporations housed in gleaming high rises and health experts, they are pests that test our commitment to cleanliness and disease control.
And while authorities and bird conservation groups argue over a practical – and ethical – way to prevent pigeons from making homes, workplaces and city infrastructure look unsightly, no one denies that their numbers are growing far beyond normal, away from their natural habitat.
Experts say the originally cliffdwelling pigeons — descendants of the wild rock dove — adapted to life in cities several decades ago, but their numbers have never been this high. The grey birds are everywhere: on roofs, eaves, windowsills and power lines, and in ducts and vents.
As they have rapidly multiplied, so have incidences of respiratory problems among citizens, and the costs of cleaning and maintenance, including installation of nylon nets, the most common method to keep the birds away.
A well-fed pigeon on an average dispenses up to 11.5 kg of droppings a year. It costs between Rs 8,000 to Rs 15,000 to install specialised nylon nets in a normal apartment and, depending on where you live, up to Rs 500 a month for one-time cleaning of balcony grilles.
So far, no comprehensive studies have been undertaken in Mumbai to establish a correlation between presence of pigeons near or in residential complexes and rising cases of respiratory infections, including lung complications.
But, a section of people living near some kabutarkhanas have started citing health concerns to pressure the BMC to relocate feeding areas away from their neighbourhoods. In March 2012, residents of Hingwala Lane in Ghatkopar (E) remonstrated with the BMC about feeding pigeons at a local kabutarkhana, saying the birds were causing serious health problems.
Such proposals, however, have faced stiff opposition from politicians and citizens who find the birds harmless and consider feeding them their religious duty.
After Hingwala Lane residents had raised the issue, MNS’s Ghatkopar MLA Ram Kadam warned them against pressing for the kabutarkhana’s relocation and instead, urged residents to continue feeding.
Bird experts say this unregulated practice of feeding, especially at kabutarkhanas, is one of the main reasons for population explosion. The other being the absence of natural predators.
“Long back, cliffs and rock ledges were pigeons’ natural habitat. The birds adapted to living
alongside humans in cities,
where buildings provide them good nesting areas,” said ornithologist Mohammed Dilawar.
“The issue of their population arose when people started leaving grains and food for them. They no longer have to make an effort to find food, which has made them prolific breeders.”
Pigeons are known to return to the place where they are fed and, according to some studies, organise their day around feeding. They lay eggs around six times a year. According to naturalist Saurabh Sawant, more food is being made available to pigeons than they require. “They are actually being overfed. Their growing numbers have affected other bird species, especially sparrows, as they take over more space for nesting,” he said.
Dr Asad R Rahmani, director of Bombay Natural History Society (BNHS), who has been involved in bird conservation efforts for several years, said any bird species that multiples out of control would pose problems to cities and towns. “Apart from people’s generosity, pigeons have also benefited from the fact that there are no major predators in urban areas,” he said.
There are half a dozen legal kabutarkhanas in Mumbai, but almost every area has four to five illegal ones. Ornithologist Dilawar said their owners were more interested in making profits than in ensuring birds’ well-being.
“It’s a commercial exploitation in the name of religious beliefs. If proper audits are done, the authorities will realise that kabutarkhanas earn crores every year,” he said. “Many of them are located close to tourist areas. The owners sell over-priced bird feed to tourists and locals, many of whom maintain monthly accounts.”
Also, currently anyone, even a grocer looking to make a quick buck, can start bird feeding in his/ her locality. There are hardly any rules that prevent people from doing so. Proponents of curbs on such practices say unregulated bird feeding increases pest menace: food meant for pigeons invariably attracts rats.
Citizens’ corporator from Colaba, Makrand Narvekar has been the lone councillor in the fight to shift bird feeding spots from congested neighbourhoods and major roads and seek restrictions on illegal ones.
He had moved a notice in the BMC for the same after a civic engineer died in an accident in July 2013. The engineer, who was riding a motorcycle, was thrown off the vehicle after being hit by a flock of pigeons near a kabutarkhana in Grant Road.
“I have received several representations from people who live close to such spots. They are very concerned about their health,” he said. “Kabutarkhanas came upduring a time when the city was not so congested and there were hardly any high rises. They no longer fit in urban areas.”
The BMC is yet to respond to his proposal to relocate bird feeding centres.
It’s not just Mumbai that is grappling with the issue. Major cities in the West have also faced the problem. Trafalgar Square in London was once famous for its feral pigeons and feeding them was a popular activity among visitors. However, their droppings caused damage to the square’s stonework and were termed a health hazard.
The sale of bird feed was stopped in 2001 and steps were taken to reduce the number of pigeons there.
In 2008, Venice introduced fines for sale of grain to feed birds at St Mark’s Square. Pigeons were eating away at marble statues by pecking at small gaps in a bid to reach for food. Communities in New York and Los Angeles have also tried to control the pigeon population, but faced opposition.
Dr Rahmani called for a crackdown on illegal feeding centres. “The BMC should ensure that unauthorised kabutarkhaanas are shut and new ones are not allowed to open. People should also be discouraged from feeding pigeons in public places,” he said, adding that it was the only way to prevent overfeeding.
Other experts feel that the city needs a comprehensive plan to control the pigeon population, but they stressed that the birds should be not harmed in the process. To begin with, there should be an awareness programme for citizens.
“People think that they are doing a good deed by feeding pigeons, but in reality they are contributing to an imbalance among different bird species, harming the ecology,” Dilawar said.
The humble pigeon and its poop have been linked to dozens of diseases in the West, but so far the most common cases in the city have been that of respiratory problems. Fresh droppings don’t pose a risk, but spores from dried-out excrement, when inhaled, can cause respiratory complications and a flu-like illness.
“Often, I get patients who suffer from lung inflation, cough and fever. Many of them said that there were several pigeons in their buildings. It’s possible that there was transmission of infection from the birds,” said Dr Om Shrivastav, director of Jaslok Hospital’s department of infectious diseases.
Psittacosis is an infection caused by Chlamydophila psittaci, a type of bacteria found in bird droppings. “People who have a history of asthma or bronchitis should avoid staying in places where there are too many birds,” Dr Shrivastav said.
While doctors try to identify a link between growing respiratory cases and pigeons, residents are trying a host of measures to keep them away. “We had a simple net earlier, but pigeons would peck at it and over time, they displaced the wooden frame. We then spent over Rs 15,000 to get nylon netting,” said Mulund homemaker Preeti Wadhwa said. “But now there’s a different issue. Pigeons’ feathers and droppings land on the nets, which are harder to clean.”
    Residents of Prithvi Palace on Dahisar Link Road have grown bougainvillea to prevent the birds from taking refuge in cavities near pipelines. “The climbing plant has thorns, so pigeons stay away,” said horticulturist Anjali Nariman, who lives in the complex.
    Anushree Mittal Yadav, a media executive from Bhandup, tried hanging CDs in balconies, hoping the sunlight reflected from the discs will keep the creatures away. “It worked for sometime before the birds started making nests in the balconies all over again,” she said.
Ashwin Nair, who lives in a rented apartment in Mulund, said that the windowsills in his house were shrouded with droppings. “I get the area cleaned, and the next day, it’s filthy again. Also, once the birds lay eggs, one does not feel like removing the nests,” he said.
A Malad homemaker said that it was frustrating to see pigeons ruining her 12th-floor balcony day in day out. “I don’t believe in harming the birds, but there has to be a way to control their population,” she said.
People’s distrust and disgust of the pigeon and its dung have given rise of businesses that offer to make houses “bird-proof”. “There is a huge demand for bird-proof nets in residential towers,” said Sanjay Chavan, who runs one such firm.
But there are thousands of citizens in Mumbai who object to such measures. “I have been feeding them for years near my house. I see no health or any other risk in doing so. They are harmless creatures who need our attention and care,” said Borivali businessman Nirav Jain, 45. “What about rats? What is the city doing to prevent problems created by them?”
Jain added that rising pollution, caused by vehicular fumes and construction activity, was the more likely cause of increasing respiratory cases.





Mulund homemaker Preeti Wadhwa, 27, spent Rs 15,000 to bird-proof her home. But maintaining cleanliness is still an issue as pigeon feathers and droppings get stuck on nylon net




Anjali Nariman of Prithvi Palace in Dahisar and other residents have grown bougainvillea to prevent pigeons from taking refuge in cavities near pipelines


The horror, the horror

Readers share their pigeon nightmares in response to our front-page report on Saturday

The pigeon menace begins at 5.30 am
I was reading my story. I face such problems every day in my first-floor Kharghar flat, which has a terrace occupied by pigeons. Despite putting up a net, the birds still manage to enter the terrace area. They sit near the air-conditioner and constantly hit the window panes. The noise wakes me up at 5.30 am and the maid spends more than 30 minutes every day cleaning the dirt that enters our home because of them.
As a working professional, it becomes difficult to keep the birds away. I am also aware of the health hazards mentioned in the article. Hopefully, stories like this will prevent people from feeding these birds every day.
— Nidhi Gulatee,
Kharghar They took over our kitchen
shopkeepers have a habit of feeding pigeons near our home. Although my mother would shoo them away, the pigeons would keep returning and settle near the kitchen window when my mother was not around.
Before my mother realised what was going on, the pigeons built a nest and laid some eggs there. There was a foul smell that dominated our kitchen. It finally took a toll on my mother, who ended up with such a bad allergy that she was unable to enter the kitchen.
Once the eggs hatched and the pigeons left, we cleaned the place and installed nylon nets so that pigeons could not enter. Despite the barricades, the birds still try to fly into our kitchen.
— Arpita Markande,
They destroy my plants
new plants. I love gardening and often used to buy plants, but have stopped doing so now.
The pigeons also leave droppings on washed clothes and enter my house whenever they get a chance. They also find it easy to build nests on our windowsills because we live on higher floors.
I wish the BMC would do something to curb this menace.
— Disha Kunder,
Pigeons damage our vehicles
in our Prabhadevi society are covered with pigeon droppings every morning. It is difficult to take our cars out because of this. People living in chawls constantly feed the pigeons, which is why they haven’t left the area. Something needs to be done to curb this menace.
— Shradha Agarwalla,
Prabhadevi Pigeons carry fungal diseases
serves as an eye-opener to those unaware of the perils of feeding pigeons. They cause skin diseases, which are contagious. They also cause a number of respiratory problems. We attribute many problems to pollen allergies, but pigeons are a bigger problem as they spread a number of fungal diseases that cause difficulties in breathing. What people fail to understand is that the spores of the fungi breed in pigeon droppings and spread diseases.
Recently, my husband’s friend died after suffering in the ICU for over a month. It was found that he had been exposed to a fungal infection by way of pigeon droppings as the birds would be perched on his window all the time.
Now that we know the dangers of pigeon breeding, we must shut down the kabutarkhanas to curb their population.
— Suresh Kala, Chembur Hazard for bikers and children
a pigeon problem for the past two years. There was a shopkeeper who would feed pigeons, which increased their population. There are hundreds of them on the main road, which is a big hazard for motorcyclists. Even pedestrians are not spared. Our society is overrun by pigeons, even around the swimming pool. This is a serious health hazard.
— Bina Pillai,     Deonar

They made my five-year-old ill
experience with pigeons was when my child was five and ended up with wheezing and breathlessness because of them. The paediatrician’s first question about our home was its proximity to pigeons. From then on, his windows were shut and the curtains and sheets rinsed every day. We moved to New Delhi when he was 10 and he never had any trouble there.
But when we moved back to Mumbai in 2006, the problems returned. We have lived in Santacruz and now in Ghatkopar and both places are infested with pigeons. We have finally installed nets to prevent the birds from flying in. Hopefully it will be a foolproof solution.
— Cheryll Pereira,     Ghatkopar

Keep them away from traffic
are on the footpath or in the middle of a junction, and pose a risk to motorists and pedestrians. Two wheelers are more prone to accidents thanks to them.
While I am not against people feeding the birds, we need to ensure that they are fed in a place that is free from traffic and not a residential area.
— Kamal Kapadia, Tardeo



We have become prisoners at home 
THERE ARE TWO pigeons that are regulars outside my front door. Because of them my parents and I feel like we’re in jail as we can never open the front door when the birds are around. The pigeons have already created a mess in the lobby area.
The nuisance has increased and we have no idea what to do. It’s impossible to keep the door shut all the time. I am planning to install a transparent net in the balcony and on every window to curn this nuisance.
— Ameya Naik,  Walkeshwar


Droppings and feathers
society has a huge pigeon population, which has resulted in major hygiene issues thanks to their droppings and feathers, which seem to be everywhere.
— Wasim, Mira Road


Menace, despite nets 
DESPITE INSTALLING NETS everywhere to keep them out, on average, one pigeon gets trapped inside my house every month. This menace also costs me Rs 5,000 every month as the roof of my AC compressor has to be cleaned every alternate day because of pigeon droppings. Others in my building have also installed nets, but the birds keep returning.
— Jinesh Hingu, Parel