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Modern India has the third largest national economy in the world in purchasing power adjusted terms. The country is also now the world’s largest generic medicines exporter. But 400-600 million Indian citizens live in severe poverty. Many still lack assured free access to good quality generic medicines and the support needed to use them to best effect. Unmet need is particularly high in the context of preventing and treating the growing burden of heart problems, strokes and other non-communicable diseases (NCDs) like diabetes, finds a new UCL School of Pharmacy report, published today.

‘Health and Health Care in India’ estimates that non-communicable diseases (NCDs) already cost India the equivalent of 12.5% of the nation’s GDP in lost welfare terms. A similar (though falling) burden is still imposed by infections and events such as traffic accidents and violent deaths in groups such as relatively young women. Co-author Professor David Taylor commented:

‘India currently spends only a little over 1 per cent of its GDP on publicly funded health care, and only about 0.1 per cent of GDP on publicly funded medicines for the Indian people. These are very low figures, even by the standards of the world’s least developed countries. It would be tragic if plans for extending universal health coverage and increasing the supply of free generic medicines for those who lack the resources to purchase even minimal cost modern treatments for common conditions such as high blood pressure and type 2 diabetes are not taken forward as an urgent priority.’

The new UCL School of Pharmacy analysis in addition argues that well-off individuals and groups living in every part of the world should contribute to the global costs of high risk bio-medical research. Failures to respect intellectual property rights needed for attracting research investment risk undermining the future development of new and more effective medicines for conditions such as cancers and dementias. They could also endanger other forms of bioscience based progress. Professor Taylor continued:

‘Some people wrongly believe that steps like reducing the prices of new anticancer drugs that can only be used effectively in high technology settings to commodity levels will significantly improve public health in India. But this is not the case. Measures like imposing compulsory licences on such medicines are mainly likely to benefit well-off individuals. The mass of the population will gain from better day to day access to low cost but highly effective treatments that are already available as off-patent generics.’

Life expectancy in India has doubled from 30-35 years to over 65 years since the country became independent from Britain in 1947. In the same period the population has grown from around 300 million to over 1200 million, and will exceed that of China in the 2030s. Despite some important successes, high residual rates of infection in poorer communities combined with an increasing prevalence of disabling chronic diseases mean that healthy life expectancy in India is only about 55 years. This compares with around 70 years recorded in countries such as China, the US and Japan.

The UCL School of Pharmacy report concludes that, without enhanced universal access to essential medicines and other forms of cost effective care, health improvement and social transition in poorer parts of India may stall. Given the size and importance of the Indian population this could in future have harmful global impacts. Report co-author Dr Jennifer Gill said:

‘There are no easy answers as to how the world community can ensure that poor people everywhere get good access to essential medicines without over-supplying products like antibiotics and analgesics or undermining provisions like patents that are needed to promote ongoing investment in medical and pharmaceutical innovation. We need strengthened mutual understanding to achieve better care in poorer areas and to sustain investment in innovative research, without which global progress will not continue.’

‘Health and Health Care in India’ highlights the potential value of solutions such as internationally agreed tiered or differential pricing arrangements. These should allow public health care providers in low income countries to obtain essential patented medicines at affordable costs from the producers responsible for their development.

Promoting greater individual and local community involvement in health care through, for example, establishing confidential SMS texting based systems for reporting corrupt practices like charging for treatments that should be supplied free of charge also have an important role to play in driving health service improvement. India faces many challenges in achieving further health gains for its increasing population. However, if in the coming decades India’s people and their leaders give investing in better health care and better health outcomes higher political priority, India could once again become one of the world’s healthiest and wealthiest nations.

Copies of ‘Health and Health Care in India: national opportunities, global impacts’ are available at https://www.ucl.ac.uk/pharmacy/news/healthcareindiareport.