Public Health and Healthcare Equity

Why has the author raised the issue of on-job training?

Directions: Read the passage and answer the question.

Health is currently a privilege in India. Not a right. Maternal and child health remains neglected even after countless plans, programmes and political proclamations. Every year, nearly 60,000 women die in pregnancy and childbirth, while approximately 1.7 million children less than five years of age also die. In absolute numbers, India outranks all other countries in both regards. Sadly, most deaths can be prevented with available technologies. Many diseases such as tuberculosis and pneumonia kill thousands every year. While infectious diseases are very much a concern, chronic diseases are now rapidly catching up. India has become the capital of diabetes, high blood pressure and heart disease. Health targets in plan after plan have not been achieved, yet there has been no systematic analysis of why health systems fail to achieve these targets. The fundamental reason why our health targets are not achieved and will not also be achieved, unless we radically change our strategies, is that we set targets without setting strategies; without understanding what is preventing progress; and without putting adequate human and financial resources toward achieving targets. First, we equate the number of buildings to available health services. The Planning Commission and Central and State governments only count the number of health centres, without bothering to find out what is happening at these centres. Many are without staff, electricity, a telephone, water, medicines or an ambulance. No wonder these centres do not have patients — mothers or children — to take care of. Surveys have shown the inadequacy of our health infrastructure and that health workers are not staying where they are posted. There are good reasons why health staff do not stay in villages. But health departments have not bothered to study this problem or remedy it. Not only are workers not staying, studies have also shown that they are quite frequently absent without reason. Such unaccountability is treated as routine and not discussed in health policy forums. The second reason for a lack of services is underfunding and poor management of medicines, leading to a lack of availability. How can an army fight without ammunition? The lack of medicines forces poor patients to buy medicines from private pharmacy shops, which can be expensive. Often times, the quality of medicines available from these shops and government health centres is poor due to the government's weak oversight on pharmacies and poor procurement policies. Patients do not want to go to clinics where they do not get medicines or where they are of poor quality. While planning and funding are major problems, the root of the health problem in India, I feel, is the lack of adequate numbers of well-trained managers. Many national health programmes cover millions beneficiaries, yet they are managed by just two or three technical managers who are general or specialist doctors. Most of the time these individuals are without any public health or management training. They learn this on the job. This is also true for health secretaries and ministers — they all learn on the job. We are obsessed with training an eighth standard-passed village health worker with six to seven modules — but there is no training or even orientation for top policymakers and managers in the health department before they take up such important managerial and policymaking jobs. Why isn't health systems management made compulsory before an officer takes up the job of director or secretary in the health department? Fortunately, things can rapidly change in the next few years, if government and society pay a little more attention to health. During the last five years, the government has put in significant resources into the National Rural Health Mission (NRHM). At the same time, many States are also using local solutions to various problems. Budgets for health services will need to increase by a factor of three to five times. The national government is committed to take health funding from less than one per cent to two to three per cent of the GDP. This is critical. The government must chart out how the Centre and States will increase these budgets over the next five years. This will also require advocacy on behalf of the health community. And we must also be more smart in how to spend the money that is already available. Money remains unspent in health because the regulations around spending are so complicated and confining that doctors and health works cannot spend the money. Many times, money does not arrive in time for it to be useful.

Children born out of unplanned pregnancies are highly vulnerable because _____.

Directions: Read the following passage & answer the question. 
Though the U.S. prides itself on being a leader in the world community, a recent report shows that it lags far behind other industrialized countries in meeting the needs of its youngest and most vulnerable citizens. The U.S. has a higher infant mortality rate, a higher proportion of low birth weight babies, a smaller proportion of babies immunized against childhood diseases and a much higher rate of adolescent pregnancies. These findings, described as a “quiet crisis requiring immediate and far-reaching action, appeared in a report prepared by a task force of educators, doctors, politicians and business people. According to the report, a fourth of the nation’s 12 million infants and toddlers live in poverty. As many as half confront risk factors that could harm their ability to develop intellectually, physically and socially. Child immunization is too low, more children are born into poverty, more are in substandard care while their parents work and more being raised raised by single parents. When taken together these and other risk factors can lead to education and health problems that are much harder and more costly to reverse.
>            The crisis begins in the womb with unplanned parenthood. Women with unplanned pregnancies are less likely to seek pre-natal care. In the U.S. 80% of teenage pregnancies and 56% of all pregnancies are unplanned. The problems continue after birth where unplanned pregnancies and unstable partnerships often go hand in hand. Since 1950, the number of single parent families has nearly tripled. More then 25 percent of all births today are to unmarried mothers. As the number of single parent families grow and more women enter the work force, infants and toddlers are increasingly in the care of people other than their parents.
            Most disturbingly, recent statistics show that American parent are increasingly neglecting or abusing their children, in only four years from 1987-1971 the number of children in foster care increased by over 50 percent. Babies under the age of one are the fastest growing category of children entering foster care. The crisis affects children under the age of three most severely, the report says. Yet, it is this period from infancy through preschool years that sets the stage for a child’s future.

According to the passage, what is the urban poor?

Directions:  Read the passage below and answer the question given underneath.
The urban poor are experiencing the same level of health as their equivalent in rural areas. Both communities have an equal status of poor health among their respective population. While there may be different characteristics for single population in different cities, they all share many common features which affect health status and social challenges. These include overcrowding, air pollution, tobacco use, unhealthy diet, lack of physical activity, alcohol and drug abuse, road injuries, etc. Other difficulties and challenges center on poor infrastructure which would include poor solid waste management, insufficient access to health care, particularly in slum areas. Most cities also face various challenges in terms of communicable diseases, non-communicable diseases, maternal and child care issues, natural disasters and the threat of reemerging and emerging diseases. As per the UHRC, one in every ten children in the slums do not live upto the age of five years in India. Furthermore, nearly 42% of slum children receive recommended vaccinations. Over half of child births that take place among poor women occur at home in slums, which puts both the mother and the newborn at risk. Another risk factor is the poor sanitation found in slums, which contributes to the high rate of diseases. Two-thirds of urban poor households do not have access to toilets and nearly 50% do not have running water supplied to their homes.
Currently, the Indian health system is more focussed towards those poor in rural areas and it has an organisational structure that begins from the grass roots to tertiary care which is managed by dedicated staff. Unfortunately, there is a huge deficiency of services and structures in urban areas. To add to this, a very rapid growth of the urban population has overburdened the existing system. The majority of healthcare in cities is mainly served by private sector doctors and hospitals which tends to cost much higher and is not accessible to the most urban poor.

Why is there a deficiency of healthcare services and structure in urban areas for the urban population of poor people?

Directions:  Read the passage below and answer the question given underneath.
The urban poor are experiencing the same level of health as their equivalent in rural areas. Both communities have an equal status of poor health among their respective population. While there may be different characteristics for single population in different cities, they all share many common features which affect health status and social challenges. These include overcrowding, air pollution, tobacco use, unhealthy diet, lack of physical activity, alcohol and drug abuse, road injuries, etc. Other difficulties and challenges center on poor infrastructure which would include poor solid waste management, insufficient access to health care, particularly in slum areas. Most cities also face various challenges in terms of communicable diseases, non-communicable diseases, maternal and child care issues, natural disasters and the threat of reemerging and emerging diseases. As per the UHRC, one in every ten children in the slums do not live upto the age of five years in India. Furthermore, nearly 42% of slum children receive recommended vaccinations. Over half of child births that take place among poor women occur at home in slums, which puts both the mother and the newborn at risk. Another risk factor is the poor sanitation found in slums, which contributes to the high rate of diseases. Two-thirds of urban poor households do not have access to toilets and nearly 50% do not have running water supplied to their homes.
Currently, the Indian health system is more focussed towards those poor in rural areas and it has an organisational structure that begins from the grass roots to tertiary care which is managed by dedicated staff. Unfortunately, there is a huge deficiency of services and structures in urban areas. To add to this, a very rapid growth of the urban population has overburdened the existing system. The majority of healthcare in cities is mainly served by private sector doctors and hospitals which tends to cost much higher and is not accessible to the most urban poor.

This passage explains that

Directions:  Read the passage below and answer the question given underneath.
The urban poor are experiencing the same level of health as their equivalent in rural areas. Both communities have an equal status of poor health among their respective population. While there may be different characteristics for single population in different cities, they all share many common features which affect health status and social challenges. These include overcrowding, air pollution, tobacco use, unhealthy diet, lack of physical activity, alcohol and drug abuse, road injuries, etc. Other difficulties and challenges center on poor infrastructure which would include poor solid waste management, insufficient access to health care, particularly in slum areas. Most cities also face various challenges in terms of communicable diseases, non-communicable diseases, maternal and child care issues, natural disasters and the threat of reemerging and emerging diseases. As per the UHRC, one in every ten children in the slums do not live upto the age of five years in India. Furthermore, nearly 42% of slum children receive recommended vaccinations. Over half of child births that take place among poor women occur at home in slums, which puts both the mother and the newborn at risk. Another risk factor is the poor sanitation found in slums, which contributes to the high rate of diseases. Two-thirds of urban poor households do not have access to toilets and nearly 50% do not have running water supplied to their homes.
Currently, the Indian health system is more focussed towards those poor in rural areas and it has an organisational structure that begins from the grass roots to tertiary care which is managed by dedicated staff. Unfortunately, there is a huge deficiency of services and structures in urban areas. To add to this, a very rapid growth of the urban population has overburdened the existing system. The majority of healthcare in cities is mainly served by private sector doctors and hospitals which tends to cost much higher and is not accessible to the most urban poor.

Choose the most appropriate title for the passage.

Directions:  Read the passage below and answer the question given underneath.
The urban poor are experiencing the same level of health as their equivalent in rural areas. Both communities have an equal status of poor health among their respective population. While there may be different characteristics for single population in different cities, they all share many common features which affect health status and social challenges. These include overcrowding, air pollution, tobacco use, unhealthy diet, lack of physical activity, alcohol and drug abuse, road injuries, etc. Other difficulties and challenges center on poor infrastructure which would include poor solid waste management, insufficient access to health care, particularly in slum areas. Most cities also face various challenges in terms of communicable diseases, non-communicable diseases, maternal and child care issues, natural disasters and the threat of reemerging and emerging diseases. As per the UHRC, one in every ten children in the slums do not live upto the age of five years in India. Furthermore, nearly 42% of slum children receive recommended vaccinations. Over half of child births that take place among poor women occur at home in slums, which puts both the mother and the newborn at risk. Another risk factor is the poor sanitation found in slums, which contributes to the high rate of diseases. Two-thirds of urban poor households do not have access to toilets and nearly 50% do not have running water supplied to their homes.
Currently, the Indian health system is more focussed towards those poor in rural areas and it has an organisational structure that begins from the grass roots to tertiary care which is managed by dedicated staff. Unfortunately, there is a huge deficiency of services and structures in urban areas. To add to this, a very rapid growth of the urban population has overburdened the existing system. The majority of healthcare in cities is mainly served by private sector doctors and hospitals which tends to cost much higher and is not accessible to the most urban poor.

Choose the correct statement:

Directions:  Read the passage below and answer the question given underneath.
The urban poor are experiencing the same level of health as their equivalent in rural areas. Both communities have an equal status of poor health among their respective population. While there may be different characteristics for single population in different cities, they all share many common features which affect health status and social challenges. These include overcrowding, air pollution, tobacco use, unhealthy diet, lack of physical activity, alcohol and drug abuse, road injuries, etc. Other difficulties and challenges center on poor infrastructure which would include poor solid waste management, insufficient access to health care, particularly in slum areas. Most cities also face various challenges in terms of communicable diseases, non-communicable diseases, maternal and child care issues, natural disasters and the threat of reemerging and emerging diseases. As per the UHRC, one in every ten children in the slums do not live upto the age of five years in India. Furthermore, nearly 42% of slum children receive recommended vaccinations. Over half of child births that take place among poor women occur at home in slums, which puts both the mother and the newborn at risk. Another risk factor is the poor sanitation found in slums, which contributes to the high rate of diseases. Two-thirds of urban poor households do not have access to toilets and nearly 50% do not have running water supplied to their homes.
Currently, the Indian health system is more focussed towards those poor in rural areas and it has an organisational structure that begins from the grass roots to tertiary care which is managed by dedicated staff. Unfortunately, there is a huge deficiency of services and structures in urban areas. To add to this, a very rapid growth of the urban population has overburdened the existing system. The majority of healthcare in cities is mainly served by private sector doctors and hospitals which tends to cost much higher and is not accessible to the most urban poor.