New Delhi: “One has to be alive to be a patriot,” former Indian health secretary K Sujatha Rao wrote on Twitter on May 13, 2019, referring to election debates that focussed on issues of “nationalism and terror and not health”.

The data back Rao’s assertion of misplaced priorities.

In 2017, terrorism claimed the lives of 766 Indians, or 0.007% of all deaths, while health reasons claimed 6.6 million Indians, or 90% of all deaths.

In 2017, the last year for which comparable data are available, India’s spending on defence was double its health expenditure, according to the 2017-18 budget.

Poor investment in health and education directly impacts the country’s productivity and economic growth. Indians work for six-and-a-half years at peak productivity, compared to 20 years in China, 16 in Brazil and 13 in Sri Lanka, ranking 158th out of 195 countries in an international ranking of human capital, as IndiaSpend reported in September 2018.

8,000 times more deaths from ill-health than terror

There were 9.9 million deaths in India in 2017, with a death rate of 717.79 deaths per 100,000 people, according to the 2018 Global Burden of Disease (GBD), a global estimate of morbidity and mortality published by the University of Washington.

Communicable, maternal, neonatal and nutritious diseases caused 26.6% of all deaths in India, and non-communicable diseases caused 63.4% of all deaths, while injuries accounted for 9.8%.

Deaths by conflict and terrorism fall under the “interpersonal violence” category, accounting for 0.007% of all deaths, or 766, according to GBD data.

Terrorism claimed fewer lives, according to another database: there were 178 terror incidents reported nationwide in 2017, killing 77 and injuring 295, according to the South Asia Terrorism Portal.

Deaths due to diabetes (254,500), suicides (210,800), infectious diseases (2 million) and non-communicable diseases (6.2 million) put together are 8,000 times the deaths caused by terrorism (766).

Defence vs health vs education spending

“... Hlth [Health] & edu [education] need to be top (sic) & [at] least 8% GDP allocated 2 [to] them,” Rao wrote in her tweet.

India’s public health spending is among the world’s lowest. With a fifth of the world’s population, India’s public expenditure was 1.02% of gross domestic product (GDP) in 2015, IndiaSpend reported in June 2018.

While India’s public-health spending was estimated to be 1.4% of GDP in 2017-18, the equivalent proportion of GDP spent on health in the Maldives is 9.4%, in Sri Lanka 1.6%, in Bhutan 2.5% and in Thailand 2.9%.

India is the fifth largest defence spender in the world. The defence budget in 2017-18 was Rs 4.31 lakh crore ($ 72.1 billion, using 2017 rates), or 2.5% of GDP, as per Institute of Defence Studies and Analyses, a think-tank. This is double the health budget that year, according to our analysis.

About a fourth of the defence budget, or 24%, goes towards pensions.

Defence Budget Almost 50% Higher than Health Budget In 2017-18
Sector Budget (Rs lakh crore) Budget (As % Of Gross Domestic Product) Budget (As % Of Total Government Expenditure)
Defence 4.31 2.5 9.8
Education 4.41 2.6 10
Health 2.25 1.4 5.1

Source: Economic Survey 2017-18, Institute of Defence Studies and Analyses

In 2017, India’s school education budget, including central and state spending, was about Rs 4.41 lakh crore ($ 73.8 billion) or 2.6% of GDP, more than defence and health separately. However, almost half of India’s grade V students cannot read a grade II text and more than 70% cannot carry out division, according to the Annual Status of Education Report (ASER) 2018, IndiaSpend reported in January 2019.

India had the second-lowest score for quality of education in South Asia in 2016 (66 out of a possible 100, just ahead of Afghanistan’s 64) and behind group leader Sri Lanka (75), IndiaSpend reported on September 25, 2018.

Health and education need more money

While India’s health budget is rising--in 2018 it was double of what it was in 2010--as IndiaSpend reported in January 2019, it is still inadequate, considering that India is home to a third of the world’s stunted children, has the highest number of tuberculosis patients and reports among the world’s highest out-of-pocket expenditure, an indicator of public healthcare failures.

The National Health Policy of 2017 talked about increasing public-health spending to 2.5% of GDP by 2025, but India has not yet met the 2010 target of 2% of GDP, IndiaSpend reported in April 2017.

The National Policy on Education, which guides India’s approach to education, has since 1968 recommended a minimum spending of 6% GDP on education but that target has never been met. There have been “pervasive and persistent failures in implementation leading to sub-optimal utilisation of the resources provided”, the 2016 document said.

(Yadavar is a principal correspondent with IndiaSpend.)

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