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The world’s most revered medical journal – “The Lancet” has lambasted prime minister Narendra Modi for ignoring India’s health sector and has warned that India is on the verge of a collapse under the weight of its own ill health. The journal will take Modi to task for failing to make health his priority, side lining his poll promise of rolling out universal health coverage and not investing in public health with a paper which will be published on December 11, written by some of the world’s foremost experts. In an exclusive interview to TOI, on the side lines of the Global Maternal New born health conference, Lancet’s editor-in-chief Richard Horton said “I don’t see any new policies, any new ideas, any significant public commitment and most importantly no financial commitment to the health sector.
Horton said “Since Modi has come in, health has completely vanished. India is on the edge. If PM Modi does not tackle health, India’s economy combined with rising population is not sustainable. For India, health is an issue of national security. The government cannot protect the sovereignty of its nation, cannot ensure sustainability unless it has a healthy population. At present Modi has done nothing much to tackle the challenge”. Horton added “At the moment, India is on the edge and it can take two routes. It can take a route of investing in health and investing in its people and creating a thriving and flourishing future for India which has a part to play in world affairs or it can do what it is doing now and ignore health it which case it will see epidemics sweep across the country creating an unsustainable future and destroying national security. I really think that it is that serious. At the moment PM Modi has not made up his mind on which choice he is going to take”.
According to Horton, failing to combat non communicable diseases like diabetes and heart disease and reduce maternal and child health will cost India’s health system and social care “enormously making India collapse”. Horton sad the Dec 11 paper will challenge the Mod government on universal health coverage and what it has done. “Frankly, not much,” Horton added. “In the paper, we will talk about health financing and service delivery. The problem in India is that health has just completely dropped off the political agenda. Before Modi came in, health was an issue that wasn’t as high in the agenda as it should have been but it was definitely on the agenda. Since Modi has come in, health has completely vanished and this is a desperate predicament for the Indian population not having health as a central political objective of the government,” Horton said. According to the Lancet editor, rolling out universal health coverage (UHC) for all India should be an absolute priority for the government. “If president Obama can make the healthcare care act one of his central priorities, why can’t PM Modi make UHC his political objective,” Horton added.
So what are the main issues Horton wants India to focus on?

“The main issue is the lack of investment in the public health system and the growth of an unregulated private sector. And this imbalance between the unregulated private sector and the quality of care in many cases appalling compared with the public system that is struggling to meet the demands of the rising population. On top of it although there has been progress with child and maternal mortality, India has the highest number of child and new born deaths. It is not just an issue of national concern but of that of national shame for the Indian government and should propel it in making health one of its central objectives. Where India stands with maternal and child health is a major concern. There are still 600,000 under five deaths in India, maternal mortality is still very high”. “Maternal and child care are indicators of civilized society. Civilized society should not be letting its mothers and daughters die. India wants to play a larger role in the world, wants to be in the security council of the United Nations, which are very legitimate objectives for India. I don’t think it can claim to be a world leader when it allows so many of its children and mothers to die of abject poverty”.

So what does Horton want Modi to do?

“Increasing percentage of GDP spent on public health system and seeing his personal leadership in UHC, in reducing rates of child and maternal mortality and addressing the epidemic of NCDs. Those should his three absolute priorities for health,” Horton added. India currently spends about 1% of its gross domestic product (GDP) on public health.

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