In today’s world, where almost everything is a click away, for many, access to healthcare, descents into alcoholism, and misperceptions about illnesses can still take us back to the 18th century. In this brief article, the idea is to give an overview of the interplay between the determinants as mentioned above while presenting some evidence from the ground.
The World Health Organization (WHO) defined human health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” They define mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.
The main factors influencing the health of an individual vary from the socio-economic status to individual habits and behaviours. As any society moves from one demographic to another, the challenges to the health and well-being of people also change accordingly. While many of these challenges can be tackled by timely and good healthcare facilities, ignorance and relying on unrealistic treatment methods and mechanisms can lead to harmful effects, which is not so such an unusual case in developing societies.
India, with a population of 1,324,171,354, was the second-most populous country in the world in 2017. More than 50% of its population is less than 25 years of age, while more than 65% of the people are below the age of 35. With 158,789,287 people between the age group of 0-6 years, 69% of the population still living in the rural areas. About 74.03% of India’s people are literate. One-fifth of maternal deaths and one-quarter of child deaths in the world occur in India. Life expectancy at birth is 63 years for males and 66 for females. The under-5 mortality rate of 69 per 1000 births in India falls behind the South-East Asia regional average.
While health outcomes have improved over time, they continue to be patterned along dimensions such as gender, caste, wealth, education and geography. We can see substantial geographic inequalities in health outcomes in India, with life expectancy ranging between 56 years in Madhya Pradesh to 74 years in Kerala – a difference of 18 years, which is higher than the provincial differences in life expectancy in China, or the inter-state differences in the United States.
Perceptions and utilization of preventive services such as antenatal care and immunizations also vary among different groups of society according to gender, socioeconomic status, geography, household wealth, education, caste, and place of residence (rural vs urban). Inadequate access to appropriate maternal health services remains an important determinant of maternal mortality. General hospitalization rates also vary by gender, wealth, and urban-rural residence.
Perceptions about illness among patients and the people close to them play an important role in the overall health condition of individuals and society. This plays a major role in directly influencing the individual’s emotional response to the illness and their coping behaviour.
An important point to remember is that the patient’s view of the symptoms caused by the illness may be quite different from that of the medical staff treating the condition. Although there may not be any clear and direct correlation between the perception of illness among patients and the clinical diagnosis, these perceptions are associated with increased future disability and a slower recovery, independent of the initial medical severity of the condition. Then again, a very crucial question comes up, especially in developing societies like India, about the percentage of the population relying on modern health facilities, rather going to a traditional healer, or conducting self-medication or religious rituals.
Let’s look at the challenges related to alcoholism. Thirty percent of the Indian population consumes alcohol regularly, with approximately 11% of Indians being moderate to heavy drinkers. A few facts remain constant, such as high rates of alcohol consumption being correlated with adverse outcomes at both individual and societal levels: increased rates of mortality, injuries, motor vehicle accidents, domestic violence and criminal activity.
Alcohol is available in close vicinity for a majority of the population, and people in different areas (depending on their socio-economic class, literacy level etc.) drink with different frequencies and in varying amounts. The harmful psychological effects of uncontrolled alcohol consumption lead to serious threats to the society, including affecting the financial conditions of the individuals and families involved in it. A World Health Organization report added that alcoholism in India increased by about 55% between 1992 and 2012. In 2012 alone, about, 3.3 million deaths in India were attributed to alcohol consumption. This amounted to approximately 5.9% of the global deaths that year
Drunkenness and alcohol misuse by the male partner is associated with poor mental health and spousal violence towards married women in India. The prevalence of alcohol use among the women themselves has consistently been estimated at less than 5%, a percentage which in the male population alone accounts for addiction or an alcohol-related disorder. There is also a widespread notion that alcohol use is not favoured by women from the middle or upper socioeconomic classes. It is seen to be confined to tribal women, women of lower socio-economic status, commercial sex workers and to a limited upper crust of the rich.
The public discourse on alcohol in India has traditionally focused on the plight of women at the receiving end of alcohol-related violence and impoverishment. Clearly, alcohol misuse represents a public health crisis in India that has yet to receive adequate attention.
Alcohol dependence is one of the most severe as well as prevalent mental disorders. The World Health Organization estimates that 76.3 million people worldwide suffer from alcohol use disorders. About 4% of all deaths and 5% of all disability-adjusted life-years lost can be attributed to alcohol. The stigma of alcoholism is likely to aggravate these effects:
1. It may hinder people from seeking professional and lay help, because they fear being labelled as alcoholics.
2. The stigma may contribute to the social exclusion of those in particular need of support.
3. It may produce structural discrimination against alcohol-dependent persons regarding the coverage of addiction treatment in the form of private or public health insurance.
People suffering from alcohol dependence (and from other addictions) are also less frequently regarded as being mentally ill, as they are generally considered to be entirely responsible for their own condition. Many negative stereotypes about alcohol-dependent people in Indian society are also misinformed: the stereotype of being weak-willed, for example, might not be true when comparing lifestyle changes and treatment adherence in alcoholism with other chronic medical conditions like diabetes or hypertension, where such changes do not occur more frequently.
Although alcohol does not necessarily cause severe mental illness, alcohol consumption can be a contributing factor to some mental health problems, such as depression.
Various scientific studies have shown that the mental disorders are also thought to be occurring due to less sexual desire, God’s punishment for their past sins and polluted air. People living in joint families rather than in nuclear families also believed that sadness and unhappiness would cause mental disorders. Among the misconceptions, the worst one is that mental illnesses are untreatable, besides the unwillingness of accepting the fact that a family member can have a mental illness.
In one of our ongoing studies, which covers several states in India, and also has data from countries like UK, USA, Canada, Nepal and Russia, we found that while the more educated strata of society are aware of mental health problems, the less educated ones are not. Further, people accept the insufficiency of mental health facilities in their surroundings but on the contrary, do not accept the likelihood of a family member having a mental health disease.
The study also highlights and quantifies the difference between actual prevalence rates of mental health problems in India and the perceived likelihood among the population. The data for this study was collected by using door-to-door questionnaires as well as an online survey.
The individuals involved this study come from various backgrounds- Dr Sukant Khurana (a neuroscientist at CDRI), Mr Ishan Goel (data scientist), Mr Raamesh Gowri Raghavan (expert in behavioural biology and advertising) and Mr Farooq Ali Khan (one of the coordinators of World Health Congress 2017). We desire to portray a real picture of these issues that concern a major portion of our world.
Without a doubt, we can say that India is a culturally loaded country with respect to perception towards illness and healthiness. The country faces many challenges which will be added to, with newer ones as demographic changes take place. Existing infrastructure and facilities are not enough, misinformation and illiteracy add fuel to the fire. A joint effort, a positive approach, stricter regulations, and health education could be just the new beginning towards making the society healthy – both mentally and physically.