Henk Bekedam recalls his days playing football as a boy in a village in the Netherlands. Sport is not just about winning, but doing things together as a team and tackling challenges, says Bekedam, the World Health Organisation’s (WHO) representative to India, linking physical activity to mental well-being.
“Today, kids are stuck to a screen,” he says, concerned at the lack of physical activity and the increasing instances of loneliness and depression, despite living in times of increased “connectivity” round the clock through the internet. In fact, the WHO is pushing for more people to talk about depression and break the silence and stigma around it. Something that found mention in Prime Minister Narendra Modi’s latest ‘Mann ki Baat’, in which he urged family and friends to speak out and help people deal with depression.
Having lived close to two decades in the region, in countries including China and Cambodia, Bekedam points to the pressure on children to perform well academically, a pattern he sees in India too. But the other challenge that is underestimated is urbanisation, he says. Increasing urbanisation makes life more impersonal, and this brings with it challenges of mental well-being, he adds. Rapidly growing economies need to recognise this, especially since mental illness has links with disability and suicide.
Just this week, Parliament passed the Mental Healthcare Bill (2016), which proposes to give better access and services to people with mental illness, and seeks to decriminalise attempted suicide. March also saw the Government announce the much-awaited National Health Policy (2017).
An expert on universal health coverage and financing, Bekedam agrees that health administration can be a “bumpy road”. With health coming under the States’ purview in India, it requires greater collaboration between the Centre and the States to achieve efficient implementation of policies, he notes.
India needs to invest in health not just to prevent people from slipping into poverty, but also because it makes economic sense, explains Bekedam. An additional 60 million people are pushed into poverty because of the healthcare bills they have to pay, he says. So, while the Government is right in proposing to increase healthcare spending to 2.5 per cent of GDP by 2025 (from about 1 per cent now), Bekedam hopes this target is achieved ahead of time.
China understood the importance of universal health coverage, investment in public health and getting quality medical services closer to people, in the post-SARS period, he says.
Bekedam has also been pushing for greater preventive surveillance measures and accountability.
South Korea’s social health insurance was rolled out on the back of transparent IT systems that brought in greater accountability, he says. India could do well to adopt similar systems involving standardised treatment procedures, which would bring in clarity and accountability on treatment, follow-ups and cost, he explains. And this needs to be strengthened with real-time web-based reporting on illnesses on the preventive side, he adds.
The National Health Protection Scheme, which promises greater health coverage to the poor, should act as a base for safe and quality products and services and their equitable distribution, he says.
And India should explore the more sustainable social health insurance model to support people in times of bad health. In other words, to make a solidarity investment when you are healthy to be used later.
Depression affects people of all ages, from all walks of life, in all countries, and is the largest single contributor to global disability.
About 322 million people around the world live with depression.
Nearly half of them live in South-East Asia and the Western Pacific, reflecting the relatively larger populations of those two regions, including India and China.
Depression can lead to suicide. Nearly 800,000 people commit suicide every year.