Population-Health Equation: Experts urge greater investment in primary care

The rising population density of cities due to their growing population makes them more susceptible to the spread of infectious diseases

Various governments and organisations across the globe are observing yet another World Population Day on July 11 amid its population crossing the 8-billion mark in 2023. However, studies say the rapid population growth, mainly driven by low income countries, poses a serious challenge to public health.

While it took thousands of years for the human population to reach one billion, the next seven billion growth was achieved in just 200 years. Although the growth of population has slowed, human numbers are expected to reach 9.7 billion by 2030.

A 2017 survey of almost a quarter of living Nobel Prize winners for chemistry, physics, physiology, medicine and economics, show that more than a third of them considered population rise and environmental degradation as the biggest threat facing humankind.

But the link between population and environmental degradation has since been disputed by many, especially considering the fact that high-income and upper-middle-income countries account for as much as 85 percent of the carbon dioxide emissions, while only having 50 percent of the global population. However, it still raises concerns for public health infrastructure.

“Rapid population growth makes it more difficult for low-income and lower-middle-income countries to commit sufficient resources to improving the health and education of their populations. Rapid growth and the associated slow progress in development also diminish their capacity to respond and adapt to emerging environmental threats, including those caused by climate change,” said a statement by the United Nations in 2022.

Population growth and infectious diseases

Researchers have linked increased population density with the rising emergence of infectious diseases.

A study of diseases that emerged since 1940 have found that human population density has been an independent predictor for all categories of infectious diseases that have emerged. And that densely populated areas with high levels of biodiversity and rapid environmental changes are hotspots for the same.

The rising population density of cities due to their growing population makes them more susceptible to the spread of infectious diseases, once they take hold.

“Healthcare facilities need to expand according to the size of the population. Overcrowded living conditions, poor sanitation, and limited access to healthcare can contribute to the spread of infectious diseases. It can exacerbate the transmission of communicable diseases, leading to higher disease burdens and public health challenges,” said Poonam Muttreja, executive director at Population Foundation of India.

“The increasing demand for healthcare services can lead to higher healthcare costs also. This can create financial barriers to healthcare access for some population segments,” she added.

According to WorldAtlas, four Indian cities - Mumbai, Kolkata, Howrah, and Delhi - figure in the list of most densely populated cities in the world.

Stressed public health infrastructure

Apart from its links to rising emergence of infectious diseases, population boom could also pose challenges for the health infrastructure in countries such as India. However, with proper investments, this could be remedied, says experts.

“As population increases, we have to put more money into public health facilities and make them more efficient. This is how countries with high population density like Singapore and Netherlands have managed to maintain good healthcare facilities,” said Dileep Mavalankar, former director of Indian Institute of Public Health, Gandhinagar.

With India surpassing China as the most populous country in the world, experts say that the country needs to invest more into its healthcare infrastructure.

Primary health centres (PHC) are supposed to be the first point of contact between the community and medical officers in India. According to data released by the Ministry of Health and Family Welfare in January, the shortfall in the number of PHCs in rural and urban areas in the country stands at 31 percent and 39.7 percent respectively.

“When there is a large and growing population, the demand for healthcare services increases, putting pressure on the allocation of limited resources. The National Health Policy 2017 recommended allocating a major proportion of resources to primary care, followed by secondary and tertiary care. However, core health programmes such as National Health Mission have witnessed a drop in their funding, over the last few budgets,” said Muttreja.

According to the Human Development Report 2021-22, India only has five hospital beds available per 10,000 population and ranks 168th among countries with data available for the same.

“We are not investing adequately in public healthcare and preventive healthcare. We can set up thousands of primary health centres with the money we spend on one AIIMS. The population with access to healthcare would have thus doubled or at least increased by 1.5 times,” said Mavalankar. “We need more decentralisation of primary level healthcare.”