Public Expenditures Overview
A comparison of Public Expenditures on Health in the two countries is the preliminary basis for evaluating where India stands with respect to the current superpower China, as both have strikingly similar demographics and health patterns.
An overview of the evolution of the health systems in China and India reveals some similar patterns and striking differences. We summarize the countries’ important historical developments and milestones in the table below. Although China and India face very different demographic and health challenges, both countries have achieved great health gains since the late 1940s. However, they have also experienced growing disparities across social classes and geographic areas as well as increasing demands for customized health care. Combined with private business interests, this demand is riving focus away from public health toward individual medical care, and from preventive treatment toward curative treatment. Meanwhile, reduced attention to and investment in public health, especially the prevention of communicable diseases, has resulted in the reemergence of some diseases and expanded health inequalities. This retrospective review aims to provide readers with a better understanding of how the health systems of China and India have evolved and reached their current forms. In the next three chapters, we discuss and compare the current systems of the two countries along dimensions of current overall performance, intermediate outcomes, and policy levers.
Overall Performance in Achieving Ultimate Ends
The WHO’s 2000 report entitled The World Health Report 2000—Health Systems: Improving Performance states that a health system should have three fundamental objectives:
* improving the health of the population it serves
* responding to people’s expectations
* providing financial protection against the costs of ill health.
In this section, we compare how China and India fare in achieving these goals.
Key Health Indicators
Overall, people in China live longer and are healthier than people in India (see Table below). According to WHO’s statistics, a woman born in India in 2004 has a life expectancy of 63 years, whereas a woman born in China at the same time has a life expectancy of 74 years. A man born in India has a life expectancy of 61 years, whereas a man born in China has a life expectancy of 70 years. The disparity in life expectancy between the two countries is greater for women than for men, which is partly a result of the ten-fold greater maternal death rate during childbirth for women in India compared with women in China. Additionally, residents of India suffer higher mortality rates in both childhood and adulthood than do residents of China.
Health status at birth in India is poor. In 2004 it was estimated that 30 percent of infants in India were born with low birth weight (LBW, less than 2,500 grams at birth), whereas only 6 percent of newborns in China were born with LBW. Fifty-eight out of every 1,000 infants in India died before their first birthday, whereas only 27 out of every 1,000 infants in China died before their first birthday.
Other Vital Health Indicators
In addition to life expectancy and mortality rates, significant differences exist between the two countries in other important health indicators. For example, India has many more deaths due to communicable diseases. The next table summarizes death rates, categorized by cause, in both countries in 2000. In China, non-communicable diseases accounted for 77 percent of all deaths. Heart disease, chronic obstructive pulmonary disease, and cancer accounted for approximately 67 percent of all deaths. Among infectious diseases, only lower respiratory infections, hepatitis B virus infection and...