The economic argument to maintaining cardio-metabolic health

Covid-19 has exposed the lack of government investment in terms of facilities, equipment and staff. On World Heart Day, noted cardiologist Dr Ramakanta Panda makes a foolproof economic argument for why prevention is better than cure

Dr Ramakanta Panda
Updated: Sep 29, 2020 12:28:41 PM UTC

Dr Ramakanta Panda is Cardiovascular Thoracic Surgeon, Vice Chairman & Managing Director at Asian Heart Institute, Mumbai

Image: Shutterstock

Good health is priceless. To truly understand what this means, lets begin with a few questions:

Is maintaining health an expensive proposition? 
Yes. Nationally, in case of nearly 1/3rd of all deaths, the family cannot afford medical attention.

Is it covered by insurance?
No. 86 percent of rural population and 82 percent of urban population are not covered under any scheme of health expenditure support.

Then who’s paying?
About 70 percent of healthcare expenses in India are met by out-of-pocket expenditure by the individual, due to which about 7 percent population is pushed below the poverty threshold every year.

The above questions seem even more ominous as the Covid-19 pandemic has wrecked havoc across the country and exposed the flaws in the public healthcare system. Treatment at public medical facilities is free, but the quality of care varies greatly among states, and Covid-19 has exposed the lack of government investment in terms of facilities, equipment and staff.

Private healthcare is expensive—India has nearly twice as many private hospitals as public ones—an estimated 43,487 versus 25,778. But if you don’t have insurance, a Covid-19 hospitalisation could set you back by nearly Rs 10 lakh. For most households, that is a deathblow (refer figure on public private split in healthcare expenditure). 


A voter survey conducted by the Association for Democratic Reforms based on a cross-country sample in 2017, suggested that healthcare is among the top priorities of Indian voters, with better healthcare facilities ranked second, after jobs among the priorities listed by respondents. People are anxious about illness and the cost of it. The obvious conclusion seems to be: Don’t fall ill. The value of self-monitoring and beneficial health behaviours to improve immune functioning and lower adverse consequences of Covid-19 are increasingly being emphasised.

You can only avert pandemics if your cardio-metabolic health is good; this includes preventing obesity, diabetes, hypertension, maintaining respiratory health etc; data shows that if these indicators are not good, you’re more susceptible to Covid. This was true for EBOLA and SARS as well.

Is maintaining good cardio-metabolic health easier than managing disease? The decline in cardio-metabolic health is attributed to a reckless lifestyle; behavioural trends show that teenage years and those as young working professionals show a marked increase in consumption patterns of both junk food, alcohol and habits such as late nights and smoking. Smoking is an important habit to avoid in addition to increasing risk of cardiovascular disease and cancer, it is known to be associated with poorer lung functions, higher susceptibility to viral infections and severity (e.g., influenza). Smoking is also a repetitive hand-to-mouth action that increases risk of infection. Bad habits, less sleep and no exercise settles down as obesity, diabetes and blood pressure in the middle age. The entire spectrum of non-communicable diseases can potentially kick in here. People with a weakened immune system or cardiorespiratory functioning are more likely to be infected with pathogens and develop complications. Cardio-metabolic co-morbidities are associated with adverse Covid-19 outcomes. Published data from the state of Tamil Nadu reveals that 82 percent of Covid deaths are associated with these co-morbidities.

So, you first spend to spoil your health and then spend lots more to repair it. Foolish, isn't it? But that's what it is. Most of India simply does not look at exercise as an important routine. Overeating and obesity are a part of the culture. While it is easy to say that the government must do more, no government in the world has been able to provide universal healthcare without healthy habits of its population. The ultimate solution to a citizen’s health lies in their own hands.

The health of the general population has to improve if we are to fight pandemics in the future. The truth is, the lifetime cost of maintaining your health is much lower than the cost of managing disease. This is a foolproof economic argument.

The writer is Cardiovascular Thoracic Surgeon, Vice Chairman & Managing Director at Asian Heart Institute, Mumbai

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The thoughts and opinions shared here are of the author.

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