Sunday, April 7, 2013

World Health Day in Pakistan: Premature Death Rate Declines Amidst Rising Violence

Years of life lost due to violence have more than doubled (up 109%) in Pakistan since 1990. Violence now ranks 20 among various causes of premature death, up from 34 in 1990. Other major killer diseases which claimed more lives include lifestyle diseases like heart disease (up 103%), cirrhosis (105% up) and diabetes (up 157%).  Overall, age-adjusted death rate in the country has declined from 1,120 per 100,000 in 1990 to 982 per 100,000 now, according to Global Burdens of Disease Study 2010.  More Pakistanis are dying due to rising violence, heart disease and diabetes, partially negating gains made by reducing premature mortality for other factors.
Leading Causes of Premature Deaths in Pakistan

Pakistan ranks in the middle among 15 similar countries compared by the Global Burden of Disease Study 2010 (GBD 2010).  Other countries in this group include India, Djibouti, Kyrgyzstan, Laos, Moldova, Mongolia, Nicaragua, Palestine, Papua New Guinea, Philippines, Solomon Island, Uzbekistan, Vietnam and Yemen. 

The fact that Pakistan ranks near the middle and outranks India among 15 similar countries in terms of disease burdens is a surprise given the reality that Pakistan spends just $58.27 per person on health (including the government contribution of $22.59) , less than half of neighboring India's per capita health spending of $132.20, which includes $38.57 from the government.  Some of the differences in health outcomes may be attributable to nutrition, sanitation and environment.

In addition to reducing violent deaths by improving security, Pakistan needs to spend a lot more on health and education to enhance the quality and productivity of its human resources. Looking at examples of nations such as the Asian Tigers which have achieved great success in the last few decades, the basic ingredient in each case has been large social sector investments they have made. It will be extremely difficult for Pakistan to catch up unless similar investments are made by Pakistani leaders.

Pakistan's HDI grew an average rate of 2.7% per year under President Musharraf from 2000 to 2007, and then its pace slowed to 0.7% per year in 2008 to 2012 under elected politicians.  Earlier in 1990s, the increase in Pakistan's HDI was just 9.3% from 1990 to 2000, less than half of the HDI gain of 18.9% on Musharraf's watch from 2000 to 2007.

As Pakistanis prepare to go to the polls on May 11, it is important that the voters demand an explanation from the incumbent political parties for their extremely poor performance in the social sector. Without accountability, these politicians will continue to ignore the badly needed investments required to develop the nation's human resources for a better tomorrow. Forcing the political leaders to prioritize social sector development is the best way to launch Pakistan on a faster trajectory.

Related Links:

Haq's Musings

Pakistan Human Development: Musharraf Vs Politicians

Pakistan Fares Marginally Better Than India on Health

America Significantly Outweighs Asia

India and Pakistan Suffer Heavy Disease Burdens 

India and Pakistan Off Track, Off Target on Sanitation

Study Finds India's Air Most Toxic

Pak Lady Health Workers "Best in the World"

Infectious Diseases Kill Millions in South Asia

WHO Says Pakistan On Track to be Polio Free


Zaid (WHO Pakistan) said...

Many Pakistanis from rural areas or small cities had to travel by train to get major treatments or surgeries done. Today, for many that is no longer an option.

Paraphrasing The Nation, Pakistan, despite its moderate size, has a largely dysfunctional railway system. As of mid 2011, it was decided to stop all goods train haulage due to severe shortage of locomotives and fuel. The financially bankrupt organization, despite bailouts, has not been able to emerge out of its troubles leading to cancellation of as many as 115 railway services. The decision has left ordinary Pakistanis at the mercy of bus operators for long distance travel. As of 2011, the PR network cancelled many trains and AC services in many trains were stopped. On 29 December 2011, PR restored freight train service from Karachi to upcountry.

Hopewins said...

^^RH: "...Forcing the political leaders to prioritize social sector development is the best way to launch Pakistan on a faster trajectory."

"...Prioritize social sector development...".

Yes, but with respect to WHAT?

Raising more taxes from a stagnating economy would make the stagnation ever worse, wouldn't it?

So how can the Government spend more on Social Sector Development without making cuts elsewhere?

And if you agree that the Government should make cut-backs elsewhere to prioritize social development, then you must tell us EXACTLY WHERE you think the cut backs should be made and how much?

Should the government slash defence expenditure? Or should it slash general subsidies? Or should it ask for waiver of debt? Or request a moratorium on interest payments? Or should it run around the world with a begging bowl and making speeched about "Friends of Democractic Pakistan? Or should it threaten the world with terrorists wielding Nuclear Weapons in order to extort cash?

Exactly what should the government do in order to "Prioritize social sector development"?

Please explain yourself.

Riaz Haq said...

HWJ: "So how can the Government spend more on Social Sector Development without making cuts elsewhere?"

The first step is to privatize money-losing and subsidy-hogging state-owned companies that are used by politicians as a vehicle for political patronage. Privatization will lead to these state-owned entities be a source of revenue for the public treasury instead of being a huge burden.

I wrote a post titled "Save Pakistan's Education, Airline & Railways" on this subject last year.

"...under 1.5% of GDP [is] going to public schools that are on the front line of Pakistan's education emergency, or less than the subsidy for PIA, Pakistan Steel, and Pepco."

Pakistan Education Task Force Report 2011

Here's how Dr. Ishrat Husain argued for it:

In the banking sector, for instance, before privatisation, the largest banks in the country were all government owned. In the early 2000s, the three big banks that the government decided to sell cost the national exchequer about Rs41 billion in bailouts in order to ensure that they were adequately capitalised. By 2011, far from needing banks, those same three banks were paying in Rs25 billion in corporate income taxes.

Riaz Haq said...

Zaid: "Many Pakistanis from rural areas or small cities had to travel by train to get major treatments or surgeries done. Today, for many that is no longer an option. "

Rural Pakistanis now have more a better access to health care than in the past. Not only is there a much improved road network and buses, there's also a community-based health program called "Ladies Health Workers Program" described by researchers as "best in the world".

As to transportation, highways have now become the most important segment of transport sector in the country, according to the Economic Survey of Pakistan. At the time of Pakistan's independence in 1947, transportation by roads accounted for only 8% of all traffic. Today, it accounts for 92% of national passenger traffic and 96% of freight.

Similarly, Indian railway has also been losing its share of India's transport market. Today, 90% of India's passenger traffic and 65% of its freight operations use road transportation, according to World Bank.

Hopewins said...

^^RH: "The first step is to privatize..."

Nawan Sharif would do this. After all, the only reason he entered politics was because Bhutto confiscated his family steel-converter business in the name of Nationalization. So he has got to HATE this state-owned nonsense.

Notice that Bhuttos and their PPP, to this day, defend State-owned COMPANIES, but there has been no real change in privately-held Zamindari land!

Bhutto-PPP is for privately-owned land but prefers state-owned companies. Why? Because it is a land-holder party and sees no threat from them. The reason Bhutto nationalized industries was because he saw a threat from the large capitalists to his power.

So what Sharif & Co should do is privatize the state-owned companies and ABOLISH Zamindari by nationalizing all hereditary land-holding larger than a maximum.

That would put the Bhutto-people in direct conflict with the Sharif-people.

The Bhuttos would label the Sharifs as anti-worker because they want to privatize nationalized industry. And the Sharif would label the Bhuttos as anti-farmer because they want to continue rent-seeking Zamindari. Labor unions in the State-owned companies would vote for Bhuttos, whilst the landless tenant-farmers would vote for Sharifs.

What do you think? Would anyone have the courage to take on the Bhuttos and privatize state-owned industry while nationalizing large hereditary land-holdings?

Riaz Haq said...

Here's a News Op Ed by Dr. Atau-ur-Rehman:

For the last five years a strange drama is being played out by the Election Commission of Pakistan to support the biggest crooks in the land. This relates to supporting hundreds of those parliamentarians that forged their degrees in order to become eligible to contest the elections in 2008, and then looted thousands of billions of rupees after coming into power.

According to Transparency International of Pakistan, a colossal sum of Rs18,000 billion (that is Rs100 crores repeated 18,000 times over!) was looted by those in power in the last five years, drowning the country in debt. This amounts to about 180 billion dollars.

Considering that we have been quibbling over aid from the USA that is only about 1-2 billion dollars annually, it shows the magnitude of what has been actually going on in the country. Pakistan has been skimmed dry and is today essentially a bankrupt country. We will be unable to pay the next installment due to the IMF unless we can get a loan from somewhere to help us do so.

All this went on under the nose of our judiciary and the army who watched helplessly as the loot and plunder continued unabated. Many Neros were just playing with the fiddle while Rome was burning. The Election Commission even ignored the orders of the Supreme Court issued about four years ago to have the degrees of the elected ‘gentlemen’ verified and looked the other way while daylight robberies on our national exchequer continued. The acute poverty that has resulted across the country has aggravated the law and order situation.

A former prime minister has been charged with massive corruption involving the hiring of obsolete power generating plants at exorbitant prices. The cost of power generation from these plants is over Rs50 per unit as opposed to Rs6-8 per unit from other plants. Money has been transferred under hand to foreign bank accounts while industries have been devastated. Had the Election Commission done its job five years ago many of these crooks that ruled us would not have been able to perform their villainy.

What is alarming is that the ‘save the crooks’ approach still continues and attempts are being made to allow these very fraudsters to escape from scrutiny and participate in the next elections. This scheme has been recently exposed in a letter written by the chairman Higher Education Commission to the chief election commissioner; it has also been sent to the chief justice of the SC.

The Election Commission, apparently bowing to political pressures, has cleared 27 of those members of parliament that had been found to have fake degrees. It may be noted that the ECP has no legal right to declare degrees fake or genuine. The HEC is the only institution that has these powers and the step taken by the ECP to declare the degrees as genuine after the HEC had found them to be fake and declared them to be so is illegal.

The HEC has formally informed the ECP of this vide its letter of March 4, 2013. The Supreme Court should take suo motu notice of this and if it is found that the Commission is guilty and continuing its ‘save the crooks’ policy, then a new commission should be constituted.
Pakistan is at a crossroads. We may be able to save this country if we can get clean people in the government and there is a huge responsibility on the Election Commission of Pakistan to ensure this. Alas it appears that the Election Commission is continuing its ‘save the crooks’ policy and failing to honour its own commitment – that it will take criminal action against all those ‘gentlemen’ who continue to refuse to produce their documents for scrutiny.

There are 189 such persons who have refused to do so till today and the Election Commission continues to look the other way. This is a national shame.

Riaz Haq said...

Here's an NDTV report today:

Of every 100 new-borns that die in the world, 29 are in India. In real, heart-rending numbers that is three lakh babies who die on the day they are born, every year.

Infants fare better even in Pakistan and Bangladesh, says a new report.

Non-governmental organisation Save the Children compared first-day deaths in 186 countries for its "State of World's Mother Report". Luxembourg has the least new-born deaths, India the most, the reports says.

While infant deaths in India have come down by almost half compared to 1990, the rate has been slower than that in, say, Nepal.

The statistics only get worse. More than half the child deaths in India happen in the first month. And India has the biggest disparity between the rich and poor in child deaths.

The country's report card on mother and child health too is abysmal; India is behind Pakistan and Bangladesh on this list.

Riaz Haq said...

India leads the world in dengue, reports The Hindu:

Dengue, the world’s most rapidly spreading mosquito-borne viral disease, is taking a far bigger human toll than was believed to be the case. As many as 390 million people across the globe could be falling victim to the virus each year, according to a multinational study published by Nature on Sunday.

India emerges in the analysis as the country with the world’s highest dengue burden, with about 34 per cent of all such cases occurring here.

According to the World Health Organisation (WHO), incidence of dengue has shot up 30 fold in the past 50 years. Its estimate has been that globally there were 50-100 million dengue infections taking place annually.

For their study, Samir Bhatt at the University of Oxford and his colleagues used a map-based approach to model how many dengue cases were occurring in various parts of the world, thereby capturing its global distribution.

They estimated that worldwide, 96 million people suffered each year from ‘apparent infections’ where the disease was severe enough to disrupt an individual’s regular routine. In addition, there were 294 million asymptomatic infections.

With “large swathes of densely populated regions coinciding with very high suitability for disease transmission,” Asia bore 70 per cent of the apparent infections that took place, the scientists pointed out in the paper.

Africa contributed about 16 per cent of the global dengue infections and the Americas 14 per cent.

“I consider it to be the most comprehensive study of dengue disease burden to date,” said Duane J. Gubler, an internationally known expert on the disease, when asked for his views on the Nature paper.

The study’s estimate of 390 million infections was “much closer to the actual figure than the 50 million WHO is still using,” observed Professor Gubler, who is now with the Duke-NUS Graduate Medical School in Singapore.

“Considering that mosquito control has failed in all dengue-endemic countries, that over half of the world’s population now lives in urban areas, and that dengue is an urban disease, even that number may be too low,” he said in an e-mail.

The study estimated that India had the largest number of dengue cases, with about 33 million apparent and another 100 million asymptomatic infections occurring annually.

However “these are estimates and there are many gaps which we now need to fill,” cautioned Jeremy Farrar, a senior author of the study, in an e-mail. “But it would not surprise me that India was home to the most dengue [patients] globally.”

The model used in the study could help provide a framework to estimate the burden of disease. Inevitably, there were gaps in the data and one needed to extrapolate from other areas. Better data collection should be encouraged so that the estimates were as accurate as possible, said Professor Farrar, who is director of the Wellcome Trust Vietnam Research Programme and Oxford University Clinical Research Unit Hospital for Tropical Diseases in Vietnam.

“We have a tremendous problem of dengue all over India,” said Umesh C. Chaturvedi, agreeing with the finding of the paper. A virologist who has studied the disease, he is a scientific consultant to the Indian Council of Medical Research.

Riaz Haq said...

Here's WSJ on world homicide rates:

MEXICO CITY—Latin America is the world's most violent region, accounting for nearly one in three global homicides, according to data from a new study by the United Nations.

Latin America racked up some 134,519 homicides in 2012, about 31% of the total for that year, according to a tally by The Wall Street Journal of the U.N. Office on Drugs and Crime's Global Study on Homicide, its first since 2011. Yet the region's 574 million people comprise just 8% of the global population, according to U.N. figures.

As a whole, Latin America's per capita homicide rate is 23.4 per 100,000 people, nearly double the rate in Africa, which is sometimes mistakenly believed to be the most violent continent. Venezuela is the only country in the region with a consistently rising homicide rate since 1994, the report said.
Brazil, the host for this year's World Cup soccer tournament, has more overall homicides than any country, at 50,108, accounting for one in 10 globally, followed by India, with 43,355 murders in 2012.

Brazil's Justice Ministry, asked about the numbers, said it has four priority programs in boosting public safety, and pointed to success stories like police pacification units in the slums, or favelas, of Rio de Janeiro.

Parts of Brazil, including São Paulo, are indeed far safer than the country's violent northeast, where crime is rising fast.

Just four Latin American nations—Brazil, Mexico, Venezuela and Colombia—accounted for nearly 107,000 homicides in 2012, nearly one in every four global killings.

Of the top 10 nations ranked by per capita homicide rate, and excluding tiny nations with fewer than 100 killings a year, Latin America has the top five nations and seven of the top 10, according to The Wall Street Journal's ranking of the data. The only three non-Latin American countries in the top 10 were Lesotho, Swaziland and South Africa.

Honduras is the world's most dangerous country outside a war zone, with 90.4 homicides per 100,000, compared with a global average rate of 6. Second is Venezuela, with 53.7 homicides per 100,000 people, up from 47.8 in 2011.

Afghanistan, by contrast, had a homicide rate of 6.5 per 100,000 in 2012, and probably a similar rate of deaths due to the country's conflict, said Ms. Me.

Southern Africa, which makes up just Botswana, South Africa, Lesotho, Namibia and Swaziland, can still claim the title as the world's most violent subregion. But even there, violent crime is on the decline. South Africa's rate has fallen from 64.9 in 1995 to 31 in 2012, for instance. Latin America, meanwhile, shows a slight increase in crime per capita since 1995, with a big exception being Colombia.

The Americas as a continent now tops Africa in terms of homicide rate. The Americas has 16.3 homicides per 100,000 people, followed by Africa with 12.5. The last UNODC survey showed a homicide rate of 15.5 for the Americas compared with Africa at 17.4 per 100,000....
The U.S. homicide rate is 4.7 per 100,000—well above every other industrialized country.

The Americas also had the highest rate of guns as the cause of homicide—with 66% of the homicides caused by guns versus 28% in Africa and Asia and 13% in Europe.

However, not all Latin America is a hotbed of violent crime. Southern South America—Chile, Argentina and Uruguay—have crime rates roughly similar to the U.S. There is far less organized crime and better policing in those nations compared to the rest of the region, Mr. Hope said.

Riaz Haq said...

Overall mortality rate: India 7.32 vs Pakistan 6.49

Riaz Haq said...

How #Pakistan’s National Health Insurance Program Will Work via @WSJIndia

Pakistan’s government launched a national health insurance program for its poorest households Thursday, marking the start of the most-ambitious public health project in the country’s history.

The Prime Minister’s National Health Program will from Thursday cover families that make less than $2 a day through a gradual rollout. In the first phase, over 3 million families will get health insurance in 23 districts, with the ultimate aim to cover 22 million households across the country, officials said.

“This is another step towards the welfare state that we promised to create when we came into power,”said Pakistani Prime Minister Nawaz Sharif.

The Pakistani government already subsidizes health care to varying degrees in public hospitals, but officials acknowledge these facilities are unable to handle the patient load or achieve public health targets.

The government said earlier this year that it wouldn’t be able to meet the United Nation’s targets for child and maternal mortality rates that formed part of the Millennium Development Goals, which had a deadline of 2015. Critics have blamed Pakistan’s low health spending and inadequate management as key factors in the poor health provision. Between July 2014 and March 2015, Pakistan spent just 0.42% of its GDP on health. The U.S. government spends about 8.3% of GDP on healthcare.

The new insurance program will cover treatment at both public and private hospitals. Private hospitals that sign up will then be offered loans on easy terms to upgrade their facilities, officials said, without providing further details about interest rates and conditions.

Saira Afzal Tarar, minister of state for health Services, regulations and coordination, said most Pakistanis pay out of pocket for treatment. “There is treatment at government-run hospitals, but there are long lines. Those who don’t have a recommendation have to wait months for treatment,” Ms. Tarar said at the launch ceremony in Islamabad. “With this [health insurance] card, you’ll be able to go to the hospitals where you weren’t allowed to even go to the front door. Now, you’ll be treated there with dignity and respect.” Ms. Tarar said.

The national health program, with an initial funding of 9 billion Pakistani rupees ($86 million) will pay for the treatment of the types of illnesses identified by the government as critical: heart disease, diabetes and related illnesses, cancer, kidney and liver diseases, complications from infections like HIV and Hepatitis, road accidents, and burn injuries. Officials said coverage can be extended to other conditions considered life-threatening.

The government said Thursday that the program will be run in partnership with provincial governments, which will share the financial burden. Beneficiaries will receive insurance cards, after selection from a database of low-income Pakistanis set up in 2008 for a separate cash support program.

The coverage includes 50,000 rupees for general treatment, and 300,000 rupees for serious illnesses. Mr. Sharif said on Thursday that the government is making arrangements for an emergency fund that would extend coverage to 600,000 rupees for cases that require longer treatment.

Officials on Thursday didn’t provide specific timelines for the rollout of the next phase, which is expected to cover another 3.3 million households. The finance ministry said earlier this year that the program aims to cover 22 million families.

The finance ministry, quoting World Bank data and 2008 population estimates, said last year that if living on $2 a day is taken as the poverty line, over 60% of the population would fall in that category.

Riaz Haq said...

#Pakistan to launch 911 #emergency helpline PEHEL (Pakistan Emergency HELpline) across the country.

Different emergency numbers will be merged into one hotline

Islamabad: The Pakistan government is set to launch an all-in-one emergency helpline 911 to swiftly respond to call for help across the country.

Different emergency numbers will be merged into one hotline called Pakistan Emergency Helpline (PEHEL). The idea is to launch a service similar to the 911 helpline in the United States.

The project is being implemented by the National Telecommunication Corporation (NTC) and the Digital Pakistan initiative of the IT ministry. NTC, which is responsible for providing secure and reliable telecommunication services to government organizations, is spearheading the initiative to help the citizens in distress. The software applications are being developed by NTC and the National Information Technology Board (NITB).

The dedicated emergency response number can be dialled to avail different services including police, ambulance, and other rescue and support so that the citizens will not have to go through different helplines during emergencies.

The decision was taken in the wake of the horrific rape incident at Lahore-Sialkot Motorway in September 2020 in which the victim failed to get any help through the motorway helpline. The incident prompted Prime Minister Imran Khan to launch a dedicated hotline to prevent such crimes and offer citizens immediate help during the emergency situation.

Khan had asked the PM Delivery Unit (PMDU) to complete work on the emergency helpline by December 2020. However, the launch of the pilot project in Islamabad is expected to take another two months. The testing of the service has been completed. The operations would initially begin at Safe City Islamabad.

The PEHEL 911 service would offer a “unified and one-window access to all emergency services” in Pakistan, according to IT Minister Syed Aminul Haq. The IT ministry will provide technical support and infrastructure and the interior ministry will ensure the smooth....

Riaz Haq said...

TFR Fertility Trend in Pakistan:

1990 2017 2100
6.1 3.4 1.3
South Asia
6.1 3.4 1.3
3.1 2.4 1.7

Riaz Haq said...

Bilal I Gilani
Continuing with looking at the brighter side of our development

Burden of disease has declined from 70,086 disability-adjusted life years (DALYs)32 lost per 100,000
people in 1990 to 42,059 in 2019 due to decreases in CDs and improvements in maternal and
child health;