Rich people are twice more likely to report an ailment than a very poor person. Likewise, urbanites are more likely to report feeling unwell than rural folks. But this is not to say that rich and urban people are more likely to fall ill, or fall ill more often.
Besides these findings, a National Sample Survey Organisation (NSSO) survey has concluded that across rural and urban India as well as across gender, the proportion of people per 1,000 persons reporting some ailment, also known as morbidity rate, has risen significantly from the mid-1990s.
For that matter, a recent NSSO report, ‘Key Indicators of Social Consumption on India: Health’, suggests that incidence of ailment among people has more than doubled between 1995-96 and 2014. When the survey was conducted in 1995-96, 54 individuals for every 1,000 persons said they were ailing during the survey period.
Previous NSSO Survey
When the NSSO conducted a similar survey in the first half of 2014, those reporting ailment had risen to 118 persons for every 1,000 – the sharpest increase being among urban women. A simplistic reading of the data would suggest that rural folks claim to be relatively ailment-free than their urban counterparts, across both genders.
The NSSO report suggests that such increase in the proportion of ailing people was probably due to increased health consciousness over time and, consequently, improvement in the habit of self-reporting ailments in urban areas. The NSSO surveys are based on self-reporting, and there is no element of examining patients.
The higher level of health consciousness and self-reporting is closely linked to living and literacy rates. This is best illustrated by Kerala which has close to 100% literacy and generally better living standards. The NSSO uses its monthly per capita consumer expenditure data as a proxy for level of living – and for many years now, Kerala is among states with the highest monthly per capita consumption expenditure.
Kerala Leads the Pack
So, against the national average of 89 ailing individuals per 1,000 for rural areas, the number for Kerala stood at 310 individuals per 1,000 persons. Likewise, in urban areas, compared to the national average of 118 ailing persons, the proportion of ailing people in Kerala was 306 per 1,000. A similar trend is seen in other southern Indian states where literacy level is high as well as Punjab with its very high per capita monthly consumer expenditure.
At the other extreme are the poorer and less literate states such as Bihar and Chhattisgarh. In rural Bihar, 57 per 1,000 reported to be ailing and in urban areas it was 62 per 1,000. In rural Chhattisgarh, 40 in 1,000 reported to be ailing while in urban areas it was 44 per 1,000. There are some exceptions to the rule – most of northeast with high literacy had very few people reporting any ailment during the survey period.
Poor are Better off
The impact of higher levels of living on self-reporting ailments is also seen in reported morbidity by those with higher incomes and consumption expenditure. Morbidity rate reported by people in the top quintile of per capita consumer expenditure is about double that of the bottom quintile, and it is more pronounced in urban than in rural areas. It is also quite likely that the poor tend to ignore some of their ailments as they struggle to make ends meet.
Another interesting finding of the survey: morbidity rates was higher among women aged between 15 and 69 compared to men in the same age group. But once people turn over 70, morbidity rates were seen to be higher among men, and that is more pronounced in rural than in urban areas. This corroborates Census 2011 data – despite leading tougher lives and despite being deprived of adequate nutrition, women tend to outlive men.
(The writer is a Delhi-based senior journalist)