• 1,128,000,000 est population – (Second only to China, 1/6 of
world pop)
• Two thousand ethnic groups• 22 official languages – Hindi
most widely spoken• 82% Hindu (Muslim12%,
Sikh2%, Jain0.4%, Christian2%, Buddhists0.8%)
• Caste system – occupational and socio-religious hierarchies– Unequal social mobilization
and uneven economic growth
Breakup of India's religions: ██ Hinduism — 90.5% ██ Islam — 3.8% ██ Christianity — 2.3% ██ Sikhism — 1.9% ██ Buddhism, Jainism, others — 1.5%
Chaos
Vital Statistics
• Population 1.1 billion• Population growth rate: 1.38% (2006 est.)• Birth rate: 22.01 births/1,000 population (2006 est.)• Death rate: 8.18 deaths/1,000 population (2006 est.)• literacy rate: 79.9%• Percent of the population under the poverty line:
22%(2006 est.)• Unemployment Rate: 9.2%• Infant mortality rate: total: 54.63 deaths/1,000 live births • Life expectancy at birth:total population: 64.71 years• Gross national income per capita: $3,460
· Iron Age Kingdoms · 1200–700 BC
Maha Janapadas 700–300 BC
Magadha 1700 BC–550 AD
· Maurya Dynasty · 321–184 BC
Middle Kingdoms 230 BC–1279 AD
· Satavahana Empire · 230 BC–199 AD
· Kushan Empire · 60–240 AD
· Gupta Empire · 240–550
· Pala Empire · 750–1174
· Chola Empire · 848–1279
Islamic Sultanates 1206–1596
· Delhi Sultanate · 1206–1526
· Deccan Sultanates · 1490–1596
Hoysala Empire 1040–1346
Kakatiya Empire 1083–1323
Vijayanagara Empire 1336–1565
Mughal Era 1526–1707
Maratha Empire 1674–1818
Sikh Empire 1799–1849
Colonial Era 1757–1947
Modern States 1947 onwards
• India independent since 1947, after 150 yrs of rule by England– English put in much infrastructure (railroads, schools, roads,
health care system).
• Republic of India – collectively 29 states (elected gov’t) and 6 union territories (appointed administrator).
• Type of government – descriptions found in the Preamble “Sovereign,” “Socialist,” “Secular,” “Democratic,” “Republic”
• Central and State governments – similar division of power
Government
• Hospitals – 18,218 - 75% private – adds to social barriers• Healthcare spending by government is 6% of GDP. • Government covers 18% of healthcare costs, 72% out of
pocket• 1.25 million doctors (1:1800 people)• Medical tourism – Saudi Arabia & England• Religious and magical cures through priests and other
religious institutions, herbal and home remedies.• Strong pharmaceutical production with large proportion of
exportation
Healthcare
Barriers• Environmental factors – sanitation and safe drinking water,
toilet facilities, electricity
• BARRIERS TO ACCESS – Geography - Unequal distribution of resources- lower in rural
areas
– Socio-economic - Disparity in quality of care (public vs private hospitals)
– GENDER - Inequality of women • Patriarical society• 2/3 are illiterate
Disease Burden• Environmental factors – Higher burden of infectious diseases
• TB – 14 million cases• Malaria 2 million cases• HIV – 4 million• Leprosy
• Major causes of death:– Infectious diseases (TB, malaria, HIV)
– Cardiovascular disease (ischemic heart and stroke)
– Injury (1/3 suicide)
• Children:• Polio• Malnutrition• HIV
• December 2004 Tsunami struck southeast coast
HIV/AIDS
- Estimated 2.2-7.6 million cases
-Stigma is major barrier
- ARV’s available, but not affordable to common
- little research being done
- lack of funding
BBH
HIV testing at Bangalore Baptist Hospital in 2003-2006
Year Tot #
HIV test
HIV test Outpt
% OP HIV test
Total # HIV +
% HIV+ of tot tested
% HIV + dx from OP
2003 4415 2033 46% 59 1.34% 49%
2004 4491 2275 50% 77 1.7% 55%
2005 4680 2071 44% 106 2.3% 63%
2006 4107 2248 55% 87 2.1% 68%
EBM
HIV KAP
Ethics
Future opportunities