Health in Punjab, India

Health in Punjab involves the state of complete physical, mental and social well-being of the people in Punjab, India.[1] Data of medical facilities, diseases and nutrition is used to determine the state of health of the population.

History edit

Between 1896 and 1921, 12 major cholera outbreaks were recorded in Punjab province, which killed about 250,000 people. In 1901, riots were recorded in some plague-hit areas, like Gurdaspur, Patiala and Sialkot as some people refused compulsory hospitalisation and quarantine.[2] From 1897 to 1947, more than 3,000,000 people died due to plague in Punjab province. In 1896, plague came from Hong Kong in India. In October 1897, first death from plague was reported in Punjab. Initially, the plague spread in Jalandhar and Hoshiarpur districts. By 1903, it had spread to almost all districts and caused large-scale causality in the province.[3]

By March 2020, Covid-19 pandemic reached Punjab. On 22 March 2020 government of Punjab imposed state-wide lockdown to combat Covid-19 pandemic in Punjab.[4][5]

Birth edit

In 2019–21, 94.3% of the births were institutional births in Punjab, which was an increase from 90.5% in 2015–16. Of this, 53.9% were institutional births in public facility, which was up from 51.7% in 2015–16. In rural areas, the births in public facility were 57.6%, compared to 47.0% in urban areas, for year 2019–21. The percentage of home births that were conducted by a skilled health personnel was 2.6%, it was 3.0% for urban areas and 2.3% for rural areas. In 2015–16, this percentage was 4.5%. Of the total, 95.6% births were attended by a skilled health personnel, 2019–21. For urban areas, this rate was 93.7% and 96.6% for rural areas.[6]

Of the total births in Punjab, 38.5% were delivered by caesarean section in 2019–21. This number was 24.6% in 2015–16. For private health facilities, 55.5% of the births were by caesarean section, in 2019–20, compared to 29.9% for public health facilities. In 2015–16, this number was 39.7% for private and 29.9% for public health facilities. For private health facilities, the rate was 57.0% for rural areas and 53.4% for urban areas in 2019–21. For public health facilities, the rate was 29.1% in rural areas and 31.1% in urban areas, in the same year.[6]

Life Expectancy edit

Between 2013 and 2017, the life expectancy at birth in Punjab was 72.4 years. It was 74 years for females and 71 for males.[7]

The table below shows the life expectancy in Punjab by gender and residence in 2013–17.

Life expectancy in Punjab in 2013–17[7]
Residence Total Female Male
Rural 71.4 72.9 70.1
Urban 74.1 76.6 72.4
Total 72.4 74 71

Estimated from civil registration and vital statistics system (CRVSS) data, the table below shows the life expectancy in the districts of Punjab, in 2012.

Estimated life expectancy in the districts of Punjab, in 2012, based on CRVSS data[8]
District Male (Years) Female (Years)
Amritsar 64 69
Bathinda 71 81
Barnala 70 76
Faridkot 67 73
Fatehgarh Sahib 72 77
Firozpur 74 80
Gurdaspur 70 76
Hoshiarpur 68 75
Jalandhar 63 69
Kapurthala 74 84
Ludhiana 69 77
Mansa 69 76
Moga 70 74
Muktsar 69 66
Patiala 68 72
Rupnagar 69 75
SAS Nagar 70 76
Sangrur 70 76
SBS Nagar 64 75
Taran Taran 66 73

Children edit

According to the national family health survey of 2020–21, anaemia rate in Punjab was 71.1% for children between the ages of 0 to 57 months.[9] This was a significant increase compared to 56.6% in 2015–16.[10] According to the National Family Health Survey (NFHS) data from 2015 to 2016, the rate stunting (low height for age) for children between the ages of 0 and 59 months was 26%, which was lower than the national average of 38%.[10]

The table below shows the data from the state nutrition profile of Punjab of children below the age of 6, by years.

State nutrition profile of Punjab of children below the age of 6, by years[11]
Indicators 2019–21 2015–16 2005-6
Low birth weight 22% 17% 28%
Stunting 24% 26% 37%
Wasting 11% 16% 9%
Sever Wasting 4% 6% 2%
Underweight 17% 12% 25%
Anemia 71% 57% 66%

Women edit

As of 2020, the percentage of deaths due to heart disease was higher in women than men, 41.8% for females compared to 32.2% for males. In the same year, the percentage of deaths due to covid-19 was lower for women compared to men, 13.4% for males and 9.9% for females.[12]

The table below shows the state nutrition profile of Punjab for women between the ages of 15 and 49 years.

State nutrition profile of Punjab of women below the age of 15 to 49, by years[11]
Indicators 2019–21 2015–16 2005-6
Underweight 13% 12% 19%
Anemia (non-preg) 59% 54% 38%
Anemia (pregnant) 52% 42% 42%
Hypertension 31% 15% NA
Diabetes 15% NA NA
Overweight/Obesity (BMI ≥25.0 kg/m2) 41% 31% 30%

In 2019, the female cervical cancer incidence rate in Punjab was 13 per 100,000 women in all ages. This was less than the rate of 14.75 in 1990. The female cervical cancer mortality rate was 7.14 per 100,000 women of all ages in 2019. This was lower than the rate of 9.34 in 1990.[13]

Reproductive health edit

The table below shows the current use of family planning methods by currently married women between the age of 15 and 49 years, in Punjab.

Family planning methods used by women between the ages of 15 and 49 years, in Punjab[6]
Method Total (2019–21) Urban (2019–21) Rural (2019–21) Total (2015–16)
Female sterilization 22.8% 18.0% 25.6% 37.5%
Male sterilization 0.5% 0.5% 0.4% 0.6%
IUD/PPIUD 3.1% 2.8% 3.2% 6.8%
Pill 1.5% 1.1% 1.7% 2.5%
Condom 22.2% 26.6% 19.7% 18.9%
Injectables 0.1% 0.1% 0.1% 0.1%
Any modern method 50.5% 49.4% 51.1% 66.3%
Any method 66.6% 68.4% 65.4% 75.8%
Total unmet need 9.9% 8.8% 10.5% 6.2%
Unmet need for spacing 3.7% 3.3% 3.9% 2.4%

Caste edit

As per National Family Health Survey (NFHS-4, 2015–16), the infant mortality rate was 40 per 1000 live births before the age of one year for scheduled castes, compared to 29 per 1000 births for the state as a whole. The infant mortality rate for other backward castes (OBC) was 21 per 1000 live births and 22 per 1000 for those who are not from SC and OBC classes.[14]

Although the prevalence of anaemia (low levels of haemoglobin in the blood) has been found quite high among all population groups in Punjab, it was still higher among the SC population than other groups. For the women between the ages of 15 and 49 years, the prevalence of anaemia among SC women was 56.9%, compared to 53.5% for the state as a whole. Among the children between the ages of 6 and 59 months, the rate of anaemia for SC children was 60%, compared to 56.9% for the state as a whole.[15]

The table below compares the health status of Scheduled Caste population of Punjab, according to NFHS-3.

Health status of Scheduled Caste (SC) population of Punjab (NFHS-3)[16]
Indicators SC Total
Infant Mortality Rate 46 44
Child Mortality Rate 16 7
Anaemic (child) 73.80% 66.40%
Anaemic (women) 42.60% 38.00%

The table below shows the early childhood mortality rates in Punjab by caste, according to NFHS-4 (2015-16).

Early childhood mortality rate in Punjab by caste, according to NFHS-4 (2015-16)[17]
Background Characteristics SC OBC Others Total
Neonatal Mortality 27.0 16.9 17.1 21.2
Post-neonatal Mortality 12.7 3.6 5.2 8.0
Infant Mortality 39.6 20.5 22.4 29.2
Child Mortality 6.5 3.3 1.9 4.1
Under five Mortality 45.9 23.7 24.2 33.2

Obesity edit

According to the National Family Health Survey 2020–21, the percentage of males in the age group of 15–49 who were obese or overweight was 32.2% in 2020–21, which an increase from the 27.8% in 2015–16. For women in the same age group, the number in 2020–21 was 40.8% which was an increase from 31.3% in 2015–16. Moreover, according to the same report, 63.1% of the men and 72.8% of the women have high risk waist-to-hip ratio, as of 2020–21.[9]

The table below shows the overweight/obesity rate of men, women and children in Punjab.

Overweight/Obesity rate of Punjab[18]
Age Group 2019–21 2015–16 2005–06
0–59 months Children (z score > 2SD) 4% 2% 2%
15–49 years Men (BMI ≥25.0 kg/m2) 41% 31% 30%
15–49 years Women (BMI ≥25.0 kg/m2) 32% 28% 22%

During the covid-19 pandemic, it was asserted that the high death rate of covid patients in Punjab is because of the prevalence of Obesity and other diseases associated with it, like hypertension and diabetes, in the state.[19]

As of December 2023, there were 3,473 recorded gyms in Punjab. Ludhiana was the city with most number of recorded gyms in Punjab at 449.[20]

Diseases edit

As of 2022, hypertension was the most prevalent non-communicable disease in Punjab, followed by diabetes and cancer.[21] High trans-fat consumption is considered to be the main cause of heart diseases in Punjab.[22] Out of the total medically certified deaths in 2020, 36.2% were due to diseases of circulatory system, which higher than due to Covid-19.[12]

The burning of crop stubble by farmers, after harvesting, has been shown to be a major cause of many respiratory diseases in Punjab.[23][24] As of October 2013, there were around 30 lakh arthritis patients in Punjab. Of which, around 5 lakh were at an advanced state, which required surgery. The main factors contributing to the growth of arthritis in Punjab were obesity and sedentary lifestyle. Higher levels of stress and modern lifestyle were the main reasons for the increase in arthritis among young people.[25]

Cancer edit

Punjab recorded 38,636 cases of cancer in 2020. This number had been gradually rising since the previous few years. It was 37,744 in 2019 and 36,888 in 2018.[26] By 2024, the number of cancer patients had rose to 42,288, which was a 7% increase from 39,521 in 2021. The numbers increased steadily from 40,435 in 2022 to 41,337 in 2023.[27]

In February 2013, there were 90 cancer patients for every 100,000 people in Punjab, which was higher than the national average of 80. In that year, Muktsar district had the highest cancer rate among all district, at 136 per 100,000. Muktsar was closely followed by Mansa, Bathinda and Firozpur districts. Taran Taran district had the lowest rate at 41 per 100,000 people.[28]

The table below shows the number of cases and estimated mortality of Breast cancer in Punjab.

Number of cases and estimated mortality of Breast cancer in Punjab[29]
Year Numbers Estimated Mortality
2023 6,667 2,480
2022 6,507 2,421
2021 6,347 2,361
2020 6,192 2,303
2019 6,037 2,246

HIV/AIDS edit

As of 2017, there were 40,600 estimated adult cases of HIV infection (AIDS) in Punjab, which comprised 0.18% of the population. As of July 2019, Amritsar district have the highest number of HIV positive cases at 16,619.[30]

The table below shows shows the number of HIV positive cases in Punjab by district.

Number of HIV positive cases in Punjab[30]
District Percent HIV Positive Total Tested
Amritsar 1.94% 16,619 855,948
Barnala 0.58% 812 139,825
Bathinda 0.93% 3,286 353,880
Faridkot 1.61% 2,812 174,640
Fatehgarh Sahib 0.61% 823 134,783
Fazilka 0.56% 699 125,381
Firozpur 1.42% 2,981 210,206
Gurdaspur 0.85% 3,267 383,963
Hoshiarpur 0.73% 2,760 377,576
Jalandhar 1.67% 7,861 471,435
Kapurthala 0.98% 2,212 225,975
Ludhiana 0.93% 8,949 963,831
Mansa 0.54% 990 184,567
Moga 1.31% 2,367 180,402
Mohali 0.34% 1,041 301,823
Muktsar 0.56% 926 164,861
Nawanshahr 1.11% 1,331 119,750
Pathankot 0.82% 1,976 242,328
Patiala 1.43% 7,769 541,448
Rupnagar 0.57% 1,571 273,490
Sangrur 0.54% 1,857 342,723
Tarn Taran 1.40% 3,060 218,971
State Total 1.09% 75,969 6,987,806

Differently Abled edit

According to the 2011 census, there were 654,043 differently abled persons in Punjab, which comprised 2.35% of the population. Out of these, 3,76,087 people have been provided with the 'disability' certificate. During 2016–2017, a total of 57,713 'disability' certificates were issued.[31]

The table below shows the percentage of differently abled people in rural and urban areas of Punjab.

Differently abled persons in Rural and Urban areas of Punjab[32]
Residence Male Female
Urban 3.1% 2.3%
Rural 3.1% 3.1%

Under the Deendayal Disabled Rehabilitation Scheme, grant-in-aid is provided to the volunteer organizations working for the welfare of the differently abled people. The aid is given to the NGOs that work for rehabilitation of differently abled persons, including providing them education, artificial limbs, etc.[33][34]

Under the Assistance to disable persons for purchase of fitting of Aid Appliances (ADIP Scheme), good quality prosthetics and assistive devices are provided to the differently abled persons with the help through voluntary organizations. Under this scheme, prosthetic devices are provided for free to the low income persons, who suffer from more than 40% disability.[35] Ministry of Social Justice and Empowerment, provides a grant-in-aid for a cochlear implant for the children from lower income households.[36]

There are 3 vocational training rehabilitation centers and one workshop in Punjab, where differently abled persons between the ages of 18 and 40 years are given training in different types of trades like tailoring, cutting, embroidery, typing/stenography, etc. to make them economically self-reliant. The rehabilitation centers are located in Ludhiana, Bathinda and Hoshiarpur and the workshop in Shimlapuri in Ludhiana district.[37]

The differently abled persons with more than 40% disability can travel for free or with concession in state buses. For a blind person, travel is free within the state on state buses. For differently abled persons other than blind, there is 50% concession within the state in these buses.[38]

Drug Use edit

According to the National Family Health Survey 2020–21, the percentage of people in Punjab above the age of 15 who consume alcohol was 22.8% for men and 0.3% for women. The rate of tobacco usage in the same age group was 12.9% for men and 0.4% for women.[9] A study conducted by PGI Chandigarh revealed that, as of March 2022, around 1.7 lakh people consume opioids in Punjab.[39]

Mental Health edit

According to a survey conducted in four districts of Punjab, in 2016, the current rate of mental morbidity was 13.42%. That means about 1,283,000 people were suffering from a mental illness in Punjab that year. The lifetime prevalence of mental morbidity was 17.94%. The number of people with high suicide risk was 51,600 and people with moderate suicide risk were 28,700.[40] It is asserted that, as of 2016, only about 20% of people suffering from mental illness had access to treatment. This is attributed to the low number of psychiatrists, which was only 0.45 per lakh people in Punjab.[41] An increase of 20 to 25% was witnessed in the number of mental health cases in Punjab due to Covid-19 pandemic. The lockdown also had long term effects on the mental health of people from medical background, students, teachers or working professionals.[42]

Punjab government runs 4 homes, called SEHYOG (Half Way Home), for persons suffering from mental illnesses from lower-income families. There the inmates are provided with free accommodation, food, health care, recreation and education. The Homes in Amritsar and Kapurthala are only for females and the Homes at Ludhiana are only for males. Each home has a capacity of 40 inmates.[43]

Medical facilities edit

The hospitals in Punjab with facilities for cancer treatment are Government Medical College in Amritsar and a tertiary cancer care center at the civil hospital in Fazilka.[26] On February 25, 2024 an AIIMS in Bathinda and a Postgraduate Institute of Medical Education and Research (PGIMER) satellite centre in Sangrur was opened. On the same day, foundation for a PGIMER satellite centre was also laid in Firozpur.[44]

On 29 March 2024, first institute of Liver and Biliary Sciences was inaugurated in Mohali.[45][46][47]

As of February 2023, at least 600 specialist doctors were required at various community health centers in Punjab, but only 151 were available.[48]

The table below shows the district wise number of registered doctors and other registered medical personnel in Punjab, in year 2018.[49][50] Note:- The ranks of the districts in this table are in the descending order of the number of registered doctors.

District wise number of registered doctors and other medical personnel in Punjab, in year 2018[49][50][51]
Sr. No. District Doctors Nurses Midwives
1 Ludhiana 4,989 10,904 8,121
2 Amritsar 4,141 6,531 4,018
3 Patiala 3,935 3,279 1,963
4 Jalandhar 3,268 5,119 4,081
5 Hoshiarpur 1,640 3,944 2,806
6 Sangrur 1,286 2,567 3,374
7 Gurdaspur 1,058 6,118 6,472
8 Firozpur 1,036 4,459 3,096
9 Bathinda 898 2,104 2,774
10 Rupnagar 864 2,409 2,159
11 Kapurthala 737 2,165 766
12 SAS Nagar 545 2,790 1,788
13 Faridkot 499 2,997 3,037
14 Mansa 325 2,616 3,424
15 Moga 312 3,172 2,084
16 Sri Muktsar Sahib 283 2,648 839
17 SBS Nagar 262 2,516 383
18 Barnala 200 2,037 825
19 Fatehgarh Sahib 198 2,064 306
20 Fazilka 162 460 987
21 Pathankot 145 50 120
22 Tarn Taran 84 3,378 2,370
Outside State Territory 630 2,855 989
Punjab 29,772 77,182 56,782

The table below shows the population served per doctor, per nurse and per midwife by districts of Punjab, in the year 2018.[52][53][54][55] Note:- The ranks of the districts in the table are in the ascending order of the population served per doctor.

Population served per doctor, per nurse and per midwife in districts of Punjab, in year 2018[52][53][54][55]
Sr. No. District Doctor Nurse Midwife
1 Faridkot 499 224 225
2 Patiala 551 161 1,172
3 Amritsar 661 424 689
4 Jalandhar 729 465 5,943
5 Ludhiana 780 357 506
6 Rupnagar 844 302 340
7 Bathinda 898 744 585
8 Hoshiarpur 1,017 423 654
9 Gurdaspur 1,058 284 280
10 Ferozpur 1,083 251 377
11 Kapurthala 1,171 398 1,226
12 Sangrur 1,404 703 558
13 Mansa 2,073 319 2,376
14 SAS Nagar 2,264 442 739
15 SBS Nagar 2,408 250 2,183
16 Barnala 3,212 320 714
17 Fatehgarh Sahib 3,286 315 2,745
18 Moga 3,456 339 318
19 Sri Muktsar Sahib 3,561 380 1,375
20 Pathankot 4,943 14,336 7,389
21 Fazilka 7,089 2,496 1,258
22 Tarn Taran 15,210 378 568
Punjab 522 1,234 950

The table given below shows the population served per doctor in Punjab, by years.[53]

Population served per doctor in Punjab, by years[53]
Year Population Year Population
2018 522 2000 1,490
2012 1,170 1999 1,485
2010 1,250 1998 1,483
2008 1,225 1997 1,472
2007 1,316 1996 1,499
2006 1,263 1995 1,487
2005 1,388 1994 1,501
2004 1,468 1993 1,608
2003 1,489 1992 1,481
2002 1,324 1991 1,514
2001 1,472 1990 1,589

The table below shows the district wise population served per bed.[56]

Population served per bed in districts of Punjab, in year 2018[56]
Sr. No. District Population
1 Faridkot 800
2 Amritsar 822
3 Patiala 941
4 Hoshiarpur 1,051
5 SBS Nagar 1,101
6 Rupnagar 1,103
7 Kapurthala 1,141
8 Fatehgarh Sahib 1,218
9 Barnala 1,262
10 Tarn Taran 1,402
11 Jalandhar 1,411
12 Sri Muktsar Sahib 1,427
13 Gurdaspur 1,437
14 Mansa 1,523
15 Sangrur 1,612
16 Pathankot 1,694
17 Ferozpur 1,700
18 Moga 1,700
19 SAS Nagar 1,704
20 Fazilka 1,709
21 Bathinda 1,927
22 Ludhiana 2,397
Punjab 1,338

See also edit

References edit

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  2. ^ "What Epidemics from the Colonial Era Can Teach Us About Society's Response". The Wire. Retrieved 15 January 2024.
  3. ^ Public response towards plague prevention policies in colonial Punjab historyjournal.net
  4. ^ https://punjab.gov.in/wp-content/uploads/2020/07/COVID-RESPONSE-PUNJAB__24.07.2020.pdf
  5. ^ https://punjab.gov.in/wp-content/uploads/2021/05/New_PUNJAB-COVID-19-RESPONSE-MAY2021.pdf
  6. ^ a b c National Family Health Survey 5 2019 Ministry of Health and Family Welfare
  7. ^ a b https://pib.gov.in/PressReleseDetail.aspx?PRID=1606209
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  15. ^ https://finance.punjab.gov.in/uploads/05Jul2022/52e95928-fcf0-4ac0-b1d3-f24c151c371f_20220705153029.pdf, 1.11
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