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1.Financing is key (The Hindu)

2.China’s shift to city-led growth (Live Mint)

1.Financing is key (The Hindu)

Synoptic line: it throws light on the issue of mental illness, which is still a taboo in India. (GS paper III)

Overview

  • Mental health is an integral part of health and it is more than the absence of mental illnesses. Mental illness has always remained taboo in both public and private discourse. In India, it is a relatively neglected subject even in the eyes of the government.
  • Historically, India has not invested sufficiently in the health-care sector. In 1950-51 the government had spent 0.22% of GDP on health (Economic Survey, 2016-17). Today, this has number risen to a little over 1% and is well below the world average of 5.99% as per the world bank data.

Legislation

  • The landmark Mental Healthcare Act, 2017 was passed recently by the parliament of India, it will change the way Indian policy approached mental health issues, including providing for a patient-centric perspective, instead of a criminal-centric one, to suicide and called for decriminalisation of Section 309 (punishment for attempt to suicide) of the Indian Penal Code. The Act also repealed the Mental Health Act, 1987 which did not administer care for patients of mental health issues.
  • The National Mental Health Policy of India 2014 and the Mental Healthcare Act, 2017 heralded a change in the right direction. The Act is revolutionary in many ways, mainly because of its patient-centric and progressive approach, along with carefully-drafted provisions for transparency and professionalism in service delivery and governance.
  • Though the Act is forward-thinking but there is a genuine fear that it will remain a paper tiger like so many other government laws and policies.

Health- a costly affair

  • In India, the health care burden is borne mainly by the patient. Out-of-pocket expenditure constitutes more than 60% of all health expenses. This expense and lost productivity due to mental illness are significant factors that contribute towards poverty.
  • Treatment and care are further compromised when families give up on persons with mental illness because of the social stigma and the financial costs. The mentally ill are often abandoned or institutionalised and left to the mercy of the government to address their medical needs and put them on the path to recovery. Public health care failed to help the vulnerable population of the country.
  • Though the 2015 draft health policy proposes raising public health expenditure to a conservative 2.5% of GDP but the spending on health decreased from 1.4% in 2009-10 to 1.2% and 1.3% in 2013-14 and 2014-15, respectively. Spending further dropped to 1.15% in 2015-16 and is shown at 1.18% (BE) for 2016-17.

Lack of planning

  • There is need to streamline Mental health financing. As per the National Mental Health Survey (NMHS) 2015-16 the total budget for mental health was less than 1% in most States. Only Gujarat and Kerala have a separate budget head for mental health.
  • Budgetary support for mental health suffers from a lack of State-level action plans that identify and define specific activities for implementation, budget availability, time lines, responsible agencies and indicators for monitoring outcomes.
  • The government has failed to have mental health professionals as there are only 4,000 psychiatrists working in the country and 70% of them practise in the private sector. Mental health programmes are covered under the flexi pool for non-communicable diseases (NCDs) of the National Health Mission. The amount allocated for the flexi pool for NCDs has nearly tripled over the past two years.
  • States can use the centrally-sponsored scheme to pay for specialists and more. This resource base has remained relatively untapped by most States.

Way ahead

  • Mental health, like other aspects of health, can be affected by a range of socioeconomic factors that need to be addressed through comprehensive strategies for promotion, prevention, treatment and recovery in a whole-of-government approach.
  • There is need to have clarity, cooperation and shared responsibility between the Centre and the States for allocation and usage of funds otherwise, mental health-care reforms will not be achievable.

Question–  Mental illness need a renewed focus on its elimination due to flawed perception towards it. Elaborate what government needs to do in this regard?

2.China’s shift to city-led growth (Live Mint) 

Synoptic line: It throws light on the issue of China’s need to focus on urbanisation, which have the potential to fuel future progress. (GS paper III)

Overview

  • Over the last decade, China has been working to shift from a manufacturing-led growth model fuelled by low-cost labour to an innovation-led, higher-value-added model underpinned by strong productivity gains.
  • Even the China has achieved some four decades of rapid economic growth but one powerful source of growth has yet to be fully tapped that is-Urbanization. Now, the potential of megacities as an engine of dynamism and increased prosperity is finally getting the high-level attention it deserves.

Current situation

  • China is the world’s most populous country and its second-largest economy but, only half its population lives in urbanized areas, and less than 10% reside permanently in megacities. And the country’s urbanization rate remains well below the global average.
  • Growth in China’s megacities has long been heavily constrained by rigid state administrative divisions and planning agencies. Indeed, in pursuing rapid industrialization, megacities have often been less successful than smaller cities, which have largely evaded such constraints, in accumulating productive capital, attracting foreign direct investment (FDI), and demonstrating entrepreneurial spirit.
  • Small cities of China like the Guangdong province, including Dongguan, Huizhou, Shunde and Zhongshan have played a critical role in establishing China as the “Factory of the World, but it s megacities which have the greatest potential to fuel future progress in productivity. So far, China has just four “first-tier” cities (with populations exceeding 20 million)-Beijing, Shanghai, Guangzhou and Shenzhen.

Need of the hour

  • There is need for China government to be much more adaptive and flexible, especially regarding its notoriously strict control of urban land-development ratios. In particular, China must abandon its land-quota system, which not only limits the amount of land cities can develop for future productivity growth, but also allocates a disproportionate share of land to factories.
  • Otherwise, urbanization will continue pushing up already-high housing costs, but not efficiently enough to power sustained growth and development. Though the local governments are working with the central government to alleviate or even eliminate existing administrative constraints.
  • For advancing China’s transition towards a city-led growth model, there is need to expand the role played by urban clusters that leverage the strength of first-tier cities to boost growth in less-developed areas.
  • From an economic standpoint, the Yangtze and Pearl River Deltas which encompass megacities like Guangzhou, Shanghai and Shenzhen are undoubtedly the most important such urban agglomerations, set to generate higher future productivity gains from economies of scale and complementarity.

Way ahead

  • The pace of China’s economic growth over the last four decades has been unprecedented. But China has yet to complete its rise to rich-country status. As it upgrades its economy to become more knowledge-based and technology-driven, it is again leveraging its strengths. There is no better example of this than the ongoing effort to tap the potential of megacities.

Question– Urbanisation is an inevitable phenomenon; however, need is there to sustainably manage it. Comment.