Читать книгу The Political Economy of the BRICS Countries - Группа авторов - Страница 76

Do the countries have a similar disease burden? Table 1 gives the top 10 causes of deaths across the BRICS countries and changes between 2005 and 2015 from the 2015 Global Burden of Diseases.

On the whole, non-communicable diseases (NCDs) dominate the top 10 causes of mortality in these countries. Ischemic heart disease, cerebrovascular diseases, and COPD are the three common causes within the top 10 causes of mortality in BRICS nations. Some other relatively common causes of mortality in the top 10 are road injuries, diabetes, and Alzheimer’s disease. Among communicable diseases, lower respiratory infections are common across countries as a major cause of deaths. South Africa is the only country to have as many as four communicable (and preventable) diseases among the top 10 causes of mortality, viz., HIV/AIDS, lower respiratory infections, tuberculosis, and diarrheal diseases. India follows closely with three (barring HIV/AIDS) of these diseases being the main causes of mortality. The decadal change in the share of each disease in total mortality shows a mixed picture, except for communicable diseases, which show a decline for all countries barring lower respiratory infections in Brazil. The top 10 causes of mortality that register the highest decadal growth are road injuries (Brazil), Alzheimer disease (Russia and China), chronic kidney disease (India), and diabetes (South Africa). On the other hand, top mortality causers with lowest decadal growth are interpersonal violence (Brazil), self-harm (Russia), neonatal pre-term birth (India), COPD (China), and HIV/AIDS (South Africa). The increasing burden of NCDs in BRICS countries is a very important challenge with implications about out-of-pocket spending (OOPS) on the one hand and response of the health system — including UHC — on the other (Jakovljevic and Olivera, 2015). In fact, countries with significant dual burden of diseases face more challenges of investing limited funds across competing uses.

Table 1:Burden of disease in BRICS.

Source: Global Burden of Disease 2015, Institute of Health Metrics and Evaluation.

A set of four basic health indicators have been presented in Table 2 to show how the countries are faring in terms of specific health outcomes, and a summary outcome index has been constructed to make the comparisons easier.

Table 2:Health outcomes in BRICS.

Note: The index for a country is an average of its normalized score in each indicator. The process of normalization is (X−X_min)/(X_max−X_min), where X is the indicator.

Source: World Development Indicators, World Bank and World Health Statistics, WHO.

The difference between the highest (China) and the lowest (South Africa) life expectancy at birth is as high as 19 years. The low LEB in South Africa is primarily on account of the HIV/AIDS epidemic because of which it declined from 62 years in 1992 to 52 in 2005. Russia currently is the best performer in basic outcome indicators of maternal and child health. India fares the worst with child mortality rates more than four times and maternal mortality rate close to seven times that of Russia. When compared with the other most populous country, China, India’s maternal and child health outcomes are alarming — a fact that underlines the importance of provision of and access to primary care.

Russia has made the highest improvement in life expectancy at birth over time (2000–2014), as exemplified by the trend growth rate, followed by India. However, for child health outcomes, India shows the least improvement in these 15 years while China shows the maximum improvement. Russia registers the largest decline in maternal mortality in this one and half decades, while South Africa actually shows an increase in maternal mortality. China achieves the top position in the overall index of health outcome, followed by Russia, Brazil, India, and South Africa. Needless to say, country-level aggregates conceal the disparities in health outcomes across gender and socio-economic groups, which is an important indicator of equitable health outcomes and access to services.