Sri Lanka’s Economic Crisis and Public Health

Sri Lanka’s current economic crisis has become a full-blown political crisis and humanitarian
emergency. Long standing irrational economic measures, lack of national policies and coherent
and consistent political will have led to a deficit of foreign currency, failure to establish
sustainable energy resources and to develop human resource effectively for the productivity of
the country. These factors ended up country in a $51bn foreign depth and are unable to make
interest payments on its loans and, have only $25m in usable foreign reserves and needs $6bn to
stay afloat for six months. Therefore, the country is on the edge of bankruptcy, with hardly any
money to import fuel, essential items and life-saving medicines too. The government defaulted
on its debt in May, for the first time in its history, after years of economic mismanagement that
has enriched a small number of elites and emptied the public coffers.

According to the WHO definition, health is a state of complete physical, mental and social Well-
being and not merely the absence of disease or infirmity. It is dependent on many factors and
according to the Ottawa charter 1986, the fundamental conditions and resources for health are
peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice
and equity. Improvement in health requires a secure foundation in these basic prerequisites.
Therefore, health is not merely a personal achievement and apart from genetic tendencies for
some diseases which are not correctable by an individual and some lifestyle correctable factors
such as smoking, health is depend on many socio-economic conditions in which a person lives.

Public health is "the science and art of preventing disease and promoting health through an
organized efforts and informed choices of communities and individuals." It provides a
framework for public health to protect and promote the health of all people in all communities
and components include access to population health status, improving factors that influence
health, and community needs and assets, improving health literacy, and to investigate, diagnose,
and address health problems and hazards affecting the population, to assure an effective system
that enables equitable access to the individual services and care needed to be healthy and to build
and maintain a strong organizational infrastructure.

We need a healthy nation to use human resource to get rid of this economic turmoil and also to
minimise the health care expenditure for disabled people due to chronic illnesses. Many studies
have shown that health care delivery via health system alone cannot maintain a healthy society
and, individualized approaches and education programs may not work well for poorer nations
and vulnerable groups. Therefore, while addressing current health issues and disease trends, as a
country, Sri Lanka needs holistic approach to mitigate the devastating effects of current
economic situation on health of the citizens.

According to the Lancet, threats to health from an economic crisis are multi-fold. Stress and lack
of health care can increase cardiovascular morbidities. Malnutrition can affect generations of
children. Communicable diseases can increase due to rising costs of amenities and the weakening
of preventive and control measures. An article in BMJ also warns that the Sri Lanka’s
universally accessible healthcare system is also on the verge of collapse and need urgent political
measures to save the lives of citizens.

We have not yet calculated the short term and long term effects of socio-economic downfall on
health. There has long been substantial evidence linking job loss to shorter lives and more health-
related problems. According to the studies by the sociologists Clemens Noelke and David E. Bell
at the Harvard Center for Population and Development Studies, it has scientifically proven that
unemployment increases mortality rates, cardiovascular disease, cognition decline, depression,
and unhealthy behaviors such as smoking and drinking. It has also found that the risk of death
was 63% higher during the study periods among those who experienced unemployment than
among those who did not, after adjusting for age and other variables. Similarly, losing a job
increased stress-related conditions such as stroke, hypertension, heart disease, arthritis, diabetes,
and emotional and psychiatric problems by 83% the odds of new health conditions likely
triggered by job loss.

According to Asian Development Bank (ADB) report, economic crisis of a country has
devastating effects on child and maternal health too. 2019 Annual Health Bulletin shows that
Prevalence of under-nutrition of children under 5 years is a significant problem and the figures
are; Stunting - 17%, Wasting - 15% and Underweight - 21%. Prevalence of micronutrient
deficiencies such as iron deficiency - 22.1% is among school going adolescents. While the
family is struggling to survive, people have to cut down health expenditure and have to take
available food rather than a balanced diet. These things have long term health sequalae such as
early onset diabetes and obesity.

Maternal malnutrition can lead to anaemia, high blood pressure during pregnancy, maternal
death and fetal loss. The children born to mothers with malnutrition are at high risk of Poorer
physical growth, Poorer health (including obesity), less learning & schooling, lower prospects of
work, poorer wages, increased social risks and, epidemiological studies have shown that lower
birth weight is associated with a wide range of adverse outcomes in later life such as diabetes,
coronary heart disease, chronic lung and kidney disease in the child. Almost 1 in 4 (22%)
pregnant women are underweight when they register for pregnancy in Sri Lanka!

Non communicable diseases (NCD) such as ischemic heart disease, strokes and neoplasms are
the leading causes of death in Sri Lanka too. The prevailing economic crisis has significant
negative impact on NCDs. People are struggling to feed their kids, continue children’s education
while compromising their health problems. At the same time, many drugs for diseases such as
diabetes, hypertension are intermittently not available in the government institutions and people
are unable to afford for them. This unfortunate situation has led to poor sugar and pressure
control. This situation will increase the incidence of long term complications such as chronic
kidney disease, ischemic heart disease, heart failure and strokes increasing the demand on health
system and a deleterious effect on fragile economy.
Dr. Dimitris Zavras, in his article in International Journal of Environmental Research and Public
Health, he emphasises that, the healthcare sector more than any other sector of the economy, has
limited margins of error or opportunities for delayed action or reaction. In addition to production
goals, its complex governance must satisfy principles of equity, efficiency, effectiveness, and
quality.

Many studies have shown that rising trends in NCDs is associated with poorer communities and
developing countries than developed countries. It is due to poor dietary habits, smoking and lack
of regular exercise. In Sri Lanka too, it is very difficult people to afford for healthy foods and a
balanced diet and they mainly rely on rice which is a high carb diet. Many people are unable to
afford for regular vegetables, fruits or nuts. When people have not a sign of recovery from their
economic crisis, most of the time advice on regular exercise is merely a joke.

As an urgent matter, it is mandatory requirements to prioritize the dire issues such as lack of
essential and life-saving medications, and health allocations and donations should be effectively
utilize to make sure they are available to save lives of patients. Similarly, it should be ensured
that essential investigations, medications for long term diseases and cancer patients are available
so that patients who have been paying various taxes throughout their lives are safe. A technical
committee should work on essential drugs, medical items and essential consumables and make
an “essential medical items” list so that unnecessary drugs, drugs with marginal or no benefits,
me-too drugs and counterfeit medications can be avoided to assure that the health budget is
maximally utilised.

The economic crisis has prompted an immediate response by government to avoid a collapse of
the financial and banking systems and maintain the essential services such as health and
education. Depreciation of human capital should be avoided and the skilled workers should be
employed for the productivity. Sri Lanka is not the only country who experienced a financial
crisis in the world and, there are many examples how they responded to it while maintaining the
health care delivery.

Therefore, it is obvious that Sri Lanka needs urgent measures to maintain health of the citizens
which otherwise can have a significant rise in many communicable diseases raising the demand
for resources for health with deleterious effects on current economic crisis.

Dr. K. Ajith Kumara

Consultant Physician

President, All Ceylon Medical Officers Association.