1. Passage To India Jane Jue Dept of Medicine

3. 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%HinduismIslamChristianitySikhismBuddhismJainism others

5. Chaos

6. 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 yearsLife expectancy Gross national income per capita: $3,460

7. · Iron Age KingdomsIron Age Kingdoms· 1200–700 BC Maha Janapadas700–300 BC Magadha1700 BC–550 AD · Maurya DynastyMaurya Dynasty· 321–184 BC Middle Kingdoms230 BC–1279 AD · Satavahana EmpireSatavahana Empire· 230 BC–199 AD · Kushan EmpireKushan Empire· 60–240 AD · Gupta EmpireGupta Empire· 240–550 · Pala EmpirePala Empire· 750–1174 · Chola EmpireChola Empire· 848–1279 Islamic Sultanates1206–1596 · Delhi SultanateDelhi Sultanate· 1206–1526 · Deccan SultanatesDeccan Sultanates· 1490–1596 Hoysala Empire1040–1346 Kakatiya Empire1083–1323 Vijayanagara Empire1336–1565 Mughal Era1526–1707 Maratha Empire1674–1818 Sikh Empire1799–1849 Colonial Era1757–1947 Modern States1947 onwards

8. 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

9. 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

10. 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

11. 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

12. 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

14. BBH

18. HIV testing at Bangalore Baptist Hospital in 2003-2006 YearTot # HIV test HIV test Outpt % OP HIV test Total # HIV + % HIV+ of tot tested % HIV + dx from OP 20034415203346%591.34%49% 20044491227550%771.7%55% 20054680207144%1062.3%63% 20064107224855%872.1%68%

19. EBM

20. HIV KAP

21. Ethics

22. Future opportunities