ASPPH logo


Member Research & Reports

Member Research & Reports

Rutgers Researcher Leads Study that Finds Delhi’s Health System Has Made Inadequate Progress

Dr. Michael K. Gusmano, associate professor at the Rutgers School of Public Health and Research Scholar at the Hastings Center lead a study to examine whether Delhi’s increased investment in public health infrastructure is associated with a reduction in premature death from preventable causes. Working with Dr. Victor Rodwin, professor at the Wagner School of Public Service at NYU and Dr. Daniel Weisz, research associate at the Butler Aging Institute at Columbia University, Dr. Gusmano analyzed vital statistics from Delhi to determine whether rates of preventable mortality between 2003 and 2013 had decreased due to increased spending on public health and healthcare initiatives.


[Photo: Dr. Michael K. Gusmano]

Over the past decade, India has emerged as one of world’s most important engines of economic growth. In the health sector, India is often associated with its accomplishments in promoting innovation in the delivery of health services and production of pharmaceuticals and drugs. In contrast, India has failed to assure minimal standards of sanitation and public health when compared to other large middle-income, such as Brazil, Russia and China.

Despite recent investments in public health and health care, Dr. Gusmano and colleagues found that access to care has not been sufficient to overcome the poverty and inequalities within the Indian state of Delhi. The authors conducted a population-based study to examine whether Delhi’s increased spending on health was associated with a decrease in death from causes preventable by public health and health care interventions. Mortality that can be prevented using public health and health care interventions is defined as amenable mortality. Amenable mortality is used as an indicator of overall health system performance. Using ICD codes and vital statistics obtained from the Delhi Statistical Handbook, the team found that between 2004 and 2013 the rate of mortality due to amenable causes rose from 0.87 to 1.09.The leading causes of death were septicemia and tuberculosis. Maternal mortality significantly decreased, but remained above the global standard for middle-income countries. During this time period, other large middle-income cities, like Moscow, Sao Paulo, and Shanghai, had decreases in premature death due to preventable diseases, like tuberculosis.

According to Dr. Gusmano, “in contrast to other middle income cities, acute illness (sepsis, tuberculosis) predominates as a leading cause of death.”

To make substantial improvements in the rates of amendable mortality, Delhi and the rest of India, should consider increasing public health spending, monitoring health system performance, and improving government capacity to adopt policies.

Delhi’s health system exceptionalism: inadequate progress for a global capital city was published in Public Health.