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Through the next few weeks, the country’s most populous state will vote for a new government. Unfortunately, besides being the most populous, Uttar Pradesh (UP) also happens to be in the company of the most “diseased states” in the country. In the recently published results of the National Family Health Survey-5 (NFHS-5), the state has done even worse than conflict zones like Jammu and Kashmir. It, therefore, appears that the poor showing of the state in the second wave of Covid-19 was not by chance, but a fallout of government neglect of healthcare. This is even more evident in the ongoing election campaign where the narrative is set by the incumbent regime and no one wants to discuss the “health of the people”.

Traditionally, health and education have never been points of discussion in electoral campaigns in India, but with the ongoing Covid -19 pandemic, it is imperative that there is clear accountability for death and disease. In the wake of the devastation unleashed by Covid-19, even the most far-right regimes (like in Brazil and the Philippines) have begun to talk about the health of their people.

The NFHS-5 has revealed some staggering facts about India’s perpetual health crisis. This, despite India being a signatory to the Millennium Development Goals (MDG) of the United Nations General Assembly in 2000. An evaluation of the NFHS-5 results from UP reveals how deep the muck is and how urgent the need to fix accountability. According to the NFHS-5, the infant mortality rate (IMR) of UP is 50.4 per 1,000 live births. This is poorer than even the most violent conflict zones in the world. The IMR for Syria is 16 per 1,000 live births and for Iraq, it is 20 per 1,000 live births. The under-five mortality rate for UP is even more dismal at 59.8 per 1,000 live births. This is in contrast to the under-five mortality of 9.8 per 1,000 live births for Jammu and Kashmir in NFHS-5 (the figure is 16 per 1,000 live births for Syria). Both IMR and under-five mortality rates are among the most important and sensitive indicators of the health of a population. For UP, these figures are nowhere near the Sustainable Development Goals 3 target for 2030, which is to ensure healthy lives and promote well-being for people of all ages.

Even as we cry a river on UP’s poor health indicators in the NFHS-5, other tragic maladies directly affect the well-being and health of the people of the state. The NFHS-5 data shows that 39.7 per cent of children under the age of 5 years are stunted. A whopping 66.4 per cent of children between the ages of 6-59 months are anaemic. This figure for anaemia has worsened from 63.4 per cent in NFHS-4 (2015-16). The 2021 Global Nutrition Report reveals that the incidence of stunting in children aged less than 5 years in South Sudan, which has the worst malnutrition in all of Africa, is 31.3 per cent. As per the NFHS-5, 50.4 per cent of women in the reproductive age group (15-49 years) in UP have anaemia. In 2019, South Sudan had 35.6 per cent anaemic women within the reproductive age group. Uttar Pradesh, thus, has more stunted children and more anaemic women than probably any region on the planet with such a significant cohort of people. Anaemia and malnutrition are the harbingers of chronic disease and death.

No wonder, among all states, UP has the largest number of tuberculosis cases and is responsible for over 20 per cent of the total TB cases notified in the country. In 2020, just over 4 lakh cases of TB were detected in UP. This was in contrast to the 1.23 lakh TB cases notified in the neighbouring state of Bihar during the same year. Bihar was known to have some of the worst TB statistics in the decades gone by. More worryingly, the incidence of multi-drug-resistant TB (MDR-TB) is second highest in UP with 4.53 per cent newly diagnosed cases of TB being MDR. The future health implications of this high percentage of drug-resistant TB is anyone’s guess.

Epidemics also make frequent appearances in UP. The 2017 deaths of children in a government hospital in Gorakhpur due to Acute Encephalitis Syndrome (AES) is a case to ponder as it symbolizes the poisonous mix of susceptibility of the malnourished and brutal neglect on part of the state. Epidemics of AES are not uncommon in UP. The number of child deaths in previous years due to AES was 5,850 in 2014, 6,917 in 2015, and 6,121 in 2016. Epidemics of dengue and malaria are also common occurrences. In November 2021, the number of dengue cases in Uttar Pradesh had crossed the 23,000-mark for the year 2021, making it the worst outbreak situation in the state in several years. This was the highest number of dengue cases reported in UP since 2016. I refrain from mentioning the death and devastation seen in the wake of the second wave of Covid-19 in the state.