For decades, Indians went to the doctor only when something serious happened to the body. People visited the clinic when the fever crossed 103 degrees, when a bone split or when the chest pain became unbearable. The medical profession was something for panicking, emptying the savings and incurring debt. The approach to illness was that of an unpredictable strike of an extremely bad fate.
That fatalism has since changed.
A huge swell of chronic illness forced the much-needed change. We became the diabetes capital of the world with over 100 million diagnosed, while millions more walked around with the condition undiscovered. Heart attacks no longer waited for retirement age. When a 32-year-old tech lead and marketing head fell unconscious in the gym shower and the airport lounge, respectively, everyone suddenly remembered a colleague who had looked fit till an emergency angioplasty drained his/her life of several lakhs.
A fear of the unknown took hold. People no longer waited for hospital beds.
The first change started on weighing scales and the kitchen table. The urban household voted off the white rice variety and the processed seed oil in favour of more ragi, jowar and cold-pressed mustard oil. These were staples in the village diet since time immemorial, but Indian cities had discarded them in favour of healthier food. It was a form of rebellion, perhaps.
Technology gave this transition a fillip. At 6.30 AM in Gurgaon and Bengaluru, phlebotomists from diagnostic apps arrive at people’s doors with a cold-storage box in their hands. They have come to take out the fasting blood for a liver function test and a measure of HbA1c. People in their twenties are wearing glucose-monitoring sensors on their triceps to determine if the poha they had for breakfast was sending their blood sugar spiralling. Smart rings are measuring their sleep cycle and heart rate variability with obsessive exactitude. Preventive medicine ceased to be an annual corporate cover-on and morphed into a hobby.
The public sector followed hot on the heels of this boom. The out-of-pocket expenses for medical care, the biggest single category for families in terms of expenditure, were bleeding the system dry. Crippling conditions such as advanced renal failure and metastatic cancer ran through the state budget as easily as through individual wallets. The government moved fast to open more than 150,000 primary health centres as Ayushman Arogya Mandirs. They stopped being dispensers of tablets and tonics only. These centres checked blood pressure for farmers, screened for cervical cancer in rural women, and distributed metformin before the arteries hardened.
Even fitness gave up its old baggage. Ten years ago, Indian gyms were sweaty holes where bodybuilding bros flexed their 20-inch biceps. Today fitness instructors are found in Marine Drive running tracks and tier-2 cities such as Jaipur and Kochi teaching strength-conditioning exercises to middle-aged chartered accountants and schoolteachers. They are building muscles to stave off the metabolic syndrome that would strike down these same men and women in their fifties.
The calculations have changed. For decades we have seen our bodies as some kind of obstinate machine that only needed fuel and occasional mechanic intervention when the engine started to belch smoke. The Indian middle class now realises that it can afford to pay 3,000 rupees for a complete metabolic analysis, rather than 3-lakh for an ICU bed.