1 in 3 Delhi families from resettlement areas in debt due to illness: Study

Few families surveyed had access to health insurance. “15.56% had access to public health insurance, and no one was availing of any private health insurance,” the study noted.

Nearly 34% of families living in Delhi’s resettlement colonies were forced into debt due to the burden of illness, averaging ₹1.8 lakh per family, according to a new study published on Sunday. The paper, “Chronic illnesses requiring home-based palliative care and their impact on families in an urban resettlement colony of Delhi,” published in Palliative Care and Social Practice, revealed the severe economic and social consequences of chronic illnesses in the city’s resettlement colonies.

A survey of 43,267 people found 34.44% families in debt, 87.10% due to illness, with average borrowings of ₹1.8 lakh, ranging from ₹7,500 to ₹5 lakh. (Reuters)

Conducted through a door-to-door survey of 43,267 people between September 25, 2024 and January 10, 2025, the study found that 34.44% of families had incurred debt, and in 87.10% of cases it was illness-related. “The families with debt had an average debt of nearly ₹1.8 lakh, ranging from a minimum of ₹7,500 to a maximum of ₹5,00,000,” the study stated.

Few families surveyed had access to health insurance. “15.56% had access to public health insurance, and no one was availing of any private health insurance,” it noted.

The study also highlighted the deterioration in families’ quality of life. It found that 62.22% of families reported suffering due to chronic illness, with 42.22% experiencing deterioration in diet, 42.22% stopping celebrations of festivals and family events, and 31.11% of caregivers’ jobs being adversely affected. “Other impacts included members dropping out of education (14.44%) and neglect of the illness of other family members (13.33%). In addition, families reported displacement from their villages due to financial pressure, being forced to change houses due to inability to pay rent, and a significant decrease in leisure and recreational activities,” the paper added.

The burden of caregiving was found to overwhelmingly fall on women. “Women overwhelmingly carried the burden of caregiving, with 84.44% of caregivers being female and an average age of 46 years. The majority of caregivers were women, often middle-aged, who had to sacrifice employment and personal well-being to provide round-the-clock care,” the study observed.

Among chronic disorders, neurological conditions were the leading cause of illness, accounting for 67.8% of all cases. Orthopedic conditions (8.9%) and old-age-related weakness with marked dependence (7.8%) followed. Stroke with deficit was the most common neurological cause of disability, found among 32.22% of participants.

Despite significant need, none of the families surveyed had ever heard of palliative care. The study stated that two in every 1,000 individuals required home-based palliative care, but “none of the study participants knew about palliative care, end-of-life care, home care for bedridden individuals, or community-based care, and reported never hearing about such services before.”

The study was led by Parth Sharma and Dr. Akshithanand Jayaprakasan, along with several other contributors. Speaking to HT, Parth Sharma said that while the government already has policies for palliative care, the gap lies in implementation. “The requirement right now is for the better implementation of those policies in a bid to make palliative care accessible. This is one of the factors that leads to generational debts. So the issue here is about the social security of the families,” he said. Dr. Jayaprakasan declined comment, saying he would respond once the policy recommendations are formally taken up by health authorities.

The study issued a series of recommendations to address these gaps: expanding home-based palliative care under the National Program for Palliative Care, involving medical colleges in community-level service delivery, ensuring access to essential pain medicines, training caregivers and Accredited Social Health Activist (ASHA) workers, covering outpatient medicines under government insurance, and extending social security schemes to families with life-limiting illnesses.

“The study highlights the significant need for home-based palliative care in urban areas and the financial hardship families face. There is a need for community-based package development for palliative care service delivery followed by an evaluation of its effectiveness,” the paper concluded.