The direction of the thoughts of prominent leaders as well as the common voters becomes decisively important during this crucial period of the parliamentary elections. The politics of power always witnesses radical upheavals after a spell of every five years. The previous government resigns and a new government is formed. But what remains constant are the problems confronted by the country. The grim reality of the problem of health becomes more serious when it appears nowhere on the agenda of the electoral campaign of the political parties nor does it come to the lips of the leaders busy in delivering fiery speeches. What is most saddening is that, nobody cares to utter even a single word about the ‘Health Policy’ of this country in the midst of all this milieu. Not a single leader, on the national or the state level, is willing to make a key statement that will give a significant direction to the efforts to solve the health problems of this country. The voters are not yet sufficiently mature to expect that the elections will revolve around the problem of health. It is this problem which actually brings us to the threshold of life and death. But the voters are not sufficiently aware of it such that they will raise questions to their constitutional representatives about the ‘Health Policy’. Similarly, the society at large is also not yet keen to demand a statement about such a policy before the actual voting takes place. The reality is that the serious problems of health are knocking on our doors for one reason or the other. Yet the voters are themselves ignorant about the fact that the health of this country itself is on deathbed today. Needless to say, thanks to the attitude of seeking easy solutions, even the politicians, infected by the epidemic of populist policies, are ignorant about this horrifying reality.
The position accorded to the problem of health in the electoral proclamations of all the leading parties makes it clear that these parties have made only a superficial study of this problem and their policies are devoid of the wisdom needed to undertake the right steps to address it. Therefore, this is indeed the right time to make an emphatic appeal to the voters that they should first raise questions about the wrong policies of health adopted throughout last seven decades and then they should cast their votes only to such candidates who are willing to implement a policy of ‘Health for All’ and who will demand a comprehensive ‘Health Policy’ for this country.
Fundamentally, it is necessary to first understand the confusion being made between the two concepts of ‘Health’ and ‘Health Services’. The medication offered to ailing person is ‘Health Service’ and the measures adopted to ensure healthy life of the people means ‘Health’. This necessarily means that making provisions for ‘Health Services’ is merely a small part of ensuring ‘Good Health’ of the people. Making a provision of various ‘Health Insurance Schemes’ meant for a variety of medical treatments is indeed necessary but it is wrong to assume that the health problem of the country will get solved by introducing such schemes. Therefore, it must be highlighted that conducting dazzling inaugural ceremonies of super-specialty hospitals does not mean satisfactorily addressing the problem of ‘Health’. We have forgotten that ‘Curtailing the need for Health Services’ should be the pivotal factor while designing the health policies. Therefore what is necessary is to implement a two-fold policy that focuses on the basic elements like healthy maternal and child health along with a health policy that concentrates over providing primary and preventive medical services. Today this pyramid of health has become exactly opposite of what it should be. Through a long period of last seventy years our population continued to grow steadily but how far did the number of primary health care centres grow? Two significant questions are decisive for judging the progress of the health sector of any country. Those are, the rate of women dying during pregnancy and the proportion of infant mortality. Today, everyday 174 women are dying during the process of giving birth to their infants or within the first week of delivery. The causes of these fatalities are also easily avoidable. Our country aims at reducing this number to 30 in as late a year as 2030. Since majority of these 174 women belong to the poor economic strata ,the health and nutrition of their newly born infants also gets buried in the dark fathoms of the abyss of their uncertain destiny. What this clearly means is that we do not possess any national policy that can be vigorously implemented to save the lives of 348 citizens of this country hanging precariously on the edge of uncertainty. Not a single leader of any political party is either willing to confidently declare that he or she won’t let any women going through her pregnancy die. Nor is he or she willing to talk about what program has been designed to ensure the reduction in this number of pregnant women meeting their untimely death. Even small countries like Thailand or Sri Lanka have already successfully reduced this national average of women dying during their pregnancy to 20 and 30. But in our country 40 children out of every thousand are dying even before their first birthday on account of insignificant and easily avoidable factors. The healthy growth of the 50% of the children who are born in this country gets arrested on account of malnutrition. This essentially means that their death is guaranteed if their physical weight does not increase urgently. And yet we are not having any defined national level policy or a program to address this problem. Even after 70 years of independence we have not yet been able to protect 62% of the children using the vaccines available free of cost. Not a single Member of Parliament has the courage to make a public declaration that he will strive to make all the children of his constituency free from the problem of malnutrition. Besides, no Member of Parliament also has the guts to see that the vaccines do not lie idle in the refrigerators of public hospitals, that they will get used before their expiry date. Worse still, none of the voters seem to be interested in compelling the candidates contesting the elections to take an oath in this regard. What should be the task of a highest priority on the agenda of the upcoming government? The next government should dare to come out with a white paper to declare the true rate of malnutrition in our country and it should also convene a special session of the parliament with the exclusive purpose of eliminating the problem of malnutrition and launching a war-like drive to address this problem.
What we have forgotten over the span of last 70 years is that ‘Health’ is one of the fundamental rights blessed upon us by our constitution. It is essentially a right to live and it is also the duty of any government. We take immense pride in claiming our democracy to be the largest democracy in the world but it is awful that this largest democracy spends only 1.1% of its GDP for the purpose of health. When all the backward countries are already spending 5% of their national income, we are being told that this expenditure will be increased merely up to 2.5% till the year 2022. No voter is keen to ask even a simple question such as ‘How much is the government willing to spend to ensure my good health?’ because nobody tries to understand the economics behind this. In all the developed countries, next to spending for the needs of national security and safety of their citizens, funds are generously made available for the purpose of health and education because they know that physical health is fiscal health. People popularised this slogan in the developed nations , and even politicians, policy makers responded to this sloganeering. While citing the glorious examples of economic growth to us it must be noted that the financial loss we have suffered in this decade on account of four serious ailments viz. heart diseases, diabetes, cancer and stroke amounts to a whopping 16,500 lakh crore rupees.Throughout last several years nobody has tried to take up the problem of population control. Vasectomy is indeed as necessary as demonetisation but it cannot be imposed dictatorially nor can it be implemented as a ‘revolution’. Public health changes need to be a evolution rather then revolution. Several problems of health will get addressed if a national policy which addresses this problem through mass public education is rendered in a manner such that vasectomy will prove to be a voluntary result of an evolutionary process resulting into an automatic curtailment of the growing population. Today 70% of the fiscal spending in the health sector is taking place on providing medicines. The situation is so alarming in the domain of granting permissions to manufacturers of medicines that if the dark secrets of this sector get exposed not only will it result into anarchy but the agitated people will also come to streets just as a political volcano had erupted when the realities of banking sector were exposed.
Sharad Joshi, the founder of the farmers’ union i.e. ‘Shetkari Sanghatana’ used to assert that the problems confronting the farmers won’t get solved till such time they are not brought on the central stage of the politics of this country and as long as the prevailing politics of this country does not revolve around the problems of farmers. I have started feeling the same about the health , that health issues should become a political priority to get solved. As long as the electoral representatives of the people who guarantee the ‘Right to Health for Everybody’ do not emerge and as long as the voters keen about the ‘Health Policy’ do not appear on the horizon, nobody will even dream of the necessity of addressing this problem. Therefore, there is no escape from the idea that politics must revolve around ‘Health’.
This article is translation of Loksatta Editorial by Dr. Amol Annadate published on 24 April 2019. Read more articles on Health Policy and Issues here
Dr. Amol Annadate | aaa@amolannadate.com