India’s political and medical classes have persistently ignored public health principles

whdBy Fr Cedric Prakash sj*

Come April 7th and World Health Day will be observed once again. The focus this year is on ‘Depression’, which as the WHO statement says, “affects people of all ages, from all walks of life, in all countries. It causes mental anguish and impacts on people’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends and the ability to earn a living”.

Depression is the leading cause of ill health and disability worldwide. According to the latest estimates from WHO, more than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. Lack of support for people with mental disorders, coupled with a fear of stigma, prevent many from accessing the treatment they need to live healthy, productive lives. “Let’s Talk” is the response part of the theme; emphasising the fact that those who suffer from depression must seek help, must talk about it- but the real challenge today is are there people who have time “to listen”?

Today, many of us live in great stress. Competition and consumerism, power and possessions tend to rule our lives and our world. What matters the most is being “up-there.” Several parents today goad and prod their children, in an obsession to making them ‘prodigies’. The result is stress on all fronts and unnecessarily so. Children are literally robbed of their childhood. The work place more often than not, becomes a source of tension. Family life is marred because everyone is so ‘busy’, that value time for the other, has become a rarity. Continuous conflicts and wars, certainly adds to the depressive state of affairs everywhere!

A few years ago, ‘our doctor’ was our family physician. We went to the doctor for minor and major ailments. We were listened to and given some good counsel. Our family doctor was privy to husband-wife problems; the concerns parents had with their children and vice-versa; and of course, those with the ‘in-laws’. Some hard-to swallow powders and bitter medicine were given. One often felt better, not depressed, after visiting one’s doctor. Most often we were cured before the medicine dosage was completely finished. The doctor found time to visit us in our homes, when we were too ill to go to the clinic. Of course, there were always the big hospitals for major illnesses, surgeries etc.

Times have changed! The ‘family doctor’ in most places has become as prehistoric as a dinosaur. Every illness necessitates that a ‘specialist’ and a ‘super-specialist’ see us. Then there are the innumerable tests to be done and reports to be got. At the end there is a huge bill to pay. Several of the ‘posh’ hospitals generate astronomical billings – no patient and not even a corpse can be taken out of that hospital until every rupee has been settled. However, these expensive medical services in the country cater to a particular clientele who can afford it; for the teeming millions, in India, it is just beyond their means.

Healthcare, which is accessible and affordable, equitable and qualitative, is the right of every single citizen. The Universal Declaration of Human Rights in Article 25 states, “everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.” The Universal Declaration makes additional accommodations for security in case of physical debilitation or disability, and makes special mention of care given to those in motherhood or childhood

All this seems good on paper. The reality is tragically different for millions of Indians –especially for the poor and marginalised sections of society. In September 2016, the first global analysis that assesses countries on sustainable development goal (SDG) health performance was launched at a special event at the UN General Assembly. This new index developed to assess each country’s achievement on a range of health indicators ranked India a pitiable 143 out of 188 countries, six places ahead of Pakistan and way behind countries like Sri Lanka (79), China (92), even war-torn Syria (117) and Iraq (128).

Dr Vikram Patel, Professor of International Mental Health at the Centre for Global Mental Health, London School of Hygiene and Tropical Medicine,  and co-author of the study says, “the reason why India continues to be one of the worst-performing countries in health is because its political and medical classes have persistently ignored public health principles which ultimately improve a nation’s health, such as addressing social determinants of disease and ensuring high-quality, accountable, universal health care for people.”

Dr. Patel hits the nail on the head. The Government shows no political will to ensure the much-needed healthcare for the poor and the marginalised. In the last Union Budget presented at the end of January 2017, the allocation for the health sector as a share of GDP has seen a marginal increase from 0.26% in 2016-17 to 0.30% in 2017-18 .This falls abysmally short of meeting the long-standing demand (articulated in the Draft National Health Policy, 2015) of increasing the total allocation for health sector to at least 2.5% of the GDP. On the other hand, the Defence allocation was hiked by a further 10%, making it scandalously to about 12.78% of the total Government expenditure.

The fact that health has not reached millions of the men and women of our country is certainly depressing news. ‘Depression’ must be addressed; but a primary question that we need to ask ourselves “Can we really celebrate ‘our health’?

*Indian human rights activist, currently based in Lebanon, engaged with the Jesuit Refugee Service (JRS) in the Middle East on advocacy and   communications

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