Manifesto for Public Health: why isn’t prevention better than cure?
If Food subsidy had not been targeted at 65 per cent people but say only 40 -50 per cent people, we would have found enough resources for overcoming anemia among poor women for ever, or nutrition linked blindness among all vulnerable children. One does not need too much of imagination to understand why preventive health care is more democratic, affordable and inclusive than curative care (not that we can neglect the latter for the poor). Over time, our performance in providing health care has been worse than most countries in south Asia and many other parts of the world. With all the recent initiatives, studies have shown that private expenditure on health is four times more than public expenditure at around 1.2 per cent of GDP. If Sri Lanka can reduce infant mortality to 13 infant under one year per thousand, why should India have it at 52, higher than Nepal, Bangladesh and Maldives. What kind of model of development are we planning for future and why should that be not at the heart of political debate. Indian does not even collect data on chronic diseases at community level in regular health surveys, providing preventive diagnostic and clinical support to a vast majority of poor is not even on cards. Every worker at employment guarantee work site could get mandatory health check up and central and state governments must then report to the nation about steps taken to remedy the inadequacies of these workers. These workers are not even provided soap (which can be made by them only) to ensure better hygiene and a water filter to prevent water borne diseases. Government has enough fund to subsidize non-poor people through food and LPG gas cylinders but it can not meet basic health and educational need of poorest people.
Twenty million people travel by train every day, as I have argued many times and can thus be reached by preventive health care messages in interesting, educating and interactive manner. We can also source ideas from people for dealing with many social, technological and cultural problems. By them time the passengers reach long to medium distance destinations, we can process these ideas through the voluntary help of students and professionals in public and private sector and give prizes in real time. And then a precise operational plan can be made to implement viable ideas after pilot testing. But there seems to be no political will among any party to give priority to such ideas of engaging with masses for near term resolution of persistent problems of health, hygiene and related education. Similarly, i will keep repeating the idea of using 1.6 lac post offices to reach 6.5 lac villages every month with focused messages coded in powerful metaphorical or symbolic and cultural forms. We have reached NMEP( for eradicating malaria though not as successful as polio) or polio vaccine messages to every nook and corner of India. We can do it again and again for all-important messages. India has enough muscle and mind space to implement ideas it decides to do unambiguously be it Moon or Mars mission at a cost no body else in the world can do or organizing fair elections involving a billion people. Then why is it that reaching preventive and essential curative health care to ever-disadvantaged citizen is so difficult? One adverse major health episode means washing away of all savings of a family besides incurring huge debt. Insurance sector covers a miniscule portion of population. Government claims has no funds for that but has enough funds for extending more and more privileges to the well off people.
In China, every single hospital has well integrated services available for allopathic and Chinese Traditional medicine. In India, most public systems dont even reimburse the health expenditure of Indian systems of medicine. The issue of integration has not been tried, exceptions apart, at great cost to the people. Indian system of medicine (which sustained the health and wellbeing of majority) has become an alternative system today. In a large number of primary health centres, since allopathic doctor dont want to work, ISM doctors any way provide health care.
I hope that various health care models developed by Dr and Mrs Abhay Bang, Aroles and many others will be given much more space in our consciousness than before. We can and must incentivize the doctors to go to rural areas for inculcating preventive health care awareness and other self care competences. Several health trains should regularly go over the country and meet needs of the poor. India is a rich country with poor leadership and time has come to ask hard questions. I hope those aspiring for powers are listening.