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Social Equality in Public Health
|by Teresa Rehman|
Its often seen that when people meet, almost always, without exception and as a second nature, the first question they ask is about each other’s health. Keeping well and healthy is a central human capability. Yet, good health continues to elude a large chunk of the population in India due to a host of reasons. A host of social conditions produce poor health as well as health inequity and there is a lack of adequate social action to combat these social causes of ill-health. The Chandrakant Patil Memorial Eastern India Regional Health Assembly held at Kolkata recently tried to delve into how issues of health could be made a central democratic priority in India.
Organised by the Pratichi Trust of Nobel Laureate Dr Amartya Sen in collaboration with the Liver Foundation, West Bengal, ADRI Patna and UNICEF, Kolkata, the health assembly tried to initiate a wider meeting and a dialogue on health in India, something in the line of the National Health Assembly held regularly in Thailand. Named after Dr. Chandrakanta Patil, who sacrificed his life while serving the flood-hit areas of eastern Bihar, the Assembly tried to tried to take a closer look at ‘what makes good health so problematic for so many people in India’.
It is important to understand the difference between health and treatment. Health is required for people who are not ill and treatment is required for people who are ill. But because of a staunch disease-centric and medicalised view of health, the public health care delivery system is also seen as hospital based infrastructure. This leads to a neglect of the preventive and educative aspects of health.
However, the public health services have been relegated to a somewhat marginalized position in the health system thinking in India. India is a land of curious contrasts. Four of the ten richest persons in the world are Indians, yet India contributes one-fifth of the world’s share of all diseases – one third of diarrhoeal diseases and tuberculosis, a quarter of maternal ailments, and a fifth of nutritional deficiencies. There is a lot India can learn about health from its neighbours, for example, from China and Bangladesh. India can learn particularly about what a massive expansion of public health care can achieve in reducing inequities in health, so also about what reversals in these aspects may occur due to market orientations.
The healthcare system in India is not uniformly weak, implicitly suggesting the critical importance of committed social and policy action in reducing social disparities in health. The lack of public health facilities gives way to a private health market, that in turn promotes a disease-centric view of health, because diseases need curing with medicines. And medicines can be commodified, at very high prices. Thus the primacy given to curative health creates a huge – and almost unregulated drug market. There is a string need for raising voice for the rationalization of the drug policy.
Interestingly the data reveal a relatively promising performance of the several of the states of the states in Northeast India on a number of health parameters. For instance, in a number of north eastern states the prevalence of underweight children is among the lowest in the country. These are also the states that have large percentages of ICDS beneficiaries as well as significant funding for the programme. Several of these states also record low prevalence of anaemia among women. Comparatively speaking, per capita public expenditure on health is sizeable in these states. According to the data collected from ICDS Nagaland’s progress is very high – only six percent of the children being moderately underweight. Sikkim, Manipur and Mizoram show a similarly encouraging show a similarly encouraging performance.
It is important to understand the concept of survival inequality. In a country where more than 50 children per thousand do not even see their first birthday, any public policy on health cannot but take serious note of this in order to improve the chances of survival of the children. Moreover, the children who survive face gross nutritional discrimination leading to poor health of the population. Children belonging to poorer families experience more nutritional deprivation than the relatively well-off ones.
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