Political outfits, budgetary constraints have prevented health reforms
Medicine is a social science and politics is nothing but medicine on a larger scale,” said Rudolph Virchow, Emeritus Professor of Pathology and a former Mayor of Berlin. Public health as a science is too serious a matter to be left in the hands of politicians alone. In countries like Cuba and Costa Rica where public health systems are effective, affordable and efficient, the political establishment has recognised that health at all costs should be the norm to ensure a healthy nation. This is not the case in most parts of the world, where health is not accorded due priority.
Whenever I discuss the political determinants of public health, I am reminded of two things. The first is a documentary called Fire in the Blood. It spoke about how pharmaceutical companies and governments in the West blocked low-cost AIDS drugs to African nations and the global south in an aggressive manner causing over 10 million deaths. It was a story of medicine, monopoly, and malice at its worst.
The second is a book written by Scott Carney called The Red Market, which talks about the world’s organ brokers, blood farmers, child traffickers and bone thieves where the secretive yet open trade in human bodies is a multi-billion dollar industry. Can these outcomes survive and thrive without the direct involvement of the political classes? Such practices can jeopardise public health futures.
What policymakers and public-health strategists need to outline is the critical role of political discourse in public health problems ranging from psychiatric rehabilitation centres and mental health clinics to road traffic injuries to the quality of care to resurrecting crumbling public health infrastructures. The response from the government departments gets influenced by the magnitude of a public health problem. Fragmented political outfits, special interest groups, and budgetary constraints push policymakers to avoid sweeping reforms in health systems and encourage piecemeal policies. Public health becomes a political issue because the patient is viewed as a community and a social collective rather than an individual who is simply treated for a disease. For example, how can the burden of tobacco consumption really reduce when the government itself holds major stakes in the Indian Tobacco Company (ITC). Another food for thought is regarding the effort to reduce Maternal Mortality Rate in the country. Isn’t reducing maternal mortality an illusion when we merely have about 70,000 practising obstetrics/gynaecology doctors for the entire country? Many of these doctors may either be practising obstetrics or gynaecology, not necessarily both; others might move abroad for fellowship or temporary job changes. A huge chunk of this doctor population may settle in urban areas, thus increasing the concentration of obstetricians and gynaecologists in cities. The rural areas with limited resources are always neglected. It’s a case of political indifference adversely affecting pro-poor outcomes.
In 2014-2015, India imported drugs in bulk from Chinese companies, worth about $2.22 billion, citing price competitiveness. This shows contrasting and conflicting priorities of the Union Government. On the one hand, Prime Minister Modi’s flagship Make In India is being touted as an official policy and, on the other hand, mid-level Indian pharmaceuticals rarely get government support to scale up.
Health in India is a state subject. True to that, the states serve as laboratories for testing new health policies, which may or may not be adopted by the rest of India. For example, Gujarat and Bihar have a brilliant mechanism in place to address Disaster Management whereas the rest of the country is still catching up. A crucial step while engaging with political determinants of health is to articulate socially credible threats supplemented by evidence-based public health. India will emerge as a public health champion if it encourages and promotes dedicated public health cadres.
The author is CEO, CHD Group and Member- Health Task Force, DDMA, Government of Karnataka