Opinion - Interviews   

Balance has gone too far in the market’s direction

— Photo: R.V. Moorthy

Not anti-market: According to Sir Michael Marmot, the public sector has a role that markets cannot play.

Sir Michael Marmot, chairperson of the Commission on Social Determinants of Health, set up by the World Health Organisation in 2005, was in India recently to advocate his group’s recommendations.

We have taken a view that health is a good measure for the wellbeing of the population, and secondly, that the whole rationale for social determinants of health is that actions in all important sectors have an impact on health and we have expressed it in our report that health may not be the aim of the social policy but it is the result.

Now, how do you make it attractive for the politicians? The people know. It is actually in the interest of the politicians if they think it is in their interest to serve the interest of the people better. After all that is what gets them re-elected — to take the sort of steps and pursue the kind of policies that have a positive impact on the health, particularly the health of the disadvantaged, or in other words to promote health equity.

What we say in the report is that our markets work wonderfully for delivering goods and services to the population for creating innovations, improving standards of living. But markets are not a wonderful way of delivering social programmes because they have different objectives. We are not anti-market but we think the balance has gone too far in one direction. If you want education, health care and social security, do not rely on them.

We rather consciously took the view and had to say how quite important the public sector is. The public sector has a role that markets cannot play. They are very good at doing certain things, but they are not very good at reducing social inequalities, dealing with environmental consequences, and they are clearly not good at delivering social welfare.

Our Commission did not spend its time on suggesting how to deal with catastrophic emergencies. We do, however, point out that there are natural disasters and phenomenon, and social organisations turn natural phenomena into natural disasters, so the Chief Minister of Bihar has to figure out what to do today or in the coming days. Perhaps, you would want to start from there. Also, if you look time after time at natural phenomenon and ask who is susceptible — it is the poor and the disadvantaged.

Even in New Orleans we realised that it were the poor — almost all Blacks — who suffered the most in Hurricane Katrina. And when we went there years after the hurricane, the people still had no healthcare facilities. The only thing that was functional were the liquor stores. It was an appalling situation. I cannot possibly comment on the Bihar situation because I have been here only 24 hours, but what I can say is that what we learnt from New Orleans was that the aftermath was inescapable. It was the poor and the disadvantaged who suffered the most, and importantly why wasn’t simple technology kept up to date in terms of flood defences. So it was reasonable to ask the question, once the flood happened, why was the flood allowed to happen and why the poor and the disadvantaged were the ones who suffered in the flood.

Our report mentions that we are concerned about the people’s health and wellbeing. To achieve this, you really have to act on a series of fronts and not simply indulging in tinkering with the healthcare system. The answer to the question why the poor people in Bihar or the disadvantaged in Kerala are affected appears that we have not taken into account environmental issues, water management, housing issues and never ever, in India, looked at the equity issues, and we are now seeing greater and greater gaps in health equity.

We pushed hard when we were here in 2005 and we asked the Indian government whether they would like to become a partner in the Commission. And, one way of summing it up is the answer was “not yet.” They were a bit at arms length. But in Brazil, the President set up a commission and asked it to suggest how they could take the sort of policies that are emerging from this commission and apply them. Now, if you ask how things have changed in Brazil, it is too early to say, they have submitted their report 3 to 4 weeks ago, even though they got active pretty early.

If India had done it in 2005, they might be issuing a report right now. But if India embraced the recommendations and said we want to take it seriously then two things would happen: one it would be very good for the cause of equity in India, and second it would shine a light for other countries.

Then, let us take education. It does not take a commission to say education is important. But how do we create the conditions for girls to stay in school in Gujarat for example. Well, the commission could not answer that question, but at the same time it is dealing with issues of poor education standards in Glasgow because the situation in Gujarat and Glasgow are a world apart. So, the big question then is to take the Commission’s recommendations about the importance of girls’ participation in education at least equally with boys, and say how do we make this a priority and apply this in our local community. We can set up partnerships with non-governmental organisations and State governments.

It is a bit quaint and old-fashioned, but the whole idea of stakeholder and capitalism seems to have a lot of merit. Corporations need to recognise that there are stakeholders other than their shareholders, and that they are important players in the community but they have responsibility not only to the shareholders but customers as well as to the community in which they operate. The corporate sector essentially is enormously powerful but they have to feel a sense of responsibility. If they feel that their responsibility is only to their shareholders and customers, then they cannot play any role, they become part of the problem. But if they actually say they have a sense of wider responsibility, then they ought to be part of the solution.

We know lots of politicians are in there for the wrong reasons, let us try and encourage the ones who are in for the right reasons. There is a strong moral, ethical reason for trying to take actions to promote social equity. I would say health is an indicator or marker of how other policies are performing. There is another reason also. Everybody values health and they would go to any great length to secure health for their families. Even in India, people would go without food to get their children vaccinated.

Printer friendly page  
Send this article to Friends by E-Mail

Stories in this Section

Yeddyurappa protests too much
’Til faith do us part
Why liberal Britain just loves Sarah Palin
Gender inequalities must be tackled if MDGs are to be achieved
Anti-terrorism laws and some imperatives
Corrections and clarifications
Singur situation
Karnataka CM’s move
Signal of change
Balance has gone too far in the market’s direction

Copyright © 2008, The Hindu. Republication or redissemination of the contents of this screen are expressly prohibited without the written consent of The Hindu