The Commission on Social Determinants of Health, a global network of policy-makers, researchers, and civil society organisations brought together by the World Health Organisation, has made vital recommendations ( www.who.int) that can help countries at various levels of development reduce the gap in health care. The key message from the Commission’s labours is that governments must come up with social policies that emphasise universal health care, free and compulsory education, good conditions at work, and the availability of opportunities for leisure. Considerable improvements have been made in health over the past 30 years but life chances continue to vary widely in different countries. These variations are expressed in data on life expectancy at birth: it is better than 80 years in Japan and Sweden, 72 years in Brazil, but still only 63 years in India and less than 50 years in many African countries. Some areas of policy-making identified by the Commission to help bridge health inequity are particularly relevant to India. Improving health care through universal coverage, treating it as a common good rather than as a market commodity, stands out as the key principle. This means the state in India must become the guaranteed provider of health care. As the Commission points out, there is compelling evidence in favour of publicly funded health care systems.
The National Rural Health Mission (NRHM), with its budgetary provision of Rs.12,050 crore for 2008-09, is the central government’s flagship equity-building scheme. Schemes such as this need greater involvement of State governments and better qualitative oversight. Unfortunately, not all States have utilised the funds optimally since the NRHM was launched in 2005. What is also clear is that better training and a bigger role for the accredited social health activists under the NRHM will improve outcomes. Village-level monitoring for diabetes and hypertension (in addition to the existing maternal health services) can improve long-term health through effective prevention. Another major social determinant of health is policy support for child development. Free and compulsory education forms the cornerstone of child development and there is simply no excuse for not redeeming this constitutional promise. Another crucial condition for bridging the health gap is stronger social security for labour. Under conditions of mass deprivation, the inability of tens of millions of people, including the urban poor, to access basic health care is evident from data gathered during the 60th round of the National Sample Survey (2004-05). Now more than ever, with a global economic slowdown beginning to bite painfully into the Indian economy, the imperative should be a massive expansion of publicly funded health care — with an infrastructure to match the demand.