Coronavirus | Opeds and editorials

COVID-19 and a country club India must leave

As a billion Indians watch with horror as the pandemic sweeps the land, many look with envy to countries to the east of us where the virus originated, and to the west of us in Europe which were devastated just a few months ago but appear to have beaten the bug and are starting to repair their societies. We can only draw some consolation from the fact that, thankfully, we are not alone in our spectacular failure to contain the pandemic: we have Trump’s U.S. and Bolsonaro’s Brazil to give us company.

The poison of inequalities

Others have also noticed the curious composition of this country club, perhaps the only one in the world which no one wants to be a member of, and have begun to wonder what features these three countries might have in common, apart from the fact that they are all populous, federal, diverse and democratic. No prizes for guessing which is the most common theory which crops up in the fertile imaginations of perceptive observers. But that is not the theory which I believe tells the whole story. My proposal is that what these three countries share is the toxic levels of historic inequalities which affect every structure of society including, most importantly, the health-care system.

Comment | Coronavirus pandemic, an opportunity to reshape health care

The value of investing in a just public health-care system has never been as starkly obvious, for never before have entire countries been brought to their knees by one disease. To be sure, there have been far deadlier epidemics which continue to kill many more people than COVID-19 but they, like HIV, diarrhoeal diseases and tuberculosis, have mostly killed the poor and the marginalised, outside the conscious radar of those in power. More to the point, no previous epidemic brought the engines of the economy to a standstill. If some poor chaps died of a horrible disease in some godforsaken slum, C-grade town or village in the back of beyond, the stock market could not care less. However, on this occasion, for the first time, the wealthy and the powerful in their urban palaces have found themselves marooned. And their high-tech doctors and “super-specialist” hospitals can do little to rescue them.

On universal coverage

What differentiates countries which have been able to pick themselves up and start walking within a few months after their first case was detected from those, like ours, which remain mired in the muck, is the commitment by both the state and civil society to the principles of universal health coverage. To be fair, if universal health coverage was conflated with the simple existence of a publicly financed health-care system, then India, like the United States and Brazil, can already boast to have met this goal. However, this is not what universal health coverage means in spirit: only a system which all people, rich and poor, those in power and those who are powerless, can rely on to be given care with the same quality regardless of their station in society, can be truly considered “universal”.

A question of quality

Such a universal health coverage system does not exist in India, or the U.S. or Brazil, where more than half the population, concentrated in the upper income groups, seeks health care in the fee-for-service private sector. The private sector in India provides almost 80% of outpatient and 60% of inpatient care, as a result of which falling ill is one of the most important contributors to indebtedness in the country. While the government’s much heralded insurance scheme does buffer a segment of our population, the very poor, from impoverishment due to hospital admissions, outpatient care which comprises the bulk of health-care expenditure remains untouched. Whereas universal health coverage is recognised by many countries as a strategy to empower people to lift themselves out of poverty and as a foundation of sustainable development, health care in India has become a leading cause of poverty. The fact that, despite this knowledge, the majority of our people prefer private care, is a damning testimonial to their experiences of the public health-care system.

Comment | Predictions, pandemics and public health

I have often heard the titans of corporate medicine in India justify their costs by arguing that these are much cheaper than in the U.S. or Europe; such comparisons are ridiculous as they are oblivious of the fact that India’s per capita income places us as one of the poorest countries in the world. But beyond the clearly visible ills of the wholesale commercialisation of health care, there are a host of other challenges to realising universal health coverage, from the standards of our infrastructure to the honesty and competency of health-care workers which contribute to the abysmal quality of care, in both the private and public sectors.

The pandemic has brought the scandalous quality of our health-care system into sharper relief as our daily diet of front-page headlines alternates between the numbers of dead on the one hand with stories of pigs roaming freely and the absence of doctors in public hospitals to shameless profiteering and refusal to care by private hospitals on the other. The proclivity of doctors to irrational medical procedures and drug prescriptions, the lack of dignity with which the poor are cared for, and the legendary levels of corrupt practices across the health-care system are well documented.

At the heart of this pathetic state of affairs is the complete lack of accountability of either the private or public sector, and the absence of the stewardship role of the state in ensuring justice and quality of health care for all its citizens. It comes as no surprise that there is a fundamental breakdown of trust between civil society and the health-care system, exemplified at its most extreme by violence against health-care providers. Fixing the rot will need structural reforms far beyond the top-down “missions” and knee-jerk punitive actions which have dominated our policy-making for over 70 years. But for this to happen, we will need a broad coalition across the political establishment and civil society, in particular the wealthy and ruling classes, to demand change.

Comment | Adopting a public systems approach to COVID-19

A historic opportunity

For the first time, I see the possibility of this happening, as economists, business leaders and politicians who were wont to view the public health-care system as a charitable cause to address disease and death of the poor, to be attended to as a footnote to the task of building our economy, can finally witness as clear as daylight how a dysfunctional, fragmented and unaccountable health-care system will ultimately destroy the economy itself. Even if the pandemic has hit the poor the hardest, it has also crippled the nation. But we need more than just new money for while health care is the wisest investment for the economy, such an investment must be accompanied by a social compact that the same system caters to all. This philosophy of universal health coverage is already practised in diverse ways, including engagement of the private sector, by scores of countries. I cannot imagine a more historic opportunity for India to join that illustrious club.

Vikram Patel is the Pershing Square Professor of Global Health at Harvard Medical School

Related Topics
This article is closed for comments.
Please Email the Editor

Printable version | Aug 12, 2020 1:28:27 AM | https://www.thehindu.com/opinion/lead/covid-19-and-a-country-club-india-must-leave/article32225367.ece

In This Package
You are reading
COVID-19 and a country club India must leave
A quest for order amid cyber insecurity
Adopting a public systems approach to COVID-19
Milestone of a million: On India’s COVID-19 numbers
Testing times: On university exams
Predictions, pandemics and public health
It’s time to flatten the pandemic stereotyping
Viral outrage only spikes the data
Sending the right message
Needed: Clear testing data
The social contract needs to be rewritten
The pandemic is about eyes shut
Joblessness and opportunity in Tamil Nadu
Green-lighting ecological decimation amidst a pandemic
COVID-19 has no religion
A case for extension: On rural jobs scheme
Surely, even if slowly: On a COVID-19 vaccine
Bend it like Italy: On flattening the COVID-19 curve
Promise and delivery: On India’s first COVID-19 vaccine
States hold the key: On Unlock 2.0
PCR testing is a double-edged sword
Science vs nonsense: On Patanjali’s COVID-19 claim
Senseless deaths: On Tamil Nadu custodial deaths
Shut and open: On tennis during the pandemic
The perils of follow the leader syndrome
The many questions about Favipiravir
In new lockdown, a second chance for Tamil Nadu
United front in Delhi: On Kejriwal government-Centre camaraderie
A prescription of equitable and effective care
Multilateralism post COVID-19
Making public transport safe during COVID-19
A better rate: On COVID-19 recovery
Look back in relief: On the migrant labour crisis
Needed, a transfusion for public health care
Wrong priorities: On keeping religious places open during a pandemic
Crossing the line: On Delhi’s decision to limit health services
Profit, not profiteering: On regulation of COVID-19 testing charges
In Persian Gulf littoral, cooperative security is key
Paging the private sector in the COVID fight
Curves and recoveries: On India’s coronavirus numbers
India’s Parliament is missing in action
Axing the economy’s trunk
Scripting a new narrative for COVID control
Open with caution: On Unlock 1
It’s time for a universal basic income programme in India
The waning of subaltern solidarity for Hindutva
Export blocks: On India’s trade amid the pandemic
A moment to trust the teacher
The echo of migrant footfalls and the silence on policy
Enjoying the fruits of their labour
Helping supply chains recover
The heavy burden of social suffering
An effective lockdown
The lockdown has highlighted stark inequalities
Will sport be the same in empty stadia?
Cinema after COVID-19
The eternal longing for the distant home
Working safely: On workplaces during the pandemic
A hole in the whole: On health sector woes
China, better prepared for the post-COVID world
How public health boosts an economy
Keep it retrospective
Backing the ‘angels in white coats’
Standstill: On opening of stadia for training
Flawed stimulus is justice denied
We need social physicians
A callous response
Peaking: On India’s coronavirus tally
Farm gate in focus: On amending Essential Commodities Act
A question of quarantine: On migrant workers and other travellers
TASMAC tribulations: On Tamil Nadu liquor sale
The pandemic and the challenge of behaviour change
One for the poor: On Centre’s corona package
Lockdown syndrome: On virus-induced economic crisis
Are India’s labour laws too restrictive?
Stop the return to laissez-faire
States cannot be left to the Centre’s mercy
Local motif: On Modi’s call for self-reliance
Liquidity lifeline: On Nirmala’s MSME package
A plan to revive a broken economy
Provide income support, restore jobs
Perilous state: On State finances
COVID-19 and the path ahead
Reaffirm cooperative federalism
Riding roughshod over State governments
Tragedy on the tracks: On the killing of 16 migrant workers
Coming to terms: On India refusing to admit community transmission
The trends shaping the post-COVID-19 world
The epidemic and ensuring safety in courts
Responding to COVID-19 at the grassroots
The face of exploitation
Contempt for labour: On dilution of labour laws
Slower growth and a tighter fiscal
Back home: On return of Indian expatriates
Blame game: On Donald Trump’s anti-China rhetoric over COVID-19
Resuscitating multilateralism with India’s help
A war-like state and a bond to the rescue
Fear and loathing in the land of the free
Everyone wants a good stimulus
Rent control amidst pandemic
Slow release: On lockdown 3.0
No comfort in numbers: On Bengal’s coronavirus cases
Pandemics without borders, South Asia’s evolution
India’s disease surveillance system needs a reboot
No relief for the nowhere people
BRICS against COVID-19
Recovering early: On India’s COVID-19 patients
It’s about food, nutrition and livelihood security
Taiwan’s coronavirus protocol shows how it is done
Needed: a pandemic patent pool
Getty Images/iStockphoto
Plasma therapy is no silver bullet
Take care of yourself too, fellow journalists
Strategic shift: On home isolation of mild coronavirus cases
Coping with today, planning for tomorrow
No end in sight: On India’s coronavirus strategy
Vividly imagining the life of migrant workers
A task for South Asia
Privacy concerns during a pandemic
Unlocking justice in the lockdown
Safe return: On migrant worker distress
The outline of another pandemic combat strategy
Pandemic and panic: On Tamil Nadu’s five-city lockdown
Protecting the poor from becoming poorer
Did SARS-CoV-2 begin from a lab?
Protection for protectors: On safety of healthcare workers
Rapid failures: On antibody testing kits
The COVID-19 paradox in South Asia
Fishing in troubled waters during a pandemic
How will India emerge out of the lockdown?
Making doctors wash hands
Locked out of cities, homes and livelihoods
Script of unity: On coronavirus and social prejudices
Exploiting a pandemic: On Trump’s immigration policy
The village is still relevant
A time for planetary solidarity
There may be no going back
No transparency in West Bengal
Focus on the curve: On India’s COVID-19 numbers
Economy in lockdown: On India’s worst case scenario
A shot of hope with a game changing vaccine
Caught in the heightened arc of communal polemics
Singing the corona tune
Helping a lending hand: On RBI’s second lockdown stimulus
A season of change: On IMD forecast system
A virus, social democracy, and dividends for Kerala
Across the gulf: On stranded Indian workers
Virtual reality: On telemedicine
A blueprint to revive the economy
A case to use JEE-Main instead of JEE-Advanced this year
Will the aviation industry recover from the pandemic?
Data-driven reporting during COVID-19
Stress test: On revised lockdown guidelines
Disastrous decision: On Trump halting funds to WHO
Cease the distractions, seize the moment
Getting the containment strategy in India right
In India’s response, a communications failure
Harmonising with nature
End the harassment of farmers now
A narrowing window: On extension of lockdown
Corona bond: On Eurozone COVID-19 rescue package
Halting the march of rumours
Polls during a pandemic
The pandemic and the contours of a health response
Economic liberalisation and its faults
Invasive, alien, most fearsome
Trade in tatters: On the global slump
Wanted, a collective national endeavour
Disingenuous and no antidote
COVID-19 and the crumbling world order
Women’s safety during lockdown
Lives and livelihoods: On economy after lockdown
Stage fright: On denying community transmission
Team India and winning the pandemic battle
In time of need: On hydroxychloroquine export
Will COVID-19 affect the course of globalisation?
Finding a scapegoat in WHO
Curating news for children during pandemic
A time for extraordinary action
For better use: On MPLADS funds
Needed, greater decentralisation of power
A key arsenal in rural India’s pandemic fight
Preparing for exit: On lifting the lockdown
Sanctions and pandemic: On America’s Iran policy
‘A script of action, responsibility and compassion’: Chief Minister Ashok Gehlot writes on Rajasthan’s fight against COVID-19
Taking a long view of the pandemic fight
Ten questions posed by the virus
A different economic approach
Why healthcare workers above 60 should be ‘benched’
Enemy at the gates: On Kerala-Karnataka border row
Reducing farm distress during a pandemic
Why everyone should wear masks
The criticality of community engagement
A niggardliness that is economically unwarranted
The spectre of a post-COVID-19 world
Light and sound: On Narendra Modi’s 9-minute light ceremony
A million and counting: On global coronavirus spread
Safe forests, safe people: On diseases of animal origin
Quarantine and the law
Making the private sector care for public health
Looking east to contain COVID-19
Limits to rugged individualism
Uncritical endorsement: On exodus of migrant workers and the Supreme Court
Beyond the blame game: On the Tablighi Jamaat episode
A long road: On India’s 21-day coronavirus lockdown
The missing notes: On politics and the fight against COVID-19
China’s zero: On China’s lead in containing coronavirus
Unprecedented step: On Wuhan lockdown
The return of the expert
Lessons from Hubei
A pandemic in an unequal India
Faith can’t override public health
Devising a people-centric response to COVID-19
Karnataka CM writes on how the State is fighting the pandemic
Tamil Nadu CM writes on how the State is stopping the pandemic in its tracks
The hunt for a cure begins with telling the truth
COVID-19 and a city’s anatomy
Long live the nation-state
The COVID cycle
Coronavirus | The worst of times, the best of times
It’s also a fight against punitive measures
The age of the neoliberal virus
The deep void in global leadership
Thinking national, acting local
Every man is a part of the main
Beyond social distancing to fight COVID-19
Next Story