A case is often made out about the neglect of public health in India and its ill-effects on successive generations. Health indices do reflect slow gains. Most Indians have read this all their lives and seem convinced by the recurring themes of being a poor nation and thus being unable to afford their own good health.
The word ‘afford’ has increasingly become part of the national health lexicon ever since the Bhore Committee in 1957 submitted its report on the structure of health services that could benefit a newly independent India. That determination of ‘unaffordability’ has pushed large sections of the population into the market to go and buy their own good health.
Health and economy
Despite the size of the economy having multiplied many times over we continue to remain a ‘poor nation’ when it comes to funding health. The dominant cause of this dichotomous reluctance is the inability to translate non-economic, non-metric but strong human attributes such as empathy and sympathy into reasons for funding health. Ironically, the poor health of individuals is now held responsible for delivering an ‘under-performing’ economy, as if that is the very purpose of health.
The economy of the nation is a composite and it is generated by the collective effort of people in various walks of life. Citizens pay directly and indirectly into national taxes, but allocating any of those revenues for the health needs of the population has layers of difficulty.
Forever ‘developing’
There is no reverse coercive mechanism available to citizens to increase budgetary allocation for long-established and proven interventions that are known to mitigate mortality or morbidity. We thus retain the ‘developing nation’ status and will likely be one so as long as we do not consider it respectable and honourable to prioritise the health of those who build the economy.
Unsatisfactory budgetary allocations for health have led to accumulated unmet needs over the decades in both the care-seeker and caregiver fraternity. Lack of capacity creation owing to under-funding has led to an inability to utilise funds, which argument is then used to deny additional resources.
Continuing story
This sort of institutionalised neglect manifests periodically as ‘freak’ disasters while other forms of neglect continue to consume lives invisibly. Clearly, human biology cannot be put on hold awaiting economic logic, understanding and sanction to come on a par.
Unfortunately there are no cut-and-paste models available that would allow us, or any other nation, to import and deploy an entire health ecosystem solution. Nations that have large allocations do not provide equitable or cost-effective care. There is no substitute to putting our heads and hearts together, to find and fund solutions for the health needs of the population.
The national economic landscape is dynamic and promises to be so in the foreseeable future. Scores of lives become victims of economic vagaries with every economic cyclical change so that health becomes, at best, a pleasant side-effect of an economy that may have performed well. There is poor understanding and implementation of the fact that determinants of economic upheavals differ vastly from those that pose biological challenges for populations.
There are diverse reasons why monetary allocation for healthcare has stagnated, but a historical analysis of past allocating behaviour suggests it might continue to be so. It is not that our GDP needs to improve or health services need to become cheaper. The health budget is deemed to be largely unproductive investment that cannot directly reflect as profit in balance sheets. This perception is false as the manner in which public health benefits are realised remain unquantifiable in the traditional economic metrics. A one-year change in life expectancy or a dip in the IMR (infant mortality rate) by one percentage point can cost sums that can potentially unbalance the exchequer.
The sense of despondency in those engaged in the health economy is a result of the same reason that is praiseworthy in other sections of the economy, namely, profit. Serious consideration must therefore be given to creating a new financial institution to cater for national health needs and priorities.
An institution that is not driven by profit but built to be sustainable for those that seek care and those who provide it. Many sectors of the organised economy such as steel, rubber and sugar have special ‘vehicles’ built for their revival but the health sector is merely allotted money. Activities in the proposed health ecosystem would derive revenue from the diverse set of goods and services in the health sector, which human populations currently consume but in a non-exploitative manner.
Such a transparently governed system should be driven by the idea of continuity and sustainability rather than profiteering. Including investments from the formal economy with realistic growth expectations can serve as a driver rather than be the one and only source of expenditure. The challenge of making biological care equitable can be started and maintained in earnest by making it independent of economic vacillation.
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