Read the symptoms
An economic boom will not ensure better health for the people. The government needs to invest heavily to fix our healthcare system, writes Sitaram Yechury.columns Updated: Jan 12, 2010 21:07 IST
With a long leg and a short leg, a slip and a leg slip, a point and a silly point, Left Hand Drive has crossed the century mark. Thank you for your indulgence and endurance.
Soon we shall be celebrating the 60th anniversary of the founding of the Indian Republic. All ancient civilisations consider the completion of 60 years — Sashtipoorti — very auspicious. This signifies the resolve for continuing to live healthily. The quality of life, thus, assumes greater importance than longevity. It is, therefore, an appropriate occasion to assess the health of our nation measured by the quality of the life of our people.
Tragically, this has to begin on an ominous note. A Planning Commission study completed in 2009 on the basis of surveys conducted in several villages showed that healthcare expenses were responsible for more than half of all people declining into poverty. On the basis of the National Sample Survey Organisation’s (NSSO) data for 2004-05 (unfortunately, it is the latest year for which such data is available), it is estimated that an additional 39 million people were pushed into poverty due to healthcare expenses in that year alone.
During these years of liberalisation, economic reforms, along with all other public services, healthcare in our country has been increasingly privatised. While public spending on healthcare has been around a measly 1 per cent of the GDP, private spending has grown alarmingly to 4.2 per cent of the GDP. It is estimated that more than 70 per cent of the entire health expenditure in India is borne by the people from their own resources.
With galloping privatisation of healthcare over the last five years, such expenditures have been rising, especially for the poor and the marginalised sections. Further, the NSSO data shows that over 80 per cent of healthcare expenditures is on the purchase of drugs. It is common knowledge that the drug prices have risen exponentially in recent years. It means that a large number of people must be sliding into poverty.
Based on the data for 2007, the United Nations Human Development Report has shown, among others, a decline in India’s per capita income over the previous year. It has also shown a decline in life expectancy at birth and in the gross enrolment ratio in schools. Forty-seven per cent of our children are underweight due to malnutrition and nearly 17 per cent fail to make it to the age of 40. It is estimated that nearly 75.6 per cent of our people live on less than $2 a day. Adjusting this in purchasing power parity terms, we come very close to the estimation made by the Prime Minister-appointed committee that 77 per cent of Indians survive on Rs 20 a day.
The liberalisation pundits often scoff at such data and argue that faster the economy grows, faster would be the reduction in poverty. The PM himself, recently, has been defensive on this logic and was on the backfoot while expressing concern at the insignificant reduction of poverty levels.
The myth of a stronger economy and a faster growth rate leading automatically to better health for its people has been exploded once again. The current pre-occupation of US President Barack Obama with his new healthcare policy was based on the fact that nearly 16 per cent of the US population has no coverage of health insurance. One half of all personal bankruptcies in the US have been due to medical expenses. Though the US Congress and the Senate have approved two separate legislations, despite tough resistance by lobbies of vested interests, they now need to be combined and approved as a single proposal before the President can sign it into law.
Despite spending nearly a fifth of its huge national income on healthcare (huge profit avenues for private capital and insurance companies), the US’s overall health indicators are worse than neighbouring socialist Cuba, which has a one-twentieth per capita income. Between 1955 and 2008, Cuba increased its life expectancy from 53 to 79 years while in the US it went up from 69 to 78 years. Both in terms of child mortality and infant mortality, Cuba fared better than the US. In fact, Cuba’s per capita daily calorie intake is marginally higher than that of the US.
This can only be explained by capitalism’s inexorable drive — more pronounced under globalisation — to reduce all public utilities into commodities in the pursuit of its raison d’etre — profit maximisation. Capitalism has little need for commodities like health, education, sanitation, etc, which have an irreplaceable ‘use value’ determining the quality of life of human beings. Capitalism needs to convert these ‘use values’ into commodities with ‘exchange values’ that generate profit.
Thus, growth per se does not guarantee better health for its people. Reliance on private capital to provide healthcare can never improve the situation for the vast majority, as such investments pursue profit maximisation and not social benefit. What’s required is a political will and a social commitment to vastly enhance public expenditures in health- care. Public pressure must ensure that this happens. It’s the only way that India, for the sake of its people, must celebrate its Sashtipoorti.
Sitaram Yechury is CPI(M) Politburo member and Rajya Sabha MP
The views expressed by the author are personal