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Health of the nation

The president underlined the need for the country to have healthy citizens. For that, at least 3% of India’s GDP — instead of the current 1.1% — must be spent on healthcare. Sitaram Yechury writes.

india Updated: Sep 01, 2011 10:36 IST

The budget session of the Parliament began with President Pratibha Patil’s address. All indications point to a normal functioning of this session, unlike the wasted winter session. This is because the UPA 2 government has agreed to constitute a Joint Parliamentary Committee (JPC) to look into the 2G spectrum allocation scam. If the government were to have done this in the winter session itself, then precious time and resources would not have been wasted. The government needs to answer this question in the public interest.

The president, as usual, detailed the declaration of intent of “my government” and listed the issues that would be taken up in the coming year. Needless to add, many of these are a repetition of what was said last year. Worse, many of these were listed by the president the year before in the agenda for the first 100 days. This year’s address, therefore, had very little to connect with the issues agitating the vast majority of our people and members of Parliament. In a sense, it reflected the general sense of drift that seems to have gripped this government.

Among the various issues listed, let us consider the most vital. The president declared: “A strong and prosperous nation needs healthy and educated citizens.” However, the gravity of the situation is grossly understated. According to the National Family Health

Survey 3, 38.4% of children under three years are too short for their age and 46% are too thin for their age, while 79.2% are anaemic. Among pregnant women, anaemia has increased from 50% to 58%.

It is fashionable to argue that high growth rates will generate the required resources to improve the situation. High growth may be a necessary but not a sufficient condition to achieve good health of our people. Nobel laureate Amartya Sen has recently drawn attention to this fact by comparing India’s per capita gross national product (GNP) of R3,250 with Bangladesh’s Rs 1,550. According to his findings, life expectancy in Bangladesh is 66.9 years compared with India’s 64.4. The proportion of underweight children in Bangladesh (41.3%) is a little lower than India’s (43.5%), and its fertility rate (2.3) is also lower than India’s (2.7). The mean years of schooling amount to 4.8 years in Bangladesh compared with India’s 4.4 years. While India is ahead of Bangladesh in male literacy rate in the age-group of 15-24, the female rate in Bangladesh is higher than in India. India’s under-5 mortality rate is 66, while it’s 55 in Bangladesh. In infant mortality, Bangladesh has a similar advantage: for India it’s 50 and in Bangladesh, it’s 41. While in Bangladesh 94% of children are immunised with the DPT (diphtheria-pertussis-tetanus) vaccine, in India, only 66% are.

What is required is a set of public policies that will ensure that our people are healthy to build a vibrant India. Higher growth tends to expand governmental revenues at an even higher level. Sen estimates that when the GNP increases by 7% to 9%, public revenue tends to expand at rates between 9% to 12%. The moot point is: how are these increased revenues utilised? The Kolkata Declaration issued last weekend at the 9th Kolkata Group Workshop chaired by Sen called for “universal entitlement to publicly provided primary health care for all”. This requires India to earmark at least 3% of GDP (from the current 1.1% of the GDP) to healthcare.

The priority of the government, however, seems to be in providing greater concessions to the rich. In last year’s budget papers, there is a Statement of Revenue Foregone. This informs us that Rs 414,099 crores was the tax revenue foregone in 2008-09. In 2009-10, this stood at Rs 502,299 crore. This whopping amount was foregone by the government because it had doled out tax concessions to the tune of 79.54% of the revenue that should have been collected. Conceding, for a moment, tax concessions in excise and customs duties would have served as a stimulus to fight the impact of recession, the concessions given to corporate and high-end personal income tax payers amounted to R104,471 crore in 2008-09 and Rs 120,483 crore in 2009-10. Nearly Rs 2.25 lakh crore of legitimate revenue was forsaken.

Instead, if these resources were used for public investments, they would have built our much needed infrastructure while generating substantial employment and improving people’s livelihood. The consequent growth of domestic demand would have laid the foundations for better economic fundamentals for a sustainable growth trajectory.

Concessions to the rich are treated as ‘incentives’ necessary for growth and those for the poor are termed as ‘subsidies’ that are detrimental for growth. Unless this is reversed, Madam President, the laudable declaration of intent of building a healthy India cannot be achieved.

Instead, invoking the often paraded argument that governmental revenues alone are not sufficient, the president emphasises the government’s singular pre-occupation with public-private-partnership. More often than not, PPP is not attracting private money for public sector projects but promoting private profit making with public money. In the health sector, this is precisely what is happening with private healthcare and private health insurance being highly subsidised by the State. Nearly every country in the world that has achieved anything like universal health coverage has done it through the public provision of primary healthcare. Unless this is done, India will remain far behind in creating a healthy nation.

(Sitaram Yechury is CPI(M) Politburo member and Rajya Sabha MP.)

*The views expressed by the author are personal.