The health system needs to be reconfigured to deliver services with efficiency, empathy and equity.
The health system needs to be reconfigured to deliver services with efficiency, empathy and equity.

HTLS 2020: Resetting the coordinates for the journey to the future

Covid-19 has taught us that even strong health systems cannot cope with the adverse consequences of distorted development that continues to create disease.
By K Srinath Reddy | Hindustan Times, New Delhi
UPDATED ON DEC 01, 2020 03:23 AM IST

Nobel laureate Toni Morrison wrote “if we do not create the future, the present extends itself”. This exhortation, to conceive and construct a better future through our efforts to mend the present, is only partly true. The future can actually be worse than the present, if we passively permit the present ills to pile up to create higher hurdles in the future.

On the other hand, an active and assertive response, collectively delivered by a chastened humanity, can ensure a healthier and happier future for all people. It is the blueprint of that cosmos that we need to craft from the chaos that Covid-19 has thrown us into. It has to extend across many domains of human activity, with commitment to course corrections that go beyond fleeting adjustments to tide over a temporary turbulence.

That effort has to begin by refocusing on health as the prime priority of societal development. It is not difficult to do so, if one recognises that health is the distillate of many domains of human activity and is the best summative indicator of sustainable and equitable development. We must begin by recognising that health extends beyond the mere recognition and redressal of illness. Health and illness are shaped by the interactions of many biological, social, economic, environmental and commercial determinants. These impact populations and individuals in varied combinations at different points in time in the development of a society and the life course of an individual.

Covid-19 has taught us that even strong health systems cannot cope with the adverse consequences of distorted development that continues to create disease. Weak health systems flounder when called upon to swiftly create a surge capacity to counter a public health emergency. Failure to protect the health of populations can derail economic development and create social instability, just as poverty and ill health can precipitate or perpetuate each other in individuals.

Many of the determinants of health are common to many other developmental distortions and are interlinked in their influence. This makes it easier to modify them through common measures that can alter many of them, to create a positive synergy to promote health, protect the environment, eliminate poverty, prevent conflict and propel humanity to a better future. Dealing with them in isolation or piecemeal will not assure us of civilisational advancement or secure survival of our species.

Let us commence by correcting the corroded connections between deforestation, agriculture, climate change and human health. Zoonotic diseases often start from microbes that habitually reside in wild animals but enter captive bred veterinary populations or human habitat, through conveyor belts created by human folly. Deforestation opens the ecological escape door for the microbes to spillover from their primary hosts and find new animal and human hosts. Animal breeding for human consumption, from poultry to livestock, gifts the microbes a large population to infect and a gateway into human bodies while a fetish for exotic foods from the wild gives them a pass for direct travel from wildlife to humans. Deforestation for agriculture, urban growth and extractive industries, also accelerates global warming. Our agriculture and food systems are degrading the environment, which in turn degrades the quantity and quality of food production. This mutually detrimental relationship must change.

Commercial forces, which drive agriculture and food systems, are not attuned to the nutrition and health needs of the growing global population. Instead, they mass produce and aggressively market ultra-processed foods, sugar sweetened beverages or breast milk substitutes which create many forms of malnutrition and disordered health. Growing water stress, due to global warming and groundwater depletion, challenges agriculture and creates a potable water crisis. Fossil fuels continue to be promoted by unbridled commercial entities, accelerating global warming. Tobacco and alcohol are advertised addictions causing marketed maladies resulting in death or disability of many millions. They also harm the environment in many ways, apart from causing poverty. Armed conflict, civil wars, racism and forced migration are often engineered or fuelled by narrow economic interests which degrade human civilisation, damage social justice and destabilise progress.

The health system too needs to be reconfigured to deliver services with efficiency, empathy and equity. Health promotion, disease prevention, early detection, effective treatment, restorative rehabilitation and supportive palliative care must provide a comprehensive set of services under a system of universal health coverage. This calls for higher public financing for health, especially primary care. Innovative and affordable technologies must supplement and not substitute a skilled health workforce.

In a world that is closely interconnected by trade and travel and interdependent due to shared vulnerabilities, whether of economy or health, we must promote shared values that foster global solidarity. As a popular ride in Disneyland is titled, “It’s a small world, after all”. It is worth remembering that Walt Disney created it originally for the New York World Fair, in support of UNICEF. We owe it to all children, now and in the future, to build a better world and a more secure future.

No vaccine can save us from climate change. According to the Stockholm Resilience Centre, we have already crossed five planetary boundaries and are at the limits of three others. We must emerge wiser from the pandemic, resolute in our commitment to reset the coordinates of our development. “Build back better” is the slogan of the times, born from the self-realisation that the pandemic has brought us. That resolve must endure and not be ephemeral. As the slogan of All Blacks, New Zealand’s world renowned rugby team says, “Better never enough. Better every day.”

Professor K Srinath Reddy, a cardiologist and epidemiologist, is President, Public Health Foundation of India (PHFI). He is the author of ‘Make Health in India: Reaching a Billion Plus’. The views expressed
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