Monday, December 31, 2012

Society and Public Health

Dhiyanesh Ravichandran

Society has an ethical obligation to ensure equitable access to quality  health services by making that care a basic social right.

Is health care a right or a privilege? This has become an enduring debate among the scholars and policy makers ever since the time when state became the sole allocator of resources on behalf of society. The capitalistic business approach has crept into field of healthcare since since industrial revolution in western nations and very recently in India too. Privatization of healthcare in India led to the rule of big corporations playing a major share of health services for huge profits, sometimes by inappropriate and unethical means as well. The stake on government on health services is too low as does its budget allocation every year. Neither the services are up to the average standards. Healthcare companies see no profits in investing in rural health infrastructure, combined with inadequate public healthcare network led to the total neglect of rural areas.

Is one's health status an outcome of his behaviour and lifestyle? Does he have absolute control in determining his well-being? Even though people have the ability to influence their health status by their individual decisions on or choice of lifestyle. But many health problems are beyond their control. They can also be affected by genetics, living of work environments, or even by chance. Even though there are several preventive measures for many such ailments, the awareness among them is definitely less and it is impossible for each and every one to know about all such health issues.

A society's commitment to healthcare reflects some of its most basic values about what it is to be a member of the human community. Society, therefore, has an ethical obligation to ensure equitable access to quality  health services by making that care a basic social right. The present day governments are the appropriate agencies to facilitate such a valued obligation, by ensuring that the health services are universal, less privatized, free of cost to all of its citizens, and are easily accessible. The National health insurance coverage in several countries is an example to universal healthcare.

In India, the status of public health is less comforting. More that three fourth of the health infrastructure is concentrated in urban areas where only 27% of total population lives. There are no private takers for the rural healthcare primarily due to profit factors, which led to the total neglect of rural India. Rural areas depend fully on government health infrastructure, which proves to be ineffective. The public health expenditure of India in 1990 was 1.3% of the GDP and dropped to 0.9% of GDP in 2009. The increase in GDP growth in this time period has not increased the health care expenditure, considering the increase in population. The Union budgetary allocation is just 1.3% and that is state budget is just 5.5% on an average.

Health Insurance is a nonentity in Indian scenario. Only 10% of our citizens have some form of health insurance, inadequate to meet their healthcare bills in most of the cases. Hospitalised Indians on an average spend about 58% of their total annual expenditure for healthcare. About 25% of them fall below poverty line because of their hospital expenses. 

Health economists say that healthy labour force increases participation ratio in the economic activities. When individuals are viewed as a stock of human capital, health status impacts the values of stock. In a family, medical expenses of adult members deplete the savings and investments meant for the nutritional and educational needs of children. Reduced earning potential of individuals ultimately affects national income. In this perspective, health economists assert individuals as assets and resources for economic excellence and healthcare as a means to extract maximum productivity. Healthcare should be considered as a basic social right irrespective of his economic productivity and what humanity wants is a more sustainable approach towards healthcare, which is universal and accessible to all.

Lack of community ownership of public health programmes has impacted so adversely in India. Various health indicators in India show unfavorable trends in health status even though the country shows positive economic growth in recent decades. A comprehensive healthcare policy is necessary, which involves increased participation of the state in infrastructural development and service delivery. In a globalised era, curbing private players would prove fatal. They need to be utilised by the state in right and just manner through public private partnerships or joint ventures. Implementation requires community patronage.