Budgets may come and go, but the nation's health is not getting any better. Not that health issues should be allowed to burden the Finance Minister's mathematically-challenged mind, but it is time someone in North Block started seeing health as an infrastructure sector, an enriching influence on the economy, for thoughtless increases in budgetary allocations don't really help. Yes, poverty is bad for people's health, so it needs to be addressed first, but it is equally true that poor health is as much an impediment to economic growth as, say, an increase in the price of urea, or the state of the nation's roads. Why, then, hasn't any Finance Minister announced any major healthcare initiative in the last ten years? Or spared a thought for the challenge of raising resources for the 80,000 hospital beds that must be added annually if India is to reach anywhere near even the standards of Brazil? Why, even the Rakesh Mohan Committee on Infrastructure, in its very original report, has ignored healthcare altogether.And officially we are not even in the race for the World Health Organisation's target of Health For All by the dawn of the new millennium. It is time to talk about the economics of good health. So let's go back to WHO's 1996 report titled Investing in Health Research and Development.* Better health, argues WHO, reduces production losses resulting from the ill-health of workers. The world, for instance, is poorer by $8.7 billion each year due to stunting alone. And stunting is related to poor nutrition. Now let's take an example closer home. In Tamil Nadu, it is estimated, if all the people living with leprosy are rid of their deformities, their annual earnings would increase more than threefold. The National Leprosy Control Programme, which is 100 per cent centrally funded, will, therefore, have to get more aggressive about rehabilitation, now that the burden of new cases each year has come down to 5.4 lakh from 40 lakh in 1981.* Better health also frees up resources previously spent on treatingillness. For each case of AIDS prevented, says the World Bank, a nation saves between two and five times its per capita GNP that would otherwise have gone into treating the patient. The savings made may even add up to a sum that could offset the necessity of slashing the subsidy on urea at a time when cash-crop farmers are committing suicide. Or take the case of vitamin and mineral deficiencies, which were estimated by the Unicef to cost India and Bangladesh the equivalent of $18 billion in lost lives and productivity in 1995. That's enough money to finance 80,000 super-speciality beds (that too, if we take the Indian Healthcare Federation's figure of Rs 20 lakh per bed) for the next four years and a half!* Better health increases national wealth by making available natural resources (like cultivable land) that had previously become inaccessible because of disease. Land laid waste by the presence of, say, disease-bearing female Anopheles mosquitoes amounts to an incalculable, though invisible, loss ofnational wealth. It hurts especially in a country where three-fifths of farm holdings are less than one hectare not enough land, as the United Nations Population Fund points out in its recent India report, to provide even a bare subsistence for an average agricultural family.So where does the Finance Minister come into the picture? If you turn to the Notes on Demands for Grants of the Ministry of Health and Family Welfare in Volume Two of the 1998-99 Expenditure Budget, there's a revealing sentence. It deals with the Kasturba Health Society, Sewagram, and says: ``It is the first and only medical college.to be located in rural surroundings and exposes students to the health problems of the rural areas.'' We have 146 medical colleges, incidentally, and just one caters to the needs of 74 per cent of our population. And that's just a part of the story. Seventy per cent of government hospitals and 60 per cent of private hospitals are located in urban centres, when it should be the other way round.Thenation's bean counters have to get their priorities right. They should begin with putting a five-year cap on setting up new government hospitals or medical colleges in big cities and towns. At the same time, New Delhi should take the lead by establishing more Sewagram-like institutions to correct the glaring rural-urban imbalances. The Finance Ministry must also get working on a package of incentives for corporate hospitals in rural areas, on the lines of the benefits extended to industries set up in backward districts there is, after all, a rural elite that keeps rushing to private-sector hospitals in the big cities. And by taking healthcare to the doorsteps of rural India, North Block will actually be doing a favour to urban India, by reducing the pressure on metropolitan hospitals from their rural hinterland.Our policy-makers will also have to take some hard decisions. Like allowing access only to certain disadvantaged socio-economic categories to premier institutions such as the All-India Institute ofMedical Sciences, New Delhi. Why should the government, after all, continue to subsidise the treatment of people who can very well afford private-sector healthcare? These invariably are the people who have the clout to get a minister or an MP to push their case for a private ward at AIIMS. It is time for them to look elsewhere for treatment, and the Finance Ministry can make their search less complicated by giving a push to healthcare investment in the private sector. It can make a beginning by allowing foreign direct investments in the health sector.That may not be swadeshi, but denying millions their access to healthcare isn't a good idea either.
