As about 900 million voters prepare to elect their next government, the agenda for the Indian elections is supposedly decided. But there is an eerie silence on part of the political class and the general public around issues of health. In most elections in Western countries, the healthcare policies of a political party are an important agenda. During the May 2015 general elections in the UK, the prestigious medical journal, Lancet, called the UK’s National Health Services (NHS) a “political hot potato” for parties in that country. Unfortunately, in India, despite a dismal healthcare setup, health still does not figure in the imagination of the rulers or the ruled.
Six days after the terrorist attack in Pulwama, the World Health Organisation (WHO) released its report on the global health expenditure, that not only reveals ground realities on health economics but also helps governments to prioritise future health expenditure. The report revealed that the global spending on health increased in low and middle-income countries by 6 per cent and in high-income countries by 4 per cent. It showed that both India and Pakistan have populations which are one of the highest in the world when it comes to spending out of pocket on health. However, its stark findings got lost in the din of a near-war between the two countries.
The current infant mortality rate (IMR) in India stands at 44 per 1,000 live births and the country stood 12th on a UNICEF list of 52 low-middle income countries with the highest IMR in the world (2016). India’s neonatal mortality rate (NMR), at 25.4 per 1,000 live births, was higher than that of Sri Lanka, Bhutan, Nepal and Bangladesh. Only Pakistan and Afghanistan fared worse than us in the subcontinent.
Considered to be a sensitive indicator of the quality of healthcare delivery, the maternal mortality rate (MMR) for India is 130 per 1,00,000 live births. The average global MMR hovers around 216 per 1,00,000 live births. What is startling is the fact that the so-called electorally most sensitive state of the country, Uttar Pradesh, has an MMR of 201 per 1,00,000 live births. UP also happens to be the electoral state of the PM.
It is interesting to note that the word “health” or “healthcare” appeared 83 times in the election manifesto of the BJP and 42 times in the manifesto of the Congress party during the run-up to the 2014 elections. Despite this, health did not become an election agenda. Even today, the Opposition does not want to make the Gorakhpur hospital childrens’ deaths (from 2017) a pivotal point for their campaigns.
It is important to analyse why something as important as the health of a nation remains undiscussed during elections here. Illiteracy, lack of awareness, diversionary communal-caste discussions by the political class, lack of political will, and, poor electoral ethics are some of the reasons which come to mind. It would, perhaps, be preposterous to believe that the people would seek health from their rulers when basic survival issues like hunger, unemployment and education go unaccounted. Even as the country with the highest number of malnourished children in the world, our expectation for good healthcare seems like a pipedream.
In view of the WHO report, however, the least we can expect from our political class is a general consensus on increasing public health funding. At present, we spend just around 1 per cent of the GDP on health. This is less than what even countries like Ethiopia and Bhutan spend on the health of their people. Most experts believe that we should be spending, at least, 3 per cent of the GDP on health. For achieving universal health coverage, it is imperative that domestic spending on health be increased. It is known that a health system with high government funding provides accessible and more affordable healthcare to its people, also ensuring financial protection of its citizens.
The Swiss medical historian, H E Sigerist once said that “the problem of public health is ultimately political”. As a mature democracy, there is an urgent need to make state-sponsored healthcare a crucial component of political campaigns during elections. As citizens of the largest democracy of the world, it is our duty to accept an electoral agenda that is as per our needs, not as per the wishes of politicians for whom hubris, rhetoric and hollow promises are routine.
This article first appeared in the print edition on March 26, 2019, under the title ‘Missing in the polls’. The writer is professor, department of orthopaedics, AIIMS, New Delhi.