Yet again, the Lancet has cut deep. For the second time this year, the premier medical publication has sniffed at the Indian government for being inattentive to public health. In September, it had published data suggesting that India would miss the target of less than 42 child deaths in the under-five category per 1,000 live births by the end of 2015.
Now, it has pulled up the Narendra Modi government for defaulting on its election promise of universal health coverage. The public health debate tends to concern the containment of communicable and non-communicable diseases, but the journal has moved the focus to the costs associated with managing them. And since the study was piloted by seasoned Indian researchers led by Vikram Patel and K. Srinath Reddy, its findings cannot be easily dismissed.
The Lancet paper, “Assuring Health Coverage for All in India”, ranks India lowest among the BRICS countries for its failure to contain out-of- pocket expenses for healthcare, which further impoverish the poor while denying them value. Indeed, India bears a disproportionate share of the global burden of disease, and this has not been falling as expected in recent years. On the other hand, the budgetary allocation for health has fallen by 0.5 per cent of the GDP over the last decade, roughly speaking. Given the inflationary surges seen after the meltdown of 2008, the real decline in allocation may be even steeper than the numbers suggest. The obvious remedies are to increase public spending while regulating private enterprise in order to deny it windfall gains at the expense of the common good. In addition, primary care must be given primal importance and some imagination is needed to close the gap between demand and supply of medical staff where it is needed most, in rural areas.
In the literature, public health is one of the components of the idea of “common security”, which developed the concept of security beyond the traditional ambit of military and geopolitical concerns. However, the problem is as easily stated in terms of the more readily accessible idea of national security: A nation with a population featuring high morbidity and mortality due to preventable factors is at risk. Neither can it actualise its full potential, nor can it compete effectively with its peers in the global marketplace. Surprisingly, for decades, this simple truth has not been adequately reflected in policy.
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