The best election news is that we Indians are
normal people; there is nothing quaint or exotic
about us. The results show that we are neither
caste driven, nor village obsessed, nor even
burdened by regional patriotism. Nobody held our
feet to the fire for this to happen; it just did,
because we are normal people.
Our body political may have returned to normal,
but our body physical is far from it. This might
take a long, long time to happen because health is,
once again, not a priority area. It does not figure in
the list of 'super ministries' that the new regime
has identified for lightning service. Predictable
heavies, such as defence and home are there,
even featherweights like civil aviation and food
processing get a nod; but no mention of health.
The bell rang next door and the next, but not here.
Why this neglect? Roughly, 30% of Indian villagers
are so poor that they do not even seek medical
treatment. If you think you are lucky because you
live in a city, think again. As many as 47%
urbanites are forced into debt every time they
check into a hospital. Look at the irony of it all.
When we voted, we vaulted over the town and
country divide. But jump as high as we might,
factoids such as these cling to our bodies and
bring us down.
No political leader in India has ever stood on the
stump and argued forcefully for universal
healthcare. It is always somewhere in the
manifesto, either on page 20 or 21, along with
other wash-and-wear views, but it sits there
unnoticed. There is competition between parties on
economic delivery, on land acquisitions, on
teaching Pakistan a lesson, but never a heated
word on health. Surely, our politicians must know
that we are alive and unwell.
The number of malnourished and stunted children
in India is greater than the population of Sub-
Saharan Africa. Yet, our state expenditure on
health, as proportion of GDP, is among the lowest
in the world. It is not just below the European
average of 8%, but behind Afghanistan and Iraq as
well. Medical bills sink about 37 million people
below the poverty line every year; still no action.
The way our health system works is as if the rich
and the poor have different body parts made by
different manufacturers. Consequently, our health
providers are never the same, even for identical
ailments. But our bodies are all alike; it is not as if
one is a car and the other a bicycle. Look it up,
this is what our school books say; even God
confirms this in every holy text. Yet none of this
comes through when we legislate on health.
For example, UPA's health insurance plan, the
Rashtriya Swasthya Bima Yojana (RSBY), is not
just less than smart, it is actually quite cynical. For
starters it assumes that the medical needs of the
poor and the better off are vastly dissimilar. Only
this can explain why RSBY has put a cap of Rs
30,000 on medical expenses for a family of five.
The obvious assumption is that the poor only get
cheap diseases. What if cancer strikes, or
something remotely cardiac?
Also, RSBY is aimed only at below poverty line
families; stray even slightly upwards, very slightly,
and you fall out of the frame. This excludes large
numbers of impoverished people as they narrowly
miss being qualified as poor. There are other
issues too, but the most basic flaw with all state
run health programmes is that they view health
from the perspective of wealth.
What is more surprising is that even if
governments fail to deliver on this, why don't we,
as voters, put up our collars and take on our
leaders? Why must we wait till something awful
strikes us? When that happens, even the street
dog outside looks better off. We sell our homes,
sink our life savings, even hock our mother's
pearls; but by then it is usually too late.
In this the voters and the voted are equally
culpable. Elections do not always sift the most
pressing issues up. History has shown that
wherever universal health has truly established
itself, and has treated rich and poor alike, it has
been a leadership effort. Whether it was Julius
Tandler in Austria, Aneurin Bevan in Britain,
Tommy Douglas in Canada, it needed people at the
top to make the difference.
There is another important lesson that we could
learn from history. When Sweden, Austria, Britain,
and even Basque Spain, started their universal
health policies they were at their poorest. Sweden,
for example, could not feed over a million people in
1933, the year it inaugurated folkhemmet, its most
ambitious social welfare programme. That these
countries got very rich soon after only shows that
the mantra 'Health is wealth' works in all
languages. If our freshly minted government is
serious about taking us out of poverty, and making
us world-class wealthy, health should top its chart
of 'super ministries'.
Unless, of course, our new leaders, like the old
ones, continue to believe that 'Wealth is health'! In
which case, asking them to listen is like talking to
a radio.