22/06/2015 8:34 AM IST | Updated 15/07/2016 8:25 AM IST

British Raj and VVIP Raj: A Public Health Insight

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An Indian tuberculosis patient looks on as he rests at the Rajan Babu Tuberculosis Hospital in New Delhi on March 24, 2014. India must stop its doctors prescribing 'irrational' treatments to cure tuberculosis, medical humanitarian group Medecins Sans Frontieres said March 22, warning the practice is increasing drug-resistant strains of the disease. AFP PHOTO/Chandan KHANNA (Photo credit should read Chandan Khanna/AFP/Getty Images)

One of the most popular debates among South Asians is whether the 200-year long British Raj was a blessing or a curse for pre-partition India. An attempt to answer that was, commendably, made by Britain itself through a high-profile debate in London last year. Perhaps surprisingly for Londoners, it was won by those who said India would have been better-off without the British (as mentioned in the book Freedom At Midnight, when the English East India Company landed on Indian soil in 1600, Queen Elizabeth was like a 'ruler of a provincial hamlet' compared to her Indian counterpart Emperor Jehangir). But then, it's very hard to predict how history would have unfolded in the chaotic subcontinent had avarice and betrayal not triumphed in that bitter Bengali summer of 1757. While British colonialism was clearly not carried out with the agenda of 'welfare for the colonised', the current state of affairs in India (and even in Pakistan and Bangladesh) makes one wonder whether, as was often said during the 2011 anti-corruption movement, 1947 marked only a banal replacement of one set of repulsive administrators with another; and whether the behaviour specifically attributed to the 'cunning British' is just a characteristic of the general human race itself, later manifesting itself in Indian politicians.

To help analyse that, the stellar discipline of public health provides some interesting comparisons between the official policies in colonial and independent India. For example, some Indian experts argue that the colonial health policy in India catered mostly to the needs of British individuals living in urban areas and that 'rural regions harboring the bulk of the Indian population were neglected'. While that is largely true, the more unfortunate situation is that even now, after Indians themselves have been governing India for nearly 70 years, the political mindset has hardly changed: rural India still suffers terribly from policy neglect. Public health infrastructure in India's more than 630,000 villages is largely derelict and just 43.5% of villages have at least one doctor. Besides, while we blame the British for providing only their 'own' people the most sophisticated care in colonial India, we tend to forget that our current politicians, for their care, tend to choose (using taxpayers' money) either foreign hospitals or India's luxurious private hospitals, while leaving millions of ailing common citizens to contend with mediocre to poor care in govt hospitals with embarrassing 'floor beds'.

"Unbelievably, the colonial and the post-independence administrations share the same attitude of enormous neglect of public hospitals and their employees, ultimately making the common Indian suffer."

We hated the British rulers for their haughtiness and sense of entitlement, so well-portrayed in the films Lagaan and The Rising. But we also know how the same arrogance has continued in independent India through what we now term the 'VIP culture'. For example, as a medical officer I was sometimes posted for duty in politicians' convoys. That 'duty', for most health personnel, is a humiliating experience: you have to be there early morning to 'receive' the concerned VIP who may arrive hours late, follow their SUVs in your ramshackle ambulance wherever they go, stay hungry till they feel like eating, and sometimes sleep in the ambulance itself at night. In another instance of deadly VIP culture, a kidney patient allegedly died in Delhi some years back when several roads were blocked for the passage of the Prime Minister's convoy, delaying his arrival to his hospital.

india hospital

One more criticism of the colonial government is that it used to earmark only a tiny budget for public health in India despite simultaneously draining phenomenal quantities of Indian wealth to Britain. After Independence, India's leaders have unfortunately continued the same policy (despite simultaneously draining phenomenal quantities of Indian wealth to Switzerland). According to the book An Uncertain Glory: India and its Contradictions, the Indian govt devotes just $39 (PPP) per person per year for health, while the corresponding figures for Sri Lanka, China and Brazil are 66, 203 and 483.

In 1943, finally realizing that healthcare in India needed serious attention, the British Indian govt constituted a committee to look into the state of affairs and provide recommendations (the famous Bhore Commission). Below is an extract from their report, where the 'current state of healthcare' is described:

"...time devoted to patients was so short as to make it perfectly obvious that no adequate medical service was given... in one dispensary the average number of cases seen in an hour was 75. The time given to each patient averaged 48 seconds..."

In 2010 I was employed in a busy government-run hospital in Maharashtra, and when I read the above lines some months back, 1943 and 2010 suddenly became one and the same number for me. Unbelievably, the colonial and the post-independence administrations share the same attitude of enormous neglect of public hospitals and their employees, ultimately making the common Indian suffer.

Why does a nation fight for freedom? The most important reason perhaps is dignity. For a long time British colonizers maintained that they were uniquely fitted to rule the 'lesser breeds'. No self-respecting population will accept such hegemony, even if they knew it would be a hard struggle to manage things by themselves. MK Gandhi once famously told the British to leave India to God or to anarchy. But Indians had other reasons too for aspiring political freedom: they were fed up of the high-handedness and corruption prevalent in the colonial leadership and desired an empathetic, supportive government of their 'own people'. In this matter, it looks as if successive Indian politicians have (surprisingly) listened to the Mahatma: they have for the most part left India to God and chaos. The Indian nation has come a long way from the miserable times of 1947, but that is decidedly more because of the resilience and resourcefulness of common citizens than because of wise political leadership. It is now high time our political leadership jettisoned the colonial mindset once and for all. Only then will the soul of our nation, long suppressed, finally find utterance.

[This article was also featured in 'India Medical Times'.]

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