Sar salamat toh pagdi hazaar is a popular Hindi saying. Translated crudely it means: First get the basics right, embellishments can wait. Several central and state government policies in India (both current and past) appear wanting in this ancient wisdom. The present government looks eager to adorn India with several colorful pagdis at the quickest, but no serious commitment to look after the sar is discernible, evident for instance from its (lack of) tackling of India's dysfunctional public health system. The health budget was slashed last year; in a weird reshuffle an ENT surgeon initially made the Minister of Health (MOH) was 'demoted'; and the deadly tobacco industry was implicitly given protection. Public health of course has never been a significant part of the political and social psyche of India: perhaps a huge, massively diverse post-colonial nation needed time to decide its priorities after Independence. But now, in the middle of 2015, one can't help but think - Wasn't 67 years enough?
"In a strange tale plausible only in 'incredible' India, parents dream of their children learning medicine in big government hospitals, but would never want to take their child to those same hospitals if they were sick."
Indian citizens are somewhat aware that their country's health system is in tatters; for example Bollywood, that great mirror of Indian society, uses the term 'sarkari hospital ki tuti hui bench' (You broken bench of a government hospital) as a legitimate insult (Welcome, 2007). An Indian is mortally afraid of three types of edifices: police station, court of law, and public hospital. In a strange tale plausible only in 'incredible' India, parents dream of their children learning medicine in big government hospitals, but would never want to take their child to those same hospitals if they were sick. As citizens we are so used to second- and third-rate government hospitals that we just cannot imagine them being efficient and sophisticated, although that indeed is entirely possible.
By default, most governments are passive about social issues; it is the job of active citizens to shake ministers out of their torpor. But we seldom display serious and sincere outpourings of outrage against how our health system is in shambles, not even when terrible adverse incidents occur. Another big issue is what can be called the 'Dr Sitting Duck' response. There sadly exists a popular perception that the cause of most problems in government hospitals is 'evil' doctors, and the disproportionate emphasis on this aspect has resulted in the focus of blame invariably shifting away from corrupt, inefficient government and bureaucracy.
We have an MP who advises women to give birth to at least four children(!), but not one urging women to register for antenatal care in hospitals. The Indian government spends only around $20 per person per year on health. China, a country whose health status was not very different from India's until some decades back, spends ten times that (World Bank data). The UNICEF reported that malnutrition is more common in India than in sub-Saharan Africa. Indians feel proud of having the largest number of 'young individuals' in the world, but how exactly is this young population going to drive the country's growth when a third of them were undernourished as children and millions suffer from chronic conditions like tuberculosis? The government may have announced a 'Make in India' initiative with great fanfare, but as the saying in the first paragraph tells us, they should probably have made something like 'Treat in India' happen first, or at least simultaneously. After all, there is overwhelming evidence that investing in health works wonders for a nation's economic progress, or 'development', as the current governmental buzzword goes.
"One of the most effective therapies for our dysfunctional public health system is bringing it more in the public discourse, a job that can be best done by the media."
It is now high time our media stepped in and helped ameliorate this depressing scenario. In the book An Uncertain Glory: India and its Contradictions (co-written by Amartya Sen) the authors say 'the coverage of health issues in editorial discussions (of India's popular English-language dailies in 2012) remains minuscule, about 1% of the total editorial space'. One of the most effective therapies for our dysfunctional public health system is bringing it more in the public discourse, a job that can be best done by the media. Contrary to popular perception, health issues aren't just dilapidated hospitals and corrupt doctors. There is an entire macrocosm of public health which has hardly been explored and analyzed in detail by India's mainstream media: universal healthcare, benefits and drawbacks of private insurance, drug pricing and patenting, quality of medical education, critical evaluations of government's health programmes, political pressures on government doctors, health systems in other countries and how they compare with India, dire need for government investment in health, etc. Increased media focus on such and related topics to inform the public is exceedingly essential: citizen awareness, after all, is the first essential step towards long-term political change.
India is a resilient nation, having achieved in the past 67 years what perhaps no other predominantly poor nation could do. It raised the life expectancy of its citizens from 32 years at Independence to 65 years in 2012, and despite grim international predictions it succeeded in eliminating polio. The Indian media has also seen great success in advocacy of issues like women's rights and anti-corruption. It is now time to combine the powers of media on one hand and health activists/workers on the other. Lasting development of any society lies in its regarding health and education more important than any other political subject. No doubt media has the power to propel India to a state where politicians passionately speak about and citizens collectively protest over issues like patchy drug supplies in government hospitals or policymaking in favour of indigenous medical research; it's just the will that is missing for now.
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