The Public health crisis in India . . .

During the 2011 budget, when the IndianGDP is estimated to increase by 37% from 2009-10 to 2011-12 the allocation for the health ministry for the various public health oriented national disease control and prevention programmes has gone down by 14%.The Indian ruling class regardless of the political parties they represent are only concerned in their vested interests which could retain them in power. The vast majority national and regional political parties have always achieved unity in their diversities in ignoring the interests of the people who elected them and further exploiting them to be in power and enjoy the privileges of power.

The very notion of Universal healthcare in India is a cruel laugh at the vast majority of its people, where the so called free and universal health infrastructure provided by the government is underfunded, understaffed, undersupplied with medicines and surgical equipments. The hospital beds to patient ratio, doctors to patient ratio, hospitals to patient ratio and the government funding to the extent of our population are all far less from the minimum standards set up by the international regulating bodies.The inadequacy of our government health care system is appalling and forcing even those who cannot afford to pay for their healthcare at the doors of the private health care providers. The average spending by ordinary people for procuring medical care in hospitals is already a large percentage of their earnings when compared toseveral other parts of the world and continuously increasing and is worse in rural areas. The irony of the more poverty stricken and impoverished people in the remote villages and rural areas to pay more for their healthcare as there is a general lack of government healthcare provisioning system and the private healthcare provides are obviously located in well affluent urban areas is a classic example of inverse care law, characterised by health inequalities which is a direct outcome of socio economic inequalities.

Public health care plays a very important role especially in the circumstances of prevailing health inequalities and this drastically inadequate health care provisioning system. Although public health care which is about prevention and control of disease, increasing quantity and quality of life and promoting health is definitely not a replacement for provisioning health care in the following levels:

-           Primary level by the general medical doctor and general dentist and other health care professionals, who not only act as a first point of consultation for all patients within the existing health care systems, like the primary health care centres and private medical clinics etc., but also provide routine check-up, diagnosis and also provide early consultation thus contributing to the prevention of disease or disease progression.

-          Secondary level of healthcare provided by the medical specialists like cardiologists, dermatologists etc., who do not have first contact with the patients. The secondary care also involves acute care and emergency care.

-          Tertiary care is again specialised health care dealing with long time inpatient treatment of chronic diseases like cancer. It also involves rehabilitation and restoration of the functions hampered by the disease progression.

Nevertheless Public health plays an important part in enhancing the quantity and quality of life by emphasising prevention and promoting health. During the First International Conference on Health Promotion, organized by the World Health Organization (WHO) and held in Ottawa, Canada, in November 1986,Ottawa Charter for Health Promotion was signed as an international agreement which apart from setting up sweeping goals to achieve “Health For All”. Itis about the World Health Organization's foremost health care approach to promote health and enhance the quality of human life. Ottawa Charter clearly identifies important areas for health promotion which are:

• -          Building healthy public policy
• -          Create supportive environments
• -          Strengthening community action
• -          Developing personal skills
• -          Re-orientating health care services toward prevention of illness and promotion of health.

To frame a healthy public policy, to create supportive environments like public parks, fitness and sports centres etc., to engage in communities to identify their health priorities subsequently enable and empower them to fulfil their health needs, to educate individuals to fulfil their health requirements and finally diverting more resources into prevention and disease control, all of these needs heavy investments. A radical budget allocation into public health care is vital. The recent budget allocations for healthcare particularly public healthcare, which is a meagre 1.4% of India’s GDP, itself, prove that the government have no serious intentions to reverse the present health care system of India. The low budgetary spending in public health care would also ensure the continuation of substandard delivery along with increasing inadequacy to meet the healthcare demands of a growing population. At the same time it also enables the exploitative private health sector to establish itself.  The health care services in the second largest populated country are already in the radar of global business corporations as an industry worth 40 billion US dollars and projected to grow exponentially.

Apart from Kerala, majority of the regional governments have so far consistently smeared the already abused pages of the Indian constitution which declares that "raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties". The insensitivity of the government policies regarding public health care is not only due to the lack of political will but it is how a vast majority of ruling governments operate throughout the world until they face a mass resistance from ordinary working people and youth. This could possibly be demonstrated in the states of India itself. Organised working people and educated, socially aware young people and also their political consciousness are all reasons for the high human development index and life expectancy seen in Kerala.

It is important to identify and consider the fact that the past and present governments have been consistently considering social spending as an unnecessary burden but vital tool for electoral politics. We expect a radical approach from the government towards public health care.  We need an independent and democratic fact finding commission to precisely estimate the amount of funding required fulfilling the health care demand of our people and the government should at once initiate the allocation of funding according to the health care needs of the people. Sadly the mainstream political parties and the big businesses have different plans. Hence the need is a political, socio economic alternative and a true working class alternative.