By Dr Arun Mitra
The year 2022 is going to be full of challenges for peace and health. On one side mankind has been grappling with COVID pandemic for the last two years and on the other increasing expenditure on arms race is draining away resources which are desperately needed to meet the challenge of the pandemic. Developing countries are the worst sufferers in such situation.
The COVID-19 pandemic has exposed the already existing shortcomings in the health care system. Diseases like tuberculosis, malaria, dengue, chikungunya, diarrhoea and non-communicable diseases like diabetes and hypertension got ignored during this period. Vaccination of children was affected as well. The situation has brought forward the fact that to meet the healthcare needs we require meticulous planning and funds.
After the first case was reported two years back, COVID-19 took the shape of pandemic and caused havoc around the globe. The medical fraternity was fast enough to meet the challenge to understand the pattern of disease, to find methods of its early diagnosis and treatment and also to spread the message of prevention of diseases through simple measures like maintaining six feet distance, washing and sanitizing hands and wearing masks. This saved millions of lives around the world. Vaccines too were developed in an emergency manner. Fighting like brave soldiers, more than 1,600 doctors lost their life in our country while taking care of the sick.
Majority of the population recognized and appreciated the role of medical fraternity during this difficult period. But as a result of ignorance and panic we witnessed bizarre behaviour by people at some places. A doctor couple in Delhi complained that people living in the society where they had their house avoided them because they were on COVID duty. Similar complaints were received from some nurses who were not allowed to enter their houses because people feared them to be potential carriers of the disease.
Violence against doctors is well known in normal conditions as well. Young doctors, who are always under stress of work and have not yet developed communication skills, become target of the mobs. Even though some states have made laws to check violence against medical personnel, there is no such law at the national level. National Human Rights Commission of India in its 17 point charter of rights of patients has specified the duties of the patients as well. The commission has categorically stated that the patient or caregivers should not resort to violence in any form and damage or destroy any property of the hospital or the service provider. A national level law against violation of doctors can be a strong deterrent to such situations.
Intolerant behaviour is not limited to India only. Nobel laureate Dr Dennis Mukwege, who has worked for decades with great courage and compassion to address the needs of survivors of sexual violence in Democratic Republic of Congo, was attacked seriously; fortunately he survived but his guard was killed. He, however, never gave up and continues to work. In many places affected with violence, the doctors have to face double crises. Professional ethics and morals teach them to take care of any individual who is sick. In the violent situations when some militant groups bring the patients to them they have to take care but then they have to face the wrath of the security forces.
Fallout of the violent conditions in the society can have serious repercussions on health. Children who watched their kith and kin being subjected to violence develop behavioural problems, depression, anxiety and post-traumatic stress disorder. Therefore, the prevention of violence is now accepted as a public health issue.
To meet the health needs of society as a whole, Health has to be declared as a fundamental right. A fundamental right is justiciable that means it is enforceable through law and in case of violation of this, individual can approach a court of law for protection. World Health Organization has categorically stated that “enjoyment of highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.
Good health is determined by other basic human rights like access to safe drinking water, sanitation, nutritious food, adequate housing, education, safe working conditions and sufficient remuneration. Therefore, poverty alleviation is essential for good health. Poverty leads to poor health, which in turn is a cause of poverty.
The International conference held at Almaty, Kazakhstan in 1978 came up with a declaration popularly known as the Alma Ata declaration. The conference strongly declared that “health which is a state of complete physical mental and social wellbeing and not merely the absence of disease or infirmity is a fundamental human right and the attainment of the highest possible level of health is the most important worldwide social goal whose realisation require the actions of many other social and economic sectors in addition to health sector”.
Constitution of India does not explicitly guarantee a fundamental right to health. But there are directive principles which give us some relief. India got its first national health policy in 1983 which emphasised on promotive, preventive, curative and rehabilitative services. It attempted a shift from vertical health programs to strengthening of primary health care network. In the next national health policy in 2002 there was a paradigm shift. It emphasised on secondary and tertiary health care services through private investment. In 2015 the national health policy draft mentioned to make health a fundamental right. However, the final draft was a complete change. The 2017 health policy made a shift to insurance-based healthcare causing diversion of public funds to the insurance companies. This is a cause of inequitable distribution of healthcare.
India has a doctor population ratio of one doctor for 1,445 people. The government doctor population is one doctor for 11,926 persons against the desired of one to 1,000. Therefore, 75% of the healthcare expenditure comes from the pockets of the household. Out of this 80% goes for the OPD care. This catastrophic healthcare expenditure is an important cause of impoverishment. Whereas the WHO mandates GDP expenditure on health at a minimum of 5%, it is only around 1.1% in our country. The budget on National Health Mission has been cut down by 10%; ICDS budget too has been decreased. The nutrition budget was reduced from Rs 3,700 crore to Rs 2,700 crores that is a reduction of Rs 1,000 crores in this year’s budget.
Insurance-based health care is unaffordable more so for the senior citizens who are faced with financial problems. Their income by that age gets reduced or they become dependent on children. This makes it impossible for them to pay high premiums of the insurance companies which increase with the age.
Therefore, it is important that health is declared as a fundamental right government has responsibility to provide healthcare to all. For this a strong people’s movement is needed. But this is unfortunately lacking. Health is never an issue in our elections.
South Asia is one of the most deprived regions. Our rank in Global Hunger Index is a cause for worry. India stands at a rank of 102 among 117 counties. Sri Lanka at 65, Nepal and Bangladesh 76 and Pakistan at 92nd position.
We need lasting peace so as to utilise our resources for health and education. Unfortunately perpetual tension between India and Pakistan has led to both the countries amass arms. Both are nuclear armed states. This poses a serious threat to the people of the region. The studies conducted by International Physicians for the Prevention (IPPNW) have highlighted that any nuclear exchange between the two countries using 100 atomic weapons would put two billion people at risk. Concerned physicians in the region have been demanding complete abolition of nuclear weapons and declare South Asia as nuclear weapons free region.
It is imperative that people’s movements for peace and health in South Asia are strengthened. We have lot to learn from each other, which is possible only through mutual dialogue and trust building. It is important to move in that direction in the coming new year. (IPA Service)