Building a fairer, healthier world

World over, health inequalities stand out stark and there is realization that, even today, the world is indeed unfair.

April 7 is observed as the World Health Day and marks the founding of the WHO. Conceived at the First World Health Assembly in 1948, the day is celebrated as an opportunity to create awareness and stir action on a theme relevant to global health, by enabling governments to formulate priorities and organizations to create long-term programs, campaigns and advocacy plans.

The theme announced by the WHO this year is – Building a fairer, healthier world.

World over, health inequalities stand out stark and there is realization that, even today, the world is indeed unfair. Poverty, lack of education, poor and unsanitary living conditions, lack of safe drinking water, hunger and malnutrition, inaccessibility to even basic health services is the sad reality for a large portion of the world.

The world has witnessed unprecedented economic growth, but when analyzed from the perspective of an individual’s quality of life and also as a significant determinant of social and economic development, it is abundantly clear that there needs to be more investment in health - at individual, national and global level - to address these inequalities.

Yet, the WHO estimates that half of the world’s population does not have access to healthcare they need, over 930 million spend at least 10% of their household income on healthcare, and annually a 100 million are driven into poverty due to out of pocket expenditure on healthcare. Therefore, measures towards poverty alleviation and economic growth risk failure when healthcare needs are not adequately met.

The Covid-19 pandemic has laid bare fault-lines in healthcare systems even in developed economies. Whether as a consequence of inaccessibility to treatment or vaccines, the poor and the marginalized have been hit the hardest. In India too, the pandemic exposed vulnerabilities of a healthcare system coping with decades of low expenditure on public health. While the unrelenting virus needs to be contained on a war footing, it is a grim reminder for a need to re-prioritize health in global and domestic agendas. Policy must strengthen long term and all-round health gains with the objective of universal health coverage where all can access timely health services without financial hardship.

The Directive Principles of State Policy of the Indian Constitution, such as in Articles 39 (E) and 47, direct the State to secure and improve health of the citizens. Moreover, Article 21 of the Constitution guarantees the right to life and liberty as a Fundamental Right, which has been interpreted to include the right to health. The government therefore is obligated to provide health services to all citizens. In 2019, the High Level Group on Health Sector under the 15th Finance Commission recommended that ‘right to health’ be declared a Fundamental Right. This would strengthen people’s access to good quality affordable health services to attain the highest possible level of health through preventive and promotive healthcare as envisaged in the National Health Policy of 2017.

World over, experts warn that a silent pandemic already on the horizon is the Mental Health pandemic. Within the health sector, mental health is often amongst the most ignored. It is poorly understood, carries stigma and falls much lower in priority. The National Mental Health Survey of India shows that 13.76% of Indians (1 in 7 Indians) are likely to suffer from a mental disorder in their lifetime, yet the treatment gap or the ‘Mental Health Gap’ is huge with more than 80% of those in need of treatment not being able to access it. The progressive Mental Healthcare Act 2017 guarantees provision of services to every Indian by the state, yet the government’s yearly expenditure on mental remains dismal at Rs 40 crore which is less than 0.05% of its already severely limited health budget.

As per the World Economic Forum 2019, India had slipped to 150th rank in healthcare. While total health expenditure - private and public - forms a little over 6% of India’s GDP, government expenditure is a meagre 1.29% of the GDP. Unsurprisingly, a significant proportion of healthcare in India is in the private sector.

Bridging the healthcare gap must necessarily address the following.

· Bring healthcare to the top of the national agenda, with a clear definition of short and long term objectives with public expenditure and investment targets

· Increase government investment in healthcare by at least doubling it, devising tax incentives for private healthcare sector and CSR funding in healthcare, and promoting PPP schemes

· Strengthening coordination between Centre and State agencies, involvement of stakeholders beyond the government setup; and expanding existing programs such as Ayushman Bharat, Pradhan Mantri Jan Aushadhi Pariyojana and similar programs

· Increasing health insurance footprint

· Creating healthcare cooperatives that are community owned of which successful examples exist in India. These can be instrumental in healthcare delivery.

· Adoption of latest medical and AI technology to improve reach and effectivity of health services.

Clearly, the challenges of building a fairer, healthier world are significant. However, a journey of a thousand miles must also start with a single step. The time to respond to this call to action is now.

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World health Day Dr. Sunil Mittal


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