Volume 1, No. 9, November 2000

— Dr. Sidhartha Gupta

In the modern world, besides food, clothing and shelter, education and health are the two essentials of life. Hence development of humanity is not possible without these fundamental necessities. A man can survive for some days even without food, but without treatment during an emergency, survival is impossible.

But in this class divided society, the ruling class has robbed the toiling mass, of their right to health and access to essential medical treatment. They treat it as a ‘privilege’ for a small section of people, rather than a fundamental human right.

With the propagation of science, the last century has witnessed spectacular achievements in modern medicine which were beyond one’s imagination a few decades back. The discovery of detailed human anatomy and physiology upto the molecular level, the invention of ‘miracle’ drugs, the improvement of surgery and anaesthesia, the application of sophisticated technologies in diagnostics, organ transplantation or genetic engineering have brought revolutionary changes. Totally fatal cases can now be saved, which was unthinkable even a few years back.

But due to extreme social inequalities, the ghastly exploitation of our working folk by the ruling classes, and the tightening grip of imperialism, more than 80% of the world population is yet to get any benefits of science. They continue to live in endless pain and misery and fail to get even two square meals a day. When, on the one hand, thousands of millions of dollars are being spent to explore any evidence of life on Mars, thousands of human lives on earth perish every day like insects and hornets.

The Indian Scenario

Our ‘Saare Jahan Se Achha’ motherland spends Rs. 30 to 35 crores a day on the Kargil war. It does not hesitate to invest millions of dollars for ‘Sankhya Vahini’ — the information highway. But it also occupies the first place as the land of the highest number of starving, diseased, homeless and illiterate people.

Out of the one billion population, no less than 300 million goes to bed, every day, without a night meal. Yet huge amounts of food grains are exported at the will of the imperialist bosses. More than 60% of people are without any primary health care. Above 35% of the rural population is without safe drinking water and village women have to walk 5 to 10 kms a day on an average to get drinking water for her family in the summer months. Proper sanitation is a joke for 60% of Indians.

India also tops the list of killer and disabling diseases as can be seen in the following table :

The infant mortality rate (73 out of 1000 live births) and perinatal mortality rate (44.2 out of 1000) are alarmingly high. So far as the human development indices are concerned, India occupies 134th position out of 170 countries whereas the position of Sri Lanka is 96 and that of Pakistan is 118.

A Short History of Health System Development

In ancient and medieval times health was never considered as a state responsibility but as a personal or familial concern.

From the 14th and 15th century the European countries took control over the oceans with their developed naval forces. The history is well known of, how they spread like a cancer over Asia, Africa and Latin America to establish their colonies. Unbelievable amounts of wealth looted from these colonies served as the fuel of the Industrial Revolution.

Thus in Europe big industries were established and the industrial proletariat also emerged as a class. Like all fields of science, medical science also started developing. Modern medicine freed itself from age old unscientific practices, quackery, witchcraft and myths. Europe inherited the allopathic medicine from ancient Greece and gave it a new shape, which became capable of saving the lives of even terminally ill patients.

But at the same time it became so expensive that it went out of reach of the working class.

The expectation of the common people to share the benefits of modern treatment became a part of their struggles against social inequalities. The demand for state sponsored free treatment became popular.

But the ruling classes were not ready to oblige. They preferred to keep health care reserved as another costly purchasable commodity.

During this time, in 1917, the Russian Revolution occurred which, like in all other fields of life, left its permanent imprint also on the sphere of health care.

The Soviet Union became the first country in the world, which recognised people’s right to health at state expense. The socialist government, in spite of all odds, built up a wonderful network of primary and higher health care in the vast country, for all its citizens.

The workers of the capitalist feudal and semi-feudal countries were greatly inspired by the revolution in Russia. They also started to claim a right to free health care.

The crisis of capitalism gave birth to two world wars in Europe over a span of 30 years. After the second world war China freed itself from the shackles of exploitation. Socialism was established in East European countries. Freedom struggles intensified in the former colonies and semi-colonies of Asia, Africa and Latin America.

World capitalism was shaken by the fear of socialism, which was spreading like a prairie fire. Hence it changed its tactics. It gave sham independence to former colonies, only to transfer them into semi-colonies. To stop communism, it adopted the economic model of a ‘welfare state’ or capitalism with a human face. The aim was to show that the solutions are already within the framework of capitalism and that there is no need to opt for communism.

Whereas in India the imperialists solicit for abolition of minimum state run health care facilities, in their own countries they provide free national health care service or state financed health insurance. The amount of free services varies from 60% (in the USA) to 100% (in Canada). (Though in the USA there is a two tier system for the rich and poor, even still it is much better than what we get here)

Recently, in the face of the deep economic crisis, most countries tried to withdraw some of the facilities. They have managed to withdraw some in the US, but have been unsuccessful in Europe due to the resistance of the working class.

Health Care after ‘Independence’
 

In British India, the Englishmen had no intention to build up a well organised health system to cater for their subjects. They only established some medical colleges to produce some doctors trained in European medicine and qualified to treat the British officers, army and the Indian Jamindars and comprador bourgeoisie.

The indigenous medical systems, like Ayurveda, Yunani etc., reached a dead end, resulting in unscientific practices, due to utter neglect and lack of research and development. A few charitable hospitals and missionary centres were opened, while the rest of the urban and rural folk were left to their destiny.

The transfer of power in 1947, converted India into a semi-colonial and semi-feudal state where the British legacy was maintained and the interests of the imperialists and their running dogs were well protected.

But the new rulers could not ignore the aspirations and expectations of the people, due to the vast upsurge against colonial rule, with thousands of martyrs laying down their lives. The Nehru-Patel-Gandhi axis were afraid that unless some of the popular demands were fulfilled, the Indians would quickly identify this sham independence and opt for socialism. One such popular demand was ‘Free health and medical service by the state’.

Inspite of that, due to public pressure, the governments were forced to set up health centres, hospitals etc., in urban and rural areas where free treatment by doctors, some free medicines, facility for indoor admission, operations etc., were available. Though grossly inadequate, and fragile, some network was established. In 1949-50, it was decided that about 23,000 health centres would be established in the country. Initially a health centre for each 10,000 people was fixed as a target. As time passed the target was lowered and lowered. For example, the proportion was reduced to a centre for every 40,000 people, then for every 1 lakh people and so on. Ultimately, there remained no target at all. Till 1996, only 14,000 (about 60%) of the proposed centres have been established. Yet, how many of them are actually in running condition is difficult to say.

Since its inception, the health budget was grossly inadequate and in comparison to the foreign debt service, defence or central expenses, it was ridiculously trivial. With each new ‘five year plan’ the health budget has reduced further to reach its nadir at 1.67% in the eighth plan. In comparison to the other countries (even some Asian countries) it is negligible. Let us go through the following charts to realise the horrible situation.

Still, the introduction of a three tier system of primary health care, the initiation of a National Health Programmes (for Tuberculosis, Malaria, Diarrhoeal diseases, Blindness) etc., could offer some relief to the people. Infectious diseases were controlled to some extent and health parameters like infant mortality rate, maternal mortality rate, crude death rate etc., were lowered and life expectancy was raised.

New Economic Policy’s Impact on Health Care
 

The so-called ‘mixed economy’, which was actually a semi-colonial and semi-feudal model to protect the interest of the imperialist bosses and their lackeys like Tata, Birla, Ambani etc., the feudal lords, bureaucrats and corrupt politicians, led India to a state of complete economic collapse and bankruptcy.

This crisis forced the rulers to shed off their mask of humanity, and withdraw even the small benevolent services which they gave.

Health is the first sector to face the axe : the national health programmes are being wound up, health care service is being gradually withdrawn, a moratorium on the establishment of new centres at states expense, a ban on the recruitment of health workers, the stoppage of the supply of life saving drugs and the introduction of ‘users fees’ at all levels. As a result killer diseases like Tuberculosis, Malaria, Kala Azar, Pneumonia, etc., are increasing at a rapid pace. Diseases which were suppressed to some extent have bounced back (like Asiatic Cholera, Dengue) and long forgotten diseases like Plague have reappeared to cause havoc. The health parameters are deteriorating day by day.

In a nutshell the effects can be described as —

The New Economic Policies have had a disastrous impact on health care in India. The World Bank has dictated the following policies for health care:

Since free medical treatment is expensive (as it requires the engagement of doctors and paramedical staff, supply of medicine, diagnostic facilities etc.), the World Bank-IMF solicit for its gradual shrinkage in the name of giving emphasis on preventive measures. But preventive and curative services are mutually complementary and not an alternative to each other.

The ‘new policy’ gives maximum emphasis on vaccination — knowing fully well that the vast majority of killer diseases are not preventable by it. Even the vaccine against tuberculosis (BCG) is only partially effective. (See box on folio)

Family planning (actually birth control and medical termination of pregnancy) is another pet project of the imperialists in the third world countries. They want to project ‘population explosion’ as the sole cause of poverty in these countries. This is a tactic adopted by the rulers to divert our attention from the horrible loot of wealth from these countries. Even today, with equal distribution of the foodgrains produced, India can support a population of 1.25 billion. Consumption wise, a US citizen consumes 200 times more than that of an average Indian. But the imperialists put all emphasis on ‘Birth Control’ and as a result the budget on family planning swells from 0.14 crore in the First Five year Plan to 6500 crores in the 8th Plan. An Indian woman is also denied the right over her own body.

The other priority sectors, according to the World Bank-IMF nexus are :

The mode of propaganda and consciousness building through telecasting, banners, etc., in the backdrop of overwhelming poverty and illiteracy, is a practical joke.

Privatisation is another key word of the new policy. Even at present 75% of health care is a purchasable commodity and in the hands of private companies. 61% of all health setups in the country (in 1996) are private in comparison to 16% previously (1976). Only 7% of doctors are employed by the state in 1995-96 compared to 35% in 1975-76. Above 60% of the total expenses in the health care sector comes from the pockets of the patients and their relatives whereas the states’ contribution is less than 30%.

The MNCs, TNCs and their local touts are not satisfied even with this. They want ‘total privatisation’ and a full market economy in this field.

The business includes private hospitals, clinics and diagnostic centres, diagnostic instruments and reagents; health insurance (particularly after privatisation of the Insurance sector); medical software; medical architecture; consultancy services etc. The largest single aspect of this is the business of pharmaceuticals (medicines) worth Rs. 12,000 crores.

Our discussion will remain incomplete without a mention of the new patent act which is likely to hit a death blow particularly to local pharmaceutical industry and raise the price of medicine to exorbitant levels.

The new patent act is an integral part of the WTO agreement. It will change the fundamental rules of the older act. The changes are as follows :

As a result of this, the cost of medicine will increase many fold and the government will loose all control even on the price of life saving drugs. Transnationals, which already control 90% of the Indian drug industry and siphon thousands of crores of dollars to their headquarters, will be benefited further. And the poor people will die of diseases with even the simplest medicine going beyond their reach.

Conclusion

The health sector in India is a part of the semi-colonial and semi-feudal system which serves, not the people, but the interests of the foreign multinationals and their brown-skinned agents like Tata, Birla, Goenka or Ambani. The mafias, politicians of all parliamentary parties, bootleggers, criminals, bureaucrats and media barons do their best to serve their bosses and get a share of the cake, so that the ringmasters can exploit the Indian people smoothly and more effectively. The police, paramilitary and military forces, fed on the money of taxpayers, are ruthlessly suppressing all genuine and justified demands of the common man. With health care getting more and more elitist, only 10% of our population will have access to proper health care, while 90% will be pushed to a slow, tortuous death from disease. And with hygiene also being defacto privatised (witness the spurt in mineral waters, and private water purification systems) and the government’s abdication of all responsibility, disease will spread hundred fold. The gainers will be the pharmaceutical companies, private hospitals, manufacturers of hygiene systems and health equipment and the health insurance companies.

The socio-political structure of India is rotten to its core. Naturally the structure of health care cannot be anything better, as it is part and parcel of the whole system.

Minor modifications within the framework of parliamentary policies, as advocated by the vote mongering parties, are no solution. The whole system is to be uprooted and thrown away by revolution. There is no other short cut to better health and a better life.

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