“You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter what the outcome.” — Patch Adams
India ranks 143 out of 188 countries in the UN’s new health-related sustainable development goal (SDG) index. India gets 42 out of 100 marks in this index, much below China and below even Syria. While the sickness industry is thriving in India, with corporate hospitals sprouting like mushrooms and corporate honchos enjoying the fruits of a global clientele for their ‘health tourism’, there are no takers for our health sector.
- Readers must be briefed, to begin with, that hospitals, whether government-run or corporate, have nothing to do with healthcare. The health of a nation depends on many other factors, the leadings ones being:
- Clean drinking water for the whole population;
- Three square meals without contamination by animal or human excreta;
- Sanitary facilities for all
- Universal toilet facilities and sewage drainage;
- Avoidance of stagnant water breeding deadly mosquitoes;
- Smokeless chulahs for rural women;
- Economic empowerment of rural women to feed their children if their husbands spend most of their money on alcohol;
- Keeping every girl in school and college till the age of 20 to bring down the fertility rates by preventing them from getting married early;
- Enlisting the village barber’s help to spread the message of family planning.
To this list, I must add the judicious use of childhood vaccines, not all those sold by the vaccine industry.
I am pleased that our prime minister (PM) is personally making the effort to kick-start some of these health initiatives. Special mention must be made of the Swachh Bharat mission, close to the PM’s heart, which must be taken up by every right-thinking individual. The government’s efforts to popularise the use of toilets, through advertisements, goes a long way in improving people’s health. The PM’s efforts to provide a smoke-free kitchen to poor villagers, through the cooking gas subsidy scheme, will greatly reduce cancer and heart attack rates in village women and pneumonia death rates in children below five years of age.
Confusion prevails in the minds of some government functionaries on what is required to improve the general health of the citizenry. One example will suffice. Every state government seems to think that starting an All India Institute of Medical Sciences (AIIMS) type of hospital in their state will solve healthcare problems. According to this thinking, the new AIIMs will improve people’s healthcare. This is far removed from the truth.
A 14-country study, covering countries from Japan to Germany, showed that in countries with a higher doctor-patient ratio (USA, Germany, etc) the health of the population and mortality and morbidity rates were much higher compared to countries where the doctor-patient ratio was much lower, as in Japan. In Japan, there are 120 doctors per 100,000 population, compared to more than 450 doctors per 100,000 population in Germany and US. Other countries, like the UK, and Europe, fall somewhere in between. Even longevity is higher in Japan compared to that in the US. These differences prevail, despite these countries, including Japan, having the best health infrastructure.
To advise India, ranking low in the quality of its health infrastructure, to ape the US model is dangerous. Going only by the quality of treatment available in corporate hospitals, India can rank almost at the top of the list. Our corporate hospitals attract patients from even the affluent West.
It is in healthcare that India is woefully deficient. If only we can provide a mosquito-net for all, especially for poor homeless people and their children, we could dramatically reduce the incidence of malaria. This would mark a major success in the battle for better healthcare and achieve a much better SDG ranking for the country.
Studies have now shown that the best malaria eradication is to provide individual mosquito-nets to the population. By providing clean drinking water, we can reduce by 40% the requirement for hospital beds to treat water-borne diseases. With economic empowerment and employment, India can significantly reduce deaths due to lifestyle-related chronic diseases. A proper diet would save the lives of millions of malnourished children and adults.
How do we take India forward in healthcare and try and attain the status that we enjoyed up until around the 12th century when India was a world leader even in trade? A healthy country is a happy country. A happy India will be a powerful India, not powerful with missiles and rockets but with 1.2 billion healthy minds. A healthy mind is defined as a mind with the enthusiasm to work and one that is compassionate. Live and let live. Even home-grown terrorism will vanish when a society nurtures healthy minds among its young, by providing them with a good education, and not just an education which leads only to a prosperous career.
Meeting the long-term health needs of India should begin with a new medical education policy. The outdated London University curriculum of 1857, which only teaches medical students about sickness and its management, is being replaced by a new healthcare-based medical education. India should move away from the Western model. Medical quick-fixes should be retained only for emergencies, which normally constitute about 2%-4% of the sick population on a given day, while the remaining 96% can make do with management modalities from all other authenticated systems, including Ayurveda.
As predicted by Benjamin Rush, one of the framers of the American Constitution, Western medicine, today, monopolises sickness-care all over the world. Its impact is highest in India, where the majority cannot avail of the hi-tech Western medicine. Those who can are significantly impoverished. Future medical education in India must have a health-based system to inculcate in future generations of doctors a humane approach to the practice of medicine and knowledge of the health needs of the country. We need to change the Hippocrates oath that our students take, to incorporate this humane model of healthcare as well as sickness-care.
“Only a life lived in the service to others is worth living.” — Albert Einstein