In a democracy people expect the government to work for their welfare. This could be through the provision of education, health, employment, housing or the development of roads, electricity etc. In this chapter we shall examine the meanings and problems related to health. Look at the sub-headings of this chapter. In what ways do you think this topic is related to the work of government?

WHAT IS HEALTH?

We can think of health in many ways. Health means our ability to remain free of illness and injuries. But health isn’t only about disease. You may have associated only some of the situations in the above collage with health. What we often ignore is the fact that each of the above situations is related to health. Apart from disease, we need to think of other factors that affect our health. For example, if people get clean drinking water or a pollution free environment they are likely to be healthy. On the other hand, if people do not get adequate food to eat or have to live in cramped conditions, they will be prone to illness.

$\quad$ All of us would like to be active and in good spirits in whatever we may be doing. It isn’t healthy to be dull, inactive, anxious or scared for long stretches of time. We all need to be without mental strain. All of these various aspects of our lives are a part of health.

Would you associate all or some of these pictures with ‘health’? In what ways? Discuss in groups.

Pick two situations from the above collage that are not related to illness and write two sentences on how they are related to health.

HEALTHCARE IN INDIA

Let us examine some of the aspects of healthcare in India. Compare and contrast the situation expressed in the first and second columns.

Can you provide a title to these columns?

In India, it is often said that we are unable to provide health services for all because the government does not have enough money and facilities. After reading the above left hand column, do you think this is true? Discuss.

In order to prevent and treat illnesses we need appropriate healthcare facilities such as health centres, hospitals, laboratories for testing, ambulance services, blood banks, etc., that can provide the required care and services that patients need. In order to run such facilities we need health workers, nurses, qualified doctors and other health professionals who can advice, diagnose and treat illnesses. We also need the medicines and equipment that are necessary for treating patients. These facilities are required to take care of us.

Patients usually have to wait in long queues in government hospitals, like this one.

India has a large number of doctors, clinics and hospitals. The country also has considerable experience and knowledge in running a public healthcare system. This is a system of hospitals and health centres run by the government. It has the ability to look after the health of a large section of its population scattered over hundreds of thousands of villages. We will go into more detail on this later. Moreover, there has been a phenomenal advancement in medical sciences whereby many new technologies and treatment procedures are available in the country.

However, the second column points out how poor the health situation in our country is. With all the above positive developments we are not able to provide proper healthcare facilities to people. This is the paradox - something that is contrary to what we would expect. Our country has the money, knowledge and people with experience but cannot make the necessary healthcare available to all. In this chapter, we will look at some of the reasons for this.

THE COST OF A CURE

Where do you go when you are ill? Are there any problems that you face? Write a paragraph based on your experience.

What problems did Aman face in the government hospital? How do you think the hospital can work in a better manner? Discuss.

Why did Ranjan have to spend so much money? Give reasons.

What problems do we face in private hospitals? Discuss.

Why pay taxes to the government?

Government uses tax money for providing many public services for the benefit of all citizens. Some services such as defence, police, judicial system, highways etc. benefit all citizens. Otherwise, the citizens cannot organise these services for themselves.

Taxes fund developmental programmes and services such as education, health care, employment, social welfare, vocational training etc. required for needy citizens. Tax money is utilised for relief and rehabilitation in case of natural disasters such as floods, earthquakes, tsunami etc. Space, nuclear, and missile programmes are also funded from the revenues collected as taxes.

Government provides some services especially for the poor who cannot afford to purchase them from the market. One example is health care. Can you give other examples?

PUBLIC AND PRIVATE HEALTH CARE SERVICES

From the above story, you must have understood that we can roughly divide up various health care facilities in two categories -

(a) Public health services and

(b) Private health facilities.

Public health services

The public health service is a chain of health centres and hospitals run by the government. They are linked together so that they cover both rural and urban areas and can also provide treatment to all kinds of problems - from common illnesses to special services. At the village level there are health centres where there is usually a nurse and a village health worker. They are trained in dealing with common illnesses and work under the supervision of doctors at the Primary Health Centre (PHC). Such a centre covers many villages in a rural area. At the district level is the District Hospital that also supervises all the health centres. Large cities have many government hospitals such as the one where Aman was taken and also specialised government hospitals.

The health service is called ‘public’ for many reasons. In order to fulfil its commitment of providing health care to all citizens, the government has established these hospitals and health centres. Also, the resources needed to run these services are obtained from the money that we, the public, pay to the government as taxes. Hence, such facilities are meant for everyone. One of the most important aspects of the public health system is that it is meant to provide quality health care services either free or at a low cost, so that even the poor can seek treatment. Another important function of public health is to take action to prevent the spread of diseases such as TB, malaria, jaundice, cholera, diarrhoea, chikungunya, etc. This has to be organised by the government with the participation of people otherwise it is not effective. For example, when taking up a campaign to see that mosquitoes do not breed in water coolers, rooftops, etc., this has to be done for all houses in the area.

According to our Constitution, it is the primary duty of the government to ensure the welfare of the people and provide health care facilities to all.

The government must safeguard the Right to Life of every person. If a hospital cannot provide timely medical treatment to a person, it means that this protection of life is not being given.

The Court also said that it was the duty of the government to provide the necessary health services, including treatment in emergency situations. Hospitals and medical staff must fulfil their duty of providing the necessary treatment. Therefore, the Court asked the State Government to give him the money that he had spent on his treatment.

Private health facilities

There is a wide range of private health facilities that exist in our country. A large number of doctors run their own private clinics. In the rural areas, one finds Registered Medical Practitioners (RMPs). Urban areas have a large number of doctors, many of them providing specialised services. There are hospitals and nursing homes that are privately owned. There are many laboratories that do tests and offer special facilities such as X-ray, ultrasound, etc. There are also shops from where we buy medicines.

As the name suggests, private health facilities are not owned or controlled by the government. Unlike the public health services, in private facilities, patients have to pay a lot of money for every service that they use.

A doctor in a rural health care centre giving medicines to a patient.

A woman and her sick child at a government hospital. According to UNICEF, more than a million children die every year in India from preventable infections.

In what ways is the public health system meant for everyone?

List some Primary Health Centres (PHCs) or hospitals near your place. From your experience (or by visiting any one of them), find out the facilities provided and people who run the centre.

A post-operative room in a leading private hospital in Delhi.

Private health facilities can mean many things. Explain with the help of some examples from your area.

The Medical Council of India’s Code of Medical Ethics states: “Every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of drugs.”

How can health care be made more affordable? Discuss.

Today the presence of private facilities can be seen all around. In fact now there are large companies that run hospitals and some are engaged in manufacturing and selling medicines. Medical shops are found in every corner of the country.

Healthcare and equality: Is adequate healthcare available to all?

In India, we face a situation where private services are increasing but public services are not. What is then available to people are mainly private services. These are concentrated in urban areas. The cost of these services is rather high. Medicines are expensive. Many people cannot afford them or have to borrow money when there is an illness in the family.

Some private services encourage incorrect practices to earn more. At times inexpensive alternatives, though available, may not be used. For example, some medical practitioners are found to prescribe superfluous medicines, injections or saline when simple medication may suffice.

In fact, barely 20 per cent of the population can afford all the medicines that they require during an illness. Hence, even for those whom one might not

think as being poor, medical expenses cause hardship. It was reported in a study that 40 per cent of people who are admitted to a hospital for some illness or injury have to borrow money or sell some of their possessions to pay for the expenses.

In rural areas, a jeep is often used to serve as a mobile clinic for patients.

$\quad$ For those who are poor, every illness in the family is a cause of great anxiety and distress. What is worse is that this situation tends to happen again and again. Those who are poor are in the first place undernourished. These families are not eating as much as they should. They are not provided basic necessities like drinking water, adequate housing, clean surroundings, etc., and therefore, are more likely to fall ill. The expenses on illness make their situation even worse.

$\quad$ Sometimes it is not only the lack of money that prevents people from getting proper medical treatment. Women, for example, are not taken to a doctor in a prompt manner. Women’s health concerns are considered to be less important than the health of men in the family. Many tribal areas have few health centres and they do not run properly. Even private health services are not available.

This pregnant lady has to travel many kilometres to see a qualified doctor.

What can be done?

There is little doubt that the health situation of most people in our country is not good. It is the responsibility of the government to provide quality healthcare services to all its citizens, especially the poor and the disadvantaged. However, health is as much dependent on basic amenities and social conditions of the people, as it is on healthcare services. Hence, it is important to work on both in order to improve the health situation of our people. And this can be done. Look at the following example.

Sustainable Development Goal (SDG) wwwin.undp.org

The Kerala Experience

In 1996, the Kerala government made some major changes in the state. Forty per cent of the entire state budget was given to panchayats. They could plan and provide for their requirements. This made it possible for a village to make sure that proper planning was done for water, food, women’s development and education. This meant that water supply schemes were checked, the working of schools and anganwadis was ensured and specific problems of the village were taken up. Health centres were also improved. All of this helped to improve the situation. Despite these efforts, however, some problems - such as shortage of medicines, insufficient hospital beds, not enough doctors remained, and these needed to be addressed.

For more details, visit http:/lsgkerala.gov.in/en

Let us look at an example of another country and its approach to issues of health.

The above map of India shows the state of Kerala in pink.
Page 97 of this book has a map of India. Using your pencil outline the state of Kerala on this map.

The Costa Rican Approach

Costa Rica is considered to be one of the healthiest countries in Central America. The main reason for this can be found in the Costa Rican Constitution. Several years ago, Costa Rica took a very important decision and decided not to have an army. This helped the Costa Rican government to spend the money that the army would have used, on health, education and other basic needs of the people. The Costa Rican government believes that a country has to be healthy for its development and pays a lot of attention to the health of its people. The Costa Rican government provides basic services and amenities to all Costa Ricans. For example, it provides safe drinking water, sanitation, nutrition and housing. Health education is also considered very important and knowledge about health is an essential part of education at all levels.

EXERCISES

1. In this chapter you have read that health is a wider concept than illness. Look at this quote from the Constitution and explain the terms ’living standard’ and ‘public health’ in your own words.

2. What are the different ways through which the government can take steps to provide healthcare for all? Discuss.

3. What differences do you find between private and public health services in your area? Use the following table to compare and contrast these.

4. ‘Improvement in water and sanitation can control many diseases.’ Explain with the help of examples.

An important part of the Constitution says it is the “duty of the State to raise the level of nutrition and the standard of living and to improve public health.”

Sustainable Development Goal (SDG) wwwin.undp.org

Glossary

Public: An activity or service that is meant for all people in the country and is mainly organised by the government. This includes schools, hospitals, telephone services, etc. People can demand these services and also raise questions about their non-functioning.

Private: An activity or service that is organised by an individual or company for their own gain.

Medical tourists: This refers to foreigners who come to this country specifically for medical treatment at hospitals that offer world-class facilities at a lower cost than what they would have to pay in their own countries.

Communicable diseases: These are diseases that are spread from one person to another in many ways such as through water, food, air, etc.

OPD: This is the short form for ‘Out Patient Department’. This is where people are first brought in and treated in a hospital without being admitted to any special ward.

Ethics: Moral principles that influence a person’s behaviour.

Generic names: These are chemical names of the drugs. They help in identifying the ingredients. They are globally recognised. For example, acetyl salicylic acid is the generic name of Aspirin.