Today'sPaperOPINION

Ayearofmanmadehealthcrises
ChapalMehra
Governmentsthatpromisedevelopment,growthandhumanwellbeingmustrecognisethatthesearenotpossiblewithoutinvestments
inhealthandhealthsystems

ILLEQUIPPED:EbolahasbeenendemictotheWestAfricaregionforalmosttwodecades.Yet,theabilityofthisregiontoaddressthis
disease,oranyother,remainsseverelylimited.PictureshowsNowaPaye,9,assheistakentoanambulanceaftershowingsignsofEbola
infectioninthevillageofFreemanReserve,about30milesnorthofMonrovia,Liberia.PHOTO:AP

Overthepastyear,severalsignificantpublichealthcriseshaveunfoldedinIndiaandglobally.Asthisyearhurtlestoan
end,itbecomesimportanttoexaminetheseevents,ifonlymomentarily,tounderstandthelessonstheyhold.
Oncloserexamination,itbecomesapparentthatmanyofthesecrisesweremanmadeeitherbecauseofcontinued
neglect,alackoffocusonpreventionandinsufficientinvestmentinhealth,orafocusonaddressingdiseasesbutnot
theirrootcauses,i.e.,thesocialdeterminantsofhealth.
Earlyintheyear,thewarinGazaandtheblockadeexacerbatedahealthcrisiscausedbycontinuedinternational
neglectofthepeopleofGaza.Atthelastcount,thefourweekconflictleft10,000homesannihilatedanddisplaced
4,50,000people.Therealpublichealthcrisiswasthelackofelectricity,cleandrinkingwaterandsafehomes.
Overcrowdingandthelackofwaterandsanitationfacilitiesledtoariseintheincidenceofwaterrelateddiseases.As
timepasses,thisdestructionwillexpectedlyresultinmultiplehealthcrisesthatwillaffectthephysicalandmental
wellbeingofhundredsofthousandsofpeople.
YetnothingmademorenewsthantheEbolacrisisinWestAfrica,whereover7,000peoplehavedied.Inthepoorest
andperhapsmostpoliticallyunstablepartofthecontinentwherethiscrisisunfolded,thebiggestareasofneglectwere
healthsystems,infrastructure,funding,trainedhumanresourcesandlittlecommunityeducation.Ebolahasbeen
endemictotheWestAfricaregionforalmosttwodecades.Yet,theabilityofthisregiontoaddressthisdisease,orany
other,remainsseverelylimited.Ebolawasntaglobalpriorityeither,becauseitwascentredinapoorregion.
Internationalagenciesbickeredandtooktheirtimetorespondwhilepeopledied.Whenthefirstcaseemergedinthe
U.S.,Ebolafinallyqualifiedasanimportantdisease,andnewexperimentaldrugs,vaccinesandpreparednesssoon
followed.Asalways,itseemedtoolittle,toolate.
HealthcareinIndia
Letsturnhomeward.AsIndiamarchedtowardsacchedin,italsomarchedtowardsgloballeadershipinmany
diseases.Thisyearwitnessedrepetitivecrisesinmalariaanddengue.Diabetesandheartdiseasecontinuedto
confoundus.Earlierthisyear,wehadashockingstockoutofHIVtestingkitsandlaterofHIVdrugsthat,ironically,
weproduceandsupplyglobally.Evenasthousandsweredeprivedofdrugsinthepublichealthsector,thegovernment
defendeditselfsayingthesituationwasnottoobad.IndiasdrugresistantTBcrisistoocameoutoftheclosetwith
overa1,00,000cases.WealsofinallyadmittedonnationaltelevisionthatTBisthecountrystimebomb.
However,thehighlightwasthesterilisationtragedyinChhattisgarh.Over10ofthe83womenwhounderwent
sterilisationsurgeriesintheStatedied,whilemanyotherswerehospitalisedinacriticalcondition.Theincident
revealedthepatriarchalmindsetofsuccessivegovernmentswhofocusonfemalesurgicalsterilisationasacornerstone
offamilyplanning.Italsorevealedtheongoingnexusbetweengovernmentofficialsandpettymanufacturers,asthe
antibioticsgiventopatientsweresuspectedofcontainingratpoison.Unfortunately,nopoliticianorgovernment
officialhasbeentriedforculpablehomicide.Thesedeathsremainunpunished.
Onabroaderlevel,thequalityofhealthservicesinurbanandruralIndia,inboththepublicandprivatesectors,
continuedtobeabysmal,asmillionsofpatientstravelledtoaccesshealthserviceselsewhere.Over60percentofall
Indianscontinuedtoaccesshealthcareintheprivatesector(manyfromquacks)atexorbitantcostsandwereoften
exploitedwithinappropriatetestsandtreatment.Indiasepidemicofmicrobacterialresistancealsocontinued
unabatedaspharmaciessoldantibioticsoverthecounterwithoutsufficientcontrolfromthegovernment.Thebiggest
blowcameattheendoftheyearasnewsleakedthatthenewgovernmentwouldcuthealthspendingbyaround20per
cent.Foracountrywhosespendingonhealthisamongthelowestintheworld,thiswasaterriblewaytowrapupthe
year.

Lessonsforthenextyear
Whatcanwelearnfor2015?GovernmentsinIndiaandelsewherethatpromisedevelopment,growthandhumanwell
beingmustrecognisethis:allthisisnotpossiblewithoutinvestmentsinhealthandhealthsystems.Weneedtoinvest
inimprovingpreventiveandprimaryhealthcare,sanitation,wastemanagementandhealtheducation.Finally,ifour
longhistoryofcontinuingdiseaseandrecentcrisesteachusanything,itisthatthefundamentalsofhealthremain
criticallyimportantindiseasecontrolsufficientnutrition,safehabitation,betterairquality,sanitation,health
seekingbehaviours,safety,andreducedconflict.Allofthesearedeeplylinked,notjusttohealthbutsocialand
economicpolicy.Reducingspendingonhealthwillmakethingsworse,notbetter,inIndiaandelsewhere.Acchedin
willnotarriveeithernextyearorthedecadeafterunlessIndiaintegratestheselessonswithitspublicpolicy.
(ChapalMehraisanindependentNewDelhibasedwriter.)
Manyofthisyearscriseswereeitherbecauseofcontinuedneglect,alackoffocusonpreventionand
insufficientinvestmentinhealth,orafocusonaddressingdiseasesbutnottheirrootcauses