D Ravi Kanth: Health beyond healthcare

TRADING THOUGHTS

Grim pictures of the flood misery in Bihar dominated global television news last week, reminding the world at large about the appaling state of social and economic development in this blighted state. But whether it is in rich or poor countries, the majority of victims tend to be the “daridra narayans [the poorest members]” and their number is multiplying by the minute.

Rarely do international commissions focus on the root causes for the worsening plight of those billions of poor people. To be reminded that “social injustice is killing people on a grand scale”, therefore, requires some courage as well as commitment. And this is precisely what an International Commission set up by the World Health Organization in 2005 did in its report last week. The global health body simply sought to know the role played by “social determinants and their impact on health inequity.”

“Social injustice is a mater of life and death,” and “it does not have to be this way and it is not right that it should be like this,” the commission observed forcefully, setting the stage for what needs to be done for “closing the gap in a generation.” It includes some of the best minds in social, economic, and health studies and is chaired by an expert on epidemiology and public health, Prof Sir Michael Marmot. Others include Nobel laureate Amartya Sen, who is well-known for his painstaking work on the interplay of social and economic conditions on health; Frances Baum, an expert on public health in Australia; Monique Begin, a sociologist in Canada; and Giovanni Berlinguer, an Italian academic on social health, among others.

At the root of the rising global disease burden that is claiming tens of millions of lives due to HIV/AIDS, tuberculosis, malaria, and other infectious ailments, lie certain core social determinants. They include primary healthcare, schools and education, conditions of work and leisure and so on. Health and disease cannot be merely tackled by focusing only on health sector choices. Though “maldistribution of healthcare — not delivering care to those who most need it — is one of the social determinants”, there are other equally important catalysts that play a vital role in the overall well-being within the society.

“The high burden of illness responsible for appaling premature loss of life arises in large part because of the conditions in which people are born, grow, live, work, and age”, it observed, noting that poor and unequal living conditions ultimately stem from “a toxic combination of poor social policies and programs, unfair economic arrangements, and bad politics.” More importantly, the Commission clarified in great detail what economic growth, in itself, can do for the miracle of providing health equity. Sound social policies — that can create material conditions to lead a “flourishing life” such as compulsory education till secondary school, encouraging and providing opportunities to girls to participate on an equal footing in education, and empowering people at gross roots — can have a major impact on the overall health sector.

In a way, the commission set a new roadmap on how to bridge the gap between economic growth and health equity. “Economic growth is without question important,” but “growth by itself, without appropriate social policies to ensure reasonable fairness in the way its benefits are distributed, brings little benefit to health equity”.

The latest poverty estimates issued by the World Bank do bolster the commission’s findings. The Bank, for example, found that the number of people below what is called the absolute poverty line of $ 1.25 PPP dollars a day has risen steeply in various developing countries, including India that has registered high economic growth in the recent period. So, it is time that the pundits of the liberalisation-driven-Manmohan Singh government realise the importance of economic policies infused with social content. Otherwise, they will face the criticism of increasing poverty and poor health!