BATTERING ON PUBLIC HEALTH-Globalisation and the Indian People

                                                                        V.G.Ranganath M.L.,(Ph.D)**

 

The Author Concentrates on Globalization and the impact on  Indian people with respect to women health. Globalization is not a new phenomenon, neither is it necessity an evil force. However what we see today in the garb of globalization is something that is unique and unprecedented. Notwithstanding the rhetoric, globalization has come to mean the legitimization of neo-imperial loot. Globalization, as being practiced today, does not encourage free flow of goods, ideas and people across the globe. On the contrary it perpetuates and increases monopoly control over resources, technology, knowledge and capital. The tools used are multinational corporations and finance capital, aided by the institutions of globalization.-the IMF and the World Ban, with the WTO functioning as the lawmaker who constantly changes the rules of the game to favour the rich and the powerful. We need to make a distinction between this form of globalization and true globalization-which would mean unhindered flow of technology, knowledge and resources to those concerns of the globe which need it most. The globalization that we see today is global only in regard to the vastly increased ability of imperialism to interfere in governance and decision-making in sovereign nations. What we have is not interdependence, but increasing dependence on a few who control productive resources and capital.

This kind of globalization is plagued with a fundamental contradiction-in an age when restrictions on information flow and flow of goods, services and capital are sought to be removed, there is a greater concentration of wealth and knowledge in a few hands. Such concentration is manifest in growing inequalities. More than a decade back the UNICEF took note of the initial signals: “Great change is in the air as the 1990’s begin… And great change is needed if a century of unprecedented progress is not to end in a decade of decline and despair for half the nations of the world. In many countries poverty, child malnutrition and ill-health are advancing again after decades of steady retreat. And although the reasons are many and complex, overshadowing all is the fact that the governments of the developing world as a whole have now reached the point of devoting half of their total annual expenditures to the maintenance of the military and the servicing of debt”. Such appeals obviously went unheeded and in the last decade of the past millennium actual per capita incomes fell in over 80 countries. This is what is unique about the present phase-the fact that the consequences of current policies are being felt at an unprecedented scale. Such wide-ranging reversals of social and economic gains have never happened in the history of human civilization.

Public Health- a Casualty

Public health is an obvious casualty of this process. There is a clear contradiction between the  principal tenets of public health and neo-liberal economic theory that permeates policy making today. The former posits that public health is “public good” i.e its benefits cannot be individually appropriated or computed, but have to be seen in the context of benefits that accrue to the public. Thus public health outcomes are shared, and their accumulation lead to better living conditions. Such goods never mechanically translate into visible economic determinants, viz., income levels or rates of economic growth. Kerala, for example, has one of the lowest per capita incomes in the country but is public health parameters rival those in many developed countries. The Infant Mortality Rate in Kerala is less than a third of any other large state in the county. But neo-liberal economic policies would rather view health as a private good that is accessed by the medium of the market.

Women’s Health Aspect

The campaign for women’s health and health-rights in India has been primarily geared towards the demand for better health services and facilities, protests against coercive tactics that endangers women’s health and their human rights, and demand for overall well-being of women.  Right to life is considered one of the fundamental rights, and health is one of the vital indicators reflecting quality of human life. In this context, it becomes one of the primary responsibilities of the state to provide health care services to all its citizens. Although programmes are being constantly reviewed and revised, the problems persist and continue to worsen.

For instance, the ratio of hospital beds to population in rural areas is fifteen times lower than that for urban areas. Similarly, a pregnant woman from the poorest quintile of the population is over six times less likely to be attended by a medically trained person during delivery. In addition, per person government spending on public health in rural areas is seven times lower as compared to the urban areas. Even though, the National Rural Health Mission (NRHM 2005) launched in certain states that were identified as having poor health indicators emphasizes on comprehensive primary health care for the rural poor. The main goal of the mission is to provide for effective health care facilities and universal access to rural population.

The trend of reduced public investments and expenditures in health care is forcing people to increasingly access healthcare from the private sector.

Availability, Accessibility and Quality to Health Care[1]

F, a woman from a Delhi slum, was suspected of having cancer of the uterus and needed to be examined immediately. She went to an esteemed Public Hospital in South Delhi for the same. She first had to stand in a queue to get a stamp on the OPD card. By the time the doctor arrived, a large number of women were already waiting. Most of them appeared to be from a lower socio - economic category. A lot of them had come from far off places and were not familiar with the processes of the hospital, which left them at the mercy of nurses and peons who shoved them around.

With great irritation, the doctor called out names one by one and attended to them. There was no privacy at all and all sorts of questions were posed to them and they were publicly rebuked too.

F was attended to after a long hour of waiting, and she was asked to have a pap smear. However, no pap smear bottles were available in the ward. The nurse told her that there were only four bottles and they had been already distributed. F was asked to come the next day.

She left and came back the next day for the pap smear. After a long waiting, the smear was taken and the bottle needed to be deposited in another room, before which F had to stand in queue to pay Rs.10 at the cash counter. She was asked to come back after a week for another test and after ten days for the result of the pap smear. She went back for the next test, and the doctor who was to conduct was away on an emergency surgery. She received the reports after a week and they turned to be positive. Her treatment however did not start on the day she went to collect her reports, for which she had to visit the hospital again.

The above case provides a vivid example of the poor health care system in India and the pre-existing inequality in the healthcare provisions.

Lack of Basic facilities:- A woman in Chidika village of Andhra Pradesh[2], developed pregnancy related complications. Since there was no transportation facility from that village, people had to carry her on a cot to the health centre in the nearby town. It took two hours to reach the health centre. By the time she reached the health centre, there was no staff available to attend her immediately. The woman was in critical condition and died.

The above case study illustrates the situation of health services in our country which lag behind in providing basic facilities and accessibility to women during pregnancy. India accounts for the second highest maternal mortality rate in the world.

Access to healthcare is becoming increasingly difficult for a growing number of people because of the continued apathy of the government to recognize health and healthcare as a national priority, along with the legitimization of an unregulated private sector. Firstly, access to healthcare is affected by physical, financial and socio-cultural factors. Further, access to services has to be seen in terms of its coverage, availability of diagnostic facilities, medicines, surgical care and quality. However, cost of care is an important factor that severely affects access to quality health care services. In resource-scarce countries like India, where 27% of the population lies below poverty line, cost becomes a

very important issue while accessing quality.

In addition to general health services provided by Ministry of Health and Family Welfare (MOHFW), specific health and nutritional needs of women are provided through the Integrated Child Development Services (ICDS) Programme under the Ministry of Human Resources Development and newly formed Ministry of Women and Child Development, that was only a department under the MOHFW till 2005.

Under the provision of the Constitution of India, Public health is primarily a state subject. National health programmes have been designed with flexibility to permit the state public health administration to create their own programmes according to their needs and depending on the epidemiological profile of the population. The implementation of the national health programmes carried out through the state government has decentralized public health machinery. The centre will play a co-ordinating role and provide technical and financial support, wherever it is felt necessary.

Most importantly, the central government is to give top funding priority to programmes promoting women’s health. The National Health  policy (1983) sets forth several time bound objectives including reduction of MMR(Maternal Mortality rate), IMR(Infant Mortality rate), due to TB and malaria by 2010, and zero growth of HIV/AIDS by 2007.

Women and Communicable Diseases[3]

In addition to the poor nutritional status, heavy work burden and maternal and prenatal ill-health, communicable diseases including Malaria, Tuberculosis, Encephalitis, Kala Azar, Dengue, Leprosy,  Swine Flu etc. contribute significantly to the heavy burden of disease faced by women. Communicable diseases remain the most common cause of death in India.

A 25 year old woman from Davanagere was married to an auto rickshaw driver. She conceived after four years of marriage and was infected with TB. It was routine to do an HIV test for all pregnant women in the hospital. The test revealed that she was HIV positive. Her husband also underwent the test found negative. This created a tension between both the families and they completely disowned her. They left Davanagere and came to Bangalore for a living. She was two months pregnant and visited a local hospital for a check up which refused to treat her and referred her to some other hospital. By then her husband was also tested positive. Thinking that the child would be orphaned, they decided to terminate the pregnancy. The doctors at the public hospital refused and asked her to go to private clinic who demanded Rs.5,000, which they could not afford. She went through a lot of mental strain as it was too late to terminate the pregnancy. Eventually she had a normal delivery, but lost the child.

The rights of the disadvantaged people are further compromised if their HIV positive status is disclosed. People living with HIV are stigmatized and isolated from the mainstream society. They are very often denied admissions into hospitals, schools and lose jobs on discovery of their positive status.

Unsafe Water and Impact on Health

Unsafe water kills more people than war plus all other forms of violence combined, said United Nations Secretary-General Ban Ki-moon in a message to the world today, designated as World Water Day[4].

The 2010 World Water Day theme is Clean Water for a Healthy World, but every day two million tons of sewage, industrial and agricultural wastes enter the Earth’s waters, while every 20 seconds a child under the age of five dies from water-related diseases. The World Health Organization reports that unsafe water, sanitation and hygiene claim the lives of an estimated 1.5 million children under the age of five each year. These deaths are an affront to our common humanity, and undermine the efforts of many countries to achieve their development potential.  Our growing population’s need for water for food, raw materials and energy is increasingly competing with nature’s own demands for water to sustain already imperiled ecosystems and the services on which we depend. Day after day, we pour millions of tons of untreated sewage and industrial and agricultural waste into the world’s water systems. Clean water has become scarce and will become even scarcer with the onset of climate change. The UN General Assembly designated the first World Water Day in 1993, and on March 22 every year since, the focus has been on a different aspect of freshwater sustainability, including sanitation and water scarcity. The 192-member body today is holding an interactive dialogue on water and the "Water for Life" International Decade 2005-2015, featuring three panel discussions on climate change, peace and security, and the Millenium Development Goals, an agenda for poverty reduction agreed by world leaders in 2000 that includes clean water and sanitation. Access to clean water and adequate sanitation are a prerequisite for lifting people out of poverty.  Currently, seven out of 10 people without improved sanitation live in rural areas, but the number of people without adequate sanitation is set to soar as urban populations grow, she said. Unclean drinking water leads to the spread of diseases such as cholera, typhoid and childhood diarrhea, one of the leading causes of death in children.

A new joint report from the World Health Organization and the UN Childrens Fund shows that 87 percent of the world’s population, about 5.9 billion people, are now using safe drinking water sources, so the world is on track to meet or even exceed the drinking water target of the Millennium Development Goals.

But with almost 39 percent of the world’s population, or over 2.6 billion people, living without improved sanitation facilities, the report estimates that the international community will miss the sanitation Millenium Development Goal by almost one billion people by 2015 - the date when the goals are intended to be accomplished. However, this practice is still widely spread in Southern Asia, where an estimated 44 percent of the population defecate in the open. Lack of access to water, sanitation and hygiene affects the health, security, livelihood and quality of life for children, impacting women and girls first and most. They are much more likely than men and boys to be the ones burdened with collecting drinking-water. When the UN General Assembly opens a new session in September the UN will host a high-level thematic debate on water and sanitation. Secretary-General Ban has called on member states to approve and incorporate an accelerated action plan during the summit, saying an inability to meet the MDGs would be an "unacceptable failure, moral and practical." In some poorer nations, more than half of treated water is lost to leaks, but saving just half of the water by repairing leaky water and sewage networks could benefit 90 million people without additional investment, the report shows. UNEP shows that that many substances that make wastewater a pollutant, such as nitrogen and phosphorus, can be used as fertilizers for agriculture and can generate gases to fuel power stations and for cooking. At last, Health is Wealth. But it can be efficacious when the correct implementations and initiatives were properly made.

The Author is V.G.Ranganath, Asst.professor, Padala Rama Reddi Law College, Hyderabad and Research Scholar(part-time),Dr.B.R.Ambedkar College of Law, Andhra University, Visakhapatnam .

E-mail:ranganathvg@yahoo.com

 

[1] N.B.Sarojini&others, “Women’s Right to Health”-National Human Rights Commission Page No. 19 available at  http://nhrc.nic.in/publications.htm (Last Visited on May 29th, 2010).

 

 

[2] N.B.Sarojini&others, “Women’s Right to Health”-National Human Rights Commission Page No. 35  available at  http://nhrc.nic.in/publications.htm (Last Visited on May 29th, 2010).

 

[3] N.B.Sarojini&others, “Women’s Right to Health”-National Human Rights Commission Page No. 37  available at  http://nhrc.nic.in/publications.htm (Last Visited on May 29th, 2010)

 

[4] “Unclean Water Claim More Lives than War” available at http://willblogforfood.typepad.com/will_blog_for_food/water/ (Last Visited on July 2, 2010).

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