People belonging to marginalised communities such as Dalit and other lower castes, Adivasi/Tribal communities, women and other minority groups, face the greatest obstacles in accessing proper healthcare. This is due to a combination of the general low economic status of these groups, as well as deeply entrenched, systemic prejudices against them. In such a scenario, it becomes even more important that instead of abdicating its responsibilities, the government exercise its powers to regulate the healthcare sector in a way which minimises bias and exclusion and ensures equal access to all. A private, profit-driven healthcare system on the other hand, will only deepen these faultlines by inevitably prioritising those who can afford to pay for its services over those who can't.
Some of the best, most efficient and inclusive healthcare systems in the world are government-run. The healthcare systems of countries like Canada, Iran and Sri Lanka are shining examples. Private cannot substitute the public. We must stop believing the illusion that privatized system of healthcare is better. There is a need to believe in the government system and to make it accountable to the people.In India too, the current Delhi government has made remarkable strides in improving access to quality healthcare among the general public by making significant investments in close to 450 primary healthcare centres around Delhi, called Mohalla Clinics, and ensuring they are well-staffed and properly equipped. The Niti Aayog would do well to take note of these international and domestic best practices.
Public health is not an 'industry'
One cannot ignore the fact the private players are there only so long as profits are to be made. Will these private players continue to play their role in so-called 'public private partnerships' if cost-benefit ratio is not in their interest? Health is not an industry, rather right to health needs to take primacy over trade.
It is common sense that we cannot mop the floor when the tap is still running on it. Neglecting preventive healthcare and focussing on curative healthcare is another major problem which makes 'curative healthcare' an industry. For example, by opening the markets for air purifiers and private on-payment lounges for 'fresh air', will we solve the problem of air pollution (and linked deadly diseases such as lung cancer)? Focussing on preventive aspect does not mean shifting priorities and competing with curative component, but both go in tandem.
Also, some industries are knowingly pushing products and lifestyles that is programmed to kill (and cause disease). For example, tobacco, alcohol and Big Food companies. With raging epidemic of non-communicable diseases (NCDs) causing over 70% of deaths, we have no choice but to hold these corporations to account (legal and financial liability). Heart diseases, stroke, cancers, diabetes, chronic respiratory diseases are among the major NCDs, a significant number of which is preventable.
It is constitutionally possible to ban alcohol and tobacco. There are Indian states that have banned alcohol (north-east states, Bihar and Gujarat for example). Gutkha (a chewing tobacco form) was also banned by the government, within existing legal and policy framework, although several other forms of tobacco continue to be consumed in India. So despite overwhelming scientific evidence linking alcohol and tobacco to deadly diseases and other ill-effects, what is preventing government to end alcohol and tobacco, and hold industries to account? Governments have aimed to reduce alcohol by 10% by 2025, but intend to end TB 100% by 2025 - but TB is linked to alcohol and tobacco use too!
We know TB is preventable and curable, but for almost 1.5 million people who died of TB in 2018 globally, it is not preventable and curable. TB is the world's biggest killer-infectious disease, and India has the highest burden. We are failing to prevent transmission of TB, as last year almost 10 million people got newly infected with TB globally. If we are serious about health security "where no one is left behind" we have to strengthen public health systems.
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