Heal-Thy India: Untold Secrets of Health Care PK Sasidharan
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1Challenges in Our Health Care System and Solutions
  • Chapter 1  Introduction to Health Care Issues in India
  • Chapter 2  Leptospirosis Epidemic in Kerala (2011): A Pointer to Our Health Care Mismanagement
  • Chapter 3  Malnutrition in India, Balanced Diet and Good Lifestyle
  • Chapter 4  Waste Management, Drinking Water Issues and Consumerism in India
  • Chapter 5  Diabetes and Our Health Care: How to Prevent Diabetes?
  • Chapter 6  Are Doctors Engaged in Genuine Health Care? What Actually is Health Care?
  • Chapter 7  The Superspecialty Menace in India
  • Chapter 8  Need for a Strong Health Policy
  • Chapter 9  Solutions to the Problems in Health Care
  • Chapter 10  Health as a Global Issue: Change the Behavior or Get Ready for the Last Laugh
  • Chapter 11  Sexual Health, Gender Discrimination and Women Empowerment2

Introduction to Health Care Issues in IndiaCHAPTER 1

India is a rich and beautiful country; truly God's own country, rich in natural resources and human resources and blessed with an optimal climate. We have all the potential to become one of the best places on earth to live in. But we underestimate our potential and ignore the basic requirements for progress. One of the most important social issues neglected in our country is health care. We neglect issues concerning health care and literally end up manufacturing diseases.
In India, over the years, diseases have multiplied disproportionate to the population growth. While the population in India has only doubled in the last 30 years, doctors and hospitals have multiplied at least a hundred times. Even so, the number of existing doctors and hospitals prove inadequate. As a ritual, every year we observe the World Health Day and several other days named after diseases and organs—all stressing on treatment of diseases and rehabilitation of patients. But we keep forgetting the basic issues of health care in India. Issues like Endosulfan, Leptospirosis and Chikungunya receive attention momentarily, but the larger causal issues underlying these problems are always overlooked. I wish we had shown at least the same amount of concern in all matters of health care as we did in the case of epidemics because all diseases known to mankind, 4including cancers and genetic/inherited disorders are caused due to lack of precautionary measures and problems in diet, lifestyle and environment. The issues involved in Endosulfan or Leptospirosis are just the external manifestations of the pitfalls in our management of the basic issues of health care. Therefore, instead of dealing with isolated problems as and when they crop up, it is imperative for us to focus our attention and care on identifying and solving the basic problems and issues involved in health care as suggested below.
 
MALNUTRITION
Malnutrition is our biggest health problem and the real enemy of our country. Subclinical malnutrition is seen even in developed countries. But our picture is different; World Health Organization (WHO) estimates that childhood malnutrition is highest in India and it is reported that 27% of the world's starving population is in India. Frank estimates on malnutrition may invite controversies, but it is a fact that subclinical malnutrition is considerably higher in India, as compared to developed countries, because of lack of awareness, religious and cultural barriers, as well as lack of access to a balanced diet. Malnutrition is the root cause of all infectious diseases and it is also the reason behind almost all other diseases including cancers and inherited disorders. Hence, our first enemy by any estimate is malnutrition.
 
DRINKING WATER
Another major healthcare issue is the lack of safe drinking water in India. Even in cities, people still depend on well water. Even small housing plots have independent wells as well as leach-pits or septic tanks, thereby increasing the risks of fecal contamination of drinking water. In crowded dwelling places and in cities, drinking water should be distributed through pipes to each household after processing it centrally, as compared to waste management, which should be decentralized and processed at the point of origin. Boiling or filtering of water or using bottled water will lead to a huge wastage of resources and invite several environmental problems. Diseases like Typhoid, Hepatitis A and the Dysenteries, which are caused by the use of contaminated drinking water are rampant in India at a time when developed countries have eliminated them several decades 5ago. Today one sees such cases only from third world countries. The lack of safe drinking water in India is being capitalized by industries manufacturing the bottled water and water filters. When the developed countries have started discouraging bottled water, we are seriously promoting it. Unless and until all our citizens have access to safe drinking water, distributed through pipes in each household, we can never claim to have achieved health care.
 
WASTE MANAGEMENT
The third major healthcare issue is poor waste management. Inadequate sanitation facilities and unhygienic surroundings pose a serious threat to our environment and health. On the world environment day, we in India should be discussing seriously on issues of waste management before we discuss global warming and ozone layer depletion. All that we do on the world environment day is hold meetings and plant some trees, which are often forgotten after that day. We casually throw away all our waste and do not manage them properly, thus providing a breeding ground for the germs responsible for several communicable diseases like Malaria, Filariasis, Dengue, Leptospirosis, Typhoid and Dysenteries. We also face other environmental issues like air and water pollution in the form of contamination of the atmospheric air with toxic gases, the water and food with toxins, bacteria and viruses. All these are signs of the absence of basic facilities in the society. There is an increasing threat to our environment from the careless dumping of electronic wastes containing heavy metals like Mercury, Cadmium and Lithium, which is the contribution of the unchecked and growing consumerism. The threat of ozone layer depletion, increasing levels of carbon dioxide and global warming are mainly caused by deforestation, but it is also linked to accumulating wastes and poor waste management. We should also realize that it is the increasing consumerism that generates more waste and promotes deforestation too.
 
CONSUMERISM
The fourth and probably one of the biggest and unrecognized global health problems is growing consumerism in every sphere of life including the disease care industry. Consumerism induces people to buy, eat or consume unwanted things or undergo unnecessary 6procedures exposing them to overeating, physical inactivity, and stress, and finally into debt trap. The more we consume, the more will be the accumulation of waste around us, especially in a situation where there are no well-coordinated or well-organized waste management systems. People are deceived into buying and using most products because of lack of empowerment and the misleading advertisements promoted and propagated by celebrities. In the long run, this trend benefits only the manufacturers and suppliers of the products inside and outside the country, of whom probably USA is a major beneficiary and is presently the capital of consumerism. If we look carefully, we can conclude that consumerism and lack of empowerment are the root causes of several diseases like diabetes, liver diseases, hypertension, cancers and autoimmune diseases, and the consumerist forces then push people into the most expensive modalities of treatment, ignoring cheaper alternatives.
 
NEGLECTFUL ATTITUDE TO HEALTH CARE
As a nation, we have been ignoring health care for long and are literally manufacturing diseases. If the USA is the capital of consumerism, India is the capital of diseases like all kinds of infections (including Tuberculosis and AIDS), lifestyle diseases like diabetes, hypertension, heart attacks, and cancers and even inherited diseases. Because of our careless attitude to health care we have ended up bearing the double burden of proliferating communicable diseases due to lack of basic health needs and the alarmingly high prevalence of noncommunicable disease due to ever growing consumerism, bad lifestyle and dietary habits acquired by imitating the bad trends in the USA. After manufacturing diseases in large numbers we now focus on socializing disease care facilities with a focus only on treatment and that too through specialist doctors and superspecialty hospitals imitating the worst disease care model in USA. We boast of the ultra-modern treatment facilities that we have, but conveniently forget the fact that we have not achieved anything in the area of basic health care needs, cost-effective basic medical care and have failed in providing human development and social security for all. To make matters worse, patients in India have the freedom to consult any doctor, bypassing all the conservative and cost-effective approaches, since we do not have a health policy and a referral system. We are wasting our resources by copying all the bad trends in the American 7model of disease care and consumerism; at the same time we forget to emulate the good things in their basic health care. The trends in India have only helped USA to sell all their modern machines and costly medicines here.
 
LACK OF PRIORITIZATION AND HOLISTIC PROVISION OF HEATH CARE
We now give priority to ultramodern treatment centers at the expense of genuine health care and basic disease care facilities. We must resolve to concentrate on ensuring availability of basic health needs for every individual as the first priority in order to reduce the disease burden (as had already happened in the developed world), and to check the power of consumerist forces in all spheres of life including treatment of diseases. Our next priority should go to popularizing general practitioners and introducing a referral system to reduce ‘over-treatment’ and ‘over- investigation’. We must also remember that providing basic health care and basic disease care to all individuals is a human right or genuine health care is our right and that is the greatest health insurance to the people. We must not forget that health care and disease care are two separate issues, disease care facilities cannot sustain in the long run unless there is genuine health care and a low disease burden.
 
DEFECTS IN MEDICAL EDUCATION AND BASIC EDUCATION
Medical education in India needs a radical change; nothing short of a major surgery will save the critically ill medical education in India. We need to modify our medical education to produce doctors capable of addressing the problems of our country which are different from those of the developed world, because we are at least 50 years behind them in terms of social health, social security and human development. These days students go to medical colleges in India only to become specialists or super-specialists and never to become general practitioners/family doctors. All this is happening since the people in the power centers of medical education have no vision on healthcare issues and we fail to develop a health policy to address the various issues mentioned before. The people, in charge of medical education, starting from Principals of medical colleges to the Medical 8Council of India should be visionaries, capable of devising policies on sustainable health care. Besides making available all the health needs, we need to evolve policies on medical education, medical practice, hospitals and drug manufacturing on a war footing.
The practice of appointing “our men” in power centers, based on political and religious considerations should go. Instead, handpicked people who have a vision for the nation and are honest, transparent and non-corrupt and devoid of selfish motives should occupy all the decision-making posts. Our basic education and general education also need radical change. They should focus on instilling humane values, social health and democratic principles rather than on priming them to take up professional courses. Basic education should enable the students to come out as health-conscious human beings who know all the democratic principles, know the basics of science and have a scientific approach. Democracy in India has to become stronger leaving aside the considerations of caste and religion in social issues. As a result of general education and empowerment, we should also ensure that only those individuals who are mature enough and are willing to set aside all their personal interests, should be allowed to enter politics or occupy decision-making posts to serve the people of this country.
 
HEALTH ECONOMICS
Every one of us, especially those in administration, should be aware of the basics of health economics. We need to be aware of the fact that the health of an individual is the manifestation of healthy social and economic reforms. Needless to say that we need to introduce economic and social reforms to achieve all the objectives mentioned above. Every person who earns money should give his share for social security and human development. Everyone should in turn get all basic health needs from the administration. The evil of gross inequitable distribution of wealth ought to be corrected by all possible measures. We must focus more on providing social security and human development, which can only be achieved when we get rid of our money-mindedness. But the paradox is that it is the lack of social security and lack of human development that instil money-mindedness in our people. Lack of social security and human development makes every Indian work only for earning money without any other larger social objectives in mind. In that process 9some become successful and accumulate all the wealth and deposit it as dead investments making it unavailable to others. The creativity of the people in nation building is stunted due to this narrow-minded objective generated by the lack of social security. To avoid wastage of resources and to raise more resources for providing basic health needs and social security, we need to root out corruption. For this, the most important step is to insist that all transactions be made transparent by using only cheques and debit cards, which will wipe out corruption, black money and counterfeit notes. India is a rich country; it only needs effective management to achieve all the objectives mentioned earlier. We must also remember that health cannot be achieved and maintained in compartments, be it in a body or in a society. Someday, the problems in health care will spread venom to other parts of the human body or society. Therefore, we should work with social concern and should act locally while thinking globally; after all, we are social beings (social animals). Naturally, this involves cooperation of all citizens and of all the departments in the government. In other words, all ministers must be health ministers in a certain sense. In the following essays, I will try and elaborate on the issues I have highlighted above.