Should health be given the status of a fundamental right, guaranteed under the Constitution? When the NDA returned to power at the Centre in 2014, it did moot such a proposal in its draft tiol health policy (NHP) in December that year. Flush with noble intentions, it spoke of the need to bring about universal and affordable healthcare to the people. It further put forward the idea that health could be made a fundamental right, very much in line with elementary education being given such a status in 2009. However, hard-headed ‘pragmatism’ took over by the time the Central government announced the NHP in March last year, that too after the Supreme Court’s prodding. tiol Health Policy 2017 has promised to hike public health spending to 2.5% of the country’s GDP in ‘time-bound manner’, to move away from ‘sick-care to wellness’ by putting the thrust on prevention and health promotion. When Union Health Minister JP dda was asked what happened to the proposal to declare health a fundamental right (and therefore legally enforceable), he candidly replied: “What if we are not able to provide the services?”. dda may have dubbed the NHP “a milestone”, but it has failed to impress healthcare activists. GDP spend of 2.5% on health by 2025 was setting the target too low, they argue. This low priority to health has been a bugbear long afflicting the country. After independence, it amounted to a measly 0.22% of GDP in 1950-51; even as late as a decade into the new millennium, this spending was barely a little over 1% of GDP, as noted by the Economic Survey last year. It quoted Reserve Bank data relating to expenditure on education and health by the Centre and States to be 2.9% and 1.4% respectively (as per 2016-17 budget estimate). The survey made a telling observation about the Indian economic model — that it is characterised by a “weakness of state capacity” in delivering essential services like health and education to the people.
Health as a right
Is it at all surprising that in terms of public spending on health, India ranked just a little above the bottom at 187th among 194 countries as per WHO World Health Statistics 2015? The pragmatists in government argue that leaving aside public health threats like epidemics, there is little the State can do if individuals happen to fall sick, ‘often because of their own carelessness’. This is countered by healthcare activists pointing to the polluted air in the country’s capital that is taking huge toll on the health of Delhi schoolchildren. Surely these children have not been irresponsible or asked for such unhealthy environs? When the circumstances of working and living can make people ill, surely the society and State owe some sort of commitment to make things better. This can be guaranteed only by making health a justiciable right, the activists argue. There is another school of thought which says that instead of blaming people for contracting health problems, the government should consider how much it is losing in economic and productivity terms. For example, a World Bank estimate in 2010 showed that India loses 6% of its GDP annually because of premature deaths and preventable illness. But how can a country like India, soon to have the world’s largest population, afford universal and affordable healthcare? This is a very difficult challenge to take up, but by no means impossible, provided the political will is there. Countries like US and Germany have put in place insurance-centric medicare, mixing public funding with private and community insurance; in contrast, the governments of Britain and Cada bear the medical costs of citizens by raising funds through progressive income tax, wealth taxes etc. In 1971, Chi was very much a developing country, yet was spending a little below 2.5% of its GDP on healthcare; this figure has more than doubled to 5.5% now and is in the global 5-6 percent GDP spend average. More creditably, Chi has achieved over 95% public medical insurance coverage.
In comparison, the tiol Health Assurance Mission (NHAM) in India is struggling to take off with its aim of universal health insurance cover. The upshot is that Indians are left to fend for themselves with healthcare costs far beyond their reach, selling off land and family assets or taking on unserviceable loans. The Out of Pocket Expenses (OPE) by Indians on healthcare is in the range of 70-80%, amongst the highest in the world. The draft tiol Health Policy, 2015 noted that over 6.3 crore people are pushed into poverty every year after spending their all on uffordable healthcare. Yet the Central government has ruled out charging a health cess on products like alcohol/tobacco or on extractive industries; it also continues to maintain that healthcare spending is adequate — only its proper utilisation is a problem! It is true that more can be done with existing resources by making health budgeting and fincing effective as well as flexible, while ensuring proper monitoring. But the government needs to ramp up medical infrastructure, build capacity and train adequate staff at all levels. For this, the mindset of the powers-be has to change by considering healthcare as an investment rather than a cost burden. Which is why, the issue of making health a right continues to be relevant. Recently, the Amika Ray Memorial Trust in Assam has pertinently raised the issue for public debate, pointing out that the Right to Life under Article 21 can be given wider scope to include the right to health. The idea is to seek greater commitment and responsibility from stakeholders, the medical fraternity and government included.