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Wealth is health?

Wealth is health?

We cannot deny that our country has prospered in terms of healthcare. Some of the deadliest diseases can now be prevented or cured by our advanced hospitals and doctors.  But where is the equity and justice for all strata of society? While many patients from poor strata die for want of any medical attention, well to do exploit the medical facilities with impunity, even after a sneeze. Money and position has a great role to reduce one’s pain and prolong one’s life, goes without saying. We are aware of the rich and powerful in our society, dominating the public hospitals, crowding the corporate hospitals and even going to the London or New York which has the world’s best hospitals with the most advanced technology. Not long ago a top cricketer was treated abroad for an ailment that looked incurable here. Similarly President of a political party went abroad for treatment for a serious ailment. Many others funded by public funds also went to western countries and could enhance their life span. They can afford treatment there and their lifestyle ensures that they must enjoy similar life expectancy as the top percentiles in the developed countries. On the other hand, healthcare for the poor in India is non-existent or of low standard. In fact Indian conditions do not offer health to most people-rich or poor.  Governments whether central or states like Punjab or Haryana have persistently kept a low outlay for health. In fact one caption in a leading daily mentioned sharp decline of Punjab health budget from 11% in 1970 to less than 5% now. The preventive education and promotive health has been given a back seat. The poor are ignored in public healthcare institutions and the rich are exploited with impunity in the corporate hospitals. Who gets appropriate attention?

 

  “Over 63 million persons are faced with poverty every year due to healthcare costs alone.”  Further, many Indians spend around 70 per cent of their income on medicines and healthcare, almost double than in Sri Lanka. Earlier we were told from our childhood— health is wealth.  The new dictum appears to be ‘wealth is health’. Does it  hold good  in the present scenario?  The Journal of American Medical Association (JAMA), this month published a study entitled, “The Association between Income and Life Expectancy in the United States, 2001-2014” by economist Raj Chetty (Stanford University, California). In this study, the authors looked at mortality data and tax records, analyzing more than 1.4 billion person-years of data and about 7 million deaths between 1999 and 2014. We always suspected that there is direct association between higher income and longevity when the richest and poorest are compared. What is surprising is the extent of difference — 15 years in men and 10 years in women. Not only do the rich live longer, this gap has been widening. Conditional on reaching 40 years of age, individuals in the top 1per cent of income have 10 to 15 more years to enjoy their richly funded lives and to spend time with their children and grandchildren. Inequality in health reinforces inequality in income, and perhaps even a longer life is for sale.” This study has direct implications for India. If anything this “longevity gap” in India must be greater. This has also been pointed by the above-mentioned Rajya Sabha report. The lack of doctors and ever-increasing medication and healthcare costs are one aspect of the problem. The overall living conditions, absence of clean water, overcrowding, infections, poor diet — all of these contribute to higher mortality rates. As if on cue, the other leading medical journal, the New England Journal of Medicine, published a study from China, which showed that higher consumption of fresh fruit was associated with 40 per cent lower risk of death due to cardiovascular diseases and about 30 per cent lower risk of stroke. Higher fruit consumption was associated with lower blood pressure and blood glucose levels. How many of the bottom 5 per cent can today afford this relatively simple but beneficial health intervention? As individuals and as societies we are willing to pay millions for anti-cancer medications that prolong the life by a few months. This “medical” part of healthcare is no doubt important but the JAMA study has shown that healthcare without appropriate socio-economic and political solutions will be of marginal benefit. Hopefully, the government planning agencies will scrutinise this study (the first author being an Indian should help), and look at the nuances, the trends  (regional, racial, gender), to come up with policies that are aimed at improving income equities.   

While money is required to sustain healthy lifestyle, It is a bad mindset that wealth is health. When a common man is behind wealth, he thinks he is getting happiness and his happiness would give him health. But he forgets the point that he has already lost much of his health in his greed.  He has to take care of his lifestyle. He cannot depend entirely on Government. This task is too immense for governments to accomplish alone, especially in the developing nations, with more than 2 billion people living on less than $3.10 a day. NGOs can play a major role, while working with the governments for better health outcomes. The first step should be to minimize, if not eliminate, poverty. We need to act quickly, as the longevity gap is widening between the haves and have-nots.

 

 

There used to be a saying ‘if you lose wealth nothing is lost, if you lose health something is lost, but if you lose character everything is lost.  In the context of Indian traditions this still looks more acceptable, but is not a modern reality. 

 

 

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