SPEND ON HEALTH, INVEST IN FUTURE

 

When it comes to health, in India we think it is God’s gift and it should be free like the air we breathe and the water we drink, though neither of them remains free today if we want them clean and healthy. Both as government and as individuals we hate to spend on health and consider such expenditure to be unnecessary, unfair and a punishment. Why should a doctor charge for his service? Is it not his duty to cure? Why is he so money minded? These are the usual utterances we hear, but we the people have never asked our governments why they tend to spend so little on our health and why are public hospitals invariably overcrowded and under-funded.

 

Then came the COVID pandemic and the government was forced to spend substantial amounts to beef up our facilities in government hospitals. Investments were made in beds, PPE kits, testing facilities, ventilators, masks etc. to accelerate our capacity building during the lockdown and thereafter, which not only made us self reliant but thankfully we were able to help a few of our neighbours. Our healthcare professionals and frontline workers responded splendidly and despite our 1.3 billion population and alarming population density we managed to keep our mortality and morbidity figures far better than the countries in the developed world. But, the fact remains, we would not have been so stressed had we spent on the capacity building of our health sector in a sustained way, right from the time of our independence.

 

Our attitude

Why did we not do so? The problem is in our attitude. We Indians still long to be treated by wizards of yesteryear, who could look into our eyes, feel our pulse and rattle out all our ailments. Even today, it is very difficult to make people understand that when in cinemas they see a ‘hakim’ feel the pulse of a heroine and declare her to be pregnant, the entire exercise is most unscientific and incorrect. Your pulse can only tell me that you are alive and a bit more, but not much! Today when a doctor listens to your history, examines you and still comes up with only a provisional diagnosis and asks you to get a list of investigations done so that he can come to a final diagnosis, you are not a happy man. You think there is a conspiracy being hatched against you to rob your money! But you fail to understand that it is this evidence based medicine, this combination of better investigations and better treatment that has improved the life expectancy of Indians from 38 years in 1947 to 72 years in the last census! And like in every other sphere in this world, anything that is better, costs more!!

 

Government spending

India spends only 1.3% of its GDP in health, one of the lowest in the world. Even China, Brazil, Indonesia and Philippines spend 7-10% of their GDP in this sector because they realize that spending on health is not an unnecessary expenditure but an investment in future. No wonder our Infant Mortality Rates and Maternal Mortality Rates remain so unacceptably high. If government fails to allocate sufficient budget for health the public hospitals remain under-funded and under-staffed and more and more patients spill over to the private sector and incur out of pocket expenditure. Even if one member of a low income family has to be treated for a major ailment in the private sector, the family runs the risk of slipping under the poverty line. Aayushman Bharat programme is today addressing this problem but only just.

 

Human Capital

Spending on health is a very valuable economic investment which will invariably yield profitable dividends in the form of healthy work force with maximum ability and minimum ill-health and absenteeism. So by investing in health we build human capital and a productive work force. Healthy adults are assets in factories, fields, industries, sports and all spheres of life. Healthy children do better in schools and sports, grow into healthy and more productive adults. Healthy girls become healthy mothers, who bear healthy babies and the cycle of health gets repeated. All these people make our nation healthy, productive and economically strong. The World Bank has a Human Capital Index which measures a country’s productivity per worker. Today India ranks 116^th in this list with a dismal score of 0.49. The first  three countries in this list are all Asian countries – Singapore 0.88, Hong Kong & China 0.81 and Japan 0.80! So our work force is half as productive, no wonder we remain a developing country!! Investing in health today will improve our GDP tomorrow.

 

Employment generation

Another huge reason why we should be investing in the health sector is that it is that it generates employment like no other sector.  You will be surprised to know that Health sector today is a $8 trillion industry. You might not have understood the size of this industry yet so let me help you – Information Technology is a $3.4 trillion industry and Oil and Automobile are both $2.0 trillion. So the health sector is I.T plus Oil plus Automobile plus more!! Now let us look at the scope of employment – Maruti employs 13,500 employees and earns revenue of Rs. 66,500.00 crores whereas Narayan Health of Dr. Devi Shetty employs 15,500 employees and and makes a profit of 1,878.00 crores! So health sector creates disproportionately higher number of jobs, a boon for particularly the semi-skilled and the non-skilled youth. India needs 2 million nurses and the rest of the world needs 9 million more. Similarly there are requirements for physiotherapists, occupational therapists, vocational trainers and domiciliary care healthcare workers for the elderly, the pregnant and the invalid, particularly when the joint families are breaking down into smaller nuclear units.

 

Spending in health is vital for the future health of our economy and our country. A change in mindset is essential both at individual level as well as at the level of the government. As individuals we must understand that vaccinations for disease prevention and investigations early diagnosis may be costly today but treating the full blown disease with its complications will be far more costly tomorrow. As a government we must invest in health to build human capital and also generate newer avenues of employment.

FAMOUS BOULEVARDS NEED A SECOND LOOK

 

I am from Lucknow and anyone who has visited Lucknow must have walked down the famous Hazaratgunj, soaking up the history, the feeling, the nazakat and nafasat of the city. The bookshops, the apparel shops, the studios and the curio shops, the cafes, the hotels, the cinema halls, the church and the hanuman temple all add up to offer an excitement like no other. The crowded street corners and the densely packed Lover’s lane, the fiercely bargaining and yet polite street hawkers and the beautifully bejewelled and bedecked ladies all by themselves or with their handsome partners  all add to the beauty of the place and being in the midst of this cultural and culinary extravaganza is a divine experience called ‘ganjing’!   Hazaratgunj has changed with time and my generation remembers the ganjing experience of the past with nostalgia, but I cannot deny that the periodic beautification has kept her young and vibrant!

 

Swanston Street is one of the main north-south streets in the city of Melbourne, lined on either side with a number of iconic landmarks and heritage buildings. Once a very congested and polluted street, it is today an example of pedestrian-oriented and transit-priority street design. Always a cultural epicentre, with excellent shopping and culinary options, the changes over time has kept it vibrant and enjoyable. These periodic changes have strengthened the identity of the city and enhanced user experience and access for shoppers, visitors, workers, cyclists, and transit users. It has created more attractive, democratic, and safe public spaces, provided spaces where people can gather and meet and organize art exhibitions, and events. There are tram stops for important landmarks like City Square and the State Library and private cars and taxis are not allowed. Increaseing the sidewalk width, creating dedicated cycle lanes and raised tram platforms has allowed universal access.

It's hard for travellers to resist the allure of a famous street whenever they visit a new city. It all seems so simple: one thoroughfare in which you can soak up local culture, do a little shopping, have something to eat, enjoy a few drinks, and maybe even spend the night. All in one location! It is not surprising when tourists flock to the world's best-known boulevards, its pre-eminent pathways and immortalize it for posterity. After all how can you not like the likes of the Royal Mile in Edinburgh, the Via Dolorosa in Jerusalem, Chandni Chowk in Delhi. Everyone should see these places and soak up the atmosphere.

 

However, plenty of the world's most famous streets have become victims of their own success, and are in dire need of a spruce up. Streets such as these…

Champs Elysees, Paris

I haven't walked down Paris's most famous street in a good 5 years or so. There's a reason for that, too. Last time I was there it just seemed to be a strip of high-rent chain stores and touristy, overpriced cafes. Why would you? And it seems as if Parisians agree, going by the recently announced plans to give the whole thing a $395 million makeover, which includes cutting traffic, extending pavements and creating new green space. Plenty of other cities could learn.

Hollywood Blvd, LA

You expect film-star glitz and glamour on one of the best-known boulevards in the world. What you get is grit and grime, an underwhelming and – depending on the block you happen to be walking on – occasionally scary thoroughfare that leaves you scratching your head for days after. Was that it? Yes, there are stars on the pavement with famous names printed on them, and a well-known theatre or two. But as a tourist attraction, Hollywood Blvd could use some serious work. I would advise you to instead try Sunset Blvd, just nearby, has a lot more going for it.

Jalan Alor, Kuala Lumpur

There's a rule in life that every traveller can pretty much swear by: if Anthony Bourdain ate there, it's going to be good. The guy had a knack for sniffing out every city's best eats, from fine-diners to dives. And in KL, Bourdain ate at Wong Ah Wah, a well-known purveyor of chicken wings on a well-known eat street, Jalan Alor. And WAW, as it's affectionately known by locals and travellers is good…. extremely good! The rest of Jalan Alor, however, is surprisingly average, particularly compared to some of the other foodie precincts in the Malaysian capital. Tourists love it, but plenty of KL residents steer clear. I would also advise you to try Jalan Raja Muda Musa which has some amazing options too.

La Rambla, Barcelona

Barcelona's most famous street is great – if you want to be robbed or ripped off, or pick up a tacky souvenir T-shirt and eat a massively overpriced paella. In a city with so much to offer, it seems bizarre that one of its most famous locations is so risky. You only have to step a few metres either side of La Rambla to find something far better: the stylish Gothic Quarter to the north-east, and the rough-and-tumble Raval on the other side. I will advise you to try Carrer del Parlament, in Sant Antoni, you will not be disappointed.

Orchard Rd, Singapore

It depends what you're into. If you like shopping, if the idea of mall after mall filled with high-end stores selling luxury items has you drooling in anticipation, then you really will enjoy Singapore's most famous street. You've got it all here: shoe shops, handbag stores, fine-dining restaurants, see-and-be-seen bars. But what you don't have is thriving culture that feels accessible and enjoyable for all. I will advise you to try Geylang Road. This is everything Orchard Road is not – for better and worse.

Times Square, NYC

Technically, this is not a street. But one of New York's most famous locations makes it to the list thanks to its incredible ability to maintain its tourist-drawing fame while offering absolutely nothing of any substance for those tourists to enjoy. Times Square itself is just an open space, not particularly lovely or inviting; the attractions that surround the square include Madame Tussaud's, Ripley's Believe It or Not, and a giant M&Ms World. Is this really what you came to New York for? If not then go to Union Square, which has far more going for it.

Khao San Rd, Bangkok

I'm a little torn here, because to change Khao San Road would be to lose its very essence. This notorious backpacker haven, popularized in the '80s and '90s, is just as sleazy as you would expect, filled with rowdy backpacker bars, cheap-as-chips hostels, and street stands selling some of the city's worst pad Thai. It's famous, but that doesn't mean it's pleasant. Still, would you want to change that? There are plenty of other places in Bangkok to go. Maybe Khao San Road should be left as it is. Phra Athit Road is Khoa San's classier cousin but perhaps my liking for it over Khao San is because I am not so young anymore and Khao San has not lost its youth!

Philosopher's Path, Kyoto

Kyoto is beautiful, stunningly, achingly beautiful, more so in the cherry blossom season. There's so much to love about this city, so much beauty to soak in, so much history to enjoy. Every street seems more charming than the last; every temple more mind-bogglingly lovely. And so for the famous Philosopher's Path, a winding walkway in the north-east of the city, you have high hopes. And those hopes, unless you arrive during cherry blossom season, will probably be dashed. The Philosopher's Path is oddly bland, a canal-side track that winds through a nondescript neighbourhood, leading nowhere in particular. The Arashiyama Bamboo Forest is an Instagrammer's fantasy and I would advise you to visit this place.

Abbey Rd, London

You only have yourself to blame if you arrive at Abbey Road in London expecting something amazing. This is a street that's famous for one thing, and one thing only: a pedestrian crossing that made it onto the cover of a fairly well-known record. Beatles fanatics and curious tourists flock here to recreate the album cover in their own special way, and then look around and realize there's nothing else to do. London's Carnaby Street and Brick Lane are also seriously underwhelming.

 

Boulevards give a city its soul and are canvases on which the culture of the city is painted. They are invariably pedestrian and cyclist friendly and have shops and cafes, cinemas and theatres, studios and curio shops and lots of open spaces for outdoor entertainment, florists, musicians and hawkers. Such streets can accommodate commercial activity; improve public participation, and sustainable environments that benefit the surrounding communities. Boulevards falling prey to civic negligence and decay need to be resuscitated urgently.