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.