It is an established and accepted fact that the health of the people in a country depends on the access to a network of basic needs that includes nutritious food and health care. A conducive physical and biological environment at the place of living and work, egalitarian social relationships, emotional well being as and a peaceful social environment are all recognised determinants of health of any population.
To those of us working in the field of health, it is clear that there is a significant deterioration in the conditions needed for people’s health.
Vital for health are not only the number of doctors, drugs and hospitals but also the distribution of these resources and the access to these by all groups within the community. The functioning of the state and the orientation provided by the political leadership of the nation are crucial to the administration of health care and all the resources needed to lead a healthy life with dignity and freedom. Also critical is a varied and balanced diet according to availability.
Challenges of Public Health Administration
Indeed the health system is a core social institution whose development, effectiveness and accessibility are determined by the political will. The past two years’ central budgets have effectively reduced allocations on health. The previous government has dragged its feet in meeting the promise of doubling the health budget to 2.5% of the GDP. The present Niti Aayog has made the situation worse by backing the reduction of public health expenditure from its already abysmally low levels even further. The withdrawal of the government services will have catastrophic effect because the private health services will exploit not only the poor and marginalised strata, but also many in middle classes. The worst affected would be those in 'unprofitable' backward areas where the privatised health care will not go.
The slashing of governmental health expenditure has now entered a multi-sectoral phase:
The changes being brought about in labour and environmental protection laws are also in directions that will create unhealthy conditions for a vast majority of the marginalised sections and regions.
The food supplementation schemes such as the ICDS programme are under threat.
Food fundamentalism, society and government
India has one of the most varied food preferences ever seen in the world: wheat in the north, rice in the south, over 10-15 kinds of millets like ragi, bajra, makai,etc. , several varieties of pulses. India has the largest number of oilseeds in the world, til, groundnut, sunflower, mustard, mahua, safflower, castor, rice bran, and many more minor oilseeds etc.
In addition we have a few vegetarians (less than 20%), many non-vegetarians (around 70-80%), vegans, non-vegetarians who do not eat pork, non-vegetarians who do not eat beef, tribals who will not drink milk, but will eat beef, entire populations who live on small animals, birds, insects which they hunt for survival. In addition, we have vegetarian Jains who will not eat root vegetables, including garlic and onions, and one can go on.
The development of any food culture is a long term historical adaptation to what is available in specific situations.
Despite this we are also home to the largest number of hungry undernourished populations (adult and children) in the world who are anaemic, with multiple nutrient deficiencies (50--80%.) Of course one justification made by the Vice Chairman of Niti Aayog is that Indians are not meant to be tall!
On the one hand, it is disturbing that the Govt. has failed to feed populations in India. It has failed to control the price of important sources of proteins like pulses. The Right to Food Act has not yet been rolled out.
On the other hand, attacks on meat eating populations belonging to certain communities in the name of a sacred Hindu vegetarianism will tear the already weak fabric of this country. This is nothing less than an attack on the eating cultures of the country, and can have a catastrophic avalanche effect.
The current governmental climate of aggression on food culture—whether the pressure to eliminate eggs in the school lunch programme, or the banning of beef in Maharashtra—presents alarming tendencies in the domains of health, economics and culture.
The lynching at Dadri and the lackadaisical governmental response to it are the tragic outcome of the wider structural problem we have described.
Administrative cutbacks, political apathy and passive encouragement
Overall, a) the freezing of health and social sector budgets; b) the weakening and dilution of critical labor protection and environment protection laws in the name of development; c) the overwhelming influence of the private sector and its vulgar profit logic on all decision making; d) the harping on a farcical notion of an ancient India that had discovered everything that was worth knowing'; and e) the consequent subversion of any rational mindset, are all aspects of the present public health crisis. The price will be paid in both short term increases in illnesses, in long term morbidity, in the tragic and avoidable loss of lives, and the decline in well being of all.
The lack of a strong message from government’s political leadership that all are to be treated as equal citizens is directly responsible for criminal acts such as lynching, murder, aggression and vandalism perpetrated on the people (dalits, religious minorities, women, tribals and rationalists). This passive response to cultural aggression serves as an active encouragement given to a majoritarian, coercive mindset. It results in direct increase in the blatant incidents that are taking lives of Indian citizens. Such an atmosphere has a telling effect on the emotional and physical well being of the population. The government has to forcefully convey its commitment to justice and democracy, punish those who disobey, and expel from government and police posts all who actively or passively encourage such activity.
Medico Friend Circle is an organization of committed physicians, experts from academia and activists from civil society. We have worked over forty years on various aspects of health in India. Ever since the Indian state embarked the neo-liberal pathway of development (and even before), Medico Friend Circle has consistently criticised the governments for their blinkered approach and lack of vision in the health care sector and its public responsibility. We are deeply concerned at this state of affairs that is in short terrible for the idea that is India, and the health of the Indian people.
• An immediate reversal to the cuts in health and social sector spending.
• Immediate reversal of the dilutions introduced to labor law and environmental law.
• Strengthening and improvement of the ICDS programme.
• Immediate price control of all essential food commodities.
• Action to fulfill the government’s responsibility to create an environment in which all sections feel a sense of justice, especially the more vulnerable, that fosters social harmony, and the health and wellbeing of all.
Medico Friend Circle www.mfcindia.org