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Jul 29, 2016

What do we want: Health as a ‘Right’ or just an ‘Assurance’

Pallavi Gupta

25 July 2016: A day  that began on an optimistic note with the news ‘Health could soon become a fundamental right’, ended with the optimism being busted by the evening edition, ‘National Health Policy: Cabinet note proposes assured services to all’. 

As many public health advocates who have been trying to get successive governments to recognise health as a fundamental right for decades would tell you, the optimism was at best naïve. Naïve, especially given the current socio-political situation in which the ‘ease of doing business’ narrative overrules principles of equity. 

The second article mentioned above quotes a ministry official saying that the “Cabinet note does not talk about making health a fundamental right as it will have legal consequences”. Even though the general perception may be that just making something a ‘right’, does not mean that people start getting it, yet the fact that governments after governments have refused to recognise health as a fundamental right, speaks volumes about the inherent fear and danger in doing so. This very resistance indicates the potential benefits it holds for the citizens. 

In fact, the government’s reluctance itself is reason enough for the public health community to continue demanding for it. 

Though not part of the generation that brought it, I’m a strong believer and proponent of the 1978 Alma Ata “Health for All” declaration and the comprehensive primary healthcare approach. Stating this aloud in the present day and time is risking oneself to sharp reactions like - “ Ah, what world do you live in, who’s going to give you that, that era is long gone, it’s a utopian idea…”, so on and so forth. 

I beg to differ here. What do we call a utopian idea? Is it utopian that we ensure people have the basic minimum requirements of daily life — education concerning prevention and control of health problems; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child healthcare; appropriate treatment of common diseases and injuries; and provision of essential drugs. 

Is this too much to ask for? Apparently it is. Our rapidly growing economy is home to over 40 million stunted children and 17 million wasted children under five (India Health Report: Nutrition 2015). 60 million people fall below the poverty line in their attempt to seek healthcare in the country (draft National Health Policy 2015). Drawing from what a colleague once noted, India can send a spaceship to Mars, but has difficulty getting food to its people and sick people to hospitals! 

Public health expenditure in India has been hovering at a meagre 1% of GDP for years and all the rationale given by experts, ranging from public health advocates to economists (like Amartya Sen and Thomas Piketty) has fallen on deaf ears. Increasingly the message being sent out from the corridors of power is that it is unrealistic to expect the government to increase public health expenditure because of competing priorities for the limited resources. In fact, the emphasis is on looking at how the existing money is being spent, and if it is giving any ‘value for money’. Considering efficiency in spending is absolutely necessary, the emphasis is well placed. However, there is absolutely no way that public investment of a meagre 1% of GDP will give us the health outcomes we aspire for in our national goals and the Sustainable Development Goals no matter how efficiently we may spend that money. 

Incidentally, the oft-repeated excuse of ‘limited resources’ is something that Oxfam’s ‘Even It Up’ campaign is challenging nationally and globally, and is suggesting ways of increasing the resource pie. 

The government’s stance of ‘assured health services to all’ is not good enough. Civil Society Organisations have had significant role in the enactment of the Right to Food Act and the Right to Education Act — two relatively new and pro-people legislations enacted under the previous regime. In the same spirit, civil society should continue its struggle for right to health as a fundamental right. At the same time, government needs to consider the proposal with an open mind, weighing its social and political gains.   


Photo Credit: Subrata Biswas

Written By: Pallavi Gupta , Programme Coordinator – Health


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