Health is as much a political as a medical issue and it is time Indian political organizations gave top priority to public health issues in their work.
This was among the conclusions arrived at by a meeting of activists who in Chennai to discuss ways to change the dire situation of public health in the country.
The meeting was the first in a series of consultations being undertaken in different parts of the country as a step towards the formation of the Indian Health Front, a broad coalition of activists and organizations working on both health and related political issues.
Similar consultations are planned to be held in Bangalore, Kolkota, New Delhi, Chandigarh, Mumbai culminating in a national conference in Bhopal on 3 December 2007, the 23rd anniversary of the Bhopal gas disaster.
A wide range of issues related to the public health situation in the country were raised by participants, who were mostly from Tamil Nadu but also from Karnataka and Andhra Pradesh.
Starting off the meeting Amal, one of the organizers, said that the challenges of solving problems of public health in the world's second most populous country with development indicators often worse than sub-Saharan Africa were immense. He explained that the idea of setting up the Indian Health Front was not to compete with any existing organizations but to add more hands to take up the huge tasks ahead and add a radical political direction to the movement.
The Indian Health Front he said would try to network all those interested in working on such issues in an open and non-sectarian manner.
Amal also emphasized that apart from addressing health policy and its proper implementation the new front would also try to make direct interventions in the community to tackle public health problems. There was a need today, he said, to build new traditions of social solidarity, mutual cooperation and compassion in Indian society.
Geeta Ramakrishnan, veteran labour and women's rights activist, spoke about the health problems of the urban poor and said that the Indian State had completely failed to meet their needs. In particular, she pointed out that unorganized labour, which formed over 90 percent of the country's workforce, had little or no health care at all. The State, instead of taking care of their health needs was busy privatizing healthcare and making it unaffordable for ordinary people.
Dr Rakhal Gaitonde spoke about the situation of health care in rural areas and said that the situation of infant and maternal mortality or access to health facilities was dismal even in a state like Tamil Nadu, which was relatively better compared to other parts of the country.
Abhay Shukla, Convenor, Jan Swasthya Abhiyan gave an overview of the campaign's history, activities and key objectives. The JSA is a campaign launched in 2000 jointly by 18 national networks working on health and related issues.
According to him from the experience of the JSA there were five important tasks ahead of the public health movement, namely:
• Making health a sustained mass issue
• Developing an overarching strategy to deal with problems of both public and private health systems
• Developing an integrated set of demands on health care and its social and economic determinants
• Carrying out constructive health service delivery work and building models that can be the basis for demanding a new approach to health issues
• Developing transitional demands which can be demanded with justification today but which would also take us towards a new system tomorrow
Dr Srinivasan of Medico Friends Circle said that the crisis of healthcare delivery services in India had deepened in the last thirty years. He gave an overview of the history of the MFC, which was formed in 1975 and its regular activities.
G.Ananthakrishnan presented a paper on the potential for introducing a universal health insurance in India. Dr Padma Balasubramaniam and Pratyush Bharati made presentations on the experience of Cuba's health care system and the changes being brought about in the health sector by Hugo Chavez's Venezuela.
In the discussions that followed participants pointed out that the health status of the population was closely linked to the social, economic, cultural and political situation in the country. Poverty, manifested in the form of low income, malnutrition, lack of drinking water and poor access to energy sources it was pointed out was the biggest disease in itself as well as the cause of most health problems.
Caste and gender discrimination, the commercialization of medical education and the lack of health facilities in rural areas were also major reasons for the poor status of health in India. In recent years, the advent of neo-liberal economic policies has compounded the problems of public health in the country by creating huge income inequalities, giving a free rein to multinationals that operated polluting industries and marginalizing people who depended on agriculture for survival.
Some participants said that the problem of impunity of multinationals, exemplified by Union Carbide (and its successor Dow Chemicals) of Bhopal gas tragedy notoriety, was only bound to get worse in the days ahead.
Apart from low investments in public health infrastructure a major problem was the poor maintenance of existing facilities and lack of implementation of announced policies. And in this situation the Indian State was washing its hands off its responsibilities by encouraging corporations to take over the health sector.
Some participants also emphasized the need not to 'medicalise' the public health system and create too much dependence on doctors, hospitals and pharmaceuticals. Instead it was suggested to help people take care of their own health in various ways, including through the use of traditional systems of medicine in the country.
Manohar of Sangama, Bangalore told participants about the various problems of discrimination, violence and lack of access to healthcare faced by sexual minorities in India.
Among the suggestions for activities to be taken up as part of the Indian Health Front's activities were:
• Campaign for free healthcare and social security for all
• Campaigning for greater State investment in basic rural and urban infrastructure such as water, energy and sanitation
• Setting up citizen's health committees at various levels to monitor public health.
• Organising healthcare workers
• Studying impact of globalization on public health
• Creating a national rural health network
• Fighting against privatization of medical education
• Working together with other organisations in the health movement
