Note ban an unguided missile fired unilaterally, says Amartya Sen

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MUMBAI: Nobel laureate and economist Amartya Sen on Saturday blamed lack of political will and public demand for the country’s failure to provide affordable healthcare to all. Speaking on ‘Healthcare For All—Why and How’ at Tata Memorial Centre’s platinum jubilee celebrations, Sen remained highly critical of the increased privatization of health services and said exploitation of the poor must stop.

A professor of economics and philosophy at Harvard University, Sen pointed out the share of private players in Indian healthcare was enormously high and distinctly more than the ratio seen even in developed nations. Yet, quality was a problem. Citing an example from Jharkhand, the professor said malaria patients are routinely pumped with saline injections to make them feel better. “Quackery, when combined with crookery, can have alarming consequences. The exploitation of the poor by private doctors must stop,” he said.

He also called the note ban an unguided “missile” fired “unilaterally” by the government without adhering to the democratic conventions. “There are reports coming in of hardships and suffering. . .it is not quite clear where the missile has landed,” Sen said.

Lamenting that India’s performance in health does not stand at the top of the world league but at the bottom, Sen said nations like Nepal and Bangladesh with much lesser per capita income have overtaken some of India’s social parameters. “India is only ahead of Pakistan in certain health parameters,” he said, adding more recognition was needed for the central role of public healthcare. A reason for the country’s health backwardness, which is a “striking failure”, was also the fact that the deprived society has hardly benefited from economic growth. The “moral hazard” created by subsidising private hospitals in schemes like the Rashtriya Suraksha Beema Yojana also has to stop, he said.

The government’s meagre 1.3% spending of GDP on healthcare also came under attack. “India spends an incredibly small amount. China spends about 3%,” he said, adding the new income generated by economic growth has been very unequally shared. Sen said the definition of healthcare should be broadened to include social determinants such as nutrition, sanitation and social equity.

Sen found it intriguing that health, despite being a matter of urgent importance, hardly finds a place in political discourse. He said it was surprising that healthcare did not find a mention in the 2014 election manifestos of any of the major political parties. He partly blamed the media for lack of discussion on the subject and said as per his own team’s analysis in 2012, less than 1% of editorial space was devoted to health news.

Sen’s speech was part of the three-day conference organised by the Tata Memorial Centre to discuss if healthcare was a commodity or a basic human need. “I disagree with healthcare being treated as a commodity. It is not the right way of delivering healthcare,” he said. A cancer survivor himself, Sen also said cancer treatment is often not treated as a right since there are questions of feasibility, etc. “The recognition of right is an ethical recognition,” he said, adding it becomes the commitment of a nation.