Richard Hurley: We need your help: what will India’s 2014 general elections mean for health?

rich_hurleyIn a couple of months India will hold parliamentary elections to determine its next central government. This administration, due to hold office from June, will also have responsibility for drafting India’s 13th five year plan, which is key to its direction of development from 2017.
Prime Minister Manmohan Singh has said that he will not serve another term. Will his left-of-centre Indian National Congress, the ruling party since 2004, hang on to power? Or might the main opposition, the more socially conservative Bharatiya Janata Party, win, giving its leader, Narendra Modi, his chance in the hot seat?

Could one of these parties gain an outright majority or might some of the smaller parties gain a footing, if a coalition is the only way to form a government? And what about the new contender on the scene, the Aam Aadmi Party? Might it continue to gain popularity and sweep up a sizeable number of seats?

How might the next government’s economic and health policies affect the future of Indian drug manufacturing, healthcare services, medical education, and clinical research, for example?

Current government spending on health ranks India at a lowly 171th place out of 175 countries, at just 1% of GDP in 2011. Indeed, health did not feature at all in the finance minister’s agenda to make India the world’s third largest economy, in the interim budget that he just announced.

But in a country where two thirds of citizens, some 800 million people, must meet all their healthcare expenses out of pocket, leading to widespread indebtedness, why is neither main party using universal health coverage to advance its campaign–that is, some form of insurance for all citizens (see this BMJ personal view article, How India can provide healthcare for all,  and a feature, Protecting India’s poorest from unaffordable medical bills, for more information)

And what about malnutrition, which affects as many as two in five Indian children under 3 years old? And the infectious diseases that continue to burden the Indian populace heavily, such as tuberculosis, dengue, rabies, and pneumonia. What about sanitation? And women’s health?And rural health? And shortcomings in nursing?

In many countries health policy is a deal breaker come election time. For example, no UK political party can afford to ignore let alone threaten the NHS. And in the United States, consider the level of public debate surrounding “Obamacare” at the last election. The same does not seem to be true in India on anywhere near the same scale.

With your help, we’d like to start to try to change that. We’d like to know what you, as a healthcare professional, think about India’s political parties, their health and other policies, their leaders, and the electoral process in general.

  • Who do you think will win, and what will it mean for health and healthcare in the country?
  • Who do you think should win and why?
  • Who would you appoint to lead India, if you could choose anyone?
  • What are the key health and other policy areas that the parties should focus on?
  • Why does health seem so far from the top of the parties’ lists of priorities?
  • Must health policy always play second fiddle to economic policy?

And, finally, as we approach this defining moment in India’s journey, how would you like to see us present these issues in The BMJ? Please do post a comment in response to this blog and let us know.

And please share this blog with your colleagues and friends.

I thank Anita Jain, The BMJ’s India editor, for useful comments on an earlier draft.

Richard Hurley is India comment editor at The BMJ

  • Giridhar R Babu

    Richard, You have raised some valid questions here. As of now, none of the political parties have shown any commitment in announcing their action points for health care. I wish these questions are asked by media to every political party.

  • BM Hegde

    Health for all- Health Care Vs Medical Care.

    Prof. B. M. Hegde,

    Doctors do not
    have anything to do with health care at all. We do medical care of trying to
    mend the broken glass with some glue that we think would make it work again.
    Based on this false foundation the WHO and many other governments believed that
    good medical care would bring about health for all by 2000 AD. Interestingly,
    in the same year the Institute of Medicine, an audit body of the American National
    Academy of Science, came out with its audit on the medical care in the US.
    The report, commented on by Barbara Starfield of the Johns Hopkins University,
    did show that the present medical care in the US, supposed to be the best in
    the world, had in fact, been a curse on mankind. Drug side effects, hospital
    errors, hospital acquired infections, and medical interventions and over
    investigations have, together been the third leading cause of death after cancer,
    heart attacks. (JAMA 2000; 284: 483-485)

    “To believe that
    doctors and hospitals help keep people healthy is plain rubbish,” wrote one of
    the great British physicians. “How to avoid modern medicine” is the title of an
    article written by the Late Lord Platt in the early 60s.

    “More people
    make a living OFF hypertension than die OF it,” wrote Sir George Pickering, a
    former Regius Professor of medicine in Oxford,
    who also taught for sometime at the Johns Hopkins. He was a great
    hypertensinologist who had written that great monograph on hypertension. He
    also wrote that the anti-hypertensive drugs robbed the patient of all that is
    enshrined in the American Constitution (Thomas Jefferson 1772) of “life,
    liberty and pursuit of happiness.” Life, George said, we are not sure, liberty
    patients do not have, and happiness would be a thing of the past after they
    start anti-hypertensive treatment!” How true?

    Richard Asher,
    that great clinician, who spent four decades teaching medicine at the Central Middlesex
    Hospital, London, wrote, “Riva Roci would grieve
    indeed, if he were to look at the abuse and misuse of the little box that he
    invented to make life miserable for human beings.” Asher was talking about the
    ubiquitous BP apparatus! All this was long before the great scientific studies
    being shown to doctors in practice by the pharma lobby like “HOT Study” and the
    ALLAHAT study. Many of these study results were doctored before being
    published. Some of the studies were stopped prematurely like the HOT study and
    we are not told why the HOT study was prematurely stopped and the results
    analysed by “intention-to-treat” analysis while quite a few patients that
    started the study initially had dropped off by then because of intolerable side

    Re-analysis of
    the famous UKPDS study of diabetes treatment analysed retrospectively after 40
    years showed how the authors were “seeing what they wanted to see” in the
    study. Our present drug treatment of diabetes seems to have done more harm than
    good. “Eye of the Beholder”, is a good reanalysis of the “good” that bypass
    surgeries were supposed to do. CAST study showed that not all that glitters is
    gold in the area of anti-arrhythmic cardiac drugs.

    Statins are made
    out to be a panacea for all ills, but have dangerous side effects.

    It looks as if
    there is a pill for every ill; while in reality, it is the other way round.
    Every pill has an ill, if not more, following it!

    A recent
    analysis of the immediate post heart attack revascularization showed that
    “getting admitted after a heart attack to a hospital was the greatest risk
    factor for stroke. This risk was much greater than hypertension, diabetes etc!

    catheters, albumin infusions and, some keyhole surgeries have all come to grief
    sooner than expected. AIDS research is four times “richer” than cancer research
    but nothing seems to have come out of it since it began way back in 1981.
    Nothing has emerged in the field of AIDS management that will set the River
    Ganges on fire.

    Health care
    needs are very few. They are clean drinking water for all mankind, three square
    healthy meals uncontaminated by human and/or animal excreta, clean surroundings
    for dwelling, tranquility of mind, moderate
    exercise on a regular basis, sanitary facilities like toilets for every house,
    sewerage drainage, cooking smoke free houses, nutrition of the pregnant mother
    and the new born babies, mosquito nets for all, universal education, education
    of girls up to the age of at least 20 years to postpone marriage and consequent
    high fertility rates, judicious vaccination of children if their nutritional
    status is satisfactory and, not the least, economic empowerment of village
    women. None of these is the concern of modern medicine.

    Health is our
    birthright. Our inbuilt immune system will keep us going as long as it could.
    In the unlikely event of it failing only should doctors intervene to “cure
    rarely, comfort mostly, but console always.” Modern medicine’s biggest curse
    has been “not letting the well alone.” Screening the healthy for early diseases
    and intervening has been the bane of modern medicine although it has been a
    boon to the industry-the medi-business. When one is healthy, he/she should
    never go to a hospital although one should see his/her doctor at the first sign
    of anything going astray with one’s body or mind. The greatest discovery of
    science in this century has been the discovery of man’s ignorance, which is at
    its best in the field of medical sciences.

    The powers that
    be that really want to have a healthy society should strive to cure the three
    ills of society that make it unhealthy-poverty, ignorance, and dependence on
    others. Poverty is the mother of all illnesses ranging from common cold to
    cancer. In addition, poverty is also a double-edged weapon. The poor, when they
    fall sick, lose their daily wage earning capacity pushing them and their dependents
    further down into the bottomless pit of poverty and illnesses! It is not just
    the quality of air that we breathe that is our biggest danger. 47 million
    children in India suffer from NIDS nutritional Immune Deficiency Syndrome, which
    needs to be tackled on a war footing. Will the candidates for the 2014
    elections take note?

  • Dr Kiran Kumbhar

    Unfortunately, the Indian sociopolitical scenario has not yet advanced
    to the degree where rational, pragmatic issues like health and education
    take precedence over caste, religion and region. The media also isn’t
    assisting much to help bring health into public discourse in a big way.
    Only if tv channels and papers come out with hard-hitting stories on the
    dismal state of healthcare and the widespread corruption in it (without
    of course solely targeting doctors as is their favorite pastime) will
    we see people and politicians both starting to talk more about health.
    Til then, it will most probably remain a very tiny concern in political talk.

  • Abraham Peedicayil

    It is a shame that India stands 171/175 countries in health expenditure. It shows how skewed our policies are. Big business dictates policy in this country!
    Recently AAP had a press release denouncing the reinstatement of corrupt officials in the MCI. Beurocrats in India are punished if they stand up to corruption; Ministers are transferred if they do not tow the line to capitalist greed.
    The forthcoming elections will throw up a fractured mandate. I hope there will be a stable coalition. I hope AAP will be there in sufficient numbers to check the corrupt. I am optimistic that India’s judiciary and press will influence and help our legislature to evolve to bring justice, peace and goodwill to our land.

  • Jagannath

    Public health measures are desperately needed in India. Every city of the country now boasts multi-speciality hospitals pointing to the quantum of serious illness that has hit its citizen. “Health care” costs are driving people crazy and insurance companies have joined Pharma to cash in on the situation. We need health not medicines and hospitals. The sooner we get it the better.

  • Somnath Salgar

    Dr Somnath Salgar
    All political parties must address health in India in their election manifesto in coming elections. Issues like malnutrition, drinking water, health care in rural india should be addressed.
    Congrats to BMJ editorial team