This Chapter discusses the role of government in health, highlighting that health is more than just the absence of disease; it includes access to clean water, a pollution-free environment, and adequate food. Healthcare in India is provided through both public and private facilities, but access is unequal, creating a paradox where the country has resources but struggles to provide healthcare for all.
The government’s role is to ensure the welfare of people by providing services like education, health, and infrastructure. Public health services are meant to be available to everyone, especially the poor, funded by taxes, but are not always adequate. The chapter also explores solutions like the Kerala government’s decentralization of resources to local governments to improve health and other services, as well as Costa Rica’s investment in health and education by abolishing its army.
What Is Health?
- Comprehensive definition: Health extends beyond the absence of disease to encompass physical and mental well-being, access to clean drinking water, a pollution-free environment, and adequate nutrition.
- Essential components: Availability of safe water, unpolluted surroundings, and sufficient food are critical, while inadequate living conditions heighten disease susceptibility.
- Government’s responsibility: The state is tasked with promoting citizens’ welfare by ensuring access to healthcare services, particularly for economically disadvantaged groups.
Healthcare in India
- Dual healthcare structure: Healthcare in India comprises government-operated public services and privately managed facilities, with disparities in accessibility across regions and populations.
- Public health services: These consist of state-run health centers and hospitals, funded through taxation, designed to deliver affordable or free medical care to all, including rural and urban communities.
- Private health facilities: Privately owned clinics, hospitals, and laboratories require payment for services, with a growing presence predominantly in urban centers.
- Constitutional obligation: The Indian Constitution mandates the government to safeguard public welfare and provide healthcare, upholding the Right to Life through timely medical intervention.
- Access disparity: Despite India’s resources, expertise, and personnel, equitable healthcare distribution remains elusive, limiting availability for many citizens.
- Social determinants: Health outcomes are influenced by factors such as poverty, inadequate housing, and lack of clean water, disproportionately affecting the underprivileged.
- Notable advancements: Kerala enhanced healthcare by decentralizing funds to local governance, while Costa Rica redirected military savings to bolster health and education services.
Public and Private Health Care Services
- Public healthcare overview: Government-managed facilities form a network of health centers and hospitals offering low-cost or free treatment, supported by public revenue.
- Private healthcare overview: Independent entities, including clinics and hospitals, provide fee-based services, with expansion largely concentrated in urban areas.
- Ownership distinction: Public services operate under state control with tax funding, whereas private services are managed by non-governmental entities for profit.
- Cost variation: Public healthcare strives for affordability, often at no charge, while private healthcare imposes significant expenses on patients.
- Geographical reach: Public services aim to span both rural and urban regions, whereas private facilities are predominantly urban, reducing rural accessibility.
Healthcare and Equality: Is Adequate Healthcare Available to All?
- Constitutional mandate: The Indian Constitution requires the state to ensure healthcare provision for all citizens, protecting the Right to Life with prompt medical support.
- Service comparison: Public healthcare seeks affordability through tax funding, while private healthcare, requiring payment, expands primarily in urban settings.
- Systemic contradiction: India possesses the knowledge and capacity for effective healthcare, yet fails to extend it uniformly across its population.
- Financial barriers: Many individuals cannot afford medications, with approximately 40% of hospitalized patients resorting to loans or asset sales to cover costs.
- Socioeconomic disparities: Poverty, gender disparities, and remote locations like tribal regions exacerbate unequal healthcare access, reflecting broader social inequities.
What Can Be Done?
- Enhancing basic amenities: Improving access to clean water, sanitation, and proper housing is essential to reduce disease prevalence and enhance public health.
- Strengthening governmental action: The state bears primary responsibility for delivering quality healthcare services universally, as mandated by constitutional duties.
- Boosting resource allocation: Increased funding for public healthcare, modeled on Kerala’s decentralized approach, can enhance service delivery and infrastructure.
- Adopting global strategies: Emulating Costa Rica’s redirection of military funds to health and education could optimize resource use for public welfare.
- Expanding public infrastructure: Upgrading and extending public health facilities to both rural and urban areas ensures broader, better-equipped coverage.
- Prioritizing prevention: Implementing state-led initiatives to curb disease spread, such as sanitation drives and water purification, bolsters community health.
The Kerala Experience
- Resource decentralization: In 1996, Kerala allocated 40% of its state budget to local panchayats, empowering them to address community-specific health requirements.
- Service enhancements: This initiative improved water supply systems, educational institutions, childcare centers, and healthcare facilities across the state.
- Persistent shortcomings: Challenges such as medicine shortages, limited hospital beds, and insufficient medical staff continue to hinder full effectiveness.
The Costa Rican Approach
- Reallocation of funds: Costa Rica eliminated its army, channeling those resources into health, education, and essential public services.
- Universal basic provisions: The government ensures all citizens receive safe drinking water, sanitation, nutrition, and housing support.
- Health education emphasis: Integrating health education into all educational levels has positioned Costa Rica as a health leader in Central America.
Questions and Answers
- Why is universal adult franchise important in a democracy?
- Universal adult franchise is very important in democratic societies. It ensures that all adult citizens (those who are 18 and above) have the right to vote, regardless of their social or economic backgrounds.
- Re-read the box on Article 15 and state two ways in which this Article addresses inequality.
- Article 15 of the Indian Constitution prohibits discrimination based on religion, race, caste, sex, or place of birth.
- It ensures that no citizen is subject to any disability, liability, restriction, or condition regarding access to shops, public restaurants, hotels, places of public entertainment, or the use of wells, tanks, bathing ghats, roads, and public resorts maintained by the State or dedicated to the general public.
- What do you understand by the term “all persons are equal before the law”? Why do you think it is important in a democracy?
- “All persons are equal before the law” means that every person, from the President to a domestic worker, must obey the same laws.
- It is crucial in a democracy because it ensures that everyone is treated equally and fairly under the legal system, which is a fundamental principle of equality.
- According to the Rights of Persons with Disabilities Act, 2016, persons with disabilities have equal rights, and that the government should make possible their full participation in society.
- The government must provide free education and integrate children with disabilities into mainstream schools.
- The law mandates that all public places, including buildings and schools, should be accessible and equipped with ramps.
- Considering the photograph of a boy being carried down the stairs, the law is not being implemented in his case. To make the building more accessible, ramps need to be provided. Being carried down the stairs affects his dignity and safety.
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