Sunday, March 21, 2010

Health Inequality and Sustainable Development



Health Care Delivery System in India consists of three tier system, i.e. primary, Secondary, and tertiary health care. 15 % of Indian population do not have access to health care system. Expansion of health care in India has been mostly urban oriented when about 60 % of population lives in rural or semi-urban locations. Mushrooming of private hospitals in India has been in the urban areas, and is profit oriented. Public health care systems are becoming extinct by the day. Insurance system may not suit Indian conditions since a very large section of population would not be able to afford it, and the governments (central or state) may not find the required budget. The paper examines the total capacity in India, genesis of the system-its effectiveness, or the shortcomings, and reasons for deficiencies. understand today leads to stressed relation amongst privileged and underprivileged classes in a society. Paper examines health inequality in a conceptual or philosophical context.

Health Care Systems are more oriented towards curative health care, and do not consider impact of environmental pollutants on human health. Reason being environmental pollution is viewed more as an environmental issue rather than health issue. Proper waste management is essential to neutralize adverse effects of environmental pollutants, including biological pollutants. There is hardly any focused attention to the growing menace of waste which is directly proportionate to growing population in the developing countries, including India. Polluter pays principle is self defeating in the sense that polluters can pollute and get away with it by paying appears accepted philosophy. In fact the principle should be ‘repair and replenish’ rather than ‘polluter pays’. Trying to copy Western models in its entirety has resulted in fragmented approach and confused results, whereas developing countries should adopt scientific advancement with modification to suit local conditions, level of awareness, and habits & practices. Existing conditions in other developing countries in the South East Asia Region has been briefly described as a case in point that in all developing countries situation remains the same-more or less. Paper examines these aspects and suggests measures for effective waste management in India.

In health matters there are gender bias, economic bias, status bias, and bias of availability of funds. Development as we
Economic development is considered benchmark of development but would not this approach justify industrial hyperactivity and exploitation of natural resources? In fact there is a requirement to re-examine the concept of ‘Sustainable Development’ and move towards concept of ‘Sustainable Existence’. The paper examines viability or relevance of ‘Sustainable Development’ vis-à-vis ‘Sustainable Existence’ in concept.

Capacity building is an essential part of Capability Approach. Capacity leads to capability. Political will, education, awareness, administrative set up etc, and development of monitoring protocols with predetermined performance indicators are required to be created.

There is great difference in the accessibility of resources. But merely by professing equitable accessibility one cannot ensure equitable sharing of resources.

There is a wide gap in policies at the macro level & implementation at the micro level in all the developing countries. For example proper legislation & rules have been framed on health care delivery & waste management in India, but implementation remains far from satisfactory. Primary Health Centres are designed for rural health care but there is hardly any cognizable action to strengthen rural health care system. Similarly in matters of waste management laws have been enacted but implementation remains unsatisfactory. Micro level factors do not guide policies etc at the macro level. Thus capacity created at the macro level fails to obtain directional capability at the micro level.

Take for example solid waste management system in the country. As per the present rules no one is to litter. But the municipalities do not have 100 % registration of food and eating joints that are largely responsible for littering. This gives rise to biological pollutants (fly & mosquito breeding, and bacterial pollution) causing degradation of the environment. Collection, transportation, and disposal system fails because of human failure almost at every level. This gives rise to deficiencies between policy & implementation. Therefore innovative approach may be required to be considered, such as decentralization of waste management to the community level, thermal treatment of the biodegradable waste in which the end product would be manure, instead of present system where waste is required to be transported to landfill for manure production. Waste to Energy concept will work only if the waste (without undergoing putrefaction) is transported in a time frame to the landfill sites. This hardly happens. Changes in policies at the macro level would narrow the gaps in policies & implementation.

Many examples of failed systems due to faulty capability approach can be found. Till few years ago health care waste management was only incinerator based. For the first time in Bangalore, India a ‘multi option’ approach was conceived and applied during WHO aided pilot project in the year 1999-2000, which resulted in a comprehensive health care waste management. It is recounted not only as a success story but also a point of successful health care waste management in India. Only incinerator based health care waste management was a faulty approach as it gave rise to pollutants in the atmosphere, was against the Basel Convention, and militated against Kyoto Protocol. Multi option approach has thus come out as the accepted protocol for health care waste management thus modifying policy framework resulting in better implementation.

Capability must be applied with community participation at the grass root level with clear understanding of weaknesses and potential human failures, and it must remain dynamic. Predetermined performance indicators should be carefully identified in relation to the policies so that capability approach itself may be subjected to analysis & modification for better implementation and results. Main thrust of the paper is that there should be two way interactions at macro and micro level for a successful capability approach.

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