Davos – Reality Check

Will India keep making excuses for the sorry health situation in the country at the World Economic Forum?

WrittenBy:Chitra Subramaniam Duella
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Folklore has it that when the late Indian Prime Minister Indira Gandhi was invited to address the European Management Forum which grew into the World Economic Forum (WEF), she reportedly said “…we don’t need them. They need us”.

As the annual session of the WEF gets underway, leaders from around the world will discuss global health issues, health systems and resources necessary to address communicable diseases such as HIV/AIDS, tuberculosis and malaria as well and non-communicable diseases which include cancers, diabetes and heart diseases. It is not known if India’s health minister who thinks homosexuality is an unnatural disease http://www.ndtv.com/article/india/ghulam-nabi-azad-calls-homosexuality-unnatural-and-a-disease-116761 will be present at the high table. He has since taken his words back and hopefully he now knows that Bill and Melinda Gates, who are at the forefront of the world’s health struggle, are not referring to the Indian capital when they speak about DALY – disease adjusted life years.

If ever India – currently the world’s favourite disease destination – needs to be present and vocal, it is now. Punditry which peaks around this time is mercifully silent as it would have been difficult to re-cycle investor-friendly talk about diseases without admitting that the fault lies with India. Pundits don’t connect with masses. They only preach to them. The worm may have turned as India no longer shines. Aspiration is raising India’s vocal chord.

“The world is living dangerously either because it has little choice or because it is making wrong choices about consumption and activity. On the one side are the millions who are dangerously short of the food, water and security they need to live. On the other side are millions who suffer because they use too much. All of them face high-risks of ill-health”, said the Director General of the World Health Organisation (WHO), Dr Gro Harlem Brundtland in 2002. If nothing else, spiraling health costs and absence of health care is an issue which connects the globe.  Accurate diagnosis is a serious medical challenge in the best conditions the world has to offer. Health illiteracy is universal.

Switzerland is a good country to discuss health issues as it is home to some of the world’s best pharmaceutical companies, the WHO, the world’s only multilateral policy-setter, as well as several other organisations like UNAIDS, the Global Fund (malaria, TB and HIV/AIDS) a global vaccine initiative etc. The country’s scientists and researchers are important players in the human genome project. It is also home to the powerful World Trade Organization (WTO) the world’s free trade policeman on issues that are critical to India – access, affordability, patents. The World Intellectual Property Organization (WIPO) offers countries a 101 on patents and is a time-limited holding platform. Many of these organisations are not on any serious speaking terms as they turn to the same donors for funding. That is an international discussion that political India has to engage with because for 800 million Indians a tablet, when they get it, is a medicine, and virus is an infection.

Sanatoriums in Davos are where rich people went to when they had tuberculosis (TB) until Klaus Schwab, the brain behind WEF, developed it into a sobriquet for high-level business and political meetings which several heads of state and governments have visited over the past 30 years. Indian doctors are reporting a totally drug-resistant strain (TDR) of TB, which means available protocols and medicines are failing. http://thorax.bmj.com/content/67/4/286.extract. India’s ministry of health has buried its head in sand fearing bad publicity and when questioned says India’s existing protocols and drugs are sufficient. The WHO has not taken a stand on TDR cases which have also been reported from Iran and Italy. http://www.who.int/tb/challenges/mdr/tdrfaqs/en/index.html

An estimated 330,000 Indians die of TB every year. http://caravanmagazine.in/reportage/growing-tuberculosis-threat. Poverty and malnutrition, where India is a global leader, are ideal grounds for TB to spread. While the world goes to India to research diseases, India does not want to report the spiraling of diseases of the poor like TB and malaria to name a few because of the image problem. People read reports on travel advisories which warn against active threat of malaria in India. http://articles.timesofindia.indiatimes.com/2012-05-11/india/31668147_1_malaria-risk-p-falciparum-

Companies require their staff to comply with such advisories. Aircrafts leaving India are routinely sprayed for stowaways. Affluent Indians and ministers, most of whom travel abroad for elective surgery – the latter at tax-payers’ money – don’t burn midnight oil over mosquitoes and spit.

For decades now, you cannot donate blood in many countries in Europe if you have travelled to some countries including India six months prior to the time of donation. Most Indians have no access to healthcare, much less a proper diagnosis. Around the time (2020) when the average Indian will be 29 years old, the country will be home to 100 million people with Type 2 diabetes to which Indians are genetically prone. http://www.ncbi.nlm.nih.gov/pubmed/15645957

By 2030, that number will be 552 million.  And these are only two diseases.

One in two Indian children under three suffers from micronutrient malnutrition. They live in remote villages and wealthy homes. Micronutrient refers to vitamins and minerals most of which the body cannot make and they have to be taken as part of a diet or as supplements. This is a quiet hunger that retards child development seriously. Three micronutrients – Vitamin A, iron and iodine are critical for a child’s growth as well as the growth of nations. Anemia (iron deficiency) places brain and social development of young children at substantial risk. Iodine deficiency disorders lead to mental retardation.

Seventy five per cent of Indian children under three suffer from anemia. Iodine deficiency is acute in all states. India has very high rates of zinc deficiency and the highest recorded incidence of foliate deficiency. In 2004, a distinguished panel of economists and Nobel laureates were asked what would be the best ways to advance global welfare if an additional $50 billion of resources were at the disposal of governments. The panel listed 17 issues including malaria control, water, food production, health services, immigration, carbon tax etc. Providing micronutrients ranked second as having the best cost/benefit ratio for a major impact in the developing world. HIV/AIDS ranked first. http://www.copenhagenconsensus.com/Home-1.aspx.

What you don’t see does hurt. Indian children do not have to suffer from malnutrition. The lamest of excuses said it was difficult to reach micronutrients to distant and remote parts. How do soda pop and chips reach corners of India where there is neither electricity nor water? Could this be a tangible private-public partnership with measurable results?

No global developmental goals – whether it is that of the United Nations or multilateral agencies or financial institutions – will be met until India is healthy.  The primary responsibility to make that happen rests with India, which has now gone from an investment destination to an interrogation destination. Health advocacy does not encourage doomsday scenarios but here’s a sample. Two jumbo jet crashes daily would account for tobacco-related deaths. In the absence of political will and determination to stay the course, initiatives however well-intentioned and bankrolled will fail as they have done in India and elsewhere.

The time for tedious dialogues, committees, permutations and combinations of solutions where administration swallows 70% of budgets need to be discarded.  The capacity of health sectors in countries to appropriately consume health aid and assistance is a major stumbling block. The myth that money in the private sector is well invested and the public sector needs to be reigned in has been seriously challenged by successes and failures on both sides. There is a raging global debate on these issues. Barring a few exceptions, India has not had a health minister with vision and gravitas to demand suitable budgetary allocations.  Cinema stars, compounder-doctors and a politician often referred to as a court-jester have been health ministers in states and at the Centre. Nobody, not even Indians, takes them seriously. At the time of writing, there are no indications about how seriously India will make India’s case on this world stage.

In 2008, United Airlines passenger Dave Carroll’s guitar was destroyed by baggage handlers. He was given the run around by the company. He wrote a song and posted it online http://www.youtube.com/watch?v=5YGc4zOqozo

Within four days bad PR caused the airlines’ stock price to plunge by 10% costing shareholders a reported $180 million. It was just a guitar.

Health is not charity, it is a right. How far is the day when unhealthy India goes viral with a song that says India kills Indians?

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