HEALTH INEQUALITY: INDIA

r~ ecent advances in in- Health-care inequalities: and resistant organisms and

~ - ~ formation technology, prevent the eradication of old
.IK ~b~have forced under- an Indian perspective diseases.
standing of the vast difference Any discussion on health
in standards between the Kurien Thomas, K Sudhakar delivery for the 21st century
"haves" and the "have-nots", that does not address the
globally and nationally. Although the dream of health for problem of HIV/AIDS will be inadequate. Competing
all by the year 2000 was unfulfilled, we need to renew our demands on referral hospitals and health-care centres will
commitment to an equitable and healthy world for the pose a major problem in the coming years. Carefully
21 st century. planned prevention programmes and pilot projects
During the 50 years since independence, Indian dealing with care and support for HIV-infected
health care and health-care delivery have had some individuals and families are essential. Fear, stigma, and
remarkable successes largely denial are major hurdles in
due to the vision of health optimising care. The private
professionals and post-inde- and public sectors need to
pendence political leaders. forge partnerships to deal
The establishment of with these issues and
primary health centres for respond to the challenges by
country areas and the early involving communities and
success in malarial control political leadership at local,
are noteworthy. The primary regional, and national levels.
health centres may not now Studies in India have
be functioning as expected shown that about 70% of
and malaria has re-emerged the population obtain
with a vengeance, but these medical help from private
setbacks can be attributed to practitioners. Yet little
loss of direction and com- attention is given to this
mitment. The diversity in sector; for example, services
standards of health delivery Urban slums: the biggest challenges to hoalth-earo flelivory could be improved through
in India needs to be continuing medical educa-
accepted. The complexities related to managing the health tion. Antibiotics are widely misused for common self-
of 1 billion people cannot be denied, but there is much to limiting ailments such as watery diarrhoea and upper
be desired in promoting health-care equity, improving respiratory infections. In the state of Tamil Nadu, 78% of
managerial structure, channelling non-governmental the population receive at least one injection and 40%
resources, and promoting people's participation in health receive more than six injections in a year for perceived
decision-making. Many less-developed countries in Asia illness.
and Africa have common health problems, and we have Nearly half of those who seek medical help obtain it
much to learn from each other. from alternative and traditional systems of medicine. The
Equity in health cannot be isolated from social and practices and cures of these systems, which sometimes
economic equity. In most less-developed countries, less claim magic cures for common ailments, must be urgently
than 3-5% of GDP is spent on health, which is a evaluated. Many people prefer the questionable efficacy
reflection of priority given to health by the respective and possible adverse effects to the loss in human values
governments. Improvement in fiscal management alone that they face in dealing with modern medicine.
could provide the essential additional inputs into health Improvement in health delivery should address this aspect
without compromising the national priorities of the and make the practice of modern medicine more humane.
countries involved. Immunisation cover as low as 25% in Understanding community needs, promoting more
some states in India is sustained interaction between the traditional and modem
evidence of poor supervision systems, and involving the private sector in health-care
and input in this important delivery programmes may be the way of the future.
area, while there is a call for Health managers have an unenviable position. There
a computed tomography are no data on which evidence-based decisions can be
unit and a medical college in made. The traditional hierarchical system of
each district of the country. administration does not promote participatory decision-
Health-care delivery in making. If people are empowered to manage their own
urban slums remains one of health, its delivery and accessibility will improve.
the biggest challenges in Currently, the Government of India is planning a
India. Data from this ever- programme of developing a state-based action-oriented
growing population are so surveillance system with emphasis on people's
unreliable that they are participation for generating and monitoring essential data
effectively no/i-existent. for action. This plan is a promising beginning.
With appalling poverty and We can achieve these goals in a reasonable time if we
hygiene and complex social set our minds to it. Resources must be found, and
dynamics, the urban slums leadership must rise to the challenge. In the beginning of
pose major hurdles in the 21st century, with attention focused on globalisation
achieving health goals, and free trade, we must not lose sight of equity,
because they foster the governance, and people's participation as important
emergence of new diseases issues.

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