Many years back in Alma Ata, the community
of nations of the world wholeheartedly sup ported
WHO’s call for "Health for All" by the
year 2000 AD. As we proceed towards the dawn of the 21st
century, we should perhaps pause and reflect why we could
not substantially achieve this goal.
We live in a world where one third of the global family
has access to everything that is essential for a healthy
existence. But unfortunately most of these privileged
societies are gradually embracing a lifestyle which is a
cause of countless health problems. As they become
conscious of these emerging threats, health destructive
industries like Tobacco, Alcohol etc. started
aggressively promoting their products among the middle
class people in developing nations, who have just
achieved a level of livelihood where they can be
reasonably healthy. However, almost one-third of our
people continue to live under deprivation in spite of the
fact that the newly independent nations of the South have
made remarkable progress in the last five decades
compared to the period they were under colonial rule.
We made serious efforts, with a great degree of
commitment, to reach the communities who live without
essential food, shelter, drinking water or health
services, but we lacked in sensitivity to appreciate
their crises. We thrust our preconceived solutions to
tackle their problems. This was perhaps due to our
centuries of biased view that the poor are uneducated and
ignorant. Gradually, but surely, we have diluted the
spirit and content of Primary Health Care so forcefully
recommended at the Alma Ata. We thrust our preconceived
solutions to tackle the problems of the deprived. We
reach them with Polio campaigns while they are dying from
the lack of safe drinking water. Nutritionists have
figured out details of calories and grams and have worked
out efficient growth charts, while the basic cause of
malnutrition like low wages, land reforms and equity
remain unattended. While planning health programmes for
the poor countries, we barely look at their health
traditions, which were evolved through thousands of years
of trial, error and experiments. We flood these
communities with our sophisticated MIS and IEC materials
without bothering to build on the systems and forums of
the traditional communities which have helped them
survive through centuries. We enthusiastically commission
advertisement agencies to promote health campaigns. They
are also the large beneficiaries of the publicity budget
of health destroying industries. On the whole, the
situation can be best summed up by an African proverb
"Until the lions have their historians, history of
hunting will glorify the hunter".
Wherever there has been effort towards sustainable health
and development through decentralized planning, working
with the community, building on their knowledge base, in
an atmosphere of mutual trust and confidence, the result
has been rewarding. This is evident from numerous
grassroots level initiatives all over the world. Can we
learn from these experiments and agree on a paradigm
shift in our future mission?
There are proven solutions to the problems which cause
ill-health in developing countries. Solutions for many of
them lie in wider areas of socio-political action. But on
the other hand, solutions to the emerging health problems
of developed countries lie in slightly hard, uncharted
areas of human behaviour, social transition and
materialism. There may be some solutions of these
problems in the traditional societies of the South.
Most influential philosophers across the world prescribe
that the ultimate fulfillment of life (Nirvana) is
possible through human existence which keeps a balance
between ‘Artha’ (earning livelihood),
‘Dharma’ (spiritualism) and ‘Karma’
(pursuing creative faculties). In our lives today, the
spiritual dimension is being replaced by a blind pursuit
of consumerism. For a healthy human society and a livable
earth, it is imperative that this balance is restored. As
Gandhi said "the world has enough for
everybody’s need, not for everybody’s greed.
As we walk towards the new millennium, we should
seriously reflect upon the fact that our civilization is
so totally driven by market forces. There can be little
doubt that the greatest economic force now sweeping
through the health care system worldwide is also that of
the market. Health is a vital human good and medicare
plays a key role in promoting it. Totally commercializing
it even for the sake of choice and efficiency runs a
potent risk of submitting it to the market-forces. The
integrity of medicine itself is at stake.
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