TIMES NEWS NETWORK FEBRUARY 12, 2007
CHENNAI: India might not be able to afford health care for everyone, but that should not stop it from recognizing health as a basic human right, Nobel prize winning economist Amartya Sen said.
Recognizing it as a right would provide the political incentive to work towards guaranteeing a minimally healthy life for everyone, Prof Sen said.
Delivering KS Sanjivi Memorial Lecture at Voluntary Health Services in Chennai on Saturday, Prof Sen said "some critics of the idea of human rights find the concept itself fine, but do not want the concept to be applied to claims which may not be immediately realizable."
The presumption that human rights should be accomplished right now, "puts such claims as the right to a minimally healthy life entirely outside the domain of possible human rights, since it may not indeed be feasible to guarantee minimally good health for all, especially in the poorer societies," he said.
Indian constitution provides for right to equality and freedom, right against exploitation, right to freedom of religion and cultural and educational rights as well as right to constitutional remedies to all its citizens. It does not guarantee minimal level of good health for all.
India is ranked 126th among 177 countries in Human Development Index, according to latest Human Development Report. The index measures human development on three basic dimensions life expectancy at birth, literacy rate and per capita income.
Life expectancy, a key measure of health, in India is 63.6 years, lower than its developing country average (65.2 years), South Asian average (63.7 years) and much lower than high income countries average (78.8 years)
The events of September 11 in New York and July 7 in London only showed that even other rights, "first generation rights" such as right not be killed or tortured might not be feasible any longer, he said.
Recognizing health as a human right can help in directing attention towards ways and means of making those claims as realisable as possible. "Even though not everyone will actually have a minimally healthy life, given biological barriers and other feasibility problems, the recognition of it as a right provides a huge political incentive to try to expand maximally the fulfillment of that claim," he said.
"Those barriers that can be removed, including institutional and economic ones, need to be dislodged as widely and rapidly as possible," he added.
He said a wide range of policies and actions have a powerful influence on health, and all of them demand attention in the cause of promoting health as human right. "Indeed, in dealing with policy making, it is important to go beyond health care facilities into general economic and social arrangements, which can have very important effects on health.
"Health is of course influenced by health care and the use of medicine, but not just by them. It depends also on the general economic prosperity and social cohesions, as well as on economic and social inequalities," he said.
Thus, non-medical arrangements also have important role to play, he said. These include, legal frameworks (such as patent laws), economic facilities (involving the generation, distribution and use of incomes) and even social hierarchy, since stratification and the loss of freedom of those at the bottom can make them much more prone to avoidable illnesses and premature death.
"The policies that can make a difference to health – and through that to basic human freedoms – can be very extensive indeed," Prof Sen said.
Prof Sen stressed on the need for state intervention in health, by pointing out to example of China. China and Indian state of Kerala were neck to neck in terms of health in 1979 before economic reforms in China. Now, Kerala leads China in measures such as longevity and infant mortality.
"Perhaps the pivotal issue in this contrast relates to the sudden privatisation of health insurance in China following the economic reforms in 1979. These economic reforms were immensely successful in liberating agricultural production and building a very dynamic industrial economy and helped to make China the world leader in economic progress. And yet the progress of longevity sharply slowed down precisely when these big economic achievements were being made," Prof Sen said.
He said, there was a strong argument for reestablishing universal health coverage in China and the case or reintroducing it now was indeed strong. So it is in India, as well as USA, he said.
Prof Sen's observations reflect some of the recent arguments made by other economists specialising in China. For example, Prof Yasheng Huang, Associate Professor of International Management MIT Sloan School of Management said contrary to popular perception, FDI and infrastructure followed China's growth, and did not cause it. "What India has to learn from China is what China did in 70s – build social investments," Prof Huang said during a visit to Chennai last July.
China's growth story began in the 80s, when it's infrastructure was actually poor. Former Soviet Union had much better infrastructure than China in the 80s. Again, India's road and rail network was better than China's in the eighties. "Much of China's impressive infrastructure did not happen until nineties. This is an important point to see to get China story right," Prof Huang had said then.