The Commune: Healthcare Inequalities

Dear friends,

According to C. E. A. Winslow, well known for creating one of the most used definitions for public health said: “Public Health is the science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts (…)”

With such a huge healthcare crisis looming over us, it felt important to return to our vision of public health. Especially in a year where our world witnessed inequalities rising – one of which was the healthcare inequality. World over the public healthcare system was incapacitated by the pandemic. Hospitals had to ration healthcare. We had to choose who to treat, which diseases were important and essential. One of the biggest decisions India had to make was to prioritise COVID-19 protocols and support over immunisations and vaccinations. This may seem small but for a country like ours that just in 2014 was able to call itself polio free, it was a risky decision to make. The healthcare system, the healthcare workers was already inadequate to take care of the health needs of the citizens. COVID-19 made this obviously so and heightened the financial burden for many of our citizens. The financial costs of access to good healthcare is intimately connected to the social and economic inequalities that prevail in our country.

In this news report released in March 2020, we see the inadequate support for the public healthcare system. “At 3.6% of GDP, India’s overall health spending is among the lowest compared with peer and advanced economies. Of this, government spending on health accounts for an abysmal 1%. Unsurprisingly, out-of-pocket health expenditure for households is extraordinarily high in India. About 65% of all health expenditure in India (approx 2.5% of GDP) is borne privately by households.” In contrast, Germany spends 11% of its GDP on healthcare, Netherlands spends 9.95% of its GDP and Nepal spends 5.84% of its GDP on healthcare. (Read the full list of country’s contributions to healthcare here.) In another study done by Centre for Disease Dynamics and Economic Policy, it was observed that we have twice as many private hospitals in the country as public ones despite a majority of India’s population being rural and most of them without any health insurance.

These facts feel overwhelming when one imagines the numbers of people in need of healthcare and how private, quality healthcare is hard to access for so many people. Walking into these hospitals with everything automated, digital can be very confusing. The other difficulty being the ways in which these hospitals treat the poor or those who probably don’t speak proper English. So what has happened to people’s health in these times? Has our system been able to build itself to be more robust? Are there more public hospitals? Have people been driven into medical debt because of the steep costs associated with healthcare in these times? What is the long term effect we are going to see within our healthcare systems?

A lot of patients with chronic long term illnesses like me had to stay away from hospitals in these times or access healthcare at great risks of contracting the virus. This brings me back to what Winslow says about public health. If universal healthcare is the goal we are striving for, then we need to commit not just to building our healthcare systems, focus on the role of our governments in not only financing (which as we can see is atrocious) but in care work and more.

It requires all of us then to imagine healthcare as a public good and in our own ways demand the strengthening of the public healthcare system so all of us can access health care as a right and not as a privilege.

If you’ve come across any interesting readings, research and experiences on this topic, do share them with us. We are always happy to hear from you!


Leave a Reply