Most are likely to agree that the accompanying call for action towards achieving universal health care in India by 2020 (hereafter referred to as the call) is timely and overdue. However, we disagree with the call in two crucial areas.

To sustain the positive economic trajectory that India has had during the past decade, and to honour the fundamental right of all citizens to adequate health care, the health of all Indian people has to be given the highest priority in public policy.

The debates around securing the right to health for all in India are at a complex and sensitive stage. In India, we have gross inequity in health-care delivery.

India's growing economic strength is based on an economic model that has enhanced the very disparities that the call is concerned about. Promotion of medical tourism at the cost of universal primary health care has not been accidental, but the result of a policy that places the market above people's basic needs.

Nearly 2 billion people (a third of the world's population) lack access to essential medicines. In low-income and middle-income countries, drugs account for 20

India has supported the ideal of health for all since it become an independent nation more than 60 years ago.

India is a welfare state in which the government has a responsibility to ensure than citizens have access to healthcare. We are also a federal state, with multiple levels of government, each with its own responsibility. The sixth item in the Constitution of India vests responsibility for 'Public Health and sanitation, hospitals and dispensaries' on the state governments. (Editorial)

The lack of skilled service providers in rural areas of India has emerged as the most important constraint in achieving universal health care. India has about 1.4 million medical practitioners, 74% of whom live in urban areas where they serve only 28% of the population, while the rural population remains largely underserved.

S. Viswanathan

Hardly five years ago, when multi-discipline hospitals started mushrooming in cities across the country, thanks to liberal support from the governments under the policy of privatisation and liberalisation, rising India celebrated their arrival. Many believed their arrival was a landmark in the history of health care in India. There was, further, the aspect of medical tourism.

Ahmedabad: An international conference on