The poor anatomy of health care

The linkages between environmental degradation and human health are well established, but it seems that governments, especially in the developing world, are the last to hear the news. And because of their blinkered approach to health care, they have been slow to check problems which are clearly linked to a fast-deteriorating human environment.

Although health expenditure and average life expectancy have increased, the health of the world's population is far from satisfactory. Lopsided health policies emphasise capital-intensive curative approaches to health care rather than more cost-effective preventive strategies. Moreover, little cognizance has been given to integrating health policy with a country's development efforts.

Skills and curative health efforts are concentrated on the urban population, which can afford health services. In India, as much as 70 per cent of the government's health spending is in the urban sector. The little money that reaches rural areas is expended on family planning programmes, with only a small proportion directed at primary health care.

With this has come the need to establish a health delivery infrastructure, making people dependent on a monolithic bureaucratic system which consumes a substantial proportion of the health budget. This year in India, some 72 per cent of the government's annual health expenditure went into salaries alone. It would be virtually impossible to extend this health care model to the rural areas -- the costs would be well beyond developing country governments, and perhaps even foreign donors.

But there are alternative approaches which have unfortunately received little attention from the urban, middle class policymakers whose interests are firmly entrenched in the present system. Several diseases which afflict rural populations can be aborted by upgrading environmental conditions. Directing investments to ensure clean drinking water and sanitation facilities, and encouraging the cultivation and consumption of nutritious foods at the local level, would be far more effective than an overdependence on highly skilled and paid medical personnel and the "magic bullets" they prescribe. Moreover, the familiar tale of the reluctance of highly trained health care professionals to work in rural areas, far from more lucrative patients, and the perennial shortage of tools and medicines seriously questions this approach.

However, more holistic and often more cost effective approaches to health care, wherein the health of a population is seen as a major component of the development process, demands the involvement of the targeted people. As it has now become evident that the environment is best protected when people whose survival depends on its conservation have a stake in it, health care will only become a reality when the felt needs of the people are addressed.