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Monday, 26 March 2012

Health inequality in West Bengal provinces in India

Professor Pranab Kumar Bhattacharya MD(cal), FIC Path(Ind); WBMES,  Professor and Head, Dept. of Pathology; Convener DCP Course of WBUHS and DLT course; *Miss Upasana Bhattacharya –  Only daughter of Prof. P.K. Bhattacharya, Mahamayatala; Garia ; **Rupak Bhattacharya BSc(cal),MSc(JU);**Ritwik Bhattacharya; **Soumyak Bhattacharya BHM Msc Student PUSHA New Delhhi;** Miss Rupsa Bhattacharya all of residence 7/51 Purbapalli, PO Sodepur, Dist 24 parganas(North) Kol-110;  *** Mrs. Dalia Mukherjee BA(hons) cal, +**Miss Oindrila Mukherjee, +++ Mr Debasis Mukherjee Bsc(cal)  of residence Swamijinagar,  SouthHabra  Noerth 24 parganas;W.B India
 *Dept of Pathology  Calcutta School of Tropical Medicine, C.R avenue Calcutta-73, W.B , India** 7/51 Purbapalli; Sodepur; 24 Parganas(north) Kol-110 W.B, India; +++)  of residence Swamijinagar,  SouthHabra  Noerth 24 parganas;W.B India

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity by definition of WHO. Before common &medically untrained people define health by its absence and so seek intervention when they are not in that state1What is and how far a right to health in West Bengal provinces of India for the low middle, low socioeconomic class & poor people? How many people of disadvantaged class are aware here for his/her key rights? How many people in Kolkata are aware of their health status? The rights to health are broad demands that go beyond legislating good health care of a state or a country2 (important as that is). They needs mostly political, governmental ,social, economic, scientific, and cultural actions2. Can health be a right here ,as there is no binding legislation in West Bengal? We doctors are demanding and just that is all? According   us the authors here, Right to health means  coverage of equal  but quality health cure & care services for all people of a state [including the pavement dwellers, beggars, unemployed, low socioeconomic class people, schizophrenic &mental patients olds,] at almost free of cost by  state government, never & never by any private health care hospitals or  health care institutes those give mostly irrational treatment(even without maintaining the bed head signed tickets) and most time repeated un necessary investigations with huge and unbearable costs & by selling lands and cow or making huge loans by the family or  by the  close keens of ailments. Every patients must have sufficient accesses to safest and highest quality of health care regardless how much they earn, where they live and how seek they are!- Question remains how much is it feasible in West Bengal state or in India?:  Can a state ensure of  it’s population that everyone will have a good Quality health? The land of West Bengal is always remained a land of extreme form of disparity & inequity between haves and haves not.   I think we first consider a minimum equity in health care system, as a right, since the health care system in West Bengal province is mostly under the control of policy making by state government. Of course Health care system does never reflect the actual state of health of the people.  What a good dignified society should have?. The acceptance of health Education & employment as a right for all - a justified demand to take into action and to promote that goal, such as we have the right to vote1   . Health human rights, and development of  state economy are complementary and synergistic, so are human rights and social justice. But does good health depend only on health care &cure?. It also depends on employment, nutrition purchase capacity, lifestyle, education, and the extent of inequality and un freedom in a society. The basic problem in West Bengal state is poverty, political  leaders unwillingness, to have a pro poor quality health care delivery system and corruption in every step from the educated mass. More the education more the corruption. The Economic growth of a state or of a country is usually measured by economists in increase of GDP and GDP per capita. GDP per capita per year is also a very important key point of human development index used by UNDP. Health care expenditure of a country is also measured by percentage of GDP spent for it & GDP spent by Indian government for health care is<3% ,despite gross domestic product growth rate of India is 9% in2007. But a very big question often strikes me does GDP per capita in a real sense reflects the poverty status of any state or of any country? It appears before me to imagine or to calculate a decline in poverty unaccompanied by a simultaneous improvement in aggregate economic performance- my 85 years old father late Mr. Bholanath Bhattacharya commented me few years back before his death.  The determinant of economic growth of a state, we people use the denominators like Life expectation at birth, Infant mortality rate [57 per1000 live birth in India], Crude birth rate, Crude death rate, Maternal mortality rate [301 per 1 lack live birth in India] etc does really reflect the economic progress of poverty laden families of the state or of a country? I, the first author myself don’t belief that now. I see daily so large rushes in public tertiary medical colleges hospitals [in the year-2006 Total OPD 1,42,51,407 cases, Total indoor admissions 1,88,8121 cases Total1,61,39,528 of 8.5 cores population (19.69%) of the state]  & most of them belongs to so poor and bellow poverty line families. But our government still says economic growth of India is 7%. Rather state level growth of real Net state Domestic product (NSDP) may be a good determinant factor. In west Bengal, PCNSDP in 2000-2001 is Rs9778/= per year, per person which means per person capacity to purchase essential goods or calorie for living is Rs 814/= only at poverty level when central govt. definition bellow poverty line is Rs1500/= and people still at BPL level in West Bengal is 27.09% & when  poverty line considered Rs 1500/=Pm per person. If PCNSDP criteria is considered to define poverty line then people at poverty level in 2008, at West Bengal will be more then 62%.Over last 3-4 decades , there had been tremendous out break of unemployment in West Bengal  amongst the educated younger generation of age range 21-45 yrs the productive age group. This picture of unemployment is not only in West Bengal but through out India. The number of registered unemployed in India through employment exchange is about 8 cores, whereas in West Bengal the figure is about 1.5 core.  Though LEB during the period of 1970s to 2008 period raised from 49.7 to 61.7 years  & Bihar state which is one of the lowest NSDP  of Rs 4123/= is in better position then MP,UP as per these conventional health indicators. But the fact also says that LEB Per capita GDP & per capita expenditure for health shows better growth. In India Poverty line is decreasing & so in West Bengal!
Then what should be the denominators of an economic growth of a family of a state of a local society of a country Growth of physical labor! Stock of physical capacity! Technological labor class advancement! Quality and quantity [skilled and unskilled ratio] of human resources and human capital! Their living standard, their nutrition, their education and their mental health- physical labors are related to economic growth of a province or of a country. As for example, physical labors are related to production in any industry, or in paddy fields, or in agriculture or in roads or other civil sectors, in construction works or in surface, Rails, in water transport works, in home guards industries and in electricity sectors.  The development of a state, in a country is thus dependent on mostly on” lower socioeconomic class and poor class peoplemy old father once replied me. My father through out his life led his life in extreme poverty and was a Marxist by his heart and action at sodepur. He worked in fields for economic uplift & fought for settlement of refugees of Bangladesh war-1970s settled at a colony areas of my native village sodepur, 24 parganas(north) W.B, India. How much was he true? If his views are correct then two elements come in questions in my mind. 1) the economic growth of a family and thus of a state in larger sense depends on 1) that how much labor forces are present in a family and how much they are educated at high school level or at university level 2) the health of these labor class forces as a big capital- Both these elementary determinant level has been neglected since freedom, in West Bengal provinces of India. The role of human health in influencing the economic outcome of a state is well understood at macroeconomic level. But health deals with microeconomics at the same time._ healthier workers are likely to able to work for longer period, becomes more productive then their relatively less healthy counterparts and are able to work for longer periods, able to secure higher earnings then the later. Illness like TB and many diseases shorter the working level of people. Health has thus a positive significance effect on the rate of growth of GDP per capita. Higher income permits individuals to achieve better nutrition and better health care improvement of them results probably improvement of net domestic products(NSDP) of state , thus increase of national income and can thus decline poverty level. So it is very important to give priority that towards which the health care should be directed! Rich or poor?
 In Indian open health market, in health tourism market, in West Bengal provinces improvement of health care delivery is mainly directed towards whom? Obviously not a pro poor health care delivery system it is! What should be focus in health care in 21st century? It must be patients cure and care both. Every patients must have sufficient accesses to safest and highest quality of health care regardless how much they earn, where they live and how seek they are!- A patient, a citizen must be the first priority and not the health industry and profitable health financing. Then why to step for privatization of health in west Bengal? Why opening accesses for so many & mushrooming Private health care institutions including private Medical colleges?
 Improvement of health care through public health care delivery when directed at poor, it contributes more directly to poverty reduction and serve as pro-poor growth strategy. In west Bengal Provinces of India, out of 8.6 cores population 27.09% population is bellow poverty line( Rs 1500/= pm I.e. < $1-1.5 per day per person) and 38.9% population is at poverty line (Rs 1500/=)even after 61 years of Independence! . How ever the definition of poverty is variable and debatable in different countries and in different years even within the country India and in 2012 budget even there is an attempt to change the definition o poverty in rural and urban areas[ possibly to approximate 825/= pm income per capita- Impractical thinking].  In India, tuberculosis kills 364,000 people and diarrheal disease and other infections kills 3 million people every years .600 million people in India lives with daily income<us$1-1.5. These poor bears disproportionate burdens of illness, psychiatric illness, schizophrenia, Suicides and various under nourishments, infectious diseases including T. B, HIV,  sanitation & sewage disposal problems, water borne infections, mosquito borne diseases, Bidi Smoking realed diseases like COPD, Bronchities, Cancer lung and head neck, then upper middle class, middle class and rich  class people. The poor suffers from ill heath due to mainly of causes of poor nutrition & habbit that reduces their ability to perform works due to weakness, due to threaten Tuberculosis, their defective immunity and resistance for diseases, frequent treatment expenditure, frequent doctors fee, nursing home charges and loss of economic forces. Poor families thus exhaust their earnings, their savings, their assets and take re curse of borrowing leading to more poverty, poor health status & drop in school & colleges.
There always remained inequalities between rich and poor population within a state within a country or between rich and poor counties.  In case of state of West Bengal, in India, the same is also true & over expressed presently. No doubt there happened a systemic (in hands of few percentage -<20% population) economic growth and number of middle class economic families or people increased in the state. In India, now 300 millions people may be classed in middle class economy. Their physical or labor contribution for economic growth of the state is though negligible and their life style is really most unhealthy one, that they are  consuming /eating too much of fat, cheese, eggs, milk diary products, packed dry foods,  red meat, chicken consume much  cooking oil & carbohydrates, but they are almost reluctant to burn their calorie by physical labor or brisk exercise. They lost all their physical activities including daily one hour walking. City middle class and upper middle class population mostly drive their cars every where they go wasting precious oil. As a result, I think, they suffer from obesity, high BMI, metabolic syndrome, diabetes mellitus type-2, high blood pressure, renal failure,  all complications of diabeties, atherosclerosis and cardiovascular diseases.  Are not these people themselves responsible for their own diseases and early death if occurs? Why the state health services policies pays priority for these people, opening marketing  accesses for business houses like mushrooming private  health institutions/hospitals[ never show any human face] in healthcare system, neglecting the real needs of poor?. we need a renaissaue in health care driving force towards an effective and strong primary health care in state of west Bengal particularly targeting poor people in regard immunization, proper food care, nutrition, safe water, sanitation, maternal and child care, prevention and quality treatment of local diseases, provision of essential drugs, laboratories diagnostic facilities extending from secondary health care tire to primary health center level. In 1983 the India’s national health policy adopted the alma- atta definition of primary health care to mean the provision of curative, preventive and rehabilitative health services and accesses of health services to rural areas. A large three tire health care system developed in all provinces including in state west Bengal. Primary health centers are units that provide integrated health care in rural villages [30,000 populations] and provide referral to secondary and tertiary care in an almost non effective referral system. But problem of PHCs remained, are unavailability of human resources [doctors, nurses], essential medicines and forcing poor people to get treatment in private chambers and often before quack doctors, on whom villagers depends on much
  The fact is that for last 2, decades, in the state, there was dominance of profit making health insurances industries, a new wave of investor-owned specialty or super specialty hospitals, and profit-maximizing behavior in west Bengal provinces including in India .The involvement of private companies any where always generates some controversy. Some health policy maker people believe that only commercial interests can bring health innovation and efficiency and can modernize the health system. –the idea is not a default .I rather assume that the profit motive is incompatible with the pursuit of excellence in health care system. The government of west Bengal so planned to  establishing at least 60 primary health centers, diagnostic laboratories services in secondary and tertiary level health care including in medical colleges of the state  to be run by private companies in the name of public Private Partnership in Health care system. Health care is the responsibility of a state government. It must be free and must not afford profit at expense of poor and what I feel. The Health inequality can be reduced by 1) reducing the poverty level 2) Improving the health 3) taking health as a Right as it is a right to Vote by a legislation 4) increasing the mental health 5) increasing the palliative care of health


1) Response by David Brookman  on 12 th December 2008 to BMJ group Blogs “A global conversation on defining health” by Alex Jadad and Laura O’Grady on10 Dec, 08 | by BMJ Group
2) Amartya Sen “Why and how is health a human right?” The Lancet, Volume 372, Issue 9655, Page 2010, 13 December 2008 doi:10.1016/S0140-6736(08)61784-5

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 Professor Pranab Kumar Bhattacharya MD(cal), FIc path(ind) Professor, Original Text

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