Monday, 27 January 2014
Blogs of Professor Pranab Kumar Bhattacharyya MD(cal.Univ) Pathology; : Health inequality in West Bengal provinces in Indi...
Blogs of Professor Pranab Kumar Bhattacharyya MD(cal.Univ) Pathology; : Health inequality in West Bengal provinces in Indi...: Author Professor (Dr. ) Pranab kumar Bhattacharyya - Professor and Head, Department of Pathology , School of Tropical Medicine ,...
Health inequality in West Bengal provinces in India
Author
Professor (Dr. ) Pranab kumar Bhattacharyya-
Professor and Head, Department of Pathology , School of Tropical Medicine
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 a right to health in West Bengal provinces of India for the low
socioeconomic class & poor people? How many people of disadvantaged class
are aware here for his/her key rights? How many people in Kolkata and its suburban areas are aware of their
health status and right for health ? 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 till days no binding legislation in West
Bengal? We doctors are demanding and just that? According me Right to health means coverage of equal but quality health cure & care and
providing quality of life for all people
of any state [including those pavement dwellers, beggars, unemployed, low
socioeconomic class people, students child, schizophrenic &mental patients,
old people,] at free of cost or with minimum user fees by government. Every
patients must have sufficient accesses to safest and / high / or highest
quality of health care regardless how much they earn, where they live and how
seek they are!- Question till 2014 remains how much is it feasible in West
Bengal state or even in India?: Can a state of India ensure of it’s population that everyone will have a good
Quality health? Nay ! The lands of West
Bengal is today turned a land of extreme level of disparity & inequity
between haves middle class and haves not proletariat class. I think,
we first consider a minimum equity in health care system, as a basic human 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 citizen - a justified demand to take into
action and to promote that goal, such as we have the right to vote in election
process with a voter card 1 . Health human rights, and development of state economy are complementary and
synergistic, so are human rights and social justice. But does good health and
quality of life depend only on health care &cure only?. It also depends on
employment, nutrition, purchase capacity, lifestyle, education level, and the
extent of inequality and un freedom in a society. The basic problems in West
Bengal state is poverty, hunger, political unwillingness to have a pro poor
quality health care delivery system and corruption at every level. 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 was 9% in2007( and in 2013 it is reduced around 4%). 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 thenlate 82 years old father late Mr. Bholanath Bhattacharya commented me 6 yearsback in 2007. The determinant of
economic growth of a state, we people use the denominators like Life
expectation at birth[ 68 years in male and 70 years in female now], Infant
mortality rate [37 per1000 live birth in India in 2007], Crude birth rate( in
West Bengal 12.7), Crude death rate( 7.5 in India and 17.6 in West Bengal in
2000], Maternal mortality rate [301 per 1 lack live birth in India in 2007] etc
does really reflect the economic progress of poverty laden families of the
state or of a country? I myself don’t belief that ever. 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(
70% of population in West Bengal seeks public health care system till today].
But our central government still says
economic growth of India is 5-6%. 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. Why? Because government is reluctant to establish
small and medium scale industries and doing memorandum of Understanding(MOU)
for heavy big industries that did never solve large section unemployment’s in
state. The system provides jobs to highly skilled young in technological education and not in general streams and in
Open market economy education is so costly and mostly unbearable for most
population without debt from bank loans to acquire the skills for large
industries. The number of registered unemployed in India through
employment
exchange is about 10 corers, whereas in West
Bengal the figure is about 2.5 corers. 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/= in 2007 is in better position
then MP,UP as per these conventional health indicators. But the fact also says
that LEB Per capita GDP & per ca pita 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! Increase of laborers in paddy
fields. Technological labor class advancement! Advancement of science,
information and technology in area of
intellectual property Right, Copy Right amendments laws as per IPR acts/laws(
every one is today conscious of his/her copy right Intellectual property right
of his/her knowledge and nothing is free but payable and India needs to develop
its own science, knowledge, technology in health care also] to grow more food
& crops and for a better health care and cure in arena of IPR, Quality and quantity [skilled and unskilled
ratio] of human resources and human resources as capital! Their living
standard, their nutrition, their education and their mental health- physical labors are always related to economic growth of a
province or of a country. As for
example, physical labors are related to production in any small ,medium scale
industries, 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 , Foundry Industry sectors
Automobile industries. These are not/were not done metropolis or urban or
semi urban so called educated “Babus” we
may call them with university degrees, post graduate degrees or phDs or
DSc or DLitt. The
development of a state, in
a country is thus dependent on mostly on” lower socioeconomic class and poor class people “my old father replied
me. My father through out his life led his life in extreme poverty and was a
Marxist by his heart and action. 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. And his name is Wikipedia
at “ Sodepur” article in the
history section provided by Panihati
Municipality North 24 parganas West Bengal, India section and was published in in News Papers like “Bangla darpan ‘ and “Gana SAkti” after
his journey in heaven in year 2009. MY youngest brother “Rupak Bhattacharya” is
today following his views and Idea for Pro-poor health care development in Sodepur area through myself. 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 i) that how much
labor forces are present in a family and how much they are educated at high
school level or at university level ii ) the health of these labor class forces as a
big capital- Both these elementary determinant level ha been neglected and is
being today also 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 and 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 or upper middle class people, to establish health industry or scientific
community based health care & cure institutions?
India is in conglomeration of states with
diverse level of socioeconomic status, governance political parties, health
systems and situation. In West Bengal provinces has shortage and mal distribution within its health work force that have contributed to inequities
in health and its outcomes. In West Bengal
health workforce is combination
of both registered, formal health care providers and informal medical
Practioners(Quacks) those are in contact with large nos of populations in
cities, urban semi urban and Rural villages
India as well as West Bengal because an expanding of Private for only
profit making center is Juxtaposed which compete for a net work of Public
health facilities and they compete for common pool for health human resources. India has also
emerged as important for health human resources in the Global Health market.
In Indian open health market, in today’s
health tourism market, in West Bengal provinces improvement of health care
delivery is till days mainly directed towards whom? Obviously not a pro poor
health care delivery system it is what was in 1977s-1990s! 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 higher / or highest quality of health care
regardless how much they earn, how much
poor they are , 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 care and cure in west Bengal? Why opening
accesses for so many & mushrooming Private health care institutions,
hospitals including private Medical
colleges in not only India but in West Bengal When there is dearth of qualified
teachers for undergraduate post
graduate or post doctoral level courses
to be recognized by Medical council of India? Whom they will serve? whom they do serve? Why to
patronize those private care hospitals from government level? As they deals
with few hundred billion dollars in health care and cure market without
spending a few to generate for their own health care providers
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 9.5 cores population 27.09% population is till bellow
poverty line( Rs 1500/= pm I.e. < $1-1.5 per day per person) and 62%
population is at poverty line (Rs 1500/=)even after 67 years of Independence! What a
shame!. 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( 2007 figure). These poor bears
disproportionate burdens of illness, psychiatric illness, suicides and various
under nourishment, Helminth
infestations ,infectious diseases including Leprosy T. B( even XDR and TDR!),
HIV,, HIV in Children of Low socioeconomic class[ HIV in children an estimated
4,30,000 children younger then 15 years are infected with HIV and almost all the
infections are in South East Asian countries and through parent to child
transmission during pregnancy, child birth or breast feeding so meeting needs
of HIV Positive people and their off springs is critical to Indian political
and financial commitment for universal access
to HIV prevention, treatment, care, rehabilitation & support ] sanitation
& sewage disposal problems related diseases, water borne infections,
mosquito borne diseases Mal nutrition
related DM ( insulin Dependent Type II DM as Per ADA), Chronic
Bronchities,COPD, Smoking related diseases GI problems like gastritis, worm
infestations, Deodinal Ulcer, G I Cancer
then upper middle class, middle class and rich people. The poor suffers
from ill heath due to mainly of causes of poor nutrition 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. They can not even adhere to a costly prescriptions in
brand name or when suffer from chronic diseases[ India is turning home for
Chronic diseases among Poor’s -26%] and old age problems.
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 last decade there has been total
transformation of middle class population life style. Material benefits appear
to lower the basic human values. The ever increasing gap between haves not and
haves had been drastically increased at all level of urban, semi urban rural
areas of India and West Bengal escalating youth violances, rape, murders, due
to widening socioeconomically disparities now posses a major threat and challenges
to all those involved in providing basic human needs at low to moderate cost.
It is fact that 62% of our people living in250 major cities with population of
1 lack and above live in pathetic, unhappy life of the less privileged millions
factually the rural services has undergone a remarkable transformation as far
as basic amenities are concerned. The problem has escalated with ever
increasing rural-urbun migration in search of openings for their dependents
survival. The rural environment are improving no doubt due to implementation of
various central government of India’s socially beneficial measures when the
urban Sub urban and metro cities scenario has worsened for last decade[3]
In India, now 350 millions people may be
classed in middle class economy. Their physical or labor contribution for
economic growth of the state is so negligible
and their life style is really most unhealthy one, that they are eating too
much of calories , fat, eggs, milk products, cheese, packed dry foods, fast foods in food plazas ,meat, chicken
perperations, consume much cooking oil,
proteins & carbohydrates salt intake(40%), but they are reluctant to burn
their calorie by physical labor. 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 even to malls and Ion ox
as their status symbol. The numbers of
self owned cars in every roads of metro cities increased at so high level, that these self owned cars are one of main causes of air
pollution in cities and towns with various poisonous chemicals and heavy metals that acts as carcinogens and are the most important causes of various lung diseases
like COPD, asthma, cancer lungs even those who are not using it. As a result, I
think, they suffer from obesity over weight, high BMI, increased abnormal waist
circumference(42%) metabolic syndrome, diabetes mellitus type-2[ India and
China share approx 1/3rd of diabetes
population of world. The International Diabetes
Federation in 2008 estimated projected India as diabetes capital of the World.
The Figure in 2011 is 61.3 million and 77 million pre-diabetics waiting to add co-existing and by 2030 my
prediction is it will be 101 million], high blood pressure(27%) and its all
sequels, Chronic renal failure, NASH,
atherosclerosis , cardiovascular diseases and CVA and they try to occupy most
beds in a hospital , ITU or ICU be in public or private hospital. If one looks
at nos of Bed distributions in Critical care units the bed strengths are triple
then in public state hospitals as because these critical care units in private
sectors are one of good means of their profitable business and generations of incentive for their health
care providers, pharmaceuticals. Are not
these people themselves responsible for their own diseases and early death if occurs? Why then
state health services policies pays priority for these people’s health care and
cure, opening marketing accesses for
business houses like mushrooming private
health institutions/hospitals[ These hospitals or institutions never show any human faces]
in healthcare system, neglecting the real needs of poor and low middle class?. We
so 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, low middle class people, unemployed people students, employed middle class, child 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, medical
instruments, gadgets through fare price
shops in every hospitals including in PHCs level, A National level policies for
access to medicine of appropriate quality efficacy and safe drugs through Fair
price shops, 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 thus 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 now.
Where is the problem? Is not infrastructure enough for an appendectomy or
cholecsytectomy or cesarean section operations in State general or
subdivisional level hospital or is not infrastructure adequate to treat
Diabetes mellitus, simple Thyroid diseases, or pneumonia or a ischemic stroke or
a gastric dyspepsia for treatment? Or Physician/ surgeon/
Gynecologists/ anesthetists/
pathologists/ technicians/ nurses/ GDAs/ Sweeper posted in those public hospitals are too insufficient or many such posts remained vacant after
retirement to give 24 hours care . The real fact is human resources
are to day so less and what ever
negligible I are there they are
busy to do private business in their private chambers
or nursing homes and they are turned qualified doctors to refer those patients
in the tertiary care hospitals or state medical colleges. Why the good quality
MD/MS or Post Doctoral DM/Mch are reluctant
to join in government run hospitals or in medical Education services but
prefer to join private care hospitals
for lucrative salaries and job facilities with incentives and rewards 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 6) Affordable Health care Act(ACA) which will require all employers to offer lower and
lowest income group workers health insurances coverage in affordable financial
terms by government instead of private health insurances and purchasing coverage
directly. ACA Should reimburse from fee for services towards rewarding of
improved quality outcomes and efficiency. Payment and delivery system
models such as patients- centered
medical homes accountable to Govt.run care organizations. Audit of
prescriptions and control of Private care & cure Health system, 7) Prescription of generic medicine 8) Fair
Price shops opening to poor class and low socioeconomic and middle class
population of the state and through out all states of India selling quality
medicine, gadazets, instruments for interventions 9) Increasing quality of
Undergraduate and Post Graduate examinations system to level of excellence 10)
Electronic Prescribing system can result better data sources and real time
maintaining of medicines required and sold, best ways of counseling to patients,
target massaging and quality improvement
At heart of
Problem lie essential questions about political motivation, human consciousness
about his/her Right to his/her health and physician’s mood, responsibility and
willingness to help people and reduce in equity in health care system of West
Bengal.
References:-
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
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
3) TG Krisnamurthi “ Value based
Education: role in empowerment” Editorial article JIMA vol11;N-09;sept;P586;
2013
Acknowledgements-:
The author acknowledges his
diseased parents late Bholanath Bhattacharya( 1926-2009) and late Mrs Bani Bhattacharya , his daughter Miss
Upasna Bhattacharya and his youngest brothers Mr Rupak Bhattacharya and RitwikBhattacharya, his sister Dalia Mukherjee whose some suggestions had been
reflected in this article which was
originally written in 2008 for BMJ group journals QHSC and BMJ Group Blogs by
the author and was submitted
Copy Right Statement-:
The opinions expressed in this article is of
author’s only. Copy Right of the article belongs
to Prof.Pranab kumar Bhattacharya-the author and only to his first degree blood relatives under Copy
Right Rules 3D/ 107/1201 (a) (b)/ RDF of Intellectual Property Right Act and
SPARC Copy Right rules-2006 and PIP Copy Right Rules-2012 of USA. For
Permission for reproducing, citation, references , further research work, for self use and for implementation of more than three words or
any meaning full sentences in any health care system either in any state of India or in any other countries or
in any pvt care & cure Institute /hospital or translating in other languages please mail to profpkb@ yahoo.co.in to avoid infringement
and plagiarism from your end to avoid copy right damage suit in million US
dollar for injury to author.
Sd/ Professor Pranab Kumar Bhattacharya MD(Calcutta Univ) - Professor and Head, Department of Pathology , School of Tropical Medicine, Kolkata-700073
JAMA. 2016;315(16):1703-1705. doi:10.1001/jama.2016.4072
under title Health Inequity in India Posted on May 3, 2016 at JAMA The Journal of American Medical Association--> as Response published -2 by Professor Dr Pranab Kumar Bhattacharya, Dr Sumana Mukherjee; Subrata Majumdar , Upasana Bhattacharya, Rupak Bhattacharya Ritwick Bhattacharya,Professor of Pathology (detailment) , Calcutta School of Tropical Medicine, Kolkata-700073, West Bengal, India --- and Professor of Pathology at Murshidabad District Medical College, Berhampore, Station Road Murshidabad West Bengal IndiaConflict of Interest: None Declared
under title Health Inequity in India Posted on May 3, 2016 at JAMA The Journal of American Medical Association--> as Response published -2 by Professor Dr Pranab Kumar Bhattacharya, Dr Sumana Mukherjee; Subrata Majumdar , Upasana Bhattacharya, Rupak Bhattacharya Ritwick Bhattacharya,Professor of Pathology (detailment) , Calcutta School of Tropical Medicine, Kolkata-700073, West Bengal, India --- and Professor of Pathology at Murshidabad District Medical College, Berhampore, Station Road Murshidabad West Bengal IndiaConflict of Interest: None Declared
Monday, 13 January 2014
Publications of Mr Rupak Bhattacharya at Journal of Uncertainity analysis and applications
Uncertainty theory based multiple objective mean-entropy-skewness stock portfolio selection model with transaction costs
Journal of Uncertainty Analysis and Applications 2013, 1:16 doi:10.1186/2195-5468-1-1
Abstract
Purpose
The aim of this paper is to develop a mean-entropy-skewness stock portfolio selection model with transaction costs in an uncertain environment.
Methods
Since entropy is free from reliance on symmetric probability distributions and can be computed from nonmetric data, it is more general than others as a competent measure of risk. In this work, returns of securities are assumed to be uncertain variables, which cannot be estimated by randomness or fuzziness. The model in the uncertain environment is formulated as a nonlinear programming model based on uncertainty theory. Also, some other criteria like short-and long-term returns, dividends, number of assets in the portfolio, and the maximum and minimum allowable capital invested in stocks of any company are considered. Since there is no efficient solution methodology to solve the proposed model, assuming the returns as some special uncertain variables, the original portfolio selection model is transformed into an equivalent deterministic model, which can be solved by any state-of-the-art solution methodology.
Results
The feasibility and effectiveness of the proposed model is verified by a numerical example extracted from Bombay Stock Exchange, India. Returns are considered in the form of trapezoidal uncertain variables. A genetic algorithm is used for simulation.
Conclusions
The efficiency of the portfolio is evaluated by looking for risk contraction on one hand and expected return and skewness augmentation on the other hand. An empirical application has served to illustrate the computational tractability of the approach and the effectiveness of the proposed algorithm.
Keywords:
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