While I was lazing around on a Sunday evening after spending the day watching some pointless TV show on Netflix, which would never further my intellect at any particular matter, my father pointedly remarked to me, ‘Health is Wealth! Go exercise your muscles for once.’
That statement truly struck my brain muscles. I decided to exercise those for a change since I was too much of a sloth to get out and workout. It dawned upon me that the statement was absolutely bogus. Wonder why? In my limited experience of 23 years on this planet, it has often become vividly clear to me that indeed the reverse is true, ‘Wealth is Health.’ To die a death of peace, without gasping for oxygen, while sitting on a wheelchair, waiting outside a hospital for a bed and a cylinder, you would have needed (on an average) a few hundred thousand rupees back in May 2021 in New Delhi.
Want to know the median household income in India? Well, it’s a handsome round off of about fifty thousand rupees per annum. Which begs the ultimate question, why is basic healthcare so expensive?
With socio-health inequalities being a raging issue of debate for most forums amidst the Covid era, the discussion has always started and ended with the incompetency of the government and the neglect of the public health infrastructure, respectively. Do I agree with that? Not in its entirety. But to delve deeper into how this mechanism works, it would be prudent for one to revisit the consequential economic steppingstones to such inequities around the world.
Health Inequity, not Inequality
It is important to address that health inequality should not be diluted into the mix of health inequity. That’s simply because health inequality is generally a by-product of disorders which kick in with older age, and often are hereditary, or genetic problems. For example, my mother’s forlorn battle with Rheumatoid arthritis is one such inequality that couldn’t be helped.
However, the health inequity that the modern world faces so rampantly today, is different from my mother’s story. Health inequity often stems from a valley surrounded by the challenging mountains of income, physical environment, social support inequalities. Those are few of the major inequalities which isolate the socio-economically disadvantaged population into facing the burnt of a forged inequity arising from the disbalanced opportunities across our demographies. You literally must climb up the socio-economic mountain to attain the accessibility of such refined services and thus, better your chances at living a healthier and longer life. For example, research shows that asthma hospitalisations are over 1.5 times more in the lower-income neighbourhoods compared to the higher-income ones. Now this combined with our improved understanding of climate change, the ill-effects of bad air quality, and the ever-so-frequent cyclones, and floods, it is no joke when we finally realise that the physical and economic confinements of an individual lead them to bearing significant disadvantages in a health battle.
Health is a Right, not a Commodity
Now, as an Economics major (which I am not sure if I should pride myself in), I cannot help but look at the notions of demand, supply, and utility in all aspects of life. They start with me succumbing to the urges of buying more affordable clothing from regular labour law abusers to deliberating if it's the healthcare policies which are truly at fault or not.
Looking at the situation from a strict Demand-Supply angle, I concede to the concept that government intervention is useless and give into the argument “let the forces of market play out to acquire efficiency”. Ah yes, ‘efficiency,’ the ‘It’ word of Economics. It is supposed to solve all our problems, right? Well, again not entirely true, just like every other ‘rational’ answer in economics which is based on an unstable jenga of numerous assumptions.
Allow me to explain the jargon of ‘efficiency’ to you. Economic efficiency is defined as a state where all goods and factors of production are distributed or productively allocated amongst the consumers to eliminate any chances of waste. However, what the jargon often leaves behind is the inability of efficiency to incorporate all players in the market. For example, if someone has more money at his or her disposal, then that person is perfectly capable and encouraged to acquire the scarce resource at a higher price while defeating another without those means. You know the saddest truth of healthcare? It is a Scarce Resource.
Therefore, the statement “let the market play out” along with the assumption that the intervention of government only leads to market failures (through monopolistic behaviour) is ridiculous and a sure shot at worsening the pickle that we already find ourselves in. Therefore, it is time to set the record straight, “Affordable healthcare is my Right, no matter if I am poor or rich, today or tomorrow.”
Big Pharma: Saints or Satan?
No matter the number of conventions, agreements and vigilance of health authorities, the pharmaceutical companies can not stop making billions off the pain of the global citizens. Again, going back to the demand and supply argument. The demand and supply should meet at equilibrium to fix the market prices. But it is a little different for drugs, especially life-saving ones. People simply don't have the option to refuse the exorbitant prices of drugs such as Hepatitis C or HIV, which gives the companies a massive leverage to fix prices as per their whims and profit margin targets.
For instance, let’s talk about Turing Pharmaceuticals and the CEO Martin Shkreli who hiked the price of an essential drug, Daraprim, by 5,000% (from $13.50 to $750). This begs the question: Can buying licences to public funded research and innovations, and then hiking prices to make the public pay for it, even legal? According to the laws, mostly it is.
In an interview when asked about what he would have liked to do differently, Shkreli went on to answer that “Healthcare prices are inelastic, I could have raised it higher and made more profits for my shareholders.” This one statement sums up the motive with which big pharma operates; they are not responsible for their patients, they are answerable to their shareholders and investors.
The unrivalled power in the lobbying halls of the American Congress and parliaments around the world has made big pharma the ultimate power player when it comes to deciding if we even have a shot at surviving. Even though they operate within the realms of humanity, they possess the strings to make us all dance on their commands. Recurring malaria symptoms due to a sudden lack of affordability to Daraprim is not fateful, it is planned.
Public-Private Partnerships: A farce or a force?
Strategic intervention of public policy in the healthcare sector is the need of the hour. In recent years, governments, international organisations and even private players have conceded to the argument that equality of opportunity should be the moral foundation to build our policies. The World Bank, for instance, has started using a Human Opportunity Index as one of the relevant indicators to assess social, human and economic development aspects.
Many government initiatives, for example the Midday Meal Scheme in India, is geared towards ensuring social and educational protection routed through the maintenance of nutritional standards for children hailing from lower income communities. As deeply deliberated by economists Amartya Sen and Jean Dreze, nutritional inadequacies can often lead to future health problems, thus, making the poor vulnerable in a competitive labour market.
Therefore, socio-health protection can stimulate economic growth for developing nations and be a key factor to combat a macroeconomic crisis. But the main problem, when seen through the lenses of developing countries, is often the laid-back attitude of the public sector projects which when coupled with a bar of fiscal deficit, can be difficult obstacles in planning a long-term inclusive plan. To bring in the private players into this mold would mean that it would contribute to capital accumulation and investment, risk management and offer diverse potential advantages to indirect stakeholders through multiplier effects. Therefore, bringing in private funding with the main hold of government in steering things to the correct conclusion, pricing, can be the way forward.
Having suggested the inclusion of private players into the mold of healthcare, I must address the problem of private players slowly taking the charge to invest and maximise profits through expensive medication (inelastic demand). Therefore, the onus must lie upon the government to take action, diversify research, be responsible and accountable to the public at large, and be strict with the pricing models.
Am I Satisfied or Worried?
Well, I would say, I am ‘impressed’. Don’t get me wrong, the statistics of COVID-19 cases unfolding while I cough my heart out to write these soulful words, has me chilled to my bones. But the honest truth is that the pandemic is here to stay. Yes, we already have a delta plus omicron variant and booster jabs available but it is not that which has impressed me (I am not a supporter of dystopia, in fact I am already dreading the advent of “oxicron”). I am impressed by the fact that our newsrooms, classrooms, zoom meetings and daily chats are now (more than ever before) focused on ‘health.’ It is probably for the first time in history that we have realised how much our lives are worth.
In one of my favourite dialogues from the movie Troy (2004), the character Odysseus goes on to tell Achilles that “War is young men dying, and old men talking.” In my opinion, this battle against Covid has proven yet again that neglect in the healthcare systems will cost us lives at all fronts, no matter how boldly the wise, grey haired intellectuals deliberate on fixing the situation without adequate expenditures. The advent of COVID-19 with the surges in internet usage around the globe has made interaction possible between people living in different continents. The debate of healthcare affordability is now no longer limited to the fancy parliament halls and the elite think tanks.
We, the global citizens, have proudly taken a step forward to progress the discussions on affordable healthcare, equitable healthcare, climate change and so much more. The GDP figures are not impressive any more. In fact they are on a dedicated downhill safari. What will it take to impress us? An increase in human development and opportunity indices, for starters, would be good. The discussions on our physical and mental health would be even better.
Earlier (pre-Covid) the politics in my country India would generally revolve around two parties trying to degrade one another with quirkier rhetoric. Now, I am not denying that those rhetorics weren’t fun. They are an absolute amaze, both for meme and conversation purposes. Who in the world would not enjoy a wholesome trash talk between the ‘defenders of faith’. It is terribly fun to watch. But it is not the essence of our existence as politics made us believe in. Our population will only truly prosper when everyone has equal opportunities and access. The world has finally started demanding what is truly theirs, and now we are debating these topics in our homes. Home, where the general scope of discussion was limited to taking trash out and gossiping about neighbours. That is steep progress according to me.
Therefore, I am hopeful when I say that I am looking forward to this decade’s unfolding. This will no doubt be one of the most ‘efficient,’ remarkable and decisive decades of human history. This time the war will not be fought on the enemy lines, rather it will be fought within our homes as we sanitise our hands and take those jabs.
COVID-19 has brought more than 19 months of caged life. So much so that going out without a mask feels alien to me at this point. But what it also helped us realise is that being healthy (and ‘negative’) is golden. Therefore, socio-health protection, extensive public health research funding and awareness is required if we are to be the ‘defenders of human existence’ and strike down these ultra effective viruses and other anomalies. By being ultra productive in building infrastructure for it and investing in pertinent research, maybe we will have a shot at it. But above all what is to be appreciated amid all of this chaos, is the resilience of humankind in not giving up. So, three cheers to humanity at large!
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