Modernising Healthcare System
The World Health Organisation adopted “Urbanisation and Health: Urban Health Matters” as the theme for the year 2010. The idea behind the theme was that more and more people would be living in the cities in future, including India. This creates enormous challenges to the healthcare providers already struggling with a vast burden of illness. India is one of the countries where the importance of data gathering has not been adequately appreciated. Though data on some health indicators such as birth rate, death rate, and maternal mortality rate are available, the actual disease burden due to important risk factors particularly the environmental factors which have become dominant in the last few decades, is not obtainable. The rapid rise in the number of people living in cities will be among the top global health issues of the twenty-first century. The World Health Organisation estimates that six out of every 10 people will be city dwellers by 2030, rising to seven out of 10 by 2050. In many cases, specially in the developing world, the speed of urbanisation has outpaced the ability of governments to build and maintain essential health, sanitation, water, and hygiene infrastructure and provide basic services.
Disease is both a symptom of poverty with overcrowding, inadequate infrastructure and lack of healthcare, increasing transmission and susceptibility, a contributor to poverty. Poor health shreds communities, undermines economic opportunity, and holds back progress. It denies children around the world the opportunity to live up to their full God-given potential. We have also seen that oceans and borders are no defence against the pandemics that threaten us all. These are global challenges that demand a global response. Good health is a state of physical and mental well-being necessary to live a meaningful, pleasant and productive life, besides, being an integral part of thriving modern societies, a cornerstone of well-performing economies, and a shared principle of democracies. Achieving good health for all means not just reacting to ill health, but proactively promoting health, preventing diseases and helping people make healthy choices. It also means successfully tackling important challenges currently facing the mankind. These challenges include ageing-related conditions, high levels of lifestyle-related diseases linked, for example, with obesity or tobacco consumption, a resurgence of serious communicable diseases, such as HIV/AIDS, and the threat of new diseases like SARS. Achieving good health for all is a shared responsibility that requires cooperation among the countries and their citizens.
The earliest culture in India centered on Mohenjo-daro and Harappa, chief cities of the Indus Valley civilization, which flourished from about BC 2500 to 1500. An astonishing feature of this urban culture was its advanced system of public sanitation. There were numerous wells, bathrooms, public baths, sewers, and garbage chutes. Streets were laid out in regular fashion, and houses were well built and ventilated.
The Vedas are the ancient texts, which contain hymns, prayers, and teachings, on which most of the religious and moral codes of India were based. The oldest, the Rig-Veda, as well as the Yajur-Veda and the Sama-Veda, were almost entirely religious. The Atharva-Veda, refers to diseases, injuries, fertility, sanity, and health; besides being a concise treatise of spells and incantations for the practice of magic.
ANCIENT INDIA AND HEALTH
The Ayurvedic Medicine: The foundations of traditional Indian healing, called Ayurvedic (knowledge of life) medicine, rested on ancient teachings together with a number of Ayurvedic medicine which was based on a vast literature which included not only the Vedas and their later commentaries (the Brahmanas, Aranyakas and Upanishads) but also a body of medical writings by many contributors, of whom two stand out as the most influential: Charaka and Sushruta. Estimates have varied widely on their dates of existance. Some have suggested the first-century AD for Charaka and the fourth century for Sushruta, but there are also claims for more ancient times.
Ayurveda was the most important philosophy that dealt with health but in a much wider sense. Ayurveda is composed of two Sanskrit words: Ayu which means life and Veda which means the knowledge of. To know about life is Ayurveda. However, to fully comprehend the vast scope of Ayurveda let us first define “Ayu” or life. According to the ancient Ayurvedic scholar Charaka, “Ayu” comprises four essential parts, the combination of mind, body, senses and the soul. This broadens the scope of health including mental, physical, emotional, and spiritual aspects which the modern medicine has now acknowledged. The modern concept of wellness stresses more emotional and spiritual health than physical and mental. Even World Health Organisation today is changing the term mental health to psychological health which recognises the importance of emotional issues.
Ayurveda is a holistic system of medicine that uses a constitutional model. Its aim is to provide guidance regarding food and lifestyle so that healthy people can stay healthy and those with health challenges can improve their health.
There are several aspects to Ayurveda that are quite unique:
- Its recommendations will often be different for maintaining the clarity of our senses which is essential for each person vis-a-vis foods and the lifestyle part in allowing the mind and body to integrate he/she should follow in order to be completely functional and help in keeping us healthy and happy.
- Everything in Ayurveda is validated by observation, inquiry, direct examination and knowledge derived from the ancient texts.
- It understands that there are energetic forces that influence nature and human beings. These forces are called the Tridosha.
- Because Ayurveda sees a strong connection between the mind and the body, a huge amount of information is available regarding this relationship.
MIND, BODY AND SENSES
We tend to identify most with our physical bodies, yet, in actuality, there is more to us than meets the eye. We can see that underlying our physical structure is the mind, which not only controls our thought processes but helps us carry out day-to-day activities such as respiration, circulation, digestion and elimination. The mind and the body work in conjunction with each other to regulate our physiology. For the mind to act appropriately to assist the physical body, we must use our senses as information gatherers. We can think of the mind as a computer and the senses as the data which get entered into the computer. Smell and taste are two important senses that help the digestive process. When the mind registers a particular food entering the gastro-intestinal tract, it directs the body to act accordingly by releasing various digestive enzymes. However, if we overindulge the taste buds with too much of a certain taste, such as sweet, we may find that the ability of the mind to perceive the sweet taste is impaired; thereby the body becomes challenged in its ability to process sweet foods.
Ayurveda also sees that before we exist in physical form with the help of mind and senses that we exist in a more subtle form known as the soul. The ancient seers of India believed that we had a certain energetic essence that precluded the inhabitance of our physical entity. In fact, they hypothesised that we may indeed occupy many physical bodies throughout the course of time but that our underlying self or soul remains unchanged. What we see to help illustrate this concept is what transpires at the time of death. When the individual nears the time to leave the physical body, many of his/her desires cease to exist. As the soul no longer identifies with the body, the desire to eat food or indulge in a particular activity that used to be a great source of satisfaction for that person drops by the wayside. In fact, many individuals have been documented to experience the sensation of being out of their bodies. These are just a few examples of how we are made up of these four components that we call life.
Unlike the modern medicine, Ayurveda views a person as a unique individual made up of five primary elements. The elements are ether (space), air, fire, water, and earth. This way the human body represents environment and so the path of attainment of health runs through the environment and its purity. Just as in nature, we too have these five elements in us. When any of these elements are present in the environment, they will in turn have some influence on us. The foods we eat and the weather are just two examples of the presence of these elements. While we are a composite of these five primary elements, certain elements are seen to have an ability to combine to create various physiological functions. Ether and air combine to form what is known in Ayurveda as the Vata dosha. Vata governs the principle of movement and therefore can be seen as the force which directs nerve impulses, circulation, respiration, and elimination. Fire and water are the elements that combine to form the Pitta dosha. The Pitta dosha is the process of transformation or metabolism.
The transformation of foods into nutrients that our bodies can assimilate is an example of a Pitta function. Pitta is also responsible for metabolism in the organ and tissue systems as well as cellular metabolism. Finally, it is predominantly the water and earth elements which combine to form the Kapha dosha. Kapha is what is responsible for growth, adding structure unit by unit. Another function of the Kapha dosha is to offer protection. Cerebrospinal fluid that protects the brain and spinal column is a type of Kapha found in the body. Also, the mucosal lining of the stomach is another example of the Kapha dosha protecting the tissues. We are all made up of unique proportions of Vata, Pitta and Kapha. These ratios of the doshas vary in each individual; and because of this, Ayurveda sees each person as a curious combination that accounts for our diversity.
Ayurveda gives us a model to look at each individual as a unique make-up of the three doshas and to thereby design treatment protocols that specifically address a person’s health challenges. When any of the dosha (Vata, Pitta or Kapha) become accumulated, Ayurveda will suggest specific lifestyle and nutritional guidelines to assist the individual in reducing the dosha that has become excessive. We may also suggest certain herbal supplements to hasten the healing process. If toxins in the body are abundant, then a cleansing process known as Pancha Karma is recommended to eliminate these unwanted toxins.
THE RIGHT TO HEALTH
As human beings, our health and the health of those we care about is a matter of daily concern. Regardless of our age, gender, socio-economic or ethnic background, we consider our health to be our most basic and essential asset. Ill health, on the other hand, can keep us from going to school or to work, from attending to our family responsibilities or from participating fully in the activities of our community. By the same token, we are willing to make many sacrifices if only that would guarantee us and our families a longer and healthier life. In short, when we talk about well-being, health is often what we have in mind.
The right to health is a fundamental part of our human rights and of our understanding of a life in dignity. The right to the enjoyment of the highest attainable standard of physical and mental health, to give it its full name, is not new. Internationally, it was first articulated in the 1946 Constitution of the World Health Organisation (WHO), whose preamble defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. The preamble further states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”
The 1948 Universal Declaration of Human Rights also mentioned health as part of the right to an adequate standard of living (art. 25). The right to health was again recognised as a human right in the 1966 International Covenant on Economic, Social and Cultural Rights.
Since then, other international human rights treaties have recognised or referred to the right to health or to elements of it, such as the right to medical care. The right to health is relevant to all States: every State has ratified at least one international human rights treaty recognising the right to health. Moreover, States have committed themselves to protecting this right through international declarations, domestic legislation and policies, and at international conferences.
In recent years, increasing attention has been paid to the right to the highest attainable standard of health, for instance by human rights treaty monitoring bodies, by WHO and by the Commission on Human Rights (now replaced by the Human Rights Council), which in 2002 created the mandate of Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health. These initiatives have helped clarify the nature of the right to health and how it can be achieved.
This fact sheet aims to shed light on the right to health in international human rights law as it currently stands, amidst the plethora of initiatives and proposals as to what the right to health may or should be. Consequently, it does not purport to provide an exhaustive list of relevant issues or to identify specific standards in relation to them.
The fact sheet starts by explaining what the right to health is and illustrating its implications for specific individuals and groups, and then elaborates upon States’ obligations with respect to the right. It ends with an overview of national, regional and international accountability and monitoring mechanisms.
WHAT IS THE RIGHT TO HEALTH?
Key aspects of the right to health
■ The right to health is an inclusive right. We frequently associate the right to health with access to health care and the building of hospitals. This is correct, but the right to health extends further. It includes a wide range of factors that can help us lead a healthy life. The Committee on Economic, Social and Cultural Rights, the body responsible for monitoring the International Covenant on Economic, Social and Cultural Rights, calls these the “underlying determinants of health”. They include:
► Safe drinking water and adequate sanitation;
► Safe food;
► Adequate nutrition and housing;
► Healthy working and environmental conditions;
► Health-related education and information;
► Gender equality.
■ The right to health contains freedoms. These freedoms include the right to be free from non-consensual medical treatment, such as medical experiments and research or forced sterilisation, and to be free from torture and other cruel, inhuman or degrading treatment or punishment.
■ The right to health contains entitlements. These entitlements include:
► The right to a system of health protection providing equality of opportunity for everyone to enjoy the highest attainable level of health;
► The right to prevention, treatment and control of diseases;
► Access to essential medicines;
► Maternal, child and reproductive health;
► Equal and timely access to basic health services;
► The provision of health-related education and information;
► Participation of the population in health-related decision making at the national and community levels.
■ Health services, goods and facilities must be provided to all without any discrimination. Non-discrimination is a key principle in human rights and is crucial to the enjoyment of the right to the highest attainable standard of health.
■ All services, goods and facilities must be available, accessible, acceptable and of good quality.
► Functioning public health and health-care facilities, goods and services must be available in sufficient quantity within a State.
► They must be accessible physically (in safe reach for all sections of the population, including children, adolescents, older persons, persons with disabilities and other vulnerable groups) as well as financially and on the basis of non-discrimination.
Accessibility also implies the right to seek, receive and impart health-related information in an accessible format (for all, including persons with disabilities), but does not impair the right to have personal health data treated confidentially.
The facilities, goods and services should also respect medical ethics, and be gender-sensitive and culturally appropriate. In other words, they should be medically and culturally acceptable.
► Finally, they must be scientifically and medically appropriate and of good quality. This requires, in particular, trained health professionals, scientifically approved and unexpired drugs and hospital equipment, adequate sanitation and safe drinking water. (A WHO feature)
MODERN CHALLENGES TO HEALTH
Today, due to a consumer and consumption oriented growth model we are witnessing tremendous upheaval in the world. Issues that were not considered to be significant are challenging our survival. The most important issue is that of global warming and climate change brought about by unbridled consumption patterns adding vast volume of greenhouse gases to the globe.
Though we are not fully aware about global warming, strangely we all are more or less contributing to ‘global warming and climate change’. Global warming implies rise in the average temperature near the surface of the earth. According to IPCC (Inter Governmental Panel on Climate Change) report the measured average atmospheric temperature near the earth’s surface rose by 0.740 degree Celsius during the last 100 years (1906-2005). Eleven out of 12 hottest years on record occurred between 1995 and 2006.
We are living in the midst of constantly changing climatic conditions, a sequel to human interference, which interference if allowed to continue can cause irreparable damage to the flora, fauna and human life. Global warming will have a potent effect on the rainfall, creating a drought-like situation and rise in the sea level. The overall change in the natural characteristics of the earth for global warming continuously for a long period is known as ‘climate change’. So, the climate change is a result of global warming. Climate change is definite if the globe becomes warm and warm.
Ancient Indians believed in a frugal way of living, amassing fewer possessions. The idea behind having fewer possessions was to prevent exploitation of natural resources which are limited and finite, and can never meet the greed of humans. This also translated into lesser manufacturing and fabrication which implied lesser pollution. Today, vast industrial areas and manufacturing hubs are springing up consuming vast resources and creating pollution of air, water and soil at an unimaginable and unprecedented scale. Some of the pollutants have created havoc that we saw in Bhopal when a leak of methyl isocyanate gas killed thousands and crippled thousands more who continue to suffer even today. The modern science has no solution to bizarre and strange health disorders that have been caused some 26 years ago, making a mockery of the claim of some of the intellectuals who claim modern medicine has answers to all ailments.
In fact, serious doubts have been raised by the ability of modern medicine and science to find solutions to the complex health phenomena that are being witnessed. First was the Acquired Immune Deficiency Syndrome about which no one knows how it began. We have nothing that can cure it though some anti-retro viral drugs are being used to retard its progression. These drugs like anti-cancer or cytotoxic drugs create serious toxic effects and many patients cannot tolerate these medicines. Hardly had the problem got addressed when we had appearance of Severe Acute Respiratory Syndrome (SARS) which was so deadly that in Hong Kong hospitals half of the physicians and nurses treating the patients themselves died. It was just good luck that the infection came under control by itself. Now we have to deal with bird flu and swine flu, two new variants of this new viral associated illness which again cannot be cured.
Growing resistance to conventional antibiotic, and resurgence of old infections such as diphtheria and tuberculosis are causing headache to the modern scientific establishments. The scientists are becoming despondent at these developments. There has been an alarming rise in the number of cases of cancer which is almost incurable and the treatment costs are mind boggling. To add insult to injury, the modern hospitals, and the treatments they offer are beyond the reach of even well-to-do. The common man cannot even dream of getting in there.
There have been tragic tales of people selling their houses, land and businesses or taking huge loans to be able to pay their medical bills. So there is a big question mark against these developments touted as miracle medicine. Instead of having “Health for All” we are having “Health for a Handful”. There is a race against time as the ‘man-made diseases’ due to environmental pollution, and ecological damage are increasing. Together with ‘lifestyle-related diseases’, and return of ‘infectious diseases’, these have become a challenge to our survival.
WHAT TO DO
The fact must be acknowledged that the modern system of medicine is focused on attainment of physical health. It has tried to find solutions through super specialists and technology which has failed us to get to the cherished goal of “Health for All”. In Indian context, the situation gets further complicated by abject poverty which seems to be growing in the wake of consumerism-based economic growth, and the way mankind lived for millennia. The insecurity, lack of safety and social support, and short-term contractual jobs are making modern living an unfriendly experience for most Indians and only a few can claim to enjoy a pleasant living.
There have been calls for not judging the prosperity of a country by GDP or share market growth but by computing the number of people who are happy and contented. If money could get people health and happiness, the US should have been the happiest, healthiest, and most contented nation. On the contrary, the country is experiencing falling standards of living, growing insecurity, poorer health and greater anxiety among the people as to what lies in store as far as their future is concerned.
To meet the new global challenges of health, we may look inwards reverting to our roots and imbibing the Ayurvedic concepts of healthcare, taking body as a representative of environment. We must place health high on the national agenda and the efforts to do so may start from the first day a child goes to school. For attaining a spiritual attitude, activities may be promoted for encouraging children to take to Yoga and imbibing values that augment their interest in sanitation, hygiene and environmental protection. The ‘healthy lifestyle approach,’ so much stressed in our scriptures, must be emphasised and pursued.
By Dr Harsh Vardhan
[The author is Advisor, World Health Organisation (South East Asia Region), and former Health & Education Minister, Delhi Government.]