Asia Times: Doctor prescribes greater investment in health


	April 19, 2000	atimes.com

India/Pakistan

Doctor prescribes greater investment in health
By Ranjit Dev Raj

NEW DELHI - Calling the 1 percent of GDP that India spends on public health grossly inadequate, Harvard economist Jeffrey Sachs said on Monday that this country's future development hinges crucially on investment in human health.

Speaking at a press conference after three days of meetings and field visits, Sachs, here as chairman of the World Health Organization's Commission on Macroeconomics and Health (CMH), said India should be spending between 3 and 5 percent of its GDP on public health.

Launched in January by WHO director general Gro Harlem Brundtland, the CMH has been tasked to clarify linkages between health and poverty alleviation and will present its first report at the 53rd World Health Assembly in May. Health and poverty, said Sachs, director of the Center for Economic Development (CID) at Harvard, had a two-way, cause-effect relationship and the ideal was a ''virtuous cycle'' of raised incomes and improved health.

Sachs said the CMH viewed India's case with particular concern because its 1 billion people represented a fifth of the world's total population in developing countries and had the largest concentration of the poor.

A visit to a resettlement colony in Delhi convinced him that there was a tremendous unmet demand for health services but people seemed to have grown resigned to neglect and the futility of protest. ''It is a paradox that while democracy is more likely to allow poor people better access to health many dictatorships are doing far better than India in health delivery.''

India, he pointed out, did not even have a strategy to tackle the problem of building a health delivery system or to mobilize resources for it - and that as a tropical country it had to make a greater public health effort.

High-income growth was essentially a feature of countries with temperate zones near the sea, like the United States, Australia, New Zealand and Southern Africa, Sachs said, adding that these were observations from three years of research. As an illustration of his theory Sachs said China was doing better than India because of its ''wonderful coastal band in the temperate zone'', which conferred good health and therefore allowed rapid development.

Tropical regions like India, he said, face a round-the-year burden of vector-borne diseases such as malaria and dengue fever and water-borne ailments, including diarrhoea, caused by various organisms. A class of diseases is concentrated in the tropics, not because of lazy public health specialists or a lack of government will, but because the warmer the temperature the longer the life of the mosquito and its ability to transmit the plasmodium, he said.

Said CMF member Isher Judge Ahluwalia, ''Our learning process has just begun. The challenges are very clear. The CMH will now work towards evolving an effective and practical response.'' Ahluwalia, who heads the Indian Center for Research on International Economic Research, attributed the low level of investment in health to the reluctance of Indian politicians to make long-term investments and their preference for projects with quick, readily visible results.

She compared Sachs's attempts at convincing the Indian government to invest in health to similar persuasion by the Nobel-prize winning economist Amartya Sen to invest in education - the other grossly neglected social sector area in this country. Like Sen, Sachs blamed India's poor economic performance, as compared to the neighboring ''tiger-economies'' of Asia, on indifference to social sectors, with investment in public health being a key component in development.

Poor health, he said, directly caused problems typical to developing countries such as non-attendance in school and low status for women, who were condemned to repeated pregnancies because of high levels of infant mortality. Additionally, agricultural productivity was better in the temperate zone than in the tropics because of such factors as better retention of soil nutrients.

Increased life expectancy, reduced disease burden, lower fertility rates and improved educational attainments are at least as important as higher economic growth and rising living standards, he said. ''Social goals are crucial not only in and of themselves but also for what they contribute to economic dynamism.''

A joint-study by Sachs and Nirupam Bajpai, director of the India Program at Harvard University's Center for International Development notes that India was starting the new century in unenviable circumstances.

''Life expectancy is around 63 years compared to 78 in the high-income countries, literacy of adult women is notoriously low at 40 percent, under-five mortality rates remain above 100 per 1,000 births,'' the study said.

(Inter Press Service)

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