Public Health Apathy and Looting of the Public
- Emerging Poverty of the Masses -

Paikhomba Khuman *

Public Health Apathy and Looting of the Public

Introduction

It will be very interesting to examine the real basic divers of growth and development in a developing or an under-developed economy. Technology in any form can trigger economic growth, but it is just necessary and not sufficient to generate the virtuous cycle of economic development. Economic de-growth for a sustainable virtuous cycle of economic development is preferable than a myopic double-digit economic growth that bring poverty of the masses or the common man in general. During the last two decades, what is observable in Manipur is that there is an illusory economic growth which has been triggered by the destructive forces of technology, black money and availability of free-flow of misallocated easy capital, but causing poverty of the masses.

Economic Growth- A Cause of Poverty in Manipur

In fact, since my college days, I had been wrongly presumed that economic growth miracle can bring the virtuous cycle of growth, but totally ignoring another possibility that it can also cause poverty of the masses resulting from barometric increase in health-related expenditure. This is a pathetic reality in Manipur that we need to address at the foremost else the face of a common man shall be wiped out from Manipur.

No doubt the general health related indicators of Manipur, particularly for the age group 0-15 years, are good. But, the other side of the coin is at what private cost. Another stark reality is at what private cost we are maintaining our life expectancy. Why are the health indicators of children not proportionate with that of the adults? Manipur has the lowest infant mortality rate (IMR) in India and even comparable to that of the advanced economies, but not the highest life expectancy in India. This is where the fallacy lies, which can be attributed to the sorry state of public healthcare in Manipur. Another fallacy is that the low IMR of Manipur is not due to availability of easy basic public healthcare but on account of food habit, favourable geography, women empowerment and personal hygiene.

At present, Polio is disease which is extraordinarily neutral-implying it makes no distinction between a poor child or a rich child. This is the underlying reason for the committed public investment to eradicate Polio. Why can’t we treat other child-related diseases like Polio?

The sad reality is that basic child healthcare has become a thriving business in Manipur due to lack of proper intervention from the public health authority. The child specialist in a public healthcare institute is not willing to perform his social duty, but the same specialist will do his private duty at his best provided the patient pays the private fee and spend enormous amount on medicines prescribed by the agents of the companies. Our public healthcare is in disarray not because of lack of basic bare health infrastructure but most of our doctors are in the motive of earning enormous private money. This is what we can term as looting of the public for any health related service.

Middle-class people living like a poor man

Roaming within the four-corners of Imphal, one can argue that economic growth has taken place. But, if we observe very closely the said economic growth is rather accompanied by emergence of poverty in a different form which was non-existent a few decades ago. Economic growth has brought forth life-style diseases, pollution-related diseases, immunity-related diseases, etc. Added to this, now we are aware of what is happening around the globe, thereby giving illusory hope to many of us. However, our public healthcare system is neither growing nor functioning in proportionate to the new challenges as demanded by economic growth, thereby leading to the mushrooming of private healthcare facilities, which will eventually lead the masses to poverty.

As for a common man, who lives in income poverty, his health related expenditure is negligible for he has already known that he could not afford any private cost for his health. But, for a middle-class common class, who can afford some level of private health expenditure, he will spend all what he earns if his health demands. He will live like a poor man implying that his income is that of a middle-class but his expenditure profile will be that of a poor man, as he is forced to spend a major part of his income on private health services. This is the living condition for most of us in the four-corners of Imphal ,i.e., people living in poverty although they don’t look like a typical poor man. Gradually, the misallocation of their own scarce resources in the middle-class group will make them poorer and poorer, and finally they will also join the group of actually poor group one day.

The Way Out

The outgrowth of private healthcare services disproportionately in an outcome of lack of regulation from the public health authority for private practitioners, mismanagement of public health resources, apathy and attitude of the masses, chain-effect of general corruption, etc. A good road, some litres of potable water and 20 hours of electricity are what a common man seeks to purchase from the public authority. If the elected representatives cannot sell even such bare needs of the common people, the continuance of the existing system is irrelevant, as the cost involved is not commensurate with the basic requirements of the masses. It is better to experiment with the rule of an elected benevolent dictator, who can ensure availability of our basic bare needs, for a few decades. It is not enough to look at the economic history of the East Asia and NICs of South-East from the present perspective, but rather there is also a need to look at their past economic history. In the 1950s, 1960s and 1970s, there were no real democracies in those regions, but decisions impacting the life of the common man were taken by the benevolent dictators.

Democracy was not evolved in Manipur but imposed by some external forces, and this may be reason why the ideal form of governance has been degenerated into mobocracy and feudal democracy. The best thing about Manipur is that geographically we are not prone to extreme weather conditions, and this is the reason why the common man has been very tolerant towards the public authority and the elected representatives. At present, the availability of common property resources and possession of a piece of fertile land to some extent is lubricating the subsistence of the common man. But, that day is not far when the common man will be squeeze out of their little possession by the increasing private health expenditure and accompanied by the depletion of the common property of resources, which will lead to the emergence of a benevolent dictator.

It is not that a benevolent dictator is good but it is better than mobocracy and feudal democracy, as it is very cost effective and decision-making is with minimal cost. The only way to prevent such an emergence is the presence of good democratic governance that can ensure availability of affordable basic bare needs of the common man. Let’s change the image of our public healthcare before it is too late. Only a healthy society is a wealthy society.