To enjoy the fruits of economic reforms holistically, it is mandatory for India to focus on health education.
A couple of years ago, two incidents made me realize that the importance of health education - as an invaluable tool, key to preventive and diagnostic health care - is poorly understood. The first was when a group of women instigated by higher officials in their beedi company made a representation to me that they were against the government's idea of a logo with a skull stating “smoking is injurious to health” on the beedi packets they produce, as that would be detrimental to their livelihood. The second was during the Assembly session when an elected member requested the then transport minister to go easy on government drivers reprimanded for drunken or rash driving.
These two case scenarios are not straightforward livelihood issues but are rather complex with a negative impact on the health, economic, and social well-being of our country. Health education is very often construed to be within the realms of sanitation, hygiene, maternal and childcare, yet even in these areas the impact of health education is incomplete and patchy. In developed countries, health education is a key component of the healthcare system and the budget.
Empowering the health-care consumer with the knowledge to understand the health-care system and to question health-care providers should be the goal of health literacy programs.
Inadequate sanitation, sub-optimal reproductive health and prevalence of life-threatening infectious diseases were all global phenomena a few hundred years ago. Industrialization and affluence alone did not contribute to optimal human development indicators in developed nations but intensive social engineering through vigorous health education programs contributed to these positive changes. India with its inherent diversity, paradoxes and its recently acquired economic prosperity, has to battle with communicable, non-communicable illnesses and psychosocial disorders.
A rise in road traffic accidents, illnesses related to alcohol, tobacco consumption and psychosocial disorders are increasingly affecting the most productive age group of our country. The long-term repercussions of these preventable deaths can become a huge burden to the nation's economy. Hence there is an urgent need not to restrict health education to primary prevention but expand it to create awareness of secondary prevention, the working of the health-care system, the importance of health insurance, etc.
For positive behavioral changes
To combat these public health problems with our limited health resources and to obtain maximum gain it is essential to create an innovative health education policy that would lead to intrinsic positive behavioral changes amid our general populace. Health education leads to empowerment and emancipation of health-care consumers resulting in a standardised quality health-care system.
Postgraduate, graduate and diploma courses on health education with adequate job opportunities should be created for health educators. Research suggests that an improvement in health literacy has a positive effect on the nation's economy. A World Bank report indicates that the economic impact of inadequate sanitation in India in 2006 was Rs.1.7 trillion, and in 2010, Rs.2.4 trillion.
The Planning Commission of India states that India accounts for 9.5 per cent of the total 1.2 million deaths from road traffic accidents, incurring an annual loss of Rs.550 billion. If just these public health problems alone can result in a loss of several trillion rupees, the amount of both direct and indirect losses to the exchequer will be an unimaginable sum when the remaining diseases are calculated.
Undoubtedly the economic reforms have uplifted millions from poverty, but one major illness, an unexpected death or severe injury from a road traffic accident will push them back to their below the poverty (starting) line. Cost-benefit analysis, cost-effective analysis and cost utility analysis are useful and powerful tools for decision making.
To enjoy the fruits of economic reforms holistically, it is mandatory for India to focus on health education, as the huge savings will enable us to achieve the millennium development goals that would in turn lead to the creation of an effective social security system on a par or even superior to what is there in the developed nations. As Mahatma Gandhi said, “it is health that is real wealth, and not pieces of gold or silver.”
---This opinion editorial originally appeared in The Hindu. The author is a practicing obstetrician and gynecologist in India; and a former Tamil Nadu Minister.