A Four-Week Immersive Online Introductory Certificate Training Course on “Fundamentals of Public Policy,” an Online Spring School Program was hosted by IMPRI Impact and Policy Research Institute, New Delhi, during the timespan of 3rd March to 25th March 2023. The program included an insightful and enriching discussion delivered by eminent speakers, where the Dr. Amar Jesani presented on the topic “Health and Public Policy”. The session was opened with introductory and welcoming remarks from Professor Mukul Asher and was further moderated by him.
Dr Amar Jesani started the session by throughing light on Healthcare Policy- Historical and Philosophical Foundations for Universal Healthcare Policy.
Relevant points covered under health and conditions for well-being:
- Definition (WHO): Not mere absence of disease, but well-being
- Health as a Human Right:
- Not a right to be healthy, but to access to conditions for health
- Not mere civil/political right, but also socio-economic right
- UN: General Comment on Article 14 of ICSECR – Right to the Highest Attainable Standard of Health:
- ” Availability-Accessibility-Acceptability-Quality
- ” State obligations: To respect, protect & fulfil
Health & Healthcare
- Primary determinants of health and well being are social/economic and
- NOT disease treatment/healthcare
- “Medicine is social science, and politics is medicine on a grand scale”
- (Rudolf Virchow)
- Developed countries: State intervention & Elimination of infectious diseases before discovery of effective medicine (T McKeon 1979)
- Determinants of Determinants of Health and Health/Medical care-
- Later 19th Century: Scientific medicine & healthcare systems developed.
- 20th Century establishment of Universal Healthcare Access in developed countries.
Critique of Health/Med care Market as an Access
• 2nd half of the 19thCentury: Evolution of Health systems took place, Professions like Doctors, nurses, took up pace and clinics, Hospitals, Scientific Medicine developed. Production systems for drugs/devices increased.
Health Policy on Healthcare:
– Market failure causing problems of access to health/medical care
– Vicious circle: Poverty- “ill health-Private cost-poverty”
– “Medical/health care: “Merit Good vs Public Good”
Evolution of strategies for university- access to health
• The common to all experiences: Need for (state) intervention to regulate / control / reform market mechanism.
• Late 19th Century onward: Increasing social insurance by the state
-Civil society initiatives (Trade Unions/Friendly Societies/others)
• Post WW2 (Europe/Canada): Transition to Welfare States
– Strategies: State Provision / State Contract-IN or Purchase / contract
• USA-Private insurance in wage agreements + state welfare (Medicare, Medicaid, Veteran Services, Obamacare)
Principle of Solidarity as Ethical/Philosophical based universal access
Sociological Definition: Solidarity is the degree of social cohesion in a group or society whereby individuals, because of various motivations, are willing to serve and promote the collective interest of the group or of society.
-In Europe, emerged from below in 19th C as local/micro system for social support and medical care
-In health and social care, solidarity has come to mean that everyone makes a fair financial contribution to a collectively organised and compulsory insurance system that guarantees equal access to health and social care services for all members of society.
As a feeling of responsibility to support those who are in need of care but not able to pay for it (Children, old people, poor etc)
• Some may also see it individualistically as (Self) “Interest
Solidarity”; “Investment” for future security
• Early communitarian theories: Exclusive – for certain communities
Modern theories of solidarity try to reconcile the recognition of individual differences with an inclusive interpretation of solidarity
• Solidarity means an interactive relationship in which individuals mutually sympathize with each other’s different ways of life because they esteem each other in reference to a shared value horizon.
Liberalism and limitation of Justice
Liberal theories on the right to healthcare (primary good):
– Provision of MINIMUM (not optimum) quantity & quality
-Made conditions to prove to be deserving poor, Which results in to disrespectful and humiliating practices, ‘subjecting the poor to a level of scrutiny and control not experienced by the better off’ – infliction of humiliation, injuring self-respect.
” The liberal ‘just society’, therefore, may not be a ‘decent society’”
Critiques: Not just access
Universal access systems did not reform production: Pharma etc
From the late 196os onward: social and cultural critiques:
– Equity-Gender, Race, etc.
-Medicine & its practice – alternate systems, monopoly, iatrogenesis
-Corporate control & Distortion of Science
– “Distortion” of medical science & search for other “sciences”
– Universal access system under pressure (1980s onward)
-Rising cost with high-tech medicine forcing introduction some market
-Erosion of solidarity
– Bureaucratization and inefficiency
Healthcare Policy and Healthcare System
Building in India
Early promise of system building
• Pre-At-Independence: (a) Sokhey Committee Report;
(b) Bhore Committee Report
-Healthcare to be made accessible irrespective of the individual’s capacity to pay (i.e. It will be publicly financed)
-Establishment of healthcare infrastructure with human and material resources of the government
– Provision of the medical-care as well as preventive/promotive/ public health from one system (Comprehensive)
-Failure to make necessary investment (infrastructure and to provide material inputs (drugs, devices etc.)
– Government Healthcare expenditure: Around 1% of GDP – Grossly inadequate for Universal Access
– 19705-19805: Comprehensive healthcare access gave way to the selective programs and coverage, Private sector allowed to flourish unregulated.
– Healthcare as public good replaced by merit good – user charges in public system, private out-of-pocket or insurance.
Acknowledgement: Aqsa Qureshi is a Research Intern at IMPRI.
Youtube Video of Fundamentals in Public Policy Programme: https://youtu.be/vmzTpBU7fwo?si=WRkcqRf7xe2N6XCS.
Read more session reports on web and policy learning events conducted by IMPRI: Time bound Justice is Easily Possible in India