If we are to transform health care in India, we need to first recognize the systemic nature of the health-care crisis. Every stakeholder—the users, providers, and managers are struggling to bandage structural fault lines. Clearly, a major surgery is needed. But individual health is not shaped solely by the medical care we can access or an individual’s genetic attributes. It is shaped by the systems that mold us—our environment, food, living and work patterns, social relationships, emotional state, and our health-care-related practices. Every day, we make choices related to these variables that impact our health, whether it is our diet, our clothes, our sleep, our leisure activities, and so on.

Despite the interconnectedness of individual and systemic variables in shaping our health care, ‘health’ has not gained the public salience to merit collective thinking or mobilization on an appreciable scale. Health care is still relegated as an area for individuals to muddle through as best as they can when they are ill. Additionally, it is considered too technical, and therefore not engaged with by most Indians as a serious policy issue.

When down with an illness, we choose from the health services available and manage with whatever is best suited for us. In such a time of crisis, firefighting is the priority—not deciding on ways to improve and strengthen the various choices in health care or generate public pressure for the same. Later, we get busy with other things. Or we scapegoat individual doctors, rather than underscore the limitations that ail the system. This ignoring of systemic and collective causes of ill-health is certainly at our own peril, as individuals and as a society.

Dilemmas and Dreams for a Healthy India: Systemic Innovations

India is set to be the biggest and youngest nation on the planet in the remaining three-quarters of the twenty-first century. With the largest number of young people, India could provide the workforce for the global economy and reap demographic dividends. However, the opposite is also likely—that India will have an aging population that struggles with chronic illnesses while the children and workforce age-group struggle with a lack of access to early diagnosis and care for acute health conditions, ending up with an earlier onset of chronic illnesses. Ensuring that India is on track to being healthy, happy, and productive will require a serious consideration of the current situation and putting in place a series of measures to enable the realisation of this dream.

Health policy concerns, articulated in pre-COVID times, will now additionally have to contend with the need for preparedness to deal with future pandemics. The COVID-19 pandemic demonstrated that we have primary-level public health services in all states and union territories that can be mobilised at the ground level—visible in efforts at contract tracing and testing and following up on people testing positive, and the extent of vaccination that was accomplished once adequate vaccine stocks became available. But it was only in some states that this primary-level care could be considered reasonably satisfactory in coverage and quality. It was again public hospitals that provided a major part of the hospital care required for moderately or seriously ill COVID-19 cases. Doctors, nurses, paramedical and support staff all performed a humongous task over the two years we experienced the pandemic, going well beyond their call of duty. Yet, even in normal times, our public hospitals are not the most patient-friendly of places.

Is it that we are so resource-constrained that we cannot develop an adequate health-care system for all Indians? Is it that the inequalities in access to incomes, material goods, and services are so wide that most Indians remain deprived, while only the better-off get good quality, trustworthy health care? Or is it also that the kind of system we have attempted to develop for ourselves has been unsuited to our context and to the provision of a societally affordable, inclusive, caring, and humane service system?

Is a doctor- and hospital-centred imagination of health care the only one we can aspire to? Or should we view them as essential but partial components of what ‘health care’ is about? Can medical services be effective in improving a population’s health if basic conditions of life are unhealthy?

COVID-19 has reminded us that human health is closely intertwined with ecology and economics. Whether the virus came from a laboratory or the wet market in Wuhan remains a matter of controversy. But in either case, it points to the breaking down of ecological barriers between viruses, which nature cloistered in remote niches, and the human species. The pandemic was the result of an interplay of factors: human initiatives focused on global chains for esoteric food, megalomaniac notions of investigating such natural virus niches to generate technological solutions to pandemic control before the infection reaches us, and the natural dynamics set up by the decreasing biodiversity. Clearly, human-centric and technology-centered approaches alone cannot protect human health. A healthy human environment requires a healthy ecological system, which includes the physical, biological, and social. Can we envisage what can be called ‘health-care habitats’—our living and working spaces as places that enhance rather than detract from our health and happiness? The post-COVID world will have to decide what is to be the central focus of future development—economics or health.

Health requires a balance of economic, technological, and social development that caters to the well-being of humans and the planet.

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.