Universal Declaration Of Human Rights (adopted by UNGA on December 10, 1948)

Features:

i) Providing of adequate health and well being as a more pragmatic standard.

ii) Includes things which should be provided by the state to ensure meeting the terms of this
definition.

iii) It is important to understand that different countries who are signatories to the UDHR have
very different economies and obviously different requirements of healthcare. The UDHR
provides the bare minimum standard that must be achieved by each state. It puts the emphasis
and responsibility on the state.

iv) This is the one of the first definitions which seems to move towards a definition of public
health.

Criticism:

1) Takes away the “mental” component from the WHO definition

2) From ‘complete’ to ‘adequate’ – we understand that complete was over-ambitious, but is

adequate sufficient – what is adequate – will it stop countries from promoting health beyond the
limit of ‘adequate’. Basically, ‘adequate’ is not defined so we don’t know what exactly the
standard is.

3) Also, health is not one universal parameter with a rigid definition that applies across spectra. It
has subjective elements – based on individuals, time, place. Individuals – therefore, Bhutan has
National Happiness Index. Health is much more than somatic elements of bodily health. Health
of society therefore becomes much more complex. And the standard prescribed in the definition
is low.

Alma Ata Declaration (1978)

The Alma Ata Declaration of the WHO is a major milestone in the field of Public health since it
identified Primary Health Care as the key to attainment of the goal of healthcare for all.

The Six main objectives of Alma Ata are:

1. To promote the concept of Primary HC in all countries

2. To exchange experience and information on the development of PHC
 3. To evaluate the present health and health care situation throughout the world as it relates
and can be improved by PHC
4. To define the principles of PHC as well as operational means of overcoming practical
problems in development of PHC
5. To define the role of governance national or international organisations in cooperation in
support of PHC
6. To formulate recommendations for development of PHC

The Alma Ata converged all three models of healthcare:

i) Rights Discourse – Described Health as a right (PHC for all). As a matter of fact Alma
Ata made healthcare a sort of entitlement.
ii) Currency Model – People are seen as means of production and they are provided
healthcare to be productive members of society. This is in Alma Ata since primary
healthcare will make people more productive. E.g. Classical communist states, Quid pro
contract. In India, this can be applied for micro-scale programmes.
iii) Sociological Phenomenon – Primary Health care in Alma Ata depends on what the
Sociological Conditions are. Concept of health dependent upon sociological surroundings
– time, place, society. Heterogenous society. Demographics are different etc For Instance,
the PHC provided to a farmer in Uttar Pradesh is different from what the PHC will be for
a middle-class city dweller in Bombay.

United Nations Sustainable Development Goals

The 2030 Sustainable Development Agenda, adopted by all UN Member States in 2015, offers a
shared blueprint for stability and prosperity for citizens and the world, now and in the future. In
its root are the 17 Sustainable Development Goals (SDGs), an immediate demand for
engagement through a collective alliance among all countries-established and emerging. They
agree that ending hunger and other deprivations must go hand and hand with policies that
promote health and education, alleviate inequalities, and boost economic development, while
combating climate change and striving to protect our oceans and forests.

The 17 SDGs are:

(1) No Poverty,

(2) Zero Hunger,

(3) Good Health and Well-being,

(4) Quality Education,

(5) Gender Equality,

(6) Clean Water and Sanitation,

(7) Affordable and Clean Energy,

(8) Decent Work and Economic Growth,

(9) Industry, Innovation and Infrastructure,

(10) Reducing Inequality,

(11) Sustainable Cities and Communities,

(12) Responsible Consumption and Production,

(13) Climate Action,

(14) Life Below Water,

(15) Life On Land,

(16) Peace, Justice, and Strong Institutions,

(17) Partnerships for the Goals.

India’s Health Policy:

While India has made several efforts to achieve a certain standard of health care it has not been
able to since there is a lack of accessibility and lack of awareness for the same.

Some attempts were made as follows:

1. Bhore Committee Report (1946)

Providing Universal PHC.
2. Mudaliar Committee Report (1962)
3. Jangalwala Committee Report (1967)
Multi-purpose workers
4. Kartar Singh Report (1973)
Integration of Health services
5. Srivastava Committee Report (1975)
Medical support
6. Rural HC scheme (1977)
7. Krishna Committee Report (1983)
Improvement of Urban HC.
 8. Bajaj Committee Report (1985)
Planning

Public healthcare, in the last decade, has been a low priority for India with just 1.29% of the
country’s GDP in 2019-20 spent on healthcare. Contrast this with the global average of 6%. In
fact, India’s public expenditure on health as a percentage of the GDP is far lower than countries
classified as the “poorest” in the world, as admitted by the Union Ministry of Health and Family
Welfare.
Ironically, we are the same country that is known for our success in eradicating small-pox and
polio through targeted public intervention.
India’s Universal Immunization Programme is renowned as one of the largest public health
interventions in the world.
However, we are today struggling to cope with the healthcare requirements of the country’s
burgeoning population. Our decadent lifestyles, unhealthy eating habits, sedentary routine, lack
of hygiene and abuse of alcohol, tobacco and drugs, combined with lack of awareness has led to
the creation of what McKinlay refers to as “illness factories”. These illness factories are
impacting the lives and health of the populace at large, slowly pushing people down the stream
into “intervene and repair” mode at our hospitals and healthcare facilities.
The growing number of people requiring medical intervention is putting relentless pressure on
the healthcare system, hospitals and public healthcare agencies who are hard pressed for time,
investments, equipment and facilities, and trained resources in successfully treating people.
Here are four ways the government and policy makers can effectively shift the focus back to
upstream, preventive healthcare in the country;

1. Increase public health spending – Community doctors, community dentists, social

healthcare workers, particularly in rural and remote areas service over 65% of the
country’s population. They lack access to basic medical tools, diagnostic equipment and
technology, and proper funding and resource support, and this must change. There is a
pressing need to increase public health spends to be closer to the global average of 6%,
focusing on preventive care in the primary and secondary sectors.

2. Invest in research and training - Community healthcare professionals (CHPs) lack access
to the latest in research and medical advancements. Their inputs are not represented at the
decision-making table while they probably have the best knowledge of health realities on
the ground. We need to address this gap with periodic training programs and provide
CHPs with access to the latest in technology, research and medical knowledge to enable
better care giving at the primary level.

3. Enable foreign investment in medical education - Even as every other industry has
embraced globalization in education, the medical fraternity, bound by regulatory
restrictions, has been the exception. Unfortunately, this has set us back in medical
education in the country by decades, largely relying on theoretical study and graded
examinations with little practical application. Policy makers need to take a hard look at
 this and open up the medical system to foreign collaborations and partnerships, enabling
empirical problem solving and hands-on exposure for medical students on the latest in
medical science.

4. Earmark a disaster management budget – COVID-19 is only one of many epidemics we

are likely to see in the coming decades. There is an urgent need to establish a separate,
long-term disaster management program with dedicated care centres across the country.
We need to scale up public health services, number of beds and physicians, medical
equipment, medicines, and care packages. Alongside, we must provide our front-line
healthcare workers and medics with the requisite intensive training if we really need to
save lives and prevent a catastrophe of this proportion again.

While the above will perhaps require a uniquely designed monetary stimulus policy, it must be
done at the earliest to safeguard the lives and livelihoods of a billion and a half Indians.