Gandhian Economics and Healthcare

Mahatma Gandhi turned 140 today and his famous treatise Hind Swaraj, a document that contains his philosophy and ideas for India’s economic prosperity, will turn 100 this November. Throughout his life, Gandhi sought to develop ways to fight India’s extreme poverty, backwardness and socio-economic challenges. What makes Gandhi’s economic philosophy debatable in this era is that his ideas of Swadeshi and non-cooperation were centered on the principles of economic self-sufficiency. This proximity of his ideas to socialism has evoked criticism from this generation of free-market economics believers. But it is the spirit of his philosophy that is more important than the letter of it. Gandhian focus on human development is also seen as an effective emphasis on the eradication of poverty, social conflict and backwardness in developing nations, which are highly relevant areas of global interest today.

Prof. Amartya Sen’s Nobel Prize winning work on the Human Development Index helps one understands the causes of famine, of poverty, and of hunger. It is therefore, easy to apply the same principles to health care. Prof. Sen notes that during famines or food shortages, people are unable to buy food though it is available, because they cannot afford it. Similarly, though health services abound, millions of poor Indians, in both urban and rural settings, cannot afford them. Therefore, as Prof. Ratna Magotra, from K. E. M. Hospital, Mumbai notes, as market forces direct economic policy driving development, the role for private health services is underscored and holds an increasingly dominant position in emerging markets such as India, where equitable distribution of such essential services is still a major challenge.

As one who had an in-depth understanding of the Indian countryside, Gandhi felt that the key to the country’s progress lay in the strengthening of the de-centralized, self-sufficient village economies. Although food is aplenty, most villages, even today, do not have adequate food to eat and live healthy lives. De-centralization and self sufficiency of the village economies would have helped distribute goods and services in a smooth manner. Poor distribution of health services is akin to the poor distribution of food. Healthcare providers offer services which the poor cannot afford to buy. This link between economics and health care is evident in both the developing and the developed world. Global red flag areas such as climate change and the global credit crisis is a by-product of‘ economic growth in a world obsessed with profit making and greed. Such waste plays havoc with the health of people in developing countries, as is seen in the recent typhoon in Philippines, drought leading to the global food crisis, and other pandemics and disasters across the world. With their low resistance to disease- because of poverty and malnourishment – the poor, especially women and children, are worst affected by this. The sustainability of our planet and its people is threatened today by issues including climate change, depletion of natural resources and disease which Gandhi foresaw over a 100 years ago!

This brings us to two features of the Mahatma’s thought are appreciable in their spirit. First, his advocating limitation of wants to take care of one’s need and not greed. The second has to do with the idea of focusing on the well-being of the poorest and weakest member of society. It is time that healthcare providers allow this single Gandhian insight to drive the agenda of inclusive growth in the vast Indian subcontinent. This is an opportunity to bring in personalized medicines specifically for Indian patients. Costs can be tremendously lowered if R&D and production in facilities in India are used. Job creation opportunities abound. The government must open up the sector to let in private players.

Domestic players developing revolutionary technology and pouring in millions of dollars to develop products do so with western markets in mind that will pay top dollar. It is time the government works with them to encourage ‘reverse innovation’ that develops personalized medicine for Indian diseases like malaria and TB. These low cost, effective products, when suitably modified, can find large western markets where variations of such infectious diseases abound. Products such as effective hand washes, cough and cold medicines, broad spectrum anti-infectives, and treatments for common ailments for all age groups will find vast markets in all parts of the world because its not like the developed world doesn’t have these problems at all! Thinking economists have already drawn attention to these anomalies when they question the efficiency of the US economy that uses 40 percent of the world’s resources to support six percent of the world’s population without any perceptible improvement in human happiness, well being, peace or culture.

Health issues that lie at this ‘lowest common denominator’ can be thoroughly analyzed to identify opportunities. Moving through the value chain, low cost diagnostic equipment [such as the hand held ECG machines and portable ultrasound devices] can address the issue of lack of technology and diagnostic facilities. Distance is another impediment between the deserving consumer and a healthcare service. If corporate hospital brands support start-up clinics by young doctors with infrastructure such as web/tele-medicine facilities and access to super-specialists, and with broadband reaching rural India, there is enough technology to cut through the distance and bring world-class healthcare to the hinterland.

The entry of private healthcare player can also help to foster technological invention in the area of sustainability. Working either with government centers for technical excellence such as IITs or other universities, outstanding inventors can be encouraged whose technological products or processes enhance development in human health and mitigate environmental impact on human health. These types of developments often positively impact the most vulnerable populations over the medium to long term.

A paradigm shift is necessary in the thinking of government and healthcare service providers alike. The government can no longer discuss growth rates, deficits and debts alone; they must talk of environmental costs, health care deficits and even happiness and human enrichment. Healthcare service providers, both public and private, similarly, need to shift their attention from disease and focus on the holistic health of people. This is relevant to Gandhi’s theory of trusteeship. The thesis was that the capitalists would hold their wealth as trustees for the service of society. Trusteeship was thus to be thought of as a moral compact between the wealthy and society at large. This can be loosely equated to the ‘giving back to society’ initiatives by the have-alls.

This was an intrinsic part of Gandhi’s moral view of the world. During India’s struggle to gain independence from British rule, a reporter asked Mohandas Gandhi, “What do you think of Western civilization?” Gandhi replied, “I think it would be a very good idea.” Gandhi’s concern was not trivial; nor his philosophy irrelevant. One needs to address the question of the appropriate choice of technique when looking at applying it in today’s ravaged and inequitable world.

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