Today's Health Care Issues
For Eastern Mirror column
The article is a part of the transcript of a talk delivered at Chakhesang Baptist Church Kohima, Health Care Service on 1st September, 2012.
I thank God and also the Youth Director and his team for giving me this privilege to share some thoughts with you on this very important Health Care Service. The idea of having this topic in a church youth service to me is not out of place. This is what the church should aim for: to give wholesome teachings to lead an integrated Christian life, and to make the Word of God speak to all areas of life. There is no dimension in life where the Gospel of Jesus Christ does not apply. But sadly, many Christians limit the Good News to the so-called ‘spiritual’ things, and preach a fractured, individualized, privatized, and an abstract gospel. Hence, the Gospel seems out of place outside the four walls of the church building, or beyond the personal private space. That should not be.
When we think of health talk, what come to mind are health tips on how to lead a healthy life and how to prevent diseases. But I’m not here to give any health tips. For a congregation as this, I thought, ‘why should I give health tips when you sit at home and google?’ Instead, I want to leave you with more questions than answers. I want to bring out some issues for your consideration and study, and not to prescribe quick fixes and easy solutions. I want to run us through some of the issues facing health care today.
Health is too important to be left to doctors. Medicine is a technical discipline and the vocabularies used may just be too much for the non-medicos to dare to try learning the trade. But medical science is only one of the components of health and there are many areas where people from other disciplines can do a better job in health than the usually-busy doctors.
In medical science, the human body is dissected into organs, tissues and cells for study. The breaking down of the complex structure of the human body into simple cellular and molecular parts has been immensely successful. For example, each and every human gene has been sequenced and it has brought to light many of the defective genes in each of us which are responsible for diseases. One day, if those defective genes can be corrected before they manifest outwardly in the form of diseases, that will revolutionize the way medical science is practiced. Technology in medicine has also been progressing at a rapid pace. From on-the-spot rapid tests for use in the field to the use of robots for surgery, human judgment and skills is making way for machines to refine our diagnostic and treatment procedures. The danger and question however is, how human can human beings be in the light of these advancements in scientific reductionism? Human beings here are thought of as a machine and are treated so. The body parts are similar to machine parts and if damaged, they need to be fixed in order to keep the machine running. The more serious implication of this is when human beings are thought of as ‘nothing but’ the sum of the body parts. Human virtues such as love, hope, dignity, etc. are nothing but activities which can be traced to certain activities in the brain. It’s being argued that wars and conflicts between people are because of the malfunctioning of the brain, and therefore understanding how the brain works can bring about world peace. If rape can be traced to a genetic defect, perhaps the rapist can argue in court that it is not his fault, but his gene made him do it. With Eugenics, some believe that they can do better than God by bringing to life better human beings who are without physical defects and have likable character traits. ‘What does it mean to be a human being in the light of modern biology?’ asked Professor John Wyatt. What does it mean for Christians that every human being is created in God’s image?
What does the church have to say about abortion? Data on abortion is hard to get in Nagaland because it is done in a hush hush manner. But there are strong reasons to believe that it is being widely practiced. There are provisions to conduct abortions legally in certain situations like pregnancy due to rape, when continuation of pregnancy endangers life of mother, failure of contraceptives in a married woman, or when the baby has risk of being born with serious physical or mental abnormalities. Abortion is a contentious issue where Christians differ among themselves, for example, when question like, ‘when does life begin?’ is raised. However, illegal abortions when none of the above criteria can be fulfilled are very common. What can the church and society do to control teenage and extramarital pregnancy? And for children who are born outside of marriage, what are the arrangements for adoption or how do we care for such people? What does the church have to say about the promotion of condom use? These are tough questions that have no easy answers, but nevertheless are important questions that cannot be swept under the carpet. They are not theoretical topics for academic discussion purposes, but are real life dilemmas.
Next, who should pay for health care: from the Government’s or the individual’s pocket? Which should be the preferred provider of medical care: public institutions or private hospitals? In India, about 70% of the expenditure on health is borne by the patients from their own pockets. Government spending on health is one of the least in the world. As a result, about 2% of the population falls below the poverty line every year due to paying of medical bills. The number one cause for falling into indebtedness is medical expenditure. So, ill health leads people into poverty. Poverty, on the other hand, also causes ill health. Many people cannot afford to have decent meals, have access to sanitary toilets and water supply or live in environments conducive for good health. Poverty also leads to social exclusion, violence and other discriminations which affect their health status. The other face of health care in India is the booming multi-billion dollar medical tourism industry and the rise of star hotel-like hospitals. Because of cheaper medical care, foreigners travel to India as medical tourists to avail medical care. These private hospitals are run on for-profit business models where patients are no longer treated as patients but as customers or business clients. In Nagaland, the private sector is a growing sector although it is limited to towns like Kohima, Dimapur, Mokokchung, and Wokha. Even in these towns and in most parts of Nagaland, people still depend on the government sector health centres for medical care. But our health centres are in such a sorry state and they have become yate-facility-nai-kohima-jabi health centres and yate-facility-nai-vellore-jabi hospitals.
One initiative that the government has resurrected recently is giving financial incentives to people to utilize health services or to achieve specific program targets. In the JSY scheme, financial incentives are paid to pregnant mothers for check up and institutional delivery. A new financial incentives services called the JSSK is being launched in the State recently which has a much wider coverage. Is paying of such incentives morally justifiable? Are they effective in the long run? Harvard Professor Michael Sandel argues that giving of such financial incentives, which he calls ‘health bribes’ can be counter-productive. To transpose his argument to the example of paying pregnant mothers to undergo sterilization, such monetary incentives ‘crowds out’ the civic duty of the mothers to seek for the welfare of their health and family. Payment of money to do so takes away that civic virtue (the sense of responsibility) and turns the health seeking behavior into a financial transaction activity. Payment of money to stay healthy is therefore counter-productive. After the payment is removed, it is seen that the civic virtue is not regained. Providing free or affordable health services is one thing. Financial incentives is a different ballgame.
Sanitary living conditions also has a direct effect on the health status of a population. Insanitary conditions cause a host of communicable diseases. While we still battle from the burden of communicable diseases; non-communicable diseases like Diabetes, Hypertension, and cancers etc. are on the rise due to change in our lifestyle and dietary habits. Therefore unlike the people of the developed countries where common communicable diseases such as diarrhea, malaria, TB etc are controlled, we have this dual burden of diseases. Added to this, there are new emerging and re-emerging communicable diseases such as bird flu, swine flu, SARS, Anthrax, etc which has the potential to create health havocs all over the world. Disasters like earthquake, cyclone, drought, flood, etc are constant dangers that are always looming across the horizons. It is discomforting that our lives can be changed forever by one night of natural fury.
The state of health in our State at present is not a rosy picture to paint. But although stuttering and stumbling, we are certainly making progress. The youths are coming of age in terms of mental maturity. Today’s youths do not accept the way things are without questioning. They are not afraid to speak their minds and they want to set things to rights. That I see is the hope for improving health status in Nagaland. Dimapur district hospital was repaired by some youths and that is a sign of the frustration with those responsible, but also taking up responsibility for ourselves. How much can the church youth engage with issues that we face in health care today? Lots. Through example by individual behavior or through collective decision, health messages can be shared effectively and creatively. The church is the place where most people gather on a weekly basis, and what an opportunity we have here to share the message of good health.