Public Affairs / Jayanthi Natarajan
Monday 9 June 2008
Today, no discussion on India is free of a focus on its infrastructure bottlenecks. To realise its economic potential, India has to urgently fix its power deficit, its roads and highways and modernise its ports. Every economist, every business guru, even chamber of commerce conference sees these mantras repeated ad nauseam.
This emphasis on physical infrastructure is correct and overdue. It does surprise and disappoint me that not enough media and public attention is paid to gaps in India's social infrastructure - basic health care, malnutrition, limited access to primary education and gender inequity.
Health care and disease prevention, in particular, are areas that demand more time and resources. No country can live with the moral ambiguity of a system where "medical tourism" provides the best doctors, medicines and healthcare facilities to foreigners who can afford it while its own people die of eminently preventable diseases, even common ones like diarrhoea and malaria, which should really be killing nobody at all.
These are issues of concern to the Congress and have often been discussed at party forums. They have helped shape sensitive government policies. The National Rural Health Mission will go down as one of the showpiece achievements of the United Progressive Alliance government.
Yet, these issues require a wide-ranging participation of the civil society, and however dynamic its own efforts, the government, in order to succeed will have to reach out to a variety of stakeholders. As a society and a polity, we have to take collective ownership of these issues. We owe it to ourselves and we owe it the world. India, has the world's largest "sick" population.
That aside, the government of India is committed to the achievement of the United Nations Millennium Development Goals. Consider goals, four and five: a) Reduce child mortality b) Improve maternal health
Due to the sheer numbers of mothers and children who suffer and die in India, the world cannot achieve these MDGs without India achieving them. As such, depending on how we fare, India can either lead the world into a healthy and prosperous new era or drag down global public health figures. Health economists and epidemiologists have often pointed out that there is a dangerous correlation between the status of women and overall public health prioritisation. When a society - and poor families - have limited means to allocate to health care and disease prevention, women tend to suffer. Their needs are seen as less important than those of men. Even middle-class families spend more on a son's illness than on a daughter's.
This only perpetuates the problem. Ill, undernourished young women are poorly equipped to be mothers. Maternal and infant illnesses and mortality are so often the result, and the vicious cycle continues.
For this reason it is vital that India uses every new technology, every available resource to fight off its public health challenges. A generation ago, the new drugs, vaccines and diagnostic tools of the West took years or even decades to come to underdeveloped countries. That paradigm is now history, it is no longer sustainable.
At the Global Summit of Women in Vietnam this week, public leaders and sector specialists from 70 countries will be discussing health challenges, how to use new diagnostic devices and an exciting new vaccine to take on cervical cancer. Cervical cancer in India's "hidden epidemic", a conflation of the many issues - social and health-related - that I have touched upon in previous paragraphs.
Half a million new cases of cervical cancer are detected each year; 85 per cent of these are in the developing world. Over a quarter million women die of cervical cancer every year. It is the most common cause of cancer death in low and medium income countries.
India bears a fourth of the world's burden, with 1,30,000 of its women newly diagnosed with cervical cancer each year. For many of them detection is a black warrant. It is almost a chronicle of death foretold. India alone is home to more cervical cancer cases than any other country in the world and cervical cancer is the number one cause of cancer-related death among women in India.
Yet cervical cancer is entirely preventable, and all these deaths are unnecessary. New research and highly accurate tests in recent years have taught us a lot about cervical cancer. Unlike most other cancers, scientists have identified the cause of cervical cancer: a common virus known as the human papillomavirus or HPV. New vaccines against HPV have also been developed in the past couple of years and give us an unusually effective weapon to save and change lives fairly quickly.
Protecting against about 70 per cent of cervical cancers, these HPV vaccines are now widely available in North America and Europe. Yet, India, where such vaccines are perhaps most needed, is a late starter in this race.
Cervical cancer poses a peculiar logistical threat to Indian women. Treatment is not widely available; the Pap test is, essentially, non-existent for most Indian women. It is too expensive, requires human expertise and sophisticated laboratory equipment and necessitates a regimen of follow up that is, in everyday life, impossible to adhere to. That is why cervical cancer is often detected in India at a very late stage. What could have been treated earlier is left neglected and ignored. There is an appalling lack of screening facilities for cervical cancer, in our country, and even a serious lack of awareness, regarding the vital importance of screening. Primary health outlets also need to be equipped with fast detection kits to identify the HPV virus. What hasn't helped is India's demography. This is a young country; one-third of its people (a full 440 million) are below 18 years of age. Two of five women in the 20-24 years age group are married by 18. Twenty-seven million babies are born in India every year. Fifteen per cent of them arrive to mothers aged between 15 years and 19 years . This demographic is also most at risk to cervical cancer. When cervical cancer hits a young woman, and kills her decades before her time, she is still a young mother, raising children. The consequences can be imagined. Entire families can be destroyed. In days gone by, vaccines made it to the "market" in western countries shortly after development but the lag period before they reached the third world was much longer. The Hepatitis B vaccine came to India a full 20 years after it was developed. Such long gaps are not just undesirable, they are downright criminal. That is why it is essential that our government and public health leaders recognise the burning need to fight this health challenge. This is not just a health or social issue but also a meaningful one for our economic growth and development. If we can prevent cervical cancer and add healthy women to the workforce - and, in turn, empower women, reduce inequities and strengthen families - we will be laying the foundations of equitable and sustainable and inclusive development.
To go back to the point with which I began, it is no longer accurate or practical to place economic and health problems, physical and social infrastructure into distinct compartments. The two form a continuum. How quickly India adopts and deploys the new technologies against cervical cancer and other such diseases will be an important test of its commitment to its future.
Jayanthi Natarajan is a Congress MP in the Rajya Sabha and AICC spokesperson.
The views expressed in this column are her own.
