FACTS againest MYTHS V0L-I-6-JANUARY-1994.pdf

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AGAINST

VIKAS ADHYAYAN KENDRA

January '94 VOL I # 6

COMMENT
THE MYTH OF HEALTH AND HEALTH
CARE

b

The World Bank-influenced liberalization policy and mar­
ket forces that is already taking a toll of the economy is
now manifesting itself in the domain of public health with
all its inherent and attendant ills. Malpractices are in­
creasing with alarming frequency:

* Action is being taken against an MNC, Johnson &
Johnson, by the Food & Drug Administration (FDA) for
marketing a new feeding bottle in open contravention of
the Feeding Bottles Act that outlaws ads and promotion
offeeding bottles in any form;
* The State Government recently ordered suspension of
the license of another MNC, Glaxo, and its closure for
110 days for allowing rejected drugs to be siphoned off
into the market without destruction.

iother offshoot of this policy is making public health
rvices the domain of the private sector which the World
Bank considers “more efficient” than the public sector
which admittedly offers abysmal services to the poor.
Despite the element of truth private hospitals are, how­
ever, unregulated and profit-driven, preoccupied with the
chase for Dollars in the name of“earning foreign exchange
for the country”(!?). Patients at best either have to fend
for themselves or be content with being at the mercy of
the nursing staff who may be incompetent and unscrupu­
lous as the above illustrations is an indicator of this grow­
ing trend. This indiscriminate transfer of public health
services to the private sector is something unheard of
even in the West which the health-care system in the coun­
try is trying to emulate. In Germany and the U.K. for in­
stance 6% of the GDP continues to be retained by the
public sector.

«

With hunger and malnutrition still widespread the promo­

FACTS against MYTHS
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tion of the private sector in the health field has encour­
aged the practice of importing costly medical technolo­
gies — and at concessional rates (!). A Bombay hospital
for instance has imported seven Magnetic Resonance
Scanners costing a massive Rs.5,80,00,000. This sort of
promotion has led to the drastic change in public percep­
tion of health-care: good health is now understood as hitech and together with curative medicine is looked upon
as the only viable health-care available. Clients therefore
end up with the misimpression that their lives inevitably
depends upon such hi-tech equipment.

The health-care industry has become a virtual preserve of
the Western health-care system and with globalization is
looked upon as a potential market for attracting health and
health related products.

Providing basic health-care especially to the poor has so
far failed. One reason for the failure is that health planners
have imposed technocentric solutions to problems that
are basically socio-political and cultural. When they, how­
ever, do succeed in examining the human causes of illhealth, all too often they focus on the behaviour and atti­
tudes of the poor rather than those of the privileged mi­
nority.

This fact and the abysmal health situation makes it neces­
sary to evolve an alternative paradigm of health-care, far
removed from the current biomedical model and nearer to
a socio-political and spiritual one. Contemporary health­
care has become more of a consumer product to be bought
and sold freely in the market, slickly and aggressively pack­
aged and marketed like (say) soap. It is no longer an or­
ganic part of community-care as it once was. The need is
to move from free-for-all, consumerised medical care, pro­
viding excellent but costly services for the few who can
pay, to a genuine-commitment to 'Health For AH'. It is
essential to look for a more humanistic model that encom­
passes a sociocultural perspective. In the process, how­
ever, false notions and misimpressions about modem
medicines and health-care systems need to be cleared and
demystified.
2^"^

January *94
Page 1

MYTH:
THE UNDERLYING CAUSE FOR
AMONG PEOPLE IS DISEASE.

ILL-HEALTH

FACT:
Doctors and drugs do not bring health today any more
than they did in the heyday of the development of
allopathic medicine. What they do bring is the notion
that disease is what ails people and medicine is what cures
them. They hold out the hope of an end to pain. But in
almost every case that hope is unfounded; the medical
profession usually ends up just playing with the pathetic,
disintegrated bodies of people as they die. In the US for
instance, 60 percent of the expenditure on health is spent
in the final years of peoples’ lives: not to ease their deaths
but to the effort to keep life in their disintegrating bodies
for a few more days.

No wonder that allopathy has little success against the
rich world’s degenerative diseases like cancer, heart dis­
eases and now AIDS. Imagine an average American
worker in his death bed: every cell and fibre thoroughly
permeated with food additives, pesticides residues, heavy
metal pollution and radiation, his thoughts rebounding
from the pain in his body to worries about his credit-card
loans to frustrations with domestic life. The electron mi­
croscopes, infibri llators and lasers of medical science are
about as relevant to him as they are to a local slum dweller.
A few hospitals in the South, premature baby units have
achieved rates that rival the best in the West. Yet 70
percent of these tiny newborns die within three months
when they are taken home to overcrowded, ill-ventilated
slums by their poor and undernourished mothers. Just as
the lives of those tiny-tots could have been saved if their
mothers had enough food when they were pregnant and
if slums had drinking water with effective drainage and
sewage systems, so the overweight American worker dy­
ing of cancer at 52 could have been saved if he had had a
diet free of carcinogens and a job providing satisfaction
and joy rather than frustration and pollution.

Far from being a riddle, the causes of cancer and heart
disease, prime killers of the affluent classes, are as wellknown as the cause of TB. If this is surprising it is mainly
due to the knee-jerk tendency of looking for the cures of
illnesses rather than for their causes.

It is well-known that cancer is almost a totally prevent­
able disease caused by smoking, food additives, alcohol,
workplace and environmental pollution and radiation. The
same is true for heart disease caused by faulty diet, lack
of exercise and stress. Inspite of all this knowledge, the
search still goes on for the so-called cancer virus, a search
that takes 50 times the amount of money spent on re­
searching of the diseases in the South. There is no can­
cer virus. Hunting for such a virus is as crazy as looking
for the parasitic worm that leads to (say) unemployment
in the country. Moreover, environmental hazards have
set up a barrier to further improvements in life expe^||
ancy. And if a cancer ‘germ’ is to be discovered that germ
would be like any other germ—flourishing in bodies weak­
ened by pollution, by faulty diet and discontentment.

MYTH:
THE HIGH RATES OF DISEASES, ILL-HEALTH AND
DEATH IN THE SOUTH ARE LARGELY DUE TO
NATURAL CAUSES E.G. BACTERIA; CALAMITIES,
VIRUSES, ETC.

FACT:
Today more than ‘natural causes’, man-made causes are
more to be blamed for high rates of illness and death in
the world. Many of these causes are related to avarice:
the efforts of some to prosper at the expense of others. A
number of MNCs, both international and national, are
taking a massive toll on the health and lives of billions of
people with enormous negative impact on the health and
survival of children. These health-effecting indus^^i

include pesticides, infant formula, tobacco, alcohol, drugs,
non-essential, dangerous, overpriced pharmaceuticals,
arms and military' hardware; including international finance.
Each of these represents a huge, powerful and massive
profitable multi-bullion
dollar industry. Their
cost in terms of human life
and health is inestimable.
The weakened physical
resistance and the eco­
nomic, mental and social
problems provoked by
these unscrupulous busi­
nesses add enormously to
the impact of infection
and malnutrition^ Andas
COURTESY:INDIAN EXPRESS: AJIT NINAN

FACTS against MYTHS

January *94
Page 2

usual, it is the poor who bear the brunt of the damage,
especially as these industries have all increasingly tar­
geted the South as their new, most valuable market, with
India as the latest prize catch.
Human rights and action groups, the UN and some gov­
ernments of SAARC and other countries have tried to
control the damage caused by these powerful industrial
agglomerates. But in the case of each and every one of
these killer industries, TNCs for instance, the US govern­
ment has defended their interests at the expense of health,
quality of life, and often survival of millions.
Clearly, in view of these massive, officially condoned as­
saults on life and health, ranging from the IMF-mandated
hunger to poisoning for profit, technological interven­
tions like the “Green” “White” or “Blue” revolutions ineluding UNICEF’s Child Survival Revolution are less than
F enough. In fact, with their apparent simplicity of coping
with the biological causes of poor health, they distract
and lure people away from confronting the far more deeper
and deadly social causes of the plight of the poor.

MYTH:
THE HEALTH AND SURVIVAL OF CHILDREN IN
THE SOUTH DEPENDS PRIMARILY ON A FEW
SIMPLE INTERVENTIONS, VIZ. GROWTH MONI­
TORING, ORAL REHYDRATION THERAPY, BREAST­
FEEDING AND IMMUNIZATION.

strategy called “Child Survival Revolution”, — dubbed
“the revolution that isn’t” — aimed at specific diseases
rather than improving the quality of life. The strategy,
not surprisingly, has the blessings of the World Bank,
IMF, USAID, including a number of government and
large international agencies.

Apart from being a blatant reversal of the Alma Ata Dec­
laration this approach based on epidemiological founda­
tion, is extremely fragile, and its logistical designs con­
tains serious flaws. No one who is concerned would
suggest that immunization of children against communi­
cable diseases is itself an undesirable act. However, in
this case, an obviously poorly designed and dependence­
producing programme is an impediment to the implemen­
tation of primary health-care as enshrined in the
Government’s National Health Policy. There are also se­
rious sociological and political implications. Because of
the distribution of power, the ruling bloc in the industrial­
ized North have long used access to health services as a
means of perpetuating their social and economic control
over the peoples of the South.

Besides, past experience with special programmes has
shown, again and again, that they do not have an impact
due to overestimation of the likely epidemiological im­
pact on selected disease and major problems in imple­
mentation. Yet planners and powers that be consciously
choose to ignore past experience and use their politicoeconomic clout and media hype to sell their cause.

FACT:
The plight of children will never improve on just these
“few interventions”. A number of other more relevant
factors are essential. These include health of parents,
family survival skills, peace and violence in communities;
on the availability, quality and cost of education, health
^services, water, shelter and transportation; the ability of
people to organise and defend their rights; on local con­
sumption of alcohol, tobacco and drugs; on who has
power over whom; on war; on military expenditure rela­
tive to public service expenditure; on international trade
economic relations; on the preservation and destructionof the environment; on the distance the mother has to
trudge for cooking fuel; on the undermining of grassroot
movements; on terrorism etc.

This myth is largely the brain-child of UNICEF whose
analysis of the cause of poverty etc., has otherwise, been
highly commendable. On offering solutions, however, it
chickened out by proposing and promulgating stopgap
technocentric interventions and measures. In trying to
change the underlying causes of poverty it instead
launched a “safety net” approach to the issue via the

FACTS against MYTHS

There is also the possibility that even in the very unlikely
eventuality of it being able to implement the immuniza­
tion programme in such a way as to give satisfactory
coverage and make an epidemiological impact, the chil­
dren who might have benefited from the programmes
would fall prey to other diseases caused by the unhealthy
environment in which they are forced to survive. Thus
even in the most optimistic situation, it can be claimed
that the operation was successful but that most of the
patients died.

MYTH:
ALLOPATHIC MEDICINE IS THE ONLY RATIONAL
ANSWER TO ILL-HEALTH.

FACT:
Modem medicine has had only a minor role for instance
in reducing mortality both in the West and rest of the
world. Available data show that specific medical technol­
ogy for each of the various infectious diseases in the
West developed after a major decline in mortality had
already taken place. (CL The Sociology Health and Illness.

January '94
Page 3

Conrad & Kqm, 1981). Medical interventions for TB, Ty­
phoid, Measles and Scarlet fever were introduced when
death rates for each of the diseased were already negli­
gible and still high. None of these death-rates, except
polio, however showed the sharp decline that would have
been expected if medical interventions had had the in­
tended impact (Cf.Conrad & Kern above). In fact, it has
been estimated that only 3.5% of the decline in mortality
due to infectious diseases took place because of medical
interventions. What this means
is that more money for food,
clean drinking water, sewage and
drainage systems to flush away
diseases-ridden filth had cut
down deaths from infections dis­
eases significantly by 80 percent
before medical interventions dis­
covered ‘cures* for them.
(Present medical technology, in­
cidentally, does not have any ef­
fective solutions to ‘killer’ dis­
eases like cancer, etc., let alone
AIDS.)
The same is the status regarding
health in India. That is, mortality statistics show that the
death rates also followed the same pattern as in the West.
Death rates began to decline long before any effective
medical technologies were accessible or used in the coun­
try. The only medical technologies that were available in
the early years were vaccinations against smallpox and
cholera. And although it has been considered a major
disease, smallpox accounted for only 0.1 % to 0.8% deaths
per thousand population between the years 1880 to 1940.
This disease was considered major because the then
League of Nations had reported that the rate of incidence
of smallpox in India was highest among all the countries
for which statistics were available. But in the context of
overall death rate, smallpox was not a major disease.
The same again is true for cholera and plague. The death
rate due to cholera was between 2 to 8 times the aver­
age death for smallpox. But research showed that cholera
vaccination during cholera epidemics was of little conse­
quence. Epidemics could not be prevented. Similarly, with
plague. Only after it had begun to decline, did the anti­
plague vaccine become widely used.
Apart from the fact that most medical technologies were
at the time either ineffective or unavailable, death rates in
the country had anyway begun to decline from 1921 on­
wards. (Cf. Health Statistics of India, Govt, of India, 1983). It
was only after Independence that medical technologies
were extended to the general public. If technology, had

FACTS against MYTHS

made a dramatic impact on the health status of the people,
as claimed, there should have been a sharper decline in
death rates in the period following Independence. This
however was not the case, (Cf.Bhorc Committee Report,
Vol. 1,1946). In fact, death rates have declined at a slower
rate during the 30 years after independence as compared
to the decline of death rates during the 30 years before
independence.

The same is true for malaria. Despite enormous resources
allocated to eradicate the disease, the impact of the ma­
laria vaccine has been limited. Besides, the result of the
anti-malaria strategy has been to produce DDT and other
drug resistance while the incidence of malaria has in­
creased. In fact, as per the latest report of the Parliamen­
tary Committee on the National Health Programme, the
evidence of malaria in urban slums has risen to 2,11,890
in 1991, i.e. around 2 million people in the country are
affected by malarial fever. This has led to renewed efforts
to develop new vaccines to combat the disease.

Medical technology therefore, has not made any dramatH
impact in the country. Infectious and parasitic diseases
are still leading to mortality. Even though the technology
for controlling many of these diseases have been devel­
oped, these technologies have left diseases pattern in
the country unchanged. The success in improving the
health of the people has been marginal, at best.

MYTH:
THE TRADITIONAL HEALTH-CARE SYSTEM PRIMI­
TIVE AND STEEPED IN MYTH.

FACT:
Traditional systems like Ayurveda, Sidda, Unani and Yoga
as other such prevailing indigenous systems elsewhere
in the South are highly advanced indigenous systems of

January *94
Page 4

health and medical care. This fact is now recognised and
Scientists in the West have begun exploring and experi­
menting with these indigenous systems. TNCs are al­
ready exploiting and even patenting some of the indig­
enous plants like neem, turmeric and garlic. Therefore it
is important to look at such systems and guard against
some of the dangers inherent in the Western model in
attempting to evolve an alternative health- care system.
Therefore it is important to look at such indigenous
systems and guard against the pit falls of the western
mode in an attempting to evolve an alternative health­
care system. At the same time there is need to be alert to
the attendant danger of exaggerating the efficacy of such
a system; neither idealising nor romanticizing it.

over-surgical isation. And yet many of their services are
no better and sometimes even worse than that of the gov­
ernment and municipal medical college hospitals which
have much better resident staff and no personal mon­
etary consideration in providing services. With the ex­
ception of a few, nursing homes are mere converted apart­
ments attracting those who can afford the expensive pri­
vate medical care or who avoid going to public hospitals
crowded by the poor.
Trained in medical colleges, medical practitioners today,
especially in rural areas — lacking in most basic facilities
for investigation and treatment—“practice a form of blun­
derbuss therapy with medical representatives as their chief
source of the latest information and education.”

MYTH:
PRIVATISATION AND INCREASED COMPETITION
WILL "DELIVER THE GOODS AND ALSO IMPROVE
THE GENERAL STATUS OF HEALTH-CARE IN THE
COUNTRY".

FACT:
Competition in the health-care profession leads to false
expectations. With the health industry being rapidly con­
verted into market economy with hi-tech inputs and the
profit motive as the driving force, widespread malprac­
tices have crept into the whole industry, costing patients’
lives, with malpractices becoming rampant. So much so,
one such malpractice led a High Court Judge to order a
survey of the 500 private hospitals and nursing homes in
Bombay. One-third were found to be unregistered. On
January 31,1994, Indian Express reported the High Court
ordering suspension of the license of Torrent Pharma­
ceuticals Limited in Gujarat on “Cardiwell Plus” tablets,
for treatment of cardiac attacks and paralysis, that were
found to be unconsumable following lab tests. Thought­
less privatisation of the health-care system has led to a
|reat deal of damage. For instance in China where over
36,000 people die of TB ever year. Through the 60’s and
70’s the country had made good progress on TB control.
Since the early 80’s however the infection rates have ei­
ther stagnated or increased mainly due to its decision to
make patients pay for their treatment. But as soon as it
reverted to free treatment for TB, the situation improved.

Apart from enjoying public subsidies in the form of free
training of their personnel and various tax concessions,
private hospitals have been responsible for distorting
the country’s medical as well as social values and influ­
encing medical education away from care to super-spe­
cialization.

Intense competition is also leading to unnecessary and
even dangerous over-investigation, over-medication and

FACTS against MYTHS

Moreover, the World Bank’s worldwide promotion of its
so-called structural adjustment programmes which intro­
duced cost-recovery and reduction in health services had
led to rise of maternal mortality rates as poor women can
ill-afford clinic attendance. Zimbabwe is a case in point.

MYTH:
MEDICAL TECHNOLOGY AND ECONOMIC
DEVELOPMENT ARE MAJOR DETERMINANTS OF
HEALTH.

FACT:
The major determinants of health are social and political.
Far reaching improvements in the health of the people
have instead occurred with gradual improvements in the
quality of life; everything from fairer wages, improved
working conditions to better water supply, public educa­
tion, and social guarantees to meet people’s essential
needs.
The accompanying myth that the answer to widespread
poverty and ill-health was imposed on the poor countries
by the World Bank, IMF, among others, as a strategy to
promote national growth through large scale industry and
agribusiness. They however, realise that such an equa­
tion would mainly benefit the industrialists, the bureau­
crats, the rich landlord and farmers. So they floated the
theory that by stimulating the growth of a poor nation’s
total Gross National Product (GNP), the fruits of develop­
ment would ‘trickle down’ to the poor. But this did not
take place. As the economy and production grew, the
gap between the rich and poor widened; more trickled up
than trickled down; the rich grew richer and the poor
poorer. In the process, the problems of poverty,
homelessness and the diseases of poverty worsened.
Obviously then neither medical technology nor economic
growth are determinants of sound health. Some coun­
tries, in fact, have even achieved favourable health sta-

January *94
Page 5

tistics inspite of very low national income. For instance.
Kerala, has achieved good health at a low cost.
References:

Sathyamala, Dr.C., et al, /’Taking sides", Asian NctworK lor
Innovative Training Trust (ANITRA). Madras, 1986.
2. Taylor, Debbie,"Justice in Health", New Internationalist, Lon
don, Sept. 1983.
3. Sharma, Kalpana, "Unhealthy Competition", PANASCOPE,
London, Oct.93.
4. Werner, D. "Health for No One by the Year 2000". Third
World Resurgence #21, 1992
5. Antia, Dr.N.H., "World Bank & India’s Health", EPW, Bombay
Dcc.25,1993
6.
, "Vaccines: Facts, Fancy and Fallacy " FRCH-NEWSLET
TER, Bombay January 1988.
1.

Average annual deaths in British India
(excluding Burma) 1932-1941
Disease

Average
annual deaths

0/
Zo

Fevers (including malaria)
Respiratory disease

36,22,869

58.4

(including tuberculosis)

4,71,802
2,61,924
1,44,924
69,474
30,932
15,99,490

7.6
4.2
2.4
1.1
0.5
25.8

Dysentery & diarrhoea
Cholera
Smallpox
Plague
Other causes

SOURCE. BHORE COMMITTEE, Vol I 1946

Facts Against Myths is a monthly
bulletin of factual information on a
number of development myths and
fallacies, etc, including information
against disinformation campaigns,
propaganda and canards spread by
communal and fundamentalist forces.

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