Medicine, Profit, and Dharma in India's health system
The state of medical ethics in India is poor—with organ transplant scandals and an emphasis on medical tourism over public health. But organisations like the Indian Journal of Medical Ethics and the Swami Vivekananda Youth Movement are trying to address the challenges and improve the system.
India v China is a game some people play when tallying the kinds of inter-country alliances and opportunities that might work in the decades to come.
India's growth rate, its freedom of expression, and its democratic governing system are usually points in its favour, at least from an Australian perspective. But India has at least one considerable drawback, and that is the state of health of its citizens. The statistics remain appalling. The rate of improvement is unconscionably slow. And the ethics of health care delivery in India look very dismal indeed.
On practically every health measure comparison, India does very much worse than China: in child malnourishment, infant mortality, maternal mortality, life expectancy. For example, while almost all Chinese children are immunised, less than 70 per cent of India's children are and India's maternal mortality rate is six times that of China. India's government spends almost half the proportion of GDP on health care as does China.
At the same time, The Indian Express newspaper just weeks ago reported that India's primary healthcare sector, estimated to be worth $30 billion and growing by at least 25 per cent a year, was 'raining money.'
'Many domestic and foreign investors are cashing in on India's potential for Medical Tourism and introducing multi-billion dollar projects,' the report said.
Behind this growth is Indian government policy. The Indian government is actively involved in the promotion of medical tourism, and as the Indian Journal of Medical Ethics reports, the Indian Tourism Ministry will often sponsor and exhibit at events in wealthy nations like Canada to attract foreigners to its health system.
In February this year economist Amartya Sen drew attention to the poor state of national health care, describing as an 'illusion' the Indian government's argument that low investment in public sector health care could be compensated for by growth in the private sector. In particular, those in rural areas often remain untouched by the benefits of economic growth and are therefore unable to access the private health care system.
Some Indians argue that government policy has not only led to distortions of health care delivery (favouring private sector growth over public sector investment), but that it has also fostered a distortion of public and professional ethics in the health care arena. The Indian Journal of Medical Ethics carries plenty of articles pointing to inequities and injustices that are related to unethical commercial relationships involving medical professionals. So do the front pages of many Indian newspapers: the year began with yet another organ transplant scandal, this time in the IT capital of India—Bangalore.
The illegal kidney transplant racket—allegedly involving major private hospitals, doctors, government officials, local touts and the poor villagers who were their victims—allegedly offered around INR 1500 (AUD 27) for a kidney. While investigations continue, this is not the first time a major illegal organ donation scheme has been uncovered, including the notorious 2008 Gurgaon Kidney Scandal.
Of course, the story is not all dismal.
India has rich cultural resources to draw upon where medical ethics are concerned—including ancient texts from the Vedic literature which articulate the obligations of doctors in realistic and careful detail. Those resources inspire people even today, like the doctors who set up the Swami Vivekananda Youth Movement in Karnataka State. They've developed over 20 years or so impressive hospitals, allied with education and development initiatives in a remote rural area. They have dedicated their lives to serving the tribal peoples and re-settled peoples of the area. The people behind the Indian Journal of Medical Ethics, which is based in Mumbai, have the same sense of purpose.
Listen to Margaret Coffey's full documentary 'India Insight: Medicine, Profit, and Dharma' at Encounter.