Year : 2014 | Volume
: 39 | Issue : 3 | Page : 127--128
Healthcare as an electoral agenda
Department of Community Medicine, University College of Medical Sciences, Delh, India
Dr. Sanjay Chaturvedi
Department of Community Medicine, University College of Medical Sciences, Delhi-110 095
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Chaturvedi S. Healthcare as an electoral agenda.Indian J Community Med 2014;39:127-128
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Chaturvedi S. Healthcare as an electoral agenda. Indian J Community Med [serial online] 2014 [cited 2022 Jul 1 ];39:127-128
Available from: https://www.ijcm.org.in/text.asp?2014/39/3/127/137141
Something phenomenal has happened in India from April through May 2014, which cannot be ignored by healthcare professionals. In the largest-ever election in the world, 553.8 million people exercised their right to choose their next government. Considering 834.1 million total electors on the roll of Election Commission of India, the national voter turnout was an all-time high at 66.4% (comparable for males and females).  Similar voter surges were seen in 1984 (64.0%) and 1957 (62.2%), but the turnout spike this year was unprecedented considering that the 1984 polls were held in exceptional circumstances following the assassination of sitting Prime Minister. Even the highly charged post-emergency elections in 1977 could result only in 60.5% turnout. Low turnouts of 2004 (58.0%) and 2009 (58.2%) do not seem to fit in this discourse. We may never be able to fully fathom the reasons behind this phenomenon. Is it a marker of improving accuracy of electoral rolls, or the raised motivation of voters, or both? And to what extent were the voters pulled by real or perceived issues, or were they pushed by extrinsic forces? Equally important is to analyze the major barriers stopping a third of our electors from exercising their right to choose their government. Nonetheless, some qualitative inferences may still be made about what issues were on the radar of our voters. Based on a summary analysis of opinion polls conducted by various national and transnational agencies, the major issues that emerged from the wider narrative included: Price rise/inflation, roads-electricity-water, unemployment, corruption, economic slowdown, security-terrorism, and religious polarization. ,,, And this was seen across all classes and regions. Health or healthcare did not figure in the list. At least this was not explicit. Contrary to this, with the opinion surveys conducted in a specimen of high-income country, for example the USA, where healthcare consistently stays among the top three concerns of the voters.  Europe is no different. Are people in different parts of the world thinking differently about their basic needs? Or the ruling classes in different parts of the world have choreographed the narrative differently?
Exceptions apart, health has always been one of the primary concerns of all individuals, households and communities regardless of their historical or geopolitical locations. Then, why are the citizens of the largest, and arguably most politicized, democracy not saying it clearly. Why don't we hear something like: Give us quality healthcare, if you seek our votes! Are the methods of our psephologists woefully faulty to capture this, or have we slowly pushed our voters to fatalism, when it comes to healthcare, through seven decades of misgovernance? The answer to these questions is not straightforward. Starting with present manifestos of two major political parties, health does not appear to be a terribly underrepresented domain in the formal electoral discourse. Even a crude form of content analysis may prove this point. Health/Healthcare appears 42 times in the Indian National Congress (INC) manifesto and 83 times in Bhartiya Janata Party (BJP) manifesto, as against Economy/Economic, which appears 57 and 51 times in the INC and BJP documents, respectively. Among other key words, Girl/Girl Child appears 6 and 13 times; Drinking Water-thrice and 6 times; and Sanitation-twice and 5 times in these manifestos, respectively. Furthermore, the BJP manifesto also mentions Specially Abled/Disabled-8 times, and Street Dwellers-once. , One may take a cynical view that this is all rhetoric and ceremonial, and there can be some substance behind such a cynicism. Nonetheless, rubbishing a manifesto altogether may also not be a pragmatic approach. Ignoring rhetoric has put some very powerful analysts in ridiculously embarrassing situations before. None can underscore this better than a popular (unverified) quote from a famous American historian explaining why the USA missed India's nuclear tests in 1998: 'Nobody at the CIA reads anything, not marked classified. And the BJP's manifesto in 1998 was not marked classified.'
So, why were the Indian voters not keeping healthcare at the top of electoral agenda? Surely, the people were angry and unforgiving this time. As we analyze the subtext of the mandate, people seem to have rejected the sickly patronizing povertarianism, where free food was considered a substitute for welfare. Where basic sanitation, basic education and reasonably okay healthcare were not found 'so important' in the din of 'take home ration'. If the present surge was a manifestation of aspirational young voter, as many of us are inclined to believe, it should have tilted towards the trends in high-income countries. And if the present mandate was a rejection of the 'lords of poverty' and their endless hubris, why were people not asking for quality healthcare with comparable intensity?
This election has also induced 'a restlessness' in the arena of ideological orientations. Highly vocal and disproportionately visible constituency of social analysts and thinkers has portrayed a specter of tectonic shift in the nature of Indian state. Many well-meaning alarmists are saying that the weak and marginalized would be forgotten under the new political dispensation. But the evidence-based assessment of reality compels the nation to ask a question from its rulers: When were the weak and marginalized actually remembered in last 67 years? Even in the seventh decade of independence, every second Indian feels weak, vulnerable and insecure. Any gross logic of accountability would take us to a conclusion that weak and vulnerable were never on the radar of governance. We are living with a scandalous irony where a century of 'political correctness' has left half of our children undernourished and not fully immunized. Over 78 million homeless people, 12 million children as subhuman labor and helpers rather than being in schools, and roughly 2 million women selling their bodies to get basic subsistence, euphemism of 'sex workers' notwithstanding, should be enough to deflate this morbid romance of political correctness. The voiceless have voiced their resounding message, if we care to listen. Neither the weak and marginalized were remembered nor would they be forgotten. They constitute more than half of the nation, and would continue to live on the margins unless their assertions are driven by real issues.
Coming back to the manifestos, both of the national parties have given a dedicated space for healthcare as a separate section, besides covering several associated issues elsewhere too. The INC manifesto talks about Right to Health, raise in health expenditure, anemia, malnutrition, intra-natal care, functional toilets and clean drinking water in every school and household, reduction in new HIV infection, child-sex ratio, girl child, universal coverage of routine immunization, primary care infrastructure and workforce. It also underlines the strengths of National Health Mission and Rashtriya Swasthya Bime Yojana. BJP's manifesto, on the other hand, is critical of National Health Mission and promises reforms through National Health Assurance Mission for reducing out of pocket spending on health. It also promises to: Formulate a New Health Policy and involving people in policy formulation and evaluation through Panchayat Raj, Jan Bhagidari, and other platforms; restructure Ministry of Health and Family Welfare by converging healthcare, food and nutrition and pharmaceuticals; address the shortfall of healthcare professionals by increasing the number of medical and paramedical colleges; modernize government hospitals; upgrade infrastructure; establish National e-Health Authority; promote Yoga and AYUSH; revamp school health and healthcare for the elderly; launch Beti Bachao-Beti Padhao campaign for girl child; universalization of emergency medical services; and a mission to eradicate malnutrition. It also promises a universal coverage of safe drinking water and basic sanitation by assuring Swachh Bharat by 2019. BJP's manifesto also has a dedicated section on care for Specially Abled citizen. ,
For all the electors, including those who did not vote or opted for none of the above (NOTA), there is enough ground in the manifestos of political parties to hold them accountable. We need to take it a bit more seriously, and pursue the cause. Democracies seldom send angels to power, but they preserve a magic to bring ordinary people to exalted positions, with an opportunity to redeem themselves. Political parties have shown their manifestos to people. Now, it is people's turn to show the manifestos to parties, both in power and in opposition. Let the people's voice be the first draft of future.
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