Kyunki Sars is a lesson for us too

The most basic of these, of course, has already been highlighted by Andrew Nikiforuk in his health bestseller, The Fourth Horseman: The history of mankind— and most recently the rise and rise of HIV/AIDS— proves that pestilence never rests. Nikiforuk quotes Rudolf Virchow, the father of modern epidemiology, to say that given the fact that people will constantly meddle with the conditions of life, the relationship between humans and microbes will keep changing in unforeseen and often fatal ways. Nikiforuk’s conclusion is a dire one: ‘‘Doctors have never arrested or changed the course of an epidemic and never will. Although their drugs and vaccines may create an illusion of competence, pestilence will continue.’’

Given this reality, nations would have to consider their health budgets as seriously as they presently do their military spending. Not only is India’s public spending in health one of the lowest in the world – only countries like Myanmar and Nigeria have worse records – its health budget graph has been moving in a direction contrary to its avowed goal of increasing spending in this sector. A new citizens’ report, Social Watch of India, points out that while the 1983 National Health Policy had recommended ‘‘universal, comprehensive primary health care services’’, these words had conveniently been excluded from the 2001 National Health Policy. In 1990, public health investment accounted for 1.3 per cent of national spending. In the current Budget, it accounts for 0.8 per cent— and most of this money goes for paying salaries and meeting infrastructural costs. There is some funding coming in for health from foreign donors and the private sector, but these sources are notoriously undependable for ensuring a long-term commitment to combat those killers of the poor like tuberculosis, diarrhoea, pneumonia, malaria.

Which brings us to the third lesson of Sars, and a familiar lesson it is too: That health is wealth, quite literally so. Sars is expected to cut China’s growth figures by a whole percentage point. Not only was a great deal of money needed to manage the epidemic, it brought several prosperous activities like tourism to a halt— China lost 2.8 million tourism jobs to Sars this year. But even without epidemics around, it makes sense to invest in health. Economists have suggested that if India could push its life expectancy by about 6 to 8 years, its GNP would get a boost of a full percentage point and more. Diseases play havoc with the economy not just in terms of putting a greater strain on a nation’s resources, but by putting pressure on productivity and undermining skills.

Handling epidemics is about handling people and public opinion. Like HIV/AIDS before it, Sars proved that secrecy is bad for health. The non-transparent manner that marked China’s early response to Sars when it first surfaced in Guangdong only ensured its long reign in the region. It went on to become, arguably, the most significant challenge to the Chinese government since Tiananmen Square. Going again by the HIV/AIDS example, it is only when the governments of nations like Thailand and Uganda began involving people, by protecting the rights of patients, demystifying the disease and addressing irrational fears about it through relevant information, did they get results. In other words, public health interests do not, and should not, come into conflict with human rights.

Finally, Sars drove home as never before the truth about globalisation. No nation is an island in the age of air travel. If Hongkong sneezes, Toronto gets Sars. Since we are all in it together, it means that health must be a universal concern and not just for the poor within countries, and poor nations within the world community. As Rudolf Virchow wrote over 150 years ago, ‘‘Epidemics resemble great warnings….’’ It is up to us to heed them.