However, the Government of Odisha continues to adhere to the failed policies of the neoliberal project by categorizing children based on severe, acute, and moderate malnutrition. Such a policy is an extension of the policies pursued by the Congress Party and BJP at the center, which dismantled the universal Public Distribution System (PDS) of food. The malnutrition of children is a consequence of the dismantling of the distribution of food under the universal PDS. The universal PDS was dismantled and replaced with revamped PDS and targeted PDS in the name of making it more effective. In reality, the neoliberal onslaught on universal PDS led to the rise of starvation and malnutrition-related deaths in the state. The universal PDS was a policy designed to support the production and distribution of food that could be available and accessible to all, irrespective of their background. It was intended to control food prices in the market and manage market linkages and leakages of food grain from the Food Corporation of India in the distribution process. The dismantling of food security under the universal PDS resulted in rising food prices, a lack of accessibility and availability of food for all. It also led to the rise of a food market dominated by corporations like Reliance.

The Government of Odisha is jeopardizing children’s food and malnutrition security by categorizing them as severe, acute, and moderate malnourished. The universalization of health and food security is the only way to eliminate the shameful hunger and malnutrition-related deaths in the state. This can be achieved if the BJD-led government abandons the failed policies of the neoliberal project pursued by the Congress Party and BJP at the center.

The Odisha government is developing multiple policies that accelerate the privatization of health in the state.

The gods and goddesses in Odisha receive more funds for the rehabilitation of their abodes with amenities, while Odia children suffer from malnutrition deaths and receive less funding from the government. This is a disturbing trend in governance where the welfare of gods is deemed more important than that of Odia children, who are the future of the state. The health infrastructure is in a dilapidated condition, yet the Government of Odisha continues to develop health policies and projects that transfer public funds to private hospitals, accelerating the business of sickness. The universalization of public health is crucial for developing healthy citizens who can contribute to the well-being of the state, society, and families in Odisha. Unfortunately, the state government promotes short-term populist health policies that undermine public health and favor private healthcare in the state.

The Biju Swasthya Kalyan Yojana, launched on 15th August 2018, represents a policy of transferring public wealth to private hospitals and healthcare providers in the name of universal health coverage in the state. This is a temporary response to the acute public health crisis in the state. It is neither sustainable nor capable of resolving the long-term health issues. The development of public health infrastructure, the establishment of medical and pharmaceutical colleges, hospitals, and improving the accessibility and availability of local hospitals and medical professionals are essential for addressing the public health crisis in the state.

The practice of private healthcare has proven unsuccessful worldwide in meeting people’s healthcare needs. Therefore, the expansion of public healthcare infrastructure in the state is the only alternative that can serve people during all forms of health crises. The Government of Odisha must ensure a sufficient health budget to develop a technologically advanced healthcare system that serves all, irrespective of their purchasing power and backgrounds. Health is not a commodity, and the business of illness must come to an end. Privatization is not a public policy but a project for profit-making by depleting the public treasury and citizens’ pockets.

The Articles such as 21, 23, 24, 38, 39, 41, and 42 under the Indian Constitution directly and indirectly deal with public health and human welfare. The right to health is fundamental to the right to life under the Indian Constitution. The Government of Odisha needs to ensure health for all in both letter and spirit by enhancing all health policies and promoting public health. Healthy citizens are crucial for the development of a prosperous and peaceful state, where human dignity is not undermined for the sake of populist religious politics. Modern states are built on healthy citizens, not merely on the abodes of gods and goddesses.

Bhabani Shankar Nayak, University of Glasgow, UK

Courtesy: CounterCurrent

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At a press conference held at the Press Club of India in the national capital on Monday, IDPD general secretary Shakeel Ur Rahman said that hill patients commute 150 km to Kohima and Dimapur in Nagaland and nearing cities in Assam to avail treatment as the movement of goods and people between the Valley and hills is severely affected.

“Our team visited the relief camps at the Khuman Lamkpak Sports Complex hostel (Imphal district) and IT relief camps under Sapormeina PHC (Kangpokpi district) in hill areas. We could not carry medicines as our local contacts told us that the mistrust among communities would make the journey difficult,” he said.

The ordeal of patients increases due to the Internet shutdown, said Rahman, a paediatrician by profession.

“We can help patients through telemedicine and train doctors in performing peritoneal dialysis (for renal failure) and other skills, like using AMBU bags in cases of Respiratory Distress Syndrome among children,and counsel mothers on breastfeeding. The shutdown has ended such possibilities,” he said.

“We also found the referral systems for serious patients at the relief camps in hilly areas unsatisfactory. It was beyond shock to find that the Kangpokpi District Hospital has neither an operation theatre nor a blood storage facility,” he added.

Besides, the state has “an acute shortage of specialists, other doctors and health workers. A vast majority of specialists doctors and all the medical colleges are in the Imphal district (three medical colleges) and Churachandpur district (one medical college)”.

Referring to the absence of vaccination among children, Rahman said that there is no special vaccination drive against measles. “Measles vaccine immunisation drive in children above nine months along with Vitamin A oral suspension is imperative for relief camps, according to the Sphere Project of the United Nations High Commissioner for Refugees (UNHCR).”

IDPD president Arun Mitra, an ENT doctor, said that nodal officers for relief camps too corroborated the reports that no green leafy vegetables/eggs/meat/fish has ever been supplied to the people. Only the local community, civil society organisations and a few individuals sometimes provide vegetables.

“Anodal officer said that the people at the camps get one egg each per day every 13 days. Green vegetables are never supplied. Rice, dal, potatoes and cooking oil constitute the bulk of the ration. The absence of green leafy vegetables and animal proteins in children’s diet in the last four months might lead to night blindness, which is caused by Vitamin A deficiency,” he said.

Mitra added that the condition of patients with chronic diseases like renal failure and diabetes is poor. “Two patients with kidney failure requested us for dialysis machines.”

Moreover, children get repeated nightmares. “Many request their parents to return home. The elderly are too anxious about the safety of their families,” he said.

Mitra demanded “robust referral systems after triage from primary health centres to higher relief centres within Manipur and neighbouring states at the earliest”.

“Restoring the Internet is a must to achieve this objective. Similarly, fabricated operation theatres should be made operational at the district and subdistrict levels immediately. Blood storage units should be set up around relief camps after cluster formation,” he further demanded.

Courtesy: Newsclick

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India is “off target” for as many as 19 of 33 so-called indicators of Sustainable Development Goals (SDGs) relating to poverty, hunger, health and gender inequality, says a study that has also flagged a worsening anaemia trend from 2016 to 2021.

The study by independent experts, which covers 707 districts, has found that in 2021, over 75 per cent of the districts were off target on key indicators such as access to basic services, anaemia, poverty, stunting in children, child marriage and partner violence.

The conclusions and findings also suggest that if India continues to progress at the same pace as during 2016-2021, it will take the country years or even decades after the 2030 target to achieve some of the SDG indicators. For example, the goals relating to improved water will be achieved by 2031, those on access to basic services by 2047, and those relating to partner violence by 2090.

The Lancet study says that the critical “off-target indicators” include Access to Basic Services, Poverty, Stunting and Wasting of Children, Anaemia, Child Marriage, Partner Violence, Tobacco Use, and Modern Contraceptive Use. For each of these these indicators, more than 75% of the districts were Off-Target. Because of a worsening trend observed between 2016 and 2021, and assuming no course correction occurs, many districts will never meet the targets on the SDGs even well after 2030. Not surprisingly, these “Off-Target districts” are concentrated in the states of Madhya Pradesh, Chhattisgarh, Jharkhand, Bihar, and Odisha. Also, it does not appear that Aspirational Districts, on average, are performing better in meeting the SDG targets than other districts on majority of the indicators.

What are the SDGs?

The Sustainable Development Goals (SDGs) are a broad and wide set of objectives defined by the UN in 2015. They represent improvements in economic development, social welfare and environmental sustainability that are to be achieved by 2030 and have been agreed on by 195 countries, including India.

“Our study provides scope for policymakers to undertake course corrections,” said S.V. Subramanian, a professor of population health at Harvard University who led the study. It was published earlier this week in The Lancet, with co-authors from India and South Korea.

Ernakulam (Kerala) and Lakshadweep have already achieved the targets relating to 13 indicators, the highest by any district. As many as 61 districts, largely located in Kerala, Tamil Nadu, Arunachal Pradesh and Punjab, have achieved the targets on 9 to 13 indicators.

However, two of the off-target indicators — which means they are unlikely to be achieved by 2030 at the current pace — are anaemia in women, which worsened from 51 per cent in 2016 to 56 per cent in 2021, and stunting in children. The districts with the most off-target indicators — 27 — are Bijapur (Chhattisgarh), East Jaintia and West Khasi Hills (Meghalaya), and Sepahijala (Tripura).

Ninety-six districts, mainly in Maharashtra, Bengal, Bihar, Jharkhand, Meghalaya and Chhattisgarh, are off target on 22 to 26 indicators.

A majority of districts are off-target on SDGs linked to “no poverty,” “zero hunger,” “good health,” and “gender inequality” despite existing programmes or schemes in place to address these goals. Examples are the Pradhan Mantri Awaas Yojana (to deliver affordable housing to the poor), the Pradhan Mantri Sahaj Bijli Har Ghar (to provide universal household electrification), or the Jal Jeevan Mission (to provide safe adequate tapped drinking water).

Notably, the Narendra Modi government launched the Beti Bachao Beti Padhao (to curb sex selective abortions and promote girls’ education) campaign in 2015 and the Mahila Shakti Kendra initiative to promote skill development and employment of women in 2017.

The study has projected that India will meet the SDG target on gender inequality by 2090 and for one-third of districts, this goal will not be met “in the foreseeable future,” the researchers said. “The findings point to a need to understand why some current policies aren’t working,” said William Joe, assistant professor at the Population Research Centre, Institute of Economic Growth, New Delhi, and a study co-author.

Subramanian and his collaborators analysed the SDG indicators through datasets from two National Family Health Surveys – those carried out in 2015-2016 and 2019-21. Both surveys covered a sample of 2.8 million people from districts across the country. However, a population scientist at the International Institute of Population Sciences, Mumbai, said that NFHS datasets might not be the best way to assess progress on SDG indicators.

“There are limitations in the NFHS data, which might not provide the complete picture,” said Sanjay Mohanty, professor and head of population and development at the IIPS. Mohanty and other health experts have also questioned the anaemia and stunting data in the NFHS. 

Using the 2016 and 2021 National Family Health Surveys, the study provides an assessment for 707 districts of India on their status with regards to meeting the SDGs on 33 indicators related to the domains of population health and social determinants of health. It also provides an assessment of the progress that is occurring among ADs. Notably, the first survey period of 2015–16 coincides with the global ratification of the Sustainable Development Agenda, and thereby providing an approximation of a timely baseline for the assessment. The indicators covered in this mid-line assessment touch upon 9 from a total of 17 SDGs, with a substantial number of indicators linked to 6 SDGs (No Poverty, Zero Hunger, Good Health and Well-Being, Gender Equality, Clean Water and Sanitation, Affordable and Clean Energy)

Basis for Interpretation

A mid-line assessment of districts’ progress on SDGs suggests an urgent need to increase the pace and momentum on four SDG goals: No Poverty (SDG 1), Zero Hunger (SDG 2), Good Health and Well-Being (SDG 3) and Gender Equality (SDG 5). Developing a strategic roadmap at this time will help India ensure success with regards to meeting the SDGs. India’s emergence and sustenance as a leading economic power depends on meeting some of the more basic health and social determinants of health-related SDGs in an immediate and equitable manner.

This work was funded by the Bill and Melinda Gates Foundation, INV-002992.

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Kolkata: Dr Fuad Halim – also known as the ‘people’s doctor of Kolkata’ is the secretary of the People’s Relief Committee (PRC) and one of the outstanding physicians in the city. The CPI(M) leader is also known for his deep understanding of health issues as well as that of the progressive movement in the state. He is the son of the well-known West Bengal Assembly Speaker Hashim Abdul Halim – who considered to be a pillar of constitutional democracy in the country. Dr Halim spoke to NewsClick about a range of issues, including the history of the PRC, the state of the health sector, and the role of the government in regulating it.

Sandip Chakraborty: Can you talk about the context of the PRC’s formation and a little bit about the people who took the lead in the process?

Fuad Halim: The 80-year-old organisation, known as PRC, has got its roots in the latter part of the 1930s when every year, cyclones and floods used to ravage Bengal. The British government had a despotic attitude towards giving service to the people who were at the receiving end of nature’s fury. Then, a permanent Bengal flood and cyclone relief fund came up.  To give a permanent shape to these efforts in 1943, in the Bharat Sabha Hall of Kolkata, the People’s Relief Committee was constituted. The president was Syed Nausher Ali, the then speaker of the undivided Bengal’s legislative Assembly. Amongst the members – also part of the steering committee of the organisation – were ‘Kakababu’ Muzaffar Ahmad and noted Bengali writer Tarashankar Bandyopadhyay (who was nominated twice for the Nobel prize). Bandyopadhyay, in his novel Arogya Niketan, portrayed the state of people’s health for the first time in Bengali literature.

Another noted member was author Manik Bandyopadhyay, whose Putul Nacher Itikatha also focused on health issues. Then, there was A R Malihabadi, who ran a press from where the literary magazine Langol – edited by poet Kazi Nazrul Islam and Muzaffar Ahmad – used to be published. Dr D K Basu and Dr Dwarkanath Kotnis were well-known physicians, who were known for their work in China. All these people brought their progressive thoughts to PRC to lay its foundation.

SC: PRC provides health services often at cheaper rates. For example, you charge only Rs 50 for dialysis when patients would have to pay at least Rs 2,500-3,000 in private hospitals. How is this made possible?

FA: The right to health should be a constitutional right of every person. But sadly, it is still not considered a basic fundamental right here. The right to health still has to be attached to the right to life and under this condition, Kolkata Swasthya Sankalp is doing the wonderful work of providing dialysis to kidney failure patients at Rs 50 only since 2008. About 35 to 50 patients undergo dialysis every day.

We work based on three principles. It is a no-frills service where the patients are given two bedsheets at the time of the start of the procedure. We don’t have lifts or any other amenities like a front desk or receptionists. And the material suppliers are part of our organisation, they supply the material to us at lower prices. There is also a donor pool to keep the service running in Kolkata so that it caters to the needy.

SC: What facilities has PRC made available for this?

FH: We have dedicated outdoor facilities where medical consultations and medicines for three days are provided to patients for a low cost of Rs 10. Then, services like ultrasound, X-ray and diagnostic tests are also arranged at a low cost for needy patients.

There is an eight-bed nursing home called ‘Kimber Nursing Home’ attached to PRC where hernia operations are conducted for Rs 50. This year, we have a target of conducting 80 hernia operations within one calendar year.  There is also an old age home associated with PRC. We have got medical centres in multiple districts and ambulance services attached with us.

SC: How do you see private players in the health sector? Why does one need to stand against privatisation – specifically pertaining to health services?

FH: In 1959, Kenneth J Arrow had written an article where he categorically said that if health becomes a marketable commodity, its characteristics still differ from other commodities. For example, if a buyer goes to the market to buy bananas, then the seller cannot give him guavas and send him home.   However, when health comes to the market as a commodity, the consumer does not know what purchase he is going to make. The whole decision-making process lies with the seller. Hence, when health enters the market as a commodity, the information asymmetry between the consumer and (service) provider acquires wide gaps. The seller has to take decisions on behalf of the consumer/buyer. Here, a moral hazard takes shape. In this case, buyers are in a helpless situation and there is nothing substantially preventing the seller from seeking unlimited profit. Arrow ultimately got the Nobel Prize in 1973 for theorising this and got attributed as the world’s first health economist.

As this was popularised in the 60s and 70s, most of the developing countries made health a government (public) sector. Only a handful of developing countries allowed private entities to be players in the health sector. India, despite its mixed economy, is now heading toward uncontrolled privatisation. We stand against this kind of profiteering.

SC: Do you think governments worldwide that retained control over the health sector have been effective in regulating it?

FH: The successful campaign to eradicate smallpox shows the efficiency of the government-run health sector. In the 60s, the wealthy capitalist nations and the socialist countries came head-to-head during the Bay of Pigs crisis. On one side, the US-led capitalist bloc was professing that all the problems of mankind can be solved through the market economy. While on the other hand, the socialist world led by the USSR remained steadfast in its belief that the market is the main reason hindering development.

In the 60s, the initiative to do smallpox vaccination raised the question of whether it will be done through the market—meaning those who have the purchasing power can purchase it—or through universal no-cost people’s health network. This question was settled in favour of a robust public health network. In the 70s, we were successful in eradicating smallpox and this happened due to the movement by robust public health networks and infrastructure sponsored by the government.

In Alma Ata (1978) all the health-conscious countries of the world met and resolved to achieve ‘Health for All’ by the year 2000. The health ministers of 148 countries agreed to erect a robust public health network in their respective countries to attain that objective. After the 90s, however, due to the neoliberal policies pursued in different countries of the world, the public health network was deliberately weakened.

Institutions like the International Monetary Fund and World Bank, in the name of aiding the health sector, started schemes like ‘pay at the point of service’. In the name of financial reconstruction, they started giving tied loans and changed the basic outlook of the whole issue.

As a result, in 2000, the target of ‘Health for All’ could not be reached and this marked the obituary of health for all declaration.

A new term called millennium development goals was coined, which too, later proved to be unattainable. Then in 2014, health for all turned into ‘healthcare for all’. It was a paradigm shift from the tertiary medical facility-oriented social determinant to the only realisation of medical services.

SC: How do you see government-run insurance schemes?

FH: It can be recalled that the great economic depression after the 2000s affected various sectors; the notable exceptions being health and education. Hence, international finance capital started investing largely in these two sectors. Accordingly, we saw in 2013 -2014, that 35-40% of those hospital beds were underutilised as people did not have the economic capacity to avail of services in these hospitals. Now, schemes like insurance have been brought in to transfer patients from government hospitals to private hospitals. In West Bengal, the Swasthya Sathi Card is also a part of it. Through these, the public health infrastructure is further weakened. Vaccination receives low priority now in the government sector. Taxpayers’ money is channelised toward private players. Under this model, government expenditure is mainly channelised toward financing other hospital costs, including their profit.  

According to NHFS (National Family Health Survey) data, when only 13% to 15% of mothers should have a caesarian, at present, in West Bengal, over 83% are having c-sections. This is happening because the charges for c-sections are higher than that for normal delivery. The health of the mother is of the lowest concern here.      

Courtesy: Newsclick

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The spread of Coronavirus in India and the subsequent misery of the migrant population has exposed the underbelly of dismal healthcare in our country. There is a daily outcry of shortage of hospital beds, doctors, nurses, ICUs, absence of functioning rural healthcare centres, etc. 

It is a great pity that while our neighbouring small nations like Bhutan and Sri Lanka provide free universal healthcare for all their citizens, India is still struggling with healthcare schemes that cover only partially a small section of our population that have to struggle meaninglessly for a gold/red/blue, etc. card to become eligible for partial healthcare facility. Almost all advanced nations like the U.K, France, Switzerland, Canada and a host of others provide free universal healthcare for all of their citizens irrespective of income status. Other countries like Cuba, Hong Kong, Singapore, New Zealand, etc. also cover all their citizens with universal healthcare. Why India does not think in this direction and consider providing free healthcare for its citizens a top priority is a mystery unsolved. 

The argument that we do not have money for providing free healthcare for all is a fictitious argument because if defense requires double the budget, the money somehow is made available. Defense is top priority but citizens’ health is at the bottom of the list. If citizens are not healthy, whom are we trying to protect with the piling of armaments? 

What is the present scenario? India’s Annual budget is Rs. 27,84,200 crores (2019-2020). Out of this allocation for health sector is a mere 2%, i.e. Rs. 63,538 crores whereas the defense budget is 11%, i.e. 2,82,733 crores. Thus India’s Defense budget is five and a half times the Health budget. 

Let us see how other nations, who provide free universal healthcare to all its citizens, do their allocation for healthcare from their budget.

Country                                        Health Budget as a % of total Budget    

Switzerland                                                         34.7

Cuba                                                                     28

U.K.                                                                      19.7

Sri Lanka                                                              11

Bhutan                                                                 9

India                                                                     2                             

India’s current population is 136 crores and average annual expenditure incurred by its citizens on their healthcare is Rs. 2,465. This means that to cover all its citizens with free universal healthcare, an annual fund of Rs. 3,35,240 crores is required to be allocated to the health sector, i.e. 12% of Budget. Is that impossible? If the health of its citizens is top priority for a nation, can we give an excuse that due to non-allocation of required resources the health sector will continue to suffer? 

Indian Government’s apathy towards healthcare delivery to its citizens is borne out by the following facts as stated by Saif Kamal in Health and Life – 

“There is only one Government allopathic doctor per 10,189 people, only one Government hospital bed per 2,046 people, and one state run Hospital per 90,343 people. Out of 1 million doctors in the country, only 10% of them work in public health sector. They lack good infrastructure, proper management, dedicated staff and many other things which are required to provide reasonable and appropriate healthcare.”

Malnutrition is a serious problem in India. According to Unicef at least 3,000 children die due to malnutrition every day in this country and every year 10,00,000 children die below the age of five.

In Global Health ranking India’s position is 145th out of 195 countries, even below Nepal. Bhutan and Sri Lanka.

Medical costs are one of the primary causes of poverty in India. Around 63 million Indians fall into poverty each year because of health care bills, and 70 percent of all charges are paid directly by patients.

Due to lack of proper and adequate healthcare delivery from the state run hospitals, patients are forced to seek relief from private hospitals where the charges are abnormally high. This results in the poor patient being forced to incur very high out-of-pocket expenditure and this forces him to sell his assets, property or land and drives him ultimately below the poverty line.

When we compare Per capita expenditure on Health for various countries, we find India at the bottom of the list as shown below –

Country                                        Per capita expenditure on Health (US $)

Switzerland                                                            6,944

Norway                                                                  4,802

U.K.                                                                        3,500

Sri Lanka                                                                     71

India                                                                            35

Comparing Healthcare Expenditure as a % of GDP –

Country                                                               Percentage of GDP         

France                                                                         8.7

Switzerland                                                                 8.5

U.K.                                                                               7.9

India                                                                             1.02

A large country like India, where 70% of total population resides in rural areas, continues to be biased in its healthcare delivery in favour of the urban population. Instead of relying on preventive care and well equipped Primary Health Centres in semi-urban and rural areas, the emphasis has been on city hospitals which become overcrowded and suffer from population pressure.   

The Constitution incorporates provisions guaranteeing everyone’s right to the highest attainable standard of physical and mental health. Article 21 of the Constitution guarantees protection of life and personal liberty to every citizen. The Supreme Court has held that the right to live with human dignity, enshrined in Article 21, derives from the directive principles of state policy and therefore includes protection of health. Further, it has also been held that the right to health is integral to the right to life and the government has a constitutional obligation to provide health facilities. 

Failure of a government hospital to provide a patient timely medical treatment results in violation of the patient’s right to life.  Similarly, the Court has upheld the state’s obligation to maintain health services.

 It is therefore imperative that we make free universal healthcare for all our citizens a goal to be achieved in the nearest future. A healthy nation is a happy nation and the exorbitant amount that the rural population has to shell out today for healthcare from their meager personal earnings leading to extreme poverty can be totally avoided.

*The author is the convener of Jharkhand Nagrik Prayas.    

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On the ninth of every month, pregnant women visit the primary health centre at Wazirabad, Gurugram district, Haryana, to receive antenatal care under the Pradhan Mantri Surakshit Matritva Abhiyan (Safe Motherhood Programme)

Wazirabad, Haryana: Rajvanti Devi, 38, stood in a long queue of pregnant women, braving the bright midday sun, at a primary health centre in Wazirabad block of Gurugram district, Haryana. This queue is usual on the ninth of every month, when the health centre provides services to pregnant women, particularly those identified with high-risk pregnancies, under India’s Pradhan Mantri Surakshit Matritva Abhiyan (Prime Minister’s Safe Motherhood Programme, PMSMA).

Rajvanti Devi, a mother of two girls, was pregnant for the third time, but she did not know how far into her pregnancy she was. This was her first visit to a health centre, and she was surprised when told she was six months pregnant. Further, the pregnancy was risky, the health centre staff told her, because with a haemoglobin level of 8.8 gm/dL, she was mildly anaemic–the normal range is 12-16 gm/dL for women. The risk was greater as her second child had been born through a caesarean section.

Her pregnancy will be tracked through Haryana’s high-risk pregnancy portal–the only one run by a state government, launched in November 2017–to make sure she receives all required antenatal check-ups, supplements, and referrals to specialists in community health centres or district hospitals. Under this system, Gurugram has recorded 2,750 high-risk pregnancies, and Jhajjar district 3,526.

This is part of Haryana’s ongoing efforts to reduce its maternal mortality ratio (MMR)–past efforts have made the state’s MMR the 12th lowest in the country, having cut it down from 101 deaths per 100,000 live births in 2014-16 to 98 in 2015-17, according to Sample Registration System (SRS) data. The Indian average was 122 in 2015-17.

Haryana’s health ministry has set a target to reduce its maternal mortality ratio to 70 per 100,000 births by 2030. The high-risk pregnancy portal helps register and better track high-risk pregnancy cases, to make sure the women never miss a check-up and their progress is monitored closely.

“The goal is to reduce the maternal mortality rate, infant mortality rate and stillbirth because morbidity and mortality is particularly high in high-risk pregnant cases,” said Alka Garg, deputy director for maternal health in the National Health Mission (NHM), Haryana.

Haryana’s experience with its portal would be instructive for all Indian states, which together detected half a million women with high-risk pregnancies under PMSMA between 2016 and 2018. High-risk pregnancies have a greater possibility of complications during labour and delivery, birth defects, premature delivery, stillbirth and, in worst cases, the death of the infant and mother. “Timely detection of risk factors during pregnancy can prevent deaths due to life-threatening complications during childbirth,” PMSMA guidelines note.

As IndiaSpend’s visit to Gurugram district showed, the programme is already showing results. The proportion of high-risk cases identified during antenatal check-ups increased from 6.91% in 2013-14 to 14.35% in 2017-18, data from NHM Haryana show.

Earlier, grassroots health workers would check up on pregnant women but there was no focus on high-risk cases. Now, if a woman with a high-risk pregnancy misses her monthly check-up, it is flagged within the system, and health workers go to her house and bring her to the health centre, said Sheela Devi, 57, a health supervisor at the Wazirabad primary health centre.

The Niti Aayog identified Haryana’s policy for managing high-risk pregnancies, including the portal, as a ‘best practice’ in antenatal care in January 2018.

However, frontline workers, beneficiaries and doctors said the quality of care must be improved, and services made available not only on the ninth but throughout the month.

Tracking high-risk pregnancies

High-risk pregnancy cases include women who have severe anaemia with hemoglobin levels below 7 gm/dl, hypertensive disorder in pregnancy (with blood pressure higher than 140/90 mmHg), Human Immunodeficiency Virus (HIV) or syphilis, gestational diabetes, previous history of caesarean section, stillbirth, abortion, premature birth, obstructed labour, and twin pregnancy.

On being found to be at risk, Rajvanti Devi was given a red card signifying high-risk pregnancy, and will now be closely monitored by grassroots health workers–accredited social health activists (ASHAs) and auxiliary nurse midwives (ANMs)–along with counselling sessions and regular follow-ups until the birth of her child.

A woman detected with a high-risk pregnancy is given a red antenatal card with a ‘High Risk’ stamp. She is closely monitored through Haryana’s high-risk pregnancy portal.

The PMSMA is an expansion of the Vande Mataram programme, first launched in the early 2000s. “In the past couple of years there has been an expansion of maternal and outreach health services and more recruitment of ANMs, so things have really improved,” said Sulakshana Nandi, national joint convener of the Jan Swasthya Abhiyan, the Indian branch of the global People’s Health Movement (PHM).

More than 10 million women received antenatal care under PMSMA between July 2016 and January 2018, according to the central Ministry of Health and Family Welfare.

“All government hospitals collate data on the number of high-risk pregnancies in the district, and the portal is updated once every month with all case details,” said Neelam Chaudhari, 44, an ANM in the Islampur health centre of Haryana’s Gurugram district.

“The portal was an innovation of the state to identify high-risk pregnancy cases,” said Garg of the National Health Mission, Haryana. “We have a 100% name-based portal where each woman’s journey through her pregnancy will be closely monitored until the birth of her child.” 

Of all the high-risk pregnancy cases recorded in Gurugram, 647 were due to previous caesarean section deliveries, 179 because of severe anaemia, 187 due to hypertension and 211 due to multiple pregnancies, according to the portal.

IndiaSpend obtained district-level data for Gurugram and Jhajjar from the high-risk pregnancy portal. Haryana’s National Health Mission did not share data for the entire state despite repeated emails and phone calls in the month of October. This story will be updated if we receive the data.

Counselling

A crucial component of PMSMA is counselling of expecting mothers. “We tell them to practice spacing between births,” said Sheela Devi. “If it’s a high-risk case or a caesarean, we counsel them to at least have a gap of three years until the next baby.” 

“If at any given point they miss their monthly check-up, ASHAs are sent to their homes or we call them to find out why they didnt come,” she added. “The high-risk pregnancy portal is extremely helpful to keep a track record of every woman.” 

For delivery or conditions requiring urgent medical attention, high-risk pregnancy cases are referred to district hospitals or community health centres that provide specialist services. “Just last month on PMSMA day, we found a case of hypertension,” said Chaudhari. “A woman had 220/190 mmHg blood pressure, she was immediately sent to the civil hospital along with an ASHA worker.” 

Antenatal care

Like Rajvanti Devi, most women do not receive proper antenatal care during their pregnancy. In 2015-16, only half (51%) of the women aged 15-49 years who were surveyed had the World Health Organization-recommended four antenatal care visits for the last birth before the survey, according to data from the National Family Health Survey 4 (NFHS 4). About 17% of women received no antenatal care during pregnancy.

Not everyone agrees that the PMSMA is the ideal way to provide antenatal care. Women have to wait in queues, some of them do not get to see a doctor, and the quality of care is poor as there are many women waiting on one single day, said Nandi of the Jan Swasthya Abhiyan.

“This programme is just another campaign,” she added. “The actual high-risk cases are not being prioritised due to herding of all pregnant women on one day of the month to increase footfall… I have seen cases in which the services that should be provided everyday are not being given because the priority is to gather as many women as you can on the 9th of every month.” 

Low intake of iron and folic acid tablets

When Rajvanti Devi’s high-risk pregnancy was detected, she was recommended to get an ultrasound, and start regular doses of iron and folic acid tablets. During pregnancy, anaemia increases the risk for maternal mortality, preterm birth and infant mortality, as IndiaSpend reported in September 2019.

“I have iron tablets but I do not eat them,” said Rajvanti Devi. “It makes me feel nauseous and I can’t do any of my chores later.”

“Women do not eat the prescribed iron tablets,” said Chandan Kachroo, 58, a gynaecologist in a private hospital in Gurugram, who has volunteered to see patients one day a month under the PMSMA. “I have mostly seen this in patients coming to government hospitals. Patients in the private hospital eat the iron tablets regularly.”

Only 14.4% of the poorest women took iron and folic acid tablets for more than 100 days, as compared to 48.2% of women in the highest wealth bracket, according to data from the 2015-16 NFHS 4.

Chandan Kachroo, 58, a private gynaecologist and volunteer under the government’s safe motherhood programme, with Rajvanti Devi, 38. Her pregnancy is high-risk as she is mildly anaemic and had a caesarean section previously. Haryana tracks high-risk pregnancy cases through an online portal, the only state to do so.

Caesarean sections

Previous caesarean sections make up for a large chunk of high-risk pregnancy cases: 24% in Gurugram and 13% in Jhajjar, based on data from the high-risk pregnancy portal.

The rate of caesarean sections has doubled from 9% in 2005-06 to 17 % in 2015-16. Caesareans are particularly common in private sector health facilities (41% of deliveries), an increase from 28% in 2005-06, according to NFHS 4.

Private sector involvement 

Doctors working in the private sector are encouraged to volunteer for PMSMA and provide voluntary services at nearby government health facilities on the ninth of every month. About 5,799 such volunteer doctors have registered to participate under the programme since July 2016, according to a reply in the Lok Sabha (lower house of the parliament).

“There was an appeal made to all the gynaecologists part of the Federation of Obstetric and Gynaecological Societies of India (FOGSI) to participate in PMSMA,” said Kachroo. “I have volunteered for this scheme as a way to give back to the society.”

Kachroo examined a total of 50 patients in the four hours of her volunteering service at the primary health centre in Wazirabad. She said she found 12 cases of high-risk pregnancies.

“Maternal health services being available to every woman is a part of universal health coverage, rather than a charity, which the PMSMA makes it out to be,” said Nandi of the Jan Swasthya Abhiyan. “Remote areas do not have as many private gynaecologists. But most private gynaecologists volunteer in bigger cities where there are already enough practitioners available.”

This story was first published here on Healthcheck.

(Ali is a reporting fellow with IndiaSpend.)

Courtesy: India Spend

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The NHM, launched in 2005, is India’s largest health programme aimed at providing universal access to healthcare. One of its primary missions is to improve maternal and child health and control communicable and non-communicable diseases.
 
Data show why it is critical that NHM funds be used optimally: India still accounts for 17% of global burden of maternal deaths, non-communicable diseases made for 61% of deaths in 2016, communicable diseases like leprosy and malaria are yet to be controlled and 55 million Indians slipped into poverty in 2011-12 because of health catastrophes they could not afford.
 
NHM also disburses funds to state health societies to help strengthen local health systems, institutions and capabilities. Rural health centres in India are short of human resources and infrastructure, as Indiaspend reported on January 30, 2018. Sub-centres were 20% short of human resources, 29% of them did not have regular water supply, 26% lacked electricity supply and 11% were not connected by all-weather roads.
 
India ranks lower than neighbouring Bangladesh and even sub-Saharan Sudan and Equatorial Guinea on healthcare access, we reported on May 23, 2018. And it spends 1.4% of its gross domestic product (GDP) on health, the least among BRICS nations.
 
In a two-part series, we look at the government auditor’s assessment of NHM’s functioning. In part one, we report on instances of financial mismanagement. The concluding part will detail the shortfalls in infrastructure and medical staff caused by this mismanagement.
 
The government has denied charges of financial irregularity. Funds were being released as soon as states fulfilled the requirements for their allocation, according to Manoj Jhalani, additional secretary and mission director, NHM.
 
“The diversion of NHM funds for non-NHM purposes/state government schemes is never supported by the ministry,” he said. “If any such instance comes to (our) notice, the same is recovered from the concerned state government, and states are directed to desist from such practice.”
 
Delayed transfers, misallocation and a growing balance
Our analysis of the CAG audit highlighted the following problems in the disbursement and usage of health funds:

18 states spent only 32% of allocation which was already 36% short
In 18 states, against a requirement of Rs 133 crore, reflected in the 2013-16 state programme implementation plans, only 64% was allocated, we found. But states were not able to utilise even the allocated amount, with no more than 32% or Rs 43 crore spent.
 
“There are a number of reasons for unspent funds, ranging from the lack of human resources to complicated procedures for procurement in construction-related activities,” said Avani Kapur, fellow at the Centre for Policy Research and Director of the Accountability Initiative. “Another key factor is the uncertainty in the timing and amount of funds received under the scheme. There is often a mismatch in the what the state/district administration demands and what is actually approved and received.”
 
NHM is funded by both the central government and the states, with the centre providing 60%. The ministry of health and family welfare used to release funds directly to the state health societies till 2013-14. The money is now sent to state governments, which then move it to the societies.
 
The state-level societies in turn, disburse the funds to district health societies for further release to blocks. From here, the money goes to various implementing units such as community and primary health centres and sub-centres and village health sanitation nutrition committees.
 
NHM funds are released in five parts: NRHM Reproductive and Child Health (RCH) Flexipool, National Urban Health Mission (NUHM) Flexipool and Flexipool for Communicable Diseases and Non-communicable Diseases, including injury and trauma and infrastructure maintenance.
 
“One of the reasons for the creation of these (state health) societies was that the unspent money gets carried over to the next year unlike the state treasury which has to return unutilised funds at the end of the financial year,” said Kapur.
 
There are significant delays in the receipt of funds as CAG reported too, she said. “Given that states/districts have to prioritise routine activities such as salaries and Janani Suraksha Yojana payouts, there is an incentive to not spend money till the funds reach specifically (for certain projects),” she said. “Our research has thus shown that a lot of the softer expenses such as IEC (information, education, communication) or training often remained neglected.”
 
There are other problems with central sponsorship of schemes like NHM. Item-wise budgeting means that states do not have the flexibility to spend as per need, said Kapur. “I have heard the case of Himachal Pradesh where ASHAs (accredited social health activists) were not needed at one time but had to be hired because of NHM norms,” she said. “Under the new norms of the 14th finance commission, there is a provision wherein 25% of the funding is completely untied. (I) haven’t yet seen how states have operationalised this though.”
 
Unspent funds ranged from 40% to 76%, Meghalaya spent least
 
State health societies had spent only Rs 1,06,180 crore ($ 20.7 billion) of the Rs 1,10,930 crore ($ 17.1 billion) available during 2011-16. In some states the unspent balance ranged between 40% to 76% — for example, in 2015-16, in Meghalaya it was 76% and in UP, 52%.

 
Source: Comptroller and Auditor General of India
 
The table above shows the unspent balance without interest and with interest (as mandated by the NRHM guidelines). In 2011-12, the unspent balance available with 27 state health societies without interest was Rs 5253 crore ($ 1.02 billion) which came down to Rs 3686 crore ($ 555 million) in 2015-16. However, over the same period, the unspent balance, including interest, with 27 states increased from Rs 7375 crore ($1.44 billion) to Rs 9509 crore($1.43 billion) .
 
Defaulting state are not being penalised, as procedure requires
States that do not spend the money given to them must be penalised, according to procedure laid out by the Union Cabinet and applicable from 2014-15.
 
State governments had to release the money to state health societies within 15 days of receiving it, and if they failed to do so state governments were liable to pay interest — 5.75% to 7.25%, depending on the going bank deposit rate.
 
The audit observed that Rs 49 crore released during 2014-15 and Rs 450 crore released during 2015-16 under Mission Flexipool and RCH Flexipool to state treasuries were not transferred to state health societies as of May 2016.
 
When asked to explain, the ministry told CAG that from time to time states had been asked to ensure timely release of funds to health societies. However, the CAG observed that the ministry had no answer when it was asked about action taken against defaulting states.
 
Operational guidelines for the funds also provide for money to be used for only specific targets. In six states (Andhra Pradesh, Gujarat, Jammu and Kashmir, Rajasthan, Telangana and Tripura), Rs 36 crore was diverted to other schemes as mentioned earlier. The ministry admitted to CAG that it had not acted properly in diverting NRHM funds for non-NRHM purposes.
 
For the period 2011-15, utilisation certificates (UCs) of Rs 4,283crore, under Mission Flexipool, were pending in 22 states/UTs. Under RCH Flexipool, UCs of Rs 3,175 crore were pending from 21 states/UTs as of May 2016.
 
‘Poor data management’
“Data management processes are under NHM are very poor, we have also found that data is often poorly maintained,” said Kapur who has authored the budget study on the NHM. “The inability to maintain data management systems has a consequence on planning for the next year as well as implementation. UCs need to show utilisation and the failure to submit it has implications for future rounds of fund release.”
 
Lack of staff and high vacancies mean that frontline functionaries have to produce and maintain most records without any clarity on how and when it will be used, Kapur said.
 
In its response to our questions, the ministry of health and family welfare has said that it has already put in place a slew of measures to deal with these problems: regulation of fresh funds, the use of the Public Financial Management System which provides a digital platform for fund management in real time, audit of state funds, training and review of state finance staff and the immediate transfer of funds between state health societies and state treasuries.
 
The central government is also advocating the use of single bank account in state operations so that in order to keep track of unspent funds, according to Jhalani.
 
(This is the first of a two-part series.)
 
Next: Upto 38% Shortfall In Medical Staff At Health Facilities Across India
 
(Salve is an analyst with IndiaSpend.)

Courtesy: India Spend
 

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Chhattisgarh had announced in 2013 a policy guaranteeing access to free generic medicines in all its public health facilities. Doctors at these facilities were also mandated to prescribe only generic medicines in the essential drug list (EDL) for patients receiving treatment there. Essential medicines “satisfy the priority health care needs of the population”, as per the World Health Organization (WHO). The are 796 such drugs listed in Chhattisgarh.
 
In the study, an analysis of 1,290 prescriptions from 100 public health facilities across 15 districts in Chhattisgarh showed that around 68% of the medicines prescribed were generic and from the EDL, but only 58% of them were available to the patients at the primary health facilities. The report titled ‘Access and availability of Essential Medicines in Chhattisgarh: Situation in Public Health Facilities’ was published in the January-February 2018 issue of the peer-reviewed Journal of Family Medicine and Primary Care.
 
The study was conducted by the State Health Resource Centre at Raipur as part of the evaluation of the implementation phase of the free generic medicine scheme in 2013-14.
 
In 2003, Chhattisgarh was the first state in India to list an EDL, and in 2011 the government set up the Chhattisgarh Medical Services Corporation Limited for centralised procurement, storage and supply-chain management of drugs, surgical items and medical equipment required by its public health facilities.
 
Easy availability of essential drugs is critical for India’s healthcare system. Indians are the sixth biggest out-of-pocket (OOP) health spenders in the low-middle income group of 50 nations, as IndiaSpend reported in May 2017. And around 70% of the overall household expenditure on health is on medicines. An estimated 469 million people in India do not have regular access to essential medicines, according to the WHO.
 
Various studies have shown the rising out-of-pocket expenditures on healthcare is pushing around 32-39 million Indians below the poverty line annually.
 
“Without the focus on the improvement in coverage and prescription of generic drugs, we may end up in a situation where public health spending goes up without commensurate reduction in OOP health spending,” said Rajeev Ahuja, a development economist formerly with the Bill and Melinda Gates Foundation and the World Bank.
 
35% of prescribed drugs had to be bought at private facilities
 
As against the overall percentage of prescriptions with generic medicines (68%), Raigarh ranked the lowest at 55%, as per the study. However, in a third of the districts surveyed, less than 50% of generic drugs were available at public health facilities, the lowest being Bilaspur district (38%).
 
Over 35% of the generic and branded drugs were purchased from private facilities across all survey sites. Narayanpur reported the highest percentage of generic prescriptions and availability, at 87.37% and 84.15%, respectively.
 
But the current situation in Chhattisgarh is an improvement over the shortages the state saw in 2011, when only 17% of essential paediatric medicines were available.
 
Studies conducted in other states have shown up similar problems. In Punjab and Haryana, only 45.2% and 51.1% of prescribed medicines were available at public health facilities. At the Jamnagar Government Medical College in Gujarat, only 63.34% of the drugs prescribed were generic. Across southern India, only 49.78% of the drugs were from essential drug list.
 
A recent study by IIT-Madras, reported by IndiaSpend on May 25, 2018, showed that within six months of upgrading primary health-care facilities (human resources, drugs and diagnostics), there was an overall fall in the financial burden on patients.
 
(John is a public health professional and works as Evidence Synthesis Specialist with the Campbell Collaboration based in New Delhi.)

Courtesy: India Spend
 

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Outside in public: Smiling, dressed real fine, manners on point. I am well schooled on how to be respectful, how to take up space, how to use silence when necessary. Travelling home on transit listening to music to drown out my day — filled with injustices from the minute I left my “sanctuary” ten hours earlier. Fumbling for keys, nearly pushing the door down to my home. All I experienced outside threatens to crash down my door and engulf my insides and swallow me whole. My breath struggles to calm itself. Grief shadows me through the hallway. I self-talk my way into the kitchen, slipping my armour off; my thick silver bangle hits the floor, the sound awakening me to reality. I am home. I sit still for a minute and contemplate how I will go out again to face the monster of anti-Black racism. I drink my tea quickly, and begin to make dinner. – Feb 9, 2018, author’s journal

Health impacts from anti-Black racism and anti-Indigeneity are often dismissed or kept silent by health scholars and health care workers. Shutterstock

Witnessing and hearing stories about racism can impact your health. The feelings evoked can make you ill if not processed.

The recent news of Tina Fontaine’s trial and the acquittal of Gerald Stanley, a white farmer accused of killing a young Indigenous man, Colten Boushie, of the Red Pheasant First Nation are examples of the Canadian legal system’s commitment to the Indian Act and colonial dominance.

This ongoing colonial dominance has a transgenerational trauma impact on the health of Indigenous and colonized peoples.

Two recent examples that indicate the kind of violence that Black people experience: A school that allowed police to shackle a Black six-year old girl’s wrists and ankles; a children’s aid system that put a child refugee from Somalia into foster care yet never applied for his Canadian citizenship, so years later he received deportation orders to a country where he does not speak the language.

The impact of this colonialism and anti-Black racism on the health of Black and Indigenous peoples is elongated and insidious. We navigate systems, structures and communities that perpetuate abhorrence towards us in all aspects of our lives.

Experiencing and fighting such systems for justice for our children, ourselves and our community members has devastating effects on our health.

As a health and human rights researcher, therapist and professor who has explored the deep implications of racism, I would like to share some insights into the impacts of racism on our health.

My hope is that by doing so I create dialogue and encourage communities to continue to voice their experiences of violence and racism — in order to demand changes and ultimately create more supports.
 

Violence is a continuum

Health indicator statistics of Indigenous communities report increasing disparities between Indigenous and settler populations. Systemic racism affects Indigenous population’s health in various ways, this includes limited healthy food choices, inadequate living conditions and substandard health care. The infant mortality rate within Indigenous communities is almost 12 times that of settler communities.

The statistics, usually presented by state authorities, come without context or consideration to the broad range of causes — one of which is the continued exposure to state violence on a daily basis.

Family and supporters of Thelma Favel, Tina Fontaine’s great-aunt and the woman who raised her, march on Friday, Feb. 23, 2018, in Winnipeg the day after the jury delivered a not-guilty verdict in the 2nd degree murder trial of Raymond Cormier. THE CANADIAN PRESS/John Woods

We have anecdotal evidence: We see loved ones, friends, ourselves and respected community leaders struggle with the emotional and physiological impacts of racism on a daily basis. While anti-Black racism’s effect on the health of Black communities is documented, studies from the U.S. are more illustrative.
In one U.S. study, researchers studied 1,574 Baltimore residents of which 20 per cent reported that they had been racially discriminated against “a lot.” This same group had higher systolic blood pressure than those who perceived they had been discriminated against very little. Additionally, over a five-year period the group that felt they had been discriminated against “a lot” had higher declines in kidney function.

In a 1997 to 2003 study on racial discrimination and breast cancer in U.S. Black women, researchers found that perceived experiences of racism resulted in increased incidents of breast cancer, especially among young Black women. In 2011, a pivotal study on the impact of racism on health scholars linked lifetime experiences of discrimination to higher prevalence of hypertension in African Americans.
 

Biases in research

These are just a few examples of some studies being done on the impact of racism on health. However, most studies have been conducted in the U.S., the U.K., New Zealand and Australia. Canada does not yet collect race-based health or experiences of racism on health data through any formal mechanism. This poses a problem when scholars are asked to produce “scientific data” to prove that racism impacts health inequities and disparities. How do you provide “statistically significant evidence” on the impact of anti-Black racism when systemic issues limits your access to collecting this same data? My future research proposes to support the collection of increased health data on the impact of anti-Black racism in Canada and globally.

In Black communities no one is immune from racism — from our unborn to our school age children to our elderly. Consciously and unconsciously our health becomes obstructed.

The impact on health intensifies for those in Black communities who are women, working class, lesbian, gay, bisexual or trans (LGBT), dis(abled), refugees or newcomers. Here, the combination of oppressions creates additional stress on mental and physical health and well-being. I call this intersectional violence.
For example, the massacre of Muslims in a Québec mosque and anti-Islam policies continue to further impact the health of marginalized, often surveilled communities. Two victims of the Québec massacre were Black. This fact is hardly mentioned. This is an example of anti-Black racism within communities of colour.

Health impacts from anti-Black racism and anti-Indigeneity are often dismissed or kept silent by health scholars and health-care workers. The findings challenge the illegitimacy of systems of dominance and question the humaneness and accountability of colonial power. As such, research on the health impact of anti-Black racism is underfunded and under researched.

The “realness” of health impacts related to racism interrupts narratives of the “disadvantaged,” the “poor,” the “lazy” and the “needy.” Such stereotypes re-victimize and further aggregate health inequities. Yet understanding racism as a determinant of health is important to understanding economic and social barriers to success.
When we fail to address the real impact of racism on Black communities’ health, we not only lose our community members to often preventable disease, illness, institutionalization and ultimately death, we also lose our opportunity for redress and to energetically participate in transnational anti-oppression movements.

Protesting against white supremacy and racism in downtown Chicago on Aug. 21, 2017, after the tragedy in Charlottesville. Shutterstock
 

Health impacts

Experiencing racism throughout our lifespan can overwhelm our health functionality. Repetitive acts of untreated trauma and violence lead to debilitating health issues.

The impact of anti-Black racism within our educational system is well documented by our lived experiences and “unexplained” drop-out rates. The effect of prolonged injustice from junior kindergarten through to post-secondary education, can lead to exacerbated health conditions.

The under-recruiting and under-hiring of African/Black and Indigenous peoples in medicine, psychology, education, health and in academia directly affects the impact of racism on these same communities.

Adversely, the over-hiring of African/Black community members as personal support workers, health aids and child care workers with little opportunity to move into positions of power in these fields directly establishes a division between the “helper” and “the helped,” resembling enslavement roles where Africans served whites while living in conditions that gravely impacted their own health.

The impact of the over-representation of our children in state care on the health of Black families due to separation and transgenerational trauma is never measured.

As our children and elders endure acts of violence during vulnerable times in their lives, without protection or support, their grief response becomes hidden or dissociated. This leads to challenges in seeking and receiving health care which increases despairing health results.

The myth that Black people do not seek mental health therapy comes from a falsified notion of “super resiliency” instead of the reality of under-funded and purposely delayed services that prevent health and wellness in our communities. This leads to many community members suffering and seeking services in silence and isolation.

The burden on Black and colonized folks’ bodies, minds, spirits, health and wellness is all-encompassing.

Experiencing racism throughout our lifespan can overwhelm our health functionality. Shutterstock
 

Possibilities for change

Having a provincial anti-racism directorate and local Toronto anti-Black racism action plan indicates a way forward. Much activism over many years resulted in these strategies getting put into action.

The directorate’s effectiveness will be measured in its implementation, the diversity of its members and its power to eliminate health disparities and address the health impacts of racism and violence on the daily lives of Black, Indigenous and racialized peoples.

Research funding needs to be increased. Universities need to hire scholars from communities who are directly impacted by racism and whose work address these health inequities — to support communities impacted by these same injustices.

What if the Afrocentric Alternative school, the only one in Canada, was well resourced and supported as a health strategy to combat the early stigmatization and violence experienced by school-aged Black children?

What if, in the case of the killing of the late Colten Boushie, the jury was not all white?

What if we looked to Black Live Matters as a public health racial justice movement trying to prevent further health atrocities?

What if we collected health data on the impact of racism – using both informal and formal research methods – empowered, developed and implemented by Black and colonized communities to create health equity programs and strategies to address our health disparities?

Roberta K. Timothy, Assistant Lecturer Global Health, Ethics and Human Rights School of Health, York University, Canada

This article was originally published on The Conversation. Read the original article.

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