The Contribution of Social and Political Factors to Good Health GOOD HEALTH AT LOW COST (The Rockefeller Foundation)

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The Contribution of Social and Political Factors
to Good HealthGOOD HEALTH AT LOW COST(The
Rockefeller Foundation)

• Patrica L.Rosenfield,
• WHO-Special Programme for Research and Training
  in Tropical Diseases
• By R Muralikrishnan Keerti Pradhan
• keerti_at_aravind.org

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Introduction

• There is no general agreement to what constitutes
  good health
• There is a pre-conceived notion that higher the
  national average income(GNP GDP), better the
  health status
• But some countries like China, Costa Rica,
  Srilanka and Kerala(a small state in a big
  country) have health status on par with developed
  countries.
• Their experiences have shown that good health is
  more than the two statisticsLong Life Expectancy
  and Low Infant Mortality Rate.
• Mortality and Morbidity reductions are only a
  part of the process of achieving good health
  which includes psychological, social and economic
  well-being also

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Methods

• In the mid 80s, the Rockefeller Foundation tried
  to study and document the social and political
  contribution to good health in these countries
• People who are active participants in the health
  development policies of their own countries
  (Eg.Dr.P.G.K.Panikar, Ex-Director,CDS)
• Followed by a conference where they consolidated
  the experiences and commonalities

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CHINA
CUBA
KERALA
SRILANKA
COSTA RICA
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Economic and Political Status

• All the four countries had shown dramatic
  improvements in mortality-related statistics of
  Low IMR and High Life Expectancy, under severe
  Economic Constraints
• Population ranged from 2.3 million(Costa Rica)
  to 1008.2 million(China)-1980-82
• GNP Per capita US 1430(Costa Rica) to
  US150(Kerala)
• Monarchy, colonization and subsequent democracy
  of government were features of their political
  development
• China, Kerala and Sri Lanka-British Rule
• Three of them had Western style democracies
• Kerala Sri Lanka-Democracy since independence
• Costa Rica was a republic for 150 years

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Comparison of Kerala All India
Kerala All-India
Death Rate/1000 (1998) 6.4 9.0
Rural Birth Rate(1998) 18.3 28.0
IMR(1998) 16 72
Life Expectancy (1993) 66.5 61.5
Literacy Rate (1991) 90.59 52.11
Female Literacy Rate(1991) 86.17 19.43
Mean age at marriage(F) 22.3 19.3
Per capita Income(1995-96) 8324 11649
Doctor-Population Ratio 17213 12148
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Political and Economic Orientations

• Political economic orientations vary between
  countries and over time within the same country
• Kerala- Communist government since 1956, although
  a coalition government was in the centre
• Sri Lanka- Socialism and Capitalism have
  prevailed at various times over the past 35 years
• Costa Rica- Power shared by the Social
  Democracy, Christian Democracy and coalition of
  left parties
• China- Marxist-Leninist economic system since
  1949 but now moving on to new economic
  orientations
• Hence, no single political or economic approach
  can claim credits

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Common Social and Political Factors

• Historical commitment to health as a social goal
• Social welfare orientation to development
• Wide spread political participation
• Equality of health services coverage for all
  social groups(equity)
• Intersectoral linkages for health

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Historical Commitment

• Legislation
• Organized government policy for access to health
  care
• Implemented at early stages of policy development
• Establishment of hospitals and health centres
• Kerala-Immunization , Sanitary Reforms and Modern
  Style Hospitals from 1860. Ayurveda (Historical
  Importance)
• Srilanka- Ayurveda. Western Medicine
• China-Chinese Medicine mainstay till 1949.
  Western Medicine(1917)
• Costa Rica- Health actions( mid 19th cent)
  village doctors
• Missionary Influences
• Spanish colonists in 16th century- Roman Catholic
• Missionaries in 19th Century-Kerala, Srilanka
  China

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Social Welfare Orientation

• Continuity in government expenditure for Social
  Sector
• Preventive health measures(Hygiene Sanitation)
• Food subsidies
• Educational programs-Historic formal programs
• Land Reforms-ensuring redistribution of income
• Srilanka and Costa Rica have the lowest defense
  expenditures
• India's defense budget around 20-25 but is not
  reflected in Kerala state budget
• In China, the large military sector has played an
  important role in health and health-related
  improvements

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Wide Spread Political Participation

• Participation in the electoral process
• Combined with education
• Awareness about the need for health programs
• Extent of Decentralization
• NGO involvement in Planning
• Community Involvement

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Equality of Health Services Coverage

• Measured as health, educational and nutritional
  status of the underserved (women,children,ethnic
  and minorities, etc)
• The Nayar society of Kerala was interested in
  womens education and the first girls school was
  established in 1819
• In addition accessibility, utilization and
  urban-rural distribution were also considered
• Rural co-operative medical centres in China.
• Tea planters health programmes in Srilanka
• Reorganization of ministry of health on reaching
  underserved areas

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Inter Sectoral Linkages

• Health, Education and Agriculture
• Mechanisms to finance health
• Inter agency committee
• Incorporation of economics into health training
  programmes
• Closer ties between social security and health
  systems
• Srilanka had established a national health
  development network
• Costa Rica drew social security and health
  together through legal mechanisms
• Kerala is using District Councils to develop
  inter sectoral systems for health
• China has closely linked political,
  administrative and economic organizations

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Conclusion

• Four studies reveal important common factors
  influencing good health
• The highest level of political commitment has
  been complemented by local conditions and
  flexibility at policy making and implementation
  levels

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Discussion

• Is there any other factor(s)?For.eg.Prof.Abel
  Smith demonstrates health seeking behaviour as
  another reason for good health in Kerala
• Do these commonalities constitute a basis for
  universal health policy application?
• Does more work need to be done to develop a
  conceptual framework for assessment?

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Thank You