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In India, a so-called low-caste woman can expect to live almost 15 years less than a so-called upper-caste woman. Suggesting that this is an international phenomenon, a just-released Oxfam report says, Life expectancy in one of the poorest parts of London is six years less than it is in one of the capital’s richest neighbourhoods, just a few miles away. Life expectancy in the richest parts of Sao Paulo, Brazil, is 79 years. In one of the poorest areas of the city it is 54 years.
Titled “Public good or private wealth?”, and asserting that “universal health, education and other public services reduce the gap between rich and poor, and between women and men”, the report , however, regrets, “In India, the highest-quality medical care is only available to those who have the money to pay for it.”
By way of comparison, the report says, if Mukesh Ambani, who ranks 19th in the Forbes 2018 billionaire list, and is the richest Indian, and his residence in Mumbai, a towering 570-foot building, is worth $1bn and is the most expensive private house in the world”, Pratima, who lives in a slum in Patna, eastern India, “lost both her twins due to delays and scarce resources in her nearest clinic.”
Underscoring that "poor women like Pratima have to give birth without proper maternal healthcare, leaving them vulnerable to complications, neglect and stillbirth as a result”, the report says, the “country is a top destination for medical tourism”, but at the same time, "levels of public spending on health are some of the lowest in the world.” It adds, “The poorest Indian states have infant mortality rates higher than those in sub-Saharan Africa.”
Noting that in India, “government neglect of public healthcare means the private sector dominates”, the report says, “In South Asia, including India, poor-quality care kills more people than lack of access to treatment and care. The poorest patients either have to cope with very poor public providers or take their chances with an array of unregulated quacks and other private providers, often bankrupting themselves in the process.”
The report continues, “Powerful private health corporations have escalated the cost of government-paid health insurance premiums three and a half times in some states, and threaten to withdraw services if governments do not comply”, adding, “In major cities like Delhi, many private hospital corporations have received free or heavily subsidized land from the government in return for providing free care for poor patients, which they consistently fail to deliver.”
Lamenting that “a number of these same hospital corporations have received substantial financial backing from the private sector investment arm of the World Bank”, the report says, “Eighty percent of payments to the government health insurance scheme go to private providers.”
According to the report, “Evidence across different states confirms unethical and corrupt practices by private providers, include charging the government for bogus patients, refusing free treatment to poor patients, and delivering unnecessary interventions and medication. Perhaps the most horrific example of the latter is that thousands of young Indian women have their uteruses needlessly removed by private healthcare providers because hysterectomies are among the most profitable procedures.”
According to the report, “India is home to the largest number of people pushed into poverty by health expenses; paying for medicines is the chief cause”, adding, “One study in the Indian state of Uttar Pradesh found that even low-cost private schools are unaffordable for the poorest 40% of families, with girls and children from lower castes or religious minorities less likely to attend.”
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