Survival of the richest

Darwin stands corrected. What was evident has been swept under the carpet. Darwin had propounded the law of natural selection suggesting that the world is a jungle in which there is a struggle for survival. Only the fittest shall survive. But our interpretation of this term fittest was wrong. Corona pandemic has proved that it was the richest who were the fittest. As the pandemic struck viciously across the globe, we realised that though the pathogen chose to infect all, it killed selectively, preferring the poor over the rich. It is the poor who are the worst sufferers, country’s economic status notwithstanding. While the rich managed to survive, the poor bore the brunt of the pandemic. It was the Black population that suffered the most in the US, not because of the colour of the skin, but due to the size of the wallet. The Black Americans make up for around 12.5 percent of the US population, yet they accounted for over 22 percent of covid deaths. That was the case of the richest democracy. In the largest democracy, it was no better. In India too, the poor were the worst sufferers. As the covid-19 ravaged through 2020 and 2021 the poor bore the brunt of the strike. The treatment protocols where costly, the availability of hospital beds had a premium and the out of the pocket expenses were beyond the capacity of the poor. The outcome was that the poor suffered the maximum casualties. Even those who could hang around had to sell or mortgage whatever they had, to save their near and dear ones. Tragically, nemesis in the form of debt trap is still staring at them. They might have won the battle but the war is on and perhaps to their disadvantage. The healthcare costs were always high but in the Corona times medical bills pushed crores of Indians into poverty. The choice was tough. To save someone today or face devastation tomorrow. According to one report, out of pocket health spending has forced more than 55 million Indians into poverty. In India, 63 percent of the health spending is borne by the households. Incidentally this is one of the highest in the world. And the poorest States are the worst off. There is a need to rethink public health. You don’t need a white paper to know that the health of a nation depends critically on the extent of access of the citizens to an equitable, affordable and accountable healthcare system. That Public health expenditure in India is insufficient and inefficient was always known but Corona made it glaringly obvious. As the second wave hit Indians hard, the poor and even the not so poor were rendered hopeless and helpless. The insufficient number of per capita health facilities were largely cornered by the highest bidders. A nominal rise of around 1.5 to two percent in healthcare GDP may bring down the out of pocket expenses of the poor considerably. Our attitude towards public health has to change and we must consider it as an investment rather than a cost. In fact, our ability to distinguish between cost and investment has always been imprudent. Let us make amends at least in the wake of Corona. We need to remember that the poor also have a right to life that is inalienable and health is that critical determinant of life.