Conceptual Framework and Historical Evolution of the Right to Health
The article 'Conceptual Framework and Historical Evolution of the Right to Health' is an insightful study about the various aspects of the emergence of the right to health along with the legislative provisions
The article 'Conceptual Framework and Historical Evolution of the Right to Health' is an insightful study about the various aspects of the emergence of the right to health along with the legislative provisions. The article also contains the importance of paramount significance to be given to the health of every individual. The article is an attempt by the author to make awareness about the essence of being healthy.
Introduction
Mental and physical health is the very basis of human personality. Since human life has come into existence, human beings have been subject to diseases and mishaps. The various sources which have caused agonies in human life include both external and internal (factors) forces. Health depends on a variety of factors. Health at the same time is very important for the human race to survive and progress. When we consider health under the human rights and Intellectual property rights realm, a question arises whether it is the main responsibility of the government to provide adequate health care services to all free of charge in a democratic country like ours.
Concept of Health
Different cultures have their own concept of health. The most ancient definition of health is the ‘absence of disease’. In some cultures, health and harmony are considered equivalent, harmony being defined as “being at peace with the self, the community, God and cosmos”.
At the International level, health was forgotten when the covenant of the League of Nations was drafted after the First World War. Only at the last moment, the World Health Organisation emerged and again forgotten, then the charter of the United Nations was drafted at the end of the Second World War, and the matter of health had to be introduced ad hoc at the United Nations Conference at San Francisco in 1945. However, during the past few decades, there has been a reawakening that health is a human right and a worldwide social goal, that it is essential to the satisfaction of basic human needs and to an improved quality of life; and that is to be attained by all people.
Meaning and Nature of Health
The human right to health means that everyone has the right to the highest attainable physical and mental health standard, which includes access to all medical services, sanitation, adequate food, decent housing, healthy working conditions, and a clean environment. Health has been defined to mean a state of absolute mental, physical and social well-being; therefore is not only restricted to merely the absence of diseases. The definition has been further simplified to include the ability to lead an economically as well as socially productive life. This led to the expansion of the dimensions and scope of the right to health which has multiple effects on the duty and responsibility of health professionals along with their relationship with society at large.
Definition of Health
According to WHO,
“A condition or quality of the human organism expressing the adequate functioning of the organism in given conditions, genetic or environmental”.- Operational definition of health.
The World Health Organization,1948 has, in its constitution, defined health as follows:
“ Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity”. (WHO 1946- emphasis added).
This statement is amplified to include the ability to lead a “ socially and economically productive life”. It is a dynamic concept. It helps people live well. work well and enjoy themselves.
The WHO definition of health is therefore considered by many as an idealistic goal than a realistic proposition. It refers to a situation that may exist in some individuals but not in everyone all the time; it is not usually observed in groups of human beings and in communities. Hence, the definition has been criticized in many ways. Good health is a prerequisite for human productivity and developmental process. It is essential for economic and technological development. Health is a common theme in most cultures. In fact, the concept of health is a part of all communities' cultures. Among definitions still used, probably the oldest is that ‘Health is the absence of disease’. In some cultures, health and harmony are considered equivalent, harmony is defined as being at peace with the self, the community, God and Cosmos. Charaka, the renowned Ayurvedic physician, said;
"Health was vital for the ethical, artistic, material and spiritual development of man."
Buddha has also said,
“Of all the gains, the gains of health are the highest and the best”. Health is man’s most precious possession, it influences all his activities, and it shapes the destinies of people. Integration of health schemes in overall developmental plans is of paramount importance ”.
Duros R. Defines, “ Health implies the relative absence of pain and discomfort and continuous adoption to the environment ". In the International Conference at Alma-Ata in 1977, a clause “ and ability to lead a socially and economically productive life” was added. The 37th World Health Assembly adopted resolution No.WHA/27/1984/RE/1-60 and incorporated ‘Spiritual dimension’ in the definition adopted at Alma –Ata.
The health status and disease status are a result of continuous adjustment between the internal and external environment. The internal environment within the human being pertains to every tissue and organ system. Man is also exposed to the external environment. Thus, Man’s external environment, air, water and food, and his personal environment relating to his work, eating, drinking, smoking etc, i.e., his way of life, all have a bearing on his health. Health habits, personal hygiene, health knowledge and mental attitude also influence health.
Basic Concepts
Health care – Health care is the prevention, treatment and management of illness and the preservation of mental and physical well-being through the services offered by the medical, nursing and allied health professions.
Public Health – Public health is “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, Public and Private, Communities and individuals. (Winslow 1920).
Health education – Health education is the profession of educating people about health. Areas within this profession encompass environmental health, Physical health, social health, emotional health, intellectual health and Spiritual health. It can be defined as the Principle by which essential health care is technically valid, economically feasible and socially acceptable.
Primary Health care - Primary Health care includes eight essential elements: education concerning Prevailing health problems and the methods of preventing and controlling them, promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning, immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries, and provision of essential drugs. ( Central Bureau of Health Intelligence – National Health Profile 2005).
Mental Health - Mental health is a term used to describe either a level of cognitive or emotional well-being or an absence of a mental disorder. ( Medilexicon’s medical dictionary).
Key aspects of the Right to Health
The right to health in all its forms and at all levels contains the following interrelated and essential elements, the precise application of which will depend on the conditions prevailing in the particular state :
Availability
Functioning public health and healthcare facilities, goods and services, as well as programmes, have to be available in sufficient quantity within the state. The precise nature of the facilities, goods and services will vary depending on numerous factors, including the state's development level. They will include, however, the underlying determinants of health, such as safe and portable drinking water and adequate sanitation facilities, hospitals, clinics and other health-related buildings, trained medical and professional personnel receiving domestically competitive salaries, and essential drugs, as defined by the WHO Action Programme on Essential Drugs.
Accessibility
Health facilities, goods and services have to be accessible to everyone without discrimination, within the jurisdiction of the State. Accessibility has four overlapping dimensions:
* Non-discrimination: health facilities, goods and services must be accessible to all, especially the most vulnerable or marginalized section of the population, in law and in fact, without discrimination on any of the prohibited grounds.
* Physical accessibility: health facilities, goods and services must be within safe physical reach for all sections of the population, especially vulnerable or marginalized groups, such as ethnic minorities and indigenous populations, women, children, adolescents, older persons, persons with disabilities and persons with epidemics.
Accessibility also implies that medical services and underlying determinants of health, such as safe and portable water and adequate sanitation facilities, are within safe physical reach, including in rural areas. Accessibility further includes adequate access to buildings for persons with disabilities.
* Economic accessibility (affordability): health facilities, goods and services must be affordable for all. Payment for healthcare services, as well as services related to the underlying determinants of health, has to be based on the principle of equity, ensuring that these services, whether privately or publicly provided, are affordable for all, including socially disadvantaged groups. Equity demands that poorer households should not be disproportionately burdened with health expenses as compared to richer households.
* Information accessibility: Accessibility includes the right to seek, receive and impart information and ideas concerning health issues. However, accessibility of information should not impair the right to have personal health data treated with confidentiality.
Acceptability
All health facilities, goods and services must be respectful of medical ethics and culturally appropriate, i.e., respectful of the culture of individuals, minorities, peoples and communities, sensitive to gender and life-cycle requirements, as well as being designed to respect confidentiality and improve the health status of those concerned.
Quality
As well as being culturally acceptable, health facilities, goods and services must also be scientifically and medically appropriate and of good quality. This requires, inter alia, skilled medical personnel, scientifically approved and unexpired drugs and hospital equipment, safe and potable water, and adequate sanitation.
Dimensions of Health
According to WHO, health has three specific dimensions- the physical, the mental and the social. Many more may be cited i.e, Spiritual, emotional, Vocational and political dimensions. As the knowledge base grows, the list may be expanding:
(i) Physical dimension
(ii) Mental dimension
(iii) Social dimension
(iv) Spiritual dimension
(v) Emotional dimension
(vi) Vocational dimension
Physical Dimension
The physical dimension of health is related to body structure and physiology. It refers to the normal functioning of all the tissues, organs and systems of the body resulting in the harmonious functioning of the body. The signs of good health are a good complexion, clean skin, bright eyes, lustrous hair, well built, firm flesh, sweet breath, a good appetite, sound sleep, regular activity of bowel and bladder and co-ordinate bodily movements.
Mental Dimension
Mental health is related to the mind and refers to the normal functioning of the mind not merely the absence of mental illness. It is rather abstract. It is a state of balance between the individual and his self on one side and between the individual and his external environment on the other.
Social Dimension
“ Social well-being of a person implies harmony and integration within the individual between each individual and other members of the society and between the individuals and the world in which they live”. Social health can be defined as the “ Quantity and Quality of an individuals’ interpersonal ties and the extent of involvement with the community”.
Spiritual Dimension
It takes into account the individual as a whole, comprising body, mind and soul. A man has a body and special senses, the mind has a ‘spirit of life’. Indian Culture names it ‘atma’, which is intangible. It transcends physiology and psychology. The spiritual dimension of health includes integrity, principles, ethics, the purpose in life, commitment to some higher being and belief in concepts that are not subject to “ state of art explanation ”.
Emotional Dimension
Emotions are sudden forces that emerge in mind, which include thoughts, emotions and will. A healthy mind is one that expresses the right emotions at the right time in a controlled form. In Psychiatric illness, emotional disturbances are expressed in certain forms like anxiety, depression and mood swings etc. In short, the mental dimension deals with ‘cognitive’(learned) behaviour, while the emotional dimension deals with ‘feelings’.
Vocational Dimension
This dimension is concerned with occupation and earning a livelihood. If the persona and his job are” made for each other”, it can be said that he is vocationally healthy. To others, it represents the culmination of the efforts of other dimensions as they function together to produce what the individual considers life “ Success”. A few other dimensions have also been suggested such as: philosophical, cultural, socio-economic, environmental, educational nutritional, curative, and preventive aspects which determine health. Hence, it is seen that there are many “ non-medical” dimensions of health. eg: social, cultural, educational etc. These symbolize a huge range of factors to which other sectors besides health must contribute if all people are indeed to attain a level of health that will permit them to lead a socially and economically productive life.
Determinants of Health
Health is multi-factorial. These factors may be internal or external. When these factors interact, the health of the individual or community would be affected. Positive health envisages perfect physical and mental well-being.
Various concepts of health have been perceived by different professional groups. New concepts of health evolved, and new patterns of the concept of health were developed on the basis of new thoughts and ideas. The concept evolved as time passed by, and there was a shift from individual concern to a worldwide social goal which included the whole quality of life. The development of various concepts of health includes the following major concepts:
(i) Biomedical Concept
(ii) Ecological Concept
(iii) Psychosocial Concept
(iv) Holistic Concept.
(i) Biomedical Concept
Traditionally, health has been viewed as an “ absence of disease”. It was believed that if one was free from disease, then he was considered healthy. This concept has the basis in the “germ theory of disease” which dominated medical thought at the run of the 20th century. The medical profession viewed the human body as a machine and one of the doctor’s tasks is repairing the machine. Thus, health, in this narrow view, becomes the ultimate goal of medicine.
There were many criticisms laid down against the biomedical concept it has minimized the role of environmental, social, psychological and cultural determinants of health. At the same time, it was considered inadequate to solve major problems of mankind like malnutrition, accidents, drug abuse, mental illness, environmental pollution etc.
(ii) Ecological Concept
Deficiencies in biomedical concepts gave rise to many other concepts. The ecologists viewed that there is a dynamic equilibrium between man and his environment. Dubos defines health by saying: “ Health implies the relative absence of pain and discomfort and a continuous adaptation and adjustment to the environment to ensure optimal function”.
Human ecological and cultural adaptations do determine not only the occurrence of disease but also the availability of food and the population explosion. The ecological concept raises two issues: viz imperfect man and imperfect environment. History argues strongly that improvement in human adaptation to natural environments can lead to longer life expectancies and a better quality of life –even in the absence of modern health delivery services.
(iii) Psychological Concepts
Recent developments show that health is not only a biomedical concept but is also influenced by social, psychological, cultural, economic and political factors of the people concerned.
(iv) Holistic Concept
The holistic model is a synthesis of all concepts. It recognizes the strength of social, economic, political and environmental influences on health. It has been variously described as a unified or multidimensional process involving the well-being of the whole person in the context of his environment. This view corresponds to the view held by the ancients that health implies a “ Sound mind in a sound body, in a sound family, in a sound Environment”.
The holistic approach implies that all sectors of society have a direct effect on health. Hence, the emphasis is on the promotion, protection and prevention of health.
Contemporary Ideology of Health
Due to revolutionary changes in the concept of human rights, incredible importance has been given to health as a human right. There has been a novel change in the idea of health. Previously it was considered as the mere absence of disease, but now the concept has changed.
It is now conceived and follows:
(i) Health is a fundamental human right.
(ii) Health is the essence of productive life and not the result of even increasing expenditure in medical care.
(iii) Health is inter-sectoral.
(iv) Health is central to the concept of quality of life.
(v) Health is an integral part of development.
(vi) Health involves individuals, state and international responsibility. Health and its maintenance is a major social investment.
(vii) Health is a worldwide social goal.
Different Phases of Public Health
The history of public health has passed through four distinct phases.
(a) Disease Control phase (1880-1920)
(b) Health Promotional phase (1920-1960)
(c) Social Engineering phase (1961-1980)
(d) Health For all phases (1981-2000)
(a) Disease Control phase (1880-1920) :
Public health during the 19th century was largely a matter of sanitary legislation and sanitary reforms aimed at the control of man’s physical environment, eg, Water supply, sewage disposal etc., clearly, these measures were not aimed at the control of any specific disease, for want of the needed technical knowledge. However, these measures vastly improved the health of the people due to disease and death control.
(b) Health Promotional phase (1920-1960):
At the beginning of the 20th century, a new concept, the concept of “Health promotion” began to take shape. It was realized that public health had neglected the citizen as an individual, and the state had direct responsibility for the health of the individual. C.E.A Winslow, in 1920 defined Public health as “ the Science and art of Preventing disease, prolonging life and promoting health and efficiency through organized community effort”. This definition summarizes the philosophy of public health which remains largely true even today. The evolution of health centres is an important development in the history of public health. The concept of health care was first mooted in 1920 by Lord Dawson in England. In 1931, the league of nations health organisation called for the establishment of health centres. The Bhore committee(1946) in India had also recommended the establishment of health centres for providing integrated curative and preventive services.
The second great movement was the community development programme to promote village development through the active participation of the whole community and the initiative of the community. This programme tried to do too much quickly with inadequate resources. It was a great opportunity lost because it failed to survive. However, the establishment of primary health centres provided the needed infrastructure for health services, especially in rural areas.
(c) Social Engineering Phase (1961-1980):
The pattern of diseases changed with the advancement of medicine and public health. Though the old problems were solved, new problems in the form of chronic diseases began to change in the developed world. These were chronic diseases like cancer, diabetes, cardiovascular etc which could not be tackled by traditional approaches like isolation, immunization and disinfection. A new concept, the concept of “ risk factors” as determinants of these diseases, came into existence.
The consequences of these diseases, unlike the swift death brought by acute infectious diseases, were to place a chronic burden on the society that created them. These problems brought new challenges to public health, which needed reorientation more towards social objectives. Public health entered a new phase in the 1960s, described as the “ social engineering phase”. Social and engineering aspects of disease; and health were given a new priority. Public health moved into the preventive fan rehabilitative aspects of chronic diseases, and behavioural overlapping became identical, namely the prevention of disease, promotion of health and prolongation of life.
(d) Health for All Phase (1981-2000):
As the centuries have unfolded, the glaring contrasts in the picture of health in developed and developing countries came into a sharper focus, despite advances in medicine. Most people in developed countries and in the elite of developing countries enjoy all the determinants of good health-adequate income, nutrition, education, sanitation, safe drinking water and comprehensive health care.
John Bryant in the introduction to his book: “ Health and the developing world” presented a gloomy picture and a challenge of inequalities in health by saying; “ large numbers of the world’s people, perhaps more than half, have no access to health care at all, and for many of the rest the care they receive does not answer the problems they have”. The global conscience was stirred to a new awakening that the health gap between rich and poor within countries and between countries should be narrowed and ultimately eliminated.
It is conceded that the neglected 80 per cent of the world’s population to have an equal claim to health care, protection from the killer diseases of childhood, to primary health care for mothers and children, to treat those ills that making has long ago learnt to control, if not to cure. Against this background, in 1982, the members of the WHO pledged themselves to an ambitious target to provide health for all by the year 2000 that lead a socially and economically productive life ”.
The goal of health for all had two perspectives. Viewed in the long–term context, it simply means the realization of the WHO’s objective of “the attainment by all peoples of the highest possible level of health”. But what is of immediate relevance is the meaning that, as a minimum, all people in all countries should have at least such a level of health that they are capable of working productively and of participating actively in the social life of the community in which they live.
Health for all means that health is to be brought within reach of everyone in a given community. It implies the removal of obstacles to health-that is to say, the elimination of malnutrition, ignorance, disease, contaminated water supply, unhygienic housing etc., depends on continued progress in medicine and public health. Health for all is a holistic concept calling for efforts in agriculture, industry, education, housing and communications just as much as in medicine and public health. The attainment of health for all by 2000 A.D was the central issue and official target of WHO and its member countries.
It symbolizes the determination of the countries of the world to provide an acceptable level of health to all people. Health for all has been described as a revolutionary concept and a historic movement-a movement in terms of its own evolutionary process.
Based on this, the Alma –Ata conference called for the acceptance of the WHO goal of ‘Health for all by 2000 A.D and proclaimed primary health care as a way to achieve health for all. Primary health presupposes services that are both simple and efficient with regard to cost, techniques and organization that are both simple and efficient with regard to cost, techniques and organization that are readily accessible to those concerned, and that contribute to improving the living conditions of individuals, families and the community as a whole.
The Alma-Ata declaration called on all governments to formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a national health system. It was left to each country to innovate, according to its own circumstances to provide primary health care. This was followed by the formulation and adoption of a global strategy for health for all by the 34th World Health Assembly in 1981. Primary health care got off to a good start in many countries with the theme “ Health for all by 2000 A.D”.
To sum up it can be said that WHO principles of health for all are based on the notions of :
Equity: All human beings have an equal right to health, and there is an urgent need to redress existing inequalities between countries, areas and groups of people.
Community Participation: As an informed, motivated and participating community, involved in decisions about their health at all stages of policy planning and implementation.
Inter-Sectoral Collaboration: The range of factors affecting health necessitates active co-operative between and with statutory, and voluntary at local, regional and international levels; health must be on the agenda of all public policy making.
Concept of Right to Health
The human right to health is a powerful and modern approach which aims at the protection of health and the well-being of all individuals. This modern approach,i.e: to give the impression of health as a human right has developed very rapidly at the international level through various international conventions and declarations whereby the state parties are made to view health as a human right. The general concept of the right to health made its first appearance in Article 25(1) of the Universal Declaration of human rights (UDHR), stating that “ Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in the circumstances beyond his control. The concept was defined as laying down certain determinants which would fulfil the right to health.
It was not a comprehensive definition as it laid down health facilities only in certain events specified. Hence, the idea was isolated and not well defined. The right to health, as a matter of international law, is a broad and complex concept, subject to interpretation and interdependent with many other established rights. Interestingly, the modern human rights movement was born partly as a result of the health–related human rights abuses perpetrated under the Nazi regime, namely the acts of physicians who performed terrible medical experiments on human subjects and then defended their actions as necessary among other things, for the advancement of public health.
The right to be free from such abuse at the hands of the medical establishment, and the obligation of governments to protect people from such actions, is perhaps the most straightforward and uncontested element of human rights as they relate to the subject of medicine and health. The right to health is now internationally recognized and protected. It has been recognized and protected. It has been recognized and reaffirmed in a body of internationally accepted norms, standards and principles. Approximately 75% of the countries have ratified the International Covenant on economic, social and cultural rights which has comprehensive provisions on the right to health. The World Conference on Human rights (WCHR) held in Vienna, Austria in 1993 emphasized that it is the duty of all states, regardless of their political, economic and cultural systems, to promote and protect all human rights and fundamental freedoms.
Health is based on a broad definition of health, that encompasses medical and public health perspectives. It accords priority to the needs of the poor and otherwise vulnerable and disadvantaged groups. It entails specific government obligations regarding health care and the underlying determinants of health, as well as obligations to ensure non-discrimination and people’s right to participate in relevant decision-making processes. The right to health is conceived in broad terms so as to include a right to a standard of living adequate for basic health. This means that health status is influenced by a number of socio-economic factors that are generally accepted as falling outside the confines of clinical curative medicine.
The right to the highest attainable standard of health takes account of both health care and social conditions as being important determinants of health status. These include comprehensive health care, adequate, accessible, acceptable, affordable, appropriate and equitable health care services; basic immunization, adequate nutrition, adequate housing, sexual and reproductive health information and services, including family planning, safe drinking water, adequate sanitation, health-related education and information, clean and safe environment as well as others such as equitable health–related resource distribution, gender differences and social well-being.
They also include socially related events that are damaging to health, such as violence and armed conflict. A further important aspect is the participation of the population in all health–related decision-making at the community, national and international levels. India, being a signatory of all the important conventions, has implemented the right to health in its letter and spirit. Right from the time our constitution came into force, we had Article 47 which provides for the raising of the level of nutrition and the improvement of public health among the primary duties of the state. We have a number of legislations and policies implementing and protecting the right to health. The Supreme court has also, in various cases, recognized the right to health as a fundamental right to be included under Article 21.
Evolution of the Right to Health in Historical Perspective:
From time immemorial, man has been interested in trying to control deadly diseases. Chinese medicine claims to be the world’s first organized body of medical knowledge dating back to 2700 BC. Similarly, Egyptians had one of the oldest civilizations, about 2000 B.C., where in the realm of public health, the Egyptians excelled. Health is a common theme in most cultures. In fact, all communities have their concept of health, as part of their culture. India has also one of the most ancient civilizations in recorded history.
Thousands of years before the Christian era, there existed a civilization in the Indus Valley Civilization. It showed the relics of planned cities with drainage, houses and public baths built of baked bricks suggesting the practices of the environment at sanitation, by an ancient people as far back as 3000 B.C. India was invaded by the Aryans around 1400 B.C. it was probably during this period the ayurveda and the Siddha Systems of medicine came into existence. Ayurveda or the Science of life developed a comprehensive concept of health.
The Manu Samhita prescribed rules and regulations for personal health dietetics and hygienic ritual at the time of birth & death, and also emphasized the unity of physical, mental and spiritual aspects of life "Sarve Jana Sukhino Bhavatu" (May all men be free from disease and may all be healthy) was an ancient saying of the Indian Sages. This concept of happiness has its roots in the ancient Indian philosophy of life, which conceived the oneness and unity of all people wherever they lived. The religious teaching of Buddhism and Jainism dominated the post-Vedic period (600 B.C.-600 A.D.). Medical education was introduced in the ancient Universities of Taxila and Nalanda, leading to the titles of Pranacharya and Pranavishara. A Hospital System was developed for men, women and animals and the system was continued and expanded by King Ashoka.
The next phase in Indian History (650-1850 AD) witnessed the rise and fall of the Mughal Empire. The Muslim rulers introduced in India around 1,000 A.D., the Arabic system of medicine popularly known as the Unani system, the origin of which is traced to Greek medicine. The Unani system since then became, part of Indian medicine. With changes in the political conditions in India, the torch which was lit thousands of years ago by the ancient sages grew dim, medical education and medical services became static, and the ancient Universities and hospitals disappeared.
After this by the middle of the 18 century, the British had established their rule in India which lasted till 1947. With the passage of time and development in the field of science and technology, the study of health was neglected. But, however, during the past few decades, there has been a reawakening that health is a fundamental human right and a worldwide social goal; that it is essential to the satisfaction of basic human needs and to an improved quality of life; and that it is to be attained by all people.
Right to Health during the Ancient Era
India had played a distinct role in the history of technology and science. The history of technology and science in India as per the present-day archaeological evidence begins with the Indus Valley Civilization which is often referred to as Harappan culture. Harappa along with Mohenjodaro are important cities of archaeological value in the Indus Valley. This period is usually called the pre-Vedic period. Harappa had established commercial, as well as cultural links with the neighbouring countries in the Central and West Asian regions.
This civilization flourished in Northern and Western India between 2500 B.C. and 1500 B.C. The evidence from the examination of the skulls discovered at Mohenjodaro and Harappa shows that the inhabitants of that time were of the aboriginal proto-australoid type. There are many representations on the seals from Mohenjodaro and Harappa of a male God-horned and three-faced, sitting in the posture of a Yogi, his legs bent double heel to heel and surrounded by animals.
This was perhaps, the prototype of the Siva who is even now treated as the God of Yoga and Medicine ." All these points out the high quality of medical science and the concern for health prevalent at that time in India. " The medical systems that are truly Indian in origin and development are the Ayurveda and the Siddha systems. Ayurveda's origin is traced far back to the Vedic times, about 5000 B.C.
During this period, medical history was associated with mythological figures, sages and seers. Dhanvantari, the Hindu God of medicine is said to have been born as a result of the churning of the oceans during a 'tug of war' between gods and demons. According to some authorities, the medical knowledge in the Atharvaveda gradually developed into the science of Ayurveda. In ancient India, the celebrated authorities in Ayurvedic medicine were Atreya, Charaka, Susruta and Veghbhatt. Atreya (about 800 BC) is acknowledged as the first great Indian physician and teacher. He lived in the ancient University of Takshashila, about 20 miles west of modern Rawalpindi.
King Ashoka and the other Buddhist Kings patronized Ayurveda as a state medicine and established schools of medicine and public hospitals. Of significance in Ayurveda is the ''tri dosha theory of disease". The doshas or humour are Vata (wind), Pitta (gall) and Kapha (Mucus). The disease was explained as a disturbance in the equilibrium of the three senses of humour; when these were in perfect balance and harmony, a person is said to be healthy. Hygiene was given an important place in ancient Indian medicine.
The laws of Manu were a code of personal hygiene. Medical historians admit that Indian medicine has played in Asia the same role as Greek medicine in the west. The broad objectives of medical education were well-defined during this period. Although treatment of the sick was considered important and primary, due emphasis was also placed on preventive and Promotive aspects of health care. Medicine was divided into two broad categories - one was for the promotion of vigour in the healthy and the other for the destruction of disease in the ailing, as quoted in the Charaka Samhita.
In the ancient scriptures, surgery also formed part of the practice of medicine. The practical skill for this used to be imparted through well-planned practical exercises mentioned in the writings of Sushruta. After the final qualifying examination, the students were granted licenses to practice by the King. Sushruta (Sutra 10.10) tells us that the requisite qualifications of the physician were "Having studied, the science, having fully grasped the meaning, having acquired practical skills, and having performed the operations on dummies, with ability to teach the science and with the King's permission, a physician should enter his profession".
Thus, it is only an Ayurveda that originated in India long back in the pre-Vedic period which deals with measures for healthful living and principles for the maintenance of health, it has also developed a wide range of therapeutic measures to combat illness. These principles of positive health and therapeutic measures relate to the physical, mental, social and spiritual welfare of human beings.
Right to Health during the Medieval Era
In the medieval era, the Muslim rulers introduced the Arabic system of medicine, popularly known as the Unani system, the origin of which is traced to Greek medicine. With changes in the political conditions in India, the torch which was lit thousands of years ago by the ancient sages grew dim, medical education and medical services became static, and the ancient Universities and hospitals disappeared. During the Mughal period, Ayurveda declined due to a lack of state support. It was a period of compilation than of original contribution.
Many works were destroyed during this period, either by invaders or also by quarrelling Hindu and Buddhist parties, who obviously had lost the true understanding of their faith. In many ways, this was a decadent period of Indian History, the consequences of which are still felt even today. To reiterate, the Unani Tibb System of medicine, whose origin is traced to ancient Greek medicine, was introduced into India by the Muslim rulers about the 10th century A.D. By the 13th century, the Unani system of medicine was firmly entrenched in certain towns and cities notably Delhi, Aligarh, Lucknow and Hyderabad. ''
It enjoyed State support under successive Muslim rulers in India, till the advent of the British in the 18' century. The Quran also addresses various diseases, especially of the heart, which often lead to direct and indirect physical and mental ailments. It mentions blindness, deafness, lameness and leprosy as well as mental disorders including psychoses and neurotic diseases, such as sadness and anxiety. But its primary focus is on moral and ethical diseases. The Quran itself is referred to as the book of healing. Thus, during the pre-modern era. Islamic medical and other sciences leaned heavily upon local medical practices, as well as on works translated from Greek. These influences resulted in the further advancement of medical sciences, especially in the 11th and 12th centuries.
Right to health during the British Period:
By the middle of the 18th century, the British had established their rule in India which lasted till 1947. The credit for introducing modern medicines goes to the Britishers in this country. At first, the aim was largely to train apprentices to help the army medical personnel, the qualifications required of such trainees being of an elementary nature. In the year 1825, the Quarantine Act was promulgated and in 1859, a Royal Commission was appointed to investigate the causes of the extremely unsatisfactory condition of health in the British Army stationed in India.
The Commission recommended the establishment of a 'Commission of Public Health' in each Presidency and pointed out the need for the protection of water supplies, construction of drains and prevention of epidemics in the civil population for safeguarding the health of the British Army. In 1864, sanitary Commissioners were appointed in the three major provinces, viz., Bombay, Madras and Bengal. The Civil Surgeons/District Medical Officers became ex-officio District Health Officers. Further, Public Health Commissioner and a Statistical Officer were appointed by the Government of India in 1869. After that, a plethora of legislations, namely, the Birth and Registration Act, 1883; the Vaccination Act, 1880; Indian Factories Act, 1881; the Local Self-Government Act, 1885; the Epidemic Diseases Act, 1897; the Madras Public Health Act, 1939; the Drugs Act, 1940 etc. were enacted by the Britishers to improve the health conditions of the citizens.
It is also crystal clear that the Government of India in 1858 directed that sanitation should be looked after by the local bodies, but no local public health staff was created to look after sanitation. It is in the year 1912, that the Government of India decided to help the local bodies with grants, and also sanctioned the appointment of Deputy Sanitary Commissioners and Health Officers. In the Montague- Chelmsford Constitutional Reforms led to the transfer of public health, sanitation and vital statistics to the provinces under the control of an elected minister. This was the first step towards being elected minister. This was the first step towards the decentralization of health administration in India. The Government of India in 1943 appointed the Health Survey and Development Committee under the Chairmanship of Sir Joseph Bhore to survey the existing position in regard to health conditions and health organizations in the country and to make recommendations for future development.
The committee laid emphasis on the integration of curative and preventive medicine at all levels. It also suggested short-term measures, that is, one primary health centre for a population of 40,000.
Each Primary Health Centre was to be manned by two doctors, one nurse, four public health nurses, four midwives, four trained dais, two sanitary inspectors, two health assistants, one pharmacist and fifteen class IV employees. On the other hand, it suggested a long-term programme of setting up primary health units with 75 bedded hospitals for each 10,000 to 20,000 population and secondary units with 650 bedded hospitals, again regionalized around district hospitals with 2500 beds. Besides this, in the middle of the nineteenth century, three Universities, namely, Calcutta, Bombay and Madras were established in order to provide better health facilities to the subjects. In 1914, the Madras Medical College started training First Class Health Officers. Medical education in this country continued to be guided for a long time by the British pattern of medical education as laid down by the General Medical Council of Great Britain. It took one hundred years to establish 27 medical colleges which we inherited at the time of Independence in 1947.
Right to Health in the Post-independence Era
For the first time in India's long history, a democratic regime was set up with its economy geared to a new concept, the establishment of a "Welfare State". The burden of improving the health of the people, and widening the scope of health measures fell upon the national government. The Bhore Committee's report and recommendations became the basis for most of the planning and measures adopted by the national government. In 1947, Ministers of Health were established at the Centre and States and in 1948 India joined the World Health Organization as a member state.
In 1949, the Constituent Assembly adopted the Constitution of India. Article 246 of the Constitution of India covers all the healthy subjects; these have been enumerated in the Seventh Schedule under three lists – Union List, Concurrent List and State List. Article 47 of the Constitution under the Directive Principles of State Policy states; "that the State; shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties."
Truly admitting that public health during the 19th century was largely a matter of sanitary legislation and sanitary reforms aimed at the control of man's physical environment, e.g., water supply, sewage disposal, etc. clearly these measures were not aimed at the control of any specific disease, for want of the needed technical knowledge.
However, these measures vastly Improved the health of the people due to disease and death control. At the beginning of the 20th century, a new concept, the concept of "Health Promotion" began to take shape. It was realized that public health had neglected the citizen as an individual and that the State had direct responsibility for the health of the individual. Consequently, in addition to disease control activities, one more goal was added to public health, that is, the health promotion of individuals.
It was initiated as a personal health service; such as mother and child health services, school health services, industrial health services, mental health and rehabilitation services. Public health nursing was a direct offshoot of this concept. Public health departments began expanding their Programmes towards health promotional activities.
(C.E.A.) Winslow, one of the leading figures in the history of public health, 1920, defined public health as
"the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort".
This definition summarizes the philosophy of public health, which remains largely true even today. Since the state had assumed direct responsibility for the health of the individual, two great movements were initiated for human development during the first half of the previous century, namely (A) provision of "basic health services" through the medium of primary health centres and sub-centres for rural and urban areas.
The evolution of health centres was an important development in the history of public health." In 1981, the League of Nations Health Organization called for the establishment of health centres. The Bhore Committee (1946) in India had also recommended the establishment of health centres for providing integrated curative and preventive services. Many developing countries have given the highest priority to the establishment of health centres for providing basic health services.
(B) The second great movement was the Community Development Programme to promote village development through the active participation of the whole community and the initiative of the community. This programme tried to do too much too quickly with inadequate resources. It was a great opportunity lost because it failed to survive.
However, the establishment of primary health centres and sub-centres provided the much-needed infrastructure of health services, especially in rural areas. With the advances in preventive medicine and the practice of public health, the pattern of disease began to change in the developed world. Many of the acute illness problems have been brought under control. However, as old problems were solved, new health problems in the form of chronic diseases began to emerge, e.g. cancer, diabetes, cardiovascular diseases, alcoholism and drug addiction, etc., especially in affluent societies. These problems could not be tackled by the traditional approaches to public health such as isolation, immunization and disinfection nor could these be explained on the basis of the germ theory of disease."
A new concept, the concept of "risk factors" as determinants of these diseases, into existence. Unlike the swift death brought by acute infectious diseases, the consequences of these diseases were to place a chronic burden on the society that created them. These problems brought new challenges to public health which needed reorientation more towards social objectives ."
Social and behavioural aspects of disease and behavioural problems. In this process, the goals of public health and preventive medicine which had already considerably overlapping became identical, namely the prevention of disease, promotion of health and prolongation of life. In short, although the term "public health" is still used, its original meaning has changed. In view of its changed meaning and scope, the term "Community Health" has been preferred by some leaders in public health. Community health incorporates services to the population at large as opposed to preventive or social medicine.
In 1950, the Planning Commission of India was set up by the Government of India, which set to work immediately for drafting the First Five-Year Plan. In the first five-year plan with a total outlay of Rs.2356 crores, a sum of Rs. 140 crores (5.9 per cent) was allotted for health programmes. In the year 1954, a number of Health Schemes and programmes were started, namely, Contributory Health Service Scheme; the National, Water Supply and Sanitation Programme; the National Leprosy Control Programme etc. Similarly, the Second Five Year Plan (1956-61) was launched with an outlay of Rs. 4800 crores, out of which Rs. 225 crores (5.0 per cent) were earmarked for health programmes.
In 1959, Mudaliar Committee was appointed by the Government of India to survey the progress made in the field of health since the submission of the Shore Committee's Report and to make recommendations for future development and expansion of health services. The Committee submitted its report in 1962. This committee found the conditions of Primary Health Centres unsatisfactory and suggested that the Primary Health Centres, already established, should be strengthened before new ones are opened. In 1960, the School Health Committee was constituted to assess the present standards of health and nutrition of school children and suggest ways and means to improve them.
The Third Five Year Plan (1961-66) was launched with an outlay of Rs. 7500 crores out of which 342 crores (4.3 per cent) were provided for health programmes. During this plan, three committees were constituted, viz. Shantilal Shah Committee, 1964; Chadha Committee, 1963; and Mukherjee Committee, 1966. Chadha Committee suggested that the vigilance activity in National Malaria Eradication Programme should be carried out by basic health workers (one per 10,000 population), who would function as multipurpose workers.
The Shatilal Shah Committee was set up with a view to studying the question of legalising abortions. The Mukherjee Committee worked out the details of Basic Health Services which should be provided at the block level, and some consequential strengthening required at higher levels of administration. Another Committee, known as the "Committee on Integration of Health Services" was set up in 1964 under the Chairmanship of Dr N. Jungalwala. The Committee was asked to look into various problems related to the integration of health services in the country.
The Modhok Committee, 1967 was constituted to review the working of the National Malaria Eradication Programme and recommended measures for improvement. In 1969, the Fourth Five Year Plan (1969-74) was launched with an outlay of Rs. 16,774 crores, out of which Rs. 840 crores were allocated to health and Rs. 315 crores to family planning. During this plan, three legislations, namely, the Central Births and Death Registration Act, 1969; The Drugs (Price Control) Order,1970; and the Medical Termination of Pregnancy Act, 1972 were promulgated. In 1973, the Kartar Singh Committee submitted its report recommending the formation of a new cadre of health workers designated "Multipurpose Health Workers" for the delivery of health, family planning and nutrition services to the rural communities, who will replace in the course of time the basic health workers, family planning, health assistants, auxiliary-nurse-mid-wives etc. The National Programme of Minimum needs was incorporated in the Fifth Five-Year Plan.
A provision of Rs. 2803 crores was made for this programme which covered elementary education, rural health, nutrition, rural roads and water supply, housing, slum improvement and rural electrification.
The Fifth Five Year launched on April 1974 with a total outlay of Rs. 53,411 crores, of which Rs. 37,250 crores were in the public sector and Rs. 16,161 crore in the private sector. A sum of Rs. 796 crores were allotted to health and Rs. 516 crores to family planning. Shrivastava Committee set up In 1974 to reorient medical education with national needs and priorities. The committee submitted its report in 1975. The acceptance of the recommendations of the Shrivastava Committee in 1977 led to the launching of the Rural Health Service.
In 1980, the Sixth Five Year Plan (1980-1985) was launched, and in 1982 the Government of India announced the National Health Policy. National Leprosy Control Programme to be called National Leprosy Eradication Programme. Guinea worm eradication programmes were launched.
The Seventh Five-Year Plan (1985-1990) was launched in 1985. Under this plan, Universal Immunization Programme, and National Diabetes Control Programme were initiated. An "Expert Committee for Health Manpower Planning, Production and Management" was constituted in 1985 under Dr J.S. Bajaj, the then Professor at AIIMS.
The major recommendations are :
(i) Formulation of National Medical and Health Education Policy.
(ii) Formulation of National Health Manpower Policy.
(iii) Establishment of an Educational Commission for Health Sciences (ECHS) on the lines of UGC.
(iv) Establishment of Health Science Universities in various states and Union Territories.
(v) Establishment of Health Manpower Cells at the Centre and in the States.
(vi) Vocationalization of Education at 10+2 levels as regards health-related fields with appropriate incentives, so that good quality paramedical personnel may be available in adequate numbers.
(viii) Carrying out a realistic health manpower survey.
In 1989, Blood Safety Programme was launched. In 1990, the Control of Acute Respiratory Infection (ARI) Programme was initiated as a pilot project in 14 districts. Eighth Five-Year Plan (1992-97) was launched in 1992. During this plan, a few legislations, namely the Infant Milk Substitute, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992; Panchayati Raj Act, 1994; Transplantation of Human Organs, 1995; and Prenatal Diagnostic Technique (Regulation and Prevention of Misuse) Act, 1994 came into force.
In 1997, Ninth Five-Year Plan was launched. During 1998- 99, National Family Health Survey-2 undertaken covering 90,000 women aged 15-49 years became effective. In 2000, the Government of India declared a guinea worm-free country and National Health Policy 2002 was announced. The Tenth Five-Year Plan was launched in 2003. Overall, the health sector budget has been increased marginally from Rs. 19,534 crores in the 2009 fiscal to Rs. 22,300 crores this time - a raise of 14.15 per cent.
The National Rural Health Mission has managed Rs. 13,910 Crore, up from Rs. 12,529 Crore last time. This little budgetary raise the health ministry has been for the construction of six new AIIMS–like institutes and the up gradation of 13 existing government medical colleges. The Government of India is already aware of the positive role and contribution of the indigenous systems of medicine in providing health care to the Indian masses. The Government had created the necessary infrastructure in the Central Ministry of Health for the promotion of the Indian System of Medicine.
From the very beginning, it had established the colleges, hospitals and dispensaries under the various system of medicine and had granted them a status equal to that of modern medicine by treating all practitioners of various systems on an equal footing in terms of employment, pay structure etc ." The Government of India has also set up a separate Council known as the Council for Indian Medicine to look after and regulate the indigenous medical education standards in the country. A separate Council on the pattern of ICMR, (Indian Council of Medical Research) the Council for Research in Indian Medicine is Homeopathy has also been established to develop and promote basic and applied research in different systems of Indian medicine.
Naturopathy, Homeopathy and yoga today is a rapidly growing system and is being practised almost all over the world. Naturopathy nature care is a way of life of which we find a number of references in the Vedas and our ancient texts, it is a system of healing science stimulating the body's inherent power to regain health with the help of five great elements of nature - Earth, Water, Air, Fire, Ether or Space. Naturopathy is a call to "Return to Nature" and to resort to a simple way of living in harmony with self, society and environment.
This nature care deals with drugless therapies like massage, electrotherapy, physiotherapy, acupuncture and acupressure, magneto therapy etc. Homeopathy in India has become a household name due to belief in the safety of its pills and the gentleness of its cure. A rough study indicates that about 10 per cent of the Indian population solely depends on homoeopathy for their healthcare needs. It is more than a century and a half now that homoeopathy is being practised in India. It has blended so well into the roots and traditions of the country that it has been recognized as one of the national systems of medicine and plays an important role in providing health care to a large number of people ."
The tradition of yoga was born in India several thousand years ago. Its founders were great saints and sages. The great yogis gave rational interpretations of their experiences with yoga and brought a practically sound and scientifically prepared method within everyone's reach. ''
Yoga was systematized by the great Indian sage 'Patanjali' in the Yoga Sutra as a special Darshana. Yoga is a science as well as an art of healthy living physically, mentally, morally and spiritually. All the systems of medicine at their best aim at curing the disease, whereas yoga aims at preventing the disease and promoting health by reconditioning the psycho-physiological mechanism of the individual. The approach of yoga is not confirmed for various disorders. It aims at bringing under perfect control of the mind senses and pranic energy and directs them towards healthier channels with a view to acquiring mental purity, intellectual stability and spiritual bliss .'
Unlike earlier, Yoga today is no longer restricted to the privileged minority of hermits; it has taken its place in our everyday lives and has undergone a worldwide awakening and acceptance in the last few decades. The science of yoga and its techniques have now been re-oriented to suit modern sociological needs and lifestyles. Experts of various branches of medicine including modern medical science are realizing the role of these techniques in the prevention of disease and promotion of health .''
Conclusion
The foregoing study clearly reveals that during the early period, Ayurveda was perhaps the only system of overall health care and medicine which served well the people in such crucial areas with regard to health, sickness, life and death. It also enjoys the support of the people. Then followed a long period of medieval history marked by unsettled political conditions and several invasions from outside the country and soon health system faced utter neglect.
With the awakening of nationalism and the movement for freedom, the Indian cultural values and way of life (including health care and sickness cure system) suffered again. After the country became free in 1947, the movement for revival gained additional momentum. The first Health Ministers Conference resolved that the health care system for the people should be developed. In due course of time, this system got official recognition and became a part of the National Health Network of the country ." Now, India has moved forward in advocating the global usefulness of Ayurveda's contemporary scenario of health care through global networks. As a result, many foreign countries have begun looking to India to understand Ayurveda and incorporating it through education, research and practice to meet the overwhelming desire of consumers to access complementary and alternative medicine.
Indian Missions in the USA, UK, Russia, Germany, Hungary, and South Africa have played an effective role in channelling information about Ayurveda and opening up opportunities for the spread of Indian Medicine into foreign institutions and the general public awareness building about Ayurveda in the foreign countries has been identified as an important thrust area.
Hence, the health of all people should be viewed as a precious public commodity, necessary for the prosperity, security and development of societies. If the health of all people is maintained then only human resource is able to contribute to the country’s development. We can say that right to health does not by itself require that the state commit more of its resources to the health sector. Moreover, it does not demand that everything that some people regard as medical care be provided. Only that care which is directed to health is a matter of entitlement.
To demand more is to demand what might not be part of the common good of the community and what might even be opposed to this good, or what might render impossible a common agreement about what constitutes this good. Nor does this right absolve individuals from responsibility for their own health, on the contrary, it presupposes this responsibility.
The right to health care requires that the members of a community committed to health be provided on an equal basis with the medical care they need. It is very rightly said by Mary Robinson, that the Right to health does not mean the right to be healthy, nor does it means that poor governments must put in place expensive health services for which they have no resources. But it does require governments and public authorities to put in place policies and action plans which will lead to available and accessible health care for all in the shortest possible time. Ensuring that this happens is the challenge facing both the human rights community and public health professionals.
References
[1] Aart Hendriks, The Right to Health in National and International Jurisprudence, Available Here
[2] Abhijit Sen, H, In-Kind Food transfers-I: Impact on Poverty, Available Here
[3] Political Culture of Health in India A Historical Perspective, Available Here
[4] Ethical Issues in Public Health Policy, Available Here
[5] D. Banerji, Politics of Rural Health in India, Available Here
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