“Our bodies are gifts from God…” a working woman from a low-income urban settlement expressed her belief during a health group discussion. Eight other women in the group echoed this sentiment. However, as the conversation unfolded, two contrasting viewpoints emerged. One suggested that if bodies are God-given, then God should maintain them and any destined ailments will occur regardless of our care. The other argued that as these bodies are divine gifts, it’s our duty to cherish and care for them.
The association of health with divine concepts and religious institutions is universal and timeless. Be it tribes that trace their umbilical cords to ancient times, or modern peoples who worship specific gods and goddesses for good health. While every culture has the right to uphold its beliefs in its private spheres, issues arise when these beliefs enter the administrative language of a secular country that weighs all cultures equally. This is relevant considering India’s recent decision to rename all Primary Health Centres as “Arogya Mandir” and the issued ordinance to submit photos of each centre post-renaming.
A temple, in Hindu tradition, is a sacred space for worshipping God. The idea behind renaming health centres as “Arogya Mandir” is probably to emphasize the importance of health, suggesting that it should be revered and cared for just as one would care for a deity.
While this philosophy might resonate with a specific community, it overlooks the diversity of India, a secular nation with various religions, different worship places, tribals who revere nature, and individuals who do not subscribe to any religious beliefs. In this culturally diverse country, using language that applies to only one group in administrative proceedings is a sign of a narrow-minded stance.
If this were about some festival, the naming might not matter. However, this concerns health, a fundamental right for everyone, regardless of religion or ideology. While a private organization might name as they wish, this involves public property, making it a public interest matter.
The Name Game
Some might argue, “What’s in a name? It’s merely a change of terminology.” However, it’s crucial to recognize that language is a vessel for culture. Changing a language can influence a society’s direction and leave a lasting impact on future generations. In a country that upholds democratic values, embedding a language that solely represents the majority in administrative affairs can be detrimental to democracy itself.
Such a move may benefit non-democratic groups, but it risks undermining constitutional values like liberty, equality, and fraternity. This is just another chapter in the narrative prescribing how to dress, what to eat, and which historical figures to believe in.
Instead of engaging in political and cultural debates over naming conventions, it would be more productive to focus on the initiatives undertaken to bolster comprehensive primary health care. The policy of “Health and Wellness” centres under the Ayushman Bharat scheme has some worthy aspects. However, the challenge lies in making the overall program narrative people-centric and providing facilities that truly enhance people’s lives. Various social research studies have highlighted the issues in implementation and utilization. For example, in 2013-14, excluding mother and child health services, only 11.5% of rural and 3.9% of urban people in need of primary healthcare services used these services.
Multidimensional Healthcare Needs: A Closer Look
Recently, when we studied two urban poor communities by interviewing people, they agreed that there’s an undeniable rise in the prevalence of diseases such as diabetes, blood pressure, and cancer. The government’s recent focus on these conditions, providing free tests and medicines, was appreciated. However, the working class, who work all day, need facilities that operate in the evening and at night.
They often prefer to buy medication from pharmacies or pay for services at private clinics that stay open late, rather than lose their daily income to visit government centers. The pilot Health and Wellness Centers operating from 5-9 pm have been well-received. There’s also a growing interest among people to obtain Ayushman Bharat insurance cards. With the escalating costs of unexpected hospital expenses and the financial burden it places on families when a member is hospitalized, such insurance is perceived to provide a much-needed safety net.
However, people also earnestly expressed that there is a significant disconnect between their daily life realities and the overall perception of health policies towards “health”. People’s deteriorating health is rooted in a multitude of issues– unclean drinking water, inadequate sewage systems, overcrowded settlements, lack of open spaces and sunlight, eviction insecurity, rising inflation, stress related to food accessibility, squatter settlements and garbage, mosquito infestations, uncertain rains and waterlogging, workplace inequality, and the chronic diseases that result from working conditions. The myriad also covers faltering social health concerns like growing substance misuse, gender-based violence, theft crimes, and growing insecurity in their settlements.
A Call for People-Centric Holistic Health Systems
A health system that is “disease-treatment focused” was not found to necessarily address the root causes of people’s health issues. There’s a noticeable lack of convergence with other government departments and insufficient integration with private stakeholders. This gap emerged to be addressed for a more holistic approach to health.
Despite the plethora of government programs for disease treatment, public awareness remained low. The perception of government systems as “being primarily for the poor” was deeply ingrained in the public consciousness, and experiences at government centres often fueled this view. Common issues included remote locations, unfriendly staff, complex management systems that are difficult to understand, and time loss for daily wagers.
Such experiences quickly became common knowledge and spread throughout the community. On the other hand, the health system, with its limited manpower, was grappling with multi-level programs. It lacked the time and motivation to change public perceptions or to address other factors impacting health.
Addressing these monumental challenges is not a task that can be accomplished overnight. However, it’s crucial for the health system to invest its time, money, and resources into finding solutions. These answers need to be sought at all levels, from policy conception to implementation. A focus on nomenclature is not just narrow and would result in cultural disparities but it’s even irrelevant when gigantic questions of the health system are at the forefront. We as a nation really need to mind our practices as well as our language!!
Acknowledgements: I sincerely acknowledge the guidance of Prof. Mathew George in developing this opinion piece.