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DEAD WEIGHT

If the electoral manifestos of the leading political parties are an indication, India’s health policies are floundering while coping with the threat posed by cancer. The Bharatiya Janata Party, which is tipped to come to power, has made vague noises about investing in research and development to find a ‘solution’ to cancer. The Congress, which has pledged to make healthcare a fundamental right, has promised to introduce mobile healthcare vans equipped to conduct mammography tests in every district. This in a nation which, according to a report in The Lancet, is expected to register 1.7 million new cancer cases annually by 2035.

Existing institutional weaknesses have certainly aggravated the crisis. Of India’s 381 medical colleges, 360 lack state-of-the-art treatment facilities. Worse, institutions offering cancer care remain unevenly distributed. For instance, eastern India accounts for only 11 per cent of India’s total radiotherapy facilities.

But what is particularly worrying is that in this battle against a contagion that is often incurable — cancer, unlike most other afflictions, can seldom be eradicated totally — health policies continue to prioritize treatment over prevention. According to one estimate, there were 275 million tobacco consumers in India in 2010. (Anxious relatives lighting up outside the Tata Medical Centre in Calcutta are a common sight.) Public awareness campaigns about cancer and tobacco-use currently rely on such measures as graphic representations on cigarette packets, warnings about smoking in film sequences, as well as initiatives like ‘breast cancer marathons’. Unfortunately, a large section of the population at risk remains outside the reach of such ‘mass’ campaigns. Ninety-two per cent of India’s rural poor, lacking in knowledge about cancer, get patients treated by practitioners of whom three quarters lack medical qualifications. In cities, is enough care being taken to ensure that awareness campaigns stop resembling ‘events’ — publicity stunts that promise a lot but achieve very little?

Smaller battles

Given the scale of the crisis, existing awareness campaigns need to follow a sustainable, extensive and inclusive model that can be operated at the grassroots, the kind that has paid rich dividends in India’s triumph over polio. Raising a dedicated health force comprising trained and salaried personnel — volunteers lack the necessary incentives to be efficient — to raise awareness, register and monitor cases and facilitate patient access to healthcare is a must. Such a proposition does not look feasible in a nation that spends 4.1 per cent of its GDP on health. Unless, the private sector bails the State out through public-private partnerships.

The other area of concern is the prohibitive cost of treatment. Here too, the battle has to be fought on several fronts. The government has to force or induce multinational pharmaceutical companies to be accommodative on patents, enabling Indian companies to manufacture generic versions that are affordable. But even such generic varieties would prove to be costly for the poor. This makes it imperative for the State to explore ways to widen the scope of medical insurance. Ongoing research is likely to heighten survival rates. Hence there is no reason why medical insurance firms, their profiteering notwithstanding, should not respond to directives to introduce cheaper or subsidized insurance policies, especially for vulnerable communities on the margins.

Cancer support groups, which disseminate crucial information and provide counselling services, should also be integrated into the formal healthcare system if India is to bear the burden of an impending epidemic.