This is the fourth blog post in a weekly series from students enrolled in the course ‘Contemporary South Asia: Entrepreneurial Solutions to Intractable Social and Economic Problems’ co-taught by SAI Director Tarun Khanna. The course features several modules on issues facing South Asia: Urbanism, Technology and Education, Health, and Humanities.
This week’s focus: Health, led by Sue Goldie, Harvard School of Public Health
How does one create standards to assess the collective health of a society? We examined the difficulty of determining the usefulness of different data in our second week of lectures with Professor Sue Goldie of the School of Public Health. Traditional measures of public health are often standardized across countries and used to shape policy agendas at the national and international level.
The widespread use of maternal and child mortality ratios in public health data collection has encouraged governments to prioritize efforts to lower corresponding figures within their domains, but the interpretation of these measures as key indicators of public health can limit one’s understanding of factors that must be taken into consideration when crafting an intervention.
Although they may provide objective data, statistics often present subjective portrayals of the contexts they are meant to reflect, complicating efforts to design intelligent, effective initiatives. Current use of health statistics in South Asia can be dangerously misrepresentative in both qualitative and quantitative terms, argued Professor Goldie.
Challenging the notion of a formal “poverty line” that excludes hundreds of millions of Indians who do not meet their government’s official criteria, she instead called upon the class to express what we viewed as fundamental requirements of a minimum acceptable standard of living. Most of these corresponded to a list compiled by the consulting firm McKinsey that Professor Goldie subsequently presented.
The McKinsey list (which included food, energy, housing, drinking water, sanitation, healthcare, education and social security) constituted what Professor Goldie called an “empowerment” line, in that these services were fundamentally necessary for all individuals to lead secure, sustainable lives. It excludes the millions who are technically above the poverty line but remain vulnerable to falling below it and are unable to hold health as a positive right. Metrics must therefore be structured to be more inclusive if they are to be more informative and useful for all who have to live with the implications of poor public health.
I was most intrigued by Professor Goldie’s message to the class that global agendas and entire understandings of needs are fundamentally influenced not only by how we structure statistical analyses, but also by what we choose to measure. The standardization of global public health indicators such maternal and child mortality has catalyzed massive investment in improving the quality of obstetric and pediatric care, but emphasis upon these measures has not been matched by increased attention to non-communicable diseases, which are spreading throughout the subcontinent and will have devastating effects upon future generations of South Asians if left unaddressed.
Heart failure, strokes, diabetes and chronic lung disease may not come to mind as readily as infectious diseases or improper basic sanitation when one thinks of fundamental health challenges in South Asia, but these deserve appreciation as such too, especially given the scale of their incidence and the rate of expected growth over the following years.
In an era when Western oncologists are debating how to balance chemotherapy and radiation treatments for cancer patients, even relatively simple surgical tumor removals remain beyond the reach of thousands of South Asians. All of these conditions have become significant health threats in the subcontinent, but they are rarely recognized as such.
Unlike many illnesses that historically have been endemic in South Asia, these were traditionally uncommon and are non-communicable, contributing to the slowness with which policymakers and health experts have reacted. Nonetheless, they now fundamentally threaten societal and individual wellbeing, and share risk factors that cannot be resolved by individual physicians. These factors transcend generations within families, living environments, and different levels of health.
Many also cross territorial boundaries, as the influence of Western tobacco and fast food demonstrates. These dangers to public health are “globalized”, showing that we cannot conceptualize public health in terms that are constrained by artificial boundaries. Even non-communicable diseases can spread across populations (albeit in a different manner), and if governments wish to secure public wellbeing, they must understand that just as their countries experience globalization, so do the conditions that afflict their citizens.