Fixing minimum and maximum income bars is vital for equitable society

Shobha Shukla, Bobby Ramakant, Sandeep Pandey
[First published in Socialist Party (India)]
[Hindi] Government doctors (and other employees) demanding salary hike is a common news. Succumbing to the temptation of greener pastures, government doctors moving to private hospitals in the country or migrating abroad is also fairly common. 

But what is turning heads around is the news of Canadian doctors declining salary hike! Amazing as it may sound, over a thousand doctors protested against a recent decision of the Canadian government to increase their salaries. This story has affirmed the faith of humanity in the concept that medical practitioners, more than other professionals, will give precedence to service over their careers.

Over 850 doctors and 150 junior doctors (who are pursuing post graduation studies or seeking advanced super specialty training) in Quebec province of Canada have declined to accept a salary hike, saying that they cannot, in “good conscience”, accept increase in salary when nurses, other health-care staff and patients are facing hardships due to cuts in health budget (read online petition and Washington Post news). These doctors believe that only stronger public health systems can deliver health security to all. When public health systems are reeling under resource crunch, how can raising the salaries of doctors be justified? If nurses and other health-care staff are forced to work in stressful and challenging conditions, and lifesaving health-care services slip beyond the reach of people, then how will the tall promises of health security and universal health coverage be delivered? These doctors have appealed that instead of raising their salaries, government should rather utilize these resources in strengthening the public health system, so that nurses and other health-care staff can work in better and secure conditions and health-care services are within the reach of all those in need, especially the most deprived or terminally ill.

Canadian doctors have raised an important issue that plagues not only the health sector but other sectors as well. Why do only salaries of the top echelon remain immune to budget cuts, whereas all other employees and common people suffer when purse strings tighten? In India too we can see this trend where not just the salaries of senior officials keep rising, but their retirement benefits get better too–and that too retrospectively most of the times. On the other hand, those working on lower positions as contractual and daily wage workers, are not on the radar of Pay Commissions. Many a times, contractual workers do not even have the guarantee that they will get paid for the work already done by them. On 11 January, 2018, the Lucknow District administration in India bulldozed on campus temporary settlements of sanitation staff, ward-boys, ward-maidens, drivers, attendants, all working as contract laborers for the state government’s Dr. Ram Manohar Lohia Hospital in Gomti Nagar as they were ‘accused’ of encroaching upon government land whereas it should have been the responsibility of the government or the contractor to provide housing to staff working for a government hospital.

There are doctors in India too who have been dedicatedly delivering health-care service. For instance, Christian Medical College (CMC) Vellore in Tamil Nadu, which ranks second (first being the All India Institute of Medical Sciences-AIIMS, in Delhi) in the entire country in terms of quality of medical education and hospital services, has very modest salaries for its doctors. Routinely senior doctors, other staff and students use public transportation. Despite the summer heat of Tamil Nadu, the office of its Director doesn’t have an air conditioner, but all such and other facilities are available for patients. Despite modest remuneration and resources, CMC doctors have accomplished significant achievements over the years, be it organ transplants, diagnosing first HIV case in the country, responding to people’s health challenges, such as snake bites and insecticide poisoning, disease mapping, or setting standards for evidence-based healthcare. After AIIMS, maximum outdoor patients seek healthcare services at CMC Vellore. It is also the only medical college and hospital in India that has, since several decades, been compulsorily sending its doctors, faculty and students every year, to serve in rural and remote areas. Now other health-care institutions are trying to follow its example or pondering over such policies. CMC has been rendering invaluable service to strengthen healthcare in very remote areas of the country. Contrary to this, there are several medical colleges where salaries of doctors is several folds high, but medical competence, research and education is often of questionable quality. Hence it is not difficult to conclude that there is no direct relationship between remuneration and innovation, medical competence, research and education. There are more examples where doctors at individual levels have served humankind with deepest commitment. Some exemplary mentions include the two sons and daughters-in-law of Baba Amte – Vikas, Prakash, Bharati and Mandakini, son and daughter-in-law of noted Gandhian thinker Thakurdas Bang – Abhay and Rani Bang, and doctors working in the hospital established in Dalli Rajhara, Chhattisgarh, by late trade union leader Shankar Guha Niyogi. These are few inspiring examples of medical professionals who chose not to settle in big cities to make money and careers, but instead went to villages to serve leprosy patients and tribal and devoted their entire life to this mission of caring for the most disadvantaged.

Why is it so important to fix maximum income cap?

If we truly want a world where no human being is forced to suffer inhuman treatment, then it is critically important to fix both minimum and maximum incomes in a society. Renowned socialist leader Dr Ram Manohar Lohia had advocated a ratio of 1:10 between the lowest and highest incomes. An unbridled income gap brews inequality, exploitation, imbalance, injustice and unrest in society. A report released by Oxfam, around the time of recent World Economic Forum, showed that in 2017, 1% of richest owned 82% of the global wealth. This report also showed that in India, 1% of richest owned 58% of the nation’s wealth in 2016, and in 2017 this inequality worsened with 1% owning 73% of the wealth. How can we expect harmony in society if only a small percentage of our population enjoys the highest quality of healthcare, education, lifestyles, while the vast majority of our population is forced to live with appallingly poor quality of healthcare, education, and is deprived of other most basic amenities. Most people in India have to compromise with dignity in their lives.

If we are truly patriotic then at least we should live the core values enshrined in India’s Constitution. The word ‘socialism’ is enshrined in our Constitution’s preamble to ensure social and economic equality in society, and it is the solemn duty of our elected governments to stop wealth accumulating in the hands of a minuscule minority of super rich only and ensure that every person has access to dignified quality of life.

Mahatma Gandhi’s wise words assume relevance here that there are enough resources in this world to meet every person’s needs but not enough for even one person’s greed.

Politician Varun Gandhi had said in January 2018 (read news) that financially well to do parliamentarians should not take salary from the government. We do hope Varun Gandhi himself is following his own sane advice, but the message is clear – every person receiving salary from the government must review if s(he) needs the salary? It is common knowledge that employees in donor funded NGOs and other development agencies, often receive salaries more than that in service sector. People in government and private sector must not get salaries that falsify ideologies they claim to champion!

A private hospital is recently reported to have reaped a profit of 1700% on consumables. Government of India had acknowledged health sector as fastest growing ‘industry’ in the draft of National Health Policy 2017. The number of private medical colleges has surpassed the number of government medical colleges. This is indeed alarming because private medical colleges usually charge hefty fees from students. Only those people should come forward to become doctors who are driven by a sense of service to providing healthcare to needy. Those people who eye healthcare service as an industry to reap profits should not have any place in public health system. There are so many doctors who have commercialized healthcare and provide paid services to reduce obesity, grow back receding hairline, or spur sex desire. This is clearly not public health.

Is Government of India’s National Health Policy 2017 a mere gimmick?

Government of India had issued a national health policy 2017 which contains several promises that are in line with India’s commitment at global level towards health and sustainable development. All countries have pledged to end Tuberculosis by 2030. It is commendable that India despite being home to highest burden of TB globally, has promised to end TB by 2025. But according to the World Health Organization (WHO) reports, TB rates are not declining in India steep enough so as to end TB by 2025. At the current rate India might get rid of TB by 2184. Also, it is important to recognize that scientific evidence shows strong linkages between TB and other development indices. The former Head of Indian Council of Medical Research (ICMR) Dr Soumya Swaminathan has said that malnutrition is the biggest risk factor for TB. Likewise there are several other matrix of health and development indices that cross-connect and justify why equitable development is so vital to make this world a better place and people healthy. If we fail to ensure development justice for every single person, especially the most marginalized, then we will also fail to deliver on our tall claims to end TB, hunger or poverty, or save the environment, for instance.

The National Health Policy 2017 of India as well as our country’s commitment to UN Sustainable Development Goals (SDGs) promise reduction of untimely deaths due to non-communicable diseases (NCDs) by 25% till 2025 and 33% by 2030. But a major chunk of disease burden that impacts the vast majority of our population is of preventable diseases. For example, the biggest cause of death of children under 5 years of age is pneumonia which is not only preventable but also curable. But still maximum number of children who die of pneumonia globally are in India. Major NCDs such as cardiovascular diseases, cancers, diabetes, chronic respiratory diseases, etc., account for 70% of deaths. Risk of NCDs can be significantly reduced through measures like reducing tobacco and alcohol use, reducing air pollution and encouraging balanced nutritious diets as well as physical activity. While on the one hand the government allows alcohol and tobacco industries to wreak havoc on our society, on another hand government is blindly chasing a ‘development model’ where a growing part of our population is finding it difficult to breathe in clean air, include optimal physical activity or exercise in daily routine, eat nutritious balanced diet, etc. It is ironical that the number of gyms for physical exercises is on a rise for the rich, but this kind of ‘development model’ is depriving common people of safe spaces to walk, cycle, run or have access to comfortable free public transport or to simply be able to breathe in clean air. It is a matter of shame for the largest democracy on earth that such a large number of its people are forced to live in inhuman conditions.

Canadian doctors have indeed shown a silver lining for those who believe in strong public health system. Other doctors and people from all sectors should emulate them, be inspired by their conscience and agree to share resources equitably with all.

All those who receive government salaries must be treated in government hospitals

Recently Justice Sudhir Agarwal and Justice Ajeet Kumar of Allahabad High Court in UP have delivered a judgment that all those who receive salaries from government must seek healthcare from government hospitals only and no special treatment should be provided to senior officials or ministers – they should also get treated like common citizens. If this happens, then the dismal conditions prevailing in government hospitals will radically improve which in turn will benefit the common masses.

India is one among more than 190 countries that have promised in UN General Assembly to deliver on Sustainable Development Goals by 2030. We believe that without establishing a just social order, sustainable development, where no one is left behind, will continue to remain a mirage.

Shobha Shukla, Bobby Ramakant, Sandeep Pandey
Citizen News Service - CNS
30 April 2018