Health Services
Inequalities Demand Action

By Bachchu Kailash Kaini

HEALTH is the basic condition for quality life. All human beings should have the right to health. Health policy, health promotion and education, health care and health care services are means to ensure this fundamental human right. Patients have a right of access to health care, right to considerate care, right to informed consent and the right to information concerning the health services available.

Care

Health care should be based on community health standards and disease occurrence rates. It must incorporate social life, active working life, and living culture. The facilities are to be provided with the benefit of time and distance, with safety and amenity of environment and good access to related services. Patients should be treated as close to their homes as possible in the smallest, cheapest, most simply equipped unit that is capable of looking after them adequately.

Most, if not all, countries, all over the globe, are striving to cope with health care transformation. Epidemiological and demographic transitions have resulted in an increase of chronic and degenerative diseases. Accompanying this trend is the emergence and re-emergence of infectious diseases. Improved life expectancy has led to an increase in the number of the old people. Developments in information and communication technology have resulted in a better informed and more demanding populace. New technology and the expansion of scientific knowledge coupled with evidence-based medicine have resulted in changes in the way care and other services are provided. Persistent and/or increasing unemployment is leading to more poverty and poorer health. There is a universal trend towards greater decentralisation, pro-market economic policies, rapid expansion of the private health sector and so on.

Many health care providers and health experts are becoming increasingly concerned about the growing incidence of significant health inequalities between social groups, and in particular, the strong association between relative deprivation and poor health. There are many factors to influence an individual's health. They are often categorised as biological factors, the physical and social environment, personal lifestyle, and health services. The standard of living in a society can influence an individual's choice of housing, work and social interactions, as well as eating and drinking habits. Some environmental factors and governed by living and working conditons, others are the result of wider structural factors, for example, attitudes towards economic growth.

Most influences on health demonstrate a social gradient, the conditions conducive to health becoming less favourable with declining social status. There is, therefore, an uneven distribution of health hazards and risk factors across the population, resulting in groups with lower status, power or income carrying a heavier burden of ill health.

An association between poverty and ill health has long been recognised. It seems likely that cumulative lifetime exposure to health damaging or health promoting physical and social environments is the main explanation for observed variations in health and life expectancy with health-related social morbidity, health damaging or promoting behaviours, use of health services and genetic or biological factors.

A strategic approach is potentially important for tackling inequalities in health at different policy levels and from a variety of entry points. This should focus on certain age groups, specific diseases and particular determinants of health, such as living and working conditions, because the differentials are caused by interrelated social and economic factors.

Improving access to essential facilities and services tackle the physical and psychological conditions in which people live and work, ensuring better access to the pre-requisites for health: clean water, sanitation, adequate housing, safe and fulfilling employment, safe and nutritious food supplies, essential health care, educational services and welfare. Such policies are the responsibility of various sectors, often operating independently of each other but with the potential for cooperation.

Policies designed to equalise access to acute health services would clearly do nothing to tackle the underlying causes of inequalities in health status. They might, however, prove much more cost-effective in tackling the results of deprivation that health promotion programmes which attempt the profound task of changing the unhealthy behaviour of those living in deprived circumstances, or preventive measures of unproven effectiveness. Attention should be focused on the underlying socio-economic inequalities which contribute to the health status variations.

Inequalities in health are avoidable and judged to be unjust and unfair. Equity is concerned with creating more equal opportunities for health and reducing differentials to the minimum. Societies which have less inequality in income, less variations in housing standards, and better working conditions seem to have less health inequalities between different socio-economic groups.
An attempt should be made to establish and pursue targets for reducing disparities in both health status and access to health services between disadvantaged population groups, and the general population programmes should be directed towards those populations in a spirit of equity, inviting their active participation in the development and implementation of the strategies.

Equity

Political will is the key to implementing various health care policies, including the necessary budgetary and administrative implementations. Efforts should be undertaken to enhance the climate for development support, including policies that focus on social equity rather than economic considerations alone, that recognise the long-term nature of social development, and that promote wider understanding and acceptance of the development process.

Elusive Energy Search

By P. Gopakumar

THE elusive search for zero-point energy is blocked by energy mafia. And yet, the need for an alternative source of energy has never before been felt as severely as of now, with conventional energy sources gradually diminishing and dangers of indiscriminate use of fossil fuels such as coal or oil mounting.

Theory

Even as conventional efforts to harness sun's rays, wind, water and wave power as also gas from bio-waste continues, there is futuristic talk of eventually deriving energy from sparks escaping black holes around the ozone layer. Physicists have for long talked elaborately about theories on the presence of zero-point energy and hope to one-day generate energy from nothing. However, the search for alternative energy resource has not enthused many full-fledged economies to invest money for the research and development in this field.

Is not zero-point energy a contradiction in terms? After all, the first law of thermodynamics makes sure that you cannot possibly get more energy than that you put in. But zero-point energy supporters say that energy than can indeed be generated from nothing - from these mysterious properties from empty space. The universe itself is believed to have come into being out of nothing. If zero-point energy were extracted, it would spell the end of the fossil-fuel era, which causes severe environmental degradation. Besides guaranteeing uninterrupted supply of energy not only for everyday uses but also to bring the outer space into our façade through revolutionary space exploration.

The genuine difficulty to develop eco-friendly as well as much cheaper energy is not very much a scientific barrier as the secret plans of a greedy energy mafia. Developed economies like the United States have always-belated attempts to develop alternative energy technologies and obstructed international efforts to reach a consensus on global cooperation in energy-connected environmental responsibilities. The blatant examples are the defying Montreal (1987) and Kyoto (1997) protocols and the first Earth Summit at Rio (1992). Post-Rio euphoria led us to believe that the agenda was now set for an eco-friendly and sustainable development blueprint for all. We were going to save ourselves by saving our planet. However, unfortunately it all ended by establishing the practice of emission trading, making it possible for the developed countries to take the easy way out.

According to classical Greek mythology, Prometheus stole fire from Olympus and gave it to humans, refusing to obey Zeus. He was penalized by gods by having him chained to a rock, where an eagle daily tore at his liver, until finally Hercules released him. The story is revealing. It makes clear how dear this energy resource was held, even by the celestials.

An Irish inventor's recent claim of the invention of "Jasker power system" that can provide free energy, is being received with predictable suspicion and disbelief. Having spent 23 years developing and perfecting this machine, he says now it is capable of replenishing its own energy source. The Jasker power system 'can power anything that requires a motor' and it has supplied all of his domestic power, free, for the past 26 months. Unbelievable, as this may sound, inventor's claim needs to be examined and not dismissed as a" Voodoo science" by an American scientist.

Researchers at the Benares Hindu University exactly one year ago demonstrated how hydrogen cubes can be used to power gensets, cooking ranges and even motorcycles. Admittedly a great deal more of research and development is required before bringing it to the market. Their promising demonstration has excited few corporate establishments to declare that they would bear its research and development costs and other inputs.

The first legitimate demonstration of harnessing zero-point energy was conducted by a Dallas based scientist in 1987. "The Patterson Power Cell" which could draw energy from plain water through tiny metal-coated spheres in a glass chamber acting electrodes, producing more heat energy than its energy input. It won several patents but nothing more has been heard of this invention, mainly due to lack of funds to make further research and development on it's project.

Certainly, there have been more incidents of bogus claims in this field too. In 1989, Utah researchers who claimed to have found the solution to cold fusion were also proved wrong - it was one of the biggest scandals in modern scientific history. Down south, who can forget the initial jubilation and later bitter disappointment when the much-hyped herbal fuel invented by Ramar Pillai in Tamil Nadu was proved false? In fact, Ramar pillai got a fair amount of chances from the government, media and even by the skeptical scientific community. But the invention eventually failed to prove in close scientific scrutiny.

Practical

It is indisputable that the inventions like Jasker power system and hydrogen cube have become inspirations for the hopes of coming close to harnessing zero-point energy. It is high time to take stock of international environmental rights and responsibilities. International efforts towards developing cleaner technologies should move forward. Ideally any re-assessment should include clearly spelt-out practical action by all and initiate a phasing out of the emissions trading regime.