Indian Healthcare Roadmap:
An exclusive interview with World’s Most Influential Economist
Jeffrey D. Sachs is Professor and Director of the Center for Sustainable Development at Columbia University. He is also the Director of UN Sustainable Development Solutions Network and Commissioner of the UN Broadband Commission for Development. He has been advisor to three United Nations Secretary-Generals. He has received many awards including India’s most prestigious award ‘Padma Bhushan’. He has authored numerous bestseller books. Sachs was twice named as Time Magazine’s 100 most influential world leaders and was ranked by The Economist among the top three most influential living economists. Nimisha Singh Verma interviews him on his viewpoint on Sustainable Development Goals and Indian healthcare roadmap to achieve its goal.
Q. Being the architect of Sustainable Development Goals, are you happy with its implementation and impact it has created globally?
I am very pleased and excited by the global acceptance of the SDGs across governments, businesses, and civil society. Yet, actual implementation lags far behind our aspirations and needs. In other words, the big challenge is aligning our plans and actions with the goals. For this we need planning, partnerships, and financial resources in budgets and business investments.
Q. As the world’s most renowned economist, what do you think should be India’s road map to achieve Sustainable Development Goals?
India should pursue the SDGs through six main transformations. First, quality education for all, based on expanded budgets for education at the Union and State levels. Second, quality healthcare for all, similarly based on expanded healthcare budgets at the Union and State levels. Third, decarbonisation of energy, by eliminating the use of coal, oil, and natural gas, and shifting to solar, wind, hydro, and geothermal energy. This will not only contribute to ending global warming but will also clean the air and save millions of lives. Fourth, sustainable land use by restoring degraded lands, protecting endangered species, and ending deforestation. Fifth, investing in sustainable cities, through all-electric vehicles, green spaces, walking areas, and affordable housing. Sixth, being the world leader in using Information and Communications Technologies (the digital revolution) for sustainable development.
Q. Countries have adopted various healthcare financing models as per their needs like Beveridge, Bismarck, and National Health Insurance Model, but every system has its limitations. Do you have any recommendations or hybrid model which India should adopt to serve its healthcare needs for varied segments of its population?
The best healthcare financing is a single-payer approach by government (shared between the Union and State levels). The US model of private health insurance is unjust, costly, and unfair, based on a powerful private – sector lobby that makes exorbitant profits at the expense of society, especially at the expense of the poor. India continues to under-invest in healthcare. It should be spending at least 4 percent of GDP on publicly financed healthcare, with the share rising gradually overtime.Until recently, India has been spending little more than 1 percent of GDP, a shockingly small amount, and perhaps the lowest public-sector outlay on health of any major country. Of course, good health comes not just through a high-quality and equitable health system, but also through healthy life practices. India should avoid the American fast-food industry and the accompanying obesity syndrome, the heavy addiction to cigarettes, and the massive air and water pollution that claim so many lives. Quality education for all, and gender equality will also strengthen health outcomes.
Q. You have vast knowledge of Indian healthcare system, having been associated with various initiatives like National Rural Health Mission. How do you think the Bottom of Pyramid can be served in its healthcare needs?
The surprising point about India is how the government chronically under-invests in healthcare. In this case, India is following the US model, of relying on privately provided healthcare. But that only works for the upper class, not the poor.
Q. How should Indian healthcare policies be structured to integrate the technological innovation to achieve its healthcare goals?
Digital technologies enable low-cost, high-quality, and innovative delivery of healthcare. Smartphones can play a vital role: to connect households with health providers, for remote sensing of patient data, for guiding community health workers (such as ASHAs), for telemedicine and distance diagnostics, for collecting and reporting data, etc. More generally, we are in an era of rapid technological breakthroughs in diagnostics, big data collection and processing, remote monitoring, new medicines, genomics, social medicine (including community-based mental health services), and environmental determinants of health. India should turn to its key institutions such as the Public Health Foundation of India to help set roadmaps for universal health coverage based on innovative technologies. And as with the US National Institutes of Health and the UK’s Wellcome Trust, India should explore an innovation ecosystem built on public financing, private foundations, and private-sector financing for cutting-edge R&D. A single-payer system should reimburse private providers at fixed public rates to give them the incentives to reduce costs and raise the quality through innovations. In other words, a single-payer system can still induce innovation by private providers, but within the context of universal coverage and without the excessive lobbying power of private health providers. European models will be helpful here.
Q. How globalization can help developing countries in improving healthcare? Is it a win-win situation for both developing and developed countries?
SDG 3 sets a shared global set of health objectives – “healthy lives for all at all ages”. In other words, the SDGs can build a shared global perspective and strategy. Of course, the gains are win-win. If all countries coordinate on decarbonizing the energy system, all will gain in improved health (fewer extreme heatwaves and climate-related disasters, reduced air pollution). If they cooperate on improved delivery of primary healthcare, there will be fewer uncontrolled epidemics of emerging diseases. If they cooperate on regulations on antibiotic use, there will be much less onset of antibiotic resistance. If all countries cooperate on sustainable farm practices, there will be healthier diets and less irresponsible use of antibiotics for farm animals. In other words, there are huge gains to global cooperation. Moreover, the poor countries depend on financial support from the rich countries like – to finance the control of epidemic diseases, the shift to clean energy, and the implementation of universal health coverage. Crucial institutions like the Global Fund to Fight AIDS, TB, and Malaria, need much more global financing. The world’s billionaires should be doing much more than most of them are doing now to put their vast wealth at the service of humanity. No country should say, “America first,” or “India first,” or “China first.” All countries should say “The World First,” and we will all come out ahead.