Greeting gestures, a language of paying honour, respect, love, adoration, graciousness, empathy towards each other. It is a global custom and has multiple variations. Each country has its own customized version and ritual. The most popular version i.e. hand-shake probably has its roots in Great Britain. Men in the United States will usually shake hands when greeting each other, but it’s not usual for them to kiss when greeting. Americans in addition to handshaking also do a fist bump, wave and hug.

For English people, the handshake is the formal way of greeting when meeting someone new. In informal situations, both men and women use a quick kiss on the cheek, and for women who know each other well. Handshake works universally as a professional way to greet. It is a little firm in Germany, more extended (3-step handshake) in Botswana and for Malays, it extends to touching each other’s fingertip followed by their hearts. Filipinos take a hand of their elders and press it to their foreheads called as ‘Mano’.

One of the major health and environmental challenge we face today is rapid emergence of novel pathogens. The spread of these pathogens, especially of nosocomial origin (hospital based), is often linked to cross-contamination by healthcare workers and ways of greeting gestures while meeting each other. An idea of handshake-free zones in hospitals have encouraged awareness. But also questioned how a doctor will take the physical examination without touching a patient. On the other hand, we cannot ignore the fact that microbes like Acinetobacter calcoaceticus, Enterococcus faecalis, E. faecium, and Shigella dysenteriae type 1 can sustain on hand surface upto one hour while Pseudomonas aeruginosa and Burkholderia cepacia survive up to 30 minutes. Rotavirus might survive for 20 min while the viability of human parainfluenza virus is nearly 60 min.

Studies indicate that a contaminated hand can transfer its viable contamination to seven different subjects or surfaces. One of two common items is a clean paper towel and soap dispenser with average transfer rate ranges between 0.01% to 0.64% and 12.4% to 13.1% respectively. We touch our face nearly 2-5 times a minute i.e., 2000 to 3000 times a day. In fact, whatever contamination we have on our hands is also getting transferred to our face. We may wonder whether our hand soap is capable of killing all the potentially pathogenic microbes. Are we washing our hands correctly and does it really help? We often use hand wash, sanitizers without giving attention to their content and standards. Do they qualify for antimicrobial purpose? Moreover, our greeting gestures further contribute to the spread of the germs.

For healthcare workers, the protected physical contact is a non-avoidable choice. Healthcare workers and doctors should change their gloves while switching from one patient to another. Avoiding greetings which involve physical contacts especially during outbreaks can provide a preventive approach to managing outbreaks. Hospitals need to improve compliance with hand hygiene. Handshake free zone can be one alternative in hospitals. But they aren’t designed to replace hand washing but to complement it. Creating handshake free zone will also bring attention to the hands as vectors for disease. It will also improve compliance with hand hygiene and an easy and inexpensive way to reduce infections.

It is rude to not to shake a hand if a person extends its hand towards you in the name of trust and honour. We can’t be rude to others but why not to adopt ‘Anjali Mudra’, Wai, Namasté, Wave, Bowing or Adaab to greet. This respectable way of greeting with no physical contact should be adopted in the healthcare settings. In India, by adopting our age-old greeting method especially in a healthcare setting can shield us from many invisible microbial infections. We just need to adopt, practice and re-practice these gestures to decrease the spread of infections.

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Last year May 24-26, 2017 was big startup event Latitude 59 in Tallinn,Estonia. I attended the event and got a flavor of the startup scene and healthcare sector discussions were held. I aligned my visit to Estonia along with the visit of my meeting with CBHEALTHACCESS delegates, innovative healthcare companies from Finland, Sweden, Estonia and Latvia.

I could witness many startups and meet some friends. At any point in the premises of the conference there were over 1000 people and all engaged about future trends and opportunities. One way to know future is always by observing what problems best startups are engaged in solving. I could witness many biotech (genetics) based startup trying their hands on personalized medicine and new age diagnostics platform. Also, interesting was the cyber security companies.

One cyber security startup from Switzerland, OneVisage, that attracted my attention was working on 3D face scanning as authentication mechanism and looked promising for applications like online banking with your own face as your password. Estonia in general has made great advances in two areas, one that of e-governance including e-health and the other cyber security. Hence, it was no surprise for me to see both kind of startups flocking in conference and building upon the existing good work happening in that country. The other exciting thing to see was the countries collaborating and there were many international visitors including from India. Japanese and Finnish presence was quite visible.

There was also heavy promotion of e-residency program with some exciting announcements about easier account opening with a Finnish provider. It lured me also to try my hands on registering a company and post conference it took me only few minutes with the help of some local friends to register a company! Although, I am yet to make it fully functional, but that was already something for me.

The highlight for me was the healthcare session on the second day, which had a keynote by Nicky Hekster from IBM Watson. Nicky started by asking everyone in the room to standup and asked first those who have been to a hospital in last six months to sit down or someone in their close family. Next, he asked if they knew someone in friends/relatives who have been to the hospital. To my surprise there were only 2-3 people standing in the room  which had over hundreds of people. This was a master tactic to drive the point home, that healthcare matters to all.

Followed by the keynote was a panel discussion, which comprised of panelists from USA, Finland, Germany, Italy, Netherlands and Estonia. They were healthcare practitioners, investors, incubators, startups and large company representatives. The session was interesting and demonstrated that how international best practices sharing and collaboration is need of the hour cutting across all type of stakeholders. I really enjoyed my two days not just in the conference but also in after parties with loads of intellectual discussions. Look forward being there again next year!

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Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2 
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz 
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 2 Issue 4 (October to December 2017) – http://amzn.to/2B2UMLw

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In most other countries, the constitution requires the government to provide some form of healthcare. The implementation, however, suffers from deficit of policy, government or resources even in the countries that consider healthcare as a part of social justice. The Author talks about how India can lead with innovations in legislation, policy, governance and finance to provide health for all.

Adequate healthcare is both, a prerequisite and a consequence, of the growth of a country. A health system can deliver public health and medical services, if its solid foundation includes skilled workforce, information systems, medical products, technology, adequate financing and governance. While technology can provide innovative tools to improve health, it is the regulatory framework whichcan provide the enabling ecosystem. It is important that Innovations not be limited to drugs and devices but also include regulations.Ultimately,it is laws that determine financing and structure of healthcare.

The nations of the world have included healthcare in their legal framework in some form.Almost all countries are signatories to one or more international human rights or health rights declarations.

One third of the countries include healthcare as a constitutional right for individual citizens. Russiaand former countries of the Soviet bloc Italy, Spain, Brazil, Philippines and South Africa have maintained health as human right in their constitution. On the other end of the spectrum are countries like the USA, which have no individual constitutional right to healthcare.

In most other countries, the constitution requires the government to provide some form of healthcare. The implementation,however, suffers from deficit of policy, governance or resources even in the countries that consider healthcare as a part of social justice.

India extrapolates health rights from other parts of the constitution.The right to health in India is outlined the Directive Principles of State Policy- Articles 42 and 47 and the fundamental right to life as stated in article 21.

Article 42 states that the State shall make provision for securing just and humane conditions of work and for maternity relief.

Article 47 states that the State shall regard the raising of level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavor to bring about prohibition of the consumption, except for medicinal purposes, of intoxicating drinks and of drugs which are injurious to health.

Article 21,“The Fundamental Right to Life” guaranties individual life.

The Indian judiciary has interpreted the “Right to Life’ in many ways. It has held that humane working conditions, health services and medical care are an essential part of Article 21. Public interest litigation, as well as litigation arising out of claims made by individuals,has generated substantial case law showingright to health is an integral part of the Right to Life.

For technological innovations to flourish in its current stage of development, India needs more proactive regulations to progress towards universal healthcare.

Currently the Indian government spends about 1 percent of GDP on healthcare. Compare that to 3 percent in China and 8.3 percent in the USA. Private expenditure on healthcare is in addition to public expenditure; approximately 70% of health expenditure in India is from private sources.

A study done by PGI Chandigarh, suggests that universal health care services for entire 1.2 billion population, the annual cost of providing preventive and curative services will be INR 2415 billion (USD 54 billion). This would amount to increasing the allocation to health sector from current nearly 1% to 3.8% of GDP.

Indian business association, FICCI and consultants EY, estimated in 2012 that universal health cover would require government health spending to increase to 3.7-4.5 percent of GDP.

The current government, under the National Health Assurance Mission, would provide all citizens free drugs and diagnostic treatment and insurance cover to treat serious ailments. It would cost an estimated $11.4 billion annually.

In 2010, a High Level Expert Group on Universal Health Coverage recommended increasing public financing from 1% of the gross domestic product to at least 2.5% to provide essential health care package through tax funding and employer-provided insurance.

The Lancet published an India focused issue on health in Jan 2011. The lead authors (K SrinathReddy, Vikram Patel, Prabhat Jha, Vinod K Paul, A K Shiva Kumar, Lalit Dandona),summarized the recommendations of various working groups as ‘call to action’ as follows. They propose the following targets to be achieved by 2020 through the creation of the Integrated National Health System with three overarching goals: ensure the reach and quality of health services to all in India; reduce the financial burden of health care on individuals; and empower people to take care of their health and hold the health-care system accountable.

Service delivery

• The entire population should be covered by an entitlement package of health care with

financing from a combination of public, employer, and private sources. Full range of relevant diseases need to be included in the entitlement package of health services with cost-effective interventions that include health promotion and disease prevention.

• All health practitioners and facilities in the public and private sectors have to be registered with the Integrated National Health System.

Health Financing

• Public spending on health should be increased from 1% to 6% of the gross domestic product, and 15% of tax revenues—including new taxes on tobacco products, alcohol, and food with little nutritional value—should be earmarked for this purpose.

• Reduce the proportion of out-of-pocket spending from 80% to 20% of the total health expenditure.

• Increase spending on health research to 8% of the health budget.

Human resources for health

• Establish the Indian Health Service with guidelines developed through an autonomous National Council for Human Resources in Health.

• An updated training curriculum should be fully in place for medical and allied professions that is relevant to the situation in India.

• Establish suitable incentive structures to retain health providers in underserved areas.

Health information system

• Have in place comprehensive health information and surveillance system that covers all major diseases, health-system issues, and key social determinants, which also facilitates assessment of public health interventions.

• Establish adequate research capacity in India to investigate and report key issues that affect the health system and policy for further improvements.

• Have in place a fully functional autonomous council that compiles and synthesizes relevant information to develop guidelines for evidence-based health care and its assessment.

Drugs and technology

• Implement a national network of pharmacies for generic low-cost drugs for the entire population.

• Establish mechanisms for bulk purchase of patented drugs at low cost.

• Have in place mechanisms to check and control the use of perverse incentives by pharmaceutical and biotechnology companies for health-care providers.

Governance

• Have in place mechanisms to make functional the components of the National Health Bill.

• Have a system in place that requires all middle and senior functionaries in public health to have relevant training in public health.

• Ensure devolution of responsibility for health care to district management systems along with accountability mechanisms and explicit community participation (The Lancet, Jan 2011).

India, at current stage of development needs more healthcare in every form and not less. Multiple studies have confirmed the fiscal feasibility and for technological innovations to flourish we needs a progressive enabling ecosystem.

Opposition to right to health emphasizes that it could increase the fiscal deficit;it could create shortage and increase the wait time for medical services, which would lead to rationing and lower the quality. It could also cause people to overuse health care resources. While appreciating valid opposing view, human development is not possible without guaranteed healthcare. Financial burden of a single episode of disease pushes millions of Indians into poverty, which stifles the market for technological progress.

Health and longevity have improved as never before in human history. And with explosive growth in the knowledge of human biology and genetics, it is likely that the life span will increase exponentially. It may even change the very definition of health to include happiness, intelligence and aesthetics as components of a new paradigm. It is imperative that innovations in legislation, policy, governance and finance will have to stay ahead of the burgeoning technologic innovations and not fall behind to irrelevance. It is important to have innovative strategic thinkers in the leadership positions that understand biology, healthcare, governance and finance.

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