Partnerships that can propel people and the economy
Rajeshwari works in a garment factory and produces 30-35 pieces per day. She often complains of fatigue and feels weak, taking extra breaks during the day and at least 2 days a month off work. Diagnosis of severe iron deficiency anemia and treatment for 3 months resulted in an improvement in all of his symptoms and an increase in productivity.
Why is Rajeshwari’s story relevant? The identification and treatment of anemia is a very simple example of the care that millions of Indians need and yet remain elusive. The factory Rajeshwari works at is likely to ‘earn’ $87,500 in a year just by insuring their thousand workers for iron deficiency anemia.
labor and the economy
In a study of garment workers in Tirupur, Tamil Nadu, 77% of workers reported musculoskeletal problems, 57% anemia, 51.6% had uncorrected vision problems, 31% had respiratory problems, 12% suffered from hypertension and 6% suffered from diabetes. It is important to remember that Rajeshwari and garment workers, as well as many of us working in the formal sector, make up only 6% of the workforce; the majority of Indian workers work in the informal sector. It doesn’t take much imagination to understand the health problems that affect workers in the informal sector. What should intrigue us more is that only 51% of Indians who can work are actually engaged in economic activity (labour force participation).
Two facts give us some clues about the quality of our workforce – there has been no decline in the incidence of low birth weight infants over the past 40 years (Gopalan, 2018) and wasting in children has not changed significantly over the past 2 decades (NFHS 2019). Low birth weight is not only a risk factor during infancy and childhood, low birth weight infants are also known to have a higher risk of developing a variety of onset conditions. adulthood.. Peak brain development occurs in the first two years of life and is nearly complete by age 6 – critical windows that now determine not only the potential of these individuals, but also how they engage. in the economy. Although we have a large working-age population, the ability to contribute to the economy, while dependent on many factors, is also dependent on health status – productivity, fewer health problems, increased participation in the population active and reduction of deaths.
Proof exists that investing in primary health care can increase GDP by up to 6% and 4 times economic returns. So it depends on where we make the investments.
Why invest in primary health care
Image credit: Systems Innovation, Iceberg model
When we think of health care, we think of illness and therefore the need to see clinicians, to take medicine and to need medical facilities. It’s what’s visible and what we see around us, but that’s honestly just the tip of the iceberg.
I believe this is why we are seeing testing camps, infrastructure (facilities, vehicles, etc.) and new diagnostic tools and technologies. Whether the services are provided by the private, public or informal sector, whether it is treatment, diagnosis or financing, it all depends on how we have structured health care. All of this is of course important, but cannot be part of a larger effort to keep people healthy.
The biggest change we need to make is our mental model of health, which should be aimed at preventing illness and supporting positive health-related behaviors. This is where it is important to understand and focus on primary health care. The WHO defines primary health care as “a society-wide approach to health and well-being, centered on the needs and preferences of individuals, families and communities, addressing the broader determinants health and focusing on the comprehensive and interrelated aspects of physical, mental, and social health and well-being.
A study shows that 90% of all health problems can be treated by primary health care. Massive evidence published by Barbara Starfield further shows that primary health care delivers better population health outcomes at lower cost and can counteract the adverse effects of poor economic conditions on health..
How would that be different from today? Individuals or families would receive support to take care of their own health – not just as a service, but as a partnership in which they would play a part. People would be supported throughout their life cycle, i.e. from birth to childhood and adulthood, by being informed and guided, navigating through various services and professionals, according to their needs. Workplaces, both formal and informal, that support workers with health and safety would add to people’s overall quality of life.
The need for partnerships and collaboration
Can the future we want for our people and our economy be achieved by any entity? India has already started its journey towards primary health care for all with the 2017 National Health Policy setting an ambitious goal of “the highest possible level of health and well-being at all ages”. Health and wellness centres, once fully operational, could function as ‘anchor institutions’ that provide health care, encourage healthy behaviors and support the physical and social environment of families. We need “everyone on deck” to realize this vision. Efforts to integrate and deliver comprehensive care through partnerships between private, public and community institutions are underway and better alignment of the different initiatives will help accelerate results. We will achieve better results if we are able to break down the silos – health is not just the business of those who work on health, but it is everyone’s business.
A clothing brand decided to use its CSR funds to improve the health not only of workers like Rajeshwari in their factories, but also of the communities in which they lived. They helped to set up a local women’s federation (modeled on NUHM Arogya Samiti’s Mahila), supported them to set up a cooperative society (which provides savings and credit financial services), the health education and primary health care are supported by local women. The cooperative and federation work closely with the district and local authorities and were recently recognized for their support to the community during the pandemic. The company worked to set up a shed recycling unit in the same community, providing additional livelihoods and income while reducing their own carbon footprint. This CSR effort over 5 years has resulted in social returns that are 3.32X the investment made. This is just one example of how long-term CSR commitments, working with multiple partners as well as local governments and communities can lead to transformations.
I’m going to take the liberty of reinterpreting Hilary Ziglar’s quote on business building “You don’t build an economy…you build people and then people build the economy”. I am convinced that together with the other structural and economic reforms, affordable, practical and accessible primary health care will lay the foundation for an inclusive and flourishing economy.
The opinions expressed above are those of the author.
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