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Preventing prevention: Indian politics and public health clash

2017; Elsevier BV; Volume: 18; Issue: 6 Linguagem: Inglês

10.1016/s1470-2045(17)30361-3

1474-5488

The Lancet Oncology,

Health and Conflict Studies

In a recent move by the Indian Government, the country's largest independent public health organisation, the Public Health Foundation of India (PHFI), has been barred from receiving foreign funding, including donations from the Bill & Melinda Gates Foundation. The PHFI, which helps to support central and local governments by promoting breast cancer awareness campaigns, developing population-based cancer registries, and promoting universal health care, will lose roughly 45% of its funding from foreign investment over concerns regarding alleged lobbying with parliamentarians and media on anti-tobacco messages, and the misuse of funds and bank accounts that were allegedly not disclosed to the Home Ministry. This suspension is part of a wider move in recent years by the Indian Government to cancel Foreign Contribution (Regulation) Act licenses, which regulate the flow of funds from foreign donors, from which some 20 000 Indian non-governmental organisations benefit. While some have seen these cancellations as part of a wider effort to appease affiliate groups to the government who have accused philanthropic organisations of pushing corporate interests, others believe that the government is trying to promote a wholly nationalistic agenda in a bid to retain power in the 2019 elections. The recent move to cut funds to the PHFI comes at a time when public health is a growing concern in India. Earlier this month, the Indian Government announced that it will miss its deadline of December 2017 to reduce coal emissions and airborne particulate matter by two-thirds, declaring instead that developed countries should be responsible for tackling global pollution levels. Although India's per capita emissions are only 1·59 metric tonnes per year compared with 7·55 for China and 16·39 for the USA, India is still the world's third-biggest emitter of greenhouse gases in absolute terms, and has notable levels of air pollution, which killed nearly 1·1 million of its residents in 2015 alone. Such an open and defiant attitude by the Indian Government about their failure to meet coal emission targets, and their dismissive attempt to shift the responsibility to other countries, is a careless and harmful attitude to adopt, but an understandable attitude at a time when the US Government is dismantling its own Environmental Protection Agency and backtracking on former President Barack Obama's Clean Power Plan. By failing to address such chronic causes of illness, the Indian Government stands to exacerbate the growing pressure the current public health system upon which a large proportion of India's working class and unemployed rely. Indian government expenditure on health is already one of the lowest in the world, at only 1·4% of gross domestic product compared with an average of 5·9% globally. As a result, India's public health-care system has wholly inadequate financial resources to sufficiently train, staff, equip, or sometimes even run, health facilities nationally—an infrastructure that is sure to worsen as one of the country's largest public health organisations loses a substantial portion of their funding from overseas. Although aligning public health targets with a political agenda is certainly nothing new, these drastic steps taken by the current government will inevitably affect public health programmes and initiatives. Cancer is an emerging health problem in India, and already causes 6% of all adult deaths every year, with the number of cancer deaths set to increase to nearly 1 million in 2025. Such high rates mean that implementing primary prevention measures has never been more crucial. This means increasing, not reducing, the availability of funds to help to promote public health campaigns that encourage healthy lifestyles, reduce tobacco use, improve cancer registries, and increase the availability of cancer screening. It is worrying that at a time when health care in India is most in need, the government has opted to push for a wholly political and nationalistic agenda at the cost of public health, which clearly needs foreign investment to realistically meet the growing burden of non-communicable diseases across the country. That the Indian government openly makes moves to undermine public health goals is somewhat paradoxical to a vision of India as an emerging social and economic superpower, and will erode the true social and democratic value that improved health holds for the country.