Justice issues in basic health care and the challenge of genetic medicines
Reviewing the current health care system in India which is grossly inadequate and inefficient, inaccessible and inequitable, this dissertation discusses the relevance of the principles of social justice such as equity, the common good and distributive justice, and the imperatives of social justice such as the option for the poor, subsidiarity, participation and solidarity and argues that a health care system informed and guided by these principles will be more effective, equitable and accessible to people. In addition to examining the numerous challenges faced by the primary health care system in the country, I also examine the many ethical challenges raised by the development of gene therapies in the country and suggest that the same principles of social justice offer guidelines to frame policies regarding the practice of them. This dissertation faces of the very complex health care situation in India. About 40% of people in the country have little or no access to basic health care because of poverty, abysmally low spending on health care by the government, neglect of basic health care facilities, and lack of social security measures like health insurance. However, the government in its effort to boost the country's GDP is making an all-out effort to promote health tourism in the country by investing in super specialty hospitals and in high-end medicines like gene therapy. The government also has been promoting and encouraging private investments in the sector, especially in setting up super-specialty hospitals and in the use of high-end medicines such as gene therapy. In an effort to boost health tourism and to earn greater foreign exchange, the government has drafted its industrial policies for the last three decades, encouraging private, for-profit health care sector. Substantial tax deductions and subsidies are provided to the private sector to allure private investment in the sector. However, in the process, the government has neglected primary health care centers that have been the primary source of health care for the poor and the underprivileged sections of people. In spite of announcing new policies in health care with high promises of programs and initiatives for the poor, women and children, the resource allocation to the sector betrays all promises. The administrative, structural, political and social anomalies, especially corruption at all levels, absenteeism among health care personnel, medical malpractices, a lack of political will, vision and transparency, poor allocation of funds, lack of monitoring and evaluation systems, etc., have crippled the health care system. It is in this context that I argue that the principles of social justice and its imperatives should inform and direct the government in its effort to provide health care in the country. These principles and imperatives should inform and direct not only provisions for basic health care but also the production and use of genetic medicines. A health care system that is based on equity, the common good, distributive justice, subsidiarity, solidarity and participation, that promotes health and meets the health care needs of all in an equitable way, irrespective of the socio-economic disparities that prevails, is the need of the hour in India.