Universal healthcare- panacea for ill-health: Japan's phenomenal rise to top position

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 Universal healthcare- panacea for ill-health:
Japan's phenomenal rise to top position

Prof. Emeritus Lt. Gen. Mahmud Ahmad Akhtar

Former Surgeon General Pak Army/DGMS(IS)

Universal health-care means providing healthcare to whole or nearly whole population of a country free of cost. It includes prevention and promotion of health (most important), early diagnosis, treatment and rehabilitation. Universal healthcare is a fundamental human right. The universal health care was introduced in Germany by Bismarck in 18th century- in Japan under Meigi in 19th century in Scandinavia in the early 20th century, in Britain in the mid-20th century by the labor government lead by Mr. Attlee, Mr Bevan being the health minister. The communist/social countries adopted it in the 20th century, the universal healthcare being integral part of their ideology.


Lt. Gen. (R) Mahmud Ahmad Akhtar

In Cuba, under Fidel Castro, his deputy medical doctor turned revolutionary CHE Guveria established the universal healthcare system with amazing success. In spite of Cuba being under heavy sanctions by the World's super power, initially primary care cum secondary system was established, followed by tertiary and later advanced research institutions came within a short span of period. The health indicators improved dramatically, the mortality rates plummeted and life span progressively increased-now it is in the highest bracket of the worlds advanced countries. Cuba is manufacturing drugs including most advanced ones, medical equipment and exporting to other countries, Cuban medical institutions produce a lot of doctors which Cuba provides to many other countries- Cuba trained one thousand Pakistani doctors, free of cost. During the Pakistan’s 2005 earthquake Cuba provided enormous medical help- its primary care doctors provided health at door steps over the hills while secondary/tertiary care hospitals established field hospitals. On leaving, Cubans gifted field hospitals and equipment to Pakistan.

During the recent "Ebola epidemic” Cuba immediately provided relief winning World Health Organization’s (WHO) accolades-while the USA couldn’t not do anything. The NEWYORK times in an editorial paid tributes to the Cuban system of health care. During the Japanese earthquake, the Cuban health teams were the first to arrive for help.

In the SAARC, Sri Lanka has adopted the universal healthcare system and also free education-. The same education for everyone. Sri Lanka achieved dramatic success- its infant mortality rate plummeted to 8 per 1000 births while Pakistan’s is above 70 and its life span increased to 76, a decade higher than Pakistan. The other “SAARC” countries also increased Public Health care to its citizens, improving their health indicators as an example their infant mortality rate have dropped below 40 per 1000 life birth- also other indictors improved. Pakistan remains to provide the lowest health care provider even below the sub-Saharan countries. Pakistani health budget is the lowest- health policies loop sided, more stress laid on least cost effective luxurious tertiary health care projects neglecting primary healthcare, also giving more importance to motorways, least to potable water, food , environment, sanitation, immunization, population control, prevention, health promotion, education etc. About 25 million children are without schools and those in schools lack basic facilities like toilets, water, boundary walls.

There is a bright example of Rwanda- a country with 700 US $ income per person. As little more than two decades ago. It was shaken by genocidal inter-ethnic conflict that killed hundreds of thousands still today, new born Rwandan baby can expect to live 64 years- more than Pakistani baby. Over the 15 years Rwanda has built near universal health care system that covers more than 90% of the population. Rwandan’s lives have increased 10 years longer than they were at the turn of the century. More than 97% Rwandan infants are vaccinated against diphtheria, tetanus, pertussis, hepatitis B, polio, measles, rubella, pneumococcus and Rota virus noted in 2014 study led by Dr. Paul Farmer of Harvard Medical School and Dr. Agnes Bingwalio, then Rwandan Health minister. Almost all Rwandan adolescent girls are vaccinated against human papilloma virus, which causes cervical cancer. Its infant mortality rate is dropped by almost three quarters since 2000 to 31 per 1000 birth in 2015 vastly outpacing Pakistan’s over 70. It’s much higher in Baluchistan, Fata, south Punjab, Sindh interior.

A number of other countries like Ghana, Mexico, Thailand and others within their political and financial limitations have made progress to universal healthcare system to offer some measure of success to all. Ghana began its health campaign reform in 2003, access has increased from 6.6 percent to 38 percent of the population, according to an analysis by researcher at the World Bank. In Peru, coverage has increased from 37% to 62% since the start of reforms, in Vietnam 16% to 67.5%, in Thailand 63% to 96%.

Japan rose from bottom to top in universal world health care indicators. The Japanese system was formed by a team of politicians and doctors. Doctors providing professional acumen, one of the pioneers of the system was Dr. Shigeaki Hinohara who expired on July 2017 at the age of 105. He was born in Tokyo in 1911, when it was unlikely to survive beyond 40 (Now Japans average age is about 86 for women and above 81 for men.) There are a large number of centenarians in Japan. Communicable diseases have been eradicated and non-communicable diseases reduced tremendously. Metabolic syndrome- a cluster of obesity, diabetes-mellitus, hypertension, dyslipidemias, fatty liver etc. reduced below 12%, the lowest in the world. Dr. Shigeaki Hinohara graduated in 1937 from the Kyoto Imperial University College of Medicine. He began practicing at St.Lukes Hospital in 1941 became its director in 1992. When he died, he was chairman emeritus of St. Luke’s and Honorary President of St. Luke’s international hospital- both in Tokyo.

DIET: He strongly advocated against gluttony- promoted diet consisting of whole complex grains, vegetables, fruits, legumes, fish, and regular exercise. He exercised by walking three thousand steps using walking cane. He cautioned against early retirement- he believed and practiced wide interest in life. He emphasized to have fun in life, relaxation, recreation, hobbies etc. He believed wider and practiced wide interest in life. He wrote musicals for children when he was 88 and also wrote a bestselling book when he was 101, keeping mentally active to prevent Alzheimer. His remarkable contribution was that in early 50s he invented a system of complete called human dry annual physical helping in lengthening of life-span of Japanese people. Disease were detected earlier and treated early, effectively. He insisted that patients be treated as individuals- that a doctor be needed to understand patient as a whole as thoroughly as his illness. Japan also provided free education and other social benefits to its people. Japan’s leaders including kings set good examples of health to their people unlike Pakistani leaders having huge abdominal bulges. Pakistan should learn lessons from these countries at least. USA, the largest world economy and the industrial power is not following the universal healthcare system, resultantly it has the worst health care indicators not only amongst the industrialized nation but also than the middle low income countries following the universal health care system. The USA system serves best the ultra-rich people, the common people particularly low income people dying due to lack of affordable healthcare, Universal health care system USA have most expensive and least cost effective, USA should have universal healthcare system Bernie Sandres. From Sri Lanka in this region and even from Bangladesh who was far behind the former West Pakistan and now has gone far ahead from population control, life span and mortality rate from still birth to old age. It is pertinent to point out that other countries in this region public healthcare system share has considerably increased in the total health care while Pakistan’s remains in- significant. Pakistan should adopt social welfare, democratic system as envisaged by the founder of the state.

Pakistan should set its priorities right, lay emphasis on population control, prevention of diseases, promotion and protection of health, early detection of diseases and early treatment Pakistan should adopt WHO drug expert committees recommended “essential medicine system” developed for low/middle income group countries. Pakistan is the only country in the world not following it, at its own peril. Pakistan narcissist and self-righteous rulers/both selected and elected should follow pro-public policies and not self-serving elite’s ones. In it lies the salvation of the country.

 It is pertinent to point out that Germany under Bismarck established the universal health care system in 18th century. While motorways were introduced by Hitler in 20th century likewise Meigi established. Universal healthcare system in Japan in 19th century while motorway came much later. Same is situation for Nordic countries, communist/socialist, block countries etc. while in Pakistan, the situation is in the reverse direction. Even in a family the first priority is health and education of the children and luxurious travelling takes later position. Country’s rulers both selected and elected should have empathy- a feeling how peoples are treated in the public hospitals, how they suffer in the crowd, clinics and wards and how their children suffer in the schools which lack facilities of drinking water, washrooms, poor conditions of classrooms without proper ventilation etc. This can happen only if they have quality of empathy and they get medical treatment at public hospitals and their children study at the public schools like leaders of the other countries including the SAARC. Our leaders and their families get treatment abroad and children study in the posh schools abroad or in the country.

Sri Lanka is a good example in SAARC, Pakistan can follow its model. Of course there are many other countries practicing the system and guidance can be taken. It requires political will and commitment and determination. The money spent on luxurious projects and luxurious life style of rules, their travel abroad costing 70 crore for the prime minster, also can be diverted to the public welfare. British prime minster and other rulers live much simpler lives.

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