Zabrain Gul and HR Ahmad*
Throughout history, the strength and potential of nations have invariably hinged on the interconnected ladder of their people, education systems, institutional integrity, and the overarching framework of the secular nation-state. Ancient civilizations such as Greece and Rome underscored education as foundational to democracy and governance, emphasizing citizens’ active participation in societal progress. Later, during the Enlightenment, Europe redefined education as a cornerstone for social equity and individual rights, laying the ideological groundwork for contemporary welfare states.
HR Ahmad
Today, this historical narrative continues to unfold, especially visible in how modern states address the fundamental rights to health and education. Europe provides a fascinating juxtaposition, with Germany and the United Kingdom demonstrating two distinct but successful models. Germany’s statutory health insurance, a multi-payer model rooted in late 19th-century reforms by Chancellor Otto von Bismarck, remains robust, securing equitable healthcare access through contributions from both employers and employees. Complementing this, Germany’s approach to education emphasizes universal access by abolishing university tuition fees, reinforcing its commitment to social equality.
Zabrain Gul
In contrast, the UK’s National Health Service, inspired by post-World War II socialist labour party, maintains universal healthcare funded through general taxation. However, its educational system reflects contemporary neoliberal policies marked by high university tuition fees, thus embedding social structural inequalities. This mixed approach mirrors a broader global trend where essential services increasingly shift towards privatization.
The consequences of privatization and commodification are clearly observable in nations such as the United States, where healthcare and higher education are largely market-driven. This stark commercialization has deepened socio-economic divides, generating significant disparities in life expectancy, quality of education, and overall social mobility, thereby fostering a gradient society increasingly defined by economic capacity rather than merit or rights.
The global scenario is complex, reflected in countries like India, Pakistan, Middle East and African nations that oscillate between state provision and privatization. There is a drastic change in distribution of health and education provision between five-provinces to four provinces Pakistan. The equilibrium has dramatically shifted from public to private urban institutions of health and education particularly after the start of Afghan war and globalisation.
Punjab: Punjab showcases a dynamic interplay between urban prosperity and rural hardship. Urban areas boast advanced healthcare institutions such as Lahore General Hospital, Punjab Institute of Cardiology, Shaukat Khanum Memorial Cancer Hospital, and educational institutions including Punjab University, University of Lahore, Government College University Lahore, Beaconhouse School System, and Lahore University of Management Sciences. In contrast, rural areas face significant challenges such as inadequate healthcare facilities and underfunded schools, highlighting stark disparities within the province.
Sindh: Urban Sindh, particularly Karachi, is home to well-equipped healthcare facilities such as Aga Khan University Hospital, Indus Hospital, Jinnah Postgraduate Medical Centre, Ruth Pfau Civil Hospital and SIUT, along with educational giants like Karachi Grammar School, Institute of Business Administration, Dow University, and the University of Karachi. Conversely, rural Sindh struggles with sparse healthcare and educational resources, amplifying socio-economic divides and institutional neglect.
Khyber Pakhtunkhwa features significant urban advancements through institutions like Lady Reading Hospital, Khyber Teaching Hospital, Hayatabad Medical Complex, Rehman Medical Institute, and educational institutions including University of Peshawar, Khyber Medical University, and Edwardes College Peshawar. However, rural areas, particularly in mountainous and remote regions, suffer from profound disparities in healthcare and education due to geographic isolation and limited resources.
Baluchistan presents substantial urban-rural contrasts, with relatively better healthcare institutions such as Bolan Medical Complex and Civil Hospital Quetta, along with educational institutions like University of Baluchistan and Baluchistan University of Information Technology, Engineering, and Management Sciences located predominantly in urban areas. Rural regions, however, experience severe deficits in educational infrastructure and healthcare services, necessitating targeted interventions and sustained commitment to development. Prominent figures like Dr. Yarjan Abdul Samad highlight Baluchistan’s potential, bridging local aspirations and global recognition through educational initiatives and innovative scientific advancements.
Inter-provincial Comparison: Punjab generally leads with comparatively better infrastructure, stronger institutions, and broader access to services, particularly in urban centres. Sindh follows, albeit with stark disparities between urban affluence and rural neglect. KP is making notable progress in urban settings but still faces significant rural challenges. Baluchistan, historically the most marginalized, continues to struggle with severe infrastructural deficits yet demonstrates remarkable resilience and potential for growth.
Thus, in examining health and education within historical and geopolitical frames, it becomes evident that nations must actively choose paths that prioritize equity over commodification. Public accountability and collective acknowledgment of systemic failures — driven by constructive societal awareness—can galvanize reforms. Progressive policies, transparent governance, and sustained public engagement are essential to overcoming societal challenges and securing national unity by implementing the well-established EID model of education – industrialisation – democracy to flatten the classed society.
Dedicated to former Surgeon General Pakistan Army Prof. Mahmud Ahmed Akhtar: “A university- hospital should be a temple for research, learning, student and patient care to serve humanity”.
*Authors can be reached at
zabrain.gul@aku.edu
hrahmad.alrazi@aku.edu
