Popularize higher education and research

 Popular articles are a reflection of our collective intellect, analytical acumen, critical prowess, sensitivity towards issues, willingness to voice our opinions, moral standing and courage to call a spade a spade and foster change in our society and therefore need to be valued and appreciated by all

In the modern era of social media boom when information technology has penetrated inside almost every household and every segment of our society through electronic gadgets like smartphones, satellite television sets and computers, there is need to utilize this platform to popularize and universalize our higher education and research with a view to promote development of scientific temper among our masses and increase their appetite about research related topics in general. Additionally, print media could be effectively utilized to make a purely scientific or intensely academic subject accessible to the general public by presenting it in a very simple, lucid and comprehensible manner in the form of a popular article. This will serve the dual purpose of reaching out to the common people with our progress in academics and research and thereby enhancing our perception and standing amongst them besides generating interest and enthusiasm among our youth for pursuing higher education and research in their own specific areas of interest. This is further necessitated by the fact that so far the research outcomes of most of our educational institutions have largely remained confined to our library shelves and digital archives thereby failing to reach out to the masses and addressing problems, needs and aspirations of our society at large. Therefore, we surely need to put greater efforts in our community outreach and extension activities through popularization of our higher education and research. 

During casual discussions a few friends in academia who often write columns for the press have revealed that some of their colleagues often mock them for writing popular articles in newspapers on technical topics and would even go to the extent of suggesting that they are wasting their time in such activities. However, need of the hour is to value popular articles as well as popular lectures as much as original research and review articles or regular classroom lectures for the simple reason that popular articles embody our own original thoughts and ideas whereas we borrow a lot, while citing references from the existing body of literature in our original research and review articles. Our own original contribution implying our own ideas and viewpoints may roughly range anywhere between 30 to 40 percent in case of an original research article and may perhaps be just 10 to 20 percent in case of a review article whereas in case of a popular article mostly it is almost 100 percent our own original contribution. Though no one can in any manner whatsoever seek to undermine the importance of original research articles that undergo a laborious peer review process before being accepted for publication, for they are the means by which we generate new knowledge which is the mainstay of academics and research, sole intention of this write-up is to highlight the importance of popular articles that are referred to as “columns” in media parlance. In popular articles we enjoy the freedom to present our own views and opinions the way we like, analyze issues as per our own understanding and comprehension, interpret situations, synthesize logical inferences and draw our own conclusions after our own critical review of the events, policies, decisions and actions. We have the liberty to give our own suggestions for bringing reforms and while doing so there is no imperative need to borrow from the works of other authors. 

One thoroughly enjoys a seamless flow of words emanating straight from one’s mind without any deviation or interruption of citing references though that is imperative and unavoidable in case of research articles. Academic publishing includes books written or edited by one or many authors, incorporating chapters written by different authors and compiled by the editor into one compendium. In consonance with the fundamental principles of scientific writing and academic publishing, each chapter then bears a reference for each and every statement made therein that however leaves comparatively lesser scope for original contribution from the author per se. More than a reference book or a curriculum-based textbook, here the reference is made to an academic, non-fiction book which is the outcome of an in-depth academic and scholarly research, usually conducted over a period of several years, making an original contribution to a particular field of study. Preferably a book must wholly and solely belong to the author though it may include direct or indirect references to the quotes and works of other authors too wherever necessitated. However, a book has to be a memorable treatise, a rich resource of informative content, thoughts, ideas and knowledge. More than information and knowledge it must reflect the wisdom of the author as well as his overall vision, proficiency and understanding of the issues besides bringing a clarity of thought among the readers on the issue under discussion in the book. Instead of writing a dozen odd books if an author writes only one that would be remembered and admired for all times to come, it is always better. A book must serve as a rich legacy of the author for his posterity and without writing a book an academician’s journey would always appear to be incomplete. A widely accepted, adored and appreciated book is one of the biggest contributions that an academician can make in which he can sum up and consolidate experiences, findings, observations, results and conclusions of his lifetime of teaching, learning and research. Here I would like to admit that I myself am yet to achieve that significant feat in my life. 

Writing popular articles in the newspapers and tabloids provides us an opportunity to get connected with the issues and concerns that our society is facing day in and day out. It helps us contribute our bit in mitigating or addressing those concerns and aids us in fulfilling our social responsibilities to some extent. If we are writing research and review articles in high impact national and international journals, which undoubtedly is the backbone of academics, but at the same time remain completely oblivious and untouched by our social issues, I think we will be failing in our duties towards our society. Every society banks upon its intellectuals like academicians in times of need to voice its prime concerns and suggest credible ways and means for their resolution. Their vibrancy and activism will reflect the maturity and dynamism of their society. On the contrary a society where its crème de la crème remains concerned solely about their own career, progression and growth, showing no empathy for others, it will be counted and denounced as a dead society though it needs to be mentioned that writing articles for the press may not be the only means of showing concern. Participation in crucial panel discussions at important fora, active involvement in decision-making wherever possible, contributions towards upliftment of poorer sections and substantial engagement in philanthropic social work are also equally important for contributing one’s bit, particularly for those individuals who may not be too good at writing. Crux of the matter is that while aiming and flying high in our career we have to remain connected to the ground by all possible means. Popular articles may not fetch us any API or research score required for our promotions but the sense of satisfaction and belonging that they bring is certainly unparalleled and gratifying. 

We need to inculcate the habits of vigorous reading and writing among our progeny so that they are not only well read themselves but well read by others too. Unfortunately, a vast segment of our society seems to be least interested in either of these vital academic activities. Mostly we read and write only to the extent necessary for passing examinations and earning our degrees whereas reading and writing are the most essential ingredients of living a well-informed, learned and meaningful life that is full of contentment besides leaving a rich legacy behind. Additionally, there appears to be a void between our academic institutions and the society that has resulted into some kind of trust deficit and alienation. Society at large seems to be unaware regarding their research and extension activities as a result of which public perception appears to have taken a deep plunge downwards. Through popular articles our academics need to connect with the society and make the common masses aware in simple and unambiguous terms about the kind of research that is being undertaken by them. This will definitely bridge the gap and improve public perception of our institutions besides promoting community outreach and public participation in our research. Need of the hour is to simplify the complex theories and principles of higher education for our common masses and thereby popularize not only education but our research too with a view to promote scientific temper in our society.  

Socialization of Medicine - IV

Socialization of medicine can be achieved through mandatory prepayments by taxation, increasing public spending for healthcare financing, reducing out-of-pocket expenditures, consolidating risk pools, improving efficiency of supply chains, breaking the link between entitlement and contributions and aligning procurement with benefits for the population

After having explained the difference between the terms, ‘social medicine’, ‘socialized medicine’ and ‘socialization of medicine’ in the previous columns, this concluding piece on the topic will attempt to explore the possibilities of achieving socialization of medicine in our local socio-political and national contexts with a view to lay a roadmap for overcoming the statistics of inequitable access to a staggering 65% of our total population. Here the term “socialization” has been used in the specific context that everything in an egalitarian society is made and achieved by the cooperative and collaborative efforts of its people and citizens, as envisioned under the conventional ideology of ‘socialism’. Main aim behind public ownership of universal healthcare is to ensure social justice, security and solidarity so that the healthcare services are responsive to the needs and aspirations of the general population and such services are distributed equitably among all sections of the society. This essentially means that the universal health coverage to all the people in a nation or a community has to be funded by the people themselves rather than by the government alone in order to make it sustainable and successful for ever. External funding or government funding alone can sustain such an initiative only for a limited period, not for ever. Ideally pooling of resources from the government, households, taxpayers, NGOs (wherever available) and insurance providers (wherever in loop) can expand the scope of coverage to a vast segment of the population for an extended period. 

In order to make substantial progress in our march towards socialization of medicine that is synonymous to universal health coverage (UHC), we need to evolve our health-financing systems, eliminate or substantially reduce direct out-of-pocket payments by the people at the point of delivery and widen progressive mandatory prepayments through various forms of taxation, including compulsory social health insurance contributions based on one’s ability to pay though the services have to be provided equitably to all the citizens irrespective of their paying capacity. This was also envisaged in a resolution adopted by the World Health Assembly in its 64^th meeting held on May 24, 2011 that calls for a mechanism to pool the risks and resources among the population in order to subsidize the cost of services and avoid catastrophic health-care expenditures and impoverishment of individuals particularly the poor and marginalized sections of the society while seeking the needed healthcare (WHA, 2011). While managing the transition of our healthcare system to universal coverage, all options available need to be thoroughly weighed, analyzed and developed in consonance with the specific epidemiological, macroeconomic, sociocultural and political context of each state of the country. 

First step in the process will be to promote the efficiency, transparency and accountability of our health-financing governing systems. This will be logically followed by the establishment and strengthening of our institutional capacity in order to generate regional evidence and effective, evidence-based policy decision-making on the design and implementation of universal health coverage systems, that includes tracking the flows of healthcare expenditures through the application of standard accounting frameworks. Additionally, we need to ensure that our overall resource allocation strikes an appropriate balance between health promotion, disease prevention, health-care provision and rehabilitation. Wherever feasible we need to take advantage of existing opportunities for collaboration between public and private providers and health-financing organizations, albeit under an overarching government-inclusive stewardship (WHA, 2011). It is hard to achieve UHC if the entitlement of citizens depends solely on individual contributions made by them because those who are most in need will remain without adequate coverage in such a regime. It will be difficult to collect direct taxes like income tax or mandatory health insurance contributions where a high proportion of the population does not have regular, salaried employment. Therefore, we need to weaken or even break the link between entitlement and contributions and place greater reliance on general budget revenues sourced mainly from indirect taxes, designed to be progressive and persistent in nature (WHA. After many years of trying to expand coverage for the informal sector with a government-run and subsidized contributory voluntary health insurance program, Thailand abandoned this approach in 2002, introducing a scheme that is funded entirely from general tax revenues (Prakongsai et al, 2009). 

Sufficient government funding or public financing is critical to subsidize the costs of care for the poor and sick populations. This requires increasing public spending on health, either by prioritizing health financing in national budget allocations, expanding the overall level of public revenues through progressive and sustainable mechanisms and expenditures, or implementing a combination of the two. For instance, Mexico ’s commitment to move toward UHC was reflected in an increase in public spending on health by an average of 5% annually from 2000 to 2006 (Garcia-Diaz et al, 2011). Similarly, enhancements in public health spending by Turkey between 1995 and 2010 contributed immensely towards significant improvements in their service delivery besides improved access for the underserved and rural populations (worldbank.org). There is need to build and consolidate pools that cover people of different economic strata and health statuses to enable the redistribution of resources since the fragmentation of risk pools inhibits our ability to distribute prepaid funds for health in accordance with the need. Attempts at splitting health insurance schemes for civil servants or formal sector workers by countries like Thailand and Mexico before extending explicit coverage to the rest of the predominantly poor population has proved dearly and their governments have been forced to spend more resources to gradually equalize the benefits across the population. 

One important measure required to ensure successful implementation of UHC is to improve efficiency of our pharmaceutical supply chains with a view to conserve our limited resources and ensure their better utilization for achieving UHC. It has been estimated by the World Health Organization that 20% and 40% of health expenditures are wasted in most countries as a result of spending on branded medicines rather than purchasing their generic versions. Effective purchasing of health services can improve efficiency and save funds that can be reinvested to increase the coverage and quality of healthcare. Such strategic purchasing involves shifting from conventional bureaucratic resource allocation processes towards data-driven approaches that use information about the service provider’s performance or health service needs of the population they serve (Kutzin et al, 2009). While health system financing is an essential component of UHC, progress toward UHC also requires coordinated actions across the pillars of the health system with particular attention to strengthen human resources for health. 

Therefore, socialization of medicine embraces a system wherein entire population of a nation contributes significantly as per their income, social status and resources towards health system financing through a just and rationalized taxation system so that poorer and marginalized segments of the society get adequately covered for their healthcare expenditures and do not suffer catastrophic expenditures leading to their impoverishment or deprivation of needed care. In the process taxpayers themselves get adequately covered for a considerable number of services and extent of costs while visiting healthcare centres thereby getting rid of the stresses causes by such out-of-pocket expenditures at the point of delivery. Thus by socialization we mean centralization of resource pooling and decentralization of service provision, wherein an affluent section of the society bears the healthcare burden of the deprived, under-privileged and marginalized sections just like we have the system of “zakat” being practiced in Islam wherein all affluent muslims contribute and pool a meagre 2.5% of their total savings for extending financial help to the poor and downtrodden sections of their community. Socialization of medicine through UHC implies that all people have access, without any discrimination, to the needed promotive, preventive, curative, palliative and rehabilitative basic health services and essential, safe, affordable, effective and quality medicines. This can be achieved by making important policy choices and inevitable trade-offs between the way pooled funds are used to extend coverage to those individuals who previously were not covered, to services that previously were not covered or to reduce the out-of-pocket payments needed for each service (WHR, 2010). These dimensions of coverage reflect a set of policy choices about benefits and their rationing that are among the critical decisions facing any country in its reform of health financing systems towards UHC. 

In Jammu and Kashmir healthcare is mainly provided to the people by the government health institutions. Though there are a few hospitals in private sector too but they do not function 24/7 and have no accident and emergency department. Surgeries are performed at private hospitals by doctors on call that too mostly during daytime only. That makes it easier for the government to acquire full control over the healthcare system through socialization of medicine in a manner similar to that of NHS in UK. Government can impose a 3-5% cess on total payable income tax just like education cess that is in vogue at present and thereby insure all its citizens for socialized, universal healthcare so that nobody has to pay out-of-pocket for his healthcare and medicines and suffer any impoverishment due to their unaffordable costs. However, the trade-off between the extent of services to be covered, percentage of population to be covered and the extent of costs to be covered by the government shall have to be worked out in consonance with our local financial, budgetary and psycho-social circumstances, disease incidence, morbidity and mortality patterns, per capita annual income and overall expenditure on healthcare by the government. Further all financial allocations for health-related expenditures shall have to be pooled centrally and distribution of goods and services decentralized to the maximum extent possible. UK model can be studied and adopted in a well-organized and systematic manner owing to the fact that it adopted socialized medicine way back in 1948 and has evolved enormously since then (concluded).

Socialization of Medicine - III

 While universal health care implies that every citizen has an equal opportunity to access basic healthcare services without suffering any financial impoverishment, socialization of medicine addresses social determinants of health and equity in order to improve health outcomes and eliminate health disparities

Emmanuel-Joseph Sieyès, a French Roman Catholic clergyman and political writer who was considered to be the chief political theorist of the French Revolution and was also the author of “What is the Third Estate”, was the first to coin the term "Sociology" in 1780 (Lenzer, 1998). French philosopher of science, Auguste Comte later redefined "Sociology" in 1838 as a new way of looking at society (Rashmi, 2014). In an attempt to unify history, psychology and economics through a scientific understanding of social life, Comte had earlier used the term "Social Physics" and had suggested that social ills could be effectively remedied through sociological positivism. However, seeds of the ideology that “medicine is a social science” were actually sown in the nineteenth century by German Pathologists Salomon Neumann and Rudolf Virchow. In 1911, Alfred Grotjahn of Berlin stressed upon the importance of social factors in the causation of disease, which he termed as “social pathology”. John Ryle and his group promoted the concept of social medicine in England and established a chair at Oxford in 1942 that was followed by the establishment of similar centres in other Universities of England. 

When Rudolf Virchow, founder of modern pathology wrote in late twentieth-century that “Medicine is a social science and politics is medicine on a large scale”, he had envisioned the influence of socio-political control over medicines. He further elaborated that medicine as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution whereas the politician, the practical anthropologist, must find the means for their actual solution (Wittern-Sterzel, 2003). With the passage of time medicine became a personalized and institutionalized service. This led to a feeling that perhaps medicine was not fully rendering its expected and envisioned service to the humanity. As the cost of medicines kept on steadily increasing, two kinds of medical care came to the fore – one for the rich and the other for the poor. This widening gap between the rich and the poor was bridged to a small extent by charitable and voluntary organizations providing free medical care and relief to the poor. Subsequently a thinking developed that the benefits of modern medicines should be equally available and affordable to all people. This is what led to the concept of “socialization of medicine” (Park, 2015). 

However, social medicine should not be confused with state medicine or socialized medicine. State medicine implies provision of free medical services to the people at government expense. Socialized medicine on the other hand envisages provision of medical services and professional training by the State as in state medicine, but the programme is operated by professional medical organizations rather than by the government (Park, 2015). Marriam-Webster Dictionary defines socialized medicine as “medical and hospital services for the members of a class or population administered by an organized group such as a state agency and paid for from funds obtained usually by assessments or taxation”. Winslow Carlton in his paper entitled, “The problem of social medicine: equilibrating the distribution and technology of medical care” published in NEJM on April 3rd, 1947 had argued that there is need for creation of a new discipline within the domain of medicine that might be called as the “social medicine”, which would mainly deal with the relationship and application of the medical arts and sciences to the society. Socialized medicine is a single-payer government-run and govt-administered system. In a socialized medicine model, the government makes all services of doctors and other healthcare providers available to the hospitals and other healthcare facilities, and also makes all payments for those services (Ridic et al, 2012). 

Socialized Medicine deals with social and economic structures of health-care delivery and health policy in addition to evolving concepts of the field like doctor-patient relationship in culturally diverse societies. Level of establishment and evolution of social medicine as an academic discipline has been internationally diverse as a result of which a coherent and universal definition of the discipline has so far remained largely elusive. A Professor of Social Medicine at Brussels University, René Sand, has stated that the roots of social medicine lay in ancient Greek philosophies of medicine and health (Sand, 1952) whereas George Rosen, an eminent historian and Professor of Public Health at Yale, while tracing the origins of the social role of medicine back to the nineteenth century, has highlighted the role of French and German health and social reformers like Jules Guerin, Alfred Grotjahn and Rudolph Virchow (Rosen, 1947; Porter and Porter, 1988). Worldwide, the primary mission of healthcare that includes curing illness, relieving pain, repairing injury, preventing disease and saving lives figures among the top national priorities. “Nationalization of Medicine” was achieved in Great Britain by the establishment of National Health Services (NHS) in 1948 wherein independent, charitable, voluntary and municipal hospitals, general and specialized, large and small were owned by the government and hundreds of thousands of doctors belonging to all medical specialties, nurses, ancillary health workers and paramedics were transferred entirely to the state's payroll (Marsland, 2005). 

Britain’s National Health Services (NHS) is a unique example of truly socialized medicine wherein healthcare care is provided by a single payer i.e., the British government and is funded by the taxpayer. Under this system all appointments and treatments including prescription drugs are free to the patients though paid through taxes. NHS officially came into existence in July 1948, in the wake of World War II, to replace an inadequate and inefficient system of volunteer hospitals that were heavily relying on government funding during the war. Establishment of NHS was vehemently opposed by the doctors and conservative politicians back then using similar arguments as cited by the opponents of greater government involvement in healthcare within USA. Fact of the matter is that today Britain like many other developed nations ranks above the U.S. in most of the indicators of health. Its citizens have a longer life expectancy and lower infant mortality, besides greater number of intensive-care hospital beds per capita and fewer deaths related to surgical or medical mishaps. What is more noteworthy is that Britain achieves all these results while spending proportionally less on healthcare than the U.S. For these and some other reasons, the World Health Organization (WHO) had ranked Britain 18th in a global league table of health-care systems whereas the U.S. was ranked 37th. However, in terms of cancer mortality rates U.S. outperforms Britain. 

Socialization of medicine addresses social determinants of health including social equity, parity and universal coverage through govt. health services. It also eliminates the unhealthy competition among physicians in search of their patients. However, maintenance of their pay parity in tune with their valuable services has been a matter of concern in some countries like Cuba. Under this system medical care becomes either completely free for the patients or reduces their out-of-pocket expenditures on healthcare to a great extent with the active financial support of the State. However, it is now recognized that in addition to socialization, “community participation” is also required in equal measure to ensure adequate and equitable utilization of health services and resources. As envisaged by WHO and UNICEF, it is “the process by which individuals and families assume responsibility for their own health and welfare and for those of the community”, and take suitable measures to develop their own capacity to contribute substantially towards their community’s holistic development and well-being (Ratcliffe, 1984). It also implies community participation in the planning, organization and management of their own health services and has also been denoted as “Health by the People” (Park, 2015). 

Socialization of medicine is the natural outcome of the social industrialization, urbanization and productive socialization based on the perspective of the social complexity of disease incidence and development. Medicine is a social enterprise and therefore it is desirable to adopt and implement the socialization of medicine in order to fully realize the great social function of medicine (Ryder, 1965). Though terms like universal health care and socialized medicine are often used synonymously and interchangeably, they fundamentally represent different political and economic approaches for making health services available to the masses. While universal health care simply means that every citizen has an equal opportunity and ability to access basic health care services without suffering any financial impoverishment or catastrophe, it does not necessarily mean that only the government pays for that access all the time (Bloom et al, 2018). Fact of the matter is that most of the countries around the world that offer universal health care to their citizens use a combination of public and private coverage including contributions from the individual households, employers, insurance companies, NGOs and foreign agencies. Contrary to that, in a single-payer system, every citizen gets coverage in which government fully pays for all healthcare services (EMTALA, 2012). Countries like UK, Canada and Germany have a well-functioning socialized medicine structure in place (to be concluded).

Socialization of Medicine - II

Ensuring equitable access to healthcare and quality medicines to all sections of the society irrespective of their caste, creed, colour, religion or paying capacity is the hallmark of a just, humane and civilized society 

Socialization of medicines is sometimes perceived as the acquisition by the government of the complete output of medical services and redistribution of those services and commodities equally among all citizens. Provision of public goods is inevitably socialized in the sense that everyone’s consumption is constrained to be the same. Public goods, such as the services of mass transit, parliament, traffic lights, fire services department, law and order, defence and so on, are normally nationalized, that is, produced in the public sector. It is desired that the public sector must provide medical care for everyone because of the concern for those who cannot afford medical care and because of everyone’s concern that he may impoverished to provide care for himself at some future time. The principal motive for socialization is the income inequality. Under a regime of proportional or progressive income taxation, socialization can be beneficial to the poorer half of the community which pays less in tax than the per capita cost of the output of the socialized industry (Usher, 1977). Medicine is a social enterprise and so it is imperative to further realize the socialization of medicine in order to fully realize the great social function of medicine. 

Access is defined as having medicines continuously available and affordable at public or private health facilities or medicine outlets that are within one hour’s walk from the homes of the population. Access to essential medicines has been viewed as an integral component of the right to health, which is a basic human right (Hogerzeil, 2003). Inequity in medicines access is widely perceived as symptomatic of weaknesses in the health-care system and represents a failure on the part of national governments to fulfil their obligations towards their citizens in terms of their right to health. Ensuring equitable access to quality pharmaceuticals is thus a key development challenge and an essential component of health system strengthening and primary health care reform programmes throughout the world (WHO, 2011). 

Entire world of a middle-class man gets shattered into shreds and pieces once he or his close kin is diagnosed of a serious affliction like some rare form of cancer, kidney failure or tuberculosis and he is left with no other choice but to pull out all his lifetime savings or sell some of his valuable assets like land or jewellery to bear spine-breaking expenses to the tune of several hundreds of thousands of rupees, on account of his dreadful disease. Even upper middle-class people find it catastrophic and devastating to pay the hefty medical bills after getting themselves treated at the corporate hospitals outside the valley.  Therefore, health is not just about diagnosing ailments, making hospital admissions and providing treatments, it is an issue of social justice, social solidarity and social security too. Getting good health care is not a privilege, it is considered to be a fundamental human right. A just, humane and civilized society must be able to provide basic health access to all its citizens irrespective of their social status or paying capacity. 

Universal health coverage (UHC) is the aspiration that all people obtain the health services they need without having to pay all costs out-of-pocket and without suffering any financial hardships paying for them. Universal Health Coverage implies that all people have access, without any discrimination, to the needed promotive, preventive, curative, palliative and rehabilitative basic health services and essential, safe, affordable, effective and quality medicines, while ensuring that the use of these services does not expose the users to financial hardships, with a special emphasis on the poor, vulnerable and marginalized segments of the population (WHO, 2019). UHC ensures that out-of-pocket expenditures by patients on their healthcare are minimized and they are covered by adequate health insurance covers by the government for which citizens have to pay a very little amount on annual basis. It is a social security scheme in essence. 

Globally, about 150 million people suffer financial catastrophe annually while 100 million are pushed below the poverty line. Only one in five people in the world has broad-based social security protection that also includes cover for lost wages in the event of illness, and more than half the world’s population lacks any type of formal social protection, according to the International Labour Organization (WHO, 2010). Due to out-of-pocket spending of their income on medicines and healthcare services, about 3.2 percent of India’s population is pushed below the poverty line every year, as per published reports (Holloway, 2013). When poor households lack access to affordable medicines, they have to forego treatment, sell precious assets, or make difficult choices between paying for medicines and other basic necessities like food, clothing and children’s education. 

Promoting and protecting health is essential for human welfare as well as sustained economic and social development. This has been recognized almost 40 years ago by the Alma-Ata Declaration signatories, who noted that ‘Health for All’ would contribute both to a better quality of life as also to global peace and security. Recognizing this, member states of the World Health Organization (WHO) committed in 2005 to develop their health financing systems so that all people have access to services and do not suffer financial catastrophes paying for them. WHO celebrates December 12th every year as the International Universal Health Coverage Day and has published three annual world health reports in the years 2003, 2010 and 2013 on the theme of Universal Health Coverage. However, UHC cannot be achieved, except for a small minority of the population, without a well-functioning health financing system that determines whether people can afford to use health services whenever they need them. Government alone cannot bear all the expenditures on account of health insurance cover of its people. Households, employers, insurance companies, NGOs and individuals need to contribute their bit through minimal payroll taxes for this purpose. If all the affluent people make small contributions annually, that can pave way for social security of all particularly the poor. 

The path to universal coverage involves important policy choices and inevitable trade-offs. All funds for health and medical care need to be pooled at one place for this purpose. The way those pooled funds – which can come from a variety of sources, such as general government budgets, compulsory insurance contributions (payroll taxes), and household or employer prepayments for voluntary health insurance - are organized, used and allocated, influences greatly the direction and progress of reforms towards universal coverage (WHO, 2013). Pooled funds can be used to extend coverage to those individuals who previously were not covered, to services that previously were not covered or to reduce the out-of-pocket payments needed for each service. These dimensions of coverage reflect a set of policy choices about benefits and their rationing that are among the critical decisions facing countries in their reform of health financing systems towards UHC (WHR, 2010). 

The health sector in Jammu and Kashmir is beset by many challenges in spite of the considerable progress it has made of late in terms of extension, service coverage and augmentation of manpower. A combination of weak institutional capacity, limited access to modern equipment and infrastructure and shortage of healthcare personnel has limited the effectiveness of health service delivery in J&K. The healthcare system in J&K is primarily run by the local government while private sector plays only a minor role in health service delivery and the non-governmental sector is largely absent. Compared to the doctor-patient ratio of 1:2000 in India, as against WHO recommendation of 1:1000, J&K has one allopathic doctor for 3866 people, as per Central Board of Health Intelligence, New Delhi (GK, 2017). However, with the establishment of five new medical colleges and two AIIMS in J&K this scenario is likely to improve in future. Though J&K govt. has provided free health insurance cover to the tune of Rs. 5 lakhs to all its citizens during the current financial year out of central/foreign assistance, in order to make it sustainable for all times to come, a robust and comprehensive Universal Health Coverage Policy framework is direly needed. 

For J&K to achieve Universal Health Coverage for its 125 lakh population we need to cross three major milestones viz., raising sufficient resources for health; removing financial risks and barriers to access; promoting efficiency and eliminating waste. To get closer to universal coverage, the J&K govt. would need to extend coverage to more people, offer more services, and/or pay a greater part of the cost. In J&K allocations for healthcare and medicines are scattered and fragmented between two directorates of health services, two government medical colleges, two government dental colleges, directorate of ISM, two super-speciality hospitals. All these funds need to be pooled and utilized centrally for increasing efficiency and conserving the available resources. However contingency grants for meeting emergent needs need to be kept available at the hospital/medical college level too for seamless availability of medicines. 

In view of considerable gains made in the healthcare sector in the recent past this author is contemplating to undertake a study in J&K state in order to analyze the situation on ground vis-a-vis availability, financial accessibility, geographical accessibility, affordability and acceptability of healthcare services particularly essential medicines at public health facilities of Jammu and Kashmir with an aim to identify the gaps, barriers, prospects and challenges towards adopting and implementing universal health coverage. Subsequently a comprehensive policy framework covering all relevant aspects concerning UHC including health service delivery, health workforce, health information systems, access to essential medicines, health systems financing, leadership and governance shall be developed that shall lay a roadmap for future policy direction of the J&K government towards implementing Universal Health Coverage scheme here and will make UHC sustainable for all times to come. This study will provide the necessary impetus and direction for making UHC a reality in J&K in near future.

Socialization of Medicine - I

 Ensuring equitable access to healthcare and quality medicines to all sections of the society irrespective of their caste, creed, colour, religion or paying capacity is the hallmark of a just, humane and civilized society

Generally, the term “socialization” is used to indicate the process of making social. It can be defined as a process by which individuals acquire the knowledge, language, social skills and values to conform to the norms and roles required for integration into a culture or a community (Stefania & Marina, 2015). It is a process of learning to behave in a way that is acceptable to the society at large. However, this term is used in an entirely different context in this write-up where it implies to make commodities like medicines easily available, affordable and accessible to all sections of the society irrespective of their caste, creed, colour, religion or even their paying capacity, without making them suffer impoverishment on account of catastrophic and spine-breaking expenditures on medicines and healthcare. Socialization of medicines is akin to universal health coverage though insurance component may not always be present in case of the former. Socialization of medicines can include a slew of measures like reducing their prices, simplifying their supply chains, minimizing the number of intermediaries, purchasing in bulk to achieve economies of scale, purchasing on generic names directly from the manufacturers and financing the medicine related expenditures through social security schemes and universal health coverage. Socialization may not always imply distribution of medicines among patients belonging to the lower strata of the society free of cost though it does include providing subsidies and financial coverage to them through government sponsored insurance schemes.

On April 17^th, 2021, on the intervention of the Govt. of India seven major manufacturers and marketers of Remdesivir, a drug that is used to reduce viral load among COVID-19 patients, reported voluntary reduction in maximum retail price of the major brands of this drug to the extent of 133 percent to 312 per cent. For instance Cadila Healthcare reduced the price of its brand Ramdac from 2800 rupees to 899 rupees whereas Cipla reduced the price of its brand Cipremi from 4000 rupees to 3000 rupees. This provides a glaring example of how drugs are often overpriced by their manufacturers and marketers as a result of which their access and affordability gets compromised and sometimes even blocked depriving a large section of the society from an equal opportunity of getting quality medicines and healthcare. As per World Health Organization (WHO) estimates one third of global population comprising of 1.3 to 2.1 billion people do not have adequate and equitable access to medicines. This percentage goes up to 50% in case of Asian and African populations whereas in India an estimated 65% population does not have an equitable and adequate access to medicines (WHO, 2011). A whole lot of examples can be cited in fact to demonstrate how life saving medicines are charged heavily by pharmaceutical companies as per their own whims and fancies at costs that are unimaginably unaffordable for the majority of the global population and thereby promoting indiscriminate profiteering and corporatization from lifesaving commodities like medicines. Few such examples are given as under to illustrate how indiscriminate profiteering on medicines is adversely impacting their affordability. 

Trastuzumab, sold under the brand name Herceptin is a monoclonal antibody that is used to treat breast and stomach cancers and was approved for medical use in US in the year 1998 at a whopping cost of 54000 USD per person per year (Harwart, 2008). Similarly Imatinib, an oral chemotherapy medication that is used to treat dreaded cancers like chronic myelogenous leukemia (CML) and acute lymphocytic leukemia (ALL) was approved for medical use in the US in the year 2001 at a stunning cost of 92000 USD per year. In the year 2003, pharmaceutical company Novartis launched beta crystalline version of this drug under the brand name of Gleevec in US costing 2200 USD (approx. Rs. 1.45 lakh) per patient per month whereas generic versions of the same drug were available in India for under 200 USD (approx. Rs. 14000) per patient per month. Another drug Sorafenib was co-developed and co-marketed by the pharmaceutical companies Bayer and Onyx under the brand name Nexavar for the treatment of advanced primary kidney cancer and advanced primary liver cancer in the year 2005. A kidney cancer patient had to pay 96,000 USD (£58,000) for a year's course of this drug, whereas the cost of the Indian version of the generic drug was around 2,800 USD (£1,700) (Bloomberg). Later a Hyderabad based generic drug company named NATCO manufactured and sold the same drug at the cost of Rs. 8800 only. In the year 2011, Bedaquiline, a medication used to treat multi-drug resistant tuberculosis was approved for medical use in the US at a cost of 30000 USD for a six-month course. Similarly, another drug named Sofosbuvir developed by Gilead Pharmaceuticals for treating Hepatitis C and approved for medical use in the United States in 2013 was sold under the brand name of Sovaldi and was costing 84000 USD per person for a twelve-week course whereas its actual production cost was estimated to be only 136 USD (Iyengar et al, 2016). 

Tocilizumab also known as Atlizumab, an immunosuppressive drug, mainly used for the treatment of rheumatoid arthritis and systemic juvenile idiopathic arthritis, a severe form of arthritis in children is also a monoclonal antibody, that was jointly developed by Osaka University and Chugai, and was licensed in 2003 by drug company Roche. This drug is useful for COVID-19 patients and is sold under the brand name Actemra. While the cost of a single vial ranges from Rs 40,000-50,000, black marketeers are offering a single vial for as much as Rs 2 lakh which is nearly four-five times the actual price (The Print). Since the pathogenesis of the acute pulmonary injury related to COVID-19 is related to a severe hyper-inflammatory state during which high amounts of pro-inflammatory cytokines are released inside the body, preliminary trial data has suggested that Tocilizumab may be effective in improving outcomes for patients severely affected by the SARS-CoV-2 virus. However its huge cost is restraining access to majority of the infected population in India as well as other developing countries like Brazil whereas minimum estimated costs of production were found to be US $0.93/day for Remdesivir, $1.45/day for Favipiravir, $0.08/day for Hydroxychloroquine, $0.02/day for Chloroquine, $0.10/day for Azithromycin, $0.28/day for Lopinavir/Ritonavir, $0.39/day for Sofosbuvir/Daclatasvir and $1.09/day for Pirfenidone whereas their actual costs of production ranged between $0.30 and $31 only per treatment course (10–28 days). Current prices of these drugs were found to be far higher than the costs of production, particularly in the US (Hill et al, 2020). Therefore all this direly needs to change and the world needs to move from corporatization to socialization of medicines shifting the focus from patents to patients and making the drugs affordable and accessible to large chunk of the world population. 

In its press release dated May 8, 2021 Indian Medical Association has appealed the Govt. of India to ensure equitable and affordable access to COVID-19 vaccination for all citizens above the age of 18 years and has termed the differential pricing of coronavirus vaccine for different age groups as unjustified. They have demanded free vaccination for the age group of 18-45 years too out of the central share of 50% burden of its cost. A bench of the Supreme Court of India, headed by justice D.Y. Chandrachud, maintained that “there are several aspects of the vaccine pricing policy adopted by the central government which require that policy be revisited,” in particular the rationale behind letting the manufacturers determine the vaccine prices for states and other private entities. The court asserted that vaccinations being provided to citizens constitute a valuable public good and thus, discrimination cannot be made between different classes of citizens who are similarly circumstanced on the ground and that while the Centre will carry the burden of providing free vaccines for the 45 years and above population, the state governments will discharge the responsibility of the 18 to 44 age group on such commercial terms as they may negotiate (Hindustan Times). The Rajasthan High Court even issued notices to the central and state governments on a plea challenging differential pricing of the vaccine for the centre and the states. In this backdrop, the plea submits that once Serum Institute of India & Bharat Biotech decide to make available the vaccine doses for Rs. 150/- per dose to the Government of India, there was no occasion or reason to be charging exorbitantly high prices of Rs. 400/- (now 300/) and Rs. 600/- (now 400/-) from state governments and Rs. 600/- and Rs. 1,200/- from the other organizations. The plea calls it 'absurd' and rather “unjustified” as to how could vaccine manufactured by the companies be sold at three different prices in the same country without any cogent rhyme or reason and that too with the approval of the Government of India against the interest of the public at large (livelaw.in). NGOs like Global Justice Now, STOPAIDS and Just Treatment have recently despatched a letter to the British Prime Minister Boris Johnson that has been signed by more than 400 academics, public health experts, civil society organizations, parliamentarians, unions, healthcare workers and patients calling for waiving off the intellectual property rights over COVID-19 vaccines and treatments at the World Trade Organization.