Like political slogans destined to have a short life span and memory, ‘Health for All’ from the highly acclaimed Alma-Ata Declaration of 1978 could not achieve much. A slogan given with much fanfare in Alma-Ata in Kazakhstan (then under the erstwhile USSR) by WHO in its conference from September 6-12, 1978, is seemingly losing its meaning and relevance in the world with prevailing inequity referring to health standards and care.
Looking back at the debate of Health for All, we see that the initial goal of bringing “an acceptable level of health for all the people of the world by the year 2000,” as envisioned in Alma-Ata Declaration, is still a chimera, even in 2021. Although it is still dreamt of, considering the inherent hiccoughs in translating it into reality, it was paraphrased as “leave no one behind” in the Sustainable Development Goals (SDG) declaration of the UN in 2015.
The utopian goal of Health for All has transformed continuously since its genesis. It was attempted to be rephrased initially in Millennium Development Goals (MDG) in 2000 with a 15-year target to accomplish it. In 2015, when it still remained unaccomplished, the goal was shifted to Sustainable Development Goals (SDG) with a grace period of another 15 years, with an objective to attain the goals by 2030. What we had in MDG and what we have now in SDG, is similar in essence to what was actually conceptualised in the Alma-Ata Declaration. Paradoxically, though the objective remains unchanged, the means to reach it are still elusive.
Fear of Uncertainty
The current pandemic has actually exposed the world’s severe limitations in terms of providing sustainable health to everyone. India witnessed the brunt of this catastrophe more closely and observed the near collapse of its health care delivery system during the second wave of the COVID-19 pandemic.
Now, when the second wave is receding, a sustained fear of the resurgence of the infection any time in future is looming around, keeping everyone on tenterhooks. Living under the constant threat of the unforeseen is one of the most compelling reasons for a clarion call to search for the pragmatic, stable and amicable solutions for omnipresent and omnipotent threats to human survival. Obviously, this requires us to think more inclusively not only in the context of the ongoing pandemic but also much beyond it.
Sick Care v/s Health Care
What is the conventional idea of health? For a common man, it is the absence of disease and the ability to enjoy life. Although WHO tried to define health in a much broader perspective by including many other dimensions like psychological, social and spiritual, this broader definition of health is little known or appreciated by the common people. Unfortunately, these less traversed dimensions of health have also been less known or appreciated in the arena of policy making related to health care. As a result, the focus of health across the world remains limited to the physical health and is found working only when a disease erupts. Obviously, our policies have remained limited to sick care rather than health care. For most part of our recent history, health care has remained a misnomer — because it has not offered care for health, but care for the sick who have lost health for some or the other reason.
A very important yet missing component of this wider definition of health as proposed by WHO is its contextuality and relevance in the backdrop of a larger ecosystem. It fails to understand that health is not a standalone phenomenon but the net sum of mutual interactions between all biotic and abiotic components of an ecosystem.
As an integral component of our ecosystem, each one of us plays a key role to ensure its sustainability. A sustainable ecosystem is the one where there is stability at each trophic level and where there is a cyclic flow of energy from producer to consumers and finally back to producer with the help of decomposers. Now, if out of greed or misdeeds, anyone in this chain behaves inappropriately, the system will not stay in equilibrium for long. The sustainability of an ecosystem lies on the simple principle of taking only that much from the surroundings which is essential to ensure survival and to allow the selfless transference of commodities essential for living to all others cohabiting the system.
Sustainiable Ecosystem and Vasudhaiva Kutumbakam
Considering the whole world as a family or ‘vasudhaiva kutumbakam’ is the epitome of this great philosophy where each one in the family seems concerned about the wellness of the others in the family. How does this connote to health in the current perspective? The simplest answer to this is that composite health lies in a healthy and happy environment where we live. The underlying message is even simpler. If we wish to be healthy, we need to make efforts to keep everyone around us happy and healthy.
This simile of macrocosm goes deep inside our body too through our microcosm. As we see outside, our own body from inside out is also the abode of innumerable microorganisms. Eventually, this makes a mini ecosystem inside our body whose stability is largely governed by our own deeds. Since the microcosmic lives inside our body are solely dependent upon our interior milieu for their survival and growth, any deviation from the normal in terms of qualitative and quantitative dietary intake, and also the intake methods, seems to have impact deeper than it may seem. Our gut microbiota is now considered an essential organ system of our body, doing immense work for the maintenance of our health. As we need to remain in harmony with our outer world to obtain health, similarly a perfect balance is needed with our internal environment too to remain healthy. Our food possibly plays the single most important role in ensuring the maintenance of our health.
What our conventional learning about health failed to deliver is that health is a composite phenomenon where the health and happiness of people living together is integrally and inseparably associated. Obviously, thinking of health needs a collective effort involving everyone who is part of micro or macro environment of an individual. We can’t be happy or healthy if others around us are passing through misery. The second and equally important yet missing fact is that remaining healthy is every one’s own responsibility. The burden of health can’t simply be placed upon the state if the people are not ready to follow certain simple rules necessary for keeping good health.
As we need to remain in harmony with our outer world to obtain health, similarly a perfect balance is needed in our internal environment too to remain healthy.
Concept of Health in Traditional Systems
Traditional health care philosophies across the world have given voice to this comprehensive definition of health and have recommended the plausible means to achieve this. The idea of self-help as the first and foremost principle of keeping oneself healthy has not only prevailed in Indian traditional health care ideology but is also reflected in traditional practices prevalent in many other parts of the globe.
Ayurveda, for example has proposed health to be a highly dynamic equilibrium of functionality of the body while putting it in context of the surroundings. By proposing ‘prasanna atmendriya manah’ or ‘a happy state of soul, senses and mind’ as one essential prerequisite of health, Ayurveda opens up all possible means of achieving real health, which are beyond the understanding of conventional modern health care. This is highly pertinent to look at ‘prasanna atma’ as one integral component of health as defined in Ayurveda. Atma, being the derivative of a larger governing soul, ought to be free from bias and greed. Its happiness, therefore, can only be derived through the deeds which are not selfish and essentially pure.
The ideology of health derived from Yoga considers the body as composed of multiple strata having different functions and different substrates to be fed. The most basic of this strata is annamaya kosha or the physical body, which feeds upon the food we eat. Naturally, the disharmony caused due to ill effects of food largely reflect at this level and is largely correctable by food alone. We understand that besides food, there are many more things affecting the health at various other levels of the body. Sleep and righteous living are two other essential components of health, which together make a health tripod. Sleep alone contains the key to many diseases and thus helps in treating many diseases just by correcting it. Current medical science has not been able to dig deep into these areas so far and therefore, has kept it limited to the diseases pertaining to annamaya kosha alone.
Disease-centric Modern Medicine
Modern medicine has undoubted excellence in handling emergencies. Because of its technical precision allowing it to reach deep into the root of the physical cause of the disease and ability to make functional corrections either by elimination or suppression, it has become the choice of common people who look at immediate solutions to their misery without looking at what lies behind all those miseries. Synthetically derived and highly potent medicines of modern health care have been capable of changing the course of a disease dramatically without the need of investigating how one has contracted the disease. So, this has become a disease-centric system where the focus is on disease and efforts are solely focused towards its elimination.
Compared to the arduous preventive recommendations of traditional health care demanding a high level of self-discipline in order to remain healthy, the ease provided by modern medicine in terms of cure through medicine was highly welcomed by the common people and this is the reason behind its unparalleled growth and support in society in contemporary times. We, however, have learned lately that mitigating the symptoms has not been the most appropriate answer to deal with diseases. From epidemiological perspectives, despite the symptomatic ease it might have provided, it has not been able to reduce the burden of diseases across the world. By not addressing appropriately the prevention of the disease and focusing only upon the cure puts a question upon our health care strategies and their real intentions. By not giving people the knowledge about preventing a disease, we indirectly contribute to the growth of illness and eventually help build a sick society.
Traditional health care wisdom from across the world comes as a great complement to modern health care to propose a complete world order for effective health as well as sick care.
Looking back at our primary question of Health for All, this is essential to ensure the easy access of means of healthy living to each individual. Ayurveda, in a straight-forward manner, declares certain attributes, which if followed, make a person immune to diseases. When asked by his disciple Agnivesh about the people who do not catch a disease (kim nanutapanti rogah?), Atreya Punarvasu — one of the greatest ancient teachers of Ayurveda — explains precisely about the qualities that make a person completely protected from diseases. Atreya speaks:
Narohitahaara vihara sevi sameekshayakari vishayeshvasaktah|
Data samah satyaparah kshamavaana aaptopasevi ca bhavatyaroga||
To state simply, the sage replies that the people who always follow wholesome diet and routine, analyse before any act, do not over indulge in sensual pleasure, are generous, have an equitable mind, stick to the truth, observe forgiveness and are respectful to elders do not usually catch a disease. Atreya Punarvasu here clearly defines the means to obtain composite health through all its domains — whether physical, mental, social or spiritual, and finally ecological, as we have recently discovered.
Putting all efforts to prevent diseases by utilising the traditional health care wisdom and treating it through advanced health care in all emergent conditions may be the new world order pertaining to health. It’s time to integrate all health care wisdom prevailing on earth to make a unified effort to ensure the survival of human race. This pandemic has given us an opportunity to begin thinking in this ultimate direction.
*The writer is Head, PG Dept of Kaya Chikitsa, State Ayurvedi College, Lucknow, and former Director, Rashtriya Ayurveda Vidyapeeth (National Academy of Ayurveda), Ministry of AYUSH, New Delhi. He has edited three bestselling books on Ayurveda, including ‘Ayurvedic Science of Food and Nutrition’ (Springer Nature, NY)
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