From net neutrality to health neutrality: It's time we got serious about universal health coverage

Citizen and media censure of Free Basics, Facebook’s subsidised internet platform, has been one of the more heartening developments in the country over the past few weeks. There seems to be a fairly universal view that net neutrality, which forms the basis for opposing Free Basics in its present form, is relevant for internet users across the globe and is a significant ethical concept to be safeguarded at all costs.

Consequently, many of us view non-discriminatory online access as a digital right. On this note, I would like to be a constructive opportunist and remind ourselves about another important ethical concept and its associated fundamental right: universal health coverage and the right to health.

We root for net neutrality because we understand the significance of the internet and the importance of access to this facility not being based on randomly determined factors.

Similarly, we need to get vocal about the unfortunate reality that access to health services – a basic requirement – is rather arbitrary in our country. In a paper published in December in medical journal Lancet, senior Indian public health experts say that health continues to be largely determined by the “lottery of sex, socioeconomic status, caste, and birthplace”. They go on to say that nearly a quarter of children born to parents in the “bottom wealth quintile” are severely malnourished, compared with 5% of children born to parents in the top quintile.

Unfortunate reality

For the most part, timely and quality health services are available only to families that can afford them – much like the worst nightmare of net neutrality supporters who worry that only wealthier companies would be able to afford “premium” speeds).

In other words, in a country like India without universal healthcare, the poor are like hapless startup companies in an online world without net neutrality.

Let us take the example of maternity care. The health system – doctors, nurses, hospital administration – is an intimate partner in the birth of a child.

Tragically, however, the accessibility and quality of healthcare are not uniform for every expecting mother.

The event is equally significant for every parent, but women in rural areas often find it difficult to reach a place where care is available. And even after overcoming that hurdle, the quality of care is often unreliable.

In cities, poorer women usually have to contend with disrespectful behaviour in easily accessible but overcrowded government hospitals – part of the worldwide phenomenon of disrespect and abuse during childbirth. In contrast, women who can afford to pay are mostly treated with respect and dignity at the same hospitals.

Support system

According to the World Health Organization, the right to health includes access to “timely, acceptable, and affordable healthcare of appropriate quality”. It’s an embarrassing truth for India that high medical expenses force more than six crore citizens into poverty every year.

What this tells us is that simply constructing a health centre does not amount to anything meaningful unless supplemented by quality services. And these provisions are insufficient if not complemented by affordability.

The core principle of net neutrality is treating all online content equally. Similarly, universal healthcare broadly means treating – in both medical and behavioural senses – all patients equally.

While it’s debatable whether the quality of accommodation in a hospital should be the same for every patient irrespective of paying capacity, there is no doubt that the quality of care should be equal.

It is shameful that a woman’s intimate memories of giving birth largely depend on her financial status. Wealthier women generally have “beautiful” memories of being treated well and spoken to respectfully, while many poor women bitterly, even depressingly, remember how hospital staff yelled at or hit them. It is even more embarrassing that our medical and political establishments have yet to realise the gravity of this terrible social injustice.

Righting a wrong

As the English-speaking, internet-loving, fairly influential electorate of India, we must understand that is as much of an injustice as technology giants trying to throttle internet equality.

We still do not know if the government will uphold net neutrality, but we know for sure that successive governments have miserably failed to uphold universal health coverage.

In November, Nobel laureate Amartya Sen said that India is the only country trying to become a global economic power with an uneducated and unhealthy labour force.

The Lancet paper concluded by saying: “(We aspire) that no Indian should be denied their fundamental right to good quality health care due to shortage of services or resources, and that no Indian should face impoverishment due to healthcare (expenses).”

Let us make sure that these well-intentioned public health activists receive the same overwhelming support that we have accorded our net neutrality activists. After all, citizens can enjoy a free and neutral internet only if they remain healthy or do not lose all their money on just getting treated.

Research for the article was made possible by funding from Sitaram Bhartia Institute of Science and Research, New Delhi.