First the good news. The World Health Organisations website informed us on June 19 that, at the end of 100 days of the Severe Acute Respiratory Syndrome (SARS), exactly zero people had died of it in India. It also listed the cumulative number of cases in the country at that point as three. So thats it: deaths zero; cases, three.
Well, you could be forgiven for thinking SARS had mowed down hundreds of Indians in its wake. The medias coverage of the disease made it seem that way. Countless words filled endless miles of newsprint on the subject. Doctors, politicians, television anchors, health activists, ambulance drivers and yes, even fashion models had something to say on it. But the WHO scoreboard was unrelenting: 0 3. Indeed, barely three weeks later, the WHO declared the virus to be largely contained across the globe. Worldwide, says the WHO site (July 8), the number of deaths was 812. Again, sad, but a far cry from the media-generated image of SARS. Of course, it could be argued that the coverage played a role in keeping the deaths down, but
The bad news?
The total number of deaths due to SARS -- across the entire globe -- is about half the number of people who die of tuberculosis every single day in India alone.
But TB would be lucky to get a couple of columns each year in India's newspapers. If it does, it's when the country's distinguished chest physicians, some of whom count newspaper owners among their clients, hold their annual congress.
Every 14 days, 7.5m children below the age of five in India suffer from diarrhoea. Over a million die of it each year. Close to 19 million contract acute respiratory infections, including pneumonia, in the same period of time. Many of these, too, die. Theres a lot the media can do, but doesnt.
Malaria, thought to have been largely controlled by the start of the 80s, has been back with a vengeance for a decade now. The biggest story Ive seen on that in the press was one of the funniest health con jobs of all time. At some obscene cost, millions of mosquito nets impregnated with mosquito-repellent would be distributed. To people who dont have beds in the first place. Who live in structures where you sleep away from the wall -- because thats where scorpions and other non-cuddly creatures reside. So its hard to use the nets from the wall, too. This idea came from experts who seemed not to know that the malaria parasite is not necessarily most active when youre asleep. It is far more so at dawn and dusk when people are moving to, working in, or returning from the fields.
Of course, you could make a bold new fashion statement by wearing your mosquito net at work, but it might cramp your style. And I doubt the village would be thrilled enough to get you a ramp to glide on.
Through the 90s, the general immunity of many poor people in this country fell, as health care became more expensive and inaccessible. (The sight of officials and ministers boasting of the higher immunity of the Indian people during the SARS scare would have been funny were it not so tragic.) As costs went up, health went down. The global politics of health, drugs and patents also kicked in. As the battle over patents went in favour of giant multinational corporations, many vital drugs became simply too costly for ordinary people. And from the 90s we also had the World Trade Organisation (WTO) to guard the MNCs interests against those of the public. So health expenses rose even further. As this happened, people moved to secondrate, low quality drugs. Even, sometimes, fake ones. They could not afford better.
Health costs have emerged the second highest cause of family debt in many rural regions. But that gets little or no media attention. Through the last decade, we closed dispensaries and opened super speciality hospitals. The latter got covered in the media. The former process was ignored.
Then how and why did SARS get so much attention?
First the obvious reasons: Its new, its unknown, and thus scary. As the WHO points out: SARS is the first severe and readily transmissible new disease to strike a globalized society The huge growth of international air travel allowed SARS to spread around the world swiftly. The close links of economies and markets made the economic impact of SARS much greater. And super fast communications further added to the social and economic disruption of SARS. This did indeed focus public concern. However, it also did that, says the WHO, to the point of panic.
Sure. But it also caused that kind of panic because it affected the wrong people. The flying classes. Their panic worked its way downwards into society. To the point where families in Ambernath, Pune and Kolkota were bullied to leave their flats and apartments. On the slightest suspicion of SARS. With around 8,400 cases worldwide and 812 deaths, the SARS fatality rate has not gone up beyond ten per cent. But its an important ten per cent thats affected. People who fly.
Tuberculosis on the other hand, mainly kills the kind of people who walk. Who dont make news unless they die in very large numbers at the same instant. People in the rural areas and in urban slums. Remember the "plague" of 1994 in India and the hysteria it caused? That made the front page almost everywhere in the world quite effortlessly. Actually, the "plague" took 54 lives. The same year, tuberculosis killed 8,000 times as many Indians as the "plague" did. Yet, TB is barely visible in the media.
Of course, coverage doesn't just depend on the number of deaths. Who dies is no less important. And that's another reason why the "plague" got so much space. It threatened the Beautiful People, not just the ones "out there" in the rural areas or in urban slums. Plague germs are notorious for their non-observance of class distinctions They board aircraft and fly club class to New York. That had the flying elites terrified. SARS worked its panic in much the same way. Yet, SARS is the beginning. Many of its ilk will surface and do far greater damage. Because countries everywhere are doing away with the health systems that once kept infectious diseases in check.
Why did SARS hit China? Why so badly? SARS devastated the Chinese in many ways. It just about finished tourism for the time being. It cost billions of dollars to counter. The GDP has taken a beating.
The Chinese are paying for years of destroying their version of a health system. Most Chinese got their health care from their work unit. That is, the factories or colleges or enterprises they worked in had health facilities. Those were accessed by people through their workplace unions or associations.
As liberalisation and privatisation took root in China, thousands of these enterprises were shut down, Millions were thrown out of work. Now they no more had access to health care. There was no longer an early warning system in place. No local dispensary or hospital to sound the alarm. SARS and other diseases will cost China a lot more than what it tried to save at the expense of its working people.
The same will unfold here, too. As the ruling classes destroy the health entitlements of the poor, diseases far worse than SARS will surface. And yes, theyll affect the flying classes too.
Growing impoverishment for hundreds of millions will launch not one but many giant health tragedies. As already obscene disparities get even worse, so will peoples access to basic health care. But when those making big bucks from such misery increasingly own the media everywhere, these issues will not be well covered or discussed. Maybe we ought to have all newspapers and television channels carry the following. STATUTORY WARNING Monopoly media are bad for your health.
