The Health of a Nation

Think you’d like a career in health management that offers plenty of challenge and responsibility, not to mention the potential to improve the lives of lots and lots of people?

Anbumani Ramadoss has that job, and he talked about it on March 29 with Medical Campus students, other health profession students, and a number of undergraduates minoring in public health. The Honorable Union Minister of Health for the Government of India spoke about what it is like to be responsible for the health of one-sixth of the world’s population.

“You name it, you have it in India,” said Ramadoss of the magnitude of chronic and communicable diseases his government is trying to prevent, treat, manage, and eradicate in a country of 1.1 billion people, 75 percent of whom live in rural areas. As chief health minister, Ramadoss has embarked on the challenge of changing a fragmented and understaffed public health and health-care delivery system to a modern and effective one. He heads India’s National Rural Health Mission, Prime Minister Manmohan Singh’s ambitious seven-year plan to bring integrated health care to poor rural populations, women and children in particular, by 2012.

A program cornerstone is the training and employment of accredited social health activists (ASHAs), women who will live in villages and provide basic health services, vaccinations, and health education to rural people. The goal is 620,000 ASHAs, one for every village in India. So far, 400,000 have volunteered, with 220,000 already trained. The government also is offering financial incentives to ASHAs to help implement improvements in the villages’ sanitation.

Ramadoss spoke as part of a special School of Public Health Public Health Forum, sponsored by the BU Global Health Initiative. The forum was organized by Gerald Keusch, GHI director and Medical Campus associate provost for global health. “We wanted to give students a unique opportunity to talk to a health leader who brings talent, vision, and a sense of urgency to his work,” said Keusch, who is also an SPH professor.

Ramadoss and a delegation of Indian health officials are visiting the United States to explore health and science collaborations with the public, private, and academic sectors in Washington, New York, and Boston. Ramadoss met with University Provost David Campbell, Medical Campus Provost and School of Medicine Dean Karen Antman, and President Robert A. Brown, with whom he talked about possible student and faculty exchanges between the University and India. The delegation also toured the construction site of the National Emerging Infectious Diseases Laboratories, scheduled to open in the fall of 2008.

John Cortright (SPH’07), an international health graduate student, said it was enlightening to hear how India is tackling its massive health challenges. “I was impressed,” he said. “It’s easy to assume that just because a country’s systems are outmoded its leaders are, but this just shows that you can have smart people reforming a system. The sheer scale of his responsibility is incomprehensible to me.”

Ramadoss, the son of the founder and leader of India’s Pattali Makkal Katchi (PMK) political party, received his medical training at Madras Medical College and soon after founded Green Motherland, an NGO responsible for planting more than a million tree saplings to promote water conservation. The 36-year-old Ramadoss was appointed health minister three years ago, the youngest of the prime minister’s cabinet. He has been an ardent anti-tobacco crusader, working to stop smoking in public places, and has proposed a controversial ban on the depiction of smoking in movies and television.

He told students that the big three communicable diseases in India are HIV/AIDS, malaria, and tuberculosis, followed by the even more troublesome big five: cardiovascular disease, diabetes, stroke, mental health disorders, and cancer. As life expectancy increases from 64 years to an anticipated 72 to 74 years in the next 15 years, the challenge of these chronic diseases will increase. “We are going to have a lot of senior people around,” he said.

Although India’s 262 medical schools and 230 dental schools are rolling out 30,000 and 17,000 graduates a year, respectively, he said, it is not enough to address the needs of rural villages, especially since many doctors do not want to move to poor areas. The government is hoping to help remedy this by making one year of service in rural areas mandatory after completion of an internship. Astonishingly, he said, India has only 3,300 psychiatrists for a population of more than a billion people. And many of them are being “poached” by developed countries.

India is taking the first step toward creating a formal public health system similar to that of the United States by establishing 10 schools of public health. The country is working with American universities to get these institutions up and running.

Despite the challenges, India is doing well addressing its problems, considering its population numbers, Ramadoss said. Occupying only 2.4 percent of the world’s land, it has 20 percent of its population. The largest of the country’s 30 states, Uttar Pradesh and Bihar, are home to 300 million people, the population of the entire United States. “So I have a lot of countries in India to take care of,” he said.

There is currently a thriving “medical tourism” industry luring people from developed nations for high-quality medical procedures at a fraction the cost in other countries. “Our treatment mode is the most cost-effective in the world,” he said. “In India you can get an X-ray for about $1 and an MRI for about $65. You can get your knee replaced for $4,000. Here I believe it is about $70,000 or $80,000.” India’s 3,000-year history of traditional medicine is something that other cultures and nations can learn from as well, he added.

Ramadoss begins each day scanning newspapers, deciding which issues he will have to confront. “My pulse starts shooting,” he said. Three years ago, when he took the job, he joked, “I was 36. Now I’m 48.”

In spite of the considerable pressures, he said, “It’s a very challenging job, but I enjoy every single second of it.”