GANDHI & HEALTH: Award-Winning Essay in Competition Organized by ICMR celebrating 150^th birth anniversary of Mahatma Gandhi

“It is health that is real wealth and not pieces of gold and silver.”

– M.K. Gandhi

When Gandhiji's name is taken in the context of health, it's essential to quote him. He believed in giving away the materialism that's often seen in the present India. Health is always the real wealth and, along with education, is the corner stone for a long-lasting sustainable development.

Examining India's health sector, government expenditure in the sector amounted to 1.15 per cent of GDP and overall expenditure was 4.02 per cent in the year of 2013–14. This is dismal as compared to other countries with less GDP per capita, like Vietnam which spends 14.2 per cent or Nicaragua's 24 per cent. This may be extrapolated to the country's performance in healthcare access and quality index, life expectancy at birth, infant mortality rate (IMR) or maternal mortality rate (MMR). For instance, IMR for the year of 2015 was 37 in India, whereas it was 11 and 10 for Vietnam and Nicaragua respectively. Household out-of-pocket health spending was 69.1 per cent of total health expenditures, making it a major issue in alleviating poverty. There exists significant disparity among Indian states, rural and urban areas, socioeconomic groups, religions, castes and genders in terms of healthcare access. Children in rural areas are about 1.6 times more likely to die before their first birthday and 1.9 times more likely to die before their fifth birthday in comparison to their urban counterparts. Individuals from impoverished backgrounds face similar disparity with ageing making the disparity more apparent. Individuals from scheduled castes and tribes had poorer self-rated health and higher rate of disability as compared to individuals from less impoverished background.

The constitution of India guarantees the ‘right to life’ as a fundamental right and makes the ‘right to health’ an obligation for the government. But to label it as solely the responsibility of the government is in disregard to the ways Gandhiji had taught us to live. Health is a choice in a continuum and the result is from collective decisions on your lifestyle, environment, thought and spirituality, not merely what you may derive from a health care provider. Gandhiji had a view that modern medicine was the bane of man and was used to circumvent our own shortfalls of lifestyle. When our body tells us our ways of life have been corrupted, we resort to the shortcut of medicines and do not face the need for lifestyle changes.

He believed in his eleven vows, namely ‘Non-violence, Truth, Control over Palate (taste), Celibacy, Physical work, Non-stealing, Non-possession, Fearlessness, Removal of caste barrier, Equality in religion, Swadeshi or self-reliance.’ These eleven vows are aimed at transforming the individual from a root level, which would inflict on him personality changes that would lead to a holistic development, both for the individual and the nation as a whole. Much of these eleven vows will be examined here, and analyzed in the context of our health system, if not endorsed wholly.

One of the most popular books to be authored by Gandhiji is Key to Health. His idea of one's health is body to ease. World Health Organization (WHO), in the preamble to its constitution, defines health as a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity. It has been further amplified to include the ability to lead a socially and economically productive life. Gandhiji's teaching insists on one having a knowledge of one's self and body to lead a healthy life. He states that the human body is composed of five elements, which ancient philosophers have described as Earth, Water, Light, Air, and Vacancy or Ether. He believed in nature's ability to heal and the body's power in regaining its composure. But the interplay of the above said elements is an absolute necessity in paving the way. Breathing exercises for those who can’t breathe, cleaning nostrils, sleeping under the sky, hydrotherapy, sun baths and mud poultices are all Gandhiji's advice on improving health. But unfortunately we have polluted our earth, water and air, have harmed Ether which helps to maintain and regain health. In recent years, it has been nearly impossible to live in majority of Indian cities, which have been consistently named as some of the most polluted cities in the world. The impact of this level of pollution will be a major health and economic crisis for India in the coming years.

Dr. Sushila Nayyar, Kasturba and Mahatma Gandhi and Sardar Vallabhbhai Patel (centre; from left) in a prayer meeting while visiting epidemic-stricken villages in Gujarat, 1940.

Gandhiji was not a man with materialistic urges. He observed brahmacharya and stated that it leads to a healthy life. Practising self-restraint of the senses and keeping control of thoughts and actions are paramount in having a healthy life. Brahmacharya is very often wrongly attributed to just sexual abstinence, but it was linked inseparably to truth and non-violence by Mahatma Gandhi. It was also the basis for his disinterest in worldly pleasures. This needs to be addressed in the present Indian scenario of lifestyle epidemics. On one hand, we have 20 per cent of children under five years suffering from wasting due to undernutrition, whereas on the other hand we have children who are overweight or obese. Somewhere between 5.74 and 8.82 per cent of school children in India are obese. The consequences of this are earlier puberty and menarchy in girls, type 2 diabetes mellitus, and increased incidents of the metabolic syndrome in youth and adults and obesity in adulthood. These changes are associated with various malignancies, cardiovascular and cerebrovascular diseases. It has to be understood that higher socio-economic status is not the reason for obesity/overweight. In a study among the urban slum dwelling daily wage laborers, prevalence of obesity was found to be high. It was found that distorted ideals and current body image percepts were significant risk factor for their obesity. As Gandhiji said, “Everything in the world can be used and abused and it applies to our body too. We abuse it when we use it for selfish purposes, to harm our body. It is put to right use if we exercise self-restraint and dedicate ourselves to the service of the whole world.” Gandhiji favoured vegetarianism over a mixed or non-vegetarian diet. He states the importance of milk, cereals, pulses, fruits, vegetables, fat and the need to keep a balanced proportion of them in the diet. Also to be read in this context is “one must not live in order to eat and drink and be merry, but eat and drink in order to make bodies temples of God and to use them for the service of man.”

Mahatma Gandhi addressing a meeting of the villagers at Vera village in the plague effected area, May 1935. From left: Manibehn Patel, Kasturba Gandhi, Mahatma Gandhi, Sardar Vallabhbhai Patel and Mahadev Desai.

Drugs, drinks and smoking cigarettes were among the other things he advised against. He said, “Drugs and drinks are the two arms of the devil with which he strikes his helpless slaves into stupefaction and intoxication.” He gave various reasons for drinking and smoking during his period such as imitating the rich, addiction formed during medicinal use, to get assistance from whites during British rule, environment and social disorganization, easy availability of it, etc. The effects lead to financial loss as well as moral loss. Gandhiji pointed various ill-effects of smoking like impaired eye-sight, problems in digestion, etc. Gandhiji further implied that “if every smoker stopped the dirty habit of making his mouth a chimney to foul breath by making a present of his savings to some national cause, he would benefit both himself and the nation.” But 150 years down the line, the prevalence of alcohol and smoking among Indians is still high. Smoking prevalence was as high as 71.8 per cent in men and 41.1 per cent in women among elderly population of the rural areas. Regular alcohol intake was seen in 16.3 per cent of the men compared with 0.8 per cent of the women. It has also caused an increase in lifestyle diseases and malignancies, including lung and oral cancers. This spread of addiction is also because of its increased availability. As manufacturing and sales have been a major revenue for the government, it has shown a blind eye to its wide prevalence. Tactics of putting precautionary image and warnings on boxes are no longer having the desired effect. What we need are regulations on manufacturing and distribution even though it may result in revenue fall for the government. The country may take the path of states like Gujarat and Bihar in the liquor ban, but care should be taken in educating people and creating awareness about illicit liquor. One other solace is that some reports have suggested a decreasing prevalence of urban smokers, but with an increase in prevalence of smoking among women.

One of the most important reason for illness in India is the defective and harmful method of defecation. Unhygienic toilets and defecating in open leads to major diseases. He stressed the importance of maintaining personal hygiene and making surroundings clean. He had then wanted us to imitate western countries regarding cleanliness. Ever since he established a community in Phoenix, South Africa, he made the cleaning of the campus a common activity for everyone. He advised every person to become a bhanghi, i.e., a sweeper to maintain cleanliness and he himself practised this. In Phoenix, the job of cleaning toilets, considered to be the dirtiest job, was taken up voluntarily by Gandhiji himself until it became a natural part of the whole process of sanitation. He conducted experiments in Sevagram with different type of latrines to make the cleaning process free of offensive smell and to use them as night soil for fertilizing farms. This made the process hygienic, economically productive as well socially important. Cleaning toilet was the allotted task to newcomers at the Ashram to test their willingness to change their lifestyle and also as an act of initiation in the Ashram way of living.

Mental health and disorders are another area of concern in India. WHO estimates that the burden of mental health problems is in the tune of 2,443 per 100,000 population and age-adjusted suicide rate per 100,000 population is 21.1. Determinants of mental health are not just the ability to manage one's thoughts, emotions, behaviours and interactions with others, but also national policies, social protection, living standards, working conditions and community social support. Specific psychological and personality factors also contribute towards the vulnerability. Mahatma Gandhi was included by Agnes Maude Royden, a preacher and suffragist, in a series of her addresses on ‘Makers of Modern Thought’. In Gandhi can be found an integration of life. If his beliefs in spirituality, better social integration, endless love for other living beings, non-violence, truth and moral values, were to be followed, it would have a significant impact on mental health of individuals.

Mahatma Gandhi with Kasturba, Sardar Vallabhbhai Patel and others during his visit to the plague affected villages in Borsad, Gujarat, May 1935.

India has so far made significant progress by taking some guidance from Gandhian views. India's health sector has been shaped by its federal structure and the federal-state divisions of responsibilities and financing. The central government is responsible for international health treaties, medical education, prevention of food adulteration, quality control in drug manufacturing, national disease control and family planning programs. States organize and implement these health services and deliver to its residents. Gandhiji believed that the ‘future of India lies in its villages’, and so would its health. India has effectively implemented the National Rural Health Mission (NRHM) by recognizing the importance of health in the process of social and economic development and to improve the quality of life of its citizens. This was further strengthened by creating the cadre of Accredited Social Health Activists (ASHA), resident women in the villages who have received formal education, and have communication and leadership skills. Gandhiji would also have endorsed the idea of women for this work, as he thought they were naturally assigned superior power and strength.

Initiatives such as Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH +A) programme and Integrated Child Development Services (ICDS) programme are aimed at reducing IMR, MMR, and improving family planning rates, child and maternal nutrition. The Rashtriya Swasthya Bima Yojana (RSBY), for providing insurance coverage to BPL families, has been increasingly subscribed to by the people. Despite various schemes, only less than 20 per cent of the population was covered by any form of health coverage making health expenses a major issue. Gandhiji may not have endorsed the idea of handing over healthcare to the private sector as it would have only further exacerbated the existing disparity of health-care access among people of different socio-economic strata.

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was implemented at the realization of the brunt of chronic non-communicable diseases and cancer in India. It has been focusing more on providing preventive and control measures, but implementing Gandhian ideas gives it an impetus in guiding the population through a healthy lifestyle.

The resilience of Gandhiji's mind and his unshakable faith in his beliefs has made him one of the greatest individuals to have walked in flesh and blood on this earth. His way of living is a guide for many of us to move towards a healthy life. But as he has taught us, health implies all aspects of life and not just physical health.

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