Forty six years ago, Pakistan had its first general election. The results are well known as are the ultimate consequences. But at least as far as what is now Pakistan, the party that came to power had a simple and attractive slogan: ‘roti, kapra aur makaan’ (food, clothing and shelter). Basically what happened was that for the first time in the history of Pakistan a political party and its leader stated that food, clothing and shelter were basic requirements that people deserved as a right.

Today besides the rights mentioned above and quite a few others, we now also include education and healthcare as basic rights. It is indeed interesting that in 1970 at the time of the general election, Pakistan People’s Party did not include universal education or universal healthcare in its political agenda. And most socialist/leftists would not have considered the need for education or healthcare as important issues.

Education has become more important as traditional stratification of society has evolved and professions are no longer inherited. But healthcare is different and in an interesting way, as the educational level of any given society improves, the need for healthcare also goes up. Here by education I mean availability of information and not just schooling.

Fifty years ago, medicine compared to what it is today was quite primitive. Healthcare can be divided into three basic aspects. Prevention, basic healthcare and advanced healthcare. Fifty years ago, prevention and basic healthcare were emphasised in most countries but especially in places like Pakistan. Even today if prevention and basic healthcare does become available the overall burden of disease will become much less. And a healthy population at all age levels is also a major impetus to economic growth. Advanced or what today might be called ‘tertiary’ healthcare was not thought of as too important.

Preventive and basic healthcare can be provided by a general practitioner assisted by nurses, pharmacists and ‘lady health visitors’. Prevention of course starts with pre-natal (during pregnancy) maternal care and subsequent infant care. From that point onward we have childhood immunisation, dietary support especially with micronutrients (important vitamins and minerals added to regular food), provision of clean drinking water and regular health monitoring. Here education becomes important especially those of women. I have, in previous articles in this space, emphasised the importance of education for girls and women to assure a healthy household.

Based upon what I have said above, the most effective as well as the least expensive healthcare will be preventive and basic healthcare. That makes eminent sense but sadly it does not make political sense. Politicians want things that they can point to as achievements so that they can convince ordinary voters to vote for them again. So politicians want to spend money on big and high visibility projects. Big hospitals, new medical colleges, liver and kidney transplant centres, heart institutes, immunisation drives and other such ‘visible’ projects. Decreasing the number of women dying during childbirth or infants dying soon after birth are major healthcare goals but are difficult to point out as an achievement by a politician looking for votes.

As I wrote once, only half in jest, no chief minister of the Punjab, including the present one, wants to go down in history as the man who made sure that all the patient toilets in Mayo Hospital were cleaned regularly. And that is where elective politics and public healthcare clash. Preventive and primary medical facilities do not carry the panache that attracts press headlines and votes in an election. It is in this vein that Prime Minister Nawaz Sharif recently announced a decision to build fifty major hospitals all over the country. But where? Health after all is now a provincial matter so where are all these hospitals going to be built, In Islamabad?

Elections are coming up in the United States and these elections will have a major impact on healthcare in the US. Affordable Care Act also known as Obamacare could undergo major changes. Millions of people that obtained affordable healthcare insurance might lose it. That could have a negative impact on many aspects of healthcare that are presently improving.

As far as health insurance is concerned, our PM keeps talking of health insurance cards but no mention is made by him or his brother in the Punjab about improving the existing health system that can provide both access as well as essentially free basic healthcare for millions of Pakistanis.

Sadly, there is no coherent healthcare policy put forward by any of the three major political parties that govern three most populous provinces in the country. Pakistan Muslim League-Nawaz has governed the Punjab for more than eight years and after all this time the best we have heard as far as the public healthcare system is concerned is that some or much of it should be privatised. Herein lies a major dichotomy. A public healthcare system is designed to provide free or heavily subsidised healthcare to the proverbial ‘masses’. A private system on the other hand will expect some profit from their investment. Privatisation might yield improved service but at a cost that might be beyond the reach of an average Pakistani.

Medicine has advanced considerably over the last few decades but our politicians and bureaucrats are still living in a time that I have described from fifty years ago. Preventive medicine and basic healthcare are still relatively simple but diagnosis and treatment of most critical disease is now quite complicated and as a result quite expensive.

Based upon statistics available, coronary artery disease (heart attacks) is the most common cause of death in Pakistan. Today, unlike fifty years ago earlier, much can be done to prevent, diagnose and treat problems with blockages of the arteries of the heart. All these modalities are available in Pakistan but are expensive.

The moral as well as political question then is that while the PM can go off to a swanky London hospital to get his arteries fixed, what happens to the ordinary Pakistani who does not have the wherewithal to even get basic treatment in Pakistan. Do we just let this person die from the disease while we feed him or her platitudes and prayers?

The same is true of other major diseases. For instance Hepatitis C that presently infects almost twelve million Pakistanis is almost a curable disease but the medicine such a cure needs is extremely expensive. And a certain percentage of these patients will go on to a point where they will need the most expensive type of treatment available and that is a liver transplant. Building a liver transplant centre is not enough; this centre has to be adequately staffed and financed.

I have just dealt with two common diseases that can be fatal if not treated. So what should be done? The next general election will soon be upon us and it is time that like the US, healthcare should get the importance it deserves as a political issue.