Bad health of people has begun to hit Indian economy

Why is the link between public health and pro-business policies not garnering the forceful attention of civil society?
First there should be recognition that our public policies are promoting, and even subsidising, major risk factors of non-communicable diseases, be they tobacco or ultra processed food. Our urban transport policies discourage cycling and walking, while actively encouraging  motorisation, increasing physical inactivity. We need sustained advocacy campaigns to reverse all such policies. Besides individuals modifying their lifestyles, focus on changes at the societal level are needed. It’s a long haul, but we should begin right away.

Your book highlights various state departments contradicting the health ministry. Sectors that generate jobs and exports are favoured despite impacting health. What can the health ministry do?
It is a misconception that health-promoting policies are automatically anti-business or anti-industry and could hit jobs. It’s the other way round. Bad health of people has begun to hit Indian economy. Diabetes and heart disease are affecting Indians in their most productive age groups, and causing a huge loss to the national economy due to illness, loss of livelihood and productivity besides cost of treatment and lifelong medication. The health ministry should sensitise others in the government to facilitate necessary policy changes. Since lifestyle diseases are multi-factorial, the approach to tackle them will also need to be multi-sectoral.

You also mention that health education is not as sustainable compared to macro-policy changes. Why is that so?
I am not undermining the role of health education at all. People should be motivated to remain active, avoid tobacco and eat healthy food. But people can’t act on isolated educational messages in an environment brimming with celebrity endorsements for colas, pre-cooked food and surrogate advertising for tobacco. The World Health Organisation recommends five servings of vegetables and fruits every day. How can people follow this advisory when a pair of bananas is costlier than a packet of potato chips; and this is so due to our skewed policies. We are seeing green shoots of change though. The Maharashtra government is promote fruits and has enlisted Amitabh Bachchan to endorse the campaign.

The budget accepted the health minister's advocacy of higher duties on cigarettes. Was tobacco just the low-hanging fruit that the health ministry could conveniently attack?
Tobacco is certainly high on the health ministry’s agenda and rightly so. But tobacco is deeply entrenched in Indian politics. The health ministry has yet not progressed beyond higher duties and health warnings. If tobacco is a killer, why should the Government of India run a Directorate of Tobacco Development, fund research into new varieties of tobacco and give awards to top cigarette and gutkha makers using taxpayers’ money? The government must stop subsidising tobacco altogether. In fact, research should be funded on rehabilitating tobacco farmers and bidi workers, and not use them as an excuse to avoid tough anti-tobacco measures.

Your book recalls an earlier way of life where we relied more on cereals and walked longer distances. What is the way ahead?
By no means am I advocating a return to the good old days or arguing against economic liberalisation. I have described the changes in our diets, our food environment and built environment in the past 25 years. This is only to analyse reasons behind the upsurge in non-communicable disease and to emphasise that additional care is needed to remain healthy and physically active. The government must create a health-promoting environment in which people can make healthy choices. Food is a basic human necessity and an essential part of one’s culture. Profit-making food companies can’t be allowed to take control of kitchens to the extent that our culinary skills are reduced to using a microwave oven and fridge.