Making healthcare fun: Role of online games

School and learning always had unpredictable effects on me as a child. Subjects, such as languages, geography and civics induced fits of yawning, while others like algebra, geometry and trigonometry induced fear and loathing. I sought out classmates who suffered similar trepidations and looked for collective comfort in each others tales of woe! So, imagine my surprise when I recently met an old ‘partner in crime’, who, I incredulously learnt, went on to get a PhD in streams as terrifying as economics and finance from a US university! Worse still, he actually taught the subjects in one such university and thoroughly enjoyed doing that! I was intrigued! My curiosity to know what changed over the years, began, what in a few minutes, turned out to be a very fascinating conversation.


Teachers have worked hard to get children and young adults interested in “boring subjects” such as personal finance. The challenge is how to do so without boring or confusing them with lectures about compound interest. Now there's a growing effort to reach and teach young people [people in an impressionable age] on their own turf: online games. More than 70% of people play some form of game, and that percentage is far higher among teens. Gaming experts see this as an opportunity to package critical lessons into an activity that people enjoy. Games, of course, won't replace other methods of teaching, but they might go a long way toward bringing to life subjects such as finance, personal health and hygiene. These and other such issues are boring to the average youngster, but the value of inculcating valuable information on these topics cannot be overstated.

Games already have been used successfully for training in many areas. Games and simulations are used to train pilots, brief commando teams about enemy terrain, simulate complicated surgical procedures and even educate truck drivers about how to decrease fuel consumption and accidents. The best thing about gaming is that you are in a fantasy world. You can decide to do things that you wouldn't do in real life and see what the consequences are without having to experience the pain.

It's too soon to know if finances can be taught through games, yet early results are promising. Teachers have used games such as Stagecoach Island, Celebrity Calamity and The Great Piggy Bank Adventure to complement other teaching methods to help students understand principles of finance that include setting goals, saving and spending wisely, the impact of inflation, asset allocation and diversification.

Games and online simulation have a role in the healthcare education and awareness space as well. Health games and virtual worlds bear the potential to improve education, provide greater engagement, and engender positive behavior to enhance health and wellness. Games can be a fun and innovative way to reach new audiences with pertinent and targeted health messages.

Take for instance, an online game, called Pos or Not, which aims to increase HIV/AIDS education and awareness. The website, posornot.com, shows photographs and short biographies of men and women ages 21 to 30, asking visitors to determine if each is HIV-positive or negative. During the game, HIV-positive participants share when they first learned their HIV status, and HIV-negative participants talk about how they have been affected by the disease. The game also provides information about HIV prevention, as well as local HIV and sexually transmitted infection resources from CDC. The message is that you can't judge someone's virus status by looks, occupation or taste in music.

Healthcare games hold huge potential for the pharmaceutical industry, by both engaging consumers and improving health and brand outcomes—all that in an interactive electronic format that will be an important part of consumers’ lives for many years.

Particle Marketing in Pharmaceutical Sales

More often than not, marketing strategy focuses on two broad areas: (i) raising willingness to pay (ii) lowering costs to create a sustainable purchase proposition. Both these areas focus on strengthening the customers’ concept of value for money when [s]he rationalizes the purchase. In pharmaceutical selling, where the person who chooses the brand [doctor/pharmacist] is not the one who finally consumes it [patient], marketers must help to improve the current expertise (effectiveness) and/or require the development of new knowledge and skills (efficiency) of the sales force. The product information and relevant service that the sales force provides, in the very limited time that the doctor/pharmacist allows for, determines the brand which is finally prescribed. This is a variable that slightly complicates the equation, and solving for this variable is the most important part which decides if the strategy is the right solution that fits market and customer requirement.

There is one more important area that needs to be factored in and that is the execution capability of the sales force. For this to happen effectively sales managers must ensure that the sales force has the right market orientation. This allows them to combine the two broad strategic areas discussed above and distill out effective selling strategies from the broad marketing strategy. By providing a unifying frame of reference focused on customer [and sales] goals, sales managers facilitate market information flow to ‘sanitize’ the strategy process. The sales force thus integrates the two activities by serving as a dynamic market-to-company linking interface.

The sales force is undeniably one of the largest costs for a pharmaceutical company. However, in tough economic times, for many large pharma companies, efficiency and effectiveness is clearly not delivering return on investment. How do I know this? Just take a look at the number of sales jobs being cut by companies around the world! While cuts may be justified based on the 80:20 rule (i.e. 20% of the sales force give companies 80% of results), it is important that sales leaders focus on the basics, not just to deliver optimum results, but to adapt selling techniques to the evolving market place.

Segmentation and Targeting

Lets start at the very beginning. Be it a marketing campaign that is about to be rolled out or a new product about to be launched. The first thing that a marketer would like to know is if the sales force knows which doctors to target. One common practice I noticed in every company I have worked with, so far, is that almost all doctor lists seem the same for all brands! Another practice is that we assume that all high-prescribing/potential doctors in the targeted therapy area should be our targets. They are all our “KOLs” or Key Opinion Leaders, pharma jargon for doctors with influence to advocate pharma products to other doctors or people who can influence the purchase of a pharma product.

One reason could be that most reps target doctors on presumption and there’s no real data to substantiate those presumptions. Maybe headquarters doesn’t think that its important to buy targeting data since there’s no way of ensuring reliability. So it’s no surprise it’s all the same. But does it make sense to assume that because physicians prescribe a lot of drugs in our targeted therapy area, they will be a perfect target for our sales force and respond as we wish (i.e. increase their prescribing of our brands)?

Delivering key messages

In so many marketing programs and new product launches, we see that the message delivery is out of focus. Yes, it differentiates the product, but often it is not based on what is driving prescribing. Differentiation is required, but if it’s not driving prescribing then it’s the wrong focus. For example, you might focus on the fact that your brand has a novel drug delivery system that offers better bioequivalence and therapeutic efficacy. That’s definitely differentiating! However, is it driving prescribing? Also, every brand [in a generics dominated market like India] may not have such novel differentiators. The marketer must equip the sales force to segment non-prescribers and high prescribers of a product, and ensure that they both equally get key product message … prescribers or otherwise. Ensuring the right message to the right customer in the right frequency and through the right channel is the most cost-effective way of moving the non-prescribers to prescribers. Sales managers must focus their teams energy and effort to deliver key prescription driver messages to the customers at the right frequency.

Multiple product detailing

Sales managers often argue that sales effectiveness diminishes when reps are required to detail on more than two or three products. But is this actually true? In many complex sales industries (e.g. high tech, etc.), professional salespeople sell a wide range of highly specialized products and services. Why do we assume that pharma sales reps are unable to do so? In fact, if we restrict the number of products the rep can detail, they may not be able to offer physicians the product mix that best suits their individual needs. Also, marketers must calculate the cost advantage of multiple products and one rep.

Customers respond differently to different kinds of sales and marketing based on a host of psychographic and demographic factors. Clearly, volume-based targeting and segmentation does not take into account other types of key differences in physicians that can often make a large difference to our results. To improve targeting, rather than target the same doctors as competitors, pharma marketers must get smarter. Therefore, “particle marketing”. The market is no longer one big homogenous group of people but smaller and smaller “particles” or individual customers. Pharma marketing is moving towards mass customization – an ability to create customized solutions for a large number of customers. There is an opportunity to use analytics to look at different groups of physicians segmented on a host of key variables and understand drivers based on sub-groups of physicians? This will show what the levers are within each sub-group that would convince them to change their prescribing behavior and help develop customized messaging.

The Importance of Training in Healthcare

From the interactivity – or the lack of it – on this blog I wondered if perhaps a problem with writing a blog is that my message may be reaching entirely the wrong audience. A couple of weeks ago, a friend who works with IBM LifeSciences asked me to address his sales group on how I thought the healthcare market was shaping in India and to help them understand how IBM, in India, could engage with healthcare service providers to develop technology solutions for their pressing problems. This was my first interaction with professionals outside the pharmaceutical sales and marketing arena and I must say, it was very stimulating!


After that, I wondered why pharmaceutical sales reps don’t think like the IBM folks and ask questions like them. After all, the objectives are the same. Of course, pharma reps don’t deal with all stakeholders across the healthcare delivery value chain – meaning hospital administrators, supply chain agents, patients and caregivers – and focus only on doctors, treating them as sole decision makers in healthcare delivery. And therein, I thought lay the problem.

Pharma reps undergo company training programs that are quite basic in nature. These deal with disease pathology and basic science, teach them how the products [that they’re supposed to sell] help to control or cure those diseases, how the products are positioned, make them conversational with the marketing support programs and brush up their conversational skills. What these training programs lack is a futuristic view on healthcare delivery. They hardly even cover the healthcare delivery value chain, choosing to focus only on the company’s product portfolio instead. A survey recently found that doctors spend only 8% of their typical working day interacting with pharma reps. Considering that Indian clinicians hardly utilize other sources of information to update their knowledge, this is paltry! But can one blame them when one looks at the value of information provided by the pharma rep? Training therefore, plays an extremely important role in shaping clinicians’ views of a pharmaceutical company and its products.

Training and re-training is a big issue, not just in India but around the world. From a clinician’s perspective, medical schools don't teach them about technology - they teach them about stethoscopes, ECGs and X-rays, but that's about it! So, clinicians need on-the-job training to bring them up to speed. But that doesn't go far enough. Training needs to start in the medical schools and nursing colleges. Courses such as Health Informatics should be a continuous stream throughout medical schools so that medical students learn how to apply technology in a variety of contexts and environments that they will work in the future. Now... just think. If doctors and clinicians are "behind", and they're in the industry, imagine the actual technical knowledge of the average patient! And, the patient pays the bills. Doesn’t it sound like they need to be trained as well?

Why Can't I Win The 2010 Nobel Peace Prize

The news that “both surprised and humbled” the free world late last week, was that its leader, Barack Husein Obama, won the 2009 Nobel Peace Prize. That this was not an ordinary announcement was seen from wide ranging reactions across the world over the weekend. The mood was best captured by Lech Walesa, the 1983 Peace Prize winner and Poland’s president from 1990 to 1995, who told reporters in Warsaw: “Who, Obama? So fast? Too fast—he hasn’t had the time to do anything yet.”

According to the committee “Obama has as president created a new climate in international politics.” Surprising! Given that he had assumed office only two weeks before the Feb. 1 deadline for nominations. When asked whether the award was, perhaps, premature, Norwegian Nobel Committee Chairman Thorbjorn Jagland compared Mr. Obama to Mikhail Gorbachev, whose reforms had also not borne fruit when they had received the prize. “The question we have to ask is who has done the most in the previous year to enhance peace in the world,” Jagland said. “And who has done more than Barack Obama?”

There is enough in the public domain on what Mr. Obama did or didn’t do – at least not yet! But let’s take Mr. Gorbachev’s example. I am not an expert on anything – and definitely not anything Russian, so don’t take my word for it. 20 years after Mr. Gorbachev won the Prize, none other than President Dmitry Medvedev, in his article, Go Russia!, published on the government’s official website on September 10, 2009 asked of the Russian people, “First, let’s answer a simple but very serious question. Should a primitive economy based on raw materials and endemic corruption accompany us into the future?...And if Russia can not relieve itself from these burdens, can it really find its own path for the future?”

Mikhail Gorbachev won the Prize for his work in ending Cold War tensions. Since coming to power in 1988, Gorbachev had undertaken to concentrate more effort and funds on his domestic reform plans by going to extraordinary lengths to reach foreign policy understandings with the noncommunist world.

Some of his accomplishments include

(i) Hope: Four summits with President Ronald Reagan, including a 1987 meeting at which an agreement was reached to dismantle the U.S. and USSR intermediate-range missiles in Europe.

Result: The missile systems in Europe are still present and were recently upgraded. The threat perception remains the same but the focus nonetheless has moved from Russia to Iran in the current scheme of things there.

(ii) Hope: Removal of Soviet troops from Afghanistan in 1988 and exerted diplomatic pressure on Cuba and Vietnam to remove their forces from Angola and Kampuchea (Cambodia), respectively.

Result: While Soviet troops moved out of Afghanistan, the world moved towards unipolarity and American foreign policy stretched its security requirement in almost every country including South America (minus Brazil, Argentina, and Chile), most of Africa, the Middle East, and Central Asia.

(iii) Hope: In a 1989 meeting with President George Bush, Gorbachev declared that the Cold War was over.

Result- Although not attributable to him, global security worsened after the end of the Cold War – not his fault.

Mikhail Gorbachev's dramatic policy initiatives transformed the Soviet Union and reshaped the world. But while international leaders hailed him as a hero, his own country was teetering on the brink of disintegration and his political standing hit rock bottom. For the average Soviet citizen, the country's administrative paralysis and economic disorder overshadowed the remarkable scope of the changes triggered by Gorbachev since he came to power.

So you see, good intentions are what Mr. Gorbachev had and now, so does Mr. Obama. Applying Chairman Jagland’s logic, it is safe to assume that Mr. Gorbachev won the Prize because before him there was no Soviet leader who even hoped to create a path out of the chaos created by the Cold War for ordinary citizens of the erstwhile USSR. Mr. Gorbachev did at least that much and hoped to do much more and for that he was rewarded. But did his hopes render fruition? Russia is still reeling under chaos. Could it have been worse? Probably.

As regards Mr. Obama, why did the Norwegian committee award him the Prize, only nine months into his presidency? The committee cited Mr. Obama's efforts at (i) nuclear nonproliferation (ii) his outreach to the Muslim world, and (iii) emphasis on multilateralism.

Lets see the progress that Mr. Obama has achieved so far.

(i) Hope: Nuclear non-proliferation

Result: Iran is a case in point. Despite the President's pledge to limit Iran's nuclear capability Tehran continues to produce uranium. Radical Islamists in Af-Pak seem dangerously close to gaining access to Pakistani nuclear capabilities and North Korea thumbs its nose at the White House every other week.

(ii) Hope: Reaching out to the Muslim world

Result: Accomplishment on the Israeli- Palestinian front? Nothing. The Israelis continue to fortify settlements while the US looks the other way. The U.S. is fanning the same hostility that Mr. Obama hoped to eliminate in his Cairo speech.

(iii) Hope: Emphasis on multilateralism

Result: In the Mideast peace plan Mr. Obama's has lost a considerable amount of support from the Arab world. He did expand the G-8 to include emerging economies at the big table, but its still symbolic. At the UN, there was no consensus on global red flag issues such as climate change, financial security and pulling up rogue nations to address terror. Gestures were at best symbolic such as promising emerging economies voting rights to control IMF, more say at the global climate change forum etc.

Of course, one cannot solely blame the President for these failures. No leader, however transformational on the global stage, would be able to successfully complete all idealistic objectives in such a short period of time. Yet, although he still enjoys incredible global popularity, people around the world seem to increasingly believe that his “audacity of hope” will not live up to his “yes we can” rhetoric.

Yet he is the 2009 Nobel Peace Prize winner. And why is that? Because we don’t know if there is anyone else who is better! And that gives us hope! Dispassionately analyzed, President Obama seems to have won the coveted Nobel Prize based on trying to create a world where Palestinians would be listened to, Muslims across the world would no longer need to worry about American military might and the Guantanamo Bay prison would shut down. Iran would shut its nuclear shop and not threaten Middle Eastern peace, allied troops would exit Iraq and Afghanistan, the Taliban would be destroyed, Pakistan would no longer create and export terror and North Koreans would get food to eat and be allowed to see their friends and family from the South. Not to mention that his own American people would have jobs and money and healthcare would be cheaper and more accessible to them. He seems to have come a long way from the time when Hillary Clinton, then his opponent in the race for Presidential nomination, had quipped that the White House was not a place to “learn on the job”!

Along with Mr. Gorbachev and Mr. Obama, there is one more person who is a contender for the Peace Prize – me! Lets see why.

(i) Hope: Environmentally conscious:
Result: I do it everyday!! I save energy by pooling cars and saving fuel, switching off lights and fans and saving electricity, limiting A/C usage to 6 hours only at 25 deg C. I do not print out every mail I receive, recycle paper, donate to environmental charities and patronize products of environmentally conscious companies. I hope to influence others to do it too...someday! Maybe winning the Prize will help popularize this hope.
(ii) Hope: Give back to society
Result: Popularizing micro-financing through a blog [that no one reads], providing ideas on how the National Rural Health Mission can be run better and hope to execute projects that help every human being in the world gains access to personalized medicines one day in the not so distant future – yes even the poor Americans who’s government spends 16% of its massive GDP and yet cannot ensure affordable healthcare for them!

(iii) Hope: Normal Indian
Result: Want the Delhi Games to happen, feel ashamed when people “mark their territories” publicly [paan ka peek or susu on the sidewalk], have plans on how to rid the country of corruption, elect citizen representatives and make life in general better for my family and those of others and do not care if its Bombay or Mumbai

Since its accepted that the “audacity of hope” determines the Prize winner and not the results thereof, then why shouldn’t I win the Prize for 2010? I admit I haven't brought in waves of change like other nominees such as Silvio Berlusconi or Michael Jackson or Ben Kingsley - but in keeping with the theme - I hope to!

Climate Change and Healthcare

The floods in south India that killed at least 350 people and made millions homeless are a result of climate change. Who had imagined that there would be floods in the dry and arid southern Indian district of Kurnool, that too in October? Climate change seems to have been the cause of a series of disasters in Asia in recent weeks - floods in India and typhoons in the Philippines, Vietnam, Cambodia Thailand and most recently in Japan. Interestingly, last month, world leaders met for a one-day global summit on climate change at the UN Sessions ahead of the G-20 meeting in America. This was a precursor to the major climate summit in Copenhagen scheduled in December to update the 1997 Kyoto Protocol. As it stands, China has overtaken the United States as top emitter of greenhouse gases that cause rising sea levels, droughts, wildfires, spread diseases and cause powerful cyclones. And yet, the world is still split over how to divide the burden of cuts in greenhouse gases between rich and poor nations.

The debate about whether global environmental change is real is now over. The recent happenings bring in the realization that it is happening more rapidly than predicted. What we probably do not realize or provide serious consideration to, is that, these changes can constitute a strong challenge to our health, both directly, and indirectly by promoting other risks as well. Do healthcare providers have a role to inform themselves about these issues and to become agents of change in their communities?

A study published in the Environmental Health Perspectives Volume 114, Number 12, December 2006, lists the impact of global climate change on health. These include the direct effect of heat (in 2003 in Europe, over 37,000 deaths were directly attributable to an historically unprecedented heat wave); influences on severe weather, flooding, and drought; worsened cardiovascular and pulmonary ailments due to heat; the influence of heat on air pollution; threats to food production and different [atypical] types of diseases that spread through insect bite [such as malaria] and waterborne disease transmission. An article in Pharmaceutical Technology, Sep2008, Vol. 32 Issue 9, p114-113 talks of an unmet need for a malaria vaccine for the modern world. Something that Bill Gates famously called "the forgotten disease".

This is the most worrisome part. What healthcare providers should worry about is that climate changes can result in more indirect, complex, and atypical causes of disease that are today considered “conquered” in the modern world. This is similar to something that one sees during war or social conflict. Both are undoubtedly to blame for deaths, but not just because they "cause" death, but because these phenomena fundamentally alter the social conditions of life in ways that create new and lethal risks to mental and physical health and human life. Furthermore, as climate change causes the ecosystem to degrade over time, this can cause greater difficulties with food production as seen in the global food crisis, which in turn increases violence and conflict - a cascading cycle of environmental change, scarcity, conflict, social disruption, and death.

The healthcare industry, through clinicians/doctors, pharmaceutical companies, hospitals, the distribution chain, counselors and awareness agents, amongst others, can play a vital role to educate patients and their communities on the connections between unsustainable behavior and global environmental changes that threaten their health and security. The industry must actively educate healthcare providers about these issues and help clinicians practice behavior change with their patients. In addition industry lobbies, hospitals and medical associations can come together adding their voices to this issue with the government. But then, do healthcare industry bodies consider this an important issue to support or one that is within their purview of influence?

Companies do consider the impact on the environment in most aspects of their activities, such as R&D, production, distribution, marketing, procurement and administration, and make the best efforts to conserve and improve the environment. But, there are some simple steps that the industry can activate easily by taking a leaf out of what others in varied sectors do, such as the development of environmental-labeling of products, utilizing options for choosing environmentally sustainable packing material, products and services etc. Even if they do it, not much of it is talked about causing very little to be known and learnt by clinicians who can subsequently influence the people they treat. An interesting idea on how companies can provide tangible evidence of being environmentally conscious is provided here.

While politicians and business leaders delay, or eternally debate and search for solutions that require minimum sacrifice and impact on economic growth, clinicians and other healthcare service providers must think rigorously about what can be done now.

Pooling “Know-How” Can Create Access to Medicines and Healthcare

Médecins Sans Frontières (MSF), an international humanitarian organization called upon Big Pharma to pool their HIV patents to enable quick transfer of know-how to manufacture and increase access to cheaper and more effective medicines for the deadly disease that affects millions around the world. This is a much needed step towards collaboration that can lead to progressive percolation of health services and essential medicines to the poor and needy than ever before.

The Indian healthcare scenario has a paradox. On one hand by 2015, India is expected to rank among the top 10 global pharmaceutical markets. According to research, the industry is growing at around twice the country’s GDP growth. Yet, according to Save the Children, despite a decade of rapid economic growth, India’s record on something as basic as child mortality at 72 per 1,000 live births is worse than that of neighboring Bangladesh, one of the poorest countries in the world. However, what is shocking is that despite having more neonatologists and neo-natal intensive care beds per person than Australia, Canada and the United Kingdom, the United States has the second worst newborn mortality rate in the developed world, according to the report. While it is obvious that the economic boom being experienced by India has been unable to control a shocking rate of infant deaths among the country’s poorest, US statistics lead us to believe that it is not necessarily the country’s economic progress that is key to basic healthcare but effort made to ensure its distribution to the needy in the best manner possible.

A 2007 CII-McKinsey report estimated that outpatient care currently accounts for 61 per cent of private healthcare spending, of which maximum is on acute infections like fever, diarrhoea and gastrointestinal disease. This for a country that is expected to emerge as the third biggest economy in the world in the next two decades! The healthcare sector contribution to GDP and employment is significant and it is one of the largest service sectors of the economy. The report suggests that to meet the rising demand, India will need to invest in infrastructure and create cost-effective facilities. Approximately 80 per cent of the required investment should come from the private sector. The government's spending on healthcare is around 0.9 per cent of the total GDP, which limits the extent and effectiveness of the coverage it can provide. The US government spends 16% of its GDP on healthcare which is still very inefficient and called for recent reforms that are still under debate.

A study on the health system in India showed that a mother’s education/awareness had a high significance in all the three factors of maternal health care services. Another very important finding was that mother’s religions have significance (99 percent level of significance) with assistance during delivery and postnatal care services. The report highlights three areas that have the most influence on child well-being: female education, presence of a trained attendant at birth and use of family planning services. This again reinforces the need for the 4 As:

1. Awareness – people know about the facilities available

2. Access – people can afford those services

3. Availability – people get the services when they need them most

4. Applicability – people know how to reach the facilities/services and are not confused about which to use when.

When economic progress does not facilitate percolation of basic benefits to its needy, it’s the system and not the progress that needs to be re-looked at. It is the country’s economic progress that got it included into the elite Group of 20.Can this inclusion be an opportunity to change things? Can Prime Minister Singh redo his magic of the Indo-US nuclear deal? Can the governments of India and the United States come together to let information flow from the knowledge based research centers in the US, to the low cost research facilities in India so that medicines and services that are essential for the common good of at least two nations, if not many more, are addressed in a coming together of elite science and quality mass production? Economists have proven that loans from IMF/World Bank to countries is not necessarily linked to economic progress. Hence, a better option is to fund projects [private or state-run] that have accountability rather than provide blanket loans that are often diverted for political benefit than anything else [as in the case of Pakistan using US military aid]. Can world leaders encourage big lenders such as IMF and the World Bank to provide capital to private players to develop products and services through pooling technology and manufacturing capability in true humanitarian spirit? Royalties and revenue sharing models can be worked out to ensure that the model becomes sustainable. In this context, does the MSF call to Big Pharma teach us something?

Gandhian Economics and Healthcare

Mahatma Gandhi turned 140 today and his famous treatise Hind Swaraj, a document that contains his philosophy and ideas for India’s economic prosperity, will turn 100 this November. Throughout his life, Gandhi sought to develop ways to fight India's extreme poverty, backwardness and socio-economic challenges. What makes Gandhi's economic philosophy debatable in this era is that his ideas of Swadeshi and non-cooperation were centered on the principles of economic self-sufficiency. This proximity of his ideas to socialism has evoked criticism from this generation of free-market economics believers. But it is the spirit of his philosophy that is more important than the letter of it. Gandhian focus on human development is also seen as an effective emphasis on the eradication of poverty, social conflict and backwardness in developing nations, which are highly relevant areas of global interest today.

Prof. Amartya Sen’s Nobel Prize winning work on the Human Development Index helps one understands the causes of famine, of poverty, and of hunger. It is therefore, easy to apply the same principles to health care. Prof. Sen notes that during famines or food shortages, people are unable to buy food though it is available, because they cannot afford it. Similarly, though health services abound, millions of poor Indians, in both urban and rural settings, cannot afford them. Therefore, as Prof. Ratna Magotra, from K. E. M. Hospital, Mumbai notes, as market forces direct economic policy driving development, the role for private health services is underscored and holds an increasingly dominant position in emerging markets such as India, where equitable distribution of such essential services is still a major challenge.

As one who had an in-depth understanding of the Indian countryside, Gandhi felt that the key to the country's progress lay in the strengthening of the de-centralized, self-sufficient village economies. Although food is aplenty, most villages, even today, do not have adequate food to eat and live healthy lives. De-centralization and self sufficiency of the village economies would have helped distribute goods and services in a smooth manner. Poor distribution of health services is akin to the poor distribution of food. Healthcare providers offer services which the poor cannot afford to buy. This link between economics and health care is evident in both the developing and the developed world. Global red flag areas such as climate change and the global credit crisis is a by-product of‘ economic growth in a world obsessed with profit making and greed. Such waste plays havoc with the health of people in developing countries, as is seen in the recent typhoon in Philippines, drought leading to the global food crisis, and other pandemics and disasters across the world. With their low resistance to disease- because of poverty and malnourishment - the poor, especially women and children, are worst affected by this. The sustainability of our planet and its people is threatened today by issues including climate change, depletion of natural resources and disease which Gandhi foresaw over a 100 years ago!

This brings us to two features of the Mahatma’s thought are appreciable in their spirit. First, his advocating limitation of wants to take care of one's need and not greed. The second has to do with the idea of focusing on the well-being of the poorest and weakest member of society. It is time that healthcare providers allow this single Gandhian insight to drive the agenda of inclusive growth in the vast Indian subcontinent. This is an opportunity to bring in personalized medicines specifically for Indian patients. Costs can be tremendously lowered if R&D and production in facilities in India are used. Job creation opportunities abound. The government must open up the sector to let in private players.

Domestic players developing revolutionary technology and pouring in millions of dollars to develop products do so with western markets in mind that will pay top dollar. It is time the government works with them to encourage ‘reverse innovation’ that develops personalized medicine for Indian diseases like malaria and TB. These low cost, effective products, when suitably modified, can find large western markets where variations of such infectious diseases abound. Products such as effective hand washes, cough and cold medicines, broad spectrum anti-infectives, and treatments for common ailments for all age groups will find vast markets in all parts of the world because its not like the developed world doesn't have these problems at all! Thinking economists have already drawn attention to these anomalies when they question the efficiency of the US economy that uses 40 percent of the world’s resources to support six percent of the world’s population without any perceptible improvement in human happiness, well being, peace or culture.

Health issues that lie at this ‘lowest common denominator’ can be thoroughly analyzed to identify opportunities. Moving through the value chain, low cost diagnostic equipment [such as the hand held ECG machines and portable ultrasound devices] can address the issue of lack of technology and diagnostic facilities. Distance is another impediment between the deserving consumer and a healthcare service. If corporate hospital brands support start-up clinics by young doctors with infrastructure such as web/tele-medicine facilities and access to super-specialists, and with broadband reaching rural India, there is enough technology to cut through the distance and bring world-class healthcare to the hinterland.

The entry of private healthcare player can also help to foster technological invention in the area of sustainability. Working either with government centers for technical excellence such as IITs or other universities, outstanding inventors can be encouraged whose technological products or processes enhance development in human health and mitigate environmental impact on human health. These types of developments often positively impact the most vulnerable populations over the medium to long term.

A paradigm shift is necessary in the thinking of government and healthcare service providers alike. The government can no longer discuss growth rates, deficits and debts alone; they must talk of environmental costs, health care deficits and even happiness and human enrichment. Healthcare service providers, both public and private, similarly, need to shift their attention from disease and focus on the holistic health of people. This is relevant to Gandhi's theory of trusteeship. The thesis was that the capitalists would hold their wealth as trustees for the service of society. Trusteeship was thus to be thought of as a moral compact between the wealthy and society at large. This can be loosely equated to the ‘giving back to society’ initiatives by the have-alls.

This was an intrinsic part of Gandhi's moral view of the world. During India's struggle to gain independence from British rule, a reporter asked Mohandas Gandhi, "What do you think of Western civilization?" Gandhi replied, "I think it would be a very good idea." Gandhi's concern was not trivial; nor his philosophy irrelevant. One needs to address the question of the appropriate choice of technique when looking at applying it in today’s ravaged and inequitable world.