Congratulations, Dr Amartya Sen! You have done us proud. May God shower his choicest blessings on you. I am personally, specially, happy for you, not because you are an Indian, but because you got the Nobel Prize for your work on the economics of poverty; the subject so dear to my heart, as I have been dabbling in the health consequences of poverty for a very long time.



We should not drown ourselves in the parochial feeling that you are an Indian. All of us must rise above those narrow geographic limitations. Knowledge and wisdom do not belong to any creed, race, country, or even time. It is universal and perennial.



“Vasudai Aeva Kutumbikam”; this world is but one family, has been the motto of our ancient culture. Gurudev Tagore, your Ideal in life, also believed in the above concept. You are a citizen of the world as we all are. May your tribe increase! God loves those who love their fellowmen.



Be that as it may, my excitement about your getting the Nobel Prize is because you have touched upon that aspect of the world economy, which has been worrying me. The western model of economic development is primarily based on the profit motive, that too with the greater concern for the haves, without any consideration for the have-nots. Western economic wisdom is in dumping excess wheat in the Altantic or Pacific Ocean, while thousands of children starve to death in sub-Saharan Africa. To avoid any loss in the procurement prices of the wheat for the grower, the excess wheat is never given free, even to the dying poor.



Another aspect of your Nobel Prize that touches me is your humility in openly admitting that in any important new contribution to knowledge, in any sphere of human activity, many people share the joys and sorrows of the discovery, but only one or two get the credit. This is so in any award or prize, where competition remains the basis of selection. Competition deals with mediocrity, while excellence relates to competing with oneself for reaching higher level of expertise. You were so honest to admit that many others had contributed significantly to the area of new knowledge in economics, for which you had the good fortune of getting the Nobel Prize. Humility, thy name is education.



My concern, as a physician, concerns the lop sided economics of health care delivery in the world. While 80% of the world’s population does not have a contact with the so-called hi-tech medicine, remaining people enjoy one hundred per cent of the health care budget. Ironically, it is poverty that begets disease! Studies, even in the West, have shown that in the developed rich first world countries, every disease has an economic foundation. For the poor in those countries, the greatest stress in life is unemployment, not knowing where the next meal comes from. This encourages all diseases from common cold to cancer. The rich, in those countries, suffer from the morbid fear of the poor and unemployed that, perforce, transform them into criminals in society. Alcoholism, drug addiction, and crime result from poverty, ignorance, and uncertainty. Consequently, both the haves and have-nots suffer ultimately due to the ravages of monitory economy.



Excellent in depth studies done on the aborigine natives of some of the pacific islands have proved the above point. In an elegant study Failure of Scientific Medicine, the Innu Community Study, published in the Canadian Medical Association Journal, demonstrated, unequivocally, the close connection between money and diseases. Innus, the aboriginal Islanders off the coast of Saskatchewan, have had documented history of more than 500 years. Before the dawn of modern western civilisation, the Innus lived a happy and healthy life without any major illness to a ripe old age of well over hundred years, in a sustenance economy. In the year 1732 AD, came to Innu land the love of God first and then the barter economy of the William’s Company dealing in hide. Today, every Innu is a Canadian citizen. Every Innu is now heir to all conceivable diseases ranging from common old to cancer, ten years ahead of their Caucasian Canadian neighbours. The only change in the lives of the Innus was the arrival of money in their lives.



Monitory economy, with its attendant greed, descended on Innu land and brought with it all the complications like anxiety, hatred, hostility, anger, jealousy, and pride-the important risk factors for fatal degenerative diseases.



Western economists, conveniently lose another face of the economics of health. Health, in the conventional sense, is the greatest economic asset. Ill health hits our kitty both ways. A sick man cannot earn his livelihood fully. To cap it he has to spend a large proportion of what he earns by way of treatment for his illness. Poverty, therefore, is a double-edged weapon, which cuts both ways.



If one is poor he begets illness. In an exhaustive study of social classes and incidence of heart attack in the UK, the results were an eye opener for the planners. The study conclusively showed that the incidence of heart attacks was at its peak in the lowest social strata, falling gradually to reach its lowest level in the highest income bracket. In a multivariate analysis, unemployment stood out as the single, most important risk factor for heart attacks.



Writing an editorial on the same issue, Tudor Edward Hart, a long-standing practising family physician in Wales, wrote, “ the poor pay for their poverty with their lives.” Poverty, in addition, results in poor quality food intake leading to lowered antibody response to invading germs, resulting in a very high incidence of communicable diseases in the poorer strata of society. Bad housing, poor ventilation, cooking smoke inside the house, insanitary surroundings, lack of clean drinking water, ignorance, illiteracy, and crowding, all add up to the misery of the poor, exposing them to hazards of all kinds of illnesses. While poverty brings on more illnesses, the case – fatality ratio is also very high in this segment of the population. A malnourished poor child has four hundred times greater risk of death compared to a well-fed child even from a very simple infection like measles.



Poverty, in addition, gives encouragement to the poor to acquire unhealthy habits like alcoholism and drug addiction. Many lives are lost in poor countries because of these unhealthy habits. To cap it, the poor go for illicit liquor, which not infrequently, leads to periodic large scale loss of life, since there is a risk of methyl alcohol poisoning due to the carelessness of the unscrupulous boot leggers.



Crime against individuals and society are much higher in this segment of the population. This creates mental tension and illness both in the perpetrators of the crime and the victims.



There are a couple of subtler aspects of poverty and illness, which are not palpably felt by even the social scientists. Poor people have higher fertility rates. Sex being their only enjoyment, they produce children at a pretty faster rate with very little financial support for the offsprings’ upbringing. Children, coming out in frequent succession do not even get adequate breast milk. This results in generations of unhealthy children with very high infant mortality and morbidity.



Still deep-rooted problem of illness starts in the mother’s womb. When the pregnant mother’s nutrition is poor during the first trimester of pregnancy, the child in the womb suffers. The various organs of the child like the heart, blood vessels, the pancreas, etc., are all being made around this time. In the poorer segment of the world’s population undernourished mothers beget badly formed organs of their babies inside the womb. Undernourished, undersized foetus, born with low birth weight, is the one that grows up to an adult inheriting the capacity for precocious heart diseases, diabetes, and high blood pressure, with the resultant excess mortality and morbidity in middle age.



This segment of the population, in addition, mutates their genes so that they could thrive on very little food – the thrifty genes. Population migrations, as seen in immigrant Asians in Europe and USA, find themselves suddenly put into a food plenty atmosphere. The latter results in food-gene mismatch. Many degenerative diseases in the immigrant population are, basically, due to this calamity.



In short, poverty is the womb of all human illnesses. The other face of poverty, nay the second cutting edge, is the economic hardship suffered by people who do not enjoy good health. Good health is not only an asset socially; it is a very profitable proposition too. When one falls sick his earning capacity obviously goes down, coupled with his mounting bills for drugs, hospitalisation and doctor’s fees. The later could impoverish, sometimes, even the upper middle class.



Surprisingly, economists, especially the western economics schools of thought, did not size up this situation correctly for a very long time.



Credit should certainly go to the 1998 Noble Laureate, Amartya Sen, who could, for the first time, throw some light on poverty as an important economic concept to be tackled. As pointed out earlier, even the rich have to take poverty very seriously, as the health consequences of the poor segment of society are very significant for their richer cousins.



In my global economic concept, the richer nations have a greater responsibility to see that the poverty line( defined by Dr Sen) is quickly brought up and billions of people suffering the above consequences of poverty have some succor. Unfortunately, since the Second World War, 90% of the financial aid given to the poor third world countries by the richer nations has been in the form of arms and ammunitions.



Wars create more economic hardships. The result of the western aid to the poorer nations so far has been counter-productive. In that long run this kind of aid would generate more poverty.



This world is not a simple wonder; it is a wonderful wonder. Man with his proclivity for comfort and his enormous greed fails to see beyond his own nose. Most of the mega growth boasted by the richer countries has resulted in greater hardship for the mankind. Reductionist science, with its tunnel vision, has contributed not insignificantly to this mess. While the stock prices of the tobacco giants, the pharmaceutical leaders, and the alcohol lobby, keeps soaring, deaths due to tobacco smoke, alcoholism, and iatrogenic diseases have kept pace with it.



Both the reductionist science and the western economy theories seem to have lost the sense of direction in this century. Thanks to an occasional thinking person, like Nobel Laureate Sen, things seem to be looking up now. George Porter, a Nobel Laureate Chemist, who was the President of the Royal Society, once said: “ mankind seems to have lost the sense of direction in the century, not seen in the centuries gone by. I am afraid, I must confess, this could be due to the so called scientific temper”.



Thanks to Dr Sen who, for the first time, showed the fallacy of the western economic policies, by focusing on the main enemy of mankind in the monitory economy that we are in, viz.: poverty. One even shudders to think of the steeply rising incidence of divorce and suicide in the western world, resulting from this aimless search for the mirage called “ money and sensual pleasures.”



In conclusion, I would like to once again congratulate Dr Amartya Sen for having been able to win the hearts of the Swedish Nobel Committee members who, at last, saw the great significance of talking and doing something about poverty in this world. Despite my repeated attempts at enlightening both the medical fraternity and the lay people about the man’s important, if not the only cause of ill health - poverty, there does not seem to be any change in the attitude of the powers-that-be to focus attention on this aspect. Even, in our country the politicians go abroad for treatment of even minor illnesses. The businessmen, including the corporate houses, want to get into hospital business to make money, and the so called medical scientists and the medical politicians do not see the writing on the wall that the prohibitively expensive, top heavy, gadget oriented, western medicine alone will not solve the problems of nearly one billion people of India.





We have the God given inexpensive, useful to nearly 80% of the sick population, system of health care in our ancient Ayurvedic system, as well as many other good alternative systems in this country, which could certainly supplement modern medicine in combating disease and disability, to reduce the health care costs drastically. Less than 10% of the sick population do need the hi-tech modern medicine. Coupled with the alternative inexpensive systems useful for the majority of 90%, we could do most good to most people most of the time.



Poverty, thy name is illness and misery for the human race on this planet. If only we could have an equitable distribution of wealth in this world, there would be no poverty and we will be able to have a disease free world. Ten per cent of the world’s population consumes 90% of the world’s resources, leaving the 90% of the population to subsist on 10% of the world’s resources.



To me this does not make economic sense. I am sure Dr Sen would agree.