By Amitabh Ranjan
The Union government recently removed cough syrups from Schedule K of the Drugs Rules, 1945. This means that they will no longer be sold without a valid prescription.
The provocation: the death of at least 24 children in October 2025 in Rajasthan and Madhya Pradesh. The children who died or fell critically ill from contaminated cough syrup were mostly under the age of 5 and belonged to rural and economically disadvantaged sections relying on public health infrastructure. An editorial in a national daily diagnosed the incident in a granular way, attributing it among others on the following factors: manufacturing units operate in unregulated conditions; there is chronic understaffing and inconsistent inspections, plus corruption; licences that are cancelled are quietly reversed once public attention fades; there’s no system for doctors to flag clusters of poisoning symptoms; and there’s no system of recall of contaminated drugs that remain in circulation.
The episode is symptomatic of a larger structural flaw in the healthcare system in much of the world, which is inequitable and sans moral moorings. Harsh Mander in his book A Matter of Life and Death delves deep into this moral erosion of the State as the provider of basic social rights even as he takes a 360-degree view of the systemic malady that lies between marginalised multitudes and a universal access to affordable and dignified healthcare.
While he brings learning and experiences from around the world, the author, for obvious reasons, keeps his probe focused on India, which has one of the most privatised healthcare systems in the world and probably the biggest in the Global South.
Despite the world’s largest social security programme, each year India continues to fall further in the global index, even as the economy continues to grow. For social rights, laws are important but they are not enough. A moral and social contract must bind people and those who govern to ensure such rights accrue to the general population in the absence of which a civilised world order is only notional. Situating healthcare within the framework of human rights, Mander underscores that the right to health entails more than the mere absence of disease; it mandates access to timely, acceptable, and affordable quality medical care with empathy.
Unfortunately, however, most nations continue in effect to treat healthcare as a programmatic or moral aspiration, but not as a right that can be enforced by law. As a result, across vast swathes of the globe, particularly in countries with low income levels where the cost of accessing private healthcare is exorbitant and public infrastructure almost non-existent, a huge number of preventable deaths occur. This, according to Mander, is an instance of structural State violence when the executive fails to ensure that the poor make a living, access food and medical aid, clothing, shelter, clean water, and sanitation.
In India and in much of the world, access to healthcare does not depend on how urgent one’s need is, but on how privileged the person is. In the words of Norman Bethune, the legendary Canadian physician who devoted his life to fighting tuberculosis, fascism, and inequality, and whose campaign the author cites, “the poor man dies because he cannot afford to live”.
The figures Mander brings to the fore to show how unequal is the world are damning: about 4.5 billion people, that is almost half the world’s population, lack access to essential health services. Two billion face financial hardship. Nearly 4.8 million children under 5 died in 2023, mostly from causes which were preventable, including neonatal complications, pneumonia, diarrhoea, malaria and malnutrition. The problem is most acute in developing economies. In India, more than 2 million people die every year because of malnutrition and morbidity.
It is in this backdrop that Mander analyses the contours and contradictions of the healthcare system. In 11 chapters, he raises and discusses such issues as to why health be accorded human right status; how far enforcing such a right is feasible; the role of private hospitals and big pharma; how to finance a universal quality healthcare; and how to mend our broken moral compass.
Making a strong case for a legally enforceable right to health, the author reiterates that with the scientific wherewithal and financial resources that they have, governments are well-equipped to achieve this. The reason this is not so lies in neo-liberal and discriminatory politics; capture of the world’s resources by big capital; rampant privatisation; and the retreat of the upper and middle classes from the larger society in pursuit of affluence.
A common thread that runs through the book makes a case for reimagining public health as a moral and right-based commitment. The book’s subtitle is evocative: The Unfinished Journey to Secure Healthcare for All. Mander has worn many hats. An IAS officer who resigned after almost 20 years of service, he has been a visiting teacher at universities across the world, a columnist, a prolific writer, a campaigner for victims of mass violence, and was the Special Commissioner to the Supreme Court of India in the Right to Food case for 12 years from 2005 to 2017.
He serves as the Director of Equity Studies, New Delhi. His critique of the healthcare system, therefore, is borne out of not only a rare scholarship but also of lived experiences, of witnessing things up close and personal.
At a time the world has seen the first trillionaire when a humongous majority go without food and shelter, the discourse the author offers could not have come at a more apt time. For legislators, bureaucrats, judges, corporate honchos, and the civil society this could be a long-awaited clarion call.
The writer is a former journalist who teaches at Patna Women’s College
Disclaimer: The views expressed are the author’s own and do not reflect the official policy or position of Financial Express.
A Matter of Life and Death: The Unfinished Journey to Secure Healthcare for All
Harsh Mander
Speaking Tiger Books
Pp 280, Rs 599