Pakistan is a country that values the tangible over the ephemeral. We are a nation that treasures sensationalism over silence; swagger over humility; and the immediate over the lasting. We celebrate Afridi’s boisterous sixer, over six crafty singles of Misbah. We glorify whimsical suo motos of Iftikhar Chaudhary over the structured need for judicial reform. We idealize the pomp of Long Marches and dharnas over the voiceless humdrum of legislative progress. And in the same breath, we rally behind physical monuments of political progress, above and beyond the quiet rhythm of permanent revolutions.

In fulfilment of this ethos, our political machinery has chosen to surrender the minor public issues such as health and the availability of life-saving drugs, at the altar of greater national projects such Metro Bus, Signal-Free Corridors, and the Orange-Line.

This creed has been manifested in the recent country-wide shortage of affordable drugs for diseases such as cancer, thalassemia, and heart-related ailments. Specifically, as has been reported across our media waves, the parents of seven year old Isra Ghazal, from Rawat, who was recently diagnosed with leukemia, a form of blood cancer, have been running from pillar to post in search of medicine for their daughter. Isra was admitted to Pakistan Institute of Medical Sciences (PIMS) last week, but had to wait several days for treatment, owing to non-availability of the affordable medication throughout the twin cities of Islamabad and Rawalpindi. Isra’s father, a small grocery shop owner in Rawat, could only “afford” the cheaper treatment, which costs over Rs. 4,000 per injection, as opposed to the alternative injections that cost almost Rs. 170,000.

Isra’s plight is not much different than that of Ayesha, a twenty-three year old patient of thalassemia, who is still waiting (in Lahore) for locally produced Folic Acid pills, because her family cannot afford the imported brand that costs up to Rs. 900 per pill.

These and other stories, across Pakistan, continue to exist as an indelible scar on our collective conscience.

As it turns out, according to figures provided by the World Bank, the Government of Pakistan spends less than 1%of its GDP on ‘Public Health’ (as opposed to almost 5% spent by most other developing countries). In fact, the private sector, which is considerably more expensive (and thus beyond the financial reach of majority of Pakistan’s population), spends at least three times as much on providing health-related services within the country. A recent report published in the Journal of the College of Physicians and Surgeons, Pakistan, details how Pakistan spends 80% of its health budget on tertiary care services, utilized by only 15% of the population, and 15% on primary healthcare services, used by 80% of the population. Furthermore, 98% of all healthcare related expenditure, in Pakistan, are done out-of-pocket, and over 75% of patients visit and use private-sector healthcare facilities. The total public health budget of Pakistan dwarves in comparison to the budget allocated for the top three infrastructure projects, and the Government healthcare facilities receive a smaller fraction of the budget for their maintenance than the subsidy provided to the airline-sector alone.

This deprecation of our public health is not simply the result of inadequate funds. The deeper issues stem from a constitutional disregard of the sector.

From the constitutional perspective, per Article 70(4) read with Article 142, the Federal Legislature has exclusive legislative authority in regards to items specifically enumerated in the Federal Legislative List (Fourth Schedule of the Constitution). As a result, the Federal Government only has the authority to constitute ministries and sectors that are expressly mentioned in the Federal legislative List, and all other items (post 18th Constitutional Amendment) fall within the exclusive legislative domain of the respective Provincial Assemblies (Article 142 (c)). And, admittedly, “Public Health” finds no mention in the Federal Legislative list at all, making it a ‘Provincial’ subject.

This constitutional paradigm, in which public health is exclusively a provincial subject, can be traced through the earlier constitutional schemes of Pakistan, including the 1956 Constitution, and the 1962 Constitution. Still, however, throughout our history, there has continued to exist a Federal Ministry of Health (presently the Ministry of National Health Services (Regulation and Coordination)), and the Provinces have taken no meaningful steps to assert their respective autonomy over the subject.

Existing somewhere between this confused legislative domain, of a Federal healthcare apparatus vis-a-vis competing provincial autonomy, our national focus on public health has suffered at the hands of debilitating apathy. Pakistan, having signed and ratified over a dozen public health related conventions and treaties, continues to lag behind the modern world in terms of provision of healthcare to its citizenry. We continue to host numerous diseases (e.g. Polio) that have been eradicated from most other countries of the world. Our population growth is disproportionate, to say the least, with our healthcare budget. Our public sector doctors continue to seek better opportunities abroad. Our borders continue to stay porous for smuggled (expensive) medication. And caught in this myriad of public health problems, the people of Pakistan struggle to find their rightful place in the comity of healthy nations.

A healthy man, woman, or child, does not make for a great campaign slogan, or form the crown-jewel of political achievement. It cannot be advertised, like the Metro Bus, on placards and holdings. Public health does not manifest itself as a monument that beckons an opening ceremony from the Chief Minister. It cannot be displayed, as a mark of development, to foreign dignitaries. It does not suit our conventional need for tangible progress. And so, naturally, it does not form a priority in the hackery of our political system.

The plight of Isra, Ayesha, and countless others like them, across Pakistan, is likely to continue till such time that we, as a country, shift our political preferences away from tangible monuments of stone and towards the intangible monuments of well-being. And if our political elites are not willing to do so, it is incumbent upon us, as responsible citizens of the State, to force their hand through the autonomy of our vote.