Most people have that one bit of their body that they're not completely comfortable with. That one - or two, or three - parts that they believe could do with a revamp. But the reality of the situation is that most of us eventually have to come to terms with our flaws and move on, to realise that there's more to life than appearance.
But what if the government gave money to solve any grievances you had about your body? Would you take it, knowing that the money could instead be spent on giving someone a lung transplant, or giving a child open heart surgery? Or would you leave it, believing that someone else deserved it more than you? Although it sounds completely crazy, this dilemma has become something of a reality in a south Indian state, which has potentially become the first in the world to offer publicly-funded breast implants.
The Tamil Nadu state health department announced this week that they were launching a free service at a clinic in the state's capital, Chennai, that will allow people to alter the size of their breasts for either health or cosmetic reasons. Along with their announcement came a controversial statement from Tamil Nadu's health minister, who argued: “Why should beauty treatment not be available to the poor?”
The Department of Health and Family Welfare justified their decision, with state health minister Dr. C Vijaya Baskar, stating that if they didn't offer the procedure for free, people looking to alter their appearance "may opt for dangerous methods or take huge loans for it." In addition, the head of plastic surgery at the clinic, Dr V Ramadevi, insisted that state-funded procedures were warranted, saying some of her patients sought to reduce their breasts to alleviate shoulder and back pain, while others sought to augment or shrink their breasts for a boost in confidence. “There is a psychological benefit," she said. Many girls who have larger breasts don’t like to go out. There is no reason this surgery should be restricted from the poor. And if it'll help protect those same people from the dangers of cheap black-market plastic surgery, then it does become a viable public health program by association.”
However, not everyone was accepting of the news, with some protesting that the funds used to pay for breast augmentation surgery could well have been used for life-saving surgery for other less wealthy patients. Former public health director for the state, Dr S Elango, criticised this latest scheme telling the Times of India: “[It] sounds populist, but it is not an ideal public health programme. State funds are required for emerging non-communicable diseases and communicable diseases. It is sad that we are now focusing on beauty instead of life-saving surgeries.”
So, it's likely that we'd all agree that access to medical care should be a right, but what about appearance? Should we all have a state-funded right to be comfortable with how we look?
India's constitution guarantees free healthcare for all citizens and each district in most states has one or more government hospitals, where everything from diagnosis to medicine is accessible for free. Despite this, India's record on public health has, in the past, been referred to as "abysmal" - and with good reason, seeing that the country reportedly currently spends a little over one per cent of gross domestic product (the broadest quantitative measure of a nation's total economic activity) on healthcare, one of the lowest levels in the world.
In October 2016, The World Bank stated that India accounted for the largest number of people living below the international poverty line in 2013, with 30 per cent of its population under the $1.90-a-day poverty measure. Poor health and steep costs alone are blamed for pushing so many of the population below the poverty line; despite free healthcare being available, the quality of public medical care is questionable and most healthcare expenses are paid out of pocket by patients and their families, rather than through insurance.
In fact, recent world health statistics have reportedly indicated that India has the highest out of pocket private healthcare costs for families, among many other comparable developing nations. In addition, the Health Ministry stated in 2015 that 63 million people were faced with poverty each year due to "catastrophic" expenditure over health, which neutralised the gains of rising income and various government schemes.
With this amount of evidence on the table, there is no doubt that many people badly need some assistance with their healthcare costs, and the Chennai clinic - which will also perform free cleft lip surgeries for children and hand transplants, among other procedures - may be a welcome help for many underprivileged individuals out there. Although more studies need to be conducted, in the past experts have linked women who undergo cosmetic surgery to higher rates of depression, anxiety and low self-esteem, also stating that they are more likely to be suicidal than others. So it's not surprising that Dr V Ramadevi has stated that the clinic expects up to 150 women a month to take up the offer.
That being said, it's difficult to argue that the money should be spent on cosmetic surgery, rather than other medical procedures that people across India may need. The Indian government appear well aware of the health crisis the country is currently going through, with Prime Minister Narendra Modi announcing a new insurance scheme in the federal budget aimed at covering the poorest of citizens. If all goes as planned, "Modicare" will cover more than 500 million Indians and provide 500,000 rupees ($7,825) in medical coverage for each family annually.
However, doubts have already been cast on the project, with former health secretary K Sujatha Rao calling it "recklessly ambitious". In addition, similar publicly-funded medical insurance schemes introduced in the past don't have a very inspiring record, with 9 of 13 studies that assessed such schemes reporting no reduction in out-of-pocket expenses for people covered by insurance. Moreover, the challenge of implementation is mammoth, with many questioning how Modi would successfully carry this out.
So, is the Indian government, in particular the Tamil Nadu state health department, going about healthcare in the wrong way? Many would say that they're going about it in completely the wrong way. With 63 million people living under the poverty line, and a dilapidated healthcare system bankrupting many people out there, surely there is no argument for boob jobs being one of their number one priorities. Whether or not this will stop people from taking up the offer is another matter entirely.
