THERE was a time not too long ago when the burden of disease seemed disproportionately biased against the poor. That someone was always dying among ‘these’ people was the irritated refrain of many an exasperated begum. ‘Fauteedgi’ (an event of death) was a dreaded word that came to be interpreted as a ready excuse to buy a few days off for the staff.

Times have changed. It is hard now to find an affluent family without its own share of prolonged, painful illnesses and fauteedgis, often premature. The speed at which graveyards are filling up in rich communities tells a story if anyone is willing to listen.

What happened? Simply, money reached its limit in the ability to buy health. It could protect against many of the factors that caused the most mortality amongst the poor but lost its edge once the factors proliferated.

The burden of disease became much more equalised.

Take the causes of the majority of deaths amongst the poor — dirty water and unsafe sanitation. The rich could afford to boil water, filter it, or even switch to the bottled alternative. And everyone who could, moved to a faraway housing society served by water closets and underground sewers. ‘Whoosh’ and the offensive stuff was gone — out of sight, out of mind. Instead of cleaning up the city, the state obliged these fugitives from pestilence favouring them with ring roads and signal-free corridors to transport them back to their places of work quite oblivious to the toxic emissions.

More of this pursuit of one-dimensional progress led to pollution of the air which was a leveller in terms of its negative effects upon the citizenry. The rich could still isolate themselves partially by living in air-conditioned homes, travelling in air-conditioned cars, and working in air-conditioned offices. Still, the protection was not complete and the begums walking briskly in the public parks and the menfolk indulging in outdoor sports were forced to inhale the same carcinogens that inhabited the air they shared with the have-nots.

Then, along the way, another discriminant between the haves and the have-nots, started to come undone. The quality of food in cities, both cooked and raw, took a nosedive with growing doubts about the safety of virtually any product on the market. The causes were many — plain greed on the part of producers, failure of quality control on the part of the state, and industrial progress itself with the increasing use of chemicals and chemical processes to increase the weight and shelf life of produce. There were few who could continue to source their asli (pure) supplies from ancestral villages and, for once, the refuge of the rich — processed foods — only added to the likelihood of negative outcomes.

It took a while, but the burden of disease became much more equalised. It did not lessen for the poor but increased sufficiently for the affluent to become a matter of private concern and grief — the number of quls (prayers for the dead) per month the affluent felt called upon to attend became occasions for the sharing of woeful tales.

Turn now to the other side of the picture. There was a time when the affluent could literally afford to inoculate themselves against the most common diseases of the poor like diarrhoea, cholera, smallpox, measles, etc. But such inoculations were less effective against the carcinogens that began to percolate through polluted air, toxic waterbodies, and contaminated foods.

Not only that, it became increasingly difficult to tell spurious medicines from the genuine articles and the overall quality of medical care declined precipitously with the glut of poorly trained providers graduating from substandard private colleges. Once again, the regulators turned a blind eye to what was happening in the pursuit of short-term gains as if money could ward off the damages being inflicted on their own bodies.

There are still a very few left who can afford to travel to Dubai or London or New York for medical checkups but since they have been ruling the country there is no relief in sight for the rest, rich or poor. A government for the people would recognise that the path to good health requires attention to basics that are simple to conceive and implement — clean water and clean air, safe sanitation and safe food, unadulterated medicines and regulated healthcare, compact cities and public transportation.

Simple as these measures are, there is little possibility of an intelligent response to the warning signs. In 1952, despite persistent warnings from scientists of precisely such a disaster, a killer smog descended on London killing 4,000 in less than a week and accounting for another 8,000 premature deaths in the months that followed. Do we need a catastrophe of such magnitude to wake up to the obvious dangers accumulating in our environment?

The writer is a fellow at the Consortium for Development Policy Research in Lahore.

Published in Dawn, March 21st, 2018