The Hindu Editorial Analysis- 6th March 2025 | Current Affairs & Hindu Analysis: Daily, Weekly & Monthly - UPSC PDF Download

Over-centralisation threatens federal health policy

Why in News?

The Supreme Court has ruled that domicile-based reservations in post-graduate medical admissions violate the right to equality under Article 14 of the Constitution.

What is the supreme court ruling?

In the case of Dr. Tanvi Behl vs Shrey Goyal (2025), the Supreme Court determined that domicile-based reservations for post-graduate medical admissions contravene Article 14 of the Constitution. The court emphasized the importance of meritocracy over state-specific quotas in the admission process.

• As a result of this ruling, states are no longer permitted to reserve seats for local candidates in post-graduate medical programs. This decision impacts the ability of states to retain medical specialists within their public healthcare systems.

• The ruling also reinforces central authority over medical admissions, but it may discourage states from investing in government medical colleges. This could potentially exacerbate regional disparities in healthcare access and quality.

Role of Domicile Quotas in State Healthcare Planning

• Domicile-based reservations are crucial for States to retain doctors who are well-acquainted with the local healthcare system, ensuring a consistent supply of medical specialists.
•  States invest significantly in medical education with the expectation that graduates will serve the local population, especially in post-graduate programs that train specialists in various fields. 
•  The Court’s reliance on previous legal cases fails to acknowledge the difference between the roles of undergraduate and post-graduate medical education in addressing healthcare needs. 
•  Without domicile quotas, States may face challenges in recruiting doctors, leading to an unpredictable and inefficient workforce. 

Effect on State Investment in Medical Education

•  If States are unable to guarantee that their trained doctors will remain and serve locally, they may scale back their investments in medical colleges. 
•  While competitive federalism encourages States to enhance their medical institutions, the Supreme Court’s decision could diminish this incentive. 
•  The absence of domicile reservations might lead to a decrease in funding for medical colleges, resulting in subpar infrastructure and exacerbating healthcare disparities. 

Medical Education and Public Health Connection

•  Access to quality healthcare, as part of the right to life under Article 21, is intricately linked to the quality of medical education. 
•  State medical colleges are pivotal not only in educating future healthcare professionals but also in delivering healthcare services, playing a significant role in public health. 
•  States require the autonomy to determine their admission policies to align medical education with local healthcare needs effectively. 
•  Excessive central control over medical education could hinder States’ abilities to plan and implement effective healthcare systems tailored to their specific needs. 

Problems with a Strict Merit-Based System

•  The ruling advocates for a strict merit-based system without addressing the existing flaws in medical entrance examinations like NEET-PG. 
•  NEET-PG has its own structural issues, such as instances where candidates with negative marks qualify due to percentile-based cutoffs, raising concerns about the validity of merit assessments. 
•  The reduction of qualifying percentiles for NEET-PG in 2023 to zero to fill vacant seats highlights inconsistencies in merit evaluation, questioning the fairness of the system. 
•  Previous legal decisions have acknowledged that merit should encompass social and regional considerations, not solely rely on exam scores, to ensure a more equitable distribution of healthcare professionals. 
•  Domicile-based reservations play a crucial role in addressing healthcare needs in underserved areas by ensuring that specialists remain in their home States, contributing to balanced healthcare service distribution. 

Need for a More Balanced Approach

•  The Court’s decision is grounded in older legal precedents that do not account for the current urgent demand for medical specialists, especially in light of increasing disease prevalence and past health emergencies. 
•  Rather than completely abolishing domicile quotas, a more effective approach would be to link these reservations with service obligations, ensuring that medical graduates serve in public hospitals for a specified period in exchange for reserved seats. 
•  Some States have already adopted such policies, where medical graduates are required to serve in public healthcare facilities as part of the conditions for reserved seats in medical programs. 
•  The ruling enhances central oversight over medical admissions, which could result in diminished State investment in medical education and broader regional disparities in healthcare access and quality. 
•  Over-centralization of medical education policies may disrupt the federal structure of healthcare governance, undermining the collaborative approach needed for an effective healthcare system. 
•  A robust and sustainable healthcare system necessitates a balanced policy framework that harmonizes merit-based admissions, State autonomy, and the imperative to meet public health needs effectively. 

​Who will apologise to the ‘Himalayans’?

 Why in News?

 Norway has recently issued a formal apology for its past policies aimed at assimilating indigenous groups, such as the Sami, Kven, and Forest Finn peoples. These policies, known as Norwegianisation, were in place from the 1850s to the 1960s and involved suppressing native languages and cultures. 

• The Norwegian government has proposed measures to combat ongoing discrimination, including the protection of indigenous languages and monitoring inclusion efforts starting in 2027.
• However, challenges persist, including endangered Sami languages and disparities in healthcare, education, and land rights.
• Similarly, in the Himalayan region, indigenous communities are grappling with issues of resource exploitation and cultural erosion.
• This region, stretching 2,500 km from Afghanistan to northeast India, is home to 52 million people from various ethnic groups.
• Historical factors, such as colonial rule, post-independence policies, and modern economic changes, have exerted assimilation pressures on these communities.

Colonial Disruption and Post-Independence Exploitation

• Colonial Impact: British colonial policies significantly disrupted Himalayan trade and local economies. In the northeast, trade blockades and forced agreements impacted the trade of goods like tea, gold, silk, and opium. In regions like Himachal Pradesh and Uttarakhand, forests were extensively exploited for timber to facilitate railway construction, leading to substantial deforestation. 
• Post-Independence Policies: Initially, post-independence policies aimed to respect and preserve tribal ways of life. However, by the 5th and 6th Five-Year Plans, there was a marked increase in resource exploitation, adversely affecting local ecosystems and cultures. 

Economic Shifts and Hydropower Projects

• Economic Changes in the 1990s: The 1990s brought about significant economic changes that compelled Himalayan states to seek new revenue sources, leading to a reliance on tourism and hydropower. 
• Hydropower Initiatives: Hydropower projects were promoted as a means to generate state revenue and reduce financial dependence. For instance, Arunachal Pradesh was projected to meet a substantial portion of India’s power demand through these projects. 
• Challenges of Hydropower Projects: Despite their potential benefits, hydropower projects often overlooked local laws and customary land ownership, resulting in displacement and cultural erosion. The involvement of bureaucrats, politicians, and corporations in large-scale land acquisitions led to environmental degradation and the loss of traditional practices. 

Recognition and Sustainable Development

• Need for Recognition and Justice: Norway’s apology underscores the significance of acknowledging historical injustices and committing to reconciliation. In contrast, the Himalayan region has yet to receive formal recognition for its experiences of resource exploitation and cultural erosion. 
• Sustainable Development: There is a pressing need for sustainable and inclusive development in the Himalayan region to safeguard the cultural identity and environment of local communities. The question remains whether similar accountability and justice, as demonstrated by Norway, will be extended to the affected communities in the Himalayas.