What is the issue?
India’s 'public health' system should become more comprehensive and can no longer function within the shadows of its 'health services' system.
What is a healthcare system?
- The public health system looks at the social ecology and determinants focusing on optimising wellness.
- Healthcare services, on the other hand, primarily focus on preventing morbidity and mortality.
- A comprehensive healthcare system will seamlessly bridge the above two.
- In India, public health and health services have been synonymous, hampering the growth of a comprehensive public health system.
Why is a public health system crucial?
- A stark increase in population growth, along with rising life expectancy, provides the burden of chronic diseases.
- Tackling this requires an interdisciplinary approach.
- An individual-centric approach within healthcare centres does little to promote well-being in the community.
- Seat belt laws, food and drug safety regulations, and policies for tobacco and substance use as well as climate change and clean energy are all intrinsic to health.
- But they are not necessarily the responsibilities of healthcare services. A robust public health system becomes vital here.
- A well organised public health system with supporting infrastructure strives to prevent catastrophic events and public health tragedies.
- E.g. the 2017 Gorakhpur tragedy in Uttar Pradesh, 2018 Majerhat bridge collapse in Kolkata, air pollution in Delhi, Punjab narcotics crisis
What are the drawbacks in India?
- Institutions - India’s public health workforce comes from an estimated 51 colleges that offer a graduate programme in public health.
- This number is lower even at the undergraduate level.
- In stark contrast, 238 universities offer a Master of Public Health (MPH) degree in the U.S.
- Workforce - India also lacks a diverse student population which is necessary to create an interdisciplinary workforce.
- In the U.S., public health graduates come from engineering, social work, medicine, finance, law, architecture, and anthropology.
- [Public health tracks include research, global health, health communication, urban planning, environmental and behavioural sciences, behavioural economics, healthcare management, financing.]
- Curriculum - The diversity is further enhanced by a curriculum that enables graduates to become key stakeholders in the health system.
- Strong academic programmes are critical to harness the potential that students from various disciplines would bring, where India needs to improve.
- Investments in health and social services tend to take precedence over public health expenditure in India.
- Benefits from population-level investments are usually long term but sustained.
- As it tends to accrue much later than the tenure of most politicians, there is reluctance in investing in public health as opposed to other health and social services.
- But the impact of saving valuable revenue through prevention is indispensable for growing economies like India.
- Health communication, an integral arm of public health, aims to disseminate critical information to improve the health literacy of the population.
- The World Health Organisation calls for efforts to improve health literacy, an independent determinant of better health outcome.
- India certainly has a serious problem with health literacy and it is the responsibility of public health professionals to close this gap.
- Also, legislation is often shaped by public perception, rather than being informed by research.
- Evaluation system - Many of the national programmes on health fail due to improper implementation.
- A system of evaluating national programmes is essential for ensuring proper outcome and saving time and money.
What could be done?
- A sound public health system is critical to overcome some of the systemic challenges in healthcare.
- A central body like the council for public health may be envisaged to work with other agencies to promote population-level health.
- These may include public works department, narcotics bureau, water management, food safety, sanitation, urban and rural planning, housing and infrastructure.
- The proposed council for public health should also work closely with academic institutions.
- This is to develop curriculum and provide license and accreditation to schools to promote interdisciplinary curriculum in public health.
- The proposed comprehensive insurance programme Ayushman Bharat caters to a subset of the population.
- Beyond this, systemic reforms in public health could shift the entire population to better health.
- With rising healthcare costs, there is also the need to systematically make healthcare inclusive to all.
Source: The Hindu
