Why is it in the News?

A fair and effective health system requires freedom from political influence, focusing on policymaking and implementation driven by scientific evidence and long-term objectives.

Background:

• Within India's diverse landscape, where bustling cities coexist with serene villages, there's a subtle yet crucial struggle unfolding in the realm of public health.
• Despite its significance, this battle often takes a backseat to the allure of curing illnesses. While disease prevention holds paramount importance, political attention tends to gravitate towards visible and immediate achievements such as constructing new medical facilities, offering affordable treatments, and managing crises.
• Hence, there arises a pressing need to examine the challenges and deficiencies within the existing democratic approach to public health, emphasizing the necessity for evidence-based strategies geared towards long-term objectives.

What is the Present Condition of Public Health and Nutrition in India?

• According to the 5th National Family Health Survey 2019-21:
  • 35.5% of children under 5 exhibited stunted growth.
  • 32.1% were underweight.
  • The prevalence of anaemia among children aged 6-59 months rose from 58.6% to 67.1%.
  • Among women aged 15-19 years, the prevalence of anaemia increased from 54.1% to 59.1%.
  • These statistics underscore a notable disparity in public health endeavours.

The Incongruity of the Democratic Process in India's Public Health:

• Emphasis on Infrastructure and Immediate Relief: The inclination towards constructing new hospitals and providing subsidized treatments reflects democratic governance in India.
  • While these initiatives address immediate healthcare needs, their impact on sustained population health still needs to be improved.
  • During health crises, political leaders often prioritize emergency response strategies, swiftly mobilizing state resources.
  • However, many of these measures yield minimal impact due to insufficient follow-through beyond public announcements.
• Preferring Emergency Response over Vital Preventive Measures: Budget constraints often limit the effective implementation of announced initiatives, raising concerns about their long-term sustainability and impact.
  • This emphasis on visible achievements can overshadow critical areas like sanitation, disease surveillance, and public health education.
  • Yet, these aspects are vital for maintaining population health and averting disease outbreaks.
  • The significance of quieter victories achieved through preventive measures, such as eradicating diseases like smallpox and controlling polio, often goes unnoticed despite their substantial contributions to public well-being.

A Case Study of Dengue Illustrating This Dilemma

• Immediate Response Emphasis: During dengue outbreaks, political leaders often prioritize swift relief actions, such as establishing relief camps and offering symptomatic treatments.
  • This reactive stance arises from the urgency of the situation and the imperative to alleviate the immediate suffering of affected communities.
  • However, the lack of emphasis on preventive measures can perpetuate a cycle of recurrent outbreaks, straining healthcare resources further.
• Overlooking Underlying Causes and Prevention: The focus on emergency relief efforts may overshadow the significance of long-term strategies, including studying vector bionomics, developing vaccines, and enhancing public health infrastructure.
  • Consequently, the current approach falls short of averting future outbreaks and burdens the healthcare system.
  • Research and development in these realms are imperative. For instance, despite limitations, the existing dengue vaccine underscores the necessity for further exploration.
  • Additionally, climate change impacts mosquito breeding and movement patterns, necessitating adaptations in public health strategies.

What are the challenges in Public Health in India:

• Prioritizing Short-Term Gains: Political leaders often prioritize initiatives promising immediate results, like constructing new hospitals and offering subsidized treatments, over long-term public health strategies.
• Budgetary Limitations: Despite announcements, the impact of these short-term measures is limited due to constraints in budget allocation and implementation beyond public announcements.
• Neglect of Vital Areas: Critical aspects such as sanitation, disease surveillance, and public health education are often overlooked, despite their significance in maintaining population health and preventing disease outbreaks.
  • For example, in the case of Dengue, relief efforts overshadow long-term strategies like vector control and vaccine development.
• Profit-Driven Pharmaceutical Sector: The profit-oriented nature of the pharmaceutical industry sidelines public health priorities, leading to disparities in medicine availability, particularly concerning diseases like tuberculosis, which disproportionately affect socio-economically disadvantaged populations.
• Lack of Holistic Approach: Addressing public health challenges necessitates interdisciplinary expertise from fields like environmental science, sociology, urban planning, and economics.
  • However, India's current approach remains predominantly physician-centric, overlooking broader societal and environmental factors.

What Steps Can Be Taken?

• Prioritize Research and Development: Emphasize research, particularly in vaccine development and understanding the influence of climate change on disease vectors, to inform proactive public health strategies.
• Depoliticize Health Decision-Making: Ensure that public health policies are driven by scientific evidence and long-term objectives rather than short-term political considerations.
• Enhance Nutrition Support: Increase investments in nutrition programs, recognising their significant long-term benefits for health and productivity.
• Adopt a Holistic Approach: Implement a comprehensive public health management strategy that encompasses preventive measures, policy development, community health initiatives, and environmental health considerations.
• Grant Autonomy to Health Ministries: Consider granting health ministries greater autonomy, potentially placing them directly under the leadership of elected officials such as Chief Ministers or Prime Ministers, similar to India’s space and atomic energy departments, to facilitate more effective decision-making and implementation processes.

Conclusion

Although democracy itself is not detrimental to public health, the existing approach within democratic frameworks frequently lacks effectiveness. There is a pressing requirement to rethink public health governance, prioritizing evidence-based, comprehensive, and forward-looking strategies that cater to both present and future health requirements.