Context

• In the diverse picture of India, with busy cities and peaceful villages living side by side, there is a quiet battle happening for public health but this fight often gets less attention compared to the appeal of curing diseases.
• Even though preventing these diseases is important, the focus in politics tends to be on immediate and tangible accomplishments like building new hospitals, providing cheaper treatments, and handling emergencies.
• Therefore, it is important to delve into difficulties and shortcomings of the current democratic approach to public health, highlighting the need to change strategies based on evidence and focused on the long-term goals.

The Dichotomy of Democratic Process in Public Health in India

• Focus on New Hospitals and Subsidised Treatments
  • The focus on constructing new hospitals and offering subsidised treatments in private healthcare institutions is a hallmark of democratic governance.
  • While these initiatives address immediate healthcare needs, their efficacy in promoting sustained population health is not seen much on the ground.
  • Political leaders often gravitate towards emergency response strategies, such as the immediate mobilisation of state machinery during health crises.
  • Many of these measures do not have much of an impact because of a lack of action beyond public announcements.
• Placement of Emergency Response Over Critical Preventive Efforts
  • The emphasis on visible achievements is often constrained by budgetary limitations, leading to challenges in the effective implementation of announced initiatives.
  • This raises concerns about the sustainability and long-term impact of such endeavours.
  • The unintended consequence of this prioritisation is the neglect of critical areas such as sanitation, disease surveillance, and public health education.
  • These aspects are indispensable in maintaining population health and preventing disease outbreaks.
  • The significance of unsung victories achieved through preventive measures is often overlooked and shadowed by tangible achievements.
  • The success stories in eradicating diseases like smallpox, controlling polio, and preventing neonatal tetanus and measles are less dramatic but they contribute significantly to the overall well-being of the population.

A Case Study of Dengue Highlighting this Dichotomy

• Short-Term Focused Response
  • In times of dengue outbreaks, political leaders tend to prioritise immediate relief measures, such as setting up relief camps and providing symptomatic treatments.
  • This reactive approach is often driven by the urgency of the situation and the need to address the immediate suffering of the affected population.
  • The lack of focus on preventive measures may lead to a recurring cycle of outbreaks, putting additional strain on the healthcare system and resources.
• Neglect of Root Causes and Prevention
  • The mobilisation of state machinery for emergency relief may overshadow the importance of long-term strategies, including understanding vector bionomics, vaccine development, and improving public health infrastructure.
  • As a result, the current approach fails to prevent future outbreaks and strains the health-care system.
  • Research and development in these areas are crucial. For example, despite its limitations and restrictions, the existing dengue vaccine underscores the need for more research.
  • Climate change is also affecting mosquito breeding and movement patterns, and public health strategies need to adapt to these changes.

Challenges and Disparities in the Landscape of Public Health in India

• Profit-Driven Nature of Pharmaceutical Industry
  • The instrumental role of the pharmaceutical industry in advancing curative medicine cannot be denied.
  • However, the industry's profit-driven nature tends to sideline public health concerns.
  • For instance, despite having the same medicines to fight tuberculosis (TB), India reported 21.4 lakh TB cases in 2021, an 18% increase from 2020, translating to an incidence of 210 cases per 1,00,000 population.
  • In contrast, the United States reported only 8,331 TB cases in 2022, about 2.5 cases per 1,00,000 persons.
• The Socio-Economic Disparity
  • This disparity between the US and India is not merely a matter of the availability of medical treatment but is deeply linked to socio-economic factors.
  • Socio-economic factors such as poverty, sanitation, and overcrowding are prevalent in India and these factors contribute significantly to the higher incidence of diseases.
• Policy Targets vs. Health Realities
  • POSHAN Abhiyan plans to reduce stunting by 2%, undernutrition by 2%, anaemia by 3%, and low birth weight by 2% every year.
  • But the fifth National Family Health Survey found 35.5% of children under five were stunted and 32.1% were underweight in 2019-21.
  • The prevalence of anaemic children aged 6-59 months increased from 58.6% to 67.1%, and 54.1% to 59.1% among women aged 15-19 years.
  • This disparity between prevalence and policy targets highlights a significant gap in public health efforts.
• Absence of Specialised Courses in Education System
  • Behavioural change is key to managing public health challenges, yet, it can be challenging in political environments influenced by populist tendencies.
  • The absence of specialised courses such as public health engineering in India’s educational institutions points to a gap in the multidisciplinary approach required in public health management.
  • Public health is not just about treating diseases rather it is about preventing them, requiring expertise from various fields such as environmental science, sociology, urban planning, and economics.
  • The current physician-centric focus of India’s public health system often fails to capture this comprehensive nature.

Way Forward

• More Focus on Preventive Management: Effective public health management should encompass preventive measures, policy formulation, community health, and environmental health, among others.
• Need for a Degree of Autonomy in Healthcare
  • In public health, adopting a separation of powers approach is essential.
  • A fair and effective health system requires freedom from political influence, focusing on policymaking and implementation driven by scientific evidence and long-term objectives.
  • While prioritising health decisions based on scientific evidence and overarching public health goals are crucial, there is a risk of disconnecting from the immediate health concerns of the general populace.
  • To address this, an ideal solution would be to place Health Ministries directly under the leadership of elected officials, such as the Chief Minister or the Prime Minister, similar to the management of the space and the atomic energy departments.
  • This structure would not only provide a degree of autonomy but also ensure that health policies are aligned with the people’s immediate and practical needs, striking a balance between expert-driven decisions and public aspirations.
  • To borrow an idea from the architecture of India’s judicial setup and also the space programme, health care will benefit from being separated from political processes.
  • This separation will ensure that public health policies are driven by data and expertise, not electoral cycles.

Conclusion

• While democracy is not inherently harmful to public health, the current approach within democratic systems often falls short.
• There is an urgent need for a reimagining of public health governance, emphasising evidence-based, holistic, and long-term strategies that address both immediate and future health needs.