What is public health?
Public health is the collective physical, mental, and social wellbeing of everyone.
Public health has also been defined as "the science and art of preventing disease”, prolonging life and improving
quality of life through organized efforts and informed choices of society, organizations (public and private),
communities and individuals.
The public can be as small as a handful of people or as large as a village or an entire city; in the case of a
pandemic, it may encompass several continents. The concept of health according to the World Health
Organization, is not merely the absence of disease or infirmity and more recently, a resource for everyday living.
Current state of India
India is presently in a state of transition — economically, demographically, and epidemiologically — in terms of
health. the last decade has seen remarkable economic development, however this progress is accompanied by
growing disparities between the rich and the poor. strong evidence suggests that this income inequality or
disparity between the different socioeconomic classes is associated with worse health outcomes.
The country at present suffers from the triple burden of disease — the unfinished agenda of infectious diseases;
the challenge of noncommunicable diseases (NCDs), linked with lifestyle changes; and emergence of new
pathogens causing epidemics and pandemics. In addition, the health infrastructure is already over-stretched and
needs to be strengthened to enable it to confront these challenges in the twenty-first century.
Presently, The Corona Virus pandemic has already rolled back progress on a number of socio-economic
indicators.
Going forward, we need to take a closer look at the COVID-19 and non-COVID-19 disease progression in India’s
cities, the lack of data, inadequate infrastructure, and insufficient budgets.
Common public health issues.
In spite of gradual progress, various diseases are expected to continue to remain a major public health problem
in the coming decades posing a threat to both national and international health security, the covid-19 pandemic
being the perfect example of a threat to international security.
Since independence, major public health problems like malaria, tuberculosis, leprosy, high maternal and child
mortality and lately, human immunodeficiency virus (HIV) have been addressed through a concerted action of
the government. Social development coupled with scientific advances and health care has led to a decrease in the
mortality rates and birth rates.
Four diseases namely heart disease, cancer, diabetes, and chronic pulmonary diseases contribute nearly 80% of
all deaths due to NCDs and they share four common risk factors namely tobacco use, harmful use of alcohol,
unhealthy diet, and lack of physical activities.
On a global scale, these are the top 10 most common health issues faced by the masses in the 21st century.
1. Physical Activity and Nutrition
2. Overweight and Obesity
3. Tobacco
4. Substance Abuse
5. HIV/AIDS
6. Mental Health
7. Injury and Violence
8. Environmental Quality
9. Immunization
10. Access to Health Care
Current Public Health facility in India
The public health system in India comprises a set of state-owned health care facilities funded and controlled by
the government of India. Some of these are controlled by agencies of the central government while some are
controlled by the governments of the states of India.
The governmental ministry which controls the central government interests in these institutions is the Ministry of
Health & Family Welfare.
Governmental spending on health care in India is exclusively this system, hence most of the treatments in these
institutions are either fully or partially subsidised.
The healthcare system is organised into primary, secondary, and tertiary levels. At the primary level are Sub
Centres and Primary Health Centres (PHCs). At the secondary level there are Community Health Centres
(CHCs) and smaller Sub-District hospitals. Finally, the top level of public care provided by the government is the
tertiary level, which consists of Medical Colleges and District/General Hospitals.
Sub Centres
A Sub Centre is designed to serve extremely rural areas with the expenses fully covered by the national
government. Mandates require health staff to be at least two workers to 5000 people. Sub Centres also work to
educate rural people about healthy habits for a more long-term impact.
Primary Health Centres
Primary Health Centres exist in more developed rural areas of 30,000 or more (20,000 in remote areas) and serve
as larger health clinics. Patients can be referred from local sub centres to PHCs for more complex cases. The state
governments fund PHCs and the PHCs also function to improve health education with a larger emphasis on
preventative measures.
Community Health Centres
A Community Health Centre is also funded by state governments and accepts patients referred from Primary
Health Centres. It serves 120,000 people in urban areas or 80,000 people in remote areas. They are required to
have obstetric care, new-born/childcare, and blood storage capacities 24/7.
District Hospitals
District Hospitals are the final referral centres for the primary and secondary levels of the public health system.
There are normally anywhere between 75 and 500 beds, depending on population demand. These district
hospitals often lack modern equipment and relations with local blood banks.
Medical Colleges and Research Institutions
All India Institutes of Medical Sciences is owned and controlled by the central government. These are referral
hospitals with specialized facilities. A Regional Cancer Centre is a cancer care hospital and research institute
controlled jointly by the central and the respective state governments.
Problems with our current public health facilities
Problems with India's healthcare system today include low quality care, corruption, unhappiness with the
system, a lack of accountability, unethical care, overcrowding of clinics, poor cooperation between public and
private spheres, barriers of access to services and medicines, lack of public health knowledge, and low-cost
factor.
The public sector offers healthcare at low or no cost but is perceived as being unreliable, of indifferent quality
and generally is not the first choice, unless one cannot afford private care. Added to the problem is the lack of
regulation in the private sector and the consequent variation in quality and costs of services.
Public clinics often have a shortage of the appropriate medicines or may supply them at excessively high prices,
resulting in large out of pocket costs (even for those with insurance coverage).
These drawbacks push wealthier Indians to use the private healthcare system, which is less accessible to low-
income families, creating unequal medical treatment between classes.
India also faces an acute shortage of health personnel. Together with inequalities in distribution of health
workers, this shortfall impedes progress towards achievement of the Millennium Development Goals.
Both social and financial inequality results in barriers of access to healthcare services in India. Large distances
also prevent Indians from getting care, and if families travel far distance there is low assurance that they will
receive proper medical attention at that particular time.
The HAQ (Health care access and quality score)
The Healthcare Access and Quality (HAQ) Index was developed by the University of Washington’s Institute for
Health Metrics and Evaluation.
The index assesses personal health care access and quality for 195 nations and territories, as well as sub-national
locations in seven countries, from 1990 to 2016.
The data gathered through the index in 2016 showed that some countries’ progress slowed or even stalled over
the period between 1990-2016, which, the authors of a study on business-standard said in a press statement,
could be a warning sign that their health systems are not evolving at the same pace as the needs of their
populations. This is especially concerning as we live at a time when many non-communicable diseases and
cancers are becoming more common.
The five countries with the highest levels of healthcare access and quality in 2016 were Iceland (97.1 points),
Norway (96.6), the Netherlands (96.1), Luxembourg (96.0), and Finland and Australia (each with 95.9).
India ranks 145th out of 195 countries with a score of 41.2.
According to the study, India performed poorly in tackling cases of T.B, rheumatic and Ischaemic heart diseases,
stroke, testicular cancer, colon cancer and chronic kidney disease etc.
Public health policies in India
Governments all over the world work towards providing good quality healthcare for their people. Creating
awareness about health issues, ensuring strong infrastructure, and promoting health insurance are also
responsibilities of the government.
A Government Health Insurance Scheme is a State or Central Government powered health insurance initiative
for its citizens. Such policies are usually offered on an annual basis.
Examples : Karunya Health Scheme:
Kerala Government had launched this initiative in the year 2012. Karunya Health Scheme is directed towards
providing Health Insurance for listed chronic illnesses. It is a Critical Illness plan for the poor and covers major
diseases such as Cancer, Kidney Ailments, Heart-related medical issues, etc.
Those below or near the poverty line can enrol themselves for this cover. Aadhaar Card and appropriate Income
Certificate are needed for this scheme.
Comparison studies of countries with good public health systems with India.
Italy is known to have the world's second-best healthcare system while Indian healthcare system is not
included even in the top 100 list.
A comparison study will help us understand where exactly the Indian system lacks.
Benchmark India Italy
Population 135 crores 6 crores
GDP size (nominal)2020 $3.202 trillion $1.989 trillion
Nominal Per Capita Income (2020 estimates) $2,338 $32,947
Health care expenditure (%of GDP), WHO data 3.65% 9%
Density of medical doctor per 10000 persons 7 40
Total Hospitals 23852 (2018) 1063 (2017)
Health expenditure per Capita, PPP (Annual) $241 $3427
From the given table we can clearly see the difference in the two countries between their GDPs and health
expenditure relative to each country’s population.
India’s population surely is a challenge, and the GDP is not at an ideal place to be able to fund our health care
expenditure like Italy.
Adding to that corruption, and the general economic situation of the masses makes them unable to afford
healthcare from private health facilities.
The ratio of health care workers to the population is also a major problem and is reflected in the table.
Stereotypes and stigmas (with relation to specific issues like mental health, physical disabilities etc)
people with serious mental/physical disabilities are challenged doubly. They struggle with the symptoms and
disabilities that result from their condition while also are challenged by the stereotypes and prejudice that result
from misconceptions about their disability.
As a result of both, people with such disabilities are robbed of the opportunities that define a quality life: good
jobs, safe housing, satisfactory health care, and affiliation with a diverse group of people.
The damaging effects of stressor exposure for mental health among people with physical health issues have
become increasingly apparent from studies that have included multiple dimensions of stressor exposure,
including major and recent life events, discriminatory events, and chronic strains.
Debunking Stigma’s with Physical Disabilities –
A physical disability is a limitation on a person's physical functioning, mobility, dexterity, or stamina.
Other physical disabilities include impairments which limit other facets of daily living, such as respiratory
disorders, blindness, epilepsy, and sleep disorders. Physical disabilities may affect, either temporarily or
permanently, a person’s physical capacity and/or mobility.
There are many different causes of physical disabilities, but they can include inherited or genetic disorders,
serious illnesses, and injury.
Debunking Mental Health –
Mental health refers to cognitive, behavioural, and emotional well-being. It is all about how people think, feel,
and behave. Mental health can affect daily living, relationships, and physical health.
The WHO stress that mental health is “more than just the absence of mental disorders or disabilities.” They also
emphasize that preserving and restoring mental health is crucial on an individual basis, as well as throughout
different communities and societies the world over.
The WHO also estimates that about 7.5 per cent Indians suffer from some mental disorder and predicts that by
end of this year roughly 20 per cent of India will suffer from mental illnesses. According to the numbers, 56
million Indians suffer from depression and another 38 million Indians suffer from anxiety disorders.
Here are the top 5 countries with the greatest burden of disease for mental and behavioural disorders, in terms of
most years of life lost due to disability or death adjusted for population size, according to WHO.
ALCOHOL AND
OVERALL DEPRESSION ANXIETY
DRUG USE
China China China China
India India India U.S
U.S. U.S. U.S. India
Brazil Brazil Brazil Russia
Russia Bangladesh Indonesia Brazil
Referring to the table we can see that India is ranked 2nd for both depression and anxiety suffering and 3rd for
alcohol and drug abuse. Nearly 1/7th of the population of the world resides in India and the information given by
the table relative to the population of India and world is concerning.
Suicide is the second leading cause of death among youth in India (15-29 years) says a Lancet Global Health
Study Report. 4 out of 10 students experienced depression as per a 2016 Lokniti-Centre for the Study of
Developing Societies youth survey. One student commits suicide every hour according to the National Crime
Records Bureau data.
However, Indian educational institutions are ill equipped to deal with students’ mental health issues.
Creating a school-based Mental Health program should be developed nationally. It would only benefit the
population and make for better people.
Reform
Health system should be strengthened to improve the process of service delivery. In order to make the health
services responsive to the need of the community, it is necessary to improve the functioning of the existing
government health infrastructure. This can be done in three steps as follows:
1. Assessing existing public health system and facilities and bringing improvements based on the findings of the
assessment by setting targets and trying to achieve them through a comprehensive and integrated approach,
with full involvement of the community. Improved access to government health services, which are used
primarily by the poorer people of society, will go a long way in achieving better health outcomes.
2. For efficient delivery of services, an efficient public-health workforce is key. India has one of the lowest
densities of health workforce; with density of physicians (7 per 10 000 population) and nurses (17.1 per 10 000
population) as against the global average of 13.9 and 28.6 respectively (World Health Statistics, 2015). The issue is
serious, particularly in the rural areas, as most doctors and hospital beds are concentrated in urban areas catering
to only 20% of the India's population. The pandemic which hit in 2020 only added salt to an open wound.
3. Focusing on evidence, excellence, and equity. Focus should be on strengthening a widespread research and
innovation culture throughout the country and generating homegrown data, so that these data can be used for
policy and strategy development, priority setting, and evaluating the impact.
4. leveraging technology to transform public health. Modern technology has great potential in bringing efficiency
in service delivery and enhancing the reach of the health services.
Mobile technology holds great promise especially due to its ubiquitous nature. With more than one billion
mobile users in the country, the mobile phones offer tremendous opportunities in efficient health service delivery
like
- ensuring timely treatment via automated SMS reminders,
- quick reporting of cases during outbreaks or epidemics,
- informing populations and creating awareness about emerging health issues or health programs.
Social media helped in spreading awareness rapidly about what India’s condition was earlier in 2021. For
instance, people created bots on twitter to find beds, oxygen cylinders etc for their loved ones, on Tumblr people
posted text posts talking about the situation and exposed donation platforms to the international audience, and
even on YouTube people made monetized videos solely for donating the proceeds on the videos to Indian
donation platforms.
Spreading awareness
Awareness of public health care is low in India as a result of educational status, poor functional literacy, low
accent on education within the healthcare system, and low priority for health in the population, etc.
We must strive to raise awareness in those whom we work with and must encourage the younger generation to
believe in the power of education for behaviour change.
Having an education opens a wide range of opportunities, and it allows a person to find jobs with benefits,
career advancements, and ideal working conditions.
Education and knowledge gained allow a person to improve their quality of life. Being educated also gives better
understanding as to why it is important to take care of ourselves, our families, or communities, and will give rise
to a healthier environment both naturally and socially.
