The corona pandemic has underlined the need to strengthen the Public Health system (not ‘healthcare’ mind you). ‘Public health’ really is an investment and not expenditure. Healthy population is what will make a strong nation. According to American public health association, 1 dollar spent on prevention of disease saves 5.6 dollars in healthcare spending. Public health really touches all the aspects of our lives because it is also concerned with disease prevention apart from healthcare. The current insurance-based system ‘Ayushman Bharat’ recognizes the right to healthcare but has no incentive to promote ‘health’ and ‘prevention of disease’. Efficient public healthcare, vaccination, population control, sanitation, pollution control, nutrition and education are all intertwined in prevention of disease.
Most experts believe that we are now facing a global recession and that trend of globalization is likely to reverse to an extent. Therefore, India will have to review her policies for economic growth and modernization. It would do us good to reduce our consumption of fossil fuel energy which is heavily dependent on imports while we have abundant human and solar energy.
In the face of recession, Indian government will have to inevitably increase spending despite increasing fiscal deficit. Government choosing to spend on PUBLIC HEALTH can really be the game changer. It has the potential to meaningfully train and employ the so called ‘demographic dividend’ of our country (average age of our population is 28) on the one hand. On the other hand, it will immensely improve our ability to offer quality healthcare and disaster management which will become increasingly important due to climate change. It also has the potential to unleash purchasing power of the masses by increasing employment as well as reducing individual healthcare spending (according to world bank every year 4 to 6 crore people are pushed into poverty due to medical expenses). Considering this is not the last pandemic or healthcare emergency we will be facing; public health should really be viewed at par with the armed forces. The system will not only protect us in such pandemics but also in other disasters and from ill health. The first step is to fill the vacancies in public health including epidemiologists by offering them good packages. That will help attract competent people to this vital service.
Now, let us consider each of these aspects of public health. Most of these departments already exist but now elected representatives and vigilant citizenry (civil societies) must ensure and prioritize their efficient implementation. Lacunae if any must be identified and addressed.
Efficient health care
The government must ensure sufficient well-trained manpower, infrastructure and supplies to the primary healthcare centers as well as district hospitals. This has the potential to boost local small industries and supply chains. Expensive private medical education must give way to scaled-up subsidized training. Protocolization and standardization of health care will help in improved and uniform standard of care. Advanced technology would be able to aid this process. Government needs to immediately scrap the plan to start public private partnership in district hospitals which serve as tertiary care centers. Establishment of single payer system for procurement of essential medicines (Tamilnadu model) and private specialist care will go a long way in bringing down the cost of essential medicines and care.
Immunization is an important aspect of public health which has so far been successful to a great extent by eradicating small pox and polio. It has also been successful in substantially reducing diphtheria, tetanus, rabies and measles. Governments should encourage epidemiological studies and facilities for testing safety and efficacy of vaccines which has become dubious in recent past due to profiteering.
Population control
Awareness campaigns, education and incentivization of smaller families have been greatly successful in this regard and should continue to do so.
Sanitation
Clean drinking water in villages; adequate treatment and disposal of human excreta and sewage in the towns and cities are of paramount importance. Preventing human contact with feces has been one of the greatest game changers in medicine apart from discovery of antibiotics and hydration. Awareness about handwashing has been the high light of our fight against Covid 19.
Pollution control
- Conservation of remaining forest lands, green patches and sacred groves (devrais) should be our top priority
- Knowledge based prevention of stubble burning
- Encouragement for buying local produce to avoid extensive transportation
- Stringent rules and awareness campaigns for fertilizer and pesticide use in farming
- Drastically cutting use of plastic and encouragement for upcycling, recycling
- Encouragement for organic farming
- Better infrastructure, healthcare and educational facilities in rural areas and small towns will stop migration and overburdening of city infrastructure
For towns and cities:
- Awareness campaigns about the chemicals and toxins in our cosmetics and detergents polluting rivers and coming back to us through food.
- Effective waste segregation and composting
- Subsidized public transport by taxing private vehicles
- Exclusive alternative pathways for walking/cycling
- Compulsory tree plantation and care by each student starting 1st standard
- Strictest norms for industrial pollutants and sewage water treatment
- Encouragement for ‘work from home’ wherever possible
Nutrition:
Awareness campaigns and spread of education has achieved significant reduction in birthrate. Our average life span has doubled since independence. Public health measures have also improved mother and infant death statistics. But it has failed in tackling malnutrition.
Effective implementation of mid-day meal and distribution of ration have demonstrated some success in this. These should be followed up zealously. Ethical treatment of farm animals is also important in nutrition. Use of hormones, unnatural living conditions negatively affect quality of dairy, poultry and meat products. Awareness and education will go a long way in tackling these problems.
Education:
School education is the most effective way to spread awareness about all of the above-mentioned aspects of PUBLIC HEALTH. These along with importance of ecology, biodiversity in our lives should be made a part of school curricula. Life skills like cooking, cleaning, sewing, plumbing, gardening, caring for other family members and animals should also be part of the school curricula. Imbibing dignity of labor and compassion towards all living beings should be an important goal of education in schools and homes. The city dwellers must understand that working out in the gym is not equivalent to productive physical activity because it lacks the satisfaction of doing something useful.
Awareness
Last but not the least, we all must understand ‘nature’ pays a ‘cost’ for every ‘thing’ we use which is not accounted for in terms of money. That there are finite natural resources and if we really cared for our children, ‘less is more’ should be our motto. It is not cool to use ‘more’. ‘Simplicity is the ultimate sophistication’: Leonardo Da Vinci