Curbing Individualism in Public Health

Why in news?

There is a strong tendency in public health to prioritise individual-oriented interventions over societal oriented population-based approaches, also known as individualism in public health.

What are the evidences for rising tendency of individualism in public health?

Pradhan Mantri Jan Arogya Yojana (PMJAY)

• It falls under Ayushman Bharat.
• It is the largest health insurance scheme in the country covering hospitalisation expenses for a family for Rs. 5 lakh a year.
• Goal - To ensure free curative care services for all kinds of hospitalisation services so that there is no financial burden to the beneficiary
• Population based approach – Data from the 75th National Sample Survey Organisation show that on an average, 3%-5% across most Indian States had an episode of hospitalisation in a year.
• Ideally, the Government needs to ensure health-care facilities to only 3%-5% of the population to cover all the hospitalisation needs of a population.
• This is population-based health-care planning.
• Individualistic response – However, every individual is given an assurance of covering the hospitalisation expenses, highlighting the probability of every individual facing hospitalisation in a year.
• Giving an assurance to every individual without ensuring the necessary health-care services to the population points to the low proportion of population that benefited from the scheme annually.
• More than 90% of those who were promised do not need hospitalisation in the near future.

Vaccination for COVID-19

• It was evident that around 20% of the total COVID-19 positive cases needed medical attention, with around 5% needing hospitalisation and around 1%-2% needing intensive care (ICU) or ventilator support.
• Population-based approach - There is a need to have primary, secondary, and tertiary health-care facilities to manage the above proportion of cases.
• However, considering the population as a single unit is neglected.
• Individualistic response - Instead, by focusing on a vaccination programme for the entire population, it is again an assurance to every individual that if you get COVID-19, you will not need hospitalisation.

What are the reasons for dominance of individualism in public health?

• Dominance of biomedical knowledge and philosophy – There is a misconception that what is done at an individual level, when done at a population level, becomes public health.
• This is against the contrasting philosophy and approaches of clinical medicine and public health and the evidence.
• Visibility of health impacts among general public - Health effects are more visible at the individual level, wherein improvements at the population level will be clear only after population-level analysis.
• The public health experts who take individual experiences at face value will judge a population’s characteristics based on individual experiences.
• Market’s role and effect of consumerism in public health - The beneficiaries for a programme become the maximum when 100% of the population is targeted.
• Propagating individualism has always been a characteristic feature of a consumerist society.
• All forms of individualistic approaches in public health need to be resisted to safeguard its original principles of practice - population, prevention and social justice.

Reference

1. The Hindu | Curbing individualism in public health