Towards a Comprehensive Healthcare System

What is the issue?

India’s 'public health' system should become more comprehensive and can no longer function within the shadows of its 'health services' system.

What is a healthcare system?

• The public health system looks at the social ecology and determinants focusing on optimising wellness.
• Healthcare services, on the other hand, primarily focus on preventing morbidity and mortality.
• A comprehensive healthcare system will seamlessly bridge the above two.
• In India, public health and health services have been synonymous, hampering the growth of a comprehensive public health system.

Why is a public health system crucial?

• A stark increase in population growth, along with rising life expectancy, provides the burden of chronic diseases.
• Tackling this requires an interdisciplinary approach.
• An individual-centric approach within healthcare centres does little to promote well-being in the community.
• Seat belt laws, food and drug safety regulations, and policies for tobacco and substance use as well as climate change and clean energy are all intrinsic to health.
• But they are not necessarily the responsibilities of healthcare services. A robust public health system becomes vital here.
• A well organised public health system with supporting infrastructure strives to prevent catastrophic events and public health tragedies.
• E.g. the 2017 Gorakhpur tragedy in Uttar Pradesh, 2018 Majerhat bridge collapse in Kolkata, air pollution in Delhi, Punjab narcotics crisis

What are the drawbacks in India?

• Institutions - India’s public health workforce comes from an estimated 51 colleges that offer a graduate programme in public health.
• This number is lower even at the undergraduate level.
• In stark contrast, 238 universities offer a Master of Public Health (MPH) degree in the U.S.
• Workforce - India also lacks a diverse student population which is necessary to create an interdisciplinary workforce.
• In the U.S., public health graduates come from engineering, social work, medicine, finance, law, architecture, and anthropology.
• [Public health tracks include research, global health, health communication, urban planning, environmental and behavioural sciences, behavioural economics, healthcare management, financing.]
• Curriculum - The diversity is further enhanced by a curriculum that enables graduates to become key stakeholders in the health system.

• Strong academic programmes are critical to harness the potential that students from various disciplines would bring, where India needs to improve.
• Investments in health and social services tend to take precedence over public health expenditure in India.
• Benefits from population-level investments are usually long term but sustained.
• As it tends to accrue much later than the tenure of most politicians, there is reluctance in investing in public health as opposed to other health and social services.
• But the impact of saving valuable revenue through prevention is indispensable for growing economies like India.

• Health communication, an integral arm of public health, aims to disseminate critical information to improve the health literacy of the population.
• The World Health Organisation calls for efforts to improve health literacy, an independent determinant of better health outcome.
• India certainly has a serious problem with health literacy and it is the responsibility of public health professionals to close this gap.
• Also, legislation is often shaped by public perception, rather than being informed by research.
• Evaluation system - Many of the national programmes on health fail due to improper implementation.
• A system of evaluating national programmes is essential for ensuring proper outcome and saving time and money.

What could be done?

• A sound public health system is critical to overcome some of the systemic challenges in healthcare.
• A central body like the council for public health may be envisaged to work with other agencies to promote population-level health.
• These may include public works department, narcotics bureau, water management, food safety, sanitation, urban and rural planning, housing and infrastructure.
• The proposed council for public health should also work closely with academic institutions.
• This is to develop curriculum and provide license and accreditation to schools to promote interdisciplinary curriculum in public health.
• The proposed comprehensive insurance programme Ayushman Bharat caters to a subset of the population.
• Beyond this, systemic reforms in public health could shift the entire population to better health.
• With rising healthcare costs, there is also the need to systematically make healthcare inclusive to all.

Source: The Hindu