Sunday, September 02, 2007

Public Health Beyond Medicine

In an editorial 'Public health in India and the developing world: beyond medicine and primary healthcare' in the Journal of Epidemiology and Community Health, July 2007 reminds, "Public health in India relies primarily on medicine to achieve its goals. Successive governments in India have come up with many schemes for the provision of safe water, sanitation, nutrition, vaccination coverage, education and employment. Despite the many attempts, millions of people do not have access to these basic needs, malnutrition is rampant in children and vaccination coverage is inadequate among the poor."

The National Health Policy 1983 proposed "to provide ‘Health for All by the year 2000 AD’, through the universal provision of comprehensive primary health care services." The National Health Policy-2002 noted, "In retrospect, it is observed that the financial resources and public health administrative capacity which it was possible to marshal, was far short of that necessary to achieve such an ambitious and holistic goal."

The policy of 2000 dealing with the Extending Public Health Services admitted, "While there is a general shortage of medical personnel in the country, this shortfall is disproportionately impacted on the less-developed and rural areas. No incentive system attempted so far, has induced private medical personnel to go to such areas; and, even in the public health sector, the effort to deploy medical personnel in such under-served areas, has usually been a losing battle. In such a situation, the possibility needs to be examined of entrusting some limited public health functions to nurses, paramedics and other personnel from the extended health sector after imparting adequate training to them."

The 2002 policy elaborated on the State of Public Health Infrastructure saying,
"As a result of such inadequate public health facilities, it has been estimated that less than 20 percent of the population, which seek OPD services, and less than 45 percent of that which seek indoor treatment, avail of such services in public hospitals. This is despite the fact that most of these patients do not have the means to make out-of-pocket payments for private health services except at the cost of other essential expenditure for items such as basic nutrition."

The editorial aptly locates Health solutions beyond medicines to which the policymakers, "The survival of the human body is best explained by the materialist explanation that locates the variation in health and longevity to tangible resources. The reciprocal relationship between poverty and disease had long been acknowledged by public health reformers who advocated social reform on political, economic, humanitarian and scientific grounds."

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