Think differently about healthcare (India's public health system)

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 Think differently about healthcare (India's public health system)

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• Public health = Health services : These two aspects are synonymous in India. As our population has grown drastically, and life expectancy has improved, the load of chroninc diseases has fallen on our public health systems.
• Wider scope : When talking of health, our people's health will be affected by many things like Seat belt laws, food and drug safety regulations, policy for tobacco use, clean energy etc. But they are not necessarily a part of healthcare services. What India lacks is one comprehensive model of public health system.
• Public health structure : This discipline includes many aspects - research, urban planning, health policy, environmental science, behavioural science, healthcare management, financial, etc.
• Quantitative problem : We have only 51 colleges that offer a PG course in public health, and even lesser at UG level. The US has 238 Universities offereing a Masters in Public Health. So there is a quantitative problem.
• Lack of diversity in our public health workforce : In the US, public health graduates come from varied fields like engineering, social work,  medicine, finance, law etc. But that is not so here in India, and hence an interdisciplinary workforce is not being built. But the tragedies we are facing are multiple - 2017 Gorakhpur tragedy, air pollution in Delhi, Punjab narcotics crisis etc.
• A conundrum in national health systems : The benefits of investing in population-level health systems come much later (after many years). That reduces political interest in it - a problem most nations face.
• Link between taxation and health : An investment of $ 1 in taxation of sugary beverages can give a return of $ 55 in the long term. Tobacco prevention programmes yield a return on investment (ROI) of 1900% for every $ 1 spent.
• Health literacy : Whatever people perceive in health communication, builds their health literacy. That will decide their reaction to legislations on health related issues. America, Europe and India all have low health literacy, in general.
• Public health system vs. Healthcare services : The first focusses on optimising wellness, and the second on preventing morbidity and mortality. The two need to be bridged by a healthcare system.
• A central body needed : India can build something like a "Council for Public Health" to deal with the many other agencies like food safety, water management, public works department, sanitation, urban and rural planning, housing and infrastructure etc. Such a council will better focus the attention of central and state agencies, and can also develop a better curriculum for public health.
• Inclusive healthcare : Worldwide, the cost of healthcare is rising. The Ayushman Bharat insurance programme will help many, but we need a systemic reform in public health to bring better health to the entire population.
• Time for change : India's public health system has to outgrow the boundaries of health services, and focus on broader issues.
• Summary : The health services need totally overshadow India's need to build a robust public health system taking into account diverse aspects.

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