Role of government in public health: Current scenario in India

Role of government in public health: Current scenario in India:

The new agenda for Public Health in India includes the

·              epidemiological transition

·              demographical transition

·              environmental changes and

·              social determinants of health

Based on the principles outlined at Alma‐Ata in 1978, there is an urgent call for revitalizing primary health care in order to meet these challenges. The role of the government in influencing population health is not limited within the health sector but also by various sectors outside the health systems. Health system strengthening, human resource development and capacity building and regulation in public health are important areas within the health sector. Contribution to health of a population also derives from social determinants of health like living conditions, nutrition, safe drinking water, sanitation, education, early child development and social security measures. Population stabilization, gender mainstreaming and empowerment, reducing the impact of climate change and disasters on health, improving community participation and governance issues are other important areas for action. Making public health a shared value across the various sectors is a politically challenging strategy, but such collective action is crucial.

1.  Challenges confronting public health in India:

The practice of public health has been dynamic in India, and has witnessed many hurdles in its attempt to affect the lives of the people of this country. Since independence, major public health problems like malaria, tuberculosis, leprosy, high maternal and child mortality and lately, human immunodeficiency virus (HIV) have been addressed through a concerted action of the government. Social development coupled with scientific advances and health care has led to a decrease in the mortality rates and birth rates.

The new agenda for Public Health in India includes the epidemiological transition (rising burden of chronic non‐communicable diseases), demographic transition (increasing elderly population) and environmental changes.

The unfinished agenda of maternal and child mortality, HIV/AIDS pandemic and other communicable diseases still exerts immense strain on the overstretched health systems.

Silent epidemics: In India, the tobacco‐attributable deaths range from 800,000 to 900,000/year, leading to huge social and economic losses. Mental, neurological and substance use disorders also cause a large burden of disease and disability. The rising toll of road deaths and injuries (2— 5 million hospitalizations, over 100,000 deaths in 2005) makes it next in the list of silent epidemics. Behind these stark figures lies human suffering.

Health systems are grappling with the effects of existing communicable and non‐communicable diseases and also with the increasing burden of emerging and re‐emerging diseases (drug‐ resistant TB, malaria, SARS, avian flu and the current H1N1 pandemic).

Inadequate financial resources for the health sector and inefficient utilization result in inequalities in health. As issues such as Trade‐Related aspects of Intellectual Property Rights continue to be debated in international forums, the health systems will face new pressures.

The causes of health inequalities lie in the social, economic and political mechanisms that lead to social stratification according to income, education, occupation, gender and race or ethnicity.

Lack of adequate progress on these underlying social determinants of health has been acknowledged as a glaring failure of public health.

In the era of globalization, numerous political, economic and social events worldwide influence the food and fuel prices of all countries; we are yet to recover from the far‐reaching consequences of the global recession of 2008.

2. Role of Govt. in addressing Public health in India:

To meet the formidable challenges described earlier, there is an urgent call for revitalizing primary health care based on the principles outlined at Alma‐Ata in 1978: Universal access and coverage, equity, community participation in defining and implementing health agendas and intersectoral approaches to health. These principles remain valid, but must be reinterpreted in light of the dramatic changes in the health field during the past 36years. Attempts to achieve “Health For All” have been carried forward in the form of “Millenium Development Goals.”

Public health is concerned with disease prevention and control at the population level, through organized efforts and informed choices of society, organizations, public and private communities and individuals. However, the role of government is crucial for addressing these challenges and achieving health equity. The Ministry of Health and Family Welfare (MOHFW) plays a key role in guiding India's public health system.

Contribution to health of a population derives from systems outside the formal health care system, and this potential of intersectoral contributions to the health of communities is increasingly recognized worldwide. Thus, the role of government in influencing population health is not limited within the health sector but also by various sectors outside the health systems.