Medicine or curative services is not the only soul contributor to health and well being of population. Health care covers not merely medical care, but also all aspects pro preventive care. There are several other determinants of health which include environmental, biological, socio-economic factors, information and communication, availability of health services, utilization of health services, age structure of the population etc. By influencing these factors or these determinants, we may play quiet a substantial role in improving the health. The excessive focus on curative medical care also detracts attention from the much more cost effective and efficient option of preventive public health investments that can stem the spread of infectious diseases and improve nutritional outcomes in the country. It is important to acknowledge factors beyond the realm of medical treatments in developing a healthy society.
The health of populations is a distinct key issue in public policy discourse in every mature society often determining the deployment of huge society. They include its cultural understanding of ill health and well-being, extent of socio-economic disparities, reach of health services and quality and costs of care and current bio-medical understanding about health and illness.
In World Health Organization’s 2009 World Health Report ranking, India’s healthcare system ranked 112 out of 190 countries. Some of the least developed countries like Senegal (59), Tunisia(52), Bangladesh(88) ranked better than India. It shows the poor policy making in relation to public health in India. Many of the policy makers argue that, country faces bigger challenges like economic development, infrastructure, jobs etc and they gave less importance to public health. But most of the time they failed to establish the relation between economy and health care.
The effects of health on development are clear. Countries with weak health and education conditions find it harder to achieve sustained growth. Indeed, economic evidence confirms that a 10% improvement in life expectancy at birth is associated with a rise in economic growth of some 0.3-0.4 percentage points a year. Disease hinders institutional performance too. Lower life expectancy discourages adult training and the emergence of deadly non-communicable diseases has become an obstacle for competitiveness, damaging the productivity.
Health financing, through out-of-pocket expenditures, is inequitable and can expose whole populations to huge cost burdens that block development and simply perpetuate the disease/poverty trap. On the other hand, health systems need financing and investment to improve their performance, yet this need cannot in turn impose an unfair burden on national spending.
Lack of healthcare insurance penetration is another major reason for high out of pocket expenditures. According to the World Bank and National Commission’s report on Macroeconomics, only 5% of Indians are covered by health insurance policies, which is only available for the urban, middle and high income populations. So there is the need for universal health coverage and I hope draft national health policy is going in the right direction.
Public health, which is, “Art and Science of protecting and improving the health of a community through an organized and systematic effort that includes education,provision of health services and protection of the public from exposures that will cause harm”.
This high burden of 3D’s, Disease, Disability and Death can only be addressed through an effective public health system. Ever increasing population with increasing geriatric population and changing lifestyle with more urbanization is putting pressure on environmental as well as on nutritional requirement resulting in nutritional deficiency, poor sanitation, increasing communicable and non communicable diseases etc.
Thus, public health approach is to deal with all determinants of health which requires multi sectoral collaboration and interdisciplinary coordination. Health care includes medical care and care of the determinants of health and this collective approach will help to improve the health of the community.
Health is wealth:“pehle shauchalay, phir devalay” (first toilets, then temples)