Public Health issue in India.

Today, I would like to post something related to public health. This is one of the best topic that I interest most because I really think that Public Health intervention is the better in the management of health rather than cure and rehabilitative management. Public health has its own way to reduce to long term cost of health. For this post, I would focus on the issue of public health in India. This is simply my expression and what do I understand about the articles produced by T. Jacob John and Jayaprakash Muliyil, Formerly professor and Head, department of Clinical virology.

Health Problem in India:
There are many diseases that are still become epidemic in India despite of well run intervention programmes carried out by government. Examples of the disease that are still become unsolved problems in India include malaria, tuberculosis, and leprosy. Malaria is still a problem because of the intervention to control the disease is not sustained and there is resurgence of p. Falciparum in many states. The prevalence of adult TB is still high and the incidence of TB infection in children does not decline. Even though, the National TB Control Programme has begun since 1962. Other examples that shows the failure of public health system intervention is the epidemic of chikungunya virus. As we know, this virus is transmitted by Aedes Aegypti, the same vector for dengue virus. This shows that the government intervention to eradicate the vector and control the dengue virus diseases was failed. 

  
How to improve?

 There are many interventions that can be taken when the Public Health infrastructures are widely available in the country. Public health focuses more on case-based and real-time disease surveillance, disease prevention, detection of early signal of outbreak and immediate interventional response, coordinated control and monitoring of trends of all endemic infectious diseases which may vary from region to other region, the maintenance of microbiology lab in all districts and its quality as it is very important for diagnostic purpose and management of the diseases and health promotion.  

Other than that, other States in India can learn from Tamil Nadu because of their successful projects in improving citizen health. Some of Tamil Nadu achievements include > 90 % coverage of the 3rd dose of DPT in infant for over a decade and virtually eliminated child death due to measles.

Moreover, they proposed the establishment of the Department of Public Health in both Central and States level. The establishment must be preceded by training and education process to produce enough manpower for public health infrastructure. Well-trained public health officer should be placed at both level and the interaction and coordination between two levels should be done regularly. States and districts officers are important for disease prevention and outbreak control and officials at central level are important for policy formulations, creation of protocols, standardization of public health interventions and procurement and supply of quality assured materials.

Why such infrastructure is needed?

In my opinion, poverty itself is the disease because it does not only effects people physically, but psychologically and socially as well. In order to eradicate poverty or at least reduce the rate, we need a tool that can be used to improve the health of the poor, so that their productivity can be improved. Public health is the tool. We can use one example to explain about this. Hepatitis B in treatment in Indonesia cost around Rp 1.800.000 per month but the vaccines only cost around Rp. 600.000. If we analyse this example, we can conclude that it is much saver if we prevent the disease early before we contract the disease. Let say poor people contracted Hepatitis B and they need to but such expensive medication monthly, this would make them become poorer. Prevention and health promotion under public health agenda give better long term benefits not only to poor but all citizens in the country.

On the other hands, globalization has brought many other diseases to many countries including India and Indonesia such as hypertension, diabetes mellitus, brain diseases, renal diseases, mental diseases, injuries, environmental and industry-related toxicities and genetic diseases. If the PH structures has not established immediately, we will face more diseases burden in the near future as the number of people contracting the “millennium diseases” become more and more.

References:
1. John, J.T. Muliyil, J. 2009. Public Health is Infrastructure for Human Development. Indian J Med Res 130, July 2009, pp 9-11.