Public health in India: unethical neglect

The vital importance of public healthcare in our country has long been neglected.

In most developed nations, public health systems play a crucial role in maintaining the health status of the populace. While the private sector focuses on curative medicine and is oriented to the individual, the government is responsible for public health services, which are concerned with preventive medicine and disease control and treatment for the population as a whole. However, public healthcare can be effectively implemented only when the government is sincerely committed to providing such healthcare facilities to its people.

When it comes to providing world class quality medical treatment, we are at par with most developed nations and can provide high quality treatment at a far lower cost than most of them. But we lag far behind when it comes to providing public health services, many of which are particularly important for the common man, for 80% of India’s population. While we boast about our booming economy marching at a fast pace, we still have numerous segments of our population suffering from disease and hunger.

Time and again, experts have voiced the need for trained public health personnel. After much deliberation and delay, the Public Health Foundation of India came into being on March 28, 2006 (1). Yet, till date, it is not fully functional as an independent body and its presence is hardly registered in Indian medical circles. There is only one institute in India whose master’s degrees in public health and applied epidemiology (National Institute of Epidemiology, Thiruvananthapuram, Kerala) are recognised by the Medical Council of India (2). A few other universities and deemed universities offer degrees or diplomas in public health. But it is not clear if all of them follow a common course relevant in the Indian context because there is, as yet, no governing body for public health training regulations in India. So, if we have admitted to the importance of public health in India, why does the state fail to provide for its development? The lack of experts and funding has forced us to modify the results of studies and measures undertaken in other places to fit our needs, and this has often had disastrous results (3, 4).

There are not many public health specialists in India excluding those doctors employed in international health agencies like the WHO, UNICEF, and NGOs providing healthcare to the community. Meanwhile, all the evidence indicates that India desperately requires such experts to boost its community and primary healthcare. Admittedly, we have made much progress in the control of malaria, tuberculosis, HIV/AIDS, blindness, leprosy etc. But much more can be achieved. For this, we require qualified and trained public health experts, trained by competent institutes, to replace the ‘experts’ who do more harm than good to the offices of public health they head. Then only would we be practising true medical ethics in the care of the community as a whole.