The time has come for public health professionals to look at sustainable development and the interconnectedness of issues such as health, food security and climate change, K. Srinath Reddy, founder, Public Health Foundation of India, has said.

It was incumbent on public health professionals to recognise this interconnect and build coalitions that can contribute collectively to improving social conditions and thereby health and development. “Medicine has evolved into broader public health, and now public health should evolve into the even broader arena of sustainable development, Dr. Reddy said delivering the 15th Dr. K.S. Sanjivi Endowment Lecture at the Voluntary Health Services here on ‘The Future of Public Health in India.’

Dr. Reddy listed the various determinants of health and appealed to everyone to become participants in the journey of advancing the mandate and mission of public health. “It is not merely a trained public health professional that is going to make the whole difference. That is because many determinants of health lie outside of the traditional health sector, and have a far more profound impact on health.”

He went on to define the mandate of public health as identifying and influencing the determinants of health at the population level so as to impact upon and improve health at the individual level. “Essentially, we are addressing all influences that operate at the wider societal level or even innovations and policies and programmes that are operationalised through the health system, but which are actually reflecting a societal need, rather than that of a single individual.”

So, whether it was increased taxation on tobacco products to bring down consumption, reducing the salt in processed foods or ensuring universal immunisation, they were steps to improve the health status of society and therefore, legitimately part of public health. Even clinical services came under the ambit of public health, though the main role of public health was before and after the clinical interface. What led a person to become ill and reach a hospital, what were the factors contributing to his illness, whether they were preventable or remediable at an early stage and the possibilities of picking these people up through surveillance were public health issues. Even after the patient left the health care facility, there were questions about whether there was appropriate rehabilitation, the affordability of drugs and availability of nutrition support.

“We have to start recognising that health is not just a simple thing that is going to be determined by a medical understanding, but that other sectors outside have a far greater influence on health. It is through this understanding that we have to proceed to influence each of them.” It was necessary to look at ensuring community self-sufficiency in food production, the whole idea of livelihoods, and the role of the market.

He proposed regulations to make the market responsive to the needs of public health and for the private health sector where out-of-pocket health expenditure was among the highest. The government had to become the key guarantor of affordable, universal health care. While it need not be the sole provider, it should guarantee that no one incurred catastrophic out-of-pocket expense on health. “This is the ultimate hallmark of a civilised society. We are far from that.”

Earlier, M.S.Swaminathan, chairman, MSSRF, and VHS president, presented the oration medal to Dr. Reddy. He also released an appeal from VHS for financial assistance for the hospital.

N.Ram, Editor-in-Chief, The Hindu, said the National Family Health Survey – 3 had painted an appalling picture in the so-called good health States of Gujarat, Punjab, Maharashtra and Andhra Pradesh. He also spoke of the poor positioning of public health expenditure and the high out-of-pocket health expenses in India.

V.K.Subburaj, principal secretary, health, highlighted the relatively better performance of Tamil Nadu in public health care.

E.S.Krishnamoorthy, honorary secretary, VHS, announced the adoption of four of the 14 mini health centres of the hospital by philanthropists. They would be upgraded and their functioning improved through collaboration with corporates. VHS was looking forward to working with others willing to adopt the other 10 centres.

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