K. Srinath Reddy
Since matters of health are substantially influenced by policies and programmes followed in other sectors, all the Ministries of government must play an active role in advancing health goals.
As India ushers in a new national government, there is a great deal of interest in the allocation of ministerial portfolios. While the Health Ministry has a new incumbent, it is important to place health-related policies and programmes prominently on the agenda of other Ministries too. This is because actions in many other sectors can have a profound impact on the health of the population, often more than even actions within the health sector. So here is a discussion of the roles that can be played by the different Ministers.
Finance: Allocations to the health sector should be increased to raise public expenditure on health to 3 per cent of GDP by 2012. Taxes on tobacco products, alcohol and cars should be increased in order to reduce their consumption and use. A substantial part of these additional tax revenues should be earmarked for upscale health promotion, primary health care and emergency health services. Some countries have done this to good effect. Health care financing mechanisms have to be reconfigured to reduce the unacceptably high out-of-pocket spending, which is now over 80 per cent of the total. This requires mainly public financing, with protection for the poor through social insurance, supported by health insurance paid for by the employer.
Education: Health literacy is essential to empower individuals, families and communities to protect, preserve and promote their health. Awareness of health-related issues should be increased in schools and colleges through curricular and co-curricular channels. Non-governmental organisations working in the health sector should be invited to assist in this process. School students and teachers should be trained to become health communicators and health advocates in order to engage with, educate and energise their neighborhood communities on a regular basis. Schools should thereby become portals of community health education. School health programmes should be strengthened, with adolescent health receiving greater attention.
Agriculture: Nutrition being vital to good health, agricultural policies must ensure that all sections of the people have essential goods available to them at affordable prices. The production, processing and pricing of cereals and grain, vegetables and fruits, as well as oilseeds which yield healthy cooking oils, should be linked to national nutritional goals. Market mechanisms must be moulded to match public health purposes. Reducing post-harvest losses will ensure greater availability of nutrient foods. Linkages among wildlife, veterinary and human surveillance systems will provide early warning signals of zoonotic diseases, while changes in livestock breeding will help prevent them. Farmers should be assisted to move from tobacco cultivation to other economically viable but also nutritive crops.
Food Processing: Food products must be regulated to reduce the salt and sugar content of manufactured foods. Trans-fats must be eliminated and the level of saturated fats reduced in processed foods. In conjunction with the Department of Consumer Affairs, colour-coded food labels must be introduced in order to increase consumer awareness of the salt, sugar and fat content in food products.
Water Resources: Clean drinking water is an absolute need to sustain life and prevent many diseases. The schemes initiated to provide sources of safe water must be speeded up and scaled up. People should be enabled to purify water from other sources using inexpensive technologies.
Rural Development: Livelihood generation and poverty reduction are critical areas of action if people have to overcome malnutrition and gain good health. The National Rural Employment Guarantee Act (NREGA) should be strengthened and rural micro-finance schemes expanded. Women’s self-help groups should be supported to perform public health-related functions.
Panchayati Raj: The success of the National Rural Health Mission (NRHM) depends on the active engagement of panchayati raj institutions. Capacity must be built within those institutions to make possible informed decisions on village-level health and sanitation plans.
Urban Development: Cities should be designed to ensure adequate provision of water and sanitation services, safe roads, pedestrian paths, protected cycle lanes and accessible community recreational spaces such as parks and green areas. All urban facilities should take into account the special needs of persons with disabilities. Fire safety measures and building standards should be strictly enforced to minimise safety hazards.
Women and Child Development: Empowerment of women and unfettered development of children must be facilitated by a variety of programmes since they have a powerful impact on health. Child nutrition must be promoted from birth through adolescence by expanding and strengthening Integrated Child Development Services (ICDS) and mid-day meal programmes. Special attention should be paid to the needs of the girl child.
Information and Broadcasting: Effective health communication strategies must be developed and delivered, using the mass media extensively, to empower people with relevant health information. A network of media resource centres should provide a regular stream of health information to the print media, especially the Indian language media.
Communications: Information technology and telecommunications can enable health education, telemedicine, emergency health services, epidemiological surveillance and health information systems.
Environment: Environmental protection measures will help prevent several health disorders, especially those related to air and water pollution. Prevention of deforestation will help reduce the threat of zoonotic infections. Action taken to mitigate climate change will have a positive health impact.
Labour: Apart from providing protection from occupational health hazards, employers in organised-sector industries must be mandated to start and sustain worksite-based health promotion programmes for employees, with family outreach. The unorganised sector workforce too should be assisted to secure healthy working conditions.
Social Justice: Programmes to assist persons with disability are anchored in this Ministry, as are special programmes to serve tribal populations. The health components of these programmes need to be greatly strengthened.
Chemicals and Fertilizers: The capacity for indigenous production of essential drugs must be increased, with appropriate mechanisms for quality and price control.
Commerce: Provisions related to the manufacture of life-saving drugs and patent restrictions imposed on them are important areas of negotiation within the World Trade Organisation. India needs to play a major role, along with other developing countries, in ensuring access to drugs and vaccines for the people.
Science and Technology: Indigenous production of technologies for the diagnosis and treatment of major diseases should be enhanced. Basic research as well as inter-disciplinary translational research must advance knowledge on the causes and cures of prioritised public health problems.
Railways: The large employee medical data bases of the Indian Railways should be used to generate useful health information on the geographic and demographic profile of health disorders, time trends of diseases and risk factors and economic estimates of health-related costs. This organised sector represents a mini-India and can provide excellent surveillance information on several health indicators at very low cost. The Railways should use the public announcement systems in trains and stations to disseminate crisp health messages to benefit its large number of travellers.
Surface Transport: Road safety is clearly a priority and the quality of roads needs to be improved. Access to health care is affected by road connectivity, which needs to be enhanced across the country.
Defence: Demobilised defence personnel should be provided an opportunity, through the Directorate of Resettlement, to be trained in public health, primary health care and emergency health care so that they may assist in the delivery of the NRHM. With their background of discipline, team work and goal-oriented performance, they can be valuable resources in a voluntary or paid capacity when they return to their villages.
Home: Police and paramilitary personnel should be trained in first-aid and emergency medical care. Disaster management programmes should be strengthened, building capacity to tackle public health emergencies arising from various types of disasters.
Law: As the government has to play the role of a regulator in many areas of public health, and act as a protector of rights, public health law should be advanced as an important instrument of social engineering.
External Affairs: Apart from utilising diplomatic talent to open up bilateral and multilateral international collaborations in health, this Ministry has to participate in negotiations on international agreements ranging from International Health Regulations to protocols arising from the World Health Organisation Framework Convention on Tobacco Control. As pandemic threats increase, global health governance is receiving greater attention. An era of ‘global health diplomacy’ has been ushered in.
Cabinet: For each of the other Ministries too we can identify actions whereby they can promote or protect health. Even at the level of the State governments, which have the main responsibility to implement health programmes, inter-ministerial coordination will be required. The key message here is that health has multiple determinants and multi-sectoral actions are needed to attain health goals. Advancing the health of the Indian people is a responsibility of the whole Cabinet, not merely that of the Health Minister.
What of the Prime Minister? His office will have the responsibility to identify health as an overarching priority for all Ministries and to establish effective mechanisms for inter-ministerial coordination and monitoring. If the improvement of the key health indicators has to be pursued in mission mode, the prime ministerial wisdom wand must conduct the pan-ministerial orchestra to play out a perfect health harmony.