Curative medicine or health care for medical conditions where a cure is considered achievable involves therapeutics, surgery and rehabilitation. Disease treatment is individual-centric, which involves an interaction between care-givers and patients. Hospitals and clinics are designed for the time-and-cost efficiency of care-givers and not for the convenience of patients. What then is health care?
Those who believe that diseases are caused by forces beyond human control can only react to disease by seeking treatment. Ayurveda and scientific medicine say that illnesses either have causes that pertain to behaviours (lifestyle) or are due to intrusions from the environment.
Knowledge about the origins of diseases can help prevent many of them, thus protecting health both in individuals and among people at large. Health in this way can be managed by preventing what we can and treating what we can’t. Therefore, managing health at an individual level is health care and at the community level, public health.
For the individual
Health care includes health protection and disease prevention in advance and disease treatment after falling ill. Health care, like disease treatment, is individual-centric. Here, regular checks to detect early signs of aberration are essential and ought to be conducted routinely through antenatal care and immunisation. For adults, check-ups are needed to screen for diabetes, hypertension, breast and uterine cervix cancers. Early detection and interventions can protect health and save lives.
In this light, a proposal by the NITI Aayog, to transform rural health sub-centres into ‘wellness clinics’ and take health care to rural people is a great idea.
Health management
Community-level disease prevention and health protection, however, is a different ballgame. Interrupting transmission channels of disease-causing microbes is the most widely-used disease-prevention intervention by public health authorities. In this way, environmentally-transmitted infectious diseases are prevented en masse. For instance, iodised common salt prevents thyroid disease and consequent mental retardation in vulnerable women and children. Public health interventions are without interpersonal transactions and thus, not individual-centric.
Public health is a term used for both the organisation or agency and its functions to prevent diseases, and to promote/protect the health of people. Health care is triggered by an individual’s initiative in seeking care in the public or private sectors whereas public health is initiated by the government, with everyone being duty-bound to cooperate.
India does not have a ministry of public health or even a full-fledged division of public health in the health ministry. Patients seek only curative medicine, which suits the interests of medical professionals. Public health interventions are both environment- and population-centric; fields out of bounds for medical professionals whose clients are in clinics/hospitals. In covering up this systemic deficiency, a myth is perpetuated that public health is curative medicine through the public sector.
The National Health Protection Scheme (NHPS) — called the world’s largest health-care programme — offers medical insurance to eligible families for financing curative medicine. It cannot address health protection and disease prevention. Conflating funding of disease treatment with health protection shows the government’s lack of clarity on the principles of health management.
‘More’ for ‘less’
What India needs urgently is preventing disease through public health. This includes addressing brucellosis, cancers due to viral infections, chickenpox, chikungunya, cholera, dengue, dysentery, influenza, leptospirosis, malaria, measles, rubella, scrub typhus, tuberculosis, typhoid fever, viral encephalitis, viral hepatitis, etc. The more we prevent, the less we will need to treat. Public health will “unclutter” clinics and hospitals, improve quality and efficiency of curative medicine, reduce household expenditure for treatments, improve productivity and promote economic development.
The wolf of lifestyle diseases is already at the door and without public health infrastructure it cannot be driven away. A country that cannot control tuberculosis and typhoid cannot control diabetes and hypertension.
The government must translate its good intentions to promote health into a true NHPS by establishing a health protection agency, which is another name for public health infrastructure.
Dr. T. Jacob John is retired Professor of Clinical Virology, Christian Medical College, Vellore
