|LETTER TO THE EDITOR
|Year : 2012 | Volume
| Issue : 3 | Page : 245
Public health in India: The challenge of politics
Assistant Professor, Department of Psychiatry, Government Medical College, Haldwani, Nainital, India
|Date of Web Publication||3-Dec-2012|
Assistant Professor, Department of Psychiatry, Government Medical College, Haldwani, Nainital
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Das A. Public health in India: The challenge of politics. Indian J Public Health 2012;56:245
With reference to the paper by Chauhan (2011),  I was at first intrigued by the opening remarks regarding the multiplicity of factors influencing public health. Yet, I found the paper missing out on some important issues that need mention when discussing about public health in India.
As per the author, the evolution of public health in India is characterized by various committee reports, 5-year plans, health, and other policies, various national and international declarations. What are missing are the related public and social policies that have affected the public health scenario. Most vital among them are the neoliberal economic measures/structural adjustment policies and their attended policies in the health service (health sector reform), farm, education, labor and employment sectors. To my consideration, this requires a credible relook.
Moreover, the understanding of health disparity (disease burden) by rural-urban divide is discussed at the exclusion of other important issues of age, class, caste, and gender imbalances. While mentioning on health service provision (in the public sphere which is mentioned to be below par due to low expenditure), the presence of a vast and often exploitative private sector goes almost unmentioned.
The consideration of the role of donor agencies in setting disease-control program priorities, their conflicts of interest, and its effect on health program integration and epidemiology of other diseases may also had merited a place. The analysis also lacks the impending situation resulting from Trade-Related Aspects of Intellectual Property Rights agreement on the pharmaceutical industry and consequent pharmaceutical pricing. In addition, the impact of trade liberalization on the environment in India remains unnoticed.
An important controversy that must require a mention and ails public health in general, and to India specifically, is related the behavioral understanding vis-à-vis a more systemic way to understand etiology of health conditions. To elaborate further, one can take the case of AIDS where often the focus on behavioral risk factors targeting interventions such as condom use/safe sex occurs at the exclusion of factors such as poverty, migration and subsistence of rural economy, gender discrimination and concepts of sexuality.
To top it all, a cursory mention of ethics in public health and health care delivery is the least expected from a paper dealing with an overview of such kind.
The final diagnosis by Chauhan  for the low development of public health in India is a result of low expenditure on health, few public health institutes and inadequate standards of public health education. This excludes the most vital role of politics. Politics not only shape the pattern of expenditure on public's health but also affect related social policies (e.g., nutritional policies, education policies, labor welfare, agrarian policies, etc.) influencing national health indicators. Thus, the foregoing author's diagnosis would lead to solutions that may be constrained in multiple ways leading to limited systemic solutions. The challenge of public health in India is to incorporate the importance of politics and public policy in the analysis of health and other related issues.
| References|| |
|1.||Chauhan LS. Public health in India: Issues and challenges. Indian J Public Health 2011;55:88-91. |