This article is written by Gitika Jain, from Amity University, Kolkata. This is an exhaustive article which deals with public health and the role of government.

Introduction

The most important thing in which a government can invest is public health. There is no doubt about the fact that early prevention is relatively inexpensive than the later healthcare problems one can face in his/her life. In India, the practice of public health has been dynamic and has witnessed various ups and downs in an attempt to improve the lives of people in this country. After independence, India witnessed several major health problems like malaria, tuberculosis, leprosy, high maternal and child mortality, Human Immunodeficiency Virus (HIV), and lately novel coronavirus (nCoV). However, a decrease in mortality and birth rates was achieved by social development and scientific advances and healthcare. 

Evolution of health policy

The three pillars of health policy are sanitization, health, and medicine. In the year 1837, Sir James Ronald Martin brought up an issue of practising sanitation in order to safeguard the British from tropical diseases. This issue led to the formulation of planning strategies to fight those diseases. Slowly and gradually all the residential spaces of Europe started practising these strategies. In the year 1871, municipalities were established beside the residential spaces of Europe. The process of setting up of municipalities was guided by the Municipality Act. In the year 1882, the advent of local self-government was brought into force by Lord Ripon. Forty years later, reform of Mortgage-Chelmsford, 1919 was brought in the matters of education, public park, and health. To resolve the problem of sanitation, various trusts were formed in large cities like Calcutta and Bombay. During the outbreak of the plague epidemic from 1896 to 1905 in Bombay, the government was interviewed for the first time in the matter of public health. Quarantine measures, fumigation, and forced house searches were conducted as a part of the intervention. In the year 1936, a blueprint to relieve congestion in old Delhi was prepared by the British officer AP Hume. The first committee to evaluate health conditions and give recommendations in the future regarding public health was established by Sir Joseph Bhore in the year 1943 known as the Health Survey and Development Committee. Another committee in 1967 was formed for the Integration of Health Services. This committee was formed to put together the things within the parameters of health by combining administrative structures, functions, and mental attitudes of people. 

In the middle of 1970, another incremental step by the government was to eradicate smallpox and expand immunization programs for immunization of children as their early stages of life were developed in the year 1978 and it included new vaccines to be incorporated from OPV in 1979. In the year 1982, a new working group was established to check up on the organisation of family welfare. The report from the working group was such that the poor and the middle-class people were forced to live in unhygienic conditions and crowded areas. Therefore they were more prone to diseases and likely to fall ill. The families working in the slums to earn their livelihood were sometimes to visit door to door for checkups. After adopting National Health Policy in 1983, the 73rd and 74th constitutional amendments empowered the local institutions in 1992, National Nutrition policy 1993, National Health policy 2002, and National Policy on Indian System of Medicine and homoeopathy and drug policy in 2002 which improved the overall health of the people living in that area. 

Society and health

Democracy and development should go hand in hand for society to be termed just and reasonable. During the time of British rule, the State was providing free social services based on three pillars that were rights, entitlements, and social justice. The preamble of the Constitution even talks about providing a sense of equality and liberty to the citizens and taking into consideration a large number of welfare functions. The proper delivery of resources must also be insured by the political institutions as it is essential for the progress of the society. Various important steps were taken in the society which included initiating education on nutrition and sanitary issues, laying down instruction for women to carry out family planning activities, and child welfare measures. However, there is still a need to overcome inequalities in the society and update value systems and for that purpose, various Articles such as Article 37 to 51 and Article 55 were framed that stated the obligation of the state for public health justiciable delivery of producers and right to receive benefit from employment. The Directive Principles of State Policy were thus used as an instrument to cater to the needs of people and inbuilt an idea of economic democracy and social justice in the country. The constituent assembly on 20th August 1947 introduced three lists each having different subjects. The state list had 57 items, the central list 37 subjects, and the concurrent list had 36 entries and the subject matter of health was declared to be a state subject. Article 229 was also introduced in the Constitution which was used as a tool by the centre to pass on various matters to the state. In 1969, Indira Gandhi introduced certain sections for the poor class of the society by mentioning the 10 point programme. In 1971 she raised the slogan of garibi hatao.

Current scenario of the health sector at the National level

The constitution of India allocates social services to various states which in turn helps the centre in economic services. There still remains an imbalance of assets from state to state which needs to be resolved by the centre by granting specific schemes. It is also the responsibility of the state government to provide proper health services as mentioned in the state list under the seventh schedule. 

• Basic indicators of health – Infant mortality rate in 2009 stood at 47 per thousand live birth. There still remains the need to overcome regional disparities that exist in different states like Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Orissa, and Assam. In 2010, there were more than 2.3 million cases of TB in India, the number of infected HIV persons is 2.5 million and every year there are 1.5 million malaria cases being reported. Also, diseases like dengue and chikungunya are also due to malfunctioning of the public health system. According to the report of 2008, the percentage of pregnant women who experience complications before and after delivery have been 61%. The malnutrition status which is reflected by the state of the world’s children 2012 shows a report that the underweight of children under 5 years in India has been 43%. In the global hunger index 2010, India ranked 67 out of 84 countries with child health as a serious issue covering 42% of the world. 
• Financial problems in the health sector- The budget of 2012-2013 reflects the overall effect the financial status of India has on the health sector. A sum total of Rs. 37,330 crore has been set aside for the new National Health Mission by the Ministry of Health and family affairs. Rupees 4727 crores have been kept aside for medical education and training, 1069 crore has been allocated for AYUSH. Further, in order to provide the best level tertiary care to the Indian citizens, institutions like AIIMS have been started. 
• Health sector initiatives – The current initiative by the Planning Commission of India in October 2010, which was a high-level expert group, was constituted and was examined by a wider perspective covering matters related to nutrition, food, supply, and determinants of health. The initiative of the government to provide basic services to the population has also increased from 72% to 88%. 

Gaps in health agenda

• Public spending on health 

India spends only one percent of its GDP on the health sector while the neighbouring country Sri Lanka spends 1.8% of GDP on the health sector. America is one of the highest amongst all which spends above 7% of GDP on the health sector. These are the differences that arise and become more obvious when the per capita indicator is taken into consideration. India spends US dollar 43 per head whereas China and Sri Lanka spends US dollar 155 and US dollar 87 respectively per head. 

• Lack of manpower

Large numbers of new graduates leaving government practice and ending up in private sectors is the main reason why there is a shortage of manpower in this industry. This happened because of various bureaucratic hurdles. This issue was addressed by Pranab Mukherjee, the former President of India who stated that there have been only 1.9 health workers per thousand persons in India.

• Policy issues

A lot needs to be done with respect to the policies framed in this regard by the government officials. Matters such as the free supply of medicines in government facilities, national urban Health mission, and universal health coverage needs proper attention. 

National Mental Health Programme

In the year 1982 with a view to look into the matter of mental illness in the country a program called National Mental Health Programme was launched which has three components:

• Treatment of ill
• Rehabilitation
• Prevention and promotion of positive mental health

District Mental Health Programme, DMHP

Another program which was launched by the Central Government at the National level in the year 1996-97 was the District Mental Health Programme where district Muktsar was selected as a pilot project with the department of psychiatry Government Medical College, Amritsar. A new scheme of training was provided to 47 senior medical officers, 225 Anganwadi workers, and 137 paramedics. 

National Programme for Control of Blindness

This program was launched in 1976 with 100% control of the centre and covered under a non-plan scheme. The main objective was to reduce the backlog of avoidable blindness through identification and treatment of curable blind at primary, secondary and tertiary levels, based on assessment of the overall burden of visual impairment in the country.

Revised National TB Control Programme

Back at the time period between 2008 to 2013, a major public health problem was tuberculosis. TB was an incurable disease at that time. But with the initiation of such a programme, the state of Punjab with the assistance of WHO, made this disease a curable one. However, to eliminate TB in India by 2025, five years ahead of the global target, a framework to guide the activities of all stakeholders including the national and state governments, development partners, civil society organizations, international agencies, research institutions, private sector, and many others whose work is relevant to TB elimination in India is formulated by RNTCP as National Strategic Plan for Tuberculosis Elimination 2017-2025.

National Cancer Control Programme

This programme was also present in seven districts namely Patiala, Hoshiyarpur, Bathinda, Muktsar, Mansa, Faridkot, and Sangrur. After establishing these programs successfully in seven districts, this was established at a national level and a sum of Rs. 1.50 lakh was given from CM cancer relief fund to 7513 patients in the year 2011. Various states had also set up cancer treatment facilities in different hospitals and medical colleges. 

Conclusion

With unique challenges popping up every day threatening the health and well-being of the population in the changing world it is becoming important for the Government and the community to act hand-in-hand and face the challenges inclusively and sustainably. Various social determinants must be addressed by universalism, justice, dignity, security, and human rights. This approach will lead humanity to realise the dream that right to health and the ultimate yardstick for success in this field for every Indian would be an improvement from remote places in Bihar to the city of Mumbai. There is no doubt about the fact that in the past as well, Government has achieved a lot in the field of public health but with increasing challenges in daily life, the role of government also increases and they are expected to achieve milestones in future as well like it did in the past such as the launch of an expanded programme of immunization in 1974, primary Health care enunciated at alma-ata in 1978, eradication of smallpox in 1979, the launch of polio eradication in 1988, CAPT Act of 2005 and FCTC ratification in 2004. Though the past was glorious, the future of public health in India also lies in proper implementation and framework of sustainable development. The ultimate goal of the nation should be a reduction in the number of diseases in the rural and urban areas with adequate access to clean water. The government should therefore aim to be responsive, transparent, and corruption-free and eradicate poverty and illiteracy crime against women and children and then a healthy Nation will not be a dream anymore. 

References

• http://shodhganga.inflibnet.ac.in/jspui/bitstream/10603/97367/10/10_chapter-2.pdf
• http://shodhganga.inflibnet.ac.in/bitstream/10603/8917/7/07_chapter%201.pdf
• http://shodhganga.inflibnet.ac.in/bitstream/10603/43767/14/14_chapter%205.pdf
• https://shodhganga.inflibnet.ac.in/bitstream/10603/145095/15/15_chapter%205.pdf

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