[Answered] What are the issues with the population-based approach in comparison to individual-oriented interventions to public health problems?

Data from the National Sample Survey Organisation shows that on an average, only 3% of the total population in India had an episode of hospitalisation in a year. Ideally, the Government needs to ensure health-care facilities to only 3%-5% of the population to cover all the hospitalisation needs of a population. This is population-based health-care planning.

Issues:

• This was evident in an evaluation of publicly-funded insurance schemes, which points to the low proportion of population that benefited from the scheme annually. The assurance of a service remains an unfulfilled promise when more than 90% of those who were given the promise do not need hospitalisation in the near future.
• For example, most of the deaths due to COVID-19 are a reflection of the failure to offer ventilator and ICU support services to the 1%-2% in desperate need of it.
• The morbidity profile of a population across age groups is an important criterion used to plan the curative care needs of a population. But curative care provisioning is never planned at an individual level as epidemiologically as every individual will not necessarily need curative care every time.
• The dominance of biomedical knowledge and philosophy in the field of public health with a misconception that what is done at an individual level, when done at a population level, becomes public health.
• Health effects are more visible and appear convincing at the individual level, wherein improvements at the population level will be clear only after population-level analysis; this needs a certain level of expertise.
• The public health experts, who take individual experiences at face value, will make the same mistake of judging a population’s characteristics based on individual experiences.
• The market’s role and the effect of consumerism in public health practice. The beneficiaries for a programme become the maximum when 100% of the population is targeted. On the contrary, from a population perspective, the actual beneficiaries are very less.
• Even after the entire COVID-19 crisis, not much is talked about in terms of the grossly inadequate health-care infrastructure to ensure the necessary primary, secondary and tertiary care services for COVID-19 patients, in turn leading to many casualties.

All forms of individualistic approaches in public health need to be resisted to safeguard its original principles of practice, viz. population, prevention, and social justice.