Reconnect Public Health with People’s Needs

UPSC Syllabus: Gs Paper 2- Issues relating to development and management of Social Sector/Services relating to Health.

Introduction

Public health policies are crucial for improving population health and helping a country realise the benefits of its demographic dividend. In recent years, Universal Health Coverage (UHC) has become a key objective of health policy. However, growing emphasis on wellness and digital health initiatives has raised concerns about whether public health policies are improving access to healthcare. This debate has become more important as private healthcare costs rise and public healthcare services continue to face quality challenges.

Evolution of Public Health Policy in India

1. Population Health as the Core Focus: Public health traditionally focused on improving population health through preventive, promotive, curative and rehabilitative services. It also considered access to water, nutrition, emergency care, and maternal and child health services.
2. Emergence of the Wellness Concept: Wellness was initially used to indicate the absence of disease and was often treated as similar to health. Over time, it expanded to include mental, spiritual, social and environmental dimensions.
3. Influence of Positive Well-being: During the 1950s, the wellness movement promoted the idea that health extends beyond biological conditions. This influenced broader thinking about health and well-being.
4. WHO’s Broader Understanding of Health: The WHO promoted the idea that health is more than the absence of disease. This encouraged greater attention to positive well-being.
5. Shift Towards Health Promotion: Public health later focused on health promotion, which recognised that social, economic and environmental conditions influence health behaviour and outcomes.

Key Government Initiatives Reflecting the Current Approach

1. Ayushman Bharat Health and Wellness Centres: Introduced in 2018, these centres were intended to strengthen health infrastructure and improve service delivery at the grassroots level.
2. Renaming of Existing Institutions: Health Sub-Centres (SCs), Primary Health Centres (PHCs), and Community Health Centres (CHCs) were given the common “Health and Wellness Centre” prefix. This changed the identity of institutions that had evolved distinct roles within the district health system.
3. Ayushman Bharat Digital Health Mission (ABDHM): The mission seeks to create a digital repository of health information through the ABHA card, a unique health identification system.
4. Creation of Digital Registries: ABDHM also maintains registries of health facilities, healthcare professionals, and health insurance-related information.
5. Large Public Investment in Digital Health: The mission receives an annual budget of around ₹300 crore, reflecting a strong policy emphasis on digital health systems.

Current Approach to Public Health

1. Shift from Population Health to Individual Well-being: Public health policy increasingly measures success through individual well-being rather than population health outcomes.
2. Wellness as a Policy Objective: The health and wellness framework promotes individual well-being as an important goal of healthcare delivery.
3. Rise of Individual-Centred Health Practices: Greater emphasis on individual well-being has encouraged health coaching and wellness messages that place responsibility for health largely on personal choices.
4. Growing Importance of Digital Health: Public health reforms increasingly rely on digital records, health IDs and information systems to improve healthcare management.

Major Concerns

1. Ambiguity in Institutional Mandates: Applying a common “Health and Wellness Centre” identity to SCs, PHCs and CHCs has created confusion regarding their distinct functions and responsibilities.
2. Difficulty in Measuring Well-being: There are no universally accepted measures of well-being at the population level. The concept remains highly subjective and individualistic.
3. Neglect of Structural Determinants: A wellness-based approach often overlooks social and structural factors that influence health outcomes.
4. Inadequate Capture of Health Needs: Excessive focus on well-being may fail to identify unmet needs related to preventive, promotive, curative and rehabilitative care.
5. Challenges in Health System Evaluation: Health systems become difficult to assess when outcomes are based on subjective well-being rather than measurable health indicators.
6. Digital Information Does Not Ensure Access: Digital health records and registries cannot by themselves solve problems of healthcare access.
7. Limited Focus on Healthcare Provisioning: ABDHM mainly generates information on individuals, facilities and professionals, but provides little guidance on actual healthcare delivery.
8. Inadequate Access to Healthcare: Access to healthcare remains limited because private healthcare is unaffordable for many people, while public healthcare facilities often suffer from poor quality and inadequate services.
9. Fragmented Functioning of Health Systems: Digital mapping of facilities and professionals does not automatically create an effective institutional mechanism for delivering care.
10. Neglect of Healthcare Infrastructure: Recent initiatives focus on wellness and digital systems, while strengthening public healthcare institutions receives limited attention.

Way Forward

1. Strengthen Public Healthcare Institutions: Greater attention should be given to strengthening the three-tier healthcare system comprising SCs, PHCs and CHCs.
2. Focus on Measurable Health Outcomes: Public health policies should prioritise outcomes that can be systematically measured and evaluated.
3. Address Healthcare Affordability: Improving access requires tackling the high cost of care in the private sector.
4. Improve Quality of Public Services: Public healthcare facilities need stronger capacity and better quality services to meet people’s needs.
5. Link Digital Systems with Service Delivery: Digital health platforms should support healthcare provisioning rather than function mainly as information repositories.
6. Recognise People’s Felt Needs: Policies should respond to people’s immediate healthcare requirements, particularly access to curative care.

Conclusion

Public health policies should focus on improving healthcare access and addressing people’s actual health needs. While wellness and digital health initiatives can support the health system, they cannot substitute strong public healthcare institutions. Achieving meaningful health outcomes requires greater attention to healthcare delivery, affordability, quality services, and the strengthening of India’s three-tier healthcare system.

Question for practice:

Discuss the changing approach of public health policy in India and examine its implications for healthcare access and public health outcomes.

Source: The Hindu