Integrative Public health- Crying need of India
Public health relates to policies, programmes and actions for promoting wellness and preventing diseases. Private or personal health starts when a person is afflicted with a disease and is required to undergo clinical treatment or is required to remain isolated to check spread of contagion to others in the community.
Public health is indeed a complex interdisciplinary subject with interconnection and interplay of many disciplines, sciences and knowledge systems. Ayurveda, our own exemplary repository of life sciences is by far the most integrative healthcare system in the world. According to it, a person is considered healthy when all forces acting within and without are in balance with each other. Thus, Ayurveda looks at facets holistically and urges the individuals and community to adopt right lifestyle, food habits, Yoga, pranayama etc. Besides, Ayurveda has been able to integrate many nutritional and medicinal elements and plants in our regular intake of foods for easy promotion of wellness, immunity, and prevention of diseases. It is also the cradle of inoculation or vaccination with a proven history of over 1500 years for securing specific immunity against selected pathogens as illustrated in case of small pox .
Post Independence, we have created better infrastructure with disproportionate attention for personalised clinical treatment (or personal health) using mainly biomedical or allopathic sciences but have done much less for the vital and relatively easier aspect of public health. Most of our efforts through various health missions like NRHM, NUHM or NHM have failed to address public health issues adequately.
It is with the above background that National Health Policy, 2017 has urged holistic action. Ayushman Bharat, a programme following the policy has emphasised creation of health and wellness centres all over the country to give thrust to public health part while assuring masses to secure clinical treatment with a suitable state sponsored insurance plan.
Our country is unique in health traditions and practices. Whereas we are fast growing in biomedical field, we are having many vibrant health sciences under the umbrella of AYUSH that has Ayurveda, Yoga, Naturopathy, Unani, Sidhha, Sowa Rigpa and Homoeopathy verticals in it. Our government has recognised the value of rational integration of AYUSH and Allopathy and has planned to promote Integrative and holistic approach with “one nation, one health” mission.
Current status of public health in India
An objective appraisal of the current position in respect of public health shows the following vital points
- Integration missing since independence
- Many ministries working on components of public health like water, sanitation, food, nutrition, immunity boost, air, pollution, environment etc without much coordination
- Public health put under MoHFW since long that is responsible for coordinating with World Health Organisation created by UN and member countries for public health
- Mother and child programme with Min of Women and Child Welfare (WCD). This ministry handling programmes relating to nutrition
- Lack of clarity in meaning of the term “Public Health”. Called variously as community health, social health, community medicine, preventive medicine etc. In essence non clinical health understood as public health. Clinical part of health taken as the major responsibility of the ministry of health and family welfare
- Bhore committee starting point. Health centres created all around allopathy. Work of various committees in India for integrative health given in annexure 3
- Public health generally covering non clinical. But taken over by clinicians putting thrust on curative or medical part with diagnostics
- Indian systems of medicine and Homoeopathy or other versions of traditional systems never became part of public health pan India
- Kits of Indian system of medicines and Homoeopathy introduced by then P M Vajpayeeji but the programme was short lived
- Asha and ANM training again geared towards curative side
- Very poor training of these people in adopting and using AYUSH
- Even Yoga not a part of these resources
- NRHM, NUHM and now as NHM same practice continuing Course of “preventive and social medicine (PSM)” in many colleges since long.
- Specialisation for epidemiology or public health in some Public health engineering and environmental engineering a part of engineering colleges with focus on water, sewage, sanitation, environment but not made a part of public health programmes pan India Paradoxically, though non clinical largely, public health centres headed by MBBS NRHM, NUHM and now NHM also largely unable to integrate Coordination missing between MOHFW, AYUSH, WCD, Environment, Water and Sanitation ministries
- Recent MOU between AYUSH and WCD ministries for collaborative work for nutrition under “POSHAN Abhiyan” a proof of non integration
- Even after 5 years, work on “diabetes control through Yoga” not mainstreamed
- Mammoth effort for Open defecation frees India (ODF) under SBM since 2014. A case of great success made possible with proper planning and execution with liberal funding for infrastructure, maintenance and IEC
- SBM + a potential success if similar thrust and dedication at all levels in coming years
Future solutions for India
As learnt from various interactions and inputs from experts in the field, we have to look at the following recommendations seriously
- To propose a strategy and implementation plan for a comprehensive integrative public health system in India building on the existing initiatives (such as the Ayushman Bharat Health and Wellness centres, National Health Mission, National AYUSH Mission etc.) and with an emphatic focus on health promotion, disease prevention and holistic primary health care Health and wellness centres to reflect aims as given in National Health Policy, 2017
- To compile relevant works done in area of water, sanitation, food, nutrition, spices, organic vegetables, herbs, medicinal plants, home remedies, simple AYUSH medicines for first line of treatment, yoga, pranayama, lifestyle etc to prepare simple modules for use in health and wellness centres for
- Training and use of ASHA and ANM workers
- Training of senior personnel for HWC
- Use by clinical doctors in practice
- Exchange of knowledge within AYUSH ministry as the six branches have some common but many unique features
- Exchange of knowledge between MOHFW and AYUSH to understand unique strengths and weaknesses of all branches
- Common modules for AYUSH based HWC and regular HWC for all promotive, preventive, rehabilitative and palliative parts. Difference in only primary curative part
- Yoga and Pranayama to be mainstreamed everywhere with simplification and feasible and basic modules like Suryamaskar, pranayama etc
- Health committees for centres to be made with people from WCD, water, sanitation, food, nutrition, yoga, naturopathy etc to be a part with AYUSH and MoHFW to be there for regular interaction and holistic work.
- Representation of community also needed for active support and involvement from them
- Swachh Bharat Mission or it’s derivatives to be a part of health movement
- Biogas programmes for families, communities or enterprises like GOBAR DHAN, SATAT etc to be integrated for conversion of organic wastes into biogas, power and organic fertilisers to be also blended with the health programmes
- Waste management programmes created by other ministries like environment and climate change to be also understood from health angle for suitable integration Cultivation of organic vegetables and herbs to be promoted at all levels in Anganwadis, schools, HWC’s etc
- Introduction of compulsory subject on health (Arogya or Swasthya) in all educational institutes at appropriate levels
- Wellness insurance products to be promoted as per IRDAI guidelines
- Constant exchange between AYUSH HWC and regular HWC in the relevant area
- Aggressive use of telemedicine and online solutions
Conclusions
Every community or country has unique health issues and hence “one size fits all” paradigm is not suited to all nations. India has pluralistic wellness knowledge traditions with abundant evidence of efficacy and effectiveness in foods, nutritional .elements, natural medicines, Yoga, Naturopathy, Homoeopathy etc that can be adopted in public health programmes after suitable examination. There is also an urgent need to adopt AYUSH components in regular health and wellness centres as well as to evolve several formats of exclusive AYUSH health and wellness centres in private, public or PPP modes. A proper combination of public health with personal health is the best way for a healthy and happy India. This much needed holistic thinking and action by all stakeholders as envisioned by Arogya Bharati will keep us disease free most times and bring us to wellness from illness in pathy agnostic manner rapidly and safely.
S B Dangayach
National vice president
Arogya Bharti
and
Founder Trustee
Innovative Thought Forum
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