Public health in India strained by flawed policy

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Context: Conceptual Misunderstanding of Public Health

Public health in India is often wrongly seen as a sub-discipline of medicine, ignoring its interdisciplinary nature.
It combines medical science (e.g., germ theory), engineering (e.g., sanitation systems), and social sciences (e.g., poverty’s impact on health).
Public health also involves communication, behaviour change, and trust-building—making it both a science and an art.

Relevance : GS 2(Governance ,Health)

Public health is treated as a State subject per the 7th Schedule, but responsibilities also lie in Union and Concurrent Lists.
Example:
- Union List: Quarantine, international health regulations.
- Concurrent List: Drug safety, food safety, pollution control.
This leads to:
- Poor coordination among ministries (Health, Water Resources, Food Safety, Municipalities).
- Overlapping jurisdictions and diluted accountability.
- Colonial legacy of fragmented governance persists in a federal setup.

Public health policies often conflict:
- E.g., promoting tobacco farming while running cancer prevention programmes.
Institutional contradictions:
- ICMR fights tobacco-related diseases while ICAR’s Central Tobacco Research Institute boosts its cultivation.

MPH curriculum mirrors public health governance—fragmented and inconsistent.
Eligibility issues:
- Some programmes restrict to medical/allied fields; others allow all graduates—without a common foundation.
Content gaps:
- Minimal focus on crucial areas like:
  - Public health engineering (sanitation infrastructure),
  - Nutrition (food technology and safety),
  - Behavioural sciences (psychology, social marketing),
  - Health technology assessment (cost-effectiveness of interventions).
Delivery problems:
- Courses often theoretical or managerial, lacking field exposure.
- The 2-year duration is too short to cover diverse skillsets in-depth.

No structured public health cadre across most states.
MPH holders are relegated to temporary NGO or clerical roles.
Their technical skills remain underutilized, violating the vision of the National Health Policy 2017.

Without a skilled public health workforce, India’s response to challenges like antimicrobial resistance, climate-related diseases, and pandemics will be inadequate.
Urgent reforms needed:
- Nationally standardized MPH curriculum with scope for regional adjustments.
- Modular, flexible programme structure to handle the field’s breadth.
- Creation of a formal, well-defined public health cadre.
- Integration of public health into national policymaking akin to national security.