Public health in India strained by flawed policy

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)

Governance Fragmentation

• 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.

Structural Contradictions in Policy

• 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.

Flawed MPH Education Ecosystem

• 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.

Systemic Invisibility of MPH Graduates

• 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.

Implications and Way Forward

• 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.