Prioritise health over disease management

Non-communicable disea ses (NCDs), such as diabetes, hypertension and related complications, dominantly affect Indians as the principal driver of catastrophic household health expenditure. The focus of the families and, as a consequence, of the government shifts towards how to mitigate the financial expenditure at the household level.

As an easy option, many state governments have started paying millions of rupees towards premiums for health insurance programmes. The assumption is that this will mitigate the adversities of the NCD burden. In reality, not addressing the risk factors that cause NCDs and inefficient screening programmes have only resulted in an increased household burden in terms of financial expenditure and loss of life.

For example, inefficient population screening results in many cancers presenting at advanced stages, limiting the options for treating oncologists and onco-surgeons and increasing the costs of medical expenditure without assured survival rates for patients.

NCDs are a great business proposition, whereas, health (preventing diseases) is a damp squib for the profit-oriented industries. The industry displays the front-end illusory screen to draw the attention of all stakeholders to only diseases like stroke, heart attacks, cancers.

While hospitals maintain that reimbursements for the procedures for these diseases are insufficient, the rest of the nation is preoccupied plentifully on how the hospitals charge exorbitantly, how to regulate doctor's fees and what should be the composition of the national medical commission etc.

Not that these are unimportant, but without addressing the risk factors feeding the diseases, any cosmetic changes to the disease-reducing machinery are incomplete, conflicting and ineffective. It is, therefore, time that the policy and implementation impasse is broken.

The immediate task for the country is to respond to the transition from communicable diseases (CDs) to NCDs, which has happened swiftly and rather precariously. Instead of the flawed proposition that Ayush practitioners should prescribe modern medicines through a bridge course, there is actually a greater demand for bridging the divide between health and diseases diligences.

An Ayurveda practitioner is trained to understand the health, as it is defined. The Ayush practitioners are most capable of reducing the weight of risky behaviours such as physical inactivity, obesity and alcohol or drug use. It is startling to note that leading Ayush practitioners are silent on the efforts of (over)medicalisation of their disciplines, which are the only hope for catering to the varied risks and pluralistic needs of the society.

The consequences of several risk factors (lifestyle, biological and social conditions) should be analysed corresponding to health consequences and economic welfare (life expectancy, life-years without long-standing limiting illness, hospital admissions, and costs to society). So, governments need to invest and strengthen resources in public health efforts towards enabling a healthier populace.

More than a mere noun used notionally by politicians and policymakers, public health processes involve every stakeholder (not just doctors or nurses) while keeping the people (and not patients) at the heart of the discipline. As a science, it aims at protecting and improving the health of the population through education, policy-making and research for disease and injury prevention.

Ahead of the next budget and before any commitment is made towards spending billions of taxpayer money on curative services alone, the Prime Minister's Office (PMO) may consider re-prioritising "health" and not "disease management" alone, to address the healthcare crisis and plan to effectively prevent future epidemics of NCDs.

Nothing less than a mission chaired by the PM can signal the due processes for providing a power of health to people. Such a group should comprise several ministries, public health practitioners, researchers, intersectoral partners and industry representatives. Most importantly, there should be representation of the common (wo)man, a term often misused politically.

Jan Aushadhi Kendras have been opened across the country to provide quality medicines at affordable prices to the masses. They are necessary, but not sufficient. To resolve the policy impasse fixated on disease management, what the country needs is Jan Aarogya (Public Health). As the 69th Republic Day goes by, can we expect the PM to commit towards stren gthening public health resources, research and programmes through asystematic approach?

(The writer is additional Professor at Indian Institute of Public Health, PHFI, Bengaluru)