Let’s debate public health this election

An aspiration of generations of public health professionals in India seems to have met with its defining moment. Every public health professional desired that health be prioritised and the budgetary allocation for health be increased. Irrespective of the quantum and direction of spending, a time has come where health is figuring in political manifestos. This in itself is a laudable first step towards what might be construed as a transformational change in the health scenario of the country.

The country has witnessed the rolling out of a national health insurance programme with justified wide publicity. As evidenced by the disastrous consequences in the US, many public health professionals expressed concern over the wrong path that the country might take by choosing insurance over strengthening the health system. However, it might be an overcautious approach to take such a stance. In a country burdened with a colossal proportion of cardiovascular diseases, this might be the best and much-required starting point. However, the insurance programme is not sufficient in itself in addressing the disease burden and envisioning a healthy nation.

India’s policymakers are aware of the same -- that overemphasis on curative services alone is going to destroy the fiscal discipline followed by the country for so many decades. Thus, it is in the best interest of taxpayers’ money that people adopt healthy lifestyles and thereby limit the feeder pipe of several non-communicable diseases. It makes no sense to spend taxpayers’ money on smokers or alcoholics, who get heart attacks as a result of lifelong cumulative risks. Therefore, there is an economic justification in providing resources for preventing diseases and promoting health. The current allocations for such activities involving health promotion are abysmally low.

It is heartening that the political parties mention increasing the GDP allocation to health in manifestos. Such optimism might be unwarranted and a pity if such investments are made only towards curative services. Therefore, it is important that the public are aware of where their money is spent while allocating for health as such.

Of the resources available at the household level, our parents have done exceedingly well in allocating how much must be spent for expenses compared to what is committed towards savings. At the national level, spending taxpayers’ money mostly on curative services is akin to spending, while focusing on prevention and health promotion is savings. Whatever pennies are worth it, impetus on allocation for prevention should start and increase over a period of time. Continued overspending on curative services will lead to disastrous economic consequences, similar to getting into a debt trap without the possibility of any relief.

While shaping the resource allocation for health, the voter must ask every political representative/party on how much they are willing to spend on public health. The efforts of public health involve disease prevention, health promotion, and prolonging of life through the organised efforts of society, involving several determinants of health.

Public health, as a discipline, promotes health which is not merely the absence of disease. Therefore, the health budget, should not limit focus only on the disease. Health is outside the hospitals and beyond the pills. To accomplish complete physical, mental and social well-being of most individuals in the society, we need to ask our representatives what they are doing to promote the health of the nation. If they answer what they are doing to relieve sickness, we can always direct them to what health means. Hence, only this perspective of the voter can change the direction of discourse on health.

Politicians in India understand the importance of maintaining good health, given that they are themselves expected to perform well irrespective of their age. Most political leaders have mastered several healthy behaviours. Hence, they would definitely understand that the population at large needs to benefit from healthy behaviours, too. To achieve this, the policies should create enabling environment, support and incentivise healthy behaviours. Initiating and increasing physical activity, access to nutritious food, and helping give up tobacco and overuse of alcohol are some such actions.

To promote health and prevent diseases, there are innumerable evidence-based interventions which can be immediately implemented in India. All it requires is strong political will and a renewed focus on prevention rather than the current preoccupation with cure alone. The next finance minister can be a potential chief architect of a paradigm shift in the direction of policy and implementation. As an example, tax benefits for adopting and sustaining a healthy lifestyle can go a long way in incentivising healthy behaviour.

The questions seem tough only till powerful leaders attempt to solve them. That time will surely come. Will that be during this election season? Will this priority be reflected in any of the debates?

(The writer is Professor and Head — Lifecourse Epidemiology, Indian Institute of Public Health, PHFI, Bengaluru)