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EDITORIAL ANALYSIS : Curbing individualism in public health

 

Source: The Hindu

  • Prelims: Current events of national importance, undernutrition, PDS, PMJAY etc
  • Mains GS Paper I & II: Social empowerment, development and management of social sectors/services related to Health and education, NEP etc

ARTICLE HIGHLIGHTS

  • A failure to examine and interpret public health problems from a population perspective is leading to ineffective and unsustainable solutions as far as complex public health problems are concerned.

INSIGHTS ON THE ISSUE

Context

Public Health:

  • It is the science of protecting the safety and improving the health of communities through education, policy making and research for disease and injury prevention.

 Undernutrition:

  • It denotes insufficient intake of energy and nutrients to meet an individual’s needs to maintain good health.

Methods used for undernutrition:

  • Micronutrient supplementation
  • Food fortification

Solutions needed:

  • Strengthening of the Public Distribution System
  • Supplementary nutrition programmes and Health services

Method used for chronic disease control:

  • Early diagnosis and treatment

What should be the solution?

  • Modify health behaviors (through organized community action).

 Individualism:

  • It is used to describe holistic, person-based approach to tailoring treatment.

 Determinants of individualism:

  • Dominance of biomedical knowledge and philosophy in the field of public health with a misconception that what is done at an individual level, when done at a population level, becomes public health.
  • Visibility of health impacts among the general public: Health effects are more visible and appear convincing at the individual level
    • Improvements at the population level will be clear only after population-level analysis.
    • This needs Certain level of expertise and orientation about society: an important skill required for public health practitioners.
  • Market’s role and the effect of consumerism in public health practice: The beneficiaries for a programme become the maximum when 100% of the population is targeted.
    • Population perspective: the actual beneficiary will reduce to only 5%-10% in case of hospitalization services and 20% of those affected with COVID-19 for treatment needs.
    • Make efforts to supply evidence of the actual prevalence of public health problems, instead to cast a wide net and cover 100% of beneficiaries.

 

Public health programmes with individual oriented approach:

1.Pradhan Mantri Jan Arogya Yojana (PMJAY)Ayushman Bharat:

 

  • It is the largest health insurance scheme in the country covering hospitalization expenses for a family for ₹5 lakh a year.
  • It ensures ‘free’ curative care services for all kinds of hospitalization services.

 

Issues Involved:

  • Need for hospitalization: It does not talk about the need for hospitalization services per year for any population.
  • Individualistic response to the problem of hospitalization expenditure faced by populations.
  • National Sample Survey Organisation: Only 3% of the total population in India had an episode of hospitalization in a year.
  1. 2. Approach to vaccination for COVID-19:
  • COVID-19 vaccine cannot prevent people from getting the disease but only reduce hospitalization and deaths in the event of contracting COVID-19.
  • 20% of the total COVID-19 positive cases needed medical attention:
    • 5% needing hospitalization
    • 1%-2% needing intensive care (ICU) or ventilator
  • Approach used:
    • Focusing on a vaccination programme for the entire population: individual vaccination approach.

Issues Involved in the approach:

  • Most of the deaths due to COVID-19 were due to failure to offer ventilator and ICU support services to the 1%-2%
  • Curative care provisioning is never planned at an individual level as epidemiologically
    • Every individual will not necessarily need curative care every time.

 

Way Forward

  • There is a strong tendency in public health to prioritize individual-oriented interventions over societal oriented population-based approaches.
  • Population-based health-care planning: The Government needs to ensure health-care facilities to only 3%-5% of the population to cover all the hospitalization needs of a population.
  • To effectively manage COVID-19: We needed to have primary, secondary, and tertiary health-care facilities to manage the above proportion of cases.
  • The morbidity profile of a population across age groups: It is an important criterion for the curative care needs of a population.
    • There is large-scale data that points to this need and can be estimated across populations.
    • The need of the population as a single unit needs to be considered.
  • All forms of individualistic approaches in public health need to be resisted to safeguard its original principles of practice, viz. population, prevention, and social justice.

 

QUESTION FOR PRACTICE

Q. Besides being a moral imperative of the Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyze.(UPSC 2021) (200 WORDS, 10 MARKS)