Retributions  

Public health is concerned with the health of the community as a whole. Its key goal is to reduce a population’s exposure to disease. It has been said that: “Health care is vital to all of us some of the time, but public health is vital to all of us all of the time’’.

There is little doubt that the public health system in India faces multiple challenges. In 2005, the average life expectancy was 62 years for males and 64 years for females—one of the lowest in the South Asian region. In the same year, only 44 per cent of children aged 12 to 23 months were fully immunized. Infant mortality rate, generally considered as the gold standard in judging the public health system of a country remains at an unacceptable 55 deaths per 1000 live births. If one looks at infectious diseases, the picture is not much better. India, despite some encouraging results in the last few years carries one fourth of the total TB burden in the world. What is especially worrying is the rise of Multiple-Drug Resistance (MDR) tuberculosis cases despite widespread adoption of DOTS. Despite strenuous efforts, polio has still not been eradicated. In fact, in some states most noticeably Uttar Pradesh, polio has shown a marked resurgence. Without discounting the progress made in the last few decades, it can be safely said that in almost every important public health indicator, India lags far behind not only the developed world but also countries with equivalent income levels.

If India has to fully reap the full benefits of the so-called demographic dividend, it needs to urgently improve public health. The crucial question is how. Here the debate tends to gets more ideological. Many public health professionals argue for a greater expansion of government’s role in the public health system. The agenda was set as far back as in 1943, the Bhure committee argued that ‘’The idea that the state should assume full responsibility for all measures, curative and preventive, which are necessary for safeguarding the health of the nation, is developing as a logical sequence’’. The committee not only rejected the role of private sector in health care but also strongly opposed private practice for government doctors and the levy of user charges. While many of its ideas remain unimplemented, they continue to influence the philosophical debate vis-à-vis state’s role in the public health system.

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