What is Public Health ?

PH is disease prevention and health promotion in communities through population based research, and science based policies and interventions

The target of PH is “public” not individual “patients”

PH aims at science based “prevention” of health risks in populations; not treatment of patients after diseases occur

PH requires active “ community participation”; not passive compliance with medical regimen

PH requires multi-sectorial “public-private partnerships”

The 4 “Ps” of PH are : Public, Prevention, Participation , & Partnership

ETIOLOGICAL PARADIGMS

• Cosmic and supernatural causes ( e.g. witchcraft and “Karma)”

• “Miasma” and personal cleanness ( e.g. bad air germs )

• Genes, germs, Toxins, & Trauma (e.g. Infectious disease epidemics )

• Health behavior and Life-style (e.g. obesity, sex, substance abuse)

• Social Determinants and man-made disasters (e.g. poverty, disparity, war)

Selected Contributions of Indian Subcontinent to Global Public Health*

1. Sanita tion syste ms in M ehrgarh (?) and Harappa civ ilizations 7 000 BCE2. Ayurv eda:Chara ka and Susurata Samhitas(Vedic) 600 BCE to 100 CE3. Yoga and M edita tion (since Pre-Vedic traditions )4. Ashok a’s edicts (M ayura dynas ty 3 rd CBC) on Universa l Health care5. Small Pox Variolation ( before Dr. Jenne r); ref of SP a nd “germs ” in Vedic era ( Madha ba’s

book “Nidana” in 8 t h century CE )6. Proto-denta l surgery in M ehe rgarh and Ha rappa 7. First unive rsities in Nalandaand Taxila (4 th Century BCE ) attract foreign s cholars8. The “ Chatra m” netwok ( shelter, food, water, c linics)9. M alaria research and control by Dr. Roland Ros s in Kolkata Nobel in 190 210. Benga l Famine Commission (1943) ;Sen’s1998 Nobel for pioneering work on “famine” ,

“ deve lopment a s freedom” & quality of life (QOL)11. The IPPF founde d (Bombay 1952 ) to prom ote women’s reproductive rights globally12. National Health Programs and RCA proje cts with global universities & agencies 13. Sen and Huq develop Huma n Developme nt Indicators (UNDP/HDR) 14. M icro-enterprise for be tter QOL (Ta gore, SEWA, Grame een- Yunus’ Nobe l in 2006)15. First World Confe rence by se x workers for AIDS prevention in Kolkata 200916. Nume rous grassroots movem ents for be tter justice, freedom, & better QOL by women,

opres sed and “ dalit”(unde rclass) populations

* India’s oral tradition means earliest innovations remain unwritten for thousands of years.

Epidemiological Transion

7

Global Causes of Death

31%

9%

60%

Noncommunicable diseases

Communicable diseases,

maternal and perinatal

conditions, and nutritional

deficiencies

Injuries

Source: WHO, World Health Report 2000—Health Systems: Improving Performance (Geneva: WHO, 2000).

© 2005 POPULATION REFERENCE BUREAU

8

United Nations Publications: ST/ESA/SER. a/306

THE PUBLIC HEALTH JOURNEY : FROM LOCAL TO GLOBAL INITIATIVES

I.MEDICAL AND SCIENTIFIC INNOVATIONS LEADING INFECTIOUS DISEASE EPIDEMICS CONTROL (e.g. eradication of Smallpox, control of Malaria, TB, Polio, air and water bourn diseases). EXTENSION OF MEDICAL INTERVENTIONS IN COMMUNITIES (Social medicine)

2. EMERGENCE OF PH RESEARCH, PH SCHOOLS , AND PROFESSIONALS ORGANIZATIONS INCLUDING SOCIAL ACTION INITIATIVES BY NGOs/CBOs (BETWEEN WWI & WWII). INCREASED INVOLVEMENT OF SOCIAL SCIENCES IN PH AND “ECOLOGICAL” PARADIGMS FOR PRIMARY PREVENTION INTERVENTIONS IN COMMUNITIES 3. EMERGENCE OF MULTINATIONAL AND GLOBAL PUBLIC HEALTH ORGANIZATIONS (e.g. WHO, UNICEF, UNDP, IMF, WORLD BANK ) INCLUDING PUBLIC HEALTH PHILANTHROPHY, AND SOCIAL ACTION MOVEMENTS ESPECIALLY AFTER WWII

4. PUBLIC-PRIVATE PARTNERSHIPS FOR DISEASE PREVENTION AND HEALTH PROMOTION, MICRO-ENTERPRISE MOVEMENTS, AND COMMUNITY EMPOWERMENT

Ten Great Public Health Achievements– United States, 1900-1999

Vaccination

Motor-vehicle safety

Safer workplaces

Control of infectious diseases

Decline in deaths from coronary heart disease and stroke

Safer and healthier foods

Healthier mothers and babies

Family planning

Fluoridation of drinking water

Recognition of tobacco use as a health hazard

http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm

Comparison of Kerala & All IndiaKerala All-India

Death Rate/1000 (1998) 6.4 9.0

Rural Birth Rate(1998) 18.3 28.0

IMR(1998) 16 72

Life Expectancy (1993) 66.5 61.5

Literacy Rate (1991) 90.59 52.11

Female Literacy Rate(1991) 86.17 19.43Mean age at marriage(F) 22.3 19.3Per capita Income(1995-96) 8324 11649Doctor-Population Ratio 1:7213 1:2148

Patricia Rosenfield/Rockefeller Study

Indian One Hundred Rupees Stated in 17 Languages

www.phfi.org/about-us/about-phfiEstablished in 2006

The Public Health Foundation of India (PHFI) is a response to redress the limited institutional capacity in India for strengthening training, research and policy development in the area of Public Health. It is a public private partnership that has collaboratively evolved through consultations with multiple constituencies including Indian and international academia, state and central governments, multi & bilateral agencies and civil society groups.

Structured as an independent foundation, PHFI adopts a broad, integrative approach to public health, tailoring its endeavours to Indian conditions and bearing relevance to countries facing similar challenges and concerns. The PHFI focuses on broad dimensions of public health that encompass promotive, preventive and therapeutic services (many of which are frequently lost sight of in policy planning, as well as in popular understanding).Main activities

The PHFI is working towards building public health capacity in India by:

Establishing 5 - 7 new institutes of public health over the next 6 years;

Assisting the growth of existing public health training institutions/departments and facilitating their evolution into major institutes of public health

Establishing a strong national research network of public health and allied institutions which would undertake policy and programme relevant research that will advance public health goals in prioritized areas - with suitable international partnerships where useful and appropriate;

Engaging public health expertise to collectively undertake analytical work for generating policy recommendations related to public health action, in not only the health sector but also in all other sectors which impact upon health of people, and developing a vigorous advocacy platform to effectively communicate these recommendations to policy makers and other relevant stake holder groups (including civil society organizations which represent the interests of people’s health); and

Establishing an independent accreditation body for degrees in public health which are awarded by training institutions across India.

The Public Health Foundation of India (PHFI)

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HIGH LEVEL EXPERT COMMITTEE ON UNIVERSAL HEALTH CARE (India)

http://planningcommission.nic.in/reports/genrep/UHC_ExecSummary.pdf

Free universal health care to all (no cash exchanged at point of delivery)Fully federal tax supportedFederal responsibility – states responsible for service delivery Options for additional care at personal cost Integrate the AYUSH System (CAM) in Universal Health Care The AYUSH System

1. Ayurveda

2.Yoga

3. Unani

4. Siddha (Naturopathy)

5. Homeopathy

CORE REFERENCES

Am. PH Assoc (APHA) www.apha.org

Assoc SPHs (ASPH) http://asph.org/

The Alma-Ata Declaration (1978), WHO/UNICEF http://www.paho.org/english/dd/pin/alma-ata_declaration.htm

British Museum http://www.ancientindia.co.uk/

Calcutta Declaration (1999) http://en.wikipedia.org/wiki/User:Prashanthns/Calcutta_Declaration

Ottawa Charter http://www.who.int/healthpromotion/conferences/previous/ottawa/en/

High Level Expert Committee on Universal Health Care in India 2012 http://planningcommission.nic.in/reports/genrep/UHC_ExecSummary.pdfhttp://www.scribd.com/doc/83282216/12th-Plan-Health-Final-Report-From-Steering-Committee

PHFI www.phfi.org/about-us/about-phfi National Geographic ( 2007 )Anita Dalal & Monica Smith - Consultant ), Ancient India : Archeology Unlocks the Secrets of India’s Past

Kar, R obin (2012), Western Legal Prehistory, University of Illinois Law Review, vol. 2012, no. 5, pp. 1499-1702 (2012). Kar, S.B. (2000), Empowerment of Women for Health and Welfare Systems Development, Background paper for the First International Meeting on Women and Health, April 5-7, 2000, Awaji Island, WHO Kobe Center, Kobe, Japan

Ministry of Health and Welfare, (India) http://mohfw.nic.in/

UCLA Fielding School of Public Health http://ph.ucla.edu/

UNDP/ HDI http://hdr.undp.org/en/humandev/ http://hdr.undp.org/en/statistics/hdi/

Sen, Amartya (1999), Development as Freedom, Random House (Also: The Argumentative Indian , Viking , 2006)

WHO 1948 http://www.who.int/about/history/en/index.html

Wolpert, S (2008) A New History of India (Eight Edition) , Oxford University Press

Witzel , Michael (2013), Origins of Worlds Mythologies, Oxford University Press