A public health ministry acts as an intelligence agency for diseases. However, India is yet to have such a body, despite facing epidemics every year.
In Kerala, a team of doctors from New Delhi’s National Institute of Communicable Diseases (NICD) is investigating the cause of some viral outbreaks.
How many outbreaks and how many cases can NICD’s teams from New Delhi investigate?
The health ministry last week announced that it was renaming NICD as National Centre for Disease Control. But does that make diseases more identifiable and controllable?
The answer, according to experts, is no.
There is the Central Bureau of Investigation (CBI) to investigate crime. There is no such agency for diseases.
The health ministry made a small beginning last week by saying that NICD would start some kind of a disease intelligence service.
T Jacob John, an eminent virologist on the ministry’s board for control of polio, says intelligence gathering by just one entity, in this case NICD, in a country with 30 states will achieve little. He says we need 60, or at least 30, NICDs to make some impact.
Secondly, Kerala, or any state for that matter, should not need NICD doctors to find the cause of a disease. Public health should be made a state and a central subject, allowing states to implement the Centre’s policies, says John. He blames states for not making health a political issue and demanding their rights.
A public health department or a ministry acts as a CBI for diseases and keeps a country ready to fight epidemics. In countries which have a public health system, the cause of every death is certified. Here, there is no such process, says John.
The Ministry of Health and Family Welfare has four departments, namely health, family welfare, National AIDS Control Organisation, and lastly, ayush, unani and homeopathy.
Jacob John points out that most countries, even those in Asia, have a separate ministry or at least a department of public health, which plays the role of a health James Bond. Sri Lanka, Bangladesh, China, all Asean countries and most Latin American countries have public health ministries or departments.
The reason why there was widespread fear and panic at the spread of swine flu was because it started in the West, said John.
John predicts the flu will be all over in three months when temperatures come down. But most frighteningly, it will percolate down and spread across the bottom of the pyramid, which has no health protection and is vulnerable.
Two-three years ago, chikangunya was all over, taking over 1,000 lives, but there was little panic. That was because it started in India and not the West.
John said HIV would not have caused a whimper had it started in India.
Writing in the National Medical Journal, John seeks setting up of a National Commission on Health Systems. This could lead to a department of public health with district-level public health officers all over the country.
He says while 1 per cent of gross domestic product is spent on health, another 1 per cent could go to public health to begin with. He said it would be the biggest poverty alleviation programme in the country as poor health bred poverty.
Hence, just renaming NICD cannot change the fact that the health system in India is in a shambles, that without a public health system, a sick Indian is very much at the mercy of the powers of nature.
