Foundation For Social Health

Public Health :- Emerging Issues

Public health deals with the determinants and defense of health at the population level, while clinical medicine deals with multiple maladies and their remedies at the level of the individ¬ual patient. Public health aims to elucidate and influence the social determinants of health as well as to study and structure health systems as efficient channels for delivery of health. Whatever happens before that patient comes to meet a doctor is the arena of public health Whether essential drugs and hea¬lthy foods are available at affordable prices, whether strong referral and follow-up systems exist for after care and whether community health ser-vices are geared to prevent recur¬rence or spread of that disease are all matters which must engage the attention of public health .

All democratic governments are socially committed to provide equitable health care services to all citizens as per the Alma Ata Declaration of 1978. . It reaffirmed the WHO’s holistic definition of health’. It explicitly reiterated the objective of ‘Health for All by the year 2000’ and formulated the primary health care approach seeking to provide preventive, curative and rehabilitative services to all citizens. The thirteenth World Health Assembly convened one year earlier, resolved all citizens of the world healthy so as to enable them to lead a socially and economically productive life. The rationale for this humanitarian declaration is that without such a subsidized health care system, most of the poor people may not be able to get proper medical attention. This principle was further endorsed in the International conferences held in Ottawa (1986), Adelaide (1988), Sundsvall (1991) and Jakarta (1997). The major principles adopted in these conferences can be summed up as follows:

• Health is a fundamental human right and social goal. Government should adopt policies to promote health for all its citizens.
• All health resources have to be equitably distributed both within and between countries.
• Health is shaped by many factors; social, economic, lifestyle and environmental. Health policies should be made to co-ordinate the actions of government agencies with the health priorities fixed.
• Health policies should be pre-emptive and precautionary as the object is to check all health problems at the earliest possible stage.
• Health improvements need community vide response and not merely the mechanical work of a government department.
• Health services should be reoriented towards primary healthcare and geared to promote health rather than simply treating illness.
• Clear performance targets and review mechanisms have to be adopted for implementing appropriate health strategies to attain prefixed aims.

The WHO periodically monitors progress towards ‘Health for All’ (HFA) targets and the efforts of member nations to incorporate these principles in their health policies. It is however worth to note that though the basic ideology has remained intact, the stress of the WHO strategy has altered over time. Presently greater emphasis is on sustainable development and the link between health and environment. It is also argued that WHO has become pro-active in implementing strategies for combating specific health threats like health inequality, alcohol and tobacco use.

Scholars like Baglehole and Binita (1997) have criticized WHO in its failures to achieve HFA targets. WHO lacks the resources and the political clout to execute effectively the public health agenda. Moreover, the organization has lost its tenacity and focus to work for the commitments already made. Twenty seven years have passed since the Declaration and it is really distressing to see that most of the proposed actions by WHO were not at all implemented .In subsequent years, we can observe that the WHO has been superseded by the world Bank and IMF as the crucial decision makers in the health sector.

The UN Millennium summit in September 2000 adopted eight Millennium Development Goals (MDGs) to be achieved by 2015 . Most of these goals are health related as ‘improvements in health are essential’ if progress in MDGs are possible. Thus we can see that much of the Alma Ata objectives are given a new time frame in the MDGs and have to be revised frequently until the end of twenty first century to be realized. Thus there is a dilution of health development strategy from Health for All to Health for the Rich. This implies that there is an increasing trend of commodifying the health care delivery system. All of these are happening in world system that is attempting to make more and more people poor by widening the free market regime where everything has a market price. It is evident that the neo-liberal order offers a better future to the individuals who are ready to serve for the interest of transnational capital. The poor globally are being further marginalized as they are displaced from their traditional mode of living by the usurping of private finance capital. The ever increasing market power of big corporations (both national / transnational) is slowly eroding the power of the state. It is doubtful whether the international community will contribute much to the pressing health needs of the world poor.

In this background, it is pertinent to point out that one year ago the President of Chile and the WHO Director-General have launched a Global commission on social determinants of health, a separate body to investigate the major social causes of ill-health. The commission will make recommendations to adopt practical programmes to ensure the health of the under privileged by breaking the vicious circle of poverty and ill-health. It is to be reiterated that the ultimate object of any health policies and planning is to attain Health for All.