Tuesday 20 March, 2018

Please Make India’s Health an Urgent Priority

Dr. K.M. Venkat Narayan

Dr. K.M. Venkat Narayan’s open letter to Prime Minister Narendra Modi

Dear Prime Minister Modi: Congratulations and best wishes.  Talking to people in my native city of Bangalore, I can sense the palpable optimism that your win has brought to the youth in India. People are longing for a decisive government:  your emphasis on economic development, affording opportunities to the common man, eliminating or reducing poverty all resonate with the people.

There is one other priority that needs urgent attention: peoples’ health.  Good health is important on its own right, but will also help realize the country’s economic potential.    Health should be an important priority to realize the full potential of India’s young people, and not to lose them from the workforce during the peak of their productivity. Furthermore, with significant numbers of people living longer into ripe old ages, it will be important to keep them healthy, productive, and fulfilled.

I want to urge you to attend to four urgent priorities.

1. Invest in, strengthen, and modernize the public health infrastructure:  A lot of the determinants of good health reside outside of the healthcare sector, and the majority of the impressive health gains that the world has had have come from public health approaches: better nutrition, hygiene and sanitation, safe water, healthy environment, immunization, poverty elimination.

Strengthening public health and making it relevant to today’s needs should be an important priority:  (a)India needs modern health information systems to measure and monitor the country’s health status in a dynamic manner, and to guide decisions. (b) A well-resourced independent central agency is needed to strengthen public health, to build the science base, and to connect federal and state-level policies and resources for effective action. A model to consider might be the US Centers for Disease Control and Prevention (CDC. (c) Better mechanisms are needed to promote collaboration across sectors for health – e.g., agriculture, urban planning, sports and entertainment, schools and education,  economics, industry, technology, citizen involvement. (d)India needs to modernize and expand training of public health professionals at every level, from grass-roots community health workers to highly trained public health science experts. Some impressive work is already happening through the Public Health Foundation of India (PHFI) and at several medical colleges.  These need to be built upon, and public health education needs to be integrated across all education systems in the country.  The creation of an independent university of public health with a network of institutes across the country may catalyze this  development.

2. Prevent and control noncommunicable diseases (NCDs):  Even as India deals with an unfinished agenda of under nutrition, infectious diseases, and maternal & child health, the country is facing the gigantic challenges of NCDs, such as diabetes, heart disease, stroke, cancers, lung disease, road traffic accidents and injuries, and poor mental health.  What is especially disturbing is that these NCDs are affecting people inIndiaat younger ages..  Yet, a high proportion of these NCDs are potentially preventable by tackling tobacco, improving diets and physical activity, reducing excess alcohol use, reducing air pollution, and by investing in evidence-based preventive clinical medicine. Addressing NCDs in an integrated manner, and based on data and evidence gathered fromIndia, is an urgent priority.

3. Invest in healthcare reform:  India’s healthcare systems require modernization to proactively deal with the new health challenges brought by the growth of NCDs superimposed on the ongoing challenges of infectious diseases, maternal and child health, undernutrition.  The country needs to strengthen its primary health care system, emphasize prevention, and retrain and expand workforce to address NCDs.  There is a huge shortage of health personnel, especially trained primary care physicians, and non-physician health workers. Innovatively addressing these shortages through public-private partnerships would offer huge opportunities for improving healthcare, while also providing employment to millions.  The challenge is to develop and implement models of healthcare that are of high quality, yet affordable in cost. Some great examples exist: the Devi Shetty approach to delivery of high-technology cardiac treatments or the Arvind Eye model of eye health for millions are some innovations to learn from. Beyond these, good integrated models of primary care for NCDs are much needed, and it is also important for India to develop mechanisms to guide and monitor healthcare quality and to introduce accountability and consumer participation in healthcare.

4. Invest in health research infrastructure:   For the size of its population and of its disease burden,Indialags woefully behind in health research. For example, although India is about 15% of the world population, she contributes to roughly 0.5% of the world’s research productivity in several health areas (e.g., diabetes).  Developing high quality research from India needs serious action at several levels: (a) the country’s education system remains largely stuck in a rote-learning model which is completely out of sync with the creative and innovative needs of a 21st century economy. Research skills and training need to be inculcated within the education system at all levels.India’s system of doctoral training needs to be reformed in a manner that encourages independent investigators, who are encouraged and supported to take risks. (b) the country needs a large network of well-supported clusters of excellence for health research and innovation across several thematic areas. Such clusters will help India retain her top talent and also attract into India talent from elsewhere. (c)India needs to drastically cut the red tape that holds research back in general, and is also a huge impediment to healthy international collaboration. Some of the recent regulations concerning clinical trials are death knells to innovation. Similarly,India still practices several protectionist policies that impede global research collaboration (e.g., huge delays with health ministry clearances for foreign grants or disallowing transfer of specimens in collaborative global studies using standardized methods).

Prime Minister, Modi, you have indicated that the 21st century will be “India’s century”. That is an inspiring and compelling vision.  I humbly offer to you that attention to health should be an urgent priority forIndiato achieve that tall and exciting vision.

K.M. Venkat Narayan is Director of Emory Global Diabetes Research Center, and Ruth and O.C. Hubert Chair of Global Health and Professor of Epidemiology and Medicine at Emory University Atlanta. He is a product of three continents, having lived and worked in India,United Arab Emirates,United Kingdom, and United States of America.

The article first appeared in the British Medical Journal blogs.


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