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COMMENTARY

India Badly Needs Public India faces very grim challenges in


improving its public health statistics,

Health Education including indicators of poor maternal


and child mortality and morbidity, a
high level of preventable infectious
diseases, rising trends of chronic dis-
Rajesh Kumar Rai, Theodore Herzl Tulchinsky eases such as diabetes, strokes, coro-
nary heart disease, along with serious

P
This article calls for the need ublic health is a part of the foun- health system related issues (Patel et al
to introduce undergraduate dations of any modern society that 2015). Indias public health workforce
values human life and health, and infrastructure is inadequate, in terms of
courses and degree programmes
seeks sustainable economic and social numbers and quality, to tackle its cur-
in public health across local growth. The achievements of public health rent and future public healthcare issues
colleges and universities in in preventing disease and early death, where a deficiency of trained public
India. Undergraduate degrees affect hundreds of millions of humans health professionals remains a primary
each year (Parascandola 1996). Sadly, concern.
in public health should be
India lags severely behind in terms of
promoted in order to have an achieving these benefits, due to weak- Need a Public Health Workforce
optimum number of public nesses in policies, investment and edu- A public health workforce requires peo-
health professionals who can cation for a strong public health work- ple, who have qualifications in public
force (Rai and Tulchinsky 2015). Recently, health education, to occupy positions
successfully meet the health
some prominent international maga- exclusively or substantially focused on
challenges posed by rapid zinesTime and Forbeshave praised population health (Sim et al 2007). Pub-
economic development. Indias remarkable economic growth, lic health professionals play a central
but reminded policymakers that eco- role in ensuring the appropriate man-
nomic progress is not balanced given agement of all aspects of the healthcare
the slow pace of improvements in public system: from logistics and facility man-
health indicators. Sustainable economic agement, to finances, and the monitor-
growth requires robust policies that ing of healthcare status and healthcare
improves the populations health and interventions (Hazarika 2013). As of
Rajesh Kumar Rai (rajesh.iips28@gmail.com) raises productivity levels across the 2011, a total of 23 institutions in India
is a senior research scientist with the Society
nation. Since 1993, the World Bank has offered a master of public health (MPH)
for Health and Demographic Surveillance.
Theodore Herzl Tulchinsky (tulchinskyted@ considered investments in health as a degree, and some institutions have
hotmail.com) is the emeritus professor at the vital factor to promote economic growth launched diploma programmes in public
Braun School of Public Health and Community and not as, previously considered, a health related disciplines (Sharma and
Medicine, Hebrew University of Jerusalem burden on economic progress (World Zodpey 2011). As a response to Indias
Hadassah.
Bank 1993). public health needs, in 2006, under the
Economic & Political Weekly EPW JULY 8, 2017 vol lIi no 27 37
COMMENTARY

banner of the Public Health Foundation mentioning that with generous support undergraduate degree in public health,
of India,1 various institutes under the from the Rockefeller Foundation, in and the reasons behind not doing so
Indian Institute of Public Health (IIPH) December 1932 the All India Institute of remain unclear.
were established in select states of India. Hygiene and Public Health2 was estab-
IIPHs have introduced many programmes lished in Kolkatait is the oldest school Policies and Recommendations
in the area of public health, including of public health in Southeast Asia. Local colleges and universities should be
postgraduate diplomas, a MPH degree Around the same time, some of the worlds supported financially and encouraged to
and an integrated Master-Doctoral pro- most renowned schools of public health develop undergraduate degree pro-
gramme. In addition, some state health such as the London School of Hygiene and grammes in public health, especially in
departments have also taken the initia- Tropical Medicine,3 the Johns Hopkins poorer states. This will ensure that the
tive to establish public health schools, Bloomberg School of Public Health,4 needs and requirements of a public
for example, the Institute of Public and the Harvard T H Chan School of health professional workforce in India
Health, Kalyani (IPHK) was established Public Health,5 in the US, were also are fulfilled. Bachelors level training for
in 2015 by the West Bengal government founded with financial support from the healthcare promotion and public health
(Government of West Bengal 2015). Rockefeller Foundation (Institute of managers is vital to the infrastructure
However, until now, none of these insti- Medicine 2002). development of essential services, such
tutes have taken the initiative to intro- Unfortunately, public health training as environmental health, road and
duce a Bachelors (degree) programme in remains neglected in India. Thus, it is workplace safety, immunisation, nutri-
public health. not surprising that, globally, the All tion and tropical disease control. Such
This article proposes a change in India Institute of Hygiene and Public programmes, like preventable morbidity
healthcare education priorities, in order Health ranks poorly when compared to and mortality, are required in develop-
to have an optimum number of public its contemporaries, such as the Schools ing countries that face various inequi-
health professionals in India. In part, this of Public Health at Harvard or Johns ties and the growing needs of an ageing
change should adopt the relatively new Hopkins universities in the US. After the population (Albertine 2008; Tulchinsky
trends in Europe and the United States Bhore Committees report, the Govern- et al 2012).
(US), promoting public health under- ment of India in 1977 launched the Re- Given the current need for an ade-
graduate degree programmes within orientation of Medical Education (ROME) quately trained public health workforce
existing universities or colleges on a broad scheme across the country, which had cadre in India, developing public health
scale. The government at the national limited success in training medical grad- undergraduate degrees should be priori-
and state levels, led by the Ministry of uates for rural services. Both the Expert tised over introducing more MPH pro-
Health and Family Welfare, should insti- Committee on Public Health Systems, grammes, although both are needed.
tute policies and incentives that promote formed by the Union Ministry of Health Universities in the US and Europe are
bachelors degree programmes. The gov- and Family Welfare in 1996, and the rapidly broadening public health educa-
ernment must also mandate that attending Voluntary Health Association of Indias tion, through bachelors degree progra-
such degree programmes is a prerequisite (VHAI) Independent Commission on mmes and the development of schools of
for occupying positions in the ministry, Health in India 1997, recommended the public health. In India, a multidiscipli-
and field service systems across the strengthening of public health training, nary workforce is badly needed in order
nation. The challenges in doing so are and the VHAI stressed on the need to to promote a proactive environment for
discussed. open new schools of public health public health education, research, advo-
(Bangdiwala et al 2011). cacy and services, that meet interna-
Undergraduate Degree Needed The Calcutta Declaration on Public tional accreditation standards (Aceijas
The importance of an undergraduate Health was adopted in 1999 at the and Foster 2011; Kuiper et al 2011; Lee
degree course in public health education Regional Conference on Public Health 2008; Tulchinsky 2010). In 2003, a report
started even before Indias independ- in South-east Asia in the 21st century. published by the US Institute of Medicine
ence in 1947, when the report of the The declaration called for mandating (IOM) recommended that all public health
Health Survey and Development Com- competent background education and professionals employed to improve pop-
mittee (formed in 1943), chaired by relevant expertise, for persons working ulation health should at the least earn a
Joseph Bhore, emphasised the inadequate in public health systems. It also empha- baccalaureate degree (Gebbie et al 2003).
teaching of preventive medicine and sised the need to strengthen and reform In 2006, the Consensus Conference on
public health in medical students under- public health education, training and Undergraduate Public Health Educa-
graduate training (Government of India research institutes, as supported through tion, held in the US, recommended that
1946). Nearly 70 years later, the quality the networking of institutions and the at all students at undergraduate institu-
of public health professionals produced use of information technology in human- tions should be provided access to the
in India is still questionable and the resources development (Bangdiwala core curriculum (Riegelman 2008). The
deficiency of qualified professionals et al 2011). However, none of these Association of Schools and Programs
aggravates the situation. It is worth reports recommended introducing an in Public Health (ASPPH 2012) are
38 JULY 8, 2017 vol lIi no 27 EPW Economic & Political Weekly
COMMENTARY

actively promoting an undergraduate More adequately trained public health 21st Century, Institute of Medicine, Washing-
ton: National Academies Press.
education in public health, including for professionals could be produced if the Government of India (1946): Report of the Health
other professions such as social work, candidates are oriented towards it in the Survey and Development Committee, Manag-
law and general arts degree programmes. undergraduate degree level. This includes er of Publication (Chairman: Sir Joseph Bhore)
New Delhi, viewed on 26 April 2017, https://
The Bologna Declaration of 1999 upgrading the current public health www.nhp.gov.in/bhore-committee-1946_pg.
(European Ministers of Education 1999) workforce with technical level diplomas, Government of West Bengal (2015): The Kolkata
Gazette, viewed on 26 April 2017, https://wbx-
called for the reorganisation of higher as well as attracting new, young and press.com/wp-content/uploads/2015/06/140-
education in Europe. The Association of highly motivated candidates. But ab- HF.pdf.
Hazarika, Indrajit (2013): Health Workforce in India:
Schools of Public Health of the European sorption into the network of the public Assessment of Availability, Production and Dis-
Region6 established a working group on health professionals remains a daunting tribution, WHO South-East Asia Journal of
undergraduate education in public health, challenge. The Ministry of Health and Public Health, Vol 2, No 2, pp 10612.
Institute of Medicine (2002): The Future of the Pub-
and also conducted a survey of under- Family Welfare, along with industry lics Health in the 21st Century, Washington DC:
graduate public health programmes. The leaders, non-governmental organisations, National Academy Press.
Kuiper, Tom, A Meijer and J Moust (2011): Innovation
working group called for the strengthen- and public health research institutes can in Public Health Teaching: The Maastricht Expe-
ing of some crucial components of the promote this initiative, by requiring can- rience, Public Health Reviews, Vol 33, pp 30014.
public health education system across didates who compete for local and Lee, Joel M (2008): Articulation of Undergraduate
and Graduate Education in Public Health, Public
the European region. national leadership positions to have a Health Reports, Vol 123, No 2 (Supplement),
suitable public health education degree. pp 1217.
Challenges and the Way Forward Parascandola, Jojn (1996): From MCWA to CDC
India must find a way to promote under- origins of the Centers for Disease Control and
Although introducing public health under- graduate degrees in public health educa- Prevention, Public Health Reports, Vol 111, No 6,
pp 54951.
graduate degree programmes is vital for tion so as to expand the qualified work- Patel, Vikram, R Parikh, S Nandraj, P Balasubra-
progress in public health, in India the force and in order to be successful in maniam, K Narayan, V K Paul, A K S Kumar,
main focus thus far has been on masters meeting the health challenges of this M Chatterjee and K S Reddy (2015): Assuring
Health Coverage for All in India, Lancet,
degree training for physicians. Progress rapidly developing nation. Vol 386, No 10011, pp 242235.
even in this field will require the esta- Rai, Rajesh Kumar and T H Tulchinsky (2015): Ad-
dressing the Sluggish Progress in Reducing
blishment of international standards of Notes Maternal Mortality in India, Asia Pacific Jour-
accreditation. In India, there is no sin- 1 Public Health Foundation of India: http://phfi. nal of Public Health, Vol 27, No 2, pp NP116169.
org/. Riegelman, Richard K (2008): Undergraduate
gle uniform, overarching, body or coun-
2 All India Institute of Hygiene and Public Public Health Education, American Journal of
cil, responsible for public health educa- Health: http://aiihph.gov.in/. Preventive Medicine, Vol 35, No 3, pp 25863.
tion in the country as a whole (Bangdi- 3 London School of Hygiene and Tropical Medi- Sharma, Kavya and S Zodpey (2011): Public Health
cine: http://www.lshtm.ac.uk/. Education in India: Need and Demand Para-
wala et al 2011). Persons from both 4 Johns Hopkins Bloomberg School of Public dox, Indian Journal of Community Medicine:
medical and non-medical backgrounds Health: http://jhsph.edu/. Official Publication of Indian Association of Pre-
5 Harvard T H Chan School of Public Health: ventive & Social Medicine, Vol 36, No 3, pp 17881.
can enrol into a public health degree http://hsph. harvard.edu/. Sim, Fiona, K Lock and M McKee (2007): Maximising
programme, but the Medical Council of 6 Association of Schools of Public Health of the the Contribution of the Public Health Workforce:
India (MCI) is the statutory body respon- European Region: http://aspher.org/. The English Experience, Bulletin of the World
Health Organization, Vol 85, No 12, pp 93540.
sible for establishing and maintaining Tulchinsky, Theodore H (2010): It Is Not Just the
uniform standards of medical education, References Broad Street Pump, Journal of Public Health
(Oxf), Vol 32, No 1, pp 13435.
that is offered at the medical college level Aceijas, Carmen and N Foster (2011): Public
Tulchinsky, Theodore H and J Goodman (2012):
Health Capacity Building in Times of Austerity:
only. Public health training at non-medical A Case Study from the University of East London,
The Role of Schools of Public Health in Capa-
city Building, Journal of Public Health (Oxf),
colleges or universities come under the Public Health Reviews, Vol 33, pp 24050.
Vol 34, No 3, pp 46264.
purview of the All India Council for Albertine, Susan (2008): Undergraduate Public
Voluntary Health Association of India (1997): Re-
Health Preparing Engaged Citizens as Future
Technical Education (AICTE) or the Uni- port of the Independent Commission on Health
Health Professionals, American Journal of Pre-
in India, New Delhi: Voluntary Health Associa-
versity Grants Commission (UGC). Thus, ventive Medicine, Vol 35, No 3, pp 25357.
tion of India.
ASPPH (2012): Recommended Critical Component
the very first challenge for India is to Elements of an Undergraduate Major in Public
World Bank (1993): World Development Report 1993:
Investing in Health, New York: Oxford Univer-
decide who will lead the delegation Health, Association of Schools and Programs
sity Press, viewed on 26 April 2017, https://
of Public Health, viewed on 26 April 2017,
while introducing undergraduate degree http://www.aspph.org/app/uploads/2014/04/
openknowledge.worldbank.org/handle/
10986/5976.
courses in public health? CCE_2012-08-03-FINAL.pdf.
Second, what can motivate suitable Bangdiwala, S I, J D Tucker, S Zodpey, S M Grif-
fiths, L Li, K S Reddy, M S Cohen, M Gross,
aspirants to pursue either a specialised K Sharma and J Tang (2011): Public Health
degree in public health (for example, a Education in India and China: History, Oppor-
tunities, and Challenges, Public Health Reviews, available at
Bachelors of Public Health), or opt for Vol 33, pp 20424.
public health as one of their undergrad- European Ministers of Education (1999): The Gyan Deep
uate degree subjects. There is no doubt
Bologna Declaration of 19 June 1999, viewed on Near Firayalal, H. B. Road
26 April 2017, http://www.magna-charta.org/
Ranchi 834 001.
that India desperately needs a large resources/files/text-of-the-bologna-declaration.
Gebbie, K M, Rosenstock, L and L M Hernandez Jharkhand
increase in its public health workforce (eds) (2003): Who Will Keep the Public Healthy? Ph: 0651-2205640
with suitable professional education. Educating Public Health Professionals for the

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