Public health in India and the developing world: beyond medicine and primary healthcare

Despite many decades of independent planning and implementation, most populations living in the developing world have yet to reach the utopian ideal of health for all. This editorial critically considers the issues and the situation in India to suggest alternatives.

The survival of the human body is best explained by the materialist explanation that locates the variation in health and longevity to tangible resources.1 The reciprocal relationship between poverty and disease had long been acknowledged by public health reformers2 who advocated social reform on political, economic, humanitarian and scientific grounds.

Successive governments in India have come up with many schemes for the provision of safe water, sanitation, nutrition, vaccination coverage, education and employment. Despite the many attempts, millions of people do not have access to these basic needs,3 malnutrition is rampant in children4 and vaccination coverage is inadequate among the poor. Elementary education is substandard5 and unemployment widespread in rural areas. Despite increased budgetary support for such schemes, most states have pursued weak policies in this area and neglected the local governments, giving them a low stake in improving infrastructure. The enormity of the unfinished tasks is mind-boggling.

The context of public health in the developing world differs markedly from the social, economic and political environment in the West when public health became part of their culture and basic standard of life. The differences that need to be taken into account are as follows:

1. The antibiotic era: The Western world completed its public health revolutions before the introduction of antibiotics and eliminated epidemics of infectious diseases through public health measures. The role of antibiotics in the prevention of diseases in populations is negligible, and they worsen the situation by providing temporary relief to …