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Whither Public Health



Whither Public Health

letter doing the rounds in US universities is revealing. It says that the Association of Schools of Public Health (ASPH) of the US has been asked to facilitate the Public Health Foundation of India (PHFI) – which was launched by the prime minister on March 28 – in identifying faculty with expertise and passion, to assist in the development of new and independent schools of public health, design curricula, build departments/ disciplines, mentor Indian faculty, and teach courses, all within four weeks to a year. The letter implies that it is child’s play to draw a suitable curriculum for public health in India. But, obviously, the Indian medical bureaucracy has not taken its own professionals into confidence, and they will now have to wait for the building of their capacity to manage public health.

Curiously, the union health secretary (now a member of PHFI’s board) – after placing the socially irrelevant reproductive and child health II (RCH II) at the core of the national rural health mission (NRHM) – is reported to have pontificated, “public health practitioners need to understand the social, economic and environmental determinants of health” (The Indian Express, March 20, 2006). He does not appear to know that India was the first country to use social science studies in its national programmes: successfully in the national tuberculosis programme, and unsuccessfully when American demography shaped the family welfare programme. The Indian Express also reported that finances for the “autonomous” PHFI are to come from US financial donors and Indian industrial houses. The working draft, marked confidential but circulated to US institutions, proposes a chain of institutions to raise an army of public health experts, led by the head of the US ASPH, to train doctors, managers, analysts, demographers, epidemiologists, and community health workers. AIDS and dengue fever are the “challenge of public health”, and the root causes are “shortage of professionals, small-scale and questionable quality of current schools of public health, and absence of high quality public health research agency”. The empowered financing committee has passed the proposal and the Foundation proposes to pay scales higher than the government institutes! Thus, while primary health centres are being curtailed to “save” money under NRHM, the Bill Gates Foundation has the freedom to push resources where it wants in the name of collaboration among selected “stakeholders”.

The idea of new AIIMS-like institutes is not new. What is new is the thought that the country cannot either mobilise its own intellectual resources to define public health needs and develop the required curricula, or

(Continued on p 2036)

  • (1) In the article ‘Housewife, Sex Worker and Reformer: Controversies over Women Writing Their Lives in Kerala’ (Review of Women’s Studies, April 29, 2006), p 1681, column 1, para 2, sentence 2 should read, “Indeed, the text dismantles the image central to the first version, of Jameela as ‘liberated’ woman (contrasted with feminists who are not), outside mainstream society and therefore somehow less subject to patriarchy” instead of “Indeed, the text dismantles the image central to the first version, of Jameela as “liberated” woman, (contrasted with feminists who are outside mainstream society and therefore, somehow less subject to patriarchy).”
  • (2) In the article ‘Diffusion of Development’ (May 6, 2006), two references dated 2004 and 2006 (p 1772) have been wrongly attributed to the author Prabhat Patnaik instead of to Utsa Patnaik.
  • (3) In the article ‘Great Indian Story of Convertibility’ (May 13, 2006), in the first para, “March 2005” (p 1881) should have been “March 2006”.
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    (Continued from p 1934)

    rejuvenate the over 200 medical colleges and their preventive and social medicine (PSM) departments. It is difficult to see humour in a situation that evokes only sadness. It is even more disconcerting to believe that those trained by India’s premier institutions will have no hesitation in joining consultancy firms to serve private capital for professed enrichment of Indian public health, and be willing to forgo what is vital for the country’s intellectual independence. In the 21st century, when linking up with the rest of the world with confidence and on our own terms is possible, a publicprivate partnership is quietly smuggled in to accommodate a political mentor. Why is India unable to define its public health needs and invite the best minds and proven practices from all over the world? Why are consultancy firms with no experience of public health, like McKinsey, given contracts to run public health projects and learn on the job when it collaterally damages the services by focusing on AIDS alone? Are we under the illusion that this is an altruistic step on the part of the donors?

    The PHFI seems to be important to both the American and the Indian governments, one needing the markets, the other more resources to increase middle class consumption patterns. In the process, what is being neatly avoided is that public health is not just the amalgamation of social sciences, health management, and epidemiology, but the integration of their perspectives. Consequently, the vision of a public health that is inclusive as well as comprehensive may get further postponed. Unless the islands of excellence deal with the new epidemics (farmer suicides, hunger, violence against the poor, their shattered homes and livelihoods, falling food availability, and disappearing little girls), and reach out to the existing medical colleges and their PSM departments that train important components of human resources in public health, there can be no revival of the same.


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