Sunday, March 28, 2010
Need of Evidence based public health in India - various issues
If we did not respect evidence, we would have very little leverage in our quest for the truth.
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals." (1920, C.E.A. Winslow)1 Public health is typically divided into epidemiology, biostatistics and health services. Environmental, social, behavioral, and occupational health are also important subfields.
There are 2 distinct characteristics of public health:
1. It deals with preventive rather than curative aspects of health
2. It deals with population-level, rather than individual-level health issues
The focus of public health intervention is to prevent rather than treat a disease through surveillance of cases and the promotion of healthy behaviors. In addition to these activities, in many cases treating a disease may be vital to preventing it in others, such as during an outbreak of an infectious disease. Hand washing, vaccination programs and distribution of condoms are examples of public health measures.
The goal of public health is to improve lives through the prevention and treatment of disease.
Ideally public health practices always include scientific evidence in making management decision, developing policies and implementing programme. But in reality such decision usually takes place based on short term demand and political need. In India, every five year government is going to change. Each government wants to show their achievements in last five years and on that ground they are asking vote form citizens. The important aspect of public health is that it is usually takes years to show the impact on health issues. So there is need to change scenario.
Till date our country has achieved accomplishment in public health, like double in life expectancy since independence, reduction in mortality and morbidity. Despite these successes, many additional public health challenges remain. To meet the expected improvement (Healthy Gujarat, MDG, vision 2020 ?) there is need to incorporate more relevant strategy. The best approach is the evidence based public health.
There are many definitions of Evidence based public health. Sackett DL has defined evidence based medicine as ‘the integration of best research evidence with clinical expertise and patient values’.2 Jenicek3has given definition as the “use of epidemiological insight while studying and applying research, clinical and public health experience and applying findings in clinical practice, health programme and policies’. Still one more definition says that ‘the development, implementation and evaluation of effective programme and policies in public health through application of principles of scientific reasoning, including systemic use of data and information system, and appropriate use of behavioral science theory and programme planning model’. Thus any activity in public health is linked with under line scientific evidences that demonstrate effectiveness. With this we can assume that our all national health program are based on some evidences. The concept of developing national programme is based on principle of structured intervention with the intent of improving the health of total population or high risk population. So the disease or problem will reduce over a period. The programme is not compulsory to follow in system. Sometime there is need to change the beahviour of population. For that the government needs to frame policies. Health policies are those laws and regulations, formal and informal rules and understanding that are adopted on a collective basis to guide individual and collective beahviour.
This is the broad outline of public health and evidence based public health. I would like to start discussion on various issues of public health with evidence. All our national health programme, health policies and practices will be evaluated on evidence which are available. My request to learned audience that please let me guide and help for refining issues.
My first issue is Health.
We know the definition of Health by WHO. But I like to ask what is Indian definition. What are the Indian indictors of health. What are the Indian landmarks in history of health. What are our actions to achieve healthy Indian and healthy nation? Action by government, action by community, action by individual.
Hope you will help to find me evidences. Waiting for your reply
Dr. Niraj Pandit
1. C.-E. A. Winslow, “The Untilled Fields of Public Health,” Science, n.s. 51 (1920), p. 23
2. Sackett DL et al, Churchill levingston 2000
3. Jenicek M Epidemology, Jouranl of Epidemiology, 1997
4. Evidance based public health, By Ross C. Brownson, Oxford
5. Wikipedia as source material