Topic 1 : Populism does not help public health.
Conclusion: A fair and effective health system requires freedom from political influence, focusing on policymaking and implementation driven by scientific evidence and long-term objectives.
Introduction
- In the heart of India’s bustling cities and tranquil villages, there is a silent but significant fight raging on the public health front.
- It is not the dramatic triumphs of curative medicine that dominate this story but the quiet victories of preventing diseases such as smallpox (though eradicated, it is still under surveillance), polio, neonatal tetanus, and measles, through improved sanitation and vaccines.
Political Leaders' Focus on Immediate Results
- In democratic settings, leaders often prioritize immediate results over preventive efforts, such as new hospitals, subsidised treatments, emergency response, and populist health policies.
- These measures often fail to have much impact due to budgetary constraints and lack of action beyond public announcements.
- Additionally, these schemes divert attention from critical areas like sanitation, disease surveillance, and public health education, which are crucial for maintaining population health and preventing disease outbreaks.
Dengue: A Case Study of Prioritizing Emergency Response over Sustainable Prevention
- Dengue, a disease with only symptomatic treatments, is a prime example of prioritizing immediate response over sustainable prevention.
- This approach overlooks the root causes of dengue and its long-term prevention, as well as the research required in vector control, vaccine development, and public health infrastructure improvement.
- Research and development in these areas are crucial, as climate change affects mosquito breeding and movement patterns.
- Health care should be separated from political processes, based on scientific evidence and long-term goals, rather than short-term political interests. This separation ensures public health policies are driven by data and expertise, not electoral cycles.
- Investments in nutrition programs have far-reaching implications for health and productivity.
- The current Prime Minister's Overarching Scheme For Holistic Nourishment (POSHAN) Abhiyan Scheme aims to reduce stunting, undernutrition, anemia, and low birth weight, but the fifth National Family Health Survey found a significant gap between prevalence and policy targets.
- The pharmaceutical industry's profit-driven nature often sidelines areas such as public health, as seen in India's tuberculosis (TB) cases. This disparity is deeply linked to socio-economic factors such as poverty, sanitation, and overcrowding in India.
Public health changes in India
- Behavioural change is key to managing public health challenges. Yet, it can be challenging in political environments influenced by populist tendencies.
- The absence of specialised courses such as public health engineering in India’s educational institutions points to a gap in the multidisciplinary approach required in public health management.
- Public health is not just about treating diseases. It is about preventing them, requiring expertise from various fields such as environmental science, sociology, urban planning, and economics.
- The current physician-centric focus of India’s public health system often fails to capture this comprehensive nature.
Public Health Management: A Separation of Powers Approach
- Effective public health management should encompass preventive measures, policy formulation, community health, and environmental health, among others. In public health, adopting a separation of powers approach is essential.
- A fair and effective health system requires freedom from political influence, focusing on policymaking and implementation driven by scientific evidence and long-term objectives.
- While prioritising health decisions based on scientific evidence and overarching public health goals are crucial, there is a risk of disconnecting from the immediate health concerns of the general populace.
- To address this, an ideal solution would be to place Health Ministries directly under the leadership of elected officials, such as the Chief Minister or the Prime Minister, similar to the management of the space and the atomic energy departments.
- This structure would not only provide a degree of autonomy but also ensure that health policies are aligned with the people’s immediate and practical needs, striking a balance between expert-driven decisions and public aspirations.
Conclusion
- In sum, democracy is not inherently harmful to public health but the way public health is managed within democratic systems often leads to significant shortcomings.
- Infectious diseases, non-communicable diseases, health-care access, mental health, and misinformation pose challenges that demand a more holistic, long-term approach in public health policy.
A separation of health-care decision-making from short-term political goals is crucial to develop sustainable health strategies that address both the immediate and future health needs of the population.
Topic 2 : Early nutrition impacts cognitive development.
Context: While cognitive skills are malleable and less dependent on educational investments, their assessment through traditional achievement tests remains complex and potentially misleading.
Introduction
- Stunting irreversibly affects not just the height, but also the cognitive development of a child.
- While the long-term impact of early childhood stunting on educational levels is recognised, the processes by which it results in lower educational achievements, particularly in low- and middle-income countries, are not well understood.
- A deeper insight into the underlying mechanisms is crucial for formulating effective policies to enhance educational outcomes in these contexts.
Research Challenges and Impact of Early Human Capital Investments on Cognitive Development
- Research on the impact of early human capital investments, such as nutrition, on cognitive development faces challenges due to their focus on specific cognitive-achievement test scores.
- Traditional achievement tests may not fully reflect inherent cognitive skills, as they depend on both cognitive abilities and access to education.
- In India, traditional achievement tests only consider children's enrolment and learning outcomes.
- A recent study by Sánchez et al. (2024) in 'World Development' examined the link between early under-nutrition and four key cognitive skills developed later in childhood: working memory, inhibitory control, long-term memory, and implicit learning.
- The study found that stunting at approximately age 5 is negatively related to executive functions measured years later, even when accounting for household fixed effects. The impact of stunting on working memory might occur as early as age 5, influenced by vocabulary development.
- India is addressing stunting through Poshan Abhiyaan and Integrated Child Development Services, which focus on enhancing the utilization and quality of Anganwadi services to ensure holistic development and adequate nutrition for pregnant women, mothers, and children.
- Improved sanitation, such as the Jal Jeevan Mission and the Swachh Bharat Mission, is crucial for reducing the incidence of diarrhoea and stunting.
Three key strategies
- To markedly improve child nutrition and combat under-nutrition in India, three key strategies can be the largest needle movers.
- First, promoting early breastfeeding, along with continued breastfeeding for two years, coupled with appropriate complementary feeding starting at six months, is essential. This not only prevents stunting but also fosters optimal child development.
- Government initiatives, such as the Mother’s Absolute Affection Programme, need expansion to provide comprehensive lactation support and create breastfeeding-friendly environments.
- Second as children grow, diversifying their diet becomes crucial. India should implement and scale up community-based complementary feeding programmes.
- These can educate parents about the importance of adding a variety of foods to their child’s diet after six months of age, focusing on locally available, nutrient-rich food options.
- Finally, adding an extra Anganwadi worker to each Anganwadi centre could help. Studies, including a randomised trial in Tamil Nadu, have shown that extra staff can double preschool instructional time and improve math and language scores and reduce child stunting and severe malnutrition.
Conclusion
- Promoting early breastfeeding, promoting complementary feeding, and expanding government initiatives are crucial for optimal child development. Community-based feeding programs and an extra Anganwadi worker can also improve educational outcomes and create employment opportunities.