My Interests in Public Health

Some Significant Issues for me

• Medical practice has turned into profit orientated business instead of Health for All 
• Practitioners concentrate largely on Illness care
• Health advice and prevention is generally ignored
• Taking responsibility of one's own health is not encouraged
• ​Irresponsible use of drugs in medical treatment is rapidly becoming a scourge
• International Aid in poor countries is weakening the health of people through dependency

Many of these Issues can be Addressed through the following

1. Public Health
2. Power of Information
3. Maternal and Child Health
4. Primary Health Care
5. Corporate Social Responsibility (CSR)
6. Collaboration with Government Health Services
7. Voluntary/Private Health Sector

Some of the approaches to address these issues are discussed here:
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Public Health
Public health practice is an action-oriented discipline that seeks to move populations towards health. (Physical activity: more of the same is not enough. The Lancet Vol 380 July 21, 2012). When we talk about public health the things, that focus on the whole community, or groups within society and the things that determine their health, are what we are talking about. This is big picture stuff. There is general misconception among medical professionals, and through them in the world, of what Public Health Is! Read on...    new_public_health.pdf

Power of Information
Civil registration and vital statistics (CRVS) systems and the data they generate will be crucial for monitoring implementation of the Sustainable Development Goals (SDGs) in countries, as well as for other national and regional health and development agendas.
CRVS as public health: CRVS maximises good health and wellbeing. CRVS data provide the evidence base for government policy decision making on population health and intersectoral issues connected to the social determinants of health. CRVS data are needed for mortality surveillance and research. Birth certification enables populations to access medical services and public health insurance and facilitates universal health coverage.
CRVS as sustainable development: CRVS promotes key pillars of human development, including equity, participation in economic, social, and political life, empowerment, security, and sustainability. CRVS data are used across multiple sectors and support country, regional, and global development policy, planning, implementation, and monitoring, including of the SDGs.
CRVS as investment: CRVS maximises countries’ economic planning and development. CRVS data allow governments and their partners to develop cost-effective policies and interventions that improve population health. Governments can use CRVS to improve financial management, resource allocation, transparency, and accountability, and their country’s overall macroeconomic landscape.
CRVS as human rights: CRVS maximises access to human rights entitlements, especially for vulnerable and marginalised populations, and women and girls. CRVS facilitates recognition of the right to identity, name, and nationality and associated rights. For children, CRVS can protect against child labour, child marriage, and trafficking. CRVS as human rights overlaps with the SDG aspiration that “no one shall be left behind”, something that cannot be achieved if all people are not recognised and counted.
CRVS as good governance: CRVS maximises government accountability. A strong legislative framework associated with CRVS, and the ability of the state to know its population, enables good governance, transparency, and accountability.

Ref: Claire E Brolan, Hebe N Gouda, Carla AbouZahr, Alan D Lopez. Beyond health: five global policy metaphors for civil registration and vital statistics. Lancet Vol 389 March 18, 2017 p 1084-85

Tools for data collection
Advances in information technology has made it possible to have incredible amounts of information available to health workers in their day to day activities. Almost all health institutions big or small, have computers, with built in spreadsheets, access database and many other software thrown in. Health workers are versed with the use of this technology as most of them are using smart phones and tablets. In addition free software are made available through international agencies such as WHO Anthro (WHO) and EpiInfo (CDC) to facilitate easy use of health information for data storage, analysis, interpretation and monitoring. 

My experience of using routinely available data 
​So much of data was collected every day, in earlier days on paper but now increasingly on computers. Most of it disappeared and never saw the light of the day. As a young public health specialist in 1985, I was very aware of the power of information, especially in epidemiology and looked for it eagerly. I discovered that with a little bit of effort, it was possible to retrieve stored information.

In the District Health authority's planning department, I was directed to a filing cabinet which contained neatly filed birth and death mainframe computer printouts of summary tables from then Office of Population Censes and Survey (OPCS) for all the districts in Wales. It was possible to extract information from these printouts on paper but it would be a time consuming effort and I would not be able to do full justice to the data contained in the printouts. After a couple of phone calls to OPCS office, I was assured that information on floppy disks could be made available after completing certain formalities. Rest is history! 
  
National census data information with postcodes were used to study small area statistics, identifying areas of social deprivation (census data) and ill health (vital registration), focusing on to address health needs of these populations. (Thomas C J and Kaul S A. The relationship between health and social conditions in Wales:  SERN. Department of Geography, University College of Swansea. Wales. UK.  July 1988). 

Using routinely available data, health status indicators were developed into a Public Health Common Data Set. All health authorities in Wales were required to produce an annual report using this data set and the Chief Medical Officer of Wales reviewed the reports annually for NHS Wales. Welsh health, the Annual Report of the Chief Medical Officer, Wales were published from 1993-1995 using this and other routinely collected data. (Welsh Public Health Common Data Set. Welsh Health Common Services Authority. First Edition 1996).

​General Practice Morbidity Database was developed, using computerized data from representative sample of General Practice populations in Wales. Over a million medical records were put together electronically to create a database which provided the basis for prevalence of common diseases in the general population, leading to prevention programs as well as indicators to identify high prevalence geographical areas.  
(Evans J, Rogers C and Kaul S. The General Practice Morbidity Database Project Wales - a methodology for primary care data extraction. Medical Informatics. International journal of information processing in health care. 1997 Volume 22 No. 2 p 191-202).
Read more under Primary Health Care > General Practice and Public Health
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Weights and Heights in a population can reveal a lot 
Measuring of the body weights and heights was one of the methods used right through the life of the project. It is simple and important means of tangibly assessing the degree of nutritional or other socioeconomic deprivation in a population. Sudden fall in the body weight in an individual or in a subgroup of a population can be a useful pointer to the special needs of the population and a lowering of the BMI profile may demonstrate that the population is being adversely affected by environmental impacts, such as sudden changes brought about by the construction of a dam. ​Heights and Weights as a Humble Tool in Monitoring (posted on 13 October 2018)

Maternal and Child Health
The health of women and children is vital in creating a healthy world. Despite great progress, there are still too many mothers and children dying—mostly from causes that could have been prevented. Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. 99% of these deaths occur in developing countries. In 2012, 6.6 million children died before age of five years, million of them in the first year of life. Improvements in maternal and child health (MCH) are a major focus of the health-related Millennium Development Goals (MDGs 4, 5, and 6), which still need substantial work to achieve 2015 targets. 
https://www.cdc.gov/globalhealth/mch/  (continued under Maternal and Child Health page)
 
Primary Health Care
Primary health care (PHC) concept, developed (rather put together) in 1979 (Alma Ata Declaration) is still not implemented effectively in most poor or less developed countries. Those countries which implemented PHC, e.g. UK under National Health Service and many counties in Europe have health indicators serving as international standards. We (medical professionals) provide illness care (to make money or someone using doctors to make a lot more money) not health care to populations. If only primary health centers and the district hospitals in less developed countries were able to provide all eight components of PHC, things would have been very different. I firmly believe in strengthening what is already there with the know-how widely available. What is needed is to ensure that national health policies are implemented to the full through primary health care. Let the slogans be announced by international agencies and world health bodies but we should not loose the site of universal PHC in our areas of responsibility. PHC holds a chance to achieve the goals.
(continued under More > Primary Health Care > General Practice pages)

​Corporate Social Responsibility
Concept of development comprises the activities designed to improve the standard of people living in less developed conditions. Corporate Social Responsibility (CSR) for large projects, is designed to address the genuine needs of people impacted by the project towards development, especially those who live in inaccessible and poverty stricken remote areas. The process can be greatly enhanced under CSR if management is sincerely interested in the welfare of the people. Read on.. Corporate Social Responsibility
 
Collaboration with Government Services
Improvement in health services is an integral part of development. Large projects provide mitigation measures for any likely adverse effects of the project on affected populations and ensure that the health of the people improves during and after the life of the project. Traditional methods of mitigating adverse effects on health in most projects are to provide additional health facilities and selective medical care to the impacted populations. Sustainability, after completion of the project, remains a challenge for such approaches.
An alternative approach for government and private enterprises is to strengthen the existing public health sector in the project area. Such an approach has been tried and tested in a large hydroelectric project in Laos where a joint venture between the government health services and the project owners implemented primary health care and strengthened other national health programmes in the project area over a period of eight years resulting in significant improvements. Such an approach has an additional advantage of sustainability after the completion of the project. 
The methodology and findings of the project are in slide shows presented at the closure of the project on 11 Dec 2013
NTPC Health Prog. Laos
NTPC Public Health Prog. Overview
Maternal & Child Health NTPC Prog.
Surveillance & Monitoring NTPC Project Laos
The Progress of the Health Prog.
NTPC Final Health Survey
NTPC Final Health Survey Instrument 2013
Sustainable Development Trophy
Health & Development in Large Projects (ICOLD 2016. Conference Proceedings. Johannesburg)
ICOLD 2016 LHDA Poster
 
Voluntary/Private Health Sector
Non-governmental health providers
Most countries have private, religious and other charitable organisations providing health care to certain sections of society.
Grown up in Christian environment and having studied in a Christian Medical College, my professional experience in India relates to working in Christian hospitals only. Clearly the health service provision is outstanding in these hospitals demonstrated by throngs of people preferring to come to mission hospitals than to the government ones and other practitioners. However, my observation is that there is imbalance in curative and preventive medicine. Whilst illness care is considered the primary role of the hospital and delivered to a high standard, little attention is paid to preventive care. Where some preventive programs are operative, approach is with limited intent and it does not keep up with needs of the day and the advances in public health field. Read on...
preventive_approaches_in_voluntary_hospitals.pdf

Authors have many years of experience in setting up such services and will be pleased to assist any one who may wish to contact us for help. 
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