HEALTH PROMOTION

“For the master spirit of the earth shall not sleep peacefully upon the wind till the needs of the least of you are satisfied.”

Kahlil Gibran





We seem to have a distorted view of health care in India. We have the health ministries that mainly look after ill health. We abuse the term health care when we, in fact, are talking about medical interventions. This brings to mind the old saying of Mark Twain: “The difference between the right word and the almost right word in a given place is the difference between lightning and the lightning bug!”

Neither doctors nor hospitals are needed for health promotion. They are both essential for looking after people who have, unfortunately, lost their health resulting in disease. Diseases are accidents and at any given day there could be a couple of million who are ill, but daily there are more than a thousand million Indians who need health care. If the latter is done correctly we could bring down the illness rates to negligible levels.



In fact, eighty per cent of the gut diseases would vanish and thousands of deaths averted if every Indian gets clean drinking water. If one gets three square balanced meals a day not contaminated by human and/or animal excreta another few thousands would not meet their maker prematurely. Smokeless houses in the villages would save thousands of women from dying of heart attacks and cancer of the lungs. An equal number of children, below the age of five, die of smoke related pneumonias. Seventy per cent of Indian children today have less than fifty per cent haemoglobin in blood mainly because of hookworms that are ubiquitous due to lack of toilet facilities for the poor. This would result in the younger generation not being able to compete in sports as also in intellectual pursuits. Recent data shows how the early development of that part of the brain looking after memory function etc., the hippocampus, needs good iron supply for its proper growth in the mother and the new born. Iron deficiency is the main cause of slow brain development and many other long term health problems.



We get worked up and go mad if there is an epidemic like SARS. Millions suffer and thousands die daily in this world for want of clean water and good food and no one bothers about that. We need some scare to wake up from our slumber and then go to sleep again only to awaken at the next pandemic. Daily deaths do not count at all. SARS did not even kill a single Indian. We seem to have some kind of racial immunity against that virus. But the epidemiologists produced a very big scare and many would have suffered stress related illnesses because of the scare. Instead of scaring the public and lowering their immune levels making them succumb to infections, the epidemiologists should work silently to quell the threat when there is a real one. We could save millions of Indians if we could look after the following in all our villages where nearly eighty per cent of Indians live.



* Clean drinking water to every one.

* Clean food as three meals a day.

* Smoke free house.

* Toilet for every house.

* Economic empowerment of women.

* Educate the village barber to put peer pressure on all men to practise family welfare schemes.

* Every village school must be the primary health centre for the village; the present PHCs could be dispensed with and replaced by village health workers that report any illness to the Taluka hospitals from where ambulances could be dispatched to transport patients when needed.

* One doctor, the same doctor, should visit every school once a week and look after the health status of the children and do the needful. Children will, in turn, educate their parents.

* Health education should be a compulsory subject in the age group of 5-15 years.

* Pregnant mothers should get special attention and more nutritious food especially during the first trimester to prevent major killer diseases in the adult population in later life as all the organs are properly made during the 12-16th weeks of gestation inside the mother’s womb. If the mother’s nutrition is poor the organs are defective. These are the children that get major killer diseases precociously in later life.

* Having done all these, vaccination to prevent communicable diseases will work well. Vaccination will not be effective in children with very low blood protein levels.



As has already been pointed out above doctors and hospitals do not promote people’s health; in fact, a recent study showed that a surfeit of hospitals of the hi-tech variety and increase in the number of interventionalists would result in higher than expected deaths in society. An audit of European countries and Japan showed that those countries with the higher number of doctors per unit population compared to countries with less number of doctors had lower health status and higher morbidity. When doctors went on strike in Israel and no intervention on the apparently healthy was carried out death rates plummeted down only to go back to the original levels when doctors resumed full duty.



I have been writing about this for the last four decades but it seems to fall on deaf years and the powers-that-be seem to have selective blindness for this kind of information. “Truth influences but half a score of men in a century while false hood and mystery will drag millions by the nose”. This saying of Aristotle is true even today.



India needs a very strong health promotion set up, may be, headed by a health promotion powerful ministry that has jurisdiction over food supply, water supply as also other infrastructural needs of the people. Large part of the present “so called” health budget could be shifted from hospitals to health care. We need a full department of health promotion. Medical schools should teach health of the public (Public Health) to students for all the five years as a doctor is trained to look after the health of the public in the first place. Unfortunately, today we teach medical students advanced diseases in a five-star technology oriented set up and make them believe that the be all and end all of health care is hi-tech intervention. Students must have their training in the community as also in the villages to learn the real time medicine.



Medical Care:



This needs hospitals, but the future hospitals must incorporate complementary systems, mainly Ayurveda to widen the net to help more patients and also save billions of rupees spent on some of the useless hi-tech stuff offered today. Majority of illnesses (80%) are but simple minor illness syndromes and they could be helped by complementary medicines and some of the chronic illness get better with Ayurveda with much less cost and less discomfort to patients.



Wellness Clinics:



Life style changes, healthy diet advice, yoga and meditation, life style modification advice, alcoholism and smoking advice, could all be done in the new concept of the wellness clinics where healthy people regularly attend, not to get themselves checked up but to get themselves trained in the above methods that would keep diseases at bay for very long time even one were eventually get an illness later on. In the latter event the wellness clinic experience would hasten healing.

These two new concepts must be a part of all Indian hospitals sooner than later for the common good.



Comments

#1 | 1999 on 1
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