Not only most lay persons, but also, in effect, health administrators, set great store by hospital based disease and cure oriented approaches as the cornerstone of health investment, to the neglect of preventive, promotional and rehabilitative aspects of health care.
In India, health policy has been dominated by the Western curative hospital based system of medicine, with its ills of centralization and mystification. A major part of investment in public health has gone in to building curative health infrastructure and medical personnel, and on supplying curative drugs.
It must be stressed that it is not our argument that the government is spending too much on curative health in absolute terms. On the contrary, expenditure on hospital beds and drugs needs to be significantly enhanced. Our point is only that given the low government expenditure on public health, the high proportion of it spent on curative aspects of health reflects inadequate understanding of health policy and lack of a clear political will to reach out to the poor. Greater stress on prevention and promotion of public health would have had a far more significant impact on public health indices. If we are serious about achieving public health goals, it would be far more cost effective to focus on prevention to a much greater extent, particularly ‘Primary prevention’ which is defined as action taken prior to the onset of disease. It removes the possibility that the disease will occur.
A few examples would clarify what we mean. A range of diseases resulting from malnutrition can be prevented by nutritional interventions for vulnerable groups. Environmental modifications for safe drinking water, toilets, drainage and housing prevent many major diseases. Health education, as for iodized salt, washing hands, safe delivery, reduced alcohol and nicotine intake etc. can again prevent diseases. Immunization, protection form pollution and accidents are some other specific examples of effective prevention of disease.