17 March 2025 : The Hindu Editorial Analysis

1. The challenges of public health education in India

(Source – The Hindu, International Edition – Page No. – 8)

Topic: GS2 – Social Justice – Health

Context

The reduction of U.S. funding for WHO and USAID has impacted global public health. Strengthening domestic public health education and employment is crucial for sustainable healthcare development.

Effect on Global Health and India

• The U.S. withdrawal from WHO and reduction in USAID funding have disrupted healthcare services in many low- and middle-income countries.
• India remains largely unaffected as international aid accounts for only 1% of its total health expenditure.
• However, this reduction in funding may shrink the public health development sector, which depends on international support.
• The decision impacts the job market for those pursuing Master of Public Health (MPH) and similar postgraduate courses.

Importance of Public Health in India

• • Public health plays a crucial role in shaping healthcare delivery and improving people’s well-being.

• The Indian Constitution, through Article 47, mandates the government to improve public health.

• A trained workforce is essential for government, civil society organizations, academic institutions, and research bodies.
• The COVID-19 pandemic highlighted the urgent need for skilled public health professionals.

Growth of Public Health Education in India

• Public health education in India has roots in the colonial era, with early training embedded in medical education.
• The first specialized institution was established in 1932, but public health remained a part of community medicine.
• Many students pursued MPH courses abroad due to limited local training opportunities.
• The demand for MPH courses grew after the launch of the National Rural Health Mission (NRHM) in 2005.
• Today, over 100 institutions in India offer MPH courses, compared to just one in 2000.
• Despite this growth, government recruitment has not kept pace, making job opportunities scarce.

Challenges in Public Health Education and Employment

• A major issue is the mismatch between the number of MPH graduates and available jobs.
• Entry-level positions attract high competition, with few vacancies.
• The shrinking number of public health roles in government has worsened job scarcity.
• The private sector prioritizes hospital and business management over public health specialists.
• Research and development opportunities depend on foreign grants, which are decreasing as India is no longer a priority country.
• National funding for public health research is still in its early stages and remains inadequate.

Quality Concerns in MPH Education

• The rapid expansion of MPH institutions has led to quality concerns.
• Many students enroll without a clear understanding of the field, affecting their career prospects.
• Faculty members often lack practical experience in public health.
• The absence of a standard curriculum and regulatory oversight impacts training quality.
• MPH courses are not regulated by any national body like the National Medical Commission (NMC) or University Grants Commission (UGC).

Approaches to Strengthen Public Health Education and Employment

• Governments should create more public health jobs at all levels to strengthen healthcare systems.
• Establishing a dedicated public health cadre in State governments would improve employment opportunities and system efficiency.
• A specialized regulatory body should set curriculum standards and training requirements.
• Public health education should integrate practical learning within health systems.
• More institutions should be developed in States with limited or no public health training facilities.
• National efforts should focus on building strong local public health ecosystems to ensure sustainability. 

Practice Question:  Discuss the challenges faced by public health education and employment in India. Suggest measures to strengthen the public health workforce for a sustainable healthcare system. (150 Words /10 marks)

2. From insurance-driven private health care to equity

(Source – The Hindu, International Edition – Page No. – 8)

Topic: GS2 – Social Justice – Health

Context

India’s insurance-based healthcare model prioritizes hospital care over primary healthcare, increasing private sector reliance and raising concerns about affordability.

Commitment to Universal Health Coverage

• India has always been committed to ensuring healthcare for all under the World Health Organization’s Universal Health Coverage (UHC) framework.
• The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was introduced to reduce out-of-pocket expenditure (OOPE) by providing insurance for hospitalization, surgeries, and tertiary care.
• However, the scheme mainly focuses on hospital-based care and neglects primary healthcare (PHC), which is essential for preventive and community-based health services.

Neglect of Primary Health Care (PHC)

• A strong PHC system reduces the burden on hospitals and provides affordable healthcare to citizens.
• The AB-PMJAY model encourages hospitalization rather than preventive care, increasing long-term healthcare costs.
• This approach contradicts the Bhore Committee’s vision, which emphasized a pyramid-shaped system with primary healthcare as the foundation.
• Since 2018, over 36 crore Ayushman cards have been issued, and 31,000+ hospitals have been empaneled. However, funds are increasingly being diverted to private insurance companies, reducing state control over healthcare spending.
• The ₹9,406 crore allocation for AB-PMJAY in the 2025 Budget is ₹2,000 crore higher than the previous year, further promoting privatization.

Privatization and Changes in the Insurance Sector

• The health budget for 2025 provides ₹95,957.87 crore to the Department of Health and Family Welfare and ₹3,900.69 crore to the Department of Health Research.
• More focus is being placed on medical education and digital infrastructure, while funding for the National Health Mission—which supports rural healthcare—is decreasing.
• This shift signals a gradual reduction in the government’s role in healthcare, increasing reliance on private players.
• The insurance sector is being liberalized by increasing Foreign Direct Investment (FDI) to 100%, aiming to expand insurance coverage, particularly in rural areas.

Challenges for Informal and Marginalized Workers

• India’s informal workforce and marginalized urban populations remain without health security.
• Many people lack awareness about health insurance, forcing them to depend on middlemen, which increases their expenses.
• Private sector regulations remain weak, leading to higher medical costs and uncovered expenses.
• Essential healthcare workers, such as Accredited Social Health Activist (ASHA) workers, have uncertain coverage under health insurance schemes.
• The lack of updated data (last Census in 2011 and the last Periodic Labour Force Survey in 2020-21) makes it difficult to plan and allocate resources effectively.

Lessons from Global Models

• Over-reliance on private insurance can lead to higher healthcare costs and widening inequalities, as seen in some countries.
• Nations like Thailand and Costa Rica have successfully implemented public health insurance models, relying on general tax revenue and regulated private insurance to prioritize primary and community-based healthcare.

The Need for Policy Reassessment

• India must rethink its healthcare priorities to ensure that preventive and primary healthcare receive adequate funding and support.
• Instead of favoring tertiary private healthcare, the government should invest in community-based health services to make healthcare affordable and accessible.
• Policies must address the needs of informal workers, migrants, and vulnerable groups, especially considering climate-related health risks.
• The government must implement safeguards to control rising healthcare costs and reduce OOPE, ensuring that India’s commitment to “Health for All” is truly effective. 

Practice Question:  Examine how India’s shift towards an insurance-driven healthcare system affects primary healthcare accessibility and financial protection for marginalized communities. (250 Words /15 marks)

3. Tackling the problem of nutrition

(Source – The Hindu, International Edition – Page No. – 9)

Topic: GS2 – Social Justice – Health

Context

India’s nutrition challenge extends beyond food insecurity to include cultural and lifestyle factors. The focus should shift from targeted malnutrition programs to a comprehensive, inclusive public health-driven nutrition agenda.

Nutrition Challenges in India

• Nutrition is not just about food insecurity but is influenced by culture, caste, and gender relations.
• Current policies mainly focus on malnutrition among women and children, neglecting other groups like men, senior citizens, and women outside the reproductive age.
• Non-communicable diseases (NCDs) like diabetes and hypertension, which stem from poor nutrition, are often overlooked.
• There are two types of nutrition deficiencies:
  • Some people do not have enough food.
  • Others consume food lacking essential nutrients.

Alarming Nutrition Statistics

• India has one of the highest rates of child malnutrition and anemia in women.
• According to NFHS-5 data:
  • 36% of children under five are stunted.
  • Only 11% of breastfed children (aged 6-23 months) receive an adequate diet.
  • 57% of women (aged 15-49 years) are anaemic.
  • 24% of women and 23% of men are overweight or obese.
  • 14% of people take medicines for diabetes.

Current Approach & Its Limitations

• Existing schemes provide take-home rations, supplementary foods, and iron-folic acid tablets.
• Poshan 2.0 focuses on aspirational districts and the North-East, reinforcing the belief that malnutrition is limited to specific areas and groups.
• A comprehensive approach is needed to address nutrition for all social strata, recognizing it as a public health issue.

Need for a Comprehensive Nutrition Strategy

A broad nutrition policy must include:

1. Identification of diverse nutrition needs beyond maternal and child health.
2. Locally sourced solutions to improve diets with nutrient-dense, affordable foods.
3. Institutional mechanisms to ensure effective nutrition delivery at the community level.

Role of Health and Wellness Centres (HWCs)

• HWCs can be key institutions for implementing a universal nutrition agenda.
• Currently, they primarily provide nutrition support to pregnant and lactating mothers and children.
• Expansion is needed to include all segments of the population, including the middle class.
• HWCs must ensure:
  • Wider coverage across urban and rural areas.
  • Dedicated staff for nutrition services.
  • Systematic implementation of nutrition advice.

Key Factors for Success

• Involvement of local elites to create a sense of ownership.
• Integration of nutrition with local cuisines to encourage better dietary habits.
• Lessons from past public health campaigns show that community engagement and alignment with local practices improve success rates.

Conclusion

• Nutrition must be seen as part of overall health and well-being, not just a deficiency issue.
• A locally owned and well-integrated nutrition plan through HWCs can ensure better health outcomes for all social groups. 

Practice Question:  How can Health and Wellness Centres (HWCs) play a crucial role in addressing India’s nutrition crisis? Suggest measures for their effective implementation. (150 Words /10 marks)

4. Should cancer be a notifiable disease?

(Source – The Hindu, International Edition – Page No. – 9)

Topic: GS2 – Social Justice – Health

Context

There is an ongoing debate on whether cancer should be designated as a notifiable disease in India.

Debate on Making Cancer a Notifiable Disease

• While some believe this would improve surveillance and early detection, the Union government argues that notification applies mainly to infectious diseases.
• Recent shifts in disease notification policies, such as the inclusion of snakebites in 2024, question the traditional reasoning.

Purpose of Disease Notification

• Disease notification ensures that infectious diseases are reported, allowing authorities to take immediate action to prevent outbreaks.
• Doctors are legally required to report notifiable diseases, and failure to do so could lead to legal consequences.
• Unlike infectious diseases, cancer is not contagious and does not require emergency containment measures.

Concerns with Making Cancer Notifiable

• Cancer is complex and includes various types ranging from benign to malignant.
• Notifiability requires immediate action, whereas cancer needs long-term treatment and management.
• Making cancer notifiable could increase the burden on doctors without significantly improving patient care.

Existing Cancer Surveillance Mechanism

• India’s National Cancer Registry Programme (NCRP) has been collecting cancer data since 1982.
• It consists of hospital-based registries (269) and population-based registries (38) as of 2022.
• The coverage is insufficient, and registries should be expanded to include all cancer-treating hospitals and district headquarters hospitals.

Privacy and Stigma Concerns

• Notifiable diseases often do not prioritize patient privacy, as public health takes precedence.
• Cancer carries social stigma, which may deter patients from seeking timely treatment if notification becomes mandatory.
• Legal provisions in public health acts could lead to misuse of power, further discouraging patients from getting diagnosed.

Alternative Approach to Strengthen Cancer Surveillance

• Expanding NCRP coverage to all tertiary and district hospitals can improve data collection.
• Strengthening cancer screening programs will help in early detection.
• Encouraging voluntary reporting by oncologists and healthcare providers can ensure accurate data collection without legal enforcement.
• A structured registry system with private hospital participation and better follow-up mechanisms is a better alternative than mandatory notification. 

Practice Question:  Discuss the pros and cons of designating cancer as a notifiable disease in India. Suggest alternative measures to improve cancer surveillance and early detection. (150 Words /10 marks)

Check More – 15 March 2025 : The Hindu Editorial Analysis