Health and Public Health
Public Health in India
Before the Colonial period
During the Colonial period
After the colonial period
Essential Public Health Functions
Mortality transition in India
The World Health Organisation defines
Health (of an individual) as the state of
complete physical mental and social well-being
and not merely the absence of disease or
World Health Organisation, however, does
not define Public Health.
Death, on the planet Earth, is inevitable.
A large number of deaths are premature.
A substantial proportion of deaths can be
Public Health is related to preventing
premature and unavoidable deaths.
Exposure to Risk
If the disease condition is avoided, the
probability or the chance of death or
disability can be reduced.
Public Health is therefore described as the
science and art of preventing diseases,
prolonging life and promoting health (of
individuals) through organised efforts and
Public Health deals with the group of people
rather than individuals.
Dimensions of public health
Early diagnosis and prompt treatment
The Indian approach to health is enshrined in
the concepts and principles of Ayurveda
which means the ‘science of life’.
Ayurveda is one of the oldest system of health
care in the World.
Ayurveda deals with both preventive and
curative aspects of health.
Health defined by WHO is very similar to
concepts of Ayurveda.
The western approach of avoiding diseases,
death and disability, traditionally focused on
personal hygiene and public sanitation during
the 19th Century.
This approach, combined with better food
availability, paid rich dividend in the
developed countries in reducing morbidity
Measurement of disease conditions in relation to
the population at risk.
Collection, presentation, analysis and
interpretation of epidemiological data.
Services directed towards meeting the health
needs of the people.
Little is known about public health activities
before the colonial period.
Main stream system of health care was
Home-based care appeared to be the
There appeared little organised efforts or
institutional care to treat diseases and
Evolution of public health system during the
colonial period followed the same path that
was followed in Britain.
Public health efforts were focused largely on
protecting British civilians and army
Sanitation was given the top priority.
Focus was also on early detection and control
of contagious diseases – cholera and plague.
Training and research Institutions in public
Public health legislation.
Ascertaining local sanitary conditions.
Monitoring disease trends.
Technical advice on control of epidemics.
Restriction of public health efforts to British
civilians and military established was a major
Majority of Indian masses remained deprived
of the dividends of these efforts.
At the time of Independence only 3 per cent
households in India had toilets.
Water, drainage and waste disposal services
were utterly lacking.
Although, public health efforts were
restricted to British civilian and military
establishment, they had impact on Indian
Mortality spikes were sharply reduced.
Mortality from cholera and plague was sharply
Diseases like malaria and gastro-enteritis
continued to take heavy toll.
Evolution of public health care system in
Independent India was shaped by two
The Report of First Health Survey and
Development Committee (Bhore Committee)
constituted during the colonial rule.
Emergence of modern medical technology for the
prevention and control of diseases, especially
Appointed in 1943.
Recommended comprehensive remodeling of
Integration of preventive and curative health
services at all levels.
Hospital-based health care system.
Development of primary health centres in two
Training in Preventive and Social Medicine.
The short-term plan
A PHC for every 40000 population.
PHC to be manned by 2 doctors, 4 PHN, 4
Midwife, 1 Nurse, and others.
The long-term plan
A primary health unit for every 10-20 thousand
population with 75 beds.
Secondary unit with 650 bedded hospital.
District unit with 2500 bedded hospital.
Mass production of antibiotics.
Availability of vaccines for diseases having
high mortality and disability rates
Pertussis (Whooping Cough)
The recommendations of Bhore Committee
and the availability of preventive and curative
medical technology resulted in the evolution
of hospital-based public health system.
The public health arrangements created
during the colonial period were replaced by
hospitals and health centres.
Public health services were merged with the
Bhore Committees recommendations were
accepted only partially.
One primary health centre for every 30 thousand
Only 6 beds in each primary health centre.
Only one doctor.
Truncated paramedical staff.
The situation has remained largely
Since Bhore Committee, numerous
committees were constituted to evolve the
public health system.
Some of the recommendations of these
committees were adopted; some were not by
All committees retained the core of the
model recommended by the Bhore
Strengthen PHCs before establishing new ones.
▪ PHC should provide preventive, promotive and curative
Strengthen sub-divisional and district hospitals.
Creation of All India Health Services.
Chaddha Committee (1963)
Malaria worker to function as multipurpose
Mukherjee Committee (1965)
Separate staff for family planning programme.
Malaria activities to be de-linked from family
Jungalwala Committee (1967)
A unified approach for all problems instead of a
segmented approach for different problems.
Medical care and public health programmes to be
put under charge of a single administrator.
Kartar Singh Committee
Concept of MPW(M) and MPW(F).
One PHC to catre 50 thousand population.
Each PHC should have 16 SHC (3-3.5 thousand
Creation of bonds of paraprofessional and
semiprofessional health workers from within the
Development of a “Referral Services Complex.”
Formulation of National Medical & Health Education
Formulation of National Health Manpower Policy.
Educational Commission for Health Sciences.
Health Science Universities in various states.
Health manpower cells.
Vocationalisation of education at 10+2 levels as
regards health related fields.
Realistic health manpower survey.
A population based normative approach is
adopted for establishing hospitals and health
SHC – One for every 5000 (3000 in hilly/tribal
PHC – One for every 30000 population (20000 in
difficult areas) with 4-6 indoor/observation beds.
CHC – One for every 80-120 thousand population
with 30 beds.
The norms are for government institutions
and are for the rural areas only.
For the urban areas, no norms have been
Nearly all government civil and district
hospitals and most of the CHCs are located in
the urban areas.
No information is available about the private
More than 6 SHC for each PHC,
More than 5 PHC for every CHC,
Beds in rural
Beds in urban
About 23 beds per rural hospital
About 117 beds per urban
One fall out of the hospital-based public
health approach was the neglect of public
A Model Public Health Act was drafted in
1950 by the Government of India.
It was revised in 1987.
This Act is yet to be adopted by any of the
constituent state of the country.
The hospital-based public health system led
to the medicalisation of the system.
The focus has been on medical services.
Public health services have largely been
Poor public health services result in high cost
of illness, debility and death.
The main sufferer are the people, especially
the poor and deprived.
The epidemiological and statistical
dimensions of public health have been
Lack of epidemiological and statistical
database affected public health planning.
In the absence of necessary
information, planning reduced to a
normative, mechanical exercise, often out of
context to people’s needs.
The problem gets complicated because of
social, economic, cultural and environmental
diversity that leaves normative planning
Decentralisation of the health system could
not succeed because of the lack of
epidemiological and statistical information
necessary for planning for public health
Public health in India is ‘hospitalised.’
Health planning is concerned more with the
health of the health care delivery system
(hospitals and health centres) then the health
of the people.
The remedy was sought in terms of specific
National health and disease control
There are numerous such programmes.
Reproductive and child health programme.
National tuberculosis control programme.
National malaria control programme.
National blindness control programme.
National water born disease control
National leprosy eradication programme.
National iodine deficiency control
All National disease control programmes are
implemented through the existing
government hospitals and health centres.
Over the years, a campaign approach has
been evolved to implement many of the
national health and disease control
Successful campaigns have often been
followed by unsuccessful maintenance.
Focus on medical services.
Neglect of public health services.
No modern public health regulation.
Lack of systematic planning.
Poor sustainability of public health efforts.
Absence of epidemiological and statistical
skills at district and below district level.
No micro-level planning, no public health
Emergencies and Distasters
Policy and planning
1973 1978 1983 1988 1993 1998 2003
1973 1978 1983 1988 1993 1998 2003
Widespread existence of preventable
diseases and deaths is a disgrace to
the society which tolerates it.