Editorial: The solution lies in our backyards

However, many have made the mistake of equating public health systems with hospitals (infrastructure), medicines (the ability to research, develop and manufacture drugs) and expertise (doctors, nurses, lab technicians, etc.). But public health is not only about a cure.

The history of medicine shows that many of the worst infectious diseases that mankind encountered – tuberculosis, influenza, dysentery, and cholera to name a few – were conquered much before vaccines and antibiotics were developed. Those wars were won not in laboratories or hospitals, but on the streets, by employing tools that are not with the Health department but with Municipal Administration: clean water, sanitation, and proper disposal of sewage and garbage and the resultant control of pests. Add nutrition, better housing, and other such essential factors to understand how the West brought the diseases down over a century or two ago. One of the most famous examples is the Broad Street cholera outbreak of 1854, an episode in London that was part of the cholera pandemic sweeping the world. John Snow, a physician deemed as one of the pioneers of epidemiology, found the culprit that claimed nearly 700 lives: a contaminated water pump.

The fall of tuberculosis as a dreaded disease is another example. In 1900, it caused about 250-300 deaths per one lakh population in the US. But by the time medicines were discovered in 1944, the TB death rate had fallen to around 75/lakh. A more dramatic example is the fall in typhoid deaths in Pittsburgh, US – from about 130/lakh in 1907 to 25-30/lakh in just two years. What changed in that interregnum was the introduction of drinking water filtration.

There are other significant factors: nutrition, which helps stave off most of the common infections; better housing that ensures fewer chances of an outbreak; and an education system that creates an informed society. Thus, while it is easy to attribute the decline of infectious diseases in advanced countries to the technology they possess, what India needs is better municipal administration. For instance, Tamil Nadu has a relatively good healthcare system and many medical colleges. But are we doing enough to manage our waste, or to ensure clean drinking water? We have four doctors for every 1,000 people, comparable to countries such as Norway and Sweden, but what about the number of sanitary workers or the salary they are paid and the equipment they are provided? The health of the public is not vested with the Public Health department alone, as hospitals and doctors are the last stop in health management. It starts with better municipal administration, water supply, education, and nutrition among others.