The COVID crisis has demonstrated once again the significance of scientific contributions of Public Health, as also the need to enhance the capacity of health systems to address the complexity of population health. A special issue of Dialogue carries an editorial and six papers addressing the issue of Deepening of Disciplinary Content of Public Health in Post-COVID times.
The editorial and papers examine several relevant issues from a futuristic perspective using an India lens. The first by Qadeer reflects on the history of public health planning in independent India to draw lessons for the present and future. It reveals the angst of a senior scientist who has invested a lifetime in shaping the discipline to suit the Indian context. Identifying strengths of the early years of development planning, it goes beyond past analyses to pin-point, within the plans as well as in the larger socio-political context, the reasons for their inadequate implementation and the decline of public health in India. Drawing on these learnings, it emphasises the centrality of attention to structural inequalities for rebuilding public health. It reminds the reader that improving health of the population with medical technology inputs given as welfare can be counter-productive if the basic conditions of life remain unaddressed. The economic impacts of the pandemic certainly require bringing these considerations back centre-stage.
The second paper by Sahay et al examines the use of ICT for pandemic control activities to analyse how its use in public health can increase efficiency of the system, empower the users and support decentralised approaches. ICT is presently viewed by Public Health practitioners as a utilitarian tool for improving service systems, without examining its characteristics and their implications. This paper reveals how the design and purposive use of ICT can be highly diverse in its technical and organisational structure as well as social impact. Thereby it needs close understanding and deeper attention.
The third paper by Bamezai discusses the development of public health genomics, the need for its improvisation as simple and cost-effective technology for LMIC contexts. It suggests a two track approach to health services development wherein the benefits of OMICS research can reach people through public health services strengthening from primary to tertiary levels of care.
The fourth one, by Das, presents the relevance of the ‘complex adaptive systems’ approach for public health, illustrated through the experience of responses to COVID-19. It underlines the use of such an approach for more realistic health policy and planning to minimise the gaps reflected through their intended and unintended outcomes of COVID suppression and mitigation strategies.
The fifth paper by Unnikrishnan discusses how pluralism of knowledge systems in the Indian health system can be a source of resilience. It discusses the initiatives taken during the pandemic to develop the AYUSH systems’ potential for public health, which is likely to continue being strengthened in the post-COVID period. It suggests that the ‘whole systems approach’ be adopted for AYUSH research, and combining this with the complex adaptive systems approach will be a strong contribution to Public Health.
The last paper by Priya argues the need for a theoretical frame to facilitate bringing the various strands and streams of Public Health into a shared thinking space that can potentially lead to a greater blending of concepts and approaches. It suggests Critical Holism as such an over-arching frame that would require all Public Health research, policy and planning to relate itself to the multi-level, multi-dimensional contours of its subject matter and locate itself within that whole. The paper illustrates what blending holism and critical theory would mean in terms of explicitly examining the diversity within ‘the whole’, and how this can be a feasible proposition.
This set of papers, we hope, will contribute to a wider discussion on the need for deepening of Public Health content and how to move towards it for the contemporary Indian, and global, context.
We invite comments on the above articles.
Ritu Priya is a Professor at Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi. Rameshwar NK Bamezai is Hon. Director, Delhi School of Public Health, University of Delhi; and President, Genomics and Public (GAP) Health Foundation, Dehradun, Uttarakhand. Views expressed are personal and do not necessarily reflect those of Confluence, its editorial board or the Academy.