What is Public Health ? PH is disease prevention and health promotion in communities through population based research, and science based policies and interventions The target of PH is “public” not individual “patients” PH aims at science based “prevention” of health risks in populations; not treatment of patients after diseases occur PH requires active “ community participation”; not passive compliance with medical regimen PH requires multi-sectorial “public-private partnerships” The 4 “Ps” of PH are : Public, Prevention, Participation, & Partnership

ETIOLOGICAL PARADIGMS Cosmic and supernatural causes ( e.g. witchcraft and “Karma)” “Miasma” and personal cleanness ( e.g. bad air germs ) Genes, germs, Toxins, & Trauma (e.g. Infectious disease epidemics ) Health behavior and Life-style (e.g. obesity, sex, substance abuse) Social Determinants and man-made disasters (e.g. poverty, disparity, war)

* India’s oral tradition means earliest innovations remain unwritten for thousands of years.

Epidemiological Transion

7 Global Causes of Death Noncommunicable diseases Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Injuries Source: WHO, World Health Report 2000—Health Systems: Improving Performance (Geneva: WHO, 2000).

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United Nations Publications: ST/ESA/SER. a/306

THE PUBLIC HEALTH JOURNEY : FROM LOCAL TO GLOBAL INITIATIVES I.MEDICAL AND SCIENTIFIC INNOVATIONS LEADING INFECTIOUS DISEASE EPIDEMICS CONTROL (e.g. eradication of Smallpox, control of Malaria, TB, Polio, air and water bourn diseases). EXTENSION OF MEDICAL INTERVENTIONS IN COMMUNITIES (Social medicine) 2. EMERGENCE OF PH RESEARCH, PH SCHOOLS, AND PROFESSIONALS ORGANIZATIONS INCLUDING SOCIAL ACTION INITIATIVES BY NGOs/CBOs (BETWEEN WWI & WWII). INCREASED INVOLVEMENT OF SOCIAL SCIENCES IN PH AND “ECOLOGICAL” PARADIGMS FOR PRIMARY PREVENTION INTERVENTIONS IN COMMUNITIES 3. EMERGENCE OF MULTINATIONAL AND GLOBAL PUBLIC HEALTH ORGANIZATIONS (e.g. WHO, UNICEF, UNDP, IMF, WORLD BANK ) INCLUDING PUBLIC HEALTH PHILANTHROPHY, AND SOCIAL ACTION MOVEMENTS ESPECIALLY AFTER WWII 4. PUBLIC-PRIVATE PARTNERSHIPS FOR DISEASE PREVENTION AND HEALTH PROMOTION, MICRO-ENTERPRISE MOVEMENTS, AND COMMUNITY EMPOWERMENT

Ten Great Public Health Achievements– United States, Vaccination Motor-vehicle safety Safer workplaces Control of infectious diseases Decline in deaths from coronary heart disease and stroke Safer and healthier foods Healthier mothers and babies Family planning Fluoridation of drinking water Recognition of tobacco use as a health hazard

Comparison of Kerala & All India KeralaAll-India Death Rate/1000 (1998) Rural Birth Rate(1998) IMR(1998)1672 Life Expectancy (1993) Literacy Rate (1991) Female Literacy Rate(1991) Mean age at marriage(F) Per capita Income( ) Doctor-Population Ratio1:72131:2148 Patricia Rosenfield/Rockefeller Study

Established in 2006 The Public Health Foundation of India (PHFI) is a response to redress the limited institutional capacity in India for strengthening training, research and policy development in the area of Public Health. It is a public private partnership that has collaboratively evolved through consultations with multiple constituencies including Indian and international academia, state and central governments, multi & bilateral agencies and civil society groups. Structured as an independent foundation, PHFI adopts a broad, integrative approach to public health, tailoring its endeavours to Indian conditions and bearing relevance to countries facing similar challenges and concerns. The PHFI focuses on broad dimensions of public health that encompass promotive, preventive and therapeutic services (many of which are frequently lost sight of in policy planning, as well as in popular understanding). Main activities The PHFI is working towards building public health capacity in India by: Establishing new institutes of public health over the next 6 years; Assisting the growth of existing public health training institutions/departments and facilitating their evolution into major institutes of public health Establishing a strong national research network of public health and allied institutions which would undertake policy and programme relevant research that will advance public health goals in prioritized areas - with suitable international partnerships where useful and appropriate; Engaging public health expertise to collectively undertake analytical work for generating policy recommendations related to public health action, in not only the health sector but also in all other sectors which impact upon health of people, and developing a vigorous advocacy platform to effectively communicate these recommendations to policy makers and other relevant stake holder groups (including civil society organizations which represent the interests of people’s health); and Establishing an independent accreditation body for degrees in public health which are awarded by training institutions across India. The Public Health Foundation of India (PHFI )

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HIGH LEVEL EXPERT COMMITTEE ON UNIVERSAL HEALTH CARE (India) Free universal health care to all (no cash exchanged at point of delivery) Fully federal tax supported Federal responsibility – states responsible for service delivery Options for additional care at personal cost Integrate the AYUSH System (CAM) in Universal Health Care The AYUSH System 1. Ayurveda 2.Yoga 3. Unani 4. Siddha (Naturopathy) 5. Homeopathy

CORE REFERENCES Am. PH Assoc (APHA) Assoc SPHs (ASPH) The Alma-Ata Declaration (1978), WHO/UNICEF British Museum Calcutta Declaration (1999) Ottawa Charter High Level Expert Committee on Universal Health Care in India PHFI National Geographic ( 2007 )Anita Dalal & Monica Smith - Consultant ), Ancient India : Archeology Unlocks the Secrets of India’s Past Kar, R obin (2012), Western Legal Prehistory, University of Illinois Law Review, vol. 2012, no. 5, pp (2012). Kar, S.B. (2000), Empowerment of Women for Health and Welfare Systems Development, Background paper for the First International Meeting on Women and Health, April 5-7, 2000, Awaji Island, WHO Kobe Center, Kobe, Japan Ministry of Health and Welfare, (India) UCLA Fielding School of Public Healthhttp://ph.ucla.edu/ UNDP/ HDI Sen, Amartya (1999), Development as Freedom, Random House (Also: The Argumentative Indian, Viking, 2006) WHO 1948http:// Wolpert, S (2008) A New History of India (Eight Edition), Oxford University Press Witzel, Michael (2013), Origins of Worlds Mythologies, Oxford University Presshttp://