Public health has been defined as the science and art of preventing disease, prolonging life and improving quality of life through collective efforts of society, public and private organisations, communities and individuals. Public may be a handful of persons of a village or town or locality but in general it means all people of a country.
The concept of health includes physical, psychological and social well-being. According to the World Health Organisation, it is not merely the absence of disease or infirmity but a resource for everyday living.
Management of health services, epidemiology, statistics, social science, are parts of public health. Moreover, environment, community, public behaviour, public policy, health education, mental health, occupational safety, disability, gender issues, sexual and reproductive health are equally important.
Aim of public health is to improve the quality of life, prevention and treatment of physical and mental disease through study of cases, health indicators and promotion of healthy behaviour. Common public health initiatives include hand-washing, breastfeeding, vaccination, cessation of smoking, increasing healthcare accessibility, ensuring availability of safe drinking water, pollution control, prevention and control of contamination and sexually transmitted diseases. Modern public health activities require a wide number of health workers and professionals including physicians, nurses, medical assistants, medical technologists, epidemiologists, pharmacists, microbiologists, health inspectors, gender experts, specialists in different diseases, dietitians and even veterinarians.
The government establishes agencies to formally inspect and monitor water supplies, food processing, sewage management and pollution, control of epidemic and pandemic, framing guidelines for appropriate medical responses and isolation procedures to prevent the spread of disease.
Various public health agencies are working on both national and international levels. For example, the British Public Health Act of 1848 established a special ministry for England and Wales. In the United States, public health is nationally coordinated by the Centre for Disease Control and Prevention (CDC). Internationally, the World Health Organisation (WHO) plays that equivalent role. WHO is especially important in providing assistance for the implementation of organisational and administrative methods of handling problems associated with health and disease in less developed countries. Health problems, limitations of resources, education of health personnel and other factors in these countries must be taken into account in designing health service systems. Advancement in medical science in developed countries plays a vital role to help these countries afflicted by a high burden of disease.
In Bangladesh the Ministry of Health and Family Welfare is responsible for health policy and implementation of all government programmes relating to family planning. It has two divisions, Health Service Division and Family Welfare Division. Several departments work under this ministry viz. Bangladesh National Nutrition Council, International Centre for Diarrheal Disease Research, Department of Drug Administration, Directorate of Nursing and Midwifery, Bangladesh Nursing and Midwifery Council, Bangladesh Medical and Dental Council, Health Economics Unit, Health Engineering Department, National Institute of Population Research and Training etc.
There is a basic difference between Health Engineering Department (HED) and Department of Public Health Engineering (established in 1936). HED (formerly CMMU) performs all construction, maintenance and repairing works in government hospitals and health centres. DPHE is the national lead agency for providing safe drinking water, sanitation facilities in rural areas and waste management in the country except the cities where WASA works. After detection of arsenic in 1993 DPHE is trying to ameliorate public sufferings in arsenic affected areas.
Public health is highly dependent on public policy. In fact, there is no public (people) health without public (government) policy. Importance of public health and public policy has appeared glaring during corona pandemic. The second wave is more terrible than the first one.
Preventing epidemic is certainly an instant emergency task in a particular place (locality, region, city or any part of the country) but fighting pandemic is a long-term war because it has no geographical boundary. Infection spreads rapidly and it is not possible to win this war without coordinated health policy that includes every place from centre to periphery.
On the backdrop of community transmission and to face challenges arising out of it a 17-member national technical consultative committee was formed by Ministry of Health and Family Welfare in May 2020. On 2nd March, 2020 district (11-member) and upazilla (10-member) committees were formed headed by DCs and UNOs aiming at preventing probable corona virus infection inside the country (as mentioned in the circular). All members of the national committee are renowned physicians whereas in the local committees only two are medical persons. The duty of the national committee is to suggest the government on ways to prevent covid-19, increase service standard of hospitals and capability of physicians, and to find out measures to provide incentive for physicians, assisting the governments in formulating policies in response management (medical infrastructure, vaccination, testing strategies). But it is not yet clear whether any coordination exists between the national and local committees. It is alleged that suggestions placed by the national committee are not properly followed by the authorities. Administrative procedures can be discussed in joint meetings with officials but epidemiological problems cannot be analysed or solved without public health experts. The second wave may be primarily a result of a lack of centre-periphery coordination and not considering specialists’ suggestions.
All efforts of medical service are engaged for treatment of Covid patients. Due to pandemic or lockdown, treatment of other patients is almost blocked. Vaccination is the initial step to prevent the coronavirus pandemic. Government is thinking of bringing everyone above 18 under vaccination.
Public policy on public health should always be framed honouring the opinions of health specialists. Otherwise it creates a negative impact on society, economy and state. No public policy becomes effective without active public cooperation. For example, government of Bangladesh is trying its best to prevent mass transmission of coronavirus but many people are totally indifferent to wear mask and maintain physical distance on road, in markets, at ferry ghats and other crowded places. Naturally, efforts of the government are bound to turn futile. William Shakespeare wrote:
“Our bodies are our gardens - our wills are our gardeners.” (Othello, Act I, Scene III).
Same is the case with public health. Public participation is essential, only enforcement of law or administrative strictness is not at all sufficient.
The writer is a former Commissioner of Taxes.