Increase in Investment for Disease Prevention is the need of the hour : Dr Bhudev Das

Dr Bhudev Das  Founder Director of Institute of Cytology and Preventive Oncology (ICPO) of ICMR has done his Ph.D from Banaras Hindu University, Varanasi and has worked several years with the Nobel Laureate, Prof.(Dr.) Harald ZurHausen at German Cancer Research Centre (DKFZ), Heidelberg, Germany. Dr Das, specializes in Biology & epidemiology of HPV, transcriptional regulation, cancer genomics chemotherapeutics, stem cell therapy and cancer drug discovery and is presently the Chairman & Hargobind Khorana Chair Professor Amity Institute of Molecular Medicine & Stem Cell Research (AIMMSCR) Amity University

Dr Das talks to Pritha Roy Choudhury on increase in investment for disease prevention and health promotion


1. Please tell us a little about Public Health Studies in India?

Public health deals and focuses to understand and identify the determinants that affect health and wellbeing of individuals, families, communities, population and the society at large with the main aim of providing solution for amelioration of human health and diseases. Public health studies have recently gained momentum with institutions offering professional courses, particularly MPH and postgraduate diplomas, so as to meet the ever increasing demand for human resource in healthcare research and management. Health indicators in India have always seen deterioration with various issues surfacing that disturbs the physiological and environmental balance, contributing to ill health. Over the last one decade, the urgent need for public health professionals has compelled the government and certain non-profit organizations to introduce various postgraduate, certificate and training courses that promise to enhance the skills of the existing healthcare workforce and to generate young and efficient cadre of health professionals.


2. Why do you think we are still way behind in addressing the health of the population of our country? 

Although several efforts have been made to ameliorate public health and disease condition in our country with various programmes and projects being implemented, the condition continues to remains daunting. We currently face an increasing burden of non-communicable diseases including existing various huge communicable diseases with additional frequent epidemics of new emerging and re-emerging resistant infectious diseases. The disease pattern is rapidly evolving and currently majority of deaths that occur in India are due to non-communicable diseases. Considering the situation, it is critical for government agencies and other research and public health organizations to understand the urgency and come forward in a collaborative and convergent way to effectively strategize programmes and concurrently monitor and evaluate them, so as to strongly achieve the desired outcome. This seems to be currently missing.  Further, health has not been a priority for political stakeholders in our country and the public expenditure on health has been very low.


 3. How can the youths of today who take up Public Health as a profession bring out a positive change in the Health scenario in the country? 

Individuals studying public health and who wishes to continue working as a public health professional can be an asset to this field. Considering the non-availability of adequate work force in this area, individuals with appropriate education and experience can add significantly to the cause of public health. They can take up positions at various research, hospitals and academic institutions and generate new and innovative ideas to implement public health projects successfully. There exists a strong difference between the rural and urban disease pattern and hence the health service provisions in India. Rural India suffers from inadequate availability of medical, para-medical and healthcare professionals, consequently affecting health indicators of the country. Youths, who have recently graduated are willing to travel and will be motivated enough to work in the rural setting. This will positively impact the health of the population. Even clinicians can immensely enhance their skills with a background in community and population based public health perspective.


 4. What are the qualities required in a person to opt for this career? 

As a public health professional, they have a challenging job and can find work in corporate, hospitals, government, NGOs and educational organizations. The competencies needed are first, the person should be highly motivated and should be willing to travel frequently within and outside of the country, as per job requirement. Secondly, the person should have sufficient managerial and multitasking skills. Thirdly, good communication and writing skills are mandatory for a person choosing public health as a career. Most importantly, the person should have a sharp eye, inquisitive mind with sufficient understanding of the public health structure in the country and have the capability to critically monitor, evaluate and analyze health programmes and related reports to identify gaps. Also, he/she should be innovative enough to strategize solutions to fill those gaps.


 5. Financially how rewarding is the career? 

The field of public health study has shown tremendous growth and opportunities in the last one decade. Individuals with suitable education and experience can benefit handsomely, not only with regard to money and job stability but also in terms of variety in career options. One can choose to be a professional researcher or an academician or work in the field as a coordinator/officer or researcher.


 6. How is the government supporting such studies? 

Government has minimal support in the area except Preventive and Social Medicine Departments in Medical Institutes and colleges in India.   Also created a National Centre for Disease Control (NCDC) in Delhi.


7. What are the challenges? How does one address the challenges?

In spite of  huge achievements made in the last decade related to eradication of polio, guinea worm disease, yaws and tetanus, India still faces a high burden of diseases, both communicable and non-communicable. Besides, endemic diseases such as HIV, TB, malaria and neglected tropical diseases continue to haunt the subcontinent and they require efficient setups for early detection and rapid response. Vector-borne diseases and antimicrobial resistance are also major challenges the world seems to be facing today. Additionally, non-communicable diseases, particularly heart disease, cancer, diabetes and chronic pulmonary disease are rapidly developing among Indians and is associated with high morbidity and mortality. Also of significance are maternal and infant mortality,  the rates of which continue to remain high. The epidemiological transition that India is going through is a direct consequence of the existing and constantly evolving social, economic and environmental determinants that cumulatively affect not just the disease pattern and occurrence but also the cellular and molecular processes individuals subsequently leading to genetic and epigenetic changes that can also be transmitted to further generations. 

To counteract these challenges firstly, the investment in health should increase and priority should be given to ‘disease prevention and health promotion’. The flow of fund should be towards primary prevention, health promotion and improving the quality of life with effective service provision at the grass root level. Secondly, the existing and inadequate health infrastructure should be strengthened and upgraded to improve the quality of service provision and delivery. Thirdly, it is critical to build an adequate and strong public health workforce, without which the system will fail to work efficiently. Fourth, focus should be given to strengthening, promoting and sufficient funding for research and innovation to generate evidence based policies to evaluate the impact.  Attaining equity in health service provision is pertinent as the main purpose of public health is to provide availability and access to the weakest and the most vulnerable section of the society. Fifth, use of technology such as IT, audio-visual and mobile, etc. are useful ways of addressing the above issues.  It has the capacity to enhance the efficiency in service delivery and provides an opportunity to make services available to the most rural parts of the country.   Sixth, government should establish a national facility for public health education, research, innovation and practice in India in the line of National Institute of Health (NIH) and Centre for Disease Control (CDC) of USA.   Also, need to establish government funded independent Public Health Institutes for both medical, non-medical graduates and post-graduates to pursue further studies in this discipline.  Last but not the least, enabling and boosting motivation for health leadership and governance has to be of utmost priority. The way to combat the existing challenge of high disease burden is to develop a strong intersectoral and interdisciplinary approach. 


8. Can you name few good educational institutions in India offering courses in Public Health? 

  • National Institute of Epidemiology (NIE - ICMR), Chennai.
  • Indian Institute of Public Health (IIPH), PHFI, Gurugram (near New Delhi)
  • Indian Institute of Health Management Research (IIHMR), Jaipur.
  • Amity Institute of Public Health (AIPH), Amity University, Noida.
  • All India Institute of Hygiene & Public Health(AIIH&PH), Kolkata

 The interview was earlier published in  Careers 360

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