Film-maker Yash Chopra’s death from an attack of dengue has exposed the fast-spreading tentacles of infectious diseases in India, and the appalling state of public health even in the nation’s richest city, Mumbai. The reaction of Mumbai’s municipal body to Chopra’s death is even more revealing, for it betrays a lack of will to reform the city’s faltering public health system.
The initial reaction of the civic body bordered on denial. Brihanmumbai Municipal Corporation (BMC) is yet to accept that Chopra died of dengue, and according to one newspaper report it is investigating if Chopra was infected outside the city, as if that can absolve the authorities of their failure to curb the dengue menace. Between 2008 and 2012, reported cases of dengue in municipal and state hospitals have nearly trebled in Mumbai, according to a recent report by the not-for-profit Praja Foundation. Malarial cases rose 71% over the same period.
Fearful of a backlash in case more cases of dengue deaths come to light, BMC has now promised to spruce up its anti-dengue campaign . But in its new-found resolve to fight dengue, the civic body seems to be missing the wood for the trees. The health threat in Mumbai and much of India today arises from a dysfunctional public health system rather than from one out-of-control virus. The state has very limited means for disease surveillance, and even lesser ability for a timely response. Health risks are exacerbated in cities such as Mumbai where the high population density leads to faster spread of diseases.
BMC’s fight against dengue illustrates a piecemeal approach to public health in India preferred by civic bodies and public health planners, in which campaigns and missions against specific diseases are planned and started with great gusto, while the cheaper and more effective alternative of providing for a universal and preventive public health network is neglected. Preventive public health services are different from medical services and include interventions in areas such as sanitation, drainage, potable water, health awareness campaigns and vector management, which minimize citizens’ exposure to diseases.
Owing to the public goods nature of these services, the market has little incentive to provide them. State investments in preventive healthcare are considered to be far more cost-effective than medical services but in India, it is the latter that has received greater attention. Despite sporadic and transient successes in its disease-specific campaigns, India’s burden of infectious diseases continues to remain extraordinarily high because of the state’s neglect of preventive healthcare, according to a 2011 Lancet research paper by Indian epidemiologist T. Jacob John. The high disease burden is a key reason why despite rising economic growth and a fall in poverty, nutrition outcomes for children, who bear a disproportionate burden of infectious diseases, have not improved much over the past two decades.
It is not surprising that the only Indian state with a long and rich history of a separate department of public health and well-trained public health cadre, Tamil Nadu, also scores highly in health and nutrition rankings.
Mumbai has seen a sharp rise in infectious diseases over the past few years and has gained notoriety for its high child malnutrition rates. The city’s civic body and Maharashtra’s health ministry need to give up their ostrich-like attitude to the looming health crisis and take a leaf out of Tamil Nadu’s book to design an overarching public health management system for the metropolis.