Das Gupta, MonicaShukla, RajendraSomanathan, T.V.Datta, K.K.2012-03-192012-03-192009-11-01https://hdl.handle.net/10986/4332The central government s policies, though well-intentioned, have inadvertently de-emphasized environmental health and other preventive public health services in India since the 1950s, when it was decided to amalgamate the medical and public health services and to focus public health services largely on single-issue programs. This paper discusses how successive policy decisions have diminished the Health Ministry s capacity for stewardship of the nation s public health. These decisions have introduced policies and fiscal incentives that have inadvertently enabled states to prioritize medical services and single-issue programs over broader public health services, and diminished the capacity of the public health workforce to deliver public health services. Diseases resulting from poor environmental health conditions continue to impose high costs even among the more affluent, and hinder development. There are many approaches to strengthening the public health system, and the authors suggest one that may require relatively little modification of existing structures and systems. They suggest establishing a focal point in the Health Ministry for public health stewardship, and re-vitalizing the states public health managerial cadres as well as the grassroots public health workers. The central government could consider linking its fiscal support to states with phased progress in four areas: (1) the enactment of state Public Health Acts; (2) the establishment by states of separate public health directorates; (3) the re-vitalization of grassroots public health workers; and (4) health department engagement in ensuring municipal public health. The central focal point could provide the needed support, oversight, incentives, and sanctions to ensure that states build robust public health systems. These measures can do much to help governments use public funds more effectively for protecting people s health.CC BY 3.0 IGOAVIAN FLUAVIAN INFLUENZABASIC LEGISLATIONBEDDINGBLINDNESSBURDEN OF DISEASECANCERCHILD HEALTHCHILD HEALTH SERVICESCHILD MORTALITYCHOLERACITIZENSCLINICAL SERVICESCLINICSCOMMUNICABLE DISEASECOMMUNICABLE DISEASESCOMMUNITY MEDICINECOMMUNITY PARTICIPATIONCONTAGIOUS DISEASESCOST-EFFECTIVENESSCOSTS OF TREATMENTDEATHSDEMAND FOR SERVICESDENGUEDEVELOPING COUNTRIESDIABETESDISASTERSDISEASE CONTROLDISEASE OUTBREAKSDISEASE PREVENTIONDISEASE PREVENTION AND CONTROLDISEASE SURVEILLANCEDISPENSARIESDRINKING WATERDRUG RESISTANCEDRUGSECONOMIC CHANGEECONOMIC GROWTHECONOMIC OUTCOMESECONOMIC PERSPECTIVESEMERGENCIESENDEMIC DISEASESENVIRONMENTAL HEALTHEPIDEMICEPIDEMICSEXERCISESEXPENDITURESEXTERNALITIESFAMILY HEALTHFAMILY PLANNINGFAMILY WELFAREFLU PANDEMICFOOD HANDLINGFOOD SAFETYFOOD STORAGEGLOBAL POLIO ERADICATION INITIATIVEGOVERNMENT CAPACITYGRASSROOTS WORKERSHAZARDSHEALTH AUTHORITIESHEALTH BUDGETSHEALTH CAREHEALTH CONDITIONSHEALTH ECONOMICSHEALTH EDUCATIONHEALTH EXPENDITUREHEALTH FACILITIESHEALTH FINANCINGHEALTH INTERVENTIONSHEALTH LEGISLATIONHEALTH MANAGEMENTHEALTH NEEDSHEALTH OFFICIALSHEALTH ORGANIZATIONHEALTH OUTCOMESHEALTH PLANNINGHEALTH POLICIESHEALTH POLICYHEALTH REGULATIONSHEALTH RESOURCESHEALTH RISKSHEALTH SECTORHEALTH SERVICEHEALTH SERVICE DELIVERYHEALTH SERVICESHEALTH SPECIALISTHEALTH SYSTEMHEALTH SYSTEMSHEALTH TRAININGHEALTH WORKFORCEHEPATITISHOSPITALSHUMAN DEVELOPMENTHYGIENEILL-HEALTHILLNESSIMMUNIZATIONIMMUNIZATIONSINFANTINFANT MORTALITYINFANT MORTALITY RATEINFECTIONSINFECTIOUS DISEASESINFLUENZAINFRASTRUCTURE DEVELOPMENTINJURIESINTERNATIONAL ECONOMIC RELATIONSIODINE DEFICIENCYLABOR FORCELACK OF FOODLATRINESLAWSLEPROSYLIFE EXPECTANCYLOCAL AUTHORITIESMALARIAMALARIA CONTROLMALARIA INCIDENCEMALE HEALTHMALE HEALTH WORKERSMALNUTRITIONMATERNAL AND CHILD HEALTHMEDICAL CAREMEDICAL DOCTORSMEDICAL EDUCATIONMEDICAL FACILITIESMEDICAL OFFICERMEDICAL RESEARCHMEDICAL SERVICESMEDICAL TRAININGMEDICINEMIDWIFEMIDWIVESMIGRANTSMINISTRY OF HEALTHMORBIDITYMORTALITYMORTALITY DECLINEMORTALITY DECLINESNATIONAL HEALTHNATIONAL HEALTH POLICYNATIONAL POLICYNATURAL DISASTERNATURAL DISASTERSNURSENURSINGNUTRITIONOCCUPATIONAL DISEASESOCCUPATIONAL HEALTHPERSONAL COMMUNICATIONPLAGUEPLAGUE CONTROLPOLICY DECISIONSPOLICY GOALSPOLICY RESEARCHPOLICY RESEARCH WORKING PAPERPOLICY SERIESPOLIOPOLIO ERADICATIONPOLIO ERADICATION PROGRAMPOPULATION DISCUSSIONPOPULATION GROWTHPOPULATION STUDIESPREVALENCEPREVENTIVE HEALTH SERVICESPREVENTIVE MEDICINEPROGRESSPUBLIC ADMINISTRATIONPUBLIC ATTENTIONPUBLIC AWARENESSPUBLIC EXPENDITUREPUBLIC EXPENDITURE ON HEALTHPUBLIC HEALTHPUBLIC HEALTH ADMINISTRATIONPUBLIC HEALTH ENGINEERSPUBLIC HEALTH EXPENDITUREPUBLIC HEALTH INTERVENTIONSPUBLIC HEALTH LAWSPUBLIC HEALTH PERSONNELPUBLIC HEALTH POLICIESPUBLIC HEALTH POLICYPUBLIC HEALTH PROGRAMSPUBLIC HEALTH SERVICESPUBLIC HEALTH SYSTEMPUBLIC HEALTH WORKERSPUBLIC SERVICESQUARANTINERABIESRESEARCH INSTITUTIONSRESOURCE MOBILIZATIONRURAL DEVELOPMENTSANITARY CONDITIONSSANITATIONSCHOOL HEALTHSCREENINGSEPTIC TANKSSEXUALLY TRANSMITTED DISEASESSMALLPOXSOCIAL POLICYSTATE GOVERNMENTST.V.TBTECHNICAL EDUCATIONTECHNICAL INFORMATIONTECHNICAL RESOURCESTREATMENTTROPICAL MEDICINETUBERCULOSISTYPHOIDURBAN AREASURBAN DEVELOPMENTURBANIZATIONVACCINATIONVACCINATION PROGRAMSVACCINEVECTOR BORNE DISEASESVECTOR CONTROLVENTILATIONVITAL STATISTICSWASTEWATER SUPPLIESWORKERSWORLD HEALTH ORGANIZATIONYAWSWorld Bank10.1596/1813-9450-5140