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Who is responsible for people's health?

Dr Giridhara R Babu

A A 

Are you healthy? Hold on to your answer till we unravel what health means. Being in

impeccable health means that you don't suffer from any physical illness in any form and,you have flawless state of mental and societal contentment. Now, are you healthy?

If your answer is no, don't be surprised, as you are among the majority !omentarily, it mightappear that being healthy might be a utopian resol"e, rarely e"er attainable by any indi"idual in

their lifespan #u$%ily, it may not be that hard too, if $on$erted a$tions are ta%en by indi"idual

and few departments

&o understand these $on$erted a$tions, it is important to understand fa$tors regulating health

Dahlgren and Whitehead in (( des$ribed numerous fa$tors at multiple le"els ranging from

so$ietal to indi"iduals &he first layer of health determinants $omprise of modifiable fa$tors

in$luding personal beha"iour and lifestyle that $an promote or res$ind health )or e*ample,smo%ing is modifiable beha"iour that $an be stopped to promote health at indi"idual le"el

&he ne*t layer $omprises of so$ial and $ommunity fa$tors, whi$h $an either support or upset the

health )or e*ample, smo%ing beha"iour $an be either started or stopped by the %ind of friends

one has or due to the family or $ommunity norms &he final le"el $ontains essential fa$tors su$has agri$ultural produ$tion, edu$ation, wor% en"ironment, li"ing and wor%ing $onditions,

unemployment, water and sanitation, health $are ser"i$es and housing +sing same analogy,

smo%ing poli$ies about toba$$o produ$tion and $onsumption affe$t o"erall smo%ing pre"alen$e

#et us e*amine another e*ample In order to wal% and be diseasefree, at indi"idual le"el, you

ha"e to ha"e a resol"e, de$ide and start wal%ing by attempting e"ery day At the $ommunityle"el, it helps to ha"e friends who moti"ate wal%ing and family whi$h has adopted wal%ing as ahabit -tru$tural le"el fa$tors in$lude whether you are able to $ross the road without fear of being

%no$%ed down by rash dri"ers, how a$$essible are wal%ing lanes, par%s or gyms in order to

$ontinue your wal%ing routine

-o, whose responsibility is to fi* the health of India's $iti.ens? +ndeniably, the first set of a$tions

is at the indi"idual le"el &hese $an be a$hie"ed through $onstant edu$ation and awareness

among the masses &he effort in promoting yoga by /rime !inister 0arendra !odi is a best firststep forward &he awareness needs e*pansion with se"eral $ollaborati"e a$tions embra$ing

religious and lo$al $ultural beliefs, enhan$ing healthy traditions, in$orporating promotion of

healthy beha"iour through s$hool $urri$ulum and in"ol"ing women's self help groups as $hangeagents

Fiing responsibility

1owe"er, the biggest problem is that se"eral programmes are e"asi"e in fi*ing responsibility for

health only at indi"idual le"el with inertia at other le"els of determinants &o redress the

longstanding ina$tion, laudable effort of the $urrent administration is the -wa$hh Bharat Abhiyan

2-BA3 aiming to ta$%le sanitation mena$e 1owe"er, barring these two initiati"es, no other

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department either at 4entre or lo$al le"els has addressed any other determinant at any other le"el

5ne would understand from the dis$ussion so far that department of health per se has limited

$ontrol o"er your health At the most, it pro"ides si$%ness relief and some health promotion

a$ti"ities su$h as immuni.ation 6et, it has be$ome an unfair tradition and $ustom to blame thehealth department for all the woes the $ountry has &he way forward for healthy India should

in"ol"e se"eral other departments and $ommunity a$tions )or India's health to impro"e, all

determinants of health should be addressed at e"ery le"el &he go"ernment $an $reate ano"erar$hing mission to address all the health determinants

A simplisti$ tool su$h as ran%ing the blo$%s7distri$ts based on the le"el of a$$omplishments in

so$ial determinants $an guide future $ourse of a$tion -imple yet effe$ti"e solutions su$h asrewarding the lo$al bodies through e*tra grants and re$ognition $an imbibe pride in the "illages

and $an ensue healthy $ompetition &he progress $an be monitored as performan$e indi$ators of

administrators at blo$% and distri$t le"el &he $hief minister $an spearhead the mission with the

a$$ountability set at the le"el of de"elopment $ommissioner

2The writer is Additional Professor, IIPH Bengaluru, a unit of Public Health Foundation of India3

-ee more at8 http877mde$$anherald$om7$ontent79:;<=97whoresponsiblepeoples

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