Health Is Not Found In Hospitals, It Is Built At Home

Having lived through the Covid-19 pandemic for so many months, we all wish things to return to "normal" as early as possible. However, one can ask a slightly philosophical question: what is normal? A world without the Internet was normal, except for a select few, in the 1980s. A world without widespread mobile telephone use was normal twenty years ago. HIV/AIDS changed our practice of how blood banks functioned and what practices we follow with regard to sex. Having experienced SARS-CoV-2, our thinking and our daily routines have changed.

When we compare the present and the probable future with pre-Covid-19 times, we have a window of opportunities at all levels—as individuals, as a society and as a nation—for three things: reject, revive and innovate.

• Reject. There are activities and actions that need to be rejected or reduced as we look forward to a new normal. Recognizing our global connectivity, we need to think about activities that led to where we are and see what we can do to change that. Our environment matters, climate change is real—deforestation and rampant and unplanned urbanization are future disasters in waiting. What can we do to change and advocate for change? We can and must reject the drivers of lifestyle diseases—fast food, lack of exercise, stress and ignoring mental health. Promoting health and reducing drivers of ill health is the best way to ensure that risks of severe disease are reduced.

• Revive. There are things which need to continue as before, such as economic and social activities. The revival of the economy in a sustainable way has to be underpinned by an improvement in the conditions of living of the most impoverished, instead of further enriching the already rich. Investments in health and education transform economies, and while this does not happen in election cycles, it is essential that scientists, economists, health workers and the public make this the keystone of our collective future.

• Innovate. The future needs new tools and new behaviours, whether it is better health surveillance or raising the consistency of handwashing, we need to find solutions that make their adoption easy at all levels from governments to individuals.

In India, in particular, the attempt to transform the health system is embodied in continuing the initiatives started under the National Health Mission, supplemented by additional measures under the Ayushman Bharat programme. Primary healthcare and public health services need to be strengthened in an accelerated manner under the HWCs of the Ayushman Bharat programme. The health initiatives need further strengthening and linking, not just across all healthcare providers in India, but with other sectors including education, women and child development, and industry. An isolated approach that views development as being driven by the government alone ignores huge resources and strengths that exist beyond the government.

There is evidence aplenty that epidemics and pandemics impact the poor, the marginalized, women and children the most. Building for their protection requires a reimagining of the base of the Indian health system—one that is equitable, affordable and accessible. This may sound like a pipe dream, but there are examples of nations achieving better health parameters with limited resources.

Health is not found in hospitals, it is built at home. Water supply, sanitation, protection from pollution, screening services and mental health support are all essential for a healthy mind and body that can handle the challenges of ill health when it occurs. In addition to the provision of healthcare, the government needs to facilitate nutrition, a better built environment, and better training of the workforce. These are areas where good policies and effective implementation are as important as direct investments.

In the provision of services, public health requires interconnected systems that share quality data based on which decisions can be made or actions taken. At the moment, fragmentation and vertical programmes lead to duplication of resources and efforts. It is time for a rethink to develop more efficient approaches that will provide the connected, resilient systems that we need to control disease and promote health, for everyone and everywhere.

In September 2020, the journal Science published the findings of a US study on the effect of reduced motor vehicular traffic on birds singing. The authors reported that due to shutdowns and other actions taken to control the pandemic, the noise level in a city had dramatically reduced to the level observed in the mid-1950s. This had resulted in the birds singing at lower amplitudes and still being heard by people far away. The authors concluded that ‘behavioural traits can change rapidly in response to newly favourable conditions’.

We have written this book to communicate a similar message. If the birds can change their behaviour so quickly, we humans should do better in recognizing the signals given by nature. The Covid-19 pandemic indicates the damage we have done to our planet and to ourselves. It is our responsibility to continue to learn and develop ways of improving our world, our health systems and our health.

Much has changed; we are in a difficult time. But there is no need to panic. Instead, there are many reasons to hope that science and technology will provide the solutions we need. Together we can create a better and healthier world for everyone.

(Excerpted from “Till We Win” with permission from Penguin Books. Dr Chandrakant Lahariya is a medical doctor and leading public policy and health systems expert, Dr Gagandeep Kang is an infectious-disease researcher and a Fellow of the Royal Society, London and Dr Randeep Guleria is director of the All India Institute of Medical Sciences, New Delhi.)