Health is dear to all, and we all strive to be in pink of our health all the time. Principles of health maintenance are simple, though repetitive actions. While it is a readily acceptable concept that basic health needs should be available to all, globally we have struggled with its execution. There are quite a few different terms for the same concept of ensuring basic healthcare for all, and a few postage stamps that mark the journey.
Setting up health facilities
Health is a state of absolute well-being. In the post world-war period, nations debated on how could we achieve it. Till 1970s, focus was on eliminating diseases. However, this proved to be a tough ask. Missionaries, colonists, democracies all struggled with establishing facilities, replete with doctors, nurses and paramedics to deliver basic health needs.
We equate basic healthcare with primary care. It needs a reasonable sized facility, with adequately trained human resources that can take care of simple treatments. It should also have a system, to refer to a secondary level if the need so arise. In a health systems approach, primary care is a base of a pyramid, and tertiary care is its peak.
Beginnings of Community health
With advances in medical science, there is a natural push towards secondary and tertiary care. This push often comes from healthcare system itself, in the name of better or more perfect treatment. On the other hand, health is a more prevalent phenomenon. Better healthcare for the society, must have a strong primary care as well as preventive health realms. This is an essential feature of Public health – that goes beyond hospitals and clinics.
The term “Community health” is often used interchangeably as “Public health”. However, purists believe that Public health is a larger umbrella-term, and encompasses everything that is done for health of entire population. In contrast community health is a term that is applied to a more local sub-set. Public health is a larger system, run by professionals. In contrast health-care delivery at the level of community is less dependent on professionals.
Community based healthcare is often delivered by lay individuals. These individuals or volunteers, are trained in essential skills, that is suitable for specific tasks. These include “barefoot doctors” in China, “visitadoras” in Brazil, “Swhasthya Shebikas” in Bangladesh, “FCHVs” in Nepal, and importantly “ASHA” in India. Such diverse workforce is collectively known as Community health workers (CHWs) or health volunteers (HV). Thus, community health focuses on simple but powerful actions to achieve a larger good.
More labels for the same
In this plethora of buzzwords, the “Public health” concept has been rebranded time and again. A careful choice of words and its interpretation is essence of this rebranding. Since Public health is delivered to the societies, it is also termed as “social medicine”. However, social medicine is closer to the word “socialism”. Similarly the word “public” is often interpreted as “not-private”. Unlike the words public and social, the word community (though sounds like communism) is more acceptable.
Community health, like its parent Public health, has a large preventive component. Hence this area of healthcare is also known as “preventive medicine” or “community medicine”. When it comes to terminologies, more professionally trained individuals love to use the suffix “medicine or medical”. Aim of “medicine” is to restore health, and has a curative tone. Prevention on the other hand, maintains health. None-the-less we continue to live amongst a few oxymorons.
By 1975, World Health Organization was more and more vocal about people themselves taking care of own health. As professionals would always fall short, communities had to be empowered. Thus, came 1978 slogan from WHO and UNICEF – “Health for all by the year 2000”.
Simple doable actions
In 1978, “Health for all” was a paradigm shift. Health rests on simple doable actions, and does not always need fancy, expensive hospitals. These simple actions could prevent, treat, or even rehabilitate. This was a primary care approach. The facilities were such care was to be administered was aptly named as “primary health centers” or “community health centers” rather than hospitals.
Universal Health Care
For simple actions to succeed, these must be applied to all. Every one in the community, must be able to access health services. This brings us to another terminology “Universal Health Care”. Immunization campaigns are a prime example of this approach. Diseases fail, only when all receive vaccines. For societies to progress, it is imperative that access is for all. This will happen only if the care is available as well as affordable.
Challenges
Challenges remain in our basic healthcare pursuit. First and foremost is economic inequality. This not only prevents individuals from seeking care when needed, but also leads to postponement of health priorities. When livelihood is a greater concern, remaining healthy becomes a lower priority.
Next is knowledge asymmetry. One one end of spectrum are low awareness levels about risk factors, and on the other is excess, unfiltered and at times harmful information. This holds us from making right choices.
Third and foremost impediment is complexity of human behavior. Despite access and knowledge, we need multiple positive reinforcements to bring about a change. This makes even basic health care to be human resource intensive.
The silver lining is the resolve and effort societies are putting in to ensure universal availability of basic health care. On the other hand with each passing year, we upgrade our understanding about what is basic healthcare need, and must be available to all.