Clinical medicine provides health in retail, public health offers health in wholesale, says Srinath Reddy
Clinical medicine provides health in retail, public health offers health in wholesale, says Srinath Reddy
Alongside excelling in their career as clinicians, it is important for doctors to develop a broader perspective and help reshape public health policy in order to address the social and commercial drivers of morbidities, K. Srinath Reddy, president, Public Health Foundation of India, said on Friday.
In his address at the 11th annual convocation for medical courses at Jipmer, Dr. Reddy said as much as the primary duty of the medical practitioner was to heal the sick, it was also important to advance the science both in clinical medicine and public health.
“Public health has a tremendous role in promoting health, preventing disease and even in organising better healthcare,” said Dr. Reddy. “When people ask me the difference between clinical medicine and public health, I tell them that clinical medicine provides health in retail, public health offers health in wholesale. Both are complementary”.
Pointing to a new study in the Lancet journal that 44% of cancer deaths and 42% of all Years of Lives Lost (a measure of premature mortality) were due to a triad of risk factors — smoking, excessive alcohol consumption and high Body Mass Index.
“Though these risk factors are conventionally attributed to unhealthy behaviour, there are many social and commercial drivers that are behind those behaviours. If we do not address them, all we have left is the clinical response. And, however much we enhance diagnostics with better biomarkers and imaging techniques or amplify our treatment modalities, we will still be dealing with a cascading load of cancer cases”, Dr. Reddy said.
A transition between 1990-2016 has seen pre-transitional communicable diseases or maternal and child health related problems contribute lesser to mortality or Disability Adjusted Life Years (DALY), whereas now about two-thirds of deaths and burden of disease are caused by non-communicable diseases. Cautioning against making the mistake of segmentation, he pointed out that during the COVID-19 pandemic, the most vulnerable group was those with co-morbidities and the failure to identify this proportion of patients was due to the compartmentalisation of health systems.
“While primary care has to be the foundational basis for a good health system, it has to be connected bi-directionally to secondary and advanced levels of care”, he said. Unless a harmonious integration is built, health systems will be functioning in islands as a disconnected and dysfunctional archipelago, he said.
Dr. Reddy called upon young doctors to not see the workplace and the public health sphere as separate but rather as a ‘continuum’ and to see the ‘big picture’, especially given the linkages between poverty and disease, aggravation of issues and denial of access to treatment. Urging the practitioners to raise their voices for public policy change such as universal health coverage, he reminded them of the words of German scientist and social medicine proponent Rudolf Carl Virchow that “physicians are the natural attorneys of the poor”.
Dr. Reddy wanted the fraternity to understand that when they see late referrals or cases of delayed diagnosis of a condition, it represents a system failure. The role of public health is to improve these systems through better primary care networks. The bottom line was that best of clinical expertise would not translate into the best of outcomes if public health systems are sub optimal.
On the transitioning of healthcare models from a physician-centred one to a patient-focused one and now a people-centric model, he said. “So, it is no longer a paternalistic pattern of clinical care, but a participatory model of care that includes the patient and the family as informed partners in the decision making as far as possible”.
He also presented degrees (for 2020 and 2021) and medals for excellence to students.
V. M. Katoch, Jipmer president, urged the junior doctors to keep reaching out to people no matter what speciality, or alternative profession, they chose to pursue. Rakesh Aggarwal, Jipmer Director, who presented a report on the achievements over the past year, disclosed that the Centre had just sanctioned 786 posts across faculty, administrative and technical levels, including 429 Nursing Officer posts.
Pankaj Kundra, Dean (Academic) administered the convocation pledge.
Gurmeet Singh, Vice Chancellor of Pondicherry University, and Ravi Kumar Chittoria, Jipmer Registrar also participated.
