COMMENTARY
India Badly Needs Public
Health Education
Rajesh Kumar Rai, Theodore Herzl Tulchinsky
This article calls for the need
to introduce undergraduate
courses and degree programmes
in public health across local
colleges and universities in
India. Undergraduate degrees
in public health should be
promoted in order to have an
optimum number of public
health professionals who can
successfully meet the health
challenges posed by rapid
economic development.
Rajesh Kumar Rai (rajesh.iips28@gmail.com)
is a senior research scientist with the Society
for Health and Demographic Surveillance.
Theodore Herzl Tulchinsky (tulchinskyted@
hotmail.com) is the emeritus professor at the
Braun School of Public Health and Community
Medicine, Hebrew University of Jerusalem
Hadassah.
Economic & Political Weekly EPW JULY 8, 2017
P
ublic health is a part of the foun-
dations of any modern society that
values human life and health, and
seeks sustainable economic and social
growth. The achievements of public health
in preventing disease and early death,
affect hundreds of millions of humans
each year (Parascandola 1996). Sadly,
India lags severely behind in terms of
achieving these benefits, due to weak-
nesses in policies, investment and edu-
cation for a strong public health work-
force (Rai and Tulchinsky 2015). Recently,
some prominent international maga-
zinesTime and Forbeshave praised
Indias remarkable economic growth,
but reminded policymakers that eco-
nomic progress is not balanced given
the slow pace of improvements in public
health indicators. Sustainable economic
growth requires robust policies that
improves the populations health and
raises productivity levels across the
nation. Since 1993, the World Bank has
considered investments in health as a
vital factor to promote economic growth
and not as, previously considered, a
burden on economic progress (World
Bank 1993).
vol lIi no 27
India faces very grim challenges in
improving its public health statistics,
including indicators of poor maternal
and child mortality and morbidity, a
high level of preventable infectious
diseases, rising trends of chronic dis-
eases such as diabetes, strokes, coro-
nary heart disease, along with serious
health system related issues (Patel et al
2015). Indias public health workforce
infrastructure is inadequate, in terms of
numbers and quality, to tackle its cur-
rent and future public healthcare issues
where a deficiency of trained public
health professionals remains a primary
concern.
Need a Public Health Workforce
A public health workforce requires peo-
ple, who have qualifications in public
health education, to occupy positions
exclusively or substantially focused on
population health (Sim et al 2007). Pub-
lic health professionals play a central
role in ensuring the appropriate man-
agement of all aspects of the healthcare
system: from logistics and facility man-
agement, to finances, and the monitor-
ing of healthcare status and healthcare
interventions (Hazarika 2013). As of
2011, a total of 23 institutions in India
offered a master of public health (MPH)
degree, and some institutions have
launched diploma programmes in public
health related disciplines (Sharma and
Zodpey 2011). As a response to Indias
public health needs, in 2006, under the
37
COMMENTARY
banner of the Public Health Foundation
of India,1 various institutes under the
Indian Institute of Public Health (IIPH)
were established in select states of India.
IIPHs have introduced many programmes
in the area of public health, including
postgraduate diplomas, a MPH degree
and an integrated Master-Doctoral pro-
gramme. In addition, some state health
departments have also taken the initia-
tive to establish public health schools,
for example, the Institute of Public
Health, Kalyani (IPHK) was established
in 2015 by the West Bengal government
(Government of West Bengal 2015).
However, until now, none of these insti-
tutes have taken the initiative to intro-
duce a Bachelors (degree) programme in
public health.
This article proposes a change in
healthcare education priorities, in order
to have an optimum number of public
health professionals in India. In part, this
change should adopt the relatively new
trends in Europe and the United States
(US), promoting public health under-
graduate degree programmes within
existing universities or colleges on a broad
scale. The government at the national
and state levels, led by the Ministry of
Health and Family Welfare, should insti-
tute policies and incentives that promote
bachelors degree programmes. The gov-
ernment must also mandate that attending
such degree programmes is a prerequisite
for occupying positions in the ministry,
and field service systems across the
nation. The challenges in doing so are
discussed.
Undergraduate Degree Needed
The importance of an undergraduate
degree course in public health education
started even before Indias independ-
ence in 1947, when the report of the
Health Survey and Development Com-
mittee (formed in 1943), chaired by
Joseph Bhore, emphasised the inadequate
teaching of preventive medicine and
public health in medical students under-
graduate training (Government of India
1946). Nearly 70 years later, the quality
of public health professionals produced
in India is still questionable and the
deficiency of qualified professionals
aggravates the situation. It is worth
38
mentioning that with generous support
from the Rockefeller Foundation, in
December 1932 the All India Institute of
Hygiene and Public Health2 was estab-
lished in Kolkatait is the oldest school
of public health in Southeast Asia.
Around the same time, some of the worlds
most renowned schools of public health
such as the London School of Hygiene and
Tropical Medicine,3 the Johns Hopkins
Bloomberg School of Public Health,4
and the Harvard T H Chan School of
Public Health,5 in the US, were also
founded with financial support from the
Rockefeller Foundation (Institute of
Medicine 2002).
Unfortunately, public health training
remains neglected in India. Thus, it is
not surprising that, globally, the All
India Institute of Hygiene and Public
Health ranks poorly when compared to
its contemporaries, such as the Schools
of Public Health at Harvard or Johns
Hopkins universities in the US. After the
Bhore Committees report, the Govern-
ment of India in 1977 launched the Re-
orientation of Medical Education (ROME)
scheme across the country, which had
limited success in training medical grad-
uates for rural services. Both the Expert
Committee on Public Health Systems,
formed by the Union Ministry of Health
and Family Welfare in 1996, and the
Voluntary Health Association of Indias
(VHAI) Independent Commission on
Health in India 1997, recommended the
strengthening of public health training,
and the VHAI stressed on the need to
open new schools of public health
(Bangdiwala et al 2011).
The Calcutta Declaration on Public
Health was adopted in 1999 at the
Regional Conference on Public Health
in South-east Asia in the 21st century.
The declaration called for mandating
competent background education and
relevant expertise, for persons working
in public health systems. It also empha-
sised the need to strengthen and reform
public health education, training and
research institutes, as supported through
the networking of institutions and the
use of information technology in human-
resources development (Bangdiwala
et al 2011). However, none of these
reports recommended introducing an
JULY 8, 2017
undergraduate degree in public health,
and the reasons behind not doing so
remain unclear.
Policies and Recommendations
Local colleges and universities should be
supported financially and encouraged to
develop undergraduate degree pro-
grammes in public health, especially in
poorer states. This will ensure that the
needs and requirements of a public
health professional workforce in India
are fulfilled. Bachelors level training for
healthcare promotion and public health
managers is vital to the infrastructure
development of essential services, such
as environmental health, road and
workplace safety, immunisation, nutri-
tion and tropical disease control. Such
programmes, like preventable morbidity
and mortality, are required in develop-
ing countries that face various inequi-
ties and the growing needs of an ageing
population (Albertine 2008; Tulchinsky
et al 2012).
Given the current need for an ade-
quately trained public health workforce
cadre in India, developing public health
undergraduate degrees should be priori-
tised over introducing more MPH pro-
grammes, although both are needed.
Universities in the US and Europe are
rapidly broadening public health educa-
tion, through bachelors degree progra-
mmes and the development of schools of
public health. In India, a multidiscipli-
nary workforce is badly needed in order
to promote a proactive environment for
public health education, research, advo-
cacy and services, that meet interna-
tional accreditation standards (Aceijas
and Foster 2011; Kuiper et al 2011; Lee
2008; Tulchinsky 2010). In 2003, a report
published by the US Institute of Medicine
(IOM) recommended that all public health
professionals employed to improve pop-
ulation health should at the least earn a
baccalaureate degree (Gebbie et al 2003).
In 2006, the Consensus Conference on
Undergraduate Public Health Educa-
tion, held in the US, recommended that
at all students at undergraduate institu-
tions should be provided access to the
core curriculum (Riegelman 2008). The
Association of Schools and Programs
in Public Health (ASPPH 2012) are
vol lIi no 27 EPW Economic & Political Weekly

actively promoting an undergraduate
education in public health, including for
other professions such as social work,
law and general arts degree programmes.
The Bologna Declaration of 1999
(European Ministers of Education 1999)
called for the reorganisation of higher
education in Europe. The Association of
Schools of Public Health of the European
Region6 established a working group on
undergraduate education in public health,
and also conducted a survey of under-
graduate public health programmes. The
working group called for the strengthen-
ing of some crucial components of the
public health education system across
the European region.
Challenges and the Way Forward
Although introducing public health under-
graduate degree programmes is vital for
progress in public health, in India the
main focus thus far has been on masters
degree training for physicians. Progress
even in this field will require the esta-
blishment of international standards of
accreditation. In India, there is no sin-
gle uniform, overarching, body or coun-
cil, responsible for public health educa-
tion in the country as a whole (Bangdi-
wala et al 2011). Persons from both
medical and non-medical backgrounds
can enrol into a public health degree
programme, but the Medical Council of
India (MCI) is the statutory body respon-
sible for establishing and maintaining
uniform standards of medical education,
that is offered at the medical college level
only. Public health training at non-medical
colleges or universities come under the
purview of the All India Council for
Technical Education (AICTE) or the Uni-
versity Grants Commission (UGC). Thus,
the very first challenge for India is to
decide who will lead the delegation
while introducing undergraduate degree
courses in public health?
Second, what can motivate suitable
aspirants to pursue either a specialised
degree in public health (for example, a
Bachelors of Public Health), or opt for
public health as one of their undergrad-
uate degree subjects. There is no doubt
that India desperately needs a large
increase in its public health workforce
with suitable professional education.
Economic & Political Weekly EPW JULY 8, 2017
More adequately trained public health
professionals could be produced if the
candidates are oriented towards it in the
undergraduate degree level. This includes
upgrading the current public health
workforce with technical level diplomas,
as well as attracting new, young and
highly motivated candidates. But ab-
sorption into the network of the public
health professionals remains a daunting
challenge. The Ministry of Health and
Family Welfare, along with industry
leaders, non-governmental organisations,
and public health research institutes can
promote this initiative, by requiring can-
didates who compete for local and
national leadership positions to have a
suitable public health education degree.
India must find a way to promote under-
graduate degrees in public health educa-
tion so as to expand the qualified work-
force and in order to be successful in
meeting the health challenges of this
rapidly developing nation.
Notes
1 Public Health Foundation of India: http://phfi.
org/.
2 All India Institute of Hygiene and Public
Health: http://aiihph.gov.in/.
3 London School of Hygiene and Tropical Medi-
cine: http://www.lshtm.ac.uk/.
4 Johns Hopkins Bloomberg School of Public
Health: http://jhsph.edu/.
5 Harvard T H Chan School of Public Health:
http://hsph. harvard.edu/.
6 Association of Schools of Public Health of the
European Region: http://aspher.org/.
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