Public Health for All

Azhar Ali

  The Covid-19 epidemic took the world off guard and Pakistan was no exception. The death rate from the virus varied from country to country and was initially linked to climate, age of patients, etc. However, at later stages, many myths about the virus changed and made the coronavirus disease even more unpredictable. The main concern from the very beginning was to flatten the curve i.e. to slow down the spread so that existing health facilities could handle the influx of patients. One option worked in some countries while another in other countries. A massive lockdown worked well in China mainly due to its authoritarian regime and a higher level of compliance to instructions by the public. In Europe, the curve was controllable but it caused heavy losses. Many countries did not fit the best practices such as the USA, Brazil and Pakistan. These countries have large populations and quite non-authoritarian government regimes when it comes to the masses. Though the literacy rates differ in these countries, it has been observed that people generally resent lockdowns and do not obey strict public health rules. The attitude has posed a greater threat to Pakistan which is not as resourceful as other nations.

Pakistan’s health system has not been in a good condition for decades. The huge population growth has placed an immense burden on resources. Private health services providers have mushroomed everywhere. The common man gets some kind of (mis)treatment even from mediocre doctors. As Covid-19 has expanded, every country has needed to re-think its health policy. Even then, few Pakistanis can be convinced to wash their hands or use water safely.

It was in September 1978 when the world had a chance to make things better for the developing countries. In Alma-Ata (a city in Kazakhstan, now known as Almaty), the WHO Annual Conference concluded with a declaration commonly known as the “Alma-Ata Declaration”. This was the result of at least 6 to 7 decades of work done by legendary public health practitioners like Jim Grant, John Gordon and Carl Taylor.

The declaration was simple and powerful and was very well-received by developing countries, including Pakistan. It promised ‘health for all’ mainly through a holistic approach of primary healthcare development and public information. However, later the idea was dismissed and specialized healthcare and medication took the front seats. This approach failed to provide health as it was focused only on treating illnesses. Dr Margaret Chan, Director General of the World Health Organization wrote on 15 September 2008 that it was time to ‘return to Alma-Ata’.

Pakistan must reconsider Alma-Ata and, under the supervision of Dr. Sania Nishtar, the goal is achievable. She knows the problems very well and has written them clearly in her book, ‘Choked Pipes: Reforming Pakistan's Mixed Health System’. Pakistan’s post-Covid-19 Public Health Policy should be more focused on ‘public health’ and just not restrict itself to treating the sick. It must emphasize on primary healthcare and public information for an extended period and should be extended to all segments of society. 

Pakistan needs to take the Alma-Ata Declaration of 1978
more seriously. There is a need to promote healthy habits
among the people through a sustained campaign.

The responsibility of handling public health should be shared with different people - doctors, nurses, para-medical staff, teachers, mosque imams, school teachers and, most importantly, mothers. Simple preventive measures should be re-introduced to keep the environment clean and consumption of safe food and water must be ensured. Healthy habits among children should be established by insisting on safe behavior, not consumerism. Since people learn and adapt through repetition, perhaps a campaign that can be sustained over years, would be required to promote healthy habits among the people.

Any improvement at the primary healthcare level would bring the pressure down on secondary and tertiary-level hospitals. Adoption of heathy habits would provide the country with a more productive, energetic and healthy workforce. The loss of productive tenures due to simple illnesses and even mental stresses could be decreased. The most suitable way forward after Covid-19 for Pakistan would be to ‘return to Alma-Ata’ and implement an ‘inclusive health policy’ for all to spread healthcare rather than focusing on illness treatments at specialized centers. All segments of society should be included and educational curricula should be equipped with public health topics for all ages. A preventive and not a curative approach should be adopted by Pakistan to safeguard its future.

The writer is a senior specialist at the Urban Unit, Lahore. He can be reached at azharuup@gmail.com