One Nation One Health—Journey of a Nation to equipoise health and disease

Chhaju R Yadav; BG Resmi; Sanjeev Sharma

doi:10.4103/jras.jras_142_22

ONE NATION, ONE HEALTH SYSTEM - SPECIAL ISSUE

Year : 2023 | Volume : 7 | Issue : 1 | Page : 42-46

One Nation One Health—Journey of a Nation to equipoise health and disease

Chhaju R Yadav¹, BG Resmi¹, Sanjeev Sharma²
¹ Department of Kriya Sharir, National Institute of Ayurveda DU, Jaipur, Rajasthan, India
² Professor and Vice-chancellor, Department of Salyatantra, National Institute of Ayurveda DU, Jaipur, Rajasthan, India

Date of Submission	26-Sep-2022
Date of Acceptance	07-Nov-2022
Date of Web Publication	08-Dec-2022

Correspondence Address:
Dr. Chhaju R Yadav
Department of Kriya Sharir, National Institute of Ayurveda DU, Jaipur, Rajasthan
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jras.jras_142_22

Abstract

Being a developing country, India has faced many challenges since freedom concerning the economy, health, and education. Providing healthcare facilities to all strata of society was a monumental task. By formulating National Health Policy in 1983, India took its first initiative in this context. Timely revision of the policy in 2002 and 2017, according to the requirements and implementation of many national healthcare programs, has enabled it to advance in the healthcare system. India now aims at bringing uniformity in the healthcare facilities provided by the government to all the people anywhere in India at minimal expenditure. In this regard, universal health coverage has been introduced as a part of the Ayushman Bharat Yojana to reduce the cost of treatment to patients. Slowly, India is heading toward sustainability in terms of quality health care assessible to all sectors of society. To bring uniformity of health care by integrating different healthcare systems according to the choice and needs of the patients, with minimal financial burden and compromise in quality, the “One Nation, One Health System by 2030” agenda has been introduced. Here, the formulation of the National Health Policy and its timely renewal and the role of Ayurveda in achieving its goals have been discussed.

Keywords: Ayurveda, AYUSH, healthy world, National Health Policy, One Nation One Health, Universal Health Coverage

How to cite this article:
Yadav CR, Resmi B G, Sharma S. One Nation One Health—Journey of a Nation to equipoise health and disease. J Res Ayurvedic Sci 2023;7:42-6

How to cite this URL:
Yadav CR, Resmi B G, Sharma S. One Nation One Health—Journey of a Nation to equipoise health and disease. J Res Ayurvedic Sci [serial online] 2023 [cited 2023 Mar 27];7:42-6. Available from: http://www.jrasccras.com/text.asp?2023/7/1/42/362936

Introduction

The basic instinct of every living being is to be in a state of equilibrium, be it physical, mental, emotional, or spiritual. Health is the primary aspiration of all living beings. The Nation’s responsibility is to provide its citizens with the necessities to attain the same. The health of the population of a country reflects its economic status. Any country’s productivity and progress depend on its citizens’ health status. For a developing nation like India, it is not easy to bring uniformity and equity in the healthcare facilities for such a diverse and multistrata population. Many time-to-time national health programs have been implemented according to the needs with enough flexibility permitting state public health administration system to implement as per their requirements.

National Health Policy 1983

^[1]

In 1983, to attain the national goal of “Health for All by 2000 AD,” the National Health Policy (NHP) was formulated by the Ministry of Health and Family Welfare, which the then Parliament of India also endorsed. This policy emphasized many areas of health such as preventive, promotive, public health, and rehabilitation.

Important Focus Areas

Initially, the NHP emphasized the development of basic requirements and essentialities in the healthcare system with special attention on rural areas. The primary objectives of the policy were as follows:

To build awareness of health problems in the community and methods to solve them by the community

To reduce the existing imbalance in health services, especially in rural areas

To supply safe drinking water and sanitation to people in an affordable way

To establish a dynamic health management information system for health planning and health program implementation

To provide legislative support for health protection and promotion

Actions to prevent widespread malnutrition

Methods to develop alternate healthcare delivery systems and low-cost health technologies

To coordinate different systems of medicine.

But there were many interfering factors in implementing the policy, such as slow socioeconomic development, insufficient infrastructure, failure to achieve equity in healthcare access facilities, rapid demographic and epidemiologic changes, etc., so the health policy was updated in 2002 and 2017 with suitable incorporation of the needs according to circumstances. NHP 2002 focused on good health for the general population without any emphasis on bearing of cost by the public.

National Health Policy 2002

The main objectives of NHP 2002 were as follows^[2]:

Reducing regional and economic inequities and imbalances in the health sector

To design national health programs with the active participation of state governments

Kick-starting the revival of the primary health system by providing some essential drugs under central government funding through the decentralized health system

To ensure the use of generic drugs and uninterrupted supply of vaccines

To increase the government-funded health research to a level of 1% of the total health spending by 2005, and thereafter, up to 2% by 2010

To establish an integrated disease control network from the lowest rung of public health administration to the central government by 2005

Enforcement of quality standards for food and drugs

To establish national health accounts, conforming to the “source-to-users” matrix structure and also continuous estimation of health costs

To review the staffing norms of the public health administration to meet the specific requirements of women in a more comprehensive manner

The Medical Council of India implements a contemporary code of medical ethics to prevent the looting of patients through irrational or profit-driven medical regimens

To keep a vigilant watch on health research involving gene manipulation and stem cell research

To simplify the recruitment procedures and rules for contract employment by the state government to provide a trained medical workforce in under-served areas.

National Health Policy 2017

^[3]

NHP 2017 focuses on attaining the highest possible level of health and well-being for all ages through increasing accessibility, improving quality, and lowering the cost of healthcare systems. When the health policies have been revised with time, there has been a shift of focus from sick care to wellness. The goal of the NHP 2017 is attaining the highest possible level of health and well-being for all ages, through a preventive and promotive healthcare orientation in all developmental policies and universal access to good quality healthcare services without financial hardship. The key principles of the policy are professionalism, integrity and ethics, equity, affordability, universality, patient centered and quality of care, accountability, pluralism, inclusive partnerships, decentralization, dynamism, and adaptiveness. The objective of the policy is to improve health status through concerted policy action in all sectors and expand preventive, promotive, curative, palliative, and rehabilitative services provided through the public health sector with a focus on the quality.

The policy ideas have focused on seven primary areas to improve environment for health, which is stated as Swastha Nagrik Abhiyan. It includes the following:

The Swacch Bharat Abhiyan

Balanced healthy diet and exercises

Addressing alcohol, tobacco, and substance abuse

Yatrisuraksha—to prevent death due to road and rail accidents

Nirbhaya Nari—action against gender violence

Reduced stress and improved safety in workplace

Reduced indoor and outdoor air pollution.

To reduce the cost of treatment, Ayushman Bharat Yojana was implemented as a part of NHP 2017. This scheme was launched to achieve the vision of universal health coverage with the underlying commitment “Leave no one behind.” It aims to address health issues holistically at primary, secondary, and tertiary levels by shifting the sectoral approach to a more comprehensive one. The establishment of health and wellness centers to provide comprehensive primary healthcare, including maternal and child healthcare with free drugs and diagnostic services, is a component of the healthcare approach in Ayushman Bharat. Pradhan Mantri Jan Arogya Yojana is another component, which aims to achieve universal health coverage and Sustainable Development Goal 3 and provide financial protection to cover medical expenses to the deserve up to an amount of rupees 500,000 per family per year.^[4]

There has been a shift in seven key policies for healthcare services in the revised NHP. The focus of primary care is shifted from selective care to assured comprehensive care. Secondary and tertiary care is shifted from input-oriented to output driven. In the public hospitals, user fees and cost recovery is shifted to assured free drugs, diagnostics, and emergency services. To make the implementation of healthcare programs more effective, the integration of different healthcare systems is being attempted. The normative approach of infrastructure and human resource development is shifted to a targeted approach. AYUSH healthcare systems are being brought to the mainstream from the lateralized stand-alone position. Urban health has been focused on organizing primary healthcare delivery and referral system for the urban poor.

Several national health programs are formulated addressing the different areas of health care. Maternal and child survival, child and adolescent health, malnutrition, immunization, communicable and noncommunicable diseases, mental health, population stabilization, etc., are some areas of focus in which health programs are designed.

For better diagnosis and treatment, women-friendly public hospitals are set up at several places to address gender-based ignorance on health issues. Efforts are also incorporated to train community members as first responders to accidents and disasters. Efforts to provide life support ambulances, trauma care centers, etc., through a unified emergency system linked to a universal access number are also an essential step for emergency care.

Human resources for health include those involved in medical education, nursing education, paramedical skill, doctors in remote areas, mid-level service providers, and Accredited Social Health Activist (ASHA) workers. Recently, efforts are also made to include ASHA workers in the AYUSH system. This is a revolutionary step to make AYUSH systems accessible and familiar to the public.

By strategic purchasing through insurance and trusts, health outcomes could be improved, and out-of-pocket expenditure could be reduced. Strategic purchasing helps reduce the critical gap in public health services. Efforts are also made to include charitable and not-for-profit hospitals to accept referrals from public healthcare systems and private hospitals to consider subsidized beds for the poor and downtrodden population. This helps increase the accessibility of health care to the people. Steps are also taken to collaborate with private sectors for immunization, organ transplants, disease surveillance, etc., so the health delivery service could be more prompt.

Health research is another area under focus in this policy as it recognizes research’s vital role in shaping the healthcare system. Fundamental research, medical product innovation, health systems, and service research are the essential areas of scope of research.

Ministry of Health and Family Welfare has a regulatory role in clinical establishments, food safety, professional and technical education, medical technologies, clinical trials, research, and other related laws.

Mainstreaming the potential of AYUSH

It has been an essential objective of this policy. It ensures the availability of AYUSH care for persons who opt for it through colocation in public facilities. The implementation of Yoga practice in schools and workplaces, standardization and validation of AYUSH drugs with adequate quality control mechanisms, the development of infrastructural facilities of teaching institutions, capacity building of institutions and professionals, building research, and public health skills for preventive and promotive healthcare, etc., are some of the agendas in this policy. Linking AYUSH systems with ASHAs and Village Health Sanitation & Nutrition Committee (VHSNC) would also be pivotal in achieving the objective. The policy also recognizes the need for integrated courses for the Indian Systems of Medicine, modern science, and Ayurgenomics.

Make-in-India in the Health Sector

Innovative steps in developing medical devices with indigenous technology to reduce cost, promote local manufacturing to provide customized indigenous products, and focus on producing active pharmaceutical ingredients have been made as a part of policy-making.

The scope of utilization of the national knowledge network for tele-education, tele-consultation, etc., to improve efficiency, transparency, and citizen experience so that the accessibility, quality, cost, burden of disease, and monitoring can be ensured. By utilizing digital technology, National, Digital Health Authority is proposed to regulate, develop, and deploy digital health across the continuum of care.

Thus, the updated health policy focuses on the growing burden of noncommunicable diseases, the emergence of a robust healthcare industry, the growing incidences of unsustainable expenditure due to healthcare costs, and rising economic growth enabling enhanced fiscal capacity. Since the private healthcare sector occupies the majority of the health delivery system in India, empowering public healthcare by incorporating private sectors is the key to a leap in health delivery. Realizing this, Government Health Policy has largely encouraged private sector expansion in conjunction with government health programs. But the expenses people have to meet for their health care make the healthcare system inaccessible to economically weaker sections of society. Making uniform health care free of cost is the solution for this. So, by integrating different healthcare systems and efforts to reduce the cost of treatment and customizing the treatment according to need, our One Nation One Health focuses on achieving free health care for all without compromising quality by 2030.

Scope of Ayurveda in One Nation One Health

Ayurveda is a prevalent system of traditional medicine in the Indian subcontinent. It has been practiced for thousands of years. Thus, the philosophy of Ayurveda is as robust as that of conventional medicine. The well-known aims of Ayurveda are to treat the diseased and maintain the health of the nondiseased^[5] through lifestyle modification based on the diurnal and seasonal changes, observance of proper conduct along with healthy diet and regimen, usage of daily admissible revitalizers, etc. Ayurveda has more significant potential to bring health to people at a reasonable expense; hence, all sectors of society could enjoy its benefits without much economic burden. As per Ayurveda, no substance in this world is useless, and everything has some or other medicinal use.^[6] This principle helps in addressing health issues in a much simpler and more cost-effective way. Many of its principles and guidance match well with the mottos of our NHP. Ayurveda has an inevitable role in the healthcare system. By bringing timely changes in the mode of application and customizing the products, it can be even more popular among people. Personalized medicine, which is a concept that recently evolved in modern medicine, has been the key concept of Ayurveda. Ayurveda treats each individual uniquely through the concept of Prakriti, Saara, etc. The pandemic of coronavirus disease 2019 (COVID-19) has helped recognize the potential of disease prevention and maintaining health in good condition.^[7] The role of Ayurveda and Yoga in boosting immunity and thereby reducing the infliction rate has also been proven. This also accounts for the incorporation of Ayurveda in the One Nation One Health policy by the government. Studies have shown that the awareness and adoption of Ayurveda for health management have increased significantly, especially postpandemic and millennials with lifestyle diseases are more inclined to embrace Ayurveda. If the root causes of diseases can be understood, the disease-inflicting risks can be avoided, and vitality can be maintained. Educating and healing this generation naturally help in healing the next generation, which is offered by the concept of “Ayurveda for millennials.”^[8] This year, Ayurveda day is celebrated with the theme “Har din Har Ghar Ayurveda” by the Ministry of Ayush to create awareness of Ayurveda for holistic health in every household to build up a healthy nation.^[9] The central government has introduced Yoga breaks in offices to boost employees’ productivity. It encourages employees to take a 5-min break to perform a set of yoga exercises to relieve work-related stress, be refreshed, and be rejuvenated. With enhanced focus, net productivity increases.^[10]

Through One Nation One Health to a Healthy World

By One Nation, One Health System, an integrated health system is aimed. Integrating modern and traditional systems of medicine in medical practice, education, and research can make citizens healthy through a holistic approach. This policy is planned to be implemented by 2030.^[11] This ensures the provision of health facilities for all comprehensively and holistically through the cooperation of all sections of society. The composite healthcare needs of an individual should be addressed to optimize the outcomes through holistic care is the fundamental concept of this policy. The focus should be nutrition, rejuvenation, and fitness of individuals through an integrated approach. This policy intends that Indian identity and wellness traditions be embraced in every walk of life. The implementation of this policy helps take away the burden of choosing the preferred healthcare by the patient and make it a responsibility of the healthcare systems according to the needs, thereby decentralizing the “pathy centric system” to a “patient-centric system.”^[12] Physical health and social, mental, and spiritual health domains are included in the scope of the integration of healthcare systems. The health of individuals is of utmost importance as it contributes to healthy families. Healthy families account for healthy villages and cities and, thereby, a healthy nation. Only a healthy nation can be stable in productivity and economic growth and be evolved as an undeniable power in the world.

Conclusions

The sustainability of a country depends on the health index of its citizens. The concept of One Nation One Health helps bring the quality of life through different medical systems cost-effectively so that the expenditure on health care could also be reduced. The concept of health as per Indian tradition is much higher as it always prays for the well-being of the whole world, Lokah Samasthah Sukhino Bhavantu. Only healthy nations can account for a healthy world, which can be the subsequent focus of concerned authorities. A healthy world can be achieved by introducing Ayurveda to every house by joining hands with other nations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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