• The public health policy in India prioritises individual-oriented interventions instead of societal oriented population-based approaches.
• Evaluation of publicly-funded insurance schemes shows that low proportion of population benefited from such schemes.
• Example: Pradhan Mantri Jan Arogya Yojana (PMJAY) and COVID-19 vaccination focused on individualism rather the focusing on population-based interventions.

Pradhan Mantri Jan Arogya Yojana (PJAY)

• It was launched by Ministry of Health and Family Welfare under Ayushman Bharat scheme.
• It is centrally sponsored scheme funded both by State government and Central government.

• It is largest health insurance scheme in country.
• It covers hospitalisation (pre- and post) expenses for a family of ₹5 lakh a year.
• Goal- to ensure free health services for all kind of hospitalisation to reduce financial burden on beneficiary.
• It is umbrella scheme of Health and wellness Centres and National Health Protection Scheme.

How PMJAY promotes ‘individualism’ in public health?

• Every individual is assured that this scheme will cover expenses of hospitalisation.
• This is individualistic response to problem of hospitalisation expenditure faced by populations.
• According to National Sample Survey Organisation (75^th round)- only 3% of total population in India suffered hospitalisation in a year.
• It varies for 1% for Assam, 4% for Goa and 10% for Kerala depending on function of availability.
• This describes ineffectiveness of PMJAY.
• PMJAY scheme does not mention actual need for hospitalization services for any population.
• The assurance of a hospitalization service remains an unfulfilled promise when more than 90% of those who were given the promise do not need hospitalisation in the near future.

How COVID-19 vaccine efforts focused on ‘individualism’ in public health?

• COVID-19 vaccine drive has showed that COVID-19 vaccine cannot prevent people from getting disease.
• It only reduces hospitalisation and deaths in when contracting COVID-19.
• Around 20% of total COVID-19 positive cases needed medical attention, 5% needed hospitalisation and 1%-2% needed intensive care (ICU) or ventilator support.
• Most of deaths in COVID-19 were due to failure in offering ventilator and ICU support services to the needed person and not due to a person missing COVID-19 vaccination.
• Public health experts mistake in judging a population’s characteristics based on individual experiences.
• This is known as atomistic fallacy in public health.

Reason for dominance of individualism (instead of population-based approaches) in public health

• There is misconception regarding public health that what is done at individual level when done at population level, becomes public health.
• Health effects are more convincing at individual level.
• Due to influence of market’s role and the effect of consumerism in public health practice Government tries to include maximum population as target beneficiaries for a particular scheme, even if the beneficiaries don’t need the benefits provided by the scheme.

Suggestions

• To overcome the undernutrition problem government should focus on population-based approaches such as a strengthening of Public Distribution System, supplementary nutrition programmes.
• There should be less emphasis on individualist solutions such as micronutrient supplementation and food fortification.
• For chronic disease control, government should not focus much on early diagnosis and treatment.
• population-based approaches such as modifying health behaviours- through organised community action should be adopted.
• For population-based health-care planning, Government must ensure health-care facilities to only those who need it.
• For example: Government needs to ensure health-care facilities to only 3%-5% of the population of a state to cover all the hospitalisation needs of a population.
• To effectively manage upcoming pandemic, focus on population-based approach by improving primary, secondary and tertiary health-care facilities to manage cases.
• Curative care services should be planed based on population-level planning.
• This is because curative care provisioning is never planned at an individual level as epidemiologically, every individual will not necessarily need curative care every time
• Morbidity profile of a population across different age groups can be used to plan curative care needs of a population.
• Improvements at population level should be done after population-level analysis.
• This requires expertise and orientation about society.
• It is a skill required for public health practitioners.

Propagating individualism is a characteristic feature of a consumerist society as every individual can be a potential customer during risk and susceptibility. Such forms of individualistic approaches in public health should be resisted to safeguard its original principles of practice which are population, prevention, and social justice.