EPIDEMIOLOGY - THE NEGLECTED TOOL IN NATIONAL-HEALTH PLANNING

The adoption of the Constitution of India on January 26, 1950, saw the country dedicating itself to a new social order and to the elimination of poverty, ignorance and ill health. An appraisal of the health situation of the country, four decades after, reveals a picture of light and shade. Life expectancy has increased, consequent to the slow but steady decline in overall mortality. Some communicable diseases like small pox and plague have been eliminated, while others like cholera contained. The prevalence of immunizable diseases has registered a decline in recent years. Nevertheless, the overall morbidity pattern remains fairly unchanged. Diarrhoeal disorders, acute respiratory infections, tuberculosis, and viral hepatitis still take a heavy toll of the lives of our people. No significant dent has been made in the problem of malnutrition. Adding to the burden of ill health is the emergence of the new life-style diseases. An examination of the programmes and policies of the Government, reveal a plethora of programmes specifically targeted at individual diseases, planned to operate with a top down approach. Classical examples are, National Malaria Control Programme (NMCP), later changed to National Malaria Eradication Programme (NMEP), National Filariasis Control Programme (NFCP), National Leprosy Control Programme (NLCP), and National Family Welfare Programme (NFWP). Evaluation of these programmes done many years after their inception have almost invariably revealed that the programmes failed to achieve their objectives. Critical examination of the reasons for failure suggests that the programmes were all conceived and implemented without adequate epidemiologic information. In the absence of an epidemiologic approach regarding the causal factors of diseases in question and the methods of control and prevention, highly technocentric specialised interventions were adopted. The social, cultural and environmental determinants of ill health were neither perceived nor incorporated into the strategies of control. It appears that we have not learnt our lessons as exemplified by the newly launched scheme of Universal Iodisation of Salt to Control Iodine Deficiency Disorders (CIDD) and the proposed Anaemia Prevention Programme envisaging universal coverage of all women and children. The need for strengthening epidemiologic research and approaches in health management cannot be understated.