| PYQ Relevance: Q) Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC CSE 2015) |
Mentor’s Comment: UPSC Mains have asked questions around the Public Health Policies (2017) and Newer Health Challenges (2020 and 2022).
India is aiming for real-time public health monitoring platforms National Health Mission Health Management Information System (NHM-HMIS), and the Integrated Disease Surveillance Programme (IDSP) to enhance surveillance, monitoring, and resource allocation at primary healthcare levels.
Today’s editorial reflects on the historical context of the Bombay Plague of 1896 and its implications for contemporary public health practices. This content can be used as a case study while exchanging ideas on ‘Public Health Policies and challenges in India’.
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Let’s learn!
Why in the News?
There are ongoing discussions in Parliament around public health strategies in the wake of recent health crises, including the past COVID-19 pandemic.
- By reflecting on historical lessons from the Bombay 1896 plague outbreak, we can analyze the significance of community engagement, comprehensive disease management strategies, and ethical considerations in health interventions.
| What were the Public Health Measures implemented by Britishers and how effective were they? • Quarantine and Isolation: Infected individuals were forcibly removed from their homes and taken to plague hospitals or camps, where they were often separated from their families. This included door-to-door searches conducted by soldiers to identify the sick. • Destruction of Property: Personal belongings and houses of the infected were often burned and demolished which led to substantial loss of property for many residents. • Sanitation Campaigns: A large-scale sanitation initiative was launched, which included flushing sewers with seawater, washing streets with lime, and disinfecting homes. o Special camps were established for the treatment of the infected but often faced criticism for poor conditions and high mortality rates. • Legislative Measures: The Epidemic Diseases Act of 1897 was enacted, granting authorities extensive powers to enforce health measures, including movement restrictions and compulsory examinations. Were they effective? • Limited Success: The death toll exceeded 33,000 within a short period, indicating that these strategies did not sufficiently curb the outbreak. • Social Backlash: Reports of disrespect during inspections and inadequate hospital conditions fueled anger, resulting in protests and even violent incidents against medical personnel. • Migration and Spread: Many residents fled Bombay in response to the plague and government actions, which inadvertently contributed to the spread of the disease beyond urban areas. • Long-term Impact: While some improvements in urban infrastructure and public health policies emerged post-plague, many immediate measures were criticized for their insensitivity to local customs and needs. |
What was positive in this policy implementation despite the criticism?
- Emphasis on control over cases: The Indian Plague Commission’s approach during the 1896 Bombay Plague focused significantly on controlling the movement of people and the spread of the disease rather than directly addressing the health needs of affected individuals. Focus Areas were:
- Railway Plague Inspection Stations Map (to monitor the movement of people) focused on railway networks and inspection points.
- Chausa Observation Camp Plan detailed layouts of observation camps that reflected a militarized approach to quarantine with prominent police presence.
- Khanpur Station Map illustrated disinfection zones and highlighted the role of police in maintaining control over these areas.
- Cartographic Approach and Its Consequences: The maps were unusually colorful for administrative reports, possibly to convey a sense of effective control while downplaying the epidemic’s severity. The emphasis moved from identifying who was affected by the plague to understanding where the disease could potentially spread.
- Prioritization of State Control: The Commission’s focus on control points indicated a prioritization of state mechanisms for surveillance rather than an understanding of epidemiological factors or community health requirements.
- This approach raised concerns about the adequacy of public health responses that prioritized state security over effective disease management and community welfare.
What lessons can contemporary public health systems learn from the Bombay Plague?
- Community Engagement: Effective public health responses must include community cooperation. The mistrust generated by colonial policies highlights the need for transparent communication and involvement of local leaders in health initiatives.
- Comprehensive Disease Management: The outbreak underscored the importance of not only immediate medical responses but also long-term strategies addressing underlying social determinants of health such as poverty and sanitation.
- Ethical Considerations: The harsh measures taken during the plague raise ethical questions regarding public health interventions. Balancing individual rights with community safety remains a critical challenge for public health officials today.
- Historical Reflection: Understanding past epidemics can inform current practices. The Bombay Plague illustrates how historical narratives shape contemporary health policies and societal attitudes toward disease management.
