From Health for All, to All for Health

Remarks by Kul Chandra Gautam
at Consultative Meeting on Establishing a School of Public Health
at Patan Academy of Health Sciences
Kathmandu, 29 January 2012

I consider it a real privilege to join you all at the beginning of what I hope will be remembered as a momentous consultative meeting for the founding of a great institution of public health in Nepal.

We know there are already two other schools of public health in Nepal. And I believe we now have over two dozen medical schools in this country.

Quantitatively, the expansion of schools and colleges in Nepal, both in the public and private sectors, has been phenomenal. But all too often, the quality of education leaves much to be desired.

I am optimistic – indeed excited – that the proposed school of public health here at the Patan Academy of Health Sciences will set a high standard of quality education that is responsive to Nepal’s public health challenges.

I am optimistic because I have seen your draft planning document and noted how thoroughly and meticulously you have done your advanced preparatory work.

In preparation for your school of public health, you have gotten the support of WHO-SEARO and visited nearly a dozen outstanding schools of public health in countries spanning from Australia, Bangladesh, Thailand, South Africa, Norway, Sweden, and Switzerland to USA.

You have assembled a high caliber international advisory team of outstanding academicians and practitioners, some of whom are here with us today.

You seem to have worked energetically to define the goals, curriculum, and the research and service agenda for the SPH with great care and attention.

Your planning document draws on accreditation criteria and guidelines of schools of public health as recommended by WHO, and accreditation bodies of various countries, and many known best practices around the world.
Besides benefitting from such international experience exchange, I am aware that the Community Medicine Department of the Patan Academy’s own Medical School is already doing some great work that provides valuable experience for the SPH to emulate and improve upon.

With such preparation, and the week-long consultation you are beginning today, I am confident that you will be able to develop a school of public health that we can all be very proud of.

Nepal has made considerable progress, and it is one of the few least developed countries in the world that is on track to achieve – and even exceed – quite a few of the Millennium Development Goals – such as reduction of child mortality, maternal mortality, fertility, access to drinking water supply, and basic education.

With the proliferation of many public as well as private hospitals and clinics, curative services are becoming widely available, though they are still not readily accessible or affordable for low income population groups.

Indeed lack of equitable access to health care services, and inadequate attention to preventive care, and empowerment of people to protect their own health, are currently our biggest challenges.

It is precisely for these reasons that we are in need of greater attention to public health in Nepal.

Public health, as we know it, is “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations and individuals.”

There are 2 distinct characteristics of public health:

1. It deals with population-level, rather than individual-level health issues, and

2. It emphasizes preventive rather than curative aspects of health
Mass vaccination is the most well-known and effective of all preventive public health measures.

But many non-medical methods, involving healthy life-styles and behaviour change are central to improving public health.

Breast-feeding, hand washing, physical exercise, use of latrines, collection and disposal of garbage, use of condoms or mosquito nets, are among the most effective public health measures.

To promote such measures, we need a new breed of public health professionals. This is what we hope the proposed school of public health at the Patan Academy of Health Sciences will produce.

Some of you will recall that when we launched Nepal’s first Public Health Foundation in June 2010, I was asked to deliver an inaugural key note address.

In my speech entitled “A 10+2 Agenda for Public Health in Nepal”, I outlined 12 key elements of public health in this country.

These comprised: scaling-up essential health care; focusing on equity; tackling malnutrition; prioritizing non-communicable diseases; preventing accidents, injuries and disabilities; promoting environmental health; harnessing the power of education and communication for behaviour change; strengthening our health systems; fostering public-private partnership; and capitalizing on the growing international health partnership.

Besides these health related interventions, I mentioned that in the current historical juncture of Nepal, we needed to add two vital elements outside the health sector, namely: institutionalizing a culture of non-violence, and consolidation of genuine democracy.

Most of these interventions are, obviously, non-medical, requiring changes in people’s life-styles and behaviour patterns.

These are the kinds of aptitudes and skills that are not taught in most medical schools.

And these are precisely the kind of issues which I hope the proposed new school of public health here at PAHS will emphasize.

It is now widely acknowledged that the greatest gains in public health in the 21st century are likely to be derived not from medical breakthroughs, but from people’s behaviour change.

I often recall a memorable remark in the 1980s by a great champion of public health and former Director of the US Centers for Disease Control, Dr. Bill Foege, who said that, at that time, it would have cost more than $10 billion annually to add a single year to the life expectancy of an average American – through medical interventions.

But he said, we could add 11 years to their life expectancy through 4 virtually cost-free actions: a) stop smoking, b) moderate alcohol consumption, c) change certain dietary habits, and d) do moderate amount of exercise regularly.

To these, one could add a few more behavioural changes, especially relevant in developing countries like Nepal, such as: practice prolonged exclusive breastfeeding, hand-washing, safe sex, and following basic traffic rules.

None of these require sophisticated medical technology, highly trained manpower or huge investments.

What they require is attitudinal and behaviour change which can be fostered through today’s amazing information and communication technologies, now penetrating even the poor, remote communities of Nepal.

I hope that the students of the proposed school of public health will be trained to harness such simple but powerful technologies; empower community level health workers such as our amazing 50, 000 female community health volunteers, auxiliary nurses and mid-wives to disseminate effective public health messages.

Let us recall that the greatest and most effective health care provider in the world is not the doctor nor a nurse, but the mother.

The more we can do to empower her – the mother – with basic knowledge and skills in good nutrition; care and stimulation of the young child; hygiene, sanitation, and better birth spacing, the better the health outcomes for the child, and the family.

School teachers are another group of potential health workers that we tend to under-estimate.

Most children spend many years every day as captive audience of their teachers. A strong school-based health education programme could, therefore, do wonders to promote public health.

We must also harness the enormous power and outreach of radio, TV, newspapers, mobile phones and SMS technology, and the voices of our artists, singers, comedians, sports personalities and other celebrities to disseminate public health messages.

Helping to provide “Health for All” is the job of Ministries of Health and medical professionals.

Empowering people to protect their own health and transforming “All for Health” is the job of all of us, as public health activists and leaders.

I hope that graduates of our new school of public health here at PAHS, will be such transformative leaders.

That is certainly a tall order for a new institution being established in a resource poor developing country like Nepal.

But I am confident that with the dynamic and dedicated leadership of the Patan Academy of Health Sciences, and with all of our support, this is a goal within our grasp.

I wish you all a most productive consultation in pursuit of this noble goal.

Thank you.