Indian Decade

India’s Awful Public Health

Could a controversial Lancet article prompt a necessary debate on public health?

As was mentioned here Wednesday, much of the Indian medical establishment is in a state of uproar following publication of an article in the eminent British medical journal The Lancet over possible antibiotic-resistant microbes that it claims can be traced to patients who underwent medical treatment in India.

Even relevant Indian health officials have entered the fray, suggesting that The Lancet’s conclusions were dubious, based upon a limited sample and even based on pecuniary considerations. Fortunately, some within India's medical community—as well as some thoughtful political commentators—have urged all concerned to avoid making ad hominem arguments against this reputed medical journal and have called for a dispassionate examination of the evidence. Some medical practitioners have also courageously argued that Indian doctors have tended to over-prescribe antibiotics.

The debate that this article has precipitated is actually quite salubrious and could actually lead to some much-needed medical reforms in India and a curb on the feckless use of antibiotics to deal with a range of microbial infections.

However, there’s a larger issue that virtually none of the commentators—whether medical or political—have addressed. This is the critical question of public health and sanitation in India. Indian's citizenry, bluntly stated, seem to have no compunctions about dumping trash across their major cities, their municipal services are either grossly inadequate or inept as mounds of trash routinely pile up on street corners and few of India's urban denizens think twice about spitting (or even urinating) in public. Not surprisingly, water and airborne diseases are common and some have even become endemic thanks to scant attention to public health and sanitation.

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Under these circumstances, it’s hardly surprising that doctors when faced with recalcitrant infections turn to more and more powerful antibiotics to suppress infections. In turn, these drugs lose their efficacy over time. In the past, there have been warnings about the risks of such over-reliance on antibiotics but few heeded these tocsins. Leaving aside the merits or shortcomings that have been directed at the Lancet article, it may be time to start a wider debate to ensure some timely action on the appalling quality of public health in India.