There is a strong tendency in public health to prioritise individual-oriented interventions over societal oriented population-based approaches, also known as individualism in public health.
Recent evidences that show individualism is preferred over population-based approach:
Pradhan Mantri Jan Arogya Yojana (PMJAY): A nationwide publicly-funded insurance scheme, it falls under Ayushman Bharat.
- It is the largest health insurance scheme in the country covering hospitalisation expenses for a family for ₹5 lakh a year. The goal is to ensure ‘free’ curative care services for all kinds of hospitalisation services so that there is no financial burden to the beneficiary.
- Population based approach – Data from the 75th National Sample Survey Organisation show that on an average, 3%-5% across most Indian States had an episode of hospitalisation in a year.
- Ideally, the Government needs to ensure health-care facilities to only 3%-5% of the population to cover all the hospitalisation needs of a population. This is population-based health-care planning.
- Individualistic response – Giving an assurance of hospitalisation to every individual without ensuring the necessary health-care services to the population points to the low proportion of population that benefited from the scheme annually.
Vaccination for COVID-19
- It was evident that around 20% of the total COVID-19 positive cases needed medical attention, with around 5% needing hospitalisation.
- Population-based approach – There is a need to have primary, secondary, and tertiary health-care facilities to manage the above proportion of cases.
- Individualistic response – Instead, by focusing on a vaccination programme for the entire population, it is again an assurance to every individual that if you get COVID-19, you will not need hospitalisation.
What are the reasons for dominance of individualism in public health?
- Dominance of biomedical knowledge and philosophy – There is a misconception that what is done at an individual level, when done at a population level, becomes public health.
This is against the contrasting philosophy and approaches of clinical medicine and public health and the evidence.
- Visibility of health impacts among general public – Health effects are more visible at the individual level, wherein improvements at the population level will be clear only after population-level analysis. The public health experts who take individual experiences at face value will judge a population’s characteristics based on individual experiences.
- Market’s role and effect of consumerism in public health – The beneficiaries for a programme become the maximum when 100% of the population is targeted.
Propagating individualism has always been a characteristic feature of a consumerist society.
