By Gauri K. Shevatekar, MBBS, MPH, CHES
I still remember the first time I was leaving India for the U.S. — the tearful goodbyes, the way my father held my hand, and the look in my parents’ eyes as they were sending me into a world of unknown.
I understand now, after becoming a parent myself, how difficult it must have been to see their daughter leave a secure future for a world they had never seen. I was not sure what America would mean for me except for so many dreams, aspirations and possibilities.
It has been 12 years now — pursuing and practicing public health — and I have started to see not only the differences but also the similarities that these two worlds have.
Although there are huge differences in terms of economy and lifestyles, there are more similarities between these India and the U.S. than meet the eye. These great countries have bravely fought for their independence. These are two of the largest democracies in the world — and home to many, many diverse populations.
From the lens of public health and medicine, the problems faced are similar, especially the disparities in health and health care. In both countries, there are differences in incidence, prevalence, burden of disease and disease outcomes among populations — with the disadvantaged populations bearing the brunt. For poor families, cost of care determines the treatment choices and duration of treatment. The access and availability to health care are severely affected in rural areas due to paucity of doctors, health care centers and lack of transportation. Attitudes and beliefs of the patients determine whether they will seek preventive services as well as treatment. Similarly, attitudes of the providers affect the quality of care, especially for the minority populations. The health problems in both countries are numerous, multifactorial and need comprehensive solutions.
As social, economic, environmental, cultural and behavioral factors influence individual as well as population health more than health care, there is need to train the physicians in applying public health research and data in decision making as well as applying public health interventions to improve outcomes.
In both countries, there is need to bring more focus on incorporating public health in medical curriculum at undergraduate and graduate levels. More community involvement opportunities should be created for medical students and residents so that they can experience first-hand the numerous factors that facilitate or hinder their patients’ ability to seek and follow the plan of care.
It is especially important because AAMC’s Entrusted Professional Activities (EPAs) state that the medical graduates are expected to integrate principles of public health in everyday practice. A report describing national findings from the CLER visits states that few programs have a formally designed structure to address disparities. There is a lack of formal cultural competency training addressing the populations served by the programs, along with lack of standardized curricula to address disparities with residents reporting poor perceived self-efficacy to discuss disease-specific disparities with patients.
As more and more medical schools and residency programs within the U.S. are gearing toward population health, a change is on the horizon.
In India, the need to put public health in medicine is far more pronounced as the country is experiencing rapid epidemiological transition with increasing rates of morbidity and mortality due to non-communicable diseases along with continued burden of the communicable diseases. There is also need for development of robust public health infrastructure and implementation of evidence-based practice of population health. Physicians in both countries also need to lead the charge in advocacy and policymaking.
Although the spectra of health problems, burden of disease, morbidity and mortality faced by these countries are different, the comprehensive solutions to today’s health problems can only be found by research-based development and practice of prevention and intervention strategies that are multifaceted, interdisciplinary and data-driven.
As the world is facing an unprecedented crisis in the form of Coronavirus pandemic (COVID-19), it is evident that we must bridge the gap between public health and medicine to lead efforts to transform health systems and to address major population health problems.
Although multiple countries, including India and the U.S., are striving to prevent the spread of the disease, to treat and protect their populations by taking varying policy and systemic approaches, there is one very important similarity: a dedicated public health and health care workforce.
Our health care workers are enduring protective equipment shortages, and the pressure is intensifying each day with strained, overburdened systems. Still, they are putting their lives at risk every day, each minute to care for the people. In these challenging times, my heart fills with gratitude to see the unwavering commitment of those who are at the frontline. I am humbled to call many of them my colleagues, friends and family. As I stand at the confluence, in this time like no other, I feel fortunate and thankful to be a part of these worlds where we stand together in solidarity: to protect ourselves, our loved ones and our community.