STUDY MATERIAL

2023-2024

Health Communication
COURSE CODE: BA (JMC) 108

Sanchita Chakraborty
Assistant Professor
DME
 INDEX

S.No Topic Concepts Lecture(s)

1. Public Health Definition and 2

Meaning

2 Health Awareness Meaning, Key 1

aspects, Process

3 Role and Importance of Yoga/ 1

Importance of Media Coverage
Yoga

4 Major Public Challenges, goals, 4

Health and solutions- Smoking
Lifestyle Issues in and Drug Addiction,
India Nutrition and
Obesity, Mental
Health and
Depression

5 Public Health Care Issues & Problems 2

System in India in Rural India

Issues & Problems

in Urban India

6 Medical Tourism India as a Medical 2

Tourism Destination

7 Health Journalism Concept, Need and 2

Importance

8. Roles & Functions, goals 2

Responsibilities of
a Health Journalist
9. Sources of Health NFHS report 5
Reporting
UNICEF reports

WHO

Census

10. Role of Media in Polio 3

Public Health Care
HIV/AIDS
Campaigns
Reproductive Child
Health

11. Ethics in Health Ethical concerns 2

Reporting

12. Structure and 2

Guidelines for
Health Reporting

13. Health Reporting Traditional and 2

for Various Media Digital Media

14. Writing for Public 2

Health Care

15. Information Concept and 2

Education Functions
Communication
(IEC)

Behaviour Change Concept and 2

Communication Functions
(BCC)

Communication Pre-test and 2

Campaign Evaluation

6. Future of Health Career Prospects 1

Communication

12. REVISION 4
Objectives of the Course: On completion of this course, the student should be able to:
1. define Public Health

2. describe need and importance of Health Communication

3. utilize knowledge gained in reporting and writing on health & lifestyle issues

Unit I: [Introduction to Public Health] L: 12

1. Public Health: Definition & Concept
2. Health Awareness and Role and Importance of Yoga
3. Major Public Health and Lifestyle Issues in India
4. Public Health Care System in India: Issues & Problems in Rural and Urban India
5. India as a Medical Tourism Destination
Unit II: [Introduction to Health Journalism] L: 12
1. Health Journalism: Concept, Need and Importance
2. Roles &Responsibilities of a Health Journalist
3. Sources of Health Reporting: NFHS reports, UNICEF reports, WHO, Census
4. Role of Media in Public Health Care Campaigns: Polio, HIV/AIDS, Reproductive Child
Health
Unit III: [Health Reporting and Writing] L: 12
1. Ethics in Health Reporting
2. Structure and Guidelines for Health Reporting
3. Health Reporting for Various Media: Traditional and Digital Media
4. Writing for Public Health Care: Think Globally and Write Locally
Unit IV: [Health Communication] L: 12
1. Define Information Education Communication (IEC): Concept and Functions
2. Define Behaviour Change Communication (BCC): Concept and Functions
3. Design Communication Campaign: Pre-test and Evaluation
4. Future of Health Communication and Career Prospects
 Unit I: Introduction to Public Health

Public Health: Definition & Concept

Concept of Public Health

The word health is widely used in public communication, and yet its meaning looks simple.
However, closer looks show various and diverse meanings.Public Health as defined by C.E.A
Winslow, a leading figure in the history of public health, is the science and art of preventing
diseases, prolonging life, promoting health and efficiencies through organized community effort.
According to WHO, “Health is a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity." It is concerned with the health of the whole
population and the prevention of disease from which it suffers. It is also one of the efforts
organized by society to protect, promote, and restore the peoples’ health. It is the combination of
sciences, skills and beliefs that is directed to the maintenance and improvement of the health of
all the people through collective social actions.

American Public Health Association (APHA) states that the public health is the practice of
preventing disease and promoting good health within groups of people, from small communities
to entire countries.

MAJOR DISCIPLINES IN PUBLIC HEALTH

● Nutrition: is the science of food, the nutrients and other substances therein, their action,
interaction and balance in relation to health and disease.

●Reproductive health: is a state of complete physical, mental and social being not only absence
of disease or infirmity, in all matters relating to reproductive system and to its functions and
process.

●Environmental Health The basic approach to environmental control is first to identify specific
biologic, chemical, social and physical factors that represent hazards to health or well-being and
to modify the environment in a manner that protects people from harmful exposures. The
principal components of environmental health are water sanitation, waste disposal , etc.

● Health Education is defined as a combination of learning experiences designed to facilitate

voluntary actions conducive to health. It is an essential part of health promotion.

●Epidemiology is the study of frequency, distribution, and determinants of diseases and other
related states or events in specified populations. The application of this study to the promotion of
health and to the prevention and control of health problems is evident.

● Health Economics is concerned with the alternative uses of resources in the health services
sector and with the efficient utilization of economic resources such as manpower, material and
financial resources.

● Biostatistics is the application of statistics to biological problems; application of statistics

especially to medical problems, but its real meaning is broader.

● Health Service Management is getting people to work harmoniously together and to make
efficient use of resources in order to achieve objectives.

● Ecology: is the study of relationship among living organisms and their environment. It is the
science, which deals with the inter-relationships between the various organisms living in an area
and their relationship with the physical environment. Human ecology means the study of human
groups as influenced by environmental factors, including social and behavioral factors.

● Research is a conscious action to acquire deeper knowledge or new facts about scientific or
technical subjects. It is a systematic investigation towards increasing knowledge. It aims at the
discovery and interpretation of facts, revision of accepted theories, or laws in the light of new
facts or practical application of such new theories or laws.

● Demography is the study of population, especially with reference to size and density, fertility,
mortality, growth, age distribution, migration, and the interaction of all those with social and
economic conditions.
Functions of public health

Public health is concerned with the process of mobilizing local, state/provincial, national and
international resources to assure the conditions in which all people can be healthy. To
successfully implement this process and to make health for all achievable public health must
perform the functions listed below:-

1. Prevent disease and its progression, and injuries.

2. Promote healthy lifestyles and good health habits.

3. Identify, measure, monitor, and anticipate community health needs.

4. Formulate, promote, and enforce essential health policies.

5. Organize and ensure high-quality, cost-effective public health and health-care services.

6. Reduce health disparities and ensure access to health care for all.

7. Promote and protect a healthy environment.

8. Disseminate health information and mobilize communities to take appropriate action.

9. Plan and prepare for natural and man-made disasters.

10. Reduce interpersonal violence and aggressive war.

11. Conduct research and evaluate health-promoting/disease-preventing strategies.

12. Develop new methodologies for research and evaluation.

13. Train and ensure a competent public health workforce

Public health identifies, measures, and monitors community and global health needs through
surveillance of disease and risk factor (e.g. smoking) trends. Analysis of these trends and the
existence of a functioning health information system provides the essential information for
predicting or anticipating future community health needs.

In order to ensure the health of the population, it is necessary to formulate, promote, and enforce
sound health policies to prevent and control disease, and to reduce the prevalence of factors
impairing the health of the community. These include policies requiring reporting of highly
transmissible diseases and health threats to the community and control of environmental threats
through the regulation of environmental hazards (e.g., water and air quality standards and
smoking). It is important to recognize that influencing politics is an essential function of public
health at the local, national, and global levels.

There are limited resources that can be devoted to public health and the assurance of high-quality
health services. Thus, an essential function of public health is to effectively plan, manage,
coordinate, and administer cost-effective health services, and to ensure their availability to all
segments of society. In every society, there are health inequalities that limit the ability of some
members to achieve their maximum ability to function. Although these disparities primarily
affect the poor, minority, rural, and remote populations and the vulnerable, they also impact on
society as a whole, particularly in regard to infectious and/or transmissible diseases. Thus, there
is not only an ethical imperative to reduce health disparities, but also a pragmatic rationale.

Technological advances and increasing commerce have done much to improve the quality of
life, but these advances have come at a high cost to the environment. In many cities of both the
developed and developing world, the poor quality of air—contaminated by industry and
commerce—has affected the respiratory health of the population, and has threatened to change
the climate, with disastrous consequences locally and globally. We have only one world. If we
do not take care of it, we will ultimately have difficulty living in it. Through education of the
public, formulation of sound regulations, and influencing policy, public health must restore and
monitor the environment to ensure that the population can live in a healthy environment.

To ensure that each individual in the population functions to his or her maximum capacity,
public health needs to educate the public, promote adoption of behaviours associated with good
health outcomes, and stimulate the community to take appropriate actions to ensure the optimal
conditions for the health of the public. Ultimately, public health cannot succeed without the
support and active involvement of the community.

We cannot predict, and rarely can we prevent, the occurrence of natural and man-made disasters,
but we can prepare for them to ensure that the resulting damage is minimized. Thus, disaster
preparedness is an essential component of public health, whether the disaster is an epidemic such
as influenza or the occurrence of typhoons and other natural disasters.

The role of Health in Development

Health plays a major role in promoting economic development and reducing poverty. The health
sector is the key social sector for development. Good health, both at the individual, Community
and national levels, is a prerequisite for full-scale productivity and creativity. In the first place,
the health sector should not be looked at in isolation from the rest of the economy , as a sort of
charitable handout to ensure that people do not die, for example, of preventive diseases.
Development of the health sector is seen to be a necessary requirement for future development.

The fact that development in the health sector may lead to further general development has given
rise to a new area of economic theory called “Investment in Human Capital”. The importance of
this theory is that, it not only helps to explain the development process in an economic way, but
it also forms the basis of measuring benefit in cost benefit-analysis in the health sector. This is
not to suggest that all the benefit of health or education projects is necessarily economic.

Development is linked not just to the improvement of social indicators or the attainment of basic
needs, but with wider aspirations such as high health status, and with social well-being and
change. The development process embraces not only the so-called “productive” sectors of the
economy, but also the social sectors. The health sector, besides producing benefits, which in their
own right are necessary for improving the wellbeing of the people, development of the health
sector helps to lay the foundation for development in the wider sense. Improving human’s
capacity to produce more and to fulfill this needs and aspirations does this.

Health development is an important element in the overall development of a country. For

instance in countries where HIV/AIDS is a public health problem there is a great challenge in
getting skilled human power and the country will get a burden in the health delivery by spending
the significant figure of the health budget to the pandemic. Here HIV/AIDS is not only a health
problem but also a situation that brings social, economic and political crisis for a country. In a
country with a greater proportion of its people still struggling for their daily survival, the scope
of development definition shall fit to the local scenarios.

Health Awareness

Health awareness as a tool for health promotion is critical for improving the health of
populations and promotes health capital. Health education or awareness programmes are
“Consciously constructed opportunities for learning involving some form of communication
designed to improve health literacy, including improving knowledge, and developing life skills,
which are conducive to individual and community health.”
Health Awareness activities occur in schools, workplaces, clinics and communities and include
topics such as healthy eating, physical activity, tobacco use prevention, mental health,
HIV/AIDS prevention and safety. Health promotion is defined by the Ottawa Charter as the
process of enabling people to increase control over and to improve their health. Health
promotion is viewed as a combination of health awareness or in other words health education
activities and the adoption of healthy public policies. Health literacy is an outcome of effective
health education, increasing individuals’ capacities to access and use health information to make
appropriate health decisions and maintain basic health.

Health has become one of the highly prioritized matters that people are concerned and cared
about. This can be further explained by the rise in the popularity of gymnasium, yoga classes,
organic food and regular organized health campaigns, programmes and projects organised by the
government, private sectors as well as the NGO's. Health awareness is the need of the hour with
the increasingly complex challenges towards the health of populations in the 21st century.

Nowadays, medical facilities for many diseases are widely available and easily accessible
especially where in some places, government subsidised medical centres can avail treatment
against diseases at minimal cost or sometimes, free of cost. However, people often tend to forget
the old saying which goes that “Prevention is better than cure”. This old saying is very much
valid even now. Taking necessary precaution and awareness are always better before the disaster
strikes. Once the disease starts spreading, the consequences can sometimes be troublesome,
dangerous and to the extent of life threatening. Ultimately, creating health awareness and taking
proper prevention against disease is of utmost importance.

Public awareness is important for many obvious reasons. But when it comes to health issues, it’s
a necessity. Not being aware of the ways one can contract and spread HIV is extremely
problematic in a society where HIV is a serious problem.

Without the awareness of this illness, people will continue to go about as they please,
unknowingly contracting or infecting other people. If you look at the statistics, in South Africa,
there are approximately 7.1 million people living with HIV and only 86% are aware of their HIV
status.
Its important to raise awareness, otherwise you are faced with issues such as :

1. A cycle of harm, as a result of being unaware, that is created and never-ending in the
suffering society.
2. People being misinformed about the severity of contracting the virus or prevention methods
regarding the health issue and who will either drastically overreact or neglect.
3. Victims feeling isolated and alone when, in fact, they aren’t alone and there are
organizations out there who are ready to help.
4. There being no sense of hope delivered to victims regarding treatment options.

The problem with some awareness campaigns is that they either dramatise the issue too much or
hopelessly too little.

By making it seem like once you know you’re HIV positive, You are going to die on the spot
unless you do this, that and the other thing, you are leaving the infected person in a state of
shock , unable to read further about treatment options. On the other hand, if you don’t highlight
the reality of HIV enough , people who are HIV positive or live a lifestyle that may lead them to
contract HIV, wont think twice about changing their behavior or seeking help.

If you are going to raise awareness on something, raise it right. With all the resources and
platforms available to you. Its easier than ever to spread the word, enlighten a society and
encourage them to adopt safe practice. As long as you know your audience and translate the
information in a way that they will be able to understand, through a medium that will deliver the
message appropriately.

Inform them of every aspect of the disease and how the country is dealing with it. For example,
were you aware that South Africa is in the process of running five new HIV trials that started in
2017, as a means to prevent the likelihood of contracting HIV? Your brochures, lectures and
awareness campaigns need to be inclusive of all the information available on the topic. The
more informed a person is, the more capable they are to process that information and make the
necessary lifestyle changes.

Health Promotion
Health promotion is a guiding concept involving activities intended to enhance individual and
community health well-being. It seeks to increase involvement and control of the individual and
the community in their own health. It acts to improve health and social welfare, and to reduce
specific determinants of diseases and risk factors that adversely affect the health, well-being, and
productive capacities of an individual or society, setting targets based on the size of the problem
but also the feasibility of successful interventions, in a cost-effective way. Health promotion is a
key element in public health and is applicable in the community, clinics or hospitals, and in all
other service settings. Raising awareness and informing people about health and lifestyle factors
that might put them at risk requires teaching.

The Elements of Health promotion comprises of :-

1. Addressing the population as a whole in health related issues, in everyday life as well as
people at risk for specific diseases

2. Directing action to risk factors or causes of illness or death;

3. Undertaking activities approach to seek out and remedy risk factors in the community that
adversely affect health;

4. Promoting factors that contribute to a better condition of health of the population;

5. Initiating actions against health hazards, including communication ,education, legislation

,fiscal measures, organizational change ,community development , and spontaneous local
activities ;

6. Involving public participation in defining problems, deciding on action;

7. Advocating relevant environmental, health, and social policy;

8. Encouraging health professionals’ participation in health education and health policy.

Health promotion focuses on achieving equity in health. Health promotion action aims at
reducing differences in current health status and ensuring equal opportunities and resources to
enable all people to achieve their fullest health potential. This includes a secure foundation in a
supportive environment, access to information, life skills and opportunities for making healthy
choices. People cannot achieve their fullest health potential unless they are able to take control of
those things which determine their health. This must apply equally to women and men.

The prerequisites and prospects for health cannot be ensured by the health sector alone. More
importantly, health promotion demands coordinated action by all concerned: by governments, by
health and other social and economic sectors, by nongoverwnental and voluntary organizations,
by local authorities, by industry and by the media. People in all walks of life are involved as
individuals, families and communities. Professional and social groups and health personnel have
a major responsibility to mediate between differing interests in society for the pursuit of health.
Health promotion strategies and programmes should be adapted to the local needs and
possibilities of individual countries and regions to take into account differing social, cultural and
economic systems.

Health promotion aims to help people to live healthy lives. It involves increasing people’s
knowledge and awareness, enabling them to take action to improve their health, and ensuring
that their circumstances allow them to make healthy choices. Health promotion includes: •
Health education • Developing personal skills • Strengthening community action • Reorienting
health services • Building healthy public policy • Creating supportive environments The
following Box provides some examples of health promotion activities to improve sexual health
and reduce the risk of HIV and STIs: Health education: • Increasing knowledge of the facts about
HIV and AIDS • How to care for people with HIV/AIDS Developing personal skills: • Being
able to use a condom • Assertiveness, communication and negotiation skills for women
Strengthening community action: • Providing economic opportunities for women and young girls
• Involving churches and NGOs Reorienting health services: • Providing HIV counselling and
testing • Integrated STD services in PHC • Health services for young people Building healthy
public policy: • Sex education in schools • Legal rights for widows to property and land Creating
supportive environments: • Legal access to condoms • Challenging harmful traditions •
Promoting condom use, abstinence and faithfulness Health education is defined by the Ministry
of Health and Child Welfare as "any combination of learning experiences designed to pre-
dispose, enable, and reinforce voluntary adoption of behaviour conducive to health". Health
education aims to increase knowledge and awareness and is an important component of health
promotion.

Role and Importance of Yoga

Yoga is a spiritual science for the integrated and holistic enlargement and magnification of our
physical, mental as well as moral-spiritual facets. Yoga is based on the philosophy that is
practical and useful for our daily lives. Yoga constructs desirable physiological alterations and
has sound scientific foundations. Carl G. Jung the eminent Swiss psychologist, described yoga as
“one of the greatest things the human mind has ever created” (“What is Yoga...”). The word
Yoga originated from “the Sanskrit word Yuj’ meaning to yoke, join or unite. This entails
unifying all facets of the individual - body with mind and soul - to achieve a balanced life.

To compare with other games and exercises which provide only muscular and cardio-vascular
fitness, Yoga gives an all-round development. A significant difference between the two is that
Physical exercise is basically an exercise of skeletal muscles, but what about other involuntary
muscles and organs. It is Yoga, which provides a solution to each and every part of our body.
Yoga provides, exercise, massage and toning to all organs and to all types of muscles. In other
words, the effect of Yoga reached to all internal organs to which the effect of no other exercise
can reach.

Due to modern life style man is suffering from various postural deformities and diseases like
Obesity, Hypertension, Diabetes, Migraine, Cervical, Backaches, Depression, Anxiety, Cancer,
Insomnia, Constipation, Allergy, Asthma, Cardiac diseases and etc. Various postural deformities
like Kyphosis, lordosis, scoliosis, knocked knee etc. can be seen in the modern population. For
these deformities congenital can be there, but the acquired especially the life style of an
individual is more responsible than any other reason. The population involved in the chair job
and driving generally suffered from Khyposis and as a result cervical spondolitis occurs.
Yogasanas like Bhujangasana, Matyasayasana, Chakarasana etc. yields best result, but in the
advance stage of diseases suksham Yog is helpful as muscles are too weak to bear the stress of
asanas. Obesity, wearing high heals shoes, carrying a heavy weight on the back and pregnancy in
some cases results in Lordosis. These people generally suffer from back ache especially in the
lumbar region. In lordosis, Scoliosis and knocked knee, whether acquired or genetic, Yoga
provides the best solution.

Yoga has achieved wonderful popularity in the last few years, it is the quickest growing health
movement, and despite it were developed thousands years ago. Age, religion, caste, sex has no
bar with breathing and meditation techniques. There are many types of yoga and it may be hard
for the beginners which type of yoga he or she wants to do. The most important advantage of
yoga is the physical and mental therapy, the very essence of yoga lies in accomplishing mental
peace, enhanced concentration power and a relaxed state of living. There are many health
benefits of yoga, studies have shown that yoga can relieve many common and life threatening
illness such as arthritis, chronic fatigue, diabetes, AIDS, asthma, high blood pressure, back pain,
weight reduction, obesity, common cold, constipation, epilepsy, skin problems and respiration
problems. Yoga also helps in rehabilitation of new and old injuries. Regular yoga practice builds
mental lucidity and coolness, boost body awareness, relives stress patterns, relaxes the minds and
sharpens concentration. Yoga provides tools through which one can manage which the pain and
helps contradict with the feeling of helplessness and depression. Yogic breathing and stretching
exercises have been seen to result in better mental and physical energy and improved mood. The
mental performance also increases with yoga. Doctors also have suggested that yoga can enhance
cognitive performance.

So Yoga is a multidimensional aspect and its scope has increased in the modern life of twenty
first century. It is obvious that yoga is a boon for the ‘modern’ man of twenty first century,
which has become a victim of everyday stress. Modern research has recognized the scientific
roots of yogic practices and yoga has now achieved international recognition and acclaim. As we
all know, 21st June has declared as Yoga Day in all over the world and it has celebrated in all
over the world. Today, yoga is a painstakingly worldwide phenomenon, it has taken the world by
tempest and is gaining reputation day by day. It is enviable that yoga must be made an integral
part of our educational as well as health care systems. If our masses practice yoga, they will be
physically, mentally and spiritually healthy. The rush and burden of our hospitals will be greatly
reduced. Hence, there is an urgent need to popularize yoga among the human beings. Yoga is
reliable with our ethnicity and harmonizing to science, so, it is our primary duty to endorse it
further.

Major Public Health and Lifestyle Issues in India

In health sector, India has made enormous strides over the past decades. The life expectancy has
crossed 67 years, infant and under-five mortality rates are declining as is the rate of disease
incidence. Many diseases, such as polio, guinea worm disease, yaws, and tetanus, have been
eradicated.
In spite of this progress, the communicable diseases is expected to continue to remain a major
public health problem in the coming decades posing a threat to both national and international
health security.

Besides endemic diseases such as human immunodeficiency virus infection and acquired
immune deficiency syndrome (HIV/AIDS), tuberculosis (TB), malaria, and neglected tropical
diseases, the communicable disease outbreaks will continue to challenge public health, requiring
high level of readiness in terms of early detection and rapid response. In this regard, vector-borne
diseases, such as dengue and acute encephalitis syndrome, are of particular concern.
Antimicrobial resistance is one of the biggest health challenges facing humanity that must be
tackled with all seriousness.

In addition, non-communicable diseases or NCDs are now the leading cause of death in the
country, contributing to 60% of deaths. Four diseases namely heart disease, cancer, diabetes, and
chronic pulmonary diseases contribute nearly 80% of all deaths due to NCDs and they share four
common risk factors namely tobacco use, harmful use of alcohol, unhealthy diet, and lack of
physical activities.

Concerns / Challenges

•NCDs linked to lifestyles have surpassed communicable diseases as the leading cause of lost
productivity and premature deaths.

•Cities are expanding at the cost of walking, exercising and cycling

•City governments are more sensitive to petrol and diesel prices, and road building than
topedestrian facilities and public transport

•Big differences in the status of social development between states.

•Greater urbanisation will also pose a major challenge to Indian health systems in coming years

•Increasing life expectancy will lead to more disability and a larger disease burden.
•Behavioural factors which include diets low in fruits, vegetables, and whole grains, but high in
salt and fat

•Unhealthy diets, high blood pressure, blood sugar and overweight, has doubled in India over the
past two decades.

•Health loss from road injuries highlighting the lack of a comprehensive national policy for
injury prevention

•The health crisis can potentially impair India's demographic dividend.

•Rapid economic growth has changed Indians’ lifestyles. People eat out more often, and prefer
Western-style junk food.

Solutions:

India needs to be awakened and the communities should be sensitised about the need for change.

•Overweight and obesity can be prevented through a well balanced lifestyle through healthy
eating and exercise.

•Soda and snack-makers such as PepsiCo and Nestle must make their products more nutritious

•India needs an effective, coordinated response that immediately reduces the level of air
pollution at it sources

•In addition to treating disease, one also has to prevent the occurrence of new disease.

•The state specific data in the report must be used by policymakers to determine how to spend
health budgets and which diseases to focus on.

•A countrywide tax on calorie-dense foods, such as the ‘fat tax’ recently implemented by Kerala
could be one possible approach.

•Families must encourage outdoor activities, rather than allowing kids to stay indoors playing
video games.
Several epidemiological studies, randomized prevention trials, and numerous short-term
intermediate endpoints reports such as on blood pressure, sugar and lipids have shown specific
dietary habits and lifestyle determinants as the major factors giving rise to the chronic diseases
(few of them discussed above). Certainly the urbanization process has caused poor lifestyle
choices, such as smoking, overuse of alcohol, poor healthy diet, insufficient physical activity and
chronic stress, leading to development and progression of various chronic diseases. Even though
doctors and social media encourage us for healthful habits to help prevent many-of-these chronic
medical disorders, but we generally ignore or are reluctant to either start or maintain these
appropriate, healthy behaviours. Nevertheless, healthy lifestyle methods are now easily
achievable with appropriate interventions, like nutritional counselling, exercise training, de-
addiction programmes, regular medical checkups and stress management techniques. A general
conclusion from most of the genetic and epidemiologic studies have strongly suggested that
reducing identified occupational hazards, modifying dietary habits and changing lifestyle-risk
aspects could avert most cases of cardiovascular disorders, stroke, diabetes, neurological diseases
and many types of cancers.

Public Health Care System in India: Issues & Problems in Rural and Urban India

In India during British rule, state and philanthropic intervention played a significant role in
healthcare, though most of these facilities were located in large towns, thus projecting a clear
urban bias and neglect of the rural population. Modern medicine gradually undermined systems
of Ayurveda and Unani, and those traditional practitioners who survived often concentrated in
the small towns and rural areas where modern medicine had not yet penetrated. Despite the
Bhore committee's recommendations at the dawn of independence towards correcting the rural-
urban imbalance and suggestion of integrated planning for increasing access to health services,
even post-independence the weakness of public health services in rural areas and growth of
private practice continued. Public health remained a low priority in successive five-year plans
and public health efforts remained focused on specific vertical programmes, of which the Family
Planning programme was the most prominent. This contributed to the slow and inadequate
improvement in health of the population in the period from the 1950s to the 1970s. It may
benoted that until 1983 India had no formal health policy; the planning process and various
committees appointed from time to time provided most of the inputs for the formulation of health
programme design. This unsatisfactory situation was recognised in the National Health Policy of
1983, which was critical of the curative-oriented western, urban-based model of healthcare, and
emphasised a primary healthcare approach.

This already unsatisfactory situation seriously worsened with the onset of globalisation-
liberalisation-privatisation from 1990s onwards. In this situation of inadequate and top-down
development of public health, the impact of neo-liberal policies from the 1990s has precipitated
the crisis of the public health system. The phase of privatisation-liberalisation has witnessed
staggering health inequities, resurgence of communicable diseases andan even more unregulated
drug industry with drug prices shooting up, adding up to the current crisis in public health. Along
with there treat from the goal of universal access, special health needs of women, children and
other sections of society with special needs have become further sidelined or are inadequately
addressed.

Statistics- The total value of the health sector in India today is annually overRs.150, 000 crores
or US$ 34 billion. This works out to about Rs.1500per capita which is 6 per cent of GDP (see
Table below). However, of this only 15 per cent is publicly financed, 4 per cent is from social
insurance, 1 per cent private insurance and the remaining 80 percent is spent out of personal
resources. (85 per cent of which goes to the private sector).

The total value of the health sector in India today is annually overRs.150, 000 crores or US$ 34
billion. This works out to about Rs.1500per capita which is 6 per cent of GDP. However, of this
only 15 per cent is publicly financed, 4 per cent is from social insurance, 1 per cent private
insurance and the remaining 80 percent is spent out of personal resources. (85 per cent of which
goes to the private sector).The tragedy is that in India, as in most other countries, those who have
the capacity to buy healthcare from the market may often get this care without having to pay forit
directly, and those who are below the poverty line are forced to make direct payments to access
healthcare from the market.

This Country has Considerable Healthcare Resources

•It has the largest number of medical colleges in the world

•It produces among largest numbers of doctors in the developing world. These doctors are
exported to many other countries, and are considered among the best in the world

•This country gets 'Medical tourists' from many developed countries reflecting the high standard
of medical skill and expertise here. They seek care in its state-of-the-art, high-tech hospitals
which compare with the best in the world.

•Turning to medicines, we find that this country is the fourth largest producer of drugs by
volume in the world and is among the largest exporter of drugs in the world. Of course, all these
resources require finances. We find that people here do not lag behind in paying and spend a lot
on healthcare -more than many other developing countries. Despite the existence of such
impressive healthcare resources, as we begin to move around and talk to some people in the
villages and towns of this country we are surprised to find that –

Despite all these resources, the majority of citizens has very limited access to quality Healthcare,
and has poor health indicators.

•There are low levels of immunisation - in fact less than half of the children are completely
immunised (added to this,complete immunisation coverage has declined in recent years!).
•Similarly, the minimum of three checkups during pregnancy remains unavailable for half of all
pregnant women
.• There are massive inequities in access to healthcare - while the rich avail of most modern and
expensive health services, the poor, especially in rural areas do not get even rudimentary
healthcare.

•Hospitalisation rates among the well off are six times higher than rates among the poor!•Despite
such a large drug industry which exports medicines across the globe, about two-thirds of the
population lack access to essential drugs

.•This is a country of paradoxes where women from well off families suffer due to unnecessary
cesarean operations - in some urban centres close to half of deliveries are done by operation-
while their poorer rural sisters frequently die during child birth due to lack of access to the same
cesarean operation at time of genuine need.

•Although people spend a lot on healthcare (the poorest spend one-eighth of their total income on
healthcare), the government spends much less. Of the total health spending in the country, all
levels of government make less than one-fifth, while the remaining major portion is shelled out
by ordinary citizens from their pockets. This makes the healthcare system in this country one of
the most privatised systems in the world

.•Taking loans or selling assets pays for two out of five hospitalisation episodes. The proportion
of people who are unable to access any form of treatment due to inability to pay is quite large
and increasing. A large private sector leads to high profit motives of private providers. It has
been estimated that almost two-thirds of the medicines prescribed here by doctors are irrational
or unnecessary. Nearly half of all outpatients receive mostly unnecessary injections.

While overall public health investment and expenditures have been low and inadequate to meet
the healthcare needs of the population at large, there are inequities even within this already
inadequate public health spending. The rural areas get only half the public resources of what
urban areas get on a per capita basis, and within this low allocation only 4 per cent is for medical
care and a little over one percent for capital expenditures. The rest is on preventive and
promotive programmes. In contrast in the urban areas it is a somewhat better mix of curative,
preventive and promotive services, with curative services comprising nearly half the urban health
budget.
In recent years, one can see deterioration in healthcare access in most parts of the country
because of reduced public investments and expenditures, which is compelling people to
increasingly access healthcare from the private sector which is expanding rapidly. Prime public
health services have come under the purview of privatization and user fees have been introduced
across the board with the consequence that large numbers of the poor who were the main users of
these services have now moved away from them. The collapse of the public health system during
the last one-and a half decades is definitely linked to the falling levels of public health
investment and the declining public health expenditures, accompanied by increased privatisation
of healthcare.

Medical Tourism

Medical tourism is not a new concept and is in practice since decades. It is generally referred to
the increasing practice of travelling overseas to get health care. Most patients opt for medical
tourism for elective procedures as well as complex specialized surgeries such as joint
replacement, cardiac surgery, dental surgery, and cosmetic surgeries. Also called as medical
travel or health tourism, medical tourism have several benefits for the patients seeking medical
help with limited budget. Easy access to state-of the-art technological and medical facilities,
diagnostics, and procedures makes medical tourism all the more useful.

BENEFITS OF MEDICAL TOURISM:

Even though most medical tourists consider lower cost as one of the main benefits of medical
tourism, but it is not the only factor responsible for its rapidly growing popularity. A major
advantage of medical tourism is that the patient can travel to any destination of the world to get
the best and most cost effective healthcare and treatment. The biggest benefactors are those
patients, who are not able to avail and access specialized procedures, surgeries, doctors, and
facilities like fertility treatment and alternative therapies, in their home country. Moreover,
individuals with nationalized healthcare services, like the UK and Canada, who don’t want to
wait for medical treatment, are drawn towards health tourism owing to convenience and quick
access to healthcare. The prospects of combining treatment with holiday for recuperating, is an
added bonus for the patients. There can be nothing more pleasurable than recovering in a
relaxing and spending time in beautiful environment, lying on a beach, or shopping in luxury
boutiques. Besides patients, those involved in medical tourism industry also benefit at-large from
it, as the health care providers/hospitals/doctors can become world-class experts in their areas of
specializations by having a wider patient base from all over the world, which in turn increases
their profitability in the long run. Globalizing the opportunities for health care provision, medical
tourism also contributes in the increasing flow of health information among doctors worldwide.
This way, doctors and health care professionals gain knowledge about the latest development in
the medical industry all over the world.

India: Medical Tourism Destination

The World Health Organization (WHO) defines medical tourism as tourism associated with
travel to health spas or resort destinations where the primary purpose is to improve traveler’s
physical well being through a process comprising physical exercises and therapy, dietary control,
and medical services relevant to health maintenance. India has become a destination of choice
for patients from all hemispheres as the destination of choice for a wide range of medical
services and surgical procedures. In addition to the tangible expertise of medical and nursing
staff, allied health services staff, the intangible compassionate care of support services staff
draws patients to tertiary care hospitals in India. Equally important is the lower cost of world
class treatment at a fraction of what it costs in the Western or so-called developed countries. In
addition, there is no waiting period for any of the major surgical interventional procedures in the
corporate hospitals in India. There are several dynamic internal and external factors which hinder
medical tourism in India. The future of medical tourism in India is exceptionally promising.

India is increasingly emerging as a destination of choice for a wide range of medical procedures.
The major advantages of traveling to India for medical tourism are:

1. Internationally accredited medical facilities.

2. Exceptionally well qualified physicians and surgeons who received training and gain valuable
experience at academic medical centers around the world.

3. The medical treatment cost in India are lower by at least 60% to 80% when compared to North
America and U.K.
4. There is no waiting period for any of the major surgical interventional procedures in the
corporate hospitals in India.

5. As India is becoming more interconnected with the world through globalization, the private
players have established a stronghold in the medical industry.

6. A major influence is the U.S. based NRI doctors and its origin begin from the relaxed
procedures in the 1960s which led to the influx of foreign Indian doctors into the U.K. and the
U.S. looking for better career opportunities. This led to brain drain, but as India started to
develop as an economic power house, these NRI doctors recognized the tremendous
opportunities in the private healthcare sector.

7. The doctors brought back their expertise and knowledge to invest in specialty hospitals in
India which were modeled along the lines of the American hospitals.

8. India’s corporate hospitals offer world class treatment at a fraction of the cost in the U.S. As a
result, an increasing number of international patients are making India their destination of
choice.

9. Further development of medical tourism in India can be strategized by paying attention to the
Seven Ps of marketing: (1) Product, (2) Price, (3) Place, (4) Promotion, (5) People, (6) Process,
and (7) Physical Evidence.

Hindrances to Medical Tourism

There are several dynamic internal and external factors which hinder medical tourism to India. A
sample of these factors are:

1. Decision of foreign countries to compete more aggressively with outbound programs.

2. Supply and infrastructure constraints like communications, water, transportation, electricity,

power generation and the like which may have a negative impact on the overall functioning of
the hospital.

3. Government policies that might increase the cost of functioning of the hospital by charging
extra through taxation for hospital rooms with air conditioning.
4. Patients’ perception regarding safety concerns and litigation rules in relation to failed medical
intervention.

5. A significant issue related to medical tourism is liability. In the event if anything goes wrong
during a procedure in India, the patient has to work through India’s legal system. This can be
burdensome because of geographical distance and related logistics.

6. Many large international health insurance companies have not embraced medical tourism
because they are worried about potential law suits linked to bad outcomes.

The popularity of medical tourism in India will continue to grow and become a significant source
of revenue generation. With experience, “International Patient Care” ha s become a seamless
process at many corporate tertiary care hospitals. Even Govt. of India’s All India Institute of
Medical Sciences (AIIMS) is now organized to treat international patients.

With present day lifestyles becoming a major cause for various illnesses, there has been a
growing demand for rejuvenating therapies worldwide. Countries promoting medical tourism
have extended the scope of their services to include an array of wellness awareness programs
.India, being the origin of Ayurveda, Yoga and Sidha, has an edge over other countries trying to
tap this potential market. However, medical/wellness tourism is still in its nascent stages.
 Health Journalism: Concept, Need and Importance

Health journalism is typically defined as a sub section of science journalism.

Science news, in turn, is often divided into two main categories: news that
popularizes scientific findings and news that discusses scientific issues within a
broader societal context. In the case of health journalism, the first type of news
typically covers new research findings and the second type broader societal issues,
such as antibiotic resistance or obesity. Especially in the case of online journalism,
these divisions do not apply as such. Wellbeing has been one of the megatrends of
the 2010s (see for example Singh 2012), and it is reflected in the media. Some
news outlets have divided their health coverage into two groups: science and
wellbeing. The science section usually covers research findings and medicine,
whereas the wellbeing section offers magazine-style features and tips that explain
how to eat healthily, how to treat common diseases and how to get rid of bad
habits. Good examples would be stories such as “The case for guilt-free holiday
feasting” (Vox 23 December 2016) or “In exam season, a look at the best brain-
boosting foods” (The Washington Post 22 May 2017). Health article can be
defined under following conditions:
a) It includes at least one health claim whose validity could be tested by using
health sciences methods.

b) The topic is at the centre of attention mainly because of its health impact. With
this definition, the topic itself can be anything from a political decision to a new
trend, if it is just covered for its health impact.

The definition leaves out health care stories that focus mainly on political decision-
making, such as the monetisation or organization of healthcare. Health journalism
– or ‘health communication’ to be specific, necessarily promotes health
information usually through public health campaigns, health education. Key
purpose of communicating health information is to influence personal health
choices. And the best way for health journalists to achieve this purpose is by
improving health literacy. It is expected that effective health communication be
tailored for a specific audience within a given context. Besides one-to-one,
interpersonal and mass-level communication, extensive research into health
communication is necessary to assess and reform health communication strategies.
Research surrounding health communication can facilitate the development of
preparing effective messages about health-related information through different
media (print, electronic and new media). Media tools are very strong assistants
here besides interpersonal relationships in health communities. Health journalists
can also promote training in health care facilities (i.e., hospitals), along with
providing education materials to especially patients, and other stakeholders.
Designing a health message is considered as a key element of forming persuasive
health communication strategy. Besides designing the message, understanding the
audience’s perception of the communicated information is also a must to ensure
effective delivery. Health journalists can communicate to inform and educate
people about ways to enhance healthy living in all sorts of countries – developed,
developing or undeveloped; besides, they are powerful enough to encourage a
people-friendly health policy and/or health communication strategy through many
a measures such as: increase the level of knowledge and awareness of a health
issue among a certain audience influence and/or change behaviors and attitudes
towards a health issue educate healthy practices demonstrate the benefits of
behavior changes to public health outcomes increase demand and support for
health services help the concerned authorities understand the necessity of increased
numbers of platforms (i.e., websites, software/apps) to be initiated, and increase
access to them increase ethical and responsible reporting on health-care issues
widely covering issues regarding best and accurate use of medicines Keeping the
society aware of issues regarding the broad context of medicine use, risks of
medicine use, non-drug alternatives etc. Diminish misconceptions about different
health issues, and above all advocate a position on a health issue or policy/strategy.