In order to address the pressing challenges of public health in any country, governments need to focus on preparing and equipping the medical workforce, and that is a result of the education they receive, said Gagandeep Kang, Fellow of the Royal Society.
She recalled a time when her son was in the third grade and his Biology textbook described the hinge joint, something that she learnt only in medical college. He later went on to learn about vaccines in the eighth grade. But it wasn't about the principle of vaccines or why it was important, it was about what a bacterial disease is and what a viral disease is. Kang couldn't understand why her son needed to know all that. She felt that children are forced to learn these things just because this is what they will need to reproduce when they appear for their exams.
Contrary to her son's primary and secondary education, Kang, while pursuing her medical degree at CMC, Vellore in 1981, had a completely different experience. "One of the things they did in our first year was take us out into a village. We were expected to live there for three weeks and gather information on who the people of the village were. You had to learn what dry land was, what wet land was — there's a main village and a Harijan colony and the water supply to both these places were different. It taught you how health is not your patient. Health is what happens in the community and disease is what brings a patient to a healthcare facility," said Kang.
She went on to add, "If you look at health, the biggest lesson is what we are relearning today after 2,400 years. Hippocrates talked about the environment, the Sun, the wind, water. He even talked about people who drink too much or are fond of exercise. If you take all those factors from 2,400 years ago into consideration, and if you look at India and what stratification and inequity mean to society, it gives us a framework within which we can operate."
Malnutrition
"When we studied malnutrition in college, it was really skinny kids with their ribs and shoulders showing, sparse hair and crying all the time. That was marasmus. The other form was children with edematous feet, orange hair and bloated stomachs. That was Kwashiorkor. The picture of starvation was acute malnutrition. We don't see that anymore. But what is still prevalent is chronic malnutrition. In fact, it determines human capital. A 1cm difference in height for men is a 4% difference in your income as an adult. For women, that figure is 6%," explained Kang.
Obesity
On the other end of the spectrum, what we are seeing today is obesity. The Comprehensive National Nutrition Survey came out last year and it states that 1 in 3 children in the country is pre-diabetic. Kang said, "If you look at children who enter school, 1.5 per cent of them are diabetic. There is an increase of three times the level of diabetes in our population. Our education system tells us that a good student is someone who comes first in class. A good student is not the well-rounded student who plays basketball and is an all-rounder. This is what needs to change. 14 per cent obesity in adolescents in Tamil Nadu is unacceptable."
Mental health
"If you look at what we study in colleges and schools, you think about diseases that you can see; we don't look at mental health. Suicide in adolescents in India is very different from those in other countries. We have suicides because of failure in academics or love failure," said Kang.
Epidemics
Talking about pandemics and epidemics, Kang said that we only start taking note after it starts. "When does the preparation actually need to be done? It needs to be done so that people understand how it's spread before it happens. We've had the examples of Ebola, Nipah, in the last 20 years alone. Have we changed any of our thinking? Absolutely not. Where are these diseases coming from? Why can't we teach people how to interact with animals in the wild," she wondered out loud.
Prevention and screening
Kang went on to say that vaccine hesitancy is on the rise. "The problem is that if people don't see the disease, they don't see the need for prevention. They don't see the need to get a vaccine. Increasingly, levels of immunisation are going down. These are things that need to be taught in schools," she said.
Financial protection
Kang believes that the education system must teach young people to plan for financial protection. She said, "Two-thirds of our spending on health comes out of our own pockets. Do we teach children about health insurance? Do we talk to politicians about what it means to be able to plan for health expenditures? Our health budget within the government is one of the lowest in the world and we keep hearing about how difficult it is to increase spending. We have new initiatives, some of them started with big announcements, and now we have started talking about making these functional."
Purposeful learning
"What we need to do is start with the end in mind," said Kang and added, "We need to integrate health as a part of life, we need to talk about screening and prevention and the promotion of health. We need to think about mental health education, physical education and nutrition. We need to teach young people financial protection, how to be ready for life. Education needs to serve the purpose, in each phase, be it primary, secondary or higher education."
