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Emergence of a Newer Health Transition in the Midst of Geopolitical Upheavals

Year: 2025
Type: article
Abstract: We, the people, have experienced three major transitions in human health during the last century, namely demographic, epidemiological, and nutritional. Add to these the phenomenal changes ensued by an increasingly complex interaction of geopolitics and global health, and we witness the silent force of people’s assertion slowly weaving their constructs against the political and strategic crises. The twentieth century also brought some other changes associated with these defining transformations. Transitions in the areas of physical activity, transport, communication, market, and healthcare delivery are restructuring our lives – quickly and significantly. While all these changes have been underscored, studied, and largely documented, the real transition in communities’ urge and aspirations on health and healthcare has not been analyzed and documented adequately. This change has manifested itself as a massive democratization of service delivery and influenced the governance of health programs globally. From the provider side, a phenomenal growth of primary and secondary care systems is improving the last-mile reach of public health interventions and from the beneficiary side, more and more nonutilizers are turning into utilizers and are demanding more from the providers. Between these two, as a critical interface, a highly active constituency of volunteers, activists, and civil society actors is emerging fast. This slow and silent wave has a tectonic character regardless of the system of governance. Even in the areas where there is no or little democracy, people’s aspirations, demands, and pressure for better health care are forcing changes in health policies and programs to aim for universal coverage with quality, equity, and dignity. Democracies are directly dependent on electoral outcomes and nondemocratic systems also need a popular support-base essential for their own continuity. In this sense, a direct or indirect mandate works universally and public health is emerging as a domain of collective activism to shape this mandate.[1] What we are witnessing increasingly is the emergence of public health agenda as a significant factor in the people–state relationships across the globe. This assertion, however, is mostly diffuse and not so explicit. In many instances, it is intertwined with other drivers with varied levels of causal distance. Health is good politics indeed, especially when political dispensations must contest periodically to keep hold on the systems of governance. The leadership of new dispensations across the world is beginning to accept what public health academia has been advocating for decades, albeit with little headway, that health cannot be dropped on people like relief material or free food coupons. It must be created and grown collectively through a participatory process using drivers that are key to dignity and equity. In the Indian context, for example, a synchrony of demand and thrust on basic sanitation and clean cooking fuel resulted in phenomenal reach and acceptance. These promotive interventions have been supported and augmented by digitally empowered communities, a nationwide health insurance scheme, and visible transformation of existing primary care facilities to Health and Wellness Centres. This has been a result of coordinated efforts by volunteers, civil society and several arms of the government led by Ministries of Drinking Water and Sanitation; Petroleum and Natural Gas; and Health and Family Welfare.[2-5] Democratization of the public health agenda is a desirable development but not enough by itself. Democracies come with a package, setting-specific challenges that can be chaotic at times. Processes of devolution of power open the windows for both opportunities and threats. The interface between providers and beneficiaries, as mentioned earlier, is a complex and “happening” space filled with the interplay of many formal and nonformal actors. Industry, activists, market, and media have a somewhat formal structure, but the ecosystem of propaganda, conspiracies, rumors, and above all, the gossip is quite amorphous to map or deconstruct. Several of these domains are quite amoeboid and noisy, especially in the systems with liberal zeal and overdrive.[6,7] Commercial drivers of health may also slowly infiltrate the systems and constitute a big risk when camouflaged as the democratic determinants. On the other hand, some democracies are showing signs of exceptional maturity by preferring better sanitation with dignity and universal health care with equity over patronizing narrative of poverty by well-entrenched “lords of poverty.” As we evolve and refine our psephology on health as an agenda of governance, we will have better insights into the riddles of public assertion, felt priorities, and electoral outcomes.[8] At the program front, the inherent verticality in certain public health interventions is in conceptual conflict with the horizontally integrated delivery of care. This conflict keeps manifesting itself with or without extraordinary situations such as epidemics or pandemics. Tension between the ideas woven around community-based and community-owned complicates the issue further. On the surface, they look like minor variations but may take a significant shape to impede the delivery of services, ownership of a program, and the final impact on health parameters. Commercial actors of health, augmented by their market drivers, enjoy a very strong community-based presence in today’s ecosystem, but the profits accumulated through the products promoted by these actors are seldom community owned. Owning the healthcare initiatives by local self-governments and their increasing participation in the decision-making processes, with some intellectual equity, may be a way ahead, but in the wake of public health crises and also in certain duly identified priority areas such as reproductive and child health care, an element of verticality may also be needed to maintain a continuum with required thrust and intensity. Public health cannot, and should not, be insulated from politics for a long period and practitioners of public health, from frontline workers to professionals and academics, may have to recognize this explicitly. Political forces across the terrain of polity need people’s support to stay relevant and promote their agenda – and here lies the window of opportunity for public health. Delivery of affordable health care with dignity and equity is a cogent political argument in itself, and the advocates of health care can build this argument further, take it to the political actors, and make them see the phenomenal dividends associated with such a futuristic investment.
DOI: 10.4103/ijph.ijph_697_25
Language: English
Open Access status: gold
Estimated APC paid: $48
OpenAlex ID: W4411927913
FWCI:
Cites: 5
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Related to: 10