India’s COVID-19 Pandemic experience: Lessons and the way forward

The history of modern clinical medicine tells us how the practice of medicine evolved through the diagnosis of individuals: the cause of ill-health being first ascribed to the wrath of God, then graduating to natural forces, to specific agents, and eventually malfunctioning bodies. Similarly, therapeutic strategies evolved from prayers and magic; to products derived from herbs, plants, insects and animals; and finally, to surgery, drugs, radio therapy etc. In contrast, the history of public health is of understanding how human illnesses are related to the environment, identifying the key causal factors, and managing them through population level measures. The cases of cholera, cancer, scurvy, pellagra are only a few examples explored by John Snow, Richard Doll, Bradford Hill, James Lind and Gold Goldberger over the 18th and 19th centuries. Using large population level data, they identified the environmental, nutritional and economic and social determinants, often even before the actual causative agents were known (Buck et al., 2000). The development of statistics helped to selectively optimise clinical interventions and promoted prevention over cure. Thus, accurate data, understanding of the environment, and organised clinical interventions (including vaccination and immunisation) became crucial for the growth of public health. Gold Berger’s work on cotton mill workers is an early example of how incomes are related to the incidence of the nutritional disease pellagra. The welfare movement in Britain and Europe gave birth to the welfare state that saw the links between health, poverty, insecurity, and welfare services.