PUBLIC HEALTH : THROUGH THE LENS OF LAW

INTRODUCTION 

Health refers to the overall well-being of an individual. It is one of the most essential  aspects of human life. When a person maintains good health, it positively impacts not only  their own life but also contributes to the well-being of future generations. Thus, health acts as  a basic foundation for the development and sustainability of future generations. In India, health  is not merely a matter of personal responsibility; it is also considered a legal obligation of the  State and society. Health law consists of a comprehensive collection of laws, rules, and  regulations governing healthcare services and medical practices, which are regulated by the  government.  

These laws are framed and implemented to ensure that every individual has easy and  equal access to proper healthcare and medical services, while also preventing malpractices  within the medical profession. It is well known that fundamental rights are guaranteed to every  citizen. Through judicial interpretation, the courts have recognized that the right to health is an  integral part of the right to life under Article 21 of the Indian Constitution. Over the years,  several legislations have played a significant role in regulating medical practices, controlling  the spread of diseases, and promoting the overall well-being of society. 

In the present era, people have become more conscious about their health due to the  increasing prevalence of epidemic and communicable diseases such as the common cold,  malaria, dengue, chickenpox, and hepatitis B. At the same time, advancements in digital  healthcare services and modern medical innovations have contributed to the maintenance of  better health standards. 

Through this article, an attempt is made to discuss and explain the concept of health  law, its types, public health, evaluation, scope, global health governance, and the major  challenges involved. This discussion helps individuals understand how health law plays a  crucial role in everyday life and contributes to maintaining good health for future generations.

Meaning of Health and Health Law 

In the year 1948, the World Health Organization (WHO) provided a comprehensive  definition of health. According to WHO, health is a complete state of physical, mental, and  social well-being of an individual and not merely the absence of disease or infirmity1. This  definition highlights that health is a multidimensional concept and goes beyond just physical  fitness. Health law refers to the body of laws that regulate, protect, and promote the health of  individuals and the public at large.  

It includes various legal frameworks such as policies, statutes, schemes, rules, and  regulations formulated by the government to ensure the proper functioning of healthcare  systems. Health law mandates that every individual has the right to access adequate healthcare  services, medical treatment, and a healthy living environment. It also aims to regulate  healthcare institutions and medical professionals in order to prevent negligence, exploitation,  and unethical practices in the medical field. 

Scope of Health Law 

The scope of health law is wide and not limited only to hospitals or medical treatment.  It extends to various aspects that are essential for maintaining a healthy society. Firstly, health  law covers disease prevention and health promotion. It focuses on preventing diseases through  vaccination programs, health awareness campaigns, and early diagnosis rather than relying  only on curative treatment. 

Secondly, it includes mental and emotional protection. Health law recognizes the  importance of mental health and emotional well-being and supports legal measures for mental  healthcare services, counselling, and rehabilitation programs. Thirdly, health law emphasizes  the importance of a clean and healthy environment. It regulates sanitation, waste management,  pollution control, and access to clean drinking water, which are vital for preventing diseases. 

Further, health law also ensures proper nutrition and food safety by regulating food  quality standards and nutrition-related policies. Additionally, it helps in maintaining public health standards, promoting healthcare programs, and spreading awareness among people  about healthy lifestyles and preventive healthcare measures 

Types of Health 

Health is not restricted only to the physical condition of the body. It includes multiple  dimensions such as mental state, emotional stability, social behaviour, environmental  surroundings, and spiritual well-being. 

1. Physical Health 

Physical health refers to the proper and efficient functioning of the human body without  the presence of illness or disease. Health laws regulate the availability and quality of medicines,  vaccinations, and medical treatments to ensure that every individual receives proper physical  healthcare services. 

2. Mental Health 

Mental health relates to an individual’s emotional and psychological well-being. It  includes the ability to think clearly, manage stress, and make decisions. Health laws aim to  promote mental health by introducing mental healthcare programs, policies, and institutions to  support individuals facing mental health challenges. 

3. Emotional Health 

Emotional health refers to the ability of a person to understand, express, and manage  emotions effectively. It also includes maintaining healthy relationships and coping with stress.  Legal provisions offer protection against abuse, harassment, and exploitation, thereby  safeguarding emotional well-being. 

4. Social Health 

Social health focuses on how individuals interact and behave within society. It involves  maintaining positive relationships and social harmony. Laws regulate social health through  workplace safety regulations, labour laws, and public health policies that ensure a safe and  healthy social environment.

5. Environmental Health 

Environmental health is concerned with maintaining a clean and pollution-free  environment. It emphasizes sanitation, waste management, and pollution control. A healthy  environment helps in preventing diseases and improving the overall quality of life. 

6. Spiritual Health 

Spiritual health refers to inner peace, moral values, ethics, and a sense of purpose in  life. It involves respecting oneself and others and living according to values and principles.  Spiritual well-being contributes to mental stability and overall health. 

Right to Health 

The Indian Constitution does not expressly mention the right to health as a separate  fundamental right. However, through judicial interpretation, the courts have recognized that  the right to health is an essential component of the right to life and personal liberty guaranteed  under Article 21 of the Constitution. The expression “right to life” under Article 21 does not  merely signify the right to exist or survive; rather, it includes the right to live with human  dignity and quality.2 This interpretation extends to access to proper healthcare services,  adequate medical treatment, nutritious food, and a clean and healthy environment necessary  for a dignified life. 

The State has a constitutional obligation to adopt appropriate measures for the  protection and promotion of the health of every individual. This responsibility includes the  establishment of hospitals with adequate infrastructure, availability of medicines at affordable  prices, and the implementation of effective measures to prevent and control epidemic and  communicable diseases. The government is also duty-bound to ensure hygienic hospital  conditions, safe drinking water, sanitation facilities, and access to basic necessities essential  for maintaining public health. 

Judicial interpretation has played a significant role in emphasizing the importance of  the right to health. Courts and tribunals have highlighted that denial or delay of medical  treatment, especially in emergency situations, amounts to a violation of Article 21.3 As a result, the State has been mandated to ensure that no individual is denied medical care due to financial  constraints or other barriers. 

The right to health is closely linked with other constitutional provisions such as the  right to a clean environment, labour welfare laws, and public health obligations. These  provisions collectively reflect the constitutional commitment to protecting the physical and  mental well-being of the public. Thus, it can be concluded that health forms an integral part of  the right to life, reinforcing the significance of health law and increasing public awareness  regarding its importance. 

Public Health 

Public health refers to the health and well-being of the public at large. It focuses on  protecting the community as a whole rather than individual medical treatment. Any act that  adversely affects public health may amount to a violation of the right to life under Article 21 of the Indian Constitution. Public health can be described as the science and art of preventing  diseases, prolonging life, and promoting health through organized efforts of society. These  efforts include government initiatives and community-based programs such as Anganwadi  services, polio drops, vaccination drives, the Ayushman Bharat Scheme, and the Mid-Day  Meal Scheme, all of which play a significant role in improving public health standards.4 

Evolution of Health in India 

Health in India has undergone a long and significant journey across different historical  periods. From ancient times, systems like Ayurveda and Yoga were developed as  comprehensive medical practices focusing on holistic well-being. 

Ancient and Medieval Period 

In the ancient period, Ayurveda formed the basis of public health by promoting balance  between the body, mind, and environment. Sushruta introduced early surgical techniques, while Charaka addressed epidemics, water pollution, and environmental health through his medical  writings. During Ashoka’s reign, public health was encouraged through hospitals, medicinal  plant cultivation, clean water facilities, and tree plantation for public welfare.5

Gupta Period 

During the Gupta period, the medical system further improved, and Ayurvedic  treatments became more organized and institutionalized. Medical knowledge was refined, and  healthcare practices gained greater recognition. 

Medieval Period 

In the medieval era, the Unani system of medicine was introduced in India. Hospitals  were established and were commonly known as Dar-ul-Shifa. The Unani system, although not  originally an Indian traditional system, contributed significantly to medical treatment during  this period. 

Colonial Period 

During the colonial period, public health administration in India was primarily  introduced by the British to safeguard their military personnel from widespread diseases.  Measures such as hospitals, vaccination, and sanitation were initially limited to soldiers but  were later extended to civilians. Recurrent epidemics, especially cholera and plague, led to the  establishment of the Sanitary Commission in 1864 and the enactment of the Epidemic Diseases  Act, 1897,6 which empowered the government to enforce strict disease-control measures like  quarantine and compulsory hospitalization. 

Health Committees 

One of the most important committees in the history of Indian public health was the Bhore  Committee (1946).7It made several significant recommendations, including: 

1. Establishment of a National Health Service 
2. Development of Primary Health Centres (PHCs) 
3. Integration of preventive and curative healthcare services 
4. Strengthening of rural health infrastructure. 

Post-Independence Period 

After independence, public health became a constitutional subject distributed among  the Union, State, and Concurrent Lists. Under the Indian Constitution, public health and  sanitation were placed under the State List Entry 6. Article 47 of the Constitution imposes a  duty on the State to improve nutrition levels, raise the standard of living, and enhance public  health. 

Several national health programs were introduced to address major public health challenges,  including: 

⮚ National Malaria Control Programme 

⮚ National Leprosy Control Programme 

⮚ National Tuberculosis Control Programme 

⮚ National Filaria Control Programme 

ADVANTAGES 

1. Medical Advancement and Technology: 

 Health law ensures that newly developed medical technologies are used in a safe,  ethical, and regulated manner by following established legal standards. It protects patient  rights and safety while encouraging innovation in medical science. Legal regulation also  prevents the misuse of advanced technologies and promotes accountability in healthcare  practices. 

2. Healthcare Infrastructure Development: 

 Healthcare infrastructure includes hospitals, clinics, diagnostic centres, and medical  institutions. Health laws and government policies encourage the development of well equipped healthcare facilities, availability of trained doctors, and access to modern medical  equipment, ensuring better and equal healthcare services for the public. 

3. Human Resource Enforcement: 

Health law mandates proper education, training, and certification of doctors, nurses, and  medical staff. This ensures efficiency, quality healthcare delivery, and accountability within  the healthcare system.

4. Public Health Initiatives: 

Health law supports vaccination programmes, disease prevention and control measures, and  public health awareness campaigns. These initiatives help reduce health risks, with support  from organisations like WHO and UNICEF8 

DISADVANTAGES 

1. Commercialization and Inequality: 

In recent times, commercialization in the healthcare sector has increased rapidly, where  profit-making often takes priority over patient care. This leads to inequality, as quality medical  treatment becomes unaffordable for economically weaker sections of society. Such  commercialization may result in financial burden on individuals and create barriers to  accessing essential healthcare services. 

2. Migration of Doctors and Nurses: 

Health laws are often unable to restrict the migration of doctors and nurses, as many  healthcare professionals seek better opportunities abroad. This migration results in a shortage  of skilled medical professionals, particularly in rural and underdeveloped areas, thereby  negatively affecting the quality and availability of healthcare services. 

3. Change in Disease Pattern: 

Changes in lifestyle, including unhealthy food habits and irregular sleep patterns, have  significantly altered disease patterns. Lifestyle-related diseases are increasing, creating new  challenges for public health systems. The public often faces difficulties in adapting to and  managing these emerging health issues. 

        4. Pharmaceutical Dependency: 

There is a growing dependence on pharmaceutical products, particularly imported  medicines. Excessive reliance on medication often leads to neglect of basic healthcare practices  such as proper diet, exercise, and preventive care. This dependency increases healthcare costs  for patients and may divert attention away from traditional and holistic healthcare systems. 

Role of Government 

The government plays a vital role in ensuring public health and well-being. It has a  legal and constitutional obligation to frame health policies and regulate affordable, accessible,  and quality healthcare services. By regulating hospitals, doctors, and public health programmes. The government maintains standards, accountability, and patient safety. It also  provides healthcare infrastructure, vaccination drives, awareness programmes, and manages  epidemic and pandemic situations. Through taxation and public funds, the government  strengthens medical facilities and trains healthcare professionals for better service delivery. 

Challenges 

Major challenges in the health sector include the migration of skilled doctors and  nurses, lack of public trust in equal healthcare access, and disparities between developed and  developing countries9. In addition, high costs and limited availability of medicines and  vaccines restrict access to proper healthcare for economically weaker sections of society. 

Conclusion 

Health is a fundamental requirement of human life and social development. Through  effective health laws and government initiatives, public health can be protected and promoted  under Article 21. Though complete health may never be fully achieved, collective efforts can  ensure better and healthier living conditions. 

Reference(S):

1 World Health Organization, Constitution of the World Health Organization (July 22, 1946),  https://www.who.int  

2INDIA CONST. art. 21. 

3Ministry of Health & Family Welfare, Gov’t of India, National Health Policy (2017), https://www.mohfw.gov.in.

4Ministry of Women & Child Dev., Gov’t of India, Anganwadi Services Scheme, https://wcd.nic.in.,Ministry of  Health & Family Welfare, Gov’t of India, Universal Immunization Programme, https://www.mohfw.gov.in.,National Health Authority, Gov’t of India, Ayushman Bharat–Pradhan Mantri Jan  Arogya Yojana, https://pmjay.gov.in.,Ministry of Educ., Gov’t of India, Mid-Day Meal Scheme,  https://www.education.gov.in

5Sushruta, Sushruta Samhita (Ancient Indian Medical Text),Charaka, charaka samhita (Ancient Treatise on  Medicine) ,Romila ,Thapar, Ashoka and the decline of the mauryas (Oxford Univ. Press).

6 Epidemic Diseases Act, No. 3 of 1897, INDIA CODE. 

7 Gov’t of India, Report of the Health Survey and Development Committee (Bhore Committee Report) (1946).

8 World Health Organization & UNICEF, Global Health and Immunization Programmes, https://www.unicef.org

9 United Nations Dev. Programme, Healthcare Inequality and Access to Medicines, UNDP Rep.,  https://www.undp.org.