A Call for Action: The Case for Establishing India’s Own Public Health Service

INTRODUCTION India, with its vast and diverse population, faces serious public health challenges, ranging from infectious diseases to rising cases of noncommunicable diseases (NCDs). Recent statistics indicate the gravity of this situation: the World Health Organization (WHO) estimates that NCDs contribute to 63% of all deaths in India, with cardiovascular diseases alone accounting for more than 27% of mortality.[1] Moreover, infectious diseases like tuberculosis (TB) continue to plague the country, with India bearing the highest TB burden globally, as per the Global TB Report 2023. The prevalence of dental NCDs in India has shown alarming trends.[2] According to the WHO data, about 60% of children aged 1–9 have untreated caries in deciduous teeth, whereas over 50% of individuals above 5 years suffer from untreated caries in permanent teeth. Severe periodontal disease affects approximately 19% of the population aged 15 years and older, whereas edentulism (complete tooth loss) impacts around 9% of individuals aged over 20. In addition, oral cancers, particularly lip and oral cavity cancers, have a significant incidence, exacerbated by high rates of tobacco and alcohol use, both key risk factors in the Indian context. These statistics reflect the critical need for a responsive and resilient health infrastructure that can handle both chronic and acute health threats. Despite efforts by various governmental agencies and health departments, India’s public health system faces significant structural limitations. Health policy implementation often remains inconsistent due to the lack of a centralized and dedicated public health service framework. Currently, health governance is largely fragmented across multiple agencies, causing overlaps, delays, and inefficiencies in responding to health crises, as seen during the COVID-19 pandemic. The pandemic underscored gaps in India’s healthcare delivery, with states struggling to coordinate and respond effectively, often competing for limited resources rather than collaborating on solutions. This patchwork approach highlights the importance of unified leadership in public health management, which is currently missing. In the face of these challenges, it is evident that India needs a focused public health governance model, akin to the Indian Administrative Service (IAS), Indian Police Service (IPS), etc., which could prioritize health outcomes and streamline policy execution. Such a dedicated Indian Public Health Service (IPHS) would not only strengthen response capacity but also enhance accountability, transparency, and resilience in public health governance. By establishing a centralized, professional service that addresses health concerns specifically, India could improve the coordination of health initiatives, optimize resource allocation, and foster a proactive stance toward health emergencies. Effective public health governance is not just about managing crises; it involves long-term planning, early intervention, and preventive care. An IPHS could fill this role, focusing on sustainable health improvements and ensuring that public health challenges are met with expertise and foresight. With health outcomes closely linked to national productivity and social stability, India’s investment in a dedicated public health service would be a vital step toward securing the health of its population and fostering a healthier, more resilient nation. THE CURRENT SCENARIO India’s public health system faces significant structural and operational limitations that hinder effective responses to health challenges. Unlike other countries with centralized public health services, India lacks a dedicated, unified system, resulting in fragmented health governance. Public health responsibilities are divided among multiple departments at central, state, and local levels, leading to overlaps, resource duplication, and gaps in accountability. A glaring example of this challenge was evident during the COVID-19 pandemic, where the lack of coordinated responses among health agencies and departments contributed to delays in critical decision-making and resource allocation. This disjointed approach also impeded the implementation of standardized protocols, leaving some regions underprepared, and overburdened. Similarly, efforts to manage NCDs and control communicable disease outbreaks suffer from insufficient coordination, impacting prevention and treatment programs, especially in rural and underserved areas.[3] The absence of a specialized IPHS has exposed these systemic inefficiencies, as current health services focus heavily on clinical care over population health management. Establishing a dedicated IPHS, modeled on the IAS or IPS, could streamline public health efforts, providing the leadership and continuity necessary to safeguard national health interests and strengthen resilience against future health crises. THE CASE FOR A DEDICATED PUBLIC HEALTH SERVICE India’s current public health landscape faces numerous challenges, from managing infectious disease outbreaks to tackling the rise in chronic diseases. In the absence of a streamlined structure dedicated solely to public health, responses are often fragmented and reactive. Establishing a dedicated IPHS would enable a proactive approach, addressing core issues with a strategic, long-term vision. One of the primary benefits of a dedicated IPHS would be an enhanced focus on public health issues. A centralized public health body would allow professionals to concentrate solely on health policy, disease prevention, and health education. This focused approach would help improve health outcomes by enabling comprehensive plans for pandemic response, preventive healthcare, and population health management. In a country as diverse as India, an IPHS would tailor responses to address regional health disparities effectively. Further, a dedicated IPHS would facilitate streamlined decision-making processes. Public health management currently spans across multiple agencies, often leading to delayed actions and miscommunications, especially during crises. An IPHS would eliminate the need for multiple approvals and streamline communication between departments, resulting in quicker, more coordinated responses. For instance, during the COVID-19 pandemic, various health departments struggled with alignment, which slowed down response efforts. An IPHS would mitigate these delays, enhancing India’s readiness for future health crises. Another significant advantage is the provision of specialized training and expertise for public health professionals. A dedicated public health service would ensure standardized, advanced training for its workforce, equipping them with the necessary skills to address complex health challenges. By developing a well-trained cadre of public health experts, India could ensure that health initiatives are led by professionals with a deep understanding of epidemiology, health economics, and public health law. This specialization would strengthen health system resilience, promoting evidence-based policy decisions. An IPHS would also foster improved accountability and transparency in health governance. A single governing body with a clear mandate for public health would enable better tracking of health outcomes and resource allocation. With transparent metrics and regular reporting, policymakers and the public would gain insights into the effectiveness of health initiatives, ensuring accountability at every level. Such transparency would build public trust, encouraging community participation in health programs and compliance with public health directives. LEARNING FROM GLOBAL MODELS Several nations have developed robust public health services that India can learn from, each tailoring its health administration to effectively address the unique needs of its population. For instance, the United States operates through the Centers for Disease Control and Prevention and the United States Public Health Service, which include dedicated commissioned officers and agencies focused on health policy, research, emergency preparedness, and disease control. This structured approach allows the U.S. to respond quickly to public health crises and implement preventive measures on a national scale.[4] Similarly, the United Kingdom’s National Health Service (NHS) operates as a centralized, comprehensive health system offering services directly to the public. Supported by trained public health officials and a well-developed administrative structure, the NHS coordinates preventive and therapeutic services across multiple regions, ensuring consistency in public health response. These systems are effective because they have a dedicated, well-trained workforce with specific mandates to protect public health and the ability to coordinate across various levels of governance.[5] Adapting these models to India’s diverse and complex sociopolitical landscape could mean establishing a centralized body under the IPHS that combines these aspects. For India, this could take the form of a dedicated cadre of health officers trained in public health, epidemiology, and emergency management, akin to the IAS and IPS. These officers could serve at national, state, and district levels, enabling coordination and rapid action, and could work closely with existing healthcare providers. By institutionalizing a professional public health service, India can create a system that not only addresses crisis situations but also maintains and improves health standards over time, focusing on preventive care, health education, and disease surveillance. CALL TO ACTION India’s policymakers must seriously consider the establishment of an IPHS, as public health challenges continue to rise. This new body could fill the significant gaps in the current health administration, bringing professionalism, dedication, and specialized expertise to public health management. To make this vision a reality, the government should start by creating specialized training programs within existing administrative institutions, such as the Lal Bahadur Shastri National Academy of Administration. A structured curriculum emphasizing epidemiology, biostatistics, healthcare management, and fieldwork experience would be essential. Funding is another critical factor. Establishing an IPHS would require dedicated financial support, not only for its initial formation but also for sustaining its operations across the country. Increased budget allocations for public health training, infrastructure, and preventive measures are essential steps to make this vision achievable. With additional resources directed toward public health, the IPHS could prioritize disease surveillance, health education campaigns, and preventive initiatives, ultimately reducing the burden on India’s healthcare system. CONTRIBUTION OF PUBLIC HEALTH DENTISTS IN THE INDIAN PUBLIC HEALTH SERVICES Public Health Dentists play a crucial role in advancing community health, addressing oral health disparities, and implementing preventive care programs. In a dedicated IPHS, these specialists could greatly enhance the country’s healthcare framework by leading initiatives on oral disease prevention, promoting public health policies, and conducting epidemiological research to identify and address emerging health challenges. With their expertise in community outreach and patient education, public health dentists would be invaluable in rural and underserved areas, improving health outcomes, reducing healthcare costs, and ultimately supporting the mission of a healthier, more equitable India. CONCLUSION Investing in public health is an investment in the nation’s future. A well-established IPHS would be an invaluable asset, improving India’s capacity to handle health challenges swiftly and effectively. The establishment of a dedicated public health service will not only save lives during emergencies but also improve the nation’s overall health outcomes by focusing on preventive care and sustainable health initiatives. We urge policymakers to take immediate action and prioritize the creation of an IPHS, recognizing it as a fundamental step towards a healthier, more resilient India. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.