In Pulse to Planet, Prof K Srinath Reddy, Founder President of the Public Health Foundation of India (PHFI), argues that greater investment in health is essential, warning that neglecting it will stall development and hinder equitable progress.
Citing lessons from the COVID-19 pandemic and beyond, he highlights how economic growth and social stability are fragile, often derailed by public health failures. For this reason, he concludes, investing in health is not optional—but imperative.
He believes it is crucial to prioritise where these health investments are directed to maximise their impact. In this regard, Prof Reddy places significant emphasis on primary health care. He considers it absolutely vital to recognise that primary care is where the majority of diseases can be effectively addressed, encompassing prevention, positive health promotion, early detection, effective treatment, and necessary referrals.
He argues that a strong primary healthcare system prevents diseases from progressing to severe stages, thus reducing the need for individuals to seek hospital care at considerable distance and expense. This, in turn, alleviates the burden on individuals, as well as the health and financial systems of the country. He reiterates that investments in health are essential, and primary health care offers the optimal opportunity due to its capacity to provide essential care for a wide range of conditions to virtually everyone.
He points out that every individual, regardless of their background, will utilise primary care services at some point in their lives, from initial vaccinations to rehabilitative care and the management of chronic conditions like blood pressure and diabetes in later years. Consequently, Prof Reddy stresses the importance of primary care systems and the need for investment in them.
Acknowledging the necessity of advanced care, Prof Reddy states that investments are also required in district and medical college hospitals to ensure the availability of secondary care and essential tertiary care services. Furthermore, he underscores the importance of establishing seamless connectivity between primary and secondary care in both directions.
He says the availability of digital technologies can facilitate this connectivity, including tele-consultations. Additionally, he suggests investing in emergency transport systems. Prof Reddy believes that these measures will enable the most effective utilisation of resources, leading to maximum health gains across all age groups and throughout the entire life course, as primary care is the point of management for everyone from pre-conception to end-of-life care. Therefore, he reiterates his conviction that investment in primary care is essential to achieve maximum health returns.
However, Prof Reddy points out that primary health care has been neglected for many years, with a perceived shift in focus towards private health care. He questions how this anomaly can be rectified.
Prof Reddy considers this shift towards neglecting primary care has been a mistake, a realisation that became apparent during the COVID-19 pandemic and even before. He notes that while these lessons have been repeated, the pandemic highlighted the issue starkly.
He explains that the majority of care during the pandemic was provided in primary care settings, both urban and rural, encompassing early detection, guidance on home isolation, testing, referrals for isolation if needed, and the entire vaccination program. He emphasises that all these crucial activities were carried out by primary health care teams.
Prof Reddy also observes that sole reliance on the private sector proved misplaced. He notes that hospital facilities did not function optimally in terms of admitting those requiring care, and even oxygen shortages were witnessed. Equally significant, he adds, was the observation that when the vaccination programme involved both the public and private sectors, most private entities could not extend their services beyond major metropolitan areas.
They lacked the accreditation to operate in smaller cities. This, according to Prof Reddy, clearly demonstrated the private sector’s limitations in serving primary care and even secondary care in many smaller cities during the pandemic.
He clarifies that he is not suggesting the private sector is unnecessary, acknowledging the need for its optimal utilisation. However, he firmly believes in the necessity of strengthening public sector primary care services in both rural and urban areas, integrating the private sector as needed and when opportunities arise. He concludes that the public sector must establish the operational terms and monitor the performance of all healthcare providers.
Considering the ongoing trend of global warming, Prof Reddy addresses how individuals can protect their own health interests. He explains that global warming will lead to various health problems. He identifies extreme heat as the most immediate and significant challenge, as evidenced by the increasing frequency of heat waves globally, including in India, causing illness and even death. He also notes that global warming and climate change will contribute to a rise in vector-borne diseases, particularly mosquito-borne illnesses such as malaria, chikungunya, dengue, and Zika, occurring with greater frequency.
Furthermore, he anticipates an increase in waterborne diseases due to extreme weather events leading to floods and water contamination, as well as droughts and water scarcity, potentially forcing people to consume unclean water if clean sources are unavailable. Prof Reddy also acknowledges the likelihood of other health issues becoming more prevalent, including strokes, heart attacks, mental health problems, and renal failure. Finally, he points out the potential impact on agriculture and food systems, leading to nutrition insecurity.
In response to the challenge of extreme heat, Prof Reddy advises individuals to avoid prolonged exposure. If such exposure is unavoidable due to occupational reasons, he recommends taking protective measures such as wearing hats, eye protection, and loose, comfortable cotton clothing that allows for ventilation.
He also suggests staying in well-ventilated areas and consuming plenty of clean water, emphasising that hydration is crucial. Prof Reddy highlights the importance of ensuring adequate ventilation even within homes to provide relief from the heat. These, he states, are some of the necessary precautions. Furthermore, to mitigate the risk of strokes and heart attacks associated with extreme heat, he advises not only drinking sufficient water but also ensuring that blood pressure is well-managed.
Reflecting on the understanding of policymakers regarding climate-resilient healthcare systems, given his influential role in healthcare globally and in India and his interactions with policymakers, Prof Reddy believes that most people have now begun to recognise the reality of climate change. He recalls a period of denial among policymakers worldwide, followed by a degree of apathy and neglect as other priorities, such as industrial development and urbanisation, took precedence, with climate change being perceived as a concern primarily for environmentalists. Consequently, environmental issues were often overlooked. However, Prof Reddy notes that in the last decade, it has become increasingly clear that the environment will be a major challenge, both now and in the future, with the potential to disrupt any developmental program. Therefore, he stresses the need to give environmental concerns top priority.
However, Prof Reddy argues that environmental protection and development should not be seen as mutually exclusive priorities. He believes there is significant overlap, as many necessary actions for environmental protection, climate resilience in food and agriculture, healthcare, urban development, and transport are integral to a country’s overall development program.
The key, he suggests, is to integrate climate-smart and climate-resilient considerations into these existing development efforts. Prof Reddy sees a convergence rather than a conflict, with resources being brought together to achieve both developmental and environmental goals effectively. He revisits the example of primary care, highlighting its potential as a major source of employment, particularly at a time when other sectors like industry and agriculture face employment limitations due to mechanisation.
The health sector, especially primary care, can offer substantial employment opportunities and build a strong health workforce. Prof Reddy believes there is a global opportunity to provide employment to a large number of young people, particularly women, through climate response and developmental initiatives, which he sees as closely intertwined.
Addressing the issue of poor overall development indicators and the realism of expecting a much-improved healthcare sector, Prof Reddy reiterates that development and climate change response should not be viewed as opposing forces but rather as interconnected necessities. He argues that neglecting climate change response will inevitably hinder or stall developmental efforts.
He provides examples, such as the impossibility of sustainable urban development amidst floods and extreme weather, and the undermining of nutrition security when food and agriculture systems are compromised by climate change. Therefore, he believes it is crucial to recognise the close link between these two areas and to invest in both intelligently.
Prof Reddy considers the perception of these as separate and potentially conflicting elements of development, particularly due to resource demands, to be incorrect. He emphasises the significant convergence between other developmental efforts and climate change response, advocating for simultaneous investment in both.
He illustrates this with the example of building healthcare infrastructure for pandemic preparedness and improving healthcare infrastructure in general, suggesting that these should be made climate-resilient and climate-smart to reduce energy consumption and enhance their ability to withstand extreme weather events.
Regarding the pressure on Indian companies, including the healthcare sector, to adopt ESG (Environmental, Social, and Governance) practices, Prof Reddy states that the adoption of ESG practices in the healthcare sector is already underway. He points out that the healthcare sector is not only a victim of climate change, experiencing infrastructure damage, transport disruptions, and the stranding of healthcare personnel due to extreme weather events, but it is also a significant contributor to greenhouse gas emissions.
Globally, he notes, approximately 5.4% of all greenhouse gas emissions originate from the healthcare sector, with about 30% attributed to energy utilisation in healthcare infrastructure and around 70% from the supply chain. Therefore, he argues that reducing energy consumption in healthcare facilities and implementing green procurement practices can significantly decrease the sector’s overall greenhouse gas emissions.
Prof Reddy believes the healthcare sector must be proactive in this regard, and he notes ongoing initiatives. He mentions the Public Health Foundation of India’s efforts to establish initiatives bringing together numerous hospitals, including a health and environment leadership platform.
He also highlights a significant global network of hospitals now coordinated by the World Health Organization. Prof Reddy concludes that many healthcare facilities are already responding to this challenge by reducing their energy consumption and greenhouse gas emissions while also adopting more climate-resilient infrastructure.
Considering India’s mixed record on the Sustainable Development Goals (SDGs), particularly concerning healthcare, Prof Reddy outlines his major concerns regarding the health-related SDG. He observes that the overall SDG agenda presents a mixed picture.
He recalls that it was built upon the Millennium Development Goals, which were not fully achieved. He notes that while the MDGs prioritised maternal and child health and infectious diseases between 2000 and 2015, progress in these areas was inadequate in many parts of the world.
Subsequently, the SDGs in 2015 expanded the scope to include non-communicable diseases, mental health, substance abuse, road traffic accidents, and other health problems, a necessary and significant expansion. When assessing India’s performance, Prof Reddy acknowledges some success in areas prioritised under the MDGs and through national health missions, such as maternal and child health, some infectious diseases, and nutritional problems.
For instance, he points to the decline in neonatal mortality rates, which had previously stagnated, as well as significant progress in reducing maternal mortality rates, infant mortality rates, and under-five mortality rates, placing India within reach of the SDG targets for 2030, although further efforts are needed in neonatal mortality. He also notes increasing success in combating tuberculosis and other infectious diseases, with remarkable control achieved in malaria in certain regions, particularly Odisha. However, he stresses the need for continued efforts to meet the 2030 targets.
Prof Reddy’s primary concern lies not with the national aggregate indicators but with the significant disparities between states. He highlights the vast differences in performance, with southern and some western Indian states generally performing well, as expected. However, he points to the NITI Aayog’s identification of states like Bihar, Jharkhand, Arunachal Pradesh, Meghalaya, Uttar Pradesh, and Assam as underperforming on composite SDG indicators, especially in health.
He emphasises the urgent need to bridge these gaps, warning that failure to do so will negatively impact national indicators. More importantly, he argues that it is unacceptable to take pride in the good performance of some states while others lag significantly. He stresses the necessity of ensuring good performance across all states in achieving SDG targets.
Furthermore, Prof Reddy reiterates that the expanded scope of the SDGs to include non-communicable diseases, mental health, and other areas is one where India has not yet made substantial progress. He urges greater attention to these areas to avoid falling short on these additional indicators.
While the momentum from MDG efforts will contribute to some SDG indicators, he cautions that areas like cardiovascular disease, cancer, respiratory diseases, and mental health are unlikely to show expected progress without the implementation of strong, targeted programmes.
When discussing the environment and planetary health, Prof Reddy observes that the conversation often remains vague, with general statements about protecting the planet. When asked for specifics, examples like avoiding deforestation, shortages, air and water pollution, and ensuring biodiversity are typically given. While these are important, Prof Reddy points out the need for a measurable metric.
He introduces the concept of “planetary overshoot day,” which measures the date each year when humanity’s demand for ecological resources and services exceeds what Earth can regenerate in that year. He explains that while humans consume natural resources annually, and natural processes lead to the depletion of some resources, nature has the capacity for regeneration within a year, provided there is no excessive interference through deforestation, excessive water consumption, pollution, etc.
Prof Reddy highlights the alarming trend of the planetary overshoot day moving earlier in the year. In 1970, it fell on December 30th, indicating a minimal environmental deficit. However, by 2023, it had moved to August 2nd, signifying a substantial environmental deficit. He further illustrates this by noting that if the entire world lived like Luxembourg or Qatar, the overshoot day would occur much earlier in the year. The concerning trend, according to Prof Reddy, is the receding date of planetary overshoot, indicating a diminishing capacity of the planet to regenerate its resources, leaving very little for future generations.
He expresses deep concern about this, stating that his book is fundamentally about the duty owed to future generations to leave the planet in a healthy state. This, he asserts, is his first key point.
Secondly, Prof Reddy emphasises the interconnectedness of all things. He notes the intricate connections within the human body and the harmonious coordination of its systems, disrupted only by detrimental behaviours like poor diet and smoking. Similarly, he argues that human beings are interconnected with each other and with nature. Failing to recognise this connectivity, he believes, causes significant harm to both the planet and ourselves.
He quotes John Muir, a Scottish-American naturalist, who stated that everything in nature is connected to everything else. Prof Reddy also references Martin Luther King Jr.’s powerful analogy of humanity being caught in an “inescapable network of mutuality, tied in a single garment of destiny,” where whatever affects one directly affects all indirectly.
He concludes by stressing the absolute necessity of recognising this harmony within individuals, society, and the global community, and working collaboratively. This collaborative effort, he reiterates, is essential not only for protecting the current generation but also as a fundamental duty towards future generations, which is also the central message of his book.
