Covid-19 · History India South Asia · History of Medicine · Medicine & Doctors · Politics · Public health

Aarogya Setu: The dangerous obsession with technology in public health policy

There has been a lot of commentary on how the Aarogya Setu app, publicized heavily by the Government of India, has hardly been of any assistance in the Covid control efforts. At the same time, it is important to note that perhaps the government was aware of its uselessness from the beginning, and that the app was still forced upon people for reasons other than public health.

This piece which I wrote in May 2020, takes a brief historical look at how technological “shortcuts” have for some time dominated public health policies, and how Aarogya Setu is just the latest disappointing example of this trend. The full article is here.

In the 1950s and 1960s, Indian scientists were at the forefront of groundbreaking tuberculosis (TB) research on how best to control the spread of this deadly disease in resource-poor nations… This evaluation began in 1956, under the aegis of the Tuberculosis Chemotherapy Centre in Chennai. Its primary aim was to see if there was any difference in outcomes when people were provided drugs at home (a new, untested strategy then) versus at a sanatorium (the convention). Members of the centre published a landmark 92-page report in 1959. Their main finding was “that treatment at home gave results closely approaching those of treatment in sanatorium, and the differences between the results of home and sanatorium treatment were surprisingly small.”

This meant, in a solely medical sense, that admission to sanatoria and hospitals was not necessary for routine TB treatment. But from a public health and societal sense, the interpretations were more radical. Before the study, if countries like India were to reduce community-level TB prevalence in any meaningful way, the only effective option available was to replicate the broader social, economic and environmental hygiene reforms that had successfully cut TB down in Europe and America. But now, policymakers thought, the new medicines made it possible to control TB without worrying about social conditions and poverty. In a comprehensive study of the history of TB control in India, the historian Niels Brimnes quoted a telling line from another paper of the Chennai centre: “… the successful treatment of patients in their homes need not await an increase in the standard of living.”…

The historian Sunil Amrith has shown that the generally reductionist framework of the Tuberculosis Chemotherapy Centre soon was challenged by findings from the Bengaluru-based National Tuberculosis Institute (NTI) in the 1960s: “… far from being a ‘magic bullet’ for tuberculosis, the success of chemotherapy [i.e. anti-TB drugs] was dependent on the improvement of socio-economic conditions, and on the expansion of health services to provide even coverage across the region and country.”…

Anti-TB drugs are no doubt a lifesaving intervention. But the major problem with our TB programs was not our reliance on the drugs as such but the absence of political will and enthusiasm (despite frequent on-paper presence) for socio-economic reforms and preventive healthcare, which are indispensable for community-wide TB control. It seems certain that excessive focus on the Aarogya Setu app and other quick-fix ideas to control the coronavirus epidemic will similarly erase more important, more sustainable approaches to epidemic control from policy discussions. Examples of the latter include paying ASHAs – India’s most peripheral healthcare workers – well and resolving longstanding issues they have raised; investing in and improving the country’s multiple healthcare-related data systems; and nurturing human resources for public health, like in Kerala. Then there are the broader social, environmental and economic causes of ill health, which sadly are considered too unfashionable to be discussed in an apps-obsessed policy milieu.


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