Public health controversies: common characteristics.

Sir,

Public health interventions have propensity to be embroiled in controversies. There are public health controversies such as climate change, if it is science or myth,[1] or Avian flu-culling birds-public health versus livelihood issues[2] or latest H1N1 pandemic-if it was pharma industry influenced scare,[3] etc. All such controversies are very engrossing. Being in public health for decades, we know that controversies are intrinsic to public health issues. They can hardly be settled once and for all to everybody's satisfaction. We have been witnessed to the fact that public health controversies erupt like a phoenix, and get fiercely debated and they abruptly die down, either because it simply gets eclipsed by new bigger controversy or passage of time-makes it irrelevant, hence it gets buried but never get resolved. It is simply not possible, because people have taken positions on two opposing point of views and refuse to part away their stand.

When a public health debate is on with divided opinions among the experts, one needs to take a cautious approach. One needs to start with the conviction that there is nothing “right” and “wrong” in a public health debate, because the argument is never on the basics of public health but rather its application or management part of it. It has the issues like mode of intervention (vaccine, mass chemotherapy, and behavior change) and its applications to human population are the bone of contention.

Controversies are bound with every public health intervention, because target groups are communities, and because of sociological and economic dynamics that are inherent in any target communities somewhere someone is bound to be affected directly or indirectly. Controversies are intrinsic to public health, take any public health issue, it has always been surrounded with controversy, public heath professionals cannot agree on one set of intervention not because of individual opinion but because of multifactorial nature of public health problems and their possible interventions. Hence since historical times, there have been two opposing point of views on any given public health problems irrespective of old or new. Malaria control,[4] Tb control,[5] family planning[6]–all have been testimonial witness to 100 years of debates and controversy, yet none of them has been resolved to everybody's satisfaction. The 1994 Plague outbreak in Surat in India still remains debated if it was natural outbreak or was it a result of biological weapon accident/experimentation.[7] The debate lingers on even till today. There is no way such debates can be settled once for all. With new emerging diseases such as swine flu and the most recent international controversy on emergence of superbug that is resistant to all the known antibiotics in the world called “New Delhi metallo beta-lactamase” (NDM-1). Is it really originated in India?[8] All such emerging diseases and many more that on the horizon are sure to keep our legacy of we being “argumentative specimen” intact and tradition will go on.

Let us forget global public health issues for a moment and focus our attention on some thing as mundane issue as garbage disposal in our cities. There we have problems in organizing ourselves to make decision to plan and execute a small coordinated activity of waste disposal of our own making, in our own backyard. Attempt to resolving it, there we have stirred hornet nest with heated arguments: who should do?, how it is to be done?, and how much to pay and by whom?-there you have the perfect recipe for the debate and controversy arising of small public health activity.

Morale of the story: If we cannot have consensus on a minor public health activity in our own limited confines of our own backyard without having controversies, how can we even fathom that a global public health issue such as climate change or H1N1 will be devoid of controversies. Arguments on both point of views are equally valid, the issue is how one presents it with dignity and mutual respect with the supporting scientific evidence.