We are living through what is perhaps the worst collective nightmare in recent times, one with no end in sight. Covid-19 has spread with alarming speed and intensity infecting millions, killing hundreds of thousands, and leaving many in recovery with debilitating side effects. The pandemic has had unprecedented socio-economic implications.

Yet, the most glaring observation of the pandemic is also the most ironical – any knowledgeable medical professional will tell you that they saw this coming for a while now. Global spending on health has risen drastically in recent years to US$ 7.8 trillion in 2017, or about 10% of GDP – mostly on intervention led research and care.

Covid-19 has focused the spotlight on the sheer unpreparedness and inability of our healthcare systems to cope with threats of this magnitude. It has also driven home the lacunae in infection control measures at the individual and institutional levels, forcing people and households to embrace a highly clinical approach to infection control. There is a dire need to recast our individual lifestyles, healthcare policies, research and infrastructure to shift gears to primordial prevention and preventive research.

What is primordial prevention?

Primordial prevention addresses the root cause of risk factors to prevent the onset and growth of illnesses and diseases. It refers to measures taken to stem the development of these ailments, rather than reacting to control their effects.

These preventive measures are rooted in the intersection of environmental, economic, social, cultural and behavioral conditions and practices. In fact, the traditional Indian socio-cultural ethos has always incorporated primordial preventive healthcare as a way of life. If you grew up in India in the last century, you would have likely followed some of the following practices at home:

• Leaving your footwear outside the house, and washing your hands and feet at the tap outside before entering the house
• Eating from individual plates and strictly avoiding sharing of food while eating
• Segregating cooking vessels from the ones used to serve and eat

What were considered rigid social mores were actually primordial infection control and hygiene practices rooted in science. In fact, a regular South Indian meal always comprised of all food elements essential for good health, and there was valid rationale behind the order in which these preparations were served and consumed. For e.g.: South Indians often served meals on plantain leaves. The science: The food will absorb the polyphenols, a characteristic cancer-preventing agent found on plantain leaves. What’s more – the leaves are said to have antibacterial properties that can kill germs in the food, and they are eco-friendly, decomposing very quickly.

With advancement in sciences and lifestyle, however, a lot of these practices changed as we blindly aped the western way of life. Despite tremendous appreciable progress in modern medicine, the focus in the last few decades has shifted drastically from preventive medical support to reactive, intervention-led care.

In today’s world of instant gratification, we have begun to glorify acute care measures as the results are obvious and immediate, and this has become the norm. But the focus on intervention only provides short-lived results and the healthcare system falls apart in the face of a true challenge such has the pandemic we are now living through.

The case for investing in primordial prevention

Primordial prevention is an intangible entity and therefore, not given its due value as it is tough to quantify the benefits and outcomes of preventive measures. Comparison against other parameters also becomes difficult with no immediate, visible results.

Added to this is the natural tendency of the human mind and our conditioning (and modern media focus) to associate and drive cause-benefit correlations only between recent events and occurrences. This is driven by our strong recall of immediate events and poor long-term memory. Consider this: Until Coronavirus surfaced, we had mostly forgotten the devastating effects of the 1918 Spanish Flu, one of the worst epidemics that we could have learnt so much from.

It is also human nature to overreact to immediate problems staring us in the face and under-react to long-term threats that build up slowly over time. However, if one needed numbers to substantiate the import of investing in primordial preventive healthcare, take this. Preliminary estimates in May 2020 by the Asian Development Bank suggests a USD 5.8 – 8.8 trillion loss to the global economy due to Covid19. And actuals could be much worse depending on how long the pandemic lasts. Not to mention the loss of over 610,000 lives at the time of drafting this article.

Covid-19 will not be the last pandemic we see in this century. Healthcare globally needs a thorough rehaul and we must shift gears from reactive panic to preventive preparation. Here’s how:

• Healthcare must immediately diversify investments into preventive research and infrastructure to focus on long term defense against possible new pathogens and diseases. It will not only prepare us for the next pandemic but will also pay-off in the long term during non-pandemic times.

• Industrialists, policy makers, and VCs must make a concentrated effort to invest in long-term, preventive research and academics in healthcare. In fact, the present pattern of VC funding which is strongly focused on software firms and technology ideas that can find a big, “immediate market”, needs to change. They need to instead focus on supporting innovations and research in healthcare for long-term good. “The true challenge”, to quote VC Zack Gray, “is to build a business that does good and can raise money.” Governments too must apportion larger amounts to primary, preventive public healthcare research and infrastructure.

• The medico-socio-educational segments of society must consciously collaborate to drive home the importance of primordial prevention. Philanthropic foundations need to invest more in educating and building awareness about preventive healthcare and hygiene amongst children, adolescents, and families, particularly the under-privileged sections of the society. The mass media can contribute in driving health education programmes.

• There needs to be a global focus on making policy changes impacting lifestyle. Take for instance, stringent regulatory approvals on passive-gaming technology for kids vs promoting active sports funding, tighter food and nutrition certification guidelines promoting the wellbeing of the society, tighter restrictions on tobacco, alcohol and narcotics distribution and consumption, and more. On the contrary, governments and regulatory bodies must also provide a boost to products and inventions that can further positive lifestyle changes.

The next pandemic is only just around the corner. And given the rate and speed of globalization and lifestyle evolution, there will be many more to come in this century. The healthcare industry, corporates, governments, and citizens need to come together and consciously shift gears in our approach to healthcare, and to life at large. Undoubtedly, the investments required in research, training, planning and implementation will be enormous – both monetarily and otherwise.

The cost and effort of prevention is extremely high – can we afford it? But then, the present nightmare also begs us to ask, can we afford to not do it? The medical fraternity needs to stop focusing on treating heart attacks and strokes, and instead, focus on preventing them. At the individual and social level, we need to re-establish some of the validated lifestyle practices from yore that aid infection control. The time to shift focus to primordial preventive healthcare is NOW. And the way to do it is to take a step back in time and lifestyle practices, in order to move forward.

By Dr. Srivats Bharadwaj,
Chairman & CEO, Vatsalya Dental, Bengaluru