While health systems evolve to be responsive to the health needs of people, the health status of people is determined by many variables outside of health systems. Various social, economic, environmental, and commercial determinants not only influence the longevity of life for people but also the burden of various diseases afflicting them. There is a growing recognition of the role played by these determinants in clinical outcomes. 

Lifestyles of people underlie most of the non-communicable diseases and certain communicable diseases. Lifestyles evolve over generations due to intermixing of cultures. Unknowingly, unhealthy lifestyles have been spreading faster across countries due to present-day global connectivity. It is a herculean task to transform these into healthy lifestyles across populations. Examples of successful interventions based on human behavioral sciences are emerging across countries.

Health literacy is an important first step in influencing lifestyles. Public policies aimed at pro-health subsidies (for healthy foods like vegetables, fruits, nuts, etc.,) and taxes (on tobacco, alcohol, sweetened beverages, etc.,) have strong evidence of improving lifestyles.

Faith-based organizations, belief systems, and practices have a strong influence on people’s behavior and have been roped in by policymakers in various interventions. Self-help groups (both on the ground and online) are trying to help each other in improving their lifestyles. Key opinion leaders like political leaders, movie actors, sports persons, etc., have an immense influence on people’s behavior. Hence, we need multi-pronged policy interventions to bring about change.

Policy interventions related to general literacy, employment, clean cooking energy, safe drinking water for every household, sanitation and hygiene, air pollution, food subsidies, tobacco control, environmental protection, climate change, road safety, drug control, food labeling, etc., have an important impact on the health of people. However, most of these are handled by other ministries and departments. This led to the emergence of the “whole of government” approach to improving the health status of people. However, operationalizing the concept into practice is highly challenging and ill-sustained unless there are well-laid-down institutional mechanisms. An easier method is to elevate health into the direct responsibility domain of prime ministers and chief ministers or whoever is the executive head of the government of the nation or the state.

For a leader, securing health is as important as securing borders. Only the apex body or the leader can orchestrate the coordination needed between different ministries and departments to formulate and implement policies, promulgate, and enforce laws in pursuit of health and well-being. Another approach is to institute good governance systems with the active participation of all the actors. Institutional mechanisms for inter-ministerial coordination and collaboration are essential to improve the health status of people and meet their health needs at all times. A similar trend is emerging at the global governance level. United Nations General Assembly is taking up global policies that have a direct and indirect bearing on health. Many of the 17 sustainable goals have a bearing on goal 3, dealing with health.

Hence, there is a need to revisit health governance architecture at global, national, subnational, and local levels to incorporate the dependency of the health status of people on upstream and downstream determinants. -Dr. Krishna Reddy Nallamalla

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