Have the public health policies failed to care for the marginalised communities?

If being a citizen of your state does not accompany you with certain vital rights and entitlements, you are as good as a stateless person. When the nationals of a country are left to fend for themselves on their own, the state policies are as good as not made. If an inclusive public health approach is not the prime concern of the government, the citizenry is as good as dead.

Does the responsibility of the government towards public health end at the stage of policymaking? Are those policies even inclusive of all the communities with their specific vulnerabilities? If yes, why do they still feel the exclusion? If not, what steps should the state’s obligations be met through? 

Public Health Policies 

Public health policies form the backbone of a society's well-being, encompassing laws, regulations, and actions aimed at promoting and maintaining optimal health. These policies are a multidisciplinary effort involving professionals from various fields, such as epidemiology, nursing, economics, sociology, and medicine. The responsibility for shaping public health policies lies not only with governments but also with international organisations like the World Health Organization and national bodies like the Centers for Disease Control and Prevention.

Public health policies address a broad spectrum of issues crucial to societal well-being. These encompass ensuring access to nutritious food, clean water, vaccines, and healthcare. The multidimensional approach of public health policies recognizes the interconnected nature of physical, mental, social, and economic health. They play a pivotal role in shaping the overall wellness and safety of a population. By translating theoretical research into practical solutions, these policies bridge the gap between knowledge and action. Policymakers are tasked with developing strategies for both health intervention and prevention, acknowledging the holistic well-being of the target population.

Despite their undeniable importance, public health services historically received less funding compared to medical services. While governments acknowledge the significance of these services, there's a need to address the historical disparity in funding, recognizing that public health is fundamental to preventing and mitigating health threats on a global scale. At its core, public health aims to understand and address the causes and consequences of diseases and deaths within a population. The term 'public' encompasses communities of varying sizes, from a small village to the global community during a pandemic. 

While science can identify solutions to public health issues, policies are the driving force that transforms these solutions into concrete reality. The responsibility lies with policymakers to translate knowledge into actions that benefit the collective well-being of society.

Neglected Diseases 

Neglected diseases (NDs) continue to afflict marginalised communities worldwide, causing severe disabilities and deformities that often go unnoticed. This analysis focuses on the dire health impact of diseases such as Lymphatic Filariasis (LF), Leishmaniasis, Schistosomiasis, Sleeping Sickness, Chaga Disease, Buruli Ulcer, Dengue, and others, particularly prevalent in Africa and Latin America. Despite the World Health Organization's (WHO) estimates, these neglected diseases persist, raising questions about the efficacy of public health policies in caring for marginalised populations.

Lymphatic Filariasis (LF), aptly named Elephantiasis, affects over 120 million people in 80 countries, primarily in Africa and Asia. It stands as the second leading cause of disability globally, with almost 100% of those at risk residing in least-developed nations. Treatment involves yearly administration of albendazole, but challenges persist in reaching affected populations. Endemic in 88 countries, Leishmaniasis affects 12 million people and poses a significant threat to impoverished urban areas. Visceral Leishmaniasis (VL) causes 57,000 deaths annually, with treatment challenges, including drug resistance and co-infection risks with diseases like AIDS. 

Amid the progress in the global battle against NTDs, this blog aims to spotlight the overlooked health crises faced by marginalised communities in Nepal. Scrub Typhus and Leishmaniasis emerge as focal points, illustrating the neglected health landscape within these minority populations. In the context of Nepal, Scrub Typhus, a preventable bacterial disease, demands immediate attention. Those presenting with acute febrile illness require prioritised investigation, underscoring the urgent need for accessible diagnostic tests across all levels of healthcare facilities. Tackling this disease necessitates robust surveillance efforts and a public health awareness campaign to curb transmission effectively.

Another formidable challenge is Leishmaniasis, transmitted through sandflies, with manifestations ranging from distressing skin ulcers to fatal effects on vital organs. Shockingly, an estimated 40,000 lives succumb to this disease annually. Research underscores the tight correlation between Leishmaniasis and poverty, malnutrition, and other immunocompromising factors. The disease's neglect is exacerbated by crowded living conditions and inadequate sanitation, reflecting the complex epidemiological challenges that governments and aid agencies grapple with.

Despite commendable strides in global initiatives, such as the USAID Act to End Neglected Tropical Diseases, East program, Nepal's marginalised communities remain mired in the persistence of Scrub Typhus and Leishmaniasis. The absence of accessible diagnostic tools, limited surveillance infrastructure, and the intricate web of poverty-related factors contribute to the perpetuation of these diseases. Addressing these challenges is paramount to ensure that public health policies are not only effective but also inclusive, leaving no community neglected in the collective fight against these debilitating diseases.

Arrangement in Nepal 

The journey of public health policies in Nepal has witnessed significant milestones, from the establishment of the Ministry of Health in 2013 B.S to the recent enactment of the National Health Policy in 2076 B.S. The initiation of planned development after 2007 B.S marked a pivotal moment in Nepal's public health landscape. The establishment of the Ministry of Health in 2013 B.S laid the foundation for organised public health services. Subsequent periods saw the implementation of long-term health plans, including the Alma Ata Declaration in 1978 A.D. The political changes in 1990 prompted the introduction of the National Health Policy 1991, focusing on expanding primary health services to rural areas and involving the private sector. The following years witnessed the introduction of the second long-term health plan in 2054 B.S.

The Interim Constitution of Nepal in 2063 B.S recognized health as a fundamental right, and the Second National Health Policy was enacted in 2071 B.S. The National Health Policy 2076 B.S reflects a commitment to social health protection, emphasising special services for marginalised communities. The objective is to ensure the fundamental health rights of citizens through collaboration, partnerships, and the optimum use of resources. The vision aims for healthy, alert, and conscious citizens leading happy lives.

Despite these advancements, the National Health Policy 2076 B.S does not explicitly address genetic diseases, such as sickle cell anaemia, within its framework. The policy focuses on integrated preparedness and response measures for communicable diseases, climate-related problems, and disasters. The oversight of genetic diseases among minorities is a critical weakness that requires urgent attention.

The challenges faced by Nepal's health sector include ensuring equal access for all citizens, reducing out-of-pocket expenditures, managing human resources effectively, and addressing health problems associated with globalisation, climate change, and lifestyle changes. The slow decrease in maternal mortality ratio and inadequate nutrition for a significant portion of children and women pose additional challenges.

Opportunities within the health sector include the decentralised responsibility among federal, state, and local levels, the implementation of health insurance policies, advancements in information technologies, and increased public awareness. The emphasis on data-driven decision-making, infrastructure development, and prioritisation of health services provides a foundation for positive change.

Several additional policies and strategies, such as the Health National Adaptation Plan, Public Health Service Act 2018, Nepal Health Sector Strategy 2015-2020, Nepal Health Sector Strategy Implementation Plan 2016-2021, and Urban Health Policy 2072, contribute to the comprehensive framework for public health in Nepal.

Exemplary Policies

In the pursuit of effective public health policies, various countries have implemented innovative strategies to address the diverse needs of their populations. Examining these approaches sheds light on potential alternatives for promoting the well-being of marginalised communities. Here are some notable examples:

  • Minnesota's Holistic Framework: The state of Minnesota has outlined comprehensive areas of public health responsibility, emphasising the need for a robust local public health infrastructure, promotion of healthy communities, disease prevention, environmental hazard protection, emergency preparedness, and assurance of health services. This multi-faceted approach serves as a model for integrating various elements into a cohesive strategy, ensuring that public health initiatives are both proactive and inclusive.
  • Hong Kong's Anti-Smoking Initiatives: Hong Kong's Legislative Council took a strategic stance against smoking harms by establishing the Hong Kong Council on Smoking and Health. Through a statutory framework, the government articulated its mission to inform and educate the public, coordinate research, and advise on health protection measures. While lacking specific enforcement mechanisms, this approach facilitated focused discussions on the necessary interventions, demonstrating the importance of clear policy goals and community engagement in addressing specific health concerns.
  • Human Rights and Public Health: The Swedish Example: The European Court of Human Rights ruled against the Swedish government's excessive use of power in detaining an HIV-positive individual based on perceived health risks. The case (Enhorn v Sweden, 2005) underscored the importance of respecting individual rights to liberty and privacy in the pursuit of public health goals. This example emphasises the delicate balance required when implementing measures that impact personal freedoms and the potential legal ramifications when such boundaries are crossed.
  • Balancing Individual Rights with Compulsory Vaccination: Many states globally have formulated vaccination policies, with a majority adopting advocacy programs rather than compulsory measures. Legal precedents, such as Jacobson v. Commonwealth of Massachusetts, affirm the legitimacy of the state's power to mandate vaccinations for the greater public good. However, historical examples, such as smallpox vaccination programs in England, the United States, and South Asia, highlight the challenges of imposing vaccinations forcefully. These instances demonstrate the importance of considering public sentiment, potential resistance, and the overall effectiveness of such measures.


In conclusion, while public health policies play a crucial role in societal well-being, the analysis reveals areas where improvements are needed, especially in addressing historical funding disparities and neglect of genetic diseases within marginalised communities. The experiences from Nepal and international examples underscore the importance of refining strategies to achieve a delicate balance between community well-being and individual rights. Strengthening policies, addressing challenges, and learning from diverse approaches will pave the way for a more inclusive and effective public health landscape, ensuring that no community is left behind.