This document summarizes the history of healthcare systems in India, particularly focusing on indigenous Ayurvedic medicine. It discusses that in pre-colonial India, Ayurvedic medicine was practiced through both formal training programs and informal rural practitioners, and knowledge was often passed down within families and castes. Buddhist monks also contributed to the development and spread of Ayurveda. Over time, surgery within Ayurveda declined and was practiced more by barber-surgeons. Tribal communities also played an important role in collecting medicinal plants. The document sets up an analysis of how different healthcare systems gained legitimacy and influence in India over time.
Abstract—Theories of sociology of health and illness defy the biomedical model of disease as many of them are ‘concerned with the social origins and influence on disease’ rather than pathological reasons only. There are five sociological perspectives of health and illness: Social Constructionism, Marxism, Feminism, Foucaulian analysis, and Functionalism. These different sociological perspectives were critically analyzed through this article as for better understanding of conceptualize management of health services Social Constructionism is a sociological perspective focus on the sociology of knowledge and reality. Marxism focuses on equity between social classes and emphasizes inequality in capitalist society. According to Marxism inequality of distribution healthcare services in capitalist society arise from the marginalization of some categories of the population who do not contribute to economic system. Feminist theory is to understand and explore the multiple and various reasons for inequalities between the genders. In the healthcare sector, feminists believe that healthcare organizations are hierarchical systems, where doctors (usually men) are at the top level while nurses (usually women) have a lower level of importance. Main areas that Foucault theory emphasizes are power, knowledge and discourse. Foucault believes that there is a relationship between power and knowledge. This relationship appears clearly in the health field, as medical professionals comprise a group of people who have special knowledge (medical knowledge) and they gain the power from this knowledge. Finally, functionalism is a sociological perspective that describes society as a system made up of ‘interconnected and interrelated parts’ and it highlights the relationships between different parts of society In conclusion, the five sociological perspectives provide holistic picture about conceptualization of healthcare systems.
Abstract—Theories of sociology of health and illness defy the biomedical model of disease as many of them are ‘concerned with the social origins and influence on disease’ rather than pathological reasons only. There are five sociological perspectives of health and illness: Social Constructionism, Marxism, Feminism, Foucaulian analysis, and Functionalism. These different sociological perspectives were critically analyzed through this article as for better understanding of conceptualize management of health services Social Constructionism is a sociological perspective focus on the sociology of knowledge and reality. Marxism focuses on equity between social classes and emphasizes inequality in capitalist society. According to Marxism inequality of distribution healthcare services in capitalist society arise from the marginalization of some categories of the population who do not contribute to economic system. Feminist theory is to understand and explore the multiple and various reasons for inequalities between the genders. In the healthcare sector, feminists believe that healthcare organizations are hierarchical systems, where doctors (usually men) are at the top level while nurses (usually women) have a lower level of importance. Main areas that Foucault theory emphasizes are power, knowledge and discourse. Foucault believes that there is a relationship between power and knowledge. This relationship appears clearly in the health field, as medical professionals comprise a group of people who have special knowledge (medical knowledge) and they gain the power from this knowledge. Finally, functionalism is a sociological perspective that describes society as a system made up of ‘interconnected and interrelated parts’ and it highlights the relationships between different parts of society In conclusion, the five sociological perspectives provide holistic picture about conceptualization of healthcare systems.
Lesson learned and not learned in COVID -19 PANDEMICHarivansh Chopra
in march 2019 WHO declared covid -19 as pandemic and since than we have come long way to understand the epidemiology of covid -19. we also have learned quite a number of unpleasant/pleasant lessons in the control and management of covod -19. vaccines have been developed by a quite rapid pace across the globe and similarly vaccine hesitancy and utilisation has also been seen across the globe . this is a very simple presentation highlighting the the importance of correct knowledge and strategies to control this pandemic
When the cold war was over at the end of 1980th, we expected that the 21st century would be peaceful, progressive, and politically stable. On the contrary, the strong consciousness of ETHNICITY was dramatically emerged in eastern European ethnic groups that were controlled by the old Soviet Union. The worse situation was the case of old Yugoslavia where were divided into three parts with arms. As we know, that war was the terrible genocide as we know.
What is “ Medical Anthropology?
Health and Sickness could be defined as the dynamic studies. Because, the concept of the sickness and health is depended on the indigenous values. It means “dynamics”.
2. Biomedicine and cultural( behavial sciences can be understood reciprocally.
Cultural Diagnosis.
The fact that the past scientific research and analysis gather so many different specialists needs to be stress. No profession can get alone the right perspective to comprehend the destructiveness of violence, we need different points of view to fight against it and hopefully to transfer this knowledge to the policy making body. It is my hope that our policy makers and society will begin to realize the importance of the anthropological aspects which I am going to discuss in this short paper.
Now, I would like to take this opportunity to share the role of Anthropology in this issue with policy makers and anthropologists but, let me first show about the role of anthropology in the process of development and its connection with violence. I believe that the anthropological theory should apply to the practical field. Another word, I would say that anthropologists must put on two hats (theoretical and practical).
The work was presented during the II Workshop on Medical Anthropology in Rome, October 14th - 15th 2011.
This book represents a thorough revision of the fi rst edition. The structure of the book has been changed to help the fl ow of learning. Key concepts of chance, bias, confoundingand causality are now introduced earlier to help student understanding.
The purpose of this investigation is:
- a new pathway to medical anthropology of split selves as found in shamanistic s?ances, and psychiatric disorders, with relevance ot self-help group settings.
In particular, the effect of small-group semi-therapeutic sessions as observed in Urakawa Bethel house will be discussed with reference to "cultural personhood.“
This work was presented during the II Workshop on Medical Anthropology in Rome, on October 14th - 15th 2011
what is community medicine ?, why it is requiered ?, what is health for all. Primary health is the key to achieve it. what is deprofessionalization of Medicine ?
At the end of this presentation the attendant is expected to:
Define Epidemiology.
Identify the main issues in the definition.
Discuss the uses of Epidemiology.
Latin american critical ('social') epidemiology new settings for an old dreamJim Bloyd, DrPH, MPH
Breilh, J. (2008). Latin american critical ('social') epidemiology: New settings for an old dream. International Journal of Epidemiology, 37(4), 745-50. doi:10.1093/ije/dyn135
The specialty which deals with population.
Comprises those doctors who try to measure the needs of sick and healthy.
Who plan and administer the services to meet the needs.
Who are engaged in research & teaching in the field.
1. Structure of mortality. The main causes of population deaths.
2. Methodology, model and principles of health promotion.
3. Types of prevention. Federal Program in Russia.
Community medicine let's think beyond diseaseDr.Jatin Chhaya
Introduction - Community Medicine
Concept of Hygeine, Public health, Preventive & Social Medicine and Community diagnosis..
Difference between Clinician and Epidemiologist..
This article from Social Science & Medicine, a peer-reviewed journal, uses the lens of medicine to understand India’s social history. The author examines how different systems of medicine – biomedicine (based on biological or biochemical principles), Ayurveda, Unani, among others – were perceived in mainstream Indian national politics in the first half of the 20th century. Not only did the British colonial state give biomedicine “cultural authority” over indigenous medical systems, but nationalist leaders and later governments did too. This has greatly shaped the contemporary view of medical practices. The article discusses the three main positions (listed in the Factoids) of policy-makers and the influential Indian elite on national healthcare, including the opposing views of former prime minister Jawaharlal Nehru and Mahatma Gandhi. The author uses as his source material the proceedings of the United Provinces (now Uttar Pradesh) Legislative Assembly and the published views of national leaders. He concludes that the bias of both the colonial and national governments is the major reason for the “deterioration and decline” of Indian indigenous medical systems.
Lesson learned and not learned in COVID -19 PANDEMICHarivansh Chopra
in march 2019 WHO declared covid -19 as pandemic and since than we have come long way to understand the epidemiology of covid -19. we also have learned quite a number of unpleasant/pleasant lessons in the control and management of covod -19. vaccines have been developed by a quite rapid pace across the globe and similarly vaccine hesitancy and utilisation has also been seen across the globe . this is a very simple presentation highlighting the the importance of correct knowledge and strategies to control this pandemic
When the cold war was over at the end of 1980th, we expected that the 21st century would be peaceful, progressive, and politically stable. On the contrary, the strong consciousness of ETHNICITY was dramatically emerged in eastern European ethnic groups that were controlled by the old Soviet Union. The worse situation was the case of old Yugoslavia where were divided into three parts with arms. As we know, that war was the terrible genocide as we know.
What is “ Medical Anthropology?
Health and Sickness could be defined as the dynamic studies. Because, the concept of the sickness and health is depended on the indigenous values. It means “dynamics”.
2. Biomedicine and cultural( behavial sciences can be understood reciprocally.
Cultural Diagnosis.
The fact that the past scientific research and analysis gather so many different specialists needs to be stress. No profession can get alone the right perspective to comprehend the destructiveness of violence, we need different points of view to fight against it and hopefully to transfer this knowledge to the policy making body. It is my hope that our policy makers and society will begin to realize the importance of the anthropological aspects which I am going to discuss in this short paper.
Now, I would like to take this opportunity to share the role of Anthropology in this issue with policy makers and anthropologists but, let me first show about the role of anthropology in the process of development and its connection with violence. I believe that the anthropological theory should apply to the practical field. Another word, I would say that anthropologists must put on two hats (theoretical and practical).
The work was presented during the II Workshop on Medical Anthropology in Rome, October 14th - 15th 2011.
This book represents a thorough revision of the fi rst edition. The structure of the book has been changed to help the fl ow of learning. Key concepts of chance, bias, confoundingand causality are now introduced earlier to help student understanding.
The purpose of this investigation is:
- a new pathway to medical anthropology of split selves as found in shamanistic s?ances, and psychiatric disorders, with relevance ot self-help group settings.
In particular, the effect of small-group semi-therapeutic sessions as observed in Urakawa Bethel house will be discussed with reference to "cultural personhood.“
This work was presented during the II Workshop on Medical Anthropology in Rome, on October 14th - 15th 2011
what is community medicine ?, why it is requiered ?, what is health for all. Primary health is the key to achieve it. what is deprofessionalization of Medicine ?
At the end of this presentation the attendant is expected to:
Define Epidemiology.
Identify the main issues in the definition.
Discuss the uses of Epidemiology.
Latin american critical ('social') epidemiology new settings for an old dreamJim Bloyd, DrPH, MPH
Breilh, J. (2008). Latin american critical ('social') epidemiology: New settings for an old dream. International Journal of Epidemiology, 37(4), 745-50. doi:10.1093/ije/dyn135
The specialty which deals with population.
Comprises those doctors who try to measure the needs of sick and healthy.
Who plan and administer the services to meet the needs.
Who are engaged in research & teaching in the field.
1. Structure of mortality. The main causes of population deaths.
2. Methodology, model and principles of health promotion.
3. Types of prevention. Federal Program in Russia.
Community medicine let's think beyond diseaseDr.Jatin Chhaya
Introduction - Community Medicine
Concept of Hygeine, Public health, Preventive & Social Medicine and Community diagnosis..
Difference between Clinician and Epidemiologist..
This article from Social Science & Medicine, a peer-reviewed journal, uses the lens of medicine to understand India’s social history. The author examines how different systems of medicine – biomedicine (based on biological or biochemical principles), Ayurveda, Unani, among others – were perceived in mainstream Indian national politics in the first half of the 20th century. Not only did the British colonial state give biomedicine “cultural authority” over indigenous medical systems, but nationalist leaders and later governments did too. This has greatly shaped the contemporary view of medical practices. The article discusses the three main positions (listed in the Factoids) of policy-makers and the influential Indian elite on national healthcare, including the opposing views of former prime minister Jawaharlal Nehru and Mahatma Gandhi. The author uses as his source material the proceedings of the United Provinces (now Uttar Pradesh) Legislative Assembly and the published views of national leaders. He concludes that the bias of both the colonial and national governments is the major reason for the “deterioration and decline” of Indian indigenous medical systems.
Medicalization of SocietyThe social construction of .docxbuffydtesurina
Medicalization of Society
The social construction of medical knowledge
*
Medicalization of SocietyDescribes a process whereby previously non-medical problems become defined and treated as medical problems, usually in terms of illness, disorders, and conditions. Some suggest that the growth of medical jurisdiction is one of the most significant transformations of the last half of the 20th century.
*
DefinitionThe term refers to the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat. The process of medicalization typically involves changes in social attitudes and terminology, and usually accompanies (or is driven by) the availability of treatments.
*
The prevalence of medicalization
Indicators:
percentage of gross national income increased from 4.5% in 1950 to 16% in 2006
# of physicians per population has doubled in that time frame, extending medical capacity
Jurisdiction of medicine has grown to encompass new problems not previously deemed ‘medical’
Examples: ADHD, eating disorders, CFS,PTSD, panic disorder, fetal alcohol syndrome, PMS, SIDS, obesity, alcoholism
*
Medicalization concerns itself with deviance and ‘normal life events’.Behaviors once defined as immoral, sinful, or criminal have been given medical meaning moving them from badness to sickness.Common life processes have been medicalized: including aging, anxiety and mood, menstruation, birth control, fertility, childbirth, menopause, and death.
*
Increasing MedicalizationNew categories of disease and drug therapies.Expanding/contracting medical categories.Elastic categories: Alzheimer Disease (AD) and the removal of age criteria led to AD encompassing senile dementia sufferers, sharply increasing the number of AD cases (now a top 5 cause of death in the US).Demedicalization whereby a problem is no longer defined as medical problem worthy of medical intervention (e.g. masturbation, homosexuality). Unsuccessful attempts include childbirth. Partial success includes disability.
*
Beyond Sociology…Numerous articles on medicalization in Medline search.British Medical Journal (2002) special issue on medicalization.PLoS Medicine (2006) devoted to ‘disease mongering’.President’s council on Bioethics dedicated session (2003).Seattle Times (2005) Suddenly Sick series.
*
Medicalization has gained attention beyond the social sciences.
Increased medicalizationNew epidemic of medical problems? Or,Is medicine better able to understand and identify and treat existing problems? Or, Are life’s problems increasingly defined as medical problems despite dubious evidence of their medical nature?
*
We’re not interested ncessarily in whether conditions are really medical or not, rather, we’re going to think of medical knowledge and the conditions which come to be understood as medical - as .
Rev. Latino-Am. Enfermagem
2010 May-Jun; 18(3):459-66
www.eerp.usp.br/rlae
Corresponding Author:
Flavio Braune Wiik
Universidade Estadual de Londrina. Centro de Letras e Ciências Humanas.
Departamento de Ciências Sociais
Campus Universitário. Caixa-Postal 6001
CEP 86051-990 Londrina, PR, Brasil
E-mail: [email protected]
Anthropology, Health and Illness: an Introduction to the Concept of
Culture Applied to the Health Sciences
Esther Jean Langdon1
Flávio Braune Wiik2
This article presents a reflection as to how notions and behavior related to the processes of
health and illness are an integral part of the culture of the social group in which they occur.
It is argued that medical and health care systems are cultural systems consonant with the
groups and social realities that produce them. Such a comprehension is fundamental for the
health care professional training.
Descriptors: Culture; Anthropology; Health Care; Health Sciences.
1 Anthropologist, Ph.D. in Anthropology, Full Professor, Universidade Federal de Santa Catarina, SC, Brazil.
Email: [email protected]
2 Social Scientist, Ph.D. in Anthropology, Adjunct Professor, Universidade Estadual de Londrina, PR, Brazil.
Email: [email protected]
Original Article
460
www.eerp.usp.br/rlae
Antropologia, saúde e doença: uma introdução ao conceito de cultura
aplicado às ciências da saúde
O objetivo deste artigo foi apresentar uma reflexão de como as noções e comportamentos
ligados aos processos de saúde e de doença integram a cultura de grupos sociais onde
os mesmos ocorrem. Argumenta-se que os sistemas médicos de atenção à saúde,
assim como as respostas dadas às doenças, são sistemas culturais, consonantes com os
grupos e realidades sociais que os produzem. A compreensão dessa relação se mostra
fundamental para a formação do profissional da saúde.
Descritores: Cultura; Antropologia; Atenção à Saúde; Ciências da Saúde.
Antropología, salud y enfermedad: una introducción al concepto de
cultura aplicado a las ciencias de la salud
Este artículo presenta una reflexión acerca de como las nociones y comportamientos
asociados a los procesos de salud y enfermedad están integrados a la cultura de los
grupos sociales en los que estos procesos ocurren. Se argumenta que los sistemas
médicos de atención a la salud, así como las respuestas dadas a la enfermedad son
sistemas culturales que están en consonancia con los grupos y las realidades sociales
que los producen. Comprender esta relación es crucial para la formación de profesionales
en el área de la salud.
Descriptores: Cultura; Antropología; Atención a la Salud; Ciencias de la Salud.
Introduction
Perhaps it seems out of place to address the theme
of culture in a journal dedicated to the Health Sciences
or to argue that the concept of culture can be useful
for professionals of this area. Everyone has a common
sense idea of what “culture” means. We say that a person
“has culture” when he or sh ...
From diagnosis to social diagnosisAuthor Phil Brown Mercedes Lys.docxshericehewat
From diagnosis to social diagnosis
Author Phil Brown Mercedes Lyson, Tania Jenkins
Abstract
In the past two decades, research on the sociology of diagnosis has attained considerable influence within medical sociology. Analyzing the process and factors that contribute to making a diagnosis amidst uncertainty and contestation, as well as the diagnostic encounter itself, are topics rich for sociological investigation. This paper provides a reformulation of the sociology of diagnosis by proposing the concept of ‘social diagnosis’ which helps us recognize the interplay between larger social structures and individual or community illness manifestations. By outlining a conceptual frame, exploring how social scientists, medical professionals and laypeople contribute to social diagnosis, and providing a case study of how the North American Mohawk Akwesasne reservation dealt with rising obesity prevalence to further illustrate the social diagnosis idea, we embark on developing a cohesive and updated framework for a sociology of diagnosis. This approach is useful not just for sociological research, but has direct implications for the fields of medicine and public health. Approaching diagnosis from this integrated perspective potentially provides a broader context for practitioners and researchers to understand extra-medical factors, which in turn has consequences for patient care and health outcomes.
Highlights
► “Social diagnosis” recognizes interplay between social structures and illness manifestations. ► Case study shows how Mohawk Akwesasne dealt with rising obesity. ► Provides broad context for practitioners and researchers to understand extra-medical factors.
· Previous article in issue
· Next article in issue
Keywords
Diagnosis
Risk
Social movements
Environment
Public health
USA
Canada
Reservations
Introduction
Sociological analysis of diagnosis has achieved considerable influence in the last two decades, providing important insight into how we understand health, disease, and illness. It has also expanded how we view the social and cultural influences that shape our knowledge and practice on health and illness. This includes studies of diagnosis that have gone beyond the interaction between physician and patient, to take into account the larger social, structural, and temporal forces that shape diagnosis (see, for example, the categorization of homosexuality as a mental disorder and the role of gay rights activists in the American Psychiatric Association’s deliberations) (Cooksey & Brown, 1998).
Recently we have also seen the emergence of diseases whose etiologies, symptoms, and, therefore, diagnoses, are often contested or uncertain. This combination of medical and social uncertainty leads us to propose a reformulation of the concept social diagnosis as a new way of thinking about the sociology of diagnosis. This paper explores social diagnosis by first, outlining a conceptual framework of social diagnosis; second, discussing the different acto ...
THE ROLE OF PUBLIC HEALTH SYSTEM IN IMPROVING THE HEALTH OF INDIANSShalvi Shankar
Public Health helps achieve the discovery, test and dissemination of health threat and problems. India is a nation that comprises many languages, religions, life styles and food habits which accounts one sixth of the world’s population occupying less than 3% of the world’s area
EDITORIALTHE ETHICAL IMPLICATIONS OF THESOCIAL DETERMINA.docxtidwellveronique
EDITORIAL
THE ETHICAL IMPLICATIONS OF THE
SOCIAL DETERMINANTS OF HEALTH:
A GLOBAL RENAISSANCE FOR
BIOETHICS
In this special issue, Bioethics explores the ethical issues
that relate to the social determinants of health. As the
articles demonstrate, the recognition that social factors
help to determine a population’s health offers bioethics
new challenges and new opportunities. With this recog-
nition, fundamental bioethical concepts, such as cau-
sation, autonomy, rights, and justice, take on new
meanings. Likewise, mainstay bioethical issues, including
the equitable distribution of resources, the duties of pro-
fessionals, and the conflict between paternalism and
autonomy, become amenable to new perspectives.
The realization that social forces help to determine
health is hardly new. For millennia people have recog-
nized a relationship between the social environment
and disease. In the 19th century, sanitarians blamed the
rampant filth of growing cities for the incessant outbreaks
of disease. Later progressive reformers lambasted both
poverty and poor working conditions for disease and
premature death. The pioneers of epidemiology docu-
mented these relationships.
The field of bioethics has never been closed to such
concerns. Since its inception in the 1960s and 1970s,
however, bioethics has deployed much of its intellectual
energy on the moral issues that relate to the development,
distribution, and delivery of health care services. In so
doing, the field reflected medicine’s eclipse of public
health in the 20th century. As medicine became predomi-
nant and illness became more and more amenable to
individualized medical treatment, ethical discourse came
to emphasize clinical encounters. At the same time, as
disease and health increasingly came to be seen as result-
ing from individual factors, individuals began to be
viewed as morally culpable for both their illnesses and the
impact of those illnesses on others.
Not surprisingly, given the importance that bioethics
placed upon individual patients and providers, autonomy
surfaced as a key concern. In the early years bioethicists
focused on the autonomy of patients. Following the lead
of John Stuart Mill, bioethicists revealed the dangers of
medical paternalism and explained why and how patient
autonomy should be respected. In this they were highly
successful, as informed consent became both widely
regarded and legally established.
Individual autonomy remained of paramount interest
in the 1990s. By then, however, the concern widened to
include the autonomy of physicians. At least within the
USA, physicians criticized managed care for interfering
with their ability to make decisions for their patients
and infringing upon their professional autonomy. And
throughout the developed world, as health care costs rose,
market solutions were debated. Patients began to be
viewed as ‘consumers’ of medical care instead of as
patients in need of treatment and care. Not surprisingly,
once patients were.
Similar to Medicine, Power and Social Legitimacy: A Socio-Historical Appraisal of Health Systems in Contemporary India (20)
The 2015-16 National Family Health Survey (NFHS-4) provides information on population, health and nutrition for each state and union territory in India. The survey was conducted by the International Institute for Population Sciences, Mumbai, for the Ministry of Health and Family Welfare.
The fieldwork for Kerala was conducted in all 14 districts of the state. Information was collected from 11,555 households, 11,033 women in the 15-49 age group, and 2,086 men between the ages of 15 and 54.
This state report for Kerala presents findings on several key socio-economic indicators like water and sanitation, marriage, fertility, contraception, children’s immunisation, sexual behaviour and domestic violence. It makes important observations too, like the near-universality of births in a health facility, the low rate of infant mortality, and the preference for sons.
The Health Survey and Development Committee were was appointed by the Government of India in October, 1943 with Sir Joseph Bhore as its Chairman to make a broad broad survey of present position with regard to health conditions and health organization services in British British India. Its chairman was Sir Joseph William Bhore, an Indian Civil Service officer. and provide recommendations for future developments.
The Committee recommended It the laid emphasis on integration of curative and preventive medicine at all levels, the development of primary health care centres, and major changes in medical education. It made comprehensive recommendations for remodelling of health services in India. Volume I
This volume (Vol 1) of the Committee’s report attempts to draws a picture of the state of the public health in India the country and of the existing health organisation of health services.
In December 1941, Japan’s entry into the Second World War The entry of Japan into the war in December 1941 marked the stage at which war conditions began to hadve serious adverse effects on India. Thus, , thus the statistical and other information in this report, which have been included for the purpose of throwing light on the state of the public health, was have been limited to the year 1941 and the preceding period of ten10 years.
The eight-member National Commission on Farmers, chaired by Prof. M.S. Swaminathan, was set up in 2004 by the United Progressive Alliance (UPA) government to assess the extent of India’s agrarian crisis. This first report was meant to assist central and state governments in arresting the decline of farm incomes and abating farmers’ distress. The report provides an overview of India’s agrarian economy and discusses the causes and effects of the agri-crisis, both environmental and policy-based. Its recommendations include setting up knowledge centres for farmers, framing a code of conduct for contract farming, ensuring better water management, providing food security, improving crop insurance and introducing insurance that covers accident, death and medical expenses. These steps, the report says, must be taken immediately to avert further damage. And that we must take Jawaharlal Nehru’s advice in this often-quoted remark from 1948: “Everything else can wait, but not agriculture.”
This report, by the Commission for Agricultural Costs and Prices (CACP), provides price recommendations and non-price measures for mandated kharif crops for the 2017-18 market season. The CACP, set up in 1965, was originally called the Agricultural Prices Commission but was given its present name in 1985. It prescribes the minimum support price (MSP) for 23 agricultural commodities to the government. These include 7 cereals, 5 pulses, 7 oilseeds and 4 commercial crops. CACP is attached to the Ministry of Agriculture and Farmers Welfare, Government of India.
In order to arrive at the MSP, the CACP takes into account factors such as cost of production, the overall demand-supply situation, domestic and international prices, changes in input costs, inter-crop price parity, terms of trade, efficient use of resources, and the impact of MSPs on price levels.
The report furnishes most of its data in tables, graphs and charts.
Since 2005, the Annual Status of Education Report (ASER) has provided data on schooling and children’s ability to do basic reading and arithmetic. Since 2006, the report has focused on the age group 5-16. This report for 2017 focuses on rural youth in the age group aged 14-18 since they are close to an income-earning age. It tries to understand their preparedness to lead productive adult lives.
In particular, the report examines what the youth are doing, whether they can apply basic reading and arithmetic skills to everyday situations, their familiarity with routine digital and financial processes, and their educational and career goals. The findings are based on data gathered from 28,323 youths, 23,868 households, and 26 rural districts in 24 states.
The National Family Health Survey (NFHS) was conducted by the International Institute for Population Sciences, Mumbai, for the Ministry of Health and Family Welfare. It provides information on population, health and nutrition in each state and union territory of India. This report presents key findings of the survey’s fourth round, conducted in 71 districts of Uttar Pradesh from January 2015 to August 2016. Previous surveys were conducted in 1992-93, 1998-99 and 2005-06.
NFHS-4 surveyed 572,000 households in 640 districts of India as per the 2011 census. In Uttar Pradesh, data was gathered from 76,233 homes, and a total of 97,661 women (aged 15-49) and 13,835 men (aged 15-54) were interviewed.
The survey collected information on the socio-economic characteristics of households, fertility, infant and child mortality, family planning, reproductive health, maternal and child health, nutrition, water, sanitation, quality of health services and health insurance. In particular, it interviewed women about marriage, work, contraception, sexual behaviour, HIV/AIDS status and domestic violence as well as their children’s immunisations and illnesses. Similarly, men were interviewed on these topics, in addition to their attitudes towards gender roles and lifestyles.
The report furnishes district-wise data collected by the survey in tables and estimates of sampling errors in the appendix.
This gazetteer, published in 1907, describes various aspects of Odisha’s Baleswar (or Orissa’s Balasore in British times) district. It surveys the district’s economy, society, politics and administrative setup, as well as its history, geography, climate, biodiversity and natural resources. It says that the name Baleshwar is derived from a temple dedicated to “Mahadeo Baneswar, i.e. Siva, the Lord of the Forest.”
By the time of the 1901 census, the district had an average population density of about 200 persons per square kilometre. This was a mobile population with a high rate of migration – large numbers of people moved to the Sunderbans to work as cultivators and field labourers and to Kolkata to work as porters and manual labourers. The caste system, the gazetteer says, was deeply ingrained in the region. The lower castes preferred to work in the mills, where people of different castes worked alongside each other.
The Bengal District Gazetteers were prepared by British colonial administrators for the districts of Angul, Balasore, Cuttack, Koraput and Puri, and the ‘Feudatory States of Orissa’. Ten years after Independence, in 1957, the responsibility of compiling the district gazetteers was transferred from the Centre to the states. In 1999, this responsibility (in Odisha) was transferred from the Revenue Department to the Gopabandhu Academy of Administration.
The Aadhaar Act aims to provide “efficient and transparent” delivery of subsidies, benefits and services to Indian residents by assigning them unique identity numbers. The Unique Identification Authority of India (UIDAI), set up under this Act, is responsible for helping people ‘enroll’ or sign up for Aadhaar numbers, verifying their identity information, issuing Aadhaar numbers, and authenticating information provided by individuals on the request of public or private entities.
The Bill was introduced in the Lok Sabha by Finance Minister Arun Jaitley on March 3, 2016, and it became an Act on March 26, 2016. An earlier version, the National Identification Authority of India Bill, 2010, was introduced in the Lok Sabha on December 3, 2010, but withdrawn in March 2016. The UIDAI became a statutory authority after the Aadhaar Act was passed, but it had been functioning as an office attached to the Planning Commission (now NITI Aayog) since 2009. Around 30 petitions challenging the government on different aspects of the Aadhaar Act have reportedly been submitted to the Supreme Court, and the matter will come up for hearing later this year.
This gazetteer, published in 1908, is the first of Angul district in Odisha. It describes various aspects about the district – its economy, society, politics and administrative setup, as well as its history, geography, climate, biodiversity and natural resources. It does so for the district’s two sub-divisions: Angul and the Khondmals.
The Marathas, who had maintained half a century of suzerainty over Odisha, surrendered Angul to the British in 1803. Angul’s chief entered into an agreement with the East India Company; he promised to say loyal to it and pay an annual tribute. After a series of rebellions though, the British invaded and occupied Angul in 1848. The district came under direct colonial rule and in 1891 it was merged with the Khondmals.
The Bengal District Gazetteers were prepared by British colonial administrators for the districts of Angul, Balasore, Cuttack, Koraput and Puri, and the ‘Feudatory States of Orissa’. After Independence, in 1957, the responsibility of compiling the district gazetteers was transferred from the Centre to the states. In 1999 in Odisha, this responsibility was transferred from the Revenue Department to the Gopabandhu Academy of Administration.
The Ministry of Health and Family Welfare developed the National Health Accounts (NHA) in 2001–02 to support the governance of health systems and enable the design of more effective health policies. This report provides an estimate of the total health expenditure for 2004-05 (taking into consideration the launch of the National Rural Health Mission in 2005), and gives provisional estimates of the health expenditure from 2005-06 to 2008-09.
In the computation of NHA, the World Health Organisation’s (WHO) definition of health expenditure was adopted. NHA includes expenditure on inpatient and outpatient care, hospitals, specialty hospitals, health promotion centres, rehabilitative care centres, capital expenditure on health, medical education, and research and training. It excludes expenses on water supply, sanitation, environmental health and the mid-day meal programme.
The Hindu centre for Politics and Public Policy is an offshoot of the Hindu publications group. It aims at promoting research and debates on public institutions delivery and policy frameworks.
The report describes the processes – and the politics – that led to the creation of ‘Other Traditional Forest Dwellers’ (OTFDs), which includes forest-dwelling Dalits. The report explores the limitations of the Act, which precludes forest-dwelling Dalit communities from accessing their rights and forest resources.
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The National Commission for Enterprises in the Unorganised Sector (NCEUS) was set up in 2004 by the United Progressive Alliance (UPA) government as an advisory body and a watchdog for the informal sector. That same year, the Prime Minister’s Office asked the NCEUS to examine the National Policy on Urban Street Vendors. The policy’s objective was to provide urban street vendors with a supportive environment in which they can earn their livelihoods. After consulting various stakeholders, the Commission recommended a revision of the policy’s implementation mechanisms.
The NCEUS noted that the urban poor in most Indian cities worked in the informal sector because of a lack of jobs in rural areas, few employment opportunities in the formal sector, and low levels of education that restricted access to better-paying jobs. As unorganised sector workers, street vendors did not have government-assisted social security.
The National Commission on Macroeconomics and Health (NCMH) was established in March 2004 to strengthen disease control and primary healthcare in India. Its overall objective was to assess how increased investments in the health sector impact poverty and economic development.
In this report, the Commission discusses the economic basis for investing in health and how public financing can be most effectively utilised. It discusses the critical issues plaguing the health sector, such as inequitable access to basic services, inefficiencies in the system, and an absence of patients’ rights.
The report states that liberalisation of the economy increased employment opportunities and incomes, thus reducing poverty levels. These developments also introduced changes in lifestyles, increased urbanisation and connectivity, and enhanced access to information. Together, this has had a profound impact on the epidemiologic and health-seeking behaviour of people.
The rising demand for health services has revealed the inadequacies of the current healthcare system, both in the public and private domains. It is the responsibility of the government to provide an efficient healthcare system, along with health education, preventive programmes, curative services, and affordable health services for the poor. This report reviews the public and private healthcare systems, and provides policy makers with a framework to improve the funding of public health.
The National Commission for Enterprises in the Unorganised Sector (NCEUS) was set up in 2004 by the United Progressive Alliance (UPA) government as an advisory body and a watchdog for the informal sector. This report by the NCEUS recommended a social security scheme for unorganised workers, which would cover minimum benefits such as old age pension, life insurance, maternity benefit, disability benefit (accident compensation), minimum healthcare and sickness benefit. The NCEUS argued that the government needed to move beyond limited social assistance schemes and introduce a full-fledged social security programme for all kinds of workers, especially unorganised workers. The Commission also drafted the Unorganised Workers’ Social Security Bill, which forms part two of this report.
This article from the Economic and Political Weekly, a peer-reviewed academic journal, traces the history and development of medical science in India, ranging from systems of witchcraft to allopathy. The author also compares the Chinese, Greek and Egyptian systems of medicine to Ayurveda and outlines their similarities. He discusses the growth of modern medicine and the dismal state of the public healthcare system in India. The article concludes that the country’s poor healthcare structure can be attributed to its strong feudal culture, which promoted both rational and irrational medical practices.
The National Commission for Enterprises in the Unorganised Sector (NCEUS) was set up in 2004 by the United Progressive Alliance (UPA) government as an advisory body and a watchdog for the informal sector. This NCEUS report reviews labour laws and social security systems that apply to workers in the unorganised sector.
It observes that while existing laws have some provisions for conditions of work for certain workers, there is no comprehensive legal framework for the “basic and minimum conditions of work” for unorganised sector workers. Therefore, it proposes comprehensive and protective laws for agricultural and non-agricultural workers in the unorganised sector that will regulate conditions of work, social security, welfare and livehood promotion. Given the differences in the conditions of work for agricultural and non-agricultural workers, two bills are proposed.
The bills also incorporate a National Security Scheme for agricultural labourers and non-agricultural workers in the unorganised sector. In case of disputes over the implementation of the bills, the NCEUS recommends conciliation through resolution instead of bureaucractic and time-consuming legal procedures. The dispute resolution process may involve the participation of workers’ representatives or elected representatives of local bodies.
The Ministry of Health and Family Welfare published the first Annual Report to the People on Health in September 2010. The report’s objective was to examine critical macro-level issues related to health, in particular, the constraints faced by the government in providing universal healthcare, and the challenges in the organisation, financing and governance of health services.
The report provides information about key health indicators such as life expectancy at birth, infant mortality and maternal mortality, and explains the variation in their numbers in different states. It also provides an overview of the National Rural Health Mission (NRHM), which was launched in 2005 to revitalise and scale up basic health services in rural areas. Besides this, it discusses the non-availability of skilled healthcare providers and their uneven distribution across the country, and suggests remedies for this problem.
Lastly, the report lists key policy issues related to health that, according to the ministry, need to be debated widely and drafted into a new health policy. Some of these issues are increased public investment in healthcare, public-private partnerships in the health sector, access to safe drinking water and sanitation, good quality education for healthcare providers, use of modern technology and technological audits of the sector, rising out-of-pocket expenditure on drugs, reduced emphasis on preventive healthcare, limited participation of community organisations, and investment of the states in primary healthcare.
The National Commission for Enterprises in the Unorganised Sector (NCEUS) was set up in 2004 by the United Progressive Alliance (UPA) government as an advisory body and a watchdog for the informal sector. In this report, the Commission discusses the technological needs of the unorganised sector and makes recommendations to increase the productivity, employment and earnings of the sector’s enterprises and the workers.
The report states that more than 94 per cent of enterprises in India are in the unorganised sector, many of them in rural India – micro, khadi and village enterprises such as handlooms, handicrafts, coir, leather, apparel, food processing and retail trade, which contribute over 31 per cent to GDP. The Third All India Census of Small Scale Industries (2001-02) says that more than 85 per cent of the total registered small-scale industry (SSI) units did not have access to technical know-how.
The post-liberalisation business environment had become difficult for micro and small enterprises because of increased domestic and international competition. They were not prepared for the ensuing challenges. This report highlights the consequent issues, including low incomes, inadequate credit, low education levels, a lack of training, difficulties in procuring materials, logistics and low sales margins. It lists recommendations to overcome each of these challenges, with a focus on improving the overall efficiency of the sector.
The National Commission for Enterprises in the Unorganised Sector (NCEUS) was set up in 2004 by the United Progressive Alliance (UPA) government as an advisory body and a watchdog for the informal sector. Its mandate was to increase the productivity of enterprises in the unorganised sector and create large-scale employment, particularly in rural areas.
This report highlights, through surveys and data analysis, the problems faced by marginal and small farmers and their households. It also mentions the agrarian policies of the National Democratic Alliance (NDA) government (1998-2004) and provides a brief history of government initiatives for the development of marginal and small farming in India. The report discusses programmes that can improve the condition of small and marginal farmers and focuses on possible solutions.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
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Medicine, Power and Social Legitimacy: A Socio-Historical Appraisal of Health Systems in Contemporary India
1. Economic and Political Weekly August 25, 2007 3491
I
npost-independentIndia,effortstodelivermodernhealthcare
in terms of institutional structures, qualified practitioners, and
health policies at national level have been well documented.
Although there has been considerable improvement in the health
status as measured by the increase in life span (33 to 62 years),
fall in infant mortality and the crude death rate, statistics also
show that such achievements have fallen far short of the nation’s
expectations. United Nations provided statistics reveal that in
sub-Saharan Africa and Asia, millions of people still die from
communicablebutpreventablediseasesliketuberculosis,malaria
and schistosomiasis, besides the scores succumbing to newly
emerging diseases such as Severe Acute Respiratory Syndrome
(SARS), bird-flu, chickungunya, and dengue. About one-third
of the world’s population is infected with TB with almost
two-thirds of them living in Asia. In the developing world, 1.2
billion people lack access to safe water, adequate sanitation and
poor housing, 800 million people lack access to health services
[All India People’s Science Network 2002].
That health services have been dismally poor and inaccessible
for a large majority of the population in India has not been
disputed. This has been adequately acknowledged recently by
government of India health policy documents as well [GoI 2002,
2005]. One of the arguments in health sector debates is that lack
of adequate institutional health services leads to ill-health and
continuing mortality and that superstition, irrationality, ignorance
continue to haunt rural India and hence the high levels of ill-
health and mortality. Accordingly, there has been an on-going
debate in explaining reasons for inaccessible health services.
This debate manifests at various levels: public health sector vs
private health sector1 (and its related arguments globalisation vs
localisation);modernhealthsystemvstraditional/indigenous/alter-
nate systems of medicine (allopathy vs ayurveda, unani, siddha,
etc), and rational vs spurious medicines. Of late, holistic/unified
models have been advocated instead of binary models say, for
instance, public-private partnership in healthcare2 including non-
government organisations (NGO) sector, and integrated medicine
that is sup‑posed to be a judicious mix of various systems of
medicine. Thus, impassionate arguments have been made in sup-
port of each of these, offering evidence, explaining the complexity
of prevailing disease-producing conditions, the present disease
burden, the existing health infrastructure and its linkages with the
hierarchical and iniquitous social structure, thus justifying scores
of single disease vertical programmes in the country.
In brief, the “inaccessibility to primary healthcare”, “pathetic
situation of community health centres” (CHCs), and “advanced
stage” of decay of health services system in the country [Muk-
hopadhyay 1997] have been explained by social scientists. Their
explanations can broadly be grouped under three theoretical
perspectives: the colonial theory of supremacy, theory of pri-
vatisation and globalisation; and the theory of discriminatory
continuities and consistency.
The advocates of colonial theory of supremacy argue that
the indigenous systems of medicine have been sidelined and
subjugated by the hegemony of the western system of medicine.
This has been done through conspiratorial methods adopted by
the colonial rulers in India. It is in fact the colonial rule that
ushered in the allopathic (western) medical system in India and
hence it became a state-imposed healthcare system both during
colonial and post-independent India. Western scientific medicine
has been imposed both as an ideology and practice in India. In
their attempt to embark upon modernity, the ruling classes here
accepted the western bio-medical system in toto leading to the
marginalisation of Indian medical knowledge systems. This ap-
proach of the colonial state has had implications for all health
policies followed in India to date [Arnold 1993, 2000; Mark
Harrison 1994; Radhika Ramasubban 1988]. The protagonists
of the theory of privatisation and globalisation argue that it is
essentially to do with the way capital has subjugated medcal
science, which has led in turn to the commodification of health,
and technological medicine (specialty and super specialty medi-
cine). In the process, drugs have become more powerful than
the providers, which has resulted in corporatisation of medical
care and increased disparities between specialised and genera-
lised medicine. By implication, the capitalist character of Indian
society continues to distort the potential contribution of scientific
medicine and this has led to the aggravation of suffering and
alienation of the poor [Banerjee 1984; Qadeer 1985]. Most of the
explanationsregardinginequalitiesofhealthcareinIndiafalleither
within the first or second perspective, however, one also finds a
combination of the first and second perspective as an analytical
Medicine, Power and Social Legitimacy
A Socio-Historical Appraisal of Health Systems
in Contemporary India
Medical pluralism has been defined as the coexistence of several medical systems and the
relatively greater choice available for everyone. However, a key issue in medical pluralism
in India is the existing unequal power relations between different medical systems as well
as between “providers” and “receivers” of healthcare. Hence, in order to understand the
dynamics of medical pluralism and to analyse current health seeking patterns in India, one
needs to trace historically the conditions under which the dominant medical systems emerged
and also understand the social bases that sustain these systems.
Purendra Prasad N
2. Economic and Political Weekly August 25, 20073492
tool in explaining health inequalities. The third perspective, i e,
the theory of discriminatory continuities and consistency is not
as explicit an explanation but certainly can be inferred from vari-
ous research studies [Zysk 1998; Whitehead 1995]. This theory
points out that external factors, whether colonial or imperialist
forces, may have certainly posed as sources of disruption but
to place everything under their rubric may be quite an exag
geration. A thorough and critical investigation of internal factors
and social forces that has led to iniquitous healthcare has not
been undertaken in India. In medical anthropology and history,
the response has been that while documenting or dealing with
the “co-existence” of varied medical traditions and practices, we
must not ignore or underplay the issue of power, domination
and hegemony, and must locate our work in a larger historical,
social and political context within each nation [Waltrand 2002;
Nichter and Lock 2002] (emphasis author’s).
Taking clues from these theories particularly the third one, this
paper argues that the very process of institutionalisation of
medicine/health services within a nation-state offers explanations
pertaining to the iniquitous healthcare in India. Any democratic
institutionalisationofmedicalsystemswouldmeantheinculcation
of new social values within existing institutional structures. Here
the purpose is to highlight how the institutionalisation of health
systems has taken place within the pluralistic medical tradition in
India. The concept of social legitimacy is used in this paper to
explain how certain social forces continue to make and impose
certain exclusions and inclusions within the social order, in effect
giving legitimacy to (or therefrom) and thus constituting that very
social order. Institutionalised medicine has acquired a legitimacy
because of its scientific credentials based on dominant ideas,
methods of validation and textual sources. This legitimacy is
further justified on the basis of the patronage derived from two
sources – one from the state and the other from civil society,
both of which in turn need to be located within the social matrix
of caste and class [Nichter 1986; Pati 1996].
In order to analyse the current health scenario, a historical
sociology perspective has been adopted. The structure of the
paper is in three sections, the first section is a historical account
of indigenous medical systems more particularly ayurveda and
the circumstances of its patronage by various rulers in pre-
colonial India. Introduction of western medicine3 in the colonial
period, the resulting competition between Indian systems of
medicine and western medicine and the axis through which
a dominant system emerged have been outlined in Section II.
Developments in health sector, particularly factors leading to the
further widening up of the space between different systems of
medicine, exclusionary policies and practices prevailing in the
institutional set-up in the post-independence period have been
traced in the third section. This is finally followed up with a
discussion summarising and analysing the processes leading to
iniquitous healthcare in India.
I
Early Indigenous Systems
The reference to plural medical systems cannot be complete
without a discussion on ayurveda and unani in India. Apart from
scattered references to monastic or university education in
medicine, the study of medicine involved apprenticeship with
a teacher as an resident in the latter’s household [Kutumbaiah
1962:xlix]. A major criterion followed by the teachers was to
admit students of the same or a closely related caste in order to
maintain the principle of purity-pollution in eating arrangements
and other caste restrictions. Perhaps for this reason different
regions tended to have dominant medical castes. Vaidyas, a
vaisya caste, are dominant in Bengal but a brahmin sub-caste
provides most ‘vaids’ in Kerala [Zimmerman 1999]. Training
in unani medicine was also carried out in the “personalistic,
informal settings of family homes and apprenticeship” [Metcalf
1985:4]. Again, quite apart from the need to learn Arabic, this
tended to restrict unani education to upper class Muslims.
Of course, within ayurvedic medical system there existed
both formally trained medical practitioners who needed seven
years of training before they could start practising and healers
who practised ayurvedic medicine in a more informal manner.
These latter physicians residing in rural India mostly treated their
patients with medicines based on herbs and natural products.
Prior to the establishment of ayurvedic medical colleges in
modern times, ayurvedic knowledge was normally passed on
within families among male descendants. Since the establish-
ment of ayurvedic colleges, the transmission of the tradition has
become more open, but the Sanskrit component remains central
and the modernised ayurveda, like its traditional transmission
remains largely in brahmin hands [Trawick 1992].
The period of the Brahmanas and the Upanishads4 (800-600
BC) is considered to be a time of great mental ferment. As
a result of the new ideas and theories developed during and
after this period, there developed rationalism in every sphere of
civilisation. The origin and spread of Jainism and Buddhism in
the 6th century BC actually influenced the thinking of the intel-
lectual class. Gradually the medicinal system broke loose from
that of popular tradition and began to develop independently;
medicine became empirico-rational. This change is attributed
to the influence of the emerging new schools of philosophy
[Hymavathi 1993].
The Buddhists were deeply concerned with human suffering
and illness. It was the Buddhists who borrowed the concepts
of ayurveda and with Buddhism these concepts reached China
in the 2nd/3rd century AD [Deshpande 2001]. The Buddhist
monasteries were places of meditation but they often also
included a sickroom. It is likely that these developed into
hospitals serviced by monks, housing not only the sick but
also offering shelter to the poor and destitute. Ayurveda while
enunciating a great number of ethical norms on life and style
of living, unhesitatingly advocated the use of meat and alcohol
as “therapy” in certain conditions. Historical studies suggest
that soon after Susruta, the practice of surgery by traditionally
trained ayurveda physicians declined and that surgery came to
be practised by barber-surgeons.
The caste system, which steadily increased in complexity in the
first millennium AD, might have created taboos concerning close
physical contact with “untouchables” or those of the lowest caste.
Surgery, which involved such physical contact would have thus
lost favour, and its practice by traditional ayurveda may have
declined. Yet, it was during this period that the importance of
pulse examination, as also urine and the value of the body mas-
sage was emphasised in ayurvedic practice. The famous surgical
procedure of removal of the cataract described and practised
during Susrata’s time reached China, probably through Buddhist
pilgrim monks and not through ayurvedic Indian physicians.
By the beginning of the 20th century, surgery was described
again, but more frequently carried out by barber-surgeons than
3. Economic and Political Weekly August 25, 2007 3493
ayurvedic practitioners. Perhaps the practice of surgery either
fell into disrepute or was disregarded by ayurveds who preferred
only to heal through medicine [Udwadia 2000].
The sources show that ayurvedic medicine derived its major
features from the work of heterodox ascetics rather than from
brahmanicintellectualsandthatmostsignificantgrowthofIndian
medicine took place in early Buddhist monastic establishments
[Zysk, 1998). Further elaborating this, Zysk says:
Even in the early Vedic period, physicians were outside the pale of
the Aryan sacrificial cults probably because of their association with
the Atharva veda, not yet considered a principal ‘sruti’ (revealed)
scripture. Moreover, their frequent travels beyond the frontiers of
Aryan society in order to acquire the rich pharmacopoeia mentioned
in the Atharva veda brought them into frequent contact with non-
Aryan peoples. Although physicians obtained from these outsiders
much new and valuable knowledge pertaining to their special craft,
these encounters caused them to be widely perceived as inferior, be-
ing polluted by contact with impure people. This attitude evidently
existed from the early vedic period but received articulation only in
the later Brahmanas, which provided the orthodox brahmanic means
for accepting healers and consecrating their services. Their contact
withnon-Aryansmightwellhavegivenrisetoanempiricalorientation
that became, as Chattopadhyaya correctly points out, antagonistic to
brahmanic orthodoxy in the later vedic period (Ibid, p 24).
Shunningthephysiciansandexcludingthemfromthe brahmanic
social structure and religious activities implies that they existed
outside mainstream society, and were probably organised into
sects who roamed the countryside as indicated by the phrase
“roving physicians”.5 Theyearnedtheirlivelihoodbyadministering
cures and increased their knowledge by keen observation and by
exchanging medical data with other healers whom they encoun-
tered along the way, for the ayurvedic medical tradition strongly
encouraged discussions and debates with other physicians.
It is documented that the meat, blood, fat, liver, bones, urine,
hair, secretions, bile, marrow, semen, horns, nails, bristles, hoops
and the bright pigment called “gorocona” of various animals were
various products used extensively as drugs.The civet and products
of various animals such as the cow, goat, monkey were the most
popular and widely used animal substances [Hymavathi 1993].
However, the usefulness of animal substances extensively in the
preparation of drugs was also contested. For instance, Ugradity-
acarya condemned animal sacrifice in the pretext of treatment.
He propagated the uselessness of “flesh diet” and convinced
the doctors who had assembled in the court of Amoghavarsa.
He proved in his work Kalyanakaraka that animal substances
though useful in treatment, are not absolutely essential and could
be discarded by using in their place, many more powerful herbs
as substitutes. But it does not seem that all physicians discarded
the use of animal substances while preparing drugs. On the
other hand, we find that they explained the usefulness of meat
and other animal substances as diet and medicine (Ibid, p 181).
Hence, the prescription of meat and alcohol finds a strong place
in a ayurvedic texts.
Literary sources mention a separate community of people
known as ‘mandulavandlu’(medicine-men) who supplied source
material for drug preparation in the Vijayanagar empire. The
koya (a tribe in south India) were considered as medicine men
as they were the people who lived by selling medicines. Simi-
larly cencus (another tribal group), were famous as collectors of
forest products. They largely collected animal substances such
as civet, horns, teeth, bones and skin of various animals, and
other vegetable substances such as ‘carapappu’, ‘mumtamamidi’
and honey. The erukala and cencu women used to sell various
kinds of medicines including some roots (Ibid, p 185). This
indicates the significance of lower social groups particularly
tribal communities who played an important role in the collec-
tion and supply of source material for the medicines.
Recounting how the then medical practitioners have been
attributed with violence and impurity, Zimmerman (1999)
says that the art of healing imposes the use of violence on the
medical practitioner: violence toward animals if meat must be
eaten, violence toward the patient if bloodletting, surgery, or
obstetrics must be carried out. These notions of ayurveda have
been abandoned in modern times.
A close scrutiny of sources from the 9th century BC to the
beginning of the first millennium AD reveals that the then
medical practitioners were denigrated by the brahmanic hier-
archy and were excluded from orthodox ritual cults because of
their pollution from contact with impure people. The literary
works, particularly the late samhitas and early brahmanas, from
the late vedic period (ca.900-500 BC) indicate that physicians
and medicines were denigrated by the priestly hierarchy, who
rebuked the physicians, their impurity and their association with
all sorts of people [Zysk 1998: 22]. The orthodox mendicants
and heterodox wandering ascetics who had abandoned society
to seek liberation from the endless cycle of birth, death and
rebirth and who were quite indifferent and even antagonistic to
the brahmanic orthodoxy based on caste and ritualism. These
heterodox ascetics generally known as ‘sramanas’ also had a
penchant for more empirical and rational modes of thought.
Direct observation of a decaying corpse considered polluting
by brahmans and the upper castes was the best and most valid
way to gain knowledge of human anatomy for the specific pur-
pose of demonstrating the Buddhist doctrine of impermancence,
to the ascetic monks, but in addition, it afforded an empirical
understanding of the human body. An empirical approach to
learning human anatomy by dissection involving direct, first-
hand observation of the body, was fundamental to ayurvedic
medical knowledge and was also common to Buddhist ascet-
ics’ quest to understand the human body. A vast storehouse of
medical knowledge developed among these sramanic physicians
supplying the Indian medical tradition with the precepts and
practices of what has come to be known as ayurveda. The
first documented codification of this medical lore took place
as wandering ascetics assumed a more stationary existence,
cloistered in the early Buddhist monasteries.
Thus Hinduisation of ayurvedic medicine coincided with
the decline of Buddhism resulting in magico-religious prac-
tices being re-imbibed as part of ayurvedic tradition. As Zysk
(1998:26) points out:
The occurrence of this phenomenon may indeed correspond to
the 4th or 5th century of the present era, when Buddhism was
declining in India and the brahmanic religious tradition was
making its resurgence through a radical reorientation of Brahman-
ism. Although considered to be extremely polluting and defiling,
medicine was now included among the Hindu sciences and came
under brahmanic religious influences, perhaps out of necessity
as the need for the healing and care of the sick and injured cut
across the existing social and religious barriers or more likely as
a result of the general process of brahmanic assimilation.
Paradoxically, it is Hinduism that assimilated the ascetic
medical repository into its socio-religious and intellectual
tradition, beginning probably during the Gupta period and
4. Economic and Political Weekly August 25, 20073494
by the application of a brahmanic veneer that made it an
orthodox Hindu science. The upper class intelligentsia tuned
to the discourses of science and colonial power/knowledge
system turned away from and virtually condemned indigenous
knowledge systems. Along with this condemnation, there were
attempts to appropriate indigenous methods. For example, the
treatment of snakebite, with the indigenous method of cutting
up the wound and sucking out the blood was given ritualised
brahminical slant. The treatment of snakebite was traditionally
mastered by the lower castes. When the brahmins tried to ap-
propriate the method, they suggested the same procedure of
treatment accompanied by certain mantras during the treatment.
The treatment was thus not only taken over but recast with
mantras associated with “high” Hinduism [Pati 1996]. There
was the endeavour to draw out and recast the indigenous system
of medicine. This latter aspect needs to be viewed within the
larger paradigm of caste and class. For instance, the reference
to the ‘nichalokas’ (lower castes) implied looking down at
castes like kelas (snake charmers) who treated those bitten by
poisonous snakes (Ibid, p 29).
During the medieval period, temples and ‘mathas’ were the
two important institutions which protected the culture and life of
the age. These institutions maintained learning centres as well as
hospitals for the promotion of the science of medicine. In most
of the village temples, the priests were the physicians also. But
in big temples, which were located in big villages, towns or
‘agraharas’, a part of the temple was allotted for taking classes
and for the maintenance of hospitals. The temples maintained
learning centres where ayurveda was taught to the students
both theoretically and practically by maintaining hospitals in
the temple complex. In the Deccan and in the south, between
6th and 9th centuries, there is evidence of village dispensaries
often close to the temple complex. In the Chola period (AD
900-1200)dispensariesweretermed‘vaidyasalai’–vaidyamean-
ing medicine and ‘salai’ meaning a charitable institution. There
were numerous such dispensaries manned by local physicians,
whose posts were often of a hereditary nature.
Nityanatha Siddha of 14th century and Gaurana of 15th
century wrote that there were students who were helping their
preceptors in preparing mineral drugs. The main Golaki Matha
during the reign of the Kakatiyas, was situated in and around
Mandadam village. In that matha, there was a college consisting
of brahmins who were well-versed in the vedas as well as in
grammar, logic and literature. Five of the brahmins were scholars
especially versed in philosophy. A physician with nurses and
clerk was appointed in the hospital built there with two wards,
i e, general and maternity [Hymavathi 1993:145-6].
This process of religious slant to the ayurveda was further consoli-
dated in mathas, temples and agraharas during the medieval period.
Hindu monastic institutions also followed the Buddhist model and
established infirmaries, hospices, and eventually hospitals in their
monasteries. However, one also finds counter-evidence where the
barbers were granted some noticeable privileges during the reign
of Vijayanagara rulers. In 1547, there is some evidence to show
that barbers were skilled in the art of healing certain diseases such
as rheumatic pains of the body, blood related diseases, eye-diseases
etc. It might be in recognition of their skill in this art that the
barbers Kondoja and his son Bhadroja were given privileges and
were granted a ‘manya’ land. These people might have requested
the ‘Raya’ to extend the privileges to all the members of the com-
munity. But, it is reported that the learned physicians did not like the
barbers, the gollas (sheperds), the malas (dalits) and others taking
up healing as profession [Rao Rama 1986]. It must be because of
this reason that they followed their traditional methods without the
knowledge of the sastras. The fact that these traditional methods
with some modifications continue till today, especially cataract
operations, piles treatment and the healing of jaundice makes us
think that these practices gave good results and gained in favour
on account of their efficacy and the resulting easy relief.
As evident, ayurveda did possess a highly abstract meta-
theoretical framework in explaining diseases. This framework
existed not only with adequate empirical verification, but was
grounded in well-recognised procedures of validation and ex-
perimentation. However, the strong principles about ayurvedic
medical system – rationality, empirical observations, sharing
knowledge in the public domain, serving the needs of suffer-
ers, were weakened with the limited patronage it received from
successive rulers and when vested interests of a select social
group gained control over the medical system in the pre-colonial
period. Hence it can be inferred from this historical account
that the scientific basis of ayurvedic medicine flourished not
simply under Buddhism but in an ambience of castelessness
or the denial of varna where knowledge production was for
the public good. The scientific content as well as the wider
dissemination of ayurvedic science were restricted when caste
came to ascendancy through brahminism. As Varma (2006)
pointed out, first the advance of ayurveda was hindered by
the brahminical culture, which exerted adverse effects not
only on medicine, but also on other scientific pursuits. One
characteristic of brahminical culture is that knowledge must
only be transferred to deserving select pupils and not to the
general public. Buddhism tried to break this mould and started
more accessible learning institutions but Buddhism lost ground
in India, partly by force and partly because it was not mystical
enough. The guru-shishya (teacher-pupil) culture is ingrained
in every science and art form. It even influenced Muslim
practitioners of unani medicine and classical musicians. Any
knowledge, which is not transferable is doomed, it cannot
evolve into a living science.
In the latter part of the story, ayurvedic medical system, its
trained practitioners as well as folk practitioners have been
further marginalised during the colonial rule since the interests
of the colonial rulers as well as the Indian elite worked dia-
metrically opposite to indigeneous systems of medicine.
II
English Medicine in Colonial India
The British imposed western medicine on the colonised people
of India, as part of their civilising mission. The Nobel prize winner
and malarial scientist Sir Ronald Ross, had boasted in 1923 that the
British had introduced into India, “honesty, law, justice, order, roads,
posts, railways, irrigation, hospitals ….. and what was necessary for
civilisation”. It became increasingly difficult for indigenous systems
of medicine to compete with the highly favoured western system.
As several scholars have pointed out, whenever there were pres-
sures on the British to recognise ayurveda and unani, they insisted
on scientific evidence of safety and efficacy and “privately” they
believed that to place these systems on a scientific basis would
be to destroy indigenous systems utterly [Jeffrey 1977:570]. No
doubt, western medicine gained its recognition primarily due to
the establishment of a new “tropical medicine” based on the germ
5. Economic and Political Weekly August 25, 2007 3495
theoryofdisease,andacorrespondingintensificationinstatemedical
intervention in India. The value of India as a tropical observatory,
where diseases as varied as cholera, dysentery, leprosy, and malaria
could be more practically or effectively investigated than in Europe
was widely acknowledged. The inability of western medicine to
identify the precise cause of ill-health encouraged practitioners and
others to situate disease, especially epidemic disease, within the
wider physical and cultural landscape of India.
Biomedicine in the world developed while different European
countries were colonising the world – a situation that would, much
later during the 18th and 19th centuries, explain the presence of
biomedicine in different colonised lands. The development of
biomedicine also occurred at the moment in which the European
capitalist system was establishing its foundations. A review of the
history of western medicine in India indicates that it was far less
successful despite state sponsorship and regulation even after 150
years of British rule. As David Arnold (1993) states:
One of the explanations about western medicine’s lack of ac-
ceptability in the beginning was that it had remained too closely
identified with the requirements of the colonial state and so was
remote from the needs of the people. It had failed to make the
transitionfromstatemedicinetopublichealth.Anotherexplanation
was that the mass of the population remained content with the
innumerable and readily accessible practitioners of indigenous
medicine – the ‘kavirajas’, the ‘vaidyas’, and the ‘hakims’ – and
either saw no reason to seek out the few western-trained practi-
tioners who were available or could not afford their fees.
The second explanation of Arnold about the kavirajas, vaidyas
and hakims serving the masses is a serious matter of contention.
Prior to the arrival of British, native medical systems (ayurveda,
unani, tibb, etc), particularly the trained medical practitioners
served the affordable sections, mainly the ruling classes and
upper castes. It is the various folk practitioners particularly the
herbalists and faith healers in every local community, who were
widespread and served the vast majority of the poor.
There is widespread generalisation about ayurveda in rural
India as if the response to illness by the lay population invariably
reflects an ayurvedic approach to healthcare. There is no doubt
about the fact that ayurveda and folk medicine share points
of commonality, e g, a concern about body heat, a hydraulic
model of the body, concern about the blood and digestion, etc.
As Mark Nichter (1986) rightly points out, it is the discrete
ayurvedicpracticesandmedicinesandnotasystematicayurvedic
model of health and pathology, that influence popular health-
care behaviour. The notion that systematic ayurvedic therapy,
based upon ayurvedic diagnostic principle, is readily available
and inexpensive in village India is unfounded. This myth is
propagated by surveys, which classify all herbal practitioners
as practitioners of ayurvedic medicine, is misleading.
However, discussing indigenous medicine, Kumar points to
the crisis of confidence that affected ayurveda and unani once
western medicine became established [cited in Pati and Harrison
2001:30]. The average social position of the elite vaids and
hakims probably deteriorated during the British rule. Until the
first world war medical college students were recruited from
a relatively narrow social background with Christians (often
European and later Anglo-Indian) and Parsi students (in Bom-
bay) providing a disproportionate share of the student body.
The over-representation of Indian Christians and of Parsis was
stable until the first world war, and suggests “both the strong
symbolic value of the degree as an index of westernisation and
the strong identification of these groups with westernisation in
this particular form” [cited in Jeffrey 1988: 84].
It is through medical education, particularly induction of the
children of kavirajas, vaidyas and hakims as western-trained
doctors, that gave legitimacy to its hegemony. Hence, it has been
pointed out that after 1914, the future of western medicine in
India lay not with Europe’s colonisers but with India’s emerging
elites. The indigenous doctors were the vital intermediaries in
the promotion of western medicine and surgery, for instance,
as seen in the Bombay Presidency [Ramanna 2006: 3221].
Although the “cultural authority” and hegemony of biomedicine
over indigenous “science” and knowledge were initiated by the
colonial state, they were extended by the mainstream national
leadership and national government (particular social forces)
with far more extensive and profound implications and less
resistance [Arnold 2000; Khan 2006].
The British were very conscious of protecting the interests of
the upper caste/classes and used it as a strategy to veer them
out of the indigenous/native medical systems. This has been
quite well demonstrated in their health surveys and vaccina-
tions undertaken on the Indian population. For instance, the
cholera vaccine trials entailed a detailed recording of cases and
deaths among the inoculated and uninoculated separately, as
well as different information according to the body population
during the colonial period. In the North-West Provinces (Oudh
and Punjab), the inoculation registers containing individual
names, father’s names or regimental numbers, sex, age, nation-
ality, birth-place, religion, caste, profession, address and date
of inoculation were deposited in the bacteriological laboratory
in Agra. The religion or the caste of inoculated persons was
also mentioned in records such as, for instance, “Radhamoni
Dassee, Hindoo” or “Shaikh Baboo, Mohomedan”. The number
of brahmins inoculated was apparently considered especially
noteworthy, as may be seen in details of inoculated persons
given in Haffkine’s report where no other caste but that of the
brahmin is specifically mentioned – Agra, 580 (117 brahmins),
Rawalpindi, 164 (20 brahmins), etc. It is clear from the kind
of information elicited that a certain imagination of the social
order determined the course of the operations and the way in
which scientific as well as administrative recording was done
[Misra 2000: 3894].
Of significance is that the upper caste and class base of in-
digenous systems of medicine shifted to western medicine as
well, and subsequently the interests of this social group were
entrenched in healthcare policies rather than the health needs
of vast majority of the Indians. However, medicine’s role as a
“tool of empire” and as an instrument of “social control” that
was part of the colonising discourse has been well documented
in the historiography of public health in British India, which
led to the domination of western medicine over indigenous
systems of medicine.
III
Post-Independent India
Without much debate, British rule ensured that allopathic medical
system became the mainstay of health services6 in post-independent
India through the Sir John Bhore Committee. The question arises,
why did the allopathic system of medicine have such a smooth
sailing while the marginalisation of indigenous systems of medicine
take place in post-independent India. Conformity to biomedical
6. Economic and Political Weekly August 25, 20073496
ideology and practice was demonstrated by the Indian ruling classes
and upper castes who not only owned up to the responsibility in
carrying it forward but it was eulogised as a sign of modernisation.
Within the nationalist imagination, Gandhi said, his motto was
“self-reliance” (‘swawalambana’) which is possible only where
there is self-health reliance (‘swasthyawalambana’). “To deepen
modern (English or western) medicine is to deepen our slavery”
[Gandhi 1993]. However, it is paradoxical that despite nationalist
leaders such as Mahatma Gandhi’s advocating swawalambana and
swasthyawalambana, the institutionalisation of allopathic medicine
has taken place without much debate.
In effect, there are three streams of health providers that
have emerged in the post-independent India – qualified allo-
pathic doctors, the qualified doctors from the Indian systems
of medicine (ayurvedic, unani, homeopathy) and unqualified
health providers (UHPs). The qualified allopathic doctors
(both working in the public and private sectors) occupy the
dominant position in the plural medical systems in India. They
have demarcated for themselves spatial and social areas of
health services largely within urban India and partially rural
India catering to the affordable social groups. Qualified doc-
tors from the Indian systems of medicine, in trying to compete
with qualified allopathic practitioners have been relegated to a
subordinate position in the plural medical system. They have
been operating within more or less the same spatial and social
boundaries, providing health services with the help of either
their own chosen medical systems or combining their own
field with that of allopathy. Both these institutionalised forms
of medicine in public and private sectors cater to the afford-
able groups (20-25 per cent) which has turned out to be an
expensive and unaffordable proposition for the vast majority
of the poor. It is the third stream, i e, UHPs who by default
have become the mainstay of health services for about 75 per
cent of the population in India.
A significant question arises, why are these UHPs still sought
after in villages instead of the “free services provided by public
health centres”, run by well-qualified and competent medical
professionals, leave alone qualified private practitioners (al-
lopathy or ayurveda/unani). The cost of treatment, which is,
supposedly “free”, often exceeds the cost of going to an UHP.
Several studies have also pointed out that apart from the cost
of treatment, it is also the reluctance of qualified practitioners
to serve the poor-sick, referral systems remaining ill-developed,
medical education not reoriented and reformed to suit the
needs of Indian masses, and the way preventive programmes
remained unintegrated. What is more important, the manner in
which the democratic concept of “primary healthcare” has been
operationalised in the Indian context needs to be analysed.
Hierarchy and division of work is unavoidable in any or-
ganised set-up. In the Indian setting, however, this is further
complicated since organisational hierarchies are to a large
extent reproduction of social hierarchies present in the larger
social system. A majority of the doctors come from upper caste/
class background while the nurses and other field staff from
middle or lower castes and classes with a few exceptions. Apart
from their class backgrounds, the health personnel reflect the
domination of certain castes. Despite reservation for the SCs
and STs, those sections still remain underemployed in the
health services. This replication of social patterns brings with
it certain other traits as well, one of which is the upper class
(elite) culture that pervades healthcare institutions. Institutional
rules have been framed and practised more according to the
needs of health personnel rather than according to the social
needs of the communities [Qadeer 1985]. Hence in accessing
health services, social status rather than disease status appears
more important.
Mark Nichter (1986) through his study in the south Kanara
region argued that medicine constitutes an arena wherein the
caste hierarchy in south Kanara is largely reproduced. Unde-
niably, caste serves as a factor undercutting or intensifying
issues of professional status as well as personal economics.
He concludes that issues of a doctor’s professional status and
the relative caste power of staff within the regional health
bureaucracy influence team work within local health centres.
In essence, these institutions that were supposed to be part of
a larger modernisation process through “inclusion” approach
actually follow “exclusionary” practices. Although poverty
and educational status are usually linked with the low health
status of rural communities, it is essential to understand the
way in which social hierarchies are mapped onto medical organi-
sational hierarchies, which is an important factor in providing
access to healthcare. As Varma (2006) argues, where public
health is in disarray in favour of modern private profit-making
hospitals in major cities, the marginalised population has little
to choose between an allopathic and ayurvedic/unani doctor.
This does indicate how in the post-independence period, the
ruling classes articulated the need for establishing modern in-
stitutional structures in public space; however, the same social
forces effectively contributed to the dilution of the spirit of
these institutions in practice.
Given the above situation, one needs to look at whether
rational choices exist for a large majority of the people, since
India is projected as a living example of medical pluralism.
Meera Chaterjee based on studies from four states (Bihar,
Madhya Pradesh, Haryana, and Maharashtra) indicated that a
significant proportion of rural illnesses are untreated by any
means, and certainly by medicine, be it traditional or modern
[cf Rhode and Viswanathan 1994]. Thus the debate in the
health sector, about the choices for the poor-sick in terms of
public or private healthcare, ayurvedic or allopathy, modern
or traditional, does not provide any great clarity in terms of
treatment-seeking patterns in India. The choice at one level
in the plural medical systems is no choice at another level.
The poor-sick are not only deprived of basic health services
but also other basic needs like proper food, drinking water,
sanitation, etc. Without understanding the circumstances of
social life, it may not be possible to deal with health issues
[Prasad 2000, 2005].
This paper argues that starting from the pre-colonial period,
there is evidence of institutionalised forms of medicine (both
allopathy and ayurveda) adapting deliberate and exclusionary
policies that led to the vast majority of the poor-sick being
alienated and marginalised in terms of health services. Unless
modern social consciousness (egalitarianism) becomes the
predominant driving force, the conditions for the emergence
and spread of modern society may not emerge.
Discussion
In analysing the contemporary health situation in India, argu-
ments about inaccessibility of healthcare to the masses are broadly
placed within the context of tradition vs modernity. Protagonists
7. Economic and Political Weekly August 25, 2007 3497
of tradition argue that it is the predominant biomedical discourse
that is trying to ascertain its hegemony and control over the body
population, in order to prove/establish not only its epistemic,
pedagogical methods, etc, as superior but also to dismiss existing
knowledge systems as irrelevant or non-scientific. Different sets
of arguments are made in this paradigm which include: tradition
is capable of innovation, tradition includes modern elements over
a period of time implying tradition is dynamic; tradition caters
to the existing needs of local communities;7 tradition is not anti-
modern but is context-sensitive. The protagonists of modernity
argue that it is the time-tested clinically proven scientific know
ledge systems that are capable of providing universal healthcare
to the masses. Modernity is capable of transcending the local,
regional, and parochial boundaries. Thus, implying that it is
only the modern nation state, which in principle can facilitate
welfare (universal health, education, development, etc) to all
its citizens without any discrimination. The pertinent question
that is not raised is, why both traditional and modern medical
systems in India, having more or less a similar social base,
have been instrumental in gaining control over the “bodies” at
different historical time periods but at the same time used the
principles of “mystification”, “exclusion” in order to practise
medicine. Instead of arguing why all the medical knowledge
(traditional or modern) have not been democratised in order to
ensure accessibility to the masses, the essential debate centres
around the issue of hegemony and control8 by one system of
knowledge over the other.
Therefore, medicine cannot be understood in its own terms
as an objective science, since it also incorporates social values
into its practice. Consequently it must be considered from a
sociological perspective. Secondly, it is not technology per se
but technological culture through which ruling classes and upper
castes gained social legitimacy in India. The way westerners
turned their white man’s burden, civilising mission, sanitation
as civilisation into the project of modernisation/development in
third world countries, similarly Hindu sanskritic elements and
vedic rituals were turned into the project of nation-building by
the upper castes and classes in India. All types of institutiona-
lised medicine have become expensive including ayurveda and
excluded a large proportion of people from accessing healthcare.
The counterpoint would be to democratise all institutions that
facilitate health services in India.
In India, a binary medical model seems to have been de-
signed and put in place by the ruling classes for the benefit
of dominant and dominated social groups. Although there is
predominance of modern scientific medicine, folk, traditional
and other indigenous forms of medicine, also co-exist. As
part of the larger project of “modernity”, a conscious effort
has been made to include certain social groups gain access
with the institutionalised forms of medicine (both allopathy
and alternate systems) while the non-institutionalised forms of
medicine would anyway serve the purpose of the excluded and
the under-classes. The non-institutionalised medicine, which is
generally available to the poor-sick, is of poor quality because
of its general subordination and exclusion from an organised
system. Hence there is a need to analyse the internal social
forces that continue to resist democratisation of institutional
strucutres and continue to perpetuate the inhuman conditions and
inequality, rather than exclusively and excessively focusing on
external and global forces alone. What we need to investigate
further in the health sector is about the institutional conditions
that sustain the inequality in healthcare in India. Thus, health
has not been a choice but an imposed preference for a large
majority of the population in India.
Email: nppss@uohyd.ernet.in
Notes
[This is a revised version of the paper, ‘Practice and Politics of Medical
Pluralism: A Study of Healers in West India’ presented at the national
workshop on ‘Mirrored Views on Healing Systems in India: Merging
Policies, Politics and Practices’, held at French Institute of Pondichery,
April 18-19, 2004. I am thankful to the organisers of the workshop and
the participants for the feedback on the paper, especially Loren Pordie. I
am grateful to Aloysius and Sudhakar Rao for their useful comments and
suggestions that helped me revise the paper substantially.]
1 Promoters of public health advocate through “health for all”, “health
for the millions” while private healthcare through “quality”, “efficacy”,
“quick care”, etc.
2 The Canadian healthcare model is often cited as a successful experi-
ment, which can be replicated across the world. However, the specific
trajectory of healthcare in each nation is either ignored or undermined in
advocating such models to be replicated. Also certain questions regarding
forging partnerships between public and private are raised such as – is
this a strength that India is not using adequately or is this what creates
the chaos and the directionless movement?
3 Westernmedicine,Englishmedicine,colonialmedicine,imperialmedicine
are various terms used to denote a allopathic medical system that was
introduced and practised during colonial rule in India.
4 By the time of Brahmanas and Upanishads, there were only four
branches in ayurveda, i e, Bhutavaidya, Sarpavaidya, Rasayana and
Vajkarana. During the transition period, four other new divisions came
into existence viz, salya, salakya, kayacikitsa and kaumarabhrtya and
are allied to ayurveda.
5 Regarding the statement that physicians in general are polluting and
therefore excluded from the brahmanic sacrificial and social system,
the Satapatha Brahmana also confirms that physicians (i e, the Asvins)
were impure because they came into constant contact with humans in
the course of performing cures. This attitude persisted in India and is
found in the later law books that repeat passages from the laws of Manu,
stating that physicians (‘cikitsaka’, ‘bhisa’) must be avoided at sacrifices
and that the food given by physicians is, as it were, pus (‘puya’) and
blood (‘sonita’) and is not to be consumed.
6 A strong plea for a rational approach, to the evolution of an integrated
system of medicine in India was made in 1948, soon after independence,
by the president of the Indian science congress. He tried to draw attention
to the fact that the practice of modern medicine also had its unscientific
aspects. Opinions were sharply divided on both sides. Modern doctors
have generally opposed through their professional bodies, including the
Indian Medical Association saying that any mixture of traditional and
modern systems of medicine will jeopardise the growth of scientific
medicine in India. Their overall opinion of traditional systems is that
these are at best refined forms of quackery.
7 Community is generally constructed and used as if there is a homogeneous
category existing in India across the country, region, and intra-region.
8 The hegemony of one system of knowledge on the other needs to be
contested but within the democratic principles of working out an inclusive
knowledge base and the institutional mechanisms.
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