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Apr-Jun2001-9(2)
A critique of health
care
Geetanjali
Gangoli
Health care - earth care: interrogating health and health policy in India. Prabha Krishnan, Earthcare Books, Mumbai, 2000, 444 pages.
In this trenchant critique of the health care
system in India, Prabha Krishan argues that modern medicine is reductionist and
detrimental to the health of men and women. Her book is divided into two
sections: the first elucidating the problems and limitations of modern medicine
and science, the second looking in some detail at the Health Awareness Centre in
Mumbai that offers an alternative to these systems.
Krishnan begins with an analysis of the impact of
multinational companies on Indian resources. She studies the Bretton Woods
institutions that ushered in the era of neocolonialism, creating a market for
American domination and a source of raw material in the East. The Indian ruling
classes have been complicit with this process as they suffer from a sense of
shame about Indian culture. This includes a rejection of Indian traditions,
dress and medicine. Thus the ruling classes have actively supported the grafting
of incompatible systems upon Indian culture and the opening up of the market to
foreign companies. Other than the cultural aspect, however, the middle classes
have been the main beneficiaries of the liberalisation process.
Krishnan points out that within this paradigm,
aspects of Indian traditions are accepted, if at all, in fragments. Ayurveda is
seen as alternative therapy not a way of life. It is commercialised by drug
companies that fragment it into pre-packaged products. The health policies of
the Indian State have reflected the class and gender bias of the policy makers.
Krishnan gives the example of the family planning programme. The socially and
politically dominant middle classes have a fear of rising population among the
poorer sections of society. This is seen as dangerous, hence the bourgeoisie
actively propagates coercive family planning programmes that are unleashed
primarily on the poor. The author points out, however, that there is often a
lack of internal or ideological coherence within health policy.
The book enumerates the results of liberalisation
on the Indian health sector. The substantial reduction in state spending on
health and other social sectors has led to the poor being left out of health
care. At another level, the State has displayed a lack of commitment in
providing good health to its people. For example, reducing restrictions against
foreign investment in tobacco firms completely negates official policies on
health.
The issue of environmental degradation is treated
as arising out of human agency. Forty years of modern farming have led to soil
depletion and a drop in the nutritive value of agricultural produce. Krishnan
makes a convincing case against the mantras of modern development paradigms that
focus on increase in production and better distribution, and argues instead for
village level self-sufficiency and distributive justice at the level of the
means of production.
The book addresses the attitude of medical science
towards women. The analysis is that women have been the repositories of
traditional wisdom and medicine, which has been marginalised. Besides, there is
little effort to understand the links between the social oppression of women and
its consequences for women's health. Instead women are seen as 'social problems'
and 'targets' by health planners. Health care systems deal with the symptom,
rather than the person and the social milieu in which he or she is placed.
All this arises out of a reductionist attitude to
health that focuses on disease elimination rather than a daily commitment to the
self and community. The body is seen as a machine.
Regarding some ethical issues in modern medicine, Krishan argues that modern medical science belies our unstinting faith in it. There is a lack of rigour in testing medicines; cases of medical negligence are frequent.
Regarding some ethical issues in modern medicine, Krishan argues that modern medical science belies our unstinting faith in it. There is a lack of rigour in testing medicines; cases of medical negligence are frequent.
The book focuses on efforts by non-governmental
organisations (NGOs) and people's groups to vest accountability on the state.
Two of the NGOs that she studies in some detail are the Lok Swastaya Parampara
Samwardhan Samiti, and the Vaishya AIDS Mukabla Parishad, Maharashtra. Such
groups perform a range of services including creating village nurseries, herbal
gardens and medicinal forests and providing personal health care for sex
workers. Some of these organisations simultaneously question the use made of
donor agency funds.
Other movements that pose a more direct challenge
to the development paradigm include the Narmada Bachao Andolan and the Chipko
movement. These redefine the concept of development through the prism of
'ordinary' men and women.
The second part of the book is a detailed case
study of the Health Awareness Centre in Mumbai. The Centre opposes the germ
theory that views disease as an external attack by viruses and microbes, and
believes that illness is caused by wrong life practices. Good health can be
attained through nutrition and proper lifestyle. Ayurveda supports this theory.
The book examines a range of issues, raising
concerns of ethics within modern medical practice. Modern medicine is based on a
relationship of inequality between the provider and the seeker. It is
reductionist in its approach to the human body and to disease. The process of
liberalisation has exacerbated the process of alienation of people from policy
makers and health providers. The book however ends on a note of hope by looking
at efforts that actively question modern medical practices.