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The politics of health in India
Sot. SC;. Med. Vol. 29, No 1. p. 899. 1989 Pergamon Press plc. Printed m Great Britain
BOOK REVIEW The Politics of Health in India, by ROGERJEFFERY.University of California Press, Berkeley, Calif., 1988. 348 pp. $39.95 Roger Jeffery notes that “societies have many varieties of healing techniques, explanations of healers and illness, and distributions of medical knowledge. The kinds of treatments, the classifications of disease, and the forms of the division of medical labor are all subject to social and other forces that produce very different results in different parts of the world” (p. 42). These forces are the subject of this book on the politics of health in India. Jeffery begins by contrasting previous accounts as either Marxist, in which imperialistic dependency relationships are paramount, or as descriptive/uncritical, in which technological transfer from the West is seen as gradually modernizing India. He sets out to avoid these two extremes. His work is hindered by the lack of reliable statistics concerning health care and living standards. However, he spent 12 years researching this book, and his meticulous work in analyzing numerous primary sources is impressive. The book is split into two parts. The first summarizes health and health policy before independence (i.e. before 1947) and includes chapters on health status, indigenous medicine, the Indian Medical Service, medical education, public health, and health expenditures. Indigenous medicine in India consists of two main traditions: Ayurveda. associated with Hinduism, and Unani, associated with Islam. Both of these are essentially humoral systems. The advent of British rule brought with it Western medicine and public health. However, little of this affected the Indian masses. “The provision of health services was excessively medical in character with preventive and sanitary measures given low priority; most concern was for European troops and European quarters of towns. Sanitary measures were often restricted to attempts at social control. Any improvements in the health of Indians was no more than accidental and the unintended consequences of quite other politics” (pp. 19-20).
The second part focuses on health policy in independent India and includes chapters on the S-year plans, India’s place in the world health economy, medical and paramedical personnel, medical colleges, hospitals, primary health centers, and rural health. Despite independence, there has not been a significant change in the gap between rich and poor. In addition, there is very little integration of the different health services (e.g. nutrition, vaccination, family planning), and ‘single-disease campaigns’ have dominated Indian public health. Western medicine exists alongside indigenous systems-sometimes within the same practitioner. Jeffery is especially insightful at outlining the factors that encourage newly trained doctors either to migrate abroad or to work in urban areas with a preference for pharmacologic or surgical care rather than preventive or public health work. JeKery does succed in his goal of avoiding total reliance on either the Marxist model or the descriptive/uncritical model in his analysis of health in India. However, he provides neither a successful synthesis of these two models nor an alternative model. Another limitation of the book relates to his vision of the future. While he correctly understands that new innovations cannot be applied “as if they are techniques divorced from a social, economic, and political contest” (p. 289), he doesn’t use his study of Indian health care past and present to offer either a prediction of the future or suggestions to reform the current system. Despite these limitations this is a valuable book for students of India, scholars of comparative health systems, practitioners interested in varieties of medical work, and those of us who may periodically come and go in travels to see what change is taking place in the country from which we come. Primary Care Program Massachusetts General Hospiral Bosron. Mass., U.S.A.
899
ASHWIN]SEHGAL
BOOK REVIEW The Politics of Health in India, by ROGERJEFFERY.University of California Press, Berkeley, Calif., 1988. 348 pp. $39.95 Roger Jeffery notes that “societies have many varieties of healing techniques, explanations of healers and illness, and distributions of medical knowledge. The kinds of treatments, the classifications of disease, and the forms of the division of medical labor are all subject to social and other forces that produce very different results in different parts of the world” (p. 42). These forces are the subject of this book on the politics of health in India. Jeffery begins by contrasting previous accounts as either Marxist, in which imperialistic dependency relationships are paramount, or as descriptive/uncritical, in which technological transfer from the West is seen as gradually modernizing India. He sets out to avoid these two extremes. His work is hindered by the lack of reliable statistics concerning health care and living standards. However, he spent 12 years researching this book, and his meticulous work in analyzing numerous primary sources is impressive. The book is split into two parts. The first summarizes health and health policy before independence (i.e. before 1947) and includes chapters on health status, indigenous medicine, the Indian Medical Service, medical education, public health, and health expenditures. Indigenous medicine in India consists of two main traditions: Ayurveda. associated with Hinduism, and Unani, associated with Islam. Both of these are essentially humoral systems. The advent of British rule brought with it Western medicine and public health. However, little of this affected the Indian masses. “The provision of health services was excessively medical in character with preventive and sanitary measures given low priority; most concern was for European troops and European quarters of towns. Sanitary measures were often restricted to attempts at social control. Any improvements in the health of Indians was no more than accidental and the unintended consequences of quite other politics” (pp. 19-20).
The second part focuses on health policy in independent India and includes chapters on the S-year plans, India’s place in the world health economy, medical and paramedical personnel, medical colleges, hospitals, primary health centers, and rural health. Despite independence, there has not been a significant change in the gap between rich and poor. In addition, there is very little integration of the different health services (e.g. nutrition, vaccination, family planning), and ‘single-disease campaigns’ have dominated Indian public health. Western medicine exists alongside indigenous systems-sometimes within the same practitioner. Jeffery is especially insightful at outlining the factors that encourage newly trained doctors either to migrate abroad or to work in urban areas with a preference for pharmacologic or surgical care rather than preventive or public health work. JeKery does succed in his goal of avoiding total reliance on either the Marxist model or the descriptive/uncritical model in his analysis of health in India. However, he provides neither a successful synthesis of these two models nor an alternative model. Another limitation of the book relates to his vision of the future. While he correctly understands that new innovations cannot be applied “as if they are techniques divorced from a social, economic, and political contest” (p. 289), he doesn’t use his study of Indian health care past and present to offer either a prediction of the future or suggestions to reform the current system. Despite these limitations this is a valuable book for students of India, scholars of comparative health systems, practitioners interested in varieties of medical work, and those of us who may periodically come and go in travels to see what change is taking place in the country from which we come. Primary Care Program Massachusetts General Hospiral Bosron. Mass., U.S.A.
899
ASHWIN]SEHGAL