Maladies, Preventives and Curatives: Debates in Public Health in India edited by Amiya Kumar Bagchi and Krishna Soman; Tulika Books, New Delhi, 2005;
Debates in Public Health
Maladies, Preventives and Curatives: Debates in Public Health in India
edited by Amiya Kumar Bagchi and
Krishna Soman;
Tulika Books, New Delhi, 2005;
pp x+173, Rs 350.
PRATIK CHAKRABARTI
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his book is an important contribution to the growing literature on the history of Indian public health. The significance of the volume lies in its focus on both the colonial and the post-colonial period as public health continues to be a major concern in contemporary India and many of the issues take us back to the colonial period when the institution actually originated.
In the first section titled ‘History Recalled’, focusing on the colonial period, Achintya Kumar Dutta writes on ‘Kala Azar’ in Assam, which ravaged Assam in the 1870s. Dutta carefully studies the efficacy of British medicine in checking the malaise in a region of the tea plantations. However, the preventative and sanitary measures adopted by the government were of little avail and the real improvement came only with the arrival of the antimony treatment in1919. Dutta makes the important observation that the eradication of the disease remained unattainable not so much due to lack of medical intervention but due to the fact that the necessary financial and welfare measures were never adopted by the colonial government.
Muraleedharan’s paper on the introduction of cinchona cultivation in India highlights both the political and economic factors involved in this significant enterprise. The British introduced its cultivation in India to reduce the huge expenditure involved in importing quinine, which by the middle of 19th century had indeed become the panacea. However, the success of the plantation and that of quinine was not straightforward. There were several contentious issues like the debates about ideal site for its cultivation (whether in the Nilgiris or in Darjeeling), modes of cheap production of quinine, as well as the debates regarding the efficacy of other cinchona alkaloids which could be manufactured economically, like the chinchonidine, quinindine and chinchonine. The latter debate persisted till the 1930s. What Muraleedharan describes as the medical profession’s “romance with quinine” till DDT technology turned the tides in the 1940s. The discussion here would have benefited from another stage of this story, the search for local substitutes of the cinchona in India by European surgeons, from the middle of the 18th century, and an enterprise which was abandoned once cinchona captured the imagination of the medical profession.
Deepak Kumar’s paper reflects his recent engagement with the history of public health issues and his search here
Economic and Political Weekly June 17, 2006 is to understand the very notion of “public health” in colonial India. He argues that within a colonial regime modern medicine failed to make the transition from state medicine to public health, based as it was more in the prejudices against “contacts” with “dangerous bodies” rather than welfare. Thus rather than critiquing the role of the state and imperialism, medical opinion here, instead, blamed the victims.
Kabita Ray’s paper highlights the other aspect of the emergence of public health concerns in the colonial period and the role of popular nationalist press in highlighting the health concerns. The issues raised involved quinine and vaccination policies, famine relief, leprosy treatment, infantile and maternal welfare, etc. Ray shows how the press through its critique of the colonial state’s health policy not only urged the government to shift its focus on various issues, but also set the early principles of a welfare state.
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In the next section ‘Challenges to the Present’, focusing more on post-colonial India, Imrana Qadeer’s (‘Continuities and Discontinuities in Public Health’) paper is the only one that links the colonial with the post-colonial. Qadeer sees several continuities in the independent India’s health policies with the colonial one. This was despite the fact the Five-Year Plans attempted to create a radical break from the colonial policies by highlighting rural health, basic services, free basic healthcare, etc. Qadeer makes an interesting observation that the break was never fully achieved due to internal continuities from the colonial period like central control of funds, dominance of central government specialists in local health and elitist medical education, and, ultimately producing a poor imitation of community health models of UK and the US. There were external elements in the post-colonial period like international monetary and institutional involvements, which increasingly guided India’s economic policies and welfare principles. Soon healthcare was seen as an independent investment area in an increasingly market-driven economy. These two combined to shape India’s eventual neoliberal public health policies promoted by the World Health Organisation.
In the same vein, Amit S Ray’s article highlights the problems faced by the pharmaceutical industry of India in a neo-liberal world. Despite being a major drugmanufacturing country in the world, India’s domestic pharmaceutical industry remains highly vulnerable to international pressures and has struggled to come to terms with the new norms of drug quality and the vigours of the R&D-driven business model from the 1990s. Ray argues that the new norms of drug quality which have been used by multinational pharmaceutical giants as entry barriers to the global generic market has demanded massive upgrading investments and has distracted the local industry from the concerns of local healthcare and patient welfare.
Dilip Mahalanabis (‘Micronutrient Malnutrition: Some Public Health Concerns’) highlights the nutritional challenges that India continues to be faced with, in the midst of growing food prices and severe malnutrition affecting almost half of the population. He insists that the need is not just of economic growth, but also of positive initiative from the state particularly in addressing child and female healthcare. One common theme that runs through the papers is the role of the state in public healthcare. The arguments highlight the various modes of the state functioning, sometimes unsympathetic, sometimes intrusive and top-heavy. While it is true that the colonial state was indeed callous regarding public health, it is also true that public health interventionism in most countries have been seen as intrusive, divisive and have faced popular resistance. An engagement with how the poor and underprivileged in several other countries have or continue to struggle with health and welfare as well as the role of state would have provided more latitude to the arguments made in this volume.
Kumar and Qadeer’s very important arguments about the problematic genesis of the Indian public health structure in its colonial past is somewhat undermined by the fact that such arguments are not based on much research in governmental records which would perhaps have provided a more nuanced picture. However, what the papers aptly highlight is that the reasons for the failure to secure a welfare state in India and ensuring the good health and well-being for all its citizens are embroiled in issues like being beholden to a colonial heritage, failures of the independent nation state and its elites, ever-present social and economic discrepancies, as well as the international economic realities.
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