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.
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.