Medicine, Power and Social Legitimacy: A Socio-Historical Appraisal of Health Systems in Contemporary India
Purendra Prasad N.
Economic and Political Weekly
25 Aug, 2007
This article from the Economic and Political Weekly, a peer-reviewed journal, discusses India’s various medical systems and the historical conditions under which allopathy or modern medicine (usually a synonym for ‘western’ medicine) assumed dominance. British rule in India, it says, was responsible for allopathic medicine becoming the backbone of independent India’s health services. The article adds that India’s ruling classes and upper castes advocated the cause of biomedical science because they saw it as a sign of ‘modernisation’. All of this contributed to the entrenchment of three streams of health providers in independent India. The articles lists these as: ‘qualified’ allopathic doctors (who have dominance over the other streams), ‘qualified’ ayurvedic, unani and homeopathic doctors (who have been relegated to a secondary position) and ‘unqualified’ health providers (who sometimes become the mainstay of health services in rural areas).
Ayurvedic medicine derived its major features from the work of heterodox ascetics rather than Brahmanic intellectuals, and the more significant growth of Indian medicine took place in early Buddhist monastic establishments.
From the 9th century BC to the beginning of the first millennium AD, heterodox medical practitioners were denigrated by the Brahmanic hierarchy, the article states, and excluded from orthodox ritual cults because of their ‘pollution’ from contact people of the ‘lower’ castes.
When the children of kavirajas, vaidyas and hakims (practitioners of indigenous medicine) entered the colonial medical education system, it gave western medicine legitimacy and a dominant position. Although it was the colonial state that first gave biomedicine cultural authority over indigenous science, India’s national leadership, both before and after Independence, continued to do so.
The upper caste and class practitioners of indigenous medicine shifted to western medicine, and subsequently the interests of this social group were entrenched in healthcare policies rather than the health needs of the vast majority of Indians. The rules of health institutions have also been framed and practised according to the needs of health personnel rather than those of the communities they serve.
The article asserts that a majority of doctors in India are now from upper caste and class backgrounds while nurses and other field staff come from the middle or lower castes and classes – with a few exceptions.
The cost of treatment at public health centres (which are supposed to be free) often exceeds the cost of going to ‘unqualified’ health providers in rural areas. Several studies have shown that: qualified practitioners are reluctant to serve the poor; referral systems are not well developed; medical education does not cater to the needs of the Indian masses; and preventive programmes are not integrated into health services.