Medicine, Power and Social Legitimacy: A Socio-Historical Appraisal of Health Systems in Contemporary India

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.

PARI Library's health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India.