Section 8: Optional Reading

Major trends in the field of Health

This section is addressed to the facilitator who may not be from the ‘Health’ background and others who may want to get glimpses of important developments in the field of Health, gender concerns being the latest one. Our understanding of ‘Health’ and health care practices have undergone massive changes in the last five centuries, often reflecting paradigm shifts in other fields of human knowledge like Science, Economics and Theology. What follows is a brief description of these major shifts. This will help facilitator (and participants through her) develop a larger conception of health system– a prerequisite to understand that it has been changing over the years.

 

Mechanistic World View: Between 1500 and 1700AD, a radical shift took place in the way people looked at the world and in their whole way of thinking. It could be summarized as –

Material universe and everything in it, including human body is a machine. It can be understood by studying the parts. There is no purpose, life or spirituality in matter. Life or even consciousness could be explained through physico-chemical properties of its constituents.

Such beliefs originated with Descartes in 17^th century, as a major departure from the organic world view sanctioned by the Church and Aristotle in the middle ages. The inherent belief in this departure was: manipulation and exploitation of ‘nature’ is not only scientific but is sanctioned by ‘science’. Such attitudes and beliefs percolated into medical science and practice as well-and can be seen to be behind such modern controversies like “womb on hire” and human cloning.

 

Reductionism: This was closely linked with the above and consisted of the belief that all aspects of complex phenomena can be understood by reducing them to their constituent parts, ie. the ‘whole’ is nothing more than the ‘sum’ of the parts. Over emphasis on such thinking led to dichotomies such as Body versus Mind and Curative versus Preventive care in time. It also led to fragmented thinking in medical profession and focus on treating the ‘sick organ’ rather than the person as a whole[1].

 

Biomedical Concept of Health: The developments in rational, observable sciences strengthened the medical profession’s belief that the human body was a machine, disease- a consequence of the breakdown of this machine and doctor’s task – repair of the machine. Thus health, in this narrow view, became the ultimate goal of medicine.

The criticism leveled against this is that it has minimized the role of the environmental, social, psychological & cultural determinants of health. The biomedical model for all its spectacular success in treating diseases, was found inadequate to solve some of the major health problems of mankind – malnutrition, accidents, drug abuse, mental illness, environmental pollution[2].

 

Germ Theory (Pasteur, 19^th Century): In practice it meant, that we live in an ocean of dangerous germs and disease is a consequence of an attack from the outside, rather than of a breakdown within the organism. This led to over emphasis on antibiotics and antiseptics. Role of other factors behind health and its maintenance got de-emphasized in the process: role of one’s own immunity, healthy life styles, environment etc. Such attitudes have been promoted by an aggressive drug industry.

 

Public Health Vs Curative Health: The great dichotomy

Industrial revolution in mid 19^th century England gave rise to slums, overcrowding and filth. Frequent Cholera epidemics led an English lawyer (Chadwick) to investigate the health of the inhabitants of the large towns and suggest ways to improve their living conditions. His report led to a great sanitary awakening which spread to Europe and America. This was also the beginning of ‘public health’ in modern era.

 

The division between Curative and preventive medicine (also Public Health) was evident at the close of the 19^th century. After 1900, medicine moved faster towards ‘specialization’ (even super-specialization) and rational scientific approach to disease. Closely linked was the growing phenomenon of excessive dependence on sophisticated (and costly) technology and drugs. It could be said that curative medicine gravitated towards rich man’s diseases while preventive health was left to deal with poor man’s problems.

 

Women and Health / Medicine

It appears that organized religion and political institutions like state, systematically kept women out of healing traditions[3] or restricted their role to ‘lowly’ nursing and midwifery fields[4]. This exclusion was effected through excluding her from formal education, insisting that her role was within the home, not outside and through licensure/ regulation and also at times through persecution & violence.

 

Witchcraft trials and witch hunts in medieval Europe was one example how state and organized religion joined hands to push ‘medical women’ out of the public arena for centuries. Men took the central role of being the physician. The rationale was: nursing required feminine qualities of nurture and caring while clinical decision making required rational intellectual acumen associated with men.

 

Only in the mid nineteenth century did women begin to be admitted to recognized medical schools. Even today more men opt for the medical profession and the few women who do so, often end up specializing or practicing Gynecology, Obstetrics, Pediatrics – branches dealing with women’s reproductive role and the new born.

 

It is believed that patriarchy was at play on a subconscious plane while modern science evolved over the last five centuries. The purpose of this science was subjugation of nature. Nature was often thought and spoken of as woman. Nature in Bacon’s view[5], had to be “hounded in her wanderings,” “bound into service” and made a slave. She was to be “put in constraint,” and the aim of the scientist was to “torture nature’s secret from her.”

This deep seated bias against women (and feminine qualities) can be seen in the following practices, beliefs:

·      Women often end up in poorly paid nursing jobs. Clinical decision making and treatment part is systematically kept out of their purview.

·      Family planning programs have targeted women more than men.

·      There are more family planning options for women than men, discovered by scientists and offered by the State in their Family welfare programs.

·      Doctor-State- Drug Industry nexus has often condoned use / trial of questionable technology/ contraceptives on women’s body. (Dalkon shield[6], Ultrasonography/ amniocentesis for female feticide, unwarranted hysterectomies, Caesarians etc)

 

Countercurrents in Health/ Medicine

In India, awareness on women’s issues in modern times started as a major social reform movement in 19^th century, led by Ram Mohan Ray, Vidyasagar and others- in the vanguard of Renaissance in Bengal. It passed through the political current of the nation, during the independence struggle. It had a resurgence in post emergency phase (1970s) as evolution of many women’s organizations and movements (Chipko & anti-arrak/liquor movement in south). 73^rd and 74^th Constitutional amendments assuring one third seats for women in the local governance structures, MTP and PNDT acts similarly in the field of health were the outcomes of long advocacy efforts of women’s groups[7]. 

 

Women’s movement in India has affected field of health in many ways, some of which are:

·      Violence against women is increasingly being recognized by health service providers and authorities.

·      Organized resistance by women’s organizations and activists, to unethical and aggressive promotion of contraceptives

·      Increasing advocacy against use of medical technology against women (Depo-provera, Norplant, Amniocentesis etc)

·      Exclusive focus of service providers on reproductive role of women (RCH, Family planning services) is being challenged; General health care, adolescent needs and topics like menopause, sexuality, gender and ‘male responsibility’ are being included increasingly in the purview of interventions being planned now.

·      Absence of Female service providers in state health services is being recognized as of a serious quality concern.

 

Other Gender Analysis Frameworks

(Brief Introduction of 4-5 common GA frameworks to be added; Idea is to help the user understand that GPIH is one among many frameworks; but these other frameworks are used in IGP and other non-health situations.)