Abstract
Arathi P. M. (Ed.), Public Health in India: Policy Shifts and Trends, Sage Publications, 2022, 365 pp., ₹1341, ISBN 978-93-5479-370-7 (Hardcover).
This book is the sixth volume in the Social Change in Contemporary India series edited by Manoranjan Mohanty. This unique series showcases selected articles from several Social Change issues to mark the journal’s golden jubilee celebrations. The guiding spirit of this series is to recapture some of the ‘momentous experience of people of India and their institutions since Independence’ (p. xi). This edited volume recaptures selected articles ranging from 1984 to 2007. Over these years, Social Change witnessed a blend of landmark social and technological events and epochs such as the Green Revolution, industrialisation through the Five Year Plans, the creation of some of the finest educational and research institutions and subsequently, neoliberal reforms, movements and mobilisation of women, dalits, socio-economically backward castes, and religious minorities. The volume on public health is thus able to draw upon the published articles of these decades in the context of these social and structural determinants of health. While these terms were not quite fashionable in those decades, the foundations of these concepts had been laid down, both in theory and practice, by many of the authors whose contributions to Social Change have been selected for this volume. Therein lies the unique attraction and value of this volume, nested in the series.
This volume is published in the aftermath of the COVID-19 pandemic that has crafted its space in the global landscape of public health. This pandemic marked its presence in India at a time when liberalisation, privatisation, and commercialisation of the public health space had almost irreversibly altered the structures and functions constitutionally envisaged at the turn of independence. P. M. Arathi, the editor, has laid out these contradictions in detail through three strands: a biomedical-disease-control-oriented approach vs. comprehensive care and wellbeing; health as a private good that entails payment to private and public providers or through insurance companies vs. public health services provisioned as a public good; and a population and planning approach vs. a human rights framing. The articles that transcend several important themes ought to be seen in the evolution of the spirit and ethos in India in this time scale.
The articles in this volume have been thoughtfully arranged into 18 chapters across four sections: political economy of health and illness, women’s health and reproductive justice, nutrition as a social determinant of health, and the Malthusian spectre. 1 It is a difficult task to create themes for the diversity of articles on public health that Social Change has published through these decades. The editor has put forth her reasons and arguments for this framing. The editor’s note (Sectional Introduction) introducing each section is useful in setting the discourse that this volume seeks to address in each of these thematic areas. Unarguably, these thematic areas have shaped public health policy and practice in a large measure in India. While it may not be so obvious to contemporary students and practitioners of public health, the editorial team deserves a special mention for recognising these as the drivers through these decades.
The first section, ‘Political Economy of Health and Illness’, is to be commended for foregrounding health as a social and political agenda. The section examines the complex interactions of society, disease and medicine, positing ‘health-illness’ as a dialectic process rather than a dichotomous category. This provides a useful background for readers since most of the collection of articles have used a similar framework for analysis. The six chapters in this section dwell upon a rather unique breadth of issues including trade (in health services), law, and ethics as well as empathy in the physician–patient relationship.
The second section on women’s health encompasses five chapters that address issues such as the impact of social change on the health of tribal women, menopause, disability in women, female infanticide, and the tensions between productive and reproductive roles of women. It is significant that the 2023 Nobel Prize in Economic Sciences was awarded to Claudia Goldin for her contributions to the understanding of women’s labour market outcomes including the roles played by determinants such as industrialisation and contraception.
The third section deals with public health dimensions of nutrition through four chapters. These articles deserve special mention for their approaches that challenge some of the conventional, mainstream, and dominant ideas and ideologies in this realm. Malnutrition has been envisioned as a social disease and the complex interplay of the scientification of nutrition and state interventions has been examined. Most nutritional and food security problems continue to challenge the policymakers and are reminders of the unfinished public health agenda even as the nation completed its 75 years of independence. Of special mention are some of the issues taken up by these chapters such as those related to women, tribal communities, and the urban poor, such as reproductive justice, employment and fertility issues, menopause, and female infanticide.
The final section, ‘Malthusian Spectre and Indian Public Health History’, addresses some of the most inglorious issues over the decades in question. The section makes an overall case that population issues have generally been viewed by policymakers through a Malthusian lens, that in many cases have been at odds with people’s perceptions and needs. Malthus’ case, intrinsically a pessimist political thought, was that the world’s population, increasing at a faster rate than its food supply, shall outstrip food availability and lead to catastrophic consequences. The sectional introduction makes a strong case for the transitions in the Indian context and how and why the state-led policies informed by the Malthusian thesis distorted priorities. The three chapters of this section were initially published in 1974, 1996, and 2007, respectively. These chapters straddle issues such as the early years of family planning policy, particularly the Emergency years (1975–1977); the determinants of ‘demand’ for children and how they are valued in India and two other countries in the region—Bangladesh and Thailand; and a chapter that provides a comprehensive overview of the highs and lows of India’s population control programme in its various avatars.
This volume falls short in capturing the key changes in the architecture and functions of the health system through the period of the National Rural Health Mission/National Health Mission. There have been a series of other important reforms too in terms of infrastructure and financing.
This volume is not just an account of five decades with contributions from a total of 23 authors. It uses some of these foundational accounts to set the agenda for contemporary discourse and debates such as the consequences of commercialisation and privatisation, pandemic management, and universal health coverage. Above all, it deserves credit for keeping the focus on health as a developmental goal. Both Sage Publications and Social Change deserve special thanks and congratulations for co-creating this series and volume that is not just a chronicle but of immense academic value to students and researchers.