AHS -547B (UNIT- III & IV)

CULTURAL DISEASE AND ILLNESS

Submitted By:
Rashmi Hussain
M.sc 4th semester
Department of Anthropology, Panjab University
[UNIT III]

SOCIO-CULTURAL ISSUES IN HEALTHCARE SYSTEM IN INDIA

India, a country with a centuries-old heritage of medical science,

first became familiar with the modern systems of medicine in the
17th century. India became an independent nation in 1947 and
became a Federal Republic in 1950. There have been various
developments in the health sector in the postindependence era. But
problems like higher population density, low socioeconomic status
of a significant number of people and low literacy rate in some parts
of the country, have resulted in poor health indicators .
The Supreme Court has held healthcare to be a fundamental
right under Article 21 of the Constitution.
The Economic times has published five paradoxes of Indian health
care system which happens to describe its characteristics. They are:
 Healthcare is a fundamental right, but it is not fundamentally
right in India
 Sector attracts investment, but delivery remains contentious
 Among the cheapest in the world, but unaffordable for most
locals
 Less than one doctor for 1,000 patients, but medical tourism
booms
 Stark divergence in health care outcomes across country

ISSUES IN HEALTHCARE SYSTEM

1. Social and Economic inequality- The indicators of health (mortality,

morbidity and life expectancy) are all directly influenced by in-
 equality in a given population. More so, it is not the absolute
deprivation of income that matters, but the relative distribution of
income. There is no other country where the distribution of the
healthcare resources is appallingly unequal as in India

2. Socio-economic problem- The healthcare infrastructure directly

depends on the economic robustness. Health Sector policies in
India have tended to stress on reducing population growth. In
many of the Indian states where stabilization of population growth
is not a priority, their health and social status is among the worst in
the world. Diseases of poverty continue to affect more than half
the population while environmental degradation; occupational
hazards and new contagious diseases such as AIDS are starting to
have a serious impact on the population. The phenomenon of
Urbanization has added to problems of healthcare. Illiteracy and
lack of awareness amongst masses pose constant threat to the
fabric of the society; more so tilts the continuum of health in the
wrong direction. Issues such as child and maternal malnutrition,
neglect of the girl child- which can sometimes take the extreme
form of female feticide or infanticide- are social evils that create
major inroads in the health of the society. Social practices and
beliefs too affect key variables like nutrition and hygiene.
Persistence of poverty in the social structure also complicates the
health scene. The poor suffer disproportionately because of the
double burden of traditional diseases as well as modern diseases
that are caused by industrialization and rapid resource depletion.

3. Emergence of private healthcare - Since nineties the public health

system was collapsing due to underfinancing of public health
services. The role of the private sector is getting stronger in view of
the government’s financial constrains in expanding the health
infrastructure and increasing healthcare costs. The understandable
inadequacy of resources in government-run medical care
infrastructure has also shifted the demand towards private
concerns. The dominance of the private sector not only denies
access to poorer sections of society, but also skews the balance
towards urban-biased, tertiary level health services with
profitability overriding equality, and rationality of care often taking
a back.
[UNIT IV]

MEDICAL ANTHROPOLOGY IN INTERNATIONAL CONTEXT

Medical anthropology is a field of anthropology focused on the relationship

between health, illness, and culture. Beliefs and practices about health vary
across different cultures and are influenced by social, religious, political, historical,
and economic factors. Medical anthropologists use anthropological theories and
methods to generate unique insights into how different cultural groups around
the world experience, interpret, and respond to questions of health, illness, and
wellness.

History of the Field

Medical anthropology emerged as a formal area of study in the mid-20th century.
Its roots are in cultural anthropology, and it extends that subfield’s focus on social
and cultural worlds to topics relating specifically to health, illness, and wellness.
Like cultural anthropologists, medical anthropologists typically use ethnography –
or ethnographic methods – to conduct research and gather data. Ethnography is a
qualitative research method that involves full immersion in the community being
studied. The ethnographer (i.e., the anthropologist) lives, works, and observes
daily life in this distinctive cultural space, which is called the field site.

Medical anthropology grew increasingly important after World War II, when
anthropologists began to formalize the process of applying ethnographic methods
and theories to questions of health around the world. This was a time of
widespread international development and humanitarian efforts aimed at
bringing modern technologies and resources to countries in the global South.
Anthropologists proved particularly useful for health-based initiatives, using their
unique skills of cultural analysis to help develop programs tailored to local
practices and belief systems. Specific campaigns focused on sanitation, infectious
disease control, and nutrition.

INTERNATIONAL DEVELOPMENT OF THE FIELD

Contemporary approaches in medical anthropology study relationships
between cultural and social structures, people's beliefs about cause, course,
cure and prevention, and their health behavior. `Culture' extends to issues of
power, control, resistance and defiance as well, and anthropology seeks to
understand the links between social stratification (gender, ethnicity, social
class), access to material and immaterial goods (food, water, health services,
education), illness representations, cultural constructions of femininity and
masculinity, attitudes to health promotion, and health behavior. These
elements form a specific cultural system in which tasks, responsibilities and
proper conduct have become self-evident (Lock and Scheper-Hughes,
1990; Morsy, 1990; Singer, 1990). Describing the relations between these
elements is called a `thick description' (Geertz, 1973). Thick descriptions are
based on meticulous fieldwork which may include participant observation,
open-ended, unstructured or semi-structured interviews and many other
techniques.
In the United States, Canada, Mexico and Brazil, collaboration between
anthropology and medicine was initially concerned with implementing
community health programs among ethnic and cultural minorities and with the
qualitative and ethnographic evaluation of health institutions (hospitals and
mental hospitals) and primary care services. Regarding the community health
programs, the intention was to resolve the problems of establishing these
services for a complex mosaic of ethnic groups. The ethnographic evaluation
involved analyzing the interclass conflicts within the institutions which had an
undesirable effect on their administrative reorganization and their institutional
objectives, particularly those conflicts among the doctors, nurses, auxiliary staff
and administrative staff. The ethnographic reports show that interclass crises
directly affected therapeutic criteria and care of the ill. They also contributed new
methodological criteria for evaluating the new institutions resulting from the
reforms as well as experimental care techniques such as therapeutic
communities.
The ethnographic evidence supported the criticisms of the institutional
custodialism and contributed decisively to policies of deinstitutionalizing
psychiatric and social care in general and led to in some countries such as Italy, a
rethink of the guidelines on education and promoting health.
The empirical answers to these questions led to the anthropologists being
involved in many areas. These include: developing international and community
health programs in developing countries; evaluating the influence of social and
cultural variables in the epidemiology of certain forms of
psychiatric pathology (transcultural psychiatry); studying cultural resistance to
innovation in therapeutic and care practices; analysing healing practices toward
immigrants; and studying traditional healers, folk healers and empirical midwives
who may be reinvented as health workers (the so-called barefoot doctors).
Also, since the 1960s, biomedicine in developed countries has been faced by a
series of problems which stipulate inspection of predisposing social or cultural
factors, which have been reduced to variables in quantitative protocols and
subordinated to causal biological or genetic interpretations. Among these the
following are of particular note:
a) The transition between a dominant system designed for acute infectious
pathology to a system designed for chronic degenerative pathology without any
specific etiological therapy.
b) The emergence of the need to develop long term treatment mechanisms and
strategies, as opposed to incisive therapeutic treatments.
c) The influence of concepts such as quality of life in relation to classic biomedical
therapeutic criteria.
Added to these are the problems associated with implementing community
health mechanisms. These problems are perceived initially as tools for fighting
against unequal access to health services. However, once a comprehensive
service is available to the public, new problems emerge from ethnic, cultural or
religious differences, or from differences between age groups, genders or social
classes.
If implementing community care mechanisms gives rise to one set of problems,
then a whole new set of problems also arises when these same mechanisms are
dismantled and the responsibilities which they once assumed are placed back on
the shoulders of individual members of society.
In all these fields, local and qualitative ethnographic research is indispensable for
understanding the way patients and their social networks incorporate knowledge
on health and illness when their experience is nuanced by complex cultural
influences. These influences result from the nature of social relations in advanced
societies and from the influence of social communication media, especially
audiovisual media and advertising.