A Review of 'Shifting Paradigms In Public Health: From Holism to Individualism' by Dr. Vijay Kumar Yadavendu
(ISBN 978-81-322-1643-8, Springer, New Delhi, Heidelberg, New York, Dordrecht and London, 2013).
Paying tribute to one of the giant philosophers Karl Marx, the visionary and fountainhead of justice and equality, as he turned 200 today is an honour. He stands tall among the prophets of human history. The man responsible for revolutionising my consciousness is paramount even after 200 years when financial capitalism has entered our private space and has been violating our being.
Karl Marx laid great stress on social equality and social justice. For him, the fundamental concepts of social justice were rooted in economic justice. According to him, economic inequality, and the existence of private property, resulted in social injustice. I was going through various articles on social justice when I got an opportunity to read an academic book ‘Shifting Paradigms in Public Health: From Holism to Individualism’ authored by Dr. Vijay Kumar Yadavendu and published by Springer. The book is deeply influenced by Marxian concept of social justice as it talks about inequalities of public health. A Marxist intellectual, Dr. Yadavendu discusses the theoretical shift with regards to public health that gradually takes place from collective to the individual.
In ancient times, societies and civilisations had tried to discover rules that would ensure good health of a collective. They had understood the fact that individual is a part of the larger collective. Shift of focus started happening after the consolidation of science, which emphasised on individual causations and exactness.
In the arena of natural sciences, health of an individual is reduced to bio-physiological and neuro-physiological system, which in turn is broken down into a number of sub-systems – anatomy, cells, molecules and genes that are functional part of a whole. This constitutes the fulcrum of modern science and medicine. Where disease is considered malfunction of one or many sub-systems resulting in somatic, psychological and social dysfunction and health is just the opposite of disease. On the other hand, ancient civilisations like that of Greeks and other contemporary ones talk about holism in the context of health. Health of a population depends on a range of factors both internal and external. It talks about the interaction of an individual with his/her physical, psychological as well as socio-economic environment. This holistic approach to health cannot be seen only as a bio-physiological occurrence but is also very much determined by historical, cultural, social and economic standards.
Such a holistic approach to public health is missing today as individuals have been reduced to an amalgamation of cellgenes and molecules that makes up a human body. Such thoughts have evolved from a positivist school of science. So the onus of being healthy or sick lies with the individual. So more and more research work and subsequent improvement in bio-medicines and vaccines have revolutionised the entire industry of pharmaceutical drugs. There is little or no scope and space for a holistic approach to health or disease. Such reductionist outlook paved the way for social inequality in various forms that plagued society at large.
It would be out of place to deny the fact that medical science has made lots of improvement in providing adequate health facilities to humanity. For instance, in India, life expectancy at birth increased from 22 years at the start of the century to 62 years at the turn of a century, and infant mortality rates declined from 200 to about 66 (per 1,000) in the same period. So much budgetary allocation was made in the health sector to reduce infectious and communicable diseases in developed countries. As a result, communicable diseases like malaria and tuberculosis became extinct in developed countries such as India. Though it is a fact that much credit for improvement of health status has been given to the advancement of bio-medical discipline in developed nations, few public health practioneers viewed that such impressive improvement is due to less exposure to infection, improved nutrition and better standard of living coupled with advancement in bio-medical field. But most of the public health practioneers did not shed light on food security, better standards of living, better housing and working conditions, water supply and sanitation as determinants of better health of human being. Instead, it chooses to give full credit to the role of bio-medicine and its impact. Thus the major understanding of public health research and the vision of its future growth remained confined to the reductionist model of science and medicine.
The publication of Black Reportin1980’s shook the edifice of confidence in United Kingdom. The report stated clearly that despite rapid enhancement of aggregate health status, disparity or inequality in health status among various groups of nation or between nations has widened. Fresh entrants in the field of diseases like AIDS and resurgence of tuberculosis and malaria, especially among impoverished communities and countries shook the faith in bio-medicine.
Health inequalities reflect on the underlying social injustice such as poor access to health care, inadequate food, impure water, unsafe living and working conditions and of course extreme poverty. In the
words of Laurel Garrett, ‘If the passage of time finds ever widening health gaps, disappearing middle classes, international financial lawlessness, and still rising individualism, the essential elements of public health will be imperilled, perhaps nonexistent, all over the world.’ As a result, there is a growth of myopic vision that the source of disease and ill health lies within the individual, in his/her genes and molecules or in a form of bacteria that resides in his/her body. It has so much influenced individuals’ mind that the cure lies locked within a pill available in the market, purchased at a cash price. This led to a booming industry of drugs. For example, to sensitise mass regarding dengue or tuberculosis, only government or private participation to campaign about the disease is not enough. Those among the masses who are aware should sensitise their fellow comrades in their own capacity.
Thus attraction to drugs acts as a catalyst to sustain such attitude that certain ‘technological fix’ or ‘behavioural modifications’ would solve all problems, rather than focussing on broader and more effective structural changes. More light is shed on the individual expertise rather than on historical and socio economic aspects. In the Sub-Saharan region where AIDS is a major cause of mortality, rampant in plantations, mines and urban quarters, emphasis is on curative medicines and preventive vaccines. There is least effort to improve the socio-economic standards of living of those working in such areas.
The crucial role that IMF and World Bank plays in disbursing funds to developing and under-developed countries facilitates and nurtures the environment of social injustice. These monetary institutions, emphasise on cutting down of state expenditure on social welfare schemes in these countries. Thus one gets to witness inflation, unemployment, fund reduction in health sectors, lack of infrastructure facilities, poor to no sanitation and water works causing ill health among poor and total disintegration of public health systems. The economic policy of the state in the form of liberalisation and privatisation is definitely lowering the chances of health survival of the deprived societies of the state.
(Dr. Vijay Kumar Yadavendu (email@example.com) writes on philosophical historiography of public health and public health ethics and teaches Psychology at the Department of Psychology, Magadh University Bodh Gaya, India.)