The response to the Corona virus epidemic in India seems to be taking the same trajectory of HIV/AIDS control in which fear, stigmatisation of victims and confusion was the rule in the initial years. One message I just got in whatsaap says someone found a vaccine for Corona infection. Some other message talks about discovery of some combination drugs to instantly kill corona virus. The truth is that no new vaccine or cure can be sold in the market within a few years of time span. In places where there is no functional health services system exist, people ask others to consume home remedies and in some bizarre cases, animal excreta. People are badly looking for quick remedies and there is nothing currently available and perhaps will not be available in the near future.
States like Kerala in India are considered as leaders in the fight against Corona virus, not because the state’s health minister is a super women, but they have a functional – available, accessible, affordable health services system. The state has also promoted scientific temper and rational thinking through imparting years of modern education.
Epidemics keep coming and going in human history. Humanity has seen numerous plagues and epidemics in which accumulated dead bodies had been burned in large numbers. Sometmes, we may think we have been successful in eliminating a virus – as in the case of smallpox, but their mutated varieties continue to re-appear and attack human beings in large numbers. Should we invest all our time in inventing magic bullets to conquer diseases? Are there alternatives?
According to C.E.A. Winslow public health is “the science and art of preventing disease, prolonging life, and promoting health and efficiency through organised community effort.” To him, public health aims at enabling “every citizen to realise his birth right of health and longevity”. Towards this end, collective efforts are to be taken to ensure: “(a) the sanitation of the environment, (b) the control of communicable infections, (c) the education of the individual in personal hygiene, {d) the organisation of nursing and medical services for the early diagnosis and preventive treatment of disease and (e) the development of social machinery to insure everyone a standard of living adequate for the maintenance of health.”
‘Decolonisation’ of Asia and Africa and the concerns of ‘justice’ and ‘equity’ in the latter half of the last century called for broadening the scope of ‘public health’ and reinterpretation of it in terms of a variety of socio-economic, ecological, technical and political factors and preference values. Consequently, public health became a ‘social enterprise’ which ‘studies’, ‘improves’ and ‘manages’ the health of the populations. Such concerns are implicit in the definition of ‘primary health care articulated in the ‘Alma-Ata Declaration’ of 1978.
Public Health theory and practice should be rooted in democratic attempts to attain economic development with distributive justice. It should not be left to the discovery and availability of magic bullets to be discovered by profit seeking pharmaceutical industry.
The modern understanding of public health perhaps begins with Hypocratus, who emphasised the importance of clean air, water, food and individual cleanliness. However, it was the ‘practical sanitarians’ of the later years who brought the discourse of health into the ‘public’ through their ‘contagion theory’ which emphasised collective cleanliness and the need to eliminate noxious ‘miasmas’ to attain health. By 1875, utopias like ‘Hygiea’ emphasised clean air, public transport, small community based hospitals, community homes for the aged and banning the use of tobacco and alcohol. In 1880s, the ‘Germ theory’ came to the forefront, when microbiologists became successful in obtaining experimental confirmation to contagionist ideas thanks to John Snow’s seminal studies in cholera affected London.
However, Robert Koch in 1892 argued that for each infectious disease there was a microbe that was the ‘specific’ and ‘sufficient’ cause. Though both ‘contagionists’ and ‘germ theorists’ believed that diseases could be eradicated, unlike the former, the germ theorists thought that exposure to filth did not matter, so long as microbes were controlled through magic bullet drugs, vaccination and other technical measures. According to this paradigm health could be attained through medical interventions based on bio-technology and not by living in accordance with the laws of nature.
This bio-medical understanding was questioned by thinkers like Dubos in 1959 and stressed that the environment has a definite influence on both the activity of the microbe and the susceptibility of the victim. To him, though a microbe is a necessary cause, it is not sufficient cause of disease. For example, a bacterium which causes TB does not automatically damage the lungs, but live within the host in a dormant stage and attacks the victim, when situations are ripe. He never thought that humans can ever be free from diseases.
To him “to be healthy does not mean that you are free- from disease; it means that you can function, do what you want to do and become what you want to become. ” He argued: “In an ever changing world, each period and each type of civilisation will continue to have its burden of diseases created by the unavoidable failures of adaptation to the new environment. ”
Then came what the present study prefer to call “the social paradigm of wellbeing. ” In 1976 Mckeown put forward his thesis on the historical irrelevance of clinical medicine and of other established public health practices towards causing a decline in death rates in 19th century Britain. To him, clinical, medicine, though successful in reducing pain, facilitated a quick recovery from infectious diseases and useful in the management of a few chronic infections, it had only a very little impact on average life expectancy. It was the steady improvement in the nutrition, since the outset of 18th century which helped the British people to have increased resistance to infectious diseases.
Above all, improvements in life standards started showing beneficial results before the introduction of bio-medical public health interventions. Even before the introduction of immunisation, people acquired resistance to infectious diseases through nutrition and by the time many of the antibiotics were available in the market, old epidemics like diphtheria were under control. Thinkers of 1970s underlined the limits of clinical medicine and even portrayed it as ‘medical nemesis’ pointing out its iatrogenic consequences.
Such thoughts along with the forces of democratisation which was active in the post-colonial world set a background for holding the Alma-Ata conference on Primary Health Care and the declaration made after the conference called for intersectoral action in health, social control of medical technology, recognition of the basic right of every individual to health, democratisation of health services and various other related measures at the community, national and international level.
Today, there is a very important school of thought which can be called as the “social paradigm of wellbeing” which advocates the primacy of social, economic and ecological solutions to health problems, denouncing the dominance of the ‘bio-medical paradigm’ which had been increasingly used by the commercial interests.
Viruses and their mutated forms are going to co-exist with humans for ever. Long term strategies to fight against any disease include promotion of a scientific temper among population, promotion of hygienic behaviours and practices among general population, and making health services accessible, available and affordable. Governments which do not have functional health services will continue to promote shamanism, animal excreta and demigods while promoting dependency on pharma companies.
(Kandathil Sebastian is a social scientist and writer based in Delhi. He has worked in the Public Health Sector of India for more than two decades.)
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