random thoughts: item numbers

how much can the efforts of private individuals and organizations help improve access to education and healthcare in a country of india's size? or in any country of any size? read an interesting article on a related subject, today, by a member of the faculty of one of the best private medical institutions in the country.

prof. k.s.jacob of the christian medical college, vellore, writes:
Caste plays out in India just as race plays out in the U.S. and the social class in Britain. Birth seems to determine health, education, employment, social and economic outcomes. Systemic injustice requires much more than a change of heart; it requires changes in social structures. Social injustice is killing people and mandates the ethical imperative of improving the social determinants of health.
he also refers to evidence on how caste affects health outcomes, in particular:
Data from the National Family Health Survey-III (2005-06) clearly highlight the caste differentials in relation to health status. The survey documents low levels of contraceptive use among the Scheduled Castes and the Scheduled Tribes compared to forward castes. Reduced access to maternal and child health care is evident with reduced levels of antenatal care, institutional deliveries and complete vaccination coverage among the lower castes. Stunting, wasting, underweight and anaemia in children and anaemia in adults are higher among the lower castes. Similarly, neonatal, postnatal, infant, child and under-five statistics clearly show a higher mortality among the SCs and the STs. Problems in accessing health care were higher among the lower castes. The National Family Health Survey-II (1998-99) documented a similar picture of lower accessibility and poorer health statistics among the lower castes.
and his approach to improving health outcomes?
The structural determinants of daily life contribute to the social determinants of health and fuel the inequities in health between caste groups. Viewing health in general as an individual or medical issue, reducing population health to a biomedical perspective and suggesting individual medical interventions reflect a poor understanding of issues. Social interventions should form the core of all health and prevention programmes as individual medical interventions have little impact on population indices, which require population interventions.
prof. jacob's overall message is quite simple, really: an aiims, or an apollo, in every state capital in the country wouldn't improve health statistics.

just as an iit in every state in the country wouldn't solve the problem of illiteracy. nothing but social intervention would solve the problem of inadequate access in healthcare and school education. in my view, private efforts can do very little and in the long run could even harm everyone's interests by taking the issue off public consciousness and policy makers' priorities.

social intervention means everyone should get a basic, assured level of attention. neither aiims nor iits/iims are social interventions: they're the policy equivalent of item numbers in indian films. they enhance the marketabilty of exclusionist projects of keeping the great majority of the underprivileged illiterate and vulnerable while seducing a few with the promises of individual advancement.

why isn't any dalit bahujan thinker demanding the dismantling of these exclusionist institutions? or opposing this sustained system of stratification in the delivery of public goods like education and health?

why is everyone focussed on issues like english, when it is quite evident that the ruling classes have no plans to deliver the same kind of education to everyone, whether in english or in any other language, now or in the foreseeable future, unless their exclusionist mindset is challenged?


Kiran said...

In kosta villages in older times a Mala while poverty stricken is generally seen as a healthy individual with a larger than average body frame. The same mala when he comes to city/town/urban agglomeration is generally seen as a weak with smaller body frame.
Reason ? In villages in those times beef/pork was freely available to Malas and provided a cheap source of healthy protein.

But in town/cities where Hindus have combined their praacheen bigotry with modern fascist style enforcement beef/pork are no longer available to malas even though its their traditional food. Their cuisine is forced to adapt to vegetables and expensive chicken, milk, goat lifestyle where they dont have the culinary traditions of caste hindus.

This is just one of the ways in which the modern India puts dalits in a position of disadvantage.

Arati said...

Why is this an either/or choice? why cannot all systems of primary, middle, higher educations co-exist? Why can't aiims, apollo co-exist with primary, easily accessible health care for all across nation? Why preclude one to have the other - granted that higher needs should be addressed first. As a nation, it is not a lack of finances that stops us from having it all - just the will at the top to implement large scale reforms on all necessary fronts.

kuffir said...


thanks for sharing that insight. i'd read about a research study a few years ago- health indicators among various caste groups in some villages of guntur were studied i think. one of the interesting findings i still remember was that kamma and other upper caste women (of around 25) weighed around 10-15 kgs more than dalit women of the same age group.as prof.jacob says, caste does determine health outcomes.

gaddeswarup said...

Among the comments in
"...what IITians are asking not exactly “more”, but what they actually deserve. Obviously they compare the salaries with that of salaries from where they came and joined in IITs ( premier institutes of abroad, industries )."
I think that the desires of people who have also are increasing considerably in comparison with what foreigners in some rich countries have. Probably there is not enough for everybody if such demands are to be met and it is advantageous to keep some sections poor and struggling for livelihood. It seems to be a similar story with scavengers.

kuffir said...


-'Why can't aiims, apollo co-exist with primary, easily accessible health care for all across nation?'

yes, you're right. so, where's the primary health care system?

i see that it's your first comment here, welcome to this blog :)

Kiran said...


Upper caste health in Guntur, parts of nalgonda dramatically improved after the completion of NS project. But before that in 50s and 60s I doubt a great difference except in the very rich caste hindus - the reason being cultural taboos among hindus. Muslims on the other hand enjoyed a vastly superior health status during those times.

As India developed the upper caste dietary habits were supported by huge investments, huge displacements of dalits and cheap labour supplied by dalits whereas the dietary habits of dalits destroyed by making beef/pork cultural taboos wherever the Hindu started asserting himself not as a religious one but as RSS style fascist one.

anu said...

The change in dietary habits of hindus and the thrusting of this on others has manifold effects on health and the environment and both come together rather nastily for the poor/dalits (the cultural effect is not only on dalits, muslims and christians are also impacted by the dominant taboos -rarely do they eat and discuss about their choice of meat in public....)

Since the time when some in the subcontinent decided to go vegetarian it has left us with this interlinking chain of health, hatred and the most terrible legacy of environment degradation due to unmanaged, unutilized cattle resource...... since we don't dairy them for anything other than milk products, we don't develop or maintain pasture lands, leave them untended and every little bit of green cover in natural unprotected habitats has been steadily lost largely to this one single habit. This traps the poor in its vicious circle again and again as the marginal lands that provided valuable nutrients in the form of greens and herbs diminish day by day as the cattle eat it all up... in the forests the sprouts are eaten as soon as they form, and new growth is inhibited leading to dramatic deforestation in small wild groves surrounding villages - a major source for supplemental diets.

Before anyone jumps on me about environmental concern also means keeping animals from being consumed (i know that such uninformed debates rage on) for that i would like to say, to indulge in this expensive habit, find ways of keeping the cattle population down, well fed and cared for at your own personal expense. Spare the land, the flora and especially the people who are NOT part of that specific cultural landscape. This country and its resources belongs to a whole lot of others who do not share these taboos.

Kiran said...

Excellent observation Anu. Environmentally disruptive effects of Hindu diet have now multiplied under the patronage of Indian state an the vast amounts of resources it has.

Identifying, delineating ,and pricing pasture land is important for protection of environment. But The sacred cow which has the right of way anywhere in India comes in the way. The "sacred" cow not only devours valuable nutrition from land but also emits copious quantities of methane leading to globa warming. India has a staggering 280 - 290 million cattle busily degrading land and emitting methane - worlds largest.

Caste, ofcourse, is the biggest reason for this. Milk is the source of animal protein for caste Hindu and the ferocity with which he protects it is matched only by his contempt for other peoples sources of protein. India is already the worlds largest producer of milk by a long way and good quality of milk is readily available anywhere at a reasonable price (for caste hindu income levels). But India has the lowest consumption levels of even chicken meat.

Kufr you should write a post on this massive food hegemony of caste hindus.

Arati said...

Hi Kuffir,

I guess my comment was a bit ambiguous when I said 'higher needs should be addressed first' - these are primary health care, education.
I believe unless the urgent needs of most are addressed first, the higher standard or facilities for a few at the top end become meaningless. Our national progress can only be measured by what we can provide for the most, and the most needy.

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