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?