Lifestyle modifications through a range of health care practices are considered central to the management, control and prevention of chronic non-communicable diseases. While there is a critical perspective on the epistemologies of such global health discourses in existing literature, empirical evidence on how people engage with such prescriptive lifestyle modifications in different cultural contexts is very limited. The paper in this context draws on illness narratives of heart patients to discuss about the anxiety and uncertainty expressed by patients and others about notions of what constitutes ‘healthy’ and ‘risky’. It specifically unpacks the global-local dynamics in the construction of risk and healthy lifestyle and examines the contexts in which such global discourses are embodied, resisted or negotiated in different cultural contexts. The paper also examines how global health discourses travel to local sites through popular press. The paper draws on evidence collected through analyzing two Indian national English dailies and in-depth interviews with heart patients and their family members in Delhi, India in 2007-2008.
As a trained allopathic practitioner myself, two decades ago I found myself in similar circumstances (1) and appreciate the dilemma of the young doctors. Since this analysis is after the event, it must be read as a tentative explanation of the confusion we often create for ourselves.
Historical influences on a doctor’s professional behaviour
The beginnings of this story must go back to the time when we clinical practitioners, along with the rest of the scientific community, adopted positivism as the way that knowledge was constructed. A positivist approach emphasises “facts” as perceived by the five senses as the basis of empirical evidence. When these facts are shared by a community of “objective observers”, the common ground becomes the basis of “truth” or “real” knowledge. In fact, the positivists would say this is the only truth, proven and set in stone. Interpretation does not play a role here, as the shared observation is considered to be true (1).
However, this knowledge is still from a particular point of view, however closely shared. Western science, in its claim to be objective, separated the observer from the observed and was willy-nilly given pride of place in the hierarchy of knowledge. Medicine, claiming to be a science, needed to be free of “subjective values” (1). This is one limb of a doctor’s training; the attitude imbibed from it has repercussions which we shall see as we proceed.
Worldwide, measles still kills 400 people every day, more than 90% of them being under-fives. Three out of four deaths happen in India, India’s progress in measles control is a major determining factor in global control of measles. Prevention of measles deaths is key to achieve millennium development goal 4; that is to reduce under-five mortality by two thirds by 2015. There is limited literature available on measles epidemiology in India. No measles surveillance was done before 2006. Built on an existing flaccid paralysis surveillance system, a measles surveillance programme was launched in four southern states of India in 2006, among them Karnataka. The objectives of this work is to describe the epidemiology of measles in Karnataka and to identify ways to improve measles control in the state.
Keywords: health insurance, quality improvement, access to care, community health insurance, realist review, India
Factors Influencing Receipt of Iron Supplementation by Young Children and their Mothers in Rural IndiaView all publications
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Article type : Research article
Submission date : 31 January 2011
Acceptance date : 3 August 2011
Publication date : 3 August 2011
Where hunting pressure is high, anti-poaching efforts are often crucial for protecting native wildlife populations in nature reserves. However, many reserves suffer from inadequate support and provisioning of staff, especially in developing nations. In Pakke Tiger Reserve in northeastern India, we found that malarial infection is a serious hindrance for front-line patrolling staff that limits the time they can spend in the field. We assessed the consequences of malaria both for local people and park staff in the general region and its indirect effects on wildlife protection. To accomplish this we compiled data from annual epidemiological records of malaria, the number of malaria cases and associated mortality, financial costs, and loss of time spent patrolling. Over a 4-year period (2006–2009), the majority (71%) of forest department staff in Pakke Tiger Reserve suffered from malaria. Malaria treatments cost park managers nearly 3% of their total budget and caused a net loss of 44,160 man hours of anti-poaching effort. The government forest and health departments involved in the employment and health of park staff have separate missions and responsibilities, yet our findings show that a multi-disciplinary approach to conservation is essential to avoid overall systemic failure.
► We examined the effects of malaria on anti-poaching staff and its consequences for park protection. ► We focussed particularly on protected areas in northeastern India that suffer from significant wildlife poaching. ► Malaria had a measurable impact on the health of forest department staff, park budgets, and anti-poaching efforts. ► Simple, short-term measures, such as the distribution of insecticide-treated nets, reduced infection rates among park staff. ► An ultimate solution is to improve health services and ensure better coordination between forest and health services.
Article type Research article
Authors : Velho N, Srinivasan U, Prashanth NS & Laurance WF
Journal: Biological Conservation
Submission date : 18 March 2011
Acceptance date : 4 June 2011
Publication date : 15 July 2011Link