Wednesday, July 20, 2011

LOK VIDYA FROM A PUBLIC HEALTH MOVEMENT PERSPECTIVE - Ritu Priya


Every society, community, family and individual attempts to understand and grapple with its health problems to minimize them. All attempt to maximize their own health and wellbeing. Historically, expertise in health emerged with persons who keenly observed the experience of health and ill health in their own body and of those around them, whether humans, other animal species or even plants. Birthing processes have been one of the natural phenomena requiring support of others and therefore are one of the commonest sites of skill and knowledge accumulation. Childcare, food and nutrition are other similar areas of knowledge development.

As the expertise grows in one area, and expert knowledge gains credence and trust by evidence of its effectiveness, both the expert and the knowledge become seats of special power and dominance. However, the people, who now become ‘lay people’ in relation to the expert, do retain their own rationality and agency. Besides being socialised into a certain way of life (which includes health related practices) by their family and community, people add to or modify the practices and knowledge they were socialized into as a result of their own experience and their interaction with the expert system(s). Thereby a third body of knowledge and practice arises that is in consonance with their prevailing social, economic, environmental and cultural context. This is Lok Vidya about health. It is passed on across generations, through oral communication and practice, but is not a static entity. Remaining responsive to the changing context and addition or modifications in available and accessible resources for health, Lok Vidya is a dynamic body of knowledge and practice.

Thus, Lok Vidya about health develops from multiple roots. It is pluralistic in its epistemology and practice. Starting with the traditional or conventional practice in the family or community, people add on new practices according to their perceived needs which the conventional system fails to fulfill. These could be through personal experience of ones own body at individual level, as in modifications of diets and daily routines. On the other hand comes new knowledge from sharing of the collective experience and various systems of expert knowledge.

In India, we have textual knowledge and expertise of Allopathy and seven officially recognized other systems--Ayurveda, Yoga & naturopathy, Unani, Siddha, Sowa Rigpa and Homeopathy (AYUSH being the official acronym in present use). There is a clear dominance of Allopathy over the AYUSH in official policy of knowledge generation, knowledge transmission and service delivery. However, informal providers abound, both traditional practitioners and modern forms of them-- the dai, the bone-setter, the snake-bite healer, herbalist, the shamans and faith healers, the 'bengali daktar' or Rural Medical Practitioner (RMP). Then there are the traditional home remedies and self-care using modern medication. Finally, there is the din charya and rtu charya, that are designed and adopted for promotion of health and wellbeing, prevention of disease at collective and individual levels. All these practices have an explanatory knowledge base. So there arises the question--Where is the boundary of Lok Vidya?

Social stratification based on caste, class and gender leads to a wide variation in the nature and context across social and economic sections in any society. While the conventional roots differ because of historical disparities, a body of common knowledge that is similar across the sections is also evident. For instance, the medicinal value of certain plants is found to be widely prevalent across the length and breadth of the country even today. However, the discriminatory caste based norms have led to differences in health related knowledge and practice among the dalit and other castes. The extent of exposure to modern medicine, through public health programmes at a mass level and through personal doctors services being availed, has led to new knowledge and practices reaching even the non-literate, non-school going populations. Some extent of demystification of modern medicine and its diffusion has also happened through paramedical personnel who come from lower socio-economic and rural backgrounds. All this makes the task of defining Lok Vidya in health even more complex.

Lok Vidya Jan Andolan

Social movements have historically, addressed issues of health and healing. Gandhiji, subsequent Gandhian organizations, the women’s movement both internationally and nationally, have introduced the notion of ‘control over ones own body’. Environment related movements have highlighted the relevance of local ecology and health-related practices. Workers’ organizations have raised issues of occupational hazards, safety and healthcare, though not in the same way or to the extent that the worker’s own experience and knowledge, i.e. Lok Vidya, require them to. People’s science movements tend to ‘take science to the people’ but not take people’s knowledge as legitimate in its own right. However, the People’s Health Movement-India chapter (Jan Swasthya Abhiyan) does recognize the value of traditional medicine due to its wider base of political ideologies and because the practice of traditional medicine is so pervasive in our society and has so many textual forms.

The dominant knowledge systems of medicine and public health are beginning to get sensitized to the significance of Lok Vidya as legitimate knowledge, rather than viewing it only as a negative force based on ignorance and superstition, as has been the conventional medical perspective over the past century. This holds true for the industrialized societies, as much as to those such as ours. Modern medicine and public health has two faces, the authoritarian and coercive as well as the progressive, liberative one. So do all the other expert based systems, as evident by the observation that AYUSH officials genrally tend to undermine the LHT (local health traditions). Relevance of Lok Vidya is recognised by the liberative stream of all systems, being viewed as mutually supportive and inter-linked, while it tends to be denied by the authoritiarian stream.

Therefore, there is at this juncture, great value in recognizing, strengthening and promoting the health related dimensions of Lok Vidya. From ensuring agency in the framework of ‘personal is political’, to rights based campaigns, to generation of context specific, decentralised forms of knowledge, Lok Vidya is today of greater significance than ever before.

18th July 2011

Ritu Priya
Professor
Centre of Social Medicine and Community Health
Jawaharlal Nehru University
New Delhi-110067

Phone: +91-11-26704615 (off), 26742102 (res), 9313350186 (m)
Email: ritu_priya_jnu@yahoo.com

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