Maladies, Preventives, and Curatives: Debates in Public Health in India (review)

The book, Maladies, Preventives and Curatives: Debate in Public Health in India, edited by Profs. Amiya Kumar Bagchi and Krishna Soman, is a collection of scholarly, thoughtful, and interesting essays on the evolution of the public health system in India and the challenges confronting public health to this date. The articles uniquely blend the issues of the present into a historical portrait of the public health infrastructure in India as a whole as well as in its subparts and subpopulations. Though based on the experiences of one nation, the book demands universal readership because of its interesting disposition, clarity of presentation, and its attempt to highlight the importance of socio-political processes in guiding the development of a public health system in a developing country. A common theme that emerges from various articles in the book is that disparities in health care—borne out of a colonial past, social class system, resource constraints, and a recent trend towards globalization and privatization—persist in spite of economic growth.

The articles of the book can be grouped into two parts: the first four articles critically examine the evolution of India's public health system before independence in British India (the first post-colonial Indian government was formed in 1947), while those in the second group carefully depict the challenges faced by the nation in the post-independence era to the present. The introductory paper by Bagchi and Soman is an outstanding piece that not only provides a thorough synthesis of the issues addressed in various papers, but also adds thoughtful analysis of these issues along with insightful comments. The paper identifies the key elements that could have acted as barriers to the implementation of a successful public health system in India.

Among the first four papers dealing with history, Achintya Kumar Dutta focuses on a specific disease, Kala-Azar, in the state of Assam, India. Dutta's paper examines both the efficacy and the limits of British medical policy in checking the progress of this epidemic. Muraleedharan's paper also recounts history by throwing light on the debates on the cinchona (and its alkaloid, quinine) policy to combat malaria, another deadly disease. Deepak Kumar's paper on "Perceptions of Public Health: A study in British India" adds a more general perspective to the public health debates in British India, highlighting the contributions of foreign medical specialists sent by the U.S.'s Rockefeller Foundation. Kabita Ray's article iterates the role of politics and the press in determining the quality of public health in local areas of colonial Bengal.

Among the second group of articles, two essays deal with the trends and consequences of the current socio-political process characterized by increased globalization and privatization of the health care market. Building on a historical perspective, Imrana Qadeer views certain organizational aspects of post-colonial public health policy as mere continuations of the past. Qadeer evaluates the role of technology and privatization in the emerging system of health care and points out that the "neo-liberal public health" system is marked by humane concerns on poverty and disease control rather than public health issues. These concerns produced a vertical technology-based program for disease and population control and a disregard for welfare sector since the mid-1980s. The paper by Amit S. Ray focuses on India's pharmaceutical industry, highlighting its importance in the global market. Ray points out that while the earlier phases were characterized by a favorable drug market with greater accessibility and lower prices, the scenario changed somewhat in later years. Ray explores the implications of a new policy regime of reforms in the 1990s, characterized by free trade, progressive decontrol of drug prices, and increased research and development expenses. Through economic analysis, Ray demonstrates the potential effects of these policies in terms of higher prices, more profit, lower access for the poor, and persistent disparities between social classes.

Since women have been the major targets...