Sunday, March 8, 2009

Health is a complex entity!!

After going through this forest of pages, I am at a loss as to where to anchor my BLOG post and how do I articulate so that I am able to talk about many of the things I have read.  In the readings about Indian Ayurveda, dominant and erased cosmologies, local politics with global connections, Chinese geomancy, KFD as a disease of development, commodification of medicines, health services, identities.....what comes across is the complexities, the dimensions and their constant movement.

Achieving a healthy status is a complex exercise. In our normal day to day lives, we unconsciously/ consciously perform a set of actions located within our culture, structure and agency and lay claim to our "health". The understanding of the complexity is important to us as health practitioners when we strive to improve the health of others through our campaigns, theories, arguments and other contritions. 

Dutta (2008) in his "pathways to curing and healing" chapter lays down such case studies where one can see the complexity in the way the subaltern achieve health (or fail to) and critiques the hegemony of the biomedical model. A  culture centered interrogation provides some succor and again reinforces that its a continuous process of engagement at all levels. No single answer exists to this problematic as it is situated in the dynamic ground impacted by political, economic and social forces and in contemporary times what one calls the global connections. So, a polymorphic approach holds promises and probably the best way for our approaches and intellectual exercises aimed at improving health outcomes. As Dutta (2008) eloquently articulates, "a polymorphic approach to health communicaiton opens up the dialogical space and encourages the exploration of the intersections of the varying systems, the overlaps between them, and those intertwined spaces of medical theorizing and practice where systems co-exist in meaningful ways"; a far cry from the patient - doctor relationship where majority of our health communication scholarship investigates. We could also find some directions in complexity science and change theory models by applying them to "health".

Nichter made some of the studies in 1970s...who reads them? How has it impacted policy? For example, he talked about Black ferrous sulphate tablets being unpopular with pregnant and postpartum women in his essay "popular perceptions of medicine" (p.227) and suggested that a cost effective cooling liquid could be more acceptable and cost effective. But I have seen thousands of discarded unused strips of black ferrous sulphate tablets in villages (as late as in 2006-7).  So, one of the many questions is how informed as those who plan for the health of the communities; who have taken the responsibility of community health or there are larger forces in the political economic scenario. Isn't it true that most health programs all over the world work in a "program delivery" mode? If yes, then what is the cure to this disease?

Nichter (1996) makes a beautiful comparison of the amount of money spent by pharma companies on detailing in a bounded locale and the amount of money allocated by government to improve the health of the community in the same bounded locale. Its a fabulous comparison. I wonder why I have never seen this kind of comparison in mass media/ popular texts/ discussion amongst health practitioners. It would be interesting to look at this comparison in the US health industry context with spendings in pharma detailing, pharma advertising, pharma lobbying in Washington, health insurance spendings (costs and admin.), medicare, other government health spending apportioned per person or over some bounded unit of analysis. I am sure the messiah (as British press have nicknamed Prez. Obama) would like to have a look at that.

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