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A Godless World


Mohan Rao

MALARIA IN THE SOCIAL CONTEXT: A STUDY IN WESTERN INDIA
By Lancy Lobo
Routledge, New Delhi, 2010, pp.214, Rs. 595.00

VOLUME XXXV NUMBER 1 January 2011

Globally, malaria continues to be a major disease with 300 to 500 million clinical cases every year, with about 1.5 to 2.7 million deaths. It kills more than one million children each year in Africa alone. In India there are about a million or more cases every year; however, we have seen a rising incidence of the more dangerous Plasmodium falciparum and indeed drug resistance cases so that malaria continues to be important epidemiologically in India.   Yet at its apogee, the National Malaria Eradication Programme (NMEP) was one of the largest public health interventions in the world, taking up 70 per cent of Indias health budget and an army of staff in a militarist vertical programme with a Preparatory Phase, an Attack Phase, a Consolidation phase and so on. India quickly became the worlds biggest market for DDTsupplied with US assistance. In 1960, for instance, the WHOs budget for malaria eradication was greater than the rest of WHOs budget put together: the former obtained US $ 18,197,726 while the total budget was US $ 16,330,900. It was also one of the first vertical programmes to fail spectacularly, not least for its technical hubris as for the inability to build a public health system that could carry out routine anti-malaria activities, precisely because of its vertical character. Indeed, these very investments made the recognition of its failure in the 1960s difficult and painful, although few were held to account. It was a programme built with no social science inputs too, unlike the tuberculosis programme, also then being designed. It is only recently, with a World Bank-led reform of health systems, including a new avatar of the programme, have some social science studies been undertaken. The book under review is one of the outcomes. Carried out in a village each in three different agro-ecological zones in Surat district, Gujarat, it seeks to understand peoples knowledge of the disease and its causes and their behaviour. This is, however, not a study utilizing the academically bankrupt but predominant behavioural approach to disease causation in public health that views behaviour as the cause of diseases and is thus an instrument of people-blaming. Instead, the study seeks to locate the cause of peoples behaviours in a social and economic context. And this is the predominant strength of the book. Mining a rich field, there is a rich harvest of gems, to mix metaphors.   For example, it is no surprise to discover that most people know that ...


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