Reconstructing the critically damaged health service system of the country.

India's ruling class, in association with international agencies, bureaucrats, and business interests, has formed a powerful syndicate that has been imposing its will on the country to the detriment of public health. After gaining independence, India developed a body of knowledge suited to its social, cultural, economic, and epidemiological conditions. This led to an alternative approach to public health education, practice, and research that foreshadowed the Alma Ata Declaration on Primary Health Care of 1978.

The World Health Organization and public health research and practice in tuberculosis in India.

Two major research studies carried out in India fundamentally affected tuberculosis treatment practices worldwide. One study demonstrated that home treatment of the disease is as efficacious as sanatorium treatment. The other showed that BCG vaccination is of little protective value from a public health viewpoint.

The political economy of the introduction of Western medicine in India and preexisting health practices.

In India, by the second century B.C., Ayurvedic medicine had already taken the momentous step of becoming rational therapeutics.

Serious crisis in the practice of international health by the World Health Organization: the Commission on Social Determinants of Health.

The Commission on Social Determinants of Health (CSDH) is the latest effort by the World Health Organization to improve health and narrow health inequalities through action on social determinants. The CSDH does not note that much work has already been done in this direction, does not make a sufficient attempt to analyze why earlier efforts failed to yield the desired results, and does not seem to have devised approaches to ensure that it will be more successful this time. The CSDH intends to complement the work of the earlier WHO Commission on Macroeconomics and Health, which has not had the desired impact, and it is unclear how the CSDH can complement work that suffers from such serious infirmities.

Distortion of some of the basic principles of public health practice in India.

India's political leadership has chosen personnel from the Indian Administrative Service cadre of generalist administrators and from the clinician-dominated cadre of the Central Health Services to run the country's health service system. The personnel's inadequate or distorted understanding of some of the basic principles of public health practice--such as developing an epidemiological approach to solving community health problems, choice of appropriate technology, and optimization of health service systems--has had a very deleterious effect on the health service system. These administrators have become vulnerable to manipulation by personnel from international agencies, who also have questionable public health credentials, to create space for imposition of their technocentric, ill-conceived, and ill-designed agenda.

Politics of rural health in India.

The setting up of the National Rural Health Mission is yet another political move by the present government of India to make yet another promise to the long-suffering rural populations to improve their health status. As has happened so often in the past, it is based on questionable premises. It adopts a simplistic approach to a highly complex problem.

The people and health service development in India: a brief overview.

Health is politics, and politics is health as if people matter--this has been a refrain of such scholars as Rudolf Virchow, Halfdan Mahler, and B.C. Roy.

Reinventing mass communication: a World Health Organization tool for behavioral change to control disease.

Most of the WHO's vertical programs, because they were ill-conceived, ill-designed, and defectively implemented, have fallen far short of expectations. These limitations have been doggedly ignored by the WHO, although the authorities in India have now realized that such vertical programs are expensive and not sustainable. Launching of Communication for Behavioral Impact (COMBI) appears to mark a desperate effort to revive their performance.

Reflections on the twenty-fifth anniversary of the Alma-Ata Declaration.

The Alma-Ata Declaration on Primary Health Care of 1978-based on the World Health Assembly's resolution of 1977 on Health for All by the Year 2000--was a watershed in the concepts and practices of public health as a scientific discipline; it was endorsed by every country in the world, rich and poor. According to the Declaration, health is a fundamental right, to be guaranteed by the state; people should be the prime movers in shaping their health services, using and enlarging upon the capacities developed in their societies; health services should operate as an integral whole, with promotive, preventive, curative, and rehabilitative components; and any western medical technology used in non-western societies must conform to the cultural, social, economic, and epidemiological conditions of the individual countries. Since Alma-Ata, a syndicate of the rich countries and the ruling elites of the poor countries, aided by the WHO, World Bank, World Trade Organization, and other international institutions, has done much to overturn the Declaration's primary health care initiatives.

Reflections of an Indian scholar.

In India, health programs have often been imposed on the deprived poor by a syndicate of foreign agencies and the local ruling class. During the first two decades after Independence, the political setting was somewhat conducive to scientific debates on the development of health services for India's people. The scenario changed radically during the next three and a half decades, when the country's ruling class became more oppressive and foreign agencies exerted increasing pressure to impose a prefabricated and scientifically suspect agenda of health services that were even more unequal and iniquitous to the interests of the deprived.

Report of the WHO Commission on Macroeconomics and Health: a critique.

The World Health Organization has been able to interest some of the world's top economists in joining the Commission on Macroeconomics and Health, to study macroeconomics of health services for the poor peoples of the world. The commission has been ahistorical, apolitical, and atheoretical. It has adopted a selective approach to conform to a preconceived ideology.