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Papers by Mathew George
National Medical Journal of India, 2019
Healthcare systems across the world are dominated by medical care services compared to public hea... more Healthcare systems across the world are dominated by medical care services compared to public health services. Within public health services, individual-oriented interventions dominate compared to population-based interventions perhaps due to the inherent dominance of biomedical approaches within public health. Clarity is needed between diverse approaches, methods and targets of public health as against clinical care services delivered under healthcare systems. Public health has a primary objective of prevention and promotion with the population as the target group with a societal focus, whereas the latter is curative in intent with an individualist orientation and logic and hence reductionist. The implications are important for developing nations such as India, which have a history of neglect towards ensuring public health due to the domination of policies on medical care. The healthcare system should use a modified typology that asserts its differential commitment to address both public health and medical care needs of its citizens. Natl Med J India 2019;32:171-4 INTRODUCTION Of the various concepts of healthcare systems*, the oldest and the most widely used is that of Roemer's 1 owing to the field of political science, where the role of state and its authority is the major focus. In this typology, the major focus has been to categorize healthcare systems based on the extent of autonomy government possesses, which ranges from the free enterprise system with minimal autonomy and responsibility with the government to the socialist system with the entire responsibility of provisioning of health services entrusted within the government. Healthcare systems are organized across nations immediately after their formation by focusing on the provisioning of medical care for citizens. This largely depends on the nature of the political system prevalent and the priority each country gives to health in relation to other concerns. 2 'Health service system' and 'healthcare system' are terms used interchangeably to denote how a nation-state organizes its commitment and resources to deliver a range of curative and disease control measures to its citizens. The deliberations on preventive and curative services provided by each healthcare system are largely about whether they are provided in a comprehensive manner or in isolation. What is missing in this typology is whether the healthcare systems of countries have adequate public health and medical care services or are dominated by either. From a value-based framework for low-and middle-income countries (LMICs), good health systems 'are those whose
Healthcare norms of a nation also reflect the extent of preventive, promotive, curative and rehab... more Healthcare norms of a nation also reflect the extent of preventive, promotive, curative and rehabilitative services that is expected to be delivered by a nation's health services system. It is a reflection of the model of healthcare delivery proposed, whether it is a physician-intensive model where the doctor requirement for a population is much higher than a community-health-worker-based model. Healthcare norms need to be differentiated from human resource requirement for health as the latter largely revolves around the professional to population ratio, which not only fail to consider inequities in the regional distribution of health personnel but also undermine the institutional level strengthening required for effective delivery of services. Thus, the present article is an attempt to propose a healthcare norm for the state of Maharashtra. This article will have two parts, first is the curative component, which is proposed based on the projected morbidity prevalence of the population, and the second part is the norm for a public health system competent enough to address the essential public health functions.
Economic and political weekly
Journal of Health Management
The present article is an attempt to examine the role of public health services in the context of... more The present article is an attempt to examine the role of public health services in the context of the epidemic of leptospirosis (1998)(1999)(2000)(2001)(2002), commonly known as rat fever in the state of Kerala. This is carried out within the larger context of the changing nature of health services in the state as part of the structural adjustment policies, as well as the specific nature of the disease characteristics (epidemics). From a public health point of view, control of an epidemic is possible not merely by preventing the occurrence of disease, but also by effectively taking care of those affected, thereby preventing transmission and also avoiding any possible disability from disease. This is possible only by coordinated interventions at the primary, secondary and tertiary levels. This within the broader perspective of social epidemiology addresses the social, political, economic, cultural and ecological determinants of the disease. In the context of the leptospirosis epidemic, it has been found that primary-level care focuses either on the techno-centric approach of killing of vectors (rat) or on educating the community. From a social epidemiology perspective, the question of livelihood and ecological imbalance become political questions whose solution being 'long term' gets conveniently sidelined. What remains to the people ultimately is the secondary-level care in which the prevalent health services play the leading role. This study reveals that even in Kerala, where private health services are widely used by the people and are claimed to be the reason for better their health status, the role of public health services in taking care of those affected with epidemics like leptospirosis cannot be overlooked.
Indian Journal of Medical Ethics
Health Mission (NRHM) to strengthen public health services in the country. Primary health centres... more Health Mission (NRHM) to strengthen public health services in the country. Primary health centres (PHCs) are the basic structure for implementing primary healthcare, and basic laboratory services are essential not only for strengthening PHCs but also for their sustainability. In order to accomplish these, possibilities within NRHM are discussed.
Economic and political weekly
Journal of Health Management
ABSTRACT
Economic and political weekly
Journal of public health policy, 2015
I examine possibilities for strengthening essential public health functions in the context of Ind... more I examine possibilities for strengthening essential public health functions in the context of India's drive to implement universal health care. In a country where population health outcomes are rooted in social, political, economic, cultural, and ecological conditions, it is important to have a state mediated public health system that can modify the causes of the major public health problems. This calls for strengthening the social epidemiological approach in public health by demarcating public health functions distinct from medical care. This will be a prerequisite for the growth of the public health profession in the country, because it can offer avenues for newly trained professionals within the country to work in 'core' public health.
Medicine Studies, 2014
ABSTRACT
Contributions to Indian Sociology, 2011
During the mid-1990s, the state of Kerala witnessed a wave of 'fever epidemics', which the govern... more During the mid-1990s, the state of Kerala witnessed a wave of 'fever epidemics', which the government tackled by establishing fever clinics. Based on an ethnography of these clinics, this article examines how, from being a symptom of the body's defensive response, fever has itself become institutionalised as a disease. It argues that the institutionalisation of fever as a disease has occurred through two sets of practices: first, discursively at the societal level by interactions among health professionals, the media, organisations representing various systems of medicine, and ordinary people; and second, curatively at the clinic while rendering fever care, including diagnosis and treatment. The article shows that, despite the discursive prevalence of a dominant system of allopathic medicine, the practices at the fever clinic are not consistently based on an allopathic understanding of physiology and pathology but rely on skilled trial-and-error which incorporates plural medical traditions. The article critically evaluates the effects of institutionalisation in terms of narrowing how fever is understood and how it may be treated.
Books by Mathew George
▶ Puts forth a theoretical proposition to examine medical care not only as an issue of provisioni... more ▶ Puts forth a theoretical proposition to examine medical care not only as an issue of provisioning but also of practice
▶ Demonstrates the use of multi-site ethnography in understanding societal discourses that are ambiguous, especially in the context of an epidemic
▶ Calls for the need to humanize medicine, using the case of fevers care in Kerala
This book is an ethnographic work that uses a critical medical anthropology approach to examine the concept of fever care in the context of southern India. Through a study of fevers, the study provides a critical overview to medical practice itself, as it is said that the history of fevers is also the history of medicine. This association between fevers and medicine is as relevant today, as this in-depth study of fever care reveals. Acknowledging the central role of health institutions in creating and propagating notions about illness in society, the author examines fever care through a study of hospitals. The study examines various discourses on fevers prevalent in the southern state of Kerala, which influence policy and programmatic dimensions of the state health services system. Fever care implies those aspects related to provisioning and cost involved among public and private sector hospitals. A second and more important dimension of this book is a critique of the culture of biomedical practice, informed by the social constructivist framework and approaches in the field of science studies. Overall, the book studies the processes by which physical symptoms like fever are treated as epidemics to be controlled, and are therefore brought within a biomedical system, thereby opening up options for commercialization of care.
Health care norms for Universal Health Care (UHC) by Mathew George
National Medical Journal of India, 2019
Healthcare systems across the world are dominated by medical care services compared to public hea... more Healthcare systems across the world are dominated by medical care services compared to public health services. Within public health services, individual-oriented interventions dominate compared to population-based interventions perhaps due to the inherent dominance of biomedical approaches within public health. Clarity is needed between diverse approaches, methods and targets of public health as against clinical care services delivered under healthcare systems. Public health has a primary objective of prevention and promotion with the population as the target group with a societal focus, whereas the latter is curative in intent with an individualist orientation and logic and hence reductionist. The implications are important for developing nations such as India, which have a history of neglect towards ensuring public health due to the domination of policies on medical care. The healthcare system should use a modified typology that asserts its differential commitment to address both public health and medical care needs of its citizens. Natl Med J India 2019;32:171-4 INTRODUCTION Of the various concepts of healthcare systems*, the oldest and the most widely used is that of Roemer's 1 owing to the field of political science, where the role of state and its authority is the major focus. In this typology, the major focus has been to categorize healthcare systems based on the extent of autonomy government possesses, which ranges from the free enterprise system with minimal autonomy and responsibility with the government to the socialist system with the entire responsibility of provisioning of health services entrusted within the government. Healthcare systems are organized across nations immediately after their formation by focusing on the provisioning of medical care for citizens. This largely depends on the nature of the political system prevalent and the priority each country gives to health in relation to other concerns. 2 'Health service system' and 'healthcare system' are terms used interchangeably to denote how a nation-state organizes its commitment and resources to deliver a range of curative and disease control measures to its citizens. The deliberations on preventive and curative services provided by each healthcare system are largely about whether they are provided in a comprehensive manner or in isolation. What is missing in this typology is whether the healthcare systems of countries have adequate public health and medical care services or are dominated by either. From a value-based framework for low-and middle-income countries (LMICs), good health systems 'are those whose
Healthcare norms of a nation also reflect the extent of preventive, promotive, curative and rehab... more Healthcare norms of a nation also reflect the extent of preventive, promotive, curative and rehabilitative services that is expected to be delivered by a nation's health services system. It is a reflection of the model of healthcare delivery proposed, whether it is a physician-intensive model where the doctor requirement for a population is much higher than a community-health-worker-based model. Healthcare norms need to be differentiated from human resource requirement for health as the latter largely revolves around the professional to population ratio, which not only fail to consider inequities in the regional distribution of health personnel but also undermine the institutional level strengthening required for effective delivery of services. Thus, the present article is an attempt to propose a healthcare norm for the state of Maharashtra. This article will have two parts, first is the curative component, which is proposed based on the projected morbidity prevalence of the population, and the second part is the norm for a public health system competent enough to address the essential public health functions.
Economic and political weekly
Journal of Health Management
The present article is an attempt to examine the role of public health services in the context of... more The present article is an attempt to examine the role of public health services in the context of the epidemic of leptospirosis (1998)(1999)(2000)(2001)(2002), commonly known as rat fever in the state of Kerala. This is carried out within the larger context of the changing nature of health services in the state as part of the structural adjustment policies, as well as the specific nature of the disease characteristics (epidemics). From a public health point of view, control of an epidemic is possible not merely by preventing the occurrence of disease, but also by effectively taking care of those affected, thereby preventing transmission and also avoiding any possible disability from disease. This is possible only by coordinated interventions at the primary, secondary and tertiary levels. This within the broader perspective of social epidemiology addresses the social, political, economic, cultural and ecological determinants of the disease. In the context of the leptospirosis epidemic, it has been found that primary-level care focuses either on the techno-centric approach of killing of vectors (rat) or on educating the community. From a social epidemiology perspective, the question of livelihood and ecological imbalance become political questions whose solution being 'long term' gets conveniently sidelined. What remains to the people ultimately is the secondary-level care in which the prevalent health services play the leading role. This study reveals that even in Kerala, where private health services are widely used by the people and are claimed to be the reason for better their health status, the role of public health services in taking care of those affected with epidemics like leptospirosis cannot be overlooked.
Indian Journal of Medical Ethics
Health Mission (NRHM) to strengthen public health services in the country. Primary health centres... more Health Mission (NRHM) to strengthen public health services in the country. Primary health centres (PHCs) are the basic structure for implementing primary healthcare, and basic laboratory services are essential not only for strengthening PHCs but also for their sustainability. In order to accomplish these, possibilities within NRHM are discussed.
Economic and political weekly
Journal of Health Management
ABSTRACT
Economic and political weekly
Journal of public health policy, 2015
I examine possibilities for strengthening essential public health functions in the context of Ind... more I examine possibilities for strengthening essential public health functions in the context of India's drive to implement universal health care. In a country where population health outcomes are rooted in social, political, economic, cultural, and ecological conditions, it is important to have a state mediated public health system that can modify the causes of the major public health problems. This calls for strengthening the social epidemiological approach in public health by demarcating public health functions distinct from medical care. This will be a prerequisite for the growth of the public health profession in the country, because it can offer avenues for newly trained professionals within the country to work in 'core' public health.
Medicine Studies, 2014
ABSTRACT
Contributions to Indian Sociology, 2011
During the mid-1990s, the state of Kerala witnessed a wave of 'fever epidemics', which the govern... more During the mid-1990s, the state of Kerala witnessed a wave of 'fever epidemics', which the government tackled by establishing fever clinics. Based on an ethnography of these clinics, this article examines how, from being a symptom of the body's defensive response, fever has itself become institutionalised as a disease. It argues that the institutionalisation of fever as a disease has occurred through two sets of practices: first, discursively at the societal level by interactions among health professionals, the media, organisations representing various systems of medicine, and ordinary people; and second, curatively at the clinic while rendering fever care, including diagnosis and treatment. The article shows that, despite the discursive prevalence of a dominant system of allopathic medicine, the practices at the fever clinic are not consistently based on an allopathic understanding of physiology and pathology but rely on skilled trial-and-error which incorporates plural medical traditions. The article critically evaluates the effects of institutionalisation in terms of narrowing how fever is understood and how it may be treated.
▶ Puts forth a theoretical proposition to examine medical care not only as an issue of provisioni... more ▶ Puts forth a theoretical proposition to examine medical care not only as an issue of provisioning but also of practice
▶ Demonstrates the use of multi-site ethnography in understanding societal discourses that are ambiguous, especially in the context of an epidemic
▶ Calls for the need to humanize medicine, using the case of fevers care in Kerala
This book is an ethnographic work that uses a critical medical anthropology approach to examine the concept of fever care in the context of southern India. Through a study of fevers, the study provides a critical overview to medical practice itself, as it is said that the history of fevers is also the history of medicine. This association between fevers and medicine is as relevant today, as this in-depth study of fever care reveals. Acknowledging the central role of health institutions in creating and propagating notions about illness in society, the author examines fever care through a study of hospitals. The study examines various discourses on fevers prevalent in the southern state of Kerala, which influence policy and programmatic dimensions of the state health services system. Fever care implies those aspects related to provisioning and cost involved among public and private sector hospitals. A second and more important dimension of this book is a critique of the culture of biomedical practice, informed by the social constructivist framework and approaches in the field of science studies. Overall, the book studies the processes by which physical symptoms like fever are treated as epidemics to be controlled, and are therefore brought within a biomedical system, thereby opening up options for commercialization of care.