Economic and Political Weekly August 25, 2007 3491 I n post-independent India, efforts to deliver modern healthcare in terms of institutional structures, qualiied practitioners, and health policies at national level have been well documented. Although there has been considerable improvement in the health status as measured by the increase in life span (33 to 62 years), fall in infant mortality and the crude death rate, statistics also show that such achievements have fallen far short of the nation’s expectations. United Nations provided statistics reveal that in sub-Saharan Africa and Asia, millions of people still die from communicable but preventable diseases like tuberculosis, malaria and schistosomiasis, besides the scores succumbing to newly emerging diseases such as Severe Acute Respiratory Syndrome (SARS), bird-lu, chickungunya, and dengue. About one-third of the world’s population is infected with TB with almost two-thirds of them living in Asia. In the developing world, 1.2 billion people lack access to safe water, adequate sanitation and poor housing, 800 million people lack access to health services [All India People’s Science Network 2002]. That health services have been dismally poor and inaccessible for a large majority of the population in India has not been disputed. This has been adequately acknowledged recently by government of India health policy documents as well [GoI 2002, 2005]. One of the arguments in health sector debates is that lack of adequate institutional health services leads to ill-health and continuing mortality and that superstition, irrationality, ignorance continue to haunt rural India and hence the high levels of ill- health and mortality. Accordingly, there has been an on-going debate in explaining reasons for inaccessible health services. This debate manifests at various levels: public health sector vs private health sector 1 (and its related arguments globalisation vs localisation); modern health system vs traditional/indigenous/alter- nate systems of medicine (allopathy vs ayurveda, unani, siddha, etc), and rational vs spurious medicines. Of late, holistic/uniied models have been advocated instead of binary models say, for instance, public-private partnership in healthcare 2 including non- government organisations (NGO) sector, and integrated medicine that is sup-posed to be a judicious mix of various systems of medicine. Thus, impassionate arguments have been made in sup- port of each of these, offering evidence, explaining the complexity of prevailing disease-producing conditions, the present disease burden, the existing health infrastructure and its linkages with the hierarchical and iniquitous social structure, thus justifying scores of single disease vertical programmes in the country. In brief, the “inaccessibility to primary healthcare”, “pathetic situation of community health centres” (CHCs), and “advanced stage” of decay of health services system in the country [Muk- hopadhyay 1997] have been explained by social scientists. Their explanations can broadly be grouped under three theoretical perspectives: the colonial theory of supremacy, theory of pri- vatisation and globalisation; and the theory of discriminatory continuities and consistency. The advocates of colonial theory of supremacy argue that the indigenous systems of medicine have been sidelined and subjugated by the hegemony of the western system of medicine. This has been done through conspiratorial methods adopted by the colonial rulers in India. It is in fact the colonial rule that ushered in the allopathic (western) medical system in India and hence it became a state-imposed healthcare system both during colonial and post-independent India. Western scientiic medicine has been imposed both as an ideology and practice in India. In their attempt to embark upon modernity, the ruling classes here accepted the western bio-medical system in toto leading to the marginalisation of Indian medical knowledge systems. This ap- proach of the colonial state has had implications for all health policies followed in India to date [Arnold 1993, 2000; Mark Harrison 1994; Radhika Ramasubban 1988]. The protagonists of the theory of privatisation and globalisation argue that it is essentially to do with the way capital has subjugated medcal science, which has led in turn to the commodiication of health, and technological medicine (specialty and super specialty medi- cine). In the process, drugs have become more powerful than the providers, which has resulted in corporatisation of medical care and increased disparities between specialised and genera- lised medicine. By implication, the capitalist character of Indian society continues to distort the potential contribution of scientiic medicine and this has led to the aggravation of suffering and alienation of the poor [Banerjee 1984; Qadeer 1985]. Most of the explanations regarding inequalities of healthcare in India fall either within the irst or second perspective, however, one also inds a combination of the irst and second perspective as an analytical Medicine, Power and Social Legitimacy A Socio-Historical Appraisal of Health Systems in Contemporary India Medical pluralism has been deined as the coexistence of several medical systems and the relatively greater choice available for everyone. However, a key issue in medical pluralism in India is the existing unequal power relations between different medical systems as well as between “providers” and “receivers” of healthcare. Hence, in order to understand the dynamics of medical pluralism and to analyse current health seeking patterns in India, one needs to trace historically the conditions under which the dominant medical systems emerged and also understand the social bases that sustain these systems. Purendra Prasad n