Health : A major Paradigm in Anthropology.
Under the evolutionary framework health is a paradigm in Anthropology; as the health status of a community is a very good indicator of adaptation to an environment (includes physical, biological and cultural). The major goal of anthropological research is to understand the as also to unravel the intricate mechanism of human variation and evolution. Health and well-being is one of the major indicators of overall development or progress of a community or a nation. Since man is a bioculturally integrated entity, health condition is a result of the interaction of both biolological and SOfactors.
This multidisciplinary programme is being carried out since 1976 following in broad outlines and supplementing the recommendations of the Human Adaptability Section, IBP, Man and the Biosphere Programme, UNESCO and The Decade of the Tropics, IUBS. The general objectives of the programme are (a) to evaluate the nutritional and health status of communities exposed to various physical, biological and sociocultural environments and/or having different genetic compositions; (b) to identify and measure the roles of factors associated with these environments, their relative roles and interaction effects, and/or of genetic compositions, in determining the same; (c) to detect the effects of human health and activity patterns on the environment; and the survival (coping) strategies adopted by the disadvantaged population to withstand the insult of the changing and adverse environment and eventually (d) to determine the limits to human adaptation.
The limits to human adaptation are defined in the following terms :
(a) lower limit--the magnitude(s) of stress(es) beyond which survival is not possible; and (b) upper limit--the magnitude(s) of withdrawal of stress(es) and/or input of favourable stimulus beyond which the chances of well-being and survival does not increase.
The programme should ideally operate at two levels :
(a) undertaking small scale, intensive studies on some selected populations of West Bengal (selected on the basis of certain environmental factors, e.g., altitude, climate, rainfall, disease vectors, social/economic conditions, etc.), to detect the effects of specific environmental factors on individual health and nutritional traits, as well as the effects of specific health/disease and activity patterns on the environment; and
(b) generating basic data on health and nutritional characteristics of populations from various ecological zones of West Bengal in particular and India in general, from different ethnic groups within a zone and from different socioeconomic strata within an ethnic group, the states and strategies for survival and the degrees of ecological success, through carefully designed sample surveys. The former approach may provide important indications as to the determinants and consequences of human health and nutritional patterns, and thereby suggest useful intervention points; the latter should provide objective data base for formulating community health policies and programmes, in addition to providing opportunities for testing the above mentioned indications and suggestions.
The small scale, intensive type of work carried out under the Human Adaptability Programme has produced interesting results. In order to pursue this line of work on a long-term basis (10-15 years, say) and to expedite its progress so as to obtain some comprehensive results within a reasonable period of time, it is necessary to place the programme on a permanent footing and providing it with certain essential facilities. Collaboration of scientists from other disciplines are available at present and will be sought in future, as necessary.
Project already completed
Project 1: Impact of Altitude on Human Populations.
Thrust areas:
(a) Is the effect of high altitude a universal phenomenon in the human case?
(b) What are the relative effects of physical environmental, biological and sociocultural factors/factor-complexes on individual health traits and a composite index of health that we may try to define?
(c) What are the impacts of human activity on environment (e.g., of population influx, industrialization, etc. on forest destruction, soil erosion, disruption of traditional values, inter-ethnic group conflicts, etc.).
Outcome : The results suggest that although altitudinal differences exist for many human biological traits for instance, delayed menarche, reduced fertility, higher haematological values, lower blood pressure, slower and protracted child growth, and absence of adolescent growth spurt, expansive chest, higher body fat as expected, but the adults are taller and heavier than their low altitude counterparts, similar difference exist between/among sociocultural, ethnic, etc. groups as well, so that altitudinal differences may not be due to altitude related physical environmental factors per se. A possible lack of universality in the capacity for biological responses of human populations with respect to one or several adaptive domains/traits may result in a given trait responding differentially to the altitude stress(es) in different regions/populations, and different traits responding differentially to the altitude stress in a given region/population. It thus appears that some of the apparently altitude related differences may be caused by complex and varied region- and population-specific interactions of physical environmental and socio-cultural stresses as well as genetic make ups. Human activities and the influx of tourists in the regions have gravely affected the mountain ecosystem. The study also shows that modernization affects life ways of the people in this harsh and extreme environment. The study also suggests that adaptive pathways of the Asian highlanders are different from Andian highlanders. The latter findings are in conformity with by and large experimental animal models. The former may be due to longer history of residence at high altitude, and warranty further research to resolve the riddle pertaining to adaptive mechanisms.
Project 2. : A study on the Determinants of Fertility and Mortality in an Urban Setting : An Anthropological Perspective,
One major objectives of the goal of "Health for All by 2000" is to reduce the maternal and child morbidity and mortality, which are extremely high in most of the Third World Countries including India (infant mortality : 121 per 1000 births, as of 1981).
Family welfare planning helps reduce the chances of high-risk pregnancies. Global evidences suggest that the risk is the highest if the mother is too young or too old, pregnancies too many and too closely spaced; even when the infants survives the pregnancies occurring during the high-risk period may lead to problems such as low birth-weight, nutritional deficiencies, frequency episodes of infectious diseases, slow physical growth and development, etc.
In many developing countries 20-25% of the children die before 5 years of age. Many of these deaths are preventable with the available health technology, but the social circumstances, including traditional cultural norms, act as a deterrent. Medical and social factors interact in generating the deterrents and, therefore, the intervention measures must incorporate such interactions. Some of these interacting factors are age at marriage, birth spacing, breast feeding, age at first birth, mother's education, mother's participation in labour force, mother's role in decision making and contraceptive knowledge, attitude and practice, etc.
The objective of study is to investigate into the determinants of fertility and mortality, especially the latter, on which hardly any urban Indian data exist, adopting a biosocial strategy, i.e., using the approaches of both biomedical and social sciences. Two minor objectives which follows from the major one are, first, to obtain a base line information on health conditions of the general population, and second, to enquire how existing living conditions and social behavioral patterns in the immediate surrounding act as determinants of, particularly, maternal and child health, including mortality of both. Identification of major social, economic and other possible determinants of maternal and child health may lead to formulation of more effective community health planning.
The study was conducted among Hindus and Muslims in slum areas of Calcutta city.
Thrust areas :
(a) Which biomedical and/or social factor(s) determine fertility, mortality and maternal and child health most effectively?
(b) Do the factor(s) varies(y) in relation to economic and/or social group affiliation?
(c) How do biomedical and social factors interact in determining the traits mentioned in (a)?
Outcome :
The general outcome of the study shows that there is a constriction at the base of the population pyramid, which may indicate a recent drop in fertility due perhaps to the acceptance of family planning methods. Polygynous marriage are almost absent and monogamy is the usual practice among both the religious groups. One or two sporadic case(s) of consanguineous marriages are found among the Muslims.
The Hindu females show somewhat late marriage compared to the Muslims.
The Muslims females are educationally backward compared to the Hindus and they start childbearing earlier than the Hindus. The percentage of nulliparous women is higher among the Hindus than the Muslims. The Muslims have higher fertility compared to the Hindus. Total Fertility Rate, Completed Family size as well as Sibship size are higher among the Muslims compared to the Hindus Spacing is too closed among the younger mothers of both the religious group but the gap increases from the 30-34 years age onwards.
Mortality Rate is higher in all the stages (neonatal, post-neonatal, childhood) in the Muslims compared to the Hindus as is the case with fertility.
From the Life Table analyses, it appears that the age specific mortality is higher among the Muslims than the Hindus.
Expectation of life at birth as well as subsequent ages are higher among the Hindus compared to the Muslims.
Both the average number of live birth and infant death reduces with the rise in literacy level in both the groups especially among the Hindus.
The average number of live birth and infant death decreases with the rise of age at marriage. The results also show that the marriage duration affects both fertility and mortality.
Only 20 percent of live births are delivered at home among the illiterate section of the Hindus. Home delivery is much higher among the Muslims compared to the Hindus. Institutional delivery among the Hindus increases with advancing education (80% to 100%, respectively), whereas the corresponding figures among the Muslims are 42.9 to 66.7 percent, respectively.
The younger mothers of both the communities prefer small family size but the attitude varies between the two groups, e.g., the Hindus prefer not more than two children whereas the Muslims want at least three. The family size rises with the increase of age of the mother in both the communities. The results show that the women, on average, have already borne more children than they preferred to have.
Among the Hindus, acceptance of modern F.P. methods is higher even among the illiterate section. The acceptance of modern F.P. method among the Muslims rises with increasing literacy level but the overall rate is lower than the Hindus.
The air-borne, water-borne and other infectious diseases like measles, chicken pox, dysentery, malaria, tuberculosis, pneumonia, liver diseases are common in both the communities at post-neonatal stage (1 - ó 5 yrs.). Such diseases are sometimes lead to death at neonatal stage in both the communities.
The allopathic treatment is the usual practice but occasionally homoeopathic treatment is also sought. Supernatural belief regarding disease and folk treatment are also found among both the groups especially among the older folks.
About 20 percent of the children are solely breastfed upto twenty five months among both the religious groups. supplementary foods are initiated from six to thirteen or above months.
The dwelling of both the religious groups, is by and large, similar and are enjoying similar civic amenities.
The slum dwelling Hindu women are engaged in out-of-home job (as maidservant, attendant at nursing home). On the other hand, the Muslim women are not permitted to go outside their own territory and some of them are engaged in making cardboard box, bidi, etc. at home.
The status of women is low in the Muslim society and practically they have no role in decision making even in the matter of her own reproductive life.
The health seeking behaviour pattern is different and which in turn lead to mortality differential between the two communities.
The higher fertility among the Muslims may be due to lower survival prospect (due to higher mortality), a strong son preference and perceived threat to existence of a minority community; and the higher mortality among the Muslims may be due to lower (female) literacy rate, poor standard of living due to poor economic condition, lower age at marriage, higher rate of "high risk pregnancy" due to lower acceptance of family planning methods, lower awareness about the importance of immunization and health care.
In general, both the Communities are reluctant about utilizing the available health infrastructural facilities (like government hospital) due to the negligence and lack of sympathy on the part of the government doctors and the unavailability of medicine in the hospital. It is therefore needed to probe the health seeking behaviour (health culture) thoroughly and intensively.
So, there is a clear influence of cultural factors associated with religion on the mortality and fertility differentials among the Hindus and the Muslims slum dwellers of Calcutta city.
ONGOING PROJECTS
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