Monday, December 31, 2012

Society and Public Health

Dhiyanesh Ravichandran

Society has an ethical obligation to ensure equitable access to quality  health services by making that care a basic social right.

Is health care a right or a privilege? This has become an enduring debate among the scholars and policy makers ever since the time when state became the sole allocator of resources on behalf of society. The capitalistic business approach has crept into field of healthcare since since industrial revolution in western nations and very recently in India too. Privatization of healthcare in India led to the rule of big corporations playing a major share of health services for huge profits, sometimes by inappropriate and unethical means as well. The stake on government on health services is too low as does its budget allocation every year. Neither the services are up to the average standards. Healthcare companies see no profits in investing in rural health infrastructure, combined with inadequate public healthcare network led to the total neglect of rural areas.

Is one's health status an outcome of his behaviour and lifestyle? Does he have absolute control in determining his well-being? Even though people have the ability to influence their health status by their individual decisions on or choice of lifestyle. But many health problems are beyond their control. They can also be affected by genetics, living of work environments, or even by chance. Even though there are several preventive measures for many such ailments, the awareness among them is definitely less and it is impossible for each and every one to know about all such health issues.

A society's commitment to healthcare reflects some of its most basic values about what it is to be a member of the human community. Society, therefore, has an ethical obligation to ensure equitable access to quality  health services by making that care a basic social right. The present day governments are the appropriate agencies to facilitate such a valued obligation, by ensuring that the health services are universal, less privatized, free of cost to all of its citizens, and are easily accessible. The National health insurance coverage in several countries is an example to universal healthcare.

In India, the status of public health is less comforting. More that three fourth of the health infrastructure is concentrated in urban areas where only 27% of total population lives. There are no private takers for the rural healthcare primarily due to profit factors, which led to the total neglect of rural India. Rural areas depend fully on government health infrastructure, which proves to be ineffective. The public health expenditure of India in 1990 was 1.3% of the GDP and dropped to 0.9% of GDP in 2009. The increase in GDP growth in this time period has not increased the health care expenditure, considering the increase in population. The Union budgetary allocation is just 1.3% and that is state budget is just 5.5% on an average.

Health Insurance is a nonentity in Indian scenario. Only 10% of our citizens have some form of health insurance, inadequate to meet their healthcare bills in most of the cases. Hospitalised Indians on an average spend about 58% of their total annual expenditure for healthcare. About 25% of them fall below poverty line because of their hospital expenses. 

Health economists say that healthy labour force increases participation ratio in the economic activities. When individuals are viewed as a stock of human capital, health status impacts the values of stock. In a family, medical expenses of adult members deplete the savings and investments meant for the nutritional and educational needs of children. Reduced earning potential of individuals ultimately affects national income. In this perspective, health economists assert individuals as assets and resources for economic excellence and healthcare as a means to extract maximum productivity. Healthcare should be considered as a basic social right irrespective of his economic productivity and what humanity wants is a more sustainable approach towards healthcare, which is universal and accessible to all.

Lack of community ownership of public health programmes has impacted so adversely in India. Various health indicators in India show unfavorable trends in health status even though the country shows positive economic growth in recent decades. A comprehensive healthcare policy is necessary, which involves increased participation of the state in infrastructural development and service delivery. In a globalised era, curbing private players would prove fatal. They need to be utilised by the state in right and just manner through public private partnerships or joint ventures. Implementation requires community patronage.

Saturday, December 15, 2012


Stuti Das
1st B.A. Sociology,
Stella Maris College.

(This entry secured 1std place in the Article Writing contest held as a part of SocioFest LIBERATE'12 of Department of Sociology, Loyola College. A slightly modified version of this article has been published in the July 2013 edition of the Reading Hour magazine.)

“My vision is utopian, but I believe in its possibility.”
 – Anne Fausto-Sterling, Sexing the Body

A video clip uploaded on the video-sharing site, YouTube, opens with the host – a news anchor with Toronto’s CityNews – walking into a cocktail lounge with a fashion model who has of late garnered much attention after appearing on the catwalk in Paris in a haute couture bridal gown for the French fashion designer Jean Paul Gaultier. They settle down for an interview.

“When I look at you,“ the beaming host tells the model, “ I see an absolutely beautiful, tall, lean, gorgeous, woman.”

“Well, thank you!” the model smiles with a tilt of the head.

The appearance of the model, a svelte blonde with cascading platinum hair, icy blue eyes, dewy skin, arched eyebrows and chiselled cheekbones, seem not untypical of those seen regularly strutting the catwalk for womenswear labels. But there is a difference: this model, Andrej Pejic, is not a woman. He is a man.

Scouted at the age of 17, one of the first jobs for this androgynous model from Broadmeadows, Australia was to open a runway show for a womenswear brand at Sydney fashion week. He then went on to become a part of the Marc by Marc Jacobs Spring 2011 campaign in which he was seen as the shorts-and-sneakers-wearing boy. That same year he was signed up to model a wedding dress for the Jean-Paul Gaultier Haute Couture Spring 2011 Fashion Show at Paris Fashion Week. Seeing Pejic’s versatility, Gaultier hired him for his Fall 2011 menswear show. In no time, Andrej emerged as one of the most sought-after figures in the world of high fashion.

“Gender doesn’t make me who I am,” Pejic tells his interviewer. He does not have a strong gender identity, he says, and prefers identifying as what he is. He leaves his gender open to interpretation and feels that we often make too big of a deal of defining people by their gender.

As the only top-tier fashion model who can walk down the runway as either a man or a woman, Pejic, who is reticent about restricting his sense of self within the confines of any one gender in particular, symbolises a revolutionary trend: emancipation from the rigidities of gender norms.

Meanwhile, in Canada Kathy Witterick and her husband, David Stocker, are raising their child, Storm, without revealing Storm’s sex. They wish to bring Storm up, not as their daughter or son, not as a girl or a boy, but as just their child. They want Storm to be “gender creative” - their way, they say, of paying “a tribute to freedom and choice in place of limitation.” They have allowed their two older sons to “make their own choices” with respect to clothing and hairstyle. So Storm’s older brothers are never deterred from wearing pink feather boas, dresses and braids. Witterick and Stocker do not feel the need to force their children into a particular gender mould; rather they want their children to develop their interests and inclinations unrestrained by specific gender norms.

In another instance, in the month of May this year, Argentina granted its citizens the freedom to determine the gender they want to be identified with without having to undergo any medical, psychiatric, or judicial procedures, thereby recognising that one’s gender ought to depend on little else except one’s own rational choice.

Are we then entitled to think that gender today is a dying concept; that we as a society are already on our way to emancipating ourselves from the straitjacket of gender norms?

The answer sadly is a no, for if we look beyond the headlines and focus on things that regulate the day-to-day lives of the great majority of human beings treading the planet, gender is alive, well and kicking.

Gender, according to the definition provided by Merriam-Webster, is ‘the behavioral, cultural, or psychological traits typically associated with one sex’. An individual’s sex, on the other hand, is solely a matter of biology: women have two X sex chromosomes, while men have XY. In addition, there are individuals with other combinations, such as XXY or XO.

What determines an individual’s gender identity – one’s private sense of one’s own gender – remains till date an inconclusive debate. But studies show that one’s biological status as a male or female has very little role to play in it, for it has often been observed that individuals who can physiologically be categorised into distinct biological groups of male and female, admit to being unable to identify with the social characteristics commonly attributed to their sex. A book by the name, The Lives of Transgender People which is based upon a survey and interviews with several thousand trans-masculine, trans-feminine, and gender- nonconforming people in the United States, demonstrates the tremendous gender fluidity that exists in the U.S. today. For instance, when asked about their gender identities, the participants provided more than 100 different responses. A number of them said that there was no easy way by which they could identify their gender. Some of the respondents resorted to percentages to describe their identities (such as one third male, one third female, and one third transgender) while others said simply, “I am me.”

However, despite innumerable evidences such as these, the society we live in views gender as tied to one’s biological sex. One’s gender identity is expected to parallel one’s physiological sex and any discrepancy in this regard is treated as an aberration.

Furthermore, the assignment of gender is done according to a binary model – a social dichotomy based on the flawed premise that biologically there exists only two sexes, which in turn necessitates that all individuals be assigned only one of the two gender identities – male and female – and consequently be permitted only one of the two gender expressions – masculine and feminine. An individual therefore is expected to be on either end of a linear spectrum. According to this model, one can neither see oneself on both ends at the same time nor anywhere in between, the principal determinant of one’s position being one’s physiological characteristics.

Gender in most societies – with the exception of a few such as the Navajo of the Southwestern United States - is a rigid binary concept that allows little room for fluidity. It demands compulsory conformity and any transgression from the norm is not without consequences.

In 2001, 16-year-old Fred Martinez, a Navajo boy who identified himself as a girl, was brutally murdered near his hometown of Cortez, Colorado. Among his own people however, he was accepted as nádleehí or a two-spirit person but mainstream America’s narrow views on gender proved fatal to him. More recently, statistics on anti-trans hate crimes published by the International Trans Murder Monitoring Project reveal that more than 220 individuals around the world were killed in the year 2010 for identifying with a gender that contrasted with the one assigned to them by society. Even in their day-to-day lives, as a result of society’s failure to recognise the multiplicity of gender possibilities, gender-nonconforming people face stigma and discrimination and become targets of verbal and physical assault.

The drawbacks of such strict gender essentialism are, in fact, numerous. For one, gender as it is known and practiced today has a pretty arbitrary basis: that one’s biological characteristics should determine how one should act, feel, think and behave, though studies so far have failed to establish any definitive relation between one’s biological sex and gender identity. Furthermore, the gender binary model is, for all purposes, a gross oversimplification, for it certainly fails to capture the entire spectrum of anatomical variations that exists. Even if gender was something restricted solely to biology – though it isn’t – this social dichotomy would not have been able to encompass the entire continuum of the many different varieties of gender identities and expressions that would then be possible.

Gender comes with an extensive list of do’s and don’ts. It is immensely restrictive as a result of which people are often compelled to act not according to their personal interests and inclinations but in keeping with the existing norms. Gender thus submerges the human and contrary to the common claim made in its favour that it facilitates self expression, gender actually restricts an individual’s capacity for self actualisation.

The greatest demerit of gender, of course, is its compulsive nature. A gender label once assigned to an individual is seen as something immutable, although research shows that gender identity isn’t static. One’s identification with one’s gender may change over time, for the way individuals identify with a particular gender is not stable, as is evident from the existence and prominence of late-transitioning trans people.

It therefore goes without saying that we are all in a gender straitjacket. But gender roles and expectations form such an intrinsic part of our culture that most people, especially those who have managed to fit neatly into the system, find it hard to imagine things differently. But the fact remains that gender is a powerful tool of structural oppression encompassing every aspect of an individual’s life, so much so that, as Judith Butler writes, “the body becomes its gender through a series of acts which are renewed, revised, and consolidated through time.”

Bruce Peter Reimer was born a male. After a botched circumcision at the age of 6 months, he was reassigned to be raised as a female and rechristened as Brenda. Living as anything other than as a man or a woman was out of question. But despite female hormones and frilly dresses, not to mention the tremendous pressure from parents, teachers and doctors to behave “like a girl”, Brenda demonstrated interests that were “typically male”. For all purposes, it was a bizarre spectacle. Deviation from gender norms isn’t something that society has ever taken a kind view of. Brenda wasn’t spared either and very soon she was the object of ruthless ridicule for her “masculinity”. Attempting to fall in line with the expectations mounting on her, she tried “acting like a girl”. This continued for a while. Unable any more to suppress her inner inclinations, Brenda went into depression and attempted suicide. It was then decided that she would switch back to being a male. She did and David Reimer was born. But “behaving like a man” after having so long “tried to act like a girl” did not come as easily as David thought it would. But he kept up his efforts. Memories of his blighted childhood continued to haunt him and at age38, he began suffering from an identity crisis. On 5 May, 2004, he finally committed suicide.

The life of disgraced, unsexed David Reimer, as much a victim of the gender straitjacket as we all are, demonstrates, without any room for doubt, that creating a fairer world by emancipating ourselves from the gender straitjacket through recognition of the existence of non-binary gender diversity and multiplicity of gender expressions and the elimination of sex-based gender assignments along with the idea that gender is a static immutable concept is something that is not just desirable but also extremely necessary.

Sounds like a brave new world? Perhaps, but definitely worth striving for.


2nd B.A Sociology
Stella Maris College.

(This entry secured 2nd place in the Article Writing contest held as a part of SocioFest LIBERATE'12 of Department of Sociology, Loyola College.)

“The question isn’t who’s going to let me; it’s who is going to stop me.” - Ayn Rand

Emancipation holds significantly different meaning form individual to individual,culture to culture and from society to society. Before discussing about the problems, status and the emancipation of women in India we must be clear about the concept and nature of emancipation. In the essay on Marx, Tocqueville, and the Problem of Emancipation, Scott beck says that “True emancipation is the result of a balance between community and personal freedom, between political and civil life, between solidarity and self-interest, and perhaps above all, the balance between the specific and the general interests of the various groups within society. Thus, the problem of emancipation is ultimately the problem of balance. More specifically it is the problem of sustaining such a balance long enough for norms of emancipation to thoroughly saturate the everyday lives of society’s denizens. How we are to arrive at this point is a question for the science of emancipation, a field which is still awaiting consideration.”

Scott beck also adds that “We might posit two alternate visions of emancipation: emancipation as inclusion, where the oppressed individual or group acquires equal rights of participation in the existing social or political structure, and emancipation as revolution, or the wholesale eradication of the existing social structure, with the assumption that that very social structure itself is both the cause of oppression and beyond reform”. Thus taking the nature and complexity of the Indian society into consideration, the process of emancipating the subjugated women minority becomes more intricate. And the worst part is women in India even today (the women indicates the women activists, educationalists, lawyers who constantly fight on behalf of the subjugated women who are the majority) contest for various reservations which are necessary but denied just because of male favored politics.

Indian society has a relatively strict social hierarchy. By the words strict social hierarchy I not only mean the caste system but also the unequal status between the gender and historical subordination of women in our country. Indian society is a male dominated society which is patrilineal and patriarchal in nature. Tracing the oppressed background of Indian women takes us back to the medieval period which is considered to be “dark ages” for Indian women. Many social evils took place against women in the name of religion and tradition. Over the ages in India women have been treated as the sole property of her father, brother or husband, not been given any choice or freedom of her own. Subordination of women was said to be aimed at the protection of women. Hence a vicious circle started in which women were at the receiving end. All this gave rise to some new evils such as Child Marriage, Sati, Jauhar and restriction on girl education.

“A woman is the full circle. Within her is the power to create, nurture and transform.”

Today the status of women in modern India is a sort of a paradox. If on one hand she is at the peak of ladder of success, on the other hand she is mutely suffering from various violence. As compared with past women in modern times have achieved a lot but in reality they have to still travel a long way. Women have left the secured domain of their home and are now in the battlefield of life, fully armored with their talent. They had proven themselves. But in India they are many crucial challenges in liberating women.

Women in India are mostly economically reliant on their male counterparts which make them dependent. Literacy level of women is rising in a very slow pace which is a major reason for the economic dependency. Even educated women in most scenarios consider that they are inferior and fragile to the men and limit their development. Another important concern is that women today more and more became the objects of advertisement and sales object. And racial discrimination between white and dark complexioned women in our society increases the complexity of the problem. Having said about the outline of the concerns faced by Indian women, let us notice certain important facts that studies reveal as the major issues of women in India at present.

The sex ratio of India shows that the Indian society is still prejudiced against female. There are 944 females per thousand males in India according to the census of 2011, which is much below the world average of 990 females. The high number of female foeticide, infanticide and human trafficking prevalent in India has placed it as the fourth most dangerous place for women in the world, according to a survey. In 2009, India's Home Secretary Madhukar Gupta had remarked that at least 100 million people were involved in human trafficking in India, according to the survey.

The CBI has estimated that in 2009 about 90 per cent of trafficking took place within the country and that there were three million prostitutes, of which 40 per cent were children. Other forms of exploitation include forced labour and forced marriage. “In India, up to 50 million girls were thought to be 'missing' over the past century due to female infanticide and foeticide," as per the UN Population Fund. Today Indian courts are filed up with the crimes against women. So even after 65 years of independence with a lot of social, political and economic changes the status of women has not significantly raised but the kind of problems concerning women have worsened.

The Indian Constitution, in Articles 14, 15 and 16, provides for equality between men and women. But in practice there is often denial of equality for women in large parts of India, particularly in the rural areas, due to the disgusting survival of remnants of feudalism and medievalism. Female foeticide is common in all parts of India despite the Pre-Natal Diagnostic Techniques Act, 1994 been passed. As MARX believed political equality and rights has not created liberty and emancipation. Emancipation is thus more than politically gaining equality.

In India we live in a transitional age, the transition being from a feudal, agricultural society to a modern, industrial society. We are neither totally backward nor totally modern, but somewhere in between. Hence remnants of the feudal culture, for example, casteism and communalism, persist. It is for this reason that our society is still largely male-dominated, and most women do not have real freedom. For instance, we often hear of ‘honour killings’ of young men and women of different castes or religions. They are killed, harassed or threatened merely because they want to marry a person belonging to a different caste or religion. This is really barbaric, and shows how backward we still are. (The ideal of women’s emancipation by

Markandey Katju, THE HINDU FEBRUARY18, 2009)

And in the article Markandey Katju adds that the remedy is spreading of scientific thinking on a massive scale, and encourages people to give up superstitions and backward, feudal ideas, for example, casteism and communalism. This is only possible by means of a complete revolution in our thinking and attitude towards women. What is needed is a massive cultural struggle involving hundreds of millions of people which will sweep away all remnants of the disgusting feudal and medieval practices and mentality, particularly with respect to women. These should be replaced with scientific thinking and genuine and complete equality between men and women.When and how this will come about is not known. But come it will, and all patriotic people in India, including men, must strive and contribute to this goal.

“The thing women have yet to learn is nobody gives you power. You just take it.”
-Roseanne Barr

The process of gender equality and women's empowerment still has a long way to go and may even have become more difficult in the recent years. Further, women should be better educated , better informed – only then can take rational decisions. It is also necessary to sensitise the other sex towards women. It is important to usher changes in the societal attitudes and perceptions with regard to the role of women in different spheres of life.

Meanwhile, a woman needs to be physically healthy in order to work equally. This is sadly lacking in a majority of women especially in the rural areas. They have unequal access to basic health resources and lack adequate counseling. The result is an increasing risk of unwanted and early pregnancies, HIV infection and other sexually transmitted diseases. There is no doubt that the status of women has improved a lot. Evil practices such as the purdah system, child marriage and the like, have not been completely eradicated but have seen a downfall. Thus, a clear vision is needed to remove the obstacles to the path of women's emancipation both from the government and women themselves. Efforts should be directed towards all round development of each and every section of Indian women by giving them their due share.

“It doesn’t matter who you are, or where you came from. The ability to triumph beginswith you. Always.” ~Oprah Winfrey

I would like to conclude my article by stating that women should realize their status and set their goal for their emancipation. Education, developing the skills would help them be independent but emancipating from various bonds of the conservative society needs much more efforts. Women should understand their issues to tackle and overcome them. Indian women have rich culture and patience and persistence as in born nature as Mahatma Gandhi always believed, so it’s our turn we have to show the world our strength through our emancipation.

HUMAN EMANCIPATION: Its need throughout History

Pooja Sathyanarayanan
III. B. Sc Psychology
JBAS College for Women

(This entry secured 3rd place in the Article Writing contest held as a part of SocioFest LIBERATE'12 of Department of Sociology, Loyola College.)

The minute I was born into this world, the first few breaths of hospital air choked and relieved me at the same time. There was silence around till I began to wail… and then, finally, once my cries were heard, celebration.

Welcome to this world.

Throughout our lives, we are at a constant struggle as societies, institutions, governments and social norms both bind us and grant us relief at the same time. They help us navigate through various pathways of life while at the same time, they stifle us… until we are forced to see what they see.

It’s true… as long as we are indeed human and social (beings), we will unite and as long as resources are scarce, there will be conflict; with the existence of regulating bodies and norms to make sense of it.

As long as we are human and social beings, we will be bound by both frivolity and stringency. There will be the rule setters and the rule breakers. There will be social constructs which bind us and more importantly, the ever present need to break free from the ties that bind us (or in some cases, shackle us).

In the history of human emancipation, it seems like the need for emancipation has been mostly focused; based its historical context.

The bourgeois-emancipatory movement, according to Marx, ended with the objective of political liberation alone. The American Civil War, on the other hand, vividly stands out as a cause for human emancipation; with the African American slaves being literally bound to their owners. Which was why January 1st, 1963 was a date to remember when the Emancipation Proclamation guaranteed emancipation of slaves; who were free forever.

What more, Martin Luther King Jr.’s dream of complete racial harmony is almost a reality now. Instances of racial conflict are few and far between.

Emancipation of women, on the other hand, has had a longer history and is still a struggle in many parts of the globe. There are invisible divides and stereotypes that still exist in the workplace and other realms. Women are still being discriminated against and denied basic rights in many underdeveloped and developed countries. Yet, for the most part, traditionally patriarchal societies are transforming though the true nature of the “feminist” movement (and if feminism = equality) is rightfully being debated.

Gay and lesbian liberation has also been seen as “central to the broader project of human emancipation”. It is definitely indicative of emancipation from oppression, of subjugation as homosexuals as “sexual subversives”; as termed by the Nazis.

The youth, the future of India, have also made their voices heard as they seek emancipation from corruption, for instance, and are willing to truly take a stand against it.

As individuals, we are at a lifelong battle against the limits placed on ourselves as well as by ourselves and the environment. We are constantly banging our fists against the cuffs which bind us; breaking sweat and bleeding chaos until we truly feel free.

As a citizen of our country, as a woman, as a youngster and as a person of a particular standing in a particular sphere of life, I am well aware of the role human emancipation has played in the history; enabling us to claim the ground we stand on and continue to question and shape the role various social constructs play in our lives.

The need for liberation is enormous and constant; as much as the need for social order is.

Throughout history, the ever present theme has been of “freedom from oppression”. Despite being born free, we feel the need to pull away the minute we develop our first true attachments and social links. We pull away the minute we feel claustrophobic and find the need to let more air in…

And from our first wail, we learn how this is done.