Public health literature, pedagogy and classroom as a shared space

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Few months ago I wrote a small article for a student magazine. It was on how classrooms need to be more inclusive, sensitive to issues of marginalizations and empowering. I also vented out my frustation with the discriminatory nature of some of the readings and examples I often come across in my class as a public health student. Here it is:

 

“Epidemiology is the study of disease patterns in man.” “Disease is what a doctor diagnoses after seeing signs and symptoms of a patient, illness is what he (a patient) feels and experiences, and sickness is what the society ascribes him.” “A doctor should be sensitive to the socio-economic conditions of his patients.” “Health services in India face massive shortage of manpower.”

These are some of the common sentences I regularly hear and read in my classroom where I am trying to learn about public health. Every time I read or hear such a sentence, I cringe. Do you see why? If you don’t, read them again.

“Epidemiology is the study of disease patterns in MAN.

“Disease is what a doctor diagnoses after seeing signs and symptoms of a patient, illness is what HE (a patient) feels and experiences, and sickness is what the society ascribes HIM.”

“A doctor should be sensitive to the socio-economic conditions of HIS patients.”

“Health services in India face massive shortage of MANpower.”

 

At such moments, ‘public’ in public health seems like a misnomer to me. Exclusive male pronouns or examples are often attempted to pass off as ‘universal’. I sometimes argue and even protest, but mostly, I sulk. A friend of mine tells me that I am overreacting and that it is not the linguistics – a ‘he’ here and there (or everywhere?) that should bother me. Rather, I should focus on the content. Okay, for a moment, I consider the argument, knowing very well that it’s a ‘he’ telling me not to bother too much about exclusive use of ‘he’. I try to take refuge in the academic works that a novice in public health like myself is supposed to revere. But there too, I end up being frustrated.

Take for example, the Bhore Committee Report of 1946 that foregrounded the field of public health in India. It was much ahead of its time when it talked about social determinants of health, occupational health, mental health and various other measures. However, one of its recommendations was that more women should be recruited for nursing jobs as they were more ‘fit’ to do that. Another milestone, the Sohkey Committee report of 1947 went a step even further in suggesting that more women were needed in medical profession so that men could be free to do the ‘more’ important works related to nation building! Interestingly, the Bhore Committee was influenced by the Beveridge Report of 1942 which founded the Welfare State in England. I wonder what stopped the Committee to be influenced by the women’s movement of that very country which was also raising important questions during those very times.

Another example is that of what is commonly called the ‘Ratcliffe study’. Indeed, this study is one of the finest in health research, breaking myths of ‘objectivity’ and stressing on value criticality and systems approach in research processes. But what is hardly ever noticed is that the study was co-authored by John W. Ratcliffe AND Amalia Gonzalez-del-Valle. How come, then, the study is exclusively called the ‘Ratcliffe study’ and not the ‘Ratcliffe and Gonzalez-del-Valle study’? If the first author logic is to be applied here, why do we still call many co-authored seminal works such as the Banerji and Anderson’s study of Tuberculosis or the recent Dreze and Sen’s book and so on and so forth? Just wondering.

To be honest, I do not intend this write up to be feminist critique of the mainstream public health literature since I have no qualification to write one. Rather, this is an unapologetic rant about how our collective, co-created and shared spaces which we call our classrooms, deemed as sites of empowerment and learning, can be hierarchical, marginalising, devaluing and discriminatory. Our classrooms and the processes that lie within them can be as much a reflection of patriarchal social processes as any other space. While we may spend semesters after semesters analysing what rots the ‘outside’ spaces or the systems, in our case the health system, we do not do enough of looking inwards or ‘within’. By not doing so, we breed, sustain and even strengthen the privileges and capital of all kinds that are unequally bestowed upon some at the cost of many others.

The language we use, the jokes we crack, the assumptions we make, the groups we form, the questions we ask, the friends we make, or the readings we like – these are not random processes but are very much shaped by our caste, class, gender, religion, ‘ability’, geographical and other locations.

For instance, as a highly privileged ‘upper’ caste, ‘upper’ class, ‘able’ bodied, urban educated and cis-gendered woman, I find myself more vocal than I should be in my class. The reason I  can comprehend, articulate, write or even score better than many hard working friends of mine is because the rules of the game called institutionalized ‘higher’ education were decided by the elites of my kind with similar privileges, and that is why I am able to ‘perform’. Even if all the rules of the game in themselves are not discriminatory, unequal endowments mean that some people find it much easier than others to do well.

We need to begin asking the hard questions around these themes. We need to interrogate our spaces, our words, our privileges and also ourselves. Every time we exclusively use a ‘he’, we discriminate against persons with other gender identities. Every time we insist on speaking a ‘common’ language, be it the ‘official’ language or the so called ‘national’ one, we intimidate and oppress persons from vernacular backgrounds. Every time we express unhappiness about reservations or argue that it should be based only on ‘merit’ or suggest that caste-based discrimination is a ‘thing of the past’, we commit an atrocity. And then there are many subtle forms of discriminations too, or the forms that I am unaware of but contribute in their perpetuation, nevertheless.

Finally, I do not claim to have solutions. Because we all need to think about them and find them together. And for that, we need to have open, frank, and deep conversations. Lots and lots of them!