I learned something interesting recently and wanted to share it with you.
When you see a health crisis and the crumbling infrastructure, do you ever connect it with socio-economic class? If you do, do you further think about the health status of two consecutive classes in any organizational hierarchy? If you do, have you ever thought about what exactly is it that brings forth so varying levels of problems no matter how higher up the echelon anyone maybe?
Control of Destiny
I learned the phrase a few months back when I came across an article. It spoke about a thought-provoking discovery made by Dr. Michael Marmot who studied coronary heart disease in 10,000 British civil servants, a discovery that made me go- huh!
As one would presume, the workers at the bottom of the hierarchy had heart disease rates 4 times higher than the ones at the very top. The data showed a descent in the disease from top-to-bottom of the civil-service hierarchy. Workers at the top had the lowest rates of disease, but surprisingly, the data showed that those one step below them — professionals and executives, doctors and lawyers — had heart disease rates twice as high as the those on the top. It is easy to explain the higher rates of health issues among people at the bottom rungs of the society or any organization. There are many reasons that plague them like poverty, poor housing, sanitation and hygiene, low nutritional levels, poor education, less accessibility to healthcare facilities, poor access to drinking water, intensity of climate change related phenomena and so forth, making them increasingly vulnerable. But how does one explain why doctors, lawyers and other such professionals might also have rates of disease twice than those above? All of the previously mentioned reasons do not apply to them. And yet, and yet they have rates twice as high. And a similar gradient has been found for almost every disease in every industrialized nation.
The article talks about “control of destiny” i.e. the ability of people to deal with the forces that affect their lives, they may not want to deal with them, but they’re there. You see, children from minority or poor backgrounds, do not really care if they miss out on school or smoke or engage in violent behavior, because it makes no difference, because they have no hope for the future. This is where intervening at the community level and tackling social forces becomes important and stands the chance of bringing thoughtful social change. Just as it is significant to look at risk factors and where the diseases stem from, it is imperative to change the environment in which a person grows up. What this brings to notice is the ability to look at alternatives in life, because for the vulnerable peoples if they don’t think what they care about can be done, then most of the time, they just lose hope.
This is related to another experiment I found out about, wherein the poor and vulnerable kids of age three to four were brought in a classroom and the onus of deciding what they’d do that day lied on them. These kids who set the agenda for the day, say, making paper airplanes, just did that, for the entire day. The researchers provided all the resources they had for the kids to do whatever they wanted. Even if they failed at the task, they’d just do it all again. This helped those kids see that there are opportunities to shape their fate, even if for a day. After a year of this, these kids were again studied when they were 18 and it showed phenomenal rates of good behaviors and health, it showed they had half the number of problems that grip such populations regarding health and violence, it showed that they had managed to create their own life trajectory.
“Annawadi boys broadly accepted the basic truths: that in a modernizing, increasingly prosperous city, their lives were embarrassments best confined to small spaces, and their deaths would not matter at all.”
— Katherine Boo, Behind the Beautiful Forevers
Children from poor, vulnerable and minority backgrounds learn that there are no alternatives, they don’t know that failure is not the end of the world and hence whatever they really do to themselves, to their health, or to the community does not really make any difference. Someone who doesn’t know that changing their behavior would actually bring about good results, would never even try.
So basically, the article I mentioned earlier by Prof. Syme really is talking about not just building hospitals but also changing the outlook of most at-risk kids for their lives. He thinks this is what empowerment means. Even if control of destiny and empowerment are not worthwhile concepts — which he thinks they are — we need other ideas like them. As he says: ‘the point is that to prevent disease, we must intervene on those community forces that cause disease problems, and social class is the obvious and most important factor. But because social class is also a complex issue, we should identify concepts related to the social-class gradient that are amenable to intervention. If “control of destiny” and “empowerment” are important factors in the cause of disease at the community level, they are also factors for which we can develop interventions.’
For the past couple of years we have been seeing India’s health sector crumple like a sandcastle and seen our healthcare workers exhausted to their bones. As the nation reimagines its medical foundation, it’s time to rethink the approach towards exactly how a more bolstered structure can be attained that is universally instrumental for all tiers of our society.
Read the full article here.
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