Sunday, 9 March 2014


Most people take health as merely an absence of disease and its value is not realized as long as it is not lost. Health is usually taken as an affair of doctors, nurses, clinics, wrong food habits and hygiene etc, however, a new consciousness has emerged which takes health out from personal and medical domains.

Today, health is largely seen as a social issue and there has been gradual realization that interventions in non medical field can bring significant changes in pattern of diseases. The focus has shifted from ‘germ theory’ to multi-causal approach and from curative to promotional, preventive and rehabilitative interventions. An integrated and interdisciplinary approach has made health a citizen’s right. This change is manifested and effected through a series of International and National declarations, legislations and other paper endeavors.

Alma Ata declaration of 2000 defined HEALTH as, ‘a state of complete physical and mental wellbeing, and not merely absence of disease or infirmity.’

Our recently amended National health policy 2002, lays special emphasis on promotion of women’s health. The various policy recommendations are with regard to expansion of primary health care infrastructure, and facilitate increased access to basic health care. The Policy commits the highest priority of the central government to the funding of the specific programmes running for women’s health. Also, the Policy recognizes the need to review the staffing norms of the public health administration to meet women’s needs in a more comprehensive manner. It emphasizes on Environmental and Occupational health and periodic screening of workers, especially for high risk diseases for their kind of occupation.


There has been a lot of talk about mining and its impact on human health. There is scorching heat, whirlpool of dust, howling machines and back breaking labour. In environmental journals, we often discuss of silicosis, asbestosis, tuberculosis and other fatal diseases of mines.

An attempt was made to ascertain, how much the women mine workers themselves know about the risks they are subject to. 306 respondents i.e. 95.3% of women had no idea that working in mines has with it some hazardous occupational diseases. Only 15 (4.6%) women answered that they knew about cough, feeling of weakness, problems due to dust and heat.  The bio-medical details of the diseases were however missing.

This data provides evidence for the lack of awareness among women. Mere disseminating of information in such a case would bring about significant changes in the health scenario. Making women aware will not only improve the health her individual health but also impact the health of the family altogether.

On asking about the health problems that they face, 168 of them denied having any manifest problems. The following pie chart shall provide a detail of their health issues as given by 153 respondents:

It is to be noted that all the respondents stated the symptoms of the disease as disease would inevitably lead to reducing the seriousness of the illness and an effort to deal with symptoms rather than disease. Taking from the above example, the woman may take medicines or try traditional system of healing for cough only and the real disease may, itself. For instance, cough may be a typical symptom of   tuberculosis but it was not the disease or  its knowledge, but the symptom that the woman knew and worked towards. This meantime continue to worsen and still be unrealized.

It is also important to note that all respondents denied access to any heath facility or reasonable treatment. In spite of the provision for regular check up for employees in mine at the cost of owner, no such facilities are made available and the legal obligation is evaded because even if these women have worked for years together in the same mine, they still remain daily wage earners through contract labour and do not become permanent employees. Due to this daily wage nature of employment, there are no Maternity benefits, sickness leave or health insurance that these women are entitled to.

148 respondents said that they were not subject to any addiction. Out of the rest, 112 were addicted to Tobacco, 35 to Gutka and 26 to Bidi. It is noteworthy that although there is widespread liquor production and consumption of indeginious liquor in the area, not women considered its habitual drinking an addition. It was a part of their culture, without stigma and with full social acceptability.

As to the direct availability of government facility, there is a Primary Health Center (PHC) in almost all villages. We met the Para medical staff, ANM and Anganwadi worker in villages. The trend that appears from their records and responses are:

Ø  There are more men who access health care facility than there are women. Out of total patients in a month, only 35% are women.
Ø  Maximum women suffer from RTIs and STDs, some of which cannot be treated successfully at village level. They are then referred to Udaipur.
Ø  Most common medicines are distributed free of cost from the PHC. However, the functionaries too admit that irregular and insufficient supply of the medicines from the government creates problems.
Ø  PHC staff claim that all major government programs like, pulse polio, family planning etc are coordinated through PHC and have led to increased consciousness among women.
Ø  Many mine workers come for general treatment like of joint pain, headache or malnutrition. The exact men- women ratio was not available with them.
Ø  PHC functionaries also work hard to reach out to people and deliver services at their door step.
Ø  Special attention is paid to pregnant and lactating mothers and their nutrition.

However, some crucial shades of color are missing in this picture painted by PHC. Why is the number of men patients significantly larger than women? Do more men fall sick and women are the healthier lot or have better immune system for self recovery? Or can there be some element of whose need is given more value and priority in society. Women usually ignore their concerns themselves or there are significant restrictions on their mobility which makes them dependent on male help. Unfortunately, data for how many women, who are referred to Udaipur city, do actually go and carry forward the treatment could not be made available. However, it will not be a difficult guess for any of us.
As for increasing consciousness, one hopes that it may certainly be the case, however, the size of the family and data for number of children speak against any popular method of family planning.  A trend for more awareness among women who have had at least primary education has been definitely noticed in Focused group discussions.

What is important to consider here is, even after that consciousness how much of it can transcend into practice will depend on the economic and social pressures that a women experiences. She may understand and wish to have the benefits of small family, but it also depends on how much of right does she has over her own fertility. Beyond consciousness, there are issues of availability, accessibility and affordability.
The real picture is reflected in the questionnaire where all i.e. 100% respondents have denied any opportunity of treatment within their capacities.

A young woman’s health is of special concern because it revolves around in a cycle and it extends beyond ‘just her’, it passes on to her children and affects their life cycle. Health of a woman does not only affect her merely as an individual, it has an impact on general well-being and health of the entire family, particularly, children. National Policy on Health- 2002 recognizes the catalytic role of empowered women in improving the health of the family and community.

Health is an issue of social justice. For long it has been delayed and denied to many. Its time for them to get it. And not as employer’s charity or government’s ambulance service of last resort. But; as a citizen’s right in a Socialist- Democratic- Republic.

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