Social Construction of Health- Social Construction of Health- The State vs. Society, a Case The State vs. Society, a Case

Study of Chikungunya Study of Chikungunya Epidemic in KeralaEpidemic in Kerala

bybyPrasad M. GopalPrasad M. Gopal

Centre of Social Medicine and Community Centre of Social Medicine and Community HealthHealth

(CSMCH), JNU, New Delhi. (CSMCH), JNU, New Delhi.

Social Construction of Social Construction of HealthHealth

Social construction (or social construct) is any phenomenon 'invented' or 'constructed' by participants in a particular culture or society existing because people agree to behave as if it exists or follow certain conventional rules.

Social construction of health which is largely encompassed of ideas from social constructionism refers to the way in which health varies from one society to another.

Social constructionism is an approach which implies that all knowledge is inevitably the product of social relations, subjected to change rather than being fixed and is not seen as a universal, independent reality but as a participant in the construction of reality..

Social Construction of HealthSocial Construction of Health - - Contd.Contd.

This theory thus examines how social forces shape This theory thus examines how social forces shape our understanding of health, illness, disease healing our understanding of health, illness, disease healing and the controlling measures towards illness and and the controlling measures towards illness and disease. It is a complex interaction between socio-disease. It is a complex interaction between socio-economic status and other social characteristics. economic status and other social characteristics.

It also looks into the trajectories in which people, It also looks into the trajectories in which people, organizations and institutions determine and create organizations and institutions determine and create knowledge or the conditions. Social problems are the knowledge or the conditions. Social problems are the activities of individuals or groups making assertions activities of individuals or groups making assertions of grievances and claims with respect to some of grievances and claims with respect to some putative conditions.putative conditions.

Chikungunya EpidemicChikungunya Epidemic First outbreak of Chikungunya was reported in 1952 First outbreak of Chikungunya was reported in 1952 in Tanzania.in Tanzania.

The term ‘Chikungunya’ is a Makonde word meaning The term ‘Chikungunya’ is a Makonde word meaning ‘The one which bends up’.‘The one which bends up’.

It is a vector borne disease. It is a vector borne disease. Aedes aegyptiAedes aegypti and and A. A. albopticusalbopticus mosquitoes act as major vector in the mosquitoes act as major vector in the transmission of the virus.transmission of the virus.

Factors facilitating the spread of the virus are rapid Factors facilitating the spread of the virus are rapid international transport, previous introduction of international transport, previous introduction of exotic mosquito species, inadequate mosquito exotic mosquito species, inadequate mosquito control, climatic conditions, imported microbes and control, climatic conditions, imported microbes and local vectors.local vectors.

Chikungunya EpidemicChikungunya Epidemic -contd. -contd. WidespreadWidespread poverty, year round tropical climate, poverty, year round tropical climate,

environmental disturbances due to war or natural environmental disturbances due to war or natural disaster, lack of public health infrastructure, disaster, lack of public health infrastructure, migration and tourism etc. are also some of the migration and tourism etc. are also some of the factors that promote uncontrolled mosquito factors that promote uncontrolled mosquito breeding and hence lead to diseases like breeding and hence lead to diseases like Chikungunya.Chikungunya.

Chikungunya has occurred in the most productive Chikungunya has occurred in the most productive age group(15- 45 years).age group(15- 45 years).

There is no specific antiviral therapy or vaccination There is no specific antiviral therapy or vaccination for Chikungunya disease. for Chikungunya disease.

The vector of Chikungunya are seen in fresh water The vector of Chikungunya are seen in fresh water and active in mid morning and late afternoon. and active in mid morning and late afternoon.

Methodology Methodology The conceptual framework of the qualitative study The conceptual framework of the qualitative study

integrates different explanatory factors such as integrates different explanatory factors such as health-related behaviour, material circumstances, health-related behaviour, material circumstances, education and occupation, working characteristics, education and occupation, working characteristics, family structure, social ties and support, caste, family structure, social ties and support, caste, cultural factors in the context of Chikungunyacultural factors in the context of Chikungunya..

The elements of explanatory framework includes:The elements of explanatory framework includes:1.1. An explanation of the cause of sickness and symptomsAn explanation of the cause of sickness and symptoms

2.2. A description of precipitating circumstances A description of precipitating circumstances

3.3. An outline of the course of the sickness, appropriate patient An outline of the course of the sickness, appropriate patient behaviorbehavior

4.4. Formulation of available treatments Formulation of available treatments

5.5. The response of the health care system to the epidemic.The response of the health care system to the epidemic.

Methodology Methodology - - contd.contd. Artifacts and available newspaper articles were used Artifacts and available newspaper articles were used

to gather data.to gather data.

A field survey was carried out. A field survey was carried out.

The randomly selected representatives were The randomly selected representatives were classified in terms of their socio-economic status. classified in terms of their socio-economic status.

Interview were done with health professionals and Interview were done with health professionals and PRI members to understand about the health PRI members to understand about the health programmes carried out at the time of epidemic. programmes carried out at the time of epidemic.

Thematic analysis was done on the transcripts. The Thematic analysis was done on the transcripts. The qualitative data collected through the observation, qualitative data collected through the observation, interview, case study and informal discussion were interview, case study and informal discussion were arranged based on different themes.arranged based on different themes.

ConclusionConclusion

The respondents belonging to working class The respondents belonging to working class community were the most affected by the epidemic. community were the most affected by the epidemic.

It is observed that women were the most affected It is observed that women were the most affected because of their nature of work. because of their nature of work.

The understanding about the diseases among the The understanding about the diseases among the public has been found to differ among various socio-public has been found to differ among various socio-economic groups.economic groups.

Case representatives from the lower and middle socio-Case representatives from the lower and middle socio-economic status believed in ways other than mosquito economic status believed in ways other than mosquito bite for the causation of the disease. bite for the causation of the disease.

The respondents of lower and middle socio-economic The respondents of lower and middle socio-economic status used their own alternatives for curing the pain status used their own alternatives for curing the pain that led to some kind of exploitation.that led to some kind of exploitation.

Conclusion Conclusion - -Contd.Contd. The respondents from lower-socio economic The respondents from lower-socio economic

background believed that unclean and untidy background believed that unclean and untidy environment is the reason for the cause of the disease. environment is the reason for the cause of the disease.

The government institution, though delayed in their The government institution, though delayed in their action, later clinched on with bio-medical way of action, later clinched on with bio-medical way of treatment against the disease which is found to be treatment against the disease which is found to be ineffective. ineffective.

Respondents of lower SES used tamarind leaves, Neem Respondents of lower SES used tamarind leaves, Neem leaves, Jaggery, coconut shells etc. to boil water that is leaves, Jaggery, coconut shells etc. to boil water that is used for bathing in order to get relief from the disease.used for bathing in order to get relief from the disease.

Religious belief associated with disease cure is also Religious belief associated with disease cure is also powerful among the lesser educated respondents powerful among the lesser educated respondents irrespective of their socio-economic class. irrespective of their socio-economic class.

ConclusionConclusion - - contd.contd. The Health care system had taken two weeks to The Health care system had taken two weeks to

confirm the diseaseconfirm the disease. . The health care system were more focused on source The health care system were more focused on source

reduction and awareness programme and organizing reduction and awareness programme and organizing

community campscommunity camps. . The patients who visited camps were given pain relief The patients who visited camps were given pain relief

tablets like Paracetomol and were adviced to take tablets like Paracetomol and were adviced to take

good diet and rest.good diet and rest. Health is not an individual concern, but it is something Health is not an individual concern, but it is something

produced and influenced by the social factors.produced and influenced by the social factors.

Thank you Thank you