The Making of ‘Local Health Traditions’ in India

The Indian government’s attention to the mainstreaming of traditional systems of medicine and the revitalisation of community-based local health traditions needs to be viewed as a part of its overall mandate of strengthening traditional systems of medicine. An analysis of existing policy documents and reviews reveals that LHTs have an eclectic policy history in India, marked by several decades of neglect by the state, with sporadic attention to the LHT practitioners as community health workers, to an upsurge of seemingly explicit, and yet somehow obtuse interest in revitalisation. Tracing the evolution (and dissolution) of these trajectories chronologically reveals that there is ambiguity and inconsistency around the rationales for the revitalisation of LHTs, potentially leading to fragmented medical pluralism.

There has been a distinct resurgence of policy interest both globally and in India in traditional systems of medicine and healing at the turn of the 21st century. The public health potential of traditional systems of medicine and the modalities of their integration into the national health systems have begun to be looked at afresh (Bodeker and Kronenberg 2002; Richter 2003; Wreford 2005). While this renewed policy attention seemingly indicates efforts towards “pluralist” health systems, academics are wary of the nature, extent and scope of pluralism in the larger context of the history and politics of medical and health knowledge. Despite the apparent apolitical connotations of the term, it is argued that pluralism needs to be situated in the context of the larger processes of globalisation, scientisation and commoditisation (Nichter and Lock 2002; Bode 2008; Banerjee 2009). Cant and Sharma (2002) argue that pluralism in such contexts should be labelled as “new medical pluralism” that draws sharper attention to the politics of knowledge, demands for evidence and efficacy, reconfiguring the relations between biomedicine, the state and the consumer/citizen. Located in this context, this article seeks to unpack the upsurge of policy interest, specifically the Indian government’s proposed strategies of mainstreaming traditional systems of medicine known as AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy) and the revitalisation of local health traditions (LHTs). We specifically turn our attention to the positioning of LHTs in this evolving policy context as an amorphous, marginal category of medical/health knowledge that is historically and epistemologically linked to, and yet distinct from and subservient to the codified and officially recognised systems of traditional medicine (AYUSH) in India.

Anthropological literature on LHTs, or what is often referred to as folk medicine/ethnomedicine/indigenous healing abounds, and yet explicit analysis of policy engagement with such forms of health traditions is lacking. LHTs, as this literature discusses, refer to a range of therapies and healing traditions that include bone setting, home remedies, the dai tradition (traditional midwives), practices of herbalists, marma chikitsa (understanding and management through vital points in the body like acupuncture), faith and spiritual healing, among others. As is evident, heterogeneity is a significant feature of LHTs in India. However, despite the heterogeneity, most LHTs exhibit certain broad common characteristics. In a large number of cases, knowledge transmission among these traditions is largely oral. It follows that evidence on efficacy draws on experiential knowledge, rather than codified processes of documentation (such as laboratory or clinical trials). Further, LHTs are also characterised by their everyday-ness: their practitioners in many cases are undistinguished from the community where these traditions are practised (Lambert 1996). Lastly, the epistemology and therapeutic techniques of LHTs are driven typically by a “cultural logic,” interwoven with local ecology (Lambert 1992, 1996; Sujatha 2002; Quack 2012).¹