Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India.
Int J Health Serv. 2012;42(3):439-64. doi: 10.2190/HS.42.3.e.
India's ruling class, in association with international agencies, bureaucrats, and business interests, has formed a powerful syndicate that has been imposing its will on the country to the detriment of public health. After gaining independence, India developed a body of knowledge suited to its social, cultural, economic, and epidemiological conditions. This led to an alternative approach to public health education, practice, and research that foreshadowed the Alma Ata Declaration on Primary Health Care of 1978. In the early 1980s, global power shifts undermined national and international commitment to the Declaration. Wealthy countries' response to the declaration of self-reliance by economically disadvantaged countries was swift: an effort to suppress the Declaration's ideals in favor of an unscientific, market-driven agenda. As a result, public health practice in India virtually disappeared. Responding to growing restiveness among a population in need, political leaders have launched the foredoomed National Rural Health Mission and pursued an American brand of public health through the Public Health Foundation of India. Reconstructing the damaged public health system will require pressure on the syndicate to ensure India's public health heritage will be used to effectively transfer "People's health in people's hands" according to the guidelines set down at Alma Ata.
印度的统治阶级与国际机构、官僚和商业利益集团勾结，形成了一个强大的联盟，他们将自己的意志强加于国家，损害了公共卫生。印度独立后，根据其社会、文化、经济和流行病学条件，发展了一套适合本国国情的知识体系。这导致了一种替代的公共卫生教育、实践和研究方法，预示着 1978 年《阿拉木图初级卫生保健宣言》的出台。20 世纪 80 年代初，全球权力转移破坏了国家和国际对该宣言的承诺。富裕国家对经济上处于不利地位的国家宣布自力更生的反应迅速：他们努力压制该宣言的理想，转而支持一种不科学、受市场驱动的议程。结果，印度的公共卫生实践几乎消失了。为了回应贫困人口的日益不满，政治领导人发起了注定失败的国家农村卫生使命，并通过印度公共卫生基金会推行了一种美国式的公共卫生。重建受损的公共卫生系统需要对该联盟施加压力，以确保印度的公共卫生遗产将根据阿拉木图确定的准则，有效地用于有效转移“人民掌握人民的健康”。
