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Socio-economic and Cultural Dimensions, and Health-seeking Behaviour for Leptospirosis

A Case Study of Kerala

Mathew George is Assistant Professor, Centre for Health and Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences, Sion-Trombay Road, Deonar, Mumbai 400088. E-mail: matsaj{at}yahoo.com

The present article is an attempt to examine the role of public health services in the context of the epidemic of leptospirosis (1998–2002), commonly known as rat fever in the state of Kerala. This is carried out within the larger context of the changing nature of health ser-vices in the state as part of the structural adjustment policies, as well as the specific nature of the disease characteristics (epidemics). From a public health point of view, control of an epidemic is possible not merely by preventing the occurrence of disease, but also by effectively taking care of those affected, thereby preventing transmission and also avoiding any possible disability from disease. This is possible only by coordinated interventions at the primary, secondary and tertiary levels. This within the broader perspective of social epidemiology addresses the social, political, economic, cultural and ecological determinants of the disease. In the context of the leptospirosis epidemic, it has been found that primary-level care focuses either on the techno-centric approach of killing of vectors (rat) or on educating the com-munity. From a social epidemiology perspective, the question of livelihood and ecological imbalance become political questions whose solution being ‘long term’ gets conveniently sidelined. What remains to the people ultimately is the secondary-level care in which the prevalent health services play the leading role. This study reveals that even in Kerala, where private health services are widely used by the people and are claimed to be the reason for better their health status, the role of public health services in taking care of those affected with epidemics like leptospirosis cannot be overlooked.

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