Indigenous Health Organizing at the Margins: Creating Access to Health by Building Health Infrastructure

ABSTRACT

Socio-economic challenges, communicative barriers, and the lack of health infrastructure constitute and reinforce obstacles to health for all, especially for those who live in the underserved spaces of the Global South. This research addresses such contextual adversities by investigating how indigenous people in a remote Himalayan village collectively took ownership of a health-organizing initiative. The result of this initiative was the creation of a four bed mini-hospital designed to increase community members’ access to basic curative and preventative health care. Grounded in praxis-based critical health communication approaches, this research challenges top-down and externally-dictated interventions by placing subalterns at the forefront of a bottom-up and community-led health initiative. The centrality of discursive engagements and local-centric participatory actions of marginalized indigenous participants in this research calls for culture- and communication-centric research initiatives for increasing access to health at the margins.

Acknowledgments

The author is immensely grateful to Prof. Judith Martin and Prof. Paul Mongeau for their invaluable insights and guidance that greatly improved the manuscript.

Notes

1. As per Government of India’s 11^th Five-Year (2007–12) Plan, “A large number of STs (indigenous people) who are living below the poverty line are landless, with no productive assets and with no access to sustainable employment and minimum wages” (p. 114). Also, the 12^th Five-Year (2012–17) Plan document noted, “Most of them live in isolated groups in relatively remote areas” such as in “forests, hills, undulating inaccessible areas.” About indigenous spaces, it further commented, “not only poverty continues at an exceptionally high levels in these regions, but the decline in poverty has been much slower here than in the entire country” (p. 228).

2. Some of such disparities are – lack of fulfillment of basic human needs, poverty, weak local economy, lack of access to basic infrastructure, as well as various socio-cultural stereotyping and discriminations (Dutta, 2018).

3. Government-run healthcare (and PPPs) in India is largely privatized and western-influenced; it pays little attention to primary care. Increasingly, overseas institutions/agencies are influencing health plans by prioritizing PPPs and interests of private sectors in contemporary India (Patil, Somasundaram, & Goyal, 2002). In remote underserved spaces, the reach of basic health services is limited; consequently, those spaces/populations are consistently neglected in policymaking. In spaces of dominant decision-making, indigenous voices and aspirations are still unheard and invisible in India; furthermore, the aspects of their inclusive involvement of indigenous people and their freedom is mostly ignored (Ashtekar, 2008).

4. Scholars opined that in rural Indian health contexts, the state lacks political will as well as failed to realize human potentials at the margins. Such moves made the rural health care system highly selective and centralized; also, considered indigenous people as objects of control (Ashtekar, 2008; Patil et al., 2002).

5. In contrast to bottom-up community-centered organizing, neoliberal organizing (i) co-opts the language of participation and empowerment, (ii) uses the façade of transferring power, and (iii) externally imposes their agendas and programs on the marginalized communities. In contrast, CHC argues that act of dialogue and listening local stories as well as foregrounding agency/action at the margins disrupt dominant depictions and misrepresentations.