Health Modernity in Tribals of South Bihar*

On a stratified random sample eight hundred rural tribal males and females the Health Modernity Scale was administered to measure scientifically correct information, attitudes and behaviour in relation to physical and mental health, diet and nutrition, family planning, child care and breast feeding and health habits. The extent of health modernity on these dimensions varied from zero to two percent. The near-absence of health modernity was due to poverty and illiteracy and it reflected in unhygienic living conditions, faulty food habits, high prevalence of diseases and disabilities and malnutrition in children under five years.

Popular usages of modernity

In popular usages the word 'modernity' is used to describe latest scientific discoveries and innovations as well as current fashions. It indicates something new and contemporary as against Indian. It also refers to the levels of industrialisation, urbanisation and education. The usages of modernity cover many aspects of life and society from dress and food to social and political institutions. The popular usages of modernity are generally concern with the external aspects of society and person. The urban metropolis with sky-scrapers and neon lamps are considered ipso facto to be modern. Jeans are modern while dhoti/saree is not; cake is modern while sewai is not. The disco-swinging, bobbed hair, jean-clad girl is considered to be the ultimate symbol of modernity. Needless to say, that this is a trivial and even perverse description of modernity, but nonetheless this forms the mental image of any persons.

Social science usages of modernity

However, in social sciences the term modernity has heels used to describe the inner qualities of the individual. Modernity refers to the psychological predispositions of the individual consisting of his attitudes, values and motivations. It is the psychological prerequisite for social, political and economic development. The concept of modernity includes such traits as rationality, internal locus of control, openness to new experience, equality of sexes, social equality, respect for opinion- variations and work-ethics. Democratic institutions fail in the absence of democratic personalities and attitudes. Economic developments is obstructed by non-economic factors of unproductive social customs, feudal inter-personal relations and indifferent work-ethics. A large social science literature is available on this theme. (Inkeles and Smith, 1974; Inkeles 1983; Kapp 1963; Loomis and Loomis 1969; McGlelland and Winter 1969; Mishra 1962; Myrdal 1968;Singh A.K. 1967, 1984b; Weber 1958a, b). The concept of modernity considers the individual to be the mainspring of political and economic development. The individual is the architect of society and society is what the individuals make of it. The psychological qualities constituting the concept of modernity transcend time, place and culture. The external appearances may be misleading and deceptive. The Arab Sheikh with his air-conditioned car may have feudal attitude. The Chinese leaders with latest military equipments have proved to be inhuman and brutal in suppressing the pro-democracy demand of the students. Gandhi, with his old watch tucked in his loin cloth, was more modern in having time-punctuality than most of the Indian politicians today with imported electronic watches.

Health modernity

Rationality and humanism are the two fundamental components of the concept of modernity which links individual growth and efficiency with sociopolitical and economic development. The individual-centered concept of modernity is inescapably related to the factors influencing the development of the individual. Health is the first input in the development of the individual. Cognitive development is decisively influenced by the nutritional status of the mother and the child. Gopalan (1983) has corrupted that less than one-fifth of the Indian children achieve full genetic potential and physical and mental growth. The importance of health, along with education, in human resource development has been acknowledged by GOI in its plan documents. The low health status of India has been identified as one of the important obstacles to human resource development (Singh A.K., 1986). The distressingly low health status in India is revealed by the major health indicators such as Infant Mortality Rate (IMR), Child Mortality Rate (CMR), Maternal Mortality Rate (MMR), low birth-weight, premature births, malnutrition, immunization coverage and incidence of preventable diseases. An overall picture of the health status in India is presented in Table 1.

A.K. Singh (1984b, 1987a) has pointed out the omission of health from the concept of modernity. As modernity has been considered to be the prerequisite for sociopolitical and economic development, health modernity should be considered to be the prerequisite of modernity.

If modernity is a prerequisite for social, economic and political development, Health Modernity is the prerequisite for human development, which undoubtedly is the summum bonnum of all development. The individual must be alive and cognitively competent to be economically productive, socially liberal and politically democratic.

Singh, A.K., 1984b, p. 7-8

The concept of Health Modernity has been developed by A.K. Singh and his associates in ICMR-sponsored researches on health education. Several studies on health modernity have been published. (Jayaswal, 1985; Singh, A.K. 1983; 1984 a, b; 1986; 1987a, b; Singh, A.K. et al., 1987a, b, 1988). The study reported in this paper is one of the ongoing researches in PG Department of Psychology, Ranchi University on health modernity and is a summary of the D. Litt. thesis of the first author.

Definition of Health Modernity

The concept of health modernity has been defined as,

'Scientifically correct information, attitudes and behaviour in relation to physical and mental health, diet and nutrition, family planning and child-care including breast feeding, personal hygiene and environmental sanitation and such other issues which are essential pre-requisites for healthy living and, therefore, for human and social development.'

Singh, A.K., et. Al., 1987a p. 12

Health Modernity Scale (HMS)

The Health Modernity Scale measures seven dimensions, namely Physical Health (MH), Diet and Nutrition (DN), Family Planning (FP), Child Care (CC), Breast Feeding (BF), and Health Habits (HH). There are ten items in each of the seven Dimensional Scales and they have been coded to have a range of 0 to 50 each; the higher scores indicating higher modernity. The themes included in the seven dimensions of Health Modernity Scale are given in Table 2.

The aims of the Present study

The present study aims to find out the extent of health modernity in the rural tribal

Population of Chotanagpur and Santal Parganas in South Bihar and to identify the areas of ignorance and misconceptions in the seven dimensions of health modernity.

The tribal population in Bihar and India

The tribal constitute about 7.53 per cent of the total Indian Population. Bihar, with it’s 5,810,867 tribals, accounts for 11.26%, of the total tribal population in India and 8.31% of the total general population in Bihar. The tribals in Bihar are mainly concern in Chotanagpur and Santal Pargana. The districts of Ranchi (56.41%), Singhbhum (44%), and Santal Pargana (36.8%) have large tribal population. The tribals in India and in Bihar are overwhelmingly rural, illiterate and poor (Table 3). The tribals are more backward than even the scheduled castes in literacy, income and nutrition (Table 4).

Sample design

The sample consisted of 800 cases selected on stratified random basis. The stratification involved a factorial design of 4 (age) X 2 (sex) X 2 (place of residence). (Table 5). The cases were selected from villages in Jamtara and Narainpur blocks of Dumka district in Santal Pargana and Kanke and Namkum blocks of Ranchi district in Chotanagpur.

Characteristics of the sample

Majority of the sample (83%) were illiterate and Poor, with 22% having no income and 71% with monthly income of upto rupees four hundred. Majority of them (72%) had occupations with low prestige such as daily wage earners. They lived in unhygienic conditions. Only 19% had wells, most of which were kachcha and were without any parapet. Very few houses had a chimney for the outlet of smoke (1.25%), ventilation in the sleeping rooms (12.5%), or sewage for waste-water disposal (4.38%). Most of them used the fields for defection, and almost none had septic latrines. At the time of the survey 20% of the families reported ailments of eyes and 9% reported ailments of ears. Almost half of the children under-5 were severely malnourished as measured by the arm circumference and another 32% were moderately malnourished (Table 6).

Extent of Health Modernity

The extent of health modernity was measured by computing the percentages of "modern" scorers and the mean scores on Health Modernity Scale and on its seven dimensions.

Modern scorers

Each item on Health Modernity Scale had six alternatives and the scoring ranged from 0 to 5; the higher scores indicating higher modernity. Scores of 4 and 5 indicated modern responses. With ten items in each of the seven dimensional scales, the modern scorers obtained a score of anything between 40 to 50, the range of each scale being 0 to 50. The total Health Modernity Scale, an aggregate of the seven dimensional scales, had seventy items, and a range of 0 to 350. The modern scores ranged from 280 to 350. Having obtained the number of modern scorers, their percentages were computed in relation to the total number in the relevant sample cell. The tabulation of the data is presented in Table 7. As can be seen not a single case in the sample obtained a modern score (minimum 280) on the Health Modernity Scale. The percentages of modern scorers varied from 0 to 2 percent in the seven dimensions.

Mean Scores

It may be argued that the criterion of percentages of modern scores as a measure of the extent of health modernity sets took high a goal. Out of a total score of 350 one has to obtain a minimum Of 280. The justification of this criterion lies in the nature of the concept of health modernity which has been defined as scientifically correct information, attitudes and behaviour. However, the percentages of modern scorers do not take into consideration the range of the scores. For this, the mean scores have been computed for the total Health Scale and its seven dimensions (Table 8). The mean scores on the total Health Modernity Scale and on its dimensions are below the mid-points, with the exception of Diet and Nutrition and Breast Feeding where these barely cross it. Thus the data on mean scores confirm the low extent of health modernity.

Areas of ignorance and misconceptions

The areas of ignorance and misconceptions have been identified by item-wise analysis of the seven dimensions of health modernity, The percentage in relation to each item has been computed for four categories of responses: very low modernity (0-25%), low modernity (26-50%), high modernity (51-75%) and very high modernity (76-100%). The items which fall into the first two categories, that is, very low and low modernity have been reported. On these items at least half of the sample was ignorant or had misconceptions. The specific themes of ignorance and misconceptions have been identified in relation to Physical Health (Table 9), Mental Health (Table 10), Diet and Nutrition (Table 11). Family Planning (Table 12), Breast Feeding (Table 13), Child Care (Table 14) and Health Habits (Table 15).

The importance of this analysis is its utility in planning intervention for improving health modernity by focussing on items failing in the categories of very low and low modernity. A few facts from the seven dimensions of health modernity may be highlighted.

Physical health

1. Almost all, except 1% of the sample, had scientifically correct information about the necessity of diet and nutrition during illness. Almost all (99%) believed that better to fast during illness because the patient did not have the power to digest.
2. Majority (87%) had fatalistic attitudes towards illness and believed that life and death depended on God and medical treatment could do nothing.
3. Majority (79%) had superstitious beliefs regarding prevention of illness and though that diseases could be avoided by pacifying the planets by prayers.
4. Majority (84%) had negative attitudes towards health services and felt that one should keep away from hospitals unless was an emergency.

Mental hospital

An overwhelmingly large majority had misconceptions about the cause of mental illness. They believed that mental illness was caused by:

1. loss of semen (94%)
2. Disorder of menstruation (82%), and
3. Evil spirits (82%)

   Majority of the sample also had misconception about the treatment and prognosis of mental illness. They believed that mental illness can be cured by:

4. sadhu/fakir and magic (68%)
5. pilgrimage (61%), and
6. insane person can never become a normal person (63%).

Diet and nutrition

1. nearly the entire sample (98%) did not know that vegetables should not be cut into small pieces as it destroyed the nutritional value.
2. They did not know the nutritional value of pulses and green vegetables (93%).
3. They had no knowledge of the amount of food required by a child (92%).
4. They approved of drinking liquor at home (85%).
5. They believed in unrestrained eating (70%).

Family Planning

Lack of modernity was related to son-preference, sex-determination of the child, birth-spacing, early marriage and contraceptives.

1. Majority believed that a son was necessary for the continuation of lineage (82%).
2. Majority did not know that the sex of the child was completely dependent on the semen of the father and the mother had no role in it (66%).
3. Almost all believed that vasectomy caused impotency (94%).
4. They also felt that condoms destroyed sexual pleasure (92%).

Breast Feeding

The ignorance and misconceptions were related to, age of weaning. advantages of breast-feeding and the first breast-milk after child birth:

1. Overwhelming majority did not know about the importance of supplementary food (95%).
2. They were ignorant about the advantages of the first breast milk after child birth (70%).
3. They did not know the contraceptive value of breast-feeding (63%)
4. They believed that breast-feeding during illness was harmful to the child (73%).

Child Care

The lack of modernity in the area of Child Care was related to the understanding of child's personality at birth, medical care during pregnancy, importance of weight for a growing child, an information related to immunisation, dehydration and developmental milestones. c Almost the entire sample did not know that the human brain starts developing even before birth (94%). They believed that the weight of the child was not related to his/her health (89%). Most of the sample was ignorant about the age at which specific immunisation should be given (93%). They were ignorant about the average weight of a normal child from birth to 12 months (90% to 99%). Majority of the sample was ignorant about developmental milestones and signs of dehydration. Majority believed that fasting was the best medicine for diarrhoea (58%). They were against giving any injection to a pregnant woman (58%).

Health Habits

The lack of modernity in health habits was related to immunisation, breast feeding, use of birth-control methods, personal hygiene and food habits.

1. The immunisation of children varied from1% to 9%.
2. Only 8% of children were breast-fed.
3. 92% were not using any contraceptive.
4. Only 9% were boiling drinking water.
5. 93% were drinking haria (rice beer).
6. 84% were taking tabacco.
7. Not even 1% were eating meat, fish and eggs and drinking milk.
8. 72% did not take bath daily.

Conclusions

The present study, as other studies reported by the authors and their associated on health modernity in tribals, has confirmed the very low extent of modernity. The present study has also confirmed the unhygienic living conditions faulty food habits, lack of personal hygiene and environmental sanitation, and high intake of haria (rice-beer) and tobacco. The low level of health modernity is a consequence of their illiteracy and poverty. It is also due to absence of health education.

References

1. Gopalan, C. (1983). Nutrition at the base, seminar, 282, 19-24.
2. Inkeles, A. (1983). Exploring individual modernity New York: Columbia University Press.
3. Inkeles, A. and Smith, D.H. (1974). Becoming modern : Individual changes in six developing countries. Cambridge Massachusetts; Harvard University Press.
4. Jayaswal, M (1985). Health modernity and its correlates in women of South Bihar. Social Change, 13 (2). 7-14.
5. Kapp, K.W. (1963) Hindu culture, economic development and social planning in India. Bombay : Asia Publishing House.
6. Loomis, C.P. and Loomis, Z.K. (1969). Socio-economic change and the religious factor in India: An Indian symposium of view on Max Weber. New Delhi: Affiliated East-west Press.
7. McGlelland, D.C. and Winter, D.G. (1960). Motivating economic achievement. New York : The Free Press.
8. Mishra V. (1962. Hinduism and economic growth. Bombay : The Oxford University Press.
9. Myrdal, G (1968). The Asian drama : An inquiry into poverty of nations, London, Allen Lane: The penguin.
10. Singh, A.K.(1983). Health modernity education in India. Social Change, 12 (2), 27-34.
11. Singh, A.K. (1984b). Health modernity : Concept and correlates. Social Change, 14 (3). 3-16
12. Singh, A.K. (1986). Human resource development in India: Barriers and prospects. Social Change, 19 (2and 3), 125-135.
13. Singh, A.K. (1987a) The myth of the health tribal:
14. Health modernity in two rural blooks of Chotanagpur (Bihar) (Report of ICMR Task Force.
15. Health modernity education Project). Ranchi:Ranchi University Post-Graduate Depaetment of Psychology.
16. Singh, A.K. (1987b). Health Population education in the tribals of south-bihar Paper presented at Regionla workshop on Technology transfer through Adult Education in Rural Areas. Ranchi University, Ranchi.
17. Singh, A.K., Sinha. S.K. Singh, S.N. Jayaswal, M. And Jabbi, M.K. (1987a). The myth of the healthy tribal. Social Change, 17. 3-23.
18. Singh, A.K., Jayaswal, M., Hans, A., Arora, A., Choudhury, A.,& Jabbi, M.K. (1987b). Family planning and child care in rural tribals of Chotanagpur, Social Change, 17 (3), 86-95.
19. Singh, A.K., Sinha, S.K., S.N., Jayaswal, M. & Jabbi, M.K. (1988). Population-health education in the tribals of south Bihar. Social Change, 18 (1), 3-29.
20. Weber, M. (1958a). The protestant ethic and the spirit of capitalism. ('r. Persons Trans ). New York: Charles Scrsbner's Sons.
21. Weber, M. (1958b) The religion of India. (I-1.H. Gerth & D. Martindale Trans.). Glencoe: The Free Press.

* The help for Dr. M.K. Jabbi, Serior Research Fellow in the Council for Social Development, New Delhi in preparation of this paper is gratefully acknowledged.

** Assistant Director, Population Education Resource Centre (PERC), Ranchi University, RANCHI - 834001.

*** Professor and Head, Post-Graduate Department of Psychology, Ranchi University, RANCHI - 834001.