Paper short abstract:

This paper will discuss how India's health system has changed from c1980 to c2010. It will argue that despite considerable changes the fundamental problem posed by the failures of India's public health services remain acute. Current proposals for resolving the situation will be critically assessed.

Paper long abstract:

In the late 1970s I developed three arguments: about how India's health system was caught up in a process of medical dependency; that the medical 'profession' in India had never been fully established, and indeed was experiencing 'deprofessionalization'; and that there was relative autonomy between India's health systems and its class structure. From the vantage point of the 2010s, these concepts have only partly stood the test of time. In order to refine these concepts, this paper will use three case studies of changes in this 30-year period: (1) provisions for rural health, the significance of the National Rural Health Mission, and renewed efforts to provide 'doctors for the villages'; (2) the growth of corporate hospitals and of clinical trials, which have in part reversed the flows of patients and knowledge between India and the Global North; and (3) changes in the global position of India's pharmaceuticals industry. It will be argued that the move of India - from the Third World to a BRICS member - is insufficient for it to have dealt with the basic contradictions that have prevented India from dealing with its fundamental public health problems. Neo-liberal models have created a new form of dependency.