Environmental Risk Transitions, Health and Health Practices in Rural NE Thailand
There is growing argument and evidence that narrow and simplistic uni-linear and single discipline approaches to social, health and environmental problems lead to inappropriate and ineffective actions, and that understanding the complexity and breadth of socio-economic, cultural,biological and environmental factors impacting on community’s health is essential to ensure sustainable health development (Bardosh 2014; Bardosh et al. 2014; Allotey et al. 2010).
It follows that top down decontextualized interventions that contribute to homogenization of landscapes, physical and local knowledge resources associated with agricultural intensification and modernization, are potentially detrimental to communities’ health, well-being and resilience, and to the very existence of therapeutic diversity. That is to say, the existence of various cultural forms and rich natural resources, from which arise myriad ways to understand the body, its afflictions and the means to deal with them. Illness does not only concern disorders of the (biological) body and health is not solely defined by the absence of disease. With the above in mind, it is important to approach health problems in their multiple biological, social, environmental, economic and symbolic dimensions. It follows that it is critical to support a range of therapeutic forms, each of which brings a different response and a different remedy for people who are, or who feel themselves to be suffering. Some medicines cure and their effectiveness is certainly remarkable. Many therapeutic forms also help taking care of people while changing the way patients perceive their afflictions. In other words, to favour therapeutic diversity allows a better consideration of both disease-as-object and the body-as-subject. From this realization, the idea of a reasoned medical pluralism is born, in which medical systems of many kinds, including biomedicine, can interdependently find their place (Baer 2004).
In Thailand, the incongruent perspectives of those in needs and of those who provide health services underline the need to clarify whether the current health system based on western biomedicine and drug administration could be reevaluated and amended to value rural communities’ traditional knowledge of healing practices, being herb-based or spiritual animistic, in order to instigate a health system capable of “curing” but also fostering health development in a sustainable way. The consequences could be the minimization of primary health care units visits and associated expenses, and the maximization of populations’ adaptive capacity and better health, including psychosocial and environmental dimensions of health, which are often neglected by modern biomedical approaches (Engel 1977).
Recognizing the value of traditional herbal healing practices among others, will not only help assess the evidence of the interdependency of people and the nature around them, it will indirectly argue for the maintenance of healthy, resilient and biodiverse environments capable of producing the resources needed in traditional remedies. This healthy environmental state is at jeopardy in the current environmental transition and agricultural intensification driven by market economy and globalization which may directly reduce plant diversity but also encourages people to adopt environmentally illiterate behaviors (labor migrations and psychosocial stress). Whether medical pluralism in rural communities is to be encouraged, it is implied that “laissez faire” capitalism and globalization needs to be nuanced, inequalities reduced and that health care systems incorporate an environmental dimension, including environmental ethic (Leopold 1949) and a de facto recognition of the importance to maintain diverse cultural and biological heritages.
This project’s objectives are to assess 1) the relative importance of traditional and biomedical health practices, 2) how beneficial is the maintenance of medical pluralism for communities health development and 3) how current modernization-urbanization trends in Northeastern Thailand have enabled or prevented this diversification through biased communication (dominance of modern medical curriculum), economic incentives (cash economy and globalization) or/and environment deterioration (and the reduction of natural resources used in traditional remedies).