Volume 4
Commentary-Special Issue(Deepening of Disciplinary Content: Public Health in Post-Covid India)

Critical Holism as Public Health Theory: Towards A Unifying Framework for Research, Policy and Planning

Ritu Priya
Professor, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi- 110067

Published 2023-09-02

Keywords

  • Epistemology, Ontology, Holistic Epidemiology, Holistic Health Systems Research, Inter-disciplinarity, Trans-disciplinarity, Value-criticality

How to Cite

Priya, R. (2023). Critical Holism as Public Health Theory: Towards A Unifying Framework for Research, Policy and Planning. DIALOGUE: Science, Scientists and Society, 4(.), 1–29. Retrieved from https://dialogue.ias.ac.in/index.php/dialogue/article/view/34

Abstract

The wide range of subject matter Public Health (PH) incorporates makes it a synthesizing science that draws upon very many disciplines of the natural, applied and social sciences. The sub-fields of research and application in PH, epidemiology, health systems research, policy studies, health education and further sub-fields within each of these, draw from the theories of their relevant base disciplines and thereby tend to think in silos rather than make the interlinkages between them. This paper argues for Critical Holism (CH) as an overarching theoretical framework that can provide PH and its sub-fields a unifying structure within which they can locate themselves in relation to each other. Thereby CH would remind PH researchers about attending to interlinkages between elements of a health problem and across problems, their multi-level and multi-dimensional complexity. Policy, planning and implementation require such unifying thought processes in order to ensure coherence between the various elements of PH action for a common objective such as policy formulation for improving the health of populations, health system strengthening, designing of programmes, pandemic response strategies and so on. PH research that generates knowledge to inform these politico-administrative processes, has also to provide them with the comprehensive lens with which to perceive the complexity of health problems, assess the resources at hand and design interventions. The paper presents an outline of what PH research adopting the Critical Holism theoretical frame would look like, as an invitation to further developments of the theoretical frame and its application.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

  1. Rosen G 1958. A History of Public Health. New York, MD Publ.
  2. Banerji D 1981: Public Health Perspective in the Formulation of the National Tuberculosis Programme of India, NTI Bull. November 14 3. Banerji D 1999. A fundamental shift in the approach to international health by WHO, UNICEF, and the World Bank: instances of the practice of "intellectual fascism" and totalitarianism in some Asian countries. Int. J. Health. Serv. 1999;29(2):227-59. doi: 10.2190/ RAB4-D873-99AMACJR.
  3. References4. Baum F 1995. Researching public health: Behind the qualitative-quantitative methodological debate. Social Science and Medicine, Vol.40, No.4, pp.449-468 5. Diez Roux A V 2011. Complex Systems Thinking and Current Impasses in Health Disparities Research. Am J Public Health. 2011 September; 101(9): 1627–1634. doi: 10.2105/ AJPH.2011.300149 6. Qadeer I, Kasturi Sen and K R Nayar (Eds.), 2001. Public Health and the Poverty of Reforms: The South Asian Predicament. New Delhi, Sage Publications.
  4. Rao M 1999. Disinvesting in Health: The World Bank's Prescriptions for Health. Thousand Oaks, CA: Sage Publications.
  5. Priya R and Mehta S (Ed.) 2008: Dialogue on AIDS-Perspectives for the Indian Context, V. K. Pub., New Delhi.
  6. Walt G, Jeremy Shiffman, Helen Schneider, Susan F Murray, Ruairi Brugha, Lucy Gilson (2008).
  7. ‘Doing’ health policy analysis: methodological and conceptual reflections and challenges.
  8. Health Policy and Planning 2008; 23:308–317.
  9. Muntaner C 2013. Invited Commentary: On the Future of Social Epidemiology—A Case for Scientific Realism. Am J Epidemiol. 2013; 178(6):852–857 11. Beaglehole and Bonita. What is Global Health? Global Health Action, 2010, 3: 5142 - DOI: 10.3402/ gha.v3i0.5142 12. Loewenson R, Villar E, Baru R, et al. Engaging globally with how to achieve healthy societies: insights from India, Latin America, and East and Southern Africa. BMJ Global Health 2021;6:e005257. doi:10.1136/ bmjgh-2021-005257 13. Prasad V, Sri B S, Gaitonde R 2020. Bridging a false dichotomy in the COVID-19 response: a public health approach to the ‘lockdown’ debate. BMJ Global Health 2020;5:e002909.
  10. doi:10.1136/ bmjgh-2020-002909 14. Susser M and Susser E 1996. Choosing a Future for Epidemiology – Parts I and II. AJPH 86 (5) pp. 668-673 and 674-677.86 (5) pp. 668-673 and 674-677.
  11. Krieger N 2001. Theories for Social Epidemiology in the 21st Century: an eco social perspective. Intern. J. Epid., 30, pp 668-77.
  12. WHO 2008a. Closing the gap in a generation: health equity through action on the social determinants of health: final report of the commission on social determinants of health. World Health Organisation, Geneva.
  13. WHO 2008b. The World Health Report 2008 - Primary Health Care Now More Than Ever.
  14. World Health Organisation, Geneva.18. Mackenzie and Jeggo 2019. The One Health Approach—Why Is It So Important? Trop. Med.
  15. Infect. Dis. 2019, 4, 88; doi:10.3390/ tropicalmed4020088 19. NIH 2021. National Centre for Complementary and Integrative Health. National Institutes of Health, USA. www.nccih.nih.gov.
  16. WHO-UNICEF 1978a. Declaration of Alma-Ata, Geneva.
  17. WHO-UNICEF 1978b. Primary Health Care (Report of the International Conference onPrimary Health Care). Geneva. WHO, 2004.
  18. Walsh J A and Warren K S 1979. Selective primary health care: an interim strategy for disease control in developing countries. N Engl J Med; 301(18):967-74. doi: 10.1056/ NEJM197911013011804.
  19. WHO-UNICEF 2018. Declaration of Astana: Global Conference on Primary Health Care (Astana, Kazhakistan, 25-26th October 2018). World Health Organisation, Geneva.
  20. Yadavendu V K 2003. Changing Perspectives in Public Health, EPW, Vol. 38, Issue No. 49 25. Arrow K J 1994. Methodological Individualism and Social Knowledge. The American Economic Review, Vol. 84 (2), 1-9.
  21. Rosenberg C E 2012. Epilogue: Airs, Waters, Places. A Status Report. Bulletin of theHistory of Medicine, Vol. 86, No. 4, Special Issue: Modern Airs, Waters, andPlaces (Winter 2012), pp. 661670.
  22. Galea S and Annas G 2017. An argument for a common-sense global public health agenda.
  23. www.thelancet.com/ public-health Vol 2 October 2017. e445-446 28. Murphy D 2021. ”Concepts of Disease and Health", The Stanford Encyclopedia of Philosophy (Spring 2021 Edition). available at; https:// plato.stanford.edu/ entries/ health-disease/ 29. Illich I 1977. Limits to Medicine– Medical Nemesis: The Expropriation of Health. Penguin, Harmondsworth.
  24. Engel G L 1980. The Clinical Application of the Biopsychosocial Model. Am. J. Psychiatry, 137:5, 535-544.
  25. WHO 1976. “Application of Systems Analysis to Health Management”, Geneva, WHO.
  26. Pawson R and Tilley N 2008. Introduction. Realistic Evaluation, Sage Pub. London.
  27. Gilson L, Hanson K, Sheikh K, Agyepong I A, Ssengooba F, et al. 2011. Building the Field of Health Policy and Systems Research: Social Science Matters. PLoS Med 8(8): e1001079.
  28. doi:10.1371/ jour- nal.pmed.1001079 34. Sheikh K, Gilson L, Agyepong IA, Hanson K, Ssengooba F, et al. (2011) Building the Field of Health Policy and Systems Research: Framing the Questions. PLoS Med 8(8): e1001073.doi:10.1371/ jour- nal.pmed.1001073 35. Bennett S, Frenk J and Mills A 2018. The evolution of the field of Health Policy and Systems Research and outstanding challenges. Health Research Policy and Systems, 16:43 https:// doi.org/ 10.1186/ s12961-018-0317-x 36. Wemrell M 2016. Contemporary Epidemiology: A Review of Critical Discussions Within the Discipline and A Call for Further Dialogue with Social Theory. Sociology Compass 10/ 2 (2016), 153–171, 10.1111/ soc4.12345 37. Lilienfield, Abraham M 2015. Foundations of Epidemiology, 4th Edition. New York, Oxford University Press 38. Pearce N 1996. Traditional Epidemiology, Modern Epidemiology and Public Health, AJPH, 86(5) p.p. 678-683.
  29. Berkman, L F and Kawachi, I (Eds.) 2000. Social Epidemiology, Oxford University Press, New York.
  30. Fava G A and Sonino N 2008. The Biopsychosocial Model Thirty Years Later. Psychother Psychosom 2008;77:1–2 DOI: 10.1159/ 000110052 41. Wade D T and Halligan P W 2017. The biopsychosocial model of illness: a model whose time has come. Clinical Rehabilitation, 2017, Vol. 31(8) 995–1004 42. Klement R J 2020. The SARS-CoV-2 Crisis: Has Medicine Finally Entered a Reductionist Era?
  31. Complement Med Res 2020;27:207–208 43. Remme J H F, Adam T, Becerra-Posada F, D’Arcangues C, Devlin M, et al. (2010) Defining Research to Improve Health Systems. PLoS Med 7(11): e1001000. doi:10.1371/ journal.pmed.1001000 44. Mills A 2011. Health policy and systems research: defining the terrain; identifying the methods. Health Policy and Planning 2012; 27:1–7 doi:10.1093/ heapol/ czr006 45. Lupton Deborah 1995. The imperative of health, public health and the regulated body. Sage publications, London.
  32. Taylor D, Bury M, Campling N, Carter S, Garfied S, Newbould J, Rennie T 2006, A Review of th e use of the Health Belief Model (HBM), the Theory of Reasoned Action (TRA), the Theory of Planned Behaviour (TPB) and the Trans-Theoretical Model (TTM) to study and predict health r elated behaviour change. Available at https:// www.researchgate.net/ publication/ 334114235_A_ Review_of_the_use_of_the_Health_Belief_Model_HBM_the_Theory_of_Reasoned_Action_TR A_the_Theory_of_Planned_Behaviour_TPB_and_the_Trans-Theoretical_Model_TTM_to_stud y_and_predict_health_related_behavio [accessed Jul 14 2021]47. Holst J 2020. Global Health – emergence, hegemonic trends and biomedical reductionism.
  33. Globalization and Health, 16:42. https:// doi.org/ 10.1186/ s12992-020-00573-4 48. Horton 2013. Offline: Is global health neocolonialist? The Lancet, COMMENT| VOLUME 382, ISSUE 9906, P1690, NOVEMBER 23, 2013 49. Almond P 2009. Postnatal depression: a global public health perspective. Perspectives in Public Health; 129(5):221-227 DOI: 10.1177/ 1757913909343882 50. Jacob K S 2019. Non-communicable diseases from a public health perspective. Natl Med J India 2019;32:193-6 51. Priya R 2001: DALYs as a Tool for Public Health Policy – A Critical Assessment, in Qadeer, I. et al. (ed.) Public Health and the Poverty of Reforms: The South Asian Predicament. New Delhi, Sage Pub.
  34. Reidpath D D, Allotey P A, Louame A, Cumins R A 2003. Measuring health in a vacuum: examining the disability weight of the DALY. HEALTH POLICY AND PLANNING; 18(4): 351– 356 doi: 10.1093/ heapol/ czg043 53. Jit M and Brisson M 2011. Modelling the Epidemiology of Infectious Diseases for Decision Analysis. Pharmacoeconomics 2011; 29 (5): 371-38.
  35. Priya R, Sanghmitra Acharya, Rama Baru, Vikas Bajpai, Ramila Bisht, Prachinkumar Ghodajkar, Nemthiang Guite, Sunita Reddy, 2020b. Indian Public Health Associations on COVID-19: The Politics of Knowledge. Economic & Political Weekly, August 8, 2020, vol lV nos 32 & 33, p/ 19-22.
  36. Priya R, Sanghmitra Acharya, Rama Baru, Vikas Bajpai, Ramila Bisht, Rajib Dasgupta, Prachinkumar Ghodajkar, Nemthiang Guite, Sunita Reddy, 2020a. Beyond Biomedical and Statistical Approaches in COVID-19: How Shoe-leather Public Health Works. Economic & Political Weekly, October 31, 2020 Vol. IV no. 44, p. 47-58.
  37. Priya R and Sayan Das 2020. The Blind Spots of Public Health. The India Forum, 25th August 2020. https:// www.theindiaforum.in/ article/ blind-spots-public-health 57. Stevens J P, O’Donoghue A, Horng S, Tandon M and Tabb K 2020. Healthcare’s earthquake: Lessons from complex adaptive systems to develop Covid-19-responsive measures and models.
  38. NEJM.catalyst. https:// catalyst.nejm.org/ doi/ full/ 10.1056/ CAT.20.0505https:// catalyst.nejm.org/ doi/ full/ 10.1056/ CAT.20.0505 58. UNAIDS, “Revised HIV Estimates,” Fact Sheet; November 2007 59. Banerji D 1996. AIDS threat to India: a response. Health Millions. Nov-Dec; 22(6):23-7.
  39. Priya R 1994. ‘AIDS, Public Health and the Panic Reaction, Part I and II’. Nat Med. J. of India, Vol. 7, Nos. 5-6, pp235-240 & 288-29161. Gruskin S, Ferguson L, Alfven T, Rugg D, Pearsman G 2013. Identifying structural barriers to an effective HIV response: using the National Composite Policy Index data to evaluate the human rights, legal and policy environment. Journal of the International AIDS Society 2013, 16:18000 62. Parker W 2004. Rethinking conceptual approaches to behaviour change: The importance of context. Communicaitong AIDS Needs Project. Centre for AIDS Development, Research and Evaluation. https:// www.researchgate.net/ publication/ 263235062_Rethinking_conceptual_approaches_to_behaviour_change_The_importance_of_context 63. Priya R 2003. ’Learning to live with AIDS: New approaches may be needed if AIDS is to be
  40. controlled’. Review of 2 books in to live with AIDS: New approaches may be needed if AIDS is
  41. to be controlled’. Review of 2 books in Nature, Vol. 423, 12 June 2003, 685-6.
  42. Barnett T and Whiteside A, 2002. AIDS in the Twenty-First Century: Disease and
  43. Globalization. Palgrave-MacMillan.
  44. WHO 2007. World Health Report 2007. Everybody’s business: Health Systems Strengthening
  45. Health Systems to Improve Health Outcomes. WHO, Geneva.
  46. Priya R and Reddy S 2005. ’Understanding Cultural Resources for AIDS Control: An
  47. Interdisciplinary Approach’, Indian Anthropologist, 35(1 & 2), 15-32.
  48. Garrido M V, F B Kristensen, R Busse, C P Nielsen, 2008. Health technology assessment and
  49. health policy-making in Europe: current status, challenges and potential. European Network
  50. for Health Technology Assessment, the European Observatories on Health Systems and
  51. Policies, WHO Regional Office for Europe, Denmark.
  52. Paina L and Peters D H 2011. Understanding pathways for scaling up health services through
  53. the lens of complex adaptive systems. Health Policy and Planning 2012; 27:365–373.
  54. doi:10.1093/ heapol/ czr054
  55. Banerjee A V, Esther Duflo, Rachel Glennerster and Dhruva Kothari 2010. Improving
  56. Immunization Coverage in Rural India: A Clustered Randomized Controlled Evaluation of
  57. Immunization Campaigns with and without Incentives. BMJ (online) 340 (May 17, 2010):c2220
  58. DOI: 10.1136/ bmj.c2220
  59. Dasgupta R, Chaturvedi S, Vivek Adhish, Ganguli K, Rai S. Sushant L, Arora N K. 2008. Social
  60. Determinants and Polio ‘Endgame’: A Qualitative Study in High Risk Districts of India. Indian
  61. Paediatrics, VOLUME 45__MAY 17, 357-365.
  62. Beaglehole R, Bonita R, Horton R, Adams O, McKee M, 2004. Public health in the new era:
  63. improving health through collective action. Lancet 2004; 363: 2084–86pp. 361-392.
  64. Bhargava A 2016. Undernutrition, nutritionally acquired immunodeficiency, and tuberculosis
  65. control. BMJ 2016; 355 doi: https:// doi.org/ 10.1136/ bmj.i5407
  66. Kontsevaya I, Lange C, Comella-del-Barrio P, et al. Perspectives for systems biology in the
  67. management of tuberculosis. Eur Respir Rev 2021; 30: 200377 [DOI: 10.1183/ 16000617.0377-
  68. .
  69. Nikolayevskyy V, Niemann S, Anthony R, van Soolingan, D, Tagliani A, Kodmon, C, et al 2019.
  70. Role and value of whole genome sequencing in studying tuberculosis transmission. Clinical
  71. Microbiology and Infection 25 (2019) 1377-1382. https:// doi.org/ 10.1016/ j.cmi.2019.03.022
  72. Sharifi-Rad J, Bahare Salehi, Zorica Z Stojanović-Radić, Patrick Valere Tsouh Fokou, Marzieh
  73. Sharifi-Rad, Gail B Mahady, Majid Sharifi-Rad, Mohammad-Reza Masjedi, Temitope O Lawal,
  74. Seyed Abdulmajid Ayatollahi, Javid Masjedi, Razieh Sharifi-Rad, William N Setzer, Mehdi
  75. Sharifi-Rad, Farzad Kobarfard, Atta-ur Rahman, Muhammad Iqbal Choudhary, Athar Ata,
  76. Marcello Iriti, Medicinal plants used in the treatment of tuberculosis - Ethnobotanical and
  77. ethnopharmacological approaches. Biotechnology Advances (2017), doi: 10.1016/
  78. j.biotechadv.2017.07.00110.1016/ j.biotechadv.2017.07.001
  79. Shastri M D, Shukla S D, Chang, W C, Dua K, Peterson G M, Patel R P, Hansbro P M, et al,
  80. Role of Oxidative Stress in the Pathology and Management of Human Tuberculosis.
  81. Hindawi, Vol. 2018, Article ID 7695364, 10 pages. https:// doi.org/ 10.1155/ 2018/ 7695364.
  82. Stirling A 2008. “Opening Up” and “Closing Down”: Power, Participation, and Pluralism in the
  83. Social Appraisal of Technology. Science, Technology, & Human Values, Vol 33 Number 2, 262-
  84. Boon M and Van Baalen S 2019. Epistemology for interdisciplinary research – shifting
  85. philosophical paradigms of science. Euro Jnl Phil Sci 9, 16 (2019). https:// doi.org/ 10.1007/
  86. s13194-018-0242-4
  87. Ackoff R L 1971. “Towards a System of Systems Concepts”, Management Science Vol. 17, No. 3
  88. pp. 661-671.
  89. Toomey A H, et al, 2015. Inter- and Trans-disciplinary Research: A Critical Perspective. GSDR
  90. Brief. https:// sustainabledevelopment.un.org/ content/ documents/ 612558-Inter-
  91. %20and%20Trans-disciplinary%20Research%20-%20A%20Critical%20Perspective.pdf
  92. Marshall, F J Dolley, R Priya 2018. Transdisciplinary research as transformative space making
  93. for sustainability: enhancing pro-poor transformative agency in peri-urban contexts. Ecology
  94. and Society 23(3):8. https:// doi.org/ 10.5751/ ES-10249-230308
  95. Pleshakova A and Quintan K M 2013. Toward a Theory of Interdisciplinarity: An Example of
  96. Conceptual Integration/ Blending in Teaching and Learning in Russian and East EuropeanLanguage- Based Area Studies. Russian Language Journal Vol. 63, pp. 169-193.
  97. DoorisM, Alan Farrier and Lynn Froggett. Wellbeing: the challenge of ‘operationalising’an
  98. holistic concept within a reductionist public health programme. Perspectivesin Public Health
  99. 138:2, 93-99.