Content

1. Signing off on an entrenched symbol of stigma
2. Lab Tests at Rural Health Centres – Plugging the Diagnostic Gap

Signing off on an entrenched symbol of stigma

Background & Context

• Announcement (April 29, 2025): Tamil Nadu CM M.K. Stalin declared removal of village names ending with ‘colony’ and others with derogatory caste references (Pallappatti, Paraiyappatti, Naavidhan Kulam, Paraiyan Kulam, Sakkilippatti) from official records.
• Objective: Replace such names with socially neutral ones (flowers, poets, scientists; avoid political leaders).
• Rationale: Words like ‘colony’ in rural TN have become social markers of untouchability, revealing caste identity and perpetuating stigma.

Relevance : GS1 (Society – Role of language and symbolism in dismantling entrenched social hierarchies)

Practice Question : “Language both reflects and reinforces social hierarchies. Discuss the significance and limitations of symbolic measures like renaming caste-linked settlements in addressing caste-based discrimination in India.” (250 words)

The Problem – How Settlement Names Perpetuate Discrimination

• In rural Tamil Nadu:
  • Colony = exclusively areas of historically marginalised castes (Dalits).
  • Residential address in official documents → immediate caste identification.
  • Triggers prejudice, condescension, and discrimination in social and institutional settings.

• Psychological Impact:
  • Constant reminder of social exclusion.
  • Feeling of being victimised for historical identity.

• Difference with Urban Usage:
  • In cities: ‘Colony’ (e.g., Railway Colony) is caste-neutral.
  • In rural TN: caste-coded term.

Historical Roots of Segregated Settlements

• 12th century CE onwards: Evidence of caste-based settlement segregation linked to varnashrama dharma.
• Settlements designated for “untouchables” kept physically apart from higher castes.
• Bhakti movement (6th–9th centuries CE):
  • Initially inclusive in religious devotion.
  • Later, during Chola period temple-building, marginalised some deities & communities.
  • Literary reference: Periya Puranam (12th century) – “theendachery” = untouchable quarters.
• Nayak rule (14th–17th centuries): Harsh enforcement of varnashrama dharma; physical segregation intensified.
• British period:
  • Codified caste-segregated settlement names in official records.
  • Strengthened permanence of such terms.

Evolution of the Words ‘Cheri’ and ‘Colony’

• ‘Cheri’ in ancient Tamil literature:
  • Early meaning (pre-medieval): Neutral term meaning settlement (Tolkappiyam, Kurunthokai, Silappathikaram).
  • No caste connotation until medieval period.
• Shift in meaning:
  • By 20th century: ‘Cheri’ and ‘Colony’ synonymous with Dalit settlements.
• ‘Colony’:
  • Original meaning (15th–18th centuries): European colonial residential quarters.
  • Over time in India, became a general term for settlements.
  • In rural TN, shifted to signify lower-caste habitation – an ironic reversal from elite colonial spaces to socially marginalised ghettos.

20th Century Dalit Identity & Terminology

• Mahatma Gandhi: Coined ‘Harijan’ (“Children of God”) – intended as respectful, but became stigmatised.
• Iyothee Thass Pandithar: Advocated ‘Adi Dravidar’ term.
• Justice Party leader M.C. Rajah:
  • 1922 resolution to replace Parayar/Panchamar with Adi Dravidar in official use.
  • Even this term later acquired stigma due to persistent discrimination.
• Result: Every successive term, however respectful in origin, risked acquiring pejorative meaning in an unchanged social mindset.

Present-Day Social Reality

• Marginalisation not just historical – continues in daily life.
• Addresses with ‘colony’ or ‘cheri’ lead to:
  • Employment discrimination.
  • Social exclusion in housing, marriage, and public services.
• Rural specificity: Urban examples of ‘colony’ are socially neutral; rural ones are caste-coded.

Government’s Renaming Initiative

• Names ending with ‘colony’ and caste identifiers to be removed from rural records.
• Replacement with socially inclusive names (flowers, poets, scientists).
• Urban names like Velachery, Pondichery, Saibaba Colony remain unaffected as they lack caste implications.
• Move is symbolic & historic, not a welfare scheme.
• Aim: Encourage social integration, dismantle linguistic caste markers.

Symbolism vs. Structural Change

• Symbolic value:
  • Public recognition of caste discrimination in language.
  • Step towards normalising caste-neutral geography.
• Limits:
  • Renaming does not end segregation or economic inequality.
  • Needs parallel investment in education, jobs, housing integration.
• Still significant in changing state records, which have historically entrenched caste divisions.

Lab Tests at Rural Health Centres – Plugging the Diagnostic Gap

Background & Context

• Accurate diagnosis is the foundation of effective treatment.
• Many diseases require a combination of:
  • Clinical history
  • Physical examination
  • Laboratory tests for confirmation
• Lack of diagnostic access → incorrect identification → mistreatment or delayed treatment.

Relevance : GS2 (Governance & Health – Strengthening primary healthcare and diagnostics for achieving Universal Health Coverage)

Practice Question : “Universal Health Coverage in India will remain incomplete without equitable access to diagnostics at the primary care level.” Critically analyse this statement in light of rural-urban healthcare disparities. (250 words)

Universal Health Coverage (UHC) & Policy Framework

• National Health Policy 2017 & India’s commitment to UN SDGs mandate UHC.
• Key Requirements of UHC:
  • High service coverage
  • Financial protection
• Challenges:
  • Outpatient care accounts for >60% of out-of-pocket expenditure.
  • Significant costs include drugs, diagnostics, and transport.
  • Health insurance mainly covers hospitalisation, not outpatient diagnostics.

Rural-Urban Diagnostic Divide

• Urban Areas: High availability of private diagnostic services.
• Rural Areas:
  • Dependent on public health infrastructure.
  • Limited access to point-of-care devices, mobile clinics.
  • Primary health centres (PHCs) & sub-centres lack adequate lab capacity.
• Result: UHC goals undermined unless diagnostics reach the “last mile”.

Changing Health Priorities – Drivers of Demand

• Epidemiological transition:
  • Declining infectious diseases like TB, but persistence in some areas.
  • Rise in non-communicable diseases (NCDs) – cardiovascular disease, diabetes, cancer.
• Ageing population, environmental & socio-economic changes increase diagnostic needs.

Advances in Diagnostic Technology

• Tele-diagnostics: Radiology, pathology, dermatology.
• Molecular diagnostics: Higher precision, increasingly usable at primary care.
• Automation: Semi-auto analysers, portable devices at PHCs.
• Examples:
  • Portable X-rays at PHCs
  • Blood sugar & cholesterol tests at sub-centres
  • Sputum collection for TB at sub-centres

Cost-effectiveness & Implementation Challenges

• Tech adoption is not just about availability — cost-effectiveness matters.
• Public health planners must:
  • Evaluate multiple tests for simultaneous use.
  • Prioritise based on evidence & health system needs.
• Government initiatives:
  • ICMR recommendations for TB, sickle cell, anaemia, HIV, hepatitis testing.
  • National List of Essential Diagnostics (NLED) – updated in 2019.

Disease-Specific Diagnostic Priorities

• Tuberculosis (TB):
  • Molecular testing (GeneXpert/Truenat) for faster detection.
  • Sputum sample collection at sub-centres.
• Diabetes:
  • HbA1c testing at PHC level.
• Sickle Cell Anaemia:
  • Screening in endemic regions.
• HIV, Hepatitis B & C, Syphilis:
  • Available at sub-centres.

Workforce & Skill Gaps

• Shortage of trained lab technicians in rural areas.
• Need for:
  • Skill development in test performance, interpretation, and equipment handling.
  • Knowledge of sensitivity, specificity, predictive values for test quality assurance.

Policy & Systemic Recommendations

• Extend point-of-care diagnostics to sub-centre level.
• Integrate diagnostics into UHC planning & budgeting.
• Invest in training, quality control, and maintenance.
• Strengthen referral chains between sub-centres, PHCs, and higher facilities.
• Ensure supply chain reliability for test kits and reagents.