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Traditional Knowledge for Sustainable Development:
A Case from the Health Sector in Kerala, India
Unnikrishnan PAYYAPPALLIMANA1* and Osamu KOIKE2
1

United Nations University Institute of Advanced Studies,
1-1-1 Minato Mirai, Nishi-ku, Yokohama 220-8502, Japan
2
Public Policy and Administration, IGSSS, Yokohama National University
79-4 Tokiwadai, Hodogaya-ku, Yokohama 240-8501, Japan*e-mail: payyappalli@ias.unu.edu

Abstract
The United Nations’ Decade of Education for Sustainable Development (DESD) aims, among otherobjectives, to foster and promote the mainstreaming of intercultural approaches within a social learning
process through multi-sectoral, collaborative and interdisciplinary methods. Biological as well as cultural
diversity are inherently linked and form an important part of the sustainable development education process.
Traditional knowledge (TK), a central dimension of bio-cultural diversity, is also receiving increased attention
in this context. However there are several socio-political and methodological challenges of integrating TK in
Education for Sustainable Development (ESD) programs. Using the case of traditional medicine from Kerala
state, India, this paper attempts to highlight the importance of and the issues pertinent to such integration in a
local context. It also highlights the role of endogenous development processes to achieve different objectives,
including specifically those related to ESD processes. Appropriate learning methods need to be designed withsensitivity to epistemological and contextual dimensions of traditional knowledge. For education programs tobe effective they need to be addressed at various levels of social integration such as communities, civil society
groups, nongovernmental organizations, formal and informal learning institutions, local administrative
structures, and national, international, multilateral and policy forums.
Key words: bio-cultural diversity, health, sustainable development, traditional knowledge (TK),
traditional medicine, wellbeing

1. Bio-cultural Knowledge and Diverse
Perspectives
Diversity of choice is becoming ever more importantand appreciated in the present era. Academics and increasingly the public concur that a single system ofknowledge cannot solve the mounting problems ofhumanity. In this perspective a fresh look at bio-cultural
diversity, related traditional knowledge and their relevance in the Education for Sustainable Development(ESD) process is vital.
The term bio-cultural diversity denotes an inseparable
relationship between the diversity of life forms, theirecosystems and environments and the array of associatedcultural expressions. This encompasses genes, species,
ecosystems, landscapes and seascapes as well as worldviews, belief systems, knowledge, morals, values, norms,
languages, rules, artistic expressions, artifacts andinstitutions (CBD & UNESCO, 2010) that have generally
been passed on through an intergenerational transmission
process and are shared by a group. Cultural diversity also
Global Environmental Research
14/2010: 167-175
printed in Japan

indicates how such expressions are transferred within thecommunities and among outside groups, societies orregions (UNESCO, 2005). The ecosystem approachtakes into account the innate, dynamic relationship between nature and humankind and hence biological diversity and cultural diversity (CBD & UNESCO, 2010).
They mutually and constantly evolve in response to achanging natural and social-economic environment whileat the same time affecting this environment.
While cultural diversity involves a range of elements,
an important dimension is TK, which is embedded inlocal systems of value, meaning and learning. According
to the World Intellectual Property Organization this extends to “literary, artistic or scientific works; performances; inventions; scientific discoveries; designs; marks,
names and symbols; undisclosed information; and allother tradition-based innovations and creations resulting
from intellectual activity in the industrial, scientific,
literary or artistic fields.” (WIPO, 2001) The term traditional knowledge is synonymous with ‘indigenous
knowledge,’ ‘cultural knowledge’ or ‘local knowledge.’©2010 AIRIES168

U. PAYYAPPALLIMANA & O. KOIKE

It plays a vital role in defining the identity of a community or a particular group. These terms have varied interpretations and may not fully represent the exact characterization. The term ‘traditional’ may obscure thedynamic nature of TK and its ability to adapt and change
according to context and time. At the same time‘indigenous’ may refer to community centricity while theterm ‘local’ may lack specificity (ICSU, 2002). As all
knowledge is presumed to be embedded in cultural roots,
the term ‘cultural’ may not capture a process of intergenerational continuity.
Diversity, collective ownership guided by customarylaws, adaptability to changing contexts, largely undocumented and orally transmitted, and relationships among
biodiversity, ecosystems and ethnic groups are some of
the key characteristics of TK. Due to its dynamic nature it
does not pertain to a period in time. Though there may bevariation in the modes of knowledge production anddiffusion among communities, there are numerous parallels in the value systems and worldviews among communities (Suneetha, 2008). Often mainstream science
does not recognize TK as valid knowledge as it is considered to have no universal methodology and is combined with beliefs and values (Couze & Featherstone,
2006, p.458 & 460). This may lead to conflicts between
the mainstream and traditional knowledge systems.
TK plays a significant role in the social and economic
dimensions of countries. Acknowledging and upholding
TK-related practices is an important instrument for ‘promoting a sense of cohesion and identity’ (WIPO, 2001). It
impacts human well-being through its contributions tohealth, agriculture, food security, environmental andnatural resource management, land use, livelihoods, disaster management, arts and culture among many others.
Consider the case of TK in the realm of medicine: theWorld Health Organization estimates that traditional
medical practices cater to a major percentage (in someregions up to 70%-80%) of the world population’s healthrequirements, especially in developing countries (WHO,
2002a; Bodeker et al., 2005). These practices use components of ecosystems (plants, animal and mineral/metal
derivatives) that are primarily locally available, easily
accessible and often cost-effective in treating illnesses.
For the last few decades TK has been acknowledged
as a worthy aspect of development. In 1957 the International Labour Organisation (ILO) highlighted the rights
of indigenous peoples by adopting the Indigenous andTribal Peoples Convention affirming the importance of
cultural diversity. TK got a major boost after the Earth
Summit and the adoption of the Convention on Biological Diversity at Rio de Janeiro in 1992. Other landmark
policies related to traditional knowledge are UNESCO
conventions such as the Convention for the Safeguardingof the Intangible Cultural Heritage (2003) and theConvention on Protection and Promotion of the Diversityof Cultural Expressions (2005). These avow the importance of cultural diversity and the link between culture
and development. Affirming the relationship between
cultural and biological diversity, efforts for strengthening

the link between the conventions of CBD and UNESCO
have been reiterated (CBD & UNESCO, 2010). It isnoteworthy that the approach of ESD is also characterized by a diversity of knowledge (including traditional
knowledge systems), and as a corollary, TK addresses therequirement of ESD to carefully consider local context inall learning processes and enables testing of new knowledge in a participatory social learning process.
Some of the common challenges facing TK and thepeople who “hold” TK are related to: lack of recognition
of TK practices and TK practitioners; rights to resources;
traditional lands; ownership of knowledge and benefits
from use of resources and knowledge; sustenance ofpractices; lack of successors; incompatibility with mainstream knowledge systems and learning processes; andpeaceful existence and preservation of diversity(Payyappalli, 2010). It is noteworthy that in the realm ofenvironmental and biological diversity TK is better
recognized or acknowledged than in any other sector.
Furthermore, although TK might have state patronage asa national heritage, practitioners of TK often remain
unrecognized, and are certainly not an integral part in thedesign or content of educational curricula. Despite this,they continue to thrive primarily due to community
legitimacy, support and intergenerational learning.

2. Cultural Diversity and Traditional
Knowledge Vital to Sustainable
Development
Traditional knowledge and practices can be seen as apivot between natural or ecological resources on the one
hand and human intervention and social and economic
development on the other hand (Berkes & Folke, 1994;
Cochrane, 2006). According to Breidlid (2009), however,the dominant discourse has fallen short of exploring thepotential of alternative knowledge systems, while considering it an impediment to development. A key challenge therefore is to find appropriate tools to convey thespearheading roles that traditional knowledge, norms andvalues can play in achieving SD. While ESD calls forpluralism, there is insufficient discussion on how diverse
knowledge systems could co-exist. Within the ESD discourse social learning is an approach which appreciates
such diversity and acknowledges legitimacy of divergent
perspectives.
The United Nation’s Decade of Education for Sustainable Development (DESD) aims, among otherobjectives, to foster and promote the mainstreaming ofintercultural approaches within a social learning process
through multi-sectoral, collaborative and interdisciplinary methods. The UNESCO Convention on Cultural
Diversity recognizes the significance of cultural knowledge “as a source of intangible and material wealth,”
especially in indigenous communities. While affirming
its positive role in SD, it asserts that “cultural diversity
widens the range of options open to everyone; it is one of
the roots of development, understood not simply in termsof economic growth, but also as a means to achieve aTraditional Knowledge for Sustainable Development: A Case from the Health Sector in Kerala

more satisfactory intellectual, emotional, moral andspiritual existence” (UNESCO, 2001). Stressing theircatalytic role in development and the need for appropriate policies, the convention says that while making certain that there is “free circulation of ideas and works,”
there is a need to create a conducive environment for
production and propagation of varied cultural goods andservices that have the strength to exert influence at the
local and global level (UNESCO, 2005).
The UNESCO convention also underlines the importance of the relationship between culture and development in all countries, specifically in developing regions,and to promote strategies both nationally and internationally to acquire recognition for this. Whileemphasizing the central role of culture and the complementary nature of economic and cultural dimensions ofdevelopment it says that individuals and communities
have the “fundamental right to participate and enjoy.” Asa core principle, protection, maintenance and promotionof cultural diversity are vital requirements of SD forpresent and future generations. Besides, equitable accessto varied expressions and the principle of openness andbalance towards other cultures are equally important.

3. Integration of Traditional Knowledge in
Sustainable Development
The UNESCO convention calls upon parties to “endeavour to integrate culture in their development policies
at all levels for the creation of conditions conducive to
SD and, within this framework, foster aspects relating to
the protection and promotion of the diversity of culturalexpressions” (UNESCO, 2005).
However there are different views and perspectives
on the ways traditional knowledge should be integrated
into development programs. These range from a romantic
view to a utilitarian and to a pluralistic perspective(Haverkort, 2006). The ‘romantic advocates’ often take aposition that all TK practitioners are knowledgeable andlogical and all elements of tradition are sound and relevant. While the ‘utilitarians’ are of the view that there arecertain relevant elements in TK and such aspects have to
be selectively studied in response to modern needs.
Those of ‘pluralistic’ view believe that different knowledge systems should be allowed to co-exist and play acomplementary role. The pluralistic approach is a central
tenet of the DESD perspective.
The utilitarian view which dominates the development discourse today focuses on TK as a commodity thatis amenable to modern protection tools such as patents orother property rights, and does not emphasize community
rights or customary laws. Equitable access and benefit
sharing mechanisms are still evolving. In this context, it
is not surprising that national policies to integrate TK
into development processes are not defined. However,progress is visible in certain sectors such as health andnutrition, agriculture, enterprise development and, tosome extent, in education. This has been chiefly led bycivil society initiatives.

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3.1 Challenges of integration
There are certain socio-political and methodologicalchallenges in integrating or mainstreaming TK.
1. An important issue is the hegemonic relationshipbetween knowledge systems that puts TK in a position of
having to prove itself through a positivist epistemology(Haverkort, 2010; Shankar & Unnikrishnan, 2004).
Jenkins (2000) says that modernization has dramaticallydevalued traditions by universalizing norms of action,
value generation and individualized patterns of socialization. In the process, tradition in general and TK in
particular have been relegated to the sidelines as a scarce,
non-renewable resource and an impediment to progress(Jenkins, 2000). The modernist attitude towards TK has
been one of ‘either modernize or disappear’ in a context
where the strongest comes to be identified with the best
rationale. They further point out that alternate worldviews get marginalized, especially due to modernity’s
characterization of history as being linear and evolutionary. This leads to a ‘critical and skeptical judgment’ ofolder knowledge (Couze & Featherstone, 2006). Even
though the International Council for Science policy
document (ICSU, 2002) points to the challenges ofdiffering epistemological premises of traditional knowledge systems, it is noteworthy that in the UNESCO conventions there is no explicit mention of this.
2. In the efforts to achieve ‘development,’ emphasis
has been placed on economic growth and related activities. In the same vein, the role of culture or TK in contemporary societies has been examined through the lens of
relevance to commercial activity. According to Jenkins(2000) “Social analysis has been largely driven by
rational behaviour models, which abstract economic
action from its historical contexts.” For example, cultural
knowledge, artifacts or art forms are seen as vehicles for
economic empowerment with less focus on their contextual nature and relevance to the communities. Often there
is also emphasis on aggregate growth rather than distributional effects or equity.
3. Another issue is the prevailing view of TK as antiquated and non-dynamic, thus relegating it to a status of acommodity that should be documented and preserved.
The discourse has been dominated by the protection of
intellectual property rights while neglecting efforts tostrengthen the social and cultural processes of continuity
and contemporary utility of such knowledge. Whereas
documentation and preservation of TK (being on theverge of extinction) are needs of the hour, promotion ofcontemporarily relevant TK and encouraging continued
creativity and dynamism are vital as well. There are also
related discourses on TK where it is considered exotic
and confined to indigenous communities. While presenceof TK might be obvious in such communities, sociological analysis amply reveals that such knowledge andrelated practices are embedded in all sections of society.
However there may be a dominant influence of social

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classes or castes or ethnic groups on such knowledge
within the communities. There is also a contested ideathat promotion of TK is only of relevance in certain sections of society where benefits from modern science andtechnology are not available or accessible. This creates
double standards within a society and further deepens
inequity, especially in less-developed countries.
4. Lack of sufficient theoretical approaches forunderstanding and assessing TK is also a concern(Jenkins, 2000). From the indigenous epistemologicalpoint of view there are certain unique features of TK suchas its non-dualistic, dynamic, informal, secret and sacred,spiritual, time-related and non-linear nature. Methods arealso intuitive and meditative, with an emphasis on
reciprocity (Haverkort, 2010, p.20). Modern methods ofvalidation cannot capture these elements. The same holds
true in the case of institutionalization of TK, whereinseveral inter-related experience-based elements may not
be secured. For example, the institutionalized learning
process of university-based traditional medical educationin India fails to capture experiential knowledge such as
pulse diagnosis or traditional diagnostic or management
techniques related to health and healing.
3.2 Challenges in the context of ESD
The dominant education and research systems tend toenhance knowledge and technologies with universal
standards, rather than support the needs of specificregions or populations (Haverkort et al., 2003). A dearthof comprehensive theoretical approaches to assessing therole, economic potential and policy implications of
traditional knowledge is a key reason for disregarding
traditional cultures (Jenkins, 2000). TK and TK practitioners are selectively utilized to suit such universal requirements, while neglecting the local needs and holistic
dimensions of local knowledge. For instance, in many
countries today traditional healers are trained to impartcentrally designed health messages among communities
on issues such as HIV/AIDS or tuberculosis to theneglect of their own practices and cultural context.
There are some pertinent questions with respect toprotecting and promoting TK and education. What is an
epistemologically sensitive method to identify suchappropriate traditional practices? What mechanisms candrive effective social as well as institutional learning
processes that integrate traditional knowledge and practices? Can traditional knowledge holders participate informal educational systems? Is it possible to introduce
such an intercultural approach in the current education
system? What challenges are encountered in the institutionalization process of such knowledge systems? To
what extent can local experiences and models be universalized and thus replicated?
It is easier to speculate about an ideal approach tointegration than to make such a model sustainable in theinstitutional, political, economic realities in the local,
regional and global arena (Cole, 1995). The western
dominant model and values have influenced education in

the last several decades. Whereas this has had tremendous positive impact on development globally, theeducation model has raised questions on pluralistic existence of knowledge systems and certain dilemmas in theminds of learners. A student from a traditional community with its own values, rules and mores, and especiallywith an inclination and certain level of learning in his/her
tradition, is constantly shuttling between traditional andmodern worldviews, which may lead to certain conflicting psychological states. The person must synergize thedivergent positions for containing a fresh experience
within the “intra/intersubjective life worlds, which provide him/her a sense of social identity’’ (Ogunnyi, 2003,
p.27-28). Often this tends to result in the neglect or sidelining of traditional worldviews, logic and practices by
the individual or in a public-private dichotomy in his/herday-to-day behaviour. Even though ESD stresses theimportance of pluralistic learning, this issue is not yet
sufficiently addressed in practice which stresses the needfor creating a platform for sensitive intercultural learning.
For promoting the role of traditional knowledge in
ESD it is essential to integrate such perspectives from theearly stages of formal education. In Japan, for instance,
many schools have introduced food education (shokuiku)
in their curricula. However, it does not focus enough on
the value of diverse traditional foods. It is important tointegrate local knowledge on food consumption alongwith modern nutritional knowledge. A dialogue process
and collective learning with mutual respect should be thebasis for such an approach. The principle of mutual
regard between institutions of higher learning and thecommunities is essential. Formal and informal educational programs have to be developed for a systematic
study of local worldviews, perceptions and practices in
the wider frame of ESD. The formal learning could havea sectoral approach to TK in areas such as in medicine,
agriculture, veterinary sciences and so on. Informal
learning should also focus on means of intergenerationaltransmission. Various pedagogical approaches can be
integrated in the school curriculum. These could include
methods such as a self-reflective analysis of TK andpractice or a historical analysis of TK development andan intercultural understanding of TK and its linkages
with wider intersectoral issues (Payyappallimana, 2008).
Of crucial significance is to ensure that issues related
to the integration of traditional knowledge are addressedat different social levels such as communities, civil society groups, non-governmental organizations, formal andinformal education institutions, local administrative
structures, and national, international, multilateral andpolicy forums.

4. Endogenous Development through Social
Learning
Endogenous development (ED) starts from the ideathat local communities have their own worldview,
reasoning methods, values and norms and there is mutualTraditional Knowledge for Sustainable Development: A Case from the Health Sector in Kerala

respect and dialogue among stakeholders (Haverkort
et al., 2003). It is close to the Gandhian concept ofswadeshi of self-reliant local communities and cooperatives, while emphasizing the idea that the world hasenough for needs but not for greed. Thus ED is also basedon a value of shared or inclusive learning processes
and development (Sillitoe, 1998, p.224; Jenkins, 2000;
Breidlid, 2009). A key principle of an ED approach is that
communities have specific local and diverse needs thatcan be primarily met from locally available knowledge
and other natural, man-made, social, cultural andeconomic resources (Table 1) while maintaining an open
view towards the global context. It also allows forretention and rejection of positive and negative aspects of
TK or practices, respectively, through a participatory
dialogue, social learning and an assessment process.
Another key element in the ED approach is that thedecision making regarding development options andprocesses is locally controlled; this can lead to retentionof benefits in the local area. ED promotes TK in its own
right, not as something to be prospected by the outside
world. A dynamic, albeit cautious, interaction with
Table 1 Endogenous development elements.
Resources
Elements
Natural resources
Land, ecosystems, climate, bio-diversity
Human resources
Knowledge and skills, local concepts,
ways of learning, teaching andexperimenting
Produced or
Buildings, infrastructure and equipment
human-maderesources
Economic-financial Markets, incomes, ownerships, priceresources
relations, credit
Social resources
Family, community organisations, social
institutions and leadership
Cultural resources Beliefs, norms, values, festivals andrituals, art, language, lifestyle

external knowledge systems, mutual exchange amongcultures and building of strategic partnerships at regional,
national and international levels is central to such an
approach (Fig. 1).
Social learning here refers to “learning that takes
place when divergent interests, norms, values and constructions of reality meet in an environment that is conducive to learning.” (Wals, 2007, p.18). This learning could
occur at various levels from an individual to a collective
or a network of stakeholders. Keen et al. (2005) also
reflect the same sense by defining social learning as a“collective action and reflection that occurs among
different individuals and groups as they work to improve
management of human and environmental relationships”(Keen et al., 2005, p.4). Thus inherent in a social learning
process is a call for reflective action by relevant stakeholders. Co-evolution and complementarity are its basic
foundations. Social learning is especially important in thecontext of sustainable development where no single
knowledge system has sufficient conceptual, theoreticalor practical authority in addressing the challenges ofsustainability (Fadeeva, 2007, p.256).
This is the basic premise of endogenous development
processes. ED processes facilitate intra and inter-culturaldialogue as a basic instrument for development through asocial learning approach. This facilitates collective reflection and action among different stakeholders foraddressing a locally significant development objective.
This also offers a unique reflexive platform for social
actors to relate and recognize strengths and weaknesses.
This contrasts with development tools being prescribedin a top down approach by ‘outside experts’ with insufficient experience of the complexity of local context. Thus
social learning forms an important tool for integrating
TK in ESD programs.

Source - Haverkort, B., Katrien Van’t Hooft, Wim Hiemstra (2003)

Supporting Local
Initiatives
Building on local needs

Understanding systems ofknowing and learning

Local use ofresources

Networking and strategic
partnerships
SocialTraining andcapacity building
Exchange and learning
between cultures

CulturalEconomic &financial

Retention of benefits inthe local area

171

NaturalHuman

Produced

Improving local
knowledge and practices

Local control ofdevelopment options
Identification ofdevelopment niches

Selective use of external
resources

Fig. 1 Endogenous development framework.
Adapted with permission from Haverkort, B., Katrien Van’t Hooft, Wim Hiemstra (2003)

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U. PAYYAPPALLIMANA & O. KOIKE

The health sector is one of the most representative andvital sectors where discussions about integration of
traditional knowledge have already progressed, at bothinternational and national policy levels and with several
models of health system integration and community
participation. To benefit from this experience, the following section will use the health sector as a case forenquiry.

5. Traditional Knowledge, Health andWell-being
According to WHO, “Health is both a resource for, as
well as an outcome of, sustainable development. The
goals of SD cannot be achieved when there is a highprevalence of debilitating illness and poverty, and thehealth of a population cannot be maintained without a
responsive health system and a healthy environment.
Environmental degradation, mismanagement of natural
resources, and unhealthy consumption patterns and lifestyles impact health. Ill-health, in turn, hampers poverty
alleviation and economic development” (WHO, 2002b).
There is increasing recognition of the social and ecological dimensions and determinants of health today.
Cultural perceptions and practices also have assumed
direct implications on health and well-being in a major
shift from the dominant biomedical view of health.
According to most traditional cultures, health equates
physical, mental, social, spiritual and ecological balance.
According to the traditional Ayurveda system of medicine, the outside world and the living being share all theelements in common; the being is a miniature representation of the universe; and, equilibrium is essential for
health and well-being. Thus health is considered aninteractive outcome of personal attributes, habitualexperiences and interaction with the environment,

whereas well-being can relate to multiple factors such as
material comfort, health, freedom of choice and action,social support systems and security. This may be context-specific, relating to geographical, cultural and ecological dimensions.
5.1 Traditional health knowledge systems
Traditional medicine forms a central health seeking
arena for a large part of the world population indeveloping countries (WHO, 2002a). Traditional medicine is highly dependent on ecosystems for providing
services, such as natural medicinal resources and nutritional sources. It also depends on cultural or recreational
services insofar as nature, the environment and their
attributes have cultural, religious and symbolic value indetermining health and promoting healing. The following
section attempts to highlight the relevance of traditional
medicine in also providing public health care using thecase of health interventions through a traditional knowledge process from Kerala state in India (Fig.2).
5.2 A Kerala health sector case
Kerala, a southern Indian state with 31.8 million inhabitants, is at par with the developed countries in its
health indices (Fig.2). In the international context Kerala
has a unique health care model of high health status at
low per capita expenditure. The state has also achieved a
relatively high human development index. Studies on thehigh health status of the state suggest a strong relationship between health status and cultural knowledge traditions. In the field of health, the state provides a uniqueexample of how cultural traditions can interact withmodernity in a complex way. The system has promoted
positive attitudes to healthcare, diet, personal hygiene
and sanitation, which have also been conducive to theacceptance of more modern approaches. Cultural ele-

Fig. 2 Map of India and Kerala State.
Source: Maps of India (http://www.mapsofindia.com)

Traditional Knowledge for Sustainable Development: A Case from the Health Sector in Kerala

ments that perceive health as a holistic system relating tophysical, emotional, mental, and spiritual dimensions andthat prescribe elaborate procedures for achieving total
well-being have been well integrated (Gunatilleke, 1984;
Payyappallimana, 2010). To illustrate an aspect of suchintegration an example of contemporary medicateddrinking water practice is presented here.
Water-related diseases form up to 80% of publichealth problems in India. Despite the formulation of a
National Water Policy (Government of India, 1987)
focused on improving drinking water access, the situation has not substantially changed (NSSO, 1999).
According to an all-India survey on prevailing conditionsof drinking water, sanitation and hygiene, Kerala has thelowest access to potable drinking water: rural – 12% andurban – 40.4% (NSSO, 1999). In 2001, the figures were
16.9% (rural) and 42.8% (urban), respectively, among
Indian states (Government of India, 2009). A large
percentage of households use drinking water from theirown water sources such as open wells (Kunhikannan &Aravindan, 2000: p11), which are considered susceptible
to contamination. In the state, latrines are made withseptic tanks (26% rural, 48% urban) and pour flush pit(29.3% rural, 25.5% urban), representing the highest
rates in India.
Kerala is the most densely populated state in India
with 819 persons per km2. The normal annual rainfall ofKerala is 3,107 mm (the India national average is 1,197mm) with an average 120-140 rainy days in a year. The
state has 44 rivers and large number of water bodies
making it highly susceptible to waterborne diseases.
Waterborne vector diseases like dengue fever, malaria,
and chikungunya are on the rise due to urbanization anddeteriorating environmental conditions. According to the
National Sample Survey, the perception of an increase inmosquito population is reported high in Kerala. Thisshows the relatively low quality of water bodies inthe state. However, the state has controlled cholera,
diarrhea, hepatitis and other waterborne diseases thatspread through consumption of contaminated water(Kunhikannan & Aravindan, 2000, p.14).
According to the State of Environment Report(Government of India, 2007), well water is the major
source of drinking water in Kerala and around 90% of
wells in Kerala are polluted by sewage. Presence of coliform bacteria was found in three out of four cases in
the rural areas of Thiruvananthapuram (capital city of
Kerala), though no major health problems are reported inthese areas. The state environment report says that “Thismay be attributed to the practice of boiling water before
drinking. Boiling water before drinking is a time-tested
method of water purification, but this tradition is being
gradually replaced by the increasing use of bottled
water.”The local population has developed some natural
adaptations to an environment filled with water bodies
and with a high prevalence of waterborne diseases.
According to national statistics, hygienic handling ofwater is high in the state compared to other states. It is

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reported that the state has the highest percentage ofhouseholds boiling drinking water (rural – 49.3% andurban – 65.3%) (NSSO, 1999) which forms a major
aspect of preventing waterborne diseases. This practice isrelated to the traditional culture of Kerala of consuming
medicated boiled water. This traditional knowledge hascontinued as a popular social tradition for several
generations even in the context of modernization. Suchprescriptions have roots in the regional ancient Ayurvedic
medical text books which recommend enhancing water
quality by boiling it with several locally grown medicinal
plants. There are two likely benefits of this practice:
microbe-free boiled water together with the physiological and clinical benefits of medicinal substances used in
the boiling process. According to the local traditional
understanding most systemic diseases are caused byfaulty metabolic processes: drinking water has a strong
effect on mitigating such effects both in states of healthand illness. Based on this, specific preparations are madefor preventive and curative purposes. According to Moni
Nag (1989), the “Kerala tradition of drinking water thathas been boiled with cumin seeds (jeerampani) and thewater remaining after rice has been boiled (kanji) may
have contributed toward lower morbidity and mortality.”
Today medicated water forms an essential component
even in restaurants and public functions, though there iserosion of the practice in the recent past. The practicealso shows good market integration and livelihood benefits with several small enterprises producing andmarketing such products supported by the Kerala Khadi
and Village Industries Board and similar organizations.
There are a number of herbal products for water treatment available today in the market.
This case presents the inherent linkage between cultural knowledge and environment and how biological andcultural precepts interrelate to form adaptations to the
local environment. A unique public health approachbased on TK, using the locally available resources, isintegrated by and in the communities. The integration ofseveral such cultural elements is likely to have had an
influence on improving life expectancy in the state. The
case shows how maintenance and/or revival of cultural
resources can enable communities with endogenousdevelopment capabilities while integrating traditional
knowledge, customs and practices in a market economy.

6. Learning Systems of TK
Both India and China, unlike other countries, have a
codified literature on traditional knowledge spanningover three millennia. Such codified knowledge systems,
especially related to traditional medicine, have been
institutionalized over the last century through the establishment of training at universities and parastatal institutions. In the state of Kerala alone there are 14 Ayurveda
university schools. Even so, there is a rich and dynamic
body of knowledge at the local or informal level that
effectively complements institutional knowledge. Conversely, such experience-based local knowledge and174

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relevant social traditions do not get sufficiently integrated into formal learning processes, the argument beingthat it is difficult to bring in such personalized learning
experiences into a standard schooling system. Despite
this disregard in mainstream education, traditional
knowledge continues to be transmitted through a different cultural learning process, which is not yet sufficiently
studied by planners.
Although ESD processes claim to provide a pluralistic learning arena, identifying and comprehensively
documenting such informal and relevant socio-cultural
traditions and validating them through a multi-stakeholder process, while integrating them into mainstream
learning systems and production processes remains achallenging task. A challenge also provides an opportunity: it is vital that higher education institutions establish
mechanisms to adequately bring forward such knowledge through appropriate teaching and research programs.
There is also the issue of a dichotomy between theformally trained ‘experts’ and the informal ‘knowledge
holders’ (Collins & Evans, 2002, p.237). The Kerala caseillustrates that this is not a truism. Within the traditional
knowledge community itself there are licensed or accredited experts and informal practitioners. This showsthat TK learning is more complex in countries like India
and China because there are various levels of informal
and formal expertise within the sector. DESD should
address such multifaceted and intricate challenges within
the sector.

7. Conclusion
The article has highlighted cultural diversity as a
pre-requisite for endurance of humanity, and revitalization of traditional knowledge as important for sustainable
development. TK is often presumed to hold the key tosustainability due to its interconnectedness with various
facets of life, as well as local patterns of resource use andmanagement. However, traditional knowledge has been
marginalized in the process of modernization. In mostcountries, cultural or traditional knowledge comes undera ministry of culture or religion with insufficient intersectoral attention from the more politically strong andresource-rich ministries of science, technology, education or development in such countries.
TK can play a central role if contemporarily relevant
elements can be strengthened through revival of thesocial processes of its generation, conservation andtransfer. The article has also highlighted DESD processes
as able to foster the preservation and revitalization of TK.
A comprehensive understanding of contextual dynamics
and levels of expertise in the field of TK is central inrevitalization. The integration of traditional and contemporary health practices in the state of Kerala, India isused as an illustrative model in this context. An important
challenge is to identify and transform such an understanding into practicable community programs. There isa critical need for culturally and locally relevant educa-

tional practices linking this to the success and appropriateness of learning for sustainability. It is essential that
increasing numbers of educational institutions havesensitive approaches to understanding traditional knowledge and promoting its integration in development planning. While the development approach involving TK canbe an endogenous model based on principles of social
learning, exchange between various cultures is also
important for the dynamic growth of such knowledge
systems. Designing and implementing culturally appropriate pedagogies and their integration into formal andinformal learning processes are therefore part of thisprocess. Through such an approach, countries that arerich in biodiversity and TK can capitalize on their inherent strengths to rise to higher levels of sustainable
well-being.

Acknowledgements
The authors would like to acknowledge the helpfulcomments by Dr. Suneetha Subramanian, Research
Fellow, Institute of Advanced Studies, United Nations
University.
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Unnikrishnan PAYYAPPALLIMANA
Unnikrishnan Payyappallimana is currently completing his Ph.D. in International Development at
the Yokohama National University and is a
doctoral fellow at the UNU-IAS in the Educationfor Sustainable Development Program. He has anundergraduate degree in medicine (specialized in
Ayurveda – traditional medicine of India) from Bharathiyar University,
India, and holds a Masters degree in Medical Anthropology from the
University of Amsterdam, the Netherlands. From 1995, he has been working with the Foundation for Revitalization of Local Health Traditions basedin Bangalore on various projects related to traditional medicine. His work
has primarily focused on the application of traditional medicine to meetprimary health care needs in local communities. Earlier he was a SeniorHouse Surgeon at the Amala Cancer Hospital and Research Centre, India(1994-1995) and also a Visiting Associate Professor at the Toyama Medical
and Pharmaceutical University, Japan (2002-2003). Unni has co-edited abook Challenging the Indian Medical Heritage and has a number of journal
articles and book chapters in the field of traditional medicine and its healthsystem integration. His main research interests include traditional medicine
in public health, medical pluralism, traditional knowledge epistemology
and sustainable development.

Osamu KOIKE
Dr. Osamu Koike is a Professor of Public Policy
and Administration at the International Graduate
School of Social Sciences, Yokohama National
University. He has obtained a Master’s and a
PhD degrees in Political Science from Meiji
University. He is interested in studies ofgovernance and policy reforms in Asian countries and working in the fieldof “Education for Sustainable Development (ESD)” as a Visiting Professor
at the Institute of Advanced Studies United Nations University, since 2006.

(Received 4 October 2010, Accepted 24 December 2010)