# **3. Public health services in colonial India**<sup>**7**</sup>

During the colonial period, public health measures were focused largely on protecting British civilians and army cantonments. There is much debate about whether this resulted from parsimoniousness where Indian wellbeing was concerned, or fear of triggering hostility by imposing alien practices. In any event, a series of measures ensured that the British lived in residentially segregated areas with good environmental sanitation. Municipal areas were privileged with machinery to assure good sanitary conditions, including the management of water, solid waste, and liquid waste. For towns and rural areas, the services were focused largely on early detection and control of outbreaks of contagious diseases with high fatality rates — such as cholera and the plague — before they could spread, and even menace the more privileged populations.

Yet even for these limited purposes, the colonial authorities built impressive capacity for delivering public health services:

- Institutions for public health training and research, which ranked amongst the best in the world ⎯ most notably the All-India School of Public Health and Hygiene, and the Calcutta School of Tropical Medicine. These conducted basic research such as discovering how malaria is transmitted; developed and tested vaccines; and provided technical leadership and support as well as training for the public health authorities.

- Public Health legislation along lines then current in Europe.

- Sanitary Departments at national and provincial levels for civilian public health services, while military hygiene was under military medical officers. They were answerable directly to the government, and administratively separate from the Indian Medical Service (IMS) which provided medical services.

- Policy making and planning for public health services, done systematically to address all major threats to the public health. The Sanitary Departments issued annual reports with information on disease patterns and associated factors such as seasonal conditions and population movements, and analyzed this information to extrapolate the potential for outbreaks for which advance planning might be necessary. Periodic Sanitary Conferences were convened to discuss and refine overall policy thrusts, and coordinate policies and implementation between provinces.

The Sanitary Departments were entasked with ascertaining local sanitary conditions and improving them; vital registration<sup>8</sup> ; monitoring disease trends; providing technical advice on disease control; and carrying out vaccination programs. They were expected to detect outbreaks early, trace them to their source and extinguish them quickly. Their medical staff was on average better-qualified, better-paid, and had faster promotion avenues than those in the Indian Medical Service. Municipal governments hired their own public health staff, consisting of medical doctors, and “a small army” of supervisors and sanitary inspectors to enforce sanitary regulations. Municipal planning was designed to avert

> 7 This section draws on Harrison (1994), Jeffrey (1988), the essays by Arnold and others in Dyson (1989), Guha (1993), Ramasubban , the reports of various Sanitary Conferences, and annual reports of the Sanitary Commissioner of Punjab Province.

> 8 In many provinces the quality of vital registration data was much higher than today (Dyson 1989).

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