Though Muslims made up only 16 percent of India’s population in 2006, they accounted for 70 percent of those infected with polio. Rashid Hussain ’10 MD’14 explores reasons behind the increase in polio among India’s Muslim population in his research paper “Partition and Poliomyelitis: An Investigation of the Polio Disparity Affecting Muslims during India’s Eradication Program,” published March 5 in Public Library of Science ONE.
Hussain began his research during his undergraduate career as an anthropology and human biology concentrator. ANTH 1030: “International Health: Anthropological Perspectives,” taught by Professor of Anthropology Daniel Smith, inspired him to conduct public health research, he said.
Hussain said he “bumped into polio by accident.”
“I just wanted to explore,” Hussain said. “There was actually very little research at the time on health inequities affecting minorities in India.”
With the lack of polio coverage in the mass media, the population disparity was “blamed exclusively on rumors” about the effects of the polio vaccine, Hussain said. In the summer of 2009, Hussain traveled to the Aligarh district of Uttar Pradesh in India to conduct research for his undergraduate senior thesis. He used the anthropological method of “participant observation” and collected his data as a part of the Global Polio Eradication Initiative’s door-to-door team. He conducted 107 “structured or semi-structured” interviews, according to the research paper.
“It was all about grassroots networking,” Hussain said, adding that he was able to make connections through “word of mouth and different people’s reputations and recommendations.” Polio was eradicated in India after Hussain had finished his research, with its last case appearing in 2011 thanks to the “extraordinary” community intervention efforts of the Indian government, Hussain said.
Though Hussain started his paper as part of his undergraduate work, he continued his research at the Alpert Medical School.
Stephen McGarvey, professor of epidemiology, and Lina Fruzzetti, professor of anthropology, assisted Hussain in producing the research paper.
“There is a relatively low level of health system development in communities,” McGarvey said, adding that sparse education and poorly run clinics contribute to the disparity of disease contraction among impoverished populations. All of these problems are “interactive” and build upon one another, McGarvey said.
Hussain’s paper has received praise from scholars, including Naomi Rogers, associate professor of history and history of medicine at Yale. Rogers said she was “very impressed” by the way the authors of the paper were able to identify relevant social and political factors in relation to the disparity of polio contraction, adding that she especially appreciated the paper’s historical explanation of how religious bias towards Muslims has translated into neglect and segregation.
“I thought this is really a thoughtful way of dealing with very profound issues around the social determinants of health,” Rogers said, adding that the paper made these determinants “come alive.”
Rogers said she was especially intrigued by Muslim families’ opposition to polio vaccines, some of which stemmed from the government’s shaky health infrastructure that can lead to more health problems, according to the paper.
There should be more research papers like Hussain’s that “strip away the easy way of dismissing people who resist vaccines as just not appreciating good science,” Rogers said, adding that it suggests a larger context of how “big, scientific goals” can be achieved by considering “structural issues” first.
The biggest cause of health inequity is poverty and the lack of resources, power and health literacy that comes with it, Hussain said.
“If you have a strong state public health institution, then that protects (people) to a large extent,” Hussain said, adding that, though having strong health care is a “luxury,” when institutions implement “forced” vaccination, people will resist at a “grassroots level.”
Though the eradication effort has succeeded in India, the process in which the overall “structural violence” continues to create such disparities within communities is “not easy” to eradicate and requires the engagement of the community through a cultural relativist lens, McGarvey said.
Closing these health gaps further will require “talking to (the communities) about whatever it is — polio, clean water, childhood diarrhea,” McGarvey said. Interventionists will have to combine cultural and biomedical knowledge to “develop a feasible and sustainable intervention.”
