Theorizing health in the context of transition: the dynamics of perceived morbidity among women in peri-urban Maharashtra, India

In international health, transition models that project global trends in fertility, morbidity, and mortality have been challenged for their underlying assumptions about modernization and the inability to capture inequities in the distribution of health and health services, the resurgence of infectious diseases and an apparent rise in perceived morbidity. The evidence that individuals' perceived morbidity rarely corresponds to biomedical measures of health status prompts questions regarding the relationship of epidemiologic transitions to shifts in ways of recognizing, representing, and responding to health and illness. In both international and national health policy and research, the discursive parameters of "women's health" in India largely reflect the logic of transition models and rarely consider how women themselves see "health" and its determinants, the dynamics of women's perceived morbidity, and women's response to changes in local medical discourse and practice. Drawing on survey and ethnographic data collected during 1996-97 in a peri-urban community located near the city of Pune in Maharashtra, Western India, I examine the context and content of intergenerational differences in perceived morbidity among women. Among these women, perceived morbidity is an important gauge of the conceptual health transition taking place in urbanizing areas of India, and, potentially, it tells us far more about social change and its impact on health than do statistical representations and models.