Some points for discussion on Panel session 1

1. Some points for discussionon Panel session 1 Dr. Abhay Shukla SATHI-CEHAT and People’s Health Movement, India

2. Key points • The political economy context of Social capital • Need for linking society-wide dynamics with community level processes • Need to understand multi-level dynamics in highly complex systems • Hierarchies of power in society must be addressed • Need to address hierarchies of power within communities • Comprehensive and organic view of the role of Community organizations • Rights as a crystallising point for various forms of social capital • Public health and HIV/AIDS

3. The political economy context of Social capital • Social capital arises not in a vaccum but has a strong material and structural basis. • Major impact of neo-liberal economic policies on communities and society. “If greed is made the god, then you don’t need the devil” - under the unbridled rule of neo-liberal economic policies. • Dissolution or weakening of traditional communities in either rural or urban areas due to migration, commercialization of local economy and privatization of community resources • Growing inequities within communities and in societies as a whole • Weakening of public institutions which help to anchor social capital – like the public health system • ‘Unbridled accumulation of economic capital can be associated with major weakening of social capital’

4. Need for linking society-wide dynamics with community level processes • Linking unfolding positive and negative changes in communities with society-wide changes and the political economic context. The AIDS epidemic is emblematic of a world in a state of flux, which is thrown off balance with often disintegrating and dysfunctional communities. • Linking patterns of development and transmission of HIV AIDS. The most ‘developed’ states in India have higher HIV. Why does Kerala have a lower prevalence despite high migration? Most ‘developed’ areas in Maharashtra have higher HIV prevalence. • How do informal networks interface with formal institutions?

5. Need to understand multi-level dynamics in highly complex systems • Association is not causation - higher social capital and better health outcomes may be both related to certain overarching social-economic dynamics. Need to focus on these social-economic-political structures and processes of which ‘social capital’ is one indicator, rather than treating it as the fundamental independent variable. • We are dealing with a highly complex system, where linear or single level intervention will not work. What is required is mutually reinforcing multi-level action. • There are no ‘magic bullets’ – neither the elusive AIDS vaccine nor ‘social capital’ as a stand alone intervention.

6. Hierarchies of power in society must be addressed • ‘Bonding’ social capital and ‘bridging’ social capital do not directly address issues of power and structural inequity; ‘linking’ social capital seeks to do this in a ‘reformist’ manner that does not seek to transform structures • When we are talking about reducing inequities and building solidarity, we are talking of major redistribution of resources based on structural changes in society.

7. Need to address hierarchies of power within communities • ‘Traditional’social collectives e.g. village communities may be internally very inequitable (by gender, class and caste) • If we want to ‘mobilise’ Social capital it cannot be based on existing traditional collectives • Must be linked to empowerment of oppressed sections and a ‘new collectivity’ which draws upon traditional collective spirit of the village or settlement but seeks to reorganise these based on equity • Caste as a peculiar form of ‘bonding’ social capital in India which simultaneously provides support to members but prevents ‘bridging’. Similar problems with religious identities

8. Comprehensive and organic view of the role of Community organizations • Community organizations and people’s movements have a crucial role and must be involved in health issues including HIV/AIDS • But such organisations do not arise ‘on demand’ or function for health alone. Beyond an ‘instrumental’ view of community organizations towards an appreciation of the deeper socio-political origin and role of such organizations. • Not logical to expect such organizations to focus just on the issue of HIV/AIDS. Need to respect and recognise of the larger role of such organizations which may threaten and challenge the political status quo.

9. ‘Bridging’ and alliance building across groups ‘Bonding’ among community members Social Rights ‘Linking’ and demanding accountability, entitlements from Public systems and power structures

10. Public health and HIV/AIDS • The public health system is both a product and causative factor related to social solidarity. The state of the public health is a reflection of level of social solidarity in any society. • Public health facilities have to be reclaimed by communities; it is not just a top-down process of better policy and funds. • Example- Community based monitoring of Health services in India. ‘Reclaiming the state’ and public systems rooted in communities

11. Public health and HIV/AIDS • Beyond HIV/AIDS as a vertical agenda – locating action on HIV/AIDS in the context of public health action and larger public action. • Common issues - Health systems issues and access to care, community accountability of health systems, patients rights across the health system. • Need for a broad based alliance of various marginalized and oppressed groups around a broad health agenda which prominently includes HIV/AIDS.