'To promote health education in Asia'

Dr. Carl E. Taylor, Professor Emeritus in the Department of International Health in the School of Hygiene and Public Health at Johns Hopkins University, was born in Mussoorie, Uttar Pradesh. His parents, both doctors, were involved in missionary work in North India. Taylor had his medical education from Harvard and Johns Hopkins; he came to India at the time of Independence to carry on missionary work among Partition victims on both sides of the border. He went back to Johns Hopkins to establish the Centre for International Health, and returned to India in 1962 to lead the first major community development project at Naragwal in Punjab. In 1974, the project was closed down and Taylor had to leave the country under controversial circumstances. Later, he worked in China for seven years as UNICEF's Regional Director and helped establish a Union School of Public Health in Beijing. He has wide-ranging experience in the field of public health in several Asian countries. At present he is involved in a major environmental and community development project in the Himalayas in China. He is the principal author of the concept paper on the proposed Asian Institute of Public Health at Munnar.

Excerpts from an interview he gave R. Krishnakumar:

How did the plans for an Asian institute originate?

We are, in a sense, responding to a very clear request from the Kerala Government to begin such an institute and, a request in which we at Hopkins were also very interested because, for many years, we have considered Kerala as a model of good health at low cost. It made sense to us to help develop and improve the pattern of education of leaders involved in public health in all of Asia. The discussions are at a very early stage, and there is no proposal as of today.

What is the core idea behind such an institute?

In Hopkins, there is no unanimous opinion on any subject. But one view, which I also support, is that there are areas where major gaps exist in promoting health education in Asian countries. India has done extremely well in developing curative medicine and high-tech hospital-based activity, and there are outstanding examples of individual curative care. But the same level of performance has not been reached in the area of public health. This gap is a matter of concern for everybody. But we do not want to be in a position of competition with local educational institutions, for example, with the Sree Chitra Tirunal school in Thiruvananthapuram and other centres in the region with which we have been collaborating.

There is concern that the proposed institute is to conduct drug and clinical trials on local people.

Questions like that seem to convey the idea that research is automatically harmful. The reason for research is that there are questions to which we do not yet know the answers. The purpose of research is to test things that may or may not yield results; we have to develop a procedure that gives you an answer, otherwise research is not worth doing.

I am fascinated that this has become something of an ethical issue to the point that there is this feeling that we might be using local people as guinea pigs. The fact is that I personally and everybody I could think of were very careful not to do that kind of research in our whole career. I can assure people here that our ethical standards would not tolerate anything that would not be beneficial within the standards that are acceptable in the United States.

There is also criticism that the State Government will not have enough control over the institute's policies.

We have just begun discussions, and depending on what the Government has to say on this issue, we will be glad to listen. If there is going to be an Asian school, we feel that other governments that choose to have a direct involvement would also like to play a role. I think it would be inappropriate for the Kerala Government to say that it should have absolute control just because the institute would be in Kerala.

The second point is the importance of community control on any health activity. A very important part of that preliminary thinking was that community-based primary health care centres that are to be set would have a close relationship with the area. The community in that area would have a great deal of control on what is done in their community. We would not do anything without their participation.

Who will have representation on the board of directors of the institute?

I have no idea what the balance would be and it is premature for anybody to express an opinion on that. But I would like to say that Hopkins is not going to impose anything in a partnership relationship.

Where will the funds come from?

We have not even begun to look at that possibility. Until we decide on some of the basic organisational things, we feel it is inappropriate to talk about money. But my guess is that there will be multiple sources - international agencies and foundations, and individual donors. And from tuition fees.

In the U.S. we are dependent on corporate donors because increasingly governments are pulling out of their roles in the funding of health activity. And the corporate sector seems most likely to make up for these cutbacks. At Hopkins, however, we make it very clear that their being a donor does not give them a say and the control will be with the people who are actually carrying out the programme. And it works well.

How do you react to allegations that you had links with the Central Intelligence Agency and you were asked to leave India in 1974?

Such charges were raised, but we did not bother to refute them; and because we did not refute the rumours, people assumed that they were true. It is time now for us to say that if anybody has any evidence, they must come forward.