Publications
Budget 2024-25 Why this neglect of health
Date: 31.07.2024
Budget 2024-25
Why this neglect of health
Dr Arun Mitra
Much was expected from the budget presented by the Finance Minister Smt.Nirmala Sitharaman on 23rd July 2024. Since the government has lost majority in the Lok Sabha and is now dependent on others to continue to be in power, there was a hope that the budget will have some pro-people out look. But it turned out to be a damp squib. Health and education, the two key sectors for any nation’s development as well as for employment generation have been neglected in this budget.
Allocation to health is far from meeting the people’s health needs. This is only 89287 cores rupees out of a total budget of 48.21 lakh crore rupees. This means health has been allocated only 1.8% of the total budget. For our population of 140 crore, this comes to only Rs.638/- per person. It is a cruel joke with the people as we are among the lowest in the health indicators and our public health spending is also among the lowest in the world. The government’s claim that they have increased the health budget by 13% is a farce. The budget allotment on health was Rs.88956/- crore last year; it was later on revised to Rs.79221/- crore. They are calculating the increase from the revised budget not from the actual budget presented last year which comes out to be only 0.37% increase. If we go by the inflation then the budget on health has been actually reduced from last year’s budget. There is likelihood that this year too the budget will be further reduced after revision. This shows the government’s total apathy towards health of the people. It smacks of push towards further corporatisation of healthcare.
For good health it is imperative that good nourishment of the mother as well as the children is ensured. According to UNICEF Child Food poverty report 2024, 40% of our children suffer from severe food poverty and 36% with moderate to severe food poverty. Food poverty refers to accessibility to vegetables, fruits, grains, protein and dairy. Those fed two or fewer food groups are in severe child food poverty; those fed three or four food groups are counted in moderate child food poverty’ (1).
Ironically in child food poverty our rank is much below even from our south Asian neighbours with Pakistan at 38%, Bangladesh 20%, Nepal 8% children suffering from severe food poverty. The seven more worse off countries than us are Somalia (63 %), Guinea (54 %), Guinea-Bissau (53 %), Afghanistan (49 %), Sierra Leone (47%), Ethiopia (46 %) and Liberia (43 %).
India’s rank in the Global Hunger Index (GHI) is 111 out of 125 countries. It may be noted that the Ministry of Women and Child Development (MoWCD) has refused to acknowledge the GHI report calling it a “flawed measure of hunger that doesn’t reflect India’s true position”. The UNICEF report is in consonance with the GHI and it has corroborated the GHI report.
The government should have considered these factors while allotting the funds to health. On the contrary the funds allotted under the Saksham Anganwadi and Poshan have been reduced instead of being raised compared to the revised amount granted last year. Allocation to Mission Vatsalya which is meant for Child Protection, Services and Child, Welfare Services too have remained stagnant in the budget presented by the Finance Minister.
The public health expenditure in our country has been much lower than required for several years. According to Oxfam’s “Commitment to reducing inequality report 2020” India ranks 154th in health spending that is 5th from the bottom. It was therefore expected that the government would be serious in budgetary allocation towards health. But it was not to be.
The report further points out that growing socio-economic inequality in India is disproportionately affecting health outcomes of marginalized groups due to the absence of Universal Health Coverage (UHC).
The budget nowhere indicates increase in allocation for the emoluments of the doctors and paramedical staff. Services of the front line health workers, ASHA, Aanganwadi, Mid day meal workers etc. have not been given due recognition. They have not been given the status of a worker in this budget.
Nearly 70% of the healthcare provided in our country is in the private sector. Here the patients have to shelve money from their own pocket. As a result 5.5 crore people are pushed to poverty because of out of pocket expenditure on health every year. With the opening of hospitals by the corporate sector in several major cities of the country the burden of advanced healthcare has further increased on the patients.
The corporate sector has entered the diagnostics in a big way. The diagnostics industry in India is currently valued at $4 Bn. The share of the organized sector is almost 25% in this segment (15% in labs and 10% in radiology). The hospital industry in India, accounting for 80% of the total healthcare market, is witnessing a huge investor demand from both global as well as domestic investors (2).
The whole concept of the healthcare as a service sector and a responsibility of the government has shifted. This is reflected in the budget itself. The per capita public expenditure on health is lowest in India among the BRICS with Russia 61.25%, China 55.64%, South Africa 48.08%, Brazil 40.24% and lastly India 33.76% (3).
It is time that total approach to healthcare to the citizens be reviewed. The present emphasis on insurance based healthcare is virtually passing the people’s money to the private conglomerates. The government has to own the responsibility of providing healthcare services as per the requirement of each individual and the society irrespective of socio economic status.
References :
- https://www.unicefusa.org/media-hub/reports/UNICEF-Child-Food-Poverty
- https://www.investindia.gov.in/sector/healthcare
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334532/
Published in:
https://countercurrents.org/2024/07/budget-2024-25-why-this-neglect-of-health/
70 hour work week detrimental to both health and productivity
Date: 22.07.2024
70 hour work week detrimental to both health and productivity
Dr Arun Mitra
The CEO of OLA, Bhavnish Aggarwal has endorsed a 70-hour work week call given by the Infosys founder Narayana Murthy some time back. He argues against the concept of work life balance saying that enjoyment of work naturally fosters happiness. Both of them are of the opinion that the 70 hour work week is important to build India as the largest economy and number one country in the world. This is not astonishing because primary motive of capitalism is profit. So they come out with several logics to prove their point including talking of pride in service to the nation. But hardly do they care about the basic needs of the workmen and their own responsibilities.
Nearly 94% of the workforce in our country is in the non-formal unorganised sector. They have nothing in store for them when they are unable to work after a particular age or in the event of any illness. They are devoid of any pension, healthcare support or educational benefits for the children. They lack proper housing or healthy working environment. With rising unemployment and economic crisis the uncertainty of jobs or means of livelihood always looms large in their mind.
Bhavnish Aggarwal sees happiness in a workman who is always living in physical and mental stress because of meagre income and no social security to fulfil basic needs to thrive. To mention the plight of the catering staff in the prestigious Vande Bharat or Shatabdi Express trains, who get about Rs.12000/- salary per month for nearly 16-18 hours work per day. This means that their salary for an 8 hour work day is about Rs. 6000/- only. They are always under the threat of being fired by the contractor if they raise voice to increase the salary.
That Capitalism thrives on unemployment and under employment is nothing new. But now, two major corporate magnates have come out openly for increasing the working time to 70 hours per week. This means that a worker should be on job for 10 hours per day for all the even days of the week with no holiday or else if he/she wants a holiday he/she has to work for 12 hours in a day for 6 days in a week.
The proposal for 70 hours work week needs to be analysed from various angles; the trade union angle, health angle, social angle and from the angle of impact of technological developments on production.
As a result of long drawn struggle workers were able to get legal right to eight hours of work, eight hours of sleep and the rest eight hours for recreation and the family. The Trade Unions have rejected 70 hours of work per week as it is clearly against the internationally accepted time framework for the workmen.
According to International Labour Organisation (ILO), people in India spend maximum time on work but are paid the least; meaning thereby, that there is too much exploitation of the workers and violation of the law. This is applicable to the organised as well as the un-organised sector. (Indians Work Longest, Earn Least With Virtually No Time for Leisure: ILO Report). India ranks fifth in the world among countries with long working hours. Only Gambia, Mongolia, Maldives and Qatar, where a quarter of the population is Indian, have average working hours longer than in India(1).
According to global data also Indians work maximum but are least paid. Indians earn 20 times less than developed world peers(2).
There are millions who are working for long hours. Those employed in sweet meat shops or the Gig workers spend long hours on work every day. With the advent of new technological developments, the companies’ production has increased manifold, so is their profit, but the gains have hardly been passed on to the workers (3).
It is a well-accepted fact that productivity increases if workers are healthy and happy. An exhausted person can never give better production. They are also liable to have more accidents and make mistakes. Due to circadian rhythm, that is to say, our daily biological cycles our organism is unable to be productive for 8 consecutive hours. How our body reacts during the day depends on many factors: our hormones, our diet, our exposure to daylight. Scientists studying these issues have found is that we have a very specific biological rhythm. Thus, we are more productive at certain times of the day, intellectually and physically speaking. So this affects all working manually or on the screens as many young people are doing these days (4) (5).
According to an article “Are Shorter Working Days The Secret To A Happier, Healthier And More Productive Life?”, published in Youmatter on 25th September 2017, ‘being in the office for more than 8 hours a day is associated with poorer overall health and with a 40% higher risk of developing heart disease or stress related diseases’ (4). Scientists generally agree that the ideal daily working time is around 6 hours, and more concentrated in the morning.
According to a study published by Insurance Journal, overworking increases the risk of being injured by 61%. They are also at higher risk of having chronic diseases like Diabetes, Arthritis, and Cancer.
Research also reveals the damage to our physical health that overwork can cause. A study from the World Health Organization (WHO) found that working an average of 55 hours or more each week increases your risk of stroke by 35% and your risk of dying from heart disease by 17%, compared to averaging a 35-40 hour workweek (6). People who work long hours are twice as likely to have a major depressive episode, according to a study, especially if they work more than 11 hours per day (7).
Workplace culture is crucial for keeping employees motivated and satisfied. It's important to create a positive environment and encourage the employees.
The decision makers must realize that without a healthy workforce working in conducive environment and guarantee of safety and health, productivity will be hit badly which will be detrimental to the interests of the country, the society and the employers.
It would be an interesting case study to find out the level of happiness in the workmen who work long hours on meagre wages, as Bhavnish Aggarwal thinks.
Mr Narayana Murthy and Bhavnish Aggarwal should have instead talked about workers’ wages as per the inflation and that workers’ wages should match the real profits of the companies. They should have exposed those who are evading taxes and not paying back loans taken from the banks as a result of which the NPA of the banks has increased to 25 lakh crore rupees in the last 10 years and is affecting our economy adversely. To say that workers will be able to think India as their own country only if they work for 70 hours a week is an insult to millions of working people who first fought against the British for our freedom and later put in hard labour for country’s growth even in extremely hazardous conditions on meagre wages.
References:
- https://www.businesstoday.in/jobs/story/indian-employees-work-longest-paid-least-globally-with-no-leisure-hours-claims-ilo-report-289559-2021-02-27
- https://economictimes.indiatimes.com/jobs/indians-earn-20-times-less-than-developed-world-peers/articleshow/4912094.cms?from=mdr
- https://thewire.in/labour/indians-work-longest-earn-least-with-virtually-no-time-for-leisure-ilo-report
- https://youmatter.world/en/schedules-working-days-productivity/
- https://hbr.org/2015/01/the-ideal-work-schedule-as-determined-by-circadian-rhythms
- https://www.who.int/news/item/17-05-2021-long-working-hours-increasing-deaths-from-heart-disease-and-stroke-who-ilo
- https://www.beforesunset.ai/post/how-many-hours-in-a-week-should-you-work
Published in:
https://ipanewspack.com/70-hour-work-week-detrimental-to-both-health-and-productivity/
https://tryxyz.com/article28414-70-HOUR-WORK-WEEK-DETRIMENTAL-TO-BOTH-HEALTH-AND-PRODUCTIVITY
https://countercurrents.org/2024/07/70-hour-work-week-detrimental-to-both-health-and-productivity/
When diplomacy takes a back seat, Humanitarian crisis is bound to increase, including nuclear danger
Date: 16 July 2024
When diplomacy takes a back seat,
Humanitarian crisis is bound to increase, including nuclear danger
Dr Arun Mitra
The missile attack on Okhmatdyt children’s hospital in central Kyiv, Ukraine on 8th July 2024 by the Russian forces is very disturbing. Since the start of the conflict in Gaza 31 out of 36 hospitals have been damaged or destroyed and over 500 healthcare workers killed according to the UN Human Rights Office. Article 18 of the Geneva Convention stipulates that a building designated as a civilian hospital cannot be the target of attack. But this has been ignored despite several appeals including by the UNO.
During the war time it is the vulnerable sections of the society, the children, women and the elderly who suffer the most. It is always heart breaking to see the children crying for help, weeping, sitting by the dead bodies of their kith and kin not really understanding what has happened and what is in store for them in future. Massacre of nearly 15000 children in Gaza as a result of Israeli aggression is the most heinous crime of the on-going times.
Number of non-combatants killed during the modern warfare is much more than the combatants. During the wars during 1990's, more than 90% killed have been the civilians; in fact more children died than soldiers. As a result of changes in warfare strategies over the last decades, civilians have become more vulnerable in the conflicts.
https://www.frontiersin.org/articles/10.3389/fpubh.2021.765261/full
The war causes extreme misery. There is uncertainty of life at any moment of time. Fear of displacement, injury and death always looms large. Normal life pattern comes to a halt. Schools are closed; tourism ends; economy slows down and there is manifold increase in wasteful expenditure on arms. This adds to hunger, deprivation, destruction and cries everywhere in the war zone. Any war in the present day times has serious global impact. Many a time wars lead to destruction of cultures even civilisations. Environment is a big causality in the war. The combined militaries of the world contribute to 6% of the global carbon footprint.
Empathy, love and affection which is a natural behaviour of a person becomes perverted. No empathy is left towards, even children and women. In fact in many war situations children and women are abused; even used as weapons of war.
It is very unfortunate that whereas every incident of war today is easily visible on our home screens, we have failed to stop them. There is no serious collective effort to stop the wars through dialogue. Rather in the last few decades we have witnessed blatant intervention by the big powers in other countries on the pretext of establishing democracy or fighting terrorism. Aggression on Iraq by the US and its allies, armed intervention in Afghanistan in the name of terrorism and aggression on Libya are the examples of these. Their role in armed conflict in Syria and some African countries is well known.
Such acts, instead of cutting down expenditure on arms have added to increase in the world military expenditure which in 2022, rose to $2240bn with $82.9bn spent on nuclear weapons alone. As per the International Campaign to Abolish of Nuclear Weapons (ICAN), in 2023, the nine nuclear-armed states spent $10.8 billion (13.4%) more on their nuclear arsenals than the year before, a total of $91.4 billion, or $2,898 per second on nuclear weapons. Every country increased the amount it spent on nuclear weapons. The United States had the biggest increase, at nearly 18%. The United States spent more than all of the other nuclear-armed states combined, at $51.5 billion. China surpassed Russia as the second-highest spender at $11.9 billion, and Russia came in third, spending $8.3 billion.
This is the time for intense diplomacy to bring down the arms race and to impress upon the global community that expenditure on arms takes away our resources from social needs. The big powers, particularly the G7, need to understand this. It is however very sad that instead of initiating diplomatic means and dialogue, the NATO in its meeting in Washington has promised US$ 43 billion to Ukraine to keep on fighting and defeat Russia.
The double standards of the US government of asking Israel to observe restraint in its offensive on hand but on the other side supplying them large cache of weapons in the name of self-defence are intriguing. Since the start of Israel’s war on Gaza in October 2023 and up to the end of June, the US had transferred at least 14,000 of the MK-84 2,000-pound bombs, 6,500 500-pound bombs, 3,000 Hellfire precision-guided air-to-ground missiles, 1,000 bunker-buster bombs, 2,600 air-dropped small-diameter bombs, and other munitions, the Reuters news agency reports.
The Military Industrial Complex is making roost by selling arms and making huge profits due to the poor diplomatic efforts to end war. The global south, facing its enormous problems of economic development and environment conservation is yearning for peace. It is only in the conditions of global peace that there would be better conditions to increase investment in the poor developing countries and a shift from the war industry to the industry for common good.
It is therefore imperative that diplomatic efforts be increased to end the on-going wars including the Russia Ukraine and War on Gaza in particular. There is also need to have dialogue to sort out conflicts in some of the African counties and to facilitate dialogue in south Asia. In the absence of NAM the BRICS can play some role even though it may not be to the liking of NATO.
It is high time that a broad initiative is taken at the international level to appeal to the nuclear weapons possessing countries to join the Treaty on the Prohibition of Nuclear Weapons (TPNW). They should be made to agree to keep all the nuclear powered weapon system off high alert. The Nuclear Weapons Possessing States (NWS) should declare no first use of nuclear weapons and never to use them on any non-nuclear state. Any escalation of war in Ukraine and Gaza is fraught with the danger of use of nuclear weapons. Any complacency in this matter or lack of diplomatic initiatives to prevent the threat of use of nuclear weapons could be catastrophic.
Published in:
https://www.ehitavada.com/index.php?edition=Mpage&date=2024-07-19&page=8
https://thehillstimes.in/epaper/19-july-2024-epaper
A DOCTORS' DAY PLEDGE
Date: 06.07.2024
A DOCTORS' DAY PLEDGE
Dr Arun Mitra
Every year First July is observed as the National Doctors Day to commemorate Dr. Bidhan Chandra Roy, the second chief minister of West Bengal and a renowned physician, who was born and passed away on this day. This is a special occasion for us to introspect the profession's contributions, achievements and present state of affairs and to draw strategies for future so as to strengthen the role of medical profession in building a healthy society. Therefore the celebrations on this day should not remain merely a ritual with doctors getting greeting from their friends, family members and the pharmaceutical companies. Many associations of the doctors organize seminars, medical camps and other such activities on this day. However a doctor is more than just a professional and practice of medicine is not only a profession but a passion. A doctor tries to allay both physical and mental suffering of fellow human beings. It is therefore important that we work for the betterment of health through scientific analysis of various factors involved in causation of disease.
I was overwhelmed when I got a message of greetings from my daughter in law. Soon, however I realised that this was not just a greetings message but a set of expectations the patient and society as a whole has from a doctor. Whereas the knowledge and wisdom form the basis of our professional expertise, it is the dedication, kindness, support, empathetic, encouraging and compassionate filled words which form the core of medical professional’s duty for the commitment to improving the lives of others and for relieving and healing the pain. In addition it is calming and comforting the fear and being patient. Every day you touch a life and life touches you.
Through the advancement in science and various researches, by far we have learnt that disease is caused because of various factors and is affected by several socio-economic, environmental and political processes. From the ancient description of the diseases in different parts of the world, we have evolved the modern scientific medicine which has tried to study the above mentioned in an evidence based manner. Whereas we are proud of the work done by our ancestors based on the contemporary knowledge, it would be unwise to keep on harping on that. Science has moved forward, so has the medicine. From the time of mythical treatments when man had little knowledge of the happenings around, the human society developed ways of medicine which played a big role during that period. However advancing the existing knowledge the modern scientific developments in medicine changed the concept of pathological processes that caused the disease. So we have developed several new methods of medical and surgical treatment which have changed our lives. The new technology during the recent period has speeded up the advances conceptually as well as in their application manifold.
It is however unfortunate that even today there exists gross inequity in health care delivery system to various sections of our population. This is true globally. The economic disparities between the erstwhile colonial powers and the present day developing countries are reflected in the healthcare delivery as well. This was very obvious during the global COVID pandemic. Many of the developing countries lacked technical knowhow and infrastructure for the management of COVID. They were exploited by the big pharmaceutical companies particularly the vaccine producing ones. The governments of these countries were made to sign one sided agreements if they wanted to purchase vaccines.
Inequality in healthcare delivery is very much present in India too. Whereas every type of advanced facility is available to those who have money, the poor and the marginalised sections, women and informal sector workers continue to face the brunt. As a result of out of pocket expenditure on health 6.3 croe are pushed to poverty every year even today.
As doctors it is painful for us to see patients in such conditions dying without proper quality healthcare. Therefore we have to understand and raise our voice for equity in healthcare. Present day public spending on health is only around 1.2% of the GDP against the required 6%. As doctors we should impress upon the government to increase budget allocation to health.
There is need to increase wages of the population to strengthen their purchasing capacity, to ensure healthy environment and good working conditions. Clean drinking water supply and healthy nutrition is the basic requirement to prevent the diseases. Improvement in social relations and harmony in society is a vital factor to ensure good health to our people. We have to demand changes in the policies which effect health of the people. Violence prevention and resolution of conflicts through dialogue is an issue of serious concern for the doctors.
It is a matter of great worry that there is increasing role of corporate in the medical education and health provision. Their motive is only profit making which is against the basic concept of health for all. Doctors have to learn to resist the pressure of commercialisation to fulfil the commitment for health to all.
Published in :
https://countercurrents.org/2024/07/a-doctors-day-pledge/
Abolish gross inequality to prevent child malnutrition
Date: 27.06.2024
Abolish gross inequality to prevent child malnutrition
Dr Arun Mitra
UNICEF Child Food poverty report 2024 has brought forward startling figures on child malnutrition in our country. As per the report 40% of our children suffer from severe food poverty and 36% with moderate to severe food poverty. Our rank is much below even from our south Asian neighbours with Pakistan at 38%, Bangladesh 20%, Nepal 8% children suffering from severe food poverty. The seven more worse off countries than us are Somalia (63 %), Guinea (54 %), Guinea-Bissau (53 %), Afghanistan (49 %), Sierra Leone (47%), Ethiopia (46 %) and Liberia (43 %).
According to this report poverty for children means ‘they are accessing and consuming fewer than five recommended food groups. These include Vegetables, fruits, grains, protein and dairy. Those fed two or fewer food groups are in severe child food poverty; those fed three or four food groups are living in moderate child food poverty’ (1).
India’s rank in the Global Hunger Index (GHI) is 111 out of 125 countries. It may be noted that the Ministry of Women and Child Development (MoWCD) has refused to acknowledge the GHI report calling it a “flawed measure of hunger that doesn’t reflect India’s true position”. The UNICEF report is in consonance with the GHI and it has corroborated the GHI report.
The UNICEF report emphasizes that ‘the three main drivers of severe child food poverty are poor food environments, poor feeding practices and household income poverty. All stem from failures in food, health and social protection systems’.
It is the duty of government to evolve an economic structure in which every citizen gets the wage sufficient to meet his/her and family’s needs for food, housing, health, education and other several requirements to thrive. Self-earning always gives a feeling of dignity and pride in a person while depending on charity, whether by the people or from the government in the form of so called freebies, lowers ones self-esteem.
It is propagated that tax payers’ money is being wastefully diverted to the population from the low income group in the form of freebies to them. It is also being said that this section of the society does not want to work and so is enjoying the free ration and other facilities from the government. This in fact is far from the truth and insult to the poor working people who are persistently in search of jobs and means of livelihood.
As a result of the economic policies pursued by the government and because of failure to provide jobs or facilitate means of livelihood, the inequality in the population in terms of income and living standard has increased manifold, more so during the last decade. According to the Oxfam (2). India's top 1% owned more than 40.5% of its total wealth in 2021. The top 10% of the Indian population holds 77% of the total national wealth. The number of billionaires increased from only 9 in 2000 to 101 in 2017. Today it stands at 162. Billionaires' fortunes increased by almost 10 times over a decade. Between 2018 and 2022, India is estimated to produce 70 new millionaires every day.
In contrast many ordinary Indians are not able to access the health care they need; 6.3 crore of them are pushed into poverty because of healthcare costs every year - almost two people every second(2).
One would think the higher working hours would reflect in the wages of Indian workers. However, that's not the case. In fact, the minimum statutory wage for Indian workers is the lowest in the world barring some African countries. According to Manya Rathore, in an article published in Statista on 14th May 2024, ‘a majority of Indian households earned between 1,25000 and 500,000 Indian rupees per year in 2021 whereas only 3% accounted for the rich households’(3).
But instead of ensuring higher wages or means of livelihood, the governments try to give subsistence wage and a few doles as charity. For example the Modi government decided to give ration worth 5 kilogram of grains, one kilogram pulses and little bit of oil. Total cost of this comes to Rs.250/- approximately. (It may be noted that even this is not in a constant supply). This is being supplied to 80 crore people which means that the government accepts that nearly 60% of our population lives in abject poverty. However as mentioned above this much ration in no way meets the nutritional requirement of a person. Child is dependent on mother’s milk alone in initial period of life. It is easy to comprehend growth problems in a child if the mother herself is poorly fed.
"India is unfortunately on a fast track to becoming a country only for the rich," Oxfam India CEO Amitabh Behar said. "The country's marginalised - Dalits, Adivasis, Muslims, women and informal sector workers are continuing to suffer in a system which ensures the survival of the richest”. The rich, currently, benefited from reduced corporate taxes, tax exemptions and other incentives. The corporate tax was reduced from 30% to 15% costing the exchequer Rs.1.76 akh Crores. Moreover the loans taken by the corporate sector worth Rs. 25 Lakh Crores were waived off. There has been a repeated borrowing of money from the RBI by the government to meet its expenditure.
Whereas the superrich are getting tax benefits , approximately 64% of the total goods and services tax (GST) in the country came from the bottom 50% of the population, while only 4% came from the top 10%.
A study by the World Inequality Lab points out that the gap between India’s rich and poor is now so wide that by some measures, the distribution of income in India was more equitable under British colonial rule than it is now, according to the group of economists who co-authored the study, including the renowned French economist Thomas Piketty (4).
All this is happening at a time when India wants to become “Vishawa Guru” and boasts of 7% growth claimed by the government. This growth rate is however contested by several economists including Prof. Arun Kumar who has cautioned that actual growth rate could be only around 2%.
For any nation to grow it is of utmost importance that the next generation should be healthy. It is therefore urgently needed that economic policies have to be redrafted to increase expenditure on nutrition, health and education. This would require mass movements in this present atmosphere of corporate driven economy in which vast majority has been marginalized in all spheres. We owe responsibility to our children otherwise the generations to come will not forgive us.
References:
- https://www.unicefusa.org/media-hub/reports/UNICEF-Child-Food-Poverty
- https://www.oxfam.org/en/india-extreme-inequality-numbers
- https://www.statista.com/statistics/482584/india-households-by-annual-income/
- https://www.cadtm.org/spip.php?page=imprimer&id_article=22516
Published in:
https://ipanewspack.com/abolish-gross-inequality-to-prevent-child-malnutrition-in-india/
https://tryxyz.com/article28263-ABOLISH-GROSS-INEQUALITY-TO-PREVENT-CHILD-MALNUTRITION-IN-INDIA
https://countercurrents.org/2024/06/abolish-gross-inequality-to-prevent-child-malnutrition/
Need to Review the whole process of Entrance into the higher education courses
Date: 14.06.2024
Need to Review the whole process of
Entrance into the higher education courses
Dr Arun Mitra
The issue generated after irregularities in the National Eligibility cum Entrance Test (NEET), an examination conducted by the National Testing Agency (NTA) for admission to the medical courses came to the fore has raised many serious questions. First the issue of contention is that a record 67 students obtained a perfect score of 720 out of 23,33,297 who appeared for the test. Never have more than three students got full marks in this test since 2020. Afterwards many students reported that they were not given question paper on time or wrong paper was given to them. The Optical Marks Recognition (OMR) sheet of some students was torn and their results delayed. For no fault of the candidates the result was blocked.
It has to be taken seriously because such situations put the students in extreme mental stress. Many students make more than one attempt. They are even more affected. The students at this tender age are unable to bear the stress as they feel their dreams being lost. They can resort to extreme any step under the stressful conditions.
It should be found out whether there was leakage of papers and at whose behest? That many OMR sheets were torn shows total failure of the National Testing Agency (NTA) which should be held accountable and the concerned persons should be taken to task. Affected students should be given relief like giving grace marks. The NTA has now decided to cancel the grace marks and re-examine 1563 students. Some students have raised the question as to why whole test should not be conducted again because retest for a few under this stressful condition can never be a level playing field and they may not perform as they did this time. In case of re-examination the expenditure should be borne by the National Testing Agency (NTA).
It is an irony that the admissions to the higher education courses have not been streamlined even after so many years. The very basic principle of education for all and its purpose to prepare good citizens and empathetic doctors is being flouted. Instead of becoming means to fulfil the above mentioned objectives education is becoming means to make profits. At one time the marks obtained in the 12th class were the criteria for admission to higher courses. MCQ as the means of judgment of one’s knowledge has limited the scope of assessment at a wider scale. Several coaching centres have come up for the students appearing in the NEET and for various other disciplines too. The schools encourage the students to join the coaching centres and show dummy attendance in their schools. These coaching centres are charging exorbitantly from the students which the students from low socio-economic status are unable to afford. It has also been found that the proportion of students from rural background in the medical profession has come down.
The entrance test was started at national level so as to ensure that the private medical colleges are not able to charge exorbitant fee and not hold their own exams. But they have found other means. The private medical colleges hold mop-up counselling for the students at the fag end of admission process. They charge hefty amounts amounting to crores of rupees. This deprives the students form low income and middle income group students both.
Several states are demanding that they should be given right to take decision in the admission process in their respective states and they be exempted from NEET for the state quota seats. NEET should only be done for the central quota and for central government controlled colleges. This will protect the states’ rights to provide education. It must be recognised that in our country there is diversity in cultures and level of development.
Therefore it is important that the students from low economic status should be supported by the government. Fees in the private colleges should be capped and made transparent including for the management quota seats. The clause of charging government level fees in the private colleges for 50% seats should be effectively implemented. Government should decide the fees for other seats. Students from the rural back ground should be given extra marks in admissions.
It is important therefore to hold detailed dialogue among various stake holders including students’ organisations, teachers’ organizations and academicians to reach a consensus. It is important to ensure that education does not become ‘only for profit’. State should own the responsibility to impart education on the principles laid down by the Kothari commission.
This is not a Hollywood drama but a real saga of cries, death and destruction
Date: 03.06.2024
This is not a Hollywood drama
but a real saga of cries, death and destruction
Dr Arun Mitra
The news that Benjamin Netanyahu, the Prime Minister of Israel, has been invited to address joint session of US Congress has come at a time when the International Criminal Court (ICC) is seeking warrants against Netanyahu and other Israeli and Hamas leaders for "war crimes." This invitation gives him the status of an honoured guest for which he is very excited as per the reports. As head of the government of Israel he is responsible for the death and misery of thousands of hapless children and women. Inviting him to address the Congress session has exposed the hypocrisy of the US administration that has been talking of humanitarian assistance to the war affected people on one side and supplying huge cache of arms to Israel in the name of self-defence from Hamas.
No wonder Israel has condemned the ICC judgment. The US President Joe Biden himself termed the ICC prosecutor’s application for arrest warrants as “outrageous” stating that the US “will always stand with Israel against threats to its security.” Secretary of State Antony Blinken said that he fundamentally rejects the ICC Prosecutor equivalence between Israel and Hamas and that the United States has been clear since well before the current conflict that that ICC has no jurisdiction over this matter (1).
It is interesting to note that human rights attorney Amal Clooney who is among the experts who advised the ICC prosecutor to seek the arrest warrants, in a statement said “I served on this panel because I believe in the rule of law and the need to protect civilian lives. The law that protects civilians in war was developed more than 100 years ago and it applies in every country in the world regardless of the reasons for a conflict,” The human rights lawyer who happens to be wife of actor George Clooney wrote of her participation in a letter on the website of the couple’s Clooney Foundation for Justice (2).
The decision to invite Benjamin Netanyahu has been rejected in strong words by Bernie Sanders who is American politician and senior US senator from Vermont and who is himself Jewish. The ICC is right, Sanders has said. “Netanyahu is a war criminal. He should not be invited to address a joint meeting of Congress. I certainly will not attend."
It is well known that Netanyahu promoted Hamas to counter moderate Palestinian leadership and Palestinian Authority President Mahmoud Abbas. In an article in the Times of Israel published on 8th October 2023, Tal Schneider, a Political Correspondent at The Times of Israel said that for years, Netanyahu propped up Hamas. Now it’s blown up in our faces. Various governments headed by Benjamin Netanyahu took an approach that divided power between the Gaza Strip and the West Bank — bringing Palestinian Authority President Mahmoud Abbas to his knees while making moves that propped up the Hamas terror group. The idea was to prevent Abbas — or anyone else in the Palestinian Authority’s West Bank government — from advancing toward the establishment of a Palestinian state says Tal Schneider(3).
Now Israel has rejected US proposal for a ceasefire and end to war in Gaza. US President Biden has said the new proposal for a Gaza truce is “a roadmap to an enduring ceasefire and the release of all hostages”, adding that “it's time to end this war.” At least 36,379 Palestinians have been killed and 82,407 wounded in Israel's war on Gaza since 7th October 2023. Prime Minister Netanyahu released a statement following Biden's remarks, claiming that Israel is still committed to "the elimination of Hamas' military and governmental capabilities," in addition to bringing home all hostages.
Netanyahu’s talk of finishing Hamas is a farce. Release of hostages could have been done long back through negotiations. Defying all the international appeals the Israeli Defence Forces have attacked Rafah creating havoc in the area. As a result there is unprecedented humanitarian crisis in Gaza. Israel is continuously ignoring international opinion for free transport of humanitarian assistance to the war affected people. The UN has warned several times that there is spread of hunger and diseases. Situation is getting worse in the absence of medical aid as Israel has destroyed most of the hospitals, which is a complete violation of international conventions. All this points to Netanyahu’s bent of mind to annihilate the Palestinians.
Experts warn that 1.7 million people are internally displaced, mostly women and 600,000 children in the Rafah area alone, and they need food assistance, shelter, healthcare, education, water, sanitation and hygiene.
Till now “189 United Nations Relief and Works Agency (UNRWA) staff has been killed by Israel since 7 October 2023—the highest number of UN staff killed in any conflict since the UN’s founding in 1945.” Multiple UNRWA facilities have been targeted, besieged and demolished by the Israeli military, in apparent violation of the principle of the inviolability of UN premises, the experts said (4).
The UN has repeatedly warned that at this existential time for millions of Palestinians in Gaza, who are enduring famine coupled with unfathomable humanitarian conditions, UN operations and facilities must be protected.
It is time for the global community to act and develop broad vision. World has suffered too much when we get carried away and develop hatred towards others on the basis of ethnic or religious identities and even become ruthless towards others forgetting all humanitarian values. We have the examples of death of 800,000 people in Rawanda in tribal violence in a matter of just 100 days. South Asia has seen killings on communal lines several times. World community was unable to save Jews and others from Nazi crimes but the times have changed. We can save the people of Gaza or anywhere else during internal or external strife.
Our inaction can be disastrous. The Military Industrial Complex has its own interests of making profit. But the present day world has its moral duty to stop wars anywhere otherwise this would have serious consequences including use of nuclear weapons. It is duty of all the countries, who are signatories to the UN Human Rights Charter to come forward for restoration of peace in Gaza. Let the peace lovers world over rise to the occasion to save our planet from another catastrophe.
References:
- https://theprint.in/world/us-lawmakers-seek-sanctions-to-punish-icc-over-netanyahu-arrest-warrant-application/2094309/
- https://www.nbcnews.com/news/world/amal-clooney-played-key-role-decision-war-crimes-charges-israel-hamas-rcna153203
- https://www.timesofisrael.com/for-years-netanyahu-propped-up-hamas-now-its-blown-up-in-our-faces/
- https://www.ohchr.org/en/press-releases/2024/05/
Published in:
Healthcare challenges of the elderly Insurance based system has failed to meet their needs
Date: 18.05.2024
Healthcare challenges of the elderly
Insurance based system has failed to meet their needs
Dr Arun Mitra
The Insurance Regulatory and Development Authority of India (IRDAI), has asked health insurance companies to abolish the age limit of 65 years and provide it to everyone, regardless of their age. This sounds to be a good decision. The question however is whether insurance based healthcare system serves the needs of our citizens particularly the elderly.
The older age period of life is full of challenges. Both physical as well as mental capacities start facing a downward trend. With weakening of immune system the likelihood of falling prey to infections increases. Chronic degenerative diseases add to the problems of health. Some of the important and more challenging illnesses include Arthritis, Heart Diseases, Cancer, Respiratory Diseases, Cerebrovascular accidents, Parkinsonism, Alzheimer’s disease, Osteoporosis, Diabetes, Infections, and Depression. This period of life is a time when social connectivity decreases and loneliness ensues.
The India Ageing Report 2023 notes that by 2050, the share of senior citizens — aged 60 years and above — will rise to 20.8 per cent of the population. That is close to 34.7 Crore (1).
In 2020, population aged 70+ years for India was 5.25 crore persons and population aged 75+ years for India was the 2.8 crore persons (2).
Our country has to therefore chalk out strategies to meet economic and health issues of this group of population. Large number of population in this age group does not have its own earning. Chattopadhyay et al. in 2022, found that only ‘some 36% of older adults above 60 years are engaged in income-generating activities. Out of them a mere 5% have full-time jobs, and only 25% have documentary evidence of their current work’. There are 92.4% informal workers (with no written contract, paid leave and other benefits) in the economy. Thus elderly who worked in the informal sector and have given up working now, have no pension and hardly any social benefits (3).
Under such circumstances they have to depend on their children to meet their needs. In some unfortunate situations the things get worse if the family is uncaring and neglecting the elderly. Elderly need compassion. They need emergency care - sometimes repeatedly. Healthcare for the elderly has to be designed accordingly with focus on palliative and rehabilitative care as well for all geriatric illnesses.
Several health schemes have failed to meet the health needs. Barring the CGHS, ECHS and ESIC all other schemes offer only a premium based limited coverage. These schemes including the Ayushman Bharat provide only hospitalization benefits. The OPD care is not covered. For day to day health care people have to visit the doctors in OPD and spend on medicines and investigations from their own pocket.
There are several conditions to be eligible to get the Ayshman card. The people who are not eligible include those who have two, three or four-wheelers, own mechanized farming equipment, they are employed by the government, earn Rs 10,000 per month, they own refrigerators and landlines, they have a decent house, they have agricultural land and they have a Kisan card with a credit limit of Rs 50,000 (4).
As a result large number of population purchase the health insurance from the private or state owned companies. The premium for such insurance is quite high and beyond the reach of common citizens. For example for an insurance cover of 10 lakh rupees a person in the age group of 71-75 has to shelve for basic cover under New India Mediclaim Policy an amount of Rs. 57,024/- plus 18% GST. The outpatient treatment is not covered under this policy. It is not possible for vast majority to pay such high premium.
Therefore it is imperative that government owns the responsibility to provide universal healthcare to the people of the country. This is possible only if there is increase in the budgetary allocation to health to 6% of the GDP. It is unfortunate that the public spending on health in our country is much below many countries. According to Indranil, Professor at the Jindal School of Government and Public Policy, O.P. Jindal Global University, Sonipat, Haryana in an article published in The Hindu on 15th May 2024, per capita public spending on health in India is only (25 $ PPP) Rs.2075/- in comparison to Bhutan (69 $ PPP) 5727, Brazil (347 $ PPP) Rs.28800/-, South Africa (352 $ PPP) Rs29216/- and China (363 $PPP) Rs.30129/- in the year 2021. Brazil’s health spending is 13% of GDP compared to 1.24% by our country. The Union Government’s spending in India on health as percentage of GDP is only 0.28% compared to 0.96% by the states.
The global experience has shown that wherever state has owned and effectively discharged its duty towards universal healthcare, the outcome has been better as compared to those with privatised and insurance based healthcare system.
References :
Published in:
https://www.ehitavada.com/index.php?edition=Mpage&date=2024-05-20&page=8
https://thenorthlines.com/health-care-needs-of-senior-citizens-must-get-priority/
https://ipanewspack.com/health-care-needs-of-senior-citizens-must-get-priority/
https://tryxyz.com/article28015-HEALTH-CARE-NEEDS-OF-SENIOR-CITIZENS-MUST-GET-PRIORITY
Talk of Peace as we remember the victory over fascism
Date: 04.05.2024
Talk of Peace as we remember the victory over fascism
As we observe 9th May as the day of victory over fascism, we are reminded of unprecedented sacrifices made by millions of people who laid down their lives fighting the most ghastly events in the human history. As per the ‘High Point Museum’, ‘World War II that lasted from 1939 to 1945 involved more than 100 million people from over 30 countries. The major participants launched their entire economic, industrial, and scientific capabilities behind the war effort, blurring the distinction between civilian and military resources. World War II was the deadliest conflict in human history marked by 50 to 85 million fatalities, most of whom were civilians in the Soviet Union and China. Causes of death included massacres, the genocide of the Holocaust, strategic bombing, premeditated death from starvation and disease, and the only use of nuclear weapons in war’(1).
There are different estimates of number of dead and wounded in the 2nd World War. As per the ‘National World War II museum, New Orleans’ 15 million died in the battle field, civilian Deaths numbered around 45 million making the total as 60 million deaths. Number of wounded is estimated to be 25 million. Country wise deaths of their soldiers and civilians are Soviet Union 34 million, China 23 million, Germany 14 million, France 7.8 lakh, United Kingdom 8 lakh, United States 0.8 million, India 2.5 million (2).
It is well known that war crimes have no boundaries. The World War II was marred with holocaust in which the Nazis killed most mercilessly 6 million Jews and a similar number of Non-Jews in the concentration camps. These included Soviet prisoners of war, Non-Jewish (ethnic) Poles, Romani men, women, and children and several other.
The nuclear weapons that killed over 200000 people in Hiroshima and Nagasaki changed the whole scenario about the wars in the future. The atomic bombs not only led to immediate death and destitution, but they left a trail of misery for several decades to come as a result of radiation fallout.
The events of the last century should have been a lesson learnt to take effective measures for peace & disarmament and steps for human development through mutual cooperation. The United Nations Organisation was formed to fulfil this aim. It was expected that the UNO will play an effective role in preventing wars and for disarmament. But contrary to the expectations for a peaceful world order, the world saw formation of military pacts in the immediate post war period. The North Atlantic Treaty Organization (NATO) was formed in 1949 by the United States, Canada, and several Western European nations to provide collective security against the communist Soviet Union. As a reaction the ‘Warsaw Pact, formally known as the Treaty of Friendship, Co-operation and Mutual Assistance’, came into existence on 14 May 1955.
After end of the cold war the Warsaw Pact was dissolved on 1st July 1991. There was no logic in continuing the NATO. But instead it continued to increase more countries into its fold. They now started finding new excuses to manufacture and sell arms to reap profits.
As per SIPRI, globally, total military expenditure reached $2443 billion in 2023, marking a 6.8 per cent increase from 2022. This is attributed to surge in on-going conflicts, rising tensions, and global insecurity. "The unprecedented rise in military spending is a direct response to the global deterioration in peace and security," said Nan Tian, Senior Researcher with Sipri’s Military Expenditure and Arms Production Programme (3). In 2023 there were a total of 12512 nuclear warheads out of which deployed warheads numbered 3844 (4).
Several parts of the world are involved in direct all out wars. War in Ukraine has attained dangerous dimensions. As per Russian defence official the Ukraine has lost 500,000 soldiers in this war. The nuclear power plants are under grave threat.
Situation in Gaza is heart rending. Already over 34000 Palestinians mostly children and women have been killed and are facing serious situation of hunger of disease. While the peace negotiations with Hamas look to be heading in the right direction Netanyahu has effectively scuttled them by saying that regardless of outcome Rafah operations will take place.
These situations are a breeding ground for the war industry to grow, even promote the use of nuclear weapons. It is well known by now that a nuclear exchange between India and Pakistan using 100 Hiroshima sized nuclear weapon would put two billion at risk of starvation and death. A nuclear exchange between the major nuclear powers could be the end of modern civilization built through thousands of years of human labour.
Major global powers are playing double standard. On one side the US government is talking of restraint by the Israeli Defence Forces on Gaza, on the other the side they are being given large amount of arsenal.
There are many regions affected by conflicts leading to crisis of hunger and malnutrition. Sudan Chad, Niger, Nigeria, Somalia, Rawanda are some such places. These regions require collective global assistance for resolution of conflict and to meet their basic need.
Paradox of the present day is that the world is adopting war as the only tool to resolve the conflicts instead of dialogue. Most of the world leaders in power today are Narcissist and delusional concerned with their own projection to stick to power. The big powers have made the global institutions virtually ineffective.
Whereas the military pacts promoted use of force, the Non-Aligned Movement (NAM) encouraged the idea of dialogue as the means of resolution of issues. In the absence of NAM the developing countries are missing an effective organisation for peace and cooperation. Thanks to the initiative taken by the South African government in bringing the case of genocide by the Israeli defence forces to the International Court of Justice.
At one time India was taken in good spirit by the developing world. Times have however changed. Prime Minister Narendra Modi does not shy away from rhetoric to make India a big military power who can break into the house and kill. He talks of Nuclear Weapons as a source of security and strength. India remains world’s largest arms importer. No wonder Indian government is becoming close ally of Israel. They are buying arms and establishing armament factories with their support. They even held a joint security exercise with Israel at this time when genocide of Palestinians is being committed by the Zionist government of Israel. Mr Modi is out to generate and arouse Hindu nationalism and demonise the minorities, particularly the Muslims. He calls them intruders even though they form 14 % population of the country. His slogans against the Muslims are similar to the ones given by Hitler against the Jews.
Protests by the University students in the US are the hope, more so as the reports point out presence of Jews among them. Much needs to be done by various peace forces to raise the voice. Any escalation in the conflicts would pose serious threat to the existence of the mankind. We have to promote Treaty Prohibiting Nuclear Weapons (TPNW) to save the world. People’s voice for peace will not go in vain. Tolstoy wrote ‘God Sees the Truth but Waits’.
References:
1. https://www.highpointnc.gov/2111/World-War-II#:~:text=World%20War%20II%20was%20the,the%20Soviet%20Union%20and%20China.
2. https://www.nationalww2museum.org/students-teachers/student-resources/research-starters/research-starters-worldwide-deaths-world-war
3. https://www.business-standard.com/external-affairs-defence-security/news/india-ranks-4th-in-global-military-spending-at-83-6-bn-in-2023-report-124042300540_1.html
Published in:
https://countercurrents.org/2024/05/talk-of-peace-as-we-remember-the-victory-over-fascism/
Patanjali, IMA and the ruthless health market
Date: 27.04.2024
Patanjali, IMA and the ruthless health market
Dr Arun Mitra
The Supreme Court in in its order on 23rd April 2024 has taken the Indian Medical Association (IMA) to task for its alleged unethical conduct over recommending overpriced drugs and line of treatment “for valuable consideration”. The apex court has pointed out that the IMA also needs to put its house in order as there are several complaints, a Bench of Justice Hima Kohli and Justice Ahsanuddin Amanullah said. The Hon’ble court showed concern over several misleading ads of FMCGs (fast-moving consumer goods) which effect health of the babies, school going children and senior citizens. The Court also asked the union of India and the state licensing authorities to activate themselves. It has also directed that the Ministry of Consumer Affairs, Ministry of Information and Broadcasting and the Ministry of Information Technology be made parties to the case, the top court asked the three ministries to file affidavits spelling out their respective stand on various issues raised in the matter.
The Supreme Court verdict has come immediately after the case of Patanjali for its fraudulent advertisements in medicine. It was after the persistent perusal of the issue by Dr Babu K.V from Kannur, Kerala who got the information on various related matter through the RTI. The IMA later filed a petition in the apex court on the plea that Ramdev and Balkrishan Achrya are misleading the people on their products and ridiculing the modern scientific methods of treatment even during the COVID pandemic. Ramdev projected his Coronil without any substantive evidence as a treatment for the disease. It is important to note that this was promoted by the then Health Minister Dr Harsh Vardhan, who is an ENT surgeon trained in modern medicine. Several health organisations had raised concern over the non-evidence based, even mythical methods of treatment being promoted by some of the higher functionaries in the BJP government.
The concerned citizens have been raising voice for the government to implement its commitment agreed upon in the Alma Ata declaration on health in 1978 to ensure health to all citizens. But contrary to what should have been done as per the Alma Ata declaration and state owning responsibility for the healthcare to the citizens, the market forces have taken over control of the healthcare. As a result there is entry of corporates in the health sector leading to conceptual change towards health. For the corporate the health is a business instead of service to the people. This was reflected during the COVID pandemic. Millions of people suffered and even lost their lives but the market forces in the health sector continued to reap huge profits. We have clear cut example of the vaccine making industry globally as well as in our country.
According to Dr Samir Malhotra, Professor of Pharmacology Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, COVID-19 scare forced many governments to enter into contracts with the companies developing vaccines. Many of these contracts had confidentiality clauses according to which the company was exempted “from any civil liability for serious side effects arising from the use of the vaccine, indefinitely”. Not only that, and this is shocking, these countries should “put up sovereign assets as collateral to guarantee indemnity”. Such assets could include embassy buildings, cultural assets, etc.
India has been no better. According to Aparna Gopalan ‘for each dose sold to private hospitals, Serum made profits of up to 2,000 % and Bharat Biotech up to 4,000 %, what might be considered as “super profits”. In India, 38 new billionaires were minted in the first year of the pandemic, while the combined wealth of the country’s 140 billionaires went up by 90.4 %’.
With the purpose to regulate the prices of drugs, National Pharmaceutical Pricing Authority (NPPA) was constituted in 1997 as an independent Regulator for pricing of drugs and to ensure availability and accessibility. Alliance of Doctors for Ethical Healthcare (ADEH) and the Indian Doctors for Peace and Development (IDPD) took up the matter of drug pricing with the NPPA in January 2017. Soon after the then chairman of the NPPA Shri Bhupendra Singh passed an order to reduce the prices of coronary stents. This was welcomed all around. But before he could take a decision on the other products and medical devices he was transferred to some other department. Initially there was some relief to the patients, but the private sector cleverly increased the hospital charges. Ultimately the benefit which should have gone to the patients did not materialise. The NPPA when approached to check the hospitals expressed its inability to intervene in this matter on the plea that this issue did not fall under its jurisdiction.
This clearly proves that under the existing system of private sector’s domination in the health it would not be possible to check their machinations. The Uniform Code of Pharmaceutical Marketing Practices (UCPMP) is being flouted with impunity. The government has ignored its own committee’s recommendations to cap the price of the pharmaceutical products. The committee on High Trade Margins in Prices of Drugs was formed in 2015 September and submitted its report in December. But it has been practically thrown into dustbin.
Nexus between these private companies and the government stands exposed as the pharma companies which were blacklisted for supplying sub-standard drugs were cleared after they purchased electoral bonds for the ruling dispensation at the centre.
Under the circumstances the medical organisations and the doctors fall prey to the existing ruthless market system which lacks empathy. The Hon’ble Apex Court should take into consideration this. Revival of the Public Sector is the only answer if we have to ensure health to all.
Published in:
https://ipanewspack.com/patanjali-private-pharma-companies-and-the-duping-of-indian-consumers/
https://countercurrents.org/2024/04/patanjali-ima-and-the-ruthless-health-market/
Nuclear weapons guarantee catastrophe on our planet To speak in favour of Nuclear weapons is irresponsible
Date: 16.04.2024
Nuclear weapons guarantee catastrophe on our planet
To speak in favour of Nuclear weapons is irresponsible
Dr Arun Mitra
Speaking in an election rally in Pipariya town in Hoshangabad Parliamentary constituency in Madhya Pradesh on 15 April 2024 the Prime Minister Shri Narendra Modi has made a mockery of nuclear disarmament. In his speech he said ‘those who talk of nuclear disarmament cannot protect the country;’ some constituents of INDIA group talk of nuclear disarmament he warned. There can be only two inferences from his statement. One, that he is using it for petty electoral gains by projecting himself as the saviour of the country who talks on the position of military strength. The other inference could be that he is naïve about the catastrophic consequences of nuclear weapons.
It is unfortunate the way the parliamentary elections are being fought this year. There has been too much of use of money and muscle power and state machinery. In addition there is blatant use of religious over tones and communal divide to polarize on the basis of religion to garner votes. In the previous parliamentary election in 2019 we had seen how the Pulwama incident occurred in which our brave soldiers had to pay with their lives. But in the present discourse talking of nuclear weapons is fraught with extremely dangerous implications.
It is well known that South Asia is one of the most deprived regions in the world. Our Human Development Index are very poor. Health scenario in the region is dismal. India is a hub to both communicable and non-communicable diseases. We will soon become Diabetes capital of the world. There is extremely high incidence of Tuberculosis as out of a population of 100000 in our country 36 persons die due to tuberculosis every year. The region needs to spend more on health and education if we have to progress.
Ironically India and Pakistan both the countries spend huge amount on arms race. Both have amassed nuclear weapons which require lot of expenditure on their maintenance. These weapons pose a real threat to the region. India and Pakistan are the only two neighbouring countries who posses nuclear weapons and have fought four full fledged wars. With the perpetual tension between the two countries the use of nuclear weapons cannot be ruled out. Even if the governments decide to refrain from using these weapons, there is a danger of these weapons being used by the non-state actors, through accident or in the event of a natural calamity.
The studies conducted by the International Physicians for the Prevention of Nuclear War (IPPNW) have shown that even a small nuclear exchange between India and Pakistan could kill 20 million people in a week and two billion people would be at risk from death by starvation. There is enough evidence of the catastrophic effects of nuclear weapons from the atomic bombing of Hiroshima and Nagasaki.
At the present juncture the whole world is much worried about the use of nuclear weapons because of on-going wars in Ukraine and Middle East. Iranian strike on Israel in retaliation for an attack that killed top Iranian officers in Damascus has further added to the seriousness of the situation. Israeli Heritage Minister Amichai Eliyahu has already said that dropping a “nuclear bomb” on Gaza is “an option,”. Eliyahu, a minister from the far-right Otzma Yehudit party, said that “one of Israel's options in the war in Gaza is to drop a nuclear bomb on the Strip”. Whereas the world has appealed to Israel to maintain restraint, uncertainty looms large at this hour. The whole Middle East stands at risk with global ramifications.
It is extremely important at this juncture that the movement for nuclear disarmament is strengthened by the civil society as well as the state parties. India can play a significant role in this process. In this context the statement by the Shri Narendra Modi is highly irresponsible. Jingoism has no place in today’s world. It is important to spread the message emanating from the Treaty on the Prohibition on Nuclear Weapons (TPNW).
Published in:
IPA
Why is the government not serious about super-profiteering by the pharmaceutical companies
Date: 25.03.2024
Why is the government not serious about
super-profiteering by the pharmaceutical companies
Dr Arun Mitra
Pharmaceutical companies have been a bone of contention around the globe. Exorbitant profiteering in this industry should not be a priority. But around the world these companies are making huge profits at the expense of people’s health. There is enough data to support super profits by the pharmaceutical companies. During the COVID Pandemic when the people were dying in large numbers, the vaccine making companies made huge profits. Not only that, they forced many developing countries that do not have resources or technical knowhow to make vaccines, to accept the conditions laid down by these companies. These included the clause of no civil liability of the company in case of any adverse reaction to the vaccine. They also made the governments to mortgage their properties as a guarantee.
India has been no better. Aparna Gopalan in an article in The Intercept published on 19th June 2021 has pointed out that ‘for each dose sold to private hospitals, Serum made profits of up to 2,000 % and Bharat Biotech up to 4,000 %, what might be considered as “super profits”. In India, 38 new billionaires were minted in the first year of the pandemic, while the combined wealth of the country’s 140 billionaires went up by 90.4 %’.(1)
After much outcry on the drug prices by the health activists the Government of India formed a Committee on the High Trade Margins in the Sale of Drugs on 16th September 2015. The committee submitted its report on 9the December 2015. The committee pointed that on some medicines the profit margin was up to 5000%. As a remedy it recommended capping of the trade margins and came out with the proposal of graded trade margins with reference to the Price to Trade (PTT). According to their proposal no capping of the trade margins was recommended on the product with a value of Rs.2/- per unit i.e per tablet, capsule, vial, injection, tube etc. But at higher unit price i.e on the product from Rs.2 – Rs. 20 per unit a capping of 50% and from per unit price Rs. 20 – Rs. 50 a capping of 40% and above Rs.50 per unit it recommended a capping of 35% on the trade margins. Even though the committee submitted the report in December 2015, the government has been just sleeping it over till date.
The World health assembly had recommended in 1988 that the Pharmaceutical marketing practices should be controlled, checked, streamlined and made ethical. As a follow up of that the Department of Pharmaceuticals, Government of India formed a code for the pharmaceutical companies named as Uniform Code for Pharmaceutical Marketing Practices (UCPMP) on 19th March, 2012. This made recommendations for the Pharmaceutical companies so that they adopt ethical practices like promoting only the evidence based drugs and desist from over claims and avoid irrational combinations which can be harmful. However the UCPMP mentioned that the code will be voluntary for a period of 6 months after which it will be reviewed and made mandatory if it is found to be not being followed properly by the pharmaceutical companies. The world wide experience however has shown that voluntary codes are hardly practiced. They have to be made legally binding.
Now the government has come up with a new UCPMP on 12th March 2024. Even this new code is not mandatory. It has again asked the companies to voluntarily implement the rules of the code. Companies have been asked to form ethical committees. Their associations too have been asked to form ethical committees. But these committees clearly have a conflict of interest. So it is only a window dressing. Interestingly the punishment to the companies is simply losing membership of the association.
Sensing the need for cost effective drugs, Prime Minister Jawahar Lal Nehru went ahead to establish drugs manufacturing in the Public sector. While inaugurating the Indian Drugs and Pharmaceutical Ltd.(IDPL) in 1961 he cautioned “the drug industry must be in the public sector….. I think an industry of the nature of the drug industry should not be in the private sector anyhow. There are far too much exploitation of the public in this industry”. The IDPL played a major role in the strategic National Health Programmes. Recognising its role, the World Health Organisation commended that “IDPL had achieved in 10 years what others have in 50. IDPL products have been examined for quality very carefully by the developed countries and many of them want to buy from here”.
All this is being reversed now. In 2016, the government took a decision to close two Public Sector Units (PSUs) of the five, namely the IDPL and RDPL. The government had also decided to strategically disinvest HAL, BCPL and Karnataka Antibiotics & Pharmaceutical Ltd (KAPL).
It is well known that the people in our country have to spend on the healthcare from their own pocket. Nearly 70% of this is on the purchase of drugs. It is therefore imperative that the prices of medicines should be within the reach of common man. But government’s indifference is a cause of concern. There is a strong suspicion of government having nexus with big pharma magnates. No wonder some pharmaceutical companies and some healthcare facilities purchased electoral bonds to the amount of 800 crore rupees. This strengthens scepticism over the nexus between the government and the big Pharma magnates.
It is time to review the policy and strengthen the public sector units in pharmaceutical to save corrupt practices and super profiteering at the expense of people’s health. Free market approach to drugs and vaccines will only help the big pharma magnates and add to profiteering while ignoring the people’s health needs.
References:
- https://theintercept.com/2021/06/19/india-covid-vaccine-profiteering/
Published Link:
World needs statesmen, not delusional leadership
Date: 06.03.2024
World needs statesmen, not delusional leadership
Dr Arun Mitra
There was lot of complacency after the end of cold war as several people felt that now we shall enter an era of lasting peace and a world free of nuclear weapons. But this did not happen. The United States and its allies, many of them erstwhile colonial masters, have constantly been putting efforts for a unipolar world. With their designs they have pushed several parts of the world in different continents into armed conflicts.
However this is being challenged by several countries who are taking stand on various issues including disarmament, abolition of nuclear weapons and other weapons of mass destruction. This is apparent from passage of the Treaty on the Prohibition of Nuclear Weapons (TPNW) in the UN General Assembly (UNGA) on 7th July 2017 despite tremendous pressure by the nuclear weapons possessing countries. Several countries after the initiative by the south Africa have contested Israeli genocide in Gaza despite US backing Israel. The developing countries have also raised their voice for changes in multilateral trade agreements, strategy for economic growth based on justice and equality, peaceful coexistence with the neighbours without third party interventions etc. But there is a constant pressure from the big powers to checkmate all these efforts. As a result we are finding tension in parts of Asia, Africa and also Europe. This is threatening global peace and endangering the use of nuclear weapons. Blatant intervention by the NATO backed by the USA for its expansionist designs led to the war between Russia and Ukraine. This has led to internal and external displacement of over 10 million people and death of large number of civilians and combatants. As a result of Israeli aggression on women and children in Gaza with explicit support of the US and allies, situation in the Middle East is like that of holocaust perpetrated by Nazis.
These situations require statesmen at the helm of affairs who have vision and influence and desire to salvage these. Unfortunately that is lacking. The west, particularly the United States of America, is obsessed with power and to sell arms around the world to make profit at the cost of human lives.
Gone are the days of Marshal Tito, Gamal Abdel Nasser and Jawaharlal Nehru, who had the vision to form a non-aligned movement (NAM) that would work outside any military block. During that period the world produced several luminaries who resisted barbaric colonialism and apartheid. It would be most appropriate to mention the name of Nelson Mandela. Rajiv Gandhi put forth an action plan for nuclear disarmament. It was during that period that democracy in different countries flourished.
Things are different now. Unfortunately several of the present day leaders have delusionary ideas. Zelensky for example is happy with claps to greet him in European parliaments without realising their designs. No wonder US & NATO are directly interfering in the affairs in Ukraine and not letting the war to end. The death of Navalny in prison has raised questions over the credibility of Putin. The Chinese leader Xi Jinping wants to rule till the end of his life. We can see North Korea's Kim Jong Un happy with clapping by the parliamentarians. Bolsenaro of Brazil and Trump in the US too fall in that category. Erdogan is out to supress democratic ethos of Turkish society. Several countries which have theocratic regimes are in similar situations.
Such leaders are narcissistic, authoritarian, ruthless, undemocratic, obscurantist and megalomaniac. With their delusionary behaviour they are unstable, unreliable, do not hesitate in telling lies repeatedly and can be a threat to the society. To stick to power they are ready to spread hatred, bigotry, obscurantism and glory of the past without evidence. This are delusional megalomaniac behaviour can be very dangerous. We have seen this in Hitler, Mussolini, Pol Pot and now in Netanyahu.
It is dismaying that in our country we have moved from the days of Nehru to the present day leadership at the helms of affairs who very well fit in that category. Our Prime Minister is always obsessed with building his image and continuously portraying himself with the help of corporate controlled media.
That he always tries to demonise Nehru, only shows his own worth. He cleverly uses Gandhi’s name even though his bandwagon is always abusive of Gandhi and eulogises his murderers. But he never utters a single word on this.
That he has not faced the media even once in the last ten years raises scepticism about his capability. Therefore he believes only in one way discourse. Several of his henchmen have already labelled him as God sent ‘Avtaar’. He is not ashamed to say himself that he has been sent by god. No wonder the BJP chief Nadda called him god of gods. Such people always feel insecure and are afraid of even their own nears and dears.
In such conditions, the only hope is people’s power with vision to save the world from marching towards neo-colonial era. Civil society around the world has a great responsibility to come forward to change the mind-set of the polity. True, the truth shall prevail, but we cannot afford the harm being done.
Published Link:
https://ipanewspack.com/big-world-leaders-are-failing-to-protect-peace-and-security-in-the-globe/
Peace in Gaza now !
Date: 27.02.24
Peace in Gaza now !
India should take a strong position
Amidst the barbaric aggression by the Israel on Gaza and its latest offensive on Rafah, the self-immolation of an active-duty member of the U.S. Air Force 25-year-old Aaron Bushnell outside the Israeli embassy in Washington, D.C., on 25th February, as a protest to the on-going Israeli aggression on Gaza, which he described as a “genocide has sent shock waves around the world. This is also a reflection of anger that is growing against the war mongering policies of his own country’s government. The death of 30000 Palestinians, 70% of which are women and children has moved saner people around the world. There is also sharp division in approach of the global south and many developed countries of the north.
Brazilian President Luiz Inacio Lula da Silva, while speaking to reporters in Addis Ababa, where he was attending an African Union summit, has accused Israel of committing "genocide" against Palestinian civilians in the Gaza Strip and compared its actions to Adolf Hitler's campaign to exterminate Jews. "It's not a war of soldiers against soldiers. It's a war between a highly prepared Army and women and children," he remarked. This is a repeat of what Hitler did to the Jews during the 2nd world war, he said. He had previously condemned Hamas's October 7 attack on Israel as a "terrorist" act. So he is not being partisan in his utterance. His views are confirmed by the latest rhetoric by the Israeli officials who are Justifying the killings of children in Gaza.
Similar statement has been issued by Republican Representative Andy Ogles of Tennessee in the US, who responded to an activist’s question about the deaths of Palestinian children in Gaza by asserting that “we should kill ‘them all”. Double standards of the US administration are obvious. Whereas they talk of humanitarian ceasefire and advise Israel to be cautious in bombing, they are supplying billions of US$ worth arms to them. The US has vetoed Algerian resolution in the Security Council for ceasefire in Gaza. All these are a pointer to serious situation likely to develop in the Middle East and is bound to have global ramifications.
After four months of unprecedented aggression on Gaza the Israel has not been able to find the Hamas or the hostages. Starting from North of Gaza to the center, to the tunnels, the hospitals, schools, every building they have destroyed and evacuated, now they are saying that the Hamas is hiding in Rafah. Palestinians are being pushed to the sea as they have nowhere to go. These happenings are reminiscent of the barbaric era of colonialism and apartheid.
It is now crystal clear that the sole aim of Israel is to eliminate the Palestinians and establish a Zionist regime in that region with the explicit support of the US administration. Western countries' recent decisions to halt aid to the UN agency for Palestinian refugees, UNRWA, after Israel accused some of its employees of involvement in the October 7 attack is totally unjustified as there is no evidence of Israel’s accusations. This has led to spread of disease and hunger among the Palestinians with serious impact on children.
It is most unfortunate and condemnable what happened during the Holocaust. But what the Zionist regime is doing is a repeat of the Holocaust. Any one who questions the Israel’s actions is dubbed as being anti-semitic by Netanyahu. Commenting on the Israel’s repeated talk of anti-Semitism, Russia's foreign minister Sergey Lavrov has said that there was a mass genocide of 6 million the Jews, but there were others too (NUMBER ?) who were killed by the Nazis in the concentration camps. These included Soviet prisoners of war, Non-Jewish (ethnic) Poles, Romani men, women, and children and other people derogatorily labeled as "Gypsies", Serb civilians murdered by Ustaša authorities of the Independent State of Croatia, People with disabilities living in institutions and care facilities, German political opponents and dissenters , Germans imprisoned in concentration camps as "professional criminals" and "asocials", Jehovah's Witnesses killed in concentration camps or executed for refusing to serve in the German military, Gay men, bisexual men, and other men accused of homosexuality Hundreds, possibly thousands Black people in Germany. Total number of these include 6 million. This however does not give anyone right to kill any German of today. It is high time that global community rises to the occasion and stops the genocide otherwise the war is likely to escalate to countries of the middle East. Other countries of the world could enter in it in the same manner as various nations joined the 2nd world war slowly during 1939 to 1945.
It is in this backdrop that the ICJ ruling on Jan 26 ordered Israel to take action to prevent acts of genocide as it wages war against Hamas militants in the Gaza Strip. The top United Nations court for handling disputes between states was ruling in a case brought by South Africa. The court ordered Israel to refrain from any acts that could fall under the Genocide Convention and to ensure its troops commit no genocidal acts in Gaza. A majority of at least 15 out of 17 judges voted in favour of imposing the so-called provisional measures, including the court's president, Joan Donoghue of the United States. Israel however has not made public the action taken in this regard till date.
The UN Secretary General expressed anguish over Israel’s decision to attack Rafah and condemned collective punishment of Palestinians. But despite his several efforts the UN has failed to contain Israel. The multilateral institutions are not properly equipped to deal with the current challenges, as has been demonstrated by the Security Council’s inability to act on the on-going conflicts. Will the G20 group whose chair is now with Brazil will be able to take a position ?.
There have been many peace keeping forces around the world b the UNO but now when situation is most complex and with grave humanitarian crisis that is missing. India as a big country and a big market could have played tangible role but it did not participate in the presentations at the ICJ. Indian government was the leader of NAM at one time but that is completely missing. Instead India changed its position on the relationship with Israel to the extent that India has developed strong defence relations with Israel and has supplied Israel with drones made by the Adani group to carry out operations. Modi government has cleared the recruitment of several thousand Indian workers to work in Israeli companies after the Palestinians were expelled by them. India’s actions are in contrast to the stand taken by several countries of global south. India should come forward to re-emerge as leader of the peace loving developing countries.
Published Link:
https://ipanewspack.com/immediate-ceasefire-in-gaza-is-imperative-to-stop-wanton-killings-by-israel/
Ensure nutritional security
Date: 21.02. 2024
Ensure nutritional security
Dr Arun Mitra
Nutritional security is essential for all-round development of an individual and the society. Only a physically and mentally healthy person can contribute for growth of the nation. Therefore it is imperative that various factors which contribute to nutrition security must be fulfilled. These include good living conditions, healthy working environment, sufficient remuneration to ensure purchasing capacity, diversified crop pattern, trading system based on justice and equality. The government is duty bound to ensure nutritional security of the citizens.
According to 'State of Working India’ report, 82% of male and 92% of female workers earn less than Rs.10,000 a month (1). The Trade Unions have been demanding Rs.26000/- per month to be fixed as minimum wage to fulfil the bare minimum needs of an individual. They have also been demanding laws to ensure healthy living conditions and good working environment. There is need to ensure jobs and means of livelihood through various schemes.
Situation is however not conducive. Unemployment in India is expected to increase in the coming years. The Organization for Economic Cooperation and Development (OECD) had predicted in 2018 that India’s unemployment rate will double from 4% to 8% by 2024, even if the country’s economy continues to grow at a healthy rate. According to a private agency named Centre for Monitoring Indian Economy (CMIE) which publishes the daily and monthly unemployment rate of India, our unemployment rate in 2024 is 7.70%. In Urban India, it is 8.60% whereas in Rural India it is 7.30%. (2). It may also be noted that women workforce in India is only 37% (3) as compared to 50% globally (4).
These reports corroborate with the findings which declared India at 111 rank out of 125 countries in Global Hunger Index as with such low wages and high unemployment rate it is not possible to have a nutritious diet. This is a cause of much worry.
That there arose the need to supply 5 Kg of Grains and one Kilo Gram of Daal to 80 crore people, which is nearly 60% of population, is a reflection of abject poverty. The supply of Grains and Daal may fill their stomach but does not meet their requirements of micronutrients essential for over all physical and mental development.
A balanced nutritious diet means sufficient number of proteins, fats, carbohydrates and micro nutrients in the form of vitamins and minerals. According to the Planetary Health Diet as suggested by the EAT-Lancet Commission on Food, Planet and Health the daily food should include Nuts: 50 g, Legumes (pulses, lentils, beans): 75 gm, Fish: 28 gm, Eggs: 13 gm / day ( 1 egg per week), Meat: 14 gm / Chicken: 29 gm, Carbohydrate: whole grain bread and rice, 232 gm, Carbohydrate: 50 gm of starchy vegetables like potato and yam, Dairy: 250 gm, Vegetables: 300 gm of non-starchy vegetables and 200 gm of fruit, Other: 31 g of sugar and Cooking oil : 50 g. Indian Council of Medical Research too has issued similar guidelines for Indians.
At the present market price the cost of this food per person comes to be around Rs.200/- per day. This means that a family of five members should spend Rs.1000/- per day or Rs.30000/- per month on food only. There is need to bring about changes in the policy framework so that income of the people must increase to sufficient level.
In addition it is important to increase the production of crops which help in providing nutritious food at affordable cost. Crop diversification can help in this. For this farmers must be assured minimum support price of their produce. The Vice Chancellor of the Punjab Agricultural University Dr S S Gosal has supported the farmers demand as it will help in diversification of crops. ‘Convincing farmers to adopt diversification without giving them basic income is not possible. We want assured MSP on all crops which are grown in Punjab if diversification has to succeed’, he said in an interview to the Indian Express on 16th February 2024.
It is being projected that at a higher price it will be difficult to procure the farmers’ produce as it will add to burden on the government. This is fallacious, says Prof Arun Kumar, a leading economist of our country. ‘Whatever the government procures would get sold in the market, so it would only need working capital which would be a fraction of the Rs.10 lakh crore bandied about’ (5).
In our country there is need for permanent solution for public stockholding (PSH) programmes for food security, in which the MSP is a critical component. The developed countries have been constantly pressing the developing countries to cut down subsidies on agriculture. Pressure by the developed countries has to be resisted to frame laws to support our farmers and fulfil nutritional security of our people. Upcoming 13th Ministerial conference of the WTO at Abu Dhabi is an occasion for India to lead the developing countries in pressing our demands. In case of stiff machinations by the developed world we should move ahead to organise the developing countries under the Non Aligned Movement (NAM) which has 120 members, 17 Observer Countries and 10 Observer organizations, for a multilateral trade agreement.
References:
- https://www.businesstoday.in/latest/trends/story/82-per-cent-of-male-and-92-per-cent-of-female-workers-earn-less-than-rs-10000-a-month-state-of-working-india-report-110136-2018-09-25#:~:text=82%20per%20cent%20of%20male,unemployment%20across%20sectors%20and%20industries
- https://www.theglobalstatistics.com/unemployment-rate-in-india/?expand_article=1
- https://www.livemint.com/economy/india-will-manage-8-pc-gdp-growth-by-2030-if-more-women-join-workforce-says-report-11698328560823.html
- https://genderdata.worldbank.org/data-stories/flfp-data-story/#:~:text=The%20global%20labor%20force%20participation,do%20work%2C%20they%20earn%20less.
- https://thewire.in/agriculture/the-solution-to-farmers-problems-lies-in-the-macro
Published link:
The science will triumph
Date: 05.02.2024
The science will triumph
Dr Arun Mitra
No one believed when Copernicus proposed that the Sun was the centre of the solar system and the Earth and other planets revolved around it or when Galileo proposed the principle of the pendulum and the law of falling bodies. They were demonised and persecuted because they said something which was against the popular philosophical religious discourse at that time. Science, which in broad terms means inquisitiveness, rationality, urge to discover and invent, to find the truth and not to believe in what has been told even for centuries without evidence. Discussion and debate are the means to reach a conclusion and not imposition or aggression. Therefore many a times there has been contradiction, even conflict between those who believe in the philosophy of divinity & eternal and those who look for the reasons about the happenings in nature.
Belief systems have been prevalent in every society. The rationalist thought has to struggle to counter them with evidence. Belief to seek blessings of the divine, will stay for long time to come because the nature is so vast and endless that we will never be able to explore it fully. In the ancient times the events in nature were attributed to the celestial happenings and powers beyond our control. Belief in the unknown became a dictum, so must we fear from it. This fear was perpetuated through centuries of propaganda. Those who came up with different ideas were demonized as evil. Questioning would meet aggression, verbal or physical. We have the example of Rishi Charvak in our ancient times who was burnt alive when he tried to question the prevailing Brahminical discourse. Similarly Socrates was made to drink poison for his rational thoughts. But such people never relented from speaking the truth.
As the number of those who questioned has been less, the majority got swayed away by the constant propaganda of belief and fear of the unknown. Slowly this propaganda got organised and took the form of what became to be called as religion. Though the basic concept of religion was belief in the divine and fear of the unknown, the principles and practices varied in different parts of the world. To sustain in public life the religion tried to preach the values system. Whereas science believed in change, the philosophy of divinity was made dogmatic.
The ruling classes have used this to retain and cling to power. King was declared to be God sent. He cannot be questioned or opposed. This was done through clique between the clergy and the ruling circles.
As the society advanced, particularly after the period of renaissance, when new technological developments took place, the voice of rationality and reasoning increased. This has been reflected in some modern philosophies.
The inimical forces however have not taken this lying down. They have used different strategies and there is persistent effort to keep their thoughts alive by eulogising our ancient past, of which every citizen is naturally proud of. Several stories about our ancient past have been manufactured and propagated to appear as truth.
Effort is being made to replace science by the Pseudo-science. The Prime Minister and his bandwagon have taken up this task. They have also promoted some religious preachers to serve them. Even the healthcare has not been left out. We have the statements about using Cow urine and cow dung as treatment for COVID even though they are the waste products with no medicinal value. Worse was that people were made to clap, bang thalies and light Diyas to get rid of COVID in 21 days.
In the recent past such effort has increased manifold. The Prime Minister immediately after the elections in 2014, while addressing a meeting of the doctors in Mumbai, had said that science in ancient India was so much advanced that we could transplant elephants head on human body. Also the Ideas like Udan Khatolas (equivalent to modern space crafts), stem cell research and powerful ‘Astras’ (equivalent to nuclear weapons) are being propagated even though all this sans evidence. People’s mind set is prepared through constant propaganda to believe in such irrational ideas.
These forces always use such manufactured thoughts and people’s beliefs to garner crowds around them. First such trial was done in 1995, when mass hysteria was created around statues of Lord Ganesha drinking milk. This gave such forces an idea that the people can be mesmerized by such obscurantist ideas and may be used to any extent.
During the COVID that experiment was used by asking the people twice to bang Thalies and to clap and shout “Go Corona Go”. They believed in Prime Minister’s statement that we will defeat Corona in 21 days the way we won Mahabharta in 18 days.
The recent example is the frenzy created over the Pran Prathishta in the idol of Ram Lalla.
These forces can turn the situation uncertain and volatile by creating hyper-nationalism, jingoism and aggression. No space is left for debate and rationality.
This will go on for some time. But the truth always prevails and scientific knowledge ultimately supersedes such mythical obsolete concepts. Not long after Galileo and Copernicus were persecuted, their theories were accepted worldwide.
Even today the obscurantist ideas are being challenged continuously. Several people have challenged the concept of putting life into the stone through the ritual of Pran Pratishtha.
Published link:
https://ipanewspack.com/narendra-modi-govt-has-been-spreading-myths-in-the-last-ten-years/
https://tryxyz.com/article27266-NARENDRA-MODI-GOVT-HAS-BEEN-SPREADING-MYTHS-IN-THE-LAST-TEN-YEARS
Students’ suicides is not just a medical problem
Date: 07.10.2023
Students’ suicides is not just a medical problem
Dr Arun Mitra
News of suicides by the students from Kota, a dream destination for the aspirants to get coaching for entry into higher education courses like the Engineering and Medicine, are highly disturbing. These students are the next generation who are to shape the future of our country. End of their life at this tender age is heart breaking for the parents who have nurtured their children with love and affection. They are shattered by this irreparable loss. Parents and other family members are likely to develop significant psychological and physical comorbidities under such circumstances. These incidents are also a warning for the society to introspect deep into the whole issue and find out causes and remedial measures.
According to the National Crime Report Bureau data the number of students committing suicides has grown by 70% over the past decade as per a report published in the Money control (1). The number of students who committed suicides in India rose from 5.7% to 8% of total suicidal deaths in 10 years; that is 7696 in 2011 to 13089 in 2021. This is nearly 70% increase in the decade (2).
In the present day cut throat competition, there is a mad race for getting better score and higher merit. MCQ type of examinations, have become the routine to check one’s knowledge. Purpose of education is to prepare good citizens with ethical values and social concerns. In the growing consumerist culture this has changed and success of a person is measured by entry into prestigious institutions and a career which ensures huge profits. This concept has diminished the trend to join the humanities. As a result large number of present day generation is devoid of information about history, civics, political science and economics. There is too much of inflow of information on the social media which the young people consider as gospel truth. This affects the analytical capabilities. Too much involvement in the online/virtual working has reduced their interaction with the fellow beings. This has adverse impact on personality development and reduces decision making though collective discussion. Mushrooming coaching enters and their glittering advertisements leave powerful impact even though such centers charge exorbitant amount.
There was a time when the students would discuss several issues in groups and make a collective wisdom. Now there is hardly any student movement compared to 40 years back when student organisations would react to increase in tuition fees, bus & train fares and travel passes for students. They would also agitate for improvement of infrastructure in their school or college. There was a trend to organise debates on the education policy, job opportunities, social harmony, gender equality etc. These things are little to be seen.
Lack of physical activity has worsened the situation. Most of the students in the middle and upper middle classes are pampered at home and are unable to bear the stress of cut throat competition once they move out. Undue pressure and expectations from parents puts them under tremendous stress and a feeling of shame in case of non-fulfillment of their desires. When they find that they are unable to satisfy and have lost all hopes, they resort to such drastic steps to end their life.
Whereas there is need for continuous counseling of the teachers, students, families, parents, there is a real need to look at the system of education. “Just giving counseling to a student will not matter much, because society defines a ‘successful’ student as someone who clears IITs or such competitive exams by defeating lakhs of other students. We need a society where a kid’s worth is tied to talent or extra-curricular activities or hobbies they enjoy, not marks,” points out Itisha Nagar, an assistant professor of psychology at Delhi University while talking to The Wire. Societal factors must be addressed in tandem with providing counseling to students according to her (3).
Albert Einstein had said way back in 1949 that “This crippling of individuals is considered the worst evil of capitalism. Our whole educational system suffers from this evil. An exaggerated competitive attitude is inculcated into the student, who is trained to worship acquisitive success as a preparation for his future career.” (4) “If you want your children to be intelligent, read them fairy tales. If you want them to be more intelligent, read them more fairy tales.” “A human being is a part of the whole called by us universe, a part limited in time and space. He experiences himself, his thoughts and feeling as something separated from the rest, a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty.” “Try not to become a man of success. Rather become a man of value.” (5) (6)
We have forgotten the fairy tales era when our grandmother used to tell us stories while going to the bed or gather a few children to narrate events of her past experience. That was preparing a person with a wider vision.
Technological revolution would go on. But we have to make corrective methods to develop a youth of moral values and full of compassion and empathy. This is possible through rationalising education for all with equity as envisaged by the Kothari Commission in 1968. The commission had recommended common school and neighbourhood school system. This would have meant mixing of students from different classes and socio economic groups.
However the whole concept has been thrown into dustbin with the neo-liberal economic policies. Education has gone under the control of elite. This has become a global phenomenon points out Michael Apple, Professor of Curriculum and instruction and educational policy, University of Wisconsin USA. Under the Neo liberal economic policy, education is only for those who have resources while a large section is marginalized and alienated.
It is important that students’ aptitude is taken into account while deciding the future education plans instead of pressure of market forces. In this work facilitators and psychological counsellors can do useful job. The students should be continuously counseled on health and encouraged to involve in recreational and extracurricular activities. This will help their physical and mental growth.
References:
http://www.exponentialimprovement.com/cms/uploads/Einstein%20on%20Why%20Socialism.pdf
https://www.goodreads.com/author/quotes/9810.Albert_Einstein
Published in:
http://epaper.thenorthlines.com/viewpage.php?edn=Main&edid=NLINE_MAI&date=2023-10-10&pn=1#Page/7
https://ipanewspack.com/engineering-students-suicides-issue-is-not-just-a-medical-problem-in-india/
The G20 Heath Declaration
Date: 27.09.2023
The G20 Heath Declaration
Drastic Policy Changes Needed at Global and National Level
Dr Arun Mitra
The declaration on health at the G20 summit has highlighted several objectives. These include Food security; Pandemic preparedness; equitable access to vaccines, therapeutics, diagnostics, and other medical countermeasures. Concern was shown for growing Antimicrobial Resistance (AMR), Mental health problems and the impact of climate change on health. The declaration also gives importance to the potential role of evidence-based Traditional and Complementary Medicine. The summit took up serious debate over the increasing use of narcotics around the world. In this background the declaration emphasized that to achieve better health of the citizens, the global health architecture is to be strengthened.
Since nutrition is the basic requirement for health, it is important to gauge the status of nutrition around the world and in our country. As many as 828 million people were undernourished in 2021 globally. Poverty, inequality, inadequate governance, poor infrastructure, and low agricultural productivity contribute to chronic hunger and vulnerability. South of the Sahara in Africa and South Asia are the regions with the highest hunger levels and are most vulnerable to future shocks and crises (1).
According to Bhavani R V in The Hindu dated 1st January 2023, the UN Food and Agriculture Organisation's (FAO) report on ‘Food Security and nutrition in the world’ puts the number of people undernourished in India in 2019-21at 224.3 million i.e., 16% of 1.4 billion population (2). India is 107 among 121 countries in the Global Hunger Index (GHI). The countries which fall below this are Sierra Leone, Uganda, Djibouti, Congo Rep., Sudan, Afghanistan, Zimbabwe, Timor-leste, Haiti, Liberia, Zambia, Madagascar, Chad, Yemen Rep. and Central African Republic.
The countries of the global south need food security for their citizens, but under the neoliberal economic policies and the diktats of the World Trade Organisation (WTO), many countries had to dismantle programs for food security (3). This has adversely affected nutritional status of the people. Situation is so pathetic that in India 800 million people were provided with 5 Kg of grain and one Kilo of cereals. This may fill their stomach but lacks the micro nutrients essential for physical and mental growth.
Equity in the supply of medicines, vaccines and other countermeasures has been a big challenge. The big vaccine producing companies exploited the situation during COVID Pandemic. They even forced the small counties to mortgage properties of their embassies as a guarantee for the supply of vaccines.
These vaccine making companies made huge profits at the cost of human needs. Pfizer made nearly $37bn (£27bn) in sales from its Covid-19 vaccine in 2021– making it one of the most lucrative products in history. The US drug maker’s overall revenues in 2021 doubled to $81.3bn says Julia Kollewe in the article published in The Guardian on 8th February 2022 (4).
The Indian government’s free-market approach to vaccine distribution too has ensured profit to the companies over lives of the people. Aparna Gopalan in an article in The Intercept published on 19th June 2021 has pointed out that for each dose sold to private hospitals, Serum made profits of up to 2,000 % and Bharat Biotech up to 4,000 percent, what might be considered as “super profits”. In India, 38 new billionaires were minted in the first year of the pandemic, while the combined wealth of the country’s 140 billionaires went up by 90.4 % (5).
In the G20 there is ample opportunity for India to highlight the health problems facing the developing world in general and India in particular. This is also time to set the direction for global equity in health care.
As per the WHO there were 6,943,390 deaths globally till 14th June 2023. Unofficial figures could be even higher! During the Pandemic, the problem of unavailability of drugs, equipment and vaccines has been very acute. Smaller countries that lacked resources and knowhow to make vaccines or drugs suffered the most.
Developing countries which have so far been faced with pressure of communicable diseases, are now feeling the burden of the non-communicable diseases as well. India is hub to both communicable and non-communicable diseases. According to Global TB Report 2022 released by the World Health Organisation (WHO) there were 505000 deaths due to Tuberculosis in India in 2021 which comes to 1383 deaths per day(6).
The Non Communicable Diseases (NCD) too are at alarming level in India. Indian Council of Medical Research–India, Diabetes (ICMR-INDIAB) study, found prevalence of Diabetes among 11.4 per cent population. The new study published in The Lancet puts the prevalence of hypertension at 35.5 per cent; general obesity at 39.5 per cent and dyslipidemia (lipid imbalance which can cause heart diseases) at 81.2 per cent. One in every three Indians has hypertension and two in five are obese (7).
Based on the above it is important to envisage the steps required to bring down the disease burden. Disease prevention and control programmes have to be designed accordingly.
It is important to develop policies for inclusive growth which ensure jobs with proper remuneration and means of livelihood to all. Purchasing capacity of the people has to be improved to meet the nutritional requirements. To utter dismay the government has fixed floor level wage at Rs.178/- per day or Rs.5340/- per month in the wage code bill approved by the union cabinet. Trade unions have however demanded Rs.26000/- as the minimum wage to ensure healthy living.
To promote equity it is important to make necessary changes in the WTO. The intellectual Property Rights and the Patent laws at present benefit the big companies. Whole issue whether the drugs should be patented has to be reviewed. The founder of ORS, Dr Dilip Mahalanabis never patented his product saying that this is for public good and not for making profits. Will the companies and the governments follow suit? Many public health experts agree that a temporary waiver of the World Trade Organization’s Trade-Related Aspects of Intellectual Property Rights, or TRIPS, provision is a necessary first step toward increasing vaccine production and access and creating a more competitive pharmaceutical industry worldwide. Drug pricing policy has to be streamlined effectively to check exorbitant profits.
With Africa inducted into the G20 there is a good chance to develop communication between India, Africa nations, Argentina and Brazil to forcefully take up the matter of bringing changes in the TRIPS. The developing countries should exchange the technical knowhow to check mate the pressures from the developed world. The clause of compulsory licensing in the WTO should be used more frequently.
Finance allocation to health in our country has to be increased substantially. It has been hovering around 1.2% of the GDP as against the minimum required of 6%. Allocation to R&D in health has to be increased.
There is need to revive the manufacture of drugs, vaccines and medical equipment in the public sector so as to produce them at lower cost with quality control.
Health education of the people on scientific grounds is important so that they do not fall prey to the unscientific, non-evidence based treatment modalities like the use of Gau Mutra (Cow Urine) or Cow Dung.
To ensure equitable health services it is important to take bold initiatives. State should own the responsibility of healthcare to its citizens. Insurance based healthcare benefits only the insurance companies. Senior citizens are worst effected in such cases as they are unable to pay hefty premiums.
India can play a big role if our approach is not limited to mere electoral gimmickry. Time only will tell whether the Indian government stands up to its commitment. The civil society however should continue to put pressure.
References:
- https://www.globalhungerindex.org/trends.html#:~:text=In%20many%20countries%20across%20regions,million%20people%20undernourished%20in%202021.
- Road to a malnutrition-free India | Latest News | The Hindu
- https://en.wikipedia.org/wiki/Criticism_of_the_World_Trade_Organization
- https://www.theguardian.com/business/2022/feb/08/pfizer-covid-vaccine-pill-profits-sales
- https://theintercept.com/2021/06/19/india-covid-vaccine-profiteering/
- https://www.businesstoday.in/latest/trends/story/despite-increased-budget-estimated-tb-deaths-rise-in-india-whos-global-tb-report-2022-351182-2022-10-29
- https://www.business-standard.com/health/over-11-4-indians-diabetic-35-5-suffer-from-hypertension-lancet-journal-123060900263_1.html
Published in
https://thearabianpost.com/india-can-take-the-lead-in-implementing-health-equity-of-g20-declaration/
https://ipanewspack.com/india-can-take-the-lead-in-implementing-health-equity-of-g20-declaration/
https://www.ehitavada.com/index.php?edition=Mpage&date=2023-09-28&page=8
No talk on nuclear weapons abolition in the G 20 summit is disappointing
Date: 12.09.2023
No talk on nuclear weapons abolition in the G 20 summit is disappointing
The G20 summit publicized with much fanfare ended without any commitment for disarmament and abolition of nuclear weapons. There were several expectations from this summit since it was held in the background of on-going war between Russia and Ukraine; and it was held in India which has been a strong protagonist of a nuclear weapon free world. Therefore, it was felt that some concrete decisions will be taken on the issues of disarmament and peace.
Concern has been expressed in the declaration over the humanitarian consequences of war. The declaration says in point 7 on page 2 ‘we note with deep concern the immense human suffering and the adverse impact of wars and conflicts around the world’. On the same page in point No. 8 the declaration mentions ‘The use or threat of use of nuclear weapons is inadmissible’. So it was imperative to expect that some concrete steps would be taken to end the Russia Ukraine war and for abolition of nuclear weapons which pose an existential threat to the mankind today.
The G20 summit is the meeting of heads of the states or their representatives. They have the authority to take concrete decisions to end Russia Ukraine war. But the declaration released reads on page 2 point 8 ‘concerning the war in Ukraine....we reiterated our national positions and resolutions adopted at the UN Security Council and the UN General Assembly (A/RES/ES-11/1 and A/RES/ES-11/6)’ These resolutions condemn the Russian invasion but nowhere mention the explicit involvement of US and NATO who are supplying huge consignments of arms to Ukraine to let the war continue and create a situation that no meaningful dialogue is held to end the war.
In the G20 there were 6 nuclear weapons possessing countries out of total of nine. The USA and Russia together possess about 90% of the world's nuclear weapons. This was the opportunity where thrust of the discussion could have been on steps to be taken to abolish nuclear weapons and avoid existential threat.
‘Nuclear Famine’, a study by the International Physicians for the Prevention of Nuclear War (IPPNW) in collaboration with Physicists, Biologists,’ Climatologists and other scientists has shown with evidence that even a limited nuclear exchange between India and Pakistan using 100 nuclear weapons would put two billion people at risk of survival. A nuclear exchange between Russia and USA-NATO would kill over 5 billion people and mean end of the modern civilization built through thousands of years of human labour.
The Treaty on the Prohibition of Nuclear Weapons (TPNW) passed by an overwhelming majority of the members of the U N General Assembly on July 7 2017 and which has already entered into force is an opportunity not to be lost. The countries present could have decided to join the TPNW and taken concrete steps to abolish nuclear weapons.
The summit also failed to elaborate steps to check proliferation of small arms. Many areas of the world are involved in large scale armed conflicts particularly in the African continent. Point 74, on page 28 in the declaration expresses concern about illicit trafficking and diversion of small arms and light weapons and calls for international cooperation among states to combat these phenomena, including export, import controls, and tracing. However, there is no mention of state sponsored terrorism, nor a word on controlling legal arms supplies which are ultimately used in violence around the world. Many countries gathered at this G20 meet have gun producing industries located on their land. These governments can very well take steps to check the proliferation and trading of small arms.
The final declaration on this score is very disappointing. India could have easily taken a lead on this as India had been the founder member of the on Aligned Movement (NAM). The seventh summit of the NAM held in Delhi in 1983 had 117 heads of the states and 20 observers. It was much bigger an event then the present one. The NAM summit held serious discussions on disarmament, peace, human rights, on the issue of Palestine and economic development of the underdeveloped world through mutual cooperation. But such issues were not given due importance in the debate in the G20.
The G20 failed to take cognizance of the growing lust for profit by the Military Industrial Complex. A day before the event, US President Joe Biden on arrival said that this is a good opportunity for defence deals with India. Shri Munish Tiwari Member Parliament has raised scepticism on the India-US joint statement after the bilateral meeting between Prime Minister Narendra Modi and US president Joe Biden on 8th September 2023. The statement says “The leaders applauded the conclusion of a second Master Ship Repair Agreement, with the most recent agreement signed by the U.S. Navy and Mazgaon Dock Shipbuilders, Ltd., in August 2023. Both sides recommitted to advancing India’s emergence as a hub for the maintenance and repair of forward-deployed U.S. Navy assets and other aircraft and vessels….” With this India would emerge as 'a hub for the maintenance and repair of forward-deployed U.S. Navy assets and other aircraft and vessels.' So far India has not provided its space for any such activity.
Published in:
https://ipanewspack.com/no-talk-on-nuclear-weapons-abolition-in-the-g20-summit-is-disappointing/
People are struggling with health issues in the relief camps of Manipur
Date: 07.09.2023
People are struggling with health issues in the relief camps of Manipur
Dr Arun Mitra
People of Manipur have a glorious history of resistance against the British imperialism. They struggled hand in hand with the Indian National Army (INA) led by Subhash Chandra Bose to free the country from the yolk of colonialism. But the state of Manipur is in crisis these days. Insensitivity of the government towards the state was apparent for a long time, but silence of the Prime Minister even after the video showing women being paraded without clothes went viral on 19th July 2023 proves the point. This insensitivity led to deterioration of the situation; as a result the violence continues unabated.
Health is a major victim under such circumstances. People lose their life, get injured and develop mental stress. It is in this connection that a five member team of Indian Doctors for Peace and Development (IDPD) including two women doctors visited relief camps in the valley and hills of Manipur on 1st and 2nd September 2023 in both Meitei and Kuki areas to assess the health conditions in the relief camps.. The team members had come from Punjab, Bihar, Tamilnadu and Telangana. The team visited the relief camps in Khumanlankpak sports hostel in Imphal district and IIT relief camps under Sapormeina Primary Health Centre (PHC) in Kangpokpi District in hill areas. There are 334 relief camps in Manipur at present. The team of doctors met inmates and nodal officers of the relief camps, officials of health department, workers of Civil Society organisations and officers of district administration.
It was observed that the referral systems for seriously ill patients in the relief camps in hilly areas are far from satisfactory. The displaced people in the hills of Manipur informed us that they had to travel to Nagaland covering a distance of up to 150 KMs to Kohima or Dimapur to get medical assistance in case of even moderately ill patients. Some of them even travel to Assam for their medical needs. Earlier, before the ethnic violence, they were referred to medical colleges in Imphal for better treatment. Now the movement of citizens from hills to valley and vice versa is impossible due to on-going ethnic conflict in Manipur.
Kangpokpi district hospital presently has neither an operation theatre nor blood storage facility. Manipur State is also facing acute shortage of specialists and other doctors and health workers. Vast majority of Specialist doctors and the medical college hospitals of the state are located in Imphal district (3 medical colleges) and 4th at Churachandpur district in the hills is at beginning stage.
As there is crowding in the camps the chances of Measles epidemic are very lightly in such situations it is imperative that children be immunised against Measles. The team found that no special immunisation drives especially against Measles has been undertaken in the visited relief camps. Measles Vaccine Immunisation drive in children above 9 months along with Vitamin A oral suspension is imperative for relief camps according to United Nations Humanitarian Commissioner for Relief (UNHCR) SPHERE standards.
Nutritional requirements of the peoples are far from being fulfilled. The inmates and nodal officer of a relief camp in the valley said that no green leafy vegetables/ eggs/ meat/fish has ever been supplied in the ration of inmates by the government; although, local community, Civil Society Organisations and few individuals provide few vegetables sometimes. Another nodal officer in a relief camp in hills told that they get one egg per inmate once every 13 days, but green vegetables are not supplied. Rice, Dal, Potatoes and cooking oil constitute the bulk of ration supply in the relief camps. The absence of green leafy vegetables and animal proteins in the diet of children for last four months may lead to night blindness which is caused by Vitamin A deficiency.
Availability of potable drinking water and water for bathing/washing/in toilets are not sufficient in quantity. Sanitation needs to be improved by many folds. Supply of Sanitary napkins to maintain good menstrual hygiene in relief camps is insufficient. There has not been fogging for mosquito control in and around relief camps which threatens the danger of spread of Dengue and Malaria.
The inmates informed that they are facing lots of mental stress by staying in relief camps for the last 4 months and they are not sure when they will go back to their homes or will they ever go back to their homes? Children are missing their schools and friends adding to their worries.
Many children are having nightmares. These are signs of Post-Traumatic Stress Disorder.
We found patients of Non Communicable Diseases like – Diabetes, High Blood pressure, Chronic Kidney Diseases etc in the relief camps. A couple of patients required haemodialysis of the patients in the hills.
Much needs to be done to allay the situation. There is urgent need for robust referral systems after triage from primary health centres to higher relief centres both within the Manipur State and neighbouring state should be put in place at the earliest. Fabricated Operation Theatres should be made operational at district and sub district level with immediate effect. Blood storage units should be started around relief camps after cluster formation.
Internet services should be restored in all health facilities around relief camps so that tele-medicine services can be available to the inmates of relief camps at the nearest health facility. These tele-medicine facilities can also be used in training of Basic doctors in performing Peritoneal Dialysis (for Renal failure patients) and other skills like use of Ambu bags in case of Respiratory Distress Syndrome among children, counselling of mothers for breastfeeding of new born children etc. Both central and state governments should implement the UNHCR SPHERE standards on meeting the health needs of the displaced people sheltered in relief camps.
A strong medicine and vaccine supply system should be made functional and a real time monitoring of the stocks of medicine at ground zero level should be done. Immunisation against Measles and providing Vitamin A supplement to children should be undertaken immediately. Supply of good nutritious food like green leafy vegetables, milk, eggs, meat, fish should be ensured for all categories of the inmates in the camps. Fogging for mosquito control should be done in and around relief camps should immediately be undertaken.
Mental health issues are invariably ignored in such situations. There is urgent need for psychological counselling of inmates so as to prevent Post Trauma Stress Disorder. This should be a regular feature in the relief camps.
There is a huge lack of trust among people. So to create mutual brotherhood and trust between Kukki and Meitei groups a lot of work needs to be done. Peace committees should be formed to prevent violence. Constructive dialogue between the stake holders should be initiated. The government will have to be sensitive and take initiative about these things and take constructive steps along with people's organizations.
Published in:
https://thearabianpost.com/people-are-struggling-with-health-issues-in-the-relief-camps-of-manipur/
https://ipanewspack.com/people-are-struggling-with-health-issues-in-the-relief-camps-of-manipur/
From Non Aligned Movement to G20
Date: 29.08.2023
From Non Aligned Movement to G20
Challenge of peace and health
Much euphoria is being created about the upcoming G-20 meet in Delhi next week. The high pitch is particularly to project that it is because of Prime Minster Narendra Modi that India has got the chairmanship of the group. Truth of the matter is that in the G-20 there is a rotatory system of chairmanship. In fact India could have been the chair of the G20 last year but it was delayed by one year. The G20 has several agendas to discuss, but the most important ones are the global peace and health for all.
World today is in a very critical situation because of on-going armed conflicts in several parts. The conflict between Russia and Ukraine is the most serious one at this juncture. As per the UNO over 14400 people have been killed including 3604 civilians. Over 8 million people have been displaced externally living as refugees in other countries.
The issue has not remained just between Russia and Ukraine; with the explicit involvement of US and NATO the things have gone too far. Both sides have warned of use of nuclear weapons. After the US President Joe Biden issued the statement that they would supply cluster weapons to Ukraine, Russia has warned that in that case they would be left with no other option but to use nuclear weapons. This is a very dangerous situation because any nuclear exchange at this time on that border will not remain between Russia and Ukraine; it will be a nuclear exchange between Russia and USA & NATO. As per the latest scientific studies this would mean death of over 5 billion people which would be an end of modern civilization built through thousands of years of human labour. Study conducted by the IPPNW and the environmental groups has already shown with evidence that even a limited nuclear exchange, for example between India and Pakistan, would lead to death of over 2 billion people. But an exchange between Russia and US would be much more catastrophic.
In addition there are conflicts going on in different parts of Africa and Asia. These internal strife have International support in one form or the other for various economic interests of the rich nations. The situation in Palestine or in Syria are examples of extreme human rights violations. It is therefore important that the G20 takes a firm decision on such issues of nuclear disarmament and check on the proliferation of small arms.
However it seems unlikely because the G20 is not a homogenous group. It is a group of countries with self-interests dominated by the multinational corporations and military industrial complex. This is in contrast to the Non-Aligned movement (NAM) which took effective steps and raised serious concerns on the issue of disarmament, development and human rights in different countries. It is well known that India had played significant role at that moment. NAM was founded at the initiative of Jawaharlal Nehru, Marshal Tito and Abdul Gamal Nasser. The NAMs 7th summit was held in Delhi in 1983 in which heads of the states from 117 countries participated and there were 20 observers from several countries. In contrast, the G20 is a tiny event but with much hype.
It seems unlikely that the G20 meet would come out with a firm declaration to abolish nuclear weapons which is now possible through a multilateral Treaty on the Prohibition of Nuclear Weapons (TPNW) passed by the UNO on 7th July 2017. There is a strong lobby within the G20 who opposed the TPNW in the UNO and put tremendous pressure on the members of the UN General Assembly. These countries are the protagonist of theory of nuclear weapons as a deterrent.
It is very much unlikely that G20 will come out with a concrete decision on health for all which requires equitable distribution of resources for healthcare. We have in fact witnessed how the Pharmaceutical companies particularly vaccine producing companies played havoc during the COVID pandemic and blackmailed smaller countries who did not have either technical knowhow or resources to produce vaccines on their own. Big Pharma companies are known to have made huge profits during the period. For any talk on health for all, affordable drug pricing and equitable healthcare, the Pharma companies have to be regulated and their profits made transparent.
It would be good to watch the on-goings of the G20 and outcome in various sectors. But the countries which are there the USA the England the France have pro corporate ideology and economic interests. Will they be ready to part away with the arms or will they be ready to make effective changes in the world trade organization so as to meet the requirements of the developing countries for health for all.
As chairperson of the 7th non-aligned summit India played a big role in organizing the developing countries on the one goal of this disarmament, equitable development, human rights, health for all etc. They passed resolutions supporting the cause of Palestinians and on other issues of human rights.
For such decisions there is need of statesmanship. That statesmanship is lacking in our polity at present.
Reference:
Published in:
https://theshillongtimes.com/2023/09/01/major-issues-including-global-peace-and-health-on-agenda/
https://thehillstimes.in/epaper/02-september-2023-epaper
https://ipanewspack.com/from-non-alignment-to-g-20-summit-in-delhi-next-week/
https://tryxyz.com/article25969-FROM-NON-ALIGNMENT-TO-G-20-SUMMIT-IN-DELHI-NEXT-WEEK
In the absence of appropriate policy, National Medical Commission’s directive to prescribe in generic names is meaningless
Date: 21.08.2023
In the absence of appropriate policy, National Medical Commission’s directive to prescribe in generic names is meaningless
Dr Arun Mitra
The latest notification of the Board of Ethics of the National Medical Commission (NMC) has asked the doctors to prescribe medicines with pharmacological names. Earlier too The Indian Medical Council (Professional Conduct, Etiquette & Ethics) Regulations, 2002, clause 1.5 mentioned use of Generic names of drugs. - “Every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of drugs”. But the difference is that the NMC notification has warned punitive action including fine even cancellation of license.
This has generated debate among the medical professionals. It has been a long standing demand of the public health activists that medicines should be prescribed with their pharmacological names. This will exclude the branded drugs and bring down the cost.
The concept of generic medicines arose because the branded medicines had high cost.
The Pharmaceutical companies spend huge amount of money for promotion of their products. The high cost of drugs seriously affects the healthcare of our population. As nearly 67% of out of pocket health expenditure in our country is on drugs. High out of pocket expenditure pushes 6.3 crore population below poverty line every year, a fact admitted in the National Health Policy document 2017. On the other hand the generic drugs are non-branded so they save the money used in promotional activities.
Having sensed this, our first Prime Minister Jawahar Lal Nehru took initiative to produce the drugs in the public sector with the purpose to produce cheap bulk drugs. While inaugurating the Indian Drugs and Pharmaceuticals Ltd. (IDPL) in 1961 he said “the drug industry must be in the public sector….. I think an industry of the nature of the drug industry should not be in the private sector anyhow. There are far too much exploitation of the public in this industry”. With this vision, Public Sector Unit Indian Drugs and Pharmaceuticals Ltd. (IDPL) was incorporated in April, 1961. IDPL played a pioneering infra-structural role in the growth of Indian Drug Industry base and produced cheap bulk drugs. It played a major role in the strategic National Health Programmes like Family Welfare Programme & Population Control (Mala-D & Mala-N) anti-malarial (Chloroquine) and prevention of dehydration (ORS) by providing quality medicines. Similarly the Hindustan Antibiotics Ltd (HAL), Central Research Institute (CRI) Kasauli were founded.
In addition to the actual generic drugs which are produced and sold solely by the pharmacological name, several companies have come out with brand names of low cost product; they are branded generics. They are cheaper than the branded drugs but more expensive than the actual bulk non branded generic drugs.
One of the contention of those opposing this is that the Generic drugs are low in quality. It is therefore important that these drugs should meet the criteria of bio-equivalence and efficacy. These criteria need to be regulated by the competent authorities in a similar way as for the branded drugs.
To make doctors prescribe only the Generic names it is important that the branded drugs have to be banned. Otherwise doctors will write generic names but the patients will be left to the mercy of the chemists who will give the brand of his choice. This will obviously be the one which has high profit margin.
To check the high trade margins, a committee was formed to look into High Trade Margins in the Sale of Drugs on 16 September 2015. This committee took serious note of the excess trade margins. They pointed out that in some cases the trade margin is as high as 5000%. This committee submitted its report on 9 December 2015. But it is now almost 8 years that the government has been sleeping over it.
There has to be evolved a method to calculate the cost of drugs. It is important that the cost of the drugs be calculated as per the cost of production with a defined trade margin.
There is a big flaw in the price of the many generic drugs. The difference between the Maximum Retail Price (MRP) and the actual purchase price of the drug is exorbitant. This has to be corrected.
To curtail the profit margin in the drugs a powerful regulatory mechanism has to be made. The public sector units which produced cheap drugs should be encouraged. It is sad to note that the government has been pushing the drug production in the private sector. The public sector units like the IDPL have been made virtually non-functional. The Union Cabinet’s recommendation in its meeting on 28th December 2016 to close down and sell the pharmaceutical PSUs is a big blow to the concept of the state ensuring affordable, and possibly free-of-cost, medicines for millions.
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Doctors can play positive role in correcting social aberrations
Date: 08.08.2023
Doctors can play positive role in correcting social aberrations
Dr Arun Mitra
Recent happenings in several parts of the country have shaken the consciousness of saner elements in the society. At the time of independence education level was very low, poverty was at its peak, GDP was a mere Rs. 2.7 lakh crore for a population of 34 Crore which accounted for nearly 3% of world's total GDP. At that time the people of India chose to adopt a constitution based on secularism and democracy. This was despite that there were large scale communal riots and biggest ever migration of population in the world at the time partition. These events did not deter people’s decision for a harmonious society. Baring a few incidents in between, people of the country have lived together without any hatred towards others since then. Now, when we have grown in all spheres and are aspiring to be a 5 trillion economy a section of our people are surcharged on communal lines and hate against others and have developed bias and prejudice in their minds. This mentality which a section of the society has developed is against the very concept of humanism that India has always stood for.
The people are being carried away by the bigotry, false propaganda and manufactured history. Hate against others based on caste, religion, tribes, ethnicity can lead to serious repercussions. It leads to loss of empathy and compassion for others. History is on record that over 25 Lakh people died during communal riots at the time of partition of India. They belonged to all the three communities, the Hindus, Sikhs and Muslims. Hate breeds mistrust which gets further aggravated into violence against each other. We witnessed it in 1984 during the anti-Sikh riots, anti-Muslim pogrom in Gujarat in 2002. Similar situation developed in Kashmir when minority Kashmiri Pandits were forced to migrate under terrorist threat and state government’s attitude.
What is happening in India at present is therefore not a new phenomenon but a continuation of what such forces have been trying to do in the past. There is a systematic campaign against the minorities who are being perceived as a threat to the majority 80% population of Hindus. Myths like the appeasement of Muslims; that they grow like mushrooms and marry four wives and they would soon overtake the Hindu population are injected into the minds of the people. This hate campaign lacks logic or evidence. These absurd ideas are spread through electronic TV media, social media, print media and also whisper campaigns. Several TV serials which are said to be historical serials are in a very subtle manner being used to spread falsehood and hate.
Women and children are the worst sufferers in such situations. Woman’s body has been used as a tool in the conflicts. Incident of Manipur where women were paraded naked and molested is to be seen with aversion, anger and as a reflection of serious aberration in our social order. State’s complete insensitivity to the situation raises scepticism whether these events have been well planned with some ulterior motive under the state patronage.
Hate campaigns do not stop on their own. Now there have been engineered communal riots in Haryana. The hate campaigners are roaming around free while the victims are being persecuted. There are similar incidents in UP, Delhi and other parts of the country. If not checked right now, this can lead to large scale violence of the level of Gujarat or Manipur.
The forces who spearhead such hate campaigns always experiment as to how they can win over masses to their side. The incident of statue of Lord Ganesha drinking milk throughout the country in 1995 was a very successful trial. This message spread across the country in no time even though there was no social media network at that time. It stopped instantaneously when it was felt that the whole myth would be exposed. It is to be noted that violence in Gujarat occurred after that. It is astonishing that such unprecedented violence took place in the land of Mahatma Gandhi.
Doctors can play a positive role in containing such situations. As the custodians of health of the society doctors are duty bound to speak and call spade a spade. They have to come out and make outreach programmes to preach harmony, love, brotherhood and sisterhood. Doctors can be a great instrument in developing confidence among the aggrieved in such situations. Viktor Frankl, an Austrian psychiatrist, who was a Holocaust survivor, did a great job to motivate prisoners in the Nazi concentration camps to never loose hope for a better future. With his persistent efforts he was able to save many from dying and survive after Hitler lost the war. Our voice matters; but our silence can be intriguing and dereliction of duty.
Despite continued threats by the hate campaigners and the dubious role of the state, there is a change. Many scientists who were till date quiet, have started challenging the myths and unscientific ideas. The doctors who clapped and banged thaalies have now realised that, that was not the scientific way to get rid of the COVID. Ultimately we had to fight out the pandemic at the cost of 1600 doctors’ lives. No amount of Gau Mutra or Cow Dung campaign worked. Many doctors understand this, but now is the time that they should develop courage to speak.
Hate campaigns have to be countered both politically as well as at societal levels. Doctors have not to sit quiet but find out means to bring the country out of this imbroglio. Doctors can communicate with their patients and in soft tone talk of love and compassion which is a part of our profession. Then follow up with them in their language. We must not shirk to identify the forces who are out to disturb harmony.
We have to understand that such violence is an epidemic health problem and thus plan as we do for other diseases.
Primary prevention approach: To stop situation from getting worse and stop violence before it starts to happen.
Secondary prevention: To target the at-risk populations and underlying risk factors.
A collective effort is needed because violent behaviour is contagious process and has to be dealt with in a similar manner. Social harmony is to be promoted through emphasizing love, sympathy, empathy and care for others. Expose the falsehood being spread. Talk on logic and evidence. Be humble to the vulnerable and deprived and firm against the fringes in our society that are trying to disturb the delicate equilibrium of social harmony in our country.
It is time we break the silence.
Never whisper in the presence of wrong.
Reducing the risks of nuclear war—the role of health professionals
Date: 05.08.2023
EDITORIAL: Reducing the risks of nuclear war—the role of health professionals
In January, 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90 s before midnight, reflecting the growing risk of nuclear war.1 In August, 2022, the UN Secretary-General António Guterres warned that the world is now in “a time of nuclear danger not seen since the height of the Cold War.(2) The danger has been underlined by growing tensions between many nuclear armed states.(1,3) As editors of health and medical journals worldwide, we call on health professionals to alert the public and our leaders to this major danger to public health and the essential life support systems of the planet—and urge action to prevent it.
Current nuclear arms control and non-proliferation efforts are inadequate to protect the world’s population against the threat of nuclear war by design, error, or miscalculation. The Treaty on the Non-Proliferation of Nuclear Weapons (NPT) commits each of the 190 participating nations ”to pursue negotiations in good faith on effective measures relating to cessation of the nuclear arms race at an early date and to nuclear disarmament, and on a treaty on general and complete disarmament under strict and effective international control”.(4) Progress has been disappointingly slow and the most recent NPT review conference in 2022 ended without an agreed statement.(5) There are many examples of near disasters that have exposed the risks of depending on nuclear deterrence for the indefinite future.(6) Modernisation of nuclear arsenals could increase risks: for example, hypersonic missiles decrease the time available to distinguish between an attack and a false alarm, increasing the likelihood of rapid escalation.
Any use of nuclear weapons would be catastrophic for humanity. Even a “limited” nuclear war involving only 250 of the 13 000 nuclear weapons in the world could kill 120 million people outright and cause global climate disruption leading to a nuclear famine, putting 2 billion people at risk.(7,8) A large-scale nuclear war between the USA and Russia could kill 200 million people or more in the near term, and potentially cause a global “nuclear winter” that could kill 5–6 billion people, threatening the survival of humanity.(7,8) Once a nuclear weapon is detonated, escalation to all-out nuclear war could occur rapidly. The prevention of any use of nuclear weapons is therefore an urgent public health priority and fundamental steps must also be taken to address the root cause of the problem—by abolishing nuclear weapons.
The health community has had a crucial role in efforts to reduce the risk of nuclear war and must continue to do so in the future.(9) In the 1980s the efforts of health professionals, led by the International Physicians for the Prevention of Nuclear War (IPPNW), helped to end the Cold War arms race by educating policy makers and the public on both sides of the Iron Curtain about the medical consequences of nuclear war. This was recognised when the 1985 Nobel Peace Prize was awarded to the IPPNW.10(http://www.ippnw.org).
In 2007, the IPPNW launched the International Campaign to Abolish Nuclear Weapons, which grew into a global civil society campaign with hundreds of partner organisations. A pathway to nuclear abolition was created with the adoption of the Treaty on the Prohibition of Nuclear Weapons in 2017, for which the International Campaign to Abolish Nuclear Weapons was awarded the 2017 Nobel Peace Prize. International medical organisations, including the International Committee of the Red Cross, the IPPNW, the World Medical Association, the World Federation of Public Health Associations, and the International Council of Nurses, had key roles in the process leading up to the negotiations, and in the negotiations themselves, presenting the scientific evidence about the catastrophic health and environmental consequences of nuclear weapons and nuclear war. They continued this important collaboration during the First Meeting of the States Parties to the Treaty on the Prohibition of Nuclear Weapons, which currently has 92 signatories, including 68 member states.(11)
We now call on health professional associations to inform their members worldwide about the threat to human survival and to join with the IPPNW to support efforts to reduce the near-term risks of nuclear war, including three immediate steps on the part of nuclear-armed states and their allies: first, adopt a no first use policy;(12) second, take their nuclear weapons off hair-trigger alert; and, third, urge all states involved in current conflicts to pledge publicly and unequivocally that they will not use nuclear weapons in these conflicts. We further ask them to work for a definitive end to the nuclear threat by supporting the urgent commencement of negotiations among the nuclear-armed states for a verifiable, time bound agreement to eliminate their nuclear weapons in accordance with commitments in the NPT, opening the way for all nations to join the Treaty on the Prohibition of Nuclear Weapons.
The danger is great and growing. The nuclear armed states must eliminate their nuclear arsenals before they eliminate us. The health community played a decisive part during the Cold War and more recently in the development of the Treaty on the Prohibition of Nuclear Weapons. We must take up this challenge again as an urgent priority, working with renewed energy to reduce the risks of nuclear war and to eliminate nuclear weapons.
1. Science and Security Board, Bulletin of the Atomic Scientists . A time of unprecedented danger: it is 90 seconds to midnight. 2023 Doomsday Clock Statement. Jan 24, 2023. (https://thebulletin.org/doomsday-clock/current-time/ (accessed June 1, 2023).
2. UN. 2022. Future Generations Counting on Our Commitment to Step Back from Abyss, Lift Cloud of Nuclear Annihilation for Good, Secretary-General Tells Review Conference, Press Release Aug 1, 2022 SG/SM/21394 (https://press.un.org/en/2022/sgsm21394.doc.htm accessed 10 July 2023)
3. Tollefson J. Is nuclear war more likely after Russia's suspension of the New START treaty? Nature 2023; 615: 386.
4. UN. 2005 Review Conference of the Parties to the Treaty on the Non-Proliferation of Nuclear Weapons (NPT). May 2–27, 2005. https://www.un.org/en/conf/npt/2005/npttreaty.html (accessed June 2, 2023). 5. Mukhatzhanova G. 10th NPT Review Conference: why it was doomed and how it almost succeeded. Arms Control Association. October, 2022. https://www.armscontrol.org/act/2022-10/features/10th-npt-review-conference-why-doomed-almost-succeeded (accessed June 2, 2023).
6. Lewis P, Williams H, Pelopidas, Aghlani S. Too close for comfort, cases of near nuclear use and options for policy. Chatham House Report. April, 2014. https://www.chathamhouse.org/2014/04/too-close-comfort-cases-near-nuclear-use-and-options-policy (accessed June 1, 2023). 7. Bivens M. Nuclear famine. IPPNW. August, 2022. https://www.ippnw.org/wp-content/uploads/2022/09/ENGLISH-Nuclear-Famine-Report-Final-bleed-marks.pdf (accessed June 1, 2023).
8. Xia L, Robock A, Scherrer K, et al. Global food insecurity and famine from reduced crop, marine fishery and livestock production due to climate disruption from nuclear war soot injection. Nat Food 2022; 3: 586–96.
9. Helfand I, Lewis P, Haines A. Reducing the risks of nuclear war to humanity. Lancet 2022; 399: 1097–98.
10. Nobel Prize Outreach AB. International Physicians for the Prevention of Nuclear War—facts. 1985. https://www.nobelprize.org/prizes/peace/1985/physicians/facts/ (accessed June 1, 2023).
11. UN Office for Disarmament Affairs. Treaties Database. Treaty on the Prohibition of Nuclear Weapons, status of the Treaty. 2023. https://treaties.unoda.org/t/tpnw (accessed June 1, 2023.
12. Center for Arms Control and Non-Proliferation. No first use: frequently asked questions. 2023. https://armscontrolcenter.org/issues/no-first-use/no-first-use-frequently-asked-questions/ (accessed June 2, 2023).
Authors:
Kamran Abbasi, Editor-in-Chief, British Medical Journal; Parveen Ali, Editor-in-Chief, International Nursing Review; Virginia Barbour, Editor-in-Chief, Medical Journal of Australia; Kirsten Bibbins-Domingo, Editor-in-Chief, JAMA; Marcel GM Olde Rikkert, Editor-in-Chief, Dutch Journal of Medicine; Andy Haines, London School of Hygiene and Tropical Medicine; Ira Helfand, Past President, International Physicians for the Prevention of Nuclear War; Richard Horton, Editor-in-Chief, The Lancet; Bob Mash, Editor-in-Chief, African Journal of Primary Health Care & Family Medicine; Arun Mitra, Past President, International Physicians for the Prevention of Nuclear War; Carlos Monteiro, Editor-in-Chief, Revista de Saúde Pública; Elena N. Naumova, Editor-in-Chief, Journal of Public Health Policy; Eric J. Rubin, Editor-in-Chief, New England Journal of Medicine; Tilman Ruff, Past President, International Physicians for the Prevention of Nuclear War; Peush Sahni, Editor-in-Chief, National Medical Journal of India; James Tumwine, Editor-in-Chief, African Health Sciences; Paul Yonga, Editor-in-Chief, East African Medical Journal; Chris Zielinski, University of Winchester, World Association of Medical Editors.
Correspondence: czielinski@ippnw.org
This Comment is being published simultaneously in multiple journals. For the full list of journals see: https://www.bmj.com/content/full-list-authors-and-signatories-nuclear
Need for complete abolition of nuclear weapons
Date: 31.07.2023
Need for complete abolition of nuclear weapons
Now is the time to put history on the right track
Dr Arun Mitra
As the 78th anniversary of the atomic bombing of Hiroshima and Nagasaki on 6th and 9th August 1945 is coming near, we are once again reminded of dreadful effects of the incident that wiped out two cities, killed over 2 lakh people and left the mankind to suffer from the effects of radiations for several decades to come. How the bodies melted in a fraction of second is beyond imagination. Those who survived envied the dead. They suffered both physical and mental trauma. It was horrifying to watch the images of effects of the atomic bombing during our visit to the Peace Museum in Hiroshima.
Second World War had almost ended and it was imminent that Japan would not be able to sustain for more than a few weeks. There was no justification in using such weapons of mass destruction. But the US wanted to tell to the world that they were the most powerful. A secret Manhattan project was launched to make a powerful weapon.
Modern science by then had given ample knowledge about the energy produced as a result of fission reaction. On July 16, 1945, at 5:29:45 a.m. the first atomic bomb exploded at the Trinity test site in the desert of New Mexico. Robert Julio Oppenheimer was the physicist behind this nuclear explosion. ‘The explosion resulted in an unprecedented release of energy - the equivalent of 20,000 tons of TNT exploding in less than 10 seconds. Even though the bomb was detonated from the top of a 30- meter steel tower, the blast created a crater over 2 meters deep and 40 meters wide. And all around the crater the ground was covered with a material never seen before’. (1)
Oppenheimer watched from afar as the first atomic bomb was successfully detonated. The impact was more than any one’s guess. Oppenheimer developed the bomb, but its further use was not under his decision making. He was a scientist, who had no control over the application of the bomb. That is why, as shown in a recent film on him, he later remarked that the explosion brought to his mind words from the Hindu scripture Bhagavad Gita: "Now I am become Death, the destroyer of worlds". (2). This is a lesson for the scientists that they should not venture over such things which could have harmful applications.
It had become clear that this weapon of mass destruction would add to the arms race. Soviet Union conducted it first nuclear weapon test at Semipalatinsk on 29th August 1949. A new study on the radiation impact of first nuclear explosion, says that the radiations reached 46 states, Canada and Mexico within 10 days of detonation. (3) At present we have 9 nuclear weapons possessing countries. There are several more countries who have the potential to develop such a device. Total number of nuclear warheads present on earth is estimated to be 13000.
The world is however now much more informed about the twin existential threat due to climate change and nuclear weapons. A landmark report, Nuclear Famine (2022), published by International Physicians for the Prevention of Nuclear War (IPPNW) summarizes the latest scientific work which shows that a so-called “limited” or “regional” nuclear war would be neither limited nor regional. ‘A war that detonated less than 1/20th of the world’s nuclear weapons, would still crash the climate, the global food supply chains, and likely public order. Famines and unrest would kill hundreds of millions, perhaps even billions. Using less than 3% of the world’s nuclear weapons, a nuclear war between India and Pakistan could kill up to every 3rd person on earth, with average global temperatures dropping about 1.3 degrees Celsius. A full-scale nuclear war between the United States and Russia would kill an estimated 5 billion people worldwide within two years’. (4) This could be an end to the modern civilization built through thousands years of human labour.
The findings come at a time of greatly heightened tensions among nuclear states and amid warnings that we are closer to nuclear war than we have ever been. The threat has increased manifold after the war began between Russia and Ukraine. The US & NATO’s explicit involvement shows their designs to increase their area of influence. In fact after dissolution of the Warsaw pact, the dissolution of NATO in a similar manner would have helped strengthen global peace.
It is time that the mankind has to unite to not let the events take a shape to a catastrophe. That nuclear weapons serve as deterrence is a myth which needs to be broken. Even if the countries decide not to use these weapons, any technology issue could play havoc. Moreover the expenditure on their production, putting them on alert and their maintenance is costing our resources which could have otherwise been used for health, education and other social needs. It is not wise to see the damage done and then cry over it later. Prevention is always a better way.
There are several movements around the globe working at international level as well as national level. Medical professionals have united under the banner of IPPNW to tell to the world about the health impacts of nuclear weapons. The International Campaign to Abolish Nuclear Weapons (ICAN) with 650 partner organisations is doing lot of work for lobbying and advocacy. In fact it was their intense work that led to passing of Treaty on the Prohibition of Nuclear Weapons by the UN General Assembly in July 2017. World Peace Council and Pugwash are others working on this. International Anti-Nuclear Movement “Nevada-Semey” is highlighting jointly the impact of nuclear detonations with the aim to promote the rapprochement of cultures, practical implementation of ideas of peace and emergence of global consciousness under the leadership of Suleimenov Olzhas.
All these movements have one common goal, to make the world free of nuclear weapons! Treaty on the Prohibition of Nuclear Weapons (TPNW) is the hope to be fulfilled collectively. India has been harbinger of peace movement under the banner of Non Aligned Movement (NAM). Time is again to show the statesmanship.
References:
- https://www.forbes.com/sites/davidbressan/2023/07/21/humanitys-first-nuclear-explosion-changed-earths-history/?sh=11c193a45b27
- https://www.history.com/news/j-robert-oppenheimer-facts-father-of-the-atomic-bomb
- https://www.nytimes.com/2023/07/20/science/trinity-nuclear-test-atomic-bomb-oppenheimer.html
- https://www.ippnw.org/programs/nuclear-weapons-abolition/nuclear-famine-climate-effects-of-regional-nuclear-war#:~:text=Ira%20Helfand%2C%20IPPNW%20co%2Dpresident,in%20jeopardy%20from%20mass%20starvation
Published Link:
Making only a few cities Smart is against the concept of equality and justice
Date: 14.07.2023
Making only a few cities Smart is against the concept of equality and justice
Dr Arun Mira
Much is being talked about making 100 cities throughout the country as smart cities. Focus of smartness is on digitalization, beautification, high rise buildings, big flyovers, wide spaces for cars to run on the roads, luxury parks etc. Little is being said about issues that relate to the needs of the common man. With the urban population in India at 35.39% in 2021, there is need to develop the cities to fulfill the socio-economic requirements and quality of life of all sections of society.
Concept of a smart city varies from person to person and among different strata of society. For a rich man, beautification of the city, big malls, wide roads to ply their cars, shining bright lights with glaring night life, big fly overs & under passes, decorated entry point to the city is the meaning of the smart city. But for a poor man and hut-met dweller, a moderate house, clean drinking water, sanitation, unbroken roads, regular electricity supply, footpath to walk on road side, lane for accident free cycling & two-wheeler ride would be a better city. A vendor would want, clean vending zones free from the threats of the Mafia and unnecessary glitches caused by the local body administration. A poor/low middle income family would be happy with a job and wage to be able to purchase a piece of land to live. For the senior citizens security is the most important in view of the everyday increasing incidents of violence against them.
There is large scale migration to the cities in search of jobs and livelihood. They need place to live but in the absence of any government support they have to live in shanties in totally sub human unhygienic conditions. A smart city should ensure proper housing for them all.
It is therefore important that the concept of smart city should cater to the needs of all citizens. The basics like clean drinking water supply, electricity, sanitation facilities, facilities for all types of waste management, good public transport, unbroken roads, low cost housing should be the priority. A common man also needs good hospitals to meet health needs at affordable cost and needs schools for affordable quality education.
There is also need for parks with green cover in all types of colonies. Subsidised Solar panels on buildings, so that everyone could afford their installation is the need of the hour. Footpaths for the disabled and ordinary pedestrians, Braille linked mobility facilities for the visually handicapped is essential. The digitalization, which in modern time is essential for the governance and communication should supplement and facilitate the above.
But all the above is far off dream in the cities earmarked to be smart cities. Rains that inundated several parts of the northern region of the country have exposed the claims of Smart cities project conceptualised by the government of India. We have witnessed how there is water logging in the cities including the capital of the country. With broken roads the commuters met with accidents. Several houses got submerged in the dirty water of sewerage drains. The smart city claim has been thus washed away in the rains.
Larger question however is whether making 100 smart cities with a population of nearly 13 crore, which is less than 1/10th of total population of 142 crore in our country is justified? Does it stand the scrutiny of principles of justice and equality to all the citizens? The government of India has allocated nearly Rs.500/- crore per city to make them smart by June 2023. This deadline has already been missed. As against 100 proposed smart cities, there are 640930 villages in India which need to be brought under the focus, but are completely out of government’s priorities.
This huge amount of 48000 crores for the smart city project if distributed evenly throughout the country would have solved the problem of housing, education, health and nutrition for low income group to an extent. Under the circumstances when the government admits abject poverty in the country and has to distribute 5 kg grains and 1 kg daal to 80 crore people, spending so much amount to make a few big cities as smart is completely unwarranted. It is time that the government reorients its priorities towards even development for all the cities and villages instead of focusing on few big cities to provide facilities to corporate business model.
Reference:
https://www.linkedin.com/pulse/concept-smart-city-india-sanket-menjoge
Published Link:
https://epaper.live7tv.com/edition/1484/morning-india-ranchi/page/6
https://thearabianpost.com/making-only-a-few-cities-smart-goes-against-the-concept-of-equality/
https://ipanewspack.com/making-only-a-few-cities-smart-goes-against-the-concept-of-equality/
https://tryxyz.com/article25550-MAKING-ONLY-A-FEW-CITIES-SMART-GOES-AGAINST-THE-CONCEPT-OF-EQUALITY
Doctors’ contribution in social change
Date: 04.07.2023
Doctors’ contribution in social change
Dr Arun Mitra
First July is always a happy day for the doctors when they get messages of good wishes from their family members, nears and dears and patients who have been successfully cured. This day is dedicated to the memory of Dr. Bidhan Chandra Roy born on 1st July 1882. He was physician, educationist, and statesman who served as Chief Minister of West Bengal from 1948 until his death on 1st July 1962. Several organisations of the doctors observe the day by organising technical lectures and hold discussions on health issues. Such an important day should not become just a ritual. It should be a day of introspection regarding the contribution which the doctors have made for the society. A continuous self-introspection and assessment by the public helps improve the professional outcome.
Medical science has progressed from faith healing of the ancient times to the modern technological advanced care. In the process were developed new medical and surgical techniques and methods of prevention of illness through health education & vaccines. However the cost of treatment with the modern technology has increased manifold. In the absence of required level of health care in the state sector, people have to shelve huge amount from their pocket on health. Many a times they have to borrow loans or sell their assets to meet even minimum healthcare needs. Increasing commercialisation in every sphere after the neo liberal economy has affected healthcare as well. It would be naive to believe that doctors will not be affected by this change. The entry of corporate sector in the healthcare has made the problem further complex because there is a conceptual change from health as social responsibility to health as a business. Medical education has become extremely expensive in the privately owned medical colleges. Attitude of a doctor who has been trained after spending so much from her/his resources is bound to have commercial tendencies.
Unfortunately, such tendencies may lead to unethical medical practices by some. This becomes a cause of trust deficit between the doctors and patients. Due to lack of technical knowledge, sometimes the attendants of the patients start blaming the doctors on frivolous grounds. Such situation can take ugly turn with attendants resorting to violence against the doctors. There have been instances when such violent acts have even lead to death of the doctors. There are several forums for redress of the grievances of the patients. No doctor can effectively deliver his/her services in the atmosphere of stress and fear. It is important therefore that laws are made and effectively implemented to offer protection to the doctors. With experience and time a doctor learns to be more empathetic, communicative, and transparent. This is important to strengthen the doctor patient relationship.
During the pandemic several inequities were observed in the healthcare. The vaccine inequity became an issue of serious concern. It is now generally accepted that insurance based healthcare does not deliver well to the lower socio economic strata. The PPP mode adopted by the governments now-a-days, is in fact handing over doles to the private sector from the states exchequer.
Equity can be achieved only by direct involvement of state in healthcare delivery system. Doctors have to continuously highlight the determinants of health with the decision makers. Important among these are nutrition particularly of pregnant and lactating mothers, potable water, sewerage facilities, healthy environment around, sufficient wages, job security and means of livelihood. Doctors have to come forward to suggest policies for equity in healthcare.
In recent years we have witnessed increase in the spread of myths in healthcare in the name of our ancient scientific knowledge. Science is a dynamic process. It learns from past to advance further. Therefore unproven, non-evidence based methods in medical treatment do more harm than good. People visit the faith healers in the pursuit of better health. Some of the common diseases they look for remedy from such faith healers are Mumps, Chicken Pox, Bell’s Palsy, epilepsy, sexual problems, infertility etc. Many a times such beliefs cause delay in treatment and worsening of illness. Preaching to produce ‘customised babies through garbh vigyan sanskar’ by the organisations like “Arogya Bharti” is like pushing the society to medieval times. But when such practices are patronized by those at the helms of power it is a very serious issue. Not too long back two ministers of the Gujarat government felicitated the ‘tantriks’ in one of their conferences. During the pandemic use of Cow Urine and Cow dung was propagated as cure for the disease. The non-evidence based Coronil of Ramdev was propagated by none others than the then Health Minister Dr. Harsh Vardhan, who is trained ENT Surgeon in modern medicine. We have speak up against such efforts.
At a time when the whole world is faced with excess spending on arms race which is bleeding the funds and resources from social needs to arms race. Doctors have to raise issues about climate change, abolition of nuclear weapons. Social disharmony adversely affects both physical and mental health. We have to speak against any effort to disturb the social harmony.
Ironically health is not a major issue in the public discourse in our country. There is need to make debate on healthcare a day-to-day agenda of the public. The medical organizations have to play vital role for this.
Medical professionals including Aanganwadi & Asha workers and local level social activists have to come forward. Health committees should be formed at the Mohalla and the Village level which should discuss the health concerns of the area as well as policy matters pertaining to health in general. Written information through pamphlets, group meetings and interactive sessions can pay real long term dividend. A real tribute to Dr B C Roy is to ensure health to all on scientific lines.
Published Link:
https://thearabianpost.com/on-doctors-day-the-society-has-to-resolve-for-universal-healthcare/
https://ipanewspack.com/on-doctors-day-the-society-has-to-resolve-for-universal-healthcare/
https://tryxyz.com/article25435-ON-DOCTORS-DAY-THE-SOCIETY-HAS-TO-RESOLVE-FOR-UNIVERSAL-HEALTHCARE
The G20 Heath Agenda – India’s concerns
Date: 24 June 2023
The G20 Heath Agenda – India’s concerns
Dr Arun Mitra
The G20 Presidency to India has given ample opportunities to highlight the health problems facing the developing world in general and India in particular. This is also time to set the direction for global equity in health care. The Third Health Working Group (HWG) meeting of the G20 was held in Hyderabad in the first week of June 2023. Dr Ranga Reddy, President Infection Control Academy and Honorary Professor University of Hyderabad who was deeply involved in organizing this meeting pointed out that the Third HWG (Health Working Group) meeting had its focus on Health Emergencies, Prevention, Preparedness and Response. Also under serious debate is strengthening cooperation in Pharmaceutical sector with focus on Access and Availability to Safe, Effective, Quality and Affordable Medical Countermeasures.
Smt S Aparna, Secretary, Department of Pharmaceuticals, addressing the HWG highlighted the role of initiatives like the Global R&D Network that we can collectively build a future where no one is left behind and access to life-saving medical countermeasures becomes a universal reality. She also talked about collaboration among nations, institutions, and stakeholders through a global R&D network that fosters innovation and accelerates research (1).
This is important because the world witnessed serious inequities and pressures during the Pandemic. As per the WHO we witnessed 6,943,390 deaths globally till 14th June 2023. Unofficial figures could be even higher! The problem of unavailability of drugs, equipment and vaccines has been very acute. Smaller countries which lacked resources and knowhow to make vaccines or drugs suffered the most. Vaccine producing companies made huge profits during this period. There are reports of blackmail of the small countries by these companies. Many of the contracts between the companies and governments of these countries had confidentiality clauses according to which the company was exempted “from any civil liability for serious side effects arising from the use of the vaccine, indefinitely”. The affected countries had to accept several clauses which would favour only the vaccine manufacturer, to the extent that the properties of the countries including their embassy buildings and cultural centres were mortgaged to these companies as a guarantee.
Developing countries which have so far been faced with burden of communicable diseases, are now feeling the burden of the non-communicable diseases as well. India is hub to both communicable and non-communicable diseases.
At a rank of 107 out of 120 countries in the Hunger Index it is easy to understand the health situation of our people. India is the largest contributor of undernourished people in the world (Worldometer), with around 194.4 Million people, or 14.37% of its population not receiving enough nutrition. India has one of the worst rates of child malnutrition in the world, with one third of malnourished children globally being Indian. As per the Government of India’s National Family Health Survey 5 (NFHS 5), ‘36% of children under age five years are stunted; 19% are wasted; 32% are underweight; and 3% are overweight’.
Anemia, also referred to as low Haemoglobin; a condition that can make you feel tired and weak as you lack enough healthy red blood cells to carry adequate oxygen to your body’s tissues, affects a staggering 67% of children below the age of 5 years, higher than the 59% in the NFHS 4 survey (2).
As per the International Vaccine Access Center at John Hopkins Bloomberg School of Public Health Pneumonia & Diarrhea Progress Report 2022, under-5 pneumonia & diarrhoea burden number of deaths in India is 146,558 (3).
Unclean drinking water is the main cause for this. A new WHO report published in the media on 10 June 2023 says that in 2018, women in India spent an average of 45.5 minutes daily collecting water to meet household needs. Overall, households without on-premises water spent a staggering 666 lakh hours each day collecting water, with the majority 558 lakh hours occurring in rural areas. The report has estimated that India’s on-going ‘Har Ghar Jal’ (water in every home) can avert nearly 400,000 diarrhoeal deaths and prevent loss of productive days caused due to unclean drinking water. “This achievement alone would result in estimated cost savings of up to $101 billion,” (4).
Tuberculosis, as a communicable disease, is an on-going global epidemic that accounts for high burden of global mortality and morbidity. Globally, with an estimated 10 million new cases and around 1.4 million deaths, TB has emerged as one of the top 10 causes of morbidity and mortality in 2019. India accounts for 28% of all TB cases in the world, according to the Global TB Report 2022. There were 21.3 lakh cases detected in 2021 Despite an increase in the budget to tackle Tuberculosis (TB), the interim estimated number of deaths due to the infectious disease in India rose by 10 per cent, from 500,000 in 2020 to 505,000 in 2021, noted the Global TB Report 2022 released by the World Health Organisation (WHO). This comes to 1383 deaths due to TB per day(5).
The Non Communicable Diseases (NCD) too are on the rise in our country to alarming level and their rate of increase is very high.
The Indian Council of Medical Research–India, Diabetes (ICMR-INDIAB) study, found prevalence of diabetes among 11.4 per cent population, which comes to 101 million. This is 1.68 times higher than the previously estimated 60 million diabetics in India and a previously known 7.84 per cent national prevalence rate of diabetes.
The new study published in The Lancet puts the prevalence of hypertension at 35.5 per cent; general obesity at 39.5 per cent and dyslipidemia (lipid imbalance which can cause heart diseases) at 81.2 per cent. One in every three Indians has hypertension and two in five are obese (6).
Based on the above points it is important to envisage the steps required to bring down the disease burden particularly among the lower strata. It is important that each citizen of the country gets nutritious food which will help in developing immunity to fight back the disease. Most important is to ensure nutritious diet to pregnant women. ‘Progress towards universal maternity benefits, sluggish as it was in the first place, has gone into reverse gear in the last few years’ point out Jeane Drez and Ritika Khera in an article published on 14th June 2023 in The India Forum (7). They further point out that the National Food Security Act passed 10 years back gave all pregnant women a right to maternity benefits. Initially the benefits were Rs.6000/- per child. Had the benefits been raised in tandem with nominal GDP, Indian women today would be receiving cash benefits of about Rs 20,000 in the event of pregnancy, as they do in Tamil Nadu. This would help to ensure that they are not deprived of adequate nutrition, rest and healthcare at this difficult time. According to them ‘the root of this fiasco is that pregnant women count for very little in public policy and electoral politics’. Situation of food security is so pathetic that 80 Crore people were given 5 Kg of grain and one kilo of daal to fill their stomach.
It is important to design disease prevention and control programmes based on the needs of lower strata of the society. The state should directly own the responsibility for heath of the citizens. The PPP (Public Private Partnership) model amounts to passing on the benefits to the private sector from the public exchequer.
It is important to develop policies for inclusive growth which ensure jobs with proper remuneration and means of livelihood to all. This will help citizens to purchase food and not depend on the state for freebies. Clean drinking water, sanitation services and housing be available to all.
There is need to revive the manufacture of drugs, vaccines and medical equipment in the public sector to produce them at lower cost. It would be pertinent to remember the statement by our First Prime Minister Shri Jawaharlal Nehru while inaugurating the Indian Drugs and Pharmaceuticals Ltd. (IDPL) in 1961. He had said “the drug industry must be in the public sector….. I think an industry of the nature of the drug industry should not be in the private sector anyhow. There are far too much exploitation of the public in this industry”.
To end the exploitation of the developing countries under the garb of various clauses of the World Trade Organisation (WTO) it is important to make necessary changes in the WTO. The intellectual Property Rights and the Patent laws under the WTO at present benefit the big companies. This has to be changed. The founder of ORS, Dr Dilip Mahalanabis never patented his product saying that this is for public good and not for making profits. Will the companies and the governments follow suit?
Finance allocation to health has to be substantially increased. It has been hovering around 1.2% of the GDP. It should be increased to minimum of 5% of the GDP. Likewise allocation to R&D in health has to be increased.
Health and education of the people on scientific grounds is important so that they do not fall prey to the unscientific, non-evidence based treatment modalities like the use of Gau Mutra or Cow Dung.
Even though the G20 is dominated by the developed countries and the corporate sector, a forceful voice by India together with others can help change the situation. The outcome of the G20 meet on health has to be seen in that background. India can play a big role if our approach is not limited to mere electoral gimmickry.
- https://pib.gov.in/PressReleseDetail.aspx?PRID=1930273
- https://www.feedingindia.org/blog/understanding-the-malnutrition-crisis-in-india/#:~:text=India%20is%20the%20largest%20contributor,population%20not%20receiving%20enough%20nutrition
- https://www.jhsph.edu/ivac/wp-content/uploads/2019/10/PDPR_2022.pdf
- https://www.tribuneindia.com/news/nation/har-ghar-jal-can-avert-4-lakh-diarrhoeal-deaths-says-who-515774
- https://www.businesstoday.in/latest/trends/story/despite-increased-budget-estimated-tb-deaths-rise-in-india-whos-global-tb-report-2022-351182-2022-10-29
- https://www.business-standard.com/health/over-11-4-indians-diabetic-35-5-suffer-from-hypertension-lancet-journal-123060900263_1.html
- https://www.theindiaforum.in/public-policy/maternity-entitlements-freefall
Published Link:
Arms Race Vs Social security
Date: 15.06.2023
Arms Race Vs Social security
The threat looming large
Dr Arun Mitra
The recent report on the state of annual assessment of the state of armaments, disarmament and international security released by the Stockholm International Peace Research Institute (SIPRI) on 12th June 2023 is startling. The report highlights that the ‘number of operational nuclear weapons has increased because several countries have expanded their long-term force modernization plans’. At present it is estimated that there were 12 512 warheads in January 2023. Out of this about 9576 were in military stockpiles for potential use which is 86 more than in January 2022. Of those, an estimated 3844 warheads were deployed with missiles and aircraft, and around 2000—nearly all of which belonged to Russia or the USA—were kept in a state of high operational alert, meaning that they were fitted to missiles or held at airbases hosting nuclear bombers. The report further elaborates that Russia and the USA together possess almost 90 per cent of all nuclear weapons.
The International Campaign to Abolish Nuclear Weapons (ICAN) in its fourth annual report on nuclear weapon spending today: “Wasted: 2022 Global Nuclear Weapons Spending” has come out with the data of country wise spending on nuclear weapons in 2022. The United States: $43.7 billion, $83,143/ minute; China: $11.7 billion, $22,219/ minute; Russia: $9.6 billion, $18,228/ minute; The United Kingdom: $6.8 billion, $12,975/ minute; France: $5.6 billion, $10,603/ minute; India: $2.7 billion, $5,181/ minute; Israel: $1.2 billion, $2,226/ minute; Pakistan: $1 billion, $1,967/ minute; North Korea: $589 million, $1,221/ minute.
Comparing it with social needs the report says that the year 2022 Nuclear weapons spending for the entire year could have Covered 37% of climate change adaptation costs for developing countries or Set up 16 million homes with solar power or Paid the annual salary of 740 thousand nurses. Nuclear weapons spending per minute in 2022 could have Provided clean water sanitation for 2.4 thousand people or Paid for 3.9 thousand COVID vaccines or Hired three high-school science teachers or Paid for 20 U.S. public housing units.
These reports point out the danger of existence to the mankind in case of their use. They also caution us about the resource crunch which is created as a result of wasteful expenditure on the arms race.
The arms race is increasing at a time when the world has just come out of the pandemic. The global capacity to deal with the pandemic stands exposed. In the present world of science and technology we witnessed 6,943,390 deaths globally as per the WHO till 14th June 2023. Unofficial figures could be even higher. The problem of unavailability of drugs, equipment and vaccines has been very acute. Smaller countries which lacked resources and knowhow to make vaccines or drugs suffered the most. Vaccine producing companies made huge profits during this period. There are reports of black mail of the small countries by these companies. These countries had to accept several clauses which would favour only the vaccine manufacturer. In an article published in the Journal of Postgraduate Medicine, Education and Research, Dr Samir Malhotra, Professor of Pharmacology Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh has pointed that the COVID-19 scare forced many governments to enter into contracts with the companies developing vaccines. Many of these contracts had confidentiality clauses according to which the company was exempted “from any civil liability for serious side effects arising from the use of the vaccine, indefinitely”. Not only that, and this is shocking, these countries should “put up sovereign assets as collateral to guarantee indemnity”. Such assets could include embassy buildings, cultural assets, etc. While people were starving because of loss of jobs and means of livelihood, the corporate sector made huge profits.
It is a matter of anguish that the polity around the world has learnt little lesson from these events. Instead of serious introspection to divert wasteful expenditure from arms race to health needs, the expenditure on arms race continues to rise unabated. We need huge funds to plan future health of the planet. We have to meticulously design strategies to manage the communicable and non-communicable diseases.
Peace movement is faced with challenging tasks to save and promote health of the mankind. There is urgent need to build and strengthen the narrative for peace and disarmament. With the efforts of ICAN and scientific knowledge on the consequences on nuclear war by the IPPNW have been able get the Treaty on the Prohibition of Nuclear Weapons (TPNW) passed in the UN General Assembly on 7th July 2017. The treaty has already entered into force with the ratification by required number of countries. Now is time to convince the countries possessing Nuclear Weapons to join the treaty. In democratic societies the voice of the people matters. There is need for intense lobbying with the decision makers. We have to build public opinion for disarmament through the promotion of mutual dialogue and trust between nations. As an immediate task tireless efforts have to be made to stop Russia Ukraine War. Any delay in ending this war could lead to catastrophic happenings. We cannot let military industrial complex to take the world for granted and make huge profits at the cost of people’s lives.
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Published link:
https://ipanewspack.com/global-initiative-is-needed-to-stop-immediately-russia-ukraine-war/
https://tryxyz.com/article25260-GLOBAL-INITIATIVE-IS-NEEDED-TO-STOP-IMMEDIATELY-RUSSIA-UKRAINE-WAR
Customised Babies Through Garbh Sanskar
Date: 13.06.2023
Customised Babies Through Garbh Sanskar
Say goodbye to scientific thoughts !
Dr Arun Mitra
The news item published in the media on 12th June 2023 that an NGO affiliated with the RSS women’s wing, the ‘Rashtriya Sevika Samiti’ has launched a documentary and guidance titled “Garbha Sanskar” to help the women bear customized “Cultured and Patriotic Children” is highly alarming. This is total negation of science and a move to push the society into utter backwardness and obscurantism. Shri Tamilisai Soundararajan the Governor of Telengana participated in the meeting of Rashtriya Sevika Samiti on 11th June 2023 giving it at official colour. The guidance prepared by the organization highlights that the chanting of mantras, shalokas, Ramayana and Mahabharata will create positive vibration and connect with the baby in the womb. This connect will produce Sanskari and Patriotic babies. Such approach of the RSS is not new but the aggressive nature with which such myths are being propagated is dangerous and a matter of grave concern.
Commenting on this Dr Ms Param Saini, a leading Clinical Psychologist, said that “positive feelings and thoughts during pregnancy or listening to soothing music be it Ragas have always been promoted to help relieve stress and stay calm during pregnancy as this results in producing endorphins in the body and a happy mom connects well with her baby. A higher level of endorphins also helps in relieving pain during labor”. We all know that the pregnant woman impacts her baby with her diet, oxygen saturation, stress, anxiety, mental and physical activities. Indian women have always been listening to all kind of Garbh Sanskar mantras and still fail to produce “Most Sanskari & Patriotic Children”.
It is the nature influenced by genetic inheritance and other biological factors and external factors such as what kind of exposure, experience and learning play a crucial role in influencing child development. This is another attempt by RSS to promote their agenda.
Dr Narjit Kaur a leading Gynaecologist at Ludhiana said that the documentary and guidance designed by the Rashtriya Sevika Samiti is not supported by any scientific evidence. It is only promoting the myths which do not stand anywhere in the modern scientific world.
The “Arogya Bharti”, another RSS outfit established in November 2002 has been holding workshops to prepare women to deliver “Uttam Santati” — a perfect, “Customised Child” with the purpose of making strong India.
Arogya Bharti claims that through giving good food and advise about the time of sexual intercourse based on planetary configurations they do “Shuddhikaran” (purification) which leads to transformation of genes and production of healthier superior babies. According to them recitation of religious hymns helps in production of healthier babies. By doing this they claim that generations to come will improve. (1)
As per a report published in Indiatimes on 08 May 2017, the claim that through this exercise, Arogya Bharti has been able to produce 450 such babies so far, has to be followed up in time to find out whether the children produced in such a manner are superior to other children! There has to be an epidemiological study on the claims by comparing the results with control groups. That all this is being done under the shield of Ayurveda is exploiting people's faith in our traditional system of medicine. (2 & 3)
The RSS patronised Arogya Bharti claim that they got this knowledge from Nazi Germany which preached the concept of superiority of German race. This they claim is through the production of strong babies which was done by mother of Germany. One of leading surgeons from Germany and leading member of the German affiliate of International Physicians for the Prevention of Nuclear War (IPPNW), Dr Christopher Kreamer whom I contacted to substantiate this claim said that there is nothing like mother of Germany. “Though I have never heard of this ‘Mother of Germany’ -but it was so interesting for me to hear with a right wing movement (and government!) that I wanted not only to tell you that, in my eyes, this ‘Mother of Germany’ story is misleading. Germany's resurrection has several other reasons which are political and economic and in no way based on the concept of mother of Germany". (4)
In a highly patriarchal society in our country large number of people give preference to male babies. The whole concept of Uttam Santati is patriarchal and masculine. We are already fighting hard to restore gender balance in the population. There are ample laws which prohibit sex determination tests because it is illegal and against the constitutional obligations of equality among genders, now even trans-genders. Then, how and why, such a campaign is being allowed? Among the 450 super babies which the proponents of this exercise claim to have produced, how many are male and how many females must be made public. Since many of these babies have grown by now their comparison with other average children must be done.
However such an exercise to talk of Garbha Sanskar meets several objectives of some outfits to spread obscurantism, medieval ideas & myths and hate campaigns against other religious groups. It is for the medical bodies, rationalist societies and right thinking people with scientific outlook to question such absurdities.
Modernity cannot be achieved through medieval ideas. Health of our people, particularly of the women and children cannot be left to be exploited by the people with irrational ideas. There has to be a concerted effort to develop a healthy India through scientific outlook. We cannot let our country be again looked as a country of serpents but be seen globally as a nation marching forward in post independent period as a modern industrially, agriculturally educationally fast growing country with the efforts of scientists, technocrats, workers, peasants, professionals and other sections of intelligentsia with achievements in medicine, space and nuclear science. The health of women and children must be a priority with special emphasis on their nutrition, education, empowerment and socio-economic security.
References:
- https://www.india.com/news/india/rss-customised-baby-plan-get-intimate-as-per-sevaks-instructions-to-have-a-stronger-taller-fairer-and-smarter-child-2106298/
- https://www.indiatimes.com/news/india/rss-medical-wing-aarogya-bharati-shares-ancient-secrets-on-how-women-can-deliver-customised-super-babies-to-make-a-samarth-bharat-315434.html
- https://indianexpress.com/article/india/rss-wing-has-prescription-for-fair-tall-customised-babies-4644280/
- https://www.india.com/news/india/rss-customised-baby-plan-get-intimate-as-per-sevaks-instructions-to-have-a-stronger-taller-fairer-and-smarter-child-2106298/
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Published Link :
https://dailyheadlinestoday.com/epaper/view/686/headlines-today/7
https://ipanewspack.com/rss-ngo-spreading-dangerous-theory-about-producing-customised-babies/
https://tryxyz.com/article25236-RSS-NGO-SPREADING-DANGEROUS-THEORY-ABOUT-PRODUCING-CUSTOMISED-BABIES
DOCTORS WARN OF TWIN EXISTENTIAL THREAT CALL FOR TIMELY ACTION
Date: 18.05.2023
DOCTORS WARN OF TWIN EXISTENTIAL THREAT
CALL FOR TIMELY ACTION
Threat to the existence of mankind has never been so acute as today. We are faced with twin existential crisis due to climate change and nuclear war. Extreme changes in the weather are a cause of grave concern. Untimely rains, storms and hitherto lesser known events like Tsunami, El-Nino etc., have become common occurrence. It is well known by now that human activities are the cause of these speedy changes in the ecology.
Unchecked and unplanned growth coupled with greed is adding to the climate crisis. There is hardly any respite from ever increasing carbon emissions. Global energy-related CO2 emissions grew by 0.9% in 2022, reaching a new high of over 36.8 Gt (1).
Countries with some of the highest per capita emissions – and therefore high total emissions – are the United States, Australia, and Canada. Australia has an average per capita footprint of 17 tonnes, followed by the US at 16.2 tonnes, and Canada at 15.6 tonnes. The carbon foot print is related to the economic level of a country. For example in just 2.3 days the average American or Australian emits as much as the average Malian or Nigerien in a year (2).
Despite several international conferences, countries responsible for high emissions since long and which has affected the ecology have not agreed to change the course. The ecological changes lead to higher activity by various micro-organisms posing serious challenge to manage new diseases. Millions of deaths from Covid-19 has exposed our capacity to deal with a public health emergency of that magnitude. Vector borne diseases like Malaria, Dengue, Chikungunya have appeared in many new areas.
Displacement of people as a result of extreme weather changes becomes a cause for several demographic changes, even conflicts. These changes affect food security in the affected areas. Despite the fact that world is producing nearly 1.5 times the food required to feed all the people, there is extreme hunger and malnutrition in several parts of the world.
It is unfortunate that even in the situation of extreme global health crisis we found inequities in access to vaccines and treatments between wealthy and struggling nations. A section of the people made huge profits of the crisis. For example in India when people in the cities had no food or shelter and were migrating to their native places, walking hundreds of kilo meters on foot, the income of corporates Ambani increased by 128% and Adani by 480%.
This is the time when the world should have united to fight the Pandemic and learn lesson for a lasting cooperation. On the contrary tensions around the world have been increasing. It is estimated that more than 110 conflicts are going in different parts of the world.
It is more than a year that war between Russia and Ukraine started after Russian invasion of Ukraine. As per estimates several thousand people including more than 20,000 non-combatants have died and over 8 million displaced to other countries. With explicit entry of US and NATO the conflict has attained new dimension. It is no more a conflict between Russia and Ukraine but is becoming conflict between the two major nuclear powers. The Military Industrial Complex (MIC) is out to make huge profits from the situation. NATO and the US are looking forward to increase their area of influence. Already Finland and Sweden have declared to join the NATO. Any continuation of the war adds to the possibility of use of nuclear weapons, which in such situations would be catastrophic. Unsurprisingly, the Doomsday Clock has recently been reset to 90 seconds before midnight, the closest it has ever been to global catastrophe.
Doctors around the globe gathered at Mombasa in Kenya under the banner of International Physicians for the Prevention of Nuclear War (IPPNW) at its 23rd World Congress and cautioned the world not to be complacent about the catastrophe in waiting from the twin existential threat. They warned in clear terms that medical fraternity has no remedy to offer in the event of such an eventuality. The Mombasa Declaration pointed out ‘Whether they are used in Ukraine, in South Asia where two nuclear-armed states, India and Pakistan, have fought four full-fledged wars, or during any other conflict, the use of nuclear weapons, for whatever reason, would almost certainly escalate into a nuclear war that would kill millions of people outright. Nuclear war would cause a climate disaster of another kind, plunging the world into a nuclear winter where agriculture would collapse and food scarcity would threaten billions of people with starvation, no matter how far removed they were from the conflict itself’.
The declaration further said “Nuclear power, which is an expensive, ineffective, and dangerous response to the climate crisis, also fuels nuclear proliferation by inextricably increasing fissile materials and the capacity to produce them. As we are seeing in Ukraine, nuclear power reactors are vulnerable military targets—essentially huge, pre-positioned radiological disasters-in-waiting. Misplaced investments in nuclear power, besides exacerbating this danger, delay the rapid scale-up of renewable energy, increased energy efficiency, and energy storage”.
Doctors expressed serious concerned at that “Military and nuclear weapons spending divert massive resources and create enormous opportunity costs that diminish and delay climate action and also steal resources from many other areas of human and environmental need, including health, shelter, and education. Militarization and armed conflict fuel tensions that diminish international cooperation in many areas, including climate action and disarmament”.
We urgently need to change course if we are to avoid the catastrophic consequences of either a nuclear war or an environmental collapse. The diplomatic and political processes that produced the Treaty on the Prohibition of Nuclear Weapons (TPNW) showed the world that a well-organized group of non-nuclear-armed nations, armed instead with scientific evidence and medical expertise about nuclear weapons and nuclear war, and supported by an informed and energized civil society, could effectively make the case that possession of nuclear weapons is illegitimate and that nuclear deterrence is not only foolhardy, but also immoral. Our responsibility is to prevent what we cannot cure.
References:
Published Link
Bigotry a serious threat to peace, harmony and health
Date: 09.05.2023
Bigotry a serious threat to peace, harmony and health
News as reported in the Nav Bharat Times dated 12 April 2023, referring to a post in which the mother of a child had mentioned that her daughter came home today crying asked me ‘are we Muslims so dirty’? This is after her class fellow in the 6th class spat on her face after the latter told her that she belongs to Muslim religion. This is a matter of great worry and is a reflection of what is being constantly discussed in some homes and fed into the children’s mind. Children of that age have no such concept of religious differences, least to talk about hating someone on the basis of religion, caste, creed, ethnicity or gender. But constant negative discussions have a long term impression on the developing mind of the child. Such observations were also made after the riots in Gujarat. The Times of India dated May 7, 2002 had reported “Secularism is gasping for that one last breath of hope. Especially with children starting to spit fire against the opposite community. The seed of hatred is sown young and in some case even before the child reached puberty. A child told his father, who wanted to help Muslim family, that he did not feel bad for the victims of riot and that the family should seek help from those who burnt alive passengers of the Sabarmati express. Children of Muslims who were affected due to the large scale riot speak of revenge the Hindus” (1).
In our society where the prejudices based on the caste and religion already existed, it is easy to arouse the feelings of hatred against others. The German Nazi politician Paul Joseph Goebbels who was the chief propagandist for the Nazi Party, and then Reich Minister of Propaganda from 1933 to 1945 worked on the dictum “If you repeat a lie often enough, people will believe it, and you will even come to believe it yourself. A lie told once remains a lie but a lie told a thousand times becomes the truth”.
He unleashed a systematic propaganda against the Jews. It was propagated that Jews grow like mushrooms and they are the cause for ills facing Germany. After that the Nazis successfully carried out pogrom of the Jews. Not much far back the propaganda against Tutsis by the Hutus led to tribal war in Rawanda which killed over 800,000 people in a span of just 100 days in 1994. During the partition of India 2.5milion people, Hindus, Sikhs and Muslims, were killed as a result of mob frenzy. Recent incidents of violence in Manipur will alienate Kukis and Meiteis from each other for decades to come.
It was most disgusting to note that even during Pandemic when people needed to be united, a false propaganda was launched against Tablighis and they were hounded out after being blamed for spreading COVID without any evidence. They were however exonerated by the court at a later stage.
When some women held a sit in Dharna at Shaheen Bagh against the Citizens Amendment Bill, they were ridiculed. Only a few months back the murders and rapists of family of Bilkis Bano were released by the Gujarat government right at the same time when the Prime Minister was talking from the Red Fort on 15th August 2022 about his commitment to save the honour of women. Now we are watching women sitting on Dharna at the Jantar Mantar New Delhi demanding arrest of Brij Bushan Sharan Singh whom they are accusing of sexual harassment of the female wrestlers. These women do not belong to any minority community. They come from Jat community. This is a clear message that perpetrators of narrative of hatred spare no one.
It is time to understand that the narrative of hatred does not stop at one community or ethnic group. It becomes a mind set against the vulnerable sections who are blamed for all ills and are then persecuted. Hitler wanted to eliminate Jews and prove himself to be true Christian. But at the end of the day out of over 55 million people killed in the 2nd world war, vast majority of them happened to be Christians.
Bigotry is not part of human behaviour. People have always yearned to live in peace. The hatred against others is spread with ulterior motive. There are few reports of Hindus and Muslims fighting against each other before the British came to India. With a purpose to rule the country the colonial power used all tools to divide the society so as to strengthen their hold on the country. They even succeeded in dividing the country. However it is important to note here that despite killing of over 2.5 million Hindus, Sikhs and Muslims in the riots during partition, people of India rebuffed the politics of hatred and defeated the communal divisive forces in the first ever elections in free India and opted to build the country based on the ideals of humanism and dignity for all irrespective of religion, caste or gender. That was the ‘idea of India’ and a reflection of collective freedom movement against the colonial power.
What has happened now is big question? Why the people of India are being swayed away by the forces who never took any part in the freedom struggle, rather sided with the colonial masters?
Social learning and psychological make up in the process of growing up makes a great difference in future behaviour patterns of young minds. They are influenced by prejudices, hatred and many other negative ideas during the course of their upbringing. It is therefore important to study this with seriousness and prevent such disorderly behaviour from happening. People have to decide now what type of country- divided or united we have to develop further? Hatred will split the society, break the cohesion, destroy the idea of India and peaceful coexistence. Such forces will not hesitate to enter into full fledged war and put the health and lives of the people at high risk particularly when the region is nuclear powered.
References:
Published link:
https://ipanewspack.com/bigotry-poses-a-serious-threat-to-peace-harmony-and-health-in-india/
https://tryxyz.com/article24933-BIGOTRY-POSES-A-SERIOUS-THREAT-TO-PEACE-HARMONY-AND-HEALTH-IN-INDIA
Food not weapons
Date: 13.04.2023
Food not weapons
Dr Arun Mitra
As per the reports, Somalia with a Population of 17 Million is passing through serious crisis of food security. Over 200,000 people are facing catastrophic levels of food insecurity. ‘Due to starvation they are dying, falling prey to diarrhoea, measles or malaria etc. Number of deaths last year is estimated to be 43,000 (1). At least half of the deaths were children under the age of 5’, according to the report by health researchers, the United Nations and the Somali government. This is the worst drought in decades. Many were forced to leave their homes to seek humanitarian assistance in urban centers or across the border in Kenya and Ethiopia. Already at the end of 2022, three million people were internally displaced, and at least 20,000 Somalis had crossed into Kenya.
The drought has wiped out millions of livestock animals, adversely affecting income of large number of families. This has left nearly half of Somalia’s population hungry. Climate change, leading to recurring droughts, flash floods, cyclones and increasing temperatures in Somalia and adjoining areas has worsened the situation.
The researchers had warned that in the first six months of the year between 18,000 and 34,000 people are likely to succumb to the drought. Despite knowing gravity of the situation not adequate attention was paid to the crisis.
Having a diet which is both sufficient in terms of energy (caloric) requirements and additional nutritional needs is essential for good health. Undernourishment, especially in children and mothers, is a leading risk factor for death and other health consequences.
The UN has set a global target as part of the Sustainable Development Goals to “end hunger by 2030“. Currently we are far from reaching this target.
The world produces 150% more food on only 13% more land compared with 1960, thanks to many innovations in food production made over the years. We produce enough food to feed 1.5 times the global population. That's enough to feed 10 billion yet we are at just over 7 billion currently. There is enough for everyone (2).
Not only Somalia but several countries of the world are facing crisis of Hunger. India which claims to be rising economy and aspires to be super power with 5 trillion US$ economy is at 107 out of 120 countries in hunger index. Similar is the situation in many countries of Asia and Africa
Unnatural death of any person, from any country or community is a cause of serious concern. But truth of the matter is that little attention is paid towards the death of the poor. Not many in the world even know that over 8 million people died in Rwanda as a result of ethnic violence in a span of just 100 days from 7thApril to 15 July 1994. That in the so much connected world today such events are occurring is a matter of shame.
It is high time the world realizes the gravity and makes a complete review of the priorities. There is need to spend more on food production and its equitable distribution to all the citizens of the world.
Total global military expenditure increased by 0.7 per cent in real terms in 2021, to reach $2113 billion. The five largest spenders in 2021 were the United States, China, India, the United Kingdom and Russia, together accounting for 62 per cent of expenditure, according to new data on global military spending published by the Stockholm International Peace Research Institute (SIPRI) (3).
In the present circumstances when several parts of the world are in tension, war between Russia and Ukraine does not seem to ending soon, the existing weapons pose a serious threat to humanity. Use of Nuclear weapons in any escalation of existing tensions cannot be ruled out.
At one time India has been the harbinger in the movement for disarmament. As leader of the Non-Aligned Movement (NAM), India played a significant role in raising the voice for nuclear weapons abolition. Even though the G20 is much different from the NAM, India as its President can play a significant role in bringing mind set change among the G20 leaders from the arms race to diversion of funds to health, education and other social needs.
The International Physicians for the Prevention of Nuclear War (IPPNW) is holding its 23rd World Congress in Mombasa, Kenya on the theme ‘Disarmament, Climate crisis and Health’ from 26 to 30 April 2023. The deliberation will be reflection of the physicians concern for the survival and good health of the human kind. The congress will formulate strategies of action by the civil society to reverse the trend of arms race and ensure food to every person on earth.
References:
- https://www.nytimes.com/2023/03/20/world/africa/somalia-drought-death-famine.html#:~:text=About%2043%2C000%20people%20died%20last,the%20Horn%20of%20Africa%20nation.
- https://news.thin-ink.net/p/we-produce-enough-food-to-feed-15#:~:text=Today%2C%20the%20world%20produces%20150,There%20is%20enough%20for%20everyone.
- https://www.sipri.org/media/press-release/2022/world-military-expenditure-passes-2-trillion-first-time#:~:text=(Stockholm%2C%2025%20April%202022),2021%2C%20to%20reach%20%242113%20billion.
Declare Right to Health a Fundamental Right
Date: 4.03.2023
Declare Right to Health
a Fundamental Right
Passing of Right to Health Bill by the Rajasthan Assembly is a long overdue requirement of the citizens and demand of the health care organizations. This Act gives the residents of Rajasthan right to free healthcare. The right to health thus becomes justiciable, that is the government is now answerable in eyes of law. The Act primarily puts the onus on the state to ensure healthcare to the people and through guarantee of nutrition, safe drinking water, sewerage facilities etc. The patients will have the facility to avail of OPD or indoor care free of charge in the public health facilities.
Since major part of the health care has been developed in the private sector in our country, the act involves the private sector also to provide emergency care to the needy and in case of emergency delivery even if the person is not able to pay. The doctors of Rajasthan have been agitating against the Act. The government has agreed to the demand of doctors and has excluded health facilities with less than 50 beds and those who have not taken any grant from the government from the purview of the Act.
Rajasthan has shown the way; it is now important that such an act is passed at the central government level and health is declared as a Fundamental right.
This is essential because the health care indices in our country are dismal. That every year out of a population of 100,000 in our country 36.11 persons die due to Tuberculosis (1); large number of children fall prey to Encephalitis, Diarrhea, Malaria and many other communicable diseases, is a matter of grave concern. Needless to mention the havoc caused by the COVID Pandemic where we failed to prevent several thousand deaths because of mismanagement and skewed priorities. Non-communicable diseases too are on the rise. It is estimated that 29.8% of Indians have hypertension. India is soon likely to become the diabetes capital of the world.
It is very unfortunate that several patients die in case of an emergency because of denial of treatment for want of money or due to some technicalities. This is deplorable and complete violation of the right to life which is a basic human right. The Supreme Court of India as long back as 1989 observed in Parmanand Katara v. Union of India AIR 1989 SC 2039 that when accidents occur and the victims are taken to hospitals or to a medical practitioner, they are not taken care of for giving emergency medical treatment on the ground that the case is a medico-legal case and the injured person should go to a Government Hospital. The Supreme Court emphasized the need for making it obligatory for hospitals and medical practitioners to provide emergency medical care. The Apex court further observed that this is not the only reason for not attending on injured persons or persons in a medical emergency, for sometimes such persons are turned out on the ground that they are not in a position to make payment immediately or that they have no insurance or that they are not members of any scheme which entitles them to medical reimbursement (2).
Despite the above information well in the knowledge of those responsible to manage the health affairs, we have failed to take steps to provide healthcare to all the citizens. The Joseph Bhore committee report had recommended way back in 1946 the need to ensure equitable healthcare to all citizens irrespective of their capacity to pay. India has been a signatory to the Alma Ata declaration of 1978 whereby our country committed to ensure health for all by the year 2000. But we failed in that. Presently 75% of healthcare expenditure comes from the pockets of households. Every year 6.3 crore population of India is pushed towards poverty due to out of pocket expenditure, a fact admitted in the Health Policy 2017. This catastrophic healthcare cost is an important cause of impoverishment which further adds to poor health. Our public health spending is one among the lowest in the world that is nearly 1.1% of the GDP against the required minimum of 5% as recommended by the WHO.
On the contrary there has been a paradigm shift in the approach to healthcare. The National Health Policy 2017 showed concern on the healthcare situation in the country but it offers the solution on the insurance based healthcare. The existing insurance based schemes cover only the indoor care while nearly 67% of the health expenditure is incurred on OPD care. With entry of corporate sector in healthcare system, healthcare has been turned into business rather than a social responsibility. Moreover those not covered under any government insurance scheme have to shelve huge amount for insurance. Senior citizens are the worst affected. The insurance based schemes have in fact turned into doling away public money to the insurance companies.
Health was recognized as human right way back in 1966. The erstwhile USSR declared health as a right of every citizen and responsibility of the state in 1936. In the year 1948 the UK government took a similar step to establish National Health Services (NHS). But ironically till date the Constitution of India does not expressly guarantee a fundamental right to health. However references to the state’s responsibility to health of the people are mentioned in the directive principles in Part IV of the Indian Constitution. These provide a basis for the right to health. Article 42 directs the State to just and humane conditions of work and maternity relief. Article 47 casts a duty on the state to raise the nutrition levels and standard of living of people and to improve public health. Article 21 guarantees the right to life.
A subject like healthcare cannot be left to the market forces alone. It will further exclude the low income strata from quality healthcare. Organisations like the Indian Doctors for Peace and Development (IDPD) and the Alliance of Doctors for Ethical Healthcare have been demanding such an Act from the central government to declare the Health as a Fundamental Right. It is the primary duty of all doctors as custodian of health to press for the demand for Health as a Fundamental Right. This will also help in reducing trust deficit between patients and doctors.
With Rajasthan Act in force it is time now for the central government to follow. References:
- https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-021-01740-y
- https://indiankanoon.org/doc/100042716/?type=print
THE COW AS A POLITICAL TOOL
Date: 11.02.2023
THE COW AS A POLITICAL TOOL
Dr Arun Mitra
The cow is in picture again, this time with the approval of competent authority and on the direction of the Department of Animal Husbandry and Dairying, Ministry of Fisheries, Animal Husbandry and Dairy. With emphasis on aiming to celebrate the 'Vedic tradition' and the immense benefits a cow possesses, the Animal Welfare Board of India has urged people to celebrate 'Cow Hug Day' on February 14 which is celebrated as Valentine's Day. "We all know that the Cow is the backbone of Indian culture and rural economy, sustains our life, and represents cattle wealth and biodiversity. It is known as "Kamdhenu" and "Gaumata" because of its nourishing nature like mother, the giver of all providing riches to humanity," the Animal Welfare Board informed in a statement. The body said that the Vedic traditions are on the verge of "extinction" due to the progress of western culture. "The dazzle of western civilization has made our culture and heritage almost forgotten," the Board stated. As per the Animal Welfare Board, owing to its immense benefits, hugging cows will bring emotional richness and increase ‘individual and collective happiness’. "Therefore, all the cow lovers may also celebrate February 14 as Cow Hug day keeping in mind the importance of mother cow and making life happy and full of positive energy," the statement added.
This statement needs to be analysed scientifically as earlier too the issues have been raised about the use of cow urine and cow dung as cure of several diseases.
Ms. Pragya Thakur, BJP member of Parliament from Bhopal had claimed that her cancer was cured by cow urine. Dr. S.S Rajput, a surgeon at Ram Manohar Lohia Institute of Medical Sciences in Lucknow however confirmed that he had done three radical operations to get her rid of the cancer of the breast. The doctor’s statement exposed the claim of Sadhvi about cow urine as a cure of her breast cancer.
There was lot of talk of use of cow urine as cure of Corona virus infection. The cow dung too has been claimed to be possessing qualities to cure Corona infection. Even more it is being claimed that the cow dung is a powerful protection from the nuclear radiations in case of nuclear war. So much so it has been claimed that cows exhale oxygen therefore breathing the air exhaled from cow will cure several diseases.
Science is based on evidence and is always ready for debate and amenable to suggestion. It is not dogmatic as many believers are. Modern scientific system of medicine enhanced the knowledge gained in the past and developed the health care system further on the basis of new scientific innovations. Anatomy and Physiology made us understand the basic structure and functioning of the life systems. Our body has an elaborate system to utilize whatever is needed and to excrete those materials which are either not required or are harmful. It is a common knowledge that part of the food which we consume is digested and rest is excreted through the gastrointestinal track. After the food has been metabolized in the body, other waste products are excreted in urine. It is therefore important to compare the chemical composition of urine of cow and human beings and to prove on evidence the usefulness and superiority of cow urine for human health. Urine is a liquid produced by the kidneys to remove waste products from the bloodstream. Basic composition of cow/human urine are Water, Urea, Sodium, Chloride, Sulfate, Potassium, Phosphate, Creatinine, Ammonia, Uric Acid, Calcium, Magnesium. Since the composition of human and cow urine are similar, it is difficult to believe how cow urine is useful for human body?
Information under RTI was obtained from the Department of Animal Husbandry, Dairying and Fisheries, government of India about the usefulness of cow urine for human body. They replied that “the information is not maintained by this CPIO of cattle Division”. Simultaneously same information was sought from the Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana. The information received from 22 departments of the GADVASU denied any such information with them. It is worth mentioning here that GADVASU, Ludhiana, has been ranked first among the 14 state veterinary universities in the country, as per the ranking of agricultural universities and research institutes conducted by the Indian Council of Agricultural Research (ICAR), New Delhi, for 2016-17.
The claim that exhaled air from Cow is useful stands no scrutiny if we examine the content of gases in the exhaled air. When we exhale, the composition of the air remains almost the same as the air we inhale, only the percentage of carbon dioxide and oxygen changes. The amount of inhaled air contains 21% of oxygen and 0.04% of carbon dioxide, while the air we breathe out contains 16.4% of oxygen and 4.4% of carbon dioxide. This is true for all animals. That is why it is recommended to give mouth to mouth respiration in case of serious emergency as part of resuscitation if no other equipment is available.
We should love not only the cow but all life forms and try to preserve them. Nature has given us an eco-system whereby a balance is maintained. The statement on cow hug day is full of contradictions. It has been said that we should preserve our Vedic culture. It is unfortunate that the scientific body like the animal husbandry department has forgotten that life is a dynamic process. We have Vedic culture as past with due respect and learning from it. But the life has moved ahead. No one can go the life style that we had even 25 years ago what to talk of ancient times. Science is for all humanity. Those who talk of Vedic culture and ancient times are using modern gadgets developed in the west by modern science and lead life in ‘western style’. They do not wear ‘Kharawans’ instead of shoes nor do they wear the dress as worn during the Vedic days.
The whole propaganda about cow in the recent period is connected to the Hindutva Agenda of the RSS and its outfits. The whole game plan is to spread obscurantism, exploit people’s faith and use it for political ends. Having failed on all fronts these forces are now spreading such myths.
One gets happiness from any pet that one possesses. Maximum happiness and strength however comes from hugging fellow human beings and care for the people around. Animals are a ‘Pashu Dhan’ to be cared for in that sense. Humans are our own species.
As we learn that the order to observe 14th February as Cow Hug day has been withdrawn, we must be cautious that the forces of obscurantism will come out with some other idea. Let us not forget that these forces made the Ganesha statue drink milk in 1995, convinced the people to bang thalies or clap to get rid of corona virus infection.
It is high time we develop and spread scientific temper which is the basis for sustainable development as per modern times.
Poor allocation to health in the budget will have serious implications
Date: 02.02.2023
Poor allocation to health in the budget will have serious implications
Dr Arun Mitra
Much was expected from the budget presented by the Finance Minister Smt.Nirmala Sitaraman on 1st February 2023. As this was the last budget of the present government before the upcoming elections to the parliament next year, people had high hopes of relief in various sectors including the health. Thumping the chest by the BJP members and its allies in NDA apart the allocation to health in the budget has completely belied people’s aspirations. This is apparently because health and education are not taken as assets by the governments in power in our country.
It is in this context to utter dismay that there is decrease in allocation to health sector in the budget presented by the FM. In the budget presented last year out of 39.45 lakh crores rupees of total budget the health was allocated Rs.86606/- crores that is 2.19 % of the budget. But this year health has been allocated Rs.88956/- crores out of total budget of 45 lakh crores rupees which means 1.97 % of the budget. There is decrease 0.22% despite high inflation during this period.
Budgetary allocation to the National Health Mission (NHM) has seen a meagre 0.21% rise. Budget for National AIDS (Acquired Immunodeficiency Syndrome) and STD (Sexually Transmitted Diseases) Control Programme has seen an increment of 11.61 per cent – Rs. 2,622.75 crore (BE) from Rs. 2349.73 crore which was the revised estimate for 2021-22. However, if we compare it to the actual money spent in 2020-21 on National AIDS (Acquired Immunodeficiency Syndrome) and STD (Sexually Transmitted Diseases) Control programme there has been a drop of 6.84 per cent.
The whole exercise is to promote digital agenda instead of the infrastructure and employment of doctors and paramedical staff in the rural health centres. It is beyond comprehension that how without actual ground level infrastructural development digitalization is going to help.
The WHO has pointed out time and again that to meet the health needs it is important that the public health spending should be 5% of the GDP. But unfortunately the public health expenditure in our country has been much lower for several years. According to the Oxfam’s “Commitment to reducing inequality report 2020” India ranks 154th in health spending, 5th from the bottom. It was therefore expected that the government would be serious in budgetary allocation towards health. But it was not to be.
‘Oxfam India’s Inequality Report 2021: India’s Unequal Healthcare Story’ further points out that growing socio-economic inequalities in India are disproportionately affecting health outcomes of marginalized groups due to the absence of Universal Health Coverage (UHC). The report shows the general category performs better than SCs and STs; Hindus perform better than Muslims; the rich perform better than the poor; men are better off than women; and the urban population is better off than the rural population on various health indicators.
The budget nowhere indicates increase in allocation for the emoluments of the doctors and paramedical staff. Services of the front line health workers, ASHA, Aanganwadi etc. have not been given due recognition. They have not been given the status of a worker in this budget.
The allocation to Poshan Abhiyan was reduced last year from Rs.3700 crore to Rs.2700 crore. This is affecting nutrition of the marginalized sections. The allocation for MGNREGA is cut from Rs 89,400 crore to Rs.60,000 crores. Further, rural development allocation has been reduced from Rs 2,43,317 crore in the revised estimate to Rs 2,38,204 crore of the total budget expenditure, it is getting 5% and that shows the low priority of the government for the rural sector. Poor allocation to the rural sector and MGNREGA will reduce the purchasing capacity of the people thus effecting their nutrition. With under nutrition it would be naïve to expect better health indictors among the people.
There is talk of increasing nursing colleges. But unless this is accompanied with job employment for them they will be left to work in the private sector at very low wages or migrate to other countries for better opportunities.
The Community Health Centres (CHCs) which are the first referral centres and are supposed to have a surgeon, an obstetrician-gynaecologist, a paediatrician, a physician and an anaesthetist. But there is over 80 % shortfall in surgeons and paediatricians, and an over 70 % shortfall in physicians and obstetrician-gynaecologists. There is no plan or direction to fill these vacancies despite that number of doctors coming out every year has increased but because of lack of infrastructural facilities in the rural areas most of them opt for private sector or migrate to other countries.
There is emphasis on Public Private Partnership (PPP) mode in the health sector through which money will be shelved to the private players.
Whole exercise of budgetary allocation is not going to improve health services in the country and shows no sign of universal health care. There is need to increase the budgetary allocation to 10% of the revenue budget if the health services have to be made inclusive for all sections of the society
Reference:
The danger of Nuclear clouds getting dark
Date: 31 January 2023
The danger of Nuclear clouds getting dark
Dr Arun Mitra
The World Health Organization (WHO) has recently updated the list of medicines and drugs recommended to treat exposure to radiological and nuclear emergencies. Last time it was done in the year 2007. Maria Neira, the director of the WHO’s Department of Public Health and Environment has reminded the world about various health emergencies in case of exposure to radiations. The new list has number of such medicines which could be of use in case of a large scale radiation exposure from nuclear war, damage to nuclear power plants to low level exposure from other radiological exposures. Among the recommended drugs are stable iodine to reduce the exposure of the thyroid to radioactive iodine; chelating agents to reduce radioactive cesium from the body which can form during nuclear fission and cytokines to mitigate damage to the bone marrow. Medicines used for diarrhoea, vomiting, physical injuries are also included in the list with an advice to make them available for use without delay. Damage to DNA causing cancer and other diseases are issue of serious concern as these are potentially fatal effects. Dr Niranjan Bhattacharya from the School of Tropical medicine Kolkata has been advocating use of blood taken from
umbilical cord in such emergencies.
As we know medical science has no effective remedy to the nuclear fallout, but that the WHO has cautioned the world about the danger, is a reflection of its perception that the world is faced with a serious threat of nuclear weapons at present.
The WHO advisory coincides with the report of Dooms day clock having been moved to 90 seconds or 10 seconds closer than last year when it was at 100 seconds. The Doomsday Clock is a symbol that represents the likelihood of a human-made global catastrophe, in the opinion of the members of the Bulletin of the Atomic Scientists. The idea was conceived after the 2nd world war. Interestingly Artist Martyl Langsdorf, the wife of Manhattan Project physicist Alexander Langsdorf, designed the clock to warn that time is running out to avert the danger of nuclear catastrophe. The clock was at 7 minutes to midnight in 1947, it was moved to 17 minutes in 1991 when it was thought that the nuclear threat has receded after the end of cold war. This made the world complacent, but the arms race including the nuclear arms race continued unabated and the clock has been moved to just 1.5 minutes on 24th January 2023.
Needless to say the danger arising out of the war between Russia and Ukraine poses a grave threat. It does not seem to be coming to an end in the near future. It has instead escalated further with the reports of increased arms supply of arms by the European countries which includes tanks and other equipment to Ukraine. Russia has intensified its attacks on the Ukrainian cities. Ukraine’s infrastructure has suffered gravely. Exact number of human casualties can never be known in the war but it must be very high including some soldiers of the Russian army too. Large scale fatality of non-combatants in Ukraine has once again proved the dangerous consequences of the modern day warfare. Dr.Barry S Levy Adjunct Professor of Public Health, Tufts University School of Medicine in a presentation at an event organized by the International Physicians for the Prevention of Nuclear War (IPPNW) on 19th February 2022 has warned of serious consequences of conventional war. According to him in case of war there is increase in the malnutrition particularly among women and children. There is rise in the communicable diseases like diarrhea, cholera, respiratory diseases, Tuberculosis. Mental disorders like depression, post-traumatic stress disorder and suicides. Reproductive health suffers badly. The non-communicable diseases like heart diseases, cancers, kidney diseases increased. Since Ukraine has 17% population above the age of 65. So there is a danger that indirect death rate would be much higher than in case of invasion of Iraq since the elderly group of population in Ukraine is more vulnerable.
It is unfortunate that despite research and warnings of the catastrophe in the event of the nuclear exchange the countries with nuclear weapons are consciously ignoring the warning. They are out to increase their armaments budget and updating the nuclear weapons system. With continuing tensions in different parts of the world the number of nuclear weapons countries may not remain limited to nine. There are several countries at the threshold of developing nuclear weapons.
Large parts of the world are faced with political instability, growing economic crisis and internal social conflicts coupled with tensions with the neighbours. Unable to solve the problems the governments in power are very likely to promote nationalist narrative and jingoism which has potential threat of escalation and use of nuclear weapons.
Peace movement around the world has lot of work to do in terms of mobilisation of public opinion and lobbying with the governments in the nuclear weapons possessing countries. External forces intervening in the conflicts have dangerous connotations. Blatant intervention by the NATO and the US is clearly preventing any solution to the on-going war between Russia and Ukraine which could be very well resolved through negotiations. Ironically the Non-Aligned movement is nowhere to be seen. Countries which used to lead this movement have taken U turn in their policies. The G 20, a conglomerate of countries with different interests is dominated by those who are involved overtly or covertly in various conflicts around the globe. Role of China increasing military expenditure too is very dubious. The military industrial
complex is however making huge profits at the cost of human lives.
Danger is grave, so the task before the peace movements, saner elements in the society and for the non-nuclear weapons countries is challenging. However at a time when the Treaty on the Prohibition of Nuclear Weapons (TPNW) has been passed by the UNO over six years back, opportunity is ripe.
The G20 Health Agenda and India’s concerns
Date: 22 January 2023
The G20 Health Agenda and India’s concerns
Dr Arun Mitra
(With gross differences in the health needs of the G20 countries it is to be seen how India gets its and other developing countries’ concerns addressed as priority in the G20 health agenda).
The first health working group meeting under India’s G-20 presidency was held at Thiruvananthapuram on 18 January 2023 to discuss about the global health concerns. The focus of discussion was bound to be around Pandemic and response to it at various levels. The discussion in the meeting as reported was on Pandemic management, emergency preparedness and vaccinations. Also under discussion were the issues of increasing antimicrobial resistance, developing blue print for vaccines, therapeutics and diagnostics. There was also discussion on harmonising a global network for countries through consensus on digital health and to mobilise funds for the same. In addition concerns were expressed over ensuring safe effective quality and affordable medicines and medical equipment.
The G20 is a heterogeneous group of countries at different level of economic development including Australia, Canada, United Kingdom, United States, France, Germany, Italy, Japan, Republic of Korea, European Union, Saudi Arabia, China, Russia, Argentina, Brazil, South Africa, Mexico, Türkiye, India and Indonesia. In the economic development, countries of the G-20 have different rankings. Whereas India and Indonesia belong to the Lower Middle income group countries, Argentina, Brazil, China, South Africa, Mexico, Russia and Turkey belong to Upper Middle income group of countries. Rest are from High income group countries. So the priorities in health agenda of each country are also different accordingly. This is reflected in prevailing gross inequity already existing in the healthcare delivery among the countries as well as for the different strata of population within the countries representing G-20
Health indicators among these countries also vary. For example in the Global Hunger Index which is based on the criteria of Inadequate food supply, Child mortality and Child under-nutrition. India is at 107 out of 120 countries compared to Indonesia at 77, South Africa at 59, Mexico at 42, Argentina at 31 and Brazil at 27. Rest of the countries are among better performers with the rankings at less than 17.
Nutrition is the basic pre requisite for good health. It means to have sufficient amount of Protein, Carbohydrate and Fats as well as micronutrients like vitamins and minerals. For better health it is thus important to have sufficient food supply, sufficient remuneration, housing and good environmental conditions. It is duty of the government to ensure that all population gets its share of healthy nutrition. That 81 Crore people are being given 5 Kg of food grains free of cost which just enough for subsistence, is a matter of grave concern. How can one expect vast majority to have good health as the grains only are not sufficient to fulfil nutritional requirements for a good health and immunity from diseases? Earlier under the National Food Security Act (NFSA) a family was entitled to get 50 Kg of grains, 25 Kg food free of cost and rest 25 Kg at Rs. 3 per Kg. This means the family was spending only Rs. Seventy five in buying this. But under the new order of the government only 25 Kg will be given free and the rest will have to be purchased at market price which is no less than Rs.20 per Kg. This will cause a burden of Rs. 500/- per month on their bybudget if we calculate the grain price at Rs. 20 per Kilogram. This will deprive the poor of basic food further adding to malnutrition and poor health. This is an important agenda for our country but representatives from the high income group countries in the G20 may not be able to comprehend this.
Moreover to have better health indicators, it is important to have more spending on health. Out of the G 20 countries India is spending 3.1% of the GDP on health. But in terms of spending on health by the government it is just 1.28%. Rest of the spending is by patients from their pocket. As a result 60 million people are pushed to poverty. In comparison Brazil spends 9.59% of th GDP on health, Argentina 9.51%, South Africa 9.11%, Indonesia 7.58%, Mexico 5.43%, China 5.35%, Turkey 4.34%. Russian expenditure is 5.65%, UK 10.15 %, Germany at 11.70% and the USA at 16.77%.
Pandemic had a negative effect on the situation of jobs and livelihood. The government hardly paid any assistance to the affected 54 crore workers and MSMEs, the nutritional health status of the low income group population was affected adversely. To add to their woes budget on Poshan Abhiyan was reduced from 3700 crore to 2700 crore rupees. These are issues of little important to several G20 countries.
The disease pattern is also quite variable. For example In 2021, eight countries accounted for more than two thirds of global TB cases: India (28%), Indonesia (9.2%), China (7.4%). Number of TB cases in High income group countries is minimal in comparison. Therefore focus has to be different in different countries.
The pandemic has seen gross inequity in global vaccine supply. The vaccine manufacturers in the high income countries were reluctant to supply the vaccines to small developing countries. They demanded guarantees from the recipient countries which included even property of the embassy buildings of those countries.
As is evident there are gross differences in the health needs of the G20 countries it is to be seen how India gets its and other developing countries’ concerns addressed as priority in the G20 health agenda.
COVID affected Health Workers’ families need empathy and support
Date: 10.01.2023
COVID affected Health Workers’ families need empathy and support
It is to utter to dismay that only about 23.8 % families of the doctors who lost their life fighting COVID-19 have received the insurance amount announced by the Prime Minister under the Pradhan Mantri Garib Kalyan Package (PMGKP). This is as per the information received by Dr Babu K V, an Ophthalmologist from Kannur, Kerala on 26th September 2022 from The New India Assurance Company Ltd. in reply to an RTI filed by him. As per this reply total number of beneficiaries under PMGKP, who died of COVID during 30th March 2020 to 30th September 2022 is 1988 and amount for them comes to be Rs.994 crore. Only 428 beneficiaries have got the benefit so far which amounts to 214 crore rupees.
According to Dr Jayesh Lele, the Hony. Secretary General of Indian Medical Association, more than 1800 doctors succumbed to Covid 19. During the first wave 757 and during the second wave 839 lost their lives. Rest 204 died later. While all 29 COVID martyr doctors of Kerala are compensated, just 27 out of 150 Delhi doctors have been compensated.
In another case a notice was issued on 31st March 2020 by the Commissioner of the Navi Mumbai Municipal Corporation to Dr Bhskar Surgade to keep his dispensary open for the treatment of patients suffering from COVID-19 during the period of the lock down. Unfortunately he succumbed to COVID on 10th June 2020. Kiran Bhaskar Surgade, the spouse of Dr Bhaskar Surgade filed a petition before the High Court of Bombay for compensation. The High Court however rejected the Petition for compensation to the family of Dr Surgade on ground that the services of Dr Surgade were not requisitioned for COVID-19 duties and that the notice that was issued on 31st March 2020 cannot be construed as a notice requisitioning his services for the specific purpose of treating COVID-19 patients and the notice did not mandate that the dispensary was required to be kept open for Covid-19 patients. The issue now has been listed in the Special Leave Petition in the Supreme Court of India. As per the Apex Court, Prima facie the object of the Scheme is to provide a measure of social security to the health professionals because of the exposure to the COVID-19 virus which they are liable to suffer in the course of the discharge of their medical duties both in public and private institutions. The Apex court also observed that the matter raises an issue of nation-wide concern.
The whole issue has raised a serious question as to whether only those doctors and other healthcare workers of a specially requisitioned institution for the purpose of giving services to the COVID-19 effected patients are liable to the compensation, or any healthcare worker who dedicated her/his life during the extreme health crises deserves to receive insurance compensation. Under any health emergency it is the duty of the medical personnel to discharge their duty with dedication to the society. We have seen that most of the healthcare workers including doctors, nurses, paramedical staff, ASHA workers, Aanganwadi workers from both public and private sector were in the fore front to prevent the disease through public education and active treatment. This they did even at the cost of verbal or physical humiliation at some places.
In case of an unfortunate mishap the family comes to cross roads. There are many instances where the deceased person was the sole bread earner. It is therefore important that all such health workers whether requisitioned for the special purpose or not should be given insurance benefit without delay because they laid down their life serving the sick. Thousands of workers who were hired for short term during the COVID are now out on lurch. They need to be looked after. ASHA workers and Aanganwadi workers should be at least given recognition as regular workers .
India is already hub to several communicable as well non communicable diseases. The government owes responsibility to care for the affected. In fact the disease spread very fast forcing lakhs of people to migrate because there were no jobs or means of livelihood left. . Firstly the lockdown was imposed without any notice and then the government did not pay heed to the demand for compensation to the poor families. Trade unions demand to pay Rs.7500/- to each family of the workers went completely ignored. At a later stage only 5 Kg of grain and one Kg. Daal was offered as help. This is in contrast to many governments around the world who paid special allowances to the people during the COVID-19 because the jobs and means of livelihood were affected.
Indian state should wake up and develop a sympathetic attitude towards the COVID warriors. Gimmicks like showering of flowers or words of praise do not mean anything if there is no practical help. All the families who lost their members need to be looked after with due compensation and support.
Health and Education should be based on scientific outlook
Date: 31.12.2022
Health and Education should be based on scientific outlook
Dr Arun Mitra
A few days ago, while addressing the 75th Amrit Utsav of Swami Narayan Gurukul Rajkot Sansthan, Prime Minister Narendra Modi said that education has been completely neglected after independence. Therefore, it has become necessary that the government should bring forward the importance of ancient educational system. When previous governments faltered, he said, saints came forward and Swami Narayan Sansthan is an example. He said that in ancient times our education system was exemplary which gave importance to knowledge. “Our Gurukuls have been representing equity, equality, care and a sense of service for centuries”.
Educational system in a particular period depends on the social and economic conditions prevailing at that time. It is well known that in ancient times education was reserved for a special type of caste and the so-called upper class. A large section of the society did not have the right to education. When Eklavya mastered the art of archery on his own, Guru Dronacharya asked for his Thumb in Dakshina because he belonged to so-called lower caste, and his caste people did not have the right to education. There are also examples that even if a so-called low caste person overheard any educational talk, his ears were filled with lead so that he would not be able to hear any more.
The modern society spread education even among the economically and socially backward sections of the society by breaking these obscurantist ideas and breaking those bonds of religion and caste which prohibit right to education to all. Although there are many weaknesses and shortcomings in the education system of our country, but one thing is clear that after independence, due to the persistence of campaigns by the progressive movements, government high schools were opened on a large scale in many parts of the country where it became possible for the children of low socio economic groups to get education under one roof along with others. In 1968, the Kothari Commission gave specific recommendations for common school system to end disparity in education. Unfortunately these have not been implemented till date.
We hardly find mention of education among women in the ancient history. Even in the last century, Savitri Bai Phule, who was born in 1931 and who was encouraged by her husband Jyotiba Phule to study, she had to face many hardships. She was ridiculed and even stones were thrown so as to stop her from pursuing education. Social reformers, Raja Ram Mohan Roy and Swami Dayananda Saratwati did a lot for the education of women. After independence, many girls' schools and colleges were opened in the government sector to encourage education among women.
In the same speech, the Prime Minister goes on to say that the new education policy will produce new type of ideal citizens. But when we take a look at the new education policy, we find that this will lead to complete privatization of education further increasing inequality in education. This will also deprive large part of the society of quality education. Presently only about 2% of the GDP is spent on education as against the required 10%. Such type of education is intended to prepare a class of specially educated persons to serve the corporate sector as was done by the education system introduced by the British in our country to produce ‘Bhadra Lok’ to serve the masters.
Similar is the story of health services. India has to its credit the contribution in medical science by Charaka, a great physician of the time around 300BC. Accordingly, the Charaka Samhita mandates the physician to lead a life of celibacy, grow beard and hair, pray for cows and Brahmins. It forbids the doctor from treating those who are in opposition to the King or whom the physician or society may despise. But that was the period of Kings where Brahmins were at the top in the social Hierarchy. The modern oaths, belonging to the present, with tremendous advances in modern science bind that every human shall be treated equally and the physicians must be committed to treat fellow humans to the best of their abilities under any circumstances.
The health policy 2017 promotes insurance based healthcare system. This far from universal healthcare system as envisaged by several health experts. Because of exorbitant cost, quality health care is getting out of reach of people. Government expenditure on health is only 1.28 percent of GDP, while according to the World Health Organization it should be 5%. Ironically health and education are taken as liability not as an asset by our policy makers. Both health and education should be fundamental right of every Indian citizen. No wonder we are at a rank of 107 out of 121 in Hunger Index as a result of the exclusive policies. Our dismal performance in managing COVID Pandemic is not an old story.
I have given these two examples because there is persistent attack not only in the political and economic sphere but all the aspects of life. There has developed strong linkage between forces of obscurantism and the corporate sector. There is concentration of wealth in few hands while vast majority is deprived of basic needs. The ruling clique use coercion, oppress people and try to divide the people through false propaganda. The Prime Minister had in 2014 said that in ancient times science in our country was so much advanced that the head of an elephant could be transplanted on a man's head and also that genetic science was so developed in our country that Karan could be born without mother's womb. Many scientists also started expressing similar views. The Vice Chancellor of Andhra Pradesh University G. Nageswara Rao said in the Indian Science Congress at Jalandhar that the Kauravas who numbered 100 were born due to advanced stem cell research and technology in our country. Recently, the Indian Space Research Organization - ISRO and the Indian Council for Historical Research - ICHR have started working together on how to integrate ancient science with modern science.
When the forces in power fail to act in the interests of the common people, then they try to highlight the achievements of the society in the past in such a way that the people forget the failures of the ruling circles and are obsessed with the glory of the achievements of the past.
It is time we understand how such forces thrive on concocted stories and false propaganda. A lie spoken time and again appears to be truth and becomes part of people's psyche. The struggle against the forces of obscurantism is not only political or economic but there is a need to struggle at every level including developing scientific outlook in education and healthcare based on present day developments in medical science.
LESSONS LEARNT FROM PANDEMIC
Date: 22.12.2022
LESSONS LEARNT FROM PANDEMIC
Dr Arun Mitra
With the news that few cases of new Omicron variant which is said to have shorter incubation period and faster spread than the previous COVID infections is a matter of concern. However we have enough experience now from the past and should utilise that for prevention from COVID and promotion of good health. In the past even though a few scientists had predicted that Pandemics come and go every time and then. That time we had probably forgotten the Spanish Flu Pandemic nearly 100 years ago which had caused immense misery and millions of deaths. That time the knowledge of medical science was not as advanced as we have now. Despite the warning of a few scientists the issue was not taken that much seriously. Therefore the world was ill prepared to meet such eventuality. There was lack of medicines, hospital staff, equipment as well as vaccines to prevent the COVID in future. As a result we faced several serious issues globally, but in our country the poor people were at receiving end. The governments all over tried to hide their data pertaining to COVID. For example the Indian government said that 4 lakh people died but independent studies have pointed out the deaths to be between 25 to 40 lakhs. The government instead of treating it as health emergency brought in disaster act to tackle the situation. Totally un-thoughtful lockdown was suddenly imposed giving time of four hours only. This led to very precarious situation. People were suddenly left with no job, no means for livelihood and became shelter less. Poor workers decided to go to their village to live with their kith and kin. Instead of helping them the government stopped all the means of transport which forced them to walk hundreds of kilometres on foot, bicycles, carts and other personal/hired means of transport paying exorbitant amount. On the way they were treated like criminals by the administration at many places. Several accidents took place in this biggest ever migration after the independence. Unfortunately none of the ministers or government officials uttered a word of sympathy for them. The economy came to a standstill. Workers’ trade unions demanded Rs.7500/- to be given to each family to enable them to have minimum food to eat. This could have also let the economy going to an extent. But the government gave only few kilograms of grain, daal and a bit of oil. The non governmental organisations and religious institutions particularly Gurudwaras gave some respite to the people in the form of cooked or uncooked ration. The public sector health workers including the ASHA and Aangwadi were in the forefront to the help of people even though they do not have work man status.
It is painful to note that the pharma companies made huge profits even during such a serious health catastrophe. Medicines, masks, sanitizers and other such equipment were sold at higher prices. Glaring inequity was observed in Healthcare and the vaccines between the developed and the developing countries. Smaller countries who were forced to procure vaccines from the big vaccine producing giants were blackmailed. Pointing out this Dr Samir Malhotra from PGI Chandigarh said that the COVID-19 scare forced many governments to enter into contracts with the companies developing vaccines. Many of these contracts had confidentiality clauses according to which the company was exempted “from any civil liability for serious side effects arising from the use of the vaccine, indefinitely”. “Purchaser hereby agrees to indemnify, defend and hold harmless [the company and] each of their affiliates from and against any and all suits, claims, actions, demands, losses, damages, liabilities, settlements, penalties, fines, costs and expenses caused by, arising out of, relating to, or resulting from the vaccine.” Not only that, and this is shocking, these countries were asked to “put up sovereign assets as collateral to guarantee indemnity”. Such assets could include embassy buildings, cultural assets, etc. We still remember the threat given by the then US President Trump to India if it did not supply Chloroquine to the US.
We expect such inequities not to happen in future but there is no guarantee to it. The companies have profit only as their motive. They justify high pricing of drugs because they have to spend on research. This claim of the Pharma industry that they have to bear high cost in developing new drugs as a justification for such high prices is totally flawed because virtually 100% of initial research leading to new drugs occurs with the support of public funding. A vaccine that requires a few dollars to manufacture brings in profits worth billions of dollars to the company. To continue their exploitation the global powers brought in Trade Related Intellectual Property Rights (TRIPS) under the various clauses of the World Trade Organisation (WTO) The situation at present demands a complete revamping of such clauses which prohibit the developing countries from manufacturing cheap medicines/vaccines. The clause of compulsory licensing should be made simple in favour of the developing countries without long debates specially when we are in serious health crisis worldwide due to Pandemic. For our country it is all the more important to rejuvenate and strengthen our own public sector pharmaceutical industry with a purpose to produce cheap drugs/vaccines for local and global supply. We have national emergencies for several diseases, communicable as well as non-communicable.
It is all more important to avoid unscientific ideas like the use of cow urine and cow dung to treat Corona infection. False hopes can be counter productive. The Prime Minister in his speech in March 2020 had said that we will defeat corona in 21 days. Such unscientific utterings do not help. In case of health emergency let the health science prevail.
Nuclear Disarmament should be priority agenda of G 20
Date: 13 December 2022
Nuclear Disarmament should be priority agenda of G 20
Dr Arun Mitra
The group of 20 countries, nick named as G20 includes Argentina, Australia, Brazil, Canada, China, France, Germany, India, Indonesia, Italy, Japan, Republic of Korea, Mexico, Russia, Saudi Arabia, South Africa, Turkey, the United Kingdom, the United States and the European Union. So far seven summits of the G20 have been held. The first one was hosted by the US in the year 2008. The presidency of the summit goes to each country by rotation. This year it is India’s turn to lead the G20.
The world is faced with several serious challenges at this juncture. However there are opportunities too if the group moves in a proper direction and honest commitment under India’s leadership. We have the history of initiating the Non-Aligned movement (NAM) led by Jawahar Lal Nehru, Marshal Tito and Gamal Abdel Nasser of India, Yugoslavia and Egypt respectively. The NAM had 120 Member States, 17 Observer Countries and 10 Observer organization. This was the biggest organization of the developing countries at one time. Most of these countries had been liberated from the colonial yoke all of whom were deprived of even basic amenities for their population as a result of extreme exploitation by the colonial masters these countries. Collective development and inclusive growth was their necessity and common agenda. They could not afford war and waste resources at any cost. So they decided to remain away from the NATO or the Warsaw Pact. Their main thrust was against nuclear arms race and for general disarmament besides economic cooperation. This group therefore posed a challenge to the imperialist powers who continued with their agenda of economic exploitation of the developing world. Even though the countries in the NAM were not global economic powers, but their collectiveness was always a concern to the developed world, particularly the erstwhile colonial powers and the NATO. The collective wisdom of the NAM helped in containing arms race and also promoting several treaties for peace and disarmament.
The times have however changed. With the global political changes newer types of blocks have come up. The G20 is a mix of highly developed and developing economies. The US, Russia, UK, France and China are big military powers. Six out of this group of twenty are nuclear weapons possessing countries. So in this heterogeneous group there are different aspirations, approaches and solutions to the problems faced by the world today. Under the circumstances India has big responsibility in promoting the concept of One Earth, One Family, One Future, as conceived by the Indian Prime Minister who is to lead the group this year.
The recently held COP27 could not take final decisions for effective steps to mitigate the climate change, even though there has been agreement on the raising funds for the developing countries so as to check carbon prints.
Global economic gaps are increasing day by day. We could see how even during the time of COVID Pandemic the rich grew richer while the low economic groups were deprived of basic needs like food, shelter, medicines and even vaccines. Vaccine inequity was glaring. African countries were at the receiving end while the big Pharma companies made billions and put stringent conditions for the supply of vaccines.
Against the expectations, the arms race has not abated during or when the Pandemic is receding. According to new data on global military spending published on 25th April 2022 by the Stockholm International Peace Research Institute (SIPRI), total global military expenditure increased by 0.7 per cent in real terms in 2021, to reach $2113 billion. The five largest spenders in 2021 were the United States, China, India, the United Kingdom and Russia, together accounting for 62 per cent of expenditure. Therefore the G20 has the biggest challenge of disarmament as all the above countries are members of the group.
According to ICAN, “$82.4 billion, that’s how much the nine nuclear-armed states spent on their nuclear weapons in 2021 during a global pandemic, raising global food insecurity…..’ Nine countries have prioritized spending $156,841 per minute on nuclear weapons, as millions of their own citizens struggle to access healthcare, heat their homes, and even buy food. Spending on nuclear weapons is violence that costs lives.
The U.S. spent three times more than the next in line- a whopping $44.2 billion. China was the only other country crossing the ten billion mark, spending $11.7 billion. Russia had the third highest spending at $8.6 billion, though the U.K.’s $6.8 billion and the French $5.9 billion weren’t so far behind. India, Israel, Pakistan also each spent over a billion on their arsenals, while North Korea spent $642 million.
The peace groups have been demanding complete nuclear abolition. According to the IPPNW report Nuclear Famine, based on research conducted by climate scientists Alan Robock, Lili Xia, and their colleagues, a nuclear exchange between India and Pakistan using 100 Hiroshima-sized nuclear bombs will put more than two billion people at risk of starvation because of the impact on global food supplies. Such a war would kill up to 20 million people outright as major cities of the subcontinent would be destroyed and it would blanket much of South Asia with radioactive fallout.
There is also a global demand for commitment to no first use of nuclear weapons by all the nuclear weapon states. But not all have agreed to this, not even Russia and NATO-US in the on-going war in Ukraine. Even though India is committed to the policy of no first use of nuclear weapons, but recently, in August, 2022, the Union Defence Minister Rajnath Singh gave a hint that the policy can be changed depending upon the situations in future. US which spends maximum on the arms race is further updating its budget. It is also a matter of concern that Indian government’s pursuit for becoming an arms exporter at a time when the country is faced with several problems like hunger, malnutrition, unemployment, inequity in health and education. In this connection the decision to export Brahmos missiles to Philippines is a dangerous trend that India is adopting. Already India has signed international agreements to manufacture arms with a purpose to export them and Israel is our major partner in this endeavour. There is also demand for nuclear weapons free zones particularly in the South Asia in the present juncture.
It is indeed a big challenge for India to raise the voice for nuclear disarmament and join the Treaty on the Prohibition on Nuclear Weapons (TPNW). It is testing time for the G20 if it wants to fulfil the desired goal of One Earth, One Family, One Future. All these countries have also to prove their commitment for inclusive growth, a harmonious society and respect of human rights of all sections in their own countries.
Perpetuating Myth as Science
Date: 5 December 2022
Perpetuating Myth as Science
Dr Arun Mitra
Recent reports that Indian Space Research Institute (ISRO) is collaborating with Indian Council for Historical Research (ICHR) to study India’s contribution to science and to establish that India has been ‘Vishwa Guru’ (World leader) in the advancement of science have to be viewed with caution. As reported in HindustanTimes by Fareeha Iftikhar, the ICHR and ISRO will shortly sign a Memorandum of Understanding (MoU) to take up the project titled "History of Indian Science and Technology". The project will cost Rs.1.5 crore. The information about India’s rich history of science and technology will be collected from the ancient religious scriptures. RSS outfit Vijnana Bharati, which promotes "swadeshi science, had conceived the idea of “Akash Tatva,” conference with the aim to introduce the youth to the ‘wisdom of ancient science along with modern scientific advancements’.
It is always a matter of pride to trace one’s history in every field including in science. But all such work has to be based on evidence and not on prejudiced beliefs. Looking at the track record of those who are out to promote such ideas, one wonders whether such an exercise will be purely scientific as is being said or only to eulogise our past with the aim to arouse ultra nationalist feelings.
In a society where belief system is very powerful, many a times blind, it is not difficult to mobilize people on myths. A very authoritative example of this is when in 1995 the statues of Lord Ganesha suddenly started drinking milk. There was mad rush outside the temples to offer the Lord’s statue with milk to earn favours and blessings. Before the whole story could be unfolded, the statues stopped drinking milk in a few hours. Who conceived this idea, is still not known? But message is that in blind belief people get swayed away even by an idea like this which on the very thought appears to be unscientific and absurd.
Many controversial papers have been presented at the Indian Science Congresses (ISC) – the largest gathering of its kind in the country in the recent years. In 2015, the first ISC held after Narendra Modi became the Prime Minister, there was huge controversy when one speaker invited to the plenary claimed that “planes were invented in the Vedic Age by a sage”. Even before the speaker delivered the talk, an online petition endorsed by 200 had demanded that the scheduled lecture should be cancelled as it “mixes mythology with science and misleads people”.
In 2019, Andhra University vice-chancellor G. Nageshwara Rao and independent researcher K.J. Krishnan also made a series of unfounded claims, including that the Kauravas were “born with the help of stem cell and test tube technologies”; Ravana had “24 types of aircraft and airports in Lanka”; and that “guided missiles were present in India thousands of years ago”. The promoters of these ideas mince no words. Prime Minister Shri Narendra Modi has also said that the science in India was so much developed in the past that we could transplant the head of an elephant on the human body. No wonder Gau mutra and cow dung were promoted as cure for the COVID and non-evidence based Coronil of Ramdev was promoted by Dr Harsh Wardhan.
That some scientists and educationists subscribe to such ideas is a matter of serious concern. Astrophysicst Jayant Narlikar, has criticised these Indian scientists who have made outlandish claims about scientific knowledge that ancient Indians had. This only diminishes the respect for achievements that are backed by evidence. “But we shouldn’t claim things of which there is no evidence or proof as it reduces the credibility of what our scientists have achieved in the past. Even the West recognizes the knowledge of mathematics held by Indians. If we start making outlandish claims, the scientific community of world will not look up to us as it does now,” he said in 2015.
We all are proud of the contributions of our scientists in the ancient times. We have on record the contribution of Aryabhatta (476 to 550 AD) author of several treatises on mathematics and astronomy; Charak, the physician around 100 BCE; Sushruta, the surgeon around 800 BCE. The concept of Zero which Indian mathematician gave to the world is a matter to be proud of. The civilizations of Harappa and Mohenjedaro are amazing. We have marvellous archaeological monuments. The paintings in Ajanta Ellora are a big scientific feat in addition to the art they exhibit. One gets astonished how at the time when we had very little technology, all this happened.
Science is a dynamic process. It has taught us that everything is in motion. Science is never dogmatic and amenable to accept newer ideas, thoughts and developments. For example the smallest particles in the ancient times were considered to be Panchbhuta (Earth, Water, Fire, Air and Space). This means that are the elements which form the life system. But with the advancement of science we have come to know that the much smaller atomic particles form the basis of whole living and non-living in the universe.
Mankind has progressed from the primitive times to the modern human society through human labour. Every step forward taken by the human society from the primitive time is based on contemporary scientific work. Primitive man used stone as the basic tool. He learnt to kill the animal with that tool which he had to do earlier with hands. He learnt to light the fire by striking two stones against each other. The process never stopped. Much of scientific developments occurred during the period of renaissance in Europe. The speed of scientific developments changed from time to time. With the present technology of microchips this speed has increased in multiples.
Spreading falsehood persistently will make the upcoming generations to believe in these things as truth. More so because opposite ideas will be made to disappear from the discourse in the media or even scientific gatherings.
Scientists have lot many challenges in the present times and have to make a louder voice to call spade a spade and expose the subtle designs of these forces. It is unfortunate that even several doctors and scientists were out in the streets to ‘clap’ and ‘bang thalies’ in the belief to quell the Novel Corona virus at a call given by the Prime Minister. This was probably yet another test of people’s mind-set after the incident of statues drinking milk.
Falling hunger index in India - A cause of concern
Date: 18 November 2022
Falling hunger index in India - A cause of concern
Dr Arun Mitra
Perplexed with the report that India has further fallen in the Hunger Index to 107th position out of 121 countries, the government of India, instead of debating corrective measures is out to criticise the agencies Welthungerhilfe (WHH) or Concern Worldwide, who calculate this index every year. The government is challenging the methodology of calculating the hunger index. It is therefore important to know how this index has been calculated in the successive years and why the government is up in arms this time. Not only that the statement has come from ministry of Women and Child Development, there is a lobby systematically justifying the stand of the government and is trying to find faults with the methodology of calculating hunger index.
From a Global Hunger Index (GHI) score of 27.5 last year, our country has fallen to 29.1. According to the GHI a rank of ≤ 9.9 is considered to be low, 10.0–19.9 moderate, 20.0–34.9 serious, 35.0–49.9 alarming, ≥ 50.0 extremely alarming. The Hunger Index is based on the criteria, Inadequate food supply, Child mortality and Child under-nutrition. Last year the report had pointed out that 1/4th of the total malnourished in the world live in India.
Supply of balanced food to all the citizens of the country is the basic requirement to reduce malnutrition. A balanced diet means sufficient number of proteins, fats, carbohydrates and micro nutrients in the form of vitamins and minerals. At the present market price the cost of nutritious food per person comes to be around Rs.225/- per day. This means that a family of five members should spend Rs.1125/- per day or Rs.33750/- per month on food only.
The government’s scheme to give 5 kg of grains and one kg daal and a bit of oil does not fulfil the nutritional requirements. The government’s bandwagon is harping on that this scheme has done away with hunger. Firstly the scheme is not operational throughout; It is in practice only during the elections. That people are satisfied with this much food is a matter of even more concern. It points out to the fact that there is so much poverty that even this much food which is far from being nutritious and is barely sufficient for subsistence is a big relief to the people. It does not at all meet the requirements of micro nutrients like vitamins and minerals essential for physical and mental growth. With 15 crore people out of a population of 23 crore in Uttar Pradesh queuing up to get this much ration free of cost is a projection of extremely dismal state of affairs of nutritional security.
Recent economic surveys have pointed out that 90% of families spend less than Rs.10000/- per month. A balanced diet for them is only a dream which does not seem to come true in the present circumstances. By imposing taxes on the essential food items, cost of filling the belly has increased. The wages on the other hand are showing a downward trend as the employment is shifting to contractual labour with no job security nor any employment benefits like the provident fund or the ESI. Small scale sector which provides livelihood to large number of people is at a receiving end under the neoliberal economic policy.
To meet the requirements of 2300 calories and a healthy food and clothing for a young adult, various workers organizations have demanded minimum wage based on the principle of these caloric needs. They have demanded a minimum wage of Rs.21000/- per month. To utter dismay, the government announced a floor level wage as Rs.178/- per day or Rs.4628/- per month. This is despite an internal labour ministry committee recommendation of Rs.375/- per day. This is even against the government’s own notification for Rs.18000/- per month for contract workers in the government’s establishments which comes to about Rs.650/- per day wage. The government is now contemplating to change the calculation from calorie based wages to time rate. The government’s intention to introduce time based work wage is against the medical advice and health needs of a person.
Large number of our population in our country is in the unorganised sector where the legal formulations are hardly implemented. The farmers and agriculture labour who are the producers are among the worst sufferers. Agriculture labourers have to face double oppression, economic as well as social. Farmers protested against the new Farm Laws fearing these will not only adversely affect their economic conditions but the food security of the citizens too will be compromised.
It is therefore imperative that essential food items are cost effective and within the reach of low socio-economic groups. Wages for all sections be revised as per the caloric needs, balanced diet, clothing, health, education, housing and recreation. In this context the GST levied on food and other day to day needs items be withdrawn to prevent further malnutrition.
Moody's India's GDP growth projections for 2022 have been slashed to 7 per cent from 7.7 per cent earlier because of the global slowdown and rising domestic interest rates. This will further dampen economic momentum and impact the food security. The government is likely to reject this as well. But it is important that economic policies are revised with an inclusive growth in mind. There is a thin line between under nutrition and hunger. It is worthless talking of some technical jargons and finding excuses to reject the global hunger index report. The GHI report is not new. Since the last few years our rank has been declining. There is day in and day out talk by the government to make India a 5 trillion economy. Such reports belie the government’s claims and bring down the image globally.
The only way is to raise the purchasing capacity of the people by ensuring sufficient wages and means of livelihood to meet the requirement of quality food for the citizens.
References:
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COP27 should take serious cognizance of Nuclear Weapons abolition for climate crisis mitigation
Date: 11.11.2022
COP27 should take serious cognizance of Nuclear Weapons abolition
for climate crisis mitigation
Humanity is on a “highway to climate hell with our foot on the accelerator”, the UN secretary general has warned, saying ‘the fight for a liveable planet will be won or lost in this decade.’ He told world leaders at the opening of the Cop27 UN climate summit in Egypt, “We are in the fight of our lives and we are losing … And our planet is fast approaching tipping points that will make climate chaos irreversible”. He warned the world faced a stark choice over the next fortnight of talks: either developed and developing countries working together to make a “historic pact” that would reduce greenhouse gas emissions and set the world on a low-carbon path – or failure, which would bring climate breakdown and catastrophe.
Governmental representatives and civil society organisations from around the globe are meeting at the Conference of Parties - COP 27 in Egypt. According to the provisional list published by the United Nations Framework Convention on Climate Change (UNFCCC), 33,449 participants have registered for COP27.
The issue has gained importance because the world is witnessing repeated natural calamities as a result of rise in temperature of the earth and melting of glaciers causing rise in the sea level. This summit is in continuation of several such meets held earlier to discuss and impress upon the governments to take steps to mitigate the factors responsible for climate change. Half-hearted measures by the governments, particularly the developed or fast developing economies in taking steps to control climate crisis have added to the crises.
Increase in military activity is one among the major causes for the production of gases responsible for climate crises. Production of arms, their maintenance, their transport and use, all involve energy. Extensive use of munitions in the war between Russia and Ukraine is adding to climate crisis. There is no sign of war coming to an end in the near future. Threat of use of nuclear weapons has not completely ended despite assurance from Russia. Nuclear power plants are in persistent danger.
It is therefore important that the countries should debate on reducing tensions in different parts of the world so that production, sale and use of the armaments is put under check.
A study, “Climate Consequences of Regional Nuclear War” conducted by Ira Helfand former Co-President International Physicians for the Prevention of Nuclear War (IPPNW) and Alan Robock from the Department of Environmental Sciences, Rutgers University, USA has pointed out that the present nuclear weapons numbering about 17000 on earth pose a serious risk to climate and thus risk to all life forms.
According to the study a nuclear exchange between India and Pakistan using 100 Hiroshima sized nuclear bombs will put over two billion people at risk. Such a war would kill up to 20 million people outright as major cities of the subcontinent would be destroyed and it would blanket much of South Asia with radioactive fallout. But the global consequences are even more alarming. Soot and debris injected into the atmosphere from the explosions and resulting fires would block sunlight from reaching the Earth, producing an average surface cooling of -1.25ºC that would last for several years. Even 10 years out, there would be a persistent average surface cooling of -0.5ºC. This will reduce rainfall globally by 10%.
The study further cautions that in such situations, there will be reduction in crop yields. The food shortage will lead to increases in food prices further affecting the already malnourished poor people across the globe. There are more than one billion people in the world whose daily caloric intake falls below the minimum requirements. Even a modest, sudden decline in agricultural production could trigger massive famine. If famine conditions persisted for a year or more, it seems reasonable to fear that the total global death toll in the Global South could exceed one billion from starvation alone.
There is a very high likelihood that famine on this scale would lead to major epidemics of infectious diseases. Illnesses such as plague, which have not been prevalent in recent years, might again become major health threats.
According to the estimates in the study the food crisis is likely to trigger internal and external conflicts. In such situation the use of nuclear weapons between the two nuclear super powers, the United States and Russia cannot be ruled out. Huge swaths of both countries would be blanketed by radioactive fallout and their industrial, transportation, and communication infrastructures would be destroyed. Most Americans and Russians would die in the succeeding months from radiation sickness, epidemic disease, exposure and starvation.
The International Physicians for the Prevention of Nuclear War (IPPNW) and the International Campaign to Abolish Nuclear Weapons (ICAN) have highlighted this issue and tried to impress upon the participating parties in the Egypt summit to take serious cognizance of nuclear weapons and ask all nuclear weapons possessing countries to join the Treaty Prohibiting Nuclear Weapons (TPNW) and abolish these weapons for good.
Persistent increase in the expenditure on the nuclear arms, despite the UNOs passing Treaty Prohibiting Nuclear Weapons (TPNW), which has declared the nuclear weapons illegal and has called for their complete abolition is a cause of concern. This is in our hand. Huge expenditure on nuclear weapons is costing several welfare needs of our people. It is unfortunate that the narrative to the effect is not being given due importance including in our country. This should have been one of the main focus of the debate, but is not seen on the top of the list. It is the duty of all peace loving citizens to raise the voice. The participating parties at the COP-27 should debate this issue seriously as a priority.
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Political parties should ensure health as a fundamental right
Date: 25.10.2022
Political parties should ensure health as a fundamental right
Dr Arun Mitra
Democracy is a means to decide how we want to be governed. To woo the voters political parties therefore decide their agenda which they feel will fetch them votes to reach the seat of power. They give populist slogans, whether they can fulfill them or not is another question. In poverty stricken society of our country even little amount of relief has lot of meaning. Education and health are assets for any society and form basis for inclusive growth and over all development. But they have not been given due attention by successive governments.
Health is the primary requisite for any person to work and contribute in man-days to full capacity. An Infant Mortality Rate (IMR) of 27.7 deaths per 1000 live births and under 5 year mortality rate of 32 and Maternal Mortality Rate (MMR) of 103 per 100,000 live births are worrisome. It is a shame that in the Global Hunger Index, India stands at 107 out of 120 countries. Because of poor planning and infrastructure the diseases like Malaria, Tuberculosis, Cardiac illnesses, Diabetes, Cancer etc. got ignored during the COVID Pandemic, even though as per many independent estimates we lost 25 to 40 lakh people due to COVID. Therefore instead of piecemeal approach we need comprehensive healthcare for or citizens.
The insurance based healthcare system introduced after the Neo-liberal economic policies, has failed to deliver comprehensive healthcare to the people, instead it has become means to divert money from the public funds to the corporate sector. All the insurance systems including Ayshman Bharat cover only the indoor care, while nearly 70% of the out of pocket expenditure is on OPD care. Only the ESI scheme, ECHS and CGHS cover both outdoor and indoor care to the patients. The government instead of owning responsibility for the healthcare is outsourcing various healthcare centers to the private sector. There is effort to bring government hospitals including district hospitals, Primary Health Centers (PHCs) under private control. This will further devoid the quality health care of low and middle income group people.
Even worse is that unscientific and non-evidence based methods of treatment are being promoted. Cow urine, Cow dung and Ramdev’s Coronil had been recommended as treatment of various diseases including the COVID-19 by the obscurantist forces with the support of the then union Health Minister Dr Harsh Vardhan, who is an ENT surgeon trained in the modern scientific medicine. It would be naïve to believe that the Prime Minister had no knowledge of all this, as no decision under this government is taken without the knowledge of PMO.
Out of pocket spending on drugs comes to nearly 67% of the total expenditure on health. But till date we lack a rational Drug Policy. As a result the Pharmaceutical companies are making huge profits. To put a check on the high trade margins in the sale of drugs the government had appointed a committee which submitted its report in December 2015. The committee had recommended capping of the trade margins. But no steps have been taken even after seven years.
It is therefore of utmost importance that state owns the responsibility for health with commitment to evidence based scientific healthcare. Unfortunately health is not a priority agenda for any political party. Dr Tejbir Singh, former Director Health Services Punjab in a seminar organized by the Indian Doctors for Peace and Development (IDPD) had pointed out that healthcare should be made justiciable; For this healthcare has to be declared a Fundamental Right. After reviewing the constitution of various political parties, he said that it is unfortunate that no political party has asked for health to be a fundamental right. The BJP has advocated expansion of health insurance system. The Congress has demanded right to health act and doubling of public health expenditure. The left parties have demanded to raise the public expenditure on health to 6% of the GDP. The Aam Admi Party is advocating Mohalla clinics. The Communist Party of India (CPI) has lately resolved to demand Health as a Fundamental Right. This is a welcome step which all political parties should follow.
The political parties should strive for a comprehensive healthcare to all for which they must come forward vociferously to demand health to be declared fundamental right. This should become their core agenda. Public expenditure on health should be increased from the present 1.28% to 6% of the GDP; All drugs, vaccines and medical devices should be produced by Union and state Governments through Public sector units to ensure drugs security without profit as the sole motive. Active pharmaceutical ingredients should also be produced by public sector units to ensure self-reliance in drugs production.
Insurance based healthcare system should be abandoned and public health system should be strengthened. All treatments, investigations and services should be given free of cost. Medical staffs including doctors, nurses, paramedics, ASHA workers and Aanganwadi workers should be appointed on permanent basis. All temporary workers should be made permanent. Equitable distribution of doctors should be ensured in rural and urban areas. Medical education should be imparted in state sector only. Instead of Mixopathy an evidence based Scientific method of medical system alone should be permitted. Good nutrition should be ensured through proper measures under the Food Security Act. In schools Mid-day meal, free breakfast scheme should be provided in all states. Universal Immunization Programme (UIP) should be expanded to adults. Provide Human papilloma Virus (HPV) vaccination for all girls and young women to prevent Cervix cancer. Newer vaccines like influenza vaccines, Pneumococcal vaccine, zoster vaccine should be included in Universal Immunization Programme.
Political parties go by the public opinion. It is therefore for the civil society to be more vocal on the issues of health for all and health a fundamental right and force every political party to take Health to be Fundamental Right as their priority agenda.
Published in
health as a fundamental right
I can't hate anyone
Date: 04.10.2022
I can't hate anyone
Dr Arun Mitra
During training as a doctor we are told to be empathetic, compassionate and caring for anyone who visits us for advice. This becomes part of the value system of most of the doctors. To treat, to care and to advise in a scientific manner to any person without any bias for caste, creed, religion, gender or socio-economic status is duty of a physician. This is because medical science has proved all human beings to have similar blood. Therefore doctors have been in the fore front to speak against discrimination and violence of any kinds. They have raised voice for the check on the proliferation of small arms which are used in violent incidents. It’s also natural for us to speak against nuclear power and doctrine of threat of violence with nuclear weapons and seek total abolition of weapons of mass destruction. The doctors have been serving people without caring for the borders. They have worked in the most arduous conditions of natural and manmade calamity. It therefore hurts when someone talks of bias against people from other religion, caste, ethnic groups or gender.
This bias is not inherent to the human feeling but is inculcated and developed during the period of growth from childhood to adolescence through our talks with those who have such feelings. The atmosphere prevailing around us helps build our thought process to a large extent. Such bigot feelings can ultimately turn into hate to the extent of committing extreme kind of violence towards those who disagree or question. We have been witnessing this in several places at different times around the globe.
Nazis had no remorse in killing Jews or others who did not conform to their ideology. Over 8 lakh people died in 100 days of violence from 7th April to 15th July 1994 where Hutu led government targeted Tutsi and moderate Hutus in Rawanda. Hatred was to the extent that even husbands killed wives from other tribe. More than 20 lakh people are supposed to have died during communal violence at the time of partition of India in which Hindus, Muslims and Sikhs killed each other for no reason. What happened during the pogrom of Muslims in Gujarat in 2002 or anti Sikh riots in 1984 are a slur on our democracy.
In the present day times of science and technology there are forces who change laws to suit the structures in power in the name of religion or race. In a patriarchal society, women bear maximum brunt through miss-interpretation of religion by those who desire to continue to subjugation the women. It is easy to impose sanctions, the dress code and other things on women. Events in Iran are a pointer to this. Looking at the pictures of women in a museums in Iran, in the ancient times Iranian women never used a purdah. Therefore they have not accepted hijab as part of their dress. So they are rejecting the hijab despite extreme repression by the religious fundamentalist government. But those in power have no remorse in killing a 22 years young woman just because she spread her hair out and removed the hijab. The protests continue even though the girls in more number are out to face the killer squads. Worse is that the law makers in the Parliament shout in favour of police who is out to kill.
Rituals of worship have become stereotypical and lost the essence of humanity/religious value system. On many occasions extreme indoctrination about certain practices have been enforced on immature minds and made to follow dictates. Like any other thing religion too needs to be updated. Dogmatic approach in religion will kill its essence.
Swami Vivekanada in his speech at Chicago had said ‘I am proud to belong to a religion which has taught the world, tolerance and universal acceptance. We accept all religions as true...I am proud to belong to a nation which has protected all persecuted...’ "Sectarianism, bigotry and its horrible descendant, fanaticism, have long possessed this beautiful earth. They have filled the earth with violence, drenched it often with human blood, destroyed civilization"
Rabindra Nath Tagore had said the same in a different manner ‘that we must wake up in a country where fear does not exist, we must not put people in fear’. The great martyr Bhagat Singh had out rightly condemned communalism as it was an impediment in uniting the people for anti-colonial struggle.
By promoting hate, enjoying wounds being afflicted to others we loose our humanness and develop bizarre mind and a sick personality. Bigotry is a mental illness. Duty of a doctor is not only to be free of hate against others, but also preach love and compassion and inculcate fearlessness among the people to speak the truth under any circumstances. This is important because several doctors sided with Nazis in conducting experiments on the prisoners. Reports that some doctors refused to treat patients from other community during the violence in Gujarat is totally unethical and unexpected of a doctor. Let us all understand that if we inflict wounds on others, one day they bounce back.
Published in :
https://dailyheadlinestoday.com/epaper/view/476/headlines-today/7
https://ipanewspack.com/doctors-have-to-care-of-all-patients-irrespective-of-religion-and-colour/
Overcharging by the corporate hospitals
Date: 30.09.2022
Overcharging by the corporate hospitals
Dr Arun Mitra
The issue of overcharging by the corporate hospitals has been a matter of much concern. In 2017 it came to highlight when a child suffering from Dengue Fever could not be saved in the Fortis hospital, Gurgaon but the parents were billed Rs.15 Lakhs. The family alleged that the hospital charged for 660 syringes, 1600 gloves for the period of 15 days for which the child was admitted. The hospital authorities clarified that all protocols were followed during the treatment. Negligence was not the issue in this case but lack of empathy on the part of the hospital administration and overcharging perturbed the family of the patient. Since the treatment for the advanced care has become expensive, many a times the charges become a cause of contention between the patient and the hospital authorities. Now this has been officially confirmed by the Competition Commission of India (CCI) who has found some corporate hospitals to be violating the competition laws and over charging on the medicines, consumables, room rent and other services etc. This affirms people’s perception of the fleecing of patients by the corporate hospitals. The CCI has found that the Apollo Hospitals, Max Healthcare, Fortis Healthcare, Sir Ganga Ram Hospital, Batra Hospital & Medical Research and St. Stephen’s Hospital have been indulging in this practice of overcharging. They have been abusing their dominance through exorbitant pricing of medical services and products in contravention of competition laws. A report published in the moneycontrol.com says that the CCI has found these hospitals charging the room rent even more than three or four star hospitals.
According to this report, as per the powers with the CCI it can impose a penalty up to 10% of the average of the annual turnover for the previous three years. Apollo Hospitals posted an average turnover of Rs 12,206 crore and Fortis Rs 4,834 crore in the past three financial years. Whether the patients who have been over charged will get any benefit is not yet known, but any proactive decision by the CCI can deter these hospitals to an extent from over charging. The CCI is yet to review the response from the hospitals and take a decision accordingly.
The question however is whether the healthcare has to be treated as an industry where profit making is the sole aim or it has to be prioritized as service to the ailing people. There is a conceptual difference between the two. The policies on the healthcare will depend on what the concept of the healthcare is being followed by the state. Such concepts not only affect the advanced healthcare but also primary and secondary care, medical education system and also the issue of drug pricing. In the last few years we have seen exorbitant growth of the corporate hospitals. In our country 90% of the families spend less than Rs.10000/- per month and people earning Rs 25,000 per month fall in top 10% of wage earners. In the present economic scenario, one can easily presume that over 95% of the population cannot even dream of visiting these hospitals.
There is thus urgent necessity to review the whole healthcare system and public health spending in our country. Presently nearly 75% of the healthcare is in the private sector where people have to spend from their pockets. It is accepted by the government’s own documents that this out of pocket expenditure on health is pushing 6 crore people into poverty every year. Poverty adds to sickness thus starting a vicious cycle of people borrowing for healthcare and landing up into serious debts. Knowing fully well the state’s spending on health is not increasing. In fact it has come down from 1.35% to 1.28% of the GDP.
Need is that the government should come forward in a big way in providing advanced healthcare at the district level so as to prevent fleecing by the corporate hospitals who have no empathy towards the sick; their only interest is profit making. Insurance based healthcare is no answer as this system has failed in the USA whose public health spending is much high, but still its health indicators are not as good as several countries who spend less than the US. In our country it is pertinent that the government should increase spending on health from 1.28% of the GDP to 6% to ensure basic minimum healthcare to all.
Publishded in :
https://www.imphaltimes.com/pdf/2022/October/2%20October.pdf
https://www.thenorthlines.com/corporate-hospitals-are-fleecing-common-patients-by-overcharging/
https://ipanewspack.com/corporate-hospitals-are-fleecing-common-patients-by-overcharging/
https://tryxyz.com/article23120-CORPORATE-HOSPITALS-ARE-FLEECING-COMMON-PATIENTS-BY-OVERCHARGING
Hate mongering has serious physical and mental health impact
Date: 19.9.2022
Hate mongering has serious physical and mental health impact
Dr Arun Mitra
Health refers to a state of complete emotional and physical well-being. It is therefore important that social and environmental milieu is conducive and fulfils the criteria of better nutrition, equitable distribution of resources and affordable healthcare facilities. There have to be sufficient conditions to prevent mental health issues. For all this, it is imperative to imbibe and practice democratic values for rapprochement of cultures, freedom of expression, right to dissent and right to demand for better life. But when these conditions are disturbed because of political and economic interests of a few, physical and mental health are bound to suffer.
Nature has bestowed upon us the life of finest creature on earth with a promise to live in peace, harmony, care for other life forms and preserve ecology for a sustainable development. Diversity is the essence of human civilization. In our country we have different cultures, languages, customs, dress code and above all will and strength to assimilate other viewpoints. We collectively have maintained unity in diversity.
Since last few years we are witnessing persistent attack on these values. Concocted stories are being projected, history is being distorted and false propaganda is being unleashed against those who disagree. These circumstances have created prejudice & bias against others in the mind of people. These cause of feeling of alienation and become cause of physical and mental trauma.
During a visit to the North East Delhi where the communal violence was perpetrated we could find several health problems in the make shift arrangements for the victims of violence. As in all refugee camps, these health issues were a result of lack of proper food, lack of hygiene facilities, lack of family atmosphere and privacy of a home. The sense of insecurity could be seen in the minds of all, particularly among women and children. It was evident that the violence was engineered by some vested interests. Similar situation was witnessed during violence against the Sikhs in 1984. Terrorist violence during that period also had similar overtones.
Worst kind of massacre in our country occurred during partition in 1947 when Hindus, Sikhs and Muslims killed each other because a propaganda of hate was unleashed against each other. Over 1.5 crore persons migrated from one place to the other, the biggest ever in the history of mankind. Trains were full with people sitting even on their roof top. At many places they were looted, killed and women were raped. Many perished on the way because of lack of food and absence of medical care. Several pregnant women lost their life died because they did not get timely care. The violent nature of the partition created an atmosphere of hostility and suspicion between India and Pakistan that affects their relationship to this day. The sense of mistrust against each other generated through hate mongering against other community resulted in killing of about 20 lakh people.
That was the time of colonial rule who had conspired to split the continent on communal lines both in terms of geography and social relations. But now we have our own elected government and we expect the government to be impartial and work as per our constitution. But when the state supports falsehood and hate, situation is bound to get worse. It was unexpected of the Prime Minister to speak the words like ‘recognize them form the clothes they wear’. This was a clear signal to the bandwagon to go berserk and be rest assured of no punitive action. When a minister of state gave an open call ‘Goli Maro Saalon Ko’, he should have been reprimanded. But instead he has been promoted as a cabinet minister. What happened during Godhra we do not exactly know, but what happened in other places of Gujarat when killing hundreds of Muslims with overt and
covert support of the then Chief Minister occurred, is not hidden from anyone. The then Prime Minister Atal Bihari Vajpayee at that time had to ask the Chief Minister to do Raj Dharma.
The resultant effect is the incidents of mob lynching, hitherto unknown in our country. Instead of punishing the accused it is the victim who have been put behind bar in many instances. Release of the rapist and the killers of family of Bilkis Bano is a clear cut signal. It was well synchronized with date and time when the Prime Minster spoke of respect to women and stringent punishment to the rapists from the Red Forte on 15th August 2022 that all the 11 accused were released.
A letter by Umar Khalid published in The Wire telling his anguish for being jailed without reason or investigation has to be taken seriously. The judgment of Allahabad High court while granting bail to Dr Kafeel about his illegal detention should be an eye opener.
It is not just the people of minority community, who at present form nearly 50% of the under trials under UAPA, but people from majority community also who question the wrong will meet similar fate. Subodh Kumar, the police inspector killed in Bulandshahar by the unruly mob belonged to majority community.
It is time to speak now otherwise with such incidents on the rise, social cohesion, which is so essential for health, education, and inclusive growth will suffer. It would be naïve to think that we cannot become Germany of Nazis. It must also be remembered that post hatred towards any community is not forgotten for generations.
Published in:
https://www.nationalheraldindia.com/opinion/is-india-headed-the-same-way-as-nazi-ruled-germany-2
https://themeghalayan.com/hate-mongering-and-mental-health-impact/
https://tryxyz.com/article23016-HATE-MONGERING-HAS-SERIOUS-PHYSICAL-AND-MENTAL-HEALTH-IMPACT
https://ipanewspack.com/hate-mongering-has-serious-physical-and-mental-health-impact/
Doctors have to be proactive in the present imbroglio
Date: 6.9.2022
Doctors have to be proactive in the present imbroglio
Dr Arun Mitra
Medicine is not a profession but a passion. To uphold the dignity of medicine and to ensure commitment to the health care of the people, the World Medical Association (WMA) Declaration of Geneva was adopted in its 2nd General Assembly at in September 1948. The declaration highlights a physician's dedication to the humanitarian goals of medicine. The declaration was especially important in view of the medical crimes which had just been committed in German-occupied Europe. As per this declaration the doctor commits and declares, ‘I solemnly pledge to dedicate my life to the service of humanity; I will maintain the utmost respect for human life; I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient’.
The medical personnel have to identify with the society and social concerns at every step. Dr. Rudolf Virchow who is considered to be the father of pathology stressed that ”If medicine is to fulfill her great task, then she must enter the political and social life.” He believed in the concept that 'medicine is a social science,' and that physicians are responsible to work on behalf of the poor. This means the physician must be sensitive to various issues of the society.
Besides the study of normal structure and working of the human body that is the anatomy, physiology, in medicine doctors have to learn the factors for causation of disease and the abnormality produced in the structure and functioning of the body. It is only after this elaborate study that one learns the art of treating the patient.
However prevention of disease forms the core of the curriculum throughout. Therefore in medicine one has to learn about the social determinants of health which include economic stability, employment, housing, poverty, food security, education, neighbourhood environment, healthcare access etc. Basic needs like clean air, clean drinking water, adequate sewerage facilities are essential to promote good health. A physician must engage on these issues if the WMA Geneva declaration is to be put into practice ideally. It is to the credit of medical profession that it raised voice against female foeticide; informed the public about the harmful effects of smoking and alcohol. Several doctors risk their lives by going deep into the areas of conflict to serve the sick and the infirm. Many doctors have also rendered yeoman’s services in natural and manmade calamities.
While treating the patients the doctors learn that peace and stability are most important for good health of the people. Violence prevention has become a public health issue. Scientifically outlined steps for its prevention have been outlined since health is the biggest calamity during such situation. The International physicians for the Prevention of Nuclear War (IPPNW) has conducted scientific studies on the climatic consequences of nuclear war and vociferously called for the complete abolition of nuclear weapons. This was instrumental in passing Treaty on the Prohibition of Nuclear Weapons (TPNW).
Unfortunately peace and stability are under threat in large parts of the world today. There are forces globally who are out to create external and internal conflicts with the intention to make huge profits by selling arms. There are forces that are out to create communal and caste conflicts for political gains. Doctors can play an effective role in getting the society rid of such menace. It is therefore important that we have to shed pre-conceived ideas and biases based on gender, caste, religion and other prejudices which have been made prevalent in the society by such vested interests. It is understandable that many a times the doctors have to work in the situations under pressure and threat particularly during the conditions of conflicts, strife and social unrest. But we have to brave through these situations.
In India we are faced with a very precarious situation today. Obsolete ideas and myths are being spread by the forces spreading obscurantism for narrow political gains. These have to be opposed. It is an important task for a physician to strengthen scientific temper in the society. As an example the use of cow urine and cow dung in treating COVID-19 was opposed by several medical organisaitons. But it is unfortunate that the same organisations kept mum or joined the chorus to make the virus runway by banging ‘thalies’, clapping and lighting ‘Diyas’. This is something totally unexpected of a doctor. Not many medical organisations or personnel came forward to side with Dr Kafeel who was falsely implicated for raising the issue of flaws in Oxygen supply at Gorakhpur hospital. Neither did they come out in open to oppose communal violence in Delhi and other places. This was due to conviction or fear, we do not know, but one thing is certain that keeping mum amounts to giving strength to communal and divisive ideas. We have to be bold enough to shed fear and speak the truth, while doing so we would be promoting right kind of politics. It is true that in the present commercialised atmosphere doctors have become part of the whole game. But we must stick to the Geneva declaration and not let any blot happen on our profession as happened during Nazi regime.
Published in :
https://dailyheadlinestoday.com/epaper/view/452/epaper-headlines-today/6
https://thearabianpost.com/medical-doctors-have-to-identify-with-society-and-peoples-concerns/
https://ipanewspack.com/medical-doctors-have-to-identify-with-society-and-peoples-concerns/
https://tryxyz.com/article39241-MEDICAL-DOCTORS-HAVE-TO-IDENTIFY-WITH-SOCIETY-AND-PEOPLE-S-CONCERNS
Any nuclear exchange would push the world to a point of no return
Date: 27.08.2022
Any nuclear exchange would push the world to a point of no return
Climate Crisis of unprecedented degree as a result of nuclear war would extinct the modern civilization, cites a new study
The war between Russia and Ukraine with an overt involvement of the NATO has killed thousands, pushed millions to refugee status and caused immense destruction of resources. Much in danger are the nuclear power plants in Ukraine which if damaged by intentional attack, accident, technology failure or the modern day cybercrime, would become potential nuclear bomb. The Plant at Zaporhizhzhia which has been occupied by the Russian forces can be a flash point. Ukraine has a history of dreadful Chernobyl nuclear accident. Moreover the danger of a use of nuclear weapons in case the war continues is real as both NATO and Russia have threatened each other with the use of these weapons if the situation arises. The collateral damage in such a situation will be catastrophic. An evidence based new scientific study “Nuclear Famine - Even a "limited" nuclear war would cause abrupt climate disruption and global Starvation” highlights the gravity of humanitarian consequences in case of use of nuclear weapons even at a smaller scale.
This report released on 15th August 2022 and published in Peer Reviewed Journal ‘Nature Food’ summarizes the latest scientific work by Lili Xia and Alan Robock of Rutgers University together with colleagues around the globe. It shows just how dangerous even a “limited” nuclear war in one part of the world would be. The report says that ‘a so- called “limited” or “regional” nuclear war would be neither limited nor regional. On the contrary, it would be a planetary-scale event. In fact, it would be far more dangerous than we understood even a few years ago. A war that detonated less than 1/20th of the world’s nuclear weapons would still crash the climate, the global food supply chains, and likely public order. Famines and unrest would kill hundreds of millions, perhaps even billions’.
When a nuclear weapon detonates, it briefly creates temperatures four times hotter than at the center of the Sun. Such detonation would start firestorms, injecting large amounts of soot into the upper atmosphere, which would spread globally and rapidly cool the planet.
An abrupt cooling event of 1.3°C that would follow after sun rays to the earth are blocked due to soot and smoke in the atmosphere would be a massive planetary shock and take back the earth to ice age temperature. The latest ice age peaked about 20,000 years ago, when global temperatures were likely about 10°F (5°C) colder than today.
Added to this, damage to the Ozone layer would increase levels of UV radiation. This would cause more sunburns, cancers, cataracts, immunosuppression, and photo-aging (skin damage that includes wrinkles, loss of skin tone, and pigmentation spots). Perhaps more importantly, increased UV radiation would also hinder crop growth.
All this would lead to crop failure leading to extreme starvation worldwide.
As a result unprecedented global famine would follow. Under every scenario, total available food calories would decline precipitously for the next seven to eight years. Xia and colleagues use 1,911 kcals/day as a starvation cutoff. They calculate – not just for the world, but nation by nation – how many people would inevitably end up persistently below that number and so would die of hunger.
For example, during the Great Bengal Famine in 1943, available food decreased only 5% – but panic-buying ensued, food prices soared and 3 million people starved to death. That resulted from a drop in available food of 5%. One can only imagine how unevenly life-sustaining food would be distributed in a world where available food had dropped 23%, 33%, 41% or 48%.
The Rutgers-led international team that modeled expected starvation deaths after a regional India-Pakistan nuclear war has also calculated, for the first time, the deaths that would result from the even worse mass famine that would follow a full-scale nuclear conflict between Russia and the United States. They estimate that 5 billion people out of 6.7 billion worldwide would be dead within two years. India and Pakistan both are expected to have 160 plus nuclear weapons.
Assuming the weapons and targets are of similar size, the consequences would be similar in the event of a nuclear exchange in any part of the world. It has been calculated that if 100 nuclear weapons of 15 kilotons each are detonated, would push 5 Tg of soot into the atmosphere. This would lead to 27 million direct fatalities and 260 million deaths as a result of nuclear famine at the end of two years. But in case of nuclear exchange between major powers 500 nuclear weapons of 100 kilotons each if detonated would push 47 Tg of soot into the atmosphere would lead to 164 million direct fatalities and 2.5 billion deaths after the end of two years as a result of nuclear famine.
(The researchers used a 2010 population dataset that assumed a total world population of 6.7 billion people. (Total world population estimates today are higher at about 8 billion people). The calculated death tolls of up to 2.6 billion people indicate that a nuclear war between India and Pakistan could kill up to every 3rd human.)
The direct consequences predicted in these scenarios would be unprecedented.
There would be 50 million to 125 million prompt fatalities – more deaths in hours or days than during all of World War II. In this newly calculated prediction – three out of every four people in the world would be dead in two years. The report expresses concern at nuclear arsenals with Russia and the US remain enormous, they are again on the rise, and collectively represent more than 90% of the world’s nuclear weapons stocks.
There is thus need to build a strong narrative globally for the complete abolition of nuclear weapons. The International Physicians for the Prevention of Nuclear War (IPPNW) has been vociferously raising the issue of humanitarian consequences of nuclear war. This was the mainstay for the adoption of Treaty on the Prohibition of Nuclear Weapons (TPNW) passed by the UN General Assembly on 7th July 2017. The International Campaign to Abolish Nuclear Weapons (ICAN) was awarded Nobel Peace Prize for this. The treaty delegitimizes and declares illegal the production possession, trade or use of the nuclear weapons in any form. This is the only multi-lateral treaty for nuclear weapons’ abolition. It is an opportunity for the global community particularly the nuclear weapons possessing countries to join the treaty and prove their intent for nuclear weapons free world. Countries of the world are meeting in the New York at Nuclear non Proliferation Treaty (NPT) review conference, the NPT RevCon. As a reports are coming the nuclear weapons possessing countries lack seriousness on the implementation of Article VI according to which ‘Each of the Parties to the Treaty undertakes to pursue negotiations in good faith on effective measures relating to cessation of the nuclear arms race at an early date and to nuclear disarmament, and on a treaty on general and complete disarmament under strict and effective international control’. The major nuclear must answer what they have done till date in the last 52 years.
It is unfortunate that after four weeks of meetings, the 10th Nuclear Non-Proliferation Treaty Review Conference has failed. If the world does not learn lesson now we would enter into a point of no return. Nuclear weapons if present on earth will always pose the danger of being used resulting into catastrophic collateral damage for which medical science has no remedy to offer.
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A paper in 2020 led by Jonas Jägermeyr, a scientist at NASA’s Goddard Institute for Space Studies, used six leading crop models to assess how agriculture would respond to the field’s most common hypothetical: 100 smaller (15 kiloton) nuclear detonations in India and Pakistan. (Again: Any number of different “limited” scenarios could be imagined – a war between China and North Korea, say, or perhaps an exchange of nuclear weapons between Russian and NATO forces over Ukraine. Assuming the weapons and targets are of similar size, the consequences would be similar. If scientists have often defaulted to war-gaming India-Pakistan scenarios, that’s in part because keeping one variable constant – the war zone – allows for easier comparisons of results across studies.)
In the NASA team’s models, 5 Tg of soot resulted in steep global cooling of 1.8°C, and at least five years of bad harvests. Hardest hit were more temperate northern regions, including the United States, Europe, Russia and China, collectively the world’s breadbasket. Corn and wheat – two of the world’s most important food crops – drop by 13% globally, with “adverse consequences for global food security unmatched in modern history.”²7
The NASA team's models found steep global cooling of 1.8°C, and at least five years of bad harvests, leading to world hunger “unmatched in modern history".
Scientists working for the U.S. nuclear weapons program at Los Alamos National Laboratories recently published a lonely dissenting view.²8 The Los Alamos team did not make its internal models available for independent review. They addressed the same hypothetical war between India and Pakistan. But they ran their simulations not using a Pakistani or Indian urban area, but a U.S. suburb, for which they included satellite imaging. In a rebuttal, Robock and colleagues note the imaging shows “a target area of
suburban Atlanta that includes a golf course, playground, and individual houses with large yards, with little material to burn, which is not representative of densely populated cities in India and Pakistan.”²? Other scientists have calculated the Los Alamos team under-estimated the fuelavailable in those dense Asian cities by at least 10- fold.³° The Los Alamos model assumed a city fire duration of only 40 minutes, when major World War II city fires lasted for hours or days; did not simulate gas line breaks as seen at Hiroshima; and set various weather and climate conditions that critics say, and the Los Alamos team concedes, prevented the development of firestorms.²? (The
U.S. military does believe in firestorms, and during World
War II both accidentally and intentionally created them – most spectacularly in the intentional firestorm created at Tokyo, but also in the bombing of Hiroshima. Despite this, there has been a well-documented, decades-long history of the Pentagon either minimizing or only belatedly appreciating the potential for nuclear weapons-initiated firestorms.5)
Meanwhile, nature itself seems to have risen up in protest against the Los Alamos claims. In their 2018 paper, the weapons lab team had asserted that soot and smoke from a regional nuclear war would be “highly unlikely” to make it into the stratosphere, “a conclusion supported by examination of … large forest fires.” Even as that was being written and published, large forest fires in Canada in 2017, and Australia in 2019 and 2020, were throwing massive amounts of soot high into the stratosphere. The soot and smoke from the Australian bush fires was tracked in the stratosphere for months, in quantities comparable to that seen after a volcanic eruption.³¹ Soot from the Canadian fires rose to 12 kilometers as a pyrocumulonimbus – a vertically-developing, fire-fed cloud – but then, as the black soot absorbed sunlight and warmed, it was lofted steadily higher over the next two months, to 23 kilometers.³² The forest fire observations contradicted Los Alamos, and were consistent with the models of Mills, Robock and other independent scientists.
Published in:
Urgent need for drugs price regulation
Date: 20.08.2022
Urgent need for drugs price regulation
Dr Arun Mitra
The news that the company producing Paracetamol in the trade name of ‘Dolo’ spent 1000 crore rupees as freebies to the doctors for the promotion of their drug is a matter of concern. It shows the total failure of the government in regulating the pharmaceutical marketing practices. It is well known that Pharma companies spend huge amount of money for promotion of their products. Much of this is spent in organizing medical conferences in the name of continued medical education programmes many a times at lavish scale. This ultimately adds to the cost of drugs and adds to out of pocket expenditure of the patients. The government framed Uniform Code of Pharmaceutical Marketing Practices (UCPMP). A letter of the ministry of chemicals and fertilizers, department of pharmaceuticals dated 12 December 2014 had mentioned that this will be voluntary for a period of six months with effect from 1st January 2015 and will be reviewed thereafter. Obviously the voluntary clause did not yield noticeable results.
Admitting this fact, Shri H.N. Ananth Kumar, the then Union Minister for Chemicals and Fertilizers, said in the Rajya Sabha in June 2016 that the voluntary code introduced in 2015 had not yielded desired results and that the government would make it mandatory because the Pharmaceutical companies did not take any tangible steps to implement the code. Clauses 6 and 7 of the code prohibit the Pharma companies from giving freebies to the medical professionals. But despite several representations from the public health activists and civil society groups the practice has not stopped. The Indian Medical Council (Professional Conduct, Etiquette and Ethics) regulation also warns the doctors against such practices to receive financial benefits in any form including for attending education programs. Taking cognizance of the matter even the central board of direct taxes (CBDT) in its Circular No. 5/2012 [F. NO. 225/142/2012-ITA.II], Dated 1-8-2012 had said that any such expenditure by the Pharma company will not be considered for tax deductions. After ten years the order has been reconfirmed by the Apex court.
Expressing concern over pharmaceutical companies giving freebies to doctors, which push medicine prices up, the Supreme Court on 22nd February 2022 held that they are not entitled to claim tax exemption on the expenditure incurred in giving incentives to medical practitioners to promote their medical products and it would be considered as part of their income.
As per the guidelines in the UCPMP the companies have to adopt stipulated procedures laid down by the competent authority for involving doctors in their research projects. These companies then use doctor’s reference including her/his photograph in their promotional literature. The UCPMP prohibits such work.
Ironically statement by the Minister of Chemicals & fertilizers DV Sadananda Gowda in the Parliament in September 2020 that the Union government has no plans to make the Uniform Code of Pharmaceutical Marketing Practices (UCPMP) mandatory is very disappointing. He said this in reply to a question by K. Muraleedharan, Congress MP from Kerala in the Lok Sabha.
The u-turn on making UCPMP mandatory raises suspicion of lack of will on the part of the government to keep its commitment and smacks of some unfair deal between the government and the Pharma companies. When a delegation of the Alliance of Doctor for Ethical Healthcare had submitted its opinion to the drugs price regulating body, the National Pharmaceutical Pricing Authority (NPPA) in February 2020, they were told that the NPPA has no jurisdiction to check the companies. This has to be done through changes in the law at the ministerial level.
The high cost of drugs seriously affects the healthcare of our population. As nearly 67% of out of pocket health expenditure in our country is on drugs. High out of pocket expenditure pushes 6.3 crore population below poverty line every year, a fact admitted in the National Health Policy document 2017. But the government has not taken any tangible steps to control the excess trade margin in the sale of drugs and medical devices.
A committee was formed to look into High Trade Margins in the Sale of Drugs on 16 September 2015. This committee took serious note of the excess trade margins. They pointed out that in some cases the trade margin is as high as 5000%. This committee submitted its report on 9 December 2015. But it is now almost 7 years that the government has been sleeping over it.
The pricing of the drugs should be calculated on the basis of the cost involved in its production. The market based pricing, calculating the average of the highest selling drugs is totally a flawed approach.
Therefore it is high time the government makes the UCPMP mandatory and comes out with an effective control on drug prices.
Having sensed that private sector in the pharmaceutical sector would be exploitative, our first Prime Minister Jawahar Lal Nehru took initiative to produce the drugs in the public sector with the purpose to produce cheap bulk drugs. While inaugurating the Indian Drugs and Pharmaceuticals Ltd. (IDPL) in 1961 he said “the drug industry must be in the public sector….. I think an industry of the nature of the drug industry should not be in the private sector anyhow. There are far too much exploitation of the public in this industry”. With this vision, IDPL was incorporated in April, 1961 It was established with main objectives of creating self-sufficiency in respect of essential life saving medicines, to free the country from dependence on imports and to provide medicines to the millions at affordable prices and not to make millions from the medicines. IDPL played a pioneering infra-structural role in the growth of Indian Drug Industry base. It played a major role in the strategic National Health Programmes like Family Welfare Programme & Population Control (Mala-D & Mala-N) anti-malarial (Chloroquine) and prevention of dehydration (ORS) by providing quality medicines. During the country’s calamity of outbreak of Plague in 1994, IDPL was the only company which played the sheet anchor role in supplying Tetracycline for the entire Nation. Similarly, company had made uninterrupted supply of Chloroquine to combat Malaria epidemic in different parts of the country. In 2005 to combat national emergency (leptospirosis) arising due to flood in Maharashtra, IDPL had supplied required Doxycycline Capsules within no time. IDPL has always supplied quality medicines and its presence has played a price balancing role in the competitive & business environment. World Health Organisation had made its observations on IDPL as follows:-“IDPL had achieved in 10 years what others have in 50. IDPL products have been examined for quality very carefully by the developed countries and many of them want to buy from here”.
Similarly the foundation stone of Hindustan Antibiotics Ltd (HAL) was laid by Prime Minister Jawaharlal Nehru. Central Research Institute (CRI) Kasauli is pioneer in the field of vaccines not only in India but in the world. Founded on 3rd of May 1905 the institute was originally established with a mandate of research work in the field of medical and public health, manufacture of vaccines and antiserum, human resource development and to act as a national referral centre for public health problems.
But when there was shift in the economic policies and there were changes in the patent rights laws under the WTO after it was founded on 1st January 1995, the whole scenario started changing. Indian companies had to bear the brunt and major impact was on the Public Sector Units (PSUs). The IDPL, HAL and Kasauli were financially constrained. Cheap vaccines produced by these companies now became very expensive and out of reach of common man.
The Union Cabinet’s recommendation in its cabinet meeting dated 28th December 2016 to close down and sell the pharmaceutical PSUs is a big blow to the concept of the state ensuring affordable, and possibly free-of-cost, medicines for millions. It is time to raise voice to build public opinion for strengthening the pharmaceutical PSUs if the country really wants affordable medicines for the people.
As per the NPPA order dated 25th March 2020 there are 856 drugs whose ceiling price has been fixed by the NPPA. Since the drug (Medicine and medical device) is not a luxury there should be ceiling on price of all the drugs without exception. The public sector units should be rejuvenated and strengthened to ensure affordable drug prices.
Published in:
https://dailyheadlinestoday.com/epaper/view/439/epaper-headlines-today/4
https://ipanewspack.com/reduction-of-prices-of-essential-drugs-is-imperative-for-common-people/
Nuclear dangers – challenge to work with undaunted spirit
Date: 3.8.2022
Nuclear dangers – challenge to work with undaunted spirit
Dr Arun Mitra
As we approach 6th August we remember 8.15 am on that day in 1945 when the US exploded first ever nuclear weapon on human population at Hiroshima in Japan. This was followed by another attack on Nagasaki on 9th August. Over two lakh people died on these two days in these two cities. Number of people injured, rendered destitute, homeless and orphaned far exceeds this number. Effect of radiations on the generations after that is still felt. That was the time of unprecedented humanitarian crises and agony never heard of before.
Dr. Dr. Marcel Junod, the new head of the ICRC's delegation in Japan was the first foreign doctor to reach Hiroshima on 8 September 1945, one month after the dropping of the atom bomb. He described that ‘the center of the city was a sort of white patch, flattened and smooth like the palm of a hand. Nothing remained. The slightest trace of houses seemed to have disappeared. The medical care was in shambles and rudimentary; dressings are made of coarse cloth. A few jars of medicine lying around on a shelf. The injured often have uncovered wounds and thousands of flies settle on them and buzz around. Everything is incredibly filthy. Several patients are suffering from the delayed effects of radioactivity with multiple haemorrhages. They need small blood transfusions at regular intervals; but there are no donors, no doctors to determine the compatibility of the blood groups; consequently, there is no treatment’.
Dr Junod noted the consequences of the bomb for Hiroshima's medical corps; out of 300 doctors, 270 died or were injured; out of 1,780 nurses, 1,654 perished or were injured. He made an appeal for the bomb to be banned outright, just as poison gas was outlawed in the aftermath of the First World War. (1)
Ironically the number of nuclear weapons has been increasing and it is assumed that there are nearly 17000 nuclear weapons on earth today. The number of countries which possess these weapons also increased from one to nine. These include USA, Russia, Britain, France, China, North Korea, India, Pakistan and Israel.
The nuclear weapons are a real threat to not only the human population but the whole flora and fauna on earth. The very presence of these weapons is fraught with the danger of their use.
The destructive power of nuclear weapons is well documented now. Ira Helfand, Co President of IPPNW in a study on Climate Consequences of Regional Nuclear War has pointed out that even a limited nuclear war between India and Pakistan using 100 Hiroshima sized nuclear weapons could put over two billion people at risk. Up to 20 million people would be killed outright as the great cities of the subcontinent would be destroyed and it would blanket much of South Asia with radioactive fallout. But the global consequences are even more alarming. This limited nuclear conflict would even affect weather patterns throughout the world. Soot and debris injected into the atmosphere from the explosions and resulting fires would block sunlight from reaching the earth, producing an average surface cooling of -1.25ºC that would last for several years. Even 10 years out, there would be a persistent average surface cooling of -0.5ºC. This would lead to crop failure and affect the size of available food stocks. If the soot injected into the atmosphere in a nuclear war caused significant ozone depletion that could cause a further major decline in actual food production. The combination of failed harvests and a collapsed distribution system would prevent essential foods from reaching the areas which require these. This scenario will affect the poor countries more and the poor people in these countries even worse.
It is therefore imperative that nuclear weapons are abolished for good. As proved in Hiroshima-Nagasaki medical science has no remedy to offer in the event of a nuclear exchange. The situation is much worse now as the present day weapons are much more deadly.
It is in this background that the Review Conference of the Nuclear Non-Proliferation Treaty, the NPT RevCon has begun in New York in which 191 member countries will deliberate on the progress made in the Nuclear Non Proliferation since the treaty came in to force in 1970. The participants include five major nuclear powered countries. The deliberations are expected to include various aspects of the treaty including the obligations by the major nuclear powered countries to take steps towards nuclear abolition. Article VI of the NPT is important as according to it ‘Each of the Parties to the Treaty undertakes to pursue negotiations in good faith on effective measures relating to cessation of the nuclear arms race at an early date and to nuclear disarmament, and on a treaty on general and complete disarmament under strict and effective international control’. The major nuclear must answer what they have done till date in the last 52 years.
It is important to note that the event is taking place for the first time after the Treaty for the Prohibition of Nuclear Weapons (TPNW). The TPNW was passed by the UN General Assembly in 2017 with 122 votes in favour and only one vote against. The treaty has delegitimized the nuclear weapons and declared them illegal as per the international law. Secretary General of the UN, Antonio Gutteres has on the occasion said that ‘Humanity is just one misunderstanding, one miscalculation away from nuclear annihilation’ This is genuine feeling of a person who is duty bound to keep the world united and in peaceful co-existence.
Adoption of Treaty Prohibiting Nuclear Weapons (TPNW) by the UNO is a big step forward and a real hope. The treaty has been already signed by the 86 countries and ratified by 60 countries. It is time now that ‘all states must condemn the recent threats to use nuclear weapons, the increase and modernization of nuclear arsenals, and the increased role of nuclear weapons in security doctrines’.
The war between Russia and Ukraine is a big threat to peace at the moment. Russia and NATO have threatened to use these weapons. It is therefore very urgent that Russia Ukraine war should stop immediately. Russian President Putin’s letter to the participants in the NPT RevCon as reported by Reuter that ‘there could be no winners in nuclear war and no such war should ever be started’ is welcome. But he must explicitly denounce the use of nuclear weapons under any circumstances during the ongoing war with Ukraine. Tension between the US and China after the arrival of the US House speaker Nancy Pelosi in Taiwan is a worrisome issue.
Some ideologues are stressing that nuclear weapons serve as deterrence. They say had Ukraine not taken the nuclear weapons off from its territory Russia won’t dare to attack. So, more countries should become nuclear weapons countries.
The Nobel laureates ICAN, IPPNW and several other civil society organizations are actively lobbying in New York at the NPT review conference with data of Humanitarian consequences of Nuclear War with the hope that the RevCon will
have a positive outcome to convince the nuclear powered countries to join TPNW.
Reference:
Published in:
https://thearabianpost.com/remembering-august-6-1945-for-first-atomic-bombing-on-hiroshima/
https://ipanewspack.com/remembering-august-6-1945-for-first-atomic-bombing-on-hiroshima/
https://tryxyz.com/article39008-REMEMBERING-AUGUST-6-1945-FOR-FIRST-ATOMIC-BOMBING-ON-HIROSHIMA
Do not take doctors for granted
Date: 01.08.2022
Do not take doctors for granted
Dr Arun Mitra
The incidence where Health Minister of Punjab rebuked the Vice Chancellor of Baba Farid University of Health Sciences and asked him to lie down on the bed with torn mattress has brought shame to the nation. Dr. Raj Bahadur Gaur, the Vice Chancellor is an upright person against whom not a single finger has been pointed for any misdeed. He has always been working in the interest of the students and has tried his best to streamline the examination system. A Surgeon Par excellence who despite busy schedule as administrator attended to the patients and has been performing spine surgery, which is his expertise. That he did not react to the unruly behavior of the minister is a reflection of that the doctors are trained to be soft to the patients and this becomes a general behavior of most of them. Dr. Raj Bahadur should not feel humiliated, rather he has shown that he is one among those who have been steeled by persons of eminence in the medical field in the prestigious institution, the PGI Chandigarh, to be empathetic and compassionate. The minster’s act is not only condemnable but demands open apology from him from not only Dr. Gaur but from society in general.
Improving infrastructure is direct responsibility of the minister. The vice chancellor is an administrator and executioner. He would work under the given circumstances with the funds provided. With a meager budget of 3.03% allocated to health out of total budget against the required of 11%, for improving the public healthcare in the state, one can expect only torn mattresses and bed sheets. The out of pocket expenditure on health by the people of Punjab is one among the highest in the country. The minster should have targeted the Finance Minister or the Chief Minister instead of the vice chancellor.
This has shown how a section of our polity thinks of the medical personnel, howsoever upright they may be.
Such incidents have been happening earlier too. Minsters’ rebuking, even slapping the teachers, have been witnessed in the past. They also do not stop their personal staff from using unconstitutional powers. When persons at the high level in the state apparatus resort to such acts, how do we expect violence against the doctors by unscrupulous elements, many a times at the behest of political bosses to stop!
There is need for united effort by the medical personnel and the other saner sections of the society against such incidents. Unity shown by all sections among the doctors in condemning the Health Minister’s act must continue in future as well. The Chief Justice of India (CJI) had recently applauded the role of the doctors and had said “they (doctors) need a better and more secure working environment”. He said that “this is where professional medical associations assume great significance” and advised them “to be proactive in highlighting the demands”. The CJI further said that the doctors’ profession “perhaps is the only profession which follows Gandhiji’s principle – service to man is service to God”.
In addition to the law for violence against the doctors, some code of conduct must be made for the ministers too. It is equally important to sensitize the police to abide by the law and behave professionally, not act on the directions of the political bosses. The incident of suicide by Dr Archna Sharma, a senior Gynaecologist of Dausa in Rajasthan shook the medical fraternity. A patient is reported to have died during a procedure after which the attendants reportedly under the patronage of a BJP leader created ruckus. The police instead of controlling the mob registered a case of murder against the doctor U/s 302 IPC. Perturbed over this, the doctor committed suicide.
When political persons thrust their whims it leads to erosion of democratic values for which India has always held itself in high esteem. In the recent years this has increased. Democratic institutions are under tremendous pressure from the higher ups in the government which affects their professionalism. Such situations can have backlash in later years. Therefore it is time to persistently strengthen professionalism and the constitutional bodies.
However it is also time for the medical professionals to stay connected with issues of public concern on the health issues. This will integrate them with the society. Not many medical bodies reacted to deaths of children in Muzaffarpur and Gorakhpur few years back. The medical bodies failed in supporting Dr.Kafeel who had to languish in the lock up because he raised the faults in the healthcare infrastructure at Gorakhpur. The incidents of Punjab can be a learning experience.
Published in
https://windobi.com/punjab-incident-involving-dr-gaur-speaks-badly-of-the-state-government/
GST on food will further add to malnutrition
Date: 21.07.2022
GST on food will further add to malnutrition
Dr Arun Mitra
In the 2021 Global Hunger Index (GHI) report, India ranks 101st out of the 116 countries. With a score of 27.5, India falls into the category of serious level of hunger. According to the GHI a rank of ≤ 9.9 is considered to be low, 10.0–19.9 moderate, 20.0–34.9 serious, 35.0–49.9 alarming, ≥ 50.0 extremely alarming(1). That we are at a serious level of hunger is a cause of concern for us. It requires pro active planning to ensure nutrition to all the citizens.
The report has pointed out that number of malnourished has increased globally in the past by 15 crorres i.e 24.3%. In 2019 the number of malnourished was 61.8 crore while it increased 76.8 crore in 2021.
The Hunger Index is based on three criteria, Inadequate food supply, Child mortality and Child under-nutrition. The report also points out that 1/4th of the total malnourished in the world live in India. This is at a time when our country is aspiring to be global leader in economic development with a 5 trillion economy.
According to Food and Agriculture Organisation (FAO) of the UNO estimates in ‘The State of Food Security and Nutrition in the World, 2020 report, 189.2 million people are undernourished in India. By this measure 14% of the population is undernourished in India’, this means nearly 20 crore people. Also, 51.4% of women in reproductive age between 15 to 49 years are anaemic; 34.7% of the children aged under five in India are too short for their age; while 20% suffer from wasting, meaning their weight is too low for their height. Malnourished children have a higher risk of death from common childhood illnesses such as diarrhoea, pneumonia, and malaria.
The National Family Health Survey 5 report is startling. That even after much advertised Poshan Abhiyan the children of our country remain stunted in such a large number calls for review of the efforts to provide nutrition to all the countrymen particularly the children. There are three criteria for malnutrition, low height for the age called as stunting, low weight for the height labeled as wasting and low weight for age that is underweight. According to these criteria 31.96 % children were found to be stunted 17.29 % children are wasted and 26.95 % children are underweight. In its report, The State of the World’s Children 2019, UNICEF has pointed out that Malnutrition caused 69% of deaths of children below the age of five in India.
Supply of balanced food to all the citizens of the country is the basic requirement to reduce malnutrition. A balanced diet means sufficient number of proteins, fats, carbohydrates and micro nutrients in the form of vitamins and minerals. Prestigious medical journal Lancet had formed a committee to go into nutritional requirements of a person. It has suggested intake of 232 grams of whole grain, 50 grams of tubers or starchy vegetables like potato, 300 grams of vegetables, 200 grams of fruits, 250 grams dairy food, 250 grams of protein sources in the form of meat, egg, poultry, fish, legumes, nuts, 50 grams saturated and unsaturated oils 30 grams of sugar. At the present market price the cost of these food items per person comes to be around Rs.225/- per day. This means that a family of five members should spend Rs.1125/- per day or Rs.33750/- per month on food only.
Barring a miniscule population our people are far from this target. The government’s scheme to give 5 kg of grains and one kg daal and a bit of oil does not fulfil the nutritional requirements. It is just not enough even for proper sustenance. It does not at all meet the requirements of micro nutrients like vitamins and minerals essential for physical and mental growth. With 15 crore people out of a population of 23 crore in Uttar Pradesh queuing up to get this much ration free of cost is a projection of extremely dismal state of affairs of nutritional security.
It is pertinent that the purchasing capacity of the people is raised through poverty alleviation, sufficient wages and ensure means of lively hood to meet the requirement of quality food for the citizens. Several economic experts including the Nobel Laureate Abhijeet Banerjee have suggested several means to alleviate poverty.
Recent economic surveys have pointed out that 90% of our population earns less than Rs.10000/- per month. A balanced diet for them is only a dream which does not seem to come true in the present circumstances. By imposing taxes on the essential food items cost of filling the belly is bound to increase. The wages on the other hand are showing a downward trend as the employment is shifting to contractual labour with no job security nor any employment benefits like the provident fund or the ESI. Small scale sector which provides livelihood to large number of people is at a receiving end under the neoliberal economic policy.
To meet the requirements of 2300 calories and a healthy food and clothing for a young adult, various workers organizations have demanded minimum wage based on the principle of these caloric needs. They have demanded a minimum wage of Rs.21000/- per month. To utter dismay, the government announced a floor level wage as Rs.178/- per day or Rs.5340/- per month. This is despite an internal labour ministry committee recommendation of Rs.375/- per day. This is even against the Supreme Court ruling on works demand for Rs.650/- per day wage, where the Hon’ble court added further 25% for health and education. The government’s intention to introduce time based work wage will be detrimental economically as well as against the medical advice and health needs of a person.
Large number of our population in our country is in the unorganised sector where the legal formulations are hardly implemented. The farmers and agriculture labour who are the producers are among the worst sufferers. Agriculture labourers have to face double oppression, economic as well as social. Farmers protested against the new Farm Laws fearing these will not only adversely affect their economic conditions but even the food security of the citizens too will be compromised.
As per the UNICEF, India has 5,772,472 children below five years affected by severe wasting — the most in the world. The global body called the situation an ‘overlooked child survival emergency’ in its May 2022 child alert. Severe wasting, also known as severe acute malnutrition, is defined as low weight-for-height.
It is therefore imperative that essential food items are cost effective and within the reach of low socio-economic groups. Wages for all sections be revised as per the caloric needs, balanced diet, clothing, health, education, housing and recreation. In this context the GST levied on food and other day to day needs items be withdrawn to prevent further malnutrition.
References:
https://theshillongtimes.com/2022/07/23/essential-items-for-consumption-must-be-affordable/
https://tryxyz.com/article38896-GST-ON-FOOD-WILL-FURTHER-ADD-TO-MALNUTRITION-AMONG-INDIAN-POOR
https://ipanewspack.com/gst-on-food-will-further-add-to-malnutrition-among-indian-poor/
Make toys not guns
Date: 13.07.2022
Make toys not guns
Gun violence is serious public health crisis
The investigations into murder of Punjabi Singer Shubhdeep Singh Sidhu, popularly known as Moosewala in the Punjab state of India should not be limited only to tracing the murderers and members of the gangs involved, or that how was the AK 94 gun used to kill was procured by them? This is time to think beyond that and pin point the manufacturers and traders of the small arms who in the so called modern day civilized society are dealing with something that is made solely to kill.
Moosewala case has come to limelight because he was a popular singer. Otherwise there are hundreds of gun violence killings taking place around the world every day. It is atrocious to hear about firing by school children in the USA. The children who should be studying and playing are instead carrying guns and are on a firing spree killing their own mates !
Killer gangs have been associated with drug smugglers and other mafia groups around the globe. Guns are sold to various groups illegally worldwide and are used for creating internal strife, ethnic conflicts and to create instability. Rwanda, Somalia, Afghanistan are few recent examples of such blatant use of small arms. Women and children are the worst sufferers in such situations.
Despite demands for banning illegal trade in small arms, such trade continues to flourish. Sales of weapons and military services by the world's 100 biggest arms companies reached a record $531bn in 2020, an increase of 1.3 per cent in real terms compared with the previous year, according to the Stockholm International Peace Research Institute (SIPRI). World's top 100 arms producers increased their sales — even in the pandemic year of 2020 when the global economy was contracting. United States has 39% share in the arms exports, Russia 19%, France 11% and China 4.6% (1).
The International Physicians for the Prevention for Nuclear War (IPPNW) has been in the forefront of raising awareness about the harmful effect of the gun violence. At the 8th Biennial Meeting of States of the UN Programme of Action (UN PoA) on Small Arms and Light Weapons at the UN headquarters in New York City the IPPNW expressed anguish at that even after over two decades of the international agreement of 2001 to reduce human suffering the goal has not been realized. Health effects of the horrific gun violence that continues worldwide range from death to physical injury to mental and emotional consequences that can last a lifetime.
IPPNW has advocated for decades that gun violence is a public health crisis, not just a police and security issue. The IPPNW in the statement submitted to States Parties of the UN PoA said that “IPPNW is a non-partisan federation of national medical groups in 55 countries representing tens of thousands of health professionals who share the common goal of preventing nuclear and armed violence. We urge delegates to the BMS 8 to understand and accept that small arms violence is a preventable public health crisis as determined by the World Health Organization. Limiting access to guns, and stemming the illegal gun trade, are two preventable measures. Another is reducing demand for guns”.
Gun violence changes the life of the effected persons and their families.
The injuries affect their ability to work and function in society, often both physically and mentally. Gunshot survivors have an increased risk of mental illness, including depression, Post-Traumatic Stress Disorder, suicide and substance abuse disorders. The risk of developing or worsening chronic illnesses such as heart diseases increases due to the stress of recovery. Intimate partner violence, coupled with guns, poses an even more significant risk to the health and well-being of women and men. Survivors of intimate partner violence have higher rates of at-risk pregnancies and sexually-transmitted diseases.
To many worldwide, the threat of gun violence has become a “way of life.” Living in this culture of fear can lead to negative health effects similar to those who have sustained a gunshot wound. The most important aspect of gun violence that should never be forgotten is that every case is a face, a family, and a community, and sadly, a long journey of rehabilitation and significant expense, from the individual to the government levels.
Gun violence has to be treated like a public health issue and managed in the same way as other diseases such as polio and smallpox, by identifying the problem and its impact on society, its risk factors, and developing interventions, policies and programs aimed at targeting those risk factors.
The IPPNW has pointed out that arms control measures need to be part of a wider spectrum of policy solutions – intersecting security, crime, human rights, health, and development. As such, healthcare professionals and policymakers can be powerful allies in armed violence prevention worldwide.
The IPPNW has been proactively advocating complete check on the manufacturing of guns and their trade. For this the organisation has carried awareness campaigns in different parts of the world. In June 2013 the IPPNW organised a protest march outside the gun making factory Heckler & Koch near Villingen-Schwenningen in Germany. The slogan is “make toys not guns”.
Reference:
Published
https://ipanewspack.com/gun-violence-is-a-serious-public-health-crisis-in-india-also/
https://tryxyz.com/article38831-GUN-VIOLENCE-IS-A-SERIOUS-PUBLIC-HEALTH-CRISIS-IN-INDIA-ALSO
https://tryxyz.com/article38831-GUN-VIOLENCE-IS-A-SERIOUS-PUBLIC-HEALTH-CRISIS-IN-INDIA-ALSO
Make toys not guns
Date: 13.07.2022
Make toys not guns
Gun violence is serious public health crisis
The investigations into murder of Punjabi Singer Shubhdeep Singh Sidhu, popularly known as Moosewala in the Punjab state of India should not be limited only to tracing the murderers and members of the gangs involved, or that how was the AK 94 gun used to kill was procured by them? This is time to think beyond that and pin point the manufacturers and traders of the small arms who in the so called modern day civilized society are dealing with something that is made solely to kill.
Moosewala case has come to limelight because he was a popular singer. Otherwise there are hundreds of gun violence killings taking place around the world every day. It is atrocious to hear about firing by school children in the USA. The children who should be studying and playing are instead carrying guns and are on a firing spree killing their own mates !
Killer gangs have been associated with drug smugglers and other mafia groups around the globe. Guns are sold to various groups illegally worldwide and are used for creating internal strife, ethnic conflicts and to create instability. Rwanda, Somalia, Afghanistan are few recent examples of such blatant use of small arms. Women and children are the worst sufferers in such situations.
Despite demands for banning illegal trade in small arms, such trade continues to flourish. Sales of weapons and military services by the world's 100 biggest arms companies reached a record $531bn in 2020, an increase of 1.3 per cent in real terms compared with the previous year, according to the Stockholm International Peace Research Institute (SIPRI). World's top 100 arms producers increased their sales — even in the pandemic year of 2020 when the global economy was contracting. United States has 39% share in the arms exports, Russia 19%, France 11% and China 4.6% (1).
The International Physicians for the Prevention for Nuclear War (IPPNW) has been in the forefront of raising awareness about the harmful effect of the gun violence. At the 8th Biennial Meeting of States of the UN Programme of Action (UN PoA) on Small Arms and Light Weapons at the UN headquarters in New York City the IPPNW expressed anguish at that even after over two decades of the international agreement of 2001 to reduce human suffering the goal has not been realized. Health effects of the horrific gun violence that continues worldwide range from death to physical injury to mental and emotional consequences that can last a lifetime.
IPPNW has advocated for decades that gun violence is a public health crisis, not just a police and security issue. The IPPNW in the statement submitted to States Parties of the UN PoA said that “IPPNW is a non-partisan federation of national medical groups in 55 countries representing tens of thousands of health professionals who share the common goal of preventing nuclear and armed violence. We urge delegates to the BMS 8 to understand and accept that small arms violence is a preventable public health crisis as determined by the World Health Organization. Limiting access to guns, and stemming the illegal gun trade, are two preventable measures. Another is reducing demand for guns”.
Gun violence changes the life of the effected persons and their families.
The injuries affect their ability to work and function in society, often both physically and mentally. Gunshot survivors have an increased risk of mental illness, including depression, Post-Traumatic Stress Disorder, suicide and substance abuse disorders. The risk of developing or worsening chronic illnesses such as heart diseases increases due to the stress of recovery. Intimate partner violence, coupled with guns, poses an even more significant risk to the health and well-being of women and men. Survivors of intimate partner violence have higher rates of at-risk pregnancies and sexually-transmitted diseases.
To many worldwide, the threat of gun violence has become a “way of life.” Living in this culture of fear can lead to negative health effects similar to those who have sustained a gunshot wound. The most important aspect of gun violence that should never be forgotten is that every case is a face, a family, and a community, and sadly, a long journey of rehabilitation and significant expense, from the individual to the government levels.
Gun violence has to be treated like a public health issue and managed in the same way as other diseases such as polio and smallpox, by identifying the problem and its impact on society, its risk factors, and developing interventions, policies and programs aimed at targeting those risk factors.
The IPPNW has pointed out that arms control measures need to be part of a wider spectrum of policy solutions – intersecting security, crime, human rights, health, and development. As such, healthcare professionals and policymakers can be powerful allies in armed violence prevention worldwide.
The IPPNW has been proactively advocating complete check on the manufacturing of guns and their trade. For this the organisation has carried awareness campaigns in different parts of the world. In June 2013 the IPPNW organised a protest march outside the gun making factory Heckler & Koch near Villingen-Schwenningen in Germany. The slogan is “make toys not guns”.
Reference:
Published
https://ipanewspack.com/gun-violence-is-a-serious-public-health-crisis-in-india-also/
https://tryxyz.com/article38831-GUN-VIOLENCE-IS-A-SERIOUS-PUBLIC-HEALTH-CRISIS-IN-INDIA-ALSO
https://tryxyz.com/article38831-GUN-VIOLENCE-IS-A-SERIOUS-PUBLIC-HEALTH-CRISIS-IN-INDIA-ALSO
Nuclear weapons possessing countries must listen to powerful global voice for nuclear weapons abolition
Date: 04.07.2022
Nuclear weapons possessing countries must listen to powerful global voice for nuclear weapons abolition
Dr Arun Mitra
The world is on the edge of a serious threat of use of nuclear weapons by Russia and NATO as both have threatened their use during the on-going war between Russia and Ukraine. Presently there are approximately 13,000 nuclear weapons on earth, many of which are on high alert and could be launched within minutes. Concerned with this threat in mind the members of the state parties who have clearly voted for nuclear weapons abolition and the Treaty Prohibiting Nuclear Weapons (TPNW) along with other organisations working for the cause decided to gather at Vienna in Austria to reinforce their commitment and to chart out an action plan to make the world nuclear weapons free.
Highlighting the humanitarian consequences of the nuclear war it was categorically stated in the first meeting of the state parties on TPNW that ‘the catastrophic humanitarian consequences of nuclear weapons cannot be adequately addressed, transcend national borders, pose grave implications for human survival and well-being and are incompatible with respect for the right to life. They inflict destruction, death and displacement, as well as profound long term damage to the environment, socioeconomic and sustainable development, the global economy, food security and the health of current and future generations, including with regard to the disproportionate impacts they have on the poor in the developing countries and women and girls in particular’.
TPNW passed by the UNO five years back on 7TH July 2017 with an overwhelming majority, 122 votes in favour and only one against is a reflection of the voice of all peace loving people who want life on earth to continue and progress. That this happened despite tremendous pressure, allurements intimidation and blackmail by the major nuclear powered states is a big achievement. Study conducted by the IPPNW on climatic impact of nuclear war has made the world community to realise the fact that even a nuclear exchange between India and Pakistan using 100 Hiroshima sized nuclear bombs would put over 2 billion people at risk. A nuclear exchange between major nuclear powers could be end of modern civilization built through thousands of years of human labour. It is this realization which is making all saner elements to raise their voice for nuclear weapons abolition. That is why they are quite vocal on the need to impress upon Russia and NATO to commit not to use nuclear weapons during the on-going war because in such circumstances the nuclear weapons could be launched intentionally or by accident !
The Vienna meet made it clear that ‘far from preserving peace and security, nuclear weapons are used as instruments of policy, linked to coercion, intimidation and heightening of tensions. This highlights now more than ever the fallacy of nuclear deterrence doctrines, which are based and rely on the threat of the actual use of nuclear weapons and, hence, the risks of the destruction of countless lives, of societies, of nations, and of inflicting global catastrophic consequences. We thus insist that, pending the total elimination of nuclear weapons, all nuclear-armed states never use or threaten to use these weapons under any circumstances’.
‘It is however a matter of regret and deep concern that despite the terrible risks, and despite their legal obligations and political commitments to disarm, none of the nuclear armed states and their allies under the nuclear umbrella are taking any serious steps to reduce their reliance on nuclear weapons. Instead, all nuclear-armed states are spending vast sums to maintain, modernize, upgrade or expand their nuclear arsenals and are placing a greater emphasis on and increasing the role of nuclear weapons in security doctrines. These resources could be better utilized for sustainable development’. The global arms spending is increasing at a rapid rate and surpassed the two trillion US dollar mark for the first time, reaching $2113 billion in 2021(SIPRI). This takes away resources from health, education, development and other social needs and also reduces security and increases uncertainties in life.
It is a matter of satisfaction that by now 66 countries have ratified the TPNW which came into force from 22nd January 2021.The task now is to bring the nuclear weapons possessing countries into its fold. For this whereas the UNO has to play a proactive role the International Red Cross and Red Crescent Movement, other international and regional organizations, the International Campaign to Abolish Nuclear Weapons (ICAN) and other non-governmental organizations, religious leaders, parliamentarians, academics, indigenous peoples, victims of the use of nuclear weapons (Hibakusha), as well as those affected by nuclear testing and youth groups all have to be involved to strengthen the voice for nuclear weapons abolition. Science is based on evidence and we have evidence of humanitarian consequences of nuclear war as researched by the IPPNW.
It is also important to continue collaborate at regional level and build Nuclear Weapons Free Zones which could play a significant moral and ethical role.
We have to move ahead with optimism despite several challenges and obstacles. There is no bigger challenge than to preserve and promote life on earth. Every means have to be utilised with a persistent work.
https://ipanewspack.com/time-to-implement-treaty-prohibiting-use-of-nuclear-weapons-by-any-country/
https://dailyheadlinestoday.com/epaper/view/399/epaper-headlines-today/7
Nuclear weapons possessing countries must listen to powerful global voice for nuclear weapons abolition
Date: 04.07.2022
Nuclear weapons possessing countries must listen to powerful global voice for nuclear weapons abolition
Dr Arun Mitra
The world is on the edge of a serious threat of use of nuclear weapons by Russia and NATO as both have threatened their use during the on-going war between Russia and Ukraine. Presently there are approximately 13,000 nuclear weapons on earth, many of which are on high alert and could be launched within minutes. Concerned with this threat in mind the members of the state parties who have clearly voted for nuclear weapons abolition and the Treaty Prohibiting Nuclear Weapons (TPNW) along with other organisations working for the cause decided to gather at Vienna in Austria to reinforce their commitment and to chart out an action plan to make the world nuclear weapons free.
Highlighting the humanitarian consequences of the nuclear war it was categorically stated in the first meeting of the state parties on TPNW that ‘the catastrophic humanitarian consequences of nuclear weapons cannot be adequately addressed, transcend national borders, pose grave implications for human survival and well-being and are incompatible with respect for the right to life. They inflict destruction, death and displacement, as well as profound long term damage to the environment, socioeconomic and sustainable development, the global economy, food security and the health of current and future generations, including with regard to the disproportionate impacts they have on the poor in the developing countries and women and girls in particular’.
TPNW passed by the UNO five years back on 7TH July 2017 with an overwhelming majority, 122 votes in favour and only one against is a reflection of the voice of all peace loving people who want life on earth to continue and progress. That this happened despite tremendous pressure, allurements intimidation and blackmail by the major nuclear powered states is a big achievement. Study conducted by the IPPNW on climatic impact of nuclear war has made the world community to realise the fact that even a nuclear exchange between India and Pakistan using 100 Hiroshima sized nuclear bombs would put over 2 billion people at risk. A nuclear exchange between major nuclear powers could be end of modern civilization built through thousands of years of human labour. It is this realization which is making all saner elements to raise their voice for nuclear weapons abolition. That is why they are quite vocal on the need to impress upon Russia and NATO to commit not to use nuclear weapons during the on-going war because in such circumstances the nuclear weapons could be launched intentionally or by accident !
The Vienna meet made it clear that ‘far from preserving peace and security, nuclear weapons are used as instruments of policy, linked to coercion, intimidation and heightening of tensions. This highlights now more than ever the fallacy of nuclear deterrence doctrines, which are based and rely on the threat of the actual use of nuclear weapons and, hence, the risks of the destruction of countless lives, of societies, of nations, and of inflicting global catastrophic consequences. We thus insist that, pending the total elimination of nuclear weapons, all nuclear-armed states never use or threaten to use these weapons under any circumstances’.
‘It is however a matter of regret and deep concern that despite the terrible risks, and despite their legal obligations and political commitments to disarm, none of the nuclear armed states and their allies under the nuclear umbrella are taking any serious steps to reduce their reliance on nuclear weapons. Instead, all nuclear-armed states are spending vast sums to maintain, modernize, upgrade or expand their nuclear arsenals and are placing a greater emphasis on and increasing the role of nuclear weapons in security doctrines. These resources could be better utilized for sustainable development’. The global arms spending is increasing at a rapid rate and surpassed the two trillion US dollar mark for the first time, reaching $2113 billion in 2021(SIPRI). This takes away resources from health, education, development and other social needs and also reduces security and increases uncertainties in life.
It is a matter of satisfaction that by now 66 countries have ratified the TPNW which came into force from 22nd January 2021.The task now is to bring the nuclear weapons possessing countries into its fold. For this whereas the UNO has to play a proactive role the International Red Cross and Red Crescent Movement, other international and regional organizations, the International Campaign to Abolish Nuclear Weapons (ICAN) and other non-governmental organizations, religious leaders, parliamentarians, academics, indigenous peoples, victims of the use of nuclear weapons (Hibakusha), as well as those affected by nuclear testing and youth groups all have to be involved to strengthen the voice for nuclear weapons abolition. Science is based on evidence and we have evidence of humanitarian consequences of nuclear war as researched by the IPPNW.
It is also important to continue collaborate at regional level and build Nuclear Weapons Free Zones which could play a significant moral and ethical role.
We have to move ahead with optimism despite several challenges and obstacles. There is no bigger challenge than to preserve and promote life on earth. Every means have to be utilised with a persistent work.
https://ipanewspack.com/time-to-implement-treaty-prohibiting-use-of-nuclear-weapons-by-any-country/
https://dailyheadlinestoday.com/epaper/view/399/epaper-headlines-today/7
Myths, mass hysteria and health
Date: 28.06.2022
Myths, mass hysteria and health
Dr Arun Mitra
Good health is essential not only for the progress of an individual but even more so for the society as whole. Since times immemorial mankind has looked into various methods and developed different techniques to impart effective healthcare. Primitive society attributed the causation and treatment of diseases to super natural powers. This was because human society lacked knowledge of causes of various events around. With the passage of time different theories and hypothesis were propounded to promote wellbeing. These developments took place almost during the same time periods in different parts of the world. It was considered that disorders in the body occurred due to natural causes. Treatment modalities were developed based on the natural products in the form herbs, shrubs and sometimes animal material. Ayurveda system developed in India, Unani in Egypt and Babylon, Sidha in Tamil Nadu, Accupuncture in China and Acupressure in Japan and so on. Modern scientific medicine developed out of continuous research for centuries. Hippocrates from Greece is considered to be its father.
The modern medicine has broken several beliefs and myths in the medical care through evidence. However belief system and myths still hold ground and have not fully been replaced by the scientific way of thinking from the minds of many people.
The belief in the faith healers is very powerful and many a times become the cause of delay in the treatment. Almost all patients of Mumps invariably go to faith healers and delay the allaying of troublesome symptoms. The faith healers presses upon the swelling on the face, recites some mantras and puts mud on the swelling. Similarly the patients of Bell’s palsy (a type of one sided paralysis of the face) also must consult the faith healers. Interestingly one such faith healer focuses bright sun light on the patient’s neck with a convex lens. This causes burn on the skin which heals in a few weeks and by that time the paralysis of the face also heals. Bell’s palsy and mums most of the times recover on their own with some supportive measures and counseling to prevent complications and allaying fear and stress from the patient’s mind as these, like many other diseases, are self-limiting disorders. Many diseases are linked to religious connotations. For example the patients of Chicken Pox (Chhoti Mata) would spend long hours in praying to the mother god. It has been observed that sometimes even literate persons would not visit a doctor on some specific days of the week which day consider not auspicious for them.
There are innumerable such instances in different parts of our country. When some such myths are propagated forcefully in the society, these tend to become part of the social thinking which sans logic. During the ongoing pandemic of COVID-19 we have witnessed how the use of ‘Gau Mutra’ (Cow Urine) and ‘Gobar (Cow Dung) was propagated. Some religious rituals too were promoted as the cure for the disease. One MP Pragya Thakur emphatically stated that her cancer was cured by Cow urine. The impact is that many ‘Gau Shalas’ (Cow care centers) are lined up by people to collect the Cow urine. Baba Ramdev went to the extent to criticize modern medical care and promote his own Coronil with no evidence about its effectiveness.
Propaganda is so effective that when the Prime Minister Shri Narendra Modi appealed to the people to bang ‘Thalies’, play ‘Shankhs’, millions of people of the country followed his directive not only once but twice with the hope that this will dispel the Corona virus. This type of mass hysteria has been studied in the past. In 1995 people throughout the country believed in that statues can drink milk. The Ganesha statue drinking milk miracle was a phenomenon which occurred on 21 September 1995, in which statues of the Hindu deity Ganesha were thought to be drinking milk offerings. That appears to be an experiment done to study the mass psychology and that if could be used for some socio-political purpose as well. People carrying out the directives of the Prime Minister about beating Thalies etc. about COVID can be very well linked to that experiment on statue of lord Ganesha. That people in England in 18th century would kill the women who had been denigrated to be witches by some vested interests and were said to be cause of evils in the society. The incident of all members of the family committing suicide at the behest of some preacher in the Burari area of Delhi few years back shook the whole country. Similar mass hysteria was generated by the Nazis in Germany against Jews and dissenters. It was used to kill and justify the killings without any remorse.
This is a very complex situation in which various sections of the society have to come forward to spread health education on scientific basis. The message needs to be percolated down to the village level. Medical organizations and doctors can play a vital role in this. We have to educate the society to respect all human beings irrespective of caste, creed, religion or gender. We must learn to respect everyone of our species; and that all humans have same blood.
Super profiteering in drugs cannot be allowed
Date: 18.06.2022
Super profiteering in drugs cannot be allowed
Drastic changes needed in international laws to make drugs affordable
Dr Arun Mitra
The COVID-19 Pandemic has brought to the fore necessity to bring about changes in the international agreements on drugs/vaccines keeping the public health priorities uppermost. Latest data points out that 66.2% of the world population has received at least one dose of a COVID-19 vaccine while this number in low income countries is only 17.7% (1).
In the African continent only 18% have received the full dose in comparison to 70% & 65% in Asia and Europe respectively. Inequality in certain countries is glaring and a cause of serious concern. In Afghanistan only 12%, Somalia 9% and Sudan 8.3% got full vaccination (2). During this period of crisis the world community and the relevant organizations including the UNO should have ensured equity in the supply of the vaccines to save human lives. It is not possible for small countries to produce their vaccine in sufficient supply. So they have to purchase from the manufacturers in developed world. This makes it imperative that international trade agreements on the drugs/vaccines should concentrate on the equity concerns.
The General Agreement on Trade and Tariff (GATT) signed in 1948 existed till 1995 after which World Trade Organization (WTO) came into being. It took steps to protect the rights of the innovator and coined Trade-Related Aspects of Intellectual Property Rights (TRIPS) (3). Under the Intellectual Property Rights (IPR) it was agreed upon that the innovator/inventor has to be given some incentive for the work in monetary terms. Thus patent rights were reformed and protected by the legal frame work. Different countries were to formulate their own patent laws in accordance with the guidelines laid down by the WTO. Before these changes the patent rights were based on the process patent, which meant that a product could not be produced by any other company through the same process for the period of 7 years but it could be done through other process. The new WTO patent regimen however changed this to Product patent for 20 years, meaning thereby that no other company can manufacture the same product for 20 years through any process. The developing countries argued that pharmaceutical industry is connected with the public health which is the basic human right. These patent laws will limit their citizens’ access to drugs at affordable prices and that patent laws needed some flexibilities. To make use of this flexibility clause countries were given the right for compulsory licensing so as to produce some products under special provisions (4).
The process patent enabled the Pharmaceutical industries in India to grow enormously between 1970 and 2005 and produce cheap & low cost generic medicines not only for our country but for several low income nations as well.
In 2003 decision was made which enabled the countries which cannot manufacture medicines themselves to import the medicines made under a compulsory license given to the other countries so as to promote ‘access to affordable medicines for all’. This declaration highlighted the potential of a nation to exploit the flexibilities included in the TRIPS Agreement, including the compulsory licensing and agreed to expand exemptions to protect pharmaceutical patents for least developing countries by 2016.
Compulsory licensing means that a third party is authorized to make, use or sell a patented invention without the patent owner’s consent. If the patented drugs are not priced reasonably and are out of reach of the population then the country can apply for a compulsory license. An application for compulsory license can also be filed under a circumstances of national emergency, extreme emergency and a case of public non-commercial use.
During the Pandemic since the big companies refused to share the technical know-how even with WHO, it was difficult for many developing countries to produce the vaccines. They were thus dependent on import. The problem was more with smaller countries with limited resources. That is how we find today that many developing countries are still lagging far behind in the vaccination of their population. These countries had to accept several clauses which would favour only the vaccine manufacturer. Pointing out the dangers involved Dr Samir Malhotra from PGI Chandigarh said that the COVID-19 scare forced many governments to enter into contracts with the companies developing vaccines. Many of these contracts had confidentiality clauses according to which the company was exempted “from any civil liability for serious side effects arising from the use of the vaccine, indefinitely”. “Purchaser hereby agrees to indemnify, defend and hold harmless [the company and] each of their affiliates from and against any and all suits, claims, actions, demands, losses, damages, liabilities, settlements, penalties, fines, costs and expenses caused by, arising out of, relating to, or resulting from the vaccine.” Not only that, and this is shocking, these countries were asked “put up sovereign assets as collateral to guarantee indemnity”. Such assets could include embassy buildings, cultural assets, etc.
The claim of the Pharma industry that they have to bear high cost in developing new drugs as a justification for such contracts is totally flawed because virtually 100% of initial research leading to new drugs occurs with the support of public funding. A vaccine that requires a few dollars to manufacture brings in profits worth billions of dollars to the company.
During the Pandemic India and South Africa proposed temporary waiver on the TRIPS proposals for the COVID vaccine so as to make it possible for many countries to produce vaccines, essential medicines, and testing kits. There is also need to provide concession on therapeutics, diagnostics and ingredients, and processes (5).
As per the reports India and South Africa are not sticking firmly to their proposals. India appears to be keen to conclude a pact now as has been pressed by the US and the EU. This would be detrimental for the production of such drugs/vaccines even during the emergencies (6).
The situation at present demands a complete revamping of the clauses of compulsory licensing to make them easy without long debates specially when we have passed through serious health crisis worldwide due to Pandemic. For our country it is all the more important to rejuvenate and strengthen our own public sector pharmaceutical industry with a purpose to produce cheap drugs/vaccines for local and global supply. We have national emergencies for several diseases, communicable as well as non-communicable.
The economic surveys point out that 90% population is earning less than Rs.10000/- per month. With very poor spending by the government on the public health it is becoming impossible for the people to purchase healthcare. Therefore India should press upon a permanent waiver for all the drugs/vaccines needed for emergencies. Whereas we were successful in producing Covaxin indigenously and also Covishield locally, their price issue always remained contentious. People had to pay large amount in the private sector while the companies reaped huge profits. In contrast the public sector companies which used to produce vaccines at one time did not have profit as a prime motive. It is well known that public research laboratories played a significant role in developing Covaxin. That India refrained from sharing this technical knowhow with other developing countries does not go well with our past approach for international collaboration on health. Even worse is that the government refused to license the vaccine even to public sector concerns.
- https://ourworldindata.org/covid-vaccinations?country=SOM
- https://ourworldindata.org/covid-vaccinations
- https://madhyapradesh.pscnotes.com/mppcs-paper-iii-technology/patents-and-intellectual-property-rights-trips-trims/
- https://www.lawctopus.com/academike/impact-of-trips-on-pharmaceutical-industry/
- https://www.orfonline.org/expert-speak/compromised-trips-waiver/
- https://www.downtoearth.org.in/blog/health/covid-19-india-trips-on-its-patent-waiver-proposal-81477
Time is now to combat climate change to promote health
Date: 31.05.2022
Time is now to combat climate change to promote health
Dr Arun Mitra
I very vividly remember when 30 years back in the year 1992 we wanted to hold a public function as a part of campaign for the promotion of healthy environment and preservation of ecology, not many people took it seriously. However we carried out with our activities and soon our actions drew attention of the public as well as the administration. We organized school education programmes, formed Eco Clubs in schools and conducted several other outreach events.
Society is more sensitized now. Environment has been an issue of serious debate among the scientists who have warned from time to time that if steps are not taken now and carbon emission is not reduced then we can land into serious climate crisis. Recently large number of scientists organized climate protests globally. Peter Kalmus, who studies biological systems and climate change at NASA's Jet Propulsion Laboratory and three others were arrested in Los Angeles after they chained themselves to the doors of a Chase Bank office building. Kalmus said, "We've been trying to warn you guys for so many decades that we're heading towards a fucking catastrophe, and we've been being ignored. The scientists of the world are being ignored, and it's got to stop. We're not joking. We're not lying. We're not exaggerating”.
These protests followed the release of report of the Intergovernmental Panel on Climate Change (IPCC), ‘Mitigation of Climate Change’, on 4 April 2022. It concluded that the world must peak emissions of heat-trapping gases like carbon dioxide in less than three years to have a chance of limiting global warming to 1.5 degrees Celsius above the preindustrial standard. The report found that the world's governments and corporations are far from meeting the emission-reduction goals that would help limit that extreme weather. We are already witnessing wildfires, hurricanes, droughts, and floods across the planet.
António Guterres, the UN secretary general, was very forthright in a press briefing when he said "Climate activists are sometimes depicted as dangerous radicals, but the truly dangerous radicals are the countries that are increasing the production of fossil fuels,".
To highlight the issue World Environment Day is observed every year on 5th June. The sufferings caused due to COVID-19 Pandemic have made us to think that the issue of environmental degradation and climate change cannot be just a ritual discussion but it has to be taken very seriously.
Climate Change is a significant change in temperature, wind patterns and precipitation that may occur in cycles over decades, hundreds, thousands and millions of years; however in the recent years we are witnessing the impact of climate change occurring much faster and in much shorter period.
In the last century scientists detected that the temperature of earth was rising abnormally. It was found that oceans were warming up and snow was melting leading to rise in level of oceans. It was also found that there was perceptible rise in the carbon dioxide in the atmosphere.
Greenhouse Gases (GHGs) resulting from mainly industrial development and urbanization, agriculture and changes in land-use patterns are the cause of global warming. Different gases have different Global Warming Potential (GWP) which means how much damage they cause to the environment. The Carbon Dioxide (CO2) has GWP of 1; Methane - GWP of 21 and Nitrous oxide - GWP of 310.
The effects of climate change have been felt in India as well. There was all India drought in 2002 and 2009. The year 2010 was one of warmest years. In the year 2013 there were Extreme rainfall events in Uttrakhand. Then there were floods in the Kashmir valley in 2014. We have seen mountains becoming baron due to large scale cutting of trees. This is resulting in hills becoming weak. Tsunami, Amfan and Nisarga all occurred due to climate change.
Climate and weather have always had a powerful impact on human health and well-being. Global climate change is a newer challenge to the ongoing efforts to protect human health. In the past few years there has been increase in Mosquitoes breeding, Malaria, Dengue and Yellow Fever. Increase in temperature by 2-3º C would increase the number of people who, in climatic terms, are at risk of malaria by around 3-5 %, which means several hundred million people globally. According to World Health Report 2002, climate change was estimated to be responsible in 2000 for approximately 2.4% of worldwide diarrhoea, and 6% of malaria in some middle-income countries.
Changes in atmosphere coupled with vehicular and industrial emissions lead to smog and poisonous gases which cause difficulty for those with cardio vascular disease, respiratory disorders as asthma, emphysema, chronic Bronchitis and allergy problems. Similarly water pollution related diseases are on the rise leading to bacterial, viral, Protozoal and Parasitic diseases.
As a result of rising sea levels and flooding of the coastal areas, there occurs increase in population density in safe areas due to migration of people to these places. People have to live in make shift camps in poor, unhygienic living conditions which cause several infectious diseases. Children lose their school. There may be violence for want of food and other basic amenities. This may lead to mental health problems like Psycho Trauma and Post Traumatic Stress disorder.
Arms race is an important cause of release of gases responsible for global warming. This occurs right from manufacture to transport, deployment and the use of arms. Extreme changes in the climate may occur in the event of a nuclear fallout. A study conducted by Dr Ira Helfand and Alan Robock et al on the ‘Climatic Consequences of Regional Nuclear War’ shows clearly that even a “limited” nuclear conflict, involving as few as 100 Hiroshima-sized atomic bombs will produce average surface cooling of -1.25ºC leading to crop failure, shortage of food which would put two billion people at risk.
Human-induced depletion of ozone may cause diseases of skin like Malignant Melanoma, Non-Melanocytic Skin Cancer – Basal Cell Carcinoma, Squamous Cell Carcinoma, Sunburn, Chronic Sun Damage, Photodermatoses.
People who are socially, economically, culturally, politically, institutionally, or otherwise marginalized are especially vulnerable to climate change.
There is urgent need to take steps to prevent climate change. “We have the means to limit climate change,” said R. K. Pachauri – Former Chair of the IPCC. “The solutions are many and allow for continued economic and human development. All we need is the will to change, which we trust will be motivated by knowledge and an understanding of the science of climate change.”
It is a matter of grave concern however that various governments have not kept the commitment to mitigate carbon emission. Developed countries are major defaulters. Developing countries have their own problems of growth. The Carbon credit system may mitigate carbon emission but it does not help self-reliant development of the poor countries.
People’s movements are required to force governments to take effective measures in this regard. Laws have to be amended and implemented. In last 10 years over 10 crore trees were cut in our country for widening roads and highways; But not more than a lakh trees have been planted by govt. or public. Let us all pledge to plant trees, which is a big contribution for combating climate change. We are not sure when the governments will learn. But as citizen concerned with life and health we have to do our bit for a better future for the generations to come.
Doctors Upfront for Social Harmony
Date: 26.05.2022
Doctors Upfront for Social Harmony
Peace and Harmony helped in development and growth in the human society most of the time; there have however been incidents of violence against others from time to time which have hampered socio-economic growth. Such incidents do not occur spontaneously. Studies have shown that most of the time they are instigated by some vested interests with political, economic, social and cultural motives.
The Homo Sapiens are supposed to be most intelligent of all species. It is beyond comprehension how and why they are swayed away and resort to violence that is undoubtedly detrimental. This has been seen in all societies and countries. To understand this phenomenon and to find remedial measures we must look for pathophysiology and epidemiology of such incidents.
Misinformation, distortion of facts and malicious propaganda form the basis of such happenings. This creates mass hysteria in the society. Goebbels’ thesis ‘Repeat a lie a thousand times and it becomes the truth’ is well known. A systematic campaign is launched against the other groups based on ethnicity, religion, linguistic background or other matters. They are blamed for all ills prevailing at the given time. This has been seen in Germany in 1930s against Jews and all others who disagreed; in Rawanda during Hutu and Tutsi violence. In South Africa, during apartheid regime. This is also evident in the racially charged killings in the USA recently. In South Asia it happened during partition of India in 1947 when nearly 25 lakh people from all major communities, the Hindus, Sikhs and Muslims killed each other. We witnessed worst form of rioting against Sikhs in 1984 when mobs burnt the people alive. Similar things happened in Gujarat in 2002. Besides this, terrorist violence continues unabated in Jammu and Kashmir and North East India. Incidents of violence between Shia and Sunni among Muslims are on record in Pakistan and other places.
Citing reports of the National Crime Records Bureau (NCRB) the Minister of State for Home Affairs, Shri Nityanand Rai told in the Parliament that 857 communal or religious riot cases were registered in 2020, 438 in 2019, 512 in 2018, 723 in 2017 and 869 in 2016 that is a total of 3399 during this period of four years from 2016-2020.
As a result of hate campaign in the recent period we have witnessed mob lynching, something hitherto almost unknown in our society. Most of those killed are Muslims while Dalits and others too have been killed. These are done on moral background by the so called vigilante groups. Killing of cows has been an excuse by such unruly mobs. They would not spare anyone and take no mercy even on their co-religionists. Police inspector Subodh Kumar a Hindu by religion was killed by the mobs in Bulandshehar. In the Neemuch district of BJP ruled Madhya Pradesh, Dinesh Khushwaha, the husband of former BJP councillor Bina Khushwaha killed Bhawarlal Jain suspecting him to be a Muslim.
There is a concerted effort in such situations to push the vulnerable groups into economic crisis. They are being prohibited from carrying out their jobs outside the places of worship of other communities. Ironically this was done even during the COVID pandemic when the vendors from minority communities were ridiculed and beaten and asked to stop coming to the societies of particular community.
Youth, who should have been contributing to national development are being pushed to the task of violence. Unfortunately communally surcharged violent incidents by the so called Hindu nationalists occurred even in the capital city of Delhi.
It has been observed that most those indulging in such rioting belong to lower economic groups. Youth from the rich or the upper middle classes are never to be seen as part of these riot mobs. This also proves the point that unemployed or underpaid youth are used by the perpetrators of violence. Having failed to meet the demands of the people, the ruling dispensations divert attention of the people towards issues which have no relevance in our day to day life. Glorifying the past and distorting the history becomes a tool to create division and disharmony. We are witnessing how the issues of Mandir and Masjid are being raked up. Every day a new such issue is added.
The end result of such incidents is injury and death of human beings in addition to economic crisis particularly among the lower income groups. This may help some groups for political or economic gains but ultimately it is the life form that suffers.
For the medical professionals who are trained to preserve and promote health this is a very serious situation. Persistent hatred for others in the mind leads to sadistic behaviour and such person at one stage forgets any compassion, empathy or love for fellow human beings including the children. Therefore several medical groups from around the globe have come forward to rescue in such situations because doctors have to take care of the injured in such situations. Therefore by the very professional commitment the doctors are against any circumstance that create dis-harmony in the society. In fact many people have risked their lives in preventing incidents from taking ugly turn.
Doctors have researched on how and why human brain gets affected by the dangerous slogans of breaking instead of uniting. How is it that knowing fully well the truth that we are all humans alike, people are made to feel different from others, even from those with whom they dwell every day, to the extent that they get motivated to kill them. Killing of school children in Texas or in a mall in the US should be eye opener. Doctors have also through researches rejected the supremacy theory of certain races, ethnic / religious groups and even gender and have found that when we mix more with each other we develop more empathetic and sympathetic attitude.
Time demands formidable struggle to work for social harmony. Medical bodies can always talk of health effects of the violence with focus on women, children and the elderly. We should encourage mixing of various social groups so as to understand each other’s cultural values and respect them. We should demand History to be taught in right perspective. Sometimes bitter past must be forgotten so as to move forward together. Different socio cultural groups should be encouraged to live in common localities instead of segregation. Common school system with children from various communities study together should be made compulsory.
The Indian Doctors for Peace and Development has been continuously working on these issues and has decided to hold outreach programmes for social harmony.
It is the duty of the state to curb such incidents and take effective measures to prevent such happenings. The criminal mind is encouraged if it goes unpunished for a violent act. If the perpetrators of violence are eulogised, the situation gets worse. It is therefore important that those in power must come forward. Silence of top brass in the government including the Prime Minister over such incidents is sceptical.
SERVICE TO MAN IS SERVICE TO GOD
Date: 19.5.22
SERVICE TO MAN IS SERVICE TO GOD
Dr Arun Mitra
Speaking at a book release in New Delhi, the Chief Justice of India (CJI) N V Ramana pointed out that “several false cases are being lodged against upright and hardworking doctors” and that “they need a better and more secure working environment”. He said that “this is where professional medical associations assume great significance” and advised them “to be proactive in highlighting the demands”. He further said that the doctors’ profession “perhaps is the only profession which follows Gandhi ji’s principle – service to man is service to God”. Medical professionals have to a large extent proved this during the Pandemic. As healthcare soldiers they served the society not caring for their lives. Over 1600 doctors lost their lives to COVID-19.
Scientists did commendable job by giving timely warnings and preventive updates about COVID-19 from time to time. The way vaccine has been developed in an emergency is a clear reflection of dedication of medical professionals who have proved that they take the health of the people as their utmost duty.
It is also worthy to note that the unscientific ideas like Gau Mutra, Cow Dung and even Tantra Mantra as cure for the disease were propagated. These myths hampered management of COVID. But the scientific medical opinion countered it timely and effectively. Medical organisations contested the promotion of Coronil by the Union Health Minister. They also contested Ramdev’s statement that people died despite the doctors, despite oxygen and due to vaccines.
The society on the whole recognized doctors’ efforts. But despite the fact that doctors played glorious role during Pandemic they and other health workers had to face unruly behaviour at some places. A doctor couple in Delhi had complained that the people living in the society where they have their house avoided them just because they are on the COVID duty and they feared that this couple will infect them too. Similarly some nurses were not allowed to enter their place of stay fearing that other persons in the locality will catch infection. Undeterred however the health workers continued to work for which they need appreciation and encouragement.
Ironically there have been several incidents of violence against the doctors, targeted by the unscrupulous mobs, some times with support of so called local leaders who instigate for extracting money. Many a times it is the young doctors, who are on regular duty, working tirelessly day and night in the hospitals, without food, rest or break have to face such violent attacks. Still under training to develop communication skills to gain trust of the patients they become soft targets. There are laws to deal with grievances against doctors. Violence under any circumstances cannot be excused and emotions cannot be allowed to turn into violent behavior. Unfortunately several times media too paints the doctors’ image in a bad light.
The National Human Rights Commission of India has come out with a 17 point charter of rights of the patients. The charter has also specified duties of the patients which include that the patient should respect the dignity of the doctors and other hospital staff as human beings and as professionals, whatever the grievance may be. Patient or caregivers should not resort to violence in any form and damage/destroy any property of the hospital or the service provider.
A national level law against violence on doctors can be a strong deterrent. Information about such laws should be percolated down to the citizens and the law enforcing agencies through media. It has been observed that the police at the Thanas is unaware of such laws in the states where these laws exist.
During violent situations the doctors have to face dilemma many a times. If the doctor treats the patient brought by the militant group – It is professional and ethical duty of the doctor to give medical care but the security forces take it otherwise and doubt her/his integrity. The doctor is thus at many times under double pressure.
Nobel Laureate Dr Denis Mukwege, who has worked for decades with great courage and compassion to address the needs of survivors of sexual violence in strife ridden Democratic Republic of Congo (DRC) and around the world, faced a deadly assault in which he narrowly escaped but his guard was killed. Undeterred he never gave up. This is true for situation in several parts of our country as well.
Poor health indicators in our country are a matter of worry. India’s Infant Mortality rate is 29 per 1000 live births and Maternal Mortality rate 103 per 100,000 live births. There occur death of 32 persons per one lakh population per year due to Tuberculosis. We lose children to Dengue fever, Encephalitis, Diarrhoea and Malaria. Non communicable diseases too are on the rise; 29.8% of Indians have hypertension. India had 72.9 million diabetes patients-second only to China (114.3 million), and is soon likely to become the diabetes capital of the world. It is therefore important that all citizens of the country get required healthcare, both preventive and curative.
The WHO is forthright in saying that “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion and political belief, economic or social condition”. It is pertinent that health has to be a fundamental right. This means these are justiciable, i.e. enforceable through law in case of their violation, the individual can approach courts for redress.
India is signatory to Alma Ata declaration of 1978. The conference held at Almaty in Kazakhstan strongly reaffirmed that “health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.” As a signatory to this declaration India is duty bound to implement the clauses.
Equity in healthcare is an important factor for the progress of society. No one should get sick and die just because they are poor, or because they cannot access the health services they need.
Determinants of health include access to safe drinking water and sanitation, nutritious foods, adequate housing, education, safe working conditions and proper remuneration. Poverty alleviation is essential for good health. Poverty leads to poor health which in turn is a cause for poverty. In the present scenario 75% of healthcare expenditure has to be met with from the pockets of households – 80% OPD, 60% Indoor. National Health Policy 2017 document and a recent document by the NITI Ayog admit that every year 63 million population of India is pushed towards poverty due to out of pocket expenditure.
The doctor-population ratio in India is 1:1200. The government doctor-population ratio – 1:10926 against the desired 1:1,000. This has to be changed to meet people’s health needs. But it is a worrying factor that real income of people is going down. Whereas the Russia Ukraine war and COVID have added to the prices of essential commodities, the prices of these items in our country have been going high every day for a long time. According to Krishna Raj, Professor Institute for Social and Economic Change Bengaluru, the prices of essential food items have increased by 50% in the last 7 years whereas the real wage rate has increased by 22% only. This is seriously affecting the poor people as food which is essential to sustain life is getting out of reach forcing them to borrow. As a result according to NSSO the consumption expenditure on food in rural India has come down drastically.
Such situations are a cause for health bodies. In the absence of support from the state the doctors are many a times left with no option but to underperform.
Doctors have done wonders and have earned worldwide applaud. Doctors without Borders is providing selfless service worldwide and the International Physicians for the Prevention of Nuclear War (IPPNW) has earned Nobel peace Prize for its relentless work for global peace.
Health can form a bridge of peace at various levels. Negotiations around healthcare delivery cultivate informal channels of communication that can contribute indirectly and directly to the peaceful settlement and confidence building. Such activities can change the dynamics of the situation. Doctors have to thus work on various fronts to promote social harmony, socio-economic uplift of the toiling masses, protection of rights of vulnerable sections of the society, promote global peace & disarmament and provide healthcare in arduous conditions. True, Gandhi Ji said that ‘Service to Man is Service to God’.
https://techy-job.com/most-indian-medical-professionals-are-doing-a-splendid-job-in-their-area/
https://novonite.com/most-indian-medical-professionals-do-a-great-job-in-their-area/
https://thearabianpost.com/most-indian-medical-professionals-are-doing-a-splendid-job-in-their-area/
Nuclear Weapons Free Zone for regional security in South Asia
Date: 12.5.22
Nuclear Weapons Free Zone for regional security in South Asia
Dr Arun Mitra
Co-President IPPNW
In 1998 that is 24 years back on 11th May India carried out first nuclear weapon test under the Vajpayee government. The event was celebrated with fanfare; public was jubilant over that India has now become a power to reckon with. Those who termed the event as a step towards mutually assured destruction were ridiculed. But just after 17 days on 28th May Pakistan too did the same. Observers felt that Pakistan has became at par with India in nuclear weapons race. Mood of the supporters of nuclear weapons in the country got subdued. Some experts argued that India who had superiority over Pakistan in conventional warfare has lost that since both countries have become nuclear armed. Exact figure unknown but there are estimates that both have 100 plus nuclear weapons each. The nuclear lobby argued that these weapons will serve as deterrent to war between the two countries who have been having perpetual tension since long. This hypothesis however was proved wrong as in about a year there was war between India and Pakistan at Kargil front in 1999. Terrorism from across the border continues unabated. There was terrorist attack on the Indian Parliament after which armies of the two countries were face to face on high alert with fear of use of nuclear weapons looming large. Possession of nuclear weapons has not deterred standoff between India and China either. There were skirmishes between the two at Galwan in June 2020. Now the nuclear lobby is actively propagating that if Ukraine had nuclear weapons, Russia would have not attacked.
South Asia comprises of eight nations: India, Pakistan, Bhutan, Nepal, Bangladesh, Afghanistan and the island nations Sri Lanka and the Maldives. Although South Asia occupies only 3.4% of the world’s land area, the region is home to approximately 24% of the world’s population, making it the most densely populated place on earth. Despite being rich in natural resources, it is among the poorest regions of the world in terms of per capita income, with 40% of the world’s poor living here. Still countries of the region especially India and Pakistan spend lot on arms race. Expenditure on nuclear weapons adds to their defence budget. As a result the countries of the region are left with little to spend on health, education and development.
Arms race in the region on the rise. With the ambition to become arms exporter India has already signed a $375 million agreement with Philippines to supply supersonic shore-based anti-ship BrahMos missile system with a range of 290 km developed jointly with Russia. Reports are that more such agreements are likely to be signed with Vietnam and Indonesia. With China acquiring advanced weapons system India has the excuse to manufacture and export arms. After China made its first nuclear bomb in 1964, there was lot of pressure on India to build nuclear weapons.
There is need to reverse this situation through mutual dialogue and confidence building among the nations. Civil society can play a big role in highlighting the humanitarian impact of nuclear weapons and build public opinion in India and Pakistan to join the Treaty Prohibiting Nuclear Weapons and for diversion of funds from arms race to development.
The peace movements have multifaceted tasks ahead. They have to build strong public opinion for disarmament. Medical peace activists have to explain how the arms race is affecting our health adversely. The message of the study by Dr. Ira Helfand, Co-President IPPNW on climatic consequences of limited nuclear war using 100 Hiroshima sized atomic bombs between India and Pakistan, which would put over two billion people at risk, has to be taken down to the masses as well as the decision makers.
Steps need to be taken for a lasting peace and nuclear disarmament in the region. Structural drivers for war have to be identified and peace activities have to be designed accordingly. India has been the harbinger of the non-aligned movement, which was initiated by the first Prime Minister Jawahar Lal Nehru along with Marshal Tito of Yugoslavia and Gamal Abdel Nasser of Egypt. The basic thrust of this movement has been non alignment from any blocks, based on the principle of respect to sovereignty and integrity of other nations. India also proposed the Rajiv Gandhi action plan for nuclear disarmament in 1988.
However given the aggressive nationalism and macho approach towards militarization, the task of peace making has become all the more difficult. India and Pakistan have not been receptive to the idea of nuclear disarmament. The ministers of the present government at the centre did not have the courtesy to meet with a delegation from IPPNW, a Nobel Laureate organization, in March 2018 at the time of an international seminar on the TPNW in New Delhi. Previously, all ministers, including the President and the Prime Minister, had shown a willingness to engage with such delegations.
Under these circumstances it has become important to initiate discussion on making south Asia a Nuclear Weapons free Zone (NFZ). Presently such zones exist in Latin America, Caribbean, South Pacific, Southeast Asia, whole of African continent and Central Asia which cover 39% of world population.
Chairman of an NGO, Blue Banner, Dr. J. Enkhsaikhan of Mongolia is quite vocal on the necessity of Nuclear-weapon-free zones (NWFZs). According to him these are recognized as important and practical regional measures of non-nuclear-weapon states (NNWSs) in promoting the goals of nuclear non-proliferation and strengthening confidence among states. Whereas the concept covers the regional areas but Mongolia set an example by declaring its territory as a single state Nuclear Weapons Free Zone in 1992.
It is imperative for the non-nuclear states in the south Asian region to build pressure on India and Pakistan to abolish their nuclear weapons and make the region NWFZ. With a long history of non-alignment and with people of India and Pakistan having same cultural values and language, even relations they will be overwhelmed with the idea. Peace activists and organisations have to carry it forward and initiate a dialogue on the issue. This appears to be a task difficult but not impossible. Humanitarian benefits for this would be manifold. It is well known now that nuclear weapons could not save us from Pandemic. They have utterly failed to even alleviate poverty and hunger so much rampant in our region. Even if India and Pakistan are unwilling, other non-nuclear weapons countries of the region can declare south Asia as NWFZ and put pressure on the two countries.
https://themeghalayan.com/s-asia-should-be-free-of-n-weapons/
https://www.thenorthlines.com/south-asia-should-be-made-into-a-nuclear-weapons-free-zone/
https://dailyheadlinestoday.com/epaper/view/352/epaper-headlines-today/9
https://ipanewspack.com/south-asia-should-be-made-into-a-nuclear-weapons-free-zone/
We will not let mankind vanish
Date: 28.04.2022
We will not let mankind vanish
Dr Arun Mitra
With repeated rhetoric of use of nuclear weapons between Russia and Ukraine, fear has gripped the minds of people around the globe. Rightly so, as the use of nuclear weapons would lead to unprecedented catastrophe. If the war doesn't stop soon there is likelihood of direct involvement of other countries particularly the US and NATO. In such situation the use of nuclear weapons will be more imminent. Studies conducted by the International Physicians for the Prevention of Nuclear War (IPPNW), Nobel Peace Prize winner in 1985 have shown with evidence that a nuclear exchange between major nuclear powers, would be end of modern civilization built through thousands of years of human labor. The nuclear exchange would lead to formation of huge amount of smoke and suit in the atmosphere. This would in turn obstruct sunlight from reaching the earth surface. It will cause drop in temperature of earth leading to nuclear winter. As a result there would be crop failure and starvation of billions of people and livestock.
Bombardment by the Russian army has already caused immense loss of lives and resources in Ukraine. Reports suggest Ukraine’s mounting death toll includes a growing number of researchers, Physicists, chemists, and mathematicians among the thousands killed. ( https://www.science.org/content/article/ukraine-s-mounting-death-toll-includes-growing-number-researchers) There have been reports of deaths of several Russian soldiers as well. Several cities of Ukraine have been virtually turned into rubble. Millions have fled Ukraine and are living in refugee camps in Poland, Romania and other countries. As always happens in the refugee camps these people are facing several hardships, physical and mental trauma with reports of increasing abuse of women and children.
This is the time for vigorous peace talks, but they seem to have taken back seat. International efforts to end the war too have dimmed.
Whereas Russia is losing a lot on the economic front as a result of sanctions, other countries too are bearing the brunt. Russia is the main source of Gas supply to the European countries. Any cut in the supply will lead to shortage of gas in the Europe with detrimental effect. The war can cause serious crisis of food security in the world. According to economist Aunindyo Chakravarty both Russia and Ukraine together are responsible for 1/4th of global export of Wheat, 1/6th of Maize and 3/4th share in the Sunflower oil. The two together also supply 1/5th of fertilizers to the world. As a result of war the prices of all these have increased.
It was expected that in the COVID times the world will unite together to formulate future strategies to prevent such diseases and their health and economic impacts. But it was not to happen. Instead the world has been plunged into arms race and threat of nuclear weapons. Several countries are already on the line to increase their arms budget as a guarantee to security. They are purchasing the weapons in large number. Some countries are in the weapons manufacturing spree. Indian government has already decided to become an arms exporter. Boris Johnson the British Prime Minister who was on a visit to India recently called Indian Prime Minister Narendra Modi as his ‘special friend’ and assured that UK will provide India knowhow on manufacturing ‘battle-winning’ fighter aircraft. The arms race is going to increase causing further misery in the poor countries.
Whereas people want immediate cessation of war through resumption of dialogue between the warring parties, it appears the arms manufacturers and sellers around the world will not let the war to end soon. Instead of taking initiative for necessary steps to end the war, the US and the NATO are instigating Ukranian Prime Minister Zelensky by clapping at his speeches sitting in their Parliaments. They are supplying arms to Ukraine to keep on fighting even at the cost of the lives of hundreds and thousands of the people.
Whereas Vladimir Putin’s action of aggression cannot be condoned, the role of NATO and the US is highly conspiratorial. The very existence of NATO is questionable. NATO came into existence on 4th April 1949 after the Second World War. In fact, the alliance's creation was part of a broader effort to serve three purposes: deterring Soviet expansionism, forbidding the revival of nationalist militarism in Europe through a strong North American presence on the continent, and encouraging European political integration. The major reason was to counter Soviet Communist block. The Warsaw Pact came into being on 14th May 1955, six years after the formation of NATO with the purpose to counterbalance the NATO. Since the Warsaw Pact does not exist anymore, there is no justification in continuation of NATO but for serving the interests of global military industrial complex. Unfortunately after the fall of Soviet block, instead of dissolving the NATO, number of countries in the NATO has increased. The war has given excuse to some governments to join NATO to get security umbrella. Reports that Sweden and Finland intend to join NATO are a dangerous signal. There is fear that more military blocks will come up in Asia and other continents, further leading to increase in the arms race. We are already witnessing the groups like AUKUS and QUAD. However the role of India in not aligning with any side is appreciable and represents carrying forward the legacy of Non Aligned Movement (NAM) started by Nehru, Tito and Nasser which is much needed in the present day world.
The IPPNW is persistently highlighting the humanitarian crisis and trying to educate the public, even the governments that nuclear weapons are the weapons of mass destruction. There is never a win-win situation in the use of nuclear weapons, rather this is a mutually assured destruction. The only way is to abolish the nuclear weapons, as medical science has no remedy to offer in case of a nuclear fallout. The IPPNW of which the author is a Co-President, as a partner in the International Campaign to Abolish Nuclear Weapons (ICAN) has repeatedly called upon all the countries including the nuclear weapons possessing countries to join Treaty Prohibiting Nuclear Weapons (TPNW) to save life on earth. The Doctors affiliated to IPPNW have taken a pledge to not let this catastrophe happen. The message from the recent Board and International Council meetings of the IPPNW is that people are a big force and they will not let their species to vanish from Earth? They have decided to forcefully raise this in the first Meeting of States Parties (1MSP) to the TPNW scheduled for 21-23 June 2022 in Vienna, Austria.
https://themeghalayan.com/fear-real-over-russia-ukraine-war-escalating/
https://ipanewspack.com/continuing-russia-ukraine-war-is-leading-to-apprehensions-about-escalation/
Never Whisper in the presence of wrong
Date: 22.04.2022
Never Whisper in the presence of wrong
Sharpen your opposition to divisive politics
Dr. Arun Mitra
‘Never Whisper in the presence of wrong’ is a quote attributed to Dr Bernard Lown, the founder president of the International Physicians for the Prevention of Nuclear War (IPPNW) from 1980 to 1993, who said ‘The ticking of numerous time bombs demands critical re-examination of the existing world order. The new way of thinking must be a final awakening to our common origins, to our shared problems as well as to our common fate. If we all are to prevail, we must never delegate in the presence of challenge and never whisper in the presence of wrong’.
Lown said it in relation to the nuclear weapons, but it is true for several other situations as well. Any type of violence is a cause of concern as it causes both physical and mental trauma. Violence is not just a law and order problem but an issue of public health importance. The world has seen catastrophic impact on human health in 1945 when the cities of Hiroshima and Nagasaki were atomic bombed by the USA. The Second World War led to loss of over 50 million lives and left over 90 million wounded. The USSR alone lost 18 million people.
The conflicts have not stopped thereafter. Dr.Barry S Levy Adjunct Professor of Public Health, Tufts University School of Medicine in a presentation at an event organized by the IPPNW on 19th February 2022 pointed out that the studies have revealed that since 1990-2017 there have occurred 50000 direct deaths annually as a result of armed conflicts while the indirect deaths have been more than one million.
Many a times the conflicts are engineered by the interested groups. They use divisive ideology and spread hared in the society. Harping on nostalgia of the past glory and hyper-nationalism they incite violence. In the recent years pushing the society into violence has become a tool for some to remain in power.
Ethnic strife between the Hutu and Tutsi tribes was the cause of death of nearly 800000 people in Rawanda. So much was the hatred spread against the each other that husbands killed their wives who belonged to the other tribe and with whom he must have been in extreme love that decided to marry. Nearly 2.5 million Hindus, Sikhs and Muslims were killed in the communal violence following partition of India in 1947 causing serious humanitarian crisis. Religious fundamentalism of the type of Taliban is danger to the society. What will be the end result of Russia Ukraine conflict, we do not know!
Fearing similar situation in the country due to on-going acts of some bigots and at many places with overt or covert support of the state machinery, several saner elements have expressed anguish at the events. Numerous videos have been circulating on social media condemning these moves to break the social fabric of the society by targeting minorities, especially Muslims, by the ‘Hindutva’ brigade in many places. They have been appealing to the Prime Minister to break persistent silence on these incidents as it makes one sceptical of his support to such elements. It appears as a member of the RSS and its pracharak at one time he is faithfully carrying forward the agenda put forth by the second Sarsanghchalak (chief) of the RSS, M S Golwalkar who in his book ‘We and Our Nationhood Identified’ clearly states that whenever they come to power, first of all hand over the government property, state lands and forests to the 2-3 trusted rich people of the country. Make 95% people beggars and after that power will not be lost for seven generations. He also said that ‘all his life I am ready to be enslaved by the British but I do not want such freedom which gives equal rights to Dalits, backward classes and Muslims’. Narendra Modi believes and practices this ideology of his Guru! Everyone can see how the nation’s wealth is being handed over to two families, namely Ambani and Adani. This is reminiscent of Nazis.
Therefore it would be naïve to appeal to and to expect from him to take such elements to task. It is time to stand up and fight against this kind of ideology that splits the social fabric. This is not the time to be silent, but to speak up and remember the quote ‘never whisper in the presence of wrong’.
https://www.imphaltimes.com/pdf/2022/April/24%20April.pdf
https://ipanewspack.com/never-whisper-in-the-presence-of-wrong/
https://tryxyz.com/article38332-NEVER-WHISPER-IN-THE-PRESENCE-OF-WRONG
Emerging challenges in healthcare
Date: 11.04.2022
Emerging challenges in healthcare
Dr Arun Mitra
Healthcare today is faced with several challenges right from medical education, primary prevention of disease, delivery of healthcare, funding for healthcare, scientific inputs, drug pricing etc. In the ancient times promotion of good health was learnt through day-to-day experience, so developed the concept of developing resistance to diseases through healthy nutrition or through specific methods like the use of herbs or other natural products. Modern scientific medicine carried forward that knowledge through extensive research to find normal functioning of the body, the causation of disease and methods of management of the disease and promotion of good health.
In India health planning started with the formation of a committee popularly known as Bhore committee under the chairmanship of Sir Joseph Bhore in 1943 to survey the then existing position regarding health conditions and health organizations in the country. The committee in its report in 1946 recommended that “the health programme should be developed on a foundation of preventive health work and that ‘if the nation’s health has to be built, such activities should proceed side by side those concerned with treatment of patients’. It was based on the principles that ‘no individual should be denied to secure adequate medical care because of inability to pay; health programme must lay special emphasis on preventive work; health service should be located close to the people; medical services should be free to all without any distinction and doctor should be a social physician’. The committee also observed that ‘health and development are inter-dependent and improvement in other sectors like water supply, sanitation, nutrition, employment led to improvement in health status’. Interestingly this is also the period when the British government introduced National Health Services in England. The Soviet Union had already introduced the concept of state’s responsibility of healthcare to all in 1936.
In the first few decades after independence, direction of the healthcare in our country was based on these principles which gave priority to public health. During that period much of the health care was developed in state sector with a special emphasis on the need for basic healthcare services. As a follow up India signed Alma-Ata Declaration in 1978 which identified primary healthcare as the key to the attainment of the goal of Health for all and conceptualized ‘health as the core function of development, encompassing the securities of life, livelihood, and basic services including food, health, education, housing, sanitation, drinking water, electricity, and transportation’.
In 1980s when neo-liberal economic policies were adopted there occurred a policy shift towards health that treats health as ‘techno-dependent and amenable to commodification’. Even the World Health Organisation (WHO) started working under the influence of international monopoly corporates and took position to increase privatization and partnership with multinational companies. In our country we find that the public sector is now responsible for the preventive services while the private sector on the other hand is investing heavily in secondary and tertiary care with a profit motive making the advanced care out of reach of low and even middle income group population.
There has been a paradigm shift in the approach from the first National Health Policy – 1983 which emphasized on promotive, preventive curative and rehabilitative services. The National Health Policy (NHP) 2017 however made a leap forward to corporate centric and insurance based healthcare system. As a result public funds are being diverted to the private insurance and health care sector. This is a period following World Trade Organisation which was founded on 1st January 1995.
Presently 75% of healthcare expenditure comes from the pockets of households – 80% for OPD care and 60% for Indoor care. This catastrophic healthcare cost is an important cause of impoverishment which further adds to poor health. No wonder the government recognises the fact that every year 6.3 crore people are pushed below poverty line because of out of pocket expenditure on health.
India has roughly 20 health workers per 10,000 population. Total doctor-population ratio including the doctors of modern medicine and AYUSH as told by Shri Mansukh Mandaviya, Union minister of health and family welfare in the Rajya Sabha April 5, 2022, is 1:834. It is to be noted that Govt. doctor-population ratio is 1:11,926 in contrast to the desired 1:1,000. This is a major cause of inequality in healthcare to the marginalized sections who are dependent solely on state healthcare system. WHO recommends minimum of 5% of the GDP as expenditure on health, while in contrast our public health spending is hovering around 1.1% of GDP.
That out of a population of 100000 in our country 32 persons die due to Tuberculosis every year, is a matter of grave concern and shame. Similar is the condition of other communicable and non – communicable diseases. Because of poor planning the diseases like Malaria, Tuberculosis, Cardiac illnesses, Diabetes, Cancers etc. got ignored during the COVID Pandemic. Despite all the above happenings, the Constitution of India does not expressly guarantee a fundamental right to health.
There is need to set up Primary Health Centre at every 30000 population, with 24-hour service, a Health Sub-Centre at every 5000 population and a fully staffed Community Health Centre with all facilities at every 100000 population. Establish round-the-clock ambulance service at every 30000 population. Post women medical and paramedical personnel in all health centres and hospitals in adequate numbers. All Government health facilities should adhere to Indian Public Health Standard (IPHS) norms.
Medical education too is on the same lines. In the last few decades there has been shift from opening the medical colleges in the state sector to the private sector.
According to the website of the National Medical Commission (NMC) presently India has 605 medical colleges with 90825 seats for the under graduate course. Out of this 306 colleges with 45035 seats are in the state sector. The number of colleges in private sector is 289 with 43965 seats and others 10 colleges with 1825 seats. The tuition fee in the private colleges ranges from 60 Lakh to over one crore rupees. This is far beyond the capacity of even the middle classes. Therefore the students look for relatively cost effective institutions. For study in the colleges abroad total cost including the travel and stay is around 30 Lakh rupees. This is pushing the students to study abroad. We have seen how the students in Ukraine had to suffer during the on-going war with Russia.
Since nutrition is the key to good health, it is imperative that Malnutrition is eliminated by implementing National Food Security Act 2013 which aims to provide subsidised food grains to approximately two thirds of India’s people and ensures maternity entitlements to all pregnant women. Set up Nutrition Rehabilitation Centre at each block to address the issue of severely malnourished children.
Even though expenditure on drugs forms nearly 63% of the out of pocket expenditure on health, till date we lack a Rational Drug Policy that allows drugs to be sold only under their generic names. The drugs pricing policy is faulty that lets the pharmaceutical companies fix up prices at their own will. There is need to ensure improved availability, accessibility and affordability of drugs including vaccines and sera in the public health system through quality conscious pooled procurement systems and promotion of manufacture of essential medicines. Drugs prices should be calculated based on their cost of production. Recommendations of the report of ‘Committee on High Trade Margins in Sale of Drugs’ submitted on 9th December 2015 need to be implemented. The National Pharmaceutical Pricing Authority should be strengthened further.
It is disgusting that unscientific non evidence based methods of treatment are being spread in health care. Promotion of Cow urine, Cow dung and Ramdev’s Coronil as treatment of various diseases including the COVID-19 has been done by the higher ups in the government including the union health minister Dr Harshvardhan, who himself is an ENT Surgeon. Latest decision of the NMC to introduce Charak Shapath instead of a scientific oath by the doctors of modern medicine is totally unscientific. The Charak Samhita written 300 BC says that a physician has to live a life of celibacy and grow beard. He has not to see a patient who is not liked by the king. This means women cannot be doctors.
Some colleges have made it compulsory for the internes of modern medicine to get raining in the AYUSH. It may be understood that there is conceptual difference about causation and treatment of disease not only between modern medicine and AYUSH but also between various constituents of AYUSH. The National Medical Commission (NMC) has also decided that the medical students of modern medicine should undergo training of Yoga under a yoga teacher and observe 21st June as Yoga day.
There has to be a concerted effort to develop a healthy India through scientific outlook, otherwise health of vast majority of our poor population will continue to be exploited through false beliefs and myths in healthcare and exorbitant charging. State has to come forward to take responsibility for health to all and for that declare health as a fundamental right.
https://dailyheadlinestoday.com/epaper/view/327/epaper-headlines-today/8
The death of a doctor !
Date: 01.04.2022
The death of a doctor !
Dr Arun Mitra
Suicide by Dr Archna Sharma, a senior Gynaecologist of Dausa in Rajasthan has shaken the medical fraternity. A patient is reported to have died during a procedure after which the attendants under the reportedly under the patronage of a BJP leader created ruckus. The police instead of controlling the mob registered a case of murder against the doctor U/s 302 IPC. Perturbed over this, the doctor committed suicide. Police role in this case is highly condemnable and demands of registering case of abetment to suicide against the concerned police officials. A doctor is more than a healer. She/He is not just adding to the economic development but also addressing the emotional part of the patient and the family. Her/his loss cannot be counted in terms of money. With the death of a doctor thousands of patients get devoid of sympathy and empathy they were getting from a trusted person. Loss of Dr Archna Sharma has to be viewed in this context.
This is not for the first time that violence has taken place against the doctors. Maximum of such incidents have occurred in Maharashtra. The violent incident in Bengal two years back got so much highlighted because the political atmosphere was highly surcharged. Doctors can be booked for negligence U/S 304A only after a thorough enquiry into the incident. Registering murder charge on a doctor without enquiry is equivalent to a criminal offence on the part of the law enforcing agency. How can one work in the atmosphere of uncertainty, particularly so when it comes to treating a person which requires lot of concentration, care and empathy.
We need to ponder over the reasons for such repeated acts of violence, immediate measures required to prevent such acts and the long term solutions to ameliorate the situation?
When death of a near and dear occurs emotional outburst is understandable. This does not in any way mean that they should resort to violence. There are several ways to redress the grievances. Many a times the young doctors in the hospitals have to work continuously for up to 36 hours or more. This puts them under lot of stress and strain. At the beginning of their career they are learning to develop communication skills to satisfy the patient’s attendants. Whatever the reason, the society has to understand that those giving treatment are trained to heal, not to kill. As medical students they are taught to be modest and sympathetic. Barring a few black sheep negligence is not a rule but an exception. As negligence cannot be condoned, so is the violence never justifiable.
A national level law against violence on doctors can be a strong deterrent. But many a times those perpetrating violence are ignorant of laws. Unfortunately it has been found that the law enforcing agencies too lack such information.
Our health care facilities in state sector lack required infrastructure. With a meager 1.1% of the GDP spending on health in the public sector, the patients have to look forward to the private sector for secondary and tertiary care which costs them exorbitant amount. This becomes another point of discord.
It is time the doctors take interest in the public concerns on the health issues. This will integrate them with the society. Not many medical bodies reacted to deaths in Muzaffarpur, nor in Gorakhpur. The medical bodies failed in supporting Dr.Kafeel who had to languish in the lock up because he raised the faults in the healthcare infrastructure at Gorakhpur.
Medicos should be in the front rows to help the needy in the event of natural calamities or other situations of public health crisis. Such gestures help to remove negative feelings about medical professionals in the society.
Culture of violence is being made a norm in our country. Calling ourselves followers of Buddha, Guru Nanak and Gandhi we have seen violence to the extreme in 1984, 2002 in which even the doctors were not speared. Now we are witnessing it in the form of vigilantes and mob lynching. Some of the law makers have been issuing very irresponsible statements, even rewarding those involved in mob lynching. Those at the helms of affairs should show more responsible behavior. If violence is eulogized then it becomes a norm and part of psyche which does not spare anyone, even the perpetrators. Violence prevention has to be a public health issue. The doctors have to stand against all sorts of violence. Unfortunately we react only when it happens to us. The communal frenzy being raised will further deteriorate the situation. Medical professionals have to be in the fore front to lead movements for social harmony. History is witness to how a section of doctors helped Nazis in eliminating the opponents.
Pledge by the doctors to raise collective voice against any kind of violence and efforts to change the culture of violence being promoted by the vested interests will be the real tribute to Dr Archna Sharma.
https://themeghalayan.com/harassment-haunts-medical-profession/
https://tryxyz.com/article38180-DEATH-OF-A-DOCTOR-HARASSMENT-HAUNTS-MEDICAL-PROFESSION
https://ipanewspack.com/death-of-a-doctor-harassment-haunts-medical-profession/
Medical ethics must be updated on the basis of scientific evidence
Date: 21.03.2022
Medical ethics must be updated on the basis of scientific evidence
Dr Arun Mitra
The Under Graduate Medical Education Board (UGMEB) of the National Medical Commission (NMC) in its video conference meeting held on 17th February 2022 has decided to replace the Hippocratic Oath taken by the doctors to affirm their commitment to medical ethics while treating the patients. This will be replaced by the Charak oath. Charak is a legendary figure in the history of medicine of our country. There are two names which are taken with reverence while remembering the history of medicine of ancient India. Charka was a physician in 300 BC and Sushruta, a surgeon in 600AD. We have all the respect and reverence. for their work in the contemporary time. Same is true for Hippocrates a Greek doctor who lived in 460 BC. Even though the name Hippocratic Oath is commonly used, in fact it is a declaration that the medical professional has to give at the time of entry into the medical practice. The Medical Council of India has formulated medical ethics for the doctors under the ‘Professional Conduct, Etiquette and Ethics’. According to this a doctor has obligation to serve the patients to the best of her/his ability and knowledge without consideration of financial returns as a primary motive. It is therefore important. To review why the above decision to replace Hippocratic Oath by the Charak Oath has been taken by the NMC, whether it has any medical background/logic or any scientific basis, or it has some other motives behind it ?
A group of doctors including Dr B Srinivas Kakkilaya, Consultant Physician, Mangaluru, Karnataka, Dr Yogananda Reddy, Consultant Paediatrician, Ballary, Karnataka, Dr. P Venkataraya Bhandary, Consultant Psychiatrist, Udupi, Karnataka, Dr Shashidhar Bilagi, Consultant Psychiatrist, Bengaluru, Karnataka, Dr Prakash C Rao, Senior Family Physician, Bengaluru, Karnataka in a letter to Dr. Suresh Chandra Sharma, Chairman, National Medical Commission have expressed their serious reservations over the move of the NMC. They have pointed out that the NMC is concerned with imparting modern scientific medicine and that the modern scientific medicine belongs to the whole world, including India, and that it has continuously evolved, and evolving, absorbing the best of medical knowledge from ancient times, including Ayurveda, Greek Medicine, Chinese Medicine, Persian Medicine etc. Similarly, the Oath of Medical Ethics, that every practitioner of modern medicine swears by, has also evolved keeping pace with changing times and socio-political systems, from the ancient times of Charaka to Hippocrates to the modern pledge adopted as the Declaration of Geneva, the latest one being adopted by the World Medical Association in 2017.
The Hippocrates swears by Apollo Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses of Greece. All this is not relevant in the modern day world of science. The ancient Hippocratic Oath makes a physician duty bound to his patients, without considering political positions or gender, however it restrains from performing abortions. It asks physicians not to use “knife, not even, verily, on sufferers from stone”.
The 300 BC in India was the period of Kings where Brahmins were at the top in the social Hierarchy. Accordingly, the Charaka Shapath mandates the physician to lead a life of celibacy, grow beard and hair, pray for cows and Brahmins. It forbids the doctor from treating those who are in opposition to the King or whom the physician or society may despise. The modern oaths, belonging to the present, with tremendous advances in modern science bind that every human shall be treated equally and the physicians must be committed to treat fellow humans to the best of their abilities under any circumstances.
‘As the graduates of modern scientific medicine are now taking the modern pledge, and not the ancient Hippocratic oath, which is actually not in use now, replacing the modern oath, by erroneously terming it as Hippocratic Oath, with what is being termed as Maharshi Charaka Shapath, which is completely out of sync with modern scientific medicine, modern social practices, and modern socio-political values, is unnecessary. Implementing the original Charaka Shapath would automatically disable every woman medical graduate from practicing, making it only men’s profession, who in turn would need to grow beard and hair and follow the other norms as was mandated in the ancient oath’.
Not only that, some other decisions taken by the UGMEB too are shocking. According to these a 10 days yoga training by allotting one hr/day for all the batches in a college in the form of Surya Namaskar, Pranayam, Breathing exercise, Meditation etc will be mandated. All doctors of modern medicine are to compulsorily celebrate the International Day of Yoga on 21st June. This is done ostensibly to allay depression, suicidal tendencies ragging activities along with de-stressing the Faculty & everybody in the loop.
Modern scientific medicine, is evidence-based. It is appalling that the NMC is mandating unproven and unrelated methods for the students and faculty of modern scientific medicine. It is even more shocking and dangerous that the same are being suggested as methods to allay depression, anxiety, and suicidal tendencies, for stress management, and even for ragging! This is completely ridiculous and not based on any evidence. Prevention of ragging needs stringent law enforcement. Management of depression, anxiety, suicidal tendencies require well-proven methods in modern scientific medicine. Using unproven non-scientific methods to treat mental disorders can do serious harm to the patient.
Considering all these the NMC should reconsider and rescind the decision to replace the modern oath which is based on the present day socio political conditions and scientific knowledge.
https://ipanewspack.com/medical-ethics-must-be-updated-on-the-basis-of-scientific-evidence/
https://tryxyz.com/article38061-MEDICAL-ETHICS-MUST-BE-UPDATED-ON-THE-BASIS-OF-SCIENTIFIC-EVIDENCE
Need to review medical education following Ukraine crisis
Date: 14 March 2022
Need to review medical education following Ukraine crisis
Dr Arun Mitra
That Indian students have finally reached home is a matter of great satisfaction not just for the family but for the country as a whole. Better late than never; finally the Indian government woke up and took effective steps to plan the evacuation from Sumy where probably last batch of our students was stranded. War between Russia and Ukraine is threatening the lives of innocent citizens and destruction of resources. The danger of use of nuclear weapons in case of escalation of war cannot be ruled out.
Evacuation of the citizens from the war zones is extremely difficult task. Foreign nationals who want to go back to their families are hard put. Indian citizens, particularly the students, most of them under going education in the medical courses, have been facing difficult time. Whereas most of the countries took away their citizens back home from Ukraine, the government of India failed to act on time. This is despite several requests from the students to the embassy in Kyiv. When the war started, instead of organising evacuation of the students the Indian embassy in Ukraine only kept on issuing advisories to the students to reach borders of Poland or Romania. It was a horrendous task for the students since from some places these borders are over 1500 kilo meters away. Several young boys and girls braved through the harsh weather and shelling to reach the borders. Patting his own back the Prime Minister and his cabinet colleagues however left no stone unturned in taking credit for what they had not done. Evacuation means to bring a persons out from the crisis area. But here the students walked several kilometres or paid exorbitant amount to hire vehicles to reach the borders from where they could take the journey back home safely. It is however unfortunate that instead of praising the students for showing bravery in crossing the borders, the question being raised is about their studies, their capabilities, their level of knowledge etc. So much is the lack of empathy at this hour of crisis that Union Minister for Parliamentary Affairs Pralhad Joshi instead of helping, castigated the students that 90 per cent of Indians who study abroad fail to pass qualifiers in India. He does not know that even to go abroad for MBBS studies the students have to pass the NEET.
The pertinent issue which has come to the fore now is why should Indian students opt for admission in the colleges abroad in such a large number ? They are studying not only in Ukraine but in much larger number in the USA, Canada and China. Many are in Philippines, Kazakhstan, Kyrgyzstan and Bangladesh.
According to the website of the National Medical Commission (NMC) presently India has 605 medical colleges with 90825 seats for the under graduate course. Out of this 306 colleges with 45035 seats are in the state sector. The number of colleges in private sector is 289 with 43965 seats and others 10 colleges with 1825 seats. The tuition fee in the private colleges ranges from 60 Lakh to over one crore rupees. This is far beyond the capacity of even the middle classes. Therefore the students look for relatively cost effective institutions. For study in the colleges abroad total cost including the travel and stay is around 30 Lakh rupees.
To get registered with the NMC these students have to clear the Foreign Medical Graduates Exam (FMGE). Those who pass this exam become at par with others. So to raise such frivolous issues of their standard of education is to hide the failure to provide medical education at affordable rates inside the country. Prime Minister has said that more medical colleges need to be opened in the country to prevent our students from going abroad and has called upon the private sector to come forward. This will not be helpful as the private sector’s motive is profit making. He has also said that half of the seats in these colleges will be free. This is not something that can be monitored easily. We have the experience of how the private sector corporate hospitals who have reaped several benefits from the government and for which they are supposed to give affordable treatment to 25% beds, are evading their responsibility with impunity. The government had earlier come up with a proposal to hand over district hospitals to the medical colleges which will be operated by the private sector. It has been proposed that 50% patients will be given free treatment in these hospitals. Those interested in getting free treatment will have to get authorisation from the designated authority. This will leave the poor people running here and there for authorisation.
It is important to see that the career of these young students does not suffer. IT Cell trollers who are out to defame these students should be taken to task. Such words at a time when the students and their families are in so much trauma after the nightmarish experience and prevailing uncertainty can have adverse effect. They are now much worried about their future. Government should reassure that they will take up the matter with empathy. All efforts should be made for the continuation of their studies in Ukraine once the situation improves. It would be apt to wait for a period of six months. The decision of the NMC to allow internees to do internship in India is a welcome step. Others who are still in the graduation process should be assured that if things do not improve in Ukraine, they would be adjusted here in government colleges while charging the same fee as they had to pay in Ukraine. More medical colleges need to be opened in state sector. To ameliorate the health crisis in remote areas an undertaking can be taken from the students to serve in the remote areas in state sector for a period from 5 to 10 years.
In the nearly 35 years after independence the medical education was imparted mainly by the state sector. It was only after the neo-liberal economic policies that the private sector got a push. In 1980 there were 112 colleges out of which 99 were in state sector while only 13 were in the private sector. But from 1980 to 2022 number of colleges that were added in state sector is 207 while the private sector college number 276. Many of these private colleges lack basic facilities for training despite charging hefty amounts. This trend has to be reversed to give a boost to the medical education based on the criteria of medicine as service - not for profit making as primary motive.
https://www.thehillstimes.in/editorial/medical-education-outside-india
Russia Ukraine conflict would lead to serious global health and humanitarian crisis
Date: 22.02.2022
Russia Ukraine conflict would lead to serious global health and humanitarian crisis
Dr Arun Mitra
Whole world has suffered due to humanitarian crisis due to COVID-19 pandemic. The threat is not yet completely over as we are still not certain about the new variants of the rapidly mutating virus. Even though vaccination has given some respite, but glaring inequity in vaccination of the population in different countries hampers the fight against the COVID-19. We need immense resources to meet the challenge not only for the pandemic but also for other diseases, both communicable and non-communicable which have been largely ignored during this period. Patients with diseases like Tuberculosis, Dengue, Malaria, Diarrhea, Diabetes, Cancer, Chronic Kidney problems suffered due to changed priorities. The effect has been seen more in the developing countries who are already short of resources.
This is a time when the whole world should get together and put in all efforts to conserve resources for the healthcare of the people. But even before this crisis has ended, we are on the brink of another humanitarian disaster that could happen in case of conflict between Russia and Ukraine.
Such a war at this moment may not remain localised to Europe alone. As it appears that USA along with NATO countries will directly or indirectly enter into the conflict, which will further Increase the crisis and lead to involvement of other countries in the time to come. Therefore it is urgently needed that the two countries reach a diplomatic solution to the crisis through mutual dialogue and confidence building measures.
It may be difficult to assess the humanitarian damage in case of war between Russia and Ukraine, but the effect is similar in case of any war. We have our experience of collateral damage caused following invasion of Iraq by the US and allies.
In any war scenario, the civilian deaths outnumber the death of soldiers as more deaths now occur due to indirect impact of war than direct effect of weapons. In war situation essentials like the food supply, water supply, healthcare and public health services, power generation, communication, transportation and other infrastructure are affected adversely. In addition there occurs displacement of population who have to live in make shift camps. This increases the risk of disease and deaths. The studies have revealed that since 1990-2017 there have occurred 50000 direct deaths annually as a result of armed conflicts while the indirect deaths have been more than one million.
Recently the US government officials estimated that the fighting could kill 25,000 to 50,000 civilians, 5,000 to 25,000 Ukrainian military personnel, and 3,000 to 10,000 Russian soldiers. It could also generate 1-to-5 million refugees. Any escalation could lead to use of nuclear weapons which would be catastrophic.
Dr.Barry S Levy Adjunct Professor of Public Health, Tufts University School of Medicine in a presentation at an event organized by the International Physicians for the Prevention of Nuclear War (IPPNW) on 19th February 2022 has warned of serious consequences of conventional war. According to him in case of war there is increase in the malnutrition particularly among women and children. There is rise in the communicable diseases like diarrhea, cholera, respiratory diseases, Tuberculosis. Mental disorders like depression, posttraumatic stress disorder and suicide increase. Reproductive health suffers badly. The non-communicable diseases like heart diseases, cancers, kidney diseases. Since Ukraine has 17% population above the age of 65. So there is a danger that indirect death rate would be much higher than in case of invasion of Iraq since this group of population is more vulnerable.
In case of Russia and Ukraine conflict danger of use of nuclear weapons cannot be ruled out. Such a situation would have extremely dangerous consequences and would put billions around the world at risk warned Dr Ira Helfand – Former Co President IPPNW in the event mentioned above.
Linda Pentz Gunter founder of Beyond Nuclear has cautioned of extremely serious catastrophe if the nuclear power plants in Ukraine are damaged in the war. We have to learn from the previous incidents of nuclear power plant accidents like Chernobyl and Fukushima she says.
Knowing well all these dangers the world is still increasing expenditure on arms. As per SIPRI world military expenditure was $1981 billion in 2020, an increase of 2.6 per cent on 2019 in real terms. https://sipri.org/sites/default/files/2021-04/fs_2104_milex_0.pdf
As the war between Russia and Ukraine is likely to spread further, in that scenario population in low income group countries will have serious adverse impact which could be long lasting on their economy.
People in both the countries yearn for conflict resolution from dialogue and lasting peace, as pointed out by Olga Mironova, MD, PhD, who is working as Associate Professor of the chair of Internal Diseases in Sechenov University while speaking in the above mentioned IPPNW event. Therefore it is needed that while on one hand urgent diplomatic efforts are made, the civil society should raise its concerns worldwide.
Health Budget belies people’s aspirations
Date: 03.02.2022
Health Budget belies people’s aspirations
Dr Arun Mitra
We have faced serious health crisis in the last two years particularly due to the COVID Pandemic which has cost dearly precious lives, economy and pushed millions of people into joblessness and loss of livelihood adding to the already existing poverty. Large number of population could not get required treatment for COVID due to lack of preparedness on the part of the government. They were unable to go to the private hospitals due to exorbitant cost. In addition, the already existing diseases, both communicable and non-communicable faced serious the resource crunch. Whereas the affluent section of the society could get treatment for the above the lower income group, who are largely dependent on the state for their health needs were deprived of the treatment for diseases like Tuberculosis, Dengue, Malaria, Diarrhoea and even Vaccination to the children.
The WHO has pointed out time and again that to meet the health needs it is important that the public health spending should be 5% of the GDP. But unfortunately the public health expenditure in our country has been hovering around 1.1% for several years. According to the Oxfam’s “Commitment to reducing inequality report 2020” India ranks 154th in health spending, 5th from the bottom. It was therefore expected that the government would be serious in budgetary allocation towards health. But it was not to be.
The budgetary allocation to health in this year’s budget is Rs.82600 crore out of total fiscal budget of Rs.39.45 lakh crore. This amounts to 2.07% of the total budget. Last year this allocation was 2.04%. This miniscule increase is not even sufficient to meet the inflation. As percentage of the GDP the allocation to health budget has in fact come down. This is a serious issue which concerns health of our people. People close to the government claim that there has been a constant increase in the health budget. They forget that health budget has increased along with the total budget. For example, in the 2013 – 14 budget health was allocated Rs.37335 Crore out of a total budget of Rs.16.65 lakh crores, this amounts to 2.24%. Then in the next two years this budget fell to1.95%, 1.86 % and 1.93%. In the subsequent years it was raised to 2.20% and 2.16 % in 2017-18 and 2018-19. Now in fact it has come down again.
There has been special mention of Mental Health. It is true that the mental health has always been a serious issue. The situation during COVID Pandemic pushed people into poverty due to joblessness caused serious problems among the people. Children who lost school days have been the worst sufferers. The digital solution offered may not serve the desired purpose. There is need to increase the number of personnel in the field. A meager increase of budget allocation from Rs. 597 crore to Rs. 610 crores is too low.
Similarly a minor increase from Rs.2663 crore to Rs.3200 on Health research should have been increased much more. Faced with several health problems we need to develop our own innovative methods through research and development. This needs more monetary allocations.
Various studies have concluded that to ensure comprehensive primary healthcare there is need to enhance public health spending on health to minimum of 5% of the GDP. Government had committed that it will spend 2.5 % of the GDP on health. If that is to be done there has to be increase in budgetary spending to 3.5 lakh crore rupees.
Much has been talked about digitalization of healthcare system. This would mean maintaining digital record of the people. But this is not the priority. What is needed is creation of trained manpower in health sector at all levels. Health is a multi-sectoral issue which requires better nutrition, education, maternal and child healthcare, job opportunities, better work environment, housing, clean drinking water supply, sewerage facilities etc. With food security being undermined and spending on schemes like MGNREGA reduced, it would be naïve to expect health of the people to improve.
It is a matter of satisfaction that we have successfully vaccinated large number of our population. But still our record is less than global average of 52.56 persons fully vaccinated per 100 people. Our number stands at 50.23 whereas China has vaccinated 83.27 persons fully per 100 population. Many more countries have done better than us.
The budget has completely failed to meet the expectations for a direction towards comprehensive universal healthcare rather there seems to be a hidden agenda of corporate push in the healthcare through PPP mode which has been so much talked about by the present dispensation in power.
https://www.readwhere.com/read/3372223#page/6/1
Health should get due place in the budget
Date: 23.01.2022
Health should get due place in the budget
Dr Arun Mitra
Needless to say that health and education form the basis of development of any society. Investment in these two sectors is an asset for the present as well as future. Unfortunately the successive governments have ignored these two sectors. Public health spending is far from the required, thus causing serious impact on the health of the people of our country. Whereas the first National Health Policy 1983 emphasized on promotive, preventive curative and rehabilitative services, the National Health Policy - 2002 shifted its emphasis towards the provision of health care through private sector and opening up secondary and tertiary level health care for private investment. As a result the spirit and principles of Primary health care was compromised. This resulted in a setback to the equitable distribution of healthcare. All this was a reflection of neo-liberal economic model adopted by our country and the World Trade Organisation after it was founded on 1st January 1995.
The National Health Policy (NHP) 2017 however made a leap forward to corporate centric and insurance based healthcare system. It also highlighted on strategic purchase of non govt. secondary and tertiary care services. Insurance system was further strengthened and public funds diverted to the private insurance and health care sector.
Presently 75% of healthcare expenditure is borne by the people from their own pockets. Out of this nearly 70% is spent on OPD care. This is pushing 6.3 crore population of India to poverty every year. This catastrophic healthcare cost is an important cause of impoverishment which in turn adds to poor health.
India has roughly 20 health workers per 10,000 population, with 39.6% doctors, 30.5% nurses and midwives, and 1.2% dentists. Total doctor-population ratio 1:1445. It is to be noted that Govt. Doctors-population ratio is 1:11,926 in contrast to the desired 1:1,000. This is a major cause of inequality in healthcare to the marginalized sections who are dependent solely on state healthcare system.
WHO recommends minimum of 5% of the GDP as expenditure on Health. The Planning Commission of India had said that the state spending on health will be 2.5% of GDP by end of 12th five year plan and 3% by 2022. Interestingly under the present BJP government the 2015 NHP draft mentioned this to be 2.5% GDP by 2020. The revised NHP 2017 pushed the time frame further to 2025. National Health Mission budget was decreased by 10%. The ICDS budget has been decreased. Nutriton budget decreased by Rs.1000 crores from 3700 to 2700 crores rupees in the 2021-22 budget.
Investment in health insurance has increased. The Ayushman Bharat is an insurance based system. The whole healthcare concept is insurance based which fails to provide comprehensive healthcare. Senior citizens are the worst affected. The Ayushman Bharat covers only 50 crore population while the rest 88 crores are left out. Moreover it is applicable for indoor care only, whereas 70% of the out of pocket expenditure on health is on OPD care. There are several conditions attached to get registered with this scheme. Eligible people also find it very hard to make the card. Other state run insurance schemes offer a limited benefit. For a person to get insured with private or public sector company, one has to shelve huge amount. The ESI started in 1952, CGHS in 1954 and ECHS in 2003 provide comprehensive healthcare to the employees to an extent. There is a move to dilute the ESI. The government is planning to handover district hospitals to the private sector to open medical colleges. In these hospitals 50% patients will get free treatment while the rest will have to pay. The free patients will have to get authorization from a designated authority, thus creating several hurdles for them.
Much was expected from the budget presented last year. An outlay of 223846 crore rupees on health in the budget for the year 2021-22 appeared very encouraging. It was said to be 137% increase from the previous budget of 94452 crore. However a detailed review of this brought forward the truth. The actual amount was a marginal increase in the allocation to department of Health and Family Welfare from rupees 65012 crore in 2020-21 budget to 71269 crore rupees; a meagre 10% increase and only 2.04% of the total budget of Rs.3483236 crores.
Most worrying factor in the budget was reduction in the spending on Nutrition from 3700 to 2700 crore rupees. This is at a time when India is at 102nd position in hunger index out of 117 countries, worse even than our neighbouring south Asian countries.
Various studies have concluded that to ensure comprehensive primary healthcare there is need to enhance public health spending on health to minimum of 5% of the GDP.
More than 40 per cent of the population has to borrow or sell assets for treatment. This is totally against the principles of equity and justice. Already marginalised sections, Dalits, Muslims and other socio-economically weaker groups are worst affected.
The concept of universal comprehensive health care was first of all realized by the Soviet Union who in the Soviet constitution 1936 guaranteed that the Citizens of the USSR have the right to health protection. The National Health Services (NHS) was launched in the UK on 5 July 1948, by the then Health Secretary, Aneurin Bevan. This gave huge benefit of free healthcare to the population. The Cuban government adopted the concept of social medicine into practice. Its effect is well recognised globally. The government of Cuba spends approximately Rs.25000/- per person each year on healthcare, while India spends around Rs.1753/- on the health per capita with a corresponding expenditure of Rs.2.65 lakh in the UK.
The Economic Survey 2020-21 had strongly recommended an increase in public spending on healthcare services from 1% to 2.5-3% of GDP, as envisaged in the National Health Policy 2017. It also noted that this can significantly reduce the Out-of-Pocket-Expenditure (OOPE) from 65 per cent to 35 per cent of the overall healthcare spend. (1)
It is therefore imperative that the public health spending has to be increased to minimum of 5% of the GDP. An immediate increase to three times of the present budget allocation to health is need of the hour in the upcoming budget.
References:
https://pib.gov.in/PressReleasePage.aspx?PRID=1693225
Ensure vaccine equity to control the third wave of COVID pandemic
Date: 9.01.22
Ensure vaccine equity to control the third wave of COVID pandemic
As predicted by the scientists, the third wave of SARS COV -2 is spreading fast around the world. First case of the variant of the virus, the Omicron was reported in South Africa only a few weeks ago. Soon it spread to Europe, America and now it is spreading tentacles in Asia including our country. The United Kingdom recorded 1.40 lakh new cases on 8th January 2022. The number of new cases in the USA on the same day stood at 4.43 lakh and India 1.59 lakh. This number is likely to go high by the middle of February. During the second wave of Delta variant the highest number in India was 4.14 lakh cases on 6th May 2022. The Delta variant was highly deadly and was the cause of loss of human lives in large number. The Omicron is said to be not as deadly; however it may be too early to give a firm opinion on this as the mutations in viruses are well known. More over at present there is a combination of SARS COV -2 viruses causing the infection.
The Delta variant virus attacked the lungs causing respiratory crises. Therefore the number of people who required admission in the hospitals was very high. In contrast the Omicron virus has been found to affect more on the nose and throat so the symptoms resemble ordinary flu. However the World Health Organization (WHO) has warned that it should not be taken lightly. The WHO Director General Tedros Adhanom Ghebreyesus said that “the more infectious Omicron variant of coronavirus appears to produce less severe disease than the globally dominant Delta strain, but should not be categorised as "mild".
Laxity by any one, the government or the people can be dangerous. The COVID appropriate behaviour in the form of using masks, washing hands, sanitising and maintaining 6 feet distance from one and another must be followed. Respiratory droplets can be transmitted through coughing, sneezing, contact with contaminated surfaces, or even through inhaled aerosols; therefore, each individual must take adequate steps to reduce their exposure to these particles by wearing masks and practicing safe social distance measures.
Wearing of proper mask is very important. The mask must fit on the face properly s that air cannot enter from sides but has to pass through the surface of the mask. Diameter of the virus has been found to range between 50 nm to 140 nm. Certain masks are considered more effective at minimizing the risk of exposure, particularly N95 masks. The protective capabilities offered by N95 masks are considered as it can remove at least 95% of all particles with an average diameter of 300 nm or less. The surgical masks are tripe layered masks which offer protection. The cotton masks have large sized pores and would be porous to SARS-COV-2 particles, though it may render limited protection by blocking aqueous micro-droplets of saliva (1). Simple measures as per the scientific information about COVID appropriate behaviour are the saviours.
If the Omicron does not cause serious harm then it may turn out to be boon as if large number people get infected, but not taken seriously ill, there may develop herd immunity in the population which could be the beginning of end of the Pandemic.
In the last two years when the first case of SARS COV-2 was reported we have become much wiser in terms of its diagnosis, management and prevention. Vaccination is a big step forward. Omicron can infect the double vaccinated person as well but the effect is relatively milder. Therefore it is important that the vaccine targets are achieved globally. Recently addressing a press briefing, the head of global health body, the WHO repeated his call for “greater equity globally in the distribution of and access to Covid-19 vaccines”. But he cautioned ‘based on the current rate of Covid-19 vaccine rollout, 109 nations will miss the WHO's target for 70% of the world's population to be fully vaccinated by July’. The number of vaccinated population varies drastically among the nations. Performance of some countries in vaccination is a real cause of concern.
Syria has vaccinated only 12% of its population by 6th January 2022. Similarly percentage of population vaccinated in Afghanistan is 10%, Sudan 8.9%, Ethiopia 7.9% and Somalia only 7.4%. This is in contrast to 99% vaccinated in UAE, 92% in Cuba, China 87%, UK 76% and Sri Lanka 74%. India has vaccinated 63% population (2). Since the world is well connected these days, it is important that all the countries around the world must achieve the vaccination target by July as envisaged by the WHO. This is not so difficult a task. It requires political will on the part of the world leaders. In fact the UNO should monitor the whole process and ensure that the vaccines reach the poorly performing countries in sufficient numbers so that they can vaccinate the population on time. If needed, even the trained man power for the job should be made available in these countries. Any inequity in vaccination will hamper the objective of getting rid of the Pandemic soon.
References:
- https://www.nature.com/articles/s43246-021-00160-z
- https://ourworldindata.org/covid-vaccinations
In quest of peace and health in the new year
Date: 22.12.2021
In quest of peace and health in the new year
Dr Arun Mitra
The year 2022 is going to be full of challenges for peace and health. On one side the mankind has been grappling with COVID Pandemic for the last two years on the other increasing expenditure on arms race is draining away resources which are desperately needed to meet the challenge of Pandemic. Developing countries are the worst sufferers in such situation.
The COVID-19 Pandemic has exposed the already existing shortcomings in the health care system. Diseases like Tuberculosis, Malaria, Dengue, Chikungunya, Diarrhoea and non-communicable diseases like Diabetes, Hypertension got ignored during this period. Vaccination of the children was affected as well. The situation has brought forward the fact that to meet the healthcare needs we require meticulous planning and funds.
After the first case was reported two years back, the COVID-19 took the shape of Pandemic and caused havoc around the globe. The medical fraternity was fast enough to meet the challenge to understand about the pattern of disease, to find methods of its early diagnosis & treatment and also to spread the message of prevention of diseases through simple measures like maintaining six feet distance, washing and sanitizing hands and wearing masks. This saved millions of lives around the world. Vaccines too were developed in an emergency manner. Fighting like brave soldiers more than 1600 doctors lost their life in our country while taking care of the sick.
Majority of population recognized and appreciated the role of medical fraternity during this difficult period. But as a result of ignorance and panic we witnessed bizarre behaviour of the people at some places. A doctor couple in Delhi complained that the people living in the society where they had their house avoided them because they were on COVID duty. Similar complaints were received from some nurses who were not allowed to enter their houses because the people feared them to be potential carriers of the disease.
Violence against doctors is well known in normal conditions as well. Young doctors, who are always under lot of stress of work and have not yet, developed communication skills become target of the mobs. Even though some states have made laws to check violence against the medical personnel, there is no such law at national level. National human rights commission of India in its 17 point charter of rights of patients has specified the duties of the patients as well. The commission has categorically stated that the patient or caregivers should not resort to violence in any form and damage or destroy any property of the hospital or the service provider. A national level law against violation doctors can be a strong deterrent to such situations.
Intolerant behaviour is not limited to India only. Nobel laureate Dr Dennis Mukwege who has worked for decades with great courage and compassion to address the needs of survivors of sexual violence in Democratic Republic of Congo, was attacked seriously; fortunately he survived but his guard was killed. He however never gave up and continues to work. In many places affected with violence, the doctors have to face double crises. Professional ethics and morals teach them to take care of any individual who is sick. In the violent situations when some militant groups bring the patients to them they have to take care but then they have to face the wrath of the security forces.
Fallout of the violent conditions in the society can have serious repercussions on health. Children who watched their kith and kin being subjected to violence, develop behavioural problems, depression, anxiety and post-traumatic stress disorder. Therefore the prevention of violence is now accepted as a public health issue.
To meet the health needs of society as a whole, Health has to be declared as a fundamental right. A fundamental right is justiciable that means it is enforceable through law and in case of violation of this, individual can approach court of law for protection. World health organization has categorically stated that “enjoyment of highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.
Good health is determined by other basic human rights like access to safe drinking water, sanitation, nutritious food, adequate housing, education, safe working conditions and sufficient remuneration. Therefore poverty alleviation is essential for good health. Poverty leads to poor health which in turn is a cause of poverty.
The International conference held at Almaty, Kazakhstan in 1978 came up with a declaration popularly known as the Alma Ata declaration. The conference strongly declared that “health which is a state of complete physical mental and social wellbeing and not merely the absence of disease or infirmity is a fundamental human right and the attainment of the highest possible level of health is the most important worldwide social goal whose realisation require the actions of many other social and economic sectors in addition to health sector”.
Constitution of India does not explicitly guarantee a fundamental right to health. But there are directive principles which give us some relief. India got its first national health policy in 1983 which emphasised on promotive, preventive, curative and rehabilitative services. It attempted shift from vertical health programs to strengthening of primary health care network. In the next national health policy in 2002 there was a paradigm shift. It emphasised on secondary and tertiary health care services through private investment. In 2015 the national health policy draft mentioned to make health a fundamental right. However the final draft was a complete change. The 2017 health policy made a shift to insurance based healthcare causing diversion of public funds to the insurance companies. This is a cause of inequitable distribution of healthcare.
India has a doctor population ratio of one doctor for 1445 people. The government doctor population is one doctor for 11926 persons against the desired of one to 1000. Therefore 75% of the healthcare expenditure comes from the pockets of the household. Out of this 80% goes for the OPD care. This catastrophic healthcare expenditure is an important cause of impoverishment. Whereas the WHO mandates GDP expenditure on health at a minimum of 5%, it is only around 1.1% in our country. The budget on National Health Mission has been cut down by 10%; ICDS budget too has been decreased. The nutrition budget was reduced from 3700 crore to 2700 crores that is a reduction of 1000 crores in this year’s budget.
Insurance based health care is unaffordable more so for the senior citizens who are faced with financial problems. Their income by that age gets reduced or they become dependent on children. This makes it impossible for them to pay high premiums of the insurance companies which increase with the age.
Therefore it is important that health is declared as a fundamental right government has responsibility to provide healthcare to all. For this a strong people’s movement is needed. But this is unfortunately lacking. Health is never an issue in our elections.
South Asia is one among the most deprived regions. Our rank in Global Hunger Index is cause for worry. India stands at a rank of 102 among 117 counties. Sri Lanka at 65, Nepal and Bangladesh 76 and Pakistan at 92nd position.
We need lasting peace so as to utilise our resources for health and education. Unfortunately perpetual tension between India and Pakistan has led to both the countries amass arms. Both are nuclear armed states. This poses a serious threat to the people of the region. The studies conducted by International Physicians for the Prevention (IPPNW) have highlighted that any nuclear exchange between the two countries using 100 atomic weapons would put two billion people at risk. Concerned physicians in the region have been demanding complete abolition of nuclear weapons and declare South Asia as nuclear weapons free region.
It is imperative that peoples movements for peace and health in South Asia are strengthened. We have lot to learn from each other which is possible only through mutual dialogue and trust building. It is important to move in that direction in the coming new year.
Nuclear Power Plant at Fatehabad, Haryana
https://www.readwhere.com/read/3312624#page/6/2
Date: 04.12.2021
Nuclear Power Plant at Fatehabad, Haryana
A word of caution!
Dr Arun Mitra
The climate crisis has forced the global community to debate over viable alternatives to the fossil fuels about which there is consensus that these are major cause of carbon generation responsible for climate crisis. There is also consensus on that renewable resources are the best alternative to the fossil fuels. But there is no such consensus on the use of Nuclear energy for power generation as it is fraught with several dangers. All this was evident in the debates in the COP26 at Glasgow. Yet in some parts of the world nuclear power is being fancied for this task. Therefore the news of the first nuclear power plant in north India in Gorakhpur village near Fatehabad in Haryana is to be read with caution.
Electricity forms the major source of energy to move the society in the present times. India is the third largest producer of electricity in the world. The national electric grid in India has an installed capacity of 388.134 GW as of 31 August 2021 (https://en.wikipedia.org/wiki/Electricity_sector_in_India). This generation is met from Fossil Fuels, Nuclear, Hydro and Renewable Energy Sources (RES). The fossil fuels i.e Coal, Gas and Diesel contribute about 60% of the total generation; Hydropower contributes 11.9%, RES 26.40% and Nuclear energy 1.7% (1).
Pursuit for nuclear power in India began in 1950s. Expected power production according the predictions made in 1950s India should have been producing 43,500 Megawatts. But actual installed capacity from nuclear power plants in 2021 is 6780 MWs only. For this we have built 22 nuclear power plants. Even after 70 years the nuclear power is producing only 1.7% of total installed capacity of electricity in our country.
The drawbacks of nuclear energy are costs, security, waste, water, radiation, proliferation and safety record. The cost of generating electricity from the nuclear power is more expensive than the other sources. According to world nuclear industry status report the cost of generating solar power ranges from $36 to $44 per megawatt hour (MWh), while onshore wind power comes in at $29–$56 per MWh. Nuclear energy costs between $112 and $189 (2).
According to Daria Iurshina, Nikita Karpov, Marie Kirkegaard, Evgeny Semenov “The design and construction of a new nuclear power plant requires many highly qualified specialists and often takes many years, compounding financing costs, which can become significant. Design changes or lawsuits can cause delays that further increase the financing charges, which in some cases exceed the actual construction costs.
The high cost of constructing plants has made it difficult for nuclear power to compete with other energy options in the United States, particularly natural gas. The high cost of nuclear power has led to a significant decline in the construction of new plants—with just one plant, Watts Bar 2, entering commercial operation in the past 20 years” (3).
Every nuclear power station needs to be decommissioned after 30-40 years of operation. Currently, it takes 6-12 years to build a nuclear station, and up to 20 years to decommission, involving extreme safety issues and huge costs.
One nuclear reactor plant requires about 20.5 km2 (7.9 mi2) of land, located near a massive body of coolant water, but away from dense population seismic and natural disaster zones. Massive opposition at sites currently selected show how challenging this task is.
Another area of concern is water which is required for uranium mining and for cooling of reactors. There is danger of water contamination. Uranium Mining needs huge amounts of water as well.
There is no fool proof method of nuclear waste management. No single nuclear waste repository exists today. High level waste of Plutonium is a problem. It is usually kept in basins; may catch fire or explode, as it happened in Kysthym/ Chelyabinsk in the former Soviet Union in 1957, when a tank with Plutonium waste exploded. Even though about 9,000 square miles (23,000 square km) of land were contaminated, more than 10,000 people were evacuated, and probably hundreds died from the effects of radioactivity (4).
These plants are also a cause of security concern. That is why there is total secrecy about these. Terrorism nowadays is a threat everywhere. Terrorists just need to cut the circuitry of the plant and the cooling system may go out of control. A direct hit or the melting of the core can potentially cause widespread radioactive contamination and make a region uninhabitable for centuries.
The world has by now realized that the nuclear power plants are fraught with danger. There is enough evidence for this. We have seen some major Nuclear accidents in Fukushima Daiichi, Japan, March 2011, Chernobyl, Ukraine (former Soviet Union), April 26, 1986, Three Mile Island, Middletown, Pennsylvania, USA, March 28, 1979 Enrico Fermi Unit 1, Frenchtown Charter Township, Michigan, USA, October 5, 1966 , SL-1, Idaho Falls, Idaho, USA, January 3, 1961, Sodium Reactor Experiment, Los Angeles, California, USA, July 1959, Windscale, Cumberland (now Cumbria), UK, October 10, 1957 (5).
Impact of exposure to nuclear radiation are a cause of serious concern. These may range from dizziness, disorientation or confusion, weakness, hair loss and baldness, vomiting blood or dysentery, low blood pressure. The impact may last for several years. Health risks are for entire population, but in particular for small children and fetus of pregnant women. Increasing scientific evidence of damage due to chronic low level radiation in and around mining site has been documented by a study on the health effects on the people living around Jafugoda Uranium mines in Jharkhand state of India. The study was carried out by the Indian Doctors for Peace and Development (IDPD).
Nuclear power plant is a potential threat for proliferation. Pu239 is one of the deadliest substances known with a Half life of 24000 years. A few micro grams cause cancers. Pu serves to generate energy or manufacture nuclear weapons. High grade (highly enriched, pure) Pu can sustain fission reaction and is used to ignite Nuclear bombs.
Track record of nuclear facilities in India is unsatisfactory. But most of these have remained official secrets so far. With the data available till 2006 tthere have been accidents at Kalpakkam, Tarapur, Maharashtra, Tarapur, Maharashtra, Bulandshahr, Uttar Pradesh, Kota, Rajasthan, Kalpakkam which have cost 910 million US$(6).
Another issue of grave concern is unfair compensation in case of a nuclear accident. According to Clause 6 of the nuclear liability bill agreed upon by the Indian government, the maximum financial liability in case a nuclear accident is $458 million (Rs. 2,087 crore). It is less than the compensation in Bhopal Gas Tragedy. The amount is considered meager in comparison to the destruction caused by a nuclear accident. A same kind of law in U.S. has set the financial liability for such accident at $10.5 billion.
People around Fatehabad raised serious objections to the plant after its proposal. They are much worried that the government may not pay them due compensation for land acquired and also for the health security of people and the livestock.
Fatehabad does not have any large natural water body around to meet the water requirements of the area.
Concerns of the people are real. Important issue is that why the government is out to embark upon the failed technology.
Reference:
- https://powermin.gov.in/en/content/power-sector-glance-all-india).
- https://www.reuters.com/article/us-energy-nuclearpower-idUSKBN1W909J).
- https://thebulletin.org/2019/06/why-nuclear-power-plants-cost-so-much-and-what-can-be-done-about-it/
- https://www.britannica.com/event/Kyshtym-disaster)
- https://www.ucsusa.org/resources/brief-history-nuclear-accidents-worldwide
- https://en.wikipedia.org/wiki/List_of_nuclear_power_accidents_by_country)
Lessons from Pandemic - Collaborative effort for Peace and health in south Asia
Date: 01.12.2021
Lessons from Pandemic - Collaborative effort for Peace and health in south Asia
Dr Arun Mitra
Harbouring nearly 1/4th of world’s population in 3.5% of the land surface area of the earth, South Asia is confronted with serious issues of health and development. These have been increasing due to persistent tension and internal and external conflicts and wasteful expenditure on ever increasing arms race which is divesting the region of resources required for growth. Health indices of the region are very poor as is reflected in the Human Development Index report released by the UNO from time to time. Out of 189 countries South Asia ranking is India 131, Pakistan 154, Bangladesh 133, Nepal 142 and Sri Lanka 72. Poverty, illiteracy, malnutrition, maternal and child deaths are quite high. Whereas the poverty, social disparities, and marginalisation lead to poor health, poor health in turn adds to poverty thus causing a vicious circle.
Main contention in the region even after 75 years of ousting the British imperialism lies between India and Pakistan. The two countries have fought four wars. There is excess spending on the military which ranges from 14 to 18 % of the government’s budget. Possession of nuclear arms by these two countries has further accentuated the enormity of the situation. Maintaining the nuclear arsenals and its delivery system causes huge amount to India and Pakistan. In addition these pose constant threat to life in the Sub-continent. The region has been the centre of various communicable and non-communicable diseases. But the COVID pandemic has exposed the hollowness and vulnerability of our healthcare systems.
Under such circumstances it is important for the countries of south Asia to collaborate with each other in containing the impact of COVID 19 and planning a long term strategy to jointly sort out health care issues by learning through each other’s experience. Basic determinants of health like poverty, good nutrition, employment and livelihood have to be identified and tackled with. Unfortunately not much has been done in this regard. There are not much reports of data exchange on health scenario among the countries of South Asia.
The economic hardships faced by the people during the lock down have been unprecedented. We have seen large scale migration of the people in India and Bangladesh. Loss of jobs and livelihood led to pressure on the food security to the people.
The opportunity has been missed but lessons must be drawn and steps taken for future. The reports of New Variant of concern the Omicron is a wakeup call. Public health experts and physicians from various streams from the countries of South Asia should organise interactive sessions among them. Such actions help in strengthening the people to people relationship which from the ultimate basis of Lasting peace and harmony. The new innovations of digital exchange programmes should be made use of.
Sensing the urgency of the situation a group of doctors from South Asian countries have collaborated to meet the challenge hence spread the message of peace, disarmament, nuclear weapons free zone and diversion of wasteful expenditure on arms race to health and development (1). Need of the hour is to organise digital dialogue among medics of the region to exchange information and design future tasks for betterment of health indices. There is need to rid of militarist attitude, instead develop humanist outlook and collectively fight back fundamentalist, extremist, obscurantist and narrow nationalist ideas. SAARC should be revitalised to promote multi-sectoral technical and economic cooperation. The refusal of the vaccine manufacturing Multi National Corporations (MNCs) to share the technical knowhow about vaccine production had put many countries in hardship in procuring vaccines. A collaborative effort can help in meeting such needs to save the life of the people.
Reference:
Vaccine inequity and Super-profiteering
Date: 23.11.2021
Vaccine inequity and Super-profiteering
Dr Arun Mitra
The statement by the Indian Council of Medical Research (ICMR) that at present booster dose against COVID-19 vaccine is not a priority and administering two doses is the present priority goes along the line of World Health Organisation (WHO). Dr Balram Bhargav, director of the council has also said that there is no scientific evidence to support need for the booster dose. This assessment is based on the studies that antibody level alone is not the way to check the immunity because all kinds of immunity develops post vaccination, the cellular and mucosal etc. So the understanding that the immunity provided by the vaccination is short lasting may not be correct. But despite WHO’s view point some countries are already into giving booster dose to its citizens. The US government has decided to give third dose. The UK is giving the booster to the health workers.
Vaccines have given protection from the diseases and scientists around the globe need to be patted for their concerted effort in producing Vaccine against COVID-19 as an emergency. Vaccination has given some reprieve from what was a big scare one year ago. Vaccines have allayed fear reduced stress & strain, saved many lives and has helped in bringing back normal activities. The process has however not been easy. For the product to reach inoculation level after several rounds of scientific trials with assured safety is normally 7 to 8 years process. But this was accomplished in a few months period. Medical scientists have successfully reassured the society that people’s health is their utmost priority.
India too was in the forefront and successfully produced its own vaccine. With all efforts we have been able to give first dose to 56% population that is 77 crore people and second dose to 29% population ie 40 crore population with a total doses of 117 crore as on 22nd November 2021. China from where the disease was first reported has inoculated 126 crore or 90% prople with first dose and 107 crore or 76% population with second dose totaling 233 crore doses. Data from our south Asian neighbours shows that both doses have been given to 22% in Pakistan, 26% in Nepal, 20% in Bangladesh and 62% in Sri Lanka. The developed countries the U K, USA have vaccinated 68% and 62% population respectively with two doses. The picture in some of the least developed countries is highly grim with Ghana at 2.7%, Somalia 3.6%, Syria 4% and Afghanistan at 8% with both doses.
Since the big companies refused to share the technical know-how even with WHO, it was difficult for many developing countries to produce these vaccines. They were thus dependent on import. The problem was more with smaller countries with limited resources. That is how we find today that many developing countries are still lagging far behind in the vaccination of their population. These countries had to accept several clauses which would favour only the vaccine manufacturer. In a recently published article in the Journal of Postgraduate Medicine, Education and Research, Dr Samir Malhotra, Professor of Pharmacology Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh has pointed that The COVID-19 scare forced many governments to enter into contracts with the companies developing vaccines. Many of these contracts had confidentiality clauses according to which the company was exempted “from any civil liability for serious side effects arising from the use of the vaccine, indefinitely”. “Purchaser hereby agrees to indemnify, defend and hold harmless [the company and] each of their affiliates from and against any and all suits, claims, actions, demands, losses, damages, liabilities, settlements, penalties, fines, costs and expenses caused by, arising out of, relating to, or resulting from the vaccine.” Not only that, and this is shocking, these countries should “put up sovereign assets as collateral to guarantee indemnity”. Such assets could include embassy buildings, cultural assets, etc.
He further points out that the claim of the pharma industry that they have to bear high cost in developing new drugs as a justification for such contracts is totally flawed because virtually 100% of initial research leading to new drugs occurs with the support of public funding. A vaccine that requires a few dollars to manufacture brings in profits worth billions of dollars to the company.
In India whereas the vaccination programmes earlier have been free of cost to the recipients, this time the government allowed 25% vaccines to be given on payment. Adar Poonawala, CEO of the Serum Institute of India had said that even at Rs.150/- per dose the company makes profit. But the government of India fixed the rate of vaccination at Covishield Rs.780/-, Covaxin Rs.1410/- and Sputinik V Rs.1145/- thus allowing the vaccine manufacturers super profit at the cost of human lives. Till date the government has not come out with data of number of people who purchased the vaccine.
There is need for controlling such super profits by few companies. The vaccine technology should be transparent so as to enable developing countries produce their own vaccines. Poor countries should be helped in the vaccination process through the UN agencies. India should rejuvenate the vaccine manufacturing public sector units so as to eliminate the profit clause and ensure equitable distribution of the vaccines.
No one is secure in the atmosphere of violence
Date: 14 November 2021
No one is secure in the atmosphere of violence
Dr Arun Mitra
The story of Wolf and the Lamb where the Wolf cooks up an excuse to eat the lamb applies to the present day human society as well. The use of force by the powerful to suppress the people whom they dislike or think to be ‘inferior’ to them, to maintain their supremacy, they would not mind even pushing the whole society into violence. Such situations have very serious implications on the society including on health. This has been observed in several parts of the world.
In the past, the kings used force against those who would question them on any issue. During the period of Chandragupta Maurya the then king Dhananand did the same, he even tried to kill Chanakya, the wise man of the period.
It is said that king Ashoka killed 100,000 people during the Kalinga war. When foreign invaders came to India they took no mercy on people. Mughals used force as well as diplomacy to control this region. Later on they declared themselves to be Indians and stayed back here and got assimilated in the Indian society and Indian culture. But the British imperialism was different; they overpowered India through diplomacy and force. They plundered our wealth and took everything to England and enriched themselves at the cost of our people. List of their violent oppression of our freedom fighters is very long.
After independence, to build a nation based on democratic principles was a big challenge which was however met with successfully. Every citizen of the country belonging to any religion, caste or gender was given equal rights in the constitution. Not only that, those who were oppressed since ages were given special privileges. As a result despite shortcomings many from them could be uplifted to an extent. This led to reduction in discrimination in the society and increased harmony. But the situation is again getting worse and there is all out effort to minimise and destroy these achievements.
A narrow thinking is being imposed and there is dissolute effort to build a monolithic society in the name of nationalism. Those who attempt this forget that all those countries who assimilated others have progressed while those which were built on sectarian principles lagged behind.
Presently we find that to fulfil their nefarious designs such forces are targeting the minorities and sending out misleading information on the religious conversions. Young people aspiring for love and affection are being refrained and for pursuance of this, acts like ‘love jihad’ have been enacted. Gangs are being promoted for such acts who indulge in violence with prudence. It is being propagated that Muslims are anti-nationals and they should be thrown out and sent to Pakistan. Many of them have been arrested on frivolous charges and put in jails for long.
Farmers protests are being labelled as being run and led by the Khalistanis. Several conspiracies are being hatched against this movement. Recently when son of the minister of state for Home affairs Ajay Mishra allegedely killed the farmers under his vehicle at Lakhimpur Kheri, his father tried to belittle the crime by saying that these farmers belong to Babbar Khalsa.
Mob lynching, hitherto unknown in this country, is occurring on one pretext or the other. Most of the time, such events go unnoticed by the police as well as the judiciary. Many times the victims have been made accused. Such forces have been emboldened by the backing of the state which is all out to suppress people’s movements. Nazi mind set is apparent from the recent statement by the Chief of Defence Staff, General Bipin Rawat in an interview to Times Now which justifies and promotes lynching.
There is now a very subtle effort to spread communal venom amongst Hindus. But it is now becoming clear that Hindus too are their target. Those who question them are labelled as anti-nationals and targeted. Many have been put to jail by terming them as urban Naxals . Kalburgi, Dabholkar, Gauri Lankesh and Govind Pansare were all Hindus, but they were eliminated by the forces of Hindutva. Police inspector Subodh Kumar who was killed by the mob at Bulandshahr too was a Hindu. Manish Kumar, a businessman from Kanpur who was killed by the surcharged police with fearless violence at Gorakhpur was also a Hindu. Recently violence against film maker Prakash Jha and his team members, all Hindus, in Madhya Pradesh is a reflection of their hate against anyone who questions them. All this is being done to silence the voice of peace, love, brother/sisterhood and harmony in the society among the people of same community. The same happened during the period of terrorist violence in Punjab or is happening in Jammy and Kashmir.
Violent mind set can breed serious outcome. People or organisations with such mind set first of all kill and threaten people from their own community so as to make them shut. This has been witnessed in Somalia where nearly 800000 people died during Tribal warfare between Tutsi and Hutu tribes. Neighbours killed neighbours, friends killed friends, even husbands killed their wives saying that otherwise they will be eliminated by the mob from their own tribe. The same happened in Jammu and Kashmir or in Punjab in 1980s during the period of terrorism. At the time of partition in 1947, 2500000 Hindus, Muslims and Sikhs all were killed. During the 2nd world war, the perpetrators and the victims of war both were killed. In fact nothing is achieved through violence. King Ashoka realised this; he adopted and spread Buddhism thinking it a religion of peace.
There is need to increase mass movements against the concept of violence. India’s freedom struggle has essentially been non-violent. There are several issues like the health education employment etc which must be raised effectively to counter these communalists. Movement has also to be built and strengthened for reforms in police as well as the judiciary so that they are not misused. Health is the biggest victim in the event of violence. People are injured, displaced and several lose their life. The madness of communal frenzy which promotes violence has to be countered by collective effort. There is no other way to save the human rights of all.
Nuclear arms pose grave threat to climate
Date: 06.11.2021
Nuclear arms pose grave threat to climate
Countries from around the globe are meeting at the Conference of Parties - COP 26 at Glasgow. The Inter-Governmental Panel on Climate Change – IPCC and several civil society organisations have raised serious concerns over deteriorating climatic conditions. The issue has gained importance because the world is witnessing repeated natural calamities as a result of rise in temperature of the earth and melting of glaciers causing rise in the sea level. This summit is in continuation of several such meets held earlier to discuss and impress upon the governments to take steps to mitigate the factors responsible for climate change. Rapid industrialization with half-hearted measures by the governments, particularly the developed or fast developing economies have added to the crises. Increase in military activity is one among the major causes for the production of gases responsible for climate crises. It is therefore important that the countries should debate on reducing tensions in different parts of the world so that production, sale and use of the armaments is put under check.
Persistent increase in the expenditure on the nuclear arms, despite the UNOs passing Treaty Prohibiting Nuclear Weapons (TPNW), which has declared the nuclear weapons illegal and has called for their complete abolition is a cause of concern. This should have been one of the main focus of the debate, but is not seen on the top of the list.
A study “Climate Consequences of Regional Nuclear War” conducted by Ira Helfand former Co-President International Physicians for the Prevention of Nuclear War (IPPNW) and Alan Robock from the Department of Environmental Sciences, Rutgers University, USA has pointed out that the present nuclear weapons numbering about 17000 on earth pose a serious risk to all life forms. According to their study a nuclear exchange between India and Pakistan using 100 Hiroshima sized nuclear bombs will put over two billion people at risk. Such a war would kill up to 20 million people outright as major cities of the subcontinent would be destroyed and it would blanket much of South Asia with radioactive fallout. But the global consequences are even more alarming. Soot and debris injected into the atmosphere from the explosions and resulting fires would block sunlight from reaching the Earth, producing an average surface cooling of -1.25ºC that would last for several years. Even 10 years out, there would be a persistent average surface cooling of -0.5ºC. This will reduce rainfall globally by 10%.
The study further cautions that in such situations there will be reduction in crop yields. The food shortage will lead to Increases in food prices further affecting the already malnourished poor people across the globe. There are more than one billion people in the world whose daily caloric intake falls below these minimum requirements. Each year some five million children in this group starve to death. A small further decline in available food would put this entire group at risk. A number of factors suggest that the accessible food for those who are already malnourished would decline dramatically. Many counties who depend on import of food will be equally affected. Given these conditions, even a modest, sudden decline in agricultural production could trigger massive famine. If famine conditions persisted for a year or more, it seems reasonable to fear that the total global death toll in the Global South could exceed one billion from starvation alone.
There is a very high likelihood that famine on this scale would lead to major epidemics of infectious diseases. Illnesses such as plague, which have not been prevalent in recent years, might again become major health threats.
According to the estimates in the study the food crisis is likely to trigger internal and external conflicts. In such situation the use of nuclear weapons between the two nuclear super powers, the United States and Russia cannot be ruled out as long as these weapons exist. Huge swaths of both countries would be blanketed by radioactive fallout and their industrial, transportation, and communication infrastructures would be destroyed. Most Americans and Russians would die in the succeeding months from radiation sickness, epidemic disease, exposure and starvation.
The lesson here is that the entire world really is targeted by the weapons of the nuclear-armed states, even if the missiles themselves are not pointed at our cities. Working to end this threat is not only responsible global citizenship, it is a vital interest for everyone on Earth.
The International Physicians for the Prevention of Nuclear War (IPPNW) and the International Campaign to Abolish Nuclear Weapons (ICAN) have highlighted this issue and tried to impress upon the participating parties in the Glasgow summit to bring this on top of the list and ask all nuclear weapons possessing countries to join the Treaty Prohibiting Nuclear Weapons (TPNW) and abolish these weapons for good. This is in our hand. Huge expenditure on nuclear weapons is costing several welfare needs of our people. It is unfortunate that the narrative to the effect is not being given due importance including in our country. It is the duty of all peace loving citizens to raise the voice. The participating parties at the COP-26 should debate this issue seriously as a priority.
https://news.anypursuit.org/article37010-NUCLEAR-ARMS-POSE-GRAVE-THREAT-TO-CLIMATE
India’s poor ranking in Global Hunger Index an issue of concern
Date: 28.10.2021
India’s poor ranking in Global Hunger Index an issue of concern
Dr Arun Mitra
After the sad happenings during COVID-19 which led to the death of 4 lakh people according to official figures (even though some independent agencies point out this number to be between 25-40 lakh), the news of vaccinating 100 crore people with first dose and 30% population with second dose gave some respite. The data on how many doses were paid and how many free of cost is yet to be released by the government. In the past too India has to its credit several successful immunization programmes 100% free of cost including the most worked out door to door Pulse Polio as well as small pox eradication.
At this juncture it is extremely disturbing to note that India’s ranking in Global Hunger Index has further declined to 101 among the 116 countries surveyed. The government’s objections to the scoring method do not hold good as it is not for the first time that this data has been released. It is an annual affair based on the similar methodology. (https://www.globalhungerindex.org/about.html )
Irony is that our rank is lower than all our South Asian neighbours with Sri Lank at 65, Nepal & Bangladesh at 76 and Pakistan at 92. Even Rwanda which has seen deadly internal strife for several years is better than us at 98. The countries below us are Papua New Guinea, Afghanistan, Nigeria, Congo (Republic of), Mozambique, Sierra Leone, Timor-Leste, Haiti, Liberia, Madagascar, Democratic Republic of the Congo, Chad, ,Central African Republic , Yemen, Somalia. All these countries are either faced with civil wars or are at very low level of economic development.
Data on the GHI score reveals that from 2000 to 2012 the GHI score for India improved by 10 points. From 2012 to 2021 this improvement is only 1.3. Our neighbouring countries have fared better with Bangladesh 9.5 points, Sri Lanka 4.6, Nepal 4 and Pakistan 7.4 points.
Undernourishment means that caloric intake is insufficient. This has serious effect on children. It causes wasting among the children which means that the child has low weight for height. This occurs as a result of acute under nutrition. Other impact is that the child does not gain enough height expected for that particular age. This is labelled as stunting and occurs due to chronic under nourishment. The poor nourishment leads to high percentage of mortality among the children.
A balanced diet means sufficient number of proteins, fats, carbohydrates and micro nutrients in the form of vitamins and minerals. Lancet had formed a committee to go into nutritional requirements of a person. It has suggested intake of 232 grams of whole grain, 50 grams of Tubers of starchy vegetables like potato, 300 grams of vegetables, 200 grams of fruits, 250 grams dairy food, 250 grams of protein sources in the form of meat, egg, poultry, fish, legumes, nuts, 50 grams saturated and unsaturated oils 30 grams of sugar. At the present market price the cost of these food items per person comes to be Rs.154/- per day. This means that a family of five members should spend Rs.770/- per day or Rs.23100/- per month on food. Barring a miniscule population our people are far from this target. The government’s scheme to give 5 kg of grains and one kg daal and a bit of oil does not fulfil the nutritional requirements. It is just enough for sustenance. It does not at all meet the requirements of micro nutrients like vitamins and minerals essential for physical and metal growth.
Therefor increasing purchasing capacity of the people and poverty alleviation with sufficient wages is the only answer to meet the requirement of quality food for the citizens. Several economic experts including the Nobel Laureate Abhijeet Banerjee have suggested several means to alleviate poverty. The basic principle however remains that buying capacity of the people should increase and the government should ensure food security to all citizens.
Various workers organizations have formulated their demand for minimum wage based on these principles. They have demanded a minimum wage of Rs.21000/- per month. To the utter dismay the government has fixed national minimum wage as Rs.178/- per day or Rs.5340/- per month. This is despite an internal labour ministry committee recommendation of Rs.375/- per day.
This low minimum wage will further increase inequality and poverty. Large number of our population is in the unorganised sector where the legal formulations are hardly implemented. The farmers and agriculture labour who are the producers are among the worst sufferers. Agriculture labourers have to face double oppression, economic as well as social. The farmers are protesting as they fear that with the new acts not only their economic conditions will go worse but food security of the citizens too will be compromised.
Unfortunately instead of increasing budgetary allocation for the nutrition programmes and increasing the wages the government is further cutting them down. The government reduced financial allocation for the mid day meal and the Integrated Child Development Services (ICDS) programmes in its 2015-16 budget. The central budget for mid-day meals was Rs.13000 crore in 2014-15 budget and is now down to Rs 11,000 crore. The allocation for ICDS has also fallen below than 2015. The allocation for the Poshan Abhiyaan, which had a meager budget of Rs 3,700 crore which has also been reduced by Rs.1000 crore to Rs.2700 crore in the annual budget 2021-22.
Nutrition forms the basis of developing immunity. A poorly nourished person is more likely to fall prey to diseases.
With the skewed policies we will never achieve a hunger free India. There is need to have the public discourse around such issues. The government has to ensure increase in financial allocation to nutritional programmes, increase and ensure minimum wage as demanded by the workers’ orgaisations, sort out issue of farming community, ensure food security to all, good housing, healthy environment, clean drinking water supply, proper sanitation and job security. People should not be made dependent like stop gap arrangements of aata daal scheme instead they should be remunerated well so as to increase their purchasing capacity.
National Digital Health Mission and Healthcare in India
Date: 19 October 2021
National Digital Health Mission and Healthcare in India
Dr Arun Mitra
The Prime Minister launched National Digital Health Mission (NDHM) on 27th September 2021 giving high hopes that it will bring about drastic improvement in healthcare of our people. The mission is basically to collect and compile health data which has been made easy by the modern technology. Maintaining database on health can be helpful in planning for healthcare. It is also useful for the epidemiologists and research workers in health to analyze health situations from time to time. Already several IT organizations have come up with systems to maintain such details. Patient does not have to carry several pages of her/his medical record as these can be obtained with click of a button. Many corporate hospitals have such systems installed.
But the present mission which is supposed to cover all citizens has several contentious clauses. There are several issues which need to be addressed. Whether this data collection in present form will address to the healthcare needs of our people; whether confidentiality of patients will be maintained; has the issue of cyber hacking been addressed; health is a state subject, how will this matter be sorted out; whether this mission will take care of inequities in healthcare?
As per the NDHM, health care providers will collect data which will then be shared with the state health authority and the central health authority. The medical ethics demand a patient’s health status a confidential issue between him/her and the doctor. No doctor should share it with anyone unless permitted by the patient himself/herself. By sharing the data with three parties this basic ethical issues has been completely ignored and flouted. With a poor track record of controlling cybercrime in our country how can it be guaranteed that the data will not be leaked?
The health care provider will give consent for his/her enrollment in this mission to collect the data. Similarly the consent of the principal, the person/individual, will be necessary to collect data about his/her health status and share it with the state and central health authorities. There is also provision that the health care provider or the principal will have the right to opt out of this mission. But according to the mission the person’s record isn't erased after they have opted out but it is simply locked. Moreover it cannot be erased for a certain period of time.
Extensive due diligence is required by all stakeholders to ensure that a right balance is created between the public healthcare needs and the legal rights of the citizens, specifically the right of privacy and data protection. One of the main concerns with the NDHM is that it suggests a framework that severely overlaps with the fundamental right to privacy as per the the privacy principles recommended by the Group of Experts on Privacy (Justice A.P. Shah Committee) and the more recent, Justice B.N. Srikrishna Committee report whose recommendations on data protection form the core foundation for the draft Personal Data Protection Bill, 2018.
The argument of maintain confidentiality is belied by the fact that the job of compiling/managing the data will be given to private setups thus completely negating the security issue. With this a person's privacy will be completely undermined under this mission. There is no provision of sufficient safeguards against commercial exploitation of sensitive personal data which may be caused by private entities that will be linked to public entities under this system. These include insurers, pharmaceutical companies, and device manufacturers.
Many issues mentioned under "sensitive personal data" are perplexing. It says that “such personal data, which may reveal or be related to, but shall not be limited to, financial information such as bank account or credit card or debit card or other payment instrument details; physical, physiological and mental health data; sex life; sexual orientation; medical records and history; biometric data; genetic data; transgender status; intersex status; caste or tribe; and religious or political belief or affiliation”. Why sensitive personal data should include religious or political belief or affiliation of data principals or about their sex life or sexual orientation for that matter?
The fear that such a data could be used by the state on some pretext or the other is not unfounded. We have the example of Aadhaar Card which is now compulsory to be linked with almost any activity and the state has complete knowledge and control of the activities of the people in our country. Gradually the digital health card will be made compulsory to join the Ayushman Bharat/RSBY/CGHS/ECHS/ESI or any other government sponsored scheme or the insurance by the companies. It is difficult to comprehend that when there is Aadhar card for every citizen, what is the rationale behind another card.
Health is a state subject. Collecting data by the centre will be complete infringement on the rights of the state.
The contention of the government that this will help us improve the health policies is unacceptable. The government already knows the problems of health care in our country but it needs political will to sort out those problems. Several health activists/civil society groups and experts have already given their view point on how to improve healthcare system.
Health is a basic human right, but despite so much talk, health is not a fundamental right in our country. Healthcare is based on holistic approach covering safe drinking water supply, sewerage facilities, clean air, healthy nutrition, good working environment, guarantee of job and sufficient remuneration etc. All these require planning with priorities towards health.
Our patients are highly burdened with the cost of the health care. The National Health Policy document clearly admits that 6.3 crore people are pushed below poverty line due to out of pocket expenditure on health. With meager spending of 1% of the GDP by the state sector on public health as against required minimum of 5% recommended by the WHO, the patients are left to remain at the mercy of private sector which accounts for nearly 80% of the health care in our country. It is no secret how the patients have ben fleeced even during Pandemic by the corporate sector.
Universal healthcare system is the only answer. There is enough information now on how the corporates hospitals fleeced the patients during COVID Pandemic. The pharmaceutical industry minted money at the cost of seriously ailing people. In the Pre COVID period there were 100 billionaires in India whose number increased to 140 during COVID. These billionaires earned 12.7 lakh crore rupees between March 2020 and March 2021. During 2nd wave of COVID pandemic 24 of these 140 companies who deal in health sector were doing business of 500 crore rupees per day in April - May 2021. In contrast despite several difficulties, the public sector institutions provided service to the people with healthcare workers risking their lives.
The NDHM type of exercise is useful in a health care system which is comprehensive and universal. In the system like ours health care delivery is so much diverse, right from the faith healers, alternative medicine to the system of modern scientific medicine. The medical practitioners vary from small scale sector to corporate sector. For the small scale single person clinic it is extremely difficult to maintain such records. They will have to employ new people for the job cost of which will ultimately fall upon the patients. This will further create inequities as elite section will get NDHM benefits because they will link themselves to the corporate health facilities. To ensure equity in the benefits of NDHM inequality in the healthcare has to be abolished through a universal state owned healthcare system.
The whole exercise in no way seems to be of help in improving the health needs of our people; it will rather be another means to give power for surveillance of the people. People will be carrying just another card in their pocket.
As of now, there is need to increase budget on health from 1% of the GDP to 5% immediately if the people’s health issues are to be addressed in the real sense. Several countries invest 10-15% of the GDP on the health of the people. Why can’t we?
Right to Health
Date: 12.10.2021
Right to Health
Dr Arun Mitra
That out of a population of 100000 in our country 32 persons die due to Tuberculosis every year (1), is a matter of grave concern and shame. Recently we have seen death of large number of children having fallen prey to Dengue fever and Encephalitis in Uttar Pradesh. Similar is the situation with Diarrhoea, Malaria and many other communicable diseases. Needless to mention the havoc caused by the COVID Pandemic where we failed to prevent several thousand deaths because of mismanagement and skewed priorities. It is not only the communicable diseases, the non-communicable diseases too are on the rise. It is estimated that 29.8% of Indians have hypertension, with 33% prevalence in urban and 25% in rural India (2). As of 2017, India had 72.9 million diabetes patients-second only to China (114.3 million), and is soon likely to become the diabetes capital of the world. About one in every two Indians (47%) living with diabetes is unaware of their condition, and only about a quarter (24%) manage to bring it under control. Rural men with low household wealth and low education levels had a higher incidence compared to other groups (3). Nearly 26 people die of diabetes per 100,000 population (4).
All this requires a comprehensive health planning by the state with resolve to provide equitable health care to the citizens. The World Health Organisation (WHO) has termed “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.
Despite the fact that India is an active participant in the WHO affairs, health has not been declared as a fundamental right in our country till date. Hence the citizen does not have a right to challenge the government in the court of law for its failure to meet health needs of the people.
To promote a wider discussion and implementation of the goals for equitable health a declaration was signed by the participants including India in the international conference at Alma Ata in 1978 – and concluded with the Alma Ata declaration. Health planning in our country started way back in mid 1940s when Joseph Bhore Committee submitted its report in 1946. It had highlighted that health services should be based on equity. Safe drinking water & sanitation, adequate nutrition, proper housing, quality education, safe working conditions and sufficient wages form the basis of health for all.
Addressing a Webinar organised by the Indian Doctors for Peace and Development (IDPD), Dr Tejbir Singh – Prof. of Community Medicine Govt. Medical College and Hospital, Amritsar pointed out that health was recognised as human right way back in 1966 in the International Covenant on Economic, Social and Cultural Rights. And in the year 2002 - Human Rights Council created the mandate of the Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health. It declared that Human rights should be exercised without discrimination of any kind based on race, colour, sex, language, religion, political, or other opinion, national or social origin, property, birth or other status such as disability, age, marital and family status, sexual orientation and gender identity, health status, place of residence, economic and social situation.
Despite all the above happenings, the Constitution of India does not expressly guarantee a fundamental right to health. The references to the state’s responsibility to health of the people are mentioned in the directive principles in Part IV of the Indian Constitution. These provide a basis for the right to health. Article 39 (E) directs the State to secure health of workers. Article 42 directs the State to just and humane conditions of work and maternity relief. Article 47 casts a duty on the state to raise the nutrition levels and standard of living of people and to improve public health. Article 21 guarantees the right to life.
As mentioned above Primary Health Care is based on Equitable distribution, Community Participation , Intersectoral Coordination and Appropriate Technology
These are to be done through Education about prevailing health problems & the methods of prevention & control , Promotion of food supply & Nutrition , Safe water and Basic Sanitation , MCH care including Family Planning , Immunization against major infections, Prevention and control of Endemic disease, Appropriate treatment of common illnesses and Provision of essential drugs mentioned Dr Tejbir Singh in his presentation.
There has been a paradigm shift in the approach from the first National Health Policy - 1983 which emphasized on promotive, preventive curative and rehabilitative services. The National Health Policy - 2002 shifted its emphasis towards the provision of health care through private sector and opening up secondary and tertiary level health care for private investment. The spirit and principles of Primary health care was compromised by shirking the responsibility for health by the public sector. This resulted in a setback to the equitable distribution of health for the people. This is a period following World Trade Organisation which was founded on 1st January 1995.
The National Rural Health Mission was launched in 2005. It was later extended to urban areas also as National Urban Health Mission in 2011. Consequently the two were merged as National Health Mission in year 2013 however, implementation of national health mission remained fragmentary and half-hearted.
The National Health Policy (NHP) 2017 however made a leap forward to corporate centric and insurance based healthcare system. It also highlighted on strategic purchase of non govt. secondary and tertiary care services. Insurance system was further strengthened and as a result public funds are diverted to the private insurance and health care sector.
As a result 75% of healthcare expenditure comes from the pockets of households – 80% for OPD care and 60% for Indoor care. Every year 6.3 crore population of India is pushed towards poverty due to out of pocket expenditure. This catastrophic healthcare cost is an important cause of impoverishment which further adds to poor health.
India has roughly 20 health workers per 10,000 population, with 39.6% doctors, 30.5% nurses and midwives, and 1.2% dentists. Of all doctors, 77.2% are allopathic and 22.8% are ayurvedic, homeopathic or unani. Total doctor-population ratio 1:1445. It is to be noted that Govt doctor-population ratio is 1:11,926 in contrast to the desired 1:1,000. This is a major cause of in equality in healthcare to the marginalized sections who are dependent solely on state healthcare system.
WHO recommends minimum of 5% of the GDP as expenditure on Health. The Planning Commission of India had said that the state spending on health will be 2.5% of GDP by end of 12th five year plan and 3% by 2022. Interestingly under the present BJP government the 2015 NHP draft mentioned this to be 2.5% GDP by 2020. The revised NHP 2017 pushed it further to 2025. In 2015-16 there was 5.7% decrease in the health budget which was increased by 5% in the budget 2016-17. In 2017-18 the budget was further increased but it was still less than the budget for the year 2011-12 (1.1% of GDP).
Now we find that investment in health insurance has increased. The Ayushman Bharat is an insurance based system. NHM budget was decreased by 10%. The ICDS budget has been decreased. Nutriton budget decreased by Rs.1000 crores from 3700 to 2700 crores rupees in this year’s budget.
Even after more than 70 years of independence, health in India is a dream for the was majority and luxury for the rich.
Unfortunately even after the dreadful experience of the Pandemic there is hardly any discussion on health in the society. The debate on healthcare is largely limited to the professional discussions that too of a few concerned. Health education in the society is very poor which becomes a cause for late detection of several diseases. Political parties have a feeling that discussion on health may not fetch them votes. So they are callous towards this. Civil society has to come forward to build a public movement demanding health as a fundamental right so as to make the state answerable.
1. https://tbfacts.org/tb-statistics-india/
2. https://www.indiaspend.com/high-blood-pressure-killed-1-6-mn-indians-in-2016-but-most-are-unaware-of-its-dangers-94201/
3. https://www.indiaspend.com/1-in-2-indian-diabetics-unaware-of-their-condition-study/
4. https://www.indiaspend.com/50-rise-in-diabetes-deaths-across-india-over-11-years-32711
https://www.nationalheraldindia.com/opinion/public-health-must-be-a-fundamental-right-in-india
Doctors in service of humanity are much above parochial ideas
Date: 16.09.2021
Doctors in service of humanity are much above parochial ideas
Dr Arun Mitra
The advertisement from Tirumala Tirupati Devasthanams: Tirupati medical department published on 09.09.2021 seeking specialist doctors belonging to Hindu Religion only is a matter of serious concern. This has belittled the medical profession which professes its commitment to render service to the mankind irrespective of caste, creed, religion, gender, socio-economic status or political affiliations.
Another news item released from Bhopal on 5th September 2021 is about the decision of Madhya Pradesh government to include lectures on RSS founder K B Hedgewar and Bhartiya Jan Sangh Leader Deen Dyal Upadhyaya, Swami Vivekanand and Dr B R Ambedkar in the first year foundation MBBS course so as to promote patriotism among the students.
This is in contrast to earlier situation when medical students were encouraged by the teachers to read about great personalities in the medical science like Louis Pasteur, Rene Laennec and Alexander Fleming who had played a significant role in the development of modern medicine. Laennec’s invention of stethoscope made it easy to reach the diagnosis of several diseases particularly those related to lungs and the heart. Through his observation Alexander Fleming discovered Penicillin which revolutionised the management of infections in the body. Louis Pasteur and Edward Jenner were pioneer in developing vaccines. These are few names but there are thousands who worked hard to advance the medical care. To know about them is motivational for the upcoming doctors to contribute effectively in the field of medicine.
Motto has been ‘Medicine is a passion not profession’. That was also the time when to discuss about ethics was common. These produced doctors with the ideals to serve the poor and the sick without any priority for financial considerations. This inculcated patriotism and desire to serve the nation.
Code of Medical Ethics was developed by the Medical Council of India (MCI). Clause 6.1 of the Code prohibits the doctors to solicit patients through advertisement. As per the declaration by the doctor at the time of registration according to clause 8.8 of this Code he/she has to pledge to ‘serve the humanity and use the medical knowledge with utmost respect for human life and will not permit considerations of religion, nationality, race, party politics or social standing to intervene between the duty and patient’. This is in continuation with the clause 1.1.2 of this ethics which states ‘The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration. Who-so-ever chooses his profession, assumes the obligation to conduct himself in accordance with its ideals. A physician should be an upright man, instructed in the art of healings. He shall keep himself pure in character and be diligent in caring for the sick; he should be modest, sober, patient, prompt in discharging his duty without anxiety; conducting himself with propriety in his profession and in all the actions of his life’.
Times have however changed. Commercialism has overtaken science. Ethics are by and large only for the record sake. Financial issues apart, there is a serious effort to divide the doctors for jobs on communal lines even though a doctor is ethically bound to serve the patient from any religion without discrimination.
Dividing the medical personnel on communal lines is not new. This was seen during the period of Hitler when some doctors were forced to collaborate with Nazis and participate in mass murders of Jews. They would extract the gold plated teeth of the prisoners just because wife of a Nazi officer liked that.
Advertisement by Tirumala Tirupati Devasthanams: Tirupati medical department should have been taken note of and opposed by the medical bodies particularly the Indian Medical Association (IMA). But unfortunately no voice has been raised on this score.
The National Medical Commission decides the syllabus of the MBBS course. It sets topics for each subject. Lectures on the political leaders to be given officially is not as per the norms. According to Madhya Pradesh Education Minister Vishwas Sarang such lectures about the RSS and BJP leaders have been introduced by the state for the purpose of character-building. Names of Swami Vivekanand and Dr B R Ambedkar in the series have been very subtly added to avoid any controversy. How will these promote ethics in medical practice is beyond comprehension. This is clear intent to thrust upon RSS ideology on medical students.
Patriotism of RSS is equivalent to narrow nationalism and creation of a Hindutva based monolithic, homogenous society marginalising the minorities. This is against the idea of India which was conceptualised by the freedom fighters and revolutionaries who had thought of a country with multi religious multi-cultural, multi-linguistic society with people living together with equal rights. Any conscious person would understand the motive of all this. Such absurd and dangerous steps must be opposed by the medical bodies to prevent medical education becoming the playground of hate politics.
DESPITE SEVERAL HEALTH PROBLEMS FARMERS SPIRIT UNDAUNTING
Date: 08.09.2021
DESPITE SEVERAL HEALTH PROBLEMS
FARMERS SPIRIT UNDAUNTING
During several visits to the Singhu and Tikri borders where farmers are protesting for the repeal of farm laws since 26th November 2020, every time it is more enthusing than the previous visit to watch the commitment and spirit among them. Staying in the tractor trolleys or makeshift hutments away from the families is not an easy task. In such situations anyone is prone to health problems, more so the elderly, women and children. Stress of staying away from their kith and kin is quite disturbing. At home, one has so many things to discuss among the family members, relations and friends. There are always many positive and negative events that happen in life which a family sorts out together. But staying here far away from their family members for too long, the day to day physical meeting with each other discussing the family issues is missing. It affects the elderly even more who now miss the happiness and charm of playing with grandchildren. Here they have to live with the unknown people and interact with them. Each family has its own issues and problems which are confidential and cannot be talked of with the unknown people. Somebody taken ill in the family, some happy occasions in the family, some wedding, some birthday or some other events, happiness and sadness always keep occurring in the human life. But togetherness of a family and concern for each other keeps us going.
Food and nutrition are so important a factor in life. To be healthy to work we need quality food. There is always a choice of food with every person. But here in a gathering like this that choice is completely missing. One has to eat whatever is provided at the community kitchen or langar. To make good food the vegetables need to be thoroughly cleaned and properly peeled off, prevented from flies, utensils need to be properly washed time and again. Drinking water glasses need to be cleaned hygienically. In the set up camps like this it is not possible at all. One cannot ensure hygienic supply of food or even the clean plates to eat food. The surroundings where the food is cooked cannot be maintained in a hygienic manner for so long a period. Even though they spray insecticides regularly but in such large gatherings where there are no facilities provided by the government, rather the government is hostile, chances of getting ill due to unclean food items always persists.
There is always a danger to fall prey to vector borne diseases like malaria and dengue. Staying with unknown people one is more prone to catch infectious diseases like Flu, Tuberculosis and other respiratory illnesses.
Another issue is the absence of proper clean toilets which is so essential in such situations. They have made some makeshift toilets but then there is a need for regular water supply and clean up staff trained for the job. This is even more important for the female folk who are there in large number.
Emergencies are difficult to treat in such situations. There have been some patients who suddenly landed up into cardiac, neurological or gastrointestinal emergencies. Such patients need to be managed effectively and on emergency basis. For such patients family support has great emotional value. Chances of losing life by the patients in such conditions is more than the normal circumstances. At home one can also go in for regular check up from the doctors. This can many a times prevent serious illness.
Therefore the people sitting there are seen to be suffering from both communicable and non-communicable diseases. As the number of people above age of 60 is substantial, it is imminent that they have developed old age problems like the joint pains and back ache. Skin diseases are rampant. Diseases like Diabetes and Hypertension need constant care which can-not be provided in make shift camps.
Every visit is a challenge for the doctors and staff accompanying the medical team. The medical teams by the Indian Doctors for Peace and Development (IDPD) have been holding medical Camps of various specialties including Eye, ENT, Cardiac, Orthopaedics, Physiotherapy and Dental. The farmers have been fitted with Hearing Aids as well as Spectacles as per the requirement.
The commitment and will of the farmers however enthuses the health staff. It is the un-daunting spirit among the farmers despite several health issues that they are continuing their protest with vow to stay till victory. They are ready to sacrifice to any extent because they are convinced that the acts passed by the government will starve them otherwise also. Even under such arduous conditions they maintain regular discipline in their life, waking up on time in the morning, some of them do some exercise. Youth plays the games like volleyball to stay fit. Elderly take a stroll around the place of their stay. To bring cheer to their life they sing songs and celebrate all the festivals of different beliefs together. It is the togetherness that fills them with un-daunting spirit of sacrifice to the last for the cause despite several physical and mental health problems.
800 MILLION PEOPLE IN FREE RATION QUEUES - A POINTER TO SERIOUS NUTRITIONAL CRISIS
Date: 31.08.2021
800 MILLION PEOPLE IN FREE RATION QUEUES - A POINTER TO SERIOUS NUTRITIONAL CRISIS
Central Government’s scheme to give 5 Kilogram of grain and One Kilogram of Daal to 80 crore people is an acceptance of abject poverty in our country. This is at a time when the country is aspiring to be 5 trillion economy. It is a pointer to persisting nutritional crisis and failure of the government to pay heed towards the nutritional demands of the people.
This scheme under the Prime Minster Garib Kalyan Yojna (PMGKY) is not a new idea. The basis lies in the National Food Security Act. According to this act it is the duty of the government to just not fill the stomach of the people but also to ensure proper nutrition. The government notified the National Food Security Act (NSA), 2013 on 10th September, 2013 ‘with the objective to provide for food and nutritional security in human life cycle approach, by ensuring access to adequate quantity of quality food at affordable prices to people to live a life with dignity’.(2)
Food security, as defined by the United Nations' Committee on World Food Security, means that all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their food preferences and dietary needs for an active and healthy life.
The NSA also has a special focus on the nutritional support to women and children. Besides meal to pregnant women and lactating mothers during pregnancy and six months after the child birth, such women will also be entitled to receive maternity benefit of not less than Rs. 6,000. Children up to 14 years of age will be entitled to nutritious meals as per the prescribed nutritional standards. In case of non-supply of entitled food grains or meals, the beneficiaries will receive food security allowance. (1) Ration given under PMGKY is less than what is required for sustenance what to talk of healthy nutrition.
Nutrition does not mean just filling the stomach. It means a balanced supply of proteins, carbohydrates, fats, minerals, vitamins and other essential items and micro nutrients required for physical and mental growth. We get these from vegetables, eggs, meat, milk and fruits. Lack of any of these items leads to deficiency diseases. Moreover we do not eat raw food. We have to cook food for which we need fuel, oil and several other items. Supply of only Daal and Grain does not serve the purpose of nutrition. It is astonishing that the union government which is talking of nutrition for all citizens, cut down expenditure on nutrition for children and women by 27% from Rs. 3700/- Crore to Rs.2700/- crore in its last budget. Therefore India has fallen much low in the hunger index; even below the other neighbouring south Asian countries. Our rank in hunger index is 94 out of 107 countries, Pakistan ranks at 88, Bangladesh 75, Nepal at 73 and Sri Lanka at 64.
Five Kg. grain and one Kg. daal costs around ?225/-. That means it is supporting a person by just ? 225/- over his/her income. From where this money will come when people are already losing jobs and means for livelihood.
A committee of experts appointed by the world renowned medical journal Lancet had proposed a diet chart wherein it had specified the amount of different types of food including grains, pulses, meat, milk, fruits, vegetables etc. needed by a person. as per the present market rates the average approximate cost of this healthy nutritious diet comes to be around Rs.130/- per person per day. For a family of 5 members this comes out to be Rs.650/- per day or Rs.19500/- per month. This is impossible to be met with in present day economic situation where millions have lost their jobs and means of livelihood. With the national-level minimum wage at around INR 176/- (US$2.80) per day, which works out to INR 5280/- per month as against the workers’ demand of Rs.18000/- per month, to fulfil basic nutritional needs is beyond imagination.
Making people dependent on free rations at the mercy of the government is no good. This affects their self-esteem. What is needed is to ensure sufficient income to the people to increase their purchasing capacity. But with new acts coming up in the name of labour reforms, we are moving towards a society where workers will be denied their right for collective bargaining. The marginal and medium farmers, who are the producers of food, too are facing the problem of nutritional deficiency because of lack of sufficient income. They feel that with new acts on agriculture their situation is likely to get worse; that is why they are protesting in large numbers. The government has already admitted in the Parliament that average income of a farmer’s family of five members is Rs. 8000 per month.
To improve nutrition of the people it is urgently required to increase income of the people, provide them with facilities for proper housing, environment, clean drinking water, sewerage facilities and quality education.
1. https://dfpd.gov.in/nfsa.htm
2. https://wocatpedia.net/wiki/Definition_and_Dimensions_of_Food_Security
Violence prevention a public health concern
Date: 18.08.2021
Violence prevention a public health concern
Dr Arun Mitra
The incident of shouting highly communalized slogans and chanting genocide of Muslims and also that they be thrown out of India by a mob of Hindutva goons with police watching as mute spectator is not a new thing. The difference however is that this incident has happened at Jantar Mantar in proximity to the Parliament. Till date neither the Prime Minister nor the Home Minister have uttered a single word to condemn it. Even in his Independence day speech the Prime Minister took no notice of this. Their silence is intriguing. Encouraged with government’s covert support, an incident of similar type occurred in Kanpur just after three days. In this case the accused got bail in the Police station itself. Earlier too we have seen crowds forcing people to chant Jai Shri Ram. Many innocents have faced mob lynching something hitherto unknown in our country. All this is not spontaneous but apparently a part of the pre-planned strategy of the Hindutva brigade to vitiate the atmosphere and generate communal riots so that the situation is then utilized to further their agenda at a time when elections in some parts of the country are a few months away. As a result of such incidents social cohesion becomes weak and health is a major casualty.
Not many have been left alive to tell the tale of partition of the country when the communal frenzy led to the death of more than 20 lakh people including Hindus, Muslims and Sikhs. In such events the mobs are made to believe that the people from other community and ethnic groups are a threat to them. These mobs do not spare even liberals belonging their own community so as to silence any sane voice among them.
Rwanda is an example of modern times where in just 100 days in 1994, about 8 lakh people were slaughtered by ethnic Hutu extremists who targeted members of the minority Tutsi community, as well as their political opponents, irrespective of their ethnic origin. Neighbours killed neighbours and some husbands even killed their Tutsi wives, saying they would be killed if they refused.
That perpetrators of violence have no mercy is apparent from the scenes of 9 year old daughter of the person being beaten at Kanpur who kept on begging mercy, but that had little effect on the goons. The child is now under extreme stress and has been refusing to eat food.
In any violent situation health bears the major burnt. Health effects are in the form of physical injury, death, nutritional deficiencies, mental stress etc. Women, children and the elderly are the worst victims. A study carried out by the IPPNW Kenya affiliate – One Bullet Story, of a teenager from D R Congo who was shot in the face and treated in Nairobi by an IPPNW doctor, was shown to United Nations delegates at an international meeting on small arms as well as many other venues. Cost of treatment in this case was $ 6000. This amount is sufficient to meet the expenditure of One year of primary education for 100 children/ 8 years of secondary education for 10 children/ Full immunizations for 250 children/ 1 1/2 years education for a medical student.
Thus Violence Prevention is a Public Health Issue. “Violence can lead to premature death or cause non-fatal injuries. People who survive violent crime endure physical pain and suffering and may also experience mental distress and reduced quality of life. Repeated exposure to crime and violence may be linked to an increase in negative health outcomes” 1.
Children exposed to violence may experience behavioral problems, depression, anxiety, and post-traumatic stress disorder. They may also show increased signs of aggression starting in upper-elementary school.
The effects of exposure to violence in childhood may be seen in adulthood and can result in greater risk for substance use, risky sexual behavior, and unsafe driving behavior. Individuals exposed to violence at any age are more likely to engage in and experience intimate partner violence. Women exposed to intimate partner violence have an increased risk of physical health issues such as injuries, and mental health disorders such as disordered eating, depression and suicidal ideation 2.
During any communal/ ethnic riot of serious nature the people are displaced and forced to live in the make shift camps. The condition in these places is generally awful. There is shortage of clean drinking water, proper sanitation, and food. A long stay of the people in such places can lead to nutritional deficiencies. The private family life is disturbed. Children loose their schooling. There is always an increased risk of sexual violence against women.
The perpetrators of communal frenzy have agenda with them. Many a times there are personal prejudices or business rivalries. Other times they intentionally want to split the society for their political gains. These have long standing implications on the society.
For a public health professional and activist it is an important duty to prevent such violence and save the social cohesion. It is important for them to speak out forcefully against any kind of violence. Engage the youth in positive activity. Try to prevent any violent reaction by the community/ group who are at the receiving end as this gives an alibi to the perpetrators to justify their communal propaganda and violence. Liberals should not take the events lying down, they must speak vociferously. It is important to select the people who are not rabidly communal but have been swayed away momentarily. They can be engaged in a positive dialogue. It is only through a conscious humanitarian and secular outlook that nefarious designs of the violence promoters can be countered. The experience of Indian Doctors for Peace and Development (IDPD) in this regard through people to people dialogue, media writings and engagement with authorities has been quite encouraging and yielded tangible results. Some times taking stand in front of mobs can prevent untoward happenings.
Reference:
Changing paradigm of healthcare during 74 years of independent India
Date: 07.08.2021
Changing paradigm of healthcare during 74 years of independent India
Dr Arun Mitra
On 15 august 2021 when we celebrate 75th day of independence from the colonial rule, it is important to review what we have achieved in these 74 years. Even though health forms an important issue to be discussed but not much has been talked about health in the debates. This time as we have passed through serious COVID pandemic crisis, there is concern in the minds of the people about healthcare situation in the country.
In the pre-independence period Indian society was largely dependent on the traditional medicines, faith healing and belief system. Modern health planning in India started after the Joseph Bhore committee recommended in 1946 that “the health programme should be developed on a foundation of preventive health work’ and that ‘if the nation’s health has to be built, such activities should proceed side by side those concerned with treatment of patients’. It was based on the principles that no individual should be denied to secure adequate medical care because of inability to pay; medical services should be free to all without any distinction and doctor should be a social physician. The committee also observed that health and development are inter-dependent and improvement in other sectors like water supply, sanitation, nutrition, employment lead to improvement in health status.
This report goes in consonance with the Public Health definition by CEA Winslow and Rudolf Virchow who had conceptualised healthcare as social medicine and that every doctor is a social physician.
In the first few decades of post-independence period the direction of the healthcare was influenced by these principles During that period much of the health care was developed in state sector with an emphasis that modern scientific healthcare should reach the remotest rural areas.
It is during this period that India started manufacturing cheap generic drugs for local and global market. With the vision of Prime Minister Jawahar Lal Nehru Indian Drugs and Pharmaceutical Ltd. (IDPL) was established in 1961. He had said “the drug industry must be in the public sector….. I think an industry of the nature of the drug industry should not be in the private sector anyhow. There are far too much exploitation of the public in this industry”. IDPL played a major role in the strategic National Health Programmes. Recognising its role, the World Health Organisation commended that “IDPL had achieved in 10 years what others have in 50. IDPL products have been examined for quality very carefully by the developed countries and many of them want to buy from here”.
But after the shift in economic policies and neo liberal model of development the whole scenario changed. From the holistic perspective there occurred a policy shift towards health, that treats health as ‘techno-dependent and amenable to commodification’. The shift was seen in the approach of WHO also. Thus in our country we find that the public sector is now responsible for the preventive services while the private sector is profiteering from the advanced tertiary care.
The Alma-Ata Declaration of 1978, a mile stone document for public health, to which India too is a signatory raised the hope for a comprehensive healthcare system. But it was not to happen. It is around this time only that shift started in whole policies and the Alma Ata declaration virtually remained on paper.
The effect on Medical Education too is evident. At the time of independence, there were 20 colleges out which only one was in private sector. Most of new additions were in the state sector till late 1980s. Between the periods 1990 to 2017 number of colleges opened in private sector was 238 while only 115 were opened in state sector. At present out of 554 medical colleges as per the National Medical Commission 285 are in government sector and 269 are in the non-government sector. This led to denial of students from lower socio economic strata to get into the private medical colleges because of exorbitant charges.
We have seen huge growth of corporate hospitals in health sector. The advanced care has become out of reach of low and even middle income group. Health is being projected only as a curative thing with little talk to improve health determinants like improved sanitation, clean drinking water supply, housing, job security and increase in capacity to spend on nutrition.
No wonder the government recognises the fact that every year 6.3 crore people are pushed below poverty line because of out of pocket expenditure on health. But the remedy being offered is rather further pushing the people into debt. The whole healthcare concept is insurance based which fail to provide comprehensive healthcare. Senior citizens are the worst affected. Even the Ayushman Bharat covers only 50 crore while the rest 88 crores are left out. It is applicable for indoor care only, whereas 70% of the out of pocket expenditure on health is on OPD care. Moreover there are several conditions attached to get registered with this scheme. Eligible people also find it very hard to make the card. Other state run insurance schemes offer a limited benefit. For a person to get insured with private or public sector company, she/he has to shelve huge amount. The ESI started in 1952, CGHS in 1954 and ECHS in 2003 provide comprehensive healthcare to the employees to an extent. There is a move to dilute the ESI. The government is planning to handover district hospitals to the private sector to open medical colleges. In these hospitals 50% patients will get free treatment while the rest will have to pay. The free patients will have to get authorization from a designated authority, thus creating several hurdles for them.
To encourage education among the children from deprived families, the National Program of Nutritional Support to Primary Education (NP-NSPE) was launched as a centrally sponsored scheme on 15th August 1995 in 2408 blocks in the country for enhancement of enrolment, retention, improvement of attendance and quality of education and improving of nutritional levels among children. To care for the children of working people Aaganwadi was started in 1975. ASHA worker scheme was started in 2005. They worked as frontline workers during the pandemic. But till date they have neither been regularised nor been given the status of worker.
The concept of universal comprehensive health care was first of all realized by the Soviet Union who in the Soviet constitution 1936 guaranteed that the Citizens of the USSR have the right to health protection. The NHS was launched in the UK on 5 July 1948, by the then Health Secretary, Aneurin Bevan. This gave huge benefit of free healthcare to the population. The Cuban government adopted the concept of social medicine into practice. Its effect is well recognised globally. Cuba has a doctor patients ratio of 1:150. In comparison India has 1:1456. Even the developed USA has 1:333. Despite long standing embargo against them by the US government Cuba has achieved commendable health indicators better than many developed countries.
The government of Cuba spends approximately Rs.25000/- per person each year on healthcare, while India spends around Rs.1418/- on the health per capita with a corresponding expenditure of Rs.2.65 lakh in the UK. (https://www.tribuneindia.com/news/nation/india-spending-rs-1-418-per-capita-per-year-on-health-govt-in-rs-223236). India is one of the 15 countries with ignominious distinction of public spending of less than or about 1% of the GDP on health; other similarly placed countries spend twice the amount while developed ones spend 10 times more – says K Sujatha Rao in her book Do We Care. Cuba spends up to 15%. It is no surprise therefore, that the secretary general of the United Nations, Ban Ki-moon, during a visit to Cuba hailed its healthcare service as, “a model for many countries”.
Quality healthcare is a dream for an average Indian. The inability to pay is pushing our population to buy loans for health or sell the assets. To make the things further worse obscurantist ideas like astrology, Gau Mutra and Tantriks are being highlighted under the present regime.
There is need for reversal of these policies to make healthcare a social responsibility with state taking effective intervention at all levels to ensure healthcare for all. It is the duty of the public health and social activists to educate people on the issues of their rights to health in proper perspective. Health should be declared as a fundamental rights. “The focus on our health policies should be grounded in the ideology of human welfare and to achieve the tree basic goals of health systems – equity, efficiency and quality” – K Sujatha Rao.
In September 2019, a High-Level Group on the health sector constituted under the 15th Finance Commission had recommended that the right to health be declared a fundamental right. This if implemented, will strengthen people’s access to healthcare.
On this independence day let the country take effective measures for health. Promise to take positive steps so that governments promote, finance and provide comprehensive Primary Health Care. Enhance public spending on health to 5 per cent of GDP immediately. Put an end to privatisation of public health services and ensure effective regulation of the private medical sector.
Assure safe drinking water supply through piped water; sanitation in all households and localities, and enforce complete safeguards against air, water and soil pollution by industries, mines and other developmental projects. Eliminate Malnutrition by implementing National Food Security Act 2013. Promote people’s spending power by ensuring sufficient wages so as to meet their nutritional needs. There is need to implement a Rational Drug Policy. Ensure improved availability, accessibility and affordability of drugs including vaccines and sera in the public health system; through quality conscious pooled procurement systems and promotion of manufacture of essential medicines. Strengthen Public Sector Units to make cheap bulk drugs. Medical education should be in the state sector only.
IS SOUTH ASIA INCHING TOWARDS POWDER KEG
Date: 30.07.2021
IS SOUTH ASIA INCHING TOWARDS POWDER KEG
Use of atomic weapons on Hiroshima and Nagasaki on 6th and 9th August 1945 respectively led to a situation where the common man was struck in dismay; even the military strategists of Japan could not imagine that such a powerful and devastating weapon had already been developed by the Americans and now being used on their population. The event is remembered around the globe by paying homage to the victims and pledging to work for complete nuclear disarmament so that no person on earth has to ever face such heinous crime.
Continuous warning by the International Physicians for the Prevention of Nuclear War (IPPNW) about the health and humanitarian consequences of the nuclear fallout has withheld the use of these weapons till date after 1945. Several treaties have been undertaken between the nations, but the biggest achievement of the peace movement is the passage of Treaty Prohibiting Nuclear Weapons (TPNW) by the UNO four years ago as a result of persistent efforts of the International Campaign to Abolish Nuclear Weapons (ICAN). The treaty has delegitimised the use of nuclear weapons in any form. It has now been signed and ratified by the countries in the required number for the treaty to enter into force.
It is however a matter of concern that nuclear weapons possessing countries have not honoured the global voice of the people. They still believe in the doctrine of nuclear deterrence, not realising that the very presence of these weapons poses a threat of their being used.
Unfortunately south Asia with all its problems of poverty and hunger too has fallen into the trap of nuclear arms race. The economy of India and Pakistan has been in crisis which has worsened during the pandemic. According to PEW Research Centre, in India, the number of people earning less than $2 has doubled from 59 million to 134 million during Pandemic; and as per study by the Center for Sustainable Employment at Azim Premji University 230 million people earn less than Rs.375/- per day. Pakistan is already in the grey list of Financial Action Task Force (FATF). The economic condition of Afghanistan is pitiable. Loss of jobs and means for livelihood are pushing people into malnutrition.
Economic hardships lead to social unrest. In such situations narrow nationalist slogans are used and blame of economic hardships is put on some social-religious groups which are to their disliking. We have seen how Nazis swayed the people in their favour.
We are witnessing similar fundamentalism in South Asia today. Taliban aspiring to capture power in Afghanistan pose a serious threat to the region. Pakistan is going to be most affected. Pakistani society is a mix of modern thought, the people who want to live in peace, practice their religion but are opposed to fundamentalist slogans. They want to live in consonance with others. There are some forces in Pakistan that ally with Taliban and intend to bring similar setup in Pakistan. As a result of such forces Pakistan has become breeding ground for terrorism. The government of Pakistan is in a very precarious situation as they are faced with challenge to develop modern, economically developed Pakistan on one hand and to fight the radical forces on the other. Women in Pakistan who have achieved a lot in the past and who have shed obscurantist ideas will be the worst sufferers if Wahabi type of Islam is imposed.
India which developed as a secular nation is now being threatened by the fundamentalists. They are out to put blame of all the ills on minorities and so increase communal conflicts. There have been incidents of violence against minorities perpetuated by these Hindutva brigade and supported by the government in BJP ruled states. This is evident from several incidents of mob lynching on the pretext of eating beef and other frivolous issues. The incident of violence against minority community in “North East” Delhi in the end of February 2020 where instead of putting cases against the perpetrators of violence the victims of violence have been arrested and are being prosecuted. Happenings in the name of Love Jehad, highlight bias against the vulnerable sections, the minorities, the so called lower castes – Dalits, women and those fighting for their rights. The present rulers want to impose majoritarianism. They have been the protagonists of ‘Akhand Bharat’ that means a ‘Greater India’ which includes Pakistan Afghanistan Indonesia, Bangladesh, Myanmar and Philippines etc.
Situation in Bangladesh is also quite fluid after the influx of large number of Rohingiyas from Myanmar who were forced to flee from their own country after government sponsored repression. We have witnessed lately the movement by the fundamentalists in Bangladesh. Nepal is in political instability. Sri Lanka has not sorted out the issues of Tamils. China, with its military designs and nuclear arms is another important factor to force India to amass arms.
Failure to meet the expectations of the people these forces from time to time raise bogey of external interventions. Such situations are a precursor to the danger of an armed conflict in the region. Under the present circumstances any armed conflict could be of grave nature. Both India and Pakistan have no intention to even reduce the expenditure on the nuclear weapons what to talk of their abolition. Skirmishes between India and Pakistan are a day to day occurrence affecting the population across the borders. Putting blame on each other both the countries are amassing arms. India is second largest importer of arms (1) and is now pursuing to become an arms exporter particularly to Indian Ocean Region Countries to balance China (2).
There was a time when despite all these problems and even after India & Pakistan had gone nuclear, there was a strong narrative for nuclear disarmament. Now that narrative is missing from the governments’ side. From the side of the people’s movements too this issue has taken a backseat. Unfortunately this is at a time when number of the armed conflicts is increasing every other day.
The COVID Pandemic has thoroughly exposed how much ill prepared we are to tackle serious health emergencies. Nuclear fallout would be much more catastrophic with effects on next generations. Medical fraternity has already warned that medical science has no remedy to offer in the event of nuclear fallout. As per a publication by the ICAN in the event of nuclear exchange between India and Pakistan, in New Delhi every doctor would be responsible for treating about 102 people simultaneously and every doctor in Islamabad would be responsible for treating about 363 people simultaneously.
We could produce vaccines to combat the Pandemic, on the contrary there is no such remedy to nuclear fallout. However good thing is that nuclear catastrophe can be prevented by abolishing the weapons which are our own creation.
Peace movement has to work very hard. A broad strong peace movement has to be built to counter such forces otherwise uncertainty will continue to prevail for which we will have no answer to the next generations.
Reference:
- https://sipri.org/sites/default/files/2021-03/fs_2103_at_2020.pdf
- https://thediplomat.com/2021/02/indias-defense-export-strategy-balancing-china-in-the-indian-ocean-region/
Misuse of draconian laws - a public health crisis
Date: 19.07.2021
Misuse of draconian laws - a public health crisis
Chief Justice of India has very validly pointed out the misuse of Section 124(A) of IPC which deals with the offence of sedition. Laws like the NSA, UAPA and sedition laws are a reflection of colonial era. He pointed it from legal perspective as these laws are utter violation of human rights. Any such such law which curtails the right to freedom of speech and right to critically analyse the events and the government’s performance amounts to negation of basic human rights as enshrined in our constitution. There have been several allegations of these laws having been misused and people being framed falsely. These allegations are corroborated by reports that out 326 sedition cases filed during 2014 to 2019 only 6 have been convicted (Mukesh Ranjan – The Tribune 19.07.2021).
In these conditions health bears the maximum brunt in terms of both physical and mental wellbeing but hardly gets any space in the public discussion. It is only after Father Stan Swamy’s death in custody that the issue is getting highlighted. This has been widely acknowledged globally. In the Indian context it poses even a more serious question because here it is the vulnerable sections of the society who are at the receiving end. Presently it is the minorities, rights activists, those working for the uplift of tribals, adivasis, the dalits and women, who are being framed under such laws. Now even the farmers protesting for their demands are being framed under such laws.
The Indian penal code has sufficient provisions to charge a person for any crime even when it concerns the integrity & sovereignty of the nation. Difference being that under these special laws there is provision of keeping the person in lockup for a long time without any trial and without the right to get reprieve from judiciary for a stipulated period. Such incidents have several health issues not only for the individual framed as accused but for his family, community and society as a whole.
Arrest of a person particularly if he/she is the bread earner, which they mostly are, pushes the family into sudden economic crisis which affects their basic needs for food, nutrition, health and education. Many a time the children and the elderly also have to go hungry as the family has to spent huge amount on litigations which further pauperizes them. Children in the growing age suffer from malnutrition which impacts their all life to come. Women in our families sacrifice their food for the family in general and for children in particular, they thus land up into nutritional deficiency disorders. Needless to mention the person in the lockup is denied a healthy diet in the prison.
Until acquittal the whole family faces social stigma for the crime which is not proven. The family members find it difficult to get job of their liking; even to find a rental accommodation is a hard task. Children face humiliation in the school. This affects their psychological makeup. Many of them are likely to develop Post Traumatic Stress Disorder (PTSD). A child who should have grown with love and compassion now grows up with contempt and hatred.
Many cases imposed on the members of a community or a group are meant to send fear signal among them to keep shut or face the consequences of being framed in false cases. As a result, even though willing, the community or the society tends to stay aloof for the fear of reprisal by the state or the antagonistic groups. The paranoia which develops has serious consequences. Affected people can develop violent reaction. The hapless accused in many cases develop suicidal tendencies out of frustration of having been falsely implicated.
The perpetrators of misuse of such laws, politicians, mafia, bureaucrats, police or vested interests in a particular situation develop narcissist behaviour and the feeling of being able to force upon their will. Guarantee to go scot free after being protected by the state apparatus gives the gangs alibi to bully any one. This adds to their criminal behaviour. Many of them had never been into crime earlier but now circumstances embolden them.
It is therefore important that only a transparent legal system be adopted to check any sort of crime giving due place to the accused. The sedition law, RSA, UAPA and TADA should be immediately revoked. We have enough history to learn from the crimes committed by the Nazis against those who differed from them.
The World Medical Association and the International Physicians for the Prevention of Nuclear War had condemned arrest of members of central council of the Turkish Medical Association when they issued a declaration titled “War is a popular health issue” in opposition to the Afrin operation. The government had charged them with “making a terrorist organisation’s propaganda” and “inciting the people to hatred and enmity” on account of the peace declaration. In India we have the example of Dr Kafeel who was arrested for raising the issue of shortages in the hospital in Gorakhpur which had led to death of children. Medical personnel who are custodians of health of the people have to raise voice vociferously against such laws so as to protect and promote people’s health.
Dr Arun Mitra- ENT Surgeon, Sr. Vice President Indian Doctors for Peace and Development (IDPD) M: 9417000360
Dr S K Prabhaker – Neuro-Psychiatrist, M: 9876155343
Insurance based system has failed to meet our health needs
Date: 13.07.2021
Insurance based system has failed to meet our health needs
Dr Arun Mitra
The COVID – 19 Pandemic has exposed the weaknesses in our healthcare system. Complications of the disease apart, unprecedented number of people lost their lives due to lack of basic needs like Oxygen, ventilators, medicines and hospital beds. Over and above exorbitant cost of treatment has become real constraint in the treatment of cases requiring hospitalization. A patient requiring ventilator had to pay around Rs.20,000 per day as ICU charge in the private hospitals which had become the people’s choice in the absence of updated government facilities in most of places. After adding the cost of medicines and other items, the patient had to shelve nearly Rs.40000/- per day. This is an amount beyond the capacity of our people who are already in deep economic crisis as a result of lockdowns, loss of jobs and livelihood. According to Pew Research Centre the number of people earning less than $2 has doubled from 5.9 crore to 13.4 crore during Pandemic and as per study by the Center for Sustainable Employment at Aziz Premji University 23 Crore people earn less than Rs.375/- per day.
People in the elder age group have been the worst hit by the COVID-19. By the time of attaining this age many people are retired and become dependent on their children even for day to day living. Despite the fact that senior citizens have contributed through their life to the nation’s building, healthcare for them remains a big challenge. The National Health Policy 2017 laid emphasis on the need for palliative and rehabilitative care for all geriatric illnesses, but in practice hardly any steps have been taken.
To meet health needs the government’s focus is on insurance based healthcare instead of health as state’s direct responsibility. The Ayushman Bharat has serious limitations. It provides healthcare coverage to only 40% of the population, that too for indoor care only. This means 60% of the population is left out of this insurance scheme. It is also a well-known fact that 70% of the out of pocket expenditure on health is on outpatient care. This affects more to the geriatric group because a person in this age group is faced with the diseases of chronic nature, for which he/she has to pay frequent visits to the outpatient clinics. Moreover there are several conditions to get benefit of the Ayushman Bharat scheme. Those who own a two/three/four wheeler or a motorised fishing boat; Those who own mechanised farming equipment; Those who have Kisan card with a credit limit of Rs. 50000/-; Those who work in government-managed non-agricultural enterprises; Those earning a monthly income above Rs.10000/-; Those owning refrigerators and landlines; Those with decent, solidly built houses; Those owning 5 acres of more of agriculture land. (https://www.bajajfinserv.in/insights/ayushman-bharat-yojana-are-you-eligible-for-the-pmjay-scheme) are not entitled to get benefit under Ayushman Bharat.
Several other healthcare schemes include Rashtriya Swasthiya Bima Yojna (RSBY) for Below Poverty Line (BPL) families, Aam Admi Bima Yojana for rural landless household, Janashree Bima Yojana (JBY) for below poverty line and marginally above poverty line, Universal Health Insurance Scheme (UHIS) for health care to poor families. These schemes provide very minimal healthcare facilities for hospitalization only.
Employees’ State Insurance Scheme (ESIS), Central Government Health Scheme” (CGHS) and Ex-Servicemen Contributory Health Scheme (ECHS) are better in this respect and provide both OPD and indoor care without any limits. Under the ESI scheme total beneficiaries number around 3.2 Crore employees or about 13 crore of their family members. The other two schemes provide benefit to about 50 lakh employees. During the COVID peak most of the ESI hospitals were converted to COVID hospitals. As a result the employees were not able to get treatment for other illnesses for which they had to go to the private hospitals and pay from their own pocket.
In the absence of any suitable healthcare schemes by the government, big chunk of our population which is in unorganised sector, is left with choice to opt for health insurance coverage either by the public sector or the private sector insurance companies. However to pay premium for insurance is becoming a nightmare. That is why even the middle income group people are now at receiving end.
Paradox is that whereas a person is more likely to be taken ill in the elderly age and looses regular income, the insurance companies increase the premium exorbitantly with age of the insured. The rate of premium of these companies has increased tremendously in the previous 5 years. For example under the Mediclaim policy of public sector unit, the New India Assurance Company Limited, premium for those in the age group of 66-70 for a sum assured Rs.100000/- increased from Rs. 5600/- in the year 2016 to Rs. 19866/- in 2021, an increase of 354%; and for sum assured 2 lakh from Rs.10630/- to Rs. 28218/- an increase of 265% in the last 5 years. For a sum assured of Rs.5 Lakh it increased from Rs.24230/- to Rs.42120/- that is a rise of 173% during this period.
For the Senior citizens, who have either no income of their own or have very meager income and are dependent on their children, it is impossible to pay such high insurance premium. Pandemic has exposed this myth of insurance based health care system. No company will cover if the expenses increase beyond the sum assured. Patients requiring ventilators had to spend much more than this amount during uncertainties of the outcome. So they had to either borrow or sell their assets.
The companies have stopped dealing with the cases directly and have appointed TPAs. This has been done only to put blocks on getting reimbursement from the companies by raising frivolous objections.
Therefore only a comprehensive universal health care system can meet the needs of our people. The government should strengthen the primary healthcare. They should open its advanced tertiary care centers where facilities for palliative and rehabilitative care are available. Insurance companies should be made to compulsorily cover OPD care cost as well for the insured. The irony is that tariff of the government owned companies is more than the private sector companies in some cases.
A critique of Prime Minister’s address to the Medical fraternity on the Doctors Day
Date: 05.07.2021
A critique of Prime Minister’s address to the Medical fraternity on the Doctors Day
Medicine is a passion not a profession. Preventing disease and treating the patients gives immense pleasure to a doctor. A person dedicated to the cause is beyond the need for praises. However recognition of medical professional’s work from the mouth of the head of the government is a different matter. The Prime Minister very well utilized the art of using words to praise the doctors on the day dedicated to the memory of Dr B C Roy, a physician, educationist, philanthropist, freedom fighter and statesman who served as the Chief Minister of West Bengal in the Congress government.
After showering praises on the doctors for their role during the pandemic the Prime Minister should have addressed the issue of violence against the doctors which continues unabated despite their role in serving the society during pandemic. He failed to give any concrete assurance. He did not utter that a bill to the effect is pending with the government since December 2019. No steps have been taken to expedite it despite several incidents of violence against the doctors.
He started by blaming the governments before 2014 for not being serious towards healthcare system. Fact of the matter is that immediately after the freedom from the British colonial rule India had been squeezed of all resources. India's GDP, in absolute numbers in 1947 was mere Rs.2.7 lakh crore. It rose to Rs.57 lakh crore in 2014(https://www.firstpost.com/business/data-business/from-1947-to-2014-how-the-indian-economy-has-changed-since-independence-1983853.html). Our life expectancy stood at as low as 37 years in 1947 which improved gradually with improvement in healthcare as well as nutrition and it rose to 68 years by 2014.
In the immediate post-independence period our healthcare was developed in the state sector so that it could reach the common man as much as possible. As a result Primary Health Centres were established and rural dispensaries were made in the far flung areas. Not only that India became a hub for producing cheap medicines under the public sector companies in particular. These were supplied not only to developing countries but also the developed countries at cheap rates. We also strengthened our own vaccine making sector. It is in 1952 that the ESIC was established to give comprehensive healthcare to the employees. Hardly any scheme matches this. Even the Aysuhman Bharat provides health care for the indoor patients only. In addition there are several conditions to be registered under the scheme. There was effort to break myths in the healthcare and develop it on scientific basis. True, there were several short comings in the planning but to say that nothing was done in those years before 2014 will be injustice and denying the fact.
Coming to the COVID he went on to say that India did better than many western countries in the field of COVID management. He forgets that India’s situation in COVID management has been worse than our neighbouring countries in south Asia even though they have much poor economy. During the second surge there was unprecedented increase in the number of COVID cases in our country. As on 17th May we recorded 2.60 lakh cases or 19 cases per lakh population, Pakistan 3232 cases or 1.4 cases, Bangladesh recorded 698 cases or 0.42 cases, Nepal recorded 9198 cases which is 31 cases, Sri Lanka recorded 2456 cases that is 11 cases per lakh of population. This data from www.worldometers.info indicates a comparison in the proportion of population being taken ill of COVID. As on 17 May 2021 India had nearly 13 time more cases than Pakistan, 44 times more than Bangladesh, 0.60 times of Nepal and 1.6 times of Sri Lanka.
People have not yet forgotten the nightmare they had gone through because of lack of oxygen, lack of a hospital beds, shortage of ventilators and other equipment to save life. He has also forgotten that 23 crore more people have gone below poverty line during this period. Many have been pushed to hunger because of the absence of any aid from the central government. The developed countries, with whom he is comparing our country, paid lakhs of dollars to their people to meet the economic crisis. On the contrary Indian government did not even heed to the economists’ advice of paying Rs.7500 to the poor families. The poor have got only 5 kilogram grain and 1 kg Daal Which costs only Rs.225.
Boasting on the increase in the health budget the prime minister said that in this year’s budget the expenditure on health has been increased by more than 2 times. This is completely untrue. The factual increase on the health budget is from Rs.65000 crore to 72000 crore. This is a marginal increase of 10 %, which is barely enough to meet the inflation in one year. Most worrying factor in this year’s budget was reduction in the spending on Nutrition from 3700 to 2700 crore rupees. This is at a time when India is at 102nd position in hunger index out of 117 countries, worse even than our neighbouring South Asian countries. In fact the public health expenditure on health has been hovering around 1% of the GDP for the last several years and has not increased since 2014 either.
However there has been increase in the corporate sector’s investment on health. With this we have improved in advanced health care but vast section has been excluded. It is only recently that his government took decisions to even privatise the district level hospitals.
Prime Minister’s boasting about vaccination drive in India is far from reality. Whereas on 21 June 80 lakhs people were vaccinated, the number is coming down since then. Number of people vaccinated on 27 June was 17 lakh, on the doctors day it was 42 lakh falling to 14.77 lakh on 4th July. As on today 6.4 crore have been fully vaccinated. With this pace of vaccination it may not be before April 2022 that we will be able to vaccinate our population.
We have recently seen how the data on the number of diseased and deceased has been fudged. This is anti-science because the database gives us knowledge on the strategies to be evolved to manage pandemics in future. It is also well known that most of the decisions being taken during the pandemic had been on the political level rather than the scientific level involving the Public health experts and the epidemiologists. Only an inclusive decision making involving experts can yield results. Our Prime Minister should understand the difference between addressing the medical fraternity and election rally.
Published at : https://www.nationalheraldindia.com/opinion/pm-modis-boasts-about-success-of-covid-vaccination-drive-far-removed-from-reality
Historic Biden – Putin summit could pave the way for complete nuclear disarmament
Date: 18.06.2021
Historic Biden – Putin summit could pave the way for complete nuclear disarmament
Contrary to the assessments by several experts based on the recent rhetoric between President of the United States of America Joseph R. Biden and President of the Russian Federation Vladimir Putin, the joint statement issued at the end of Geneva summit on 16th June is quite encouraging. The two leaders have realized the importance of mutual dialogue. They have spelled clearly “note the United States and Russia have demonstrated that, even in periods of tension, they are able to make progress on our shared goals of ensuring predictability in the strategic sphere, reducing the risk of armed conflicts and the threat of nuclear war”.
They have further affirmed their commitment to nuclear arms control by extending the New START Treaty. The wording “Today, we reaffirm the principle that a nuclear war cannot be won and must never be fought” is what of peace organisations around the globe have been cautioning. “Consistent with these goals, the United States and Russia will embark together on an integrated bilateral Strategic Stability Dialogue in the near future that will be deliberate and robust. Through this Dialogue, we seek to lay the groundwork for future arms control and risk reduction measures” is quite valuable statement in the present circumstances.
If carefully taken forward, this summit can yield several positive outcomes. First, all the nuclear weapons possessing countries should take a lead from this statement that nuclear weapons are the weapons of mass destruction. This has been amply proved by the damage done in Hiroshima and Nagasaki. The medical experts have warned that the medical science has no remedy to offer in the case of a nuclear war. The International Physicians for the Prevention of Nuclear War (IPPNW) has come out with an evidence based study that even a nuclear exchange between India and Pakistan with 100 Hiroshima sized nuclear weapons each will put over two billion people at risk of starvation and death. A nuclear exchange between Russia and the USA would mean end of modern civilization built through thousands years of human labour.
The second important point is the talk of arms control as an important issue today. It gives a boost to the peace organisations who have been advocating effective arms control treaties. Several parts of the world particularly the Middle East is in the midst of serious armed conflicts leading to deaths, injury and displacement of hundreds and thousands of citizens.
The third important outcome of the summit is the realization of persistent dialogue to resolve the issues. This is a signal to several countries involved in the armed conflict to come to peace. It is particularly important for developing countries like India and Pakistan to shun rhetoric and give importance to mutual dialogue.
But we have to move with caution and skepticism. The military Industrial complex is very powerful and would not so easily surrender its super profits. More over the two countries are party to the ongoing conflicts and skirmishes in many parts of the world. They have made lots of money by creating such situations and selling arms. They have even attacked militarily on other countries in the name of establishing democracy.
However their joint statement can generate virtually dead debate on the importance of nuclear disarmament. The medical consequences of nuclear war have been high on agenda of the IPPNW and the International Campaign to Abolish Nuclear Weapons (ICAN). It became a nodal point to generate opinion among the nations in the UNO which led to passage of Treaty Prohibiting Nuclear Weapons (TPNW) in July 2017 for which the ICAN was awarded Noel Peace Prize. Let us hope that taking the outcome of the this summit forward we can convince all the nuclear weapons possessing countries to join the TPNW.
Dr Arun Mitra
Co-President IPPNW
Mobile: 9417000360
Why doctors must protest !
Date: 18.06.2021
Why doctors must protest !
Dr Arun Mitra
A doctor was called to the police station for inquiry into a complaint lodged by him against someone who had misbehaved with him. The police officer asked the doctor that why he did not retaliate when the said person was misbehaving. The doctor politely replied that as a doctor he is not trained to shout at anyone but to be modest, polite, caring, listening and serving to best of his ability. This is true for most of the medical professionals who have been bound with the books in their teenage and then on entry into the medical college further burdened with the huge syllabus which they must remember to be a doctor. To meet the expectations of the society he is trained to be modest, caring and polite towards the persons who visit him for advice. During the training he forgets that once he comes into practice of medicine there is much difference between what he has been taught and what he has to do as a practitioner particularly in respect to the social behaviour. Generally speaking the medical students are not educated on how to win over the confidence of the patient and how to communicate with them in the event of a crisis. Therefore for a young doctor many a times it becomes difficult to tell the attendants about the pattern of the disease. In case of death of the patient it is further a hard task for the young doctor to inform. Therefore it is very important that the young medicos are trained in the art of communication. It has become all the more important because degeneration in the society can be seen in every sphere and with the lowering of moral values, sometimes the attendants of the deceased overreact and even become violent towards the doctor. Young doctors have to face the wrath more often because they are the immediate contact with the attendants.
Violent behaviour of the attendants often is an immediate reaction because they had not apprehended a serious happening to their patient. Therefore they can easily blame the doctors for negligence. It is not that incidents of negligence do not occur, but it is not a routine as the doctor has to meet up to her/his reputation in the society and continue with getting goodwill of the patients. At times there are elements who suddenly crop up when such incidents occur and instigate the attendants to be in their good books and even worse they try to extract money from the doctor. Such incidents have lately increased in all parts of the country leading to extreme violence against the doctors at some places.
The doctors have now started protesting and demanding from the government to make laws against such people who indulge into violence against them, their staff or cause damage to property. Some states have come up with such laws but they have not been implemented in letter and spirit. Therefore the doctors are now demanding a central legislation to the fact which should be a guiding force for all the states to adopt and for this the Indian Medical Association (IMA) had given a call for National Protest Day on 18th June.
Violence is not the only issue that the doctors are protesting against. The doctors have been under much physical and mental stress during the ongoing pandemic. Giving long duties in the PPEs has been a horrendous task. This has brought a definite behavioural problem in them which has affected their family life as well. The family members of such doctors on COVID duties are equally under stress and fear. There has been demand that such health workers should not be put on more than four hours duty in one day in the COVID wards. In many parts of the country however the doctors have not been given their due. Just showering flowers on them from the aeroplanes cannot build up their morale. The doctors protested when they were not being provided the basic equipment to protect themselves from the virus. They also protested for higher wages when on such duties. Nearly 3000 doctors in Madhya Pradesh have threatened to submit mass resignations in case their demands are not fulfilled. This has conveyed their feelings to the government and the society that they are ready to work but must be given due care in return.
But protests by the doctors have generated anger in the ruling government. Dr Kafeel Khan of Gorakhpur was arrested for raising the issue of oxygen shortage tragedy that led to the deaths of more than a hundred children. Similarly Dr Sudhakar Rao a doctor with a government hospital in Andhra Pradesh, who was suspended for questioning the shortage of PPE kits, was admitted to a mental health facility, a day after he was allegedly manhandled by the police and arrested for creating nuisance in Visakhapatnam.
Doctors were outraged when the Union Health Minister started promoting Coronil manufactured by Ramdev who had claimed it to be a remedy against the COVID but had no evidence for it. Modern science is dynamic and believes in evidence based practice. Therefore it is amenable to changes with time in the process of development of science. Ramdev said that people died despite the doctors and despite the oxygen and due to vaccines. This has been highly contested by none other than the IMA. They even demanded FIR against Ramdev for his utterings which could damage the management of COVID as it could give strength to the unscientific ideas among the people’s mind who could be influenced and become hesitant to adopt scientific medical treatment for the management of the disease. Unfortunately neither the Health Minister nor the Prime Minister took any notice of this demand of the doctors. This anti science attitude of the higher ups in the government has further irked many medical personnel. No wonder the Prime Minister as long back as in 2014 had claimed that the ancient India had the technical knowhow to transplant an elephant's head on a human body. This was contested by many medical scientists. But it was an indication that how the message has to be percolated down to the people in the coming period. No wonder as an obedient servant Dr Nageshwar Rao - Vice Chancellor of Andhra University in Indian Science Congress in January 2019 said that ancient India had the technology of stem cells in. That is how we see the propagation of use of cow urine cow dung or religious rituals to fight back the COVID and spread of anti-science ideas.
Vaccine policy will encourage super profits and add to health inequity
Date: 17.06.2021
Vaccine policy will encourage super profits and add to health inequity
Dr Arun Mitra
As per the reports the Sputnik vaccine on its arrival will be first given to Apollo Hospital. Whether it will be inoculated free of cost or will be paid has not been made clear by the government. It is understandable that the production of vaccine against COVID-19 was not an easy task. But the hard work by the scientists around the globe made it happen. Normally it takes five years plus to prepare a vaccine but because of urgency during the pandemic it had to be made in less than one year. Most of the countries had promised vaccines by the end of 2020. Manufactures like Pfizer, Moderna, Astra Zeneca etc. even booked them by October 2020. The affluent countries booked large percentage of these as it involved money. Besides Covishield of Astra Zeneca from the Serum Institute of India, Pune India aspired to make indigenous vaccine named Covaxin. The Prime Minister was so jubilant about it that he even announced in the July 2020 that Indian vaccine would be ready by 15th August 2020. He probably wanted to take super credit by announcing this on the Independence Day from the Red Fort. The ICMR director Dr Bhargav issued directives to speed up the trials. It was only after he was put to corner by the scientific community that he retreated and announced the vaccine could be ready by December 2020 or January 2021. This was realistic estimate since vaccine production requires several trials. It has however been allowed for emergency use. The WHO has not approved of the Covxin till date. As a result many international travellers particularly the students going to USA/Canada have to face many problems. Convinced that India has controlled the COVID-19, the government allowed export of millions of vaccines in the name of Vaccine Maitri, ignoring the warning by the scientists and the medical community of a second wave which could be much more harsh than the first one. This has created difficulties in vaccination for domestic use. Presently our vaccine stock is insufficient, that is why now India is importing them.
So far in all the National Immunization Programmes including the small pox, pulse polio the vaccination has been given free of charge to the citizens. The pulse polio has been one of the most elaborate programme where the doses were administered door to door. There has been some resistance by a section to the vaccination programmes including that of Small Pox. But this was overcome by extensive health education and motivation. Ironically this time the resistance is being intentionally generated by persons like Ramdev and protagonists of use of cow urine, cow dung. These people are in regular visits to the corridors of the power in Delhi.
As announced by the Prime Minister from 21st June onwards 25% of the vaccines will be given to private sector who will be permitted to charge Rs.780/- for Covishield, Rs.1410/- for Covaxin and Rs.1145/- for Sputnik. It is interesting to note that the CEO of the Serum Institute of India Adhar Punawala had said in May 2021 about the price of Rs.150/- per dose to the government “it is not that we are not making profits but we are not making super profits”. As a philanthropic gesture on behalf of @seruminstindia he Tweeted on 28th April 2021 ‘I hereby reduced the price to the states from Rs.400/- to Rs.300/- per dose, effective immediately, this will save thousands of crores of state funds going forward. This will enable more vaccination and save countless lives’. In the light of this it is difficult to comprehend why the rates have been fixed so high. As an afterthought the Biotech has come out with the statement that the price of Rs.150/- per does is not sustainable. It is astonishing that the price of such products is decided by the companies even during the pandemic. The government should have come out clearly on the production cost of the vaccine and fixed a minimum margin of profit. Several organisations have been pleading with the government to channelize the pricing of the drugs based on cost accountancy. A report by the Committee on High Trade Margins in the Sale of Drugs submitted in December 2015 had given similar recommendations.
The government should have planned to give Sputnik Vaccine through its own infrastructure instead of Apollo Hospital. This is a signal towards the happenings in future. The 25% share to the private sector will enable the upper middle and high income groups to vaccinate themselves. This will leave large chunk of the society spending their time standing in the queues waiting for their turn. Science tells us that if you leave large section unvaccinated the pandemic will not come under control. It is high time the government rejuvenates state owned vaccines and drugs producing companies so that profit does not become the prime motive during this crisis. The present vaccination policies will encourage super profiteering by the companies and add to the already existing health inequity to serious dimensions.
INCREASE IN SPENDING ON NUCLEAR WEAPONS DURING PANDEMIC AMOUNTS TO MASS GENOCIDE
Date: 10.06.2021
INCREASE IN SPENDING ON NUCLEAR WEAPONS DURING PANDEMIC
AMOUNTS TO MASS GENOCIDE
Dr Arun Mitra
A recent report published by the International Campaign to Abolish Nuclear Weapons (ICAN) titled Complicit: 2020 GLOBAL NUCLEAR WEAPONS SPENDING has brought forwards startling facts on the total insensitivity of the governments and the nuclear weapons industry during the Pandemic which has already cost 37.5 lakh lives. In addition the health problems, including the mental ones, of those who fell ill but recovered are unaccountable. It is reported now that the mental health issues have increased by five times during this period. India witnessed death of 3.54 lakhs. As many as 30,071 children were orphaned, lost a parent or abandoned mostly due to the COVID-19 pandemic as per data submitted by different states till June 5, the National Commission for Protection of Child Rights (NCPCR) informed the Supreme Court. Of the total, 26,176 children have lost a parent, 3,621 have been orphaned and 274 have been abandoned according to the NCPCR.
Barring a few, the economic activity was affected in all sectors during this period. The daily wage earners were the worst affected. Whereas in some countries the government took care of the people or the business, in India the low income groups have been a harried lot in the absence of any substantial support from the government. Nearly 54 crore workers which means 40% of the country’s population had to face hunger like situation.
This was an opportunity when the global community could have joined hands and decided to put in all energy and finances in controlling and minimizing the damage by the Pandemic. But it was not to happen despite repeated appeals by the scientists and medical personnel. The ICAN report has highlighted that the nuclear weapons industry continued to flourish unabated. The US has been the worst spender on the nuclear weapons during 2020. It spent 270000 crore rupees or 51.72 lakh rupees per minute on nuclear weapons. China spent 72970 crore rupees or 13.97 lakh rupees per minute. Coming to South Asia Pakistan spent 7297 crore rupees or 1.4 lakh rupees per minute. India spent 17500 crore rupees or 3.3 lakh rupees per minute. This amount is half the money allocated towards vaccination programme which is 35000 crore rupees.
The report says that ‘During the worst pandemic in a century, nine countries chose to increase their spending on nuclear weapons by about $1,400,000,000. During a year when health care workers got applause instead of raises. A year in which it was essential to have minimum wage workers risk their lives to keep economies afloat, but not essential to pay them a living wage. A year in which millions of lives were lost and the status quo that sustained systems of power for decades started to get upturned. A year in which the first treaty making nuclear weapons illegal finally became international law. During this year, nine countries still decided nuclear weapons spending was a priority. The fault doesn't lie with the leaders of these nine countries alone. Behind them is a massive enterprise of vested interests, eager to get a piece of the $72.6 billion taxpayer-funded pie. The twenty-one companies profiting from nuclear weapons spent $117 million making sure that lobbyists kept the systems they build as the solution to policy makers’ problems. And they spent at least $5-10 million funding think tanks who write and research about nuclear weapons’. The Military Industrial Complex in connivance with the governments is out to make profits from spending on nuclear weapons.
Ironically such information is intentionally not percolated down to the people fearing some section of the society is bound to react and demand from the governments to show more concern towards life of the people than nuclear weapons. The International Physicians for the Prevention of Nuclear War (IPPNW) has been constantly raising the issue of humanitarian consequences of nuclear war. Even if the war does not occur such huge expenses on the nuclear arms race if diverted towards welfare could solve the problems of health and education for a large section of the people particularly in the developing nations. It is disgusting that none of the governments in the nine nuclear weapons possessing countries took lead to denounce the spending on nuclear weapons under the present circumstances. Instead we are watching unashamed war in Middle East which could have very serious consequences as the big powers are overtly or covertly involved in it.
The whole responsibility comes on the shoulders of the peace movement to raise this issue, educate the public and organize them to put their foot down to demand end to nuclear arms race for the sake of mankind otherwise the upcoming waves of the pandemic with new variants of the Corona virus will continue to play havoc in which the poor countries and poor in the poor countries will have to pay the ultimate price. It is therefore important to form broad alliances of peace movements, students & youth bodies, women organisations, trade unions and farmers organisations to raise their voice asking for health and education instead of nuclear weapons. It is important to lobby with every elected official, company representative and researcher to get out of the destructive nuclear weapons spending cycle and back the Treaty Prohibiting Nuclear Weapons (TPNW) to get rid of them once and for all.
PATENT RIGHTS ON MEDICINES AND VACCINES MUST BE WAIVED OFF
Date: 03.06.2021
PATENT RIGHTS ON MEDICINES AND VACCINES MUST BE WAIVED OFF
Dr Arun Mitra
As the world is passing through serious crisis of COVID Pandemic, at present Vaccination seems to be the only answer to put a break to it. The process has to be carried out simultaneously at the global level if we have to achieve an early end to Pandemic. This is important because in this highly interconnected world movement of people from one to other country cannot be stopped for very long. Whereas the developed countries have been able to vaccinate substantial number of their population, most of the developing countries are finding it hard to procure the vaccines in required numbers. The affluent countries booked the vaccines much early. Under the circumstances several developing countries including India are unable to get the vaccines now from the companies in other countries.
It is also important to note that maximum number of people should be vaccinated in a short span of time. If the gap of time is too large, then the people vaccinated in the early stages may loose the immunity due to vaccination by the time next lot of people is vaccinated. This would defeat the purpose to obtain herd immunity which is expected to be reached if 60% - 70% population is immunised.
The high cost and unavailability of medicines is another serious issue of concern. It is highly distressing to see people running from pillar to post in search of Oxygen and essential medicines such as steroids which are the lifesaving in COVID.
In this connection 74th World Health Assembly (WHA) on 24th May 2021 called for a concrete action plan and coordinated strategies to control the Pandemic. The WHA statement said that “where countries have struggled to implement effective COVID-19 control, political leadership has often undermined the critical role of skilled frontline professionals. The greatest success has been achieved between the government, professionals, trade unions, and communities working together with a high level of mutual trust. Where this has occurred there has been an important increased control of the virus allowing countries to resume freedoms and functional economies”.
The WHA in the statement called on World Health Organization (WHO) and its member states to take action to:
- Ensure that treatments and vaccines are available to everyone everywhere. This requires establishing multidisciplinary engagement with local up to cross-borders social protection systems to reach all people.
- Transform COVAX into a COVID-19 Solidarity Pooling Platform, enabling knowledge sharing as well as boosting production capacity under a public health-driven alliance of vaccine manufacturers, dedicated to research, development, manufacturing, and supply of high-quality, efficient, safe and sustainable vaccines and treatments.
- Increase preparedness including health literacy while decreasing vulnerability to future pandemics through reducing health and social inequalities that have undermined the current interventions in controlling this pandemic.
- Establish a clear partnership between the politicians and the health, social, and trade unions’ professionals to build public trust and engagement.
The statement which has been signed by International Physicians for the Prevention of Nuclear War, World Federation of Public Health Associations, International Federation on Ageing, International Hospital Federation, World Organization of Family Doctors, World Federation of Occupational Therapists, International League of Dermatological Societies called on member states to build their strategies on the human rights-based approach to guarantee equal access to the highest attainable standard of health, to build concrete, healthy, socially equitable, and environmentally sustainable solutions for the short and long term.
It is important that the developing countries get to produce medicines and vaccines on their own at affordable costs. There was a time when India was hub of cheap medicines supply not only to developing countries but also countries in Europe. But after the introduction of TRIPS under the World Trade Organisation (WTO) rules the situation changed entirely. Members of the WTO, countries are bound to agree on 18 specific points in the agreement. The Trade-Related Aspects of Intellectual Property Rights (TRIPS) is the most important one in context of the pharmaceutical sector and access to medicines.
(https://www.who.int/medicines/areas/policy/wto_trips/en/)
Under the TRIPS Agreement WTO Members are bound to provide protection for a minimum term of 20 years from the filing date of a patent application for any invention including for a pharmaceutical product or process. Prior to the TRIPS Agreement, patent duration was significantly shorter in many countries. For example, both developed and developing countries provided for patent terms ranging from 15 to 17 years, whilst in certain developing countries, patents were granted for shorter terms of 5 to 7 years. The TRIPS Agreement also requires countries to provide patent protection for both processes and products, in all fields of technology. Before TRIPS, many countries provided only process — but not product patents. Product patents provide for absolute protection of the product, whereas process patents provide protection in respect of the technology and the process or method of manufacture. These clauses created constraints for the pharmaceutical companies to produce generic medicines thus leading to high cost of medicines.
However, TRIPS also contains provisions that allow a degree of flexibility and sufficient room for countries to accommodate their own patent and intellectual property systems and developmental needs. This means countries have a certain amount of freedom in modifying their regulations and, various options exist for them in formulating their national legislation to ensure a proper balance between the goal of providing incentives for future inventions of new drugs and the goal of affordable access to existing medicines. This however requires political will in the leadership of the time.
Dr Vandana Shiva, a crusader for equity in trade practices and abolition of patent laws in medicine and agriculture warned that it is not just the medicines or the vaccines, the Multinational Corporations (MNCs) have patented each and every product. It is astonishing to note that even the bacteria and viruses including the Corona Virus have been patented. Such patenting denies the right of a person, a community or country over its own produce. She has contended the claim of the MNCs that they are doing research and so have the right to earn profit. Most of the research done worldwide is by the Public institutions and through public funding, she says.
Bill Gates who till date had the image of a philanthropist stands exposed as a thoroughly insensitive businessman who wants to make huge profit in this hour of global health crises by denying the transfer of vaccine technology to the developing countries.
This has to be changed through public movements and the governments have to be forced not to work under the diktats of corporations or persons like Bill Gates. The patent rights on vaccines and medicines have to be waived off to save and promote health of the people globally particularly during this crisis of Pandemic. It is high time Indian government rejuvenates the public institutions which produced medicines and vaccines and who have commendable track record of serving the nation during health calamities in the past.
A CRY THAT WAS NOT
Date: 25.05.2021
A CRY THAT WAS NOT
The catastrophic damage caused by the COVID Pandemic has put every person on physical and mental strain. Several families have lost their members. Losing kith and kin leads to biggest stress on one’s mind. No person unless totally emotionless can avoid crying with sorrow and pain of others. The process began from suddenly announced lockdown one year back without consulting anyone or considering the damage to the jobs and livelihood it would cause. The number of people in reverse migration was beyond imagination. People walked on foot, bicycles, rickshaws, autos or any other means they could get. They were herded in the vehicles on exorbitant charges like the animals are carried by the butchers. It is not easy to forget the video of a two years baby whose mother had died on the railway station and the baby was covering her with sheet. The scene was not less heart-rending than the photo of a Syrian child dead at sea shore or the picture of a vulture waiting for the child to die so that it could eat the dead baby during civil war in Somalia. None in the government at the centre was moved by such events albeit the Prime Minster termed the sufferings of the working people as ‘Tapasya’. It is an addition to the vocabulary that sufferings caused due to some other person’s acts are Tapasya.
The 2nd wave has turned out to be much worse. Number of positive cases per day has been more than four times of the last year. Number of dead too is in similar proportion. We are in worst situation in South Asia. People are running in search of Oxygen to save their nears and dears. They are searching for beds. The number of equipment does not match the requirements. In this one year when we had known the course of the disease we failed to prepare. Dead bodies floating in Ganga river was some thing hitherto unknown in a democratic country which wants to be Vishva Guru. Our per capita income fell below Bangladesh which has nearly three times more population density than us and has much less number of industries.
Some people faulted, but 139 crores are meeting the fate and are struggling hard to save lives and to earn living during the lock downs re-imposed. The crisis has been since the beginning of April. But all this left the prime mover unmoved. He was going around the election bound states addressing rallies with pride. It is difficult to imagine how many times he might have rehearsed before pretending to cry for the dead probably after receiving repeated reports of his losing popularity. People of the country are not fools. They give a damn to such gimmicks. That is why so many sections of media reflected people’s views terming the so called act of crying as Crocodile tears.
Crisis have to be faced boldly with logic and scientific bent of mind. India has the history where freedom fighters sacrificed their whole property and lands. They sacrificed their lives. But never compromised with the imperialist tyrants. Such people never shed tears, they stand firm. When one is at a governing position he/she has to be a strength for others; so has to show boldness. Pretending to cry is an act of cover up of failures and cowardice.
Instead of pretending to cry it would have been better to talk to health care workers, the doctors, nurses, ASHA & Aanganwadi workers and others and listened to their grievances and sorted out their issues of concern. Would have paid special attention of the staff working in the COVID wards. Assuaged stress and strain they and their families are passing through. But alas the ministry even did not have data of health workers who had died of COVID. The PM could have won over farmers’ heart by deferring the implementation of the farm laws till the government reaches an agreement with them. He could have held dialogue with workers over their grievances to the new codes. This is a good time to defer central vista project and divert money to Pandemic for buying vaccines.
Mother gets upset when the child is in pain but boldly tries to solve the problem with love and affection. In the poem Cry of the Children, Mrs Browning has brought forward the agony children were passing through in the early industrialization period in England. These children never pretended and so did the poetess. “The Cry of the Children" is a poem by English writer Elizabeth Barrett Browning. It examines children's manual labor forced upon them by their exploiters. It was published in August 1843 in Blackwood's. The PM could have talked of children’s agony as we know hundreds of children die of mal nutrition in our country, and in present times they are loosing their parents being orphaned by dreaded decease Covid 19.
That is why it was not a cry, just another means to try to befool others.
India at worst in COVID crisis in South Asia
Date: 18.05.2021
India at worst in COVID crisis in South Asia
Dr Arun Mitra
Number of COVID cases and deaths due to it is a cause of grave concern. Presently India stands number two in the total number of COVID cases in the world after USA. True that we have a large population and so the number is high, but even a proportionate number comparison with other countries in south Asia is worrisome. We come from same ethnic background, have similar culture, food habits, nutritional status and have same level of inequities in income as well as disparities in the access to the healthcare system.
As on 17th May 2021 out of a population of 139 crore India has recorded 2.5 crore cases and 2.78 lakhs deaths. Pakistan with a population of 22.5 crore has recorded 8.80 lakh cases and deaths 19752. Bangladesh has a population of 16.6 crore and has 7.8 lakh cases and the number of deaths due to COVID is 12181. Like wise Nepal with population is 2.9 crores has 4.6 lakh cases and death 5215. Sri Lanka population is 2.14 crore has 1.45 lakh cases and deaths 981.
As per the above figures India recoded 1812 cases and 20 deaths for each one lakh population. In comparison number of cases in Pakistan 393 cases and 9 deaths, Bangladesh 470 cases and 7 deaths. Nepal has 1569 cases and 17 deaths per lakh of the population. Sri Lanka has 675 cases and 5 deaths per lakh of the population.
During the second surge there is unprecedented increase in the number of COVID cases in our country. As on 17th May we recorded 2.60 lakh cases or 19 cases per lakh population, Pakistan 3232 cases or 1.4 cases, Bangladesh recorded 698 cases or 0.42 cases, Nepal recorded 9198 cases which is 31 cases, Sri Lanka recorded 2456 cases that is 11 cases per lakh of population.
This data from www.worldometers.info indicates a comparison in the proportion of population being taken ill of COVID. As on 17 May 2021 India had nearly 13 time more cases than Pakistan, 44 times more than Bangladesh, 0.60 times of Nepal and 1.6 times of Sri Lanka.
If this data is to be believed then we have to very seriously introspect into the causes of such a catastrophic situation. Countries which we have been calling to be far behind us in economy have fared better in COVID management till date.
It is acknowledged globally that India has high level of expertise in medical science and has several hospitals with advanced care facilities compared to anyone in the world. As a result people have been coming to our country for medical treatment (medical tourism) from across the world including the developed countries for the last over 20 years.
We also have good number of pharmaceutical companies, and have been supplying medicines and vaccines to other countries including Europe. We have already fought several national calamities successfully and even launched the biggest immunization programme of Pulse Polio in the world since 1994. We also successfully managed Plague in 1994 in Surat. With some ifs and buts we also fulfilled health needs of our people during national disasters like Earthquakes, Tsunami, Cyclones, Floods, Landslides and Drought in the last few decades. This has been possible through the health planning in the post-independence period. Our health personnel took active part in developing national health missions like Revised T B Control Programme, National Leprosy Control Programme etc. This means we have sufficient scientific knowledge.
Then where did we fault ?
The above said successes were met with through a coordinated effort between the polity, medical personnel, and concerned citizens groups. But the present day disaster is of catastrophic nature which occurred because of skewed priorities and lack of scientific temper.
Science has never been the centre of focus during the on-going Pandemic. Political interests took over science in managing Pandemic. Ironically, a public health issue was never discussed with public health experts or epidemiologists. All decision making was done in a totally centralized non transparent manner by the Prime Minister himself without any consultation with medical personnel, economists, civil society, elected representatives or even his colleagues in the cabinet.
The government completely ignored the advice of the experts in December 2019 and then in January & February 2020 when they were busy in welcoming the US President and later allegedly in engineering communal violence in North East Delhi. It was only in March 2020 that the Prime Minister suddenly woke up to impose a lock down without consulting any expert. That caused immense damage to the economy of the country and livelihood of the people. Instead of talking with seriousness, he raised gimmicks like banging Thaalies and clapping etc. Unscientific ways such as use of Cow urine and cow dung to control the disease or perform Yagya to push corona virus away were propagated through his bandwagons; unfortunately some of the doctors and scientists too were part of it. The Health Minister who is a trained person in modern scientific medicine and at a very prestigious position in the WHO propagated non proven drug like the Coronil of Baba Ramdev. He even advised people to eat Cocolate, something reminiscent of the French princess advising people to eat cakes if they do not get bread.
As a consequence despite the briefings by the scientists about the upcoming 2nd wave the government was totally unprepared for the second wave because of preoccupation in elections and Kumbh Mela.
In any heath emergency database is important to plan for the present and also the future. But the data of the number of people taken ill and deceased was purposefully fudged. This led to complacency in the society. Government’s acts added to such complacency in the minds of people. The Prime Minister was full of self-praise in the months of January and February even at the international forums.
There was no definite strategy about immunisation programme. That is why the vaccination schedule is being changed every now and then. The Public sector units in pharmaceuticals and vaccine production have been closed even though they have a praiseworthy track record of participation in national health programmes. We failed to procure sufficient number of vaccines for our people on time.
Not a word of empathy for those taken seriously ill or deceased from the mouth of Prime Minister who is always vocal even on trivial matters. The government is not ready to divert funds allocated for Central Vista project to Pandemic. Any one questioning the approach of the government is being threatened with prosecution. This is against all norms of democratic values of our great nation.
Health services in the last few years have been corporatized. That is why even the middle classes have been feeling the pinch of corporatized healthcare. Only public health services with more emphasis on the preventive aspect and allocation of sufficient budget for primary, secondary and tertiary prevention is the way out for future.
LESSONS FROM PANDEMIC- BUILD HOSPITALS, NOT BOMBS
Date: 29.04.2021
LESSONS FROM PANDEMIC- BUILD HOSPITALS, NOT BOMBS
Even though the world is into the deep crisis of COVID pandemic, the situation in low and medium economic group of countries with limited resources is precarious. For the first time there is a realization that we need huge resources and meticulous planning for universal healthcare system where each section of the society in all the countries around the globe gets required facilities and we do not suffer inequity in healthcare. High cost of care is affecting the availability of oxygen and medicines to the economically moderate and poor sections. Black marketing is making it worse. There is a situation like health anarchy in the country with people running from door to door for want of required medical assistance including Oxygen and medicines. Over and above the Chief Minister of Uttar Pradesh has warned of strict action even NSA against those who create panic of oxygen. Insensitivity can be gauged easily when the Chief Minister of Haryana says that we should not talk of the dead because they will not come back. Now there are reports that less than 20% of the declared number of oxygen plants under the PM cares fund were installed in last one year.
These are serious matters which need statesmanship and vision, not gimmickry or chest thumping and cheap politics. There is need for serious introspection as to the nature of spending we have to do. Concerned with this, organisations of doctors of South Asia affiliated to International Physicians for the Prevention of Nuclear War (IPPNW) recently came out with a clear cut opinion that the countries of South Asia specially should immediately drastically bring down the expenditure on the arms race, completely shun the nuclear weapons, declare the region as nuclear weapons free zone and divert money from arms race towards health. They declared that it is proven beyond doubt that medical science has no remedy to offer in the event of nuclear fallout. It has been estimated through scientific studies that even a limited nuclear exchange with 100 Hiroshima size nuclear weapons between India and Pakistan will put over two billion people at the risk of starvation and death globally.
The International Campaign to Abolish Nuclear Weapons (ICAN) in a recent study has come out with data on health capacity in Delhi and Islamabad. Predicted capacity after nuclear attack in Islamabad is 730 doctors and 373 nurses and midwives. In such situation 264870 people are likely to be injured. That means every doctor in Islamabad would be responsible of treating 363 people simultaneously. Likewise with the health capacity available in Delhi in the eventuality of a nuclear attack every doctor would be responsible for treating 102 people simultaneously.
Going by the history of nuclear catastrophe in Hiroshima on 6th August 1945 as reported by Dr Marcel Junod from Red Cross, very few health workers were willing to go to the radiation affected areas. We have developed PPEs for protection of the health workers from the SARS COV-2 but it would be impossible to develop such equipment for protection from the nuclear radiations.
Crisis is grave and real as both India and Pakistan have estimated number of 150 nuclear weapons each. They are the only two nuclear weapons possessing countries who have been on hot and cold wars since long. Even the armies of the two countries have faced each other in high alert. There is no indication of thaw in the tension between them in near future. It is high time the nuclear weapons possessing countries realize gravity of the situation. Doctors and other peace loving sections of the society have to come forward to impress upon the governments of India and Pakistan to reach agreement for the region to be nuclear weapons free zone. The Treaty Prohibiting Nuclear Weapons (TPNW) passed by the UNO, which delegitimizes the nuclear weapons is an opportunity. Only Bangladesh has ratified the treaty while Nepal has signed but not ratified it. The non nuclear weapons possessing countries of the region can play significant role in calling upon both India and Pakistan to become nuclear free.
Lack of seriousness on COVID
Date: 20.04.21
Lack of seriousness on COVID
Dr Arun Mitra
The Prime Minister has woken very late in appealing to the pilgrims at Kumbh to go back and that Kumbh should be symbolic now. The damage has already been done. Even if those at Kumbh at present start to vacate the place, it may take several days before the area is completely free. These people have come from all over the country and now returning home they will carry the virus to the rural areas as well which have been having low incidence of the disease till date. The scientists had already warned about the surge of COVID in March and it would be naïve to believe that the Prime Minister was not briefed on this and the danger ahead if such huge gathering takes place in Haridwar. Not only that the site lacked required facilities to test and to treat. The rallies in West Bengal totally without following COVID norms has been seen by everyone. When the head of the government defies his own edict how can one expect COVID appropriate behaviour from the ordinary masses who always view the leaders as role models and try to follow them.
In fact there has been lack of concern and scientific approach towards the COVID crises. It has been more of gimmickry, political oriented and self-chest thumping. The whole thing started from the total unpreparedness and callous attitude of the government when the spread of COVID was known globally and the WHO had issued warnings. Months of December 2019 then January, February and March 2020 were wasted as the government was busy in other affairs. It has now become clear that the lockdown imposed on 24th March 2020 was without consultation with the health professionals, economists, the cabinet or the executive. This has been revealed by the BBC which got the information through several RTIs. The government has not denied BBC’s report. This means that it was totally authoritarian and unscientific decision on the part of the Prime Minister without considering any benefit that the lockdown would give or the harm it would do to the jobs, livelihood, food security and life as a whole of the working people. No wonder it led to unemployment of more than 12 crore people and economic set back to the vast majority. Sadly during this last one year the Prime Minister has not uttered a single word of empathy for those who suffered while walking to their native places during the lockdown. However during that period, according to Oxfam, the average increase in Ambani’s wealth in just over four days represented more than the combined annual wages of all of Reliance Industries’ 195,000 employees. (1)
The scientific experience has shown that lockdown does not help in eliminating the disease. It only gives you time to prepare. This is evident from the fact that at the time of lockdown there were only few hundred cases, while we found persistent increase in number of cases thereafter.
It was sickening to hear the Prime Minister saying in his speech on 25th March that we had won Mahabharata in 18 days and will defeat COVID in 21 days. Such unscientific utterings led to complacency in the society thinking that soon we will be free of disease. This type of gimmicks were repeated from time to time by his band wagon. Lot many myths were spread about treatment of COVID. People were advised to drink cow urine as a cure and the use of Panchgaya which is a mixture of cow dung, cow urine, milk, curd, jaggery, ghee, banana, tender coconut and water were propagated to be effective. These absurdities were spoken by several well-meaning leaders including the west Bengal chief of BJP. Soon there was introduction of Coronil by Baba Ramdev a so called medicine developed without any evidence. Worst scenario is that it was promoted by none other than Dr Harshvardhan, Union Health Minister who is an ENT Surgeon trained in modern scientific medicine.
When the vaccines became a global issue, the Prime Minister thought of taking lead and become world’s first to develop vaccines. He asked scientific community to develop vaccine before 15th August 2020. This forced director ICMR to issue strict directives on this. He however retreated after being criticized by the scientific community. Alas the Prime Minister’s dream to announce the vaccine from Red Fort was not fulfilled. Then he decided to send vaccines to other countries without realizing our own needs.
Some very dangerous events occurred. The Tabhighis who had gathered in a Masjid in Delhi in a few hundreds were labelled as Corona Bomb and communal hatred was spread against Muslims. They got relief ultimately from the court. But the situation had already been communalised. In contrast we are witnessing lakhs of people at Kumbh who are super spreaders of the disease.
The government kept on boasting about the check on COVID successfully in India as a major gain of the BJP government in general and PM personally in particular. Now we are seeing the surge and shortage of basic things to manage the pandemic, the beds, oxygen, vaccines etc. It was very sorry indeed when the Minister failed to produce any data on number of doctors who died fighting COVID, and for whom the PM had asked our air force to shower flowers.
The time is not lost. Much can be done to assuage the sufferings of the poor. While the upper classes will enjoy the present short lockdowns by eating delicious foods at their home the poor are again seen rushing back home out of real panic based on their experience one year back. They would prefer to die of COVID than starvation. So are the farmers sitting at Delhi borders. Instead of asking them to vacate the place the government should address to their issues.
Health education is a leading factor to prevent, control and treat diseases. State and the people both are responsible for this. Whereas the common man is not expected to hold knowledge on this, the government has sufficient infrastructure and departments who are supposed to design the health education programme and propagate down to the common citizens. For any health education programme to be successful honesty of action is important in the concerned machinery right from ministry to the executive. Such programmes have to be evidence based and promoted by the professionals. The people must have trust on the educators. It is therefore important that health personnel take lead and guide the polity who should follow their advice as people have more trust on the health professionals when it is an issue of health. The role of several politicians has been more of gimmickry and political interests rather than health concerns even during this serious COVID Pandemic.
Culture of violence is unending, inhuman and a potential threat of escalation
Date: 07.04.2021
Culture of violence is unending, inhuman and a potential threat of escalation
Dr Arun Mitra
Global community is rightly outraged at the killings of over 500 peacefully protesting people by the Military Junta in Myanmar. Not long ago the Rohingyas were forced to flee by the violent mobs. People are again running away from their homeland and are trying to take shelter in India and Bangladesh. That this is happening in a country inhabited by the Buddhists is totally beyond comprehension, because Buddhists confess, preach and are supposed to practice non-violence. We are more concerned about Myanmar because they are our neighbour and migration of population to our country and other south Asian countries poses several problems. Migrants are forced to live in subhuman conditions in the refugee camps. There is always reaction of the local people against the influx of foreigners. Such reaction is exploited by some conservative groups for their vested political and economic interests.
It is not just in Myanmar but all of our region, the South Asia, we are witnessing culture of violence growing. Violence is being committed in the name of religion, caste, ethnicity, gender etc. Situation gets worse when state is overtly or covertly supportive of such acts. Lies are spread against particular communities, castes, ethnic groups who are demonized. Their killings are either condoned or justified in the name of some cooked up historical events.
We have witnessed unashamed violence and denial of rights to women in Afghanistan on the pretext self-proclaimed values of religious scriptures. In Pakistan the Blasphemy law has been used to punish those whom the perpetrators of violence think to be enemies of Islam. In some parts honour killing is rampant and so is violence against minorities. Such forces are so powerful that they dictate terms to the government even if it wants to take some positive measures. We have seen extreme violence in Sri Lanka in the name of ethnicity. Tension still persists. Nepal too has been a centre of violence for other reasons. In Bangladesh also we are witnessing fundamentalists taking to streets.
India which developed as a secular democratic country is moving in that direction. Laws like CAA and Love Jihad are passed to prevent mixing of people and create a monolithic society. There have been several incidents of engineered riots and violent mobs killing people of minority communities. The minorities are disgraced and blamed for all the ills of society including spread of COVID as we witnessed when propaganda was unleashed against Tablighis for spreading COVID. Christian Nuns were recently detrained after being blamed for religious conversions by some unscrupulous groups. Any one differing with them is termed as anti-national and violence against them is justified openly even by the Ministers in the central government. Worst was a case of Police Inspector Subodh Kumar Singh who was murdered by gangs but the killers instead of being punished were eulogised and rewarded. Such groups indulge in violent acts against their own community people and intimidate them to keep shut. Such violent acts have not remained limited to the people from minorities but even other marginalized sections of society. There has been surge in violence against Dalits in the last few years.
Pushing people into hunger and deprivation as we saw when lakhs of workers had to walk for hundreds of Kilo meters on foot to reach home after sudden lockdown one year back which left them without food, job, means of livelihood or place of stay is another form of violence. Ironically not a word has been uttered in their sympathy by the Prime Minister or any of the higher up in the government even after one year. This behaviour is expected only from political salesmen and not statesmen. There is worldwide experience in history that people with mediocre intelligence and narcissist grandiose personality who are propped up by the corporates stoop too low to keep themselves in power.
In such situations democratic ethos of the people are crushed. We are seeing this in the form of anti-farmer laws, changes in labour laws and even education policy in our country during the times of COVID crisis when we need to build a more humane society.
Such situations have been seen globally. In Rawanda violence between Tutsi and Hutu tribes killed lakhs of innocent people in the name of ethnicity. There are reports that in some cases even the married couples killed their spouse after being swayed away by such slogans. This is also true of the Nazi government who banned marriages between Christians and Jews. Love Jihad campaign is of similar variety.
However this may not remain limited and the perpetrators of such acts too have to bear the brunt of violent acts by those being suppressed and denied rights. Violence against the BJP leaders in Punjab and Haryana is an example. Such situations push the society into anarchy.
Violence may also not remain limited to some area or country. The internal strife may be used to indulge in external aggression. In such situations there is always a danger of large scale war which further kills many more besides affecting economic development and further marginalizing the already deprived. Such deprivation may again be a cause of violence. So the violence becomes an unending phenomenon and a serious humanitarian crisis. With the nuclear weapons any further escalation could be catastrophic. It has to be stopped, earlier the better !
In the ‘Notes on Cultures of Violence, Cultures of Caring and Peace, and the Fulfillment of Basic Human Needs’ Ervin Staub - University of Massachusetts at Amherst has outlined what is required for individuals, groups, and nations to not act violently, but instead to care about and promote others’ welfare? What are the cultural, social, and psychological requirements for a peaceful world that nourishes the human spirit and helps individuals develop their personal and human potentials? Influences that generate violence, have to be put to end. Cultural and societal conditions that frustrate basic psychological needs make violence more likely, whereas conditions that help fulfill these needs in constructive ways contribute to the development of peaceful relations and fully human lives.
Coping up with Quarantine
Date: 04.04.2021
Coping up with Quarantine
Dr Arun Mitra
With a linear fall of Corona infection cases not only in our country but around the globe a complacency had developed about the preventive measures. Life cannot come to a standstill but when the situation is not conducive some changes in the lifestyle need to be made. As there is a surge in the cases of COVID the whole discussion about prevention of the disease has started again. With new variant strains coming in we find some people getting infected for the second time. With the coming of vaccine there is a renewed hope among the population, even though there is controversy over the efficacy and the time period for which immunity will be provided by the vaccine. The experts give us hope that vaccine may not give complete protection but if someone is taken ill after the vaccination then the severity of diseases is minimized and life is saved. This has given some confidence among the population after an initial hesitancy in getting vaccinated.
Much has been said about the preventive measures like keeping physical distance, washing and sanitizing hands, using masks and staying away from the crowded places etc. but not much attention has been paid to the stress which the patient and the family pass through. Even though percentage of death rate is less than 2%, the tension and stress in the family suddenly escalates. Since even the doctors cannot predict the course of disease, uncertainty adds to the problem. We however know that the elderly and those with co-morbid conditions are more vulnerable to become serious. The uncertainty of the course of the disease is a cause for mental stress the patient as well as the family pass through. Therefore it is important that this issue is discussed more and the fears are allayed.
The family has to be explained that the number of people getting serious is very little. Therefore if the person is not having any co-morbid condition and is not in highly vulnerable age group the chances of his coming out of the disease are very bright. This gives lot of confidence to the whole family and the patient. Even those in the vulnerable age group and with co morbid conditions are to be given confidence and hope that if they take care they would remain alright.
When the reports come positive the patient is advised to go into quarantine for 17 days. This adds to the already stressful mental state of affairs of the person. Beside the illness the person gets worried of the long duration to stay alone.
This is a crucial period but a meticulous scientific planning soon reduces the stress and one learns to manage these 17 days. One should not count 17 days, but one day at a time. After the report comes there is some time during which one should collect the essential items and other things like mobile phone, laptop, pen, note book and books of interest etc. These will help in planning the period and keep you connected with the outside world.
During the quarantine it is important to keep regular oxygen check before and after a six minute walk minimum of four times a day. This gives us clue of the lung functions at that particular moment.
It is advisable to sleep with belly below and back up. This helps in clearing lungs. Sleeping on one side also helps. The patient should undertake breathing exercises in the morning hours. This helps in giving strength to the lungs.
In the day time one should spend sufficient time in reading news papers, books of interest and also checking your emails and chatting with your friends. Video conferencing helps in connecting better and reduces loneliness. One should try to live in a room with balcony and spend some time in watching the people moving around. If there is attached kitchen with the room one should try to cook if the health permits. This helps in fulfilling your taste needs as well as nourishment. Light exercise is important to keep the joints free in mobility.
It helps to watch entertainment programmes on the television.
As the condition improves and fever has gone down then one can do some exercise.
It is important for the others to stay away from the patient’s room when the food is given from outside but the patient should maintain good hydration by taking sufficient amount of liquids and healthy diet as advised by the doctor.
Best is to design your own day as you are the best person who knows your interests and daily requirements. By keeping oneself busy, soon one will find the hidden skills coming out which give pleasure because you were not able to carry out those earlier because of several reasons. It is always good to share daily experience with someone whom you trust.
Remember you are not in jail but in quarantine in your own home. Read about those who have lived in isolation in solitary cells in jails for several years but never lost hope. Large number of freedom fighters in cellular jail in Andeman Nicobar islands spent their prime youth in tough times but kept themselves strong. Nelson Mandela spent 18 years in one cell in loneliness but never felt alone instead continued to fight to victory.
Ratification of Treaty Prohibiting Nuclear Weapons an enormous win for planetary health
Date: 27.10.2020
Ratification of Treaty Prohibiting Nuclear Weapons
an enormous win for planetary health
It will pave way for stronger movement
for nuclear weapons abolition
Dr Arun Mitra
It is unfortunate that an event that concerns the very existence of life on earth is hardly under debate and is poorly reported. With Honduras submitting its document of ratification to the UNO on 24th October, the Treaty Prohibiting Nuclear Weapons (TPNW) have now been ratified by 50 countries. This fulfils the criteria for its entry into force. The treaty is now set to be operational within 90 days from ratification, that is on 20th January 2021 the treaty will become international law binding on the states that have already ratified it and those which subsequently ratify the treaty. This is a great step forward to eliminate nuclear weapons and save the mankind from extinction. This is all the more important as several parts of the world are now under low level conflicts and some parts of the world witnessing full scale war with the blatant intervention of big powers. Any escalation could trigger the use of nuclear weapons.
We have witnessed atomic bombing of Hiroshima and Nagasaki in Japan on 6th and 9th August 1945. The two incidents led to the death of over 200000 people and destituted many more. Blast was so powerful that large buildings also crumbled. Temperature generated by the bombs was so high that even the concrete buildings around the epicentre could not withstand that and melted what to talk of the people and other life systems in that area. There was total chaos in the two cities with no one to take care. This was reported by none other than Dr Marcel Junod from the International Red Cross who was the first foreigner to visit Hiroshima in September 1945. Radiations all around made the situation much worse and the effect has been passed to the next generation in form of malformed babies and cancers.
All this has been testified several times by the Hibakusha, the survivors of atomic bombing.
There are nearly 2000 nuclear weapons on high alert. Studies have shown that even if one per cent of the existing nearly 14000 nuclear weapons are used, there will be global nuclear icing leading to crop failure, nuclear famine and will put over two billion people at risk . Any nuclear exchange between the two major nuclear powers could be an end of human civilisation built through thousands of years of human labour.
Situation now is so complex that even if the states decide not to use nuclear weapons, their being used under natural catastrophe, use by the terrorist groups or the cyber criminals cannot be ruled out.
The TPNW is an opportunity which the global society must utilise. The nuclear weapons possessing countries are already spending huge amounts in further updating and strengthening their nuclear arsenal. The US has shown no intention to carry forward the START-2 which is to expire on 5th February 2021. Moreover that is a bilateral treaty. The TPNW is a global treaty passed by the UNO on 7th July 2017with 122 votes in favour and only one against and one abstention.
The whole process has not been easy. The peace forces around the globe have been advocating for a comprehensive treaty which would lead to nuclear weapons abolition. The International Physicians for the Prevention of Nuclear War (IPPNW) was awarded Nobel peace prize in 1985 for highlighting the Humanitarian Consequences of nuclear war. It took initiative to unite all the peace movements under the banner of the International Campaign to Abolish Nuclear Weapons (ICAN). Adoption of treaty by the UNO was largely a result of massive campaigning, lobbying and advocacy by the ICAN who were able to convince the governments of different countries to join the treaty. For this the ICAN was bestowed with Nobel Peace Prize in 2017. Passage of treaty despite immense pressure by the nuclear weapon countries on the smaller states is a moral defeat for the big nuclear powers.
The disastrous effects of the nuclear weapons have no cure. The World Health Organization (WHO) and the Red Cross have now confirmed that emergency services would not be able to respond in such a catastrophic health emergencies. Prevention is the only answer. TPNW is an opportunity.
We have treaties that prohibit the use of Landmines, Cluster Munitions, Chemical Weapons and the Biological Weapons. These treaties have been holding good and helped save the mankind. The nuclear weapons are much more deadly. Therefore it is imperative that the TPNW must be respected and joined by all the countries of the world. The nine nuclear weapon countries out of which five are in Asia bear special responsibility in this situation.
Dr Arun Mitra
MBBS; MS (Consultant ENT Surgeon)
Co-President
International Physicians for the Prevention of Nuclear War (IPPNW)
139-E, Kitchlu Nagar
Ludhiana – 141001
M: 9417000360
Government’s Insensitivity towards drug price control sceptical
Date: 12.10.2020
Government’s Insensitivity towards drug price control sceptical
Dr Arun Mitra
Statement by the Minister of Chemicals & fertilizers DV Sadananda Gowda in the Parliament that the Union government has no plans to make the Uniform Code of Pharmaceutical Marketing Practices (UCPMP) mandatory is very disappointing. He said this in reply to a question by K. Muraleedharan, Congress MP from Kerala in the Lok Sabha. His reply caused utter disgust as the matter concerns the health of the people.
The Pharma companies spend huge amount of money for promotion of their products. Much of this is spent in organizing medical conferences in the name of continued medical education programmes. This involves travel expenditure to the doctors, lavish stay in five star hotels and sometimes even foreign trips for the whole family. This ultimately adds to the cost of drugs. Sensing this and on the demand of several civil society organisations the government formed a UCPMP. This was prepared by the Department of Pharmaceuticals, Government of India. But it was said to be voluntary for some time. A letter of the ministry of chemicals and fertilizers, department of pharmaceuticals dated 12 December 2014 had mentioned that this will be voluntary for a period of six months with effect from 1st January 2015 and will be reviewed thereafter.
The voluntary implementation of the code however did not yield desired results. H.N. Ananth Kumar, the then Union Minister for Chemicals and Fertilizers, had said in the Rajya Sabha in June 2016 that the voluntary code introduced in 2015 had not yielded desired results and that the government would make it mandatory. Pharmaceutical companies did not take any tangible steps to implement the code. Clauses 6 and 7 of the code prohibit the Pharma companies from giving freebies to the medical professionals. But despite several representations from the public health activists and civil society groups the practice has not stopped. The Indian medical council (professional conduct, etiquette and ethics) regulation also warns the doctors against such practices to receive financial benefits in any form including for attending education programs. Taking cognizance of the matter even the central board of direct taxes (CBDT) in its Circular No. 5/2012 [F. NO. 225/142/2012-ITA.II], Dated 1-8-2012 had said that any such expenditure by the Pharma company will not be considered for tax deductions.
As per the guidelines in the UCPMP the companies have to adopt stipulated procedures laid down by the competent authority for involving doctors in their research projects. Several research works are not carried out in accordance with the laid down procedures. There are instances when the companies paid money to the doctors for the work which they had actually not done. It is a common practice that the companies approach doctors to do surveys highlighting efficacy of a particular drug produced/marketed by their company. These companies then use doctor’s reference including her/his photograph in their promotional literature. The UCPMP prohibits such work.
The U turn on making UCPMP mandatory raises suspicion of lack of will on the part of the government to keep its commitment and smells of some unfair deals between the government and the Pharma companies. When a delegation of the Alliance of Doctor for Ethical Healthcare had submitted its opinion to the drugs price regulating body, the National Pharmaceutical Pricing Authority (NPPA) in February 2020, they were told that the NPPA has no jurisdiction to check the companies. This has to be done through changes in the law at the ministerial level.
The high cost of drugs seriously affects the healthcare of our population. As nearly 67% of out of pocket health expenditure in our country is on drugs, this pushes 6.3 crore population below poverty line every year, a fact admitted by the National Health Policy document 2017. But the government has not taken any tangible steps to control the trade margin which many a times has been found to be 700 – 800%.
A committee was formed on high trade margins in the sale of drugs to go into the whole issue on 16 September 2015. This committee submitted its report on 9 December 2015. But it is now almost 5 years that the government has been sleeping over it. Even though this committee also did not spell on how the cost price of the drugs should be calculated but it took serious note of the excess trade margins. They pointed out that in some cases the trade margin is as high as 5000%. The government’s sleeping over the report for a such a long period raises scepticism over its intentions.
The pricing of the drugs should be calculated on the basis of the cost involved in its production. The market based pricing calculating the average of the highest selling drugs is totally a flawed approach.
It is high time the government makes the UCPMP mandatory and comes out with an effective control on drug prices.
LEST WE FORGET!
Date: 22.09.2020
LEST WE FORGET!
Dr Arun Mitra
Co-President IPPNW
Mobile: 9417000360
Twitter: @DrArunMitra51
The harrowing experiences shared by the Hibakusha, the survivors of the atomic bombing at Hiroshima and Nagasaki, make everyone shiver and think how can human being stoop so low as to develop bombs to kill their fellow beings in such large number in such a brutal manner? The testimonies by them about the devastation caused in the two cities and the socio economic problems, in addition to the health issues, faced by them are nothing but a nightmarish experience to listen. The information by Dr. Marcel Junod, a Swiss doctor who was the first foreigner to visit Hiroshima in September 1945 gives us a glimpse of the destruction. It has been estimated that these bombs killed a total of 213,000 people immediately. The radiation effects have continued till date on the generations that have grown since. The deadly bombs destroyed 42 of 45 hospitals, killed 272 of 300 doctors and 1684 nurses out of 1780 perished. People were burnt to death, buildings collapsed like cards and there were radiations all around.
The memories of the bad events of past are a rejoinder to never let such mistakes be repeated. Therefore some days have been marked to warn and remind the people from time to time. The 26th September, declared by the UN as the International Day for Total Elimination of Nuclear Weapons is not only to remind us of the worst ever destruction in human history, but also to pledge to avert any such happening in future.
The United Nations was founded On 24TH October in 1945 after the Second World War by 51 countries committed to maintaining international peace and security, developing friendly relations among nations and promoting social progress, better living standards and human rights. (1) Global nuclear disarmament is one of its major goals. The UN General Assembly (UNGA) established the Atomic Energy Commission to make specific proposals for the control of nuclear energy and the elimination of atomic weapons and all other major weapons adaptable to mass destruction. It continued several diplomatic efforts in that direction. This also strengthened peace movement globally.
As a result of peace movement there have been treaties in the effort for reduction of nuclear weapons. The Strategic Arms Reduction Treaty (START -1) is one such very important treaty between George Bush and Mikhail Gorbachev. The treaty was signed on 31 July 1991 and entered into force on 5 December 1994. The treaty barred its signatories from deploying more than 6,000 nuclear warheads atop a total of 1,600 inter-continental ballistic missiles (ICBMs) and bombers. START negotiated the largest and most complex arms control treaty in history, and its final implementation in late 2001 resulted in the removal of about 80 percent of all strategic nuclear weapons then in existence. (2)
New START treaty was signed in Prague by United States President Barack Obama and Russian President Dmitry Medvedev. Following ratification by the U.S. Senate and the Federal Assembly of Russia, it went into force on 26 January 2011 (3). But there have been difficulties in it. As a statement of Deputy Foreign Minister Russia Sergei Ryabkov published in the media on 22nd September ‘that the conditions setup the US administration are impediment in extending the New START Treaty’. It is an unfortunate development. (4).
As per the information from different sources there are somewhere between 14000 to 17000 nuclear weapons on earth. All the nuclear weapons possessing countries have separate budget allocations to upgrade their nuclear stockpiles. Presently nine countries USA, Russia, UK, France, China, Pakistan, India, Israel and North Korea possess nuclear weapons. There are many others who have potential to develop their nuclear arsenal. Nearly half of the world’s population lives in counties which either have such weapons or are members of nuclear alliances (5).
The nuclear weapons possessing countries take the alibi of nuclear weapons as the weapons of deterrence. But they forget that the very presence of these weapons poses a potential threat of their being used at any time. Moreover the expenditure on their upkeep is at the cost of the public health needs globally. Despite that both India and Pakistan posses nuclear weapons, the two countries went to war at Kargil in 1999.
There have been several achievements to the credit of the global peace movement. There are five Nuclear Weapons Free Zones in the world. The Latin America negotiated the Treaty for the Prohibition of Nuclear Weapons in Latin America In 1967 known as the Treaty of Tlatelolco, and established the first nuclear weapons-free zone (6).
The South Pacific became the second nuclear-weapon-free zone, the Treaty of Rarotonga in 1985. South Africa voluntarily renounced its nuclear weapons programme in 1991. Belarus, Kazakhstan and Ukraine voluntarily renounced nuclear weapons in their possession following the dissolution of the Soviet Union. In 1995 Southeast Asia became the third nuclear-weapon-free zone, the Bangkok Treaty. In 1996 Africa became the fourth nuclear-weapon-free zone the Pelindaba Treaty. Central Asia became the fifth nuclear-weapon-free zone - Treaty on a Nuclear-Weapon-Free Zone in Central Asia.
The efforts of International Campaign to Abolish Nuclear Weapons (ICAN), a brain child of International Physicians for the Prevention of Nuclear War (IPPNW) bore fruits after long and hard campaign. On 7 July 2017, the Treaty on the Prohibition of Nuclear Weapons (TPNW) was adopted. It is the first multilateral legally binding instrument for nuclear disarmament to have been negotiated in 20 years. The treaty has already been signed by 85 countries and ratified by 46 countries; only four short of its entry into force.
True that all global effort is now directed towards tackling COVID. We will succeed in that soon. But Nuclear weapons are our own creation. Barring the Military Industrial Complex, they serve no one’s interest! Time is now to dismantle these weapons. A study by the IPPNW that even a limited nuclear exchange between Pakistan and India would put over two billion people at risk is a warning. The only true guarantee against the use of nuclear weapons is their total elimination. The Treaty Prohibiting Nuclear Weapons is an opportunity.
References:
- https://www.un.org/un70/en/content/history/index.html#:~:text=The%20United%20Nations%20is%20an,living%20standards%20and%20human%20rights.
- https://www.jatinverma.org/start-treaty
- https://en.wikipedia.org/wiki/New_START
- Indian Express 22nd September 2020; Page-10
- https://www.un.org/en/observances/nuclear-weapons-elimination-day
- https://www.un.org/en/observances/nuclear-weapons-elimination-day
Doctors too have the right to dissent
Date: 14.09.2020
Doctors too have the right to dissent
Dissent and different views are always strength of democracy and essential for development of any society. Unfortunately there is increasing intolerance to Dissent by those at the helms of affairs. This is not limited to one part of the world or any set of people. Even those who save the life of others are not being spared. Nobel Laureate Dr Denis Mukwege, who has worked for decades with great courage and compassion to address the needs of survivors of sexual violence has been getting threats to his life. He has been opposing the use of sexual violence as a weapon of war, in the strife ridden Democratic Republic of Congo (DRC) and around the world. In 2012 he faced a deadly assault in which he narrowly escaped but his guard was killed. Undeterred he never gave up and is continuing to raise his voice vociferously. He has operated upon hundreds of such patients and given them a new lease of life both physically and mentally. For his work he was awarded Nobel Peace Prize in 2018 along with Nadia Murad. Threats to his life have increased recently. Several Health activists and Nobel Laureates including the International Physicians for the Prevention of Nuclear War (IPPNW) Nobel Peace Prize awardee 1985 and then as a partner of International Campaign to Abolish Nuclear Weapons (ICAN) in 2017 have in strong words condemned such cowardly acts and have extended all support to Dr Mukwege.
There are reports of onslaught on doctors in Turkey. Doctors who called war a “man-made public health problem” received jail sentences, in the government-led assault on the Turkish Medical Association last year.
In India in the state of Punjab many health personal faced threat and were attacked during the terrorist violence in the decade from 1980 - 1990. Some of these health activists preached against the violence while there were others who were attacked for extortion. They suffered at the hands of both, the government and the terrorists.
But recently such threats form the state have increased in our country. Dr Kafeel Khan, who worked in Gorakhpur and treated the cases of encephalitis, was charged by the authorities for raising voice against lack of oxygen supply and other basic equipment which led to death of several children. Even though he was exonerated by the local enquiries twice, he was not taken back to the job. Not only that, he was booked under National Security Act (NSA) for addressing a rally at Aligarh on the charges of inciting, communal hatred and violence. In a strong worded judgment the Allahabad high court, while relieving him of all charges, has warned those who had booked him under the NSA for complete dereliction of duty and constitutional oath. Dr Kafeel has appealed to the government to take him back to the job as now he has been discharged by the high court. But the government has not responded so far.
Likewise Dr Anwar who helped hundreds of patients from all communities irrespective of socio economic status and financial considerations during the engineered communal violence in Delhi in the end February has been named in the list of those who in the eyes of government abetted communal violence.
Dr Sudhakar Rao from Andhra Pradesh was suspended from the job when he raised the issue of lack of regular supply of PPEs during the COVID. After some time when he again raised the issues he was stripped off and dragged by the police. It was later said that he is mentally unstable. To drag a mentally unstable person like this is even a bigger crime because such patients have to be dealt with more empathy and sympathy than others.
It is a matter of anguish that the health workers have been looked upon with suspicion at some places as spreaders of COVID infection. A doctor couple in Delhi had complained that the people living in the society where they have their house were against them just because they are on the COVID duty and they feared that this couple will infect them too. Some nurses were not allowed to enter their place of stay fearing that other persons in the locality will cath infection. The health workers engaged in difficult tasks need appreciation and encouragement. But such incidents and in human behavior discourages them. This can have long lasting effect on their behavior which may affect the psychological build up of their children.
There have also been incidents when the doctors had been attacked by the mobs and injured seriously just because they thought that their ward has not been treated well.
Whatever may happen, it is the moral, ethical and professional duty of the doctors to continue to work for the betterment of society. The Red Cross, the Doctors Without Borders are the organizations which show the way. In the Sikh history in India Bhai Ghanhaiya is a well known figure who gave water to wounded soldiers from both sides of the army despite objections by some of his mates. But Guru Gobind Singh ji appreciated his humanly task.
Let the government and the society realise that doctors too have the right to dissent and express their opinion which must be given due respect and consideration and not treated with violence by the people or the state.
The National Digital Health Mission will be another mechanism for surveillance by the state through personal data collection on health
Date: 10.09.2020
The National Digital Health Mission will be another mechanism for surveillance by the state through personal data collection on health
Will in no way help in improving health of our people
Dr Arun Mitra
Healthcare has always been a concern in our country, but lately the people are more sensitised towards it. This is because of the spread of COVID which is taking toll on the lives of many people from all socio economic strata. In addition the repeated lockdowns have affected the day to day life and economy. Crores of people have lost their jobs/livelihood. As a result they are unable to meet their healthcare requirements. People have started questioning the healthcare system in our country. It appears that it is in this background the Prime Minister announced National Digital Health Mission in his independence day address to the nation on 15th August 2020.
The mission will singularly focus on collection of data of all the citizens on their health status. On the face of it appears very attractive and useful. The government’s contention is that through this data collection they will be able to frame policies for the healthcare in the time to come.
That the draft of the National Digital Health Mission (NDHM) was kept in public domain for opinion from the people for only seven days shows government’s reluctance to discuss the issue of such immense importance. It is only after lot of inputs from the health activists that this period was extended by just seven days.
As per the draft health care providers will collect data which will then be shared with the state health authority and the central health authority. As per the medical ethics a patients' health status is a confidential issue and no doctor should share it with anyone unless permitted by the patient himself/herself. By sharing the data with three parties this basic ethical issues has been completely ignored and flouted. In this world of cybercrime where even the prime minister's twitter account was hacked for some time, how can you guarantee that the data will not be leaked.
This is blatant interference with the fundamental right to privacy. India has been debating the Draft Personal Data Protection Bill for the past two years. Under the bill, data relating to health, finance, genetics etc. is considered ‘sensitive personal data’ as its disclosure can cause serious harm to individuals and institutions. Extensive due diligence is required by all stakeholders to ensure that a right balance is created between the public healthcare needs and the legal rights of the citizens, specifically the right of privacy and data protection.
The health care provider will give consent for his/her enrollment in this mission to collect the data. Similarly the consent of the principal, the person/individual, will be necessary to collect data about his/her health status and share it with the state of the central health authorities. There is also provision that the health care provider or the principal will have the right to opt out of this mission. But according to the draft the person’s record isn't erased after they have opted out but it is simply locked. Moreover it cannot be erased for a certain period of time. The government of India doesn't have a good track record with cyber security, and the strategy doesn’t allay one’s concerns.
It is said that the data will be totally confidential with no scope of leakage or sharing with anyone. The job of compiling/managing the data will be given to private setups thus completely negating the security issue. Thus a person's privacy will be completely undermined under this mission. There is no provision of sufficient safeguards against commercial exploitation of Sensitive Personal Data that may be caused by private entities that will be linked to public entities under this system. These include insurers, pharmaceutical companies, and device manufacturers.
There is also provision to collect highly sensitive personal data like financial information such as bank account or credit card or debit card or other payment instrument details; physical, physiological and mental health data; sex life; sexual orientation; medical records and history; biometric data; genetic data; transgender status; intersex status; caste or tribe; and religious or political belief or affiliation. All these have nothing to do with the health of the people but can have negative impact.
The fear that such a data could be used by the state on some pretext or the other is not unfounded. We have the example of Aadhaar Card which is now compulsory to be linked in almost any activity and the state has complete knowledge and control of the activities of the people in our country. Gradually the digital health card will be made compulsory to join the Ayushman Bharat/RSBY/CGHS/ECHS/ESI or any other government sponsored scheme or the insurance by the companies.
Health is a state subject but through this there will be complete infringement on the rights of the state.
The contention of the government that this will help us improve the health policies is a joke. The government already knows the problems of health care in our country but it needs political will to sort out those problems. Several health activists/civil society groups and experts have already given their view point on how to improve healthcare system.
This type of exercise may be useful in a health care system which is comprehensive and universal. But in the system like ours, where health care delivery is so much diverse, right from the faith healers, alternative medicine to the system of modern scientific medicine. The medical practitioners vary from small scale sector to corporate sector. For the small scale sector it is extremely difficult to maintain such records in details. Small scale sector which lacks the infrastructure will have to employ new people for the job which will ultimately fall upon the patients to pay the cost. Already our patients are highly burdened with the cost of the health care. The National Health Policy document clearly admits that 6.3 crore people are pushed below poverty line due to out of pocket expenditure on health. With very meager spending by the state sector on public health, the patients are left to remain at the mercy of private sector which accounts for nearly 80% of the health care in our country.
This bill which in no way will help in improving the health needs of our people, rather will be another means to give power for surveillance of the people should be shelved.
Finance Minister should not evade responsibility by calling COVID-19 an act of God
Finance Minister should not evade responsibility by calling COVID-19 an act of God
COVID has several factors which need to be analysed scientifically
By calling the COVID 19 an act of God, the finance minister Smt Nirmala Sitharaman has not only tried to evade responsibility but also sent misleading information to the people and perpetuated myths already prevalent in the society. She said this in the meeting of the GST council on 27th August. Several states have demanded that the GST due to them should be given which the central government is evading.
Every disease has a scientific basis, so has the COVID-19. It is spread by a virus, but unfortunately it is a taken the shape of pandemic. The pandemics are not new. We've seen Bubonic plague several times in the history and we had most deadly pandemic of the Spanish Flu in 1918 in which over 5 crore people died the world over and we lost about 1.5 crore people in our country, which is about 5 % of India’s population at that time. That was a different time; medicine had not developed so much by then. The information technology was primitive compared to present level. Moreover we were ruled by the colonial power. So we could expect the colonial rulers to be apathetic to the problems of our people. That in fact lead to death of so many. This also occurred during the Bengal famine in 1940s when 30 lakh people are reported to have died as a result of starvation because the food meant for the famine affected areas was diverted to the soldiers of the British army in Myanmar. Therefore the finance minister must understand that disease has to be viewed on the basis of science.
Scientists are on the job of finding out reasons for the spread of Novel Corona virus in so much intensity. Doctors have already given suggestions about the prevention of the disease by simple measures like hand washing, sanitizing, physical distancing and use of masks. There is all out effort around the globe to find vaccine to prevent the disease and also to find anti-viral drugs to treat the sick. When the Finance Minister terms it an act of God, it means we are helpless and that we cannot do anything to the God’s creation.
Several diseases have come up because of climate change which has led to mutations in the micro-organisms. There is need to find out whether there is any such relationship between the climate change which has occurred due to human activity in the past few years to the COVID. We have already seen several catastrophes due to climate change. Recent enactment of the new Environmental Impact Assessment Act (EIA) which ignores and dilutes many important environmental clauses for the clearance of projects is likely result into many such happenings in future, which we may again attribute to God’s act to escape the responsibility.
There are also rumbling around the world that this virus was generated with the purpose of Biological warfare, even though this is not proven till date? It is only when we believe that there is a reason for a disease that we look forward to its prevention and treatment. But if we label it as an act of God, then it is sheer helplessness because no one can do anything against the wish of God. In this situation should we stop doing research on the virus; should we ask the WHO do not do anything on COVID; should we ask to ICMR not to do any work on this; should we ask the doctors to not treat the patients but only pray to God?
This is not the time to talk such things and spread myths. Our country was already late in responding to the COVID. To hide its failure the Prime Minister said on 25th March that we will win over the COVID in 21 days because Mahabharta was won in 18 days. Not stopping at that, he made Indian public to clap, beat Thalies, sound Shankha, light candles in the belief that COVID will be taken care of by such acts. During all this there was chest thumping by the government at that time that India has very low number of cases even though the epidemiologists had warned of peak ahead. Now when the number is rising fast, there are no briefings by the government on COVID. It was said by many in the ruling that the cow urine or cow dung is the treatment. Let us be honest to ourselves. Very senior ministers in the government including the Home Minister are under treatment in big hospitals under modern scientific medical system. They should have spoken against such myths at that time. Ironically even the Health Minister, who is a doctor himself did not counter such myths. It is time to strengthen scientific temper.
IGNORING OTHER DISEASES DURING PANDEMIC COULD BE COUNTERPRODUCTIVE
Date: 27.08.2020
IGNORING OTHER DISEASES DURING PANDEMIC
COULD BE COUNTERPRODUCTIVE
Dr Arun Mitra
The Pandemics bring with them misery in the form of morbidities and mortalities. Bubonic plagues are an example. The Great Plague of 1665 was one of the worst during which 100,000 residents of London died just in a span of seven months (1). The Spanish flu in 1918 was even worse. During this period the pandemic is believed to have killed up to 14 -17 million people in our country, the most among all countries which is about 5-6% of total population(2).
In addition pandemics are associated with economic hardships because in such situations the economic activity is affected adversely. On one side the people who fall ill are forced to absent themselves from work. Measures by the governments taken supposedly to control the spread of the disease add to the problem. Poor sections of the society are affected more. We have witnessed this during the lockdown imposed in our county in the end of March, which was done without thorough consultations with the epidemiologists and those working in public health & community medicine and without taking effective measures to prevent hardships to the working people who suddenly lost their of jobs and livelihood. The International Labour Organisation (ILO) has pointed out "In India, with a share of almost 90 per cent of people working in the informal economy, about 400 million workers in the informal economy are at risk of falling deeper into poverty during the crisis …..forcing many of them to return to rural areas(3)."
It is true that corona infection has involved crores of people around the world and in our own country currently there are over seven lakh active cases. Over 65,000 new Covid-19 cases are being reported every 24 hours pushing the number of COVID patients to more than 32 lakhs. Till now more than 58,000 people have succumbed to the virus. It is therefore a serious issue and we must concentrate on prevention of infection and save lives of people taken ill.
But what is of equal concern is that we cannot ignore other pre-existing diseases as India is the hub of many communicable and non-communicable diseases. The number of morbidity and mortality due to these is nowhere less. But in the last five months many of these diseases have been completely ignored.
Some of the important disease that India is hub to are Tuberculosis (TB), Hepatitis, Diarrhoea, Diabetes, Coronary Heart Disease, Cancer and Kidney diseases etc.
India has the largest number of TB cases in the world. As per the latest report released by the World Health Organisation (WHO) India accounted for 27 per cent of the total, followed by China with 9 per cent, Indonesia at 8 per cent, Pakistan (6 per cent) and Bangladesh (4 per cent) (4). According to the India TB report 2020 India notifies 24.04 Lakh TB Cases. This is 14 per cent increase over the previous year. The country recorded 79,144 Deaths in 2019. This figure is much lower than the WHO estimate of 4.4 lakh fatalities. However in the absence of any substantive change in the TB control in the last one year, the figures given by the Ministry of Health and Family Welfare need to be reconfirmed particularly in view of that in 2018, 4.4 lakh people died from TB that is 1205 patients daily. The corresponding number was 4.1 lakh in 2017 (4 a).
Diarrhoea and Pneumonia are other deadly diseases in our country. In 2016, almost 261,000 Indian children died before their fifth birthday due to diarrhoea or pneumonia, both preventable diseases. This is the highest toll taken anywhere in the world by the two diseases--a fifth of their global burden--according to the 2018 Pneumonia & diarrhoea Progress Report, released on November 12, 2018, which was World Pneumonia Day (5).
With 1.5 lakh deaths annually and almost 60 million Indians affected, Viral Hepatitis continues to be a serious public health concern. It is estimated that 4 crore people are suffering from Hepatitis B and 0.6-1.2 crore people are suffering from Hepatitis C in India (6).
According to the National Institute of Cancer Prevention and Research (NICPR), an estimated 2.25 million people in India live with cancer and more than 1,157,294 new cancer patients are registered every year (7).
There has been an alarming increase over the past two decades in the prevalence of Coronary Heart Diseases (CHD) and Cardiovascular mortality in India and other south Asian countries. Current estimates from epidemiologic studies from various parts of the country indicate a prevalence of CHD to be between 7% and 13% in urban3–5 and 2% and 7% in rural 6,7 populations. Epidemiologic studies have shown that there are at present over 30 million cases of CHD in this country (8).
During this period of COVID-19, the patients of above mentioned and several other diseases have been suffering as hospitals are occupied with COVID care. As a result, many of those suffering from chronic diseases have lost their lives. There is urgent need to evolve a comprehensive healthcare system where it is ensured that a balance is maintained between the care of pandemic and the pre-existing diseases. Some special hospitals have to be built to deal with epidemics while the already existing medical care facilities should continue to provide healthcare to the people suffering from other diseases, failing which there will ensue another crisis of diseases which could have been managed otherwise. Let the COVID-19 be a lesson to move forward. The governments have to take healthcare seriously which has been hitherto ignored. It has been generally observed that we tend to forget once the situation has changed. It should not happen now.
References:
- https://www.nationalarchives.gov.uk/education/resources/great-plague/)
- https://en.wikipedia.org/wiki/1918_flu_pandemic_in_India
- (https://economictimes.indiatimes.com/news/economy/indicators/about-400-million-workers-in-india-may-sink-into-poverty-un-report/articleshow/75041922.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst )
4a. https://thewire.in/health/india-tb-cases-drop
South Asian countries should increase cooperation to combat COVID-19
Date: 20.08.2020
South Asian countries should increase cooperation to combat COVID-19
Dr Arun Mitra
Increase in the number of the cases of COVID-19 in India is a worrying factor even though it is on the expected lines as predicted by several epidemiologists. While Delhi has shown some downward trend, other states have now been showing rising numbers. Bihar, Uttar Pradesh, Punjab, Haryana, Himachal and some areas in North East are having increasing number of cases. This has added to the overall number of cases country wide. Vaccine is long awaited. But the vaccines have to pass through several trials before they are put to use on human population in large number. Since the infection of Corona is not age specific, the vaccine has to be given to each and every person. This in itself is a huge task which involves production, distribution and then inoculation in such large numbers. It is not yet certain up to what duration the vaccine will provide immunity to the individual.
The consolation so far is that mortality rate in our country is not as high as in the USA or Europe. This however is true for all the South Asian countries. With similar ethnic background and similar socio economic situation, it is time that the South Asian countries should collaborate with each other and review the strategy to check the spread of disease. Reviewing the data of cases in the South Asian countries it has been found that out of all Sri Lanka has done better in controlling the spread of COVID-19. As on 15th August Sri Lanka with a population of 2.2 cores has only 2890 cases and 11 deaths. Nepal with population of nearly 3 crores has 26660 cases and 104 deaths. Bangladesh which has population of nearly 16 crores has 276549 number of cases and 3657 deaths. Pakistan has a population of nearly 21 crores and has 288717 number of cases and 6168 deaths. India which is the largest country in South Asia with a population of 138 crores has 2618877 cases and 50464 deaths.
According to the above data Sri Lanka has 0.01% population which is positive for COVID-19 and out of these 0.38% died. Nepal has 0.08% of population sick with COVID-19 and a mortality of 0.39% out of these sick people. Bangladesh has 0.17% people developed COVID-19 infection out of 1.32% could not survive. Pakistan has 0.17% sick population and mortality of 2.25% out of these. India has 0.11% population infected with COVID and a mortality of 1.92% out of these.
It is not time to browbeat anyone’s loss or highlight any ones victory. It is a human issue. So we have to work on multipronged strategy. One, that we have to check the spread of disease and have to devise strategy for early detection of cases, test all the suspected cases and the positive cases have to be advised for care as per the grading of the disease. Those who understand and have facilities for home quarantine should be encouraged for that. For others we have to develop large number of places where the cases can be observed in the institutions. Those needing oxygen only can be then shifted to oxygen beds while those who require ventilator can be taken for further treatment. All this requires lots of money. So it is time for serious global cooperation. For the South Asian countries it is even more important to coordinate and cooperate, know about the strategies adopted by each country to combat the COVID.
Several South Asian doctors with social orientation affiliated to International Physicians for the Prevention of Nuclear War (IPPNW) have suggested following steps to be taken in this regard.
- The South Asian countries as members of the SAARC should increase their cooperation in fighting such pandemics as well as other health related issues in region.
- We should develop a continuous system of sharing of knowledge on the health issues in different countries of South Asia and also try to learn from health care delivery system in each country.
- South Asian countries should increase the public health spending to a minimum of 5% of the GDP.
- We should also devise means to make people of the region to travel to other countries for healthcare needs without any visa problems.
- Countries of the region should hold continuous mutual dialogue to sort out problems between them.
- We should have a joint platform to sort out the food security issues in the region.
- We should reduce spending on the arms and instead spend on the health care issues.
SAARC is an appropriate forum which should be made active at this juncture. This is not the time for rhetoric but it is time to take steps to strengthen coordination and cooperation. South Asia is already in turmoil due to severe socio economic disparities, low Human Development Index and at a poor grading in the Hunger Index. Let COVID be a lesson for our polity and people to learn to live in peace and harmony.
Remembering the victims on 75th Anniversary of Atomic Bombing of Hiroshima and Nagasaki
Remembering the victims on 75th Anniversary of Atomic Bombing of Hiroshima and Nagasaki
The Time for Nuclear Weapons Abolition has come now
(This article is a homage to the victims of atomic bombing at Hiroshima and Nagasaki and is dedicated to the forces of peace and disarmament)
Dr Arun Mitra
While visiting the Peace Memorial in Hiroshima, one wonders how with the knowledge of destructive power of weapons could man build and then use the nuclear arms on human population. To watch the pictures of the destruction while going around the memorial and to read the account of the loss that took place as a result of atomic bombing is a nightmarish experience. The tiny atomic bombs (as per the standards of the present day nuclear weapons) killed around 140,000 people in Hiroshima and nearly 70,000 in Nagasaki and roughly half of the deaths in each city occurred on the first day. Out of 300 doctors 272 died, 1684 of 1780 died and 42 of 45 hospitals were destroyed. There was complete lack of medical care. High dose of radiations added to the chaos. Listening to the testimonies of the Hibakusha, the survivors of Atomic Bombing, one cannot control the emotions while they are narrating the incidents. It is difficult to imagine how it must have been to watch nears and dears melt away in a matter of seconds as a result of intense heat produced by the nuclear detonation. Today Hiroshima is like any other modern city. However the building which was the epicentre of the explosion has been preserved in the same form as it was after the explosion on 6th August 1945 so that generations to come remember the devastation caused and imagine how insane man could be at certain times.
With the surrender of Germany 9th May 1945 the war had virtually come to an end on. Surrender of Japan was imminent in a few weeks. It was expected that long lasting peace would prevail after the Potsdam Agreement between the three heads of the state Joseph Stalin, Harry Truman & Winston Churchill (replaced by Clement Attlee) in July 1945. But it was within a few days of this conference that Hiroshima was bombarded with atomic weapon followed by Nagasaki after three days. While lakhs were crying in despair in the two cities, the American administration rejoiced over this barbarous act. Use of atomic weapons on human population by the US was a show of strength and muscle power which unfortunately instead of halting, unleashed the nuclear arms race.
The number of nuclear weapons has been increasing and it is assumed that there are nearly 17000 nuclear weapons on earth today. The number of countries which possess these weapons also increased from one to nine. These include USA, Russia, Britain, France, China, North Korea, India, Pakistan and Israel.
The nuclear weapons are a real threat to not only the human population but the whole flora and fauna on earth. The very presence of these weapons is fraught with the danger of their use. It is well known that India and Pakistan have threatened each other with use of nuclear weapons 13 times and this rhetoric is not stopping. We are witnessing every day violent actions by highly motivated individuals and groups around the world who are ready to kill the innocent without any remorse. Even if the states decide not to use the nuclear weapons, there is a grave danger that these could fall in the hands of non-state actors who with their utterly insane outlook would not hesitate to use them.
The destructive power of nuclear weapons is well documented now. Ira Helfand, Co President of IPPNW in a study on Climate Consequences of Regional Nuclear War has pointed out that even a limited nuclear war between India and Pakistan using Hiroshima sized nuclear weapons could put over two billion people at risk. Up to 20 million people would be killed outright as the great cities of the subcontinent were destroyed and it would blanket much of South Asia with radioactive fallout. But the global consequences are even more alarming. Peer-reviewed studies by climate experts show clearly that this limited nuclear conflict would even affect weather patterns throughout the world. Soot and debris injected into the atmosphere from the explosions and resulting fires would block sunlight from reaching the earth, producing an average surface cooling of -1.25ºC that would last for several years. Even 10 years out, there would be a persistent average surface cooling of -0.5ºC. This would lead to crop failure and affect the size of available food stocks. If the soot injected into the atmosphere in a nuclear war caused significant ozone depletion that could cause a further major decline in actual food production. The combination of failed harvests and a collapsed distribution system would prevent essential foods from reaching the areas which require these. This scenario will affect the poor countries more and the poor people in these countries even worse.
It is being slowly realized that complete abolition of nuclear weapons is the ultimate and in fact the only solution to overcome the potential consequences of nuclear weapons for humanity. Without the complete elimination of nuclear weapons, the element of risk that nuclear weapons will be, will continue to exist. Our former Prime Minister Rajiv Gandhi had proposed an action Plan for nuclear disarmament. He had pointed out that the use of nuclear weapons could result in the death of 4 billion people, or the end of life on Earth as we know it. On 21 January 1988, in his speech at the opening session of the Six-Nation Five-Continent Peace Initiative in Stockholm, he had stated: “What we need to end is the option of unleashing global devastation or holding the survival of humanity to ransom. We must protect humanity as much from the known dangers of extinction as from those that are still unknown.”
Adoption of Treaty Prohibiting Nuclear Weapons (TPNW) by the UNO is a big step forward and a real hope. The treaty has been already signed by the 82 countries and ratified by 40 countries. There is need for 10 more ratifications for its entry into force. The treaty delegitimizes and prohibits the possession, testing, use, trade of the nuclear weapons in any form. This is indeed a big achievement. The nuclear weapons possessing countries have met a moral defeat in the highest international forum by not joining the treaty. It is time all the nuclear weapons possessing countries realize their duty to join the treaty and abolish these weapons of mas destruction.
In her highly emotive lecture at the Nobel Peace Prize giving ceremony to the International Campaign for the Abolition of Nuclear Weapons (ICAN) in Oslo on 10th December 2017, Hibakusha Setsuko Thurlow had said "To every President and Prime minister of every nation of the world, I beseech you: Join this treaty; forever eradicate the threat of nuclear annihilation”.
Dr Arun Mitra
MBBS, MS (ENT Surgeon)
Co-President International Physicians for the Prevention of Nuclear War (IPPNW)
139-E, Kitchlu Nagar, Ludhiana – 141001
Mobile: 94170 00360
Health Minister’s Silence is Intriguing Proactive intervention by the Health Ministry could have mitigated the damage by COVID-19
Date: 23.07.2020
Health Minister’s Silence is Intriguing
Proactive intervention by the Health Ministry could have mitigated the damage by COVID-19
Dr Arun Mitra
It is the prerogative of the Health Minister to speak on the issues that concern health of the people in our country. This is even more relevant when the Health Minister is a doctor specialized in Otorhinolaryngology and is also Chairman of the Executive Board of the WHO, which is specialised agency of the United Nations responsible for international public health and is currently at the forefront of global efforts towards containing the novel coronavirus pandemic. COVID-19 is the period when people expect scientific information on issues related to prevention and management of the disease from a doctor’s mouth as they think it to be more appropriate and it gives confidence to them. The virus enters our body from the nose and the mouth, and the Health Minister is an ENT Surgeon.
When the disease was first reported from Wuhan in China there was apprehension that this would spread around the world and carried to other places by the travellers. Many doctors, particularly those who are working in the field of Epidemiology and Social and Preventable Medicine had warned about this. The Health Ministry should have become pro-active in December 2019 when it became a worldwide knowledge that COVID could spread globally. First case was reported in India on 30th January. On the same date WHO had warned about COVID to be a serious Public Health Emergency. The Health Ministry knew very well that the disease is contagious and is being spread by those who are coming from outside. Check-up of those entering India should have been done extensively from that time onwards. But it did not happen. Whether the ministry did not realize the gravity of the situation or was under some other compulsions to ignore, this is not clear till date. When the US President Donald Trump came to India, four thousand personnel accompanied him. Health Ministry should have insisted on their COVID tests. When the organized engineered violence was going in North East Delhi in the end of February causing death of more than 50 and serious injury to hundreds of people, a visit to the area by the Health Minister to assess the health situation and oversee the make shift camps and ensure proper health care to them could have assuaged the feelings to an extent, more so with impending danger of COVID. Full one month of February was lost without warning and directions from Health Ministry. Even in the month of March the advisory issued by the Health Ministry on 13th March did not point to a grave emergency.
Before the Prime Minister announced sudden lockdown on 24th March, the Health Ministry should have made a detailed assessment of its impact on health, nutrition and necessary preparations to upgrade health system to deal with this Pandemic. This should have included suggestion to the government to take appraisal of the impact on economy, job situation, livelihood, nutrition of the people particularly of those going to their native places and the issues of stay of people and correlating it to physical distancing etc. while taking any steps to deal with the situation. Ministry should have then advised to the Prime Minister accordingly. But this did not happen and as a result, the sudden lock down created immense problems of health and nutrition for the marginalised sections of society.
When the Prime Minister appealed to the people to bang thaalies, clap and sound shankhs, light candles and diyas which created complacency and understanding among masses as if these could dispel the threat of corona, the Health Ministry should have said that this is unscientific and will not get rid of Corona. Even when the Prime Minister said that we will be able to win over Corona infection in 21 days, the Health Minster should have not kept mum and warned the people to remain prepared to fight with the disease for several months..
The Health Minster was hardly to be seen on briefings on Corona. Initially these were addressed by the bureaucrats and ICMR, but soon the ICMR officials vanished from such briefings for the reasons unknown. The Health Ministry should have ensured that such briefings are always addressed by medical scientists alongside the government officials.
The Ministry should have vehemently opposed absurd ideas like cow urine and cow dung to be cure for Corona infection and warned people of the country to beware of myths.
When ICMR said that the community spread has not occurred, while several epidemiologists issued statements to the contrary, the Health Ministry should have assessed the situation clearly and then come out with a concrete statement.
ICMR Director’s statement that the vaccine against COVID will be ready by 15th August, created sharp reaction from many scientists who warned against any fixation of dates on that and the use of unpalatable language in the letter. This put the prestigious body in a precarious situation. The Health Ministry should have intervened timely.
It would be naive to believe that the Health Minister who is a doctor himself is ignorant about such things. Scientists and medical personnel have to learn to withstand pressures. It is worth pointing out that two Health Minsters of Brazil resigned over their differences with the Prime Minister on tackling the COVID -19.
Physical distancing and social cohesion is needed during COVID times
Date: 17.07.2020
Physical distancing and social cohesion is needed during COVID times
Three main precautions are suggested to prevent oneself from Novel Corona Virus infection. These include washing hands regularly, putting mask on face to cover mouth and nose, and maintaining ‘social distance’. All the conscious citizens in general are following these instructions as advised by the medical scientists. There are however some issues on how to wear the mask, from where to hold it, which parts of the face to cover, what type of material to use for the mask, how long to wash hands and the way to use the sanitizer etc. These all need constant education to the people. Since the people are not used to wearing the masks, they feel suffocated and remove them time and again. Most of them cover only the lips and leave the nose uncovered. They hold the mask from front, which is the dirtiest part of the mask, thus soiling their hands which they are likely to touch on to the face. Many people use handkerchiefs or ‘chunnies’ or ‘gamchhas’ to cover the face. One is likely to forget which was the inner side and cover the face next time with the outer side which is already soiled. Not many wash their hands for 20 seconds or rub the hands with sanitizer till it gets dried up. These small tips are very important.
After the relaxation in lockdown the bazars are crowded, and there is total flouting of distance between the people. The Prime Minister in his speeches has time and again emphasized on social distancing. Social distancing means not to connect with society, that is your mates, friends, family relations etc., meaning thereby, staying aloof. In fact this is a wrong term projected particularly in the Indian context.
Our society is composed of very diverse groups based on caste, creed, religion, ethnicity, language and socio economic status. Despite the guarantees in constitution there persist bias against each other. The social distancing word could be used to perpetuate such bias. We have seen how the Tablighi Jamaat was demonized purposefully and blamed for spreading the COVID. This was followed by a hate campaign against a particular community to the extent that many people refused to buy vegetables from them. Similarly the issue of pilgrims from Nanded Sahib was also built but was not hyped to the level of Tablighis. The poor section who do not have enough space to live, lack of education and are under nourished were also blamed for spreading the COVID. Because of this there has been denial to entry of the maids in the colonies.
Lockdown led to virtual isolation of the people from each other. This left more impact on the children, teen agers and younger generation who are more into mixing with their peer group in schools, colleges, play grounds and parties etc. Many teen agers have developed fear of the COVID because of lack of interaction with the society. They have landed into anxiety related problems.
Social media remained the only medium of contact. But virtual contact is no alternative to personal face to face meetings. In any situation of stress and anxiety it is all the more important that we have social cohesiveness and social involvement to allay the fears. Constant information from the government to maintain social distance is against the concept of medical science. The advisory to keep the distance from another person six feet or above does not mean that one stops contacts with the people. Human society has all the experience that social support is much more needed during the times of crisis. Therefore In the present situation we need much more social cohesiveness to overcome the COVID not only in the physical terms but also its fallout on mental status of the people and our social fabric. The term social distance is a misnomer, more so in the present crisis where we all have to work together.
Using Scientific bodies for political ambitions is unethical
Date: 10 July 2020
Using Scientific bodies for political ambitions is unethical
Dr Arun Mitra
The Indian Council of Medical Research (ICMR), the apex body in India for the formulation, coordination and promotion of biomedical research has been and upright institution of our country and its opinions have been valued widely. But unfortunately like several other institutions in the country the credibility of ICMR has been eroded in the past few months. Initially it was the ICMR which was giving briefings on the status of the COVID in the country. Despite the Prime Minister's assertion in his speech on 25th March that that we will defeat corona in 21 days, the ICMR did not issue any statement in its favour. Even after Dr.Vinod Paul, a member of NITI Ayog said that there will be no Corona case in our country after 16 May, the ICMR did not come out with any statement in his support. ICMR was very forthright in giving scientific opinion on the spread of COVID since March. But to everyone’s surprise the medical body virtually disappeared from the press briefings in the month of May onwards. The press briefings were entirely overtaken by the bureaucrats who did not feel shy to answer even the technical medical questions even though the people in this health emergency expected to hear scientists’ opinion about the disease pattern. It is however a different matter that these bureaucrats also have stopped giving any briefings now and there has been no official briefing to the press after 11th June. The bureaucrats are trained to carry out the government’s orders, but the scientists have to speak on evidence. What the epidemiologists, virologists and the professionals from preventive and social medicine said is proven as we watch rising number of cases and reduced doubling time for COVID cases. The fear of the disease and wish for an early treatment to it is seen from that the people believed completely unscientific and absurd statement on the Covanil by Baba Ramdev as treatment of COVID.
To allay the concerns about the disease the whole global medical community is seized with developing preventive or curative treatment for COVID-19. Scientists around the world have been working to find vaccine for its prevention. The news that Indian scientists have almost hit the vaccine and it will be released by 15 August was very heartening and a matter of pride for the nation. Our genius scientists have been working hard to control the course of the disease. But that the vaccine will be out in almost a month raised skepticism, as it did not appear to be holding ground on scientific criteria. The vaccine production has to pass through several stages of clinical trials. Every phase of clinical trial takes several months to be completed with accurate results. Vaccine trials are an extremely serious matter even more than drug production because vaccine is to be injected into a healthy person. If the vaccine produced showed negative results it would mean that a healthy person is being made sick. Therefore trials of vaccine have to be very meticulous. The MD of Biotech Ltd. Dr Krishna Ella, who has been entrusted with the job of vaccine production, in an interview said that they will be able to produce the vaccine by December. He was non-committal about the 15 August date. In the first letter on 2nd July the Director General ICMR Balram Bhargav had asked the hospitals involved in the trials to be on fast track and enrol all participants in the trial before 7 July 2020. His letter further warned that ‘noncompliance will be viewed very seriously’. This language is totally unpalatable and unexpected of a person of that stature. But after the questions were raised by scientists that such speedy trials would compromise accuracy and efficacy of the vaccine, the ICMR issued another statement on 4th July that they did not mean 15 August to be the deadline, but this was to get the matter speeded up. On 6th July the Ministry of Science and Technology issued a statement that vaccine production is not possible before 2021. These events have brought the credibility of the ICMR into a very precarious situation. We are proud of our scientists. A top level person like Balram Bhargav cannot be unaware of the complexities of vaccine production. What led to issuing such statement is best known to him, but it has definitely put a question mark on the uprightness of a scientific body.
Science is not a political game. The fear that ICMR was under duress to give statement is not unfounded. Whatever has happened is very sad and such a thing should not be repeated. Science has said nothing to do with preconceived ideas or with political ambitions. The scientists have to raise their voice against any misleading information. The feebleness in the reaction by the scientific and medical bodies to the absurd statements like transplanting an elephant head on human body in ancient India or that we had highly advanced space science 7000 years back and many similar ones is intriguing. We are successors of Aryabhatt, Galelio, Copernicus and Jagdish Chander Bose who stood by what they felt to be true on evidence.
Any escalation in South Asia would be a health disaster
Any escalation in South Asia would be a health disaster
Dr Arun Mitra
Recent events in the south Asian region are upsetting and worrisome and these require statesmanship to wriggle out. There has been perpetual tension between Pakistan and India which has led to immense wasteful expenditure on arms race thus marring development in the two countries and adversely affecting health and education in particular. With some periods of thaw, most of the time, the two countries have been engaged in cold or hot war. There have been four full-fledged wars in addition to skirmishes at the border from time to time.
India and China had one war in 1962 when China annexed large chunk of Indian land. During this the Indian army suffered 1,383 casualties, 1,047 wounded, 1,696 missing and 3,968 jawans captured. On the Chinese side the PLA (People's Liberation Army) had 722 soldiers killed and 1,697 wounded (1).
China has been claiming some parts of Indian territory even after that. As a result there have been clashes at the border. In 2017 there was tension at Doklam which was resolved and forces from both sides retreated. But the Chinese aggression in Galwan valley was unexpected and sudden because of which India was taken aback. Killing of 20 Indian soldiers including an officer, and capture of 10 soldiers and 4 officers by the Chinese in most gruesome manner has evoked a reaction of revenge in India who feel cheated and have a defeatist feeling.
The experts and strategists have been talking against any larger conflict and have warned to tread cautiously lest the situation gets out of control. There are however others who, knowing very well the consequences are out to raise jingoism and push the region into long standing conflict. The situation has given alibi to other foreign powers to intervene. Statement by the US President Trump that he would send 9500 troops to Asia is a new dimension which will have serious ramifications over regional security. The role of US in the past in escalating the situation is well known right from 1962 till date. More over Indians have not forgotten US partisan attitude during the Bangladesh liberation movement in 1971.
Needless to explain, that the south Asia is a poor region. China does not technically fall in south Asia, but it has long border with India and Pakistan. It also has trade relations with India and strategic relations with Pakistan. So any event that occurs in the region, automatically gets connected to China. Therefore when we look at the present scenario in south Asia we cannot ignore Chinese dimension.
If we look at the Human Development Index of the region we find it at the unacceptable level. India ranks at 129 in the global HDI. The ranking of China is 85, Pakistan at 152, Bangladesh 135, Sri Lanka 71 and Nepal 147 (2).
Maternal Mortality Rate (MMR) in China 29, India 145, Pakistan 140, Sri Lanka 36 Bangladesh 173, Nepal 186 (3).
Infant Mortality Rate (IMR) of China is 8.6, India 36.6, Pakistan 69.3, Sri Lanka 7.4, Bangladesh 30.2, Nepal 32.2 (4).
Global Hunger Index of China 25, India 102, Pakistan 94, Sri Lanka 66, Bangladesh 88, Nepal 73.
China is better placed than all South Asian countries in terms of development. But its defence budget is very high. It has announced a 6.6% growth in its defence budget for this year. The growth in China’s defence budget would see spending rise from $167 billion last year to $178.2 billion, an increase of about $11 billion. The country has the second-largest defence budget in the world, behind only the United States (5).
In contrast India has earmarked Rs. 4,71,378 crore (US$ 66.9 billion1) for the Ministry of Defence (MoD), stating that national security is a top priority of the government (6).
Both India and China are Nuclear Weapons possessing countries. China has 270 Nuclear weapons , India 120 to 130 and Pakistan 130 to 140 (7).
Any escalation would mean long drawn war and perpetual tension on Indo-China border. This would mean immense stress on the economy of both countries which would ultimately fall back on health under the present COVID crisis. Recently India has signed an agreement with Russia and plans to spend Rs.38900/- crores on purchasing long range attack missiles and fighter jets.
We have to avoid war under any circumstances. Diplomatic and economic initiatives with caution are the need of the hour. When tension was brewing up at the border in April we should have taken it seriously and initiated a dialogue. This is not impossible now even though difficult.
It is an irony that global powers have enough money to spend on arms. Even the extreme difficult situations in tackling the COVID-19 crises have not deterred them. We must be cautious that any escalation at the border would not be for short time. Any increase in the defense expenditure would mean playing into the conspiracies of the Military Industrial Complex who are the real beneficiaries in such situations at the cost of lives of people.
We have results of the hypothetical study of Pakistan India nuclear exchange which would put 2 billion people at risk globally. With China it would be worse as it would invite other countries to take benefit.
References:
1. https://www.indiatvnews.com/news/india/1962-india-china-war-a-war-which-should-never-have-been-fought-18235.html
2. https://en.wikipedia.org/wiki/List_of_countries_by_Human_Development_Index
3. https://en.wikipedia.org/wiki/List_of_countries_by_maternal_mortality_ratio
4. https://en.wikipedia.org/wiki/List_of_countries_by_infant_and_under-five_mortality_rates
5. https://www.defensenews.com/global/asia-pacific/2020/05/22/china-announces-1782-billion- military-budget/
6. https://idsa.in/issuebrief/india-def-budget-2020-21-lkbehera-040220
7. https://www.cnbc.com/2018/03/16/list-of-countries-with-nuclear-weapons.html
Government’s Apathy towards Health Workers They need much beyond Taalies, thaalies and flowers
Date: 17.06.2020
Government’s Apathy towards Health Workers
They need much beyond Taalies, thaalies and flowers
Dr Arun Mitra
The news that the doctor's and other health workers fighting COVID-19 have not been paid salary for several months in some places is a matter of shame. The Hon’ble Supreme Court reprimanded the government and directed to not suspend or file any case against those raising the issues of their concern. Statements by resident doctors working in the Municipal Corporation Delhi hospitals, that as a result they are unable to afford their day to day life, are awful indeed. Young doctors who are the frontline workers against COVID-19 and also the non COVID diseases get limited salary. With the meager income they can hardly manage to make both ends meet. As one resident doctors in an interview to a TV channel said that he has to pay monthly rent for his accommodation and also EMI; he is in a fix as to what he should do? In such situations of serious health emergency if they are not paid salary for four to five months, what more insensitivity can be expected on the part of the government than this? Those on contractual job are likely to leave the government hospitals and join the private settings, thus affecting the healthcare to the vast majority in these time of crises. Similar reports are coming from Telengana. Unwillingly, the healthcare workers have to resort to agitation in such situation. This is happening in the present state of affairs when we are passing through a global emergency and we have already reached fourth position in the number of cases. It is not unlikely that we may be in for the worse in the coming period. The situation requires constant vigil by the healthcare workers.
No wonder doctors are ethically bound to work under any circumstances, but they too have some necessities for life. The above situations will have a negative effect on the healthcare of the patients, which is already in a dismal state. Such situations have to be dealt with serious effort through empathy sympathy and hard work.
This is not for the first time that the Doctors have to face discrimination and violence. Many COVID warriors, the doctors, nurses and others have been denied entry to their apartments at some places. In one incident two young female doctors were beaten by a goon just because he thought they were spreading infection. In another incident the police beat the doctors and even broke their bones who were returning from their duty and had an argument with the police on wearing the mask. They told the police that they have been working with the PPE whole day long and that it is not necessary to wear mask always.
There have been several incidents of violence against the doctors in the past in different parts of the country. Sometimes unscrupulous elements in the public with the backing of high powered people have misbehaved with the doctors, on frivolous issues. The young doctors, who are always hard pressed because of the long working hours have been facing wrath in such situations. Now also we see in the present COVID crises, it is the young doctors again who are at the receiving end. In fact they are future of our country’s healthcare system.
There are reports that even the complaints by the doctors that they are not getting PPEs or other equipment required to care for the patients and for their own protection have earned wrath of the authorities. One such doctor, Sudhakar Rao in the state of Andhra Pradesh was suspended after he raised the issue of non-supply of required material. Later when he raised the issue again, he was beaten and dragged by the police. It was said that he is not mentally stable. If this is true, then he all the more requires more empathy and medical care.
Our Prime Minister had asked the people to bang Thaalies, clap Taalies and to sound Shankhs in the honour of health care workers. In another speech after 21 days, he asked the people to light candles. Later on he used the army to shower flowers on the hospitals. The purpose was to express gratitude to the doctors, nurses and other healthcare staff and motivate them in the fight against the COVID. Such gimmicks however have no meaning and are short termed. They bear no fruits. What is needed at the ground level is the personal protective equipment (PPEs), properly equipped hospitals, number of beds and proper assessment of the situation to move ahead to take care of the COVID.
Other health staff is even in more difficulties. At many places the nursing staff and the safai karamcharies are on contractual duties with no assurance of job security. The ASHA workers till date do not have the status of the worker with benefits due to them. Similar is the condition of Anganwadi workers. Special care has to be given to them.
It is to be noted that the government doctors have done their best in such situation whether senior or junior. It is however sad to find that large number of doctors in the private sector, who are neither in the vulnerable age group nor have any co-morbid condition, closed their clinics and stopped examining the patients out of fear of falling prey to COVID-19. This behavior was unimaginable as this amounts to running away from duty. Doctors are trained to work in the most adverse conditions. What will happen if doctors fear? This will enhance fear among the public and delay early detection of many diseases. They could very well purchase PPEs for themselves and their staff. Some doctors started video conferencing with the patients. The tele medicine can be supplementary but not an alternative to the direct examination of the patient. We have still to go long way as the COVID Pandemic is not going to end so soon. For this we have to ensure that the health staff gets all the care due to them.
PREVENT CLIMATE CHANGE TO SAVE HEALTH
Date: 03.06.2020
PREVENT CLIMATE CHANGE TO SAVE HEALTH
Dr Arun Mitra
World Environment Day is observed every year on 5th June. The COVID-19 Pandemic has made us to think that the issue of environmental degradation and climate change cannot be just a ritual discussion but it has to be taken very seriously.
Climate Change is a significant change in temperature, wind patterns and precipitation that may occur in cycles over decades, hundreds, thousands and millions of years; sometimes these changes may be random occurrences. These may result in extreme weather events like thunderstorms, cyclones, tornados etc. In the recent years we are witnessing the impact of climate change occurring much faster and in much shorter period.
In the last century scientists detected that the temperature of earth was rising abnormally. It was found that oceans were warming up and snow was melting leading to rise in level of oceans. It was also found that there was perceptible rise in the carbon dioxide in the atmosphere.
Greenhouse Gases (GHGs) resulting from mainly industrial development and urbanization, agriculture and changes in land-use patterns are the cause of global warming. Different gases have different Global Warming Potential (GWP) which means how much damage they cause to the environment. The Carbon Dioxide (CO2) has GWP of 1; Methane - GWP of 21 and Nitrous oxide - GWP of 310.
The effects have been felt in India as well. There was all India drought in 2002. There was all India Severe drought in 2009. The year 2010 was one of warmest year. In the year 2013 there were Extreme rainfall events in Uttrakhand. We have seen mountains becoming baron due to large scale cutting of trees. This is resulting in hills becoming weak. Tsunami and Amfan and now Nisarga at our western coast.
Climate and weather have always had a powerful impact on human health and well-being. Global climate change is a newer challenge to ongoing efforts to protect human health. In the past few years there has been increased Mosquitoes Breeding, Malaria, Dengue and Yellow Fever. Increase in temperature by 2-3º C would increase the number of people who, in climatic terms, are at risk of malaria by around 3-5 %, which means several hundred million people globally. According to World Health Report 2002, climate change was estimated to be responsible in 2000 for approximately 2.4% of worldwide diarrhoea, and 6% of malaria in some middle-income countries.
In this century we have witnessed the outbreak of SARS, H1N1 Flu, Swine Flu and now the COVID-19. Several hypotheses are attributed to such outbreaks. The changing climate as a result of human activity has caused several changes in the flora and fauna. Viruses are known to mutate and the climate change is hastening the process.
Changes in atmosphere coupled with vehicular and industrial emissions lead to smog and poisonous gases which cause difficulty for those with cardio vascular disease, respiratory disorders as asthma, emphysema, chronic Bronchitis and allergy problems.
Similarly Water Pollution Related Diseases are on the rise. There is Poor quality of drinking water because water resources are threatened by drought, leading to bacterial, viral, Protozoal and Parasitic diseases.
The climate change has several indirect effects on our health. As a result of rising sea levels and flooding of the coastal areas, there occurs increase in population density due to migration of people to safe areas. People have to live in make shift camps in poor, unhygienic living conditions which cause several infectious diseases. Children lose their school. There may be violence for want of food and other basic amenities. This may lead to Psycho Trauma and Post Traumatic Stress disorder.
Arms race is an important cause of release of gases responsible for global warming. This occurs right from manufacture to transport to deployment to use of arms. Extreme changes in the climate may occur in the event of a nuclear fallout. A study conducted by Dr Ira Helfand, MD and Alan Robock et al on the climatic consequences of regional nuclear war shows clearly that even a “limited” nuclear conflict, involving as few as 100 Hiroshima-sized bombs, would also have global implications with significant effects on weather patterns throughout the world. Debris injected into the atmosphere from the explosions and resulting fires would produce an average surface cooling of -1.25ºC that would last for several years. Because of fall in temperature there would occur crop failure. This would result in serious food shortage. This would put the lives of over 2 billion people at risk.
Human-induced depletion of stratospheric ozone is another issue affecting human health. Stratospheric ozone absorbs much of the incoming solar ultraviolet radiation (UVR), especially the biologically more damaging, shorter-wavelength, UVR. The solar ultraviolet radiation may cause diseases of skin like Malignant Melanoma, Non-Melanocytic Skin Cancer – Basal Cell Carcinoma, Squamous Cell Carcinoma, Sunburn, Chronic Sun Damage, Photodermatoses. They may affect our eyes in the form of Acute photokeratitis and photoconjunctivitis, Climatic droplet keratopathy, Pterygium, Cancer of the cornea and conjunctiva, cataract, Uveal melanoma, Acute solar retinopathy and Macular degeneration. There is also negative impact on immunity. There may occur suppression of cell mediated immunity, Increased susceptibility to infection, impairment of prophylactic immunization, activation of latent virus infection.
The climate change also leads to altered general well-being, disturbed sleep/wake cycles, Seasonal affective disorder and disturbance in mood. Number of heat stroke related diseases is on rise during summer. Similarly due to erratic winter there is detrimental effect on human health.
The health effects of climate change also depend on other relevant factors like age and gender, socio economic condition, geographic locations—already cold areas/already warm areas/temperate regions, population density, sanitation and healthcare, nutrition, preexisting diseases, public healthcare system, literacy and infrastructure. People who are socially, economically, culturally, politically, institutionally, or otherwise marginalized are especially vulnerable to climate change.
There is urgent need to take steps to prevent climate change to save health. These may include policy making and Strategies to reduce risks of climate change. There is need to develop better infrastructure to combat negative effect of climate change. Holistic approach is needed to health care in form of better nutrition, job opportunities, housing, shelter, clean water etc. Also important are change in life style, equity, seriousness to the problem, international agreements and peoples campaigns.
“We have the means to limit climate change,” said R. K. Pachauri – Former Chair of the IPCC. “The solutions are many and allow for continued economic and human development. All we need is the will to change, which we trust will be motivated by knowledge and an understanding of the science of climate change.”
References: https://data.worldbank.org/indicator/EN.ATM.CO2E.PC
Preventing the Final Pandemic
Date: 16.05.2020
Preventing the Final Pandemic
The world is seized with tackling COVID-19 which is being perceived as biggest health threat to the humanity today. True, this virus is more lethal than other Corona viruses. There is an all out effort by the scientists around the world to develop vaccines to boost immunity in the body to enable it to fight back the infection. Research is going on to develop antiviral drugs. The world is hoping that soon we shall develop herd immunity so that the impact of COVID-19 gets reduced. Our scientists have made great achievements in getting rid of Plague which was a highly deadly disease at one time. Likewise an equally dangerous Small Pox has been eliminated through vaccination long time back. We have already achieved substantial success in Polio eradication.
Scientists and medical professionals have warned from time to time about various diseases and cautioned about the imminent health emergencies. They have also guided about the steps to be taken to prevent such happenings. The International Physicians for the Prevention of Nuclear War (IPPNW) has warned the global community about a highly grave threat to humanity for which we have no remedy. This is from the nuclear weapons. The use of nuclear weapons would be the final epidemic. Prevention is the only way out as we do not have any remedy to offer in such an eventuality.
We have witnessed atomic bombing of Hiroshima and Nagasaki in Japan on 6th and 9th August 1945 respectively. These two incidents led to death of over two lakh people and destituted many more. The present day nuclear weapons are much more powerful and deadly. A study conducted by Ira Helfand, Co-President IPPNW and Alan Robock, Department of Environmental Sciences Rutgers University, USA has revealed that any nuclear exchange between India and Pakistan using 100 nuclear weapons will lead to nuclear winter which in turn will cause serious crop failure. As a result there will be extreme starvation putting more than two billion people at risk globally. The impact will be more on the developing countries and on the poor in the poor countries.
Any nuclear exchange between the two major nuclear powers, Russia and US could cause extinction of modern civilisation built through thousands of years of human labour. Medical scientists have warned that there is no remedy to such an outbreak.
The nuclear weapons are different from other weapons because they cause multi pronged impact. M V Ramnna – a physicist who works at the Nuclear Futures Laboratory and the Program on Science and Global Security, at Princeton University, on the future of nuclear power in the context of climate change and nuclear disarmament in his study titled Bombing Bombay has documented the impact of nuclear weapons. A nuclear blast produces an extremely intense flash of heat and light, brighter than a thousand suns which could cause blindness and burn wood, paper, clothes, vegetation, and all other combustible materials in the radius of 1.6-3.2 km around the point of explosion. The shock of blast wave, would reach velocities of more than 110 km/h to a distance of 3 km or more. The shock wave would destroy everything within a circle of 1.1 km. Up to 1.7 km from the point of explosion, all houses not built with concrete would be destroyed. The firestorm of several hundred degrees centigrade temperature will make it almost certain that there would be no survivors. Furthermore, fire-fighting would be almost impossible due to the combination of hurricane-force winds, thick smoke, the destruction of water mains and tanks by the shock wave, and the presence of debris from the blast blocking roads and access routes. Other factors would lead to a probability of small explosions in the fire region and, therefore, to a greater chance that people would be injured as well as burned. Exposure to neutron and gamma radiation will induce leukaemia, thyroid cancer, breast cancer, and lung cancer, as well as non-fatal diseases such as birth defects, cataract, mental retardation in young children, keloids, and others. A visit to the Peace Museum in Hiroshima shows several pictures of people bleeding profusely, having been burnt instantly and melted away.
There are several hotspots in the world; Syria, Libya, Iraq and Iran in the Middle East; tension between Russia and Ukraine, tensions in South Asia, and between US and North Korea. Low intensity conflicts involving nuclear weapons powers as in South Asia and Northeast Asia can pose a threat of escalation which could lead to the actual use of nuclear weapons.
Under these circumstance when there is need for urgent global peace dialogue, we are witnessing increase in the military expenditure. According to SIPRI Global military expenditure sees largest annual increase in a decade reaching $1917 billion in 2019. The five largest spenders in 2019, which accounted for 62 per cent of expenditure, were the United States, China, India, Russia and Saudi Arabia. This is the first time that two Asian states have featured among the top three military spenders.
Global military spending in 2019 equates to approximately $249 per person. The United States accounted for 38 per cent of global military spending. In 2019 China and India were, respectively, the second- and third-largest military spenders in the world. China’s military expenditure reached $261 billion in 2019, a 5.1 per cent increase compared with 2018, while India’s grew by 6.8 per cent to $71.1 billion.
In its report "Enough is Enough: Global Nuclear Weapons Spending 2020" the International Campaign to Abolish Nuclear Weapons (ICAN) estimates that the nine nuclear-armed countries spent $72.9 billion on their 13,000+ nuclear weapons in 2019, equalling $138,699 (1.05 crore rupees) every minute of 2019 on nuclear weapons, and a $7.1 billion increase from 2018.
Taking cognisance of seriousness of the issue, the UN General Assembly passed Treaty Prohibiting Nuclear Weapons (TPNW). It prohibits nations from developing, testing, producing, manufacturing, transferring, possessing, stockpiling, using or threatening to use nuclear weapons, or allowing nuclear weapons to be stationed on their territory. It also prohibits them from assisting, encouraging or inducing anyone to engage in any of these activities. For the entry into force of the treaty there is need for ratifications by the parliaments/assemblies of 50 countries. Already 36 have ratified. This is an important step forward. There is urgent need to complete this number. The nuclear weapons possessing countries have to understand the gravity of the situation. We cannot be taken unaware of such a disaster. We have to take definite steps to prevent it.
The COVID 19 has put the whole world into jeopardy. But one day we will overcome this. On the contrary there will never be a victory over the nuclear weapons. Their very presence on earth threatens the economy due to huge amount of wasteful expenditure on their maintenance; danger of their use through accident or non state actors is real and grave. Abolition of these weapons is the only answer and TPNW is an opportunity. The money saved from this wasteful expenditure could help us spend more on providing healthcare facilities to the people. We have no time to loose.
COVID – 19 Lesson- Health should be nodal point for growth
Date: 09.05.2020
COVID – 19 Lesson- Health should be nodal point for growth
Dr Arun Mitra
Amidst the ongoing crisis, debate has already begun over the strategies for Post COVID - 19 economic growth. The discussion is centered around how to restart the industry and other work which have been on stand still since the lockdown. One opinion is to carry forward the same old corporate driven development model which talks only of wealth generation but ignores the needs of the vast majority of our people and breeds inequality while catering to the interests of a few. It is this model which is responsible for degradation of environment and climate change. There is another opinion which quotes Gandhi Ji and his ideas of rural based development model. Another view point is scientifically based inclusive growth. What will ultimately happen, only time will tell? But one thing most essential is that we need growth which cares for the needs of all sections of the people and puts human factor as primary.
Development, progress and economic growth of a society and country is proportional to the participation of workforce in these activities. Only a disease free healthy person can contribute effectively in this process. Disease scenario in our country is very dismal. India accounts for a relatively large share of the world’s disease burden. The National Sample Survey Office’s (NSSO) 71st round report on ‘Health in India’, has brought out certain facts which need serious consideration.
About 9% of rural population and 12% of urban population reported ailment during a 15 day reference period. Proportion (no. per 1000) of Ailing Persons (PAP) was highest for the age group of 60 & above (276 in rural, 362 in urban) followed by that among children (103 in rural, 114 in urban). About 4.4% of the urban population was hospitalized (excluding childbirth) at any time during a reference period of 365 days. The proportion of persons hospitalized in the rural areas was lower (3.5%). When such a large number is unwell at any time of the year, their participation in nation’s building is bound to be affected.
The COVID-19 crisis has brought to the fore shortcomings of our system to meet the challenge of health crisis. It appears the lockdown has worked only for about 20% population who own their house, have sufficient income to feed themselves for a few months and have education level to understand the importance of steps for prevention. But for a majority population it has been a cause of misery. They do not have sufficient income to feed themselves even for few days if they do not work. The physical distancing is not possible as many live in the shanty areas with 7-8 persons sharing a 8 x 8 feet room. Nor do they have android mobile phones to download the applications to understand the intricacies of the preventive measures from COVID-19. Availability of healthcare for routine illnesses in this crisis situation is a dream for them as OPD care in several state run hospitals is closed and they are unable to afford expenditure in private set up.
India is always in an emergency situation for health. Tuberculosis is cause of death for about 1400 persons per day in our country. Over 900 people in India die due to Respiratory Tract Infection (RTI) every day. Despite decline the current infant mortality rate for India in 2019 stands at 29.848 deaths per 1000 live births (1).
A study by Lancet, one of the most credible medical journals, points out death of hundreds in India due to poor nutrition. The study estimates that one in five deaths globally are due to poor dietary intake. This contributes to a range of chronic diseases in people around the world (2).
The World Bank estimates that 21 percent of communicable diseases in India are linked to unsafe water and the lack of hygiene practices. Further, more than 500 children under the age of five die each day from diarrhea in India alone (3).
The Lancet had formed a 37 member EAT Lancet Commission for the purpose including Dr. K Srinath Reddy, a renowned Cardiologist and President of Public Health Foundation of India and Ms. Sunita Narayan- Director General, Centre for Science and Environment and editor of the Down to Earth. It had recommended for a healthy adult an average daily intake of 232 grams of Whole grain (Rice, Wheat, Corn etc.), 50 grams of starchy vegetables (Potatoes and cassava), 300 grams all vegetables, 200 grams fruits, 250 grams dairy foods (milk or equivalents), about 200 grams Protein Sources from non-vegetarian food, about 50 grams added fats (Unsaturated oils and Saturated oils) and 30 grams of Added Sugar all sugar to meet the requirement of our balanced diet.
The average approximate cost of this diet at the present market price was found to be around Rs.130 per person per day. For a family of 5 members this comes out to be Rs.650 per day or Rs.19500 per month. This is impossible to be met with in present day socio-economic structure of our country particularly in the present day context when the many people have lost the jobs and in the absence of provision of a nutritional diet to such persons by the state, several of them are at the mercy of others to get food / ration. This falls much below the nutritional requirements even for subsistence level.
In the circumstances at today when large number of population is away from their families as result of lockdown, the mental health is at a great risk. Lack of food, distance from kith and kin, uncertainty of future, walking hundreds of kilometers on foot to reach their native place is a grave issue. Unfortunately this does not come under any discussion in our country, while it can have far reaching impact on people’s health in time to come.
Therefore steps need to be taken and strategy evolved to meet the nutritional needs of our population as a whole, provide clean drinking water and sanitation facilities to all the population, ensure healthy housing for all the people including the workers at their work places as well as in their native places, strengthen the state healthcare system to provide adequate healthcare facilities to the low income groups. There is also a need to have hospital care for already prevalent diseases in emergency situations as today. It is however commendable in the present crises the state sector, despite extremely poor infrastructure, is doing yeoman’s job right from giving medical aid in the healthcare facilities and public education through field workers.
Unfortunately our public health spending is very poor hovering around 1.02% of the GDP. This must be increased minimum to 6%. Growth with mere wealth generation producing inequities will not meet the above needs. There is need for urgent policy evaluation to develop growth strategies centered around health. Otherwise times to come will be very hard for the working people with low wages.
References
https://www.macrotrends.net/countries/IND/india/infant-mortality-rate
https://water.org/our-impact/india/
On this May Day Health of workers our top priority
Date: 29.04.2020
On this May Day Health of workers our top priority
In response to a survey conducted by the Health Ministry, 44% of respondents have said that they have reduced their food intake or miss one meal per day. Only one third of the respondents said that they received any relief in kind or cash. India has a work force of 54 crore people out of which about 50 crore are in the unorganized sector, among them those who are not covered under any statutary social security schemes are almost 40 crores and who get no benefit from any schemes of the government. In this situation of lock down the workers who are stranded and unable to go to their home are faced with serious food crisis. Even the children of the workers are not getting meals. Milk, which is the most essential for the growth of children is a dream for them. Whatever ration the people are getting is mainly Atta, Daal, Rice or Oil. These too are supplied mainly by the Philanthropist organizations. Contribution of the government is much less. The Atta, Daal and rice form the staple food but they are not a balanced meal. For normal growth a person needs 2100 calories which should be met with from the balanced food. The Balanced food includes Proteins, Carbohydrates, Fats, Vitamins and Minerals. At the present price index, the balanced food to meet basic caloric and nutritional requirements for a family of 5 members costs about 14000 rupees per month. If we add to this other basic minimum needs for education, clothing, electricity, water supply, mobile phones and recreation, the amount comes to at least double of this. The 15th Indian Labour Conference held in July 1957 had said that the wages of the workers should be calculated accordingly. But nothing concrete has been done till date.
This food requirement is essential to develop basic immunity in a person to fight the disease. But as we are facing COVID-19 Pandemic, we need more immunity to protect ourselves from the infections. With the acute shortage of food intake, what to talk of balanced meal, how do we expect these workers to develop immunity. The likelihood of any person with poor nutrition in getting infected is much more than a person taking balanced meal. The question of women's health safety is even much more serious. Pregnant and lactating women need more food but under the present circumstances of loss of job, no income, dependence of food at mercy coupled with uncertainties, fulfilling the requirement of food is a dream for the poor workers’ families. Issue of women’s sanitary needs is an important issue which is being ignored completely.
Since most of the workers live in shanty areas sharing the rooms the physical distancing is not possible. As per some reports 6-7 workers share a room of 8 x 10 feet size, without any separate toilet facilities.
Since there is no job at the present place, the workers want to go home to their families. But as there is no train or bus service, they along with children and women are walking on the roads several hundreds of kilometers without food and water. Many of them, including children have died.
Stress and strain on the workers mind is unimaginable. This is because of hunger and being away from their kith and kin and also fear of COVID-19. But it is being hardly taken as seriously by the authorities. They need proper arrangements to fulfill their nutritional needs and emotional needs. So minimum what can be done is to ensure three square meals a day to each and every person. For this to make the public distribution system universal. Each and every person should be given at least 7-8 thousand rupees per month in addition to the ration. Workers’ housing has to be taken care of and this opportunity should give us an insight into the planning.
Most of the workers are neither covered under the EPF nor they are enrolled in the ESIC. The Ayushman bharat which covers fifty crores families gives coverage for indoor patients only. Those attending to outdoor consultations have no entitlement in Ayushman Bharat. In this scheme there are several clauses like if one has a motorcycle or a pucca house, is not covered under Ayushmann Bharat benefits. Therefore a large number of people who the government says have been covered in Ayushman Bharat are excluded automatically. Neither has this scheme any mention of food security to the people which is the most essential part of the life.
Workers are the foundation stone of the nation. To fulfill their basic needs is our duty and their right, for which they raise collective voice on 1st May every year. During this COVID-19 crisis special steps need to be taken to ensure their care.
COVID-19 cautions for a new global order
10.04.2020
COVID-19 cautions for a new global order
The COVID-19 Pandemic has created global panic. This is relatively a new strain of virus and we have little knowledge of its spread and the damage it can cause. We are not sure about how long will it continue? The Pandemic has brought the global economy to a standstill. Even the highly developed countries are finding it hard to cope up and are trying to meet the minimum basic needs of their people. Whereas the developed world may be able to feed its population for months in this crisis but for the developing world it is going to be a horrendous task. India with hunger index of 102 out of 117 and human development index at 129 out of 189 countries faces an uphill task to feed the hungry whose number will increase exponentially as result of lockdown. Out of nearly 54 crore labour force in the country about 47 crores is in the informal sector. They are without any job security, guarantee of minimum wage or savings. Most of them are not even able to make bare minimum earnings to live a healthy life every day. It is these large numbers who need empathy with on the ground real steps to feed them. We require huge funds to ensure that this majority populace gets at least sustenance meals, what to talk of a balanced diet.
But it is an irony that the global community has been having skewed priorities which do not conform to the present day requirements.
While hundreds of millions of people across the globe go hungry, the world military expenditure is rising constantly. Total world military expenditure rose to $1822 billion in 2018, representing an increase of 2.6 per cent from 2017, according to new data from the Stockholm International Peace Research Institute (SIPRI). The US tops the defense spending at 684 billion USD. China’s defense expenditure is 181 billion USD, while India is the 5th largest military spender with an outlay of 60 billion USD with a GDP spending of 2.4 %. Pakistan’s spending on arms is 4% of the GDP.
The nuclear-armed nations spend close to US$300 million (Rs.2000 crores) a day on their nuclear forces. The production, maintenance and modernization of nuclear forces diverts vast public resources away from healthcare, education, climate change mitigation, disaster relief, development assistance and other vital services. Globally, annual expenditure on nuclear weapons is estimated at US$ 105 billion – or $ 12 million an hour. The World Bank forecast in 2002 that an annual investment of just US$ 40–60 billion, or roughly half the amount currently spent on nuclear weapons, would be enough to meet the internationally agreed goals for poverty alleviation. Nuclear weapons spending in 2010 was more than twice the official development assistance provided to Africa and equal to the gross domestic product of Bangladesh, a nation of some 160 million people. The Office for Disarmament Affairs – the principal UN body responsible for advancing a nuclear-weapon-free world – has an annual budget of $10 million, which is less than the amount spent on nuclear weapons every hour. As former UN Secretary General Ban Ki Moon said “The world is over-armed and peace is under-funded …. The end of the cold war has led the world to expect a massive peace dividend. Yet, there are over 20,000 nuclear weapons around the world. Many of them are still on hair-trigger alert, threatening our own survival.”
Several organizations including the International Physicians for the Prevention of Nuclear War (IPPNW) have been warning since long that the enormous expenditure on the arms race will deprive the world of required expenditure on health and education. Any nuclear exchange between India and Pakistan would put 2 billion people at risk; And any such exchange between the two major nuclear powers can lead to extinction of modern civilization built through thousands of years of human labour. The arms have the power to kill directly; but their continued production and maintenance leads to diversion of huge funds which could have otherwise met the needs of improving health of millions around the globe. Present situation, when the world has come to stand still, is in itself more than a warning that the world has to develop mutual cooperation to move forward. There is urgent need for development of an equitable healthcare delivery system which meets the needs of all sections of society without distinction of cast, creed, religion, ethnicity, gender and socio economic status through a global frame work.
It may not sound appropriate, but COVID 19 pandemic can be utilized as an opportunity to work towards disarmament and establish a global peace order where the priorities are changed from controlling other’s wealth to sharing knowledge and technology to promote mutual cooperation and development.
COVID-19 Lockdown and health challenges Urgent need to evolve a strategy to combat pre-existing diseases as well
COVID-19 Lockdown and health challenges
Urgent need to evolve a strategy to combat pre-existing diseases as well
The lockdown to break the chain of spread of COVID-19 is an essential step. In the initial stages it was found that the people who had come from abroad, Indian or non-Indians carried this virus with them. So they were screened at the airports and the suspicious cases were quarantined. Since this process was started quite late, therefore several people escaped the testing and many of them even returned after visiting India.
Even though first case was reported in China in December 2019, the global community became serious about it only after number of cases increased exorbitantly in the Wuhan province in China. By the time the disease had already spread in parts of Europe. The WHO too was quite late in assessing the seriousness of the situation in its early phase.
Unfortunately Indian government did not take it that seriously. This is apparent from the Health Ministry statement on 13th march which said that Corona Virus is not Health Emergency. Therefore several large congregations, religious, political and social continued to happen. When it became apparent that things may get worse, the Prime Minister suddenly announced for a closure for one day on 22nd March and then 21 days lockdown on 24th March. This sudden lockdown, without giving any time created chaos and split the society into those who have means to survive for 21 days and beyond, to stay at home to protect their health and others who earn and spend every day. These more than 90% of the workforce, which is in the unorganized sector or informally employed in the organized sector, and especially for casual labourers who earn on a daily basis, the farm labour and marginal farmers the lockdown is both an immediate health risk and an economic catastrophe.
A lockdown of society, by itself, is not a cure for the COVID-19 epidemic; it is for prevention of transmission and a stratagem for winning some time for the healthcare system updation. Epidemiological models consistently suggest that, in the absence of other factors, the epidemic could bounce back once the lockdown is lifted. If this were to happen at the end of India’s lockdown, the epidemic would hit a society already under severe economic distress, with potentially devastating consequences.
Huge migration is occurring because of fear of being overtaken by the Corona, loss of jobs, lack of food and desire to be with family, at a time when the coming period is full of uncertainties. This will have long term impact. In the absence of any transport lakhs of migratory population including women and children are walking on foot for hundreds of kilometers without food & medicines. They are facing hurdles on the way from the state machinery because of which several of them have already died. They are facing hunger, lack of clean water, spending time in unhygienic conditions on the way coupled with uncertainty. Such a situation will push any person into extreme mental stress. The purpose of lockdown is completely defeated under such circumstances. Even the lucky ones who have been able to get the facility to travel in the buses or the trains are in the danger of catching all sorts of infections from each other. The incident where a group of migrant workers were sprayed with disinfectant at Barreiley in UP is not only totally inhuman but a criminal act as the chemical can cause nausea, vomiting, head ache, irritation and damage to eyes, burns in the respiratory tract agitation, delusion, drowsiness, hallucination, impaired judgment, excitement, and mood changes. It would be a sorry state of affairs if the persons responsible for this go unpunished.
Lack of preparedness on the part of the government is becoming a serious issue with every passing day not only for the ordinary people but also for the health professionals. There is acute shortage of masks, sanitizers and personal protective equipment (PPE) for the health professionals and the allied staff. In such situations when we need nearly 10 lakh ventilators in contrast to the present available 40 thousand, the future seems very bleak in case of a sudden surge in the number of cases.
A post lockdown plan is very necessary. We are deeply concerned that the government of India has not released a roadmap, detailing how it plans to deal with the epidemic, once the lockdown is eased. We believe that such a plan should have been put in place before the lockdown was announced, and we urge the government to do so as soon as possible. Such a move would also enhance the confidence of people in the government’s long-term strategy.
The lockdown may succeed in temporarily suppressing the epidemic, at great social cost, but we are concerned that the government is not using this precious interval of time to actually identify as many cases of COVID-19 as possible. Much more testing is necessary. The current restricted testing-policy creates the risk that a large number of mildly symptomatic or asymptomatic cases—which constitute the majority of infections—will remain undetected even at the end of the lockdown period. These cases could easily serve as the nucleus for the epidemic to bounce back.
India is a hub for various types of diseases, both communicable and non-communicable. Our hunger index is at 102 out of 117 countries and we stand at 129 in the Human Development Index out of a total of 189 countries. In the coming days there will be surge in the diseases related undernourishment. There would be increase in the pre-existing diseases like Tuberculosis, Diarrhea, Hepatitis, High Blood Pressure, Diabetes, Cardiac illnesses, Kidney problems and the Mental Health which till date remains largely ignored.
Under these circumstances the already existing diseases are getting completely ignored. Govt. has announced closure of OPDs. The state healthcare delivery system is incompetent to meet these needs because for years together the state health budget has been hovering around 1% of the GDP. India loses about 1500 lives every day because of Tuberculosis. Since all attention is now diverted to Corona these patients will have difficult times, many of them will enter into the MDR stage. Other common diseases like Diabetes which is presently prevalent in about 12 % of our population, Hypertension which is among 25 % of our population, Hepatitis which is a very common cause of death have lost importance in the treatment line. Such patients likely to get worse and their number would increase. Patients with cancer are another category facing sufferings.
Lot of myths are being spread. There are groups who propagate use of Cow urine for its cure. They also say that the sound of ‘Shankhs’ will split the outer wall of the Virus and the virus will be killed. It is very sickening to note that some are trying to give the deadly disease a communal colour. This is in total contravention to medical oath, the spirit of Red Cross and sacrifice of Bhai Kanhaiya a legend in Sikh history who supplied water to even the injured Moghul soldiers during war and earned appreciation from Guru Gobind Singh Ji for his humanitarian work.
So an arduous struggle is on along with minimizing the damage by Corona Virus.
References:
1. https://www.livemint.com/science/health/government-survey-found-11-8-prevalence-of-diabetes-in-india-11570702665713.html
2. https://www.nature.com/articles/s41371-018-0117-3
Dr Arun Mitra
Consultant ENT Surgeon
Sr. Vice President IDPD
M: 9417000360
Dr Tejbir Singh
Former Director Research and Medical Education
M: 8146144002
Dr Sham Sunder Deepti
Professor Emeritus, Dept. of Community Medicine
Govt. Medical College, Amritsar
M: 9815808506
Covid 19 - Belated hurried steps may not be as productive without a comprehensive approach to ensure nutrition and stress reduction
Date: 28.03.2020
Covid 19 - Belated hurried steps may not be as productive without a comprehensive approach to ensure nutrition and stress reduction
Like many parts of the world our country too is grappling to prevent spread of Covid -19 to the 3rd stage. This is a very precarious situation where every step has to be taken cautiously with lot of precaution. The medical, paramedical staff and the Safai Karamcharis are at high risk. Several doctors and nurses lost their lives in China, Italy, Iran and Spain after they caught infection while caring for the sick.
Even though flu is a common disease but sometimes it could take serious forms. The world has witnessed the influenza pandemic of 1918-1919, known as "Spanish Flu" or "La Grippe" which killed between 20 and 40 million people, which is more number of people than in the First World War. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague. It has been cited as the most devastating epidemic in recorded world history.(1) Between 17 and 18 million Indians died in this. We lost 6% of our people. More women - relatively undernourished, living in unhygienic and ill-ventilated dwellings, and nursing the sick - died than men. The pandemic is believed to have infected a third of the world's population. (2)
But those were different times. Medical science was not as much advanced to fight back the disease as it is today. In comparison we have much more advanced medical care now a days. We have more information about spread of diseases and their control measures. The fear however is that there is much more increase in mobility which can be the cause of fast spread of infection. In India so far we have been saved of community spread of Covid-19. But there is lot of uncertainty in the coming days.
Keeping this in view, the government, on the advice of medical scientists has taken certain measures including lock down. Social distancing, (or better call it physical distancing/medical distancing), is an important way to prevent spread. The John Hopkins COVID 19 modeling for India points out ‘that the Social distancing is an important step as the virus spreads through droplet infection. But a national lockdown is not productive and could cause serious economic damage, increase hunger and reduce the population resilience for handling the infection peak’. The poor people, which form more than 50% population of the country, may not be able to withstand this situation if some effective measures are not taken by the state to fulfill their basic needs for sustenance of life.
In such situations people look towards the state for care and help. The announced packages by the Prime Minister and then by the Finance Minister are meager in the wake of huge requirements for investments in the health system to provide for safety equipment, Personal Protective Equipment(PPEs), increase of beds and other infrastructure and to fulfill basic needs of almost 50 crore of 54 crore labour force which has been rendered jobless suddenly and have no means for livelihood due to lock down.
The government woke up too late and then abruptly announced lock down and curfew. This caused lot of displacement of the migrant workers in different states. These people are now facing hunger and we expect them to face Covid? When the first case was reported on January 30 many at the responsible positions in the assembly and the parliament started spreading myths for the management of Corona virus. The scientific guidelines were also totally ignored when some groups were seen taking out rallies and jostling with each other beating Thalies, playing Ghanties and shankhs with the hope that this sound will kill the virus. In many such rallies politicians and bureaucrats were seen leading. It was even more sickening to watch the Chief Minister of Madhya Pradesh taking oath in the presence of hundreds of people totally in contravention to the medical advice.
It was good on the part of the govt. to announce insurance coverage to doctors for Rs.50 lakh, for nurses Rs.30 lakh and others in the health sector for Rs 20 lakh but this package once again ignores the emergency needs of health professionals and para-medicals and other workers of the health system to meet the challenge. Immediate investments are required in the health sector for PPEs, masks, increasing beds in hospitals and creation of new facilities in school buildings and stadiums to meet the emergency situation of testing, segregating and quarantine of those tested positive in these places. As per estimates our country has about 40000 ventilators only. Govt. has decided to purchase 40000 more. But in this global crisis it may be difficult to get these from abroad. However the requirement is being estimated to the tune of ten lakh if the situation worsens.
We need immediate steps to improve nutrition level of our population. An announcement of Rs. 500 per month to those with Jan Dhan accounts, many of which have already been closed, is very insufficient. Govt. must ensure balanced diet for all citizens providing 2100 calories and required amount of minerals and vitamins.
In a very bold statement, Senior Consultant Gastroenterologist and Transplant Hepatologist from Hyderabad, Dr. Manisha Bangar challenged government’s approach and dared govt. not to waste energy on Ghantis and Thalis but care for those engaged in care of the patients. She suggested the government to ask corporate to shelve their pockets and to take money from the huge amount of offerings lying with the temples (3).
Several doctors from Indian Doctors for Peace and Development (IDPD) who are engaged in relief work have reported from different states the difficulties being faced by the health professionals in the absence of basic items like masks and gloves.
The Kerala government has released a relief package of Rs.20,000 crores. Punjab, Rajasthan and Delhi also have come out with economic relief packages. United States of America has passed CARES Act (Coronavirus Aid Relief and Economic Security) which includes cash relief, small business loans to enable payment of wages to workers, Industry specific loan guarantees that largely protects cargo industry and its workers, health care that includes free health care, extension of tax deadline, provision of loan holidays to students and industries. Australia has come out with $189 billion economic rescue package. Germany, UK, EU etc all have come out with economic relief packages as well. Why is our government refraining from being liberal in announcing the package?
What we need at present is to do large number of tests at random because the number being projected may not be correct in the present situation. Stress level among the population is increasing, including among children and teenagers. Lot needs to be done to allay their fears and reduce stress level. Such stress can lead to anxiety, depression, loss of sleep etc. Not much is being done in this direction till date!
References:
- https://virus.stanford.edu/uda/
- https://www.bbc.com/news/world-asia-india-51904019
- https://www.facebook.com/100004202117248/posts/1603154309834624/
Organized Violence a challenge for health
Organized Violence a challenge for health
Reports that in many cases the victims of violence in Delhi were not allowed to reach hospitals are very disturbing. Even worse, the ambulances were stopped and searched by the police, and patients’ dressings removed while on way to healthcare facilities. This is against all the norms and forms of justice to the sick and patients' rights. A doctor was not able to shift the patent to higher center because under the circumstances when mob violence was in full swing it was not possible to transport without police support. When he tried to contact the police officials repeatedly, none of them picked his phone. The police officials contacted the doctor only after the intervention by the high court at midnight. That led to delay in shifting the serious patients.
Health is the biggest victim during the conditions of violence. This has been observed in different parts of our country recently as well globally.
Violence perpetrated by any section is not pardonable as it leads to physical injuries, mental trauma and death. There develops mistrust on each other. These have long standing impact not only on the health of the individual but also the society as a whole. There are reports of 53 people having died in the hospitals. Over 450 are reported to be injured. From a visit to the affected area it was found that number of the injured could be much higher as only the serious patients reach the hospitals. Patients with minor to moderate injuries did not go to the hospital. They took treatment from the nearby medical facilities. Many have not even ventured to come out to go to the medical personnel because of fear of violence. Such fear exists even today after 10 days of violence. Several civil society groups are organizing medical camps. Besides common ailments and injuries large number of people suffer from mental health problems some of them of serious nature.
The people have been having difficulty in getting the dead bodies, the medico legal reports and postmortem reports of their kith & kin causing further stress on their mind.
Any kind of violence is an issue of serious concern for public health. Violence committed by group of people in the name of ethnicity, religion, caste, creed, pseudo nationalism, beliefs can cause collateral damage including social disharmony and instability. There develops a mindset which makes people believe in things without ascertaining the facts. Mob lynching on getting a message on social media is a relatively new phenomenon. A systematic hate campaign is launched to poison the mindset. When the state becomes the perpetrator situation becomes much graver. We have witnessed such situation in Gujarat in 2002 where the state was not only a mute spectator but a perpetrator. This is reminiscence of Nazi Germany. The New York Times dated 11 November 1938 published as lead news ‘Nazis Smash and burn Jewish shops and temples until Goebbels calls halt”. This happened in Rawanda too where Hutu and Tutsi tribes fought against each other. Neighbors killed neighbors and Hutu husbands even murdered their Tutsi wives out of fear for their own lives. Nearly 10 Lakh people died in this violence.
Violence of the scale that occurred in the capital city is very disturbing, shocking and a signal to the coming days if things are not set right immediately. The affected area has never witnessed communal frenzy. The present events reflect ideology of the perpetrators and intentional failure of law enforcing agencies that are directly under the Minister of Home Affairs. In 1984 too the capital had witnessed similar violence unleashed on innocent people. No lessons seem to have been learnt from that. A timely proactive action by the state government also could have saved several precious human lives and damage to property.
Even now little is being done for relief and rehabilitation work. Delhi is the capital city with all infrastructures. Violence affected areas are a very small part of total area of Delhi. Reaching out to any place in the city is not at all difficult. Then why this apathetic attitude towards medical relief and rehabilitation work? Denial of healthcare either by act of commission or omission is a crime. Health is recognized as an important human right. This must be ensured for all populations particularly those in conflict areas where there is always a fear of abuse.
It is important that after such a harsh violence the feelings of affected people are assuaged. They need lot of empathy and support. This is unfortunately missing in Delhi. The central government has been perceived as perpetrator of the violence because of utterances by their senior leaders who have incited violence. None of them had the courtesy to visit the areas affected by violence till date. It is however intriguing why the recently elected Delhi government kept mum and took no steps to stop this.
Health can form a bridge of peace. Advocates argue that negotiations around healthcare delivery cultivate informal channels of communication that can contribute indirectly and directly to the peaceful settlement and confidence building. Such activities can change the dynamics of the situation.
Even though, both state and non-state providers have a duty to provide healthcare impartially and equitably as stated in medical ethics and international law, the states has a primary responsibility to deliver healthcare to affected populations. This is a legal duty.
Any factors that contribute to the violence have to be removed. Continuous hate campaigns can have serious adverse effect in polarizing the population in which even the doctors can be carried away. That at several places people from different communities saved each other is a positive reflection of human behavior which we must carry forward.
Make Uniform Code of Pharmaceutical Marketing Practices Mandatory
Date: 19.01.2020
Make Uniform Code of Pharmaceutical Marketing Practices Mandatory
As per the reports, the Prime Minister in a meeting with the Pharma giants, Zydus Cadila, Torrent, Sun Pharma and Wockhardt has warned that they should strictly adhere to the Ethical Marketing Practices and not bribe the doctors. The Indian Pharmaceutical Alliance (IPA) has however denied any such discussion; “The meeting was called to discuss future roadmap for growth of the healthcare industry. The focus of discussion was on: Research and development, building innovation ecosystem, improving access to high quality medicine, and strengthening global competitiveness of the industry,” said a press statement issued by the IPA.
The Uniform Code of Pharmaceutical Marketing Practices (UCPMP) prohibits pharmaceutical companies from offering freebies to the doctors with an aim of getting business from them through prescription of their products. The Indian Medical Council (Professional Conduct, Etiquette & Ethics) Regulations, 2002 also asks the doctors to adhere to ethics and not accept freebies from the Pharmaceutical companies. This practice adds to the price of drugs and ultimately taxes on the pocket of poor patients who are already overburdened by the out of pocket expenditure on health.
It is well know that the Pharma companies (now even the corporate hospitals) sponsor nearly all the medical conferences or CMEs. They pay for the expenses including travel, accommodation and even registration fee for the participants.
The UCPMP has been in vogue since December 2014. When it was framed, it was said that it would be voluntary for six months and then reviewed after the inputs received. Several representations were given to the government by the Alliance of Doctors for Ethical Healthcare (ADEH) and Indian Doctors for Peace and Development (IDPD) to make it mandatory but government has not taken any steps and it remains voluntary even after more than five years. The Punjab Medical Council too was seized with the issue at one time and had given representations to the government in this regard but to no effect.
The Medical Council of India (MCI) in its meeting on 18th February 2014 exempted the "Professional Association of Doctors" from the purview of The Indian Medical Council (Professional Conduct, Etiquette & Ethics) Regulations, 2002. This gave an alibi to the pharma companies to pass on money to the medical associations for various expenditure which has been used for the benefit to the members in form of travel, accommodation, registration etc. to attend the meetings, conferences and CMEs orgnaised by the associations. However according to the clause 7.2 of the UCPMP “companies or their associations/representatives shall not extend any hospitality like hotel accommodation to healthcare practitioners and their family members under any pretext”. The implied meaning of this is that extending benefits to the doctors through associations too is not permissible. It would be naïve to expect from the companies to implement the code voluntarily. Global experience is also the same. The only way is to make UCPMP mandatory.
Through its circular No. 5/2012 [F. No. 225/142/2012-ITA.II], dated 1-8-2012, the Central Board of Direct Taxes (CBDT) had taken away exemption to the pharma companies on expenditure incurred on freebies. It also said that ‘the sum equivalent to value of freebees enjoyed by the aforesaid medical practitioner or professional associations is also taxable as business income or income from other sources as the case may be depending on the facts of each case’. But this decision was reversed by the Pune Bench of Bench of the Income Tax Appellate Tribunal.
Thus the issue involves making the UCPMP mandatory, reverse the decision of the MCI exempting the doctors associations from the code of medical ethics and also imposing the no tax emption on pharma companies as well as the doctors and their associations for the freebies.
The government’s stance from the media reports that the PM has warned the pharma companies against giving freebies sounds encouraging. But the denial by the IPA of any such thing creates doubts because the PMO has not commented on this statement of the IPA. The PMO must clarify its position over the denial by the IPA of any warning from the Prime Minister. It remains to be seen whether the UCPMP becomes reality. The skepticism arises from the fact that the Prime Minster’s Madison square event in 2014 which has been estimated to have cost US$ 1.5 Million, was sponsored mainly by the pharmaceutical giant the Sun Pharma.
MEDICINE IS SCIENCE NOT A FICTION
Date: 14.12.2019
MEDICINE IS SCIENCE NOT A FICTION
Interesting statement has been given by the BJP Member of Parliament Shri Ganesh Singh speaking Sanskrit language on a daily basis boosts the nervous system and keeps Diabetes and Cholesterol at bay. Earlier too similar statements have been given by some political leaders. The Prime Minister of India Shri Narendra Modi in 2014 had said that in ancient times Plastic Surgery in India was so well advanced that head of an elephant could be transplanted on human body. Taking alibi from his statement many of their leaders jumped into fray and started giving similar statements.
Pragya Thakur the member of Parliament from Bhopal came out with the statement that her Breast Cancer was cured by cow urine. However Dr.S.S Rajput, a surgeon at Ram Manohar Lohia Institute of Medical Sciences in Lucknow has confirmed that he had done three operations on her Breasts to get her rid of cancer. Pragya has not denied doctor’s assertion.
Uttrakhand Chief Minister Trivendra Singh Rawat recently said cows are the only animal which can inhale and exhale oxygen and that massaging the animal can cure breathing problems. He further said living in close proximity with cows can also cure Tuberculosis. The Pradesh BJP president and Nainital MP Ajay Bhatt recently said pregnant women can avoid caesarian deliveries if they drink water of Garud Ganga, a river in Bageshwar district.
The 'Garbh Vigyan Sanskar’ propagated by Arogya Bharti advises couples to recite Shlokas at the time of mating so as to have customized babies of their choice - the Uttam Santati. They also say that they got this idea from Germany which has been brushed by the German doctors. However they have not come out with any data confirming the number of customized babies born through this.
Not only that some of the ministers of the Gujarat government attended the felicitation ceremony of Tantriks.
Such statements are not limited to the political people only. In a statement of the Vice Chancellor of the Andhra Pradesh University G Nageshwar Rao at the Indian Science Congress in Jalandhar said that “we had hundreds of Kauravas from one mother because of stem cell research and test tube baby technology. It happened a few thousand years ago. This was science in this country."
A retired judge of the high court of Rajasthan had given a statement that the Pea-Hen gives birth to the offspring by licking the tears of the Peacock.
We already have several obscurantist ideas and myths about the causation and treatment of disease in our society. Large number of people go to the faith healers for the treatment of several diseases, like the Mumps, the Facial palsy and for the treatment of chicken pox. Another myth is that Jaundice is cured by perforating the ear drum and extracting jaundice out from this.
Medical science is not fiction nor is it belief system. It is a science based on evidence. Ay treatment to be undertaken has to be proved in the laboratory, then on the animals and ultimately on the human beings before that particular modality of treatment is made functional without harm to the human body. Propagation of such obscurantist ideas by the political leaders or some others makes the ordinary illiterate people believe these as gospel truth. This is not only dangerous but a criminal act which must be punishable. It is sad that the government is not only apathetic towards many irrational ideas on health but is very subtly promoting them.
It is ironical that such statements are coming up in the present times when science has advanced on the basis of evidence. It is more ironical that the resistance to such statements is not as much as it should be. The scientific or medical bodies are not coming out boldly and openly against these obscurantist and irrational unscientific ideas. Whether they are convinced by these ideas or they are afraid to come out openly, is best known to them.
Doctors And Patients Must Have A Collaborative Relationship
Date: 5.12.2019
Doctors And Patients Must Have A Collaborative Relationship
By Dr. Arun Mitra
In the past few years there has been increase in incidents of violence against the doctors, some of them of very serious nature in which doctors have been seriously injured. Unfortunately most of the times it is the young doctors, who are at regular duty, working tirelessly day and night in the hospitals, without food, rest or break have been targeted by the mobs. This not only shakes the confidence of a budding doctor but also affects his/her attitude towards the patients. A doctor cannot perform in the atmosphere of fear.
True, that a doctor is duty bound to cure, but the end result can never be guaranteed. It depends on the nature of disease and several other factors. Mishaps occur in the best hands and in the best conditions. Negligence cannot be condoned, but to err is human. Many a time faults occur unknowingly. This however does not mean that medical professionals are not accountable. There are laws to deal with such situations. Violence under any circumstances cannot be excused and emotions cannot be allowed to turn into violent behaviour.
In addition to medical skill, trust is the most important thing in medical practice. It is this trust which has become weak and has adversely affected harmonious relationship between the doctor and the patient which is of utmost importance to build a healthy society. Degeneration in the value system as a whole in the society has affected medical profession as well. In the changed socio-economic relations, medical professionals too have become amenable to machinations by the vested business. The cuts and commissions for referrals by a few have lowered the image of a doctor who hitherto has been considered as next to god.
Under the circumstances, the family like relationship between patient and doctor has undergone sea change. Entry of corporate sector in healthcare has turned it into business where profit is the only motive. This is against the very principles of healthcare. Medicine is not a profession but a passion. A world of compassion and empathy is a big healing factor. In the corporate culture compassion has no meaning; it is only making profit. The medical education system too is not left out.
This has necessitated the need to define the rights and responsibilities of both patients and the doctors at global level. The National Human Rights Commission of India has come out with a 17 point charter of rights of the patients. These include, right to information, right to records & reports, right to emergency medical care, right to informed consent, right to confidentiality human dignity & privacy, right to second opinion, right to transparency in rates & care according to prescribed rates wherever relevant, right to non-discrimination, right to safety and quality care according to standards, right to choose alternative treatment options if available, right to choose source for obtaining medicines, right to proper referral and transfer which is free from perverse commercial influence, right to protection for patients involved in clinical trials, right to protection of participants involved in bio medical & health research, right to take the charge of patient or receive body of deceased from hospital, right to patient education and right to be heard and seek redressal.
As per Supreme Court, all hospitals both in the government and in the private sector are duty bound to provide basic Emergency Medical Care, and injured persons have a right to get Emergency Medical Care. Such care must be initiated without demanding payment / advance and basic care should be provided to the patient irrespective of paying capacity. It is the duty of the hospital management to ensure provision of such emergency care through its doctors and staff, rendered promptly without compromising on the quality and safety of the patients.
The charter has also specified duties of the patients which include that the patient should respect the dignity of the doctors and other hospital staff as human beings and as professionals, whatever the grievance may be. Patient or caregivers should not resort to violence in any form and damage/destroy any property of the hospital or the service provider. Patient must provide all the related information and query to the doctors without conceding any relevant information; patient should cooperate with the doctor during examination; patient should follow all the instructions regarding appointment time and cooperate with the hospital staff and fellow patients; patient should take responsibility for their actions based on choices made regarding treatment options.
The universal declaration of human rights 1948 emphasized the fundamental dignity and equality of all human beings. Based on this concept, the notion of patient rights has been developed across the globe in the last few decades. In India there are various legal provisions related to patient's rights like the Constitution of India Article 21, Indian Medical Council Professional Conduct and Etiquettes and Ethics - 2002, Drugs and Cosmetics act. Inspired by the international charts the national human rights commission has drawn all relevant provisions in a comprehensive manner thereby making them publicly known in a coherent manner.
It is important that these are imbibed into both doctors and patients to understand responsibilities towards each other. Contempt against the other cannot sustain and will be disastrous for health of the society. (IPA Service)
NUCLEAR WEAPONS ABOLITION – TIME IS NOW TO ACT
NUCLEAR WEAPONS ABOLITION – TIME IS NOW TO ACT
7th July is a historic day when the UN General Assembly passed Treaty Prohibiting Nuclear Weapons in 2017. The treaty is an opportunity which the global community must utilize to make the world free of nuclear weapons. An opportunity lost may never be regained.
World has never been in such uncertain situation in the last several decades as it is now. The ongoing conflicts in several hot spots in the world if not cooled down urgently, may escalate into larger wars. A last minute decision by the US President Trump to not attack Iran has only saved time. The tension still persists. The situation in Syria has been one of the worst scenarios in the recent times. Iraq and Afghanistan are not yet stabilized. Internal strife in Somalia, Rawanda and Yemen are other grave scenarios. Our own region, the South Asia is equally volatile. The events following Pulwama terrorist violence which martyred 49 CRPF personnel had almost pushed India and Pakistan to the brink of war. Threat of use of nuclear weapons gave dreadful shiver to the people on both sides. The jingoists on either side of the border took no time calling for destruction of the other. Any use of nuclear weapons would have been catastrophic not only for India and Pakistan, but the whole world.
Ira Helfand, Co-President International Physicians for the Prevention of Nuclear War (IPPNW) and Allan Robock & colleagues from Department of Environmental Sciences School of Environmental and Biological Sciences Rutgers University, New Jersey, USA conducted a study on the Climatic Consequences of limited Nuclear Conflict between India and Pakistan using 100 Hiroshima size nuclear bombs. The study proved with evidence that over 2 billion people would be put to risk globally as an aftermath of nuclear famine which would ensue under such situation. Any nuclear conflict between the major nuclear powers could be end of modern civilization. Such situation is not a utopia. We have already seen unprecedented damage after the atomic bombing of Hiroshima and Nagasaki where over 200000 people were killed. The after effects of radiations are seen even today.
South Asia is one of the poorest regions in the world. The human development ranking for India and Pakistan is at 130 and 150 respectively. Hunger index of India is at 103 and Pakistan at 106 out of 119 countries. About 40% of the world’s stunted children and 53% of all wasted children live in South Asia. Around 34% of the population has no access to sanitation. Investments in health and education remain less than 4% and 3% of respective GDPs. Yet successive governments and military establishments have escalated military spending in India and Pakistan to US$ 64 billion and US$ 11 billion annually in 2017, respectively. India’s defense expenditure is 1.62 % of its GDP, while its central health budget is 0.26 of GDP, six times less than its arms budget. Pakistan’s spending on arms is equivalent with budgetary allocation 8.9 billion USD. With Pakistan worth 300 billion USD economy its defense expenditure comes to 2.9% of the GDP.
As per the latest report of Stockholm International Peace Research Institute (SIPRI) the annual global defense expenditure is US$ 1699 billion (2.2 % of the global GDP). The US tops the defense spending at 611 billion USD. China’s defense expenditure is 215 billion USD, while India is the 5th largest military spender with an outlay of 55.9 billion USD (Rs.363350 crore).
Increase in spending on arms race causes serious resource crunch on health, education and development. The developing countries and poor in these countries are worst affected.
It is time, steps are taken for complete nuclear disarmament and end to arms race. On 7th July 2017 historic Treaty Prohibiting Nuclear Weapons (TPNW) passed by the UN General Assembly with 122 votes in favour and only one against. This is a moral victory for the peace movement globally. The Treaty on the Prohibition of Nuclear Weapons opened for signature at United Nations headquarters in New York on 20 September 2017 and will remain open indefinitely. Once 50 nations have ratified or acceded to it, it will enter into force. Already 70 countries have signed it and 23 have ratified.
It is a big opportunity for complete nuclear disarmament and save the world from nuclear catastrophe. It is time the nuclear armed states realize this and join the treaty without any ifs and buts. India should take lead.
Dilution of ESI scheme will compromise with workers health and productivity
Dilution of ESI scheme will compromise with workers health and productivity
India has a work force of about 54 crore people. Despite that they are engaged in the productivity and development of the nation, they remain marginalized. Since most of them are in unorganized sectors they are devoid of any social security benefits. Those in the government departments and public sector enterprises, who are covered under social security, are only about 3%. Among the rest work force small number are in formal economy and vast majority, 93%, are in the informal economy. Other than Government and public sector employees, only about 11% of the total work force is covered under the social security schemes.
The Employees’ State Insurance Scheme (ESIS) is a multidimensional social security scheme meant to provide Socio-economic protection to the employees in the organized sector against the events of sickness, maternity, disablement & death due to employment injury and to provide medical care to the insured employees and their families. The scheme provides full medical care to the employees registered under the ESI Act, 1948 during the period of his incapacity, restoration of his health and working capacity. It provides financial assistance to compensate the loss of his/her wages during the period of his/her abstention from work due to sickness, maternity and employment injury. The scheme also provides medical care to his/her family members.
The ESI scheme is different from any insurance scheme as it covers medical benefit, retirement benefit, sickness benefit, disablement benefit, dependent benefit, maternity benefit, confinement expenses, funeral expenses, unemployment allowance, vocational rehabilitation allowance. It covers from OPD care to in patient care to the post hospitalization expenses. No insurance scheme gives so much coverage. The ESIC could be a guiding scheme where the government directly imparts healthcare at various levels.
It is unfortunate that the Union Government has been initiating ill-advised ‘reforms’ in the ESI Scheme without differentiating between ‘health insurance’ and ‘social security’.
The ESIS is based on contributions by the employers to the amount of 4.75% of the wages and the workers to the amount of 1.75% of their wages. With effect from 1st July 2019, the rates of contributions to ESI Scheme will be reduced from 4.75% to 3.25% of wages for the employers and from 1.75% to 0.75% of wages for the workers, as decided by the Ministry of Labour and Employment.
The logic given by the government behind this reduction in contribution is that they have accumulated huge reserves out of this scheme. This needs to be studied on the basis of facts. During the period from 2014 to 2019, ‘non-earmarked reserves’ grew from Rs.15,650 crore in March 2013 to Rs.68,292 crore in March 2019. The reserves have accumulated because of the increase in the income ceiling for coverage under ESIC from Rs.15,000/- to Rs.21,000/- per month in January 2017. This added to the number of workers covered under the scheme, so the contribution amount. The other reason for increase in the reserves is that the government has in fact reduced its spending on the workers. In the year 2014, a lot of changes were effected in the ESI Scheme. These curtailed a majority of benefits under the ESI Scheme, especially the super specialty treatment. This resulted in a huge reduction in the expenditure of the ESI. The eligibility criteria to get super specialty treatment which was three months of joining the scheme was changed to two year of service. The workers and their families could not avail the facilities during that period.
Another fact is that while the number of employees covered under the ESI increased from 1.95 crore to 3.11 crore i.e 59.5% during the period from 2014 to 2018, the number of dispensaries increased only marginally from 1418 to 1500 ie. 5.7% only. This has led to further underutilization of funds collected. There are only 44 model hospitals in the whole country, which is too low a number. The condition of the whole system is far from satisfactory as even many of the model hospitals do not have up to date facilities. The infrastructure in terms of modern diagnostics, super specialty care and number of doctors and paramedical staff is not as per the requirement. There is huge rush of patients in each hospital which the unmatched number of doctors find difficult to cope with. Patients’ complaint invariably is that the availability of medicines too is not sufficient. Many a times the patients are out sourced for diagnostics and treatment. There is need to develop own infrastructure to cater to the needs of the patients effectively.
If proper medical care are extended to all the employees covered under the ESI scheme, as per calculations based on the expenditure towards medical care incurred by the ESIC Delhi, the expenditure on medical care alone may amount to Rs.18400/- crore per annum. (In Delhi, where the primary, secondary and tertiary medical care – all are administered by ESIC directly per capita medical expenditure is Rs.5,555/- in 2017-18). The income from contribution of ESIC in the year 2017-18 is Rs.20077/- crore. Meaning thereby, that the ESI will not save more than Rs.1677/- crore which in fact may not be sufficient to meet the other social security benefits to the employees. Thus the Labour Ministry through its decision, has been instrumental in piling up of huge reserves, without properly utilizing the same for providing social security to the employees and their family members.
There is need to differentiate between ‘health insurance’ and ‘social security’.
Social security is non-negotiable, as it is enshrined in articles 39(e), 41 and 42 of the Directive Principles of the Constitution of India. Besides, social security is one of the fundamental principles of the International Labour Organisation (ILO), of which India is also a founding member. As per the established principles, social security, which is supplementary to the Fundamental Rights of citizens of the country, are mandatory and not something which could be left to the option of either the employees or employers. Extension of Medical Care, sickness benefit, maternity benefit, employment injury benefit disablement benefit and dependent benefit (family benefit) are mandatory provisions as per internationally accepted social security standards. Leaving even one of these benefits out of the social security net, would be nothing but working in a manner contrary to the Directive Principles of the State Policy of our Constitution. It has to be clearly understood by the decision makers that productivity of a person depends on his health. Any step to dilute the health scheme will affect productivity and thus development of the nation.
Healthcare Education Policy Will undermine the basic essence of medical education
Healthcare Education Policy
Will undermine the basic essence of medical education
The draft of National Education Policy 2019 is in public domain. This means people across the country can give their inputs on this draft before it is discussed in the standing committee followed by debate in the parliament for formal adoption. The document dwells on various aspects and different sectors of the education. Medical education is generally debated along with the national health policy document where general guidelines about the approach are presented. But the present National Education Policy document too has given space to it as ‘Healthcare Education’ in the Clause number 16.8. The initial part of the document recognizes “that Healthcare Education must ensure that skilled doctors, nurses, and paramedics are trained in a scheme that appreciates pluralistic health education perspectives alongside specific disciplinary foci. Reforms in medical education must necessarily have a profound impact on the quality of healthcare delivery. The goals and standards for medical education must be derived from the vision of ‘state of the art, quality, and affordable healthcare for all’. Reforms in healthcare education must aim to improve the quality of infrastructure for primary and secondary healthcare, particularly in rural areas. Improving access to healthcare education for rural students, and lowering the cost of education is key to achieving this goal”.
The sub clause 16.8.1 deals with the basics of MBBS training and lays stress on regular assessment of the students. This is important step. It stresses on introducing rotatory internship. The rotatory internship already exists; without a certificate of having done this one does not get the degree. It is another matter that because of pressure of entrance into post graduate courses, the students do not spend much time in it. However for training a basic MBBS doctor for general practice it is important that the young doctors spend stipulated time in the hospital during the internship seriously.
Next clause suggests introducing the basic course for first 1-2 years. After this they will be free to join MBBS, BDS or Nursing etc. It is not clear in this how this will be done. The document leaves the issue to be discussed with the National Medical Commission (NMC). Bridging of courses, that is lateral entry of students from nursing and other disciplines to join is another point taken up in this clause. How this will be integrated is again not clear in the draft.
The clause 16.8.3 deals with the exit examination for the MBBS graduates. The document has outlined that the students will appear in the examination after 4thyear. Selection to the post graduate courses will also be made on the basis of this exit examination so that the students do not have to appear in the examination for PG courses again. But what is not clear is the status of the students who are not able to get minimum qualifying marks. These students have already appeared in the final year examination in different subjects. Those who have passed in the regular exam will not get the degree until they get minimum qualifying marks in the exit exam. The students from medical colleges which are better equipped are likely to clear the exit exam. But since the exit exams are in the MCQ format, the result may not be as expected. This is an extra stress on the students. In fact the logic behind it is to discourage the students from getting admission to the substandard colleges. This amounts to in fact running away by the government from the responsibility to ensure quality education in all the colleges. The NEET exam is already under lot of debate. Some states like Tamil Nadu are opposed to it and they lay stress on rules for the medical education to be state specific also. There are also issues of language in the examination.
The WHO recommends one doctor per one thousand of population. Replying to a question, the Minister of State for Health, Smt. Krishna Patel had told in the Lok Sabha that on 31st March 2018 that 1022859 doctors of modern medicine are registered with various state medical councils. She further said that around 8 lakh doctors are actively available at one time. This means that the doctor population ratio in India is 0.62 doctors per one thousand populations. While nearly 70% of India’s population lives in rural areas, the rural India has 1/4th the doctors as compared to urban areas. This is a huge gap to be fulfilled. Thus we need more doctors for our population. For this the government plans to open more colleges. To fulfill the health requirements of our people we have to have medical colleges which impart relevant training to the students and orient them to the needs of our society and encourage them to work in areas so far neglected.
A review of the medical education scenario shows that admission to the medical colleges has been a contentious issue for quite some time. Initially most of the medical colleges were in state sector. Going by the information from the website of Medical Council of India, at the time of independence, there were 20 colleges out which only one was in private sector. Most of new additions were in the state sector till late eighties. But after the shift in economic policies and neo liberal model of development the whole scenario changed. Between the periods 1990 to 2017 number of colleges opened in private sector was 238 while only 115 were opened in state sector. Many of these were made as deemed universities which could have their own examinations, admission system and fee structure.
Many of these were charging under hand money as capitation fee. Merit was completely ignored and money became supreme. Seats are reserved under the management quota where they can charge at their will. For example in the state of Punjab the tuition fee in the government colleges is Rs.13.4 lakh for the full course of MBBS for 4.5 years. In the private colleges in the seats under the management and the NRI quota it varies from Rs.35 lakh for the full course to Rs.63.9 lakhs. Astonishingly telephonic enquiry from the Era’s Medical College Lucknow revealed the tuition to be 17 lakh per annum which with 10% increase every year comes out to be nearly Rs.91.34 Lakh for MBBS course. The PG seats tuition fee in this college is up to Rs.49 lakhs per year. That means for MBBS and MS/MD both from this college, one will have to pay nearly 2.5 crore rupees and an additional charges for books, travel etc. This means the student has to spend nearly 3 lakh rupees per month or Rs.10000/- per day.
This is a cruel joke. In our country where vast majority of population is devoid of even basic needs, it is literally impossible for them to imagine to send their wards to the medical college even when they are on merit. There was hope that after introduction of NEET, capitation fee will end. But what has happened is to the contrary. The private colleges increased their tuition fee and are now earning legally in white money. This will simply undermine the quality of medical education and not fulfill the needs of society we are striving to achieve. Going by the track record it appears that the advice to the MCI to regulate the fee structure can turn out to be an eye wash.
The proposal to upgrade 600 district hospitals to teaching ones sounds good. This again would require lot of funds. Similar is the case of post graduate courses in which seats are proposed to be increased. The national medical commission in its outlines has said that the private players will be allowed to open medical colleges where only up to 40% seats fee will be governed while the rest will be free for the institutions to charge the tuition fee.
The situation of the allied branches and paramedical branches is worse. Most of such colleges in private sector that are imparting nursing training, laboratory training and other courses do not fulfill the requirements. Many of these do not have any hospital attachment. The proposals in this document that these training programmes will be hospital-based, at those hospitals that have adequate facilities, including state-of-the-art simulation facilities, and adequate student-patient ratio and that these courses will be made accessible and affordable to students from rural backgrounds. Focus will also be given to priority areas like physiotherapy, hospital management, medical engineering and technology etc. All this has to be watched. For this we need to increase funds in the public sector.
The proposal to upgrade Ayush is welcome. There is need to make them evidence based and more scientific.
State must recognize its responsibility to health and education if it really wants to serve the people. Health and medical education cannot be left to market economy mechanism, they should be taken as social responsibility. The governing bodies for the purpose need to be democratic. The structure of NMC has 25 members, all of whom will be nominated by the central or the state government/UT. This makes the regulatory body totally undemocratic with only bureaucratic control and no involvement of various stake holders.
Cry of the children – who is to care?
Dr Arun Mitra
It is time to remember Elizabeth Barrett Browning for her poem ‘The Cry of the Children’ dedicated to the condition of children in England who were made to clean chimneys and work in hazardous industry. As a result many would catch serious diseases and eventually die an early death. The poem examines children's manual labor forced upon them by their exploiters. It was published in August 1843 in Blackwood's Magazine. But since then England has moved far ahead. All the children go to school, get proper nutrition and healthcare required of them. But where do we stand today !
Death of over 125 children in Muzaffarpur due to Acute Encephalitis is very shocking. At this tender age many of these children would not even know what is happening to them. A timely action could have prevented many deaths and such a big catastrophe. These children come from low income group families and are poorly nourished. Even though exact cause of this disease is not clear but one thing is certain that a malnourished child does not have enough resistance to fight any disease. For the last about 25 years such epidemics occur in the area off and on, but no specific measures have been taken till date. It is to be noted with deep anguish that the announcements made in 2014 about improving the infrastructure in health facilities in the district have still not been met with even after 5 years. There is serious lack of infrastructure. The number of doctors is less than 25% of the required. Similar is the situation of the paramedical staff. The technical facilities are in extreme shortage. There is need for immediate measures to save the lives of all those who are still alive but ill and also to prevent healthy children from falling sick. The situation should be declared as a calamity and emergency situation. The central government should send immediate financial/medical aid for speedy action.
Such events are a reflection of total apathy on the part of central and state governments towards the poor people of the region which is known for such epidemics. Only 2 years back similar incident happened in Gorakhpur where 125 children died due to lack of oxygen. That also drew lot of media attention and promises. Good nutrition forms the primary basis of good health. It is even more important at the tender age of first five years of life. But we are one among the worst performers as far as nutrition is concerned. Our hunger index is 103 among 118 countries. It is even worse than some of our neighbors.
Despite economic growth the nutritional status of our children is alarmingly below required standards. In India 44% of children under the age of 5 are underweight. 72% of infants and 52% of married women have anemia. Research has conclusively shown that malnutrition during pregnancy causes the child to have increased risk of future diseases, physical retardation, and reduced cognitive abilities. Malnutrition in our country is both lack of calories as well as lack of intake of nutrients in proper proportion.
All these issues have to be sorted out through a comprehensive healthcare policy with budgeting enough to meet the needs of the people. To ensure good health of our children we have to:
- Ensure proper nutrition to all the children.
- Healthy nutrition to all women in reproductive age group.
- Compulsory regular health checkup and basic investigations of children in the school to know about their health status.
- Health education to children in schools and to prospective mothers.
- To meet the above ensure universal compulsory education.
- Raise family income by ensuring sufficient remuneration to meet their nutritional needs.
- Provide healthy environment, proper housing, clean drinking water supply and sewerage facilities.
- Strengthen midday meal scheme.
- Economic measures have to be taken for inclusive growth.
These are the minimum measures needed to be taken to prevent such happenings in future. Public health spending has to be increased immediately to 3% and subsequently to 6% of the GDP in the coming years.
Healers, not Predators
Dr Arun Mitra
This is not for first time that violence has taken place against the doctors. Maximum of such incidents have occurred in Maharashtra. The violent incidents in Bengal got so much highlighted because the political atmosphere was already surcharged and the approach of the Chief Minster to the whole incident was rather precarious. A few words of sympathy and an assurance of inquiry into the whole incident were needed. No one can work in the atmosphere of uncertainty, particularly so when it comes to treating a person which requires lot of concentration, care and empathy. Persistent resistance by the medical fraternity and the support of senior doctors to the junior colleagues made the chief Minister realize that she was on wrong path. Situation is now defused and doctors are back to work. But this has left several questions which need deep introspection.
What are the reasons for such repeated acts of violence, what are the immediate measures required to prevent such acts and what are the long term solutions to ameliorate the situation?
When death of a near and dear occurs there can be an emotional outburst. This does not in any way mean that persons should resort to violence. There are several ways to redress the grievances. One must realize that the state hospitals lack infrastructure and good governance. In most of the state run hospitals the young doctors are over worked. Sometimes they have to work continuously for up to 36 hours or more. This puts them under lot of stress and strain. These young doctors do not have time to explain the seriousness of the condition of the patient to the attendants in details. In the absence of a senior colleague there is a trust deficit which becomes an irritating point for the attendants. Whatever the reason, the society has to understand that those giving treatment are trained to heal, not to kill. As medical students they are taught to be modest and sympathetic. Error is human. Barring a few black sheep negligence is not a rule but an exception. As negligence cannot be condoned, neither is the violence as a reaction to it justified.
A national level law against violence on doctors can be a strong deterrent. But many a times those perpetrating violence are ignorant of laws. Such a law may reduce the number of incidents but will not put an end to it completely. Despite such a law, the state of Maharashtra has been witnessing such violent attacks. For violence to come down substantially there is need to strengthen the doctor patient relationship. It is a very pious one based on faith on each other. The society has to realize that there are limitations for doctors. Our health care facilities in state sector lack required infrastructure. With a meager 1.1% of the GDP spending on health in the public sector, the working conditions are not going to improve. Such issues must be shared by the doctors with the public. This will integrate them with the society. Many doctors live in a shell without mixing with the common man. The doctors must react to the patients’ concerns. Unfortunately not many medical bodies have reacted to deaths in Muzaffarpur, nor did they do at the time of deaths in Gorakhur. Such preventable deaths are a slur oonour healthcare delivery system. Such issues should be our primary concerns. Medicos should be in the front rows to help the needy in the event of natural calamities. Such gestures help to remove negative feelings in the society about medical professionals.
Medicine is a passion and service. Not denying the fact that a doctor has to earn, the medical profession cannot be made ruthless profit making commercial business as it has become after the entry of corporate sector which view it as a means to reap huge profits. This is failure of the state. Vast majority of our population cannot afford treatment in private sector and have therefore to depend on state sector only.
Because of poor spending on health by the government the patients have to shelve money from their pockets. Nearly 40% of the patients have to borrow for their treatment. No wonder 6.3 crore people of our country are pushed below poverty line because of out of pocket expenditure on healthcare. High cost of treatment in the private sector, particularly in the corporate hospitals has even started affecting the middle classes. There is urgent need to make an inclusive healthcare policy.
Somehow violence is becoming a culture in our country. Calling ourselves followers of Buddha, Guru Nanak and Gandhi we have seen violence to the extreme in 1984, 2002 and now in the form of vigilantes and mob lynching. Some of the law makers have been issuing very irresponsible statements in past and rewarding those involved in mob lynching. Those at the helms of affairs should show more responsible behavior. If violence is eulogized then it becomes a part of psyche which does not spare anyone, even the perpetrators.
Health as National Agenda
Dr Arun Mitra
The recently concluded general elections lacked talk on healthcare for the people, even though health and education form basis for development of any society. Unfortunately both of these have been given back seat in the election campaign which has been essentially centered on emotive issues. This is a very sad reflection of our political scenario. Even the representatives of most marginalized sections of the society, who are worst affected due to poor state support on these two core issues, have failed to highlight these points.
In the last about two decades our country has moved ahead in terms of advanced healthcare. But much of it has developed in private sector because of which access is limited to only high income group of our population. Focus on health tourism in healthcare provides opportunities to rich and affluent from abroad to avail advanced healthcare in India at a lower cost of what it is in their countries. These policies however leave vast majority of our population devoid of access to quality healthcare.
The inequalities in health care are a global issue, but they are worse in the developing countries. In 2017 nearly 50% of the world’s total population did not have access to quality essential services to protect and promote health. Around 800 million people were spending 10% of their household budget on out of pocket health expenses. As a result 100 million people were being pushed into extreme poverty every year (1). In our country out-of-pocket expenditure by the households constitutes 63% of Total Health Expenditure (THE). Due to this 6.3 Crore people are pushed below the poverty line every year (2). The share of Out of Pocket Expenditure on health care as a proportion of total household monthly per capita spending is 6.9% in rural areas and 5.5% in urban areas(3). This is considered to be catastrophic expenditure.
According to the National Sample Survey Office’s (NSSO) 71st round report on ‘Health in India’ (4), India accounts for a relatively large share of the world’s disease burden. Lack of access to food, education, safe drinking water, sanitation, shelter, declining control over land and its resources by the already marginalized sections and falling opportunities for employment further adds to disease burden. There is an epidemiological transition from the communicable diseases to non-communicable diseases.
Public spending on health in our country is only around 1.1% of its GDP (2015-16). As high as 86% of rural population and 82% of urban population are not covered under any scheme of health expenditure support. The Ayushman Bharat gives coverage only for indoor care whereas about 70% expenditure is incurred on outpatient care. The scheme excludes major part of the low income group population out of it. Rural households primarily depended on their ‘household income/savings’ (68%) and on ‘borrowings’ (25%), the urban households relied much more on their ‘income/saving’ (75%) for financing expenditure on hospitalization, than on ‘borrowings’ (only 18%) (5). About 60% people took treatment without any medical advice. This was primarily attributed to ‘financial constraints’ (57% in rural, 68% in urban). Out of the total medical expenditure, around 72% in rural and 68% in urban areas was made for purchasing ‘medicine’ for non-hospitalized treatment (6).
Recently released National Health Accounts (NHA) Estimate for 2014-15, shows that the Government Health Expenditure (GHE) per person per year is just Rs. 1108. According to NHA, Total Health Expenditure (THE) for the same period worked out to Rs 3,286 per person. Of this, out-of-pocket expenditure was Rs. 2,394 constituting 63% of Total Health Expenditure (7). The Centre:State share in total public expenditure on health was 31:69 in 2015-16. The share of Central government in total public expenditure on health has been declining steadily over the years.
India is one among 193 countries who have signed the Agenda for Sustainable Development Goals (SDGs) launched by a UN Summit in New York on 25-27 September 2015. The Goal No 3 of the SDGs solely focuses on health. It comprises of 13 targets which include, No Poverty, Zero Hunger, Good Health and Well-Being for people, Quality Education, Gender Equality, Clean Water and Sanitation etc. Some of the important targets to be achieved by 2030 include maternal mortality ratio to less than 70 per 100,000 live births, end preventable deaths of new-born and children under 5 years of age, reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births. It also envisions to end the epidemics of AIDS, Tuberculosis, Malaria and neglected tropical diseases and combat Hepatitis, water-borne diseases and other communicable diseases. This demands national strategies and programmes to achieve universal healthcare and access to safe, effective, quality and affordable essential medicines and vaccines for all. This requires 5% - 6% of the public spending of GDP. Since our public health spending is around 1.1% only, it sounds difficult to meet these targets. According to SDG Index and Dashboards Report 2018 India’s ranking in SDG is 112. In comparison other South Asian countries barring Pakistan are better in their performance. Their rankings are Pakistan 126, Sri Lanka 89, Nepal 102, Bangladesh 111, Bhutan 83, China 54. In SDG on health India ranks at 143 out of 188 countries(8).
The NITI Ayog has been given the task to take steps to achieve SDG targets. There is need to involve various stake holders for implementing these. Health is state subject in India, but the health policy decisions are guided by the Central Government. Therefore the government should come out with all details on the steps taken till date. The NSSO data 2018 should be made public. The Ayushman Bharat is based on involving insurance sector. The global experience shows that better results are achieved by state’s direct spending on health. There is need to immediately increase the public health spending to 3% of GDP and increase it to 5% to be able to meet the SDG requirements on health.
In a Multi-country consultative workshop to assess the progress on implementation of health and health-related sustainable development goals, held at Dubai, 29-30 May 2019, it was observed that the Low and Medium Income countries (LMIC) need special assistance to meet these goals. It is to be ensured that these goals should not meet the fate of Alma Ata declaration signed in 1978. The Alma Ata declaration had envisioned health for all by the year 2000. India too was a signatory to that. But the targets were never achieved. We cannot loose time; effective measures need to be taken for not only the points mentioned in the target 3 on health of the SDGs but the other related targets need to be equally fulfilled if desired results are to be achieved. Special focus has to be laid on gender equality as women are by and large sufferers in the pursuit for better health. Maternal and child healthcare have to be given priority.
Since out of pocket expenditure on health is one of the major causes of impoverishment, families send their children for labor to support day today needs of the family. There are reports that some families mortgage their children to meet healthcare needs. Income disparities have to be reduced. Steps have to be taken for economic reforms targeted at working people’s needs for appropriate remuneration. Ensure job security and food security and. Prices of essential commodities have to be curtailed to make them within reach of low income groups. Growth has to be made inclusive so as to translate its gains to the deprived sections. Goal no.4 stresses on the quality education. This can be fulfilled only through an education policy with increase in public spending on education. Right to Education should apply to all the levels of education. Steps need to be taken for the promotion of good climate.
Goal no.16 is emphatic on peace and justice. Conflicts are leading to reversals in SDG progress. (9). The countries that are facing armed conflicts and civil wars, more so those in the category of low-income countries are finding it difficult to meet the health objectives. India is the second biggest buyer of arms. Our spending on the defense is adversely effecting the spending on health and education. To reverse this trend it is pertinent to hold mutual dialogue with the neighbors to sort out pending issues. Peace is the most essential to have healthy living.
It is time people come forward to demand the effective implementation of the SDG target on health. Health has to be made a national agenda by the society and force the Indian polity to be serious on health.
References:
- World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses, 13 December 2017
News Release Tokyo https://www.who.int/news-room/detail/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses. - National Health Policy 2017: http://cdsco.nic.in/writereaddata/national-health-policy.pdf.
- Situation Analysis Backdrop to National Health Policy 2017: https://mohfw.gov.in/sites/default/files/71275472221489753307.pdf
- Health in India NSS 71st Round Report : http://mospi.nic.in/sites/default/files/publication_reports/nss_rep574.pdfhttp://mospi.nic.in/sites/default/files/publication_reports/nss_rep574.pdf
- Ministry of Health and Family Welfare - Cabinet approves Ayushman Bharat - http://pib.nic.in/PressReleaseIframePage.aspx?PRID=1525684.
- https://www.livemint.com/Politics/30z97MDZDMewkJHsfM5D6I/Medicine-costs-form-bulk-of-outofpocket-health-expenses-N.html
- National Health Accounts- Estimates for India - 2014-15 - https://mohfw.gov.in/sites/default/files/National%20Health%20Accounts%20Estimates%20Report%202014-15.pdf.
- The 2018 SDG Index and Dashboard reporthttps://www.sdgindex.org/assets/files/2018/01%20SDGS%20GLOBAL%20EDITION%20WEB%20V9%20180718.pdf#page=22.
- The 2018 SDG Index and Dashboard reporthttps://www.sdgindex.org/assets/files/2018/01%20SDGS%20GLOBAL%20EDITION%20WEB%20V9%20180718.pdf#page=22.
Health as nodal point for a lasting peace in South Asia
Dr Arun Mitra
With the elections over, it is time to think beyond nuclear rhetoric, surgical strikes, threats of hitting inside the territory and waging war. Such slogans sound good for short term gains, but in the long run these can be catastrophic with serious impact on the life of people. There is lack of trust among nations in South Asia, particularly in respect to the relationship between India and Pakistan. This mistrust becomes an alibi for the military industrial complex on either side to justify huge military spending. This is done on the pretext of threats, some of them existential and some imaginary. It is therefore important to be realistic in defining and propagating such threats as this concerns our lives.
Global arms expenditure is a cause of serious concern. The US defense budget is about three times as large as China’s. China’s military spending was three times more than India in 2017. But China’s percentage of GDP spent on defense was less than India’s. The Stockholm International Peace Research Institute (SIPRI) database, estimated that even though China’s military expenditure was USD 228 billion in 2017 while India spent 64 billion, India’s expenditure in terms of GDP was 2.5% of its GDP while China spent 1.9% of the GDP. India’s defense spending increased by around 7 per cent from the previous fiscal year and Pakistan increased its defense budget by around 20% for 2018-19. However, Pakistan being a small country, its defense budget is five times lower. The ‘Military Balance 2018’ report by the International Institute for Strategic Studies (IISS) estimates India overtook the UK as the fifth-largest defense spender in the world in 2017. According to SIPRI, with talk about increasing Military spending towards 3% of GDP, India is likely to be at world number three military spending level. By 2025-2027, India will likely double its military spending.
In a “The BMJ South Asia collection 2020 Authors’ Consultation”, organized by the British Medical Journal (BMJ) on May 29th 2019’ at Dubai, the issue was seriously debated. Participants from India, Pakistan, Sri Lanka, Bangladesh and Nepal reached a consensus that the South Asian countries have similar health problems and thus common solutions. While there is abundance of Communicable Disease burden, there has been observed that non communicable diseases have shown an increase in the last few years. It is therefore essential that a collective effort is put in to sort out the health related issues. As health indicators of the region are very dismal this becomes even more important. All these countries should increase public spending on health and education and other social needs.
We have to face the challenge to meet the SDG goals on health by 2030. India is one among 193 countries who have signed the Agenda for Sustainable Development Goals (SDGs) launched by a UN Summit in New York on 25-27 September 2015. To attain indicators of health there is urgent need for poverty eradication; bring down hunger to zero, quality education, gender equality, clean water and sanitation etc. Maternal mortality ratio has to be brought down to less than 70 per 100,000 live births, neonatal mortality to 12 per 1,000 live births and under-5 mortality to less than 25 per 1,000 live births. This requires minimum of 5% - 6% of the public spending of GDP. Since our public health spending is around 1.1% only, it sounds difficult to meet these targets. According to SDG Index and Dashboards Report 2018 India’s ranking in SDG is 112 and Pakistan 126. With ranking at Sri Lanka 89, Nepal 102, Bangladesh 111, Bhutan 83, China 54 these countries are doing better. In SDG on health India ranks at 143 out of 188 countries.
It is time to review our priorities. The civil society has to come forward in all the countries of the region to raise the issues that concern our health. A strong voice is needed to force the decision makers to cut down the arms expenditure. For this there is need for a continuous dialogue among nations and monitoring by the civil society. Health as a common goal can be the nodal point for a lasting peace in the region.
Challenge of Healthcare for the New Government
Dr Arun Mitra
The elections are over and it is just a matter of procedures that the new government will take over. The people have given unprecedented mandate. Even though the basic issues were missing in the election campaign, but at the end of the day people would expect steps to be taken by the new government to improve their lot in terms of employment opportunities, job security, proper remuneration, quality healthcare and education etc. Even though unfortunately none of these were in the frontline of the agenda of the elections, however they remain core issues of life.
It is admitted by repeated documents of the government including the national health policy 2017 document that as a result of out of pocket expenditure on health 6.3 crore people of or country are pushed below poverty line. This is a serious issue. There is immediate need to improve this situation. There is need for several steps to be taken to ameliorate the situation.
Health is a basic requirement of all individuals irrespective of caste, creed, gender, religious groups or economic status. It is therefore imperative that health is recognized as a fundamental right. There is need to enact National Health Bill as Right to Health care Act that can guarantee that every citizen shall have right to comprehensive and quality healthcare at state’s expense, in a government health facility, and in case of its non-availability in a private health facility. Health should be included in the concurrent list of the Constitution and adoption of a National Health Policy legally binding on the executive.
To meet the above it is urgently required that public spending on health should be increased. The share of Out Of Pocket Expenditure on health care as a proportion of total household monthly per capita expenditure was 6.9% in rural area and 5.5% in urban area. This poses heavy burden on the households. More than 40 per cent of the population has to borrow or sell assets for treatment, according to the 2004 National Sample Survey Organisation. The estimated costs of Universal Health coverage range between 4 and 6 per cent of GDP. Though considerable, this financial commitment is achievable. As an immediate step the public health spending should be increased from 1% to 2.5% and then to 5% in the coming four years. Direct spending by the government has shown better results compared to the insurance based healthcare delivery system worldwide.
National Health Profile 2015; Central Bureau of Health Intelligence, Directorate General of Health Services, Ministry of Health and Family Welfare, Govt. of India estimates that expenditure on medicines constitutes nearly two-thirds (60%) of out of pocket expenditure, forcing them to get buried in quagmire of poverty. There is need to implement a Rational Drug Policy that allows drugs to be sold only under their generic names. Exempt production of generics from patent rules. Ensure improved availability, accessibility and affordability of drugs including vaccines and sera in the public health system; through quality conscious pooled procurement systems and promotion of manufacture of essential medicines. There is need to adhere to policy of cost of production for ceiling of drug price.
In the last few decades there has been shift from opening the medical colleges in the state sector to the private sector. This process has been further speeded up in the last four years. In the year 2017 there were 214 government medical college and 253 private medical colleges. In the period between 2014-2017 the number of new medical colleges opened was 36 in government sector and 58 in the private sector. The colleges in the private sector charge exorbitant fee to the tune of rupees one crore for the MBBS course. Most of these colleges lack proper infrastructure and violate the norms and forms of medical ethics. There is commercialization of medical education. Policy should be change to open more medical colleges in the state sector.
Set up Primary Health Centre at every 30000 population, with 24-hour service, a Health Sub-Centre at every 5000 population and a fully staffed Community Health Centre with all facilities at every 100000 population. Establish round-the-clock ambulance service at every 30000 population. Post women medical and paramedical personnel in all health centres and hospitals in adequate numbers. All Government health facilities should adhere to Indian Public Health Standard (IPHS) norms.
Social determinants of health like safe drinking water, sewage facilities, clean environment, proper housing, sufficient remuneration, employment opportunities and job security must be given priority. Rules should be framed accordingly. Arrange assured safe drinking water supply through piped water in all habitations, total sanitation in all households and localities, and enforce complete safeguards against air, water and soil pollution by industries, mines and other developmental projects.
Eliminate Malnutrition by implementing National Food Security Act 2013 which aims to provide subsidised food grains to approximately two thirds of India’s people and ensures Maternity entitlements to all pregnant women. Set up Nutrition Rehabilitation Centre at each block to address the issue of severely malnourished children.
Whereas our spending on health is very low, we are spending huge amount on arms race including the nuclear weapon system. Presently India is the second biggest buyer of arms in the world and also aspires to become an arms exporting country. We have to play a leading role in initiating mutual dialogue with neighbours to strengthen peace and divert money towards health, education and development.
NUCLEAR RHETORIC BY SHRI NARINDRA MODI A DANGEROUS CONNOTATION
Dr Arun Mitra
Nuclear rhetoric by the prime minister in his election speech at Barmer on 21st April that India does not have nuclear weapons for Diwali is irresponsible, dangerous and provocative. Counter statement by Mehbooba Mufti that Pakistan does not have these weapons for Eid have brought to the fore how vulnerable situation in our region could be. Prime Minister’s statement may fetch him some votes and applaud from innocent followers and admirers, but it shows complete lack of statesmanship that his utterances could have far flung impact.
The events following Pulwama terrorist violence which martyred 49 CRPF personnel had nearly pushed India and Pakistan to the brink of war. Threat of use of nuclear weapons gave dreadful shiver to the people on both sides. The jingoists on either side of the border took no time calling for destruction of the other. But for the timely release of Wing Commander Abhinandan and public opinion of the saner elements in the civil society situation could have taken ugly turn leading to catastrophic collateral damage and mutually assured destruction since both India and Pakistan are nuclear weapons possessing countries.
Ira Helfand, Co-President International Physicians for the Prevention of Nuclear War (IPPNW) and Allan Robock & colleagues from Department of Environmental Sciences School of Environmental and Biological Sciences Rutgers University, New Jersey, USA conducted a study on the Climatic Consequences of Nuclear Conflict between India and Pakistan using 100 Hiroshima size nuclear bombs. The study warns that over 2 billion people would be put to risk globally as an aftermath of nuclear famine which would ensue under such situation.
South Asia is one of the poorest regions in the world. The Human Development Index ranking for India and Pakistan is at 130 and 150 respectively. Hunger index of India is at 103 and Pakistan at 106 out of 119 countries. About 40% of the world’s stunted children and 53% of all wasted children live in South Asia. Around 34% of the population has no access to sanitation. Investments in health and education remain less than 4% and 3% of respective GDPs. Yet successive governments and military establishments have escalated military spending in India and Pakistan to US$ 64 billion and US$ 11 billion annually in 2017, respectively. India’s defense expenditure is 1.62 % of its GDP, while its central health budget is 0.26 of GDP, six times less than its arms budget. Pakistan’s spending on arms is equivalent with budgetary allocation 8.9 billion USD. With Pakistan worth 300 billion USD economy its defense expenditure comes to 2.9% of the GDP.
Increase in spending on arms race causes serious resource crunch on health, education and development. The developing countries and poor in these countries are worst affected.
It is time, steps are taken for complete nuclear disarmament and end to arms race. The Treaty Prohibiting Nuclear Weapons (TPNW) passed by the UN General Assembly on 7th July 2017 is a big opportunity for complete nuclear disarmament and save the world from nuclear catastrophe. It is time the nuclear armed states realize this and join the treaty without any ifs and buts.
India has been harbinger in the peace movement. India’s role under the leadership of Jawahar Lal Nehru in founding Non Aligned Movement has been path breaking. Rajiv Gandhi action plan for nuclear disarmament is still relevant. We must take initiative to join the TPNW. Let peace and disarmament become a leading factor in the region instead of jingoism for electoral benefits. Role of peace movements in India is very vital in the present context. Absence of timely realization of this could trigger the situation to disaster as the type of rhetoric made recently is likely to be repeated any time and may not remain just in worlds next time.
References:
- United Nations Organisation. Treaty on the prohibition of nuclear weapons. New York: UNO;2017 July 7 [cited 2018 Feb 14]. Available from: https://treaties.un.org/doc/Treaties/2017/07/20170707%2003-42%20PM/Ch_XXVI_9.pdf
- The Nobel Peace Prize 2017. International Campaign to Abolish Nuclear Weapons (ICAN). Nobelprize.org. 2017 Oct 6 [cited 2018 Feb 14]. Available from: https://www.nobelprize.org/nobel_prizes/peace/laureates/2017/
- ICAN receives 2017 Nobel Peace Prize. Icanw.org. 2017 Dec 22 [cited 2018 Feb 14]. Available from: http://www.icanw.org/
- International Campaign to Abolish Nuclear Weapons. Spending on nuclear weapons. Date unknown [cited 2018 Feb 14]. Available from: http://www.icanw.org/the-facts/catastrophic-harm/a-diversion-of-public-resources/
- Ban Ki-moon. Opening address to 62nd DPI’NGO Conference. ‘The world is over-armed and peace is under-funded’ says Secretary-General as he opens Mexico City Conference’. Un.org. 2009 Sep 9 [cited 2018 Feb 14]. Available from: https://www.un.org/press/en/2009/sgsm12445.doc.html
- Stockholm International Peace Research Institute. World military spending: Increases in the USA and Europe, decreases in oil-exporting countries. Sipri.org. 2017 Apr 24 [cited 2018 Feb 14]. Available from: https://www.sipri.org/media/press-release/2017/world-military-spending-increases-usa-and-europe
- Khan B. Pakistan raises annual defence budget to $8.78 billion U.S. Quwa.org. 2017 May 28[cited 2018 Feb 28]. Available from: https://quwa.org/2017/05/28/pakistan-raises-annual-defence-budget-8-78-billion-u-s/
- Rana S. Pakistan is now a $300-billion economy. The Express Tribune. 2017 May 18 [cited 2018 Feb 28]. Available from: https://tribune.com.pk/story/1412545/pakistan-now-300-billion-economy-gdp-growth-5-3/
- http://www.icanw.org/the-facts/the-nuclear-age/
- https://ourworldindata.org/nuclear-weapons
- https://www.cnbc.com/2018/08/13/trump-signs-717-billion-defense-bill.html
- https://www.cnbc.com/2017/05/02/how-us-defense-spending-stacks-up-against-the-rest-of-the-world.html
- https://www.ippnw.org/pdf/Bombay.pdf
India’s Pursuit to meet Sustainable Development Goals on Health
Dr Arun Mitra
To ensure empowerment of vulnerable groups women, children, young people, persons with disabilities, older persons, refugees, internally displaced persons and migrants and to protect human rights the 2030 Agenda for Sustainable Development was launched by a UN Summit in New York on 25-27 September 2015 which has 193 countries as signatories(1). It envisages “a world of universal respect for human rights and human dignity, the rule of law, justice, equality and non-discrimination”. The Agenda has 17 Sustainable Development Goals (SDG), and 169 targets which seek to eradicate poverty, promote human rights and achieve gender equality. The agenda became effective from 1st January 2016.
The UNO has defined sustainable development as that meets the needs of the present without compromising the ability of future generations to meet their own needs. To achieve sustainable development it is important to have economic growth social inclusion and environmental protection. The Sustainable Development Goals (SDGs) are not legally binding, nevertheless, countries are expected to take ownership and establish a national framework for achieving the 17 Goals. Implementation and success will rely on countries’ own sustainable development policies, plans and programmes (2).
The Goal No 3 of the Sustainable Development Goal (SDGs) solely focuses on health, which is “to ensure healthy lives and promote well-being for all age groups (3)”.
SDG-3 comprises 13 targets. These include No Poverty, Zero Hunger, Good Health and Well-Being for people, Quality Education, Gender Equality, Clean Water and Sanitation, Affordable and Clean Energy, Decent Work and Economic Growth, Industry, Innovation and Infrastructure, Reduced Inequalities, Sustainable Cities and Communities, Responsible Consumption and Production, Climate Action, Life below Water, Life on Land, Peace, Justice and Strong Institutions, Partnerships for the Goals.
Targets to be achieved by 2030 include maternal mortality ratio to less than 70 per 100,000 live births, end preventable deaths of new-borns and children under 5 years of age, reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births, end the epidemics of AIDS, Tuberculosis, Malaria and neglected tropical diseases and combat Hepatitis, water-borne diseases and other communicable diseases, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being, strengthen the prevention and treatment of substance abuse, halve the number of global deaths and injuries from road traffic accidents, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes, achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.
WHO has estimated cost of reaching global health targets by 2030 (4). A study conducted by the Lancet Global Health shows that investments to expand services towards universal health coverage and the other SDG health targets could prevent 97 million premature deaths globally between now and 2030, and add as much as 8.4 years of life expectancy in some countries. While most countries can afford the investments needed, the poorest 67 low- and middle-income countries that face the greatest challenges in terms of expanding health services will need assistance to reach the targets. "Universal health coverage is ultimately a political choice. It is the responsibility of every country and national government to pursue it," says Dr Tedros Adhanom Ghebreyesus, the Director-General of WHO.
To meet the SDG target would require up to US$ 371 billion or US$ 58 per person by 2030. This would require health spending as a proportion of gross domestic product from an average of 5.6% to 7.5%. The global average for health spending as a proportion of GDP is 9.9%. Although higher spending does not necessarily translate to improved health, making the right investments at the right time can.
For India it is a big challenge to meet the SDG goals on health. Our public health spending is around 1.1% only. This is too low an expenditure on health. Our Maternal Mortality Rate is 130 per 100000 live births. To bring it down to 70 requires political will. India’s under 5 mortality rate was 43 in 2015. It has to be brought down to 25 and the Infant mortality rate has to be brought down to 12 from 34 in 2016 (5).
According to SDG Index and Dashboards Report 2018 India’s ranking in SDG is 112. In comparison other South Asian countries barring Pakistan are better in their performance. Their rankings are Pakistan 126, Sri Lanka 89, Nepal 102, Bangladesh 111, Bhutan 83, China 54. In SDG on health India ranks at 143 out of 188 countries (6).
The government’s recently announced health scheme Aushman Bharat is based on involving insurance sector. The global experience shows that health has improved by direct spending by the state. There is need to immediately increase the public health spending to 2.5% of GDP and increase is to 5% to be able to meet the SDG requirements on health.
References:
- https://www.coe.int/en/web/programmes/un-2030-agenda
- https://www.un.org/sustainabledevelopment/development-agenda/
- https://www.nhp.gov.in/sustainable-development-goal-(sdg)_pg
- https://www.who.int/en/news-room/detail/17-07-2017-who-estimates-cost-of-reaching-global-health-targets-by-2030
- https://www.livemint.com/Opinion/dwStpMl7oSnvNz4sMEia5L/India-needs-a-better-report-card-to-meet-SDG-targets-on-heal.html
- https://sdsnyouth.org/sdg-index-2018
ABSENCE OF HEALTH DISCOURSE IN THE ELECTION PROCESS IS UNFORTUNATE
With election fever picking up, the blame game is increasing with every passing day. Issues concerning the people are not being highlighted as they should have been. The ruling party has very cleverly brought the rhetoric against Pakistan as core issue. The speeches by the first rank leadership are by and large ignoring the issues of health and education. Even though the points related to healthcare have been mentioned in the manifestos of the various parties but until and unless they are emphasized by the leadership in their public discourses time and again, these do not become part of people’s mind. A critical analysis of the manifesto of two major parties shows some differences in the approach.
The manifesto of the BJP is centered around eulogizing the Ayushman Bharat which is said to cover 50 crore people for in patient care only. It nowhere talks of how to get the rest 80 crore people in the scheme in future. Moreover it does not give any proposal of bringing the people seeking outpatient care only in the scheme. Thus it sans any step towards universal healthcare. It talks of opening more medical colleges but does not give any information on whether they will be in the state sector or the private sector. This is important because the number of medical colleges opened in the last few years is more in the private sector. These colleges are charging exorbitant tuition fee which makes them out of reach of even the middle class families. The manifesto also does not talk of increasing public spending on healthcare which is essential for ensuring quality healthcare to the common citizens.
The manifesto of Congress party recognizes the healthcare as a right of every citizen. It promises to increase the public spending from present 1.1% to 3% of the GDP by the year 2023-24 with step by step increase in every budget. What is needed is immediate increase to 2.5% of the GDP to be raised to 6% in the next five years. The manifesto promises to enact Right to Healthcare Act ‘that will guarantee to every citizen the right to healthcare services, including free diagnostics, out-patient care, medicines and hospitalisation through a network of public hospitals and enlisted private hospitals’. That the manifesto recognizes insurance based model not a preferred model to provide healthcare is a welcome note. It promises to implement free public hospital model to provide universal healthcare. Increasing the number of doctors by establishing more medical colleges, providing scholarship and loans to the medical students.
The manifesto of the left parties highlights the right to free health as a fundamental right. Increase in the public health spending to 6% of the GDP, end to commercialization of medical education. Strengthening of public health facilities, fixing the drug prices based on their cost of production and enact patent laws favourable to our country.
However these are documents which are important in a way that the governments to come can be questioned on their performance based on the promises made in the manifesto. But what is lacking is special forceful emphasis in the public speeches by the political leaders. This reflects lack of sensitivity to the health issues to the required level even though it is admitted that nearly 6% of the population is pushed below poverty line because of catastrophic out of pocket expenditure on health. There are also reports that financial stress as a result of out of pocket healthcare expenditure is an important cause of suicide among farmers. It is time for public to act and force a pro-people healthcare discourse.
SEWERMEN’S HEALTH – WHO WILL CARE?
SEWERMEN’S HEALTH – WHO WILL CARE?
One cannot help but tremble at the very thought that even today human beings go down in the gutters full of garbage to clean them manually. During the process they get submerged in the waste, which we even hate to smell. It is not unlikely that deep in the sewer where hot dirty water and soiled waste is flowing, some of it enters into the mouth and stomach leading to serious health problems. As a result many of them fall prey to several diseases of skin, eyes, oral cavity, respiratory system, gastrointestinal tract, nervous system and may develop even mental problems. In extreme situations they fall unconscious after inhaling poisonous gases which many a times proves fatal.
Sewer gas is a complex mixture of toxic and nontoxic gases produced and collected in sewage systems by the decomposition of organic household or industrial wastes. Typical sewer gases include hydrogen sulfide, ammonia, methane, esters, carbon monoxide, sulfur dioxide and nitrogen oxides(1).
Exposure to low levels of hydrogen sulfide causes irritation of the eyes and respiratory tract. Other symptoms include nervousness, dizziness, nausea, headache and drowsiness. This gas smells like rotten eggs, even at extremely low concentrations (2). Inhalation of the combination of the two toxic gases hydrogen sulfide and carbon monoxide and the suffocating gas methane is can be fatal (3).
Government of India had notified Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013 and Rules 2013. The act recognises that working near or in a manhole inherits potential dangers which may result in serious accidents and in some extreme cases, loss of life as well. The common accidents include falls/slips, fire or explosion, oxygen depletion, gas poisoning, heat stress, drowning, asphyxiation arising from gas, fume, vapour and entrapment by free-flowing solids. Amongst these, dangerous gases are easily overlooked or neglected, leading to serious casualties. The health and safety of personnel can be safeguarded to a great extent by use of safety equipment and by taking precautions appropriate for each hazard condition.
It is ironical that despite latest scientific knowledge about the hazards involved in manual scavenging of sewers, this practice continues to exist. Central Public Health Environmental Engineering Organisation under the Ministry of Housing (CPHEEO) and Urban Affairs Govt. of India has set Standard Operating Procedures (SOP) for cleaning of Sewers and Septic Tanks. There are several directions given in it (4).
These have to be followed before sending a person in the sewer, which is to be done in an extreme case, otherwise manual scavenging has to avoided. The CPHEEO has given a list of 44 equipment required for the purpose. Some of these include Protective Suits, Head lights, Air blowers, emergency medical kits, Ambulance at the cleaning site and breathing apparatus. It is mandatory for the supervisor to explain the dangers involved in going down the sewer to the person and to obtain his written consent. It is important to check gas level beforehand and to give proper time for aeration of the sewer. In case the gas level is dangerous then air as to be blown in. The scavengers have to be trained personnel for the job and their medical examination has to be done to ensure that they are in good health.
It is ironical that despite reports of hazards, the number of deaths is not coming down. Bezwada Wilson, founder of the Safai Karamchari Andolan says that as of now 1760 persons have died in the sewers. He contests the government’s data of only 666 deaths.
The issue that why till date we have not been able to check this practice, requires deep introspection. Even though the act was framed in 2013, the instructions are hardly followed. There is complete lack of monitoring system. Legal action against the defaulters is very weak. There is need to devise and follow proper monitoring and stringent punishment to the defaulters.
There is need for proper education of the workers engaged in cleaning work. Since most of them come from low education status, they have to be briefed about the health hazards. In the situation of grave unemployment such workers are likely to be exploited by the vested interests who have no care for the human beings. Even though the Hon’ble Supreme Court had passed an order of giving 10 lakh compensation to the effected family of the deceased, it is not easy for the family to get it. There is need to strengthen the collective efforts by the unions of the Safai Karmacharis in this regards. It is ironical that the authorities do not have exact data of how many people have died cleaning sewers or received compensation(5).
References:
- https://en.wikipedia.org/wiki/Sewer_gas
- Sewer Gas | Wisconsin Department of Health Services: https://www.dhs.wisconsin.gov/air/sewergas.htm
- Bad Air: Sewer Gas and Death | The Crime Fiction Writer's Blog https://writersforensicsblog.wordpress.com/2015/09/22/bad-air-sewer-gas-and-death/
- http://164.100.228.143:8080/sbm/content/writereaddata/AMRUT%20SOP%20Book%20Final.pdf
- https://thewire.in/labour/sewer-cleaning-deaths-compensation
SPREADING THE MYTH OF COW URINE
The claim by Ms.Pragya Thakur, BJP candidate from Bhopal, that her cancer was cured by cow urine has once again brought to the fore the issue whether medical science in our country will be governed by myths or by scientific evidence based approach. Dr.S.S Rajput, a surgeon at Ram Manohar Lohia Institute of Medical Sciences in Lucknow has confirmed that he had done three radical operations on her breasts to get her rid of cancer. The doctor’s statement has exposed the claim of Sadhvi about cow urine as a cure of her breast cancer.
Benefits of cow urine for human consumption have been propagated since long. The propaganda has increased manifold after the present government came to power. Any item to be consumed by us must be proven for its usefulness and harmlessness. This is even more important for the products labeled to be used for medicinal purpose.
Modern scientific system of medicine enhanced the knowledge gained in the past and developed it further on the basis of new scientific innovations. Anatomy and Physiology made us understand the basic structure and functioning of the life systems. Our body has an elaborate system to utilize whatever is needed and to excrete those materials which are either not required or are harmful. It is a common knowledge that part of the food which we consume is digested and rest is excreted through the gastrointestinal track. After the food has been metabolized in the body, the waste products are excreted in urine. The chemical composition of urine of mammals is essentially the same. That cow urine is different from human urine sans evidence.
Urine is a liquid produced by the kidneys to remove waste products from the bloodstream. Basic composition of cow/human urine are Water, Urea, Sodium, Chloride, Sulfate, Potassium, Phosphate, Creatinine, Ammonia, Uric Acid, Calcium, Magnesium etc. Since the composition of human and cow urine are similar, it is difficult to believe that with similar composition how only the cow urine is useful for human body?
To get scientific information of the utility of the cow urine and cow dung for the human consumption, information under RTI was obtained from the Department of Animal Husbandry, Dairying and Fisheries, government of India. They replied that “the information is not maintained by this CPIO of cattle Division”. Simultaneously same information was sought from the Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana. The information received from 22 departments of the GADVASU denied any such information with them. It is worth mentioning here that GADVASU, Ludhiana, has been ranked first among the 14 state veterinary universities in the country, as per the ranking of agricultural universities and research institutes conducted by the Indian Council of Agricultural Research (ICAR), New Delhi, for 2016-17.
Thus there is no scientific information available about the usefulness of cow urine for human health at the highest level of academics in the veterinary. On the contrary some studies have reported toxic effects of cow urine concoction. Moreover cow urine consumed in crude form could be infectious and may lead to serious health problems.
Many scientists have already exposed the claims by Baba Ramdev and others that the cow urine destroys the ‘poison like Betadine’. They show in their experiment that the pure water discoloured by adding Betadine to it is again purified by adding cow urine into it. This occurs with any urine because of the chemical reaction of Sodium Thiosulphate present in the urine which reacts with Tri-Iodide ion present in Betadine. When the two react there is formation of Sodium Iodide which is a colourless solution and this reaction is same with any urine.
According to veteran historian D N Jha, the cow and its products (milk, curd, clarified butter, dung and urine) or their mixture called Panchagavya assumed a purificatory role during the medieval period. But here too several Dharmasastra forbid its use by women and the lower castes because if a Shudra drinks cow urine he goes to hell.
Therefore one has to be to be skeptical about the role of cow urine for human health. The evidence does not hold true on that. It is more of a belief system than science. The propaganda about the benefits of the cow urine in the recent days seems to be connected to the Hindutva Agenda of the RSS and its outfits. It is part of their strategy to push the society back to the medieval times.
It is high time that the Ministry of Pharmaceuticals as well as the Ministry of Health intervene to stop this propaganda. It is for the election commission to see whether spreading of such obscurantist unscientific ideas meets the requirement to cancel her nomination.
References:
https://www.ncbi.nlm.nih.gov/pubmed/6314793
http://servecows.org/chemical-composition-of-distilled-cow-urine/
https://www.thoughtco.com/the-chemical-composition-of-urine-603883
NUCLEAR RHETORIC BY SHRI NARINDRA MODI A DANGEROUS CONNOTATION
NUCLEAR RHETORIC BY SHRI NARINDRA MODI
A DANGEROUS CONNOTATION
Nuclear rhetoric by the prime minister in his election speech at Barmer on 21st April that India does not have nuclear weapons for Diwali is irresponsible, dangerous and provocative. Counter statement by Mehbooba Mufti that Pakistan does not have these weapons for Eid have brought to the fore how vulnerable situation in our region could be. Prime Minister’s statement may fetch him some votes and applaud from innocent followers and admirers, but it shows complete lack of statesmanship that his utterances could have far flung impact.
The events following Pulwama terrorist violence which martyred 49 CRPF personnel had nearly pushed India and Pakistan to the brink of war. Threat of use of nuclear weapons gave dreadful shiver to the people on both sides. The jingoists on either side of the border took no time calling for destruction of the other. But for the timely release of Wing Commander Abhinandan and public opinion of the saner elements in the civil society situation could have taken ugly turn leading to catastrophic collateral damage and mutually assured destruction since both India and Pakistan are nuclear weapons possessing countries.
Ira Helfand, Co-President International Physicians for the Prevention of Nuclear War (IPPNW) and Allan Robock & colleagues from Department of Environmental Sciences School of Environmental and Biological Sciences Rutgers University, New Jersey, USA conducted a study on the Climatic Consequences of Nuclear Conflict between India and Pakistan using 100 Hiroshima size nuclear bombs. The study warns that over 2 billion people would be put to risk globally as an aftermath of nuclear famine which would ensue under such situation.
South Asia is one of the poorest regions in the world. The Human Development Index ranking for India and Pakistan is at 130 and 150 respectively. Hunger index of India is at 103 and Pakistan at 106 out of 119 countries. About 40% of the world’s stunted children and 53% of all wasted children live in South Asia. Around 34% of the population has no access to sanitation. Investments in health and education remain less than 4% and 3% of respective GDPs. Yet successive governments and military establishments have escalated military spending in India and Pakistan to US$ 64 billion and US$ 11 billion annually in 2017, respectively. India’s defense expenditure is 1.62 % of its GDP, while its central health budget is 0.26 of GDP, six times less than its arms budget. Pakistan’s spending on arms is equivalent with budgetary allocation 8.9 billion USD. With Pakistan worth 300 billion USD economy its defense expenditure comes to 2.9% of the GDP.
Increase in spending on arms race causes serious resource crunch on health, education and development. The developing countries and poor in these countries are worst affected.
It is time, steps are taken for complete nuclear disarmament and end to arms race. The Treaty Prohibiting Nuclear Weapons (TPNW) passed by the UN General Assembly on 7th July 2017 is a big opportunity for complete nuclear disarmament and save the world from nuclear catastrophe. It is time the nuclear armed states realize this and join the treaty without any ifs and buts.
India has been harbinger in the peace movement. India’s role under the leadership of Jawahar Lal Nehru in founding Non Aligned Movement has been path breaking. Rajiv Gandhi action plan for nuclear disarmament is still relevant. We must take initiative to join the TPNW. Let peace and disarmament become a leading factor in the region instead of jingoism for electoral benefits. Role of peace movements in India is very vital in the present context. Absence of timely realization of this could trigger the situation to disaster as the type of rhetoric made recently is likely to be repeated any time and may not remain just in worlds next time.
References:
- United Nations Organisation. Treaty on the prohibition of nuclear weapons. New York: UNO;2017 July 7 [cited 2018 Feb 14]. Available from: https://treaties.un.org/doc/Treaties/2017/07/20170707%2003-42%20PM/Ch_XXVI_9.pdf
- The Nobel Peace Prize 2017. International Campaign to Abolish Nuclear Weapons (ICAN). Nobelprize.org. 2017 Oct 6 [cited 2018 Feb 14]. Available from: https://www.nobelprize.org/nobel_prizes/peace/laureates/2017/
- ICAN receives 2017 Nobel Peace Prize. Icanw.org. 2017 Dec 22 [cited 2018 Feb 14]. Available from: http://www.icanw.org/
- International Campaign to Abolish Nuclear Weapons. Spending on nuclear weapons. Date unknown [cited 2018 Feb 14]. Available from: http://www.icanw.org/the-facts/catastrophic-harm/a-diversion-of-public-resources/
- Ban Ki-moon. Opening address to 62nd DPI’NGO Conference. ‘The world is over-armed and peace is under-funded’ says Secretary-General as he opens Mexico City Conference’. Un.org. 2009 Sep 9 [cited 2018 Feb 14]. Available from: https://www.un.org/press/en/2009/sgsm12445.doc.html
- Stockholm International Peace Research Institute. World military spending: Increases in the USA and Europe, decreases in oil-exporting countries. Sipri.org. 2017 Apr 24 [cited 2018 Feb 14]. Available from: https://www.sipri.org/media/press-release/2017/world-military-spending-increases-usa-and-europe
- Khan B. Pakistan raises annual defence budget to $8.78 billion U.S. Quwa.org. 2017 May 28[cited 2018 Feb 28]. Available from: https://quwa.org/2017/05/28/pakistan-raises-annual-defence-budget-8-78-billion-u-s/
- Rana S. Pakistan is now a $300-billion economy. The Express Tribune. 2017 May 18 [cited 2018 Feb 28]. Available from: https://tribune.com.pk/story/1412545/pakistan-now-300-billion-economy-gdp-growth-5-3/
- http://www.icanw.org/the-facts/the-nuclear-age/
- https://ourworldindata.org/nuclear-weapons
- https://www.cnbc.com/2018/08/13/trump-signs-717-billion-defense-bill.html
- https://www.cnbc.com/2017/05/02/how-us-defense-spending-stacks-up-against-the-rest-of-the-world.html
- https://www.ippnw.org/pdf/Bombay.pdf
ABSENCE OF HEALTH DISCOURSE IN THE ELECTION PROCESS IS UNFORTUNATE
16.04.2019
ABSENCE OF HEALTH DISCOURSE IN THE ELECTION PROCESS
IS UNFORTUNATE
With election fever picking up, the blame game is increasing with every passing day. Issues concerning the people are not being highlighted as they should have been. The ruling party has very cleverly brought the rhetoric against Pakistan as core issue. The speeches by the first rank leadership are by and large ignoring the issues of health and education. Even though the points related to healthcare have been mentioned in the manifestos of the various parties but until and unless they are emphasized by the leadership in their public discourses time and again, these do not become part of people’s mind. A critical analysis of the manifesto of two major parties shows some differences in the approach.
The manifesto of the BJP is centered around eulogizing the Ayushman Bharat which is said to cover 50 crore people for in patient care only. It nowhere talks of how to get the rest 80 crore people in the scheme in future. Moreover it does not give any proposal of bringing the people seeking outpatient care only in the scheme. Thus it sans any step towards universal healthcare. It talks of opening more medical colleges but does not give any information on whether they will be in the state sector or the private sector. This is important because the number of medical colleges opened in the last few years is more in the private sector. These colleges are charging exorbitant tuition fee which makes them out of reach of even the middle class families. The manifesto also does not talk of increasing public spending on healthcare which is essential for ensuring quality healthcare to the common citizens.
The manifesto of Congress party recognizes the healthcare as a right of every citizen. It promises to increase the public spending from present 1.1% to 3% of the GDP by the year 2023-24 with step by step increase in every budget. What is needed is immediate increase to 2.5% of the GDP to be raised to 6% in the next five years. The manifesto promises to enact Right to Healthcare Act ‘that will guarantee to every citizen the right to healthcare services, including free diagnostics, out-patient care, medicines and hospitalisation through a network of public hospitals and enlisted private hospitals’. That the manifesto recognizes insurance based model not a preferred model to provide healthcare is a welcome note. It promises to implement free public hospital model to provide universal healthcare. Increasing the number of doctors by establishing more medical colleges, providing scholarship and loans to the medical students.
The manifesto of the left parties highlights the right to free health as a fundamental right. Increase in the public health spending to 6% of the GDP, end to commercialization of medical education. Strengthening of public health facilities, fixing the drug prices based on their cost of production and enact patent laws favourable to our country.
However these are documents which are important in a way that the governments to come can be questioned on their performance based on the promises made in the manifesto. But what is lacking is special forceful emphasis in the public speeches by the political leaders. This reflects lack of sensitivity to the health issues to the required level even though it is admitted that nearly 6% of the population is pushed below poverty line because of catastrophic out of pocket expenditure on health. There are also reports that financial stress as a result of out of pocket healthcare expenditure is an important cause of suicide among farmers. It is time for public to act and force a pro-people healthcare discourse.
WORLD HEALTH DAY PLEDGE
WORLD HEALTH DAY PLEDGE
Since the year 1950 the 7th of April is observed as world health day all over the world. The decision to observe this day was taken by the world health assembly in 1948 at Geneva. It is an important day to highlight the plight of people’s health and thence plan strategy to take steps to ameliorate the related problems. The objective is to increase public awareness of various causes and prevention of different diseases and also to provide knowledge how to prevent their complications. It is important to impart knowledge to the people about how to take self-care. It is also time to ask governments to provide healthy environment.
It is a matter of concern that health still remains a pipe dream for large number of population. In 2017 nearly 50% of the global population did not have access to quality essential services to protect and promote health. Around 800 million people were spending 10% of their house hold budget on out of pocket health expenses. As a result 100 million people were being pushed into extreme poverty. Situation in the poor countries is more pathetic.
In our country despite advances in healthcare there persist gross inequalities in access to it. The low socio economic groups have difficulty in getting modern healthcare. Inequalities persist in terms of geography, caste, religion and gender as well. Rising cost of health care adds to these inequalities. Out-of-pocket expenditure by the patient constitutes 63% of Total Health Expenditure. The share of Out of Pocket Expenditure on health care as a proportion of total household monthly per capita expenditure is 6.9% in rural areas and 5.5% in urban areas.
The communicable diseases have been the major cause of illness in our country. Many of these can be prevented by simple measures through health awareness in the public. The air borne diseases like the influenza can be prevented if the persons take precautions like covering their face with mask and to maintain distance from the patient. Tuberculosis is another illness which can be prevented by avoiding contact with the patient. Many vector borne diseases can be prevented by taking care of the vector. The Dengue, Chikungunya and Malaria can be prevented by avoiding the mosquito bite and checking reproduction of mosquitoes. For this people be encouraged to remove stagnant water from the area, to use mosquito nets and mosquito repellents. Many water borne diseases like the jaundice and other abdominal infections can be prevented by using clean drinking water and boiled water. Simple measures like washing hands before eating, washing vegetables in running water, not to eat uncovered food products, to avoid preserved food, to do exercise regularly, to take balanced diet can prevent many diseases. Since the non-communicable diseases are increasing in the society, there is need to inculcate basic knowledge about their prevention. Senior citizens and children who are more prone to be taken ill need more attention through awareness among their families. There is also need to give knowledge about the methods of waste management. Such above said measures do not incur huge cost. What is needed is change in habits, life style and some medical tips.
It is also important to rid the society of myths about diseases particularly in the low socio economic and less literate section of the society. Even today large number of our population is swayed away by myths. They visit the faith healers in the pursuit of better health. Some of the common diseases they look for remedy from such faith healers are Mumps, Chicken Pox, Bell’s Palsy, epilepsy, sexual problems, infertility etc. Many a times such beliefs cause delay in treatment and worsening of illness. Preaching to produce ‘customised babies through garbh vigyan sanskar’ by the the “Arogya Bharti” is pushing the society to medieval times. But when such practices are patronized by those at the helms of power it is a very serious issue. Not too long back two ministers of the Gujarat government felicitated the ‘tantriks’ in one of their conferences.
Unfortunately health care is not a major issue in the public discourse. There is need to make debate on healthcare a day-to-day agenda of the public. The medical organizations have to play vital role for this. Medical professionals along with Anganwadi & Asha workers and local level social activists have to come forward. Health committees should be formed at the Mohalla and the Village level which should discuss the health concerns of the area as well as policy matters pertaining to health in general. Written information through pamphlets, group meetings and interactive sessions can pay real long term dividend.
With ASAT would we be really secure?
With ASAT would we be really secure?
Not long ago when on 11th May 1998 India conducted nuclear test, there was lot of jubilation by the government and the workers of the ruling party. People were made to believe that with this India will become a powerful country to reckon with. Those who raised skepticism about the whole programme were dubbed not standing with national interest. In response, the Pakistan government conducted nuclear tests just after 17 days on 28th May. Whereas India had done 6 explosions, Pakistan did seven. The whole talk of powerful nation with nuclear weapons got subdued. With this, we got into nuclear arms race, spending huge amount on nuclear weapons programme. At present both countries spend exorbitant amount on arms race in comparison to the expenditure on the social needs.
Now that Indian government has developed Anti Satellite missile (ASAT), it would be naïve to believe that our neighbouring country will not react to it. Even though the Anti-Satellite missiles are not directed towards Pakistan because they do not have any satellite, yet Pakistan would not tolerate the macho image of India. China too has satellites. However it is not possible to target them.
Pakistan reaction will be seen in due course of time. But the situation has become murkier. The whole campaign against the weaponisaiton of outer space may be weakened. Many technologically developed countries have not jointed this star wars programme because there is a general agreement that outer space should be left without any such waste.
ISRO is a respectable organisation which has to its credit developing satellites for communication and other purposes. This apparent move during election days is not only undesirable but dangerous. We cannot afford to waste our resources in such competition and develop programmes with a desire to create a sham image nationally and internationally. Statements by the Finance and Defence minister that the test firing is India's bid to prepare for "tomorrow's war" is unwarranted and too ominous.
At this time when the electioneering is its peak, the Prime Minister should lay more emphasis on health, education and social indices. It is risky to justify the achievements of scientific community by statements like “My aim is to make every Indian feel secured. I have great belief in the countrymen’s capabilities, commitment, dedication and ability to craft unitedly a nation which is strong, prosperous and secure. I envision such a Bharat where people can imagine such futuristic projects and garner the courage to go forward.”
India is signatory to the Outer Space Treaty reached in January 1967. International treaty is binding on the parties to use outer space only for peaceful purposes.
We must plan our strategies based on priority needs of our people. India ranks at 140 in human development index and Pakistan at 150. Our hunger index is 103 out of 118 countries and Pakistan’s is 106. While the government admits below poverty line people to be 20% of our population, the unofficial figures may be much higher. India’s happiness index fell from 133 to 140 last year out of 156 countries as per the survey by the Sustainable Development solutions network under the UN. Investments in health and education remain less than 4% and 3% of respective gross domestic product (GDP) in the region. These are serious issues which to be addressed.
We should develop new strategies to combat terrorism in south Asia. Rhetoric against each other has not paid till date. We are a big country with immense diversity. It is time to take initiatives for a sustainable peace and development.
DIFFERENTLY ABLED NEED CARE - NOT MOCKING
Disability is an unfortunate part of human life which affects the natural way of living. It becomes a cause of misery and dejection. It becomes the cause of disadvantage and restriction of activities. In our country persons with disabilities do not get attention which is due to them. They become subjects of mercy and pity. Even though such people have several rights under various Indian laws as well as UN conventions that are followed in India, but there is by and large apathy towards them. This apathy adds to the feeling of despair among such people who have physical, sensory or mental impairments. We must realize that such persons need special care if we have to get best out of them. They may not be able to perform several functions which other people can do, but they can do well in many fields. That is why they are called as differently abled persons. What these people need is their rightful place in the society. They need special rights from the society and the government not pity from any one.
In the Hindu mythology when Rishi Ashtawakra, who had several deformities on his body, entered the ‘sabha’ of Raja Janak, the ministers sitting there started laughing at him. In response he too started laughing. He was asked that people sitting in the sabha were laughing at his disfigured body, but why did he laugh? He replied that he had thought that this sabha is a gathering of wise men. But I am sorry to say, he said that there is hardly any intellect in this gathering. Their insensitivity and poverty of intellect is reflected from their behavior that they judge a person by his appearance not by the qualities he possesses. This story can be compared to the episode at IIT Kharagpur in which the Prime Minister addressed the meeting of engineering students where a young lady was explaining about an app developed to help the dyslexics. Suddenly, to the astonishment ofevery one the Prime Minister interrupted and said, “Will this help 40- or 50-year-old persons?” Then after a pause he continued “That will make their mother happy!” The IIT should have been wise enough to invite someone who could meet their expectations on science instead of the Prime Minister Narendra Modi because science is not his domain. It is well known that he is poor in knowledge and lacks sensitivities. He has grandiose & megalomaniac behaviour. His mocking at the function has brought to the fore the poverty of thinking specifically in respect to the differently abled persons.
Dyslexia is a learning disorder which can cause problem with reading, writing and spelling. A dyslexic person is not in intellect. He has difficulty in decoding single words like b may be read as d ordoes may be confused with goes. He makes errors in reading and writing. Because of inconsistencies such persons develop complex in facing new situation and develop anxious behaviour. There are special training facilities for the persons with disabilities which can help to bring them to the main stream of society.
Our society attributes many disabilities to the god’s will or a result of Karmas of the previous life. The term ‘Divyang’ is an outcome of this thinking. This is escaping responsibility to care such persons because once it is will of god we cannot do much about it and be satisfied with it. It is because of this insensitivity which is inherent part of thinking of many of us that the students of IIT who are supposed to be cream of the society clapped when Narendra Modi made fun of dyslexia by making remarks on his political opponent. They only know whether their response was after they understood the intention of the prime Minister or it was a part of behavior that everyone must laugh when the king laughs. But whatever the reason, it showed lack of scientific temper among the students of that level and lack of courage to question the wrong. Making mockery of the disabled person is ethically & morally wrong and socially inappropriate; more so when it comes from the mouth of a person who is custodian of the nation.
Such a behavior from the person of the level of the Prime Minister should have been widely condemned. But barring a few activists and organizations most of the social and medical organization have kept themselves aloof from the issue. Even the medical organizations, the IMA or the organizations involved in caring for such children have not come out in open in large number in protest. This is a worrisome issue reflecting inertia in the society. Disability can befall on any individual or family. So far we do not have any such mechanism to study the genetic structure of the parents and counsel them about parenting to prevent disabilities in the offspring. Even Thalassemia which can be prevented by genetic counseling and advice about marriage is not any issue in our country. Instead we believe in myths and take the advice of horoscopes when it comes to matrimonial matters. There is need for social awareness on such issues. However, in no case, making disability as an issue in election campaign can be condoned.
Dr Arun Mitra
HEALTH IN WAR TIMES
Dr Arun Mitra
War is the one of the most serious threat to public health with catastrophic effects on infrastructure & environment and accounts for more deaths and disability than many major diseases combined. It destroys families, communities and sometimes-whole cultures. It channels limited resources away from health and other social needs.
The escalation of tension between India and Pakistan has to be viewed in that context. When the tension persists there is always an imminent danger of its entering into larger war. Warning about such situations, Maj. Gen. (Retd.) Vinod Saighal in a letter to the Prime Minister in 1990 had written “another war between India and Pakistan could result in physical suicide for Pakistan, economic suicide for India and a catastrophe for the subcontinent". It holds true now as well, even more so. Events in the last few days are witness to it. In wars, wellbeing of people is the chief concern; their livelihood, health, nutrition and other needs all become uncertain.
The issue in the present context is of much more seriousness as both India and Pakistan are one of the most deprived in the world. The priorities in the two countries have to be to correct the abysmally poor human development index of 130 and 150 in India and Pakistan respectively. Hunger index of India at 103 and Pakistan at 106 out of 119 countries is a matter of grave concern. War will mean destruction and further deprivation, hunger, disease, mental problems and unprecedented loss of life.
Health effects during war times range from displacements, injuries, incapacitation, mental stress, lack of food, under nutrition, starvation and death. During the two world wars around 9 crore people are reported to have died. In 1965 Indo-Pak war which lasted for 17 days the Indian army suffered 11,479 casualties with 2862 killed and 8617 wounded and according to Indian records 5800 Pakistanis were killed. Inter-communal violence between Hindus, Sikhs and Muslims at the time of partition had resulted in between 500,000 and 1 million casualties.
During war times there occur large number of displacements from near the border areas and people have to live in the refugee camps. There were 21.3 million refugees worldwide in 2015. The health indicators of refugee population are poorer than the communities from which they come. They are more prone to diarrheal diseases, measles, acute respiratory infections, malaria, malnutrition and other infectious diseases. The incidence of Sexually Transmitted Diseases and HIV transmission are high in refugee camps due to engagement with sex workers, rape, and insufficient access to reproductive health services.
Refugee camps are generally away from the main population and poorly accessible by road, and lack basic amenities like clean drinking water supply, proper sewerage system and have a limited power supply. The high mobility of the refugee setting, with the constant inflow and outflow of people, presents a unique challenge because it is difficult to provide sustained care over a period of time.
Loss of family life, death of near and dears, uncertainty of the future leads to extreme mental stress; the children are more likely to be affected. They are likely to develop Post Traumatic Stress Disorder (PTSD). Women and children are worst sufferers as they are more vulnerable to be abused. All this affects their behavior even after the things get settled down and they return to their native places.
The International Physicians for the Prevention of Nuclear War (IPPNW) in its Aiming for Prevention - International Initiatives on small arms had carried out One Bullet Stories by its IPPNW-Kenya affiliate. The One Bullet Story (OBS) is about the people, their stories, and the injuries caused by the guns and bullets. It was done with the aim to infuse the human face into the campaign against armed violence by highlighting the plight of the victims through their experiences and powerful testimony. Health professionals are in the front lines as the primary witnesses of the horrific impact of firearm violence.
The Ottawa Process that led to the Mine Ban Treaty achieved its high level of success largely through the exposure of the plight of the victims and survivors of the mine explosions. It is the gruesome photos of the innocent and unsuspecting civilians injured by the Antipersonnel Mines (APMs) that created the public outcry and attracted high profile personalities like the late Princess Diana to the campaign. The initiators of this outcry were the International Committee of the Red Cross (ICRC) field surgeons such as Robin Coupland MD who brought the focus of the international community to bear on the indiscriminate and horrific nature of landmine injuries.
Nuclear weapons have totally changed the war scenario. Testimonies by the Hibakusha (Atomic Bomb Survivors of Hiroshima and Nagasaki) would move any one. It is of utmost urgency that tension between India and Pakistan has to be deescalated. Present day bombs are much more deadly compared to those dropped at Hiroshima and Nagasaki. Even a limited nuclear war would put over 2 billion people at risk. It is through highlighting the Humanitarian Impact of Nuclear Weapons that the IPPNW and the International Campaign to abolish nuclear weapons (ICAN) played a vital role in getting the Treaty Prohibiting Nuclear Weapons (TPNW) passed in the UN General Assembly in July 2017 and won the organization Nobel Peace Prize that year.
There is no place for Jingoism in such situation. Any talk of war today means mutually assured destruction. Nothing is more precious than a healthy life of our children.
References:
http://www.uniteforsight.org/refugee-health/module1
https://emergency.unhcr.org/entry/111814/health-in-camps
https://www.unhcr.org/health.html
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Malnutrition in India – Who will take care?
Arun Mitra
The report published in the Drug Today Medical Times on 19thFebruary 2019 by Shri B S Rawat that 244 malnutrition deaths occurred in Delhi hospitals in 4 years is highly alarming. This report is based on the information received on an RTI information provided by Deputy Director of Delhi based State Family Welfare Bureau Shri C K Dutta to Shri Raj Hans Bansal. It is an extremely serious matter because Delhi is capital of the country and despite its serious pollution problems it is a dream city for millions of Indians who come here for education and in search of jobs besides tourism. Large number of workforce come to Delhi from different states to work in factories, dhabas, households and other places. Many of them live in shanty areas without proper water supply, hygiene or housing.
Quoting Health Minister Deepak Sawant the PTI had reported on 22nd July 2018 that as many as 19,799 children died in Maharashtra between April 2017 and March 2018 due to various reasons, including poor weight and respiratory illnesses. The main reasons of death during the period were poor weight at the time of birth, premature delivery, contagious diseases, congenital respiratory illnesses and deformities, besides others. The Minister said this in a written reply during the Monsoon Session of the Legislative Council in Nagpur.
Despite the claims of substantial growth in the GDP our country is unable to provide sufficient food to feed its population; it is unable to provide access to food to a large number of people, especially women and children. According to Food and agriculture Organisation (FAO) estimates in ‘The State of Food Security and Nutrition in the World, 2018” report, 195.9 million people are undernourished in India. By this measure 14.8% of the population or 1 in 4 children is undernourished in our country. Also, 51.4% of women in reproductive age between 15 to 49 years are anaemic. Further according to the report 38.4% of the children aged under five in India are stunted (too short for their age), while 21% suffer from wasting, meaning their weight is too low for their height. Malnourished children have a higher risk of death from common childhood illnesses such as diarrhea, pneumonia, and malaria. The Global Hunger Index 2018 ranks India at 103 out of 119 countries on the basis of three leading indicators -- prevalence of wasting and stunting in children under 5 years, under 5 child mortality rate, and the proportion of undernourished in the population.
The Malnutrition is caused due to lack of balanced diet. India's malnutrition problem results not from calorie intake but from dependence on a carbohydrate based diet low in protein and fat. Another factor triggering malnutrition is inadequate sanitation, which triggers an increase in infection-borne deficiencies in nutrients.
There are two major types of malnutrition:
- Protein-energy malnutrition - resulting from deficiencies in any or all nutrients.
- Micronutrient deficiency diseases - resulting from a deficiency of specific micronutrients.
According to the reports up to 40 per cent of the food produced in India is bound to get wasted. About 21 million tonnes of India's entire wheat produce are wasted and 50 per cent of all the food across the world meets the same fate. India Wastes As Much Food As United Kingdom Consumes.
Child malnutrition impacts on economic productivity. The mental impairment caused by iodine deficiency is permanent and directly linked to productivity loss. Maternal malnutrition increases the risk of poor pregnancy outcomes including obstructed labour, premature or low-birth-weight babies and postpartum haemorrhage.
Animal studies have shown that malnutrition can cause decrease in brain volume, number of neurons, synapses, dendrites and reactive zones. ... The greatest effect of malnutrition on brain development is experienced during the time of rapid brain growth which is first three years of life. This is the period during which the brain is vulnerable.
To prevent malnutrition one needs plenty of fruit and vegetables, plenty of bread, rice, potatoes and other starchy foods, some milk and dairy foods, some meat, fish, eggs, beans and other non-dairy sources of protein.
The Lancet, one of the most authentic medical journals has come out with daily dietary recommendation for 2500 calories from various food items fulfilling caloric requirements, as well as ingredients essential for growth of different body parts and mental faculties. An estimation of the cost of this daily diet based on the present day price of the food items comes out to be approximately Rs.130 per person per day. For a family of 5 members this comes out to be Rs.650 per day or Rs.19500 per month. This is impossible to be met with in present day economic structure of our country.
The minimum wage in India as recommended by the expert Committee, in the name of national minimum wage, amounts ranging from Rs 8892 to Rs 11,622 per month meant for unskilled worker. This is far below the level of minimum wage recommended by 7thPay Commission. The trade unions have been demanding minimum wage to be Rs.18000/- even though this also does not meet the nutritional requirements. The major work force in our country is in the unorganized sector where these acts are hardly implemented. The agriculture labour and the marginal farmer is worst affected.
Bold socio-economic initiatives coupled with public movements are needed to ameliorate the situation if we really want to care for our children and make them physically and mentally strong and to a strong nation. Midday meal is a good scheme. It needs to be implemented effectively. But ultimately it is the increase in purchasing capacity of the people which can sort out the issue of mal nutrition.
References:
- (http://www.drugtodayonline.com/medical-news/latest/8825-244-malnutrition-deaths-in-delhi-hospitals-in-4-years.html)
- (https://www.theweek.in/news/india/2018/07/22/19799-children-died-in-maharashtra-in-12-months-says-health-minister.html)
https://www.indiafoodbanking.org/hunger
- https://www.stylecraze.com/articles/causes-of-malnutrition/
- https://www.savethechildren.in/.../why-malnutrition-continues-
- https://www.tandfonline.com/doi/pdf/10.1080/20786204.2007.10873530
https://www.nhsinform.scot/illnesses-and-conditions/nutritional/malnutrition
Collective effort needed to save life and health
Arun Mitra
Terrorist violence in Pulwama which killed our brave young soldiers fighting to save the sovereignty of the country has shaken the whole nation. Each citizen is aghast at this violent act. There is natural wide spread anger and feeling of revenge. Life is the most sacred thing on earth. It is beyond imagination how can one think of destroying this beautiful gift of nature. Medical profession has through the history worked to save life and promote good health. Doctors around the world work day and night for preserving life and preventing disease so that we do not fall sick. In the event of being taken ill medics put forth all their efforts to get the person rid of illness and put him/her back to work. Every year millions are spent globally on doing research to invent new methods of treatment so that the generations to come can lead a healthy life. Death is the end of life which doctors try their best to prevent. This is why it is important to oppose violence of all kinds.
It is unfortunate that our region which is one among the most deprived in the world is suffering the heat of violence constantly in one form or the other leading to further deprivation of our resources away from our basic needs to wasteful expenditure on arms race. Terrorist violence has killed large number of people both in India and Pakistan.
As per a report by National Consortium for the Study of Terrorism and Responses to Terrorism, A Department of Homeland Security Science and Technology Center of Excellence, Based at the University of Maryland published in September 2018 number of terrorist attacks globally in 2017 was 8584 which caused death of 18753 people and injured 19461 persons.
During the same year there were 574 terrorist attacks in Pakistan causing death of 851 persons. In India there occurred 860 attacks leading to death of 380 persons including the incidents in Chhattisgarh and North East. Both the countries have witnessed serious terrorist violence incidents like the attack on Indian Parliament in 2001 and Mumbai in 2008. In Pakistan the worst incident has been the terrorist attack on school children in Lahore.
Such violence leaves behind a long tale of unforgettable events and misery. Those injured in such violence have to suffer all their life due to the loss of limbs, eyes or other organs besides the mental disorders including Post Traumatic Stress Disorder (PTSD). Children lose their school education and worst is the loss of love and affection and care of parents.
Such events create a natural hatred against the perpetrator and demands for a similar response and stringent action. But such situations have to be tackled with much seriousness and statesmanship. Rhetoric may yield catastrophic results.
War is the one of the most serious threat to public health with catastrophic effects on infrastructure & environment and accounts for more deaths and disability than many major diseases combined. It destroys families, communities and sometimes-whole cultures. It channels limited resources away from health and other social needs.
In the present situation any talk of aggression could be of serious consequences as both countries are nuclear weapons possessing countries. The use of these weapons in the event of a war cannot be ruled out. The death of over 200,000 people killed by atomic bombing of Hiroshima and Nagasaki and the effects of radiation fallout are still not forgotten. Present day nuclear weapons are much more deadly. Even a limited use of 100 nuclear weapons could put 2 billion people at risk.
It is time to work collectively to curb the menace of terrorism which is totally inhuman and dastardly act. Whereas it is important to defend the sovereignty of the nation, it is imperative to wage ideological struggle against terrorism through civil society actions against fundamentalism, conservatism and also creation of more avenues for education and job opportunities.
Reference:
https://www.state.gov/documents/organization/283097.pdf
Health Care - What the political parties must promise
Dr Arun Mitra
Despite advances in health care there persist gross inequalities as far as access to it is concerned. Even today the low socio economic groups have difficulty in getting modern healthcare. Inequalities also persist in terms of geography, caste, religion and gender. High out-of- pocket expenditures, with the rising financial burden of health care adds to these inequalities. Out-of-pocket expenditure by the patient constitutes 63% of Total Health Expenditure. As a result every year 6.3 Crore people are pushed below the poverty line in India due to health care costs. The share of Out of Pocket Expenditure on health care as a proportion of total household monthly per capita expenditure is 6.9% in rural area and 5.5% in urban area. This led to an increasing number of households facing catastrophic expenditure due to health costs. A large proportion of the population still lacks access to food, education, safe drinking water, sanitation, shelter, land and its resources, employment and health care services. It affects both the occurrence of disease and access to health care.
The recently launched National Health Protection Scheme (NHPS) reduces universal health care to health insurance coverage, and that too for only 50 Crore population while the rest 80 Crores are left out. Moreover it covers only inpatient care even though more than 60% of healthcare cost incurred by the patient is on outpatient treatment. The private health insurance companies and health care providers are already expecting huge windfalls from NHPS. With significant involvement of the private sector, the scheme is clearly indication of a shift from public provisioning of health towards privatization. These would have far reaching implications especially in the area of healthcare.
Health is a social, economic and political issue and above all a fundamental human right. Inequality, poverty, exploitation, violence and injustice are at the root of ill-health and the deaths of poor and marginalised people. Health for all means that powerful interests have to be challenged. That globalisation has to be opposed, and that political and economic priorities have to be drastically changed.
It is in this context that the political parties should come forward with promises on healthcare in the coming elections to the Lok Sabha.
Political parties have to agree to that the attainment of the highest possible level of health and well-being is a fundamental human right, regardless of a person's socio-economic and ethnic background, religion, gender, age, abilities, sexual orientation, class or caste. The principles of universal, comprehensive Primary Health Care, envisioned in the 1978 Alma Ata Declaration, should be the basis for formulating policies related to health.
Therefore the parties should promise to:
Enact National Health Bill as Right to Health care Act that can guarantee that every citizen shall have right to comprehensive and quality healthcare at state’s expense, in a government health facility, and in case of its non-availability in some cases in a private health facility.
Include health in the concurrent list of the Constitution. Adopt a National Health Policy legally binding on the executive.
Promise to take positive steps so that governments promote, finance and provide comprehensive Primary Health Care as the most effective way of addressing health problems and organising public health services so as to ensure free and universal access.
Enhance public spending on health to 4 per cent of GDP .
Set up a standing National Commission of Health with judicial powers to which the bureaucracy would be answerable followed by such commissions at state level.
Put an end to privatisation of public health services and ensure effective regulation of the private medical sector, including charitable and NGO medical services.
Set up Primary Health Centre at every 30000 population, with 24-hour service, a Health Sub-Centre at every 5000 population and a fully staffed Community Health Centre equipped with all modern facilities at every 100000 population. Establish round-the-clock ambulance service at every 30000 population. Post women medical and paramedical personnel in all health centres and hospitals in adequate numbers. All Government health facilities should adhere to Indian Public Health Standard (IPHS) norms.
Arrange assured safe drinking water supply through piped water in all habitations, total sanitation in all households and localities, and enforce complete safeguards against air, water and soil pollution by industries, mines and other developmental projects.
Eliminate Malnutrition by implementing National Food Security Act 2013 which aims to provide subsidised food grains to approximately two thirds of India’s people. Set up Nutrition Rehabilitation Centre at each block to address the issue of severely malnourished children.
Promote people’s spending power by ensuring sufficient wages so as to meet their nutritional needs.
Expenditure on medicines constitutes nearly two-thirds (60%) of out of pocket expenditure. There is need to implement a Rational Drug Policy that allows drugs to be sold only under their generic names. Exempt production of generics from patent rules.
Ensure improved availability, accessibility and affordability of drugs including vaccines and sera in the public health system; through quality conscious pooled procurement systems and promotion of manufacture of essential medicines.
Strengthen Public Sector Units to make cheap bulk drugs.
Adhere to policy of cost of production for ceiling of drug price with no more than 30% trade margin.
Establish a regularly updated Indian National Formulary on the lines of British National Formulary to provide unbiased prescribing information and rational guidelines for use of drugs.
The estimated costs of Universal Health coverage ranges between 4 and 6 per cent of GDP. This financial commitment is achievable. What is required is political will for this if we want to build healthy India.
Combating Malnutrition Bold socio economic initiatives needed
Arun Mitra
The Lancet, one of the most credible medical journals took up the challenge to study the dietary patterns around the world and then come up with recommendations for a healthy diet. It formed an EAT Lancet Commission for the purpose which had 37 members on it. From our country, a renowned Cardiologist and President of Public Health Foundation of India, Dr.K.Srinath Reddy and Ms.Sunita Narayan- Director General, Centre for Science and Environment and editor of the Down to Earth were the part of this team. The commission’s exercise was done with focus on how to maintain good health of a person in regard to dietary intake and the impact of present day dietary patterns on environment. The commission studied and need to develop such dietary habits which are sustainable and ensure availability of sufficient food in times to come. The recommendations also highlight need for intake of micro nutrients required for physical and mental growth. Thus they have come out with recommendations about diet which is essential, healthy and also environmental friendly. Its basic recommendations include less intake of red meat & sugar and increase the intake of vegetables.
The recommendations also take into concern the report of Food and Agriculture Organization of UNO which points out that emissions from the global livestock account for 14.5% of the green-house gases emission as a result of the human activity.
Despite economic growth the nutritional status of our children is alarmingly below required standards. Roughly 40% of children under five are stunted and 21% of children under five are severely wasted or undernourished. Needless to say that a well-nourished child is likely to have better immunity and has more chances to remain healthy and grow well. Most of the undernourished children come from poor socio economic groups.
In India 44% of children under the age of 5 are underweight. 72% of infants and52% of married women have anemia. Research has conclusively shown that malnutrition during pregnancy causes the child to have increased risk of future diseases, physical retardation, and reduced cognitive abilities.
Malnutrition in our country is both lack of calories as well as lack of intake of nutrients in proper proportion.
The Lancet diet chart has given a deep insight into daily requirements of balanced food, fulfilling caloric requirements, as well as ingredients essential for growth of different body parts and mental faculties. Question however is now to fulfill these in the socio economic structure of our society?
The average approximate cost of this diet was found to be around Rs.130 per person per day. For a family of 5 members this comes out to be Rs.650 per day or Rs. 19500 per month. This is impossible to be met with in present day economic structure of our country. According to the World Bank data 27 crores people in our country are poor who cannot afford two square meals per day. With the economic reforms undertaken by the government there is constant onslaught on the poor strata of people. Jobs are being constantly contractorized and outsourced. Wages of workers are falling every day. The social security benefits are being withdrawn. For these people it is a nightmarish job to feed themselves with a balanced diet. There is thus need for very strong economic reforms for job security of workers, fixing minimum wages based on persons daily food intake and his/her other needs of family including clothing, housing, education, recreation etc. For this we need a powerful public movement if we have to feed our children and develop a healthy nation.
Lancet Diet Chart:
|
Food Item |
Recommended intake per day in grams |
Caloric intake per day |
Cost in Rupees February 2019 |
|
|
Whole grain Rice, Wheat, Corn and others |
232 |
811 |
7 |
|
|
Tubers of starchy vegetables Potatoes and cassava |
50 (0-100) |
39 |
2 |
|
|
Vegetables All vegetables |
300 (200-600) |
78 |
10 |
|
|
Fruits All Fruits |
200 (100-300) |
126 |
20 |
|
|
Dairy Foods Whole milk or equivalents |
250 (0-500) |
153 |
15 |
|
|
Protein Sources Beef, Lamb and pork Chicken and other poultry Eggs Fish Legumes Nuts |
14 (0-28) 29 (0-58) 13 (0-25) 28 (0-100) 75 (0-100) 50 (0-75) |
30 62 19 40 284 291 |
7 7 5 12 7 25 |
|
|
Added fats Unsaturated oils Saturated oils |
40 (20-80) 11.8 (0-11.8) |
354 96 |
5 5 |
|
|
Added Sugar All sugar |
31 (0-31) |
120 |
2 |
|
|
TOTAL |
129 |
Reference:
https://www.google.com/search?q=malnutrition+india+2018&oq=malnutritinin+indi&aqs=chrome.2.69i57j0l5.7784j0j8&sourceid=chrome&ie=UTF-8
https://www.weforum.org/agenda/2019/01/why-we-all-need-to-go-on-the-planetary-health-diet-to-save-the-world/
https://www.savethechildren.in/articles/malnutrition-in-india-statistics-state-wise
HANDING OVER GOVERNMENT HOSPITALS TO THE PRIVATE SECTOR WOULD PUSH ALREADY MARGINALIZED SECTIONS TO FURTHER IMPOVERISHMENT
The Punjab government through a public notice given in the newspapers has invited expression of interest from the private NGOs, doctors or others for providing services in the Government Hospitals and running of health institutions situated in difficult areas. This has drawn sharp reaction from various sections in the state including medical organizations, civil society groups and political parties. Such a decision of Punjab government to hand over hospitals under its care to the private sector will have serious detrimental impact on health services in the state. It will escalate the cost of treatment and increase the out of pocket expenditure on health. Public health spending by the government in the state is already very low. The state has more of a curative oriented healthcare. Public spending on preventive healthcare is only around 8% compared to the recommendation of National health policy document 2017, which says that more than two-third of the resources should be allocated for primary care. Therefore because of obvious reasons of lack of proper nutrition, lack of clean drinking water supply and sewerage facilities and absence of proper housing poor households have to bear the catastrophic expenditure on healthcare.
The research papers titled ‘Health-care utilization and expenditure patterns in the rural areas of Punjab, India’ published in J Family Med Prim Care and ‘Sub-national health accounts: Experience from Punjab State in India’ have brought forward some relevant points and made recommendations to improve the healthcare in the state. The total health expenditure of Punjab is around 4.11% of Gross State Domestic Product (GSDP). Share of public health expenditure is less than one-fourth of this. The Out of Pocket Expenditure by the patients is more than 76%. People have to shelve from their pocket to get healthcare the cost of which has gone high after increase in the non-communicable diseases for which they go to private sector.
More than 10% of the household expenditure on health is considered as catastrophic. In the above studies it was found that Catastrophic expenditure was incurred by 7% of the households while seeking outpatient care and by 53% while seeking inpatient care. Catastrophic expenditure was more often borne by households in poorer quintiles. About, 23.3% of outpatient and 59% of the inpatient health-care expenditures were financed through borrowings or from other sources such as sale of assets suggesting financial hardship in meeting health expenses. Need to borrow even for outpatient health care was higher in the poorer household expenditure quintiles. In rural Punjab, 67% of increases in poverty were estimated to be due to Out of Pocket expenditure.
Global experience has shown that dependence on the curative care does not sort out our healthcare problems. It is therefore needed to spend more on preventive aspect. The strengthening of primary health care is the only way to have Universal Health Care. The public health spending thus has to be increased to minimum of 2.5% immediately followed by raising it to 4% in subsequent years. Availability of medicines in public healthcare facilities should be ensured as major chunk of expenses is incurred on purchasing medicines.
The retraction by the Health Minister after public outcry that there is no such plan to handover government hospitals to the private sector is to be viewed with skepticism. He has said that this was to strengthen the public health system by inviting private specialists to give healthcare in the government hospitals and that this could be a trial in few selected hospitals. The excuse that government has dearth of doctors and therefore need for Public Private Partnership is not a correct understanding. It is because of lack facilities and infrastructure in the state hospitals that many doctors trained in various specialties do not opt for state services. After all they want to utilize their talent to the best of their ability. This is just an alibi to handover public sector facilities to the private sector. Handing over state sector hospitals for better services has already been experimented and failed in the state of Bihar. Medical education forms the basis of training of doctors. Due to exorbitant fees in the private medical colleges in the state many deserving students cannot get admission in the medical course. Last year when some Private Medical colleges increased tuition fees arbitrarily the Minister stood with them and supported their increase in fees. This has already put much burden on the medical students and their families. Expensive medical education coupled with expensive healthcare delivery system under the PPP mode will make healthcare even more expensive.
It is important to control the corruption in the healthcare system rather than handing over the government hospitals to the private sector. The corporate sector would jump into this and will further enhance the atmosphere to a unaffordable health care. The statutory & regulatory bodies should be strengthened to control the unfair happenings in the healthcare and check the prices of drugs and medical devices.
It is the duty of the government to provide healthcare to its citizens. India is signatory to the Alma Ata declaration for universal healthcare and is thus bound by this international treaty. However successive governments have failed to keep their promises. But by handing over its own hospitals the state government has completely washed off its hands from its responsibility.
References:
- Bahuguna P, Mukhopadhyay I, Chauhan AS, Rana SK, Selvaraj S, Prinja S (2018) Sub-national health accounts: Experience from Punjab State in India. PLoS ONE 13(12): e0208298.https://doi.org/10.1371/journal.pone.0208298, it was reported that ‘In 2013–14.
- Singh T, Bhatnagar N, Singh G, Kaur M, Kaur S, Thaware P, Kumar R. Health-care utilization and expenditure patterns in the rural areas of Punjab, India. J Family Med Prim Care [serial online] 2018 [cited 2019 Jan 21];7:39-44. Available from: http://www.jfmpc.com/text.asp?2018/7/1/39/231571)
Dr Arun Mitra Dr G S Grewal
Member Core Committee Member Core Committee
Alliance of Doctors for Ethical Healthcare Alliance of Doctors for Ethical Healthcare
Former Chairman Ethical Committee Former President
Punjab Medical Council Punjab Medical Council
POOR OUTRAGE FROM MEDICAL AND SCIENTIFIC COMMUNITY A CAUSE OF CONCERN
Dr. Arun Mitra
The statement of the Vice Chancellor of the Andhra Pradesh University G Nageshwar Rao at the Indian Science Congress in Jalandhar that “we had hundreds of Kauravas from one mother because of stem cell research and test tube baby technology. It happened a few thousand years ago. This was science in this country," needs a critical review.
It is important to review this statement in the perspective of history and modern medicine. Before going into other questions of rationality it is necessary that the scientific information about stem cells is reviewed.
As per the information on stem cells by the National Institutes of Health (NIH), U.S Department of Health and Human Services, scientists discovered ways to derive embryonic stem cells from early mouse embryos in 1981. The detailed study of the biology of mouse stem cells led to the discovery, in 1998, of a method to derive stem cells from human embryos and grow the cells in the laboratory. These cells are called human embryonic stem cells. The embryos used in these studies were created for reproductive purposes through in vitro fertilization procedures. When they were no longer needed for that purpose, they were donated for research with the informed consent of the donor. In 2006, researchers made another breakthrough by identifying conditions that would allow some specialized adult cells to be "reprogrammed" genetically to assume a stem cell-like state.
Stem cell is the basic cell from where many complex structures of the body develop. As the fertilization of egg takes place, the newly formed cell starts to proliferate and form embryo. In a 3-5 days embryo which has about 150 cells there develop embryonic stem cells. These cells are basic raw material for the body. They can either keep on growing and dividing into further stem cells or may take up specialized functions.
Stem cells are important for living organisms for many reasons. In the 3- to 5-day-old embryo, called a blastocyst, the inner cells give rise to the entire body of the organism, including all of the many specialized cell types and organs such as the heart, lungs, skin, sperm, eggs and other tissues. In some adult tissues, such as bone marrow, muscle, and brain, discrete populations of adult stem cells generate replacements for cells that are lost through normal wear and tear, injury, or disease.
Stem cells are distinguished from other cell types by two important characteristics. First, they are unspecialized cells capable of renewing themselves through cell division, sometimes after long periods of inactivity. Second, under certain physiologic or experimental conditions, they can be induced to become tissue or organ-specific cells with special functions. In some organs, such as the gut and bone marrow, stem cells regularly divide to repair and replace worn out or damaged tissues. In other organs, however, such as the pancreas and the heart, stem cells only divide under special conditions.
Thus stem cells research and its applications are a very complex issue developed only very recently. It needs lot of further research for its application to be utilized for the benefit of health of mankind.
We are yet to find evidence of such research and its applications anywhere in the world in the past. To talk of stem cells in the ancient India when people used to wear wooden chappals “kharawans”, ride the elephant (not even horse), used gadaas, spears and arrows as weapons, to expect them to use the highly complex advanced technology of stem cells is difficult to swallow. Such a statement shows either bankruptcy of mind, irrationality of thinking or deceit in the effort to mix science with mythology. This could also be to please the masters for personal benefits. Whatever the reason it has raised a serious question as to which way we are going?
Some time back a similar statement was given by a retired judge of Rajasthan high court in which he had said that the Peahen gives birth to the offspring when it licks the tears of Peacock. What type of judgments this man would have pronounced can easily be deduced from this statement which crossed all limits of irrationality.
When Prime Minster Narendra Modi while addressing a gathering of doctors and other professionals at a hospital in Mumbai said that in ancient India Plastic surgery was so advanced that an elephant’s head could be transplanted on a human body or that “…… Karna was not born from his mother’s womb. This means that genetic science was present at that time. That is why Karna could be born outside his mother’s womb,” it was no matter to rejoice but it could be tolerated presuming that it was a gimmick by a politician to woo those who believe in such irrational ideas. Barring a few rationalists the scientific community did not speak much about this illogical utterance.
But when such a statement comes from the mouth of an academician it is a very serious matter. Even more serious matter of concern is that the medical and scientific community has not showed outrage over such obscurantist ideas being spread by those at the helm of affairs. It is time the medical associations come forward to condemn such irrational ideas before it is too late and country is pushed into medieval set of mind.
We have great respect and honour for our epics Ramayana and Mahabharta for their highlighting the cotemporary value system; but to use them for political ends must be condemned.
Refrences:
https://stemcells.nih.gov/info/basics/1.htm
https://www.theguardian.com/world/2014/oct/28/indian-prime-minister-genetic-science-existed-ancient-times
http://www.newindianexpress.com/states/andhra-pradesh/2019/jan/04/kauravas-born-of-test-tube-baby-technology-andhra-university-vice-chancellor%E2%80%8B-1920659.html
MAKE RIGHT TO HEALTH A FUNDAMENTAL RIGHT
Dr Arun Mitra
Health is the basic human right. Every person has the right to live a healthy life and contribute effectively to the society’s development. As right to health is included in the directive principles, it becomes the duty of state to provide comprehensive universal healthcare to all citizens. It has to ensure prevention of disease, promotion of good health and rehabilitation of the diseased and the infirm.
Nutrition is the key to health. A poorly nourished person is more likely to be taken ill. Therefore prerequisites for a healthy life are safe drinking water, proper sewerage facilities, balanced nourished food with sufficient calories and other nutrients, proper housing and healthy environmental surroundings. There is need for special care for women, children and the elderly. Unfortunately we are far from meeting these requirements. Our hunger index is 103 out of 118 countries. This is a serious matter. How do we expect children with stunted growth to build a healthy developed nation?
Various studies have concluded that to ensure comprehensive primary healthcare there is need to enhance public health spending on health to minimum of 5% of the GDP. As per the National Health Accounts (NHA) Estimate for 2014-15, the Government Health Expenditure (GHE) per person per year is just Rs.1108/-. This is in contrast to the Out of Pocket Expenditure (OPE) of Rs.2394/- which comes out to be 63% of total health expenditure which is Rs.3286/- per person. Even this expenditure is not homogenous. The spending on health varies on socio-economic status, gender, religion, caste and geography. The average share of OPE on health care as a proportion of total household monthly per capita expenditure was 6.9% in rural area and 5.5% in urban area. This led to an increasing number of households facing catastrophic expenditure due to health costs. More than 40 per cent of the population has to borrow or sell assets for treatment. This is totally against the principles of equity and justice. Already marginalised sections, Dalits, Muslims and other socio-economically weaker groups are worst affected. Flaws in planning and implementation of the policies have been pointed out by the Comptroller and Auditor General of India (CAG) in 2017. The audit pointed towards inadequate funding, under-spending of available financial resources, delays in transfer of funds, diversion of allocated programme funds, limited capacity to spend due to shortages in infrastructure and human resources among other issues.
The recently launched National Health Protection Scheme (NHPS) aims to cover almost half the population with publicly funded health insurance. The private health insurance companies and health care providers are already expecting huge dividends from NHPS. There is also proposal for Health and Wellness Centres (HWC) to deliver preventive, promotive, curative and rehabilitative services. With a low financial allocation this will not take up. There is shift from public provisioning of health towards privatisation.
To improve the health of the people drastic steps need to be taken at various levels. Health should be declared a fundamental rights irrespective of religion, age, sex, cast and socio economic status. The government owes its responsibility to deliver health to all by ensuring universal access to quality healthcare, education and other day to day needs. For this they should be continuous evaluation of health status of the people. Health should get proper place in the political agenda and the policy making bodies.
Certain steps that need urgent action is the rationalization of drug prices. Regulate drug prices in line with the rationalization of trade margins in medical devices. The ex-factory cost of the drugs should be actual cost based. Cap trade margin on drugs and medical devices to a maximum of 30%.
Provide free medicines and investigations in all public hospitals on the lines of Tamil Nadu, Kerala and Rajasthan. Pledge to increase the public expenditure on healthcare from 1.1% to 2.5% of GDP immediately and then increase it to 5% in subsequent five years.
Medical education has to be revamped and within approach of all sections. Regulate tuition fees of 100% seats in private medical colleges.
The Constitution guarantees six fundamental rights to Indian citizens as follows: (i) right to equality, (ii) right to freedom, (iii) right against exploitation, (iv) right to freedom of religion, (v) cultural and educational rights, and (vi) right to constitutional remedies.
Fundamental Rights are justiciable, as they can be enforced, whereas the directive principles are non-justiciable, in that, they are not enforceable in the court of law. It is high time the health is included as one of the fundamental rights.
References:
Rs 3: Amount India Spends Every Day On Each Indian’s Health Swagata Yadavar June 21, 2018 https://www.indiaspend.com/rs-3-amount-india-spends-every-day-on-each-indians-health-53127/
https://www.downtoearth.org.in/news/out-of-pocket-health-spending-has-risen-in-rural-india-study-35613 (per house hold expenditure)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5115797/
(Dnyaneshwar Chour i- Constitutional Perspective of Right to Health in India: AnAnalysisrighthttps://www.researchgate.net/signup.SignUp.html?ev=su_requestFulltext)
Ethical Doctor’s Manifesto – Alliance of Doctors for Ethical Healthcare
People’s Charter for Health - Adopted at Bihar Health Assembly – September 2018
Promote Generic Drugs with Effective Quality Control
Dr Arun Mitra
The issue of cheap drugs and their quality has always been a cause of concern. With more than 40% of our population living below poverty line, if a patient needs medicines he has to pay more than half of her/his earning. As per the Trends in catastrophic health expenditure in India: 1993 to 2014 published in the Bulletin of WHO 2018, out of pocket expenditure on health in India is catastrophic. The catastrophic health expenditure is defined as ‘out-of-pocket payments on health equaling or exceeding 10% of total household expenditure and 40% of the household’s capacity to pay’. Proportion of households experiencing catastrophic health expenditure increased in the last 20 years, and the increase was greater for the poor than the rich.
As per the National Sample Survey on healthcare in 2014, ‘medicines emerged as a principal component of total health expenses—72% in rural areas and 68% in urban areas’. It is therefore pertinent that their prices be regulated effectively and quality control ensured.
Drugs in our country are sold in two forms. The branded drugs, which are promoted by the manufacturers. They are given specific trade name by the company. Since their cost involves several promotional expenses, their price is higher. At least 90% of the Indian domestic pharmaceutical market, of `1,00,000 crore and more, comprises drugs sold under brand names.
The concept of generic drugs was evolved to cut down this excess cost involved in packaging and other promotional means. The Indian government began encouraging more drug manufacturing by Indian companies in the early 1960s. Public Sector Pharmaceutical units played a vital role in this. A generic drug is sold under pharmaceutical/chemical name and has equal efficacy to the branded drugs. These are marketed under the chemical/pharmacological name without advertising. However here too, companies started manufacturing them under brand names. These are termed branded generic drugs which are being sold not under pharmacological name but under a different brand name even though produced by a company which is involved in manufacturing and promoting branded drugs.
To facilitate the use of generic drugs the Government of India has set up Jan Aushadhis, which sell only generic name medicines.. There are not enough Jan Aushadhis, possibly less than 3,000 against more than eight lakh retail outlets selling branded drugs.
Through the Indian pharma’s field force numbering nearly one million medical representatives, there has developed trust among the doctors and also the patients in the companies and their brands. For similar trust to develop on the generic drugs there is need for perceptible quality assurance. Otherwise the use of generic drugs is unlikely to increase.
With value of worth US $20 billion, the Pharma sector in India is doing better than many other sectors and still continues to be major source of supply of cheap bulk drugs globally even to some of the developed countries.
But there are also reports of low quality medicines. Spurious/falsely-labeled/falsified/counterfeit (SFFC) drugs can cause treatment failure or even death. This is unacceptable. A working paper published through the U.S. National Bureau of Economic Research gave details of the results of an extensive investigation into Indian pharmaceutical quality. Around 1,500 India-made drug samples collected from 22 cities throughout Africa. It was found that ‘10 percent of the antibiotic and anti-tuberculosis samples contained insufficient levels of the key active ingredients’. Most of those drugs were not counterfeit they are legally made by the legitimate companies. They contain some therapeutic elements, but probably not enough active ingredients to actually treat disease’.
There have been cases of default by some of the leading companies. ‘Ranbaxy was found guilty in a US court in May 2013 and had to pay over half a billion dollars in fines and settlements. In 2012, Ranbaxy was forced to recall millions worth of drugs after glass particles were found mixed in with the raw ingredients used for its generic version of Lipitor. Dr. Reddy's Laboratories had to recall about 58,000 bottles of an ulcer medication because some of the pills were found to be contaminated’. According to Central Drugs Standard Control Organization (CDSCO) estimation, during 2003-2008, 6.3-7.5% of the samples were of substandard quality and 0.16-0.35% were encountered as spurious.
Such reports reduce confidence among the health providers and patients on drugs more so on generic drugs. It may be noted that there is powerful propaganda against the generic drugs by the companies selling branded drugs. This propaganda also impacts the patients who invariably ask for the branded drugs from multinational companies. This can be countered through strict quality control on all drugs particularly the generic drugs. Their trade margins have to be regulated. To enforce the regulations there should be surprise random check of the samples collected from the market. The CDSCO has to play a vital role in this. People’s confidence has to be built through public awareness and effective standardization of drug quality. More Public Sector pharmaceutical Units should be opened as it is easier to exercise quality control on them.
References:
https://www.forbes.com/sites/theapothecary/2014/09/17/india-must-fix-its-drug-quality-problem/#145d9fd770b3
https://en.wikipedia.org/wiki/Central_Drugs_Standard_Control_Organization
https://www.pacificbridgemedical.com/regulatory-services/medical-device-pharmaceutical/quality-compliance/india
https://www.downtoearth.org.in/news/fake-drugs-constitute-25-of-domestic-medicines-market-in-india-assocham-45393
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355878/
Bulletin of the World Health Organization 2018;96:18-28.doi: http://dx.doi.org/10.2471/BLT.17.191759
Healthcare must withstand market pressure to meet people’s aspirations
Dr Arun Mitra
A lot of debate has been generated not only in the medical circle but also the civil society whether the healthcare is a business or a profession. Anything that is termed as business is for profit only and could therefore be ruthless, apathetic and self-centered. The business has to compete in the market and follow the rules thereof which lack empathy and compassion. About four decades back healthcare was a profession where one would earn by serving. But the scenario has undergone much change nowand medical profession too has started following the rules of market. There are several reports of overcharging and unnecessary interventions by some health providers. The infamous case of Fortis hospital charging exorbitantly from a child who had died of Dengue fever is not too old to be forgotten.
Many of these hospitals have taken land on lease from the government at throw away prices.They are thus bound to give free healthcare facilities to a stipulated number of patients from low economic group. But this hardly happens in practice.Eventhe doctors and other staff seesuch patients with contempt. This may be because of pressure from the management or apathy that they have developed in the system they have been working for long.
The process of shift in values in medical profession started by the 1980s when the policies in the South Asian countries began to be influenced significantly by the Bretton Woods institutions, specially the World Bank. The developing countries had to accept structural adjustment policies (SAP) under the corporate driven one way globalization which served the interests of the international finance capital. The governments in the developing countries changed laws in favour of multinational corporations and the local elite while denying the basic fundamental rights to the poor strata of the society.Rights to hold protests and unionize were curtailed. Subsidies to the poor taken off.Job security taken away and employment generation occurred in the form of contract labour with very low wages. This happened not only in private sector but even in public sector. The priorities in the agriculture production also shifted from the basic food to the produce that was to be used by the elite in these countries. All this further resulted into increase in the problem for the lower income groups leading to fall of health determinants.
There occurred a policy shift that treats health as ‘techno-dependent and amenable to commodification’. The shift in concept is evident in the WHO itself when in 1996 it proposed a behaviorist model which stressed more on the individual effort for better health rather than social responsibility.The WHO started working under the influence of international monopoly corporates and took position to increase privatization and partnership with multinational companies.So the emphasis shifted to address only population control and some selected communicable diseases at the cost of its earlier broad-based approach. As a result the institution which was supposed to work for inclusive healthcare policies took lead in destroying its own agenda set at Alma Ata.
There were serious implications on medical education in our country. More medical colleges opened in private sector than in state sector affecting the very concept of social service in the medical training.
|
Year |
Govt. |
Govt. Society |
Private |
|
1947 |
19 |
1 |
|
|
1947 – 1950 |
7 |
||
|
1951-1960 |
31 |
3 |
|
|
1961 – 1970 |
34 |
6 |
|
|
1971 – 1980 |
8 |
3 |
|
|
Total A |
99 |
0 |
13 |
|
1981 – 1990 |
7 |
25 |
|
|
1991 – 2000 |
12 |
31 |
|
|
2001 – 2010 |
34 |
89 |
|
|
2011 – 2017 |
62 |
9 |
93 |
|
Total B |
115 |
9 |
238 |
|
Total A + B |
214 |
9 |
251 |
(Medical colleges that opened in state and private sector)
This is the time when the patent laws alsochanged under the new patent regime of the WTO.The local pharmaceuticals industries suffered. As a result, prices of newer drug increased. After lot of hue and cry from the public the government appointed a committee to go into the drug prices vis a vis trade margins, that is the difference between the price of the drug when it comes out of the manufacturing unit and the maximum retail price i.e at what it is sold at retails. The committee pointed out startling figures of the trade margin to be the tune of even 300% - 5000% in some cases. The committee recommended capping of trade margin so that the cost of drugs to the patients is streamlined.
Sudhanshu Pant Committee Recommendations on Trade Margins
|
Product Price Per Unit |
Trade Margin |
|
Rs. 2/-. |
No Capping |
|
Above Rs. 2/- |
50% |
|
From 20-50 Rupees |
40% |
|
Above 50 rupees |
35% |
Committee also pointed out that in case of bonus offer the benefit should go the consumer not the retailer. For example if there is a bonus offer of 1+1 then trade margin should be halved.
The market system also pushed practices of cuts and commissions for referrals and freebies to the medical professionals by the pharmaceutical companies. This corrupted even the doctor. Time has come now to think whether health services are to be treated as business or they have to be retained as a professional service and restore its glory and nobility.
People Need Health and Education Rhetoric would be Catastrophic
Dr Arun Mitra
The Kartarpur Corridor at the Indo Pak border is not just a religious symbol, it is a hope of millions of people across the border who have been denied the opportunity to visit their nears and dears, to have a glimpse of the places they or their predecessors were born, lived and spent their childhood & part of their youth. There has been denial of strong wish to meet their newly developed friends through modern technology – Facebook and WhatsApp etc. With similar background of cultural values people of the two countries have always been having strong yearning to go to the places they have been only reading about. The Kartarpur Corridor would also be an opportunity to break myths being spread against each other. It is only when one visits Pakistan from India or vice versa one realizes how much is the love lost between the two people who not too long ago in the history lived together. The political reasons distanced them through lines but could not break the bonds of brotherhood/sisterhood. The success story of Sada-e-Sarhad bus service started in 1999 during the Vajpayee government is a glaring example. It is time and an opportunity that has come before us through Kartarpur Corridor which we should not loose.
The path however is not so simple or straight forward. Only a few days back while addressing an event to highlight the 100 day achievement of Punjab government, Imran Khan, Prime Minister of Pakistan said that “we will show the Modi government how to treat minorities. Even in India, people are saying that minorities are not being treated as equal citizens". This was an unnecessary statement. Everyone knows that Indian constitution gives equal rights to all its citizens belonging to any religion, ethnicity, caste, creed or gender. We do not need sermons from any outsider. Imran Khan’s statement amounted to interference in India’s internal affairs. This statement is also in total disregard to his previous utterances suggesting that the foreign ministers of India and Pakistan meet on the sidelines of the United Nations General Assembly. It is well on record that during the inauguration of the Kartarpur Corridor he had warned that a war between India and Pakistan would be catastrophic as both are nuclear weapons possessing countries. In this context his statement of teaching India about minority rights is totally unacceptable.
On the similar lines Prime Minister Narendra Modi has in an interview on 1st January 2019 said that ‘Pakistan will not learn lesson from one war. They will take more time to mend the ways’. We have been hearing this rhetoric from both sides since long. This would lead us to nowhere. For any country to be able to wipe out the other from globe is just an imagination. We need to think beyond such statements.
We are the nations where vast majority of people live in abject poverty. India’s hunger index is at 103 out of 118 countries and Pakistan’s is 106. We are even below our other neighbors in south Asia. Our ranking in Human Development Index is 130 while Pakistan is 150. This is at a time when India is said to be fast growing economy. But the arms race has put a stop to our inclusive development. People are devoid of basic needs like food, shelter, health, education. Our per capita public health spending is just 1108 rupees.
India’s defense expenditure is 1.62 % of its GDP, while its central health budget is 0.26 of GDP, six times less than its arms budget. Pakistan’s spending on arms is equivalent with budgetary allocation 8.9 billion USD. With Pakistan worth 300 billion USD economy its defense expenditure comes to 2.9% of the GDP. Whereas Pakistan is out to purchase modern tanks, India is spending large amount on combat vehicles. This arms race is making the situation worse as it is taking resources away from social needs. The only way is to put an end to rhetoric and have dialogue and leave a better future for our next generations.
HEALTH AND MEDICAL EDUCATION CANNOT BE LEFT TO MARKET ECONOMY MECHANISM
Dr Arun Mitra
The report that the health ministry has asked the MCI to review the tuition fees in medical colleges is a welcome step. Better late than never, it has become so essential because the fee structure in private medical colleges has gone sky high and is out of reach of not only poor people but even the middle classes are now feeling the pinch. They have to shelve their savings and even borrow to send their wards to the medical colleges. This is not only for MBBS courses, but even for the admissions to the Ayurvedic colleges. Tuition fess even in some of the Ayurvedic colleges, especially those which are deemed universities are quite high. As a result several meritorious students are left out of the medical colleges due to exorbitant charges which they are unable to pay. Such situation leads to feeling of helplessness causing serious stress in the minds of the students and the whole family. The students have worked hard to fulfill their aspirations to become doctor; Now at the stage when they have achieved merit, they are denied admission because of financial reasons, is a very sorry state of affairs.
The WHO recommends one doctor per one thousand of population. Replying to a question, the Minister of State for Health, Smt. Krishna Patel had told in the Lok Sabha that on 31st March this year 1022859 doctors of modern medicine are registered with various state medical councils. She further said that around 8 lakh doctors are actively available at one time. This means that the doctor population ratio in India is 0.62 doctors per one thousand population. While nearly 70% of India’s population lives in rural areas, the rural India has 1/4th the doctors as compared to urban areas. This is a huge gap to be fulfilled. Thus we need more doctors for our population. For this the government plans to open more colleges. To fulfill the health requirements of our people we have to have medical colleges which impart relevant training to the students and orient them to the needs of our society and encourage them to work in areas so far neglected.
A review of the medical education scenario tells that admission to the medical colleges has been a contentious issue for quite some time. Initially most of the medical colleges were in state sector. Going by the information from the website of Medical Council of India, at the time of independence, there were 20 colleges out which only one was in private sector. Most of new additions were in the state sector till late eighties. But after the shift in economic policies and neo liberal model of development the whole scenario changed. Between the periods 1990 to 2017 number of colleges opened in private sector was 238 while only 115 were opened in state sector. Many of these were made as deemed universities which could have their own examinations, admission system and fee structure.
Many of these were charging under hand money as capitation fee. Merit was completely ignored and money became supreme.
Seats are reserved under the management quota where they can charge at their will. For example in the state of Punjab the tuition fee in the government colleges is Rs.13.4 lakh for the full course of MBBS for 4.5 years, in the seats under the management and the NRI quota it varies from Rs.35 lakh for the full course to Rs.63.9 lakhs. Astonishingly telephonic enquiry from the Era’s Medical College Lucknow revealed the tuition to be 17 lakh per annum which with 10% increase every year comes out to be nearly Rs.91.34 Lakh for MBBS course. The PG seats tuition fee in this college is up to Rs.49 lakhs per year. That means for MBBS and MS/MD both from this college, one will have to pay nearly 2.5 crore rupees and an additional charges for books, travel etc. This means the student has to spend nearly 3 lakh rupees per month or Rs.10000/- per day.
This is a cruel joke. In our country where vast majority of population is devoid of even basic needs, it is literally impossible for them to imagine to send their wards to the medical college even when they are on merit. There was hope that after introduction of NEET, capitation fee will end. But what has happened is to the contrary. The private colleges increased their tuition fee and are now earning legally in white money. This will simply undermine the quality of medical education and not fulfill the needs of society we are striving to achieve. Going by the track record it appears that this advice to the MCI to regulate the fee structure may not turn out to be an eye wash. State must recognize its responsibility to health and education if really wants to serve the people. Health and medical education cannot be left to market economy mechanism, they should be taken as social responsibility.
YOGA FOR MENTAL HEALTH – IRRATIONAL PRACTICES CAN BE HARMFUL
Dr Arun Mitra
Reports of medical students and young doctors committing suicides even in the premier institute AIIMS is a matter of grave concern. This issue needs serious introspection on the part of medical profession as well as the society. Depression that these young doctors and students have to pass through may have several causes, both external and internal. Stress starts in students and their parents even before the admission when the children enter into 10+1 class and are preparing to get into medical course. Many promising students remain devoid of admission to the course they have aspired for all through their schooling because of exorbitant increase in the tuition fees due to privatization of medical education. Just because one does not have money to pay as tuition fee to the tune of nearly one crore rupees for graduation, and another one crore for post-graduation they do not become doctors. They then look for other allied courses but never get reconciled to this.
According to Psychiatrists, the possible causes of depressive and suicidal symptomatology in medical students include stress and anxiety secondary to the competitiveness of medical school; inability to cope with the vast curriculum; repeated examinations; high expectations of the parents, teachers, and patients, and time constraints for pursuing their alternate interests etc. Weakening cohesiveness in the society is perpetuating the problem. Strong social relations were helpful in reducing the stress. Remedial measures include restructuring of medical school curricula and student evaluations, reducing barriers to mental health services, including addressing the stigma of depression, having a dedicated psychological help clinic in the campus or having alternate means of communication through a helpline or E-mail, peer mentorship programs, consultation by psychiatrists and clinical psychologists, life skills counseling etc.
Interestingly the Indian Medical Association (IMA) decided to start IMA Initiative for Emotional Health & Emotional Well-Being of Medical Students and Doctors in India, ostensibly considering the increased rate of mental illness and in some cases even suicides, especially in young medicos. The Karnatka unit of IMA even organized a workshop at IMA House, Bengaluru on 8th July, 2018, comprising of presentations and orations by Isha Yoga Foundation, Banjara Academy, Laughter Yoga, and Art of Living Foundation.
Dr.Srinivas Kakilaya an Internal Medical Specialist at Mangaluru and a few more doctors including Psychiatrists, Neurologist and family medical practitioner challenged the approach of IMA. They called upon the IMA not to promote unproven, non-evidence based practices on such an issue of mental health which is so delicate. They pointed out that in modern medicine there are innumerable resources regarding suicidal risk, its identification and management, including emergency care. There is enough evidence regarding the effectiveness of dialectical behavioural therapy and cognitive behavioural therapy in preventing suicides. It is in fact dangerous to promote yoga and such methods for anyone with suicidal ideation, and deny the evidence based critical interventions required for such people, they pointed out. This will also send wrong message about scientific method of treating depression. Already in India, there is a treatment gap of 87.2 to 95.7 for depression in community-based studies; therefore, promotion of methods such as yoga will create further confusion and denial of care for the needy, they said.
The medical ethics demands of a medical practitioner to be rational and scientific in approach while treating a patient. The Indian Medical Council (Professional Conduct, Etiquette & Ethics) Regulations, 2002 says - no person other than a doctor having qualification recognised by Medical Council of India and registered with Medical Council of India/State Medical Council (s) is allowed to practice Modern system of Medicine or Surgery. A person obtaining qualification in any other system of Medicine is not allowed to practice Modern system of Medicine in any form.
As per the clause 1.2.1 of this the Principal objective of the medical profession is to render service to humanity with full respect for the dignity of profession and man. Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. Physicians should try continuously to improve medical knowledge and skills and should make available to their patients and colleagues the benefits of their professional attainments. The physician should practice methods of healing founded on scientific basis and should not associate professionally with anyone who violates this principle. The honoured ideals of the medical profession imply that the responsibilities of the physician extend not only to individuals but also to society.
In our country there are already several myths and unscientific practices regarding diseases and their cure which continue to persist even among the literates.This is despite several advances in the medical science and information mechanism.
It is saddening that the government is not only apathetic towards many irrational ideas on health but is very subtly promoting irrational ideas. Use of Cow urine, Astrology in the hospitals with advisory to the patients to visit these astrologers, the 'Garbh Vigyan Sanskar' by Arogya Bharti advising couples to recite Shlokas at the time of mating so as to have customized babies of their choice - the Uttam Santati. Some ministers have been seen to attend the conference of 'Tantriks' and felicitate them in Gujarat. Such acts lead to misconceptions in the minds of people and spread obscurantism. It is for the medical bodies, rationalist societies and right thinking people with scientific outlook to question rather than promoting Yoga for everything which might have only placebo effect said Dr S K Prabhakar a Psychiatrist from Ludhiana.
WITHOUT RIGHT DIRECTION, DISSOLUTION OF MEDICAL COUNCIL OF INDIA WILL BE COUNTER PRODUCTIVE
Dr Arun Mitra
Even though dissolution of Medical Council of India (MCI) was on cards, but that it would be done so unceremoniously through an ordinance bypassing the Parliament was not expected. It is unfortunate that such exercise have become routine of the government. Till date the MCI has been the regulatory body which decided about the admission process to the undergraduate as well as postgraduate classes; it set basic minimum standards required to open a medical college and carried out regular inspections of the colleges to check the status of education. It also maintained the registry of doctors around the country. The MCI also could derecognize any medical college which did not fulfill the required standards. It also decided the medical curriculum. Whereas the government’s nominated members were there in the MCI, it had elected members as well which gave it a partial democratic structure. Unfortunately the MCI lost its reputation as there have been allegations of corruption against some of its higher-ups particularly the past president Ketan Desai.
The Supreme Court of India had taken cognizance of the irregularities in the council and recommended restructuring of the system so as to make it more transparent to curb corruption and maintain high standard of medical education. The government had some time back proposed a national medical commission instead of the MCI which was put in public domain for suggestions. The structure of NMC has 25 members, all of whom will be nominated by the government. This makes the regulatory body totally undemocratic with outright bureaucratic control without involvement of various stake holders.
In the last few years majority of medical colleges have come up in private sector. From 1990 to 2017 medical colleges opened in private sector number 238 while only 115 in state sector. Many of these were made deemed universities with their own examination & admission system and fee structure. In the proposed NMC, the government will exercise control over the tuition fee of only up to 40% of seats which means tuition fees in 60% plus seats will be at the mercy of private managements. Thus the cost of medical education which is already very high in the private sector will further rise and will be virtually reserved for the rich classes. Since there will be no regular inspections, check on the standard of the medical education will be compromised. Already low standard of education in many medical colleges who are notoriously known to hire the faculty and patients during inspection will further go down.
There will be exit exam for the undergraduate students. This is being done because difference in the standard of education in various medical colleges is glaring. Instead of meeting its responsibility to standardize education, the government is working on approach to judge ranking of the colleges by the performance of the students.
There is also effort to mix the various systems of medicine and permit the AYUSH to practice modern medicine. This will further jeopardize the whole healthcare delivery process.
It is obvious that the medical education will become totally unregulated and go in the hands of business interests. It would be naïve to expect a person who has spent crores on getting education to have social interest and service attitude towards healthcare. The already over privatized healthcare in our country will further get expensive and out of reach of majority of citizens who are already devoid of quality health care due to high cost of out of pocket expenditure.
The standing committee on health headed by Shri Ram Gopal Yadav had called various stake holders to put forward their view point on the National Medical Commission (NMC). The Alliance of Doctors for Ethical Healthcare (ADEH) in its submission before the standing committee on 13th February had clearly given its view points on various issues but in the final recommendations there are hardly changes to meet the expectations. That corruption will end in the NMC is difficult to believe. It has been observed that bureaucratic structures can be more corrupt as they are not directly answerable to the people. Time is still not lost. Government should review the final draft of the NMC otherwise worse may come out of dissolving the MCI.