PublicHealthWatch

Major Initiatives Undertaken by the DGFASLI during the XIth 5 year plan

2011-12-07T01:18:00.000-08:00

DGFASLI is operating following two plan schemes under the XI^th 5 year plan:

1. Establishment of New Regional Labour Institute at Faridabad

2. Strengthening of DGFASLI Organisation and Occupational Safety & Health in Factories, Ports and Docks.

One more plan scheme with the following title has been proposed DGFASLI which is under consideration with planning commission for approval:

Identification & Elimination of Silicosis in India

The objectives and the initiatives being pursue under each of the schemes are presented below scheme wise:

ESTABLISHMENT OF REGIONAL LABOUR INSTITUTE AT FARIDABAD

Objective:

1. To cater to the Occupational Safety and Health (OSH) needs of the factories in North Western States of India (i.e. Haryana, Punjab, Himachal Pradesh, Jammu & Kashmir, National Capital Delhi & UT Chandigarh) effectively as a Centre of Excellence in OSH.

2. To liaison with the Chief Inspectors of Factories of the North Western States of India for effective implementation of the statutes.

3. To liaison with the Ministry of Labour & Employment, Government of India, on behalf of the DGFASLI on urgent matters related to policy planning and administration.

Initiatives :

1.     Establishment of infrastructure, human resources and procedures for initializing the technical
        activities such as:
          a.      Consultancy, Research and Training in the field of:

Industrial Safety
Industrial Hygiene
Industrial Medicine
Workplace Environment Engineering
Industrial Physiology & Ergonomics

b. Personal Protective Equipment Testing

c. Industrial Safety, Health and Welfare Centre (Exhibition)

d. Mobile Safety Exhibition Van

2. Establishment of liaison with the Chief Inspectors of Factories of North Western States.

3. Initializing the educational/vocational programmes on:

a. One year - Post Diploma in Industrial Safety.

b. Two weeks - Refresher course on Occupational Health for Medical Officers.

c. Six weeks - certificate course on Industrial Hygiene

d. Others - as per the arising training needs.

4. Initializing the package programme on, 'Higher Productivity and Better Place at Work' for
Small Scale Industries.

5. Initializing the technical advice services on risk assessment for safe site selection, risk
reduction and emergency preparedness in process plants and MAH installations.

6. Initializing research studies, technical guidance, specialized training programmes in the
field of 'Psychological well-being of industrial workers'

7. To establish a link between the Ministry of Labour & Employment, Government of India,
and DGFASLI on urgent matters related to policy planning and administration.

STRENGTHENING OF DGFASLI ORGANISATION AND OSH IN FACTORIES, PORTS & DOCKS

Objective:

To strengthen the infrastructure facilities at DGFASLI, CLI and RLIs for improving occupational safety and health in factories, ports and docks thereby contributing in prevention of occupational injuries and diseases.

Initiative:

1. 1. Development of occupational safety and health national inventory and connectivity between
State Factory Inspectorate and DGFASLI.

2. 2. Creation of occupational safety and health information action resource centers at five labour
institutes.

3. 3. Dissemination of OSH information through electronic media.

4. Dissemination of information through conventional media through newsletter and technical
reports, safety cards etc.

5    5.    Creation of databases on handling of containers and dangerous goods, hazardous
       installations, inland container depots, minor and intermediate ports, competent persons,
       panel of doctors in ports etc.

6. 6. Promotion of E- Governance.

7. To amend the Statute and Regulations connected with dock work.

8. To establish enforcement and advisory system in the Inland Container Depots and ship
breaking units in the country.

9. 9. Establishment of an accreditation system for experts and facilities in the field of Occupational
Safety & Health

10. 10. Formulation of policies and programmes for improving productivity in industries, ports, mines,
construction and unorganized sectors in consistence with Occupational Safety & Health.

11. 11. Development and adopting of comprehensive OSH standards for industries, ports, mines,
construction and unorganized sectors.

12.12.   Up gradation of different laboratories of CLI & RLIs by acquisition of high precision and
        state-of -the art instruments and equipments to act as National Referral Laboratories on
        occupational safety and health.

13. 13. Monitoring of Occupational Safety, Health and Work environment in factories, ports and
docks

14. 14. Strengthening of enforcing systems in the major ports

15. 15. Enhancement of technical capabilities of officers of DGFASLI & State Factory Inspectorates.

16. 16. Creating awareness on occupational safety and health in various sectors of the economy
through training.

IDENTIFICATION & ELIMINATION OF SILICOSIS IN INDIA (PROPOSED)

OBJECTIVES:

To assess the prevalence of Silicosis in India.

To Create and update a data base.

To suggest appropriate preventive and control measures.

To generate awareness.

Rehabilitation of the afflicted workers when incapacitated.

Initiatives

1. Identification of the cases of silicosis among the workmen with the help of ESI, Medical
College of the State & Inspectorate.

2. Creation of Database on Silicosis.

       3.      Conduct of training programmes on Silicosis & ILO Radiographs on Pneumoconiosis for
        ESIS/IMA Doctors/Factory Medical Officers/Certifying Surgeons/Medical Inspectors of
        Factories/Govt. Hospital doctors etc. is proposed to create awareness.

4. Conduct of training programmes on Silicosis for Nurses/ Medical Assistants.

DTAB Urged to Deny Permission to Injectible Contraceptives DMPA

2010-11-25T10:45:00.001-08:00

PRESS RELEASE

DTAB Urged to Deny Permission to Injectible Contraceptives DMPA

Women’s organizations and leading health experts including Member Population Commission urge the Drug Technical Advisory Board [DTAB] to deny permission to use DMPA in the mass family planning programme

DMPA, Depo medroxy progesterone acetate, a three monthly progestogen only contraceptive injection was licenced for use by the Drugs Controller in the nineties. An intervention petition filed in the matter had led to DTAB restricting its use to private market. The approval itself was based on the manufacturer Max Pharma carrying out post marketing studies as this injection was not properly researched into in India. Even at that time women’s groups had objected to the licencing because of the many contraindications and unmanageable side effects already known.

Since then more data has become available and now its use is linked with loss of bone density and increasing the susceptibility of the user to HIV. In more than fifteen years since the licence was granted there is no reliable treatment for heavy bleeding suffered by a substantial proportion of women administered DMPA.

DTAB at the time had refused to revoke the licence but had restrained the government from using it in the family planning programme as the members had felt that the almost superstitious belief of women in the power of injections would render them to misuse of the injections. The health of the user has to be monitored to watch for the array of disturbing side effects of DMPA. The Indian public health system is too inadequate, inefficient and indifferent to do this work properly. Up to two-thirds of the women on DMPA suffer menstrual chaos which may be culturally unacceptable to women.

Women’s organizations have asserted that contrary to the claims of the health secretary nothing has improved in the public health system. Though the UPA government had promised to increase proportionate expenditure on health this has not materialized. The only personnel that have been added are ill trained ASHAs in the rural areas who have no relevance for delivery of injectable contraceptive.

Further the data from post marketing study done by the Population Council is rather discouraging. Despite training, MBBS doctors had poor recall of contraindications, indications, side effects and management of side effects. Doctors specialising in obsterics and gynaecology [OB/GYNs] were better and the study recommended that these specialists are suitable for delivery of injectables. If the government does not have enough specialists to deal with serious health problems of women, can they be deployed to improve the basket of choices of contraceptives, ask womens’s groups.

They have demanded that in the light of the data thrown up by post marketing studies the DTAB should restrict the use of DMPA to OB/GYNs and extend this restriction for NGOs as well who are using this injection in their programme.

Women’s organizations have consistently opposed the introduction of all long-acting hormonal injectables, including Net-En, and implants such as Norplant, due to their hazardous side effects, potential of abuse and inability of the health system to deliver them safely and they are appalled by repeated attempts of the government to introduce them in the family planning programme in total disregard of the health of women.

Dr. Mohan Rao, Member, Population Commission of India
Dr. Betsy Hartmann, Director, Population and Development Program, Hampshire College, USA
Dr.Veena Poonacha, director, Research Centre for Women' s Studies, SNDT University, Mumbai,
Dr. Nalini Vishvanathan, USA
Anveshi Research Centre for Women's Studies, Hyderabad
Centre for Women’s Development Studies, Delhi
Global Sisterhood Network, Australia
Majlis, Mumbai
Sama Resource Group for Women and Health, Delhi
Saheli women’s Resource Centre, Delhi

November 25,2010, Delhi

Contact saheliwomen@gmail.com, Saheli Women’s Resource Centre, Under Defence Colony Flyover, New Delhi 110024

Experts Question Approval of Bt Brinjal

2010-01-27T22:39:00.000-08:00

Press Release
Experts Question Approval of Bt Brinjal

Violates Cartagena Protocol & Precautionary Principle

New Delhi 28/1/2010: THE claimed benefits and the apparent risks emerging from inadequate regulatory and monitoring systems of the proposed introduction of Bt Brinjal, a transgenic variety of brinjal were rigorously examined at a Colloquium organised by the Centre of Social Medicine and Community Health (CSMCH), School of Social Sciences, Jawaharlal Nehru University (JNU), New Delhi, in collaboration with Hazards Centre, New Delhi on the 27th of January.

Taking cognisance of the valid questions raised about the conflict of interest ridden Genetic Engineering Approval Committee, the experts recommended adoption of precautionary principles and adherence to Cartagena protocol of which India is a party. The experts at the Colloquium felt that Bt Brinjal requires to be further studied by a trans-disciplinary, independent and impartial team of scientists keeping in mind the short-term and long-term consequences of genetic pollution linked acute and chronic toxicity of food chain.

The Colloquium adopted the following Resolution.

RESOLUTION
The Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, New Delhi, in collaboration with Hazards Centre, New Delhi, organised a Colloquium on Bt Brinjals on the 27th of January 2010. Attended by students and faculty, the house resolved as follows.

Various issues are unresolved about the problematic nature of transgenic technologies in general and Bt in particular. One core issue was the competence, the transparency and the conflict of interest in the regulatory process prior to the grant of licence to market Bt brinjal.
Safety issues have not been adequately dealt with both in terms of food safety and environmental safety. Long-term studies on allergicity and toxicity have not been carried out prior to approval.

We are also concerned about the implications for food security for the country. It is not desirable to hand over the control of seeds to transnational monopolies. To ensure that access to seed is ensured, the Intellectual Property Rights (IPR) regime must retain farmer’s rights and must not reduce flexibilities in Indian law.

As per the Cartagena protocol, to which India is a signatory, transgenic versions of crops for which we are the country of origin should not be permitted. Mexico, China and Peru follow this protocol. Thus transgenic varieties of Bt brinjal cannot be permitted in India.

A system of post-release monitoring must be put in place before commercial release is allowed into the environment to assess the performance and impact. Exhaustive socio-economic studies are necessary to assess the impact of transgenic crops on traditional agricultural systems and indigenous crops.

A proper system of labelling of GM crops must be put in place with public awareness to enable informed choices.

A system of public participation in decision- making and in regulatory bodies must be put in place. All regulatory data and bio-safety data should be available to the public.

A law of liability must also be in place before commercial release is permitted so that companies are liable to health and environmental damage that might ensue.

Till such systems are in place, this house calls for a moratorium on all transgenic crops.

The herbicide tolerant trait should not be permitted in India as this will displace agricultural labour and destroy valuable plants used as food, fodder and medicines.

There is indeed an acute agrarian crisis in the country. The solution to this does not lie in GM technologies. There are cheaper, safer, healthier options that must be explored and supported.
-----------------------------------------------------------------------------------------------------------------
The participants included eminent experts like Dr Pushpa Bhargava, Founder Director, Centre for Cellular and Molecular Biology, Prof. Mohan Rao, Professor, CSMCH, JNU, Prof. Deepak Pental, Vice Chancellor, University of Delhi, Dr. Suman Sahai, Convener, Gene Campaign, Dr. Rama Baru, Professor, CSMCH, JNU, Dr N. Raghuram, School of Biotech, Guru Gobind Singh Indraprastha University, Dr K.C. Bansal, Professor, National Research Centre on Plant Biotech, IARI, Prof. K.J. Mukherjee, School of Biotechnology, JNU and Dunu Roy, Director, Hazards Centre.

The Colloquium was preceded by a letter sent by CSMCH to the Union Ministry of Environment and Forests. The resolution of the Colloquium would be sent to the Union Agriculture Ministry and Union Health Ministry shortly besides the Union Ministry of Environment and Forests. The program of the Colloquium is attached.

For Details: Dr. Mohan Rao, Professor, Centre of Social Medicine and Community Health, JNU
Phone: 26704490, E-mail: mohanrao2008@gmail.com

Programme Schedule

0930 : Registration
10 00 : Inaugural Session

Welcome Address:
Prof. Mohan Rao, Professor, CSMCH, JNU
10 30 : Tea

10 45 – 12 00 hrs : Session I:
Benefits Claimed and Apparent Risks
Prof. Deepak Pental, Vice Chancellor, University of Delhi
Dr.Suman Sahai, Convener, Gene Campaign
12 00 – 13 30 : Session II :
Regulatory System and Concerns
Chair: Dr. Rama Baru, Professor, CSMCH, JNU.
Dr. K.Satyanarayana, Member of Exp Comm II, Genetic Engineering Approval Committee.
Dr. Pushpa Bhargava, Founder Director, Centre for Cellular and Molecular Biology
13 30- 14 30 : Lunch

14 30 – 16 00- Session III :
Need for Bt Brinjal
Chair : Dr. N.Raghuram, School of Biotech, Guru Gobind Singh Indraprasth University.
Dr. K.C. Bansal, Professor, National Research Centre on Plant Biotech, IARI.
Dr. G.V Ramanjaneyulu, Executive Director, Centre for Sustainable Agriculture
16 00- 16 30 – Tea
16 30- 17 30-

Concluding Session
Prof. K.J.Mukherjee, School of Biotechnology, JNU
Dunu Roy, Directror Hazards Centre
Vote of Thanks by Dr. Ramila Bisht, CSMCH, JNU

Note: Dr. G.V Ramanjaneyulu and Dr. K.Satyanarayana could not come for the program.

Bt Brinjal & Food Security

2010-01-27T06:05:00.000-08:00

Center for Social Medicine & Community Health of JNU and Hazard Center organized a Colloquium on "Bt. Brinjal & Food Security" today at Jawaharlal Nehru University (JNU), New Delhi. Speakers underlined the inter linkage between food safety and security. Proceedings of the Colloquium would be shared in due course.

Earlier, responding to the introduction of Bt Brinjal in the country for public discussion by Jairam Ramesh, the Union Environment Minister, the Centre of Social Medicine and Community Health (CSMCH), Jawaharlal Nehru University had sent a letter to the Union Minister saying, “We believe that there are serious issues of safety that are not yet addressed through long term studies. There is some data that these crops could be allergy- inducing, and indeed that they might be mutagenic. It is for these reasons that in the European Union but major countries have a restrictive regulatory regime. Countries in EU have a precautionary approach towards GM crops and major countries like Germany, France, Hungary, Greece etc has a ban on their cultivation.”

CSMCH took cognizance of the reports suggesting that the Genetic Engineering Approval Committee (GEAC) has decided to approve the environmental release of Bt Brinjal from Monsanto/Mahyco in India which would for all purposes permit the use of transgenic and Genetically Modified Organisms (GMOs) and products for edible purposes.

The letter notes that CSMCH is seriously troubled with this move. The letter says, “ First of all, this is entirely unnecessary from a public health perspective, indeed undesirable. The argument that Bt brinjal would not require pesticides is dissembling. There are other, better, pest management methods like non pesticidal management that we need to utilize.”

It refers to “serious methodological flaws in the studies that have been carried out, not to mention ethical ones.”

It takes note of the “profound conflict of interest issues involved in the studies carried out in India. The companies that stand to gain by the introduction of these crops into the market were the sponsors of the studies. This is entirely unacceptable.”

The Prof Mohan Rao, Chairperson, CSMCH says, “There has not been adequate assessment of the ecological consequences of the introduction of this food crop. These concerns regarding the health and environmental risks associated with GM crops are too serious to be disregarded. Given our retailing structure, labeling is impossible in India and contamination is inevitable. Introduction of GM crops would kill the choice of the consumer."

The letter concludes saying that “this policy move is entirely unnecessary, has not been transparent and is potentially injurious to public health. We believe there should be a moratorium on such technologies till their safety both to human beings and the environment is proven.”

ENVIRONMENTAL POLLUTION IN 11TH PLAN

2009-11-23T21:55:00.000-08:00

Serious environmental health problems affect millions of people who suffer from respiratory and
other diseases caused or exacerbated by biological and chemical agents, both indoors and outdoors. Millions are exposed to unnecessary chemical and physical hazards in their home, workplace, or wider environment.

Concern about the health effects of the high levels of air pollution observed in many mega cities is growing; moreover, it is likely that this problem will continue to grow because countries are trapped in the trade-offs of economic growth and environmental protection. Population in urban areas are at risk of suffering adverse health effects due to rising problems of severe air and water pollution.

Cooking and heating with solid fuels on open fires or traditional stoves results in high levels of indoor air pollution. Indoor smoke contains a range of health-damaging pollutants, such as small particles and carbon monoxide.

Indian women spend nearly 60% of their reproductive life in either pregnancy or breast-feeding.
Most of the women keep their children in the kitchen when they are cooking, thereby exposing the children to the pollutants too. This, combined with malnutrition may retard growth and lead to smaller lungs and a greater prevalence of chronic bronchitis. There is an urgent need for the implementation of control programs to reduce levels of particulate and other pollutant emissions. To be effective, these programs should include the participation of the different stakeholders
and initiate activities to identify and characterize air pollution problems, as well to estimate
potential health impacts. A full understanding of the problem and its potential consequences for the local setting is essential for effectively targeting interventions to reduce the harmful impacts of air pollution.

Monitoring of air and water quality is crucial for devising programmes and policies related to pollution management. Establishing a reasonably adequate monitoring network with contemporary technology will be given priority. Ways of linking treatment of sewage and industrial effluents to the urban and industrial development planning need to be worked out. The goal should be to ensure that by the end of the Eleventh Plan no untreated sewage or effluent flows into rivers from cities and towns.

OCCUPATIONAL HEALTH IN 11TH PLAN

2009-11-23T21:46:00.000-08:00

Exposure to chemicals, biological agents, physical factors and adverse ergonomic conditions,
allergens, safety risks, and psychological factors often afflict working population of all ages. People also suffer from injuries, hearing loss, respiratory, musculoskeletal, cardiovascular, reproductive, neurotoxic, dermatological, and psychological effects. Such risks are often preventable. The illness resulting from such exposures is not identified properly due to lack of
adequate expertise. The work up of the cases by physicians lacking skills to identify such illness leads to unnecessary use and waste of scarce medical resources as well as their own time. Freedom from occupational illness is essential in today’s competitive world where workers’ productivity is an important determinant of growth and development.

The objectives of occupational health initiative during the Eleventh Five Year Plan will be to promote and maintain highest degree of physical, mental, and social well-being of workers in all occupations; identify and prevent occupational risks of old as well as newer technologies such as Information and Nano technology; build capacity for prevention, that is, early identification of occupational illness; create an occupational health cell under NRHM in each district headquarter, well-equipped to be able to promote primary, secondary, as well as tertiary prevention; and establish occupational health services in agriculture, health and other key sectors for placement of workers in suitable work and propagating adaptation of work to humans.

During the Eleventh Five Year Plan, following strategies will be implemented to reduce occupational health problems:

• Creating awareness among policymakers on the cost of occupational ill health including injuries
• Ensuring use of technologies that are safe and free from risks to health of the workers
• Sensitizing employers as well as workers’ organizations for their right to safety and the implication of injuries in their lives
• Instituting legislation and ensuring proper enforcement for prevention and control of occupational ill health and compensating those who suffer intractable illness due to work
• Building a national data base of occupational illness and injuries
• Monitoring and evaluating programmes and policies related to pollution prevention and control
• Establishing surveillance and research on occupational injuries and building capacity in health
sector to be able to participate in preventing work related illness and injuries
• Enforcing safety regulations and standards
• Introducing no-fault insurance schemes for all workers in the formal and informal sectors

Cancer & Public Sector Spending: 11th Plan

2009-11-23T21:37:00.000-08:00

Cancer has become an important public health problem in India with an estimated 7 to 9 lakh cases
occurring every year. At any point of time, it is estimated that there are nearly 25 lakh cases in the country. The strategy under the National Cancer Control Programme (NCCP) was revised in 1984–85 and further in 2004 with stress on primary prevention and early detection of cancer cases. In India, tobacco related cancers account for about half the total cancers among men and 20% among women. About one million tobacco related deaths occur each year, making tobacco related health issues a major public health concern.

NATIONAL CANCER CONTROL PROGRAMME (NCCP)

During the Tenth Five Year Plan, a taskforce comprising experts from across the country was
constituted. Based on recommendations from the national taskforce a comprehensive NCCP will be
implemented during the Plan. The main activities during the Plan will be:
• Establishing new Regional Cancer Centres
• Upgradation of the existing Regional Cancer Centres based on their performance and linkages with
other cancer organizations in the region.
• Creating skilled human resources for quality cancer care services
• Training health care providers for early detection of cancers at primary and secondary level
• Increasing accessibility and availability of cancer care services
• Providing behavioural change communication along with provision of cost effective screening
techniques and early detection services at the door step of community
• Propagating self-screening of common cancers (oral, breast)
• Upgrading Oncology Wings in government medical colleges
• Creating and upgrading Cancer detection and Surgical and Medical Treatment facilities in District Hospitals/Charitable/NGO/Private Hospitals
• Promoting research on effective strategies of prevention, community-based screening, early
diagnosis, environmental, and behavioural factors associated with cancers and development of cost
effective vaccines
• Creating Palliative Care and Rehabilitation Centres
• Monitoring, Evaluation, and Surveillance

As per NSSO 60th Round, during 2004, 24% of the episodes of ailments among the poor were
untreated in rural areas and 22% in urban areas. Lack of finances was cited as a reason by 28% of persons with untreated episodes in rural areas and 20% in urban areas. It is also notable that 12% cited lack of medical facility as the cause of not receiving treatment in rural areas.

Public spending on health in India is amongst the lowest in the world (about 1% of GDP), whereas
its proportion of private spending on health is one of the highest. Households in India spend about 5–6% of their consumption expenditure on health (NSSO). The cost of services in the private sector makes it unaffordable for the poor and the underprivileged.

The cost of health care in the private sector is much higher than the public sector. Many small
providers have poor knowledge base and tend to follow irrational, ineffective, and sometimes even harmful practices for treating minor ailments. Bulk of the qualified medical practitioners and nurses are subject to self-regulation by their respective State Medical Councils under central legislation. In practice, however, regulation of these professionals is weak and close
to non-existent.

We have a huge working population of about 400 million. Almost 93% of this work force is in the
unorganized sector. There are numerous occupational groups in economic activities, passed on from generation to generation, scattered all over the country with differing employer–employee relationship. Those in the organized sector of the economy, whether in the public or private sector, have access to some form of health service coverage. The unorganized sector workers have no access. The National Commission for Enterprises in the Unorganized Sector (NCEUS) has recommended a specific scheme for health in incidences of illness and hospitalization for workers
and their families.

The Eleventh Five Year Plan will introduce a new scheme based on cashless transaction with the
objective of improving access to health care and protecting the individual and her family from exorbitant out-of-pocket expenses. Under the scheme, coverage will be given to the beneficiary and her family of five members. Providers will be both public and private.

Time-Bound Goals for the Eleventh Five Year Plan

2009-11-23T21:34:00.000-08:00

• Reducing Maternal Mortality Ratio (MMR) to 1 per 1000 live births.

• Reducing Infant Mortality Rate (IMR) to 28 per 1000 live births.

• Reducing Total Fertility Rate (TFR) to 2.1.

• Providing clean drinking water for all by 2009 and ensuring no slip-backs.

• Reducing malnutrition among children of age group 0–3 to half its present level.

• Reducing anaemia among women and girls by 50%.

• Raising the sex ratio for age group 0–6 to 935 by 2011–12 and 950 by 2016–17.

Eleventh Plan and health care

2009-11-23T21:21:00.001-08:00

Eleventh Five-Year Plan: There is a shortage of 5,801 doctors in PHCs and a shortfall of 4,681 specialists in Community Health Centres (CHCs).

Rashtriya Swasthya Bima Yojana: I have serious doubts about the benefits that will actually accrue to the rural poor from health insurance and the option to go to private hospitals.

The Eleventh Plan, whose central theme is ‘Inclusive Growth,’ has substantially stepped up the allocation for health. The public health care system in many States is in [a] shambles. Extreme inequalities and disparities persist both in terms of access to health care as well as health outcome, bemoans the Plan document.

The role of health care in economic development has received increasing attention in recent years. There is a general agreement that economic growth is not merely a function of incremental capital-output ratio. Investment in man -- enhanced allocation for education, imparting skills and health care -- plays a significant role in fostering economic growth. It is, therefore, in the fitness of things that the Eleventh Five-Year Plan, whose central theme is ‘Inclusive Growth,’ has substantially stepped up the allocation for health. The Plan document presents a well-conceived, comprehensive programme for the sector. According to the Prime Minister, the aim is to provide broad-based health care in rural areas through the National Rural Health Mission (NRHM).

Health care in a shambles

While the proposed structure for providing health care is adequate and commendable, what is in place at present is thoroughly disappointing. The Plan document itself bemoans: “The public health care system in many States is in [a] shambles. Extreme inequalities and disparities persist both in terms of access to health care as well as health outcome.” (The Eleventh Plan: Vol. II, page 61, para 3.1.16.) The Plan deplores the critical shortage of health personnel, particularly doctors and nurses, poor working conditions and inadequate incentives, and the low utilisation of the meagre facilities in government hospitals. Government hospitals at all levels present a picture of neglect and decline.

I shall deal with two major problems: shortage of doctors for rural service; and the desperate state of medical education.

Health care after independence

Before independence, medical facilities in rural India were rudimentary. The Community Development Block pattern of rural development launched in the 1950s was the harbinger of modern health care in rural areas. According to the approved model, every block was to have a Primary Health Centre (PHC) with 10 beds at the block headquarters and three sub-centres at carefully selected locations. The sanctioned staff for a PHC consisted of two doctors, one Lady Health Visitor and two Sanitary Inspectors. One post of Auxiliary Health Worker and two posts of Auxiliary Nurse-Midwives were sanctioned for each sub-centre. A doctor was required to visit each sub-centre twice a week. I was the Collector of Darbhanga in north Bihar from mid-1958 to the end of 1960. During my tenure, out of the 44 blocks sanctioned for the district, only 37 had become operational. Some 25 blocks had one doctor each and the rest none. Most posts of Lady Health Visitors and Auxiliary Nurse Midwives were vacant.

As chance would have it, I became Bihar’s Health Secretary in July 1962 and stayed on in the post for nearly five years. The total number of blocks in Bihar was about 600. In spite of my best efforts, very few blocks had the full complement of doctors and paramedical staff. During the severe drought of 1965-66, it was only by resorting to draconian measures that we could ensure that all blocks had at least one doctor. Most doctors had an urban background and were reluctant to go to rural areas lacking in modern amenities. There has been no significant improvement in the situation during the last four decades. According to the data given in the Eleventh Plan, there is a shortage of 5,801 doctors in PHCs and a shortfall of 4,681 specialists in Community Health Centres (CHCs).

The Eleventh Plan presents a well thought-out and comprehensive structure for health care in rural areas. The important features of the set-up are:

— 1.75 lakh sub-centres each with two Auxiliary Nurse Midwives at one sub-centre for each panchayat (five or six villages).

— 30,000 PHCs at one for a group of four or five sub-centres. Each PHC will have one Lady Health Visitor and three staff nurses. There will also be an AYUSH physician. (AYUSH is acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy).

— 6500 CHCs each with 30-50 beds. The staff will include seven specialists and nine staff nurses.

— 1800 taluk or sub-divisional hospitals and 600 district hospitals will be fully equipped to provide quality health service.

When this structure is in position, and if it functions reasonably well, we can expect a significant improvement in the quality of medical care in rural India. There will, of course, be an enormous increase in the number of medical graduates, postgraduates and nurses needed to operate the system. The baffling question is how to find the number of personnel needed to fill the vacancies and new posts.

It should be possible to recruit adequate number of doctors and persuade them to stay in the field if the three suggestions given below are adopted and strictly enforced.

— After internship, every medical graduate should be required to work for a minimum of two years in rural areas before he is granted the MBBS degree.

— Only those who have completed three years of rural service should be admitted to any postgraduate course, including the Diplomate of the National Board.

— Every postgraduate student should serve for one year as a specialist in a CHC or sub-divisional hospital before he is awarded the degree or a diploma.

These proposals are not entirely new. Assam has already made rural service compulsory for medical graduates. Some medical colleges have been encouraging fresh graduates to opt for rural service for short periods. The implementation of the proposals, of course, calls for resolute political will. The rationale for making these seemingly harsh suggestions is this. Despite the recent increase in fee, medical education is heavily subsidised by the state. It is manifestly just and fair to stipulate that those who receive medical education should serve the rural society for a short period. Incidentally, the young graduates will benefit a great deal by getting an opportunity to improve their clinical skill. There should, of course, be substantial improvement in the salary of doctors and the amenities available to them.

Shameful state

The proliferation of sub-standard, under-staffed and ill-equipped private medical colleges in recent years is an unmitigated menace. A few institutions like the CMC, Vellore; St. John’s, Bangalore; and the Kasturba Medical College, Manipal, are among the country’s best. But many private colleges lack basic facilities and are run as profit centres for garnering huge amounts as capitation fee. I hear that the present capitation fee for an MBBS seat is Rs. 35 lakh-50 lakh and for a postgraduate seat above Rs.60 lakh. For a discipline like Radiology, the amount could exceed Rs. 1 crore!

Some 15 years ago, a relative of mine had to pay only Rs. 2 lakh through a bank draft and Rs. 2 lakh in cash to get his son admitted to a postgraduate course. The Indian Medical Council has laid down arduous norms in respect of faculty, hospital beds, equipment and so on. Apparently, there is some laxity in the enforcement of the norms. I have heard that while a well-equipped college may run into difficulties, substandard institutions manage to pass muster. I have also heard of cases in which retired teachers and other doctors with postgraduate qualification are shown as visiting faculty for short periods during an inspection by Medical Council teams. No civilised country, not even a soft state like India, can allow such a scandalous state of affairs to continue. It is time the government took resolute action to stem the rot.

Some reservations

The Prime Minister in the Foreword and the Deputy Chairman of the Planning Commission in the Preface have highlighted the positive role the Rashtriya Swasthya Bima Yojana will play in providing health care to the population below the poverty line. I have serious doubts about the benefits that will actually accrue to the rural poor from health insurance and the option to go to private hospitals. As I have not personally observed the working of the scheme, I would leave it to experts familiar with field conditions to evaluate the Yojana.

Another controversial matter is Public Private Partnership (PPP) in providing health care. I do not share the optimism expressed in the Plan document about the role of private institutions in providing health care in rural India. Nor do I agree with the Commission’s enthusiasm about the role of corporate health care and the benefits flowing from the expansion of medical tourism. These issues deserve to be dealt with by more knowledgeable persons.

I shall conclude reiterating that health care in rural India and school education throughout the country should squarely be the concern of the government. Private initiative can certainly supplement the government’s efforts in these fields, but that will benefit only the affluent.

(P.S. Appu is a former Chief Secretary of Bihar and former Director of the Lal Bahadur Shastri National Academy of Administration, Mussoorie. He can be reached at: psappu@hotmail.com)

The Hindu, 23 Nov. 2009

JNU’s Centre for Community Health Warns Against Bt Brinjal Hazards

2009-11-20T01:08:00.001-08:00

Press Release

New Delhi, 20/11/2009: Responding to the introduction of Bt Brinjal in the country for public discussion by Jairam Ramesh, the Union Environment Minister, the Centre of Social Medicine and Community Health (CSMCH), Jawaharlal Nehru University has sent a letter to the Union Minister saying, “We believe that there are serious issues of safety that are not yet addressed through long term studies. There is some data that these crops could be allergy- inducing, and indeed that they might be mutagenic. It is for these reasons that in the European Union but major countries have a restrictive regulatory regime. Countries in EU have a precautionary approach towards GM crops and major countries like Germany, France, Hungary, Greece etc has a ban on their cultivation.”

CSMCH took cognizance of the reports suggesting that the Genetic Engineering Approval Committee (GEAC) has decided to approve the environmental release of Bt Brinjal from Monsanto/Mahyco in India which would for all purposes permit the use of transgenic and Genetically Modified Organisms (GMOs) and products for edible purposes.

The letter notes that CSMCH is seriously troubled with this move. The letter says, “ First of all, this is entirely unnecessary from a public health perspective, indeed undesirable. The argument that Bt brinjal would not require pesticides is dissembling. There are other, better, pest management methods like non pesticidal management that we need to utilize.”

It refers to “serious methodological flaws in the studies that have been carried out, not to mention ethical ones.”

It takes note of the “profound conflict of interest issues involved in the studies carried out in India. The companies that stand to gain by the introduction of these crops into the market were the sponsors of the studies. This is entirely unacceptable.”

The Prof Mohan Rao, Chairperson, CSMCH says, “There has not been adequate assessment of the ecological consequences of the introduction of this food crop. These concerns regarding the health and environmental risks associated with GM crops are too serious to be disregarded. Given our retailing structure, labeling is impossible in India and contamination is inevitable. Introduction of GM crops would kill the choice of the consumer."

The letter concludes saying that “this policy move is entirely unnecessary, has not been transparent and is potentially injurious to public health. We believe there should be a moratorium on such technologies till their safety both to human beings and the environment is proven.”

PublichealthWatch is a collective of public health researchers.

For Details Contact: Prof. Mohan Rao, Chairperson, CSMCH, JNU Ph: 26704420, 26717676, E-mail: mohanrao2008@gmail.com

Management of A(H1N1) epidemic: greater clarity needed

2009-08-13T03:43:00.000-07:00

*Dr. Mohan Rao, Prof. Rama Baru, Dr. Rajib Dasgupta, Prof. Sanghmitra Acharya, Prof. K.R. Nayar, Prof. Ramila Bisht, and Dr. Ritu Priya of the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi write: *

As public health workers, we are concerned with the reaction in various quarters to the A(H1N1) (swine flu) epidemic. The hysteria created by the media and the knee-jerk reaction from the Ministry of Health and Family Welfare, are not conducive to rational and well-informed management of the situation.

Swine flu is not more lethal, for instance, than ordinary flu and dengue. There is thus no need for the panic response. It can be treated like any ordinary flu unless there are complications that require hospitalisation. There needs to be greater clarity in the management and treatment of A(H1N1) so that the public is informed regarding the aetiology, treatment and management of swine flu.

Secondary and tertiary levels should be used for confirmation and treatment alone and not for screening, as is being done at present. Screening should be done at the primary level — whether public or private. These have to be given guidelines for screening and testing. The Indian Medical Association will need to play a proactive role in professionally and ethically sensitising its members. Treatment should, at least in the current phase, be limited to designated public hospitals. The government needs to explicitly come out with guidelines regarding the stage of the epidemic at which presumptive cases and not just (laboratory) confirmed cases will be treated with specific antivirals.

Equally, there is no need for the government to open up testing and treatment in the private sector. As public health workers, we know that the private sector is diverse in quality and competence. The situation therefore is ripe for unnecessary — and expensive — testing for swine flu and unnecessary over-diagnosis and treatment. This will not only lead to resistance to the only drugs we have but widespread exploitation of people wrongly diagnosed to have swine flu. The response to this epidemic must be coordinated by institutions such as the National Institute of Communicable Diseases, Indian Council for Medical Research and the National Institute of Virology and not be guided by clinicians alone.

The swine flu epidemic must not be used as an opportunity for quick money making but must be used to strengthen the capacities of the public health infrastructure, including systems for surveillance and monitoring.

Tamiflu & H1N1 flu (Swine flu)

2009-08-13T03:30:00.000-07:00

The US Centers for Disease Control and Prevention (CDC) recommends Tamiflu for prevention and treatment of swine flu. Tamiflu is the first neuraminidase inhibitor tablet for the treatment and prevention of influenza A and B. Tamiflu was approved by the US FDA for the treatment of influenza in October 1999 and for influenza prevention in November 2000.

The product, which was developed by Gilead Sciences, a US biopharmaceutical company (that discovers, develops and manufactures therapies for viral diseases and infectious diseases) is commercialized globally by Hoffmann-La Roche, a Swiss global health-care company that operates worldwide.

Notably, Donald Rumsfeld was chairman of the board of directors of Gilead company from 1997 until 2001, when he was appointed U.S. Secretary of Defense but he retained a huge shareholding.

The CDC website states, "CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses."

Researchers conducted a review of numerous studies of of anti-viral medications, which was then published in the prestigious medical journal Lancet on Jan. 19, 2006. As per this review of 51 randomized controlled trials, Tamiflu was useless against the avian flu and many other flus. Contrary to the CDC, their recommendation was not to use Tamiflu.

According to Roche Laboratories, the pharmaceutical company which owns exclusive distribution rights to the drug, Tamiflu has a shelf life of 48 months.

Stock prices of both the companies Roche and Gilead Sciences soared once the drug was recommended by the government as the best treatment. Gilead earns healthy royalties on every pack of Tamiflu.

Indeed what is lacking in the overall discussion about pandemic flu is disagreement, criticism, and skepticism from researchers willing to question and test the data on the efficacy of Tamiflu.

Ghulam Nabi Azad takes over as Health Minister

2009-06-07T02:51:00.000-07:00

NATIONAL RURAL HEALTH MISSION TO BE IMPLEMENTED IN LETTER AND SPIRIT

Ghulam Nabi Azad, took over as Union Minister of Health & Family Welfare May 29, 2009. Terming his new assignment as an opportunity to serve even the most deprived section of society, Azad emphasized implementation of National Rural Health Mission (NRHM)‘in letter and spirit’ as his first priority. He said that UPA Government has undertaken many major programmes which were long awaited by the people of India such as NREGA, Rural Road Connectivity, Highways and Jawaharlal Nehru Urban Renewal Mission. National Rural Health Mission is one such programme, which is playing a major role in improving the health status of over one billion people in India. This has addressed a long-standing grievance of non-existing rural health infrastructure. ‘It is not possible to implement NRHM just by sitting in the Ministry, therefore I have decided to take a half yearly review of the programme with all the State Governments so that Mission is implemented fully,’ Azad said.

The new Health Minister said that National Urban Health Mission will be vigorously pursued and will be soon implemented after approval by the Cabinet. Underlining the importance of the Mission, Azad said that urban population is increasing very fast and urban health care infrastructure is not able to cope with growing demand.

The Minister also pointed out the initiative of strengthening six new AIIMS and up-gradation of 13 state medical institutions under the first phase of PMSSY. Two more AIIMS like institutes and upgradation of six state medical institutions will be taken up in the phase II. Referring to the new diseases, which have emerged in the recent times, Azad said that production of new vaccines will be a priority area. India needs to be independent in this crucial sector as these new diseases are a major danger in the light of large population and paucity of health infrastructure, the Minister said.

The Minister also counted early detection of non-communicable diseases, establishment of a drug authority, promotion of ayurveda, AIDS prevention and strengthening of health research as his chief priorities.

On a question regarding AIIMS the Minister said that supremacy of institutions is sacrosanct in the authority of institutions will not be allowed to be diluted.

Minister of State in the Ministry of Health & Family Welfare, Dinesh Trivedi also took over the charge. Both the Ministers were later briefed by the senior officers of the Ministry.

Central Reserve Police Force (CRPF) fights diseases

2009-05-23T07:57:00.001-07:00

Central Reserve Police Force (CRPF) fights diseases

Among the many fights it has been engaged in, the Central Reserve Police Force (CRPF) is waging one against its own ailments. A large proportion of this fighting force—about 25 per cent—is suffering from serious diseases.

The numbers are startling. In the last four years, from 2005 to 2008, almost half of its 2.6 lakh-strong workforce has suffered serious ailments.

Close to 50 per cent of these—almost 60,000 of the entire force—is suffering from diseases, which are either long-term or permanent afflictions and potentially life-threatening, like cancer, hepatitis, hypertension, heart problems, AIDS or psychiatric symptoms.

The most common problem, however, relates to the skin.

In these four years, the force has lost 1,425 men to diseases.

The number is only marginally less than the total number of casualties it has suffered in combat operations since 1946—1,659 men, including the 25 who died this year.

While there are several factors for the poor health of one of the largest para-military units of the world, one of the biggest reason is the pathetic conditions they live and operate in. Though this is a reserve force, of late it has almost permanently been deployed in troubled regions.

According to data obtained from the CRPF, more than 80 per cent of its personnel, including 6,000 officers of assistant commandant level and above, have not got a peaceful/static posting in the last 20 years.

The continuous deployment has resulted in a sharp rise in the stress levels of the soldiers, as evident from a large number of stress-related diseases like hypertension, heart ailments and psychiatric problems.

The stress factor has also led to a rise in incidents of fratricide in recent times. Since 2001, the CRPF has lost 35 men in fratricidal incidents.

Indian Express

3 May, 2009

Note: At present, CRPF has 191 Battalions. The Force remained committed to internal security and counter insurgency cum- anti-terrorist operations in various parts of the country. This is a Force with ladies contingents organised in two Mahila Battalions.

CRPF has been unable to halt the suicides among its personnel, despite introducing counselling and yoga.

India's Profile

2009-05-17T11:18:00.000-07:00

Population:	1,168,714,600
Children-under-5 mortality rate:	79 per 1000
Vitamin A deficiency, in children 6 to 59 months old:	57%
Iodine deficiency:	33%
Prevalence of anemia, in children 6 to 59 months old:	69%
Prevalence of anemia, in women:	62%

Sanitation, Defecation, Gandhi, Nehru & Sulabh

2009-05-14T03:07:00.001-07:00

Our toilets bring our civilization into discredit, they violate the rules of hygiene. A toilet must be as clean as a drawing-room, said Mahatma Gandhi reflecting on abysmal sanitary condition in India in general.

Access to public toilet, private toilet, urban toilet, rural toilet and toilet facility especially for women and girls remains quite poor in the country. This is acknowledged by the Eleventh Plan document of the Planning Commission which notes that only 36.4% of the total population has latrines within or attached to their houses as per 2001 census. Another estimate puts the sanitation coverage in the country at about 49% (as on November 2007). Clearly, open defecation remains prevalent.

On May 12, 2009, a panel discussion on `The Attitude called Sanitation' at India International Centre, New Delhi brought together Prof Amitabh Kundu of Jawaharlal Nehru University, Bindeshwar Pathak of Sulabh International, Arumugam Kalimuthu of WES-Net, Rajiv Vora, a noted Gandhian and Sudhirendar Sharma of Ecological Foundation to dwell on 'sanitation' issue that remained focussed on the issue of defecation, which is a very significant component of sanitation.

It is noteworthy that Sulabh's intervention through Sulabh Sauchalaya that started in 1973 in Ara municipality, a small town in the Bhojpur district of Bihar which is deemed a turning point remains in one of the worst unhygienic conditions imaginable. This situation prevails because a very important but micro aspect of sanitation was attended to without even attempting to alter the institutional structures that deal with the broad issue of sanitation. A fact-finding team can visit and ascertain as to why this small town still awaits and invites the intervention of Plague like crisis to liberate itself from filth.

Like Nehru who got elected as the Mayor of Allahabad by promising better sanitation but did not succeed in bringing the required change, sanitation condition of Ara in particular did not and has not improved despite the limited but potent intervention of Sulabh. Although Nehru and Sulabh moved on, the sanitation conditions in Allahabad and Ara and most of India leaves a lot to be desired in spite of purposeful interventions by likes of Sulabh. However, it must be acknowledged that Sulabh’s intervention on human waste disposal and social reforms is a remarkable. In fact the Economic and Social Council of the United Nations has granted Special Consultative Status to Sulabh in recognition of its 'outstanding service to mankind'.

Nehru said, “The day everyone in India gets a toilet to use, I shall know that our country has reached the pinnacle of progress” that day is yet to come and still political parties paid no attention to `sanitation' in the current elections.

It is now being argued that sanitation does not figure prominently in the priority of the communities. But most of the indicators of basic amenities show positive correlation with those of economic development across the states. The percentage of households with flush toilets, for example, exhibits a very strong relationship with per capita income, notes Amitabh Kundu who has authored In The Name of Urban Poor: Access to Basic Amenities. He sought to know as to why institutions like Sulabh, which emerged from a social movement, is being cited to legitimise the withdrawal of the state from sanitation and other basic sectors like health, education, housing and water-supply. Kundu referred to Bindeshwar Pathak’s book The Road to Freedom, a seminal piece of work on scavenging and the social inequity, to stress the role of community mobilisation and the need for state intervention. Kundu pointed out that while individual investment in housing, education and health has gone up the same is not true for sanitation. Consequently, he opined that the state has a significant role to play because poor don't have disposable income to invest on sanitation given the fact that over 87 % income goes into buying food.

Pathak, founder of the Sulabh Sanitation Movement and 2009 Stockholm Water Prize laureate stated that public toilet could be a place of national integration. He cited Puranas to show how there was religious order from the scriptures to keep defecation `away from the household' as opposed to the current practice of creating and promoting facility for it in the household itself. He argued that like habits `cultural change will take time. Taking the recommendations of the Planning Commission in the 10th Five Year Plan a step further with regard to allocation for subsidy for low-cost household toilets for rural families below poverty line at par with subsidy in the urban households, he argued that the rich should be `targeted' as much as the poor while raising the issue of sanitation. Dr. Pathak will formally receive the Stockholm Water Prize at a Royal Award Ceremony and Banquet during the World Water Week in Stockholm in August, 2009. This annual prize includes a $ 150,000 award. Responding to Prof Kundu’s question, Pathak, a Padma Bhushan awardee said, government does have a role but it has to be a combined effort.

Sudhirendar Sharma who chaired and moderated the discussion posed questions like why people don't adopt toilets? Why government's subsidised number game isn't effective? Has Orientalism contributed to our being what `we' are?

Kalimuthu informed that communities are not seeking sanitation. He argued that a new model is emerging wherein people will be paid for using toilet instead of they having to pay for it. Despite the rural sanitation coverage being 57 per cent, over 50 per cent of the covered households have slipped back to open defecation. Unless there is paradigm shift in our policy thrust towards sanitation, the situation may get worse.

The implementation of Nirmal Gram Puraskar, which is given to the Gram Panchayats, blocks, and districts, that achieve 100% sanitation coverage in terms of 100% sanitation coverage of individual households, 100% school sanitation coverage, making the village, block, district free from open defecation and with clean environment and organizations that have been the driving force for effecting full sanitation coverage in the respective geographical area came in for criticism.

Although sanitation also includes waste management among other things, there seemed to be a justified pre-occupation with defecation. It is estimated that about 115000 MT of municipal solid waste is generated daily in the country. This also merits serious attention.

Rajiv Vora submitted that for Gandhi, sanitation was more important than independence and by this logic most Indians are yet to gain independence. He brought forth the issue of cultural diversity in tackling sanitation. `Just toilet' may not work given the varied socio-cultural constructs of sanitation in each of the communities. Gandhi saw the state of sanitation in our trains, railway platforms and around the railway tracks as revealing the truth about sanitation in our country.

The unending discussions on defecation as part of sanitation and state’s role could not be concluded, as many questions remained unattended due to time constraint creating a necessity for an elaborate and rigorous deliberation on another occasion. One hopes that the transcript of the discussions or a perspective paper based on the discussions would be made available in the public domain at the earliest.

Green Hospitals

2008-11-23T23:23:00.000-08:00

Critics say hospital buildings and food are enough to make you sick. Today there's a growing movement in health care to get hospitals to green their facilities and, as host Bruce Gellerman reports, it's transforming the medical community.

GELLERMAN: About a dozen years ago, the U. S. Environmental Protection Agency reported that medical waste incinerators in hospitals were the largest source of deadly dioxins in the country. The disclosure shook the medical community and led to the creation of an organization that takes its name from the doctor's Hippocratic Oath. Gary Cohen is the executive director of Health Care Without Harm.

COHEN: And we thought how ironic that is that hospitals whose mission is to heal people are contributing to environmentally related disease in this society and we said we need to redefine what that "first, do no harm" ethic means and it means clean up your act.

GELLERMAN: The hospitals quickly cleaned up their act. The number of medical waste incinerators went from 5600 to fewer than 70 still operating today and Health Care Without Harm has become a worldwide coalition of nearly 500 organizations in more than 50 countries. The mission: hospitals, heal thyself, go green. The group led the effort to safely rid medical facilities of toxic mercury found in thermometers and blood pressure devices. But Cohen says there are still things in hospitals that can make you sick:

COHEN: And in the case of patients, if you're getting your IV drip with a PVC medical device it is dripping a reproductive toxin into your veins. Nobody's telling you that but that's the facts, and so our challenge to the hospitals has been look, can't we build cancer centers without carcinogens? Can't we build pediatric units without chemicals linked to birth defects and asthma? This is what health care needs to do. They haven't looked at, except for the last number of years they haven't looked at their environmental health impacts of their operations and their buildings and the stuff they buy.

GELLERMA: From bedpans and surgical gloves to operating rooms and MRI machines, hospitals are enormously expensive to build, equip and operate. And when it comes to making life saving decisions, administrators aren't about to worry about buying energy-saving devices. Still, medicine is starting to use the power of the purse to go green. Architect Robin Guenther is co-author of the book "Sustainable Health Care Architecture."

GUENTHER: Health care is 17 percent of the gross domestic product so health care purchasing represents a huge market leverage around any goods and services a hospital may buy.

LEVY: This is not brain surgery to save energy and water in a hospital. This is common sense kind of stuff.

GELLERMAN: Paul Levy is CEO and president of Beth Israel Deaconess Medical Center. It's a teaching hospital - one of three in Boston's Longwood Medical area. It has three million square feet of space, seven thousand employees, and a 1.2 billion dollar budget. Levy's first priority is patient care; his second is green - as in money, not green as in the environment.

LEVY: Much of the energy work and environmental work in hospitals is driven more by cost issues than by a desire to make the world cleaner and reduce carbon emissions and the like, but that's okay because they end up being the same program anyway.

GELLERMAN: Cutting costs and emissions in hospitals requires a healthy dose of technology. The prescription calls for using automated devices that control lights and temperature, the flow of air and water. Most of these devices are hidden in walls and out of sight.

[WALKING DOWN HALLWAY]

GELLERMAN: But at Beth Israel Deaconess some sensors can see you.

LEVY: It's your traditional vending machine, it's got a picture on the front that's brightly light. It has a refrigerator built to keep things cool, and on top of the machine is a little sensor to keep...

GELLERMAN: Oh, look at that. I wouldn't have noticed it...

LEVY: ...to track of how many people walking by it, and when it detects that the traffic has dropped, it powers down the machine the same way your computer would go into rest mode.

[SOUND OF MAKING A PURCHASE AT A VENDING MACHINE]

GELLERMAN: Vending machines are energy vampires, so hospital utility manager Mark Lukitsch has installed automatic detection devices to curb their appetite. He says small change can add up.

LUKITSCH: We're able to save probably, with the 26 units we installed over the next 10 years, somewhere in the 70, 000 dollar range, just for a simple device that has a payback of less than a year.

GELLERMAN: Again, hospital CEO Paul Levy.

LEVY: The thing is about hospital buildings, because they're so big, and because they're so energy intensive, you can make a minor modification in the operation of building and actually result in a fairly substantial savings.

[WALKING DOWN HALLWAY]

GELLERMAN: Down the street from Boston's Beth Israel is Brigham and Women's Hospital. It has nearly twice as many employees, 13,000.

MOMBOURQUETTE: It's a big business, it's a big business. About 9,000 babies are born here every year. It's the biggest in New England, and one of the biggest in the country actually.

GELLERMAN: Art Mombourquette is vice president of support services at Brigham and Woman's. The hospital is a city unto itself. A hallway a quarter of a mile long - called the pike - connects buildings.

MOMBOURQUETTE: We're walking on one of our green initiatives – this corridor is in the process of being replaced. It's an old vinyl composition tile that we're ripping out and replacing it with a renewable product, it's a rubber product. Not only is it a renewable product, it also doesn't require any floor finishes, which means it doesn't need any harsh chemicals to clean it off when it yellows. So it's much better for the people who need to clean it. It's also softer, to walk on, it's a nice product.

GELLERMAN: It's quiet.

MOMBOURQUETTE: It's very quiet.

GELLERMAN: The long hallway leads to Brigham's newest building, the Shapiro Cardiovascular Center, 300,000 square feet of highly specialized space. It's certified silver LEED – it was designed green from the get go. No new parking spaces were added. Instead, employees were given mass transit passes. Houses that once stood on the property were moved - recycled, in a sense - to preserve the community. And inside the building's soaring atrium, special glazing was used on glass to reduce heating and cooling needs. And every patient's room has floor-to-ceiling windows.

MOMBOURQUETTE: The patient rooms actually slope up at the window, so literally funneling light into the room.

GELLERMAN: This is a hospital. Can the things that you've changed, letting in more light, using environmentally sound cleaning materials, can that help save people's lives or improve their health?

MOMBOURQUETTE: I think there's beginning to be evidence that that's a true statement, and so while it's a little difficult to quantify, there is beginning to be evidence that natural light helps healing.

GELLERMAN: Studies show hospital patients with an outside view suffer fewer complications, need less pain medication and are discharged sooner. Similar benefits have been found in hospitals where family members can stay overnight. And many hospitals are starting to build green roofs to bring nature closer to patients. And they're improving the food they serve, buying organic and locally grown.

It's all part of what's called "evidence based design." It's a concept that architect Robin Guenther says expands the definition of what constitutes health care.

GUENTHER: Buildings ultimately are the clothing that we put on our institutions. Buildings embody all our values, so when you inhabit a green building, it changes how you think about who you are and what you're doing.

GELLERMAN: At Boston's Beth Israel Deaconess, changes in architecture are changing attitudes. Community director Jane Matlaw founded "Healthy Work/Healthy Home," a program encouraging employees to bring new green ideas to the hospital.

MATLAW: And now I have people calling me frequently, saying, "Why aren't we doing this? Could we be doing this? How do we do that? and How do we make it better?" So, it's really gone from, you're a lunatic out there doing your thing, to something people really have embraced.

GELLERMAN: The benefits from going green, says Bill Ravanesi, Boston Director of Health Care Without Harm will pay for themselves - in more ways than money.

RAVANESI: There's a big transformation. We have a green tsunami around us right now, and what we're seeing is a transformation in thinking in health care, going from a mindset that says "let's build an institution," into a different kind of vision, and this vision is a healing environment.

GELLERMAN: The green wave has gone mainstream - and hospitals, their workers, their patients, and communities are the better for it.

Source: http://www.loe.org/shows/segments.htm?programID=08-P13-00047&segmentID=7

Will There Be Another Alma-Ata?

2008-10-11T23:08:00.000-07:00

What of the declaration from 1978 promising “Health for All”?

Thirty years have gone by since the “Alma-Ata Declaration” – adopted on September 12, 1978 at the end of an international conference on primary healthcare at Alma-Ata in the then Soviet Union (now, Almaty in Kazakhstan) – set the goal of “Health for All” by the year 2000, to be realised through universal, comprehensive primary healthcare.

The declaration, non-binding on the member-states of the United Nations, came at a time when the first and the second worlds were contending among themselves for advancing their respective power and influence in the World Health Organisation
(WHO), and the third world was pushing for a “new international economic order”. The world has since changed so very dramatically that one wonders if one should at all look at Alma-Ata 30 years on. Hardly had the dust in the aftermath of the declaration
settled down when neo-liberalism as an ideology and as an agenda began its hegemonic ascent. So what of Alma-Ata?

Alma-Ata happened five years after the democratically-elected Popular Unity government in Chile was overthrown in the coup d’état organised by Washington, in which president Salvador Allende was assassinated. Allende was a medical doctor who understood the social origins of disease and ill-health, just like Che Guevara, also a medical practitioner, did. Both of them saw “politics as medicine on a grand scale”.

Allende knew from his practice since the 1930s that a solution to the ill-health of the Chilean people lay not merely in the provision of healthcare but in bringing
about better conditions of work, housing, sanitation, nutrition, and so on. On its part, Cuba, a third world country that practised universal, comprehensive primary healthcare has attained health indicators corresponding to those of the developed world. Closer home, in our part of the world, Alma-Ata came at a time when the Maoist model of development in China – which had incorporated universal, comprehensive primary healthcare, among other things, as an integral part of a long-term programme – was being sought to be discarded following the third plenum of the 11th central committee of the Chinese Communist Party that announced the decision to launch “market reforms”.

The prospects of fulfilling Alma-Ata dimmed even further when conservative, right-wing governments in the United States and the United Kingdom headed by Ronald Reagan and Margaret Thatcher, respectively, took office. After all, Alma-Ata was informed by a
Weltanschauung that was wholly at odds with that of neoliberalism.

In the declaration, health “is a fundamental human right” whose attainment requires a multi pronged attack on the social determinants of ill-health and disease. Existing “gross inequality in the health status of the people is politically, socially, and economically unacceptable”. While the state is held responsible for the health of
the people, the latter “have a right and duty to participate...in the planning and implementation of their healthcare”. And, the conception and practice of primary healthcare should be informed by the understanding that social and economic relations and conditions profoundly influence health, disease and medicine (Paras VI
and VII of the declaration).

Sadly, on the ground, what was practised was selective primary healthcare, for instance, “targeting” children under age five with immunisation and oral rehydration salts (ORS), technical fixes that are useful but cannot go a long way in dealing with health problems whose roots are to be found in exploitation and oppression.

With World Bank-imposed structural adjustment programmes (SAPs) in the 1980s and the slashing of public health expenditure, poor families in the third world landed up at times spending a third of their daily earnings to buy the ORS packets that were being
promoted via “social marketing”. The SAPs adversely affected not only health expenditures, but also those related to education, food subsidy, public transport, etc, pruning a whole gamut of social welfare activity undertaken by states. User-fees, basically cost recovery measures, and the privatisation of health service functions
became the order of the day under the World Bank-mandated SAPs, even as the United Nations Children’s Fund (UNICEF) pleaded for undertaking them “with a human face”.

Whatever happened to healthcare as a “fundamental human right”?

The World Bank’s World Development Report 1993: Investing in Health, as David Werner wrote in an article in this journal 13 years ago (January 21, 1995), “put the last nail in the coffin of the Alma-Ata Declaration”. The World Bank has since pushed the
WHO into second place as the global agency influencing health policy, with a three-fold impact on the ground.

First, the responsibility for the coverage of health costs is a huge burden the poor have to bear more than ever before. Second, primary healthcare has become even more narrow and selective than it was in the 1980s. And, third, the private sector, including the insurance industry, has boomed in the “business” of healthcare. Yes, the business of healthcare – patients are now “clients” and clinical services are “product lines”.

The rights of the pharmaceutical corporations to their intellectual property precede the “fundamental right to healthcare”, which is anyway “non-binding”.

What then of Alma-Ata?

What goes around comes around. If disease is socially derived, then ill-health and disease are an indictment of the social, economic and political order. There will be many a “Sicko” (the title of the film on healthcare in the US by Michael Moore), and, sooner rather than later, the counter-movement against the market mechanism will generate its own Alma-Ata. The struggle for healthcare as a fundamental human right goes on.

Playing God: The Global Population Control Movement

2008-10-11T22:37:00.000-07:00

Playing God: The Global Population Control Movement

Book Review, The Economic & Political Weekly, October 4, 2008

Fatal Misconception: The Struggle to Control World Population by Matthew Connelly; Harvard University Press, Cambridge, Massachusetts, 2008

by

Mohan Rao

This is a truly extraordinary book that I cannot recommend too
highly, not just to the small community of historians working in the area of health and population, but for public health workers, demographers, scholars in gender studies, feminist and health
activists and, indeed, even the occasional policymaker who reads.

The book has been reviewed favourably in extremely unlikely places, including the New York Times and the Economist. Both point out
that the author is born in a Catholic family, with many children, implying this would explain the critique of the global population control movement that this book is. Both reviews did not point out
that some of the harshest criticism in the book is reserved for the Catholic church’s stand on contraception and abortion.

Reviewers in both places seem to think ideas underlying population control is a thing of the past, like political incorrectness.
And here, they have some misguided support from the author himself, but more on this later.

Here is a scholar who had infamously written in the Atlantic Monthly, with that Cold Warrior Paul Kennedy, that population
growth in the third world, along with growing economic inequalities and migration, portended nothing less than a clash of civilisations, in a familiar replay of neo-Malthusian tropes. Here he is several years later, with extensive research under his belt, prepared not
only to critique his own earlier position, but examine what factors lead to that position itself. This self-questioning, selfdoubt,
is truly catholic – with a small c –and indeed a conversion.

Hopefully, reading this book will take others through the same journey of discovery. Being politically correct, influential
people in policymaking circles in the first world no longer talk of the yellow peril, or use phrases such as population explosion,
or metaphors like the population bomb. Nevertheless, neo-Malthusian thinking –that population growth is the cause of a host of problems, of hunger and poverty, or indeed famines, and today, genocide
and global warming – frames other policy discourses, that on immigration and the environment being prominent ones. “Most
Americans Want Immigration Drastically Reduced” reads a full-page advertisement in Harper’s, put forth by Negative Population
Growth. It goes on to argue about the “catastrophic effect of overpopulation on our environment, resources and standard
of living” (Harper’s 2004:19).1 Neo-Malthusian underpinnings are evident in some of the security discourses on refugees.

The ghastly Rwandan tragedy was seen as an inevitable consequence of
p opulation growth, not the politics of g enocide (Mamdani 2001).2 Hum do hamare do, who paanch, unke pachees (“The two of us have two, the five of them have 25”), was a slogan that won an infamous election in Gujarat after the genocide of Muslims in 2002 (Rao 2007).3 We only need to remember that as soon as the last elections
were announced in the UK, immigration became an issue, not just for the Conservatives but for the New Labour of Tony Blair as well. Both Italy and France have recently elected right wing presidents on an explicit anti-immigration platform.

Fundamentalism

At the same time, a sub-discipline of “strategic demography” has emerged, that seeks to locate the growth of slamic “fundamentalism”4 in the “youth bulge theory”. This fanciful theory argues that population growth in Islamic countries, characterised by a high proportion of youth, leads to the growth of Islamic funda mentalism, spelling political d anger, not just to democracy in these co untries but to the so-called free world (Hendrixson 2004).5 This search for biological metaphors to political and economic problems does not, for instance, explain the rise to political dominance of Protestant fundamentalism in the United States, which has of course no youth bulge, nor indeed significant po pulation growth. But such matters of truth or rigour rarely troubled demographic discourses in the past, and obviously do not, today. In other words, the population growth argument remains compelling, and truly protean, explaining just about everything, and thus of course
explaining nothing.

Here is a remarkable book, of solid scholarship (although rather overburdened with more than a 100 pages of notes and references. Another quick paperback edition is called for without this, cheaper, and thus accessible to more people). Along with a host of secondary
materials, the author has extensively tracked government and UN reports, and, most extraordinarily, been granted permission
to go through the records of organisations such as the Rockefeller
Foundation, the Population Council and so on – the prime players, or villains, in the population drama. Does this mean they have come to terms with their pasts? Or does it mean they do not really care?
Whatever it is, we must salute these organisations for the unusual courage they have displayed.

Fatal Misconception abjures rhetoric and conspiracy theories, indicating the concatenation of ideas, institutions and the
contingencies of global politics to, to use current jargon, deconstruct neo- Malthusian assumptions that lie at the heart of
population policies. It shows with meticulous attention to details of ideas, personalities and funding, how the global population
control movement was created, tracing the extraordinary unfolding of
population policies under the guidance of this movement, in India and China in particular. However, for a book that claims
to be “the first global history of population control” (p 10), the book does not give enough attention to events in Africa, Peru
(forced sterilisation of indigenous people), or indeed the US itself, with its history of eugenic sterilisations.

The book documents admirably this movement’s command over resources,
financial, and intellectual, and the strategies adopted to win friends and influence people – that is so overwhelming even
today.6 And how, in the process, was established a pattern of domination, and a network of institutions, that continues to be
effective in areas as diverse as HIV/AIDS policy and indeed reproductive health policy. Yet, it is not a simple, or simplistic,
first world – imperialism story, which it fundamentally is, but a nuanced, multilayered one. The book is above all rich in
tracing the ideas that influenced such a motley, and huge, group of people. Yes, imperialism is central to the population control movement, but there is also the element of individual freedom and rights it promises, especially to women. Yes, it was hugely racist – and sexist – and this was of course at the heart of the science of
eugenics, which saw its apogee in the Holocaust, but this was not unique to G ermany.7 Indeed the Scandinavian countries and Canada had eugenic sterilisation laws long after the Nuremburg trials discredited them. Yes, cold war politics – communism will spread because of population growth – dictated many of the urges of the movement in the hopeful post- second world war years. Yes, too, that the things done were terrible, but above all that there was consent, approval and indeed active participation from a host of
third world elites. This was a joint global elite project, using different threads of arguments at various times. The movement
felt it could decide who could be allowed to be born and where, and who could be allowed to die.

At times the arguments were eugenic: that the worst were breeding whilst the best were not. This argument seemed to find particular resonance in India with all the leading population control people,
predominantly upper caste Hindus (and indeed a few upper caste Muslims), being particularly suspicious, and fearful of
lower caste and Muslim reproduction. This argument was what led to the sterilisation laws in a host of states in the US, and indeed the US’ immigration policies early in the 20th century. Eugenics is of course currently being reinvented as n eo-eugenics in the wake of advances in biotechnology: parents can now “freely” decide, if they can afford it, what genetic characteristics they do not want in
their child.

Women’s Rights

At other places, the arguments were about women’s rights, as is the case today. It is indeed a case for women’s and men’s rights – but the problem was that this was used instrumentally. Margaret
Sanger, who made this argument forcefully, was also a eugenist, causing profound embarrassment to her erstwhile socialist colleagues. Matthew Connelly is inexplicably rather sweet on Sanger. I would suggest he quickly read Sarah Hodges (2006)8 and Sanjam Ahluwalia (2008)9 before the quick new edition of this book. A question Connelly does not raise is why Sanger, during her tour of
India influencing people to the population control cause,10 did not make overtures to Periyar or Ambedkar, both fierce proponents of birth control. The reason is of course very simple: for Sanger contraception was for eugenic purposes; for Periyar and Ambedkar, it was a quest for gender justice and a blow against
patriarchy and caste.

Above all, the arguments were about economics and development. Population growth in third world countries was seen as the primary reason for their horrible poverty. Colonialism, or indeed the continuing drain of resources from these countries, did not figure. Economic growth could only take place if population was
controlled, it was argued, if necessary with force. I was astonished to discover in this book that Kingsley Davis, the guru of
demographers, who gave testimony in the US senate as to why population control is necessary to combat communism, gave
approval to Sanjay Gandhi’s fearful policies of coercive sterilisations during the Emergency in India (p 320).

The many-headed, hydra-like beast that was created, acting globally, accountable to no one but themselves – which is unfortunately characteristic of most non-governmental organisations (NGOs) – comprised a network of organisations including the Population Council, the Rockefeller Foundation, the For Foundation, the
International Planned Parenthood Federation (with its clutch of poodle national family planning associations) and so on.
They obtained funding from organisations such as the World Bank, the USAID and the UNFPA, and in turn funded a whole range of activist NGOs. As the book documents, during the 20th century more money has
been poured into this movement by first world governments, and others, than any other cause. Linked through funds and people were the leading academic departments at Harvard, Princeton and so on,
and think tanks that increasingly influenced foreign policy. Significantly, all the major demographic journals were funded
by the same institutions and were thus largely responsible for the scientific sheen demography carried. The interconnection between these that Connelly demonstrates is both mind-boggling and
frighteningly impressive.

Revealing Facts

Connelly also shows us how these ideas were used to push the population control agenda globally. Utterly revealing was the
fact that leading donors knew what the Emergency was doing to family planning in India and welcomed it (pp 322-23). Similarly,
I was shocked to discover that donors knew that ultrasounds were
d istorting child sex ratios in China – but that, in their anxiety to control population, encouraged China to import ultrasounds
with aid funds (p 347), and indeed, that the World Bank used structural adjustment loans to push population control policies (p 349).

Connelly does not note the irony that it is precisely these groups and organisations that are involved with reproductive
health and rights today. He seems to believe, inexplicably, that population control is a thing of the past. Thus we have
some paeans to the idea of reproductive health and rights that came to centrestage at the International Conference on Population
and Development at Cairo in 1994. There is such a wealth of literature on the troubled relationship between this evocation of women and reproductive rights – and the wrongs that accompanied it. He misses the significant point that what was being pushed through as the Cairo consensus was the agenda of US feminists. It has been described as white, western and quintessentially bourgeoise.

From Angela Davis onwards, a whole lot of people have written about this. I have described this as an outcome of the marriage
of multinational feminisms with international debt. Surely it is significant that the Cairo consensus not only had the imprimatur of the World Bank, but was silent on what the Bank’s policies had
unleashed on women and their rights and entitlements globally through structural adjustment programmes. Indeed, the Cairo consensus came in for scathing criticism by the leading women’s groups in India on precisely this ground. There is also a movement for reproductive justice, which rejects this concept of
reproductive rights.

Birth rates are declining across the globe, although it is not clear if this is linked in any significant manner with population control programmes. Yet, as we have seen, ideas associated with this
movement have a way of resurfacing in inexplicable ways. Today, warns Connelly, we may already be witnessing something no
less pernicious: the privatisation of population control. It is governmentality without government, in which people police themselves, unconsciously reproducing and reinforcing
inequality with every generation.…

Parents increasingly experience genetic counselling and solicitous concern for foetal health as social pressure to have perfect children, even if standards for perfection are constantly changing. In everyday conversation, people ascribe a whole range of
behaviours to good or bad genes, faithfully reciting a eugenic catechism without the faintest idea of where it comes from or where
it can lead (p 382).

Email: mohanrao2008@gmail.com

Notes
1 Harper’s (2004), Vol 309, No 1853, October.
2 Mahmood Mamdani (2001), When Victims Become
Killers: Colonialism, Nativism and the Genocide in
Rwanda, Princeton University Press, Princeton.
3 Mohan Rao (2007), ‘Saffron Demography: So
Dangerous, Yet So Appealing’, Different Takes,
No 48, Spring 2007, Amherst, Mass, Reprinted in
Babies, Burdens and Threats: Current Faces of
P opulation Control, Hampshire College, Mass.
4 The untroubled use of this word, as of the phrase
“Hindu nationalism”, to describe Hindu fascist
groups indicates the reach and dominance of
crude western thinking, repeated unquestioningly
in India and elsewhere. The word fundamentalism
of course derives very specifically from
the history of Protestant groups in the US, wishing
to reach into the fundamentals of their version
of Christianity to guide their politics and
everyday lives. There are enormous problems
with this characterisation of the Sangh parivar as
Hindu fundamentalist or Hindu nationalist. In
the first place, they do not represent Hindus, and
indeed seem to be deeply ashamed of Hinduism,
wishing to transform it into a more semitic, “masculine”
religion, like Christianity or Islam. There
are of course no fundamentals in Hinduism. Their
claim to be nationalistic is equally moot since
they played an extremely marginal role in India’s
freedom struggle. Indeed, the assassin of
Mahatma Gandhi, a good and proper Hindu, was
a member of the Sangh parivar as it then existed.
5 Anne Hendrixson (2004), Angry Young Men,
Veiled Young Women: Constructing a New Population
Threat, Cornerhouse Briefing No 34, December,
Dorset.
6 As I write the review I see a news item in the
Times of India (‘In Kerala, Having a 3rd Kid May
Invite Penalty’, July 30, 2008) that Kerala seeks
to introduce a two-child norm, with a number of
penalising disincentives. The Kerala Law
C ommission that has mooted this, under the
leadership of the progressive justice Krishna Iyer,
does not seem to know that Kerala has long completed
her demographic transition. In other
words, that even for purely instrumental reasons,
the move is entirely unnecessary, and equally
entirely foolish.
7 Indeed, many doctors and scientists involved in
eugenic sterilisation, and worse, in Nazi G ermany,
got away at the Nuremberg trials where it was
pointed out that the German laws were modelled
on ones current in the US and in many other countries.
Indeed, the US Supreme Court had found
these laws constitutionally valid and thus acceptable.
See Harry Brunius (2006), Better for All the
World: The Secret History of Forced Sterilisations
and America’s Quest for Racial Purity, Alfred
A Knopf, NY.
8 Sarah Hodges (2006), Reproductive Health in
India: History, Politics, Controversies, Orient
Longman, New Delhi.
9 Sanjam Ahluwalia (2008), Reproductive
Restraints: Birth Control in India, 1877-1947,
P ermanent Black, Ranikhet.
10 This, incidentally has been famously rebuffed by
Gandhi. Gandhi rejected contraception sometimes
arguing that contraception would lead to sin and
the weakening of individuals and nations; he sometimes
also rejected contraception on the grounds
that neo-Malthusianism was fundamentally flawed;
at all times arguing that celibacy was the solution
where women, and indeed men, were concerned.

Health care costs: A market-based view

2008-10-11T22:08:00.000-07:00

If health care costs continue to rise at current rates, they could amount to 20 percent or more of the GDP of many developed countries. To understand how to manage—or influence—this expenditure, decision makers should look at the factors that influence the supply and demand of health care services.

* Throughout the world, leaders of government health agencies, heads of health care companies, and even patients—collectively, the shapers of the modern health care system—behold the growth of health care spending with alarm. For almost 50 years, spending has grown by 2 percentage points in excess of GDP growth across all Organisation for Economic Co-operation and Development (OECD) countries. As a result, health care has become a much bigger part of most of these economies.
* If current trends persist to 2050, most OECD countries will spend more than a fifth of GDP on health care. By 2080 Switzerland and the United States will devote more than half of GDP to it—and by 2100 most other OECD countries will reach this level of spending.
* Health care leaders fervently hope that the projections are off the mark. What will have to change to prevent health care from devouring half of a national economy?

This article contains the following exhibits:

* Exhibit 1: In the health-care market, the line between supply and demand is sometimes blurred.
* Exhibit 2: Per capita spending on health care strongly correlates with national GDP.
* Exhibit 3: The median increase in health-care spending in member countries of the Organisation for Economic Co-operation and Development (OECD) has been two percentage points above GDP for nearly 50 years.
* Exhibit 4: At the historic growth rate, health care will consume an ever-growing proportion of developed nations' wealth.
* Exhibit 5: In many countries, the tax-financed part of health care represents a massive transfer from young taxpayers to older health care users.

The McKinsey Quarterly

The Corner House on Health

2008-10-11T22:03:00.000-07:00

Who Owns the Knowledge Economy? Political Organising Behind TRIPS

by Peter Drahos with John Braithwaite

When TRIPS was signed in 1994, the United States, Europe and Japan dominated the world's software, pharmaceutical, chemical and entertainment industries. The rest of the world had little to gain by agreeing to these terms of trade for intellectual property. They did so because a failure of democratic processes nationally and internationally enabled a small group of men within the United States to capture the US trade-agenda-setting process, to draft intellectual property principles that became the blueprint for TRIPS and to crush resistance through US trade power.

A Decade After Cairo Women's Health in a Free Market Economy

by Sumati Nair and Preeti Kirbat with Sarah Sexton

This briefing evaluates the 1994 UN International Conference on Population and Development. It assesses several processes that affect women's reproductive and sexual rights and health: the decline and collapse in health services; neo-liberal economic policies and religious fundamentalisms; and development policies underpinned by neo-Malthusianism.

GATS, Privatisation and Health

by Sarah Sexton

The World Trade Organisation's General Agreement on Trade in Services (GATS) could have a significant effect on human health, and health care services.

Trading Health Care Away? GATS, Public Services and Privatisation

by Sarah Sexton

If Cloning is the Answer, What was the Question? Power and Decision-Making in the Geneticisation of Health

by Sarah Sexton

Most discussions about human embryo cloning focus on ethics and potential health benefits. In the process, the many social, economic and environmental aspects of health and disease are increasingly hidden, while issues such as how the potential benefits of biotech would be obtained and distributed are sidelined. It has therefore become hard to raise key questions about the increased geneticisation of our lives and societies.

Contaminated milk kills Babies

2008-09-20T09:22:00.000-07:00

China is once again rocked by a baby milk formula scandal. Four babies have died and at least six thousand are suffering from kidney stones, which has led to acute kidney failure in many of the sick children. Originally, only the San Lu brand was thought to be contaminated, but it has since transpired that twenty other brands have been tested positive for melamine. The World Health Organisation has called on the Chinese authorities to explain how the scandal was allowed to develop.

Baby milk inspection in ChinaAnd while hospital waiting rooms across China are filling up with worried parents and babies with kidney stones, TV commercials promoting baby formula are still on air:

"This is a TV commercial for formula. A special ingredient makes this formula easier to digest - specially designed for your baby's delicate digestive system. Nestle Grow Formula Number 3 - for babies growing the healthy way."

The text for this commercial typifies the kind of claims made by the marketers - they emphasise the special quality attributed to their brand. Aggressive advertising campaigns like this have led to a sharp decrease in the number of women breast-feeding their babies.

And now the magic formula has been found to contain melamine, a chemical used in the manufacture of durable household products like plastic dinnerware and cutlery. Suppliers - be it the farmers or the dairies - are suspected of diluting milk to cut costs, then adding melamine to make it appear higher in protein. More protein means more money.

Kidney stones
It also means more babies - thousands of them - with kidney stones. John Foreman, an American paediatrician and kidney specialist:

"We know that melamine can form stones, and presumably that's what's happening to those children. They are getting stones in their kidneys and that's blocking the flow of urine, which is backing up in the kidneys and causing them not to function properly."

The San Lu Group knew that melamine was being added to formula for three years, but opted to remain silent. Local authorities also chose not to investigate the affair, for fear of bad press just when the spotlight was on Beijing for the Olympic Games.

The Chinese media released the information about the contaminated San Lu milk on 11 September. On 16 September, it was revealed that 21 other brands had the same problem, including Olympic Games sponsor Yili.

Confidence waning
Now the public has little or no confidence in any of the popular dairy products. In a supermarket at the Workers' Stadium, an old woman is looking up and down the shelves:
"I wouldn't dare buy [Yili] anymore. Only foreign milk; that should be alright."

Imported milk is three times more expensive, but many are prepared to pay to be safe. On an internet forum for mothers, 94 percent of those questioned have said that they will not use Chinese brands. And now, not even regular milk is an alternative. On Friday, it was announced that liquid milk from three of China's largest dairies was tainted with melamine.

The current milk crisis is the last in a series of food scandals in China. Eggs, steamed sandwiches, animal feed and prawns have all featured in the string of health scares. Three years ago, 13 babies died in the Anhui province as a result of malnutrition. They had been fed a kind of fake formula containing no nutrition.

Indeed we need to reach far beyond the actual consumers of baby milks. This is a case of Globalised Contamination.

The hue and cry around the Sanlu baby milk tragedy in China is focusing very narrowly on the quality of the milk produced by one Chinese company. This detracts from the fact that formula feeding regardless of brand and origin has inherent risks. What is also being overlooked is the large number of babies dependent on formula feeding at an age when breastfeeding should be the norm. The fact that aggressive marketing may be one key factor that is tilting the balance against breastfeeding
is also not being addressed.

China has had regulations that implement the International Code of Marketing of Breastmilk Substitutes since 1995. The regulations are incomplete and have regrettably never been fully implemented or enforced despite ICDC's past and recent efforts. Maybe this latest episode of babies dying and suffering as a result of formula feeding will get the Chinese authorities to sit up and give breastfeeding the support it deserves. They must act to protect their children. It is the least they can do. There will doubtlessly be more muck-ups with milks but the harm will be
minimised if breastfeeding is made popular and routine.

Until that time, foreign companies selling formula in China will be gloating over increased sales.

No package deal

2008-03-18T01:57:00.000-07:00

Rajib Dasgupta and Rama V. Baru

Health and education are fundamental rights of every child and it is imperative that the state and civil society ensure that these services are available, accessible and of good quality. Data from the National Nutritional Monitoring Bureau and the National Family Health Survey 3 indicate that child malnutrition continues to be a serious concern.

The government is now considering the replacement of cooked meals with packaged foods and biscuits in its Mid-Day Meal (MDM) and Integrated Child Development Services (ICDS) programmes. It is argued that this shift would improve efficiency and help overcome fiscal and managerial constraints faced in the implementation of these programmes. Reports also point to the role of the packaged food and biscuit industries that see the potential for furthering their business interests through these government programmes. The proposed policy shift has evinced concern from the academic community of senior scientists, medical professionals, educationists, nutritionists, public health experts and civil society organisations.

The objective of the mid-day meal programme was to increase enrollment and ensure better nutritional status among children. Several studies have demonstrated the positive impact of mid-day meals on school enrollment. The extent of impact on the health and nutrition of children is largely dependent on whether the meal that is provided is supplementary or a substitute for a full meal.

Several civil society alliances, professional networks like the Indian Association for Preventive and Social Medicine (IAPSM) and academics came together at a consultation that was initiated by the University School Resource Network project at Jawaharlal Nehru University. This consultation sought to review the scientific evidence that favoured cooked meals in the nutritional support programmes. Those present at this consultation unanimously opposed the idea of replacing cooked meals with packaged foods. A review of available evidence showed the value of cooked meals over dry rations or biscuits. Several studies have shown that not only is the quality variable but the nutritional impact of dry snacks is also questionable.

A fresh meal offers a better range of nutrients and is less costly in terms of per rupee nutrient yield when compared to packaged food. Calorie deficiency is by far the single most important challenge and its correction through wholesome balanced diets will go a long way in tackling micronutrient deficiencies as well. The other benefits of cooked meals are that they address ‘classroom hunger’ and also provide protection against acute hunger among children in drought affected areas.

A wholesome cooked meal makes the school attractive for the child and along with improved enrollment and attendance helps the learning process. Children learn to sit and eat together and that contributes to breaking caste and class barriers.

Despite overwhelming evidence regarding the positive contribution and demand for these schemes, these programmes are not without problems. These are related to resources, infrastructure, problems in delivery and issues of quality and quantity. Different states have different experiences related to the cooked meal programme that need to be properly studied.

The consultation was of the view that the constraints of finances and management that are faced by these programmes need to be addressed by context-specific fiscal and managerial solutions. In the context of hunger and malnutrition, the MDM and ICDS programmes have contributed significantly but they need to be strengthened further. Therefore those present at the consultation argued against any shift in policy without acknowledging the overwhelming scientific evidence regarding the value of cooked meals at feeding programmes.

In response to a public interest litigation on the right to food, the Supreme Court had in 2001 ordered that each child was entitled to a cooked meal that had 300 calories and 8-12 gm of protein per day for a minimum of 200 days a year. Malnourished children were entitled to 600 calories and 16-20 gm of protein. At present, the allocation per child does not allow for variety in the menu and therefore it is necessary to enhance financial allocation. This would ensure an increase in both quantity and nutritional quality of the food that is being served.

Instead of a supplementary feeding programme, the children would get a full meal that takes into account locally available foods with nutritional adequacy. Infrastructure in schools — water supply, toilets, kitchen area and hiring of cooks — often does not receive adequate attention. Monitoring systems to check quality and possible corruption and leakages in food grain supply need to be strengthened.

The strategy for implementation needs a decentralised approach taking into account the regional and local contexts. This would also result in greater accountability and transparency at every level of the programme.

Rajib Dasgupta is assistant professor and Rama V. Baru is associate professor at the Centre of Social Medicine and Community Health, JNU

March 18, 2008
Indian Express

Apology & a Bitter History of Stolen Generations

2008-02-19T21:48:00.001-08:00

Australia's prime minister delivered an historic apology to the Aboriginal people in a gesture of reconciliation for injustices committed over two centuries of white settlement.

"We apologise for the laws and policies of successive parliaments and governments that have inflicted profound grief, suffering and loss on these our fellow Australians," Kevin Rudd told the Australian parliament.

His speech focused in particular on the suffering of what have become known as the "Stolen Generations" - mostly mixed-race children, who were taken from their families up until the 1970s in a bid to assimilate them into white society.

But Rudd's address also took in a broader apology over what he called "a great wrong" committed against Australia's indigenous peoples, repeatedly using the crucial word "sorry".

"As prime minister of Australia, I am sorry. On behalf of the government of Australia, I am sorry. On behalf of the parliament of Australia, I am sorry," Rudd said.

Use of the word "sorry" carries major symbolism for Aborigines after Australian Prime Minister Kevin Rudd's conservative predecessor, John Howard, refused to utter it when he was in power. Howard was the only one of Australia's five surviving prime ministers who was not in parliament on February 13, 2008 to hear Rudd's speech, although his Liberal party, now in opposition, backed the motion of apology.

Howard lost his parliamentary seat in last November's national elections which saw a landslide victory for Rudd's Labor party.

The full text of the speech is available at:
http://english.aljazeera.net/NR/exeres/BFA16B6A-E168-48B9-8E0A-F841361F893A.htm

A Bitter History

Aboriginal population of Australia estimated between 750,000 to two million prior to arrival of first white settlers in 1788.

Combination of disease, loss of land and violence reduced numbers by 80 per cent over the following century. Smallpox wiped out more than half the population.

Between 1900 and early 1970s estimated 100,000 Aborigines were taken from their natural parents as part of an assimilation programme, now dubbed the Stolen Generation.

Aborigines not granted vote in federal elections until 1962.

Aboriginal population was not counted in national census until 1967, prior to which Aboriginal affairs were governed under Australian flora and fauna laws.

According to 2006 census, Aboriginal and Torres Strait Islanders population stood at 455,031, out of total Australian population of 20,061,646.

Many aboriginal communities are plagued by high unemployment, juvenile delinquency, school dropouts, drugs, crime, domestic and sexual problems, and alcoholism.

Government statistics show an indigenous Australian is 11 times more likely to be in prison than a non-indigenous Australian, while indigenous Australians are twice as likely to be a victim of violence.

A 2007 study found standards of healthcare for Aborigines 100 years behind rest of Australia, with Aboriginal men having life expectancy 18 years below national average.

On 21 June 2007 then Prime Minister, John Howard, and the Minister
for Indigenous Affairs, Mal Brough announced 'national emergency
measures to protect Aboriginal children in the Northern Territory from
abuse and give them a better, safer future'. This initiative was bi-
partisan and endorsed by then opposition leader Kevin Rudd. Although the intervention is presented as a broad based social welfare initiative, it has a significant public health component.

The paper available at http://phmoz.org/wiki/index.php?title=Northern_Territory_Emergency_Response_-_Public_Health_Implications_Commentary briefly analyses the public health implications and the overall context of the intervention.

Rambling notes on Union Budget 2008

2008-02-11T05:37:00.000-08:00

Ramon Magasasay once said: "Those who have less in life should have more in law."

Era Sezhiyan, A former Member of the Lok Sabha says, "While the Budgets are growing richer and richer, the poor are growing poorer and poorer without having any worthwhile share in the benefits of budgeting and the government expenditures.
In India, those who have less in life have much less in law. "

How long will it take, for the fury of the long-suffering masses to explode?

The Finance Ministers of India: First row: R.K. Shanmukham Chetti, John Maththai, C.D. Deshmukh, T.T. Krishnamachari, Jawaharlal Nehru and Morarji Desai. Second row: Sachindra Chaudhuri, Indira Gandhi, Y.B. Chavan, C. Subramaniam and H.M. Patel. Third row: Charan Singh, R. Venkatraman, Pranab Mukherjee, V.P. Singh, and Rajiv Gandhi. Fourth row: N.D. Tiwari, S.B. Chavan, Madhu Dandavate, Yashwant Sinha, Manmohan Singh and P. Chidambaram.

Union Budget 2008 will be announced on 29th February 2008. "The Budget for 2008-09 will be the least taxing (no pun intended!) for the Finance Minister, P. Chidambaram, in several respects and for various reasons." The budget document is not only a statement of its accounts but also a charter of the government’s economic policies. These policies are reflected at the macro-level in instances like allowing of 51% foreign direct investment in certain sectors in 1999 by Manmohan Singh to the micro level in 1962 when Morarji Desai specified the number of matchsticks(50 in each packet) that a matchbox could contain in order to get excise exemptions.

Given the fact that the Finance Minister is formulating his last budget in the backdrop of a good economic performance of nine percent growth and the upcoming parliamentary elections, he is expected to announce seemingly socialist programmes. These would include token measures in the field of education, health and water concerns.

Hospitals and doctors must be brought in the service tax net. Also the Minister must not cave in to pressure from Bar Associations and to his own bias towards his and his wife's profession by imposing service tax on advocates in this Budget and treat them at par with the other professionals in the country.

Indeed any doctor and advocate who earns more than Rs 800,000 in a year, can definitely afford to pay the service tax.

The Telegraph talked of how Budget can go Nano:

2008 is the year of the Nano, and by now, Nano has come to stand for anything that is small — small in size and small in means. In keeping with the trend, this year’s budget is going to be a Nano budget. Lest readers misunderstand, one must quickly add that there has been no official proposal to curtail the lengthy budget speech. But when budget-minister P Chidambaram went to meet his party colleagues at 24 Akbar Road, the message was loud and clear: aam aadmi is passé, zero in on the garib aadmi. The latter, Chidambaram was told, was not getting the benefits of the 9 per cent growth rate of the GDP. Here’s what the Nano-budget might contain: a Nano loan-waiver programme for small farmers, and a Nano housing scheme (with Rs 1 lakh houses, silly!). So what happens to the aam aadmi, and aurat for that matter? He and she must Nano-ize their aspirations, what else? And hope that the GDP growth rate doesn’t go the Nano way.

The Economic Times carried a piece Men who shaped up India's economy

India had as many as 30 finance ministers after it secured independence from imperialist British rule in 1947. And, these gentlemen shaped up India’s economy which has grown in size to about US$ 800 billion. India has also emerged as the fastest growing economy after China and become a major provider of services and goods to the world.

The story of India’s evolution as a major economic power is an interesting saga intertwined with political happenings. While three Prime Ministers held the coveted portfolio of Finance, only four ministers presented more than five budgets. A brief profile of these men is given below.

Nawabzada Liaquat Ali Khan (1896 - 1951) was an Indian Muslim politician and a leading member of the All India Muslim League (AIML). He played an influential role in the partition of India and the creation of Pakistan. He was closely involved in the negotiations over the form of independence to be granted to India after World War II.

When the Indian political leadership asked the Muslim League to send its nominees for representation in the interim government, Liaquat Ali was asked to lead the League group in the Union Cabinet. He was assigned the finance portfolio by the first Indian Prime Minister Pandit Jawahar Lal Nehru. Acknowledged as Jinnah's "right hand" and as such Liaquat was the obvious choice to become prime minister of independent Pakistan in 1947. He went on to become the country's senior most leader after Jinnah's death in 1948.

India’s First FM R K Shanmukham Chetty (1947-1948): Independent India's first Budget was presented by the country's first finance minister, R K Shanmukham Chetty, on November 26, 1947. And, that was an interim Budget. It was a review of the economy and no new taxes were proposed as the budget day for 1948-49 was just 95 days away. He resigned shortly. It is believed that he was asked to resign by Jawaharlal Nehru, the Prime Minister of India due to a minor dereliction of duty by a subordinate official, so as to ensure probity.

K C Neogy: 1948 K C Neogy then took charge. He was the second Finance Minister of free India. He held office for just 35 days and didn't get an opportunity to present a Budget.

John Mathai (1948-1950): John Mathai was an economist who served as India's first Railway Minister and subsequently as Finance Minister, taking office shortly after the presentation of India's first Budget, in 1948. He presented two budgets for 1949-50 and 1950-51. He resigned after presenting the 1950 Budget following protests against vesting large powers with the Planning Commission and P C Mahalanobis.

C D Deshmukh (1950-1956): C D Deshmukh was also the first Indian Governor of the Reserve Bank of India. He presented an interim budget for 1951-52. The first general elections in post-independence era were held between December - February 1952. Deshmukh was given the Finance portfolio after the new ministry assumed office. He felt honoured to present the first budget to the first-time elected members of Lok Sabha. Hindi crept into the budget documents beginning 1955-56. His stewardship of the country's finances was marked by prudence and humane perspective. He provided the much desired vision to deal with the changing financial needs of a young, independent and under-developed country like India.

He made significant contributions to the formulation and implementation of the country's First and Second Five Year Plans that provided strong base for the years ahead. He was responsible for ensuring social control of the financial structure such as the enactment of a new Companies Act, and nationalisation of the Imperial Bank of India and life insurance companies. He resigned from the Union Cabinet after protesting separation of Mumbai from Maharastra.

T T Krishnamachari (1957-1958): T T Krishnamachari took over from him. He found that the calculations made in the budget for 1955-56 had gone awry. So, on November 30, 1956 in a five-thousand-word speech he described the changed economic situation and underlined the need to levy fresh taxes even before the next budget was presented. The Second General Elections were held in February-March 1957 and he presented an interim budget for 1957-58 on March 14, 1957 and the full budget subsequently. He was instrumental in setting up the country's three major steel plants and financial institutions like IDBI, ICICI and UTI. He introduced path-breaking tax reforms during his stint as Finance Minister. Krishnamachari had to resign in Feburary 1958 when one man Justice Chagla Commission found him guilty of corruption.

Jawaharlal Nehru (1958-1959): Following Krishnamachari's resignation, the then Prime Minister, Jawaharlal Nehru, himself took charge of the Finance portfolio and presented the budget for 1958-59. In the opening para of his budget speech Nehru had said ... "According to custom, the budget statement for the coming year has to be presented today (February 28, 1958). By an unexpected and unhappy chain of circumstances the Finance Minister, who would normally have made this statement this afternoon is no longer with us. This heavy duty has fallen upon me almost at the last moment."

Morarji Desai (1959-1964): Morarji Desai became the next Finance Minister and he presented the maximum number of budgets so far- ten. They included five annual and one interim budget during his first stint. In his second tenure, he presented three full budgets and one interim as Finance Minister and Deputy Prime Minister. His annual budgets were for the years from 1959-60 to 1963-64 and the interim budget for 1962-63.

T T Krishnamachari (1964-1966): After the first stint of Morarji Desai, Krishnamachari once again became the Finance Minister for the second time. He presented the budgets for 1964-65 and 1965-66. Embarking upon measures needed for providing social security, Krishnamachari expanded the pension scheme to cover family members of the deceased government servants by introducing a new Family Pension Scheme in 1964. He planned schemes like the Rajasthan Canal Schemes, Dandakaranya and Damodar Valley Projects. The Neyveli Lignite Projects owe their existence to the fillip given by Krishnamachari. He resigned in late 1966.

Sachindra Choudhuri (1966-1967): Sachindra Choudhuri presented the budget for 1966-67 after the resignation of T T Krishnamachari. It was an interim arrangement.

Morarji Desai (1967-1969): After the fourth General Elections in 1967, Morarji Desai once again became the Finance Minister. This was his second stint. The annual budgets for three years 1967-68 to 1969-70 and the interim budget for 1967-68 were also presented by him. The interim budget for 1967-68 was on account of the General Elections in March 1967. He was the only Finance Minister to have had the opportunity to present two budgets on his birthday - in 1964 and 1968. He was born on February 29. Desai resigned in July 1969 in protest against the nationalisation of major banks by an ordinance on a Saturday evening. He felt social control of banks would regulate their functioning and make them accountable.

Indira Gandhi (1969-71): After Morarji Desai's resignation, Indira Gandhi, the then Prime Minister assumed the Finance portfolio. So far, she has been the only woman Finance Minister.

Y B Chavan (1971-1975): Following the Fifth General Elections in March, 1971, Y B Chavan became the Finance Minister. He presented the interim budget for 1971-72 and the final budgets for four years - 1971-72 to 1974-75.

C Subramaniam (1975-1977): C Subramaniam presented the budgets between 1975-76 and 1976-77. He cast the widest net to increase revenue through excise.

H M Patel (1977-1979): After the Seventh General Elections in March 1977, the first non-Congress Ministry under the then Janata Party assumed office at the centre. Morarji Desai was elected as the Prime Minister. H M Patel held the Finance portfolio. He presented the interim budget for 1977-78. He also presented the annual budget for 1978-79.

Chaudhary Charan Singh (1979-1980): The budget for 1979-80 was presented by Chaudhary Charan Singh who was also Deputy Prime Minister.

Ramaswamy Venkataraman (1980-1982): After the seventh General Elections in January, 1980, the Congress Party returned to power. Venkataraman presented the interim and final budgets for 1980-81 and the annual budget for 1981-82. Later he rose to become the country's Vice President and President.

Pranab Mukherjee (1982-1984): Pranab Mukherjee presented the annual budgets for 1982-83, 1983-84 and 1984-85. He was the first Rajya Sabha member to hold the Finance portfolio.

V P Singh (1985-1987): After the Eighth General Elections in 1984, V P Singh presented the annual budgets for 1985-86 and 1986-87. There was no interim budget since the elections were held in December 1984. He was part of the ministry headed by Rajiv Gandhi.

He oversaw the gradual relaxation of the license raj that Rajiv had in mind. He also gave extra power to the Enforcement Directorate of the Finance Ministry, that was given charge of tracking down tax evaders. Following a number of high-profile raids on suspected evaders - including Dhirubhai Ambani - Rajiv Gandhi was forced to sack him as Finance Minister, possibly because many of the raids were conducted on industrialists who had supported the Congress financially in the past.

Rajiv Gandhi (1987-1988): Rajiv Gandhi presented the budget for 1987-88. He was the third Prime Minister to present a budget after his mother, and grand father. The exercise in zero-based budget began in 1987-88. The zero-based budgeting is a process of review, analysis and evolution for each budget request in order to justify its inclusion or exclusion from the integrated whole budget before it is finally approved. In India, the zero-based budgeting was implemented in three phases - one third in the first year, two thirds in the second year and fully from the third year. It is a continuous process.

N D Tiwari (1988-1989): N D Tiwari presented the budget for the year 1988-1989.

S B Chavan (1989-1990): S.B. Chavan did the budget exercise for 1989-90. He also served twice as the Chief Minister of Maharashtra.

Madhu Dandavate (1990-1991): After the General Elections in November 1989, the then Janata Dal Government's Finance Minister Madhu Dandavate presented the annual budget for 1990-91.

Yashwant Sinha (1991-1992): Following subsequent political developments, Yashwant Sinha became the Finance Minister and presented the interim budget for 1991-92.

Manmohan Singh (1991-1996): Manmohan Singh served as the governor of the Reserve Bank of India in the late 1980s, and was given the portfoilo of finance in 1991 by Prime Minister Narasimha Rao. He presented the final budget for 1991-92 in July 1991. This was the first occasion when the interim and final budgets were presented by two ministers of two different political parties. The next four annual budgets of Manmohan Singh had an orientation different from the one followed till then.

The economic liberalisation package pushed by Singh and Rao opened the nation to foreign direct investment and reduced the red tape that had previously impeded business growth. The liberalisation was prompted by an acute balance-of-payments crisis whereby the Indian government was left without sufficient reserves to meet its obligations, and had begun preparations to mortgage its gold reserves to the Bank of England in order to obtain the cash reserves needed to run the country. As such, he was instrumental in making of an opened economy. He reduced the peak import duty from 300 plus to 50 per cent. He will be remembered best for making the rupee convertible in current account in just two phases. Introducing the concept of 'service tax' was his idea.

Jaswant Singh (1996): He served as Finance minister in the short-lived government of Atal Bihari Vajpayee, which lasted just from May 16, 1996, to June 1, 1996.

P Chidambaram (1996-1998): The general elections held in 1996, paved way for a coalition government supported by the left parties. This came as a big break for Chidambaram, who was given the key cabinet portfolio of Finance; this put him in the limelight. The final budget for 1996-97 was presented by P Chidambaram of the then Tamil Maanila Congress.

It was the second time that interim and final budgets were presented by two ministers of different political parties. Following a constitutional crisis, the I.K. Gujral Ministry was on its way out and a special session of Parliament was convened only to pass Shri Chidambaram's 1997-98 budget. It was passed without a debate. Although the coalition government was a short-lived one (it fell in 1998), it showed Chidambaram's competence as Finance Minister, a factor which was to lead to his re-appointment to the same key portfolio under Prime Minister Manmohan Singh in 2004.

Yashwant Sinha (1998-2002): After the General Elections in March 1998, Yashwant Sinha got the Finance portfolio in the first ever BJP-led Atal Bihari Vajpayee Government. He presented the interim and final budgets for 1998-99. After the 13th General Elections in 1999, he became the Finance Minister once again. He had presented four annual budgets - from 1999-2000 to 2002-2003. Yashwant Sinha presented the budget for 1999-2000 in the forenoon. Earlier, the budgets used to be presented at five in the evening as a pre-independence custom introduced by British establishment. While Manmohan Singh concentrated on making imports flexible, Sinha paid great attention to rationalization of excise and reduced the slabs from 11 to one.

Jaswant Singh (2002-2004): In July 2002 he became Finance Minister again, switching posts with Yashwant Sinha. He served as Finance Minister until the defeat of the Vajpayee government in May 2004 and was instrumental in defining and pushing through the market-friendly reforms of the government.

P Chidambaram: Incumbent Chidambaram became Minister of Finance again in the congress party-led United Progressive Alliance government on May 24, 2004.

In 2004, A K Bhattacharya wrote a historical piece about "All about interim Budgets ":

Independent India's first Budget was presented by India's first finance minister, R K Shanmukham Chetty, on November 26, 1947. And that was an interim Budget!

So when Finance Minister Jaswant Singh presents the interim Budget for 2004-05 on Tuesday, he won't be doing something unique. In fact, between him and Chetty, the Indian Parliament has seen the presentation of 10 interim Budgets.

Five of these interim Budgets were presented by finance ministers of newly elected governments that did not have sufficient time to prepare a full Budget before March 31.

And five of them were presented by governments that had decided to go for general elections immediately after or before the end of the financial year.

An interim Budget or a vote-on-account becomes a necessity because every year, Parliament's approval for drawing funds from the Consolidated Fund of India (CFI) for expenditure is usually obtained by March 31, the last day of the financial year.

If a regular Budget is not presented before March 31, and further approval for drawing funds for expenditure beyond March 31 is not obtained, the government can come to a halt.

So, all the interim Budgets so far have been presented primarily to enable the governments to continue incurring their obligatory expenditure until a regular Budget is passed by Parliament.

The exception was the first interim Budget on November 26, 1947. When he presented it, Chetty did not describe his Budget as an interim exercise.

But in the second Budget he presented to Parliament on February 28, 1948, he said his first exercise was an interim Budget. Under normal circumstances, there was no need for the Indian government to present a Budget so soon � less than four months after independence.

But as Chetty explained in his speech: "With the division of the country and the emergence of two independent governments in place of the old central government, the Budget for the current year 1947-48 passed by the legislature last March ceased to be operative. Although, under the transitional provisions of the Constitution, the government could authorise the expenditure necessary for the rest of the financial year, it was felt that it will be in accordance with the public wish that a Budget should be placed before the representatives of the people at the earliest possible moment."

Chetty's first Budget speech also contained a detailed assessment of the state of the Indian economy. He hoped to end the financial year with a deficit of Rs 25 crore, but only after he had proposed an increase in export duty on cotton cloth and yarn to fetch an additional annual revenue of Rs 8 crore.

That was the only new tax proposal in the first interim Budget. But then, that was an indirect tax proposal that could be enforced through a notification and did not require Parliament's sanction.

The next interim Budgets were all presented before general elections. That was quite understandable. The Congress was the ruling party and there was hardly any opposition to its return to power. All these interim Budgets were presented with Jawahar Lal Nehru as prime minister.

On February 29, 1952, C D Deshmukh presented the second interim Budget and set a new trend. Along with the revised estimates for 1951-52 and the Budget estimates for 1952-53, Deshmukh presented a "white paper" on the state of the economy.

But Deshmukh's interim Budget would be remembered for his claim of how he had converted a Budget deficit projected earlier into a Budget surplus by the time the year was coming to a close.

Equally significant was his bold announcement that food subsidies would have to be abolished to relieve the exchequer of this growing burden.

When he returned to Parliament with a regular Budget, Deshmukh proposed no new taxes, although he had to leave a deficit of about Rs 75 crore uncovered.

Instead of looking for more revenue, Deshmukh had initiated an exercise to identify areas where government expenditure could be cut.

T T Krishnamachari (TTK) also presented his interim Budget for 1957-58, just before the general elections. The highlight of his interim Budget speech was his reference to a growing foreign exchange shortage and the need to mobilise adequate resources to fund the second Five-year Plan that was then being finalised.

TTK's interim Budget showed for the first time the finance ministry's scant regard for the sanctity of the revenue and expenditure numbers presented to Parliament.

The interim Budget brought down the revised estimates for the deficit in 1956-57 to Rs 216 crore. But after the elections, the regular Budget presented a few weeks later showed that the actual deficit was Rs 368 crore.

Morarji Desai presented two interim Budgets � one for 1962-63 and the other for 1967-68. The first one was presented in his capacity as finance minister under Nehru's prime ministership, while the latter was as finance minister and deputy prime minister in Indira Gandhi's government. Both interim Budgets were significant for different reasons.

The interim Budget for 1962-63 was presented before the 1962 general elections. In it, Desai presented a full-scale economic survey along with his speech that dwelt on the critical issue of foreign aid from developed countries and the World Bank.

He justified the need for loans to developing countries at concessional terms, paving the way for the setting up of the Aid India Club.

The revised estimates for 1961-62 showed a surplus instead of a deficit projected in the Budget estimates. That was clearly aimed at wooing the electorate. Another attempt at pleasing the voters was to outline the details of expenditure allocation for different sectors for 1962-63. This was the first time that an interim Budget indicated expenditure outlay for the coming financial year.

Desai's second interim Budget was even more significant. This was soon after India's currency devaluation in 1966. Indira Gandhi was the newly elected Congress leader and prime minister, having returned to power after a well-fought general election. Also, this was the first interim Budget of a government at the start of a new five-year tenure.

Not surprisingly, Desai used the speech to outline quite a grim picture for the economy. He touched on the need for more foreign aid, the deteriorating foreign exchange reserves, the need for import restrictions and declining exports. But there was no indication of a Budget deficit. Indeed, Desai's regular Budget presented some weeks later balanced the revenue with expenditure.

The interim Budget presented by Y B Chavan for 1971-72 had no special features. It reviewed the economy, but gave sufficient indication of the need for new taxation in the regular Budget that he would present a few weeks later.

There was a longish section in his speech where Chavan waxed eloquent on the positive impact of the government's policy of nationalising 14 banks in July 1969.

H M Patel's interim Budget had many firsts. This was the first interim Budget to be presented by a former bureaucrat and also a finance secretary. No wonder his speech was the shortest of all interim Budget speeches delivered so far.

Although he had the opportunity to rubbish the Congress government's claims of an economic miracle during the Emergency (1975-77), Patel avoided all such temptations.

Instead, he let the figures do the talking. The Budget deficit in 1976-77, he said, increased from the earlier estimate of Rs 328 crore to Rs 425 crore in the revised estimate.

Patel's interim Budget also clearly hinted at the need to raise revenue through non-inflationary methods and for economy measures.

In sharp contrast to Patel's restraint, R Venkataraman converted his interim Budget speech for 1980-81 into a political statement aimed at attacking the Janata government's economic policies. And like Desai and Chavan, Venkataraman presented a long speech of over 40 paragraphs.

Yashwant Sinha's debut as finance minister was with an interim Budget, caused by the fall of the Chandra Shekhar government requiring a general election in May 1990.

This was at the height of India's economic crisis. Sinha's interim Budget will be remembered for his announcement that the government would disinvest equity in public sector undertakings.

In comparison, Sinha's second interim Budget was sober and mildly critical of his predecessor P Chidambaram's failure to meet the various revenue and expenditure targets.

Sinha also announced the government's decision to accept the Tenth Finance Commission's new formula for sharing of tax revenue among the Centre and the states through an amendment to the Constitution.

That leaves Manmohan Singh with his only interim Budget. He made it into a full-fledged election speech, outlining the Narasimha Rao government's achievements in economic policy.

He also announced a series of policy imperatives that the government ought to pursue, apart from presenting a sector-wise break-up of his expenditure plan for 1996-97.

He projected a fiscal deficit of only 5 per cent of gross domestic product, much lower than the 5.9 per cent achieved in the revised estimates for 1995-96. Singh ended his interim Budget speech with a virtual call to the voters to return the Congress party to power.

Like Manmohan Singh, Jaswant Singh also presents an interim Budget before the elections. The key question is: Will Jaswant Singh restrict himself to an election speech or set a new trend by announcing some new tax proposals too?

Electronic journal for medical colleges

2008-02-11T00:40:00.000-08:00

Union Health Secretary Naresh Dayal launched the ERMED portal

The National Medical Library has started an electronic journal consortium, “Electronic Resources in Medicine” (ERMED), for providing full-text electronic journal service to 39 medical colleges and institutions across the country. These include ten Directorate-General of Health Services libraries and 28 Indian Council of Medical Research libraries and the All-India Institute of Medical Sciences library.

Union Health Secretary Naresh Dayal launched the ERMED portal www.nmlermed.in According to a release issued by the National Medical Library, the facility offers over a million articles in the open-access mode from over 1,515 medical journals. Articles can be searched by using the choice of journals, publishers, subjects and keywords of database.

“The library has adopted the most cost-effective strategy to put together the project that is aimed at building up a sustainable health information base and is committed to dissemination of a free flow of information,” said an official release.

The Director-General of Health Services is financing the entire project for 39 libraries. “The National Medical Library is the one-stop resource-sharing centre for medical literature across the country,” said National Medical Library director Anjana Chattopadhyay.

Rewrite the health petition

2008-02-11T00:33:00.000-08:00

The petition initiative (http://www.gopetition.com/petitions/india-s-health-sector.html) targeting Health Minister must be revised, rewritten and made holistic. It should also be updated and should target Finance Minister.

Currently, Union Health Secretary is Naresh Dayal (not Mr J V R Prasad Rao) who is seized with the corruption in the health sector. An inquiry is underway since 2006 by the Central Bureau of Investigation in the health projects.

Comptroller and Auditor General (CAG) report that was tabled before Parliament in November 2007 revealed that mismanagement rules the roost in the department of health and family welfare and in government-run hospitals. The petition must include these and other aspects as well.

The petition notes that "80% of the population lives in rural areas, but 80% of health provision is urban. Over 85% of health provision is through private enterprise" but does not articulate any specific solution and does not state that private health sector in India is burgeoning, but at the cost of public health care.

A Transparency International survey had noted that 30% of patients in government hospitals informed that they had had to pay bribes or use influence. This aspect also needs to be addressed.

The petition refers to the recommendations made in the World Bank Report, "India, raising the sights: better health systems for India's poor. Health, Nutrition, Population Sector Unit, India, South Asia Region, 2001" but does not suggest any remedy in recognition of the conclusion of the report. The report concluded: "The hospitalised Indian spends more than half his total annual expenditure on buying healthcare; more than 40% of hospitalised people borrow money or sell assets to cover their expenses, and 35% fall below the poverty line."

It appears that the petition is quite "Medical Council of India" and "medical practitioner's salary" centric. It fails to note that although expenditure on health has increased in absolute terms, the proportion of GDP it represents has declined despite the promises made by th UPA government.

Health schemes caught between government & World Bank

2008-02-06T07:04:00.001-08:00

Health schemes caught between government & World Bank

india is set to make another round of changes in procurement norms for health schemes funded by World Bank loans. This follows the bank’s review of Indian projects running on its loans, highlighting corrupt practices in procurement of drugs and other items by the government and drug companies. While such practices are well known—the bank’s own reviews have repeatedly mentioned them—the timing of the latest review has raised eyebrows.

Public health researchers doubt the bank’s motive: the review is more about wresting control than removing corruption. There are suggestions that it’s about getting the bank’s favourite firms on board. How this will arrest corruption is not clear.

In 2006, Pricewater-houseCoopers had appraised the bank’s review system, finding it inadequate.

Re-re…review
The review detailed the nexus between government bodies and pharma firms. This leads to corruption at several levels (see box: News you can’t use). The centre accepted the report and announced a series of changes in procurement norms. The schemes at stake deal with critical health concerns: tuberculosis, hiv/aids, malaria, and reproductive and child health. Procurement—of drugs, testing kits, bandages and equipment—is a major part of these programmes.

The schemes had recently completed five-year cycles, and were up for renewal. In fact, the bank has already sanctioned the next lot of funds, but hasn’t released them. This is where the questions arise. When the bank knew of corruption all along, why did it continue funding projects for years? The bank reviews projects every six months. What’s the point if they don’t help check corruption?

The striking aspect of these reviews—conducted by consultants at the bank’s high rates—is that they are paid for out of loans. Independent reviews show that up to 20 per cent of loans is spent on consultants.

Musical chairs
In 2005, the bank had released some findings of its review of the first phase of the reproductive and child health project. It had ‘found’ inconsistencies in the purchase of vitamins. The bank suggested funds go directly to states, instead of being routed through the centre. It recommended Tamil Nadu’s methods, which cut corruption and delays: the state was buying drugs directly from suppliers, instead of dealing with procurement agencies. It didn’t take long to realize that all states did not have this capacity. A year ago, the bank came up with an alternative to government agencies buying through their flawed tendering process: the un Office for Project Services (unops) was called in to handle procurement for projects running on the bank’s loans. The assumption being a un agency wouldn’t be corrupt.

Around that time, the Union Ministry of Health and Family Welfare realized it was time for another government agency, and decided to call it the Empowered Procurement Wing. A British consultant, Crown Agent, was en-gaged to streamline procurement. All solutions featured foreign agencies. Little attention has gone into a investigation and punishment.

If the bank wanted to clean up health schemes, it would have tried to bring the guilty to the book. But it provides nothing for criminal proceedings and is not usable as evidence in a court. Nor does it identify corrupt officials and suppliers. After the bank released the long-term review, health secretary Naresh Dayal has announced a probe.

Look who’s talking
What really weakens the bank’s position is recent events in its own house. Suzanne Rich-Folsom, director of the bank’s Department of Institutional Integrity that published the review of Indian health schemes, resigned on January 18. There is talk of corruption. Her credibility suffered further because she was also a counsellor to the previous World Bank president, Paul Wolfowitz, who resigned under a cloud.

Which is why when the bank talks about corruption in the Indian government, it doesn’t sound convincing.

News you can’t use
The World Bank’s assessed five projects: one each on HIV/AIDS, malaria and tuberculosis; the Food and Drug Capacity Building Project; and the Orissa Health Systems Development Project. These use bank loans of US $569 million. The review showed the following problems were common:

* Some bidders were favoured in violation of bank’s bidding norms
* Fraudulent bids
* Uninstalled and improperly installed equipment; substandard material
* Ministry set up panel to oversee bids. It often overruled project’s bid evaluation committee’s decisions.
* Bank had okayed contracts in spite of finding shortcomings
* lack of financial record-keeping
* Fictitious NGOs awarded contracts
* Lack of controls to monitor funds
* Bribing of health ministry officials

INTELLECTUAL PROPERTY RIGHTS REGIME OPPORTUNITY & CHALLENGE

2008-02-06T02:52:00.000-08:00

INTELLECTUAL PROPERTY RIGHTS REGIME IS BOTH AN OPPORTUNITY AS WELL AS A CHALLENGE BEFORE THE MEMBER STATES: DR. RAMADOSS

Addressing the plenary meeting of the 60th World Health Assembly in Geneva on 16th May, 2007, the Minister for Health & Family Welfare, Dr. Anbumani Ramadoss said that the World Health Organisation (WHO) needs to develop the capacities of many countries to participate in the Intellectual Property Rights (IPR) regime and reap its benefits. He said there are valid reservations on whether or not the IPR regime will lead to innovations in so far as neglected and tropical diseases are concerned. Ms Jane Halton, President, World Health Assembly and Dr Margaret Chan, Director-General, WHO were also present on the occasion.

The following is the text of the Minister’s speech:

It is indeed a pleasure for me to address the WHA once again. Last year I also had the privilege of chairing the proceedings of Committee-A. This provided me with a deep insight into the wide gamut of issues placed before the World Health Assembly. While it was no doubt enlightening for me to participate in these deliberations I cannot but help suggesting that WHO needs to progressively assume a more proactive role on global health issues rather than on advocating remedial measures after events have taken place. In particular WHO can be a bridge between developed and developing countries on issues relating to human resources, technology transfers, building consensus as well as capacities on emerging issues such as Intellectual Property Rights, Innovation and Public Health. There is also a case for a fresh look on the representation of developing countries like India and China on different WHO fora considering their population size and share of global disease burden.

The theme adopted by the 60th WHA, “Health Security” is of great interest to all of us. The global threat of emerging and re-emerging infectious diseases has been demonstrated by the emergence of Human Immunodeficiency Virus (HIV) in the 1980s, Avian Influenza H5N1 in Hong Kong originally seen in 1997 and continuing through today and a global epidemic of Severe Acute Respiratory Syndrome (SARS) in 2003. No country is immune to the occurrence of these diseases. It is therefore altogether appropriate for the WHA to focus on health security.

Development issues including health, nutrition, drinking water, education are today at the forefront of world politics. Health, as we all know is fundamental to social and economic development. The Millennium Development Goals 2015 are less than a decade away and most countries are feeling the pressure from all stakeholders to design policies which accelerate the achievement of the goals as per schedule.

In India, the state supported public health delivery system is being comprehensively rejuvenated under the National Rural Health Mission which is the biggest and most ambitious programme in the health sector ever in India. The National Rural Health Mission which is a convergence of health, nutrition, sanitation and drinking water, seeks to provide accessible, affordable and accountable quality health services specially to the poorest households in the remotest rural regions, focusing on reducing IMR and MMR. The thrust of NRHM is on establishing a fully functional, community owned, decentralized health delivery system with inter sectoral convergence at all levels. Quality care through adoption of the Indian Public Health Standards, focus on outcomes and adoption of evidence based strategies are some of the other salient features of NRHM.

We realize the need to target programmes for our women and children. We are going for major capacity building initiatives both for human and physical resources to ensure nutritional adequacy, deliveries at institutions and by skilled birth attendants, referral transport and emergency obstetric care. The Janani Suraksha Yojana, a path breaking programme for cash support for institutional deliveries, has had an overwhelming response.

Newborn and child health strategies range from the integrated management of neonatal and childhood illnesses, immunisation strategies, including this year, a US$300 million polio eradication programme and the recently launched Norway-India partnership initiative.

We have more than 400,000 Accredited Social Health Activists (ASHAs) who are empowered village women forming a link between the government and our clients for better service delivery.

The double burden of diseases experienced by a large number of low and middle income countries of the world has made it necessary for these countries to initiate mechanisms for effective prevention and control mechanisms.

The initiatives taken by us in addressing communicable diseases have given dividends. The progress made by the various national programs for control and elimination of TB, Malaria, Leprosy, HIV/AIDS are noteworthy.

A national program for prevention and control of Non Communicable Diseases like Diabetes, Cardiovascular diseases and stroke has been initiated. Taking care of the elderly population, a national programme for the care of elderly is also on the anvil. Issues of emergency and trauma care are being taken as priority areas.

The consumption of tobacco is also a major cause of morbidity. The global community is slowly recognizing the threat of the tobacco epidemic and the WHO Framework Convention on Tobacco Control (FCTC) is an important step in this direction. India, one of the first signatories of the FCTC, is in the process of launching a National programme on Tobacco Control. An anti-tobacco law was enacted as far back as 2003 and rules have been enacted banning smoking in public places; direct and indirect advertisements and sale of tobacco products to minors.

India is a key participant in the WHO supported Tobacco Free Initiative (TFI) and we are actively engaged in developing surveillance systems, building capacities of key stakeholders, undertaking advocacy measures and intensifying training programmes to combat consumption of tobacco. A Tobacco Regulatory Authority is on the anvil which will make recommendations on tobacco taxation policy, advertising, anti-smuggling measures, enforcement of the Act as well as on other measures both for disease prevention as well as prevalence reduction.

I believe that in the new Millennium the future of the health sector is going to be in substantial measure determined by the quality and availability of human resources; the spirit of innovation and enterprise, which alone will find cost effective solutions to seemingly intractable problems and by technological advancements in information technology as well as biotechnology. There are issues relating to migration of qualified health work force, which are leaving gaps within the exiting infrastructure and services, both within and outside the public sector.

The WHO needs to help the affected countries to address contributing factors to human resource shortages. The Intellectual Property Rights regime is both an opportunity as well as a challenge before the Member States. There are valid reservations on whether or not the IPR regime will lead to innovations in so far as neglected and tropical diseases are concerned. Similarly access and pricing of essential drugs is indeed a matter of concern.

The WHO will need to develop the capacities of many countries to participate in the IPR regime and reap its benefits.

Finally technology and technological advancements cannot be wished away and must in fact be relied upon to provide solutions to improve health care systems, both technical as well as managerial.

From some perspective I can say that if the Information Technology Industry was responsible for the present growth of India, then the future of India lies in the growth of the bio-medical industry. The WHO needs to position itself as the harbinger of technology to nations.

Consultation on “Healthy Environment Programme in India”

2008-02-06T01:50:00.000-08:00

Stephen L. Johnson, Administrator, Environmental Protection Agency, USA visited New Delhi on 2-3 April 2007. The Ministry of Health and Family Welfare, Government of India, and WHO India jointly organized a Consultation on “Healthy Environment Programme in India” on 2 April 2007. The meeting was chaired by the Secretary, Ministry of Health & Family Welfare.

Dr S J Habayeb, WHO Representative to India, introduced the basic objective of the consultation and narrated the three ongoing joint collaborations between WHO and US-EPA, namely Water Safety Plan, and the risks of Lindane and Mercury. Welcoming the participants, Naresh Dayal, Secretary for Health and Family Welfare, highlighted the needs of healthy environment with special reference to drinking water quality monitoring. He also suggested regulated use of water and impact of climate change on the water balance. Johnson, in his introductory remark, highlighted various activities being carried out by US-EPA in USA for a “Healthy Community Programme”. He mentioned that around 25% of the disease burden is due to environment factors. He also highlighted the Indo-USA joint activities in the field of environment, benefiting the public health programmes.

Ms. Shantha Sheela Nair, Secretary, Department of Drinking Water, explained the rural water and sanitation scenario in the country. This was followed by a presentation from Dr. B Sengupta, Member Secretary, Central Pollution Control Board on “Environmental concerns and Waste Management” in the country. The salient features of “Jawaharlal Nehru National Urban Renewal Mission” and its impact on the urban poor were presented by Dr. P K Mohanty, Joint Secretary, Ministry of Housing and Poverty Alleviation. The various ongoing joint activities of ICMR with US-EPA, with special reference to occupational health, were explained by Prof. N K Ganguly, DG, ICMR. This was followed by thought provoking discussions on healthy environment issues being faced by the country.

Finally, the ‘Guidance Manual for Drinking Water Quality Monitoring and Assessment’ was jointly launched by Stephen L Johnson and Naresh Dayal. The Manual, developed by NEERI, Nagpur and NICD, New Delhi, is a joint effort of Ministry of Health and Family Welfare; Ministry of Environment and Forests; Central Pollution Control Board; Department of Drinking Water; Ministry of Urban Development; Ministry of Water Resources; WHO, Country Office for India; and US-EPA. The Manual will be released for dissemination in May 2007.

The meeting ended with a vote of thanks proposed by Dr. Shiv Lal, Additional DG & Director, NICD.

Social security for the unorganised sector Workers ?

2008-01-28T19:43:00.000-08:00

A bill to provide social security to the unorganised sector workers is pending in the Parliament. A standing committee had scrutinised it and submitted their recommendations. The Left has rejected the Bill in its present form and wants the government to change the proposed legislation, which aims to cover 309 million workers.
because it does not incorporate committee's suggestions.

The Parliament Standing Committee on Labour invited suggestions, views, comments from individuals, institutions and organisations on the Unorganised Sector Workers' Social Security Bill, 2007. The Bill, introduced in Rajya Sabha on September 10, 2007, was referred to the Standing Committee on Labour under the Chairmanship of Lok Sabha MP, Suravaram Sudhakar Reddy for examination.

The Unorganized Sector Workers' Social Security Bill, 2007 talks about the social security and welfare of unorganized sector workers.

The bill provides for setting up of a National Social Security Advisory Board by the Central Government and the State Social Security Advisory Board by the State Governments respectively, for recommending suitable welfare schemes for different sections of unorganized sector workers.

A health insurance for workers of unorganised sector would be implemented from April 1. It provided a Rs 30,000 free health insurance cover to a five-member-family belonging to BPL category.

The labour ministry is reluctant to incorporate any major change suggested by the parliamentary standing committee.

The labour ministry doesn't see merit in the two main suggestions of the standing committee the creation of a dedicated fund for schemes for the sector and an administrative authority to implement these schemes.

Whether there is a dedicated fund or not is immaterial. Our only concern is availability of money. The government is already providing funds for the BPL (below poverty line) families. There is no shortage of funds,� said a top official in the labour ministry.

Ministry sources cite the example of the dedicated fund for north- eastern states. The huge amounts these funds are supposed to have are absent. Ministry officials say the welfare of unorganised labourers boils down to providing pension and life insurance. Since most of the schemes will be implemented by insurance companies and government agencies, there is no need to create another administrative body, they say.

The labour ministry says it has already extended old-age pension to all BPL families which is expected to cover a large section of unorganised workers. Then there is the Rashtriya Swasthya Bima Yojana for BPL families which will be functional from April 2008. After these schemes, where money for the beneficiaries� health needs is paid for, the government is framing schemes for other unorganised labourers.

We will soon moot schemes for autorickshaw drivers, domestic helps, fishermen, tailors, taxi-drivers and other unorganised sector workers. However, these schemes will be participatory,� said Union Labour Minister Oscar Fernandes.

Another important demand of the Left and the standing committee's separate arrangements for the agricultural workers is not a priority for the ministry. Most farmers or agricultural workers shift to other manual jobs in off-season, so it�s difficult to assess them as a different category, officials say.

A final decision on the recommendations of the standing committee will be taken by the Cabinet. We will try to pass the Bill in the coming session of Parliament, said Fernandes.

It is to be seen how much pressure the Left can exert on the government when the ministry is not ready to accept its major demands. A stubborn approach of the Left might stall the passage of the Bill and the Congress would have a political opportunity to campaign that the Left was obstructing the welfare of unorganised workers.

Business Standard reported on January 18, 2008 that “Pension scheme for mine workers” by April, 2008 is on the cards.

Impatient with parliamentary delay in passing the omnibus legislation for the unorganised labour, the labour ministry has decided to strike out on its own.

The ministry plans to launch a provident fund/pension scheme for mine and cine workers with contributions from both the worker and the government from April.

The scheme, under the rubric of the Unorganised Sector Workers’ Social Security Bill, comes amid the expectation that the enabling Bill will be passed during the Budget session of Parliament.

As labour is on the concurrent list, both the Centre and state governments can legislate on it. But the complaint has always been that state governments have been unable to sustain them because of a resource crunch. By claiming ownership of a scheme wholly funded by it, the Centre hopes to avoid that situation in the case of this scheme.

Initially, the scheme will cover around 500,000 mine and cine workers registered with the Labour Welfare Organisation. Later, all workers in the unorganised sector which constitutes 94 per cent of the country’s workforce will be brought under the scheme.

This is the first-of-its-kind scheme for the unorganised sector where the workers will also contribute a share. The ministry expects to bring a vast mass of the working population that has stayed outside the pale of the formal economy so far, under this scheme.

The scheme will be run by the labour ministry. Of the Rs 100 subscription per month, Rs 75 would be paid by the worker, while Rs 25 would be contributed through Labour Welfare Funds.

The government’s contribution for the pilot scheme covering two sectors is likely to cost around Rs 810 lakh annually. The funds will come from the labour ministry’s internal resources.

Workers of limestone, dolomite, iron/manganese/ chrome ore mines along with cine workers in the age group of 18 to 52 years, who are not already covered under a provident fund scheme of the government, are eligible under the scheme. Subscribers will be eligible for provident fund/pension at the age of 58.

�Workers will deposit the monthly premium in a designated post office/bank or with the Labour Welfare Organisation�s dispensaries. The money would be transferred to UTI which would act as the fund manager of the corpus created from the contribution from workers and government,� a labour department official said.

UTI will provide the members’ list to the Welfare Commissioners who will deposit the central government’s share, as a subsidy, with UTI periodically.

The worker would be eligible for a lump sum amount at the time of maturity, equivalent to the value of the units issued to him by UTI from time to time. An option for a pension scheme in lieu of the lump sum amount will also be provided to the worker.

The only other pension scheme for unorganised labour is the government’s proposal to pay Rs 200 per month to all below the poverty line (BPL) persons above 65 under the National Old Age Pension Scheme.

There is no structured contributory pension/provident fund schemes for workers in unorganised sector. So, the ministry is working on a scheme to provide old age security to this segment of unorganised workers.

As the scheme is contributory, a worker is free to join any other scheme as well. In case of default, the deposited money will not be confiscated and the member can rejoin the scheme later.

A member is eligible for pension only after attaining 58 years of age which will be paid through a bank or post office. If a worker wants to withdraw his money, he is free to do so but in such cases he will not get the pension and is only eligible to get his deposits and growth amount subject to deduction of 1 per cent exit load.

Background to Omnibus legislation for the unorganised labour based on a PIB Release

A survey conducted by the National Sample Survey Organization (NSSO), shows that the total employment in both the organized and the unorganised sectors in the country is 39.7 crore, of which 2.8 crore are in the organized sector and 36.9 crore (about 93%) are in the unorganised sector. Of this, 23.7 crore workers are in the agricultural sector and 1.7 crore are engaged in construction sector. Remaining workers are engaged in mining, manufacturing and services sector. On account of their unorganised nature, these workers do not get adequate social security and welfare.

Some welfare schemes are being implemented by the Central Government for specific occupational groups of unorganised sector workers such as beedi workers, non-coal mine workers, cine workers, handloom weavers, fishermen, etc. These are apart from the National old Age Pension Scheme and National Rural Health Mission. Some of the State Governments have also been implementing welfare programmes for certain categories of the unorganised sector workers. Some NGOs are also providing social security to certain categories of workers. Despite all these efforts, there is a deficit in the coverage of the unorganised sector workers in the matter of labour protection and social security measures.

THE MANDATE OF NCMP

In line with the commitment made by the United Progressive Alliance (UPA) Government in the National Common Minimum Programme (NCMP), the National Commission for Enterprises in the Unorganised Sector (NCEUS) was set up in September 2004 under the chairmanship of Dr. Arjun Sengupta as an advisory body and as a watchdog for the unorganized sector. The Commission has the mandate to examine the problems of the unorganized sector (also referred to as informal sector) and suggest measures to overcome them. The term of the Commission, which was initially fixed at one year, was extended to three years. The Commission has been assigned wide-ranging terms of reference. Being an advisory body, the Commission is supposed to submit its recommendations to the Government of India. An Advisory Board has also been constituted to enable the Commission to have the benefit of the advice of experienced persons in the relevant areas.

The Commission has been focusing on a few significant programmatic interventions, which could be adopted in the immediate term. These interventions are aimed at bringing about improvement in the productivity of enterprises in the unorganized/Informal Sector, generation of large-scale employment opportunities on a sustainable basis and enhancing the welfare of the workers in the unorganized sector.

COMMISSION’S FINDINGS

The Commission’s findings show that forty per cent of the workers in the unorganised agricultural and non-agricultural sector are wage workers and sixty per cent are self-employed. Among the self-employed, the overwhelming majorities are own account or assisting family workers and only 1.15 % (among non-agricultural workers) are employers.

The vast majority of the self-employed in the unorganised sector themselves work under poor conditions and the productivity of their enterprises is very low. Measures to protect the livelihood of the self-employed workers and to promote the productivity of the unorganised enterprises, will not only have an impact on the condition of the self-employed, but also on the condition of the unorganised wage workers who work in the unorganised enterprises. Thus, regulation of the condition of work of wage workers needs to go hand in hand with the protection and promotion of livelihood of the self-employed workers and enhancing the growth and productivity of the unorganised sector enterprises.

PROPOSED BILLS

The Commission had initially proposed a draft Bill “Unorganised Sector Workers (Conditions of Work & Livelihood Promotion) Bill, 2005” for comments and feedback. Based on the comments received from states, trade unions and other stake holders, the Commission revised the earlier proposal and has now proposed two Bills “Unorganised Non-agricultural Sector Workers (Conditions of Work and Livelihood Promotion) Bill, 2007” and the “Unorganised Agricultural Sector Workers (Conditions of Work and Livelihood Promotion) Bill, 2007” to cover unorganised agricultural workers and non-agricultural workers respectively. Part 1 of each of the Bills contains provisions relating to the regulation of conditions of work of wage workers. Part 2 of the Bill relates to the protection and promotion of livelihoods of the unorganised workers.

The Draft Bills provide for basic and minimum conditions of work for all unorganised wage workers and home workers. Instead of relying on bureaucratic implementation and costly and time consuming legal redressal procedures, the Commission has accorded priority to conciliation and has proposed the participation of workers’ representatives and elected representatives of the local bodies in the conciliation and dispute resolution committees.

The proposed Bills also mandate that the appropriate governments take the necessary steps to protect and promote these livelihoods through appropriate policies and programmes, and have provided for an institutional machinery to take a holistic view of the sector and to mobilise the necessary resources to help the sector overcome such constraints and facilitate its growth.

NATIONAL FUND

The NCEUS has proposed the formation of a National Fund designed to meet the multi purpose needs of both enterprises and workers in the unorganized sector. The tasks proposed to be handled by the Fund are extensive as the sector needs a holistic approach for its development taking into account all essential needs covering finance, technology, raw material, marketing, infrastructure, skill and entrepreneurship and would cover both farm and non-farm sectors and also rural and urban areas.

CABINET NOD FOR SOCIAL SECURITY

In a significant move the Union Cabinet on 24th May, 2007 gave its approval for social security for the unorganised sector workers. It said that the welfare schemes for workers in the unorganized sector would be introduced in a phased manner to fulfil the commitment made in the National Common Minimum Programme. Besides, the Government would constitute a National Advisory Board to design, from time to time, suitable welfare schemes for different sections of unorganized workers and recommend the same to the Government. On the recommendations of the National Advisory Board, the Central Government will, from time to time, notify scheme or schemes for one or more sections of unorganized workers.

Apart from designing model schemes for workers in unorganized sector, the National Advisory Board shall monitor the implementation of all notified welfare schemes; ensure that every eligible worker in the unorganized sector is registered and receives an identity card; oversee the record keeping functions performed at the district level and the State level.

The Cabinet also paved the way for a Bill to be introduced in Parliament as early as possible for this purpose. The Bill would provide for setting up a National Advisory Board and enable the Central Government to notify welfare schemes from time to time.

The Bill will also provide for constitution of a State Level Advisory Board by the State Government concerned.

The schemes notified by the Central Government will contain provisions for: (a) life and disability cover; (b) health benefits; (c) old age protection; or (d) any other benefit as decided by the Central Govt.

The procedure for registering the workers in the unorganized sector will be prescribed and implemented. Every worker in the unorganized sector shall be eligible for registration subject to the following conditions: (a) he/she should have completed 18 years of age; (b) he/she should make a self-declaration affirming that he/she is a worker in the unorganized sector.

Every registered worker in the unorganized sector shall be issued an identity card, which shall be a smart card. It shall carry a unique identification number and shall be portable.

The record-keeping agency for this purpose shall be the district administration and the record keeping function shall be performed by the District Panchayat in rural areas, and Urban Local Bodies in urban areas. This will be directed by the concerned State Governments.

These schemes and proposed Bill/Bills, if introduced, will go a long way to mitigate the plight of the unorganized workers in the country.

Public health in private hands? A note on the Public Health Foundation of India

2008-01-18T05:25:00.000-08:00

Speaking for Ourselves 221

MOHAN RAO, K. R. NAYAR

We live in a world of profound, and growing, inequalities. Changes in the global economy over the past three decades have been accompanied by dramatic reversals of health gains made in the post-Second World War period. While some countries have witnessed stagnation in health indices, others have seen dramatic declines. At the same time, what is termed the health divide—between rich nations and poor nations, and between the rich and poor within countries—is increasing remarkably. Thus, for example, the gap in the under-5 death rate, considered a sensitive indicator of social and economic development, has widened between the rich countries and the poor. The under-5 death rate gap increased from a ratio of 7.8 in 1978 to 12.5 in 1998. Similarly, the death rate ratio in the age group 5–14 years also increased from 3.8 in 1950 to 7 in 1990.

It is widely accepted that these widening health inequalities are the consequence of the imposition of the World Bank and International Monetary Fund (IMF)-led policies of structural adjustment and the accompanying health sector reforms around the globe. Over the same period, the role of the WHO has shrunk, with the World Bank increasingly setting the agenda for health. World Bank loans for one disease alone, malaria, exceed the entire budget of the WHO.

In addition to reducing state commitment to health, typically, these health prescriptions of the World Bank are committed to methodological individualism and to behaviourism; they do not recognize the structural factors that govern and contour the health or ecology of disease. As a result, interventions tend to be disjointed (oral rehydration solution [ORS] for diarrhoea rather than emphasizing on water supply and sanitation; focusing on anaemia in pregnancy, but not anaemia in the general population), and of a technical nature—what is referred to as the biomedical approach in public health. This has led to the growth of disease-centric vertical programmes. Globally—and reflected even in India’s National Health Policy 2002—it is recognized that one of the failures of health sector development in the past has been due to such vertical programme approaches. Assuming there is a grave fiscal crisis—which still seems to allow for subsidies to be given to the rich in a variety of areas—these prescriptions typically include fee for services. Again, the global experience has been that this excludes the poor from access to health services. Indeed, it is this explicit recognition that has led countries such as Zambia to do away with this policy prescription. What the package of prescriptions tends to do is to wrench apart comprehensive public healthcare, entrust profitable sectors of it to the private sector and enjoin the state to subsidize a minimum clinical package, which typically involves family planning.

The global experience with this approach to health sector development has been dismal, and not just in poor countries. In Russia, following the neo-liberal changes in the economy and the accompanying health sector reforms, between 1991 and 1994, life expectancy among men decreased by close to 7 years, from 63.6 to 57.5 years; among women the decline was close to 3 years, from 74.4 to 71.1 years. Such a decline in life expectations in populations not at war or suffering the onslaught of that other horse of the apocalypse, famine, is historically unprecedented. Accompanying the collapse of under-funded systems of healthcare, a booming private health system has emerged, along with a resurgence of old communicable diseases and hunger. Indeed, even in the USA, data on life expectancy by race, a crude indicator of inequality, shows increasing divergence between whites and blacks beginning in the Reagan years. The most telling data are from the UK that reveal increasing mortality differentials by class. The Black Report showed a substantial increase in mortality differentials by social class; the mortality rates among unskilled working-class men in 1981 were higher than they had ever been in the twentieth century, deteriorating after 1971.

This is despite the fact that developed countries spend much more on health than India does, not only in absolute per capita terms but also as shares of national income or public budgets. The UK spends 6% of its budget on health, India now less than 1%. In contrast, the USA spends 12% of its budget on health. The UK relies on universal coverage and a state-supported and -led National Health Service. It has better health indices than the USA despite spending less on health. In the USA, for instance, about 40 million people obtain no health coverage. Infant mortality rates (IMRs) and under-5 mortality rates (U5MR) are significantly higher than in the UK. This calls for re-thinking of some neo-liberal shibboleths such as the supposed inefficiency of the public sector and the greater efficiency of market-driven private behaviour. Sri Lanka offers an excellent example of state-led quality healthcare provision. In Sri Lanka, about 97% of inpatient care and 83% of outpatient care is in the public sector, where they have also integrated the so-called indigenous systems of medicine.

India is yet to achieve the National Health Policy 1983 target of reducing the IMR to less than 60 per 1000 live births. More serious is the fact that the rate of decline in the IMR, which was significant in the 1970s and 1980s, has markedly decelerated in the 1990s. The percentage decline in IMR between 1971 and 1981 was 14.7; between 1981 and 1991 it was even greater at 27.3. However, in the period 1991–99, there has been a stagnation, with the rate of decline in the IMR at 10%. Similarly, while there has been a decline in the U5MR, the pace of decline has come down and the U5MR is currently hovering around 95. During 1971–81, the percentage decline was 20.6. The decline was much sharper during the 1980s, with a percentage decline of 35.7. However, during the 1990s, with the onset of policies of liberalization, the rate of decline fell to 15.1.1

Other changes have been equally important. Interregional, rural–urban, gender and economic class differentials in access to healthcare in India are well documented. But since the onset of liberalization policies, these have widened considerably. The decline in public investments was matched by growing subsidies to the private sector in healthcare in a variety of ways.2 State support for private healthcare grew with the initiation of private–public partnerships that took a variety of forms. At the same time, there were far-reaching changes in drug policies. Thus India—earlier characterized by relatively low costs of drugs and pharmaceuticals, along with major indigenous production of drugs—has witnessed a greater concentration of drug production, a larger role for multinationals, a higher proportion of imported drugs and unbelievably steep rises in the costs of drugs.3 Concurrently, marked shifts have occurred in healthcare utilization. Among people who sought outpatient services in 1995–96, more than 80% did so in the private sector, a sharp increase in even the poorer states of the country.4 In 1995–96, 55% and 57% of people in rural and urban areas, respectively, were hospitalized in the private sector compared to 40% in 1986–87. The National Sample Survey (NSS) data indicate greater inequality in the use of health facilities by economic class gradients. In rural areas the class gradient in inpatient use of public hospitals—which was insignificant in the mid-1980s—turned statistically significant in the mid-1990s. In urban areas, inequality in the use of public facilities did not worsen significantly, but inequality in the use of private facilities did. The steep fall in rural hospitalization rates, along with increasing use by the better-off indicates that the poor are being squeezed out. Fee-for-services is undoubtedly one important mechanism that has succeeded in doing this. In other words, World Bank policies on health, contained in the influential World development report 1993 succeeded in doing exactly the opposite of what was ostensibly its raison d’être: reduce the utilization of public services by the better-off to increase access
to the poor.

Costs of both outpatient and inpatient care have increased sharply in both rural and urban areas, compared to the mid-1980s. Private outpatient costs increased by 142% as against 77% in the public sector in rural areas. In urban areas, private outpatient costs increased by 150% compared to 124% in the public sector. The increase in costs in inpatient care is even more striking: average costs rose by 436% in rural and 320% in urban areas.4 Thus, it is not surprising that, as the National Health Policy 2002 notes, medical expenditure has emerged as one of the leading causes of indebtedness.5 At the same time, the proportion of people not availing any type of medical care due to financial reasons between 1986–87 and 1995–96 increased from 10% to 21% in urban areas, and from 15% to 24% in rural areas.6

What we need is state-led support to primary healthcare in all its dimensions. Efforts to do so through the National Rural Health Mission appear diminished in vision, and totally lack a systemic perspective. It is also seriously underfunded. Thus, the need is to concentrate on strengthening the entire primary healthcare (PHC) system—which includes efficient referral systems to secondary and tertiary levels of care. State governments are facing huge financial problems in doing so. There are massive shortages of human resources such as public health nurses, auxiliary nurse–midwives, male multipurpose workers, etc. not to mention specialists. This is especially the case in states with poor health indices. Given the low financial outlays, a large part of the health budget goes towards salaries. Without resources, time, support staff and drugs to provide effective public healthcare, doctors lose motivation and seek alternative work. In this situation the PHC system offers little other than family planning and oral polio vaccination, driving people, the poor included, into the private sector. In this situation of state-led collapse of the public health structure, community initiatives are both inadequate and regressive. Accredited social health activists (ASHAs) cannot function in a dysfunctional healthcare system. A further drain on public resources is through knee-jerk initiatives such as increasing public–private partnerships (PPP) or ‘NGOization’.

It is against this backdrop that the effort to create a Public Health Foundation of India (PHFI) needs to be critically examined. This is apparently an autonomous institution with 15% of funds from the government and the rest from other sources. State governments are expected to provide land and other infrastructure facilities. The PHFI will create 5 new institutions for training in public health, commencing initially with 2 schools. We understand that recruitment of faculty has already commenced in schools of public health in the USA (the last date for applications was 9 March 2006, as per a circular to Deans and Assistant Deans of schools of public health in the USA; the PHFI was inaugurated on 28 March 2006).

There are a number of issues with regard to the new-found love for world-class ‘India-centric, India-relevant and tailored to India’ public health. It is apparent that dual systems of healthcare will now extend to dual systems of training in public health. This includes possibly dual salary structures, leading to internal brain drain.
The question that needs to be seriously considered is the system of public health that is now being considered worthy of emulation. As we noted earlier, one model of healthcare that should not to be emulated is the American model. It is not only much more expensive, but also leaves out substantial sections of the population. Indeed, it would not be an exaggeration to state that the aim of the American system of public health is the creation of markets in healthcare. Under the influence of such a system, the global industry in health has increased from US$ 396 billion in 1976 to US$ 786 billion in 1990.

It is in this context that one should examine the role of the Harvard School of Public Health, indeed, the American system of public health schools, in shaping public health education and research in India and in many other developing countries, including China. Scholars such as Hugh Leavell, Benjamin Paul, John Gordon, Carl Taylor, Theodore Ingalls, James Simmons and John Wyon, collectively known as the ‘Harvard group’, were instrumental in shaping the population control agenda with a neo-Malthusian bias in the early 1960s. The damage this has caused to health sector development in India is well known. Their enthnocentrism was evident when one of their influential studies concluded: ‘Westerners have strong feelings about the value of children not shared by Punjabi villagers.’7

However, perhaps more important is the shaping of the curriculum of Preventive and Social Medicine by scholars such as Carl Taylor who chaired the Department of Preventive and Social Medicine (PSM) of the Christian Medical College in Ludhiana. No doubt, at that time as well, the curriculum was India-relevant as it was based on the well-known ‘internship studies’ undertaken by the Harvard group. The approach was strikingly similar to colonial anthropology, that of studying the ‘natives’.8 A survey undertaken in 1959 of the teaching of PSM revealed that rural internship programmes were in serious trouble. It was found that rural health centres for training interns had evolved without proper planning. The major problems were inadequate staffing, equipment and accommodation. There was widespread apathy among the interns regarding the purpose of the programme. Following this, a project on rural orientation of physicians was undertaken on a request from the Minister of Health, Government of India by the PSM Department of the Ludhiana Medical College under the leadership of Carl Taylor. The project was funded through a PL-480 grant from the Bureau of Educational and Cultural Affairs of the United States Department of State. The study reinforced the internship approach by expanding the practical training over 4 levels of facilities: teaching hospitals, average district hospitals, teaching health centres and average health centres, and suggested the philosophy of ‘medical colleges without walls’. Despite such heavy foreign funding and American ‘wheat’ funding, the quality of public health teaching could not be salvaged.

The intervention of the Medical Council of India (MCI) and recommendations of the Srivastava Committee led to further shifts in the teaching of public health in medical colleges. The important shift was the introduction of the Reorientation of Medical Education (ROME) scheme in 1977. The objectives of the ROME scheme were to involve medical colleges in direct delivery of health services to the rural population as well as expose students to the rural environment. Some foreign governments even donated huge mobile clinics for rural areas under the programme, which of course did not serve the purpose since these large vans could not traverse narrow, unpaved rural roads. The ROME scheme was implemented initially in 25 medical colleges and was extended to all the medical colleges recognized by the MCI. It can now be safely asserted that the present poor state of PSM education in medical colleges in India and the failure to produce a ‘managerial physician’ could be attributed to the original sin committed in the 1950s. Further cosmetic changes did not succeed due to the poorly envisioned curriculum that continued to remain unattractive.

It is evident that without strengthening the existing public health teaching in medical colleges—there are 120 of them throughout the country at present—it will be impossible to create a ‘managerial physician’ who needs to provide effective leadership in the health services system. An elite-oriented public health education on such a large scale and in a vertical fashion may not achieve such an objective.

It appears that planners in India seek to bring back this variety of American-exported public health. Once famously described as a-theoretical, a-political and a-historical, this is now touted as a model for ‘high impact public health research’. It is also not accidental that many American and European schools of public
(one can see the table published in the original article at www.nmji.in/archives/volume_19_4_Jul_Aug_2006/speaking_for_myself/Public%20health.pdf)
health (based on the so-called ‘hygiene’ and ‘tropical’ medicine models) that have been cornering international research funds for ‘sanitizing’ and intellectually ‘colonizing’ many African countries are looking for new markets for their knowledge.

The PHFI initiative also aims to create a capacity to train 10 000 people per year in public health by offering long and short term programmes with multiple degrees such as certificates, diplomas, masters, doctorates, etc. Is this what India actually needs? If we look at the manpower requirement in rural primary healthcare, it becomes evident that most shortages are those of ‘low-level’ primary care staff such as nurses and male health workers (Table I). Can such high-profile institutes provide the personnel needed to manage primary healthcare services? There is no doubt that the duality in public health education will breed elitism and produce an unfit and unwanted class of professionals. What it will also do is produce public health staff for the First World, at a cheaper price. Currently 4000–5000 doctors trained at public expense emigrate every year, at an estimated cost of US$ 160 million to the Indian exchequer.9

It is also necessary to mention the role of private foundation funding in this whole process. For instance, the Bill and Melinda Gates Foundation is a major partner in PHFI. The ‘grand challenges’ proposed by the Gates Foundation have turned critical challenges in public health into a narrowly conceived understanding of health as the product of technical interventions divorced from the economic, social and epidemiological contexts.10 Six of the 14 grand challenges in public health relate to vaccine development. It is possible that such a narrow technology-driven vision of public health will be the paradigmatic basis of the grand new public health in future. Should such a public health orientation set standards and determine the accreditation of public health education in India as has been proposed through the PHFI? When the market starts dominating the discourse of public health, it will only undermine academic autonomy as is already the case in management education.11 Indeed, it will create a discipline based on the rules and games of the market including profits and student-customers who can buy such an education.

A further substantial part of the PHFI’s budget is to come from unspecified private sector contributions. This is even more undesirable as it will distort public health priorities even further towards profitable interventions alone. Examples are legion of private sector funding skewing research agendas and findings. Thus, for instance, the ban on routine inclusion of antibiotics in animal feed in order to reduce antibiotic resistance in the general human population, effected in England after the outbreak of bovine spongiform encephalitis (mad cow disease), has been bitterly contested by public health scientists in the USA on the basis of research funded by the animal foods industry.12

It is not our argument that public health training does not need strengthening or that institutionalized education in this matter is not necessary. Both are very important. However, before we set up new institutions at great cost—whatever the source of funds—we must examine what ails the existing system. India already has institutions such as the National Institute of Health and Family Welfare, the National Tuberculosis Institute, the All India Institute of Hygiene and Public Health and so forth—some of which did remarkable public health work in the past. There are, however, problems with many of these institutions, such as lack of funds, lack of autonomy and so on, which need to be dealt with. Without doing so, to start new institutions is not only undesirable, but in a situation of fund constraint, also hugely wasteful economically.

ACKNOWLEDGEMENTS
Our grateful thanks to Jayati Ghosh for her comments. She is, however, not to be besmirched by the weaknesses of our arguments—or infelicities in them.

REFERENCES

1. Misra R, Chatterjee R, Rao S. India health report. New Delhi:Oxford University Press; 2003.
2. Baru R. Private health in India: Social characteristics and trends. New Delhi:Sage; 1998.
3. Sengupta A. Economic reforms, health and pharmaceuticals. Economic Political Weekly 1996;31:3155–9.
4. Sen G, Iyer A, George A. Class, gender and health equity: Lessons from liberalising India. In: Sen G, George A, Ostlin P (eds). Engendering international health. Massachusetts:MIT Press; 2002:281–312.
5. Government of India, Ministry of Health and Family Welfare. National health policy. New Delhi:Ministry of Health and Family Welfare; 2002.
6. Government of India, Ministry of Statistics and Programme Implementation. Note on morbidity and treatment of ailments: NSS 52nd round (July 1995–June 1996). Sarvekshana 2000;XXIII:59–67.
7. Wyon JB, Gordan JE. The Khanna study: Population problems in rural Punjab. Cambridge, Massachusetts:Harvard University Press; 1971.
8. Qadeer I, Nayar KR. Politics of pedagogy in public health. Social Scientist 2005:33:47–75.
9. Voluntary Health Association of India. Report of the Independent Commission on Health in India. New Delhi:Voluntary Health Association of India; 1997.
10. Birn A-E. Gates’s grandest challenge: Transcending technology as public health ideology. Lancet 2005;366:514–19.
11. Editorial. Higher education: From politics to market. Economic Political Weekly 2006;XLI:669.
12. Walters MJ. Six modern plagues: And how we are causing them. Washington:
Island Press; 2004.

Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, New Delhi 110067, India. mohanrao@mail.jnu.ac.in

Published in VOLUME 19, NUMBER 4 JULY/AUGUST2006, The National Medical Journal of India

Public health needs a boost, not bickering

Speaking for Ourselves 224
K. SRINATH REDDY

Because things are the way they are,
things will not stay the way they are.
— Bertolt Brecht

It is difficult to disagree with passionate champions of public health such as Mohan Rao and Nayar. There is also no cause to disagree when they argue, in the initial part of their viewpoint exposition, that the social determinants of health and disease need to be identified and addressed through fundamental social changes that promote equity, access and affordability as essential characteristics of the health system. There is no dispute also when they argue for the strengthening of primary healthcare and affirm that it is governments that bear the major responsibility for ensuring the availability of healthcare to all sections of the people, through appropriately structured and adequately financed public health services.

There could be some minor differences, however, when they posit oral rehydration solution (ORS) and provision of safe water and sanitation as mutually exclusive public health programmes. While it is undoubtedly important to advocate, aim for and accomplish sustainable social promoters of health such as universal supply of safe drinking water, interventions such as ORS could still save thousands of young children who may fall victim to diarrhoea, till that salutary social objective is achieved. Obsession with technology should never drive public health polices or programmes, which need to address the determinants of health rather than merely attempt quick-fix solutions for disease. At the same time, public health should never shun appropriate use of suitable technologies to advance towards its goals.

Similarly, prevention and amelioration of anaemia in the general population, through policies for improvement of mass nutrition and creation of hygienic conditions where parasitic diseases are avoided, is a laudable and necessary objective. Till that goal is achieved, would not special attention to the detection and correction of anaemia in an especially vulnerable group of pregnant women, who run a high risk of pregnancy-related complications and death, serve a useful public health purpose? Public health needs a broad array of interventions which can make complementary contributions to create a comprehensive response to complex health challenges. An ‘either–or’ approachcan be self-defeating and may freeze the status quo till major social changes can successfully influence all of the social determinants.

However, my major area of discord with Mohan Rao and Nayar’s writing arises only when it strays from being a sound social critique, which it is in the initial section, to become a string of speculative comments on the role of the Public Health Foundation of India (PHFI) in the latter part of the article. The criticism of PHFI is based on assumptions that the PHFI Institutes would (i) follow an American model of education, (ii) produce public health professionals for an export market, (iii) create a cadre of elitist ‘managerial physicians’ distanced from primary healthcare, (iv) promote a technology-driven biomedical model of public health, and (v) result in neglect of existing public health training institutions.

None of the above assumptions are valid. The PHFI will mainly draw upon Indian experience and Indian expertise, while drawing up its curriculum and developing its learning resources. Future faculty would be drawn from available expertise in India and others trained abroad, in multiple reputed centres across the world. PHFI would establish academic partnerships with public health institutions from all regions of the world and access global learnings which are robust in academic content as well as relevant to the Indian context. Connectivity with public health institutions in other developing countries would be accorded a high priority. No exclusive relationship has been established with any American school of public health and each PHFI Institute will connect with a number of Indian and international partners. In the overall context of public health education, it is useful to draw upon the strengths of international partners, including American schools where appropriate, in core disciplines such as epidemiology, health economics, biostatistics and behavioural sciences. We should remember that American universities are also home to persons such as Amartya Sen, Noam Chomsky and Joseph Stiglitz, who are respected for their independent thinking and contributions to public discourse. Similarly, American universities also house many public health teachers and researchers who are not inimical to the interests of developing countries such as India. It is for us to evolve the models of education most relevant to us and engage with those who can help us in the areas of our identified needs. Countries such as Thailand, Iran and Bangladesh have much to teach us and we will learn from them, as we will also learn from institutions in Europe, North America and Australia.

Initially, the majority of those trained in the PHFI Institutes would be persons already employed in the State health services or health NGOs. The aim would be to add value to their role as serving functionaries in the health system. Simultaneously, efforts would be made to persuade states to create definitive positions for persons with public health expertise, so that even fresh graduates can be absorbed. The creation of a public health cadre has been recommended by several expert committees (Bhore Committee, 1946; Mudaliar Committee 1961; the Expert Committee on Public Health System 1996, constituted by the Government of India). PHFI would advocate for the creation of such a cadre, even while training existing physician and non-physician public health functionaries who are presently positioned in the health system. There would also be efforts to increase the absorption of public health professionals into the voluntary and private sectors in India. The purpose is to invigorate all components of the Indian health system with infusion of public health expertise.

Far from creating ‘elitist physician managers’, PHFI aims to provide multidisciplinary education and training to a wide range of public health resource persons. In a situation where neither nurses nor nutritionists have a major programme for training in public health and where public health law and public health engineering are rudimentary disciplines, PHFI hopes to evolve innovative models of education. Health management too would be an important educational stream, but only as one among several that PHFI would nurture.

In the present scenario, where are the programmes that can inform and influence sectors such as agriculture and urban planning to address public health needs? How many health economists are available in India to conduct policy-relevant studies and document the effects of distorted development on the health of the people, leave aside teach courses in this much-needed but almost non-existent discipline? At the grassroots, how many trained personnel are available for nationwide disease surveillance? Why are cause-specific mortality data not available for many common diseases? Training programmes are obviously needed at many levels and PHFI would try to facilitate them, along with other institutions.

The fact that PHFI derives a part of its initial funding from the Gates Foundation cannot be construed as evidence that its public health education programmes would have a tubular technovision. The broad-based education that PHFI envisages will encompass a clear understanding of the multiple determinants of health and provide the skill sets for undertaking multisectoral actions to advance public health. The Gates grant is an unrestricted grant and does not bind PHFI to any particular pattern of education or research.

PHFI is also committed to assist the growth of existing and other emerging public health training institutions in India. It would help to create a network of such institutions which can strengthen each other through sharing of technical expertise and conduct conjoint programmes in teaching and research. It must be recognized that the existing institutional strength in public health education and training is highly inadequate for developing human resources on a scale needed to transform the health services. If the present institutions were fully capable of delivering all that is required, why would the prevailing scene be so dismal both in terms of the available public health workforce and public health advocacy? Whether for advocating policy change or for implementing programmes, many more public health professionals are needed to generate and apply knowledge as relevant to public health goals.

Finally, it is misleading to suggest that PHFI has been created to place public health in private hands. The primary objective of PHFI is to strengthen public health services. The partnership with the Central and State Governments and their participation in the governance of PHFI and its institutes will ensure that the activities of PHFI are closely aligned to the priorities identified by the government and will readily respond to the needs of public health services. A number of State Governments have already communicated their interest in establishing such a close partnership. The voice of civil society would also be heard and heeded when it provides its inputs through various advisory bodies which would soon be established. It is only when public health continues to be neglected that the health of the people will be mostly transferred to private hands, by default. The PHFI’s mandate is to protect public health, not to undermine it.

To let the ‘status quo’ continue, because of false insecurity about new institutions or misplaced fears about hidden agendas, would be a grave disservice to the Indian people. To deliver an advance verdict of ‘guilt by suspicion’ on PHFI, even before it has started functioning, reflects neither natural justice nor scientific objectivity.

A new initiative should be judged neither by the best hopes of its friends nor the worst fears of its critics but by the reality of its activities as they unfold. It would be better for skeptics to closely monitor the activities of the PHFI, which is just born, and reserve their judgement till it opens its first Institute in 2008. It would be best, of course, if all well-meaning advocates of public health join hands and promote a sound framework for addressing India’s many health challenges.

Public Health Foundation of India, New Delhi, India; ksreddy@ccdcindia.org

Published in VOLUME 19, NUMBER 4 JULY/AUGUST2006, The National Medical Journal of India

Medicine prices up by 10%

2007-11-16T10:41:00.000-08:00

Prices of commonly-used medicines have gone up by nearly 10% every year for the last 10 years. This is much more than the country's inflation rate and higher than annual increase in income of the common man.

The drugs include popular antibiotics such as ampicillin, and painkillers like as paracetamol and diclofenac.

The study by drug watchdog, National Pharmaceutical Pricing Authority (NPPA), was carried out on the top 15 drugs. The medicines, which have recorded a 10% increase in prices every year are those, which are not under prices notified by the government.

This has happened even as the prices of bulk drugs (raw material) have been coming down drastically every year. Interestingly, in a sample covering top 15 drugs that were under government control, the annualized increase is only about 1%. The period under study in both the samples was over 12 years, from 1994-end till July 2007.

The study strengthens the government's case to increase its ambit of price control to cover 354 essential medicines from the existing 74 drugs. The issue — part of the draft pharma policy, was referred to a group of ministers. But this has not yet been finalised. However, the industry has a contrary view.

"Prices have gone up because of the higher transaction costs which include excise duty and margins to retailers and distributors," an executive with an industry player said.

The problem in the country is more to do with delivery, rather than high prices. Moreover, the industry needs to invest in research and development which requires massive investments, he added.

Not only have drug prices shot up, but cases of over-charging and selling without government approval have also been discovered. In about 660 samples of scheduled drugs (under price control) collected from 12 cities over three months this year, there have been prima-facie violations relating to charging more than the price decided by the government in nearly 60% of the cases.

The government is expected to issue notices to the companies that have been over-charging or selling without approval soon, official sources said. Over 2006-07, the drug watchdog received 83-odd complaints from 479 scheduled packs, of which a majority were related to over-charging, while a few were concerned with sale without government approval.

State governments have started throwing their weight behind the Centre, which is about to finalise a new drug policy allowing the government to fix prices of more drugs. Some states have told the Centre that drug makers who promised to reduce prices of 886 brands while negotiating a softer drug pricing formula with the government have delivered poorly on their commitment.

The feedback from state governments on the availability and pricing of medicines comes in the wake of a crucial meeting of a ministerial panel on the new policy, probably the final one, was scheduled for the first week of November. Possibility of early elections could encourage the group of ministers headed by Arjun Singh to take feedback from state governments seriously.

The Tamil Nadu government, for example, has conveyed to the Centre that none of the 886 formulation packs (brands in the form of a particular quantity of a medicine of a particular strength), on which leading companies have committed to reduce prices, are available in the state. Some states in the North East have said not more than three or four of these drugs are available in chemist shops there. The West Bengal government is understood to have told the Centre that only about 30% of these drugs are available in the state.

Interestingly, some companies have either modified their brand names or changed the pack size or the strength of the medicine, it is understood. The feedback from far-flung markets is expected to be a strong tool for the government while finalising a new pricing formula.

The drug industry feels the offer to lower prices of 886 formulation packs was made to persuade the government not to go ahead with its proposal to price control all drugs in the national list of essential drugs.

Drug price watchdog NPPA had recently asked companies to explain why they have not honoured their commitments. More importantly, it has asked them to explain the violations noticed in the case of these drugs.

Many brands on which they offered to slash prices were in the market without the mandatory government-fixed prices in the first place.

Economic Times, 25 Oct, 2007
The Times of India, Nov 14, 2007

Diabetes drug Avandia/Windia in danger zone

2007-11-16T09:51:00.000-08:00

The United States’s Food and Drug Administration has directed pharmaceutical major GlaxoSmithKline (GSK), a British based pharmaceutical, biological, and healthcare company.to put a “black box” warning on its diabetesdrug Avandia, stating that its use could cause chest pain or heart attack. Over two million people worldwide take the drug for Type-II diabetes.

Generic versions of Avandia — its scientific name is rosiglitazone maleate — are available under 10 brand names in India and sold to about eight million people. In India, GSK sells it under Windia brand name.

A “black box” warning is the FDA’s strongest warning, falling just short of withdrawing the drug from the market. The warning is made mandatory when studies indicate the drug carries a significant risk of serious or life-threatening side effects.

Concerns about Avandia’s safety started when a study in The New England Journal of Medicine in May reported that patients who used it had a 43 per cent higher risk of heart attack and a 64 per cent higher risk of dying of heart problems.

“We are keeping Avandia in the market because we have concluded that there isn’t enough evidence to conclude the risk for heart attack or cardiac ischemia is higher than for other Type-II diabetes drugs,” said the FDA’s Dr Janet Woodcock.

GSK will start a trial comparing Avandia with other drugs to see whether the cardiovascular risks are unique to it alone.

In India, no such warning on rosiglitazone has been issued by the Drugs Controller General Dr M. Venkateswarlu.

Rosiglitazone is popular here because besides regulating insulin and blood sugar, it is found to have a favourable impact on lipids (blood fats like cholesterol), coagulation (clotting) and fat in liver. It is a third-line drug prescribed after two lines of treatment — like sulfisoxazole and metformin — become ineffective. Many firms here were promoting it as a drug that prevents diabetes.

The lesson in this, says Dr Anoop Misra, head, department of metabolic diseases, Fortis Group of Hospitals, is that both physicians and patients should refrain from blindly accepting new medicines as cure-alls when existing therapies have been established to be equally effective.

“The mechanism for increased risk of death from heart attacks may be due to the adverse effect of rosiglitazone on lipids, particularly because of the increase in bad cholesterol by 18.6 per cent. The drug was claimed to ‘have a favourable effect on lipids’ when launched, which is a false claim,” said Dr C.M. Gulati, drug specialist and editor of the Monthly Index of Medical Specialities.

16, November, 2007
Hindustan Times

An unhealthy practice

2007-11-13T09:22:00.000-08:00

Four years after Mumbai-based Sun Pharmaceuticals was found unauthorisedly promoting and marketing letrozole, a drug prescribed for advanced breast cancer in postmenopausal women, for treating infertility in women, it has been cleared by the Indian Drugs Controller-General for that very purpose.

What is shocking is that this approval has come despite the drug, developed by the Swiss company Novartis, being clearly marked contra-indicative for infertility treatment and in t he absence of results from clinical trials that were designed and conducted properly. Since the drug approved in 1998 by the U.S. Food and Drug Administration was for treating advanced breast cancer, using the same drug for other purposes, would, by default, make it a new drug warranting full fledged clinical trials before regulatory approval.

While animal studies conducted by the original developer have found harmful effects on the foetus when the drug is administered during the period of organogenesis, trials are under way on women for treating infertility and a clear verdict is yet to be returned. In fact, many of these trials do not meet the stringent requirements of the U.S. FDA or the European Agency for the Evaluation of Medicinal Products.

That the approval by the Indian authorities was based on cursory studies and was not backed by sufficient domestic clinical trial data makes a mockery of the country’s drug approval system. While there are instances where off-label use of a drug has “led the way while industry and regulatory agencies trailed behind,” such uses were not for conditions for which the drug was originally found to be contra-indicative.

Though there are cases where drug manufacturers discourage the use of the drugs for unapproved conditions even when it has some desirable effects on patients, the way the Indian authorities have gone about approving letrozole leaves much to be desired.

The letrozole experience does not portend well for a country that expects to be seen as a preferred destination for clinical trials.

Editorial
The Hindu
13 November, 2007

Understanding Stem Cell Research -1

2007-11-12T10:35:00.001-08:00

On 8th November, 2007 the Indian Council of Medical Research (ICMR) and the Department of Biotechnology that has finalized extensive guidelines for embryonic stem cell research after five years of discussion submitted them to the Union health ministry. These guidelines have been prepared for public debate. It envisages two committees: a National Apex Committee for Stem Cell Research and Therapy and an Institutional Committee for Stem Cell Research and Therapy.

Earlier there was a “Ethical guidelines for Biomedical Research on HumanSubjects” issued by the ICMR in October, 2000. In 2004, ICMR had prepared a Draft Guidelines for Stem Cell Research/Regulation in India that has noted sources of stem cells as follows:

i) Adult stem cell : Derived from peripheral blood, tissue or bone marrow

ii) Cord Blood Cell : Derived from placenta

iii) Embryonal stem cells: Derived either from blastocysts or foetal tissues

Meanwhile, on 5 November, 2007, Kapil Sibal, Union Minister for Science & Technology laid the foundation stone for nation’s first Clinical Research Facility (CRF) for Stem Cells and Regenerative Medicine (CRF) on a five-acre site at Uppal in Hyderabad by the Centre for Cellular and Molecular Biology (CCMB) along with Nizam’s Institute of Medical Sciences. The Minister revealed that in aspects of embryonic and adult stem cell research more than 40 institutions and hospitals in country are involved and a Bill is planned to be introduced to provide incentives or 30 per cent of license fee as royalty to scientists to encourage them for research.

It is noteworthy that so far human cloning is banned everywhere. The UN General Assembly adopted the United Nations Declaration on Human Cloning, by which Member States were called on to adopt all measures necessary to prohibit all forms of human cloning inasmuch as they are incompatible with human dignity and the protection of human life on 8th March, 2005 by a vote of 84 in favour to 34 against, with 37 abstentions. World opinion is divided on the possibilities of therapeutic cloning. India is on the side of the partial ban.

It is significant to note that India had voted against the UN Declaration. However, the immediate issue facing the Indian policymakers is embryonic stem cell research that includes harvesting stem cells from embryos in order to treat diseases, such as Alzheimer’s, or diabetes, or even cancer, destroy, in the present state of technology, the embryos from which the cells are taken.Stem cells are obtained from foetuses, embryos, the umbilical cord and bone marrow.

Countries representing about 3.5 billion people have a permissive or flexible policy on human embryonic stem cell research and all have banned human reproductive cloning.

Can the logic of scientific progress be barred by concerns that are social and ethical in the matter of stem cell research?

Is it not always possible that a banned activity will go underground?

Should possibility of abuse prevent research leading to healing and greater knowledge?

Note: The Draft Guidelines for Stem Cell Research/Regulation in India were prepared by the Expert Group Members and Drafting Committee as mentioned below:

Expert Group Members
1. Dr. P.N. Tandon, New Delhi Chairman
2. Dr. S.S. Agarwal, ACTREC, Mumbai
3. Dr. N.K. Mehra, AIIMS, New Delhi
4. Dr. Dipika Mohanty, IIH, Mumbai
5. Dr. Y.N. Rao, DGHS, New Delhi
6. Ashwini Kumar, DCGI, New Delhi
7. Dr. Narayan Swamy, Dy. DCGI, New Delhi
8. Dr. Hari Gopal, DST, New Delhi
9. Dr. T.S. Rao, DBT, New Delhi
10. Dr. Alka Sharma, DBT, New Delhi
11. Dr. C.M. Habibullah, DCMC & Allied Hospitals, Hyderabad
12. Dr. U.V. Wagh, NCCS, Pune
13. Dr. Vinod Raina, AIIMS, New Delhi
14. Dr. Vineeta Salvi, KEM, Mumbai
15. Dr. Satish Kumar, CCMB, Hyderabad
16. Dr. G.R. Chandak, CCMB, Hyderabad
17. Dr. Ambika Nanu, AIIMS, New Delhi
18. Dr. S.G.A. Rao, Reliance, Mumbai

Drafting Committee

1. Dr. A.N. Bhisey, CRI, Mumbai Chairman
2. Dr. U.V. Wagh, NCCS, Pune
3. Dr. D. Mohanty, IIH, Mumbai
4. Dr. P.B. Seshagiri, IISc, Bangalore
5. Dr. M.G. Deo, Moving Academy, Pune
6. Dr. V. Salvi, KEM, Mumbai
7. Dr. S.S. Agarwal, ACTREC, Mumbai
8. Dr. K. Ghosh, IIH, Mumbai
9. Dr. V. Muthuswamy, ICMR, New Delhi Member Secretary

Will proposed Food Safety Agency undo the wrongs?

2007-11-12T03:44:00.000-08:00

Food Safety Agency is likely to be set up in India by the end of this year to set stricter standards and recall procedures after having attempted streamlining of food laws by enacting a new overarching food safety law in 2006 to create an agency along the lines of the US Food and Drug Administration. The Food Safety and Standards Bill, 2006 as passed by Parliament has been enacted from August 24. The President gave his assent to the legislation on August 23, 2006.

It is claimed that the enactment takes care of international practices in guiding and regulating persons engaged in the manufacture, marketing, processing, handling, transportation, import and sale of food. It seeks to serve the consumers’ interests through food safety systems. It sets scientific standards and transparency to meet the dynamic needs of the food trade and industry sector as also international trade practices in processed food.

The proposed Food Safety agency, envisaged in the Food Safety and Standards Act will set standards for pesticides, additives, supplements, organic food and hygiene for locally produced and imported food.

Contamination and adulteration of foods is a worrying commentary on the state of India's 100-billion-dollar food market, about a third of which is processed foods. India uses about 30,000 tons of pesticides a year, more than 60 percent of it on food crops. It is worrisome that food standards apply only when the food item is in market and not before that when they are in the agricultural field.

Most of the countries of the world, developed or developing are the members of Codex Alimentarius Commission. The Codex Commission while discussing the Strategic Framework and the Action Plan has emphasised the need to encourage developing countries to convene Codex Committee meetings periodically.

The Codex Committee on Food Hygiene (CCFH) is responsible for drafting basic provisions on food hygiene applicable to all food as well as for considering amendments if necessary pertaining to the provisions on hygiene contained in Codex Commodity Standard. The technical meeting of the CCFH is held every year. CCFH is one of the important committees whose deliberations have impact on Indian exports. It is considered useful that various segments of Trade and Industry be exposed to its deliberations. In view of this, the Ministry of Health & Family Welfare organised the 39th Session of the Codex Committee on Food Hygiene from 30th October – 4th November 2007.

Panabaka Lakshmi, Minister of State for Health & Family Welfare opined that food safety legislation alone is not enough to maintain a high quality of food hygiene. It must be complemented by efforts to improve the overall standard of education among consumers. This is a fundamental area where progress could easily be made by teaching basic food hygiene in schools and through the media.
Following the recommendations of an ad hoc panel chaired by India, the 39th session of the Codex Committee on Food Hygiene (CCFH), has agreed to take up the new work on the code of hygienic practices for fresh fruits and vegetables. The CCFH agreed that the US should take the initiative and set up an electronic working group for receiving comments and suggestions. The electronic working group would be open to all interested parties.
The 40th session of CCFH is scheduled to take place in the US in December 1-5, 2008. Guatemala, which expressed its desire to co-host the meeting, has been told to take up the issue with the US Codex Secretariat.
On the issue, the use of lifting the restrictions on the use of lactoperoxidase system (LPS) for milk and milk products in global trade, the 39th CCFH decided to refer the issue to the Codex Alimentarius Commission to clarify and explain that "restriction of the use of the LPS for milk in global trade in no way precluded the use of the system by countries at the national level."
The 39th CCFH also decided to work on proposed guidelines for control of Campylobacter and Salmonella spp in broiler (young birds), chicken meat, meat carcass, and portions. CCFH will also coordinate with the world organisation for animal health - OIE - which is working on the issue at the primary level. The FAO has also drafted a document on good practices for poultry. The CCFH has decided to finalise the proposed guidelines on basis of the code of hygienic practices for meat (CAC/RCP 58-2005) and where specific information on Campylobacter and Salmonella in birds other than broilers was lacking.
It was decided that "since the structure of the microbiological risk management metrics annex had substantially changed, there was no longer any need to develop an annex to the code of hygienic practices on liquid eggs."
The 39th CCFH noted the need to provide a more detailed scientific approach for the proposed draft on Listeria Monocytogenes in ready-to-eat foods. It deliberated on the proposed drafts on hygienic practices for powdered formula for infant and young children, validation of food safety control measures, conduct of microbiological risk management, and metrics.
The CCFH meeting was attended by Naresh Dayal, Secretary, Ministry of Health & Family Welfare, Debasish Panda, Joint Secretary, Ministry of Health & Family Welfare and Co-chairperson, Codex Committee on Food Hygiene, officials from the Ministry of Health & Family Welfare and representatives of WHO and FAO. Nearly 200 delegates from all over the world, both developing and developed countries participated in it.

The Codex Alimentarius Commission (CAC) was created in 1961/62 by Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO), to develop food standards, guidelines and related texts such as codes of practice under the Joint FAO/WHO Food Standards Programme. The main purpose of this Programme is to protect the health of consumers, ensure fair practices in the food trade, and promote coordination of all food standards work undertaken by international governmental and non-governmental organizations.

"Codex India" the National Codex Contact Point (NCCP) for India, is located at the Directorate General Of Health Services, Ministry of Health and Family Welfare (MOH&FW), Government of India. It coordinates and promotes Codex activities in India in association with the National Codex Committee and facilitates India's input to the work of Codex through an established consultation process.

Sustainability of Malaria Control efforts through Chemicals

2007-11-08T11:31:00.000-08:00

The annual incidence of malaria was estimated at around 75 million cases in 1953 with about 8 lakhs deaths annually. To combat this menace, the Government of India launched the National Malaria Control Programme in April 1953.

It proved highly successful and within five years the incidence dropped to 2 million.

The programme was changed to a more ambitious National Malaria Eradication Programme in 1958.

By 1961 the incidence dropped to a mere 50,00 cases a year. But since then the programme suffered repeated set-backs due to technical, operational and administrative reasons and the cases started rising again.

Malaria has now staged a dramatic comeback in India after its near eradication in the early and mid sixties.

During the period of resurgence of malaria, certain states like Uttar Pradesh, Bihar, Karnataka, Orissa, Rajasthan, Madhya Pradesh and Pondichery are found to be worst affected, particularly with increasing incidence of P. falciparum infection.

National Malaria Eradication Programme has been now renamed as National Anti Malaria Programme.

Malaria is an infectious disease caused by the parasite called Plasmodia. There are four identified species of this parasite causing human malaria, namely, Plasmodium vivax, P. falciparum, P. ovale and P. malariae. It is transmitted by the female anopheles mosquito. It is a disease that can be treated in just 48 hours, yet it can cause fatal complications if the diagnosis and treatment are delayed.

* Malaria affects more than 2400 million people, over 40% of the world's population, in more than 100 countries in the tropics from South America to the Indian peninsula. The tropics provide ideal breeding and living conditions for the anopheles mosquito, and hence this distribution.
* Every year 300 million to 500 million people suffer from this disease (90% of them in sub-Saharan Africa, two thirds of the remaining cases occur in six countries- India, Brazil, Sri Lanka, Vietnam, Colombia and Solomon Islands).
* WHO forecasts a 16% growth in malaria cases annually.
* About 1.5 million to 3 million people die of malaria every year (85% of these occur in Africa), accounting for about 4-5% of all fatalities in the world.
* One child dies of malaria somewhere in Africa every 20 sec., and there is one malarial death every 12 sec somewhere in the world.
* Malaria kills in 1 year what AIDS killed in 5 years. In 15 years, if 5 million have died of AIDS, 50 million have died of malaria.
* Malaria ranks third among the major infectious diseases in causing deaths- after pneumococcal acute respiratory infections and tuberculosis. It is expected that by the turn of the century malaria would be the number one infectious killer disease in the world.
* It accounts for 2.6 percent of the total disease burden of the world. It is responsible for the loss of more than 35 million disability-adjusted life-years each year.
* Every year ~ 30000 visitors to endemic areas develop malaria and 1% of them may die.
* Estimated global annual cost (in 1995) for malaria: US$ 2 billion (direct and indirect costs, including loss of labour).
* Estimated worldwide expenditure on malaria research: US$ 58 million, one thousandth of the US$ 56 billion spent globally on health research annually.
* Estimated annual expenditure on malaria research, prevention and treatment: $ 84 million.
* Estimated worldwide expenditure per malaria fatality: $ 65; as compared to $ 3274 for HIV/AIDS and $ 789 for asthma. That is to say, one HIV/AIDS death is equal to about 50 malaria deaths!

Malaria was nearly eradicated from most parts of the world by the early 60's, owing largely to concerted anti malarial campaigns world over under the guidance of the World Health Organization.

The following are some of the reasons for the resurgence of malaria:
Man made Complacency and laxity in anti malarial campaigns; conflicts and wars; migrations; deteriorating health systems; poverty
Parasite Drug Resistance
Vector Insecticide Resistance and ? ban on DDT
Environment Global Warming - increased breeding and life span of the insect vector
Jet Age Shrinking World - spread of malaria from endemic areas to all other parts of the world

1. Which chemicals are used to prevent Dengue-Malaraia? How they are harming environment and human being ?

Answer: Chemical Control measures for malaria prevention include use of Indoor Residual Spray with insecticides recommended under the programnme, use of chemical larvicides like Abate in potable water, aerosol space spray during day time and Malathion fogging during outbreaks. Although banned in developed countries, DDT is still being used in some developing countries to control malaria, but the debate is continuing.

Chemical control measures for Dengue prevention include larvicides, adulticides like Temephos (larvicides), an organophosphate, Pyrethrum (adulticide) and Malathion (adulticide) are used.

DDT residues remain in topsoil up to 7-8 cm and being immobile rarely contaminates ground water. Half-life of DDT residues in temperate soil is estimated to be 2-15 yr as against 6-14 months in tropical and subtropical soils. Similar is the case with other chemicals that enter our food chain.

DDT causes chronic liver damage cirrhosis and chronic hepatitis, endocrine and reproductive disorders, immuno suppression, cytogenic effects, breast cancer, Non hodkins lymphoma, polyneuritis.

Malathion and its oxygen analog malaoxon are both quite carcinogenic and have been linked with increased incidence of leukemia in mammals. Chronic health effects include: suspected mutagen and teratogen, delayed neurotoxin, allergic reactions, behavioral effects, ulcers, eye damage, abnormal brain waves and immuno-suppression. Contrary to what the public is being told by the Agriculture Industry and some governmental agencies, scientists are stating that Malathion (even at low levels) is in fact, a harmful chemical.

Chlorpyrifos is also used against mosquitoes. It has chronic neurobehavioral effects like persistent headaches, blurred vision, unusual fatigue or muscle weakness, and problems with mental function including memory, concentration, depression, and irritability.

Fenitrothion used against domestic insects and mosquitoes Human epidemiological evidence indicates fenitrothion causes eye effects such as retinal degeneration and myopia. Chronic exposure to Fenitrothion can cause frontal lobe impairment. Organo-phosphates are suspected of causing neurologic deficits.

2. What can substitute these chemicals ?

Answer: Biological Control measures for Malaria include use of larvivorous fish in ornamental tanks, fountains etc. and use of biocides.

Biological Control for Dengue includes use of larvivorous fish are recommended for control of Ae. aegypti in large water bodies or large water containers and Endotoxin-producing bacteria, Bacillus thuringiensis serotype H-14 (Bt H-14) has been found an effective mosquito control agent.

It is noteworthy that more effective and safer approaches to malaria control are now being used in many countries. For example, Vietnam reduced malaria deaths by 97% and malaria cases by 59% when they switched in 1991 from trying to eradicate malaria using DDT to a DDT-free malaria control program involving distribution of drugs and mosquito nets and widespread health education organized with village leaders. Mexico phased out DDT use in 2000 and implemented a successful integrated and community-based approach.

3. A number of people lost their lives due to this. why government is not banning the use of these chemicals?

The restriction permits indoor residual sprays of DDT in malaria control as per the WHO specifications for its production and following safety precautions for its proper use and disposal. Phasing out of DDT is delayed till an effective, affordable and safe alternative is available. In such a backdrop, the strong recommendation of WHO for indoor use of DDT to fight against malaria in September, 2006 that gave a clean bill to use of DDT to combat malaria where he vectors are still susceptible to DDT is believed to be the result of corporate influence especially from the pesticide industry.

The traditonal malaria control strategy has been the spraying of insecticides. Spraying of insecticides (DDT, HCH, Malathion)

As to Malathion, there are two types of malathion that can be used in medical health effects research. One is the "purified form" (which is approximately 99.9% malathion) and the other is called "technical grade" (which is approximately 96.5% malathion). The technical grade is approximately 10 times stronger in causing death to laboratory animals.

Perhaps the most sensitive of all forms of wildlife to exposure to malathion are the "dwarf lizards." These reptiles perform a service consuming significant amounts of other small insects. Lizards were exposed to malathion at levels of only 1 milligram of malathion per kilogram body weight (mg/kg) - 2 mg/kg - and 3 mg/kg. Each dosage caused significant damage to the animal's livers, kidneys, and small intestines. Note, these exposure levels are extremely small as the amount needed to cause death in most mammals is well above 500 mg/kg.

The researchers concluded by stating "Uncontrolled use of malathion or related compounds will certainly endanger not only the lives of lizards but also affect food chain and ecological balance of nature negatively."

The currently used pesticides globally cause about 20,000 deaths annually by accidental and deliberate/intentional poisoning. Unsafe spraying practices, hazardous transport, lack of storage, leakage to agriculture and poor disposal of waste etc. are major unaddressed issues.

4. what are environmentalist doing against this ?

As a result of the campaign by environmentalists, India is a signatory to Stockholm Convention on persistent organic pollutants (POPs) that has identified DDT as one of the 12 POPs that are banned. But DDT ban has certain restrictions applicable to countries for its continued use. the ban exempts its use in public health emergencies like outbreaks of malaria.

Environmentalists are arguing with the policymakers saying that resurgence of malaria calls for paradigm shift from the insecticidal to the ecological approach such as free or low-cost access to neem oil. Research shows that the natural pesticide "pyrethrum" has characteristics which make it especially effective for eliminating biting mosquitoes without harming the environment or public health.

Beware of Fifth Columnists !

2007-10-31T08:38:00.000-07:00

Beware of Fifth Columnists (Mir Zafars, Jai Chands)!

We are witnessing verbal gymnastics in full swing in the JNU campus as elsewhere. While observing different point of views of various outfits, one is concerned over the attempts of some outfits to ‘mis-diagnose’ the reasons of ill-health and health inequality in India. Why no one has raised this issue so far?

The propaganda, while putting the blame on politicians, takes pain to glorify (a) the role of “western medicine and a status quoist profession of doctors”, (b) the charitable “medical camp approach” and (c) to self-perpetuate its own tribe. Irrespective of the political ilk of these outfits, the fact that they are an outcome of promoters of corporate interest that legitimizes contract system for workers is revealing enough. These outfits end up supporting the main beneficiaries (and exploiters) and ignore the mushrooming of exploitative clinics in cities at the cost of both the urban poor and the rural poor. Don’t we know who these collaborators are who end up supporting contract work regime?

The nexus between medical professionals and pharma companies is an established fact. What is worse is that both the urban poor and rural poor are being administered outdated, harmful, banned and spurious drugs. India remains one among the few third world countries that connives at the ongoing inhuman practice of guinea pig medical experiments on poor people for foreign firms. Do the outfits have remedy for this menace?

The damaging impact of these male dominated professionals on ill heath and health inequality in India is well documented in academic literature. There is a promise of working for Health for all. While the promise of universal health care is worth struggling for, it gives a sense of déjà vu. Didn’t the National Health Policy, 1983 had this as its target? After failing to meet the target, instead of working towards overcoming the admitted failure, the National Health Policy 2002 changed the target. Is there any reason to believe that the outfits who make this promise will not do the same?

While the aim for 24 X 7 medical facilities is understandable, their use of medical facility as the route for achieving health for all is deceptive. Is “medical facility” and “health for all” one and the same?

Some of these outfits are glaringly one dimensional with their obsession with single issue. Far-reaching structural changes in the land-tenurial system and institutional reforms for the educational and economic upliftment of the weaker sections of society are required but these outfits have not even taken note of it. Is sloganeering sufficient to bring equality even as the country is getting infested with at least 36 billionaires whose combined wealth is one-fourth of India’s GDP? All contemplative minds must remain ever vigilant about the various shapes and sizes of the fifth columnists in the campus and even in their own outfits.

-public interest release
(Gopal Krishna, 47 Brahmaputra and M. Kumaran, 163 Tapti)

new anti-pregnancy vaccine not a magic solution

2007-10-26T21:37:00.002-07:00

Note: "There is an urgent need for health and family welfare services as acknowledged by the National Population Policy of 2000. Without meeting this existing need, to think of magic bullets is absurd. What we need is safe, effective, user-friendly and user-controlled contraception and not something which has huge potential for misuse in India's target-driven family planning programme."

-- Mohan Rao, professor, Centre for Social Medicine and Community Health, Jawaharlal Nehru University and member of the National Population Commission in Outlook, October 29, 2007

Immaculate Injection?

A new anti-pregnancy vaccine may yet be a trusted contraceptive

* Clinical trials in the early 1990s led to protests from women's groups. The project was shelved.
* Revived after a genetically modified antigen was developed last year
* The vaccine generates antibodies that do not allow the uterus to be readied for the embryo
* Critics say focus should be on safer and user-controlled contraceptions like condoms
* The vaccine does not protect against sexually transmitted diseases

***
It was a pathbreaking medical project that once fell victim to its own side-effects: coming in the form of ethical doubts and partisan ire. Now, clinical tests of one of India's most ambitious and controversial vaccines to prevent pregnancy have been relaunched, with the Indian Council of Medical Research expressing interest in a new version of the vaccine. Currently, it is being tested on mice and will later be tested on women volunteers. Work on the first form of the vaccine was shelved over a decade ago because of limited success. The clinical trials in Delhi and Chandigarh had also come in for sharp criticism from women activists who alleged that those tested were not informed volunteers and that the vaccine had possible side-effects.

But it has now been revived after a genetically engineered version of the human chorionic gonadotropin (HCG) vaccine was developed last April by G.P. Talwar, director of the New Delhi-based Talwar Research Foundation. A former director of the National Institute of Immunology (NII), Talwar conceived of such a vaccine in the late 1970s and worked on it through the '80s and early '90s.

About a month back, an ICMR task force met to study the data produced by Talwar and his team from tests conducted on mice at NII. "The data showed that all the mice administered with the vaccine had produced promising levels of antibodies. We have now asked Talwar to generate more data using mice of different genetic backgrounds," Indira Nath, chairman of the ICMR task force, told Outlook.

The project also got a boost following Manmohan Singh's visit to the US in March 2005, when an Indo-American forum on contraception expressed its interest. "I had forgotten about this project," admits Talwar. "Then the Americans came asking about its progress, claiming even women there wanted such a vaccine." The project is now being supported by the central government's department of biotechnology.

The vaccine works by generating antibodies that neutralise HCG, a hormone secreted by pregnant women. HCG plays a critical role in ensuring pregnancy, as it readies the uterus for the embryo to be implanted. Devoid of the hormone, the uterus rejects the embryo, thus preventing pregnancy. However, this effect is reversible because the antibodies generated by a single dose of the vaccine lose their effect over time and allow the HCG hormone to resume its normal function. A woman who wishes to remain immune to pregnancy for longer periods would therefore need to take booster doses.

The current form of the vaccine differs from its older version in that it uses genetically engineered HCG unlike the earlier version, which used HCG purified from the urine of pregnant women. The HCG is fused with alien substances (like tetanus toxoid) that alter its properties and also act as carriers, provoking the body to create antibodies to HCG.

"The vaccine can now be industrially produced and at much cheaper rates than it could be with the earlier form," Talwar says. The vaccine in its present form will also have to be injected, but work is on to develop an alternative which can be orally consumed.

But before the vaccine reaches the market, like all drugs and vaccines, it too will have to clear several efficacy and toxicology tests.It will also have to be tested on women. Talwar declined to set a deadline to his project. "Why should I? No scientist can say when his work is going to end till it actually ends. All I can say at this stage is that the vaccine is on its way and that the progress is encouraging." This vaccine, if released to the public successfully, may have a lasting impact on the market for contraceptives.

Women at a family planning centre

But not everyone is as enthusiastic about the vaccine as Talwar and his colleagues. Notes N.B. Sarojini, a health activist with Sama, a Delhi-based women's health group that is opposed to the project: "Vaccines are supposed to fight infectious diseases, not pregnancy, which is a normal function of the human body. It may also cause auto-immune disorders, like allergies or hypersensitivity. It also does not offer protection against sexually transmitted diseases."

Incidentally, the earlier form of the vaccine had its limitations since only 60 to 80 per cent of the women generated the required level of antibodies (50 nanogram/ml of blood) to prevent pregnancy. Moreover, human trials of the vaccine, conducted in aiims and Safdarjung Hospital in New Delhi and pgimer in Chandigarh, generated controversy. Talwar and his team were accused of not taking informed consent from the participants and experimenting on lactating women. Talwar says this in his defence: "These accusations have no scientific basis. Why would I use lactating women in any case? The protocol never stated we would test it on them because they do not have menstrual cycles and are naturally protected from pregnancy. As for informed consent, the whole protocol was approved by the drug controller and trials carried out in reputed institutions. And for those who would still like to see, the records are available with NII."

Talwar says the vaccine offers an "ideal" family planning tool compared to those currently in use. "People often opt for surgery (vasectomy or tubectomy) at a late stage in life after having many children. Again, intra-uterine devices often cause bleeding and that is unhealthy because most women in the country are already on the margin of anaemia. And as for steroid-based contraceptives, they stop a woman from ovulating normally," he points out. According to him, the HCG vaccine's effect can be reversed, it does not harm the normal physiology of a woman and does not demand a day-to-day intake.

However, the very search for a 'magic solution' has its critics. Says Mohan Rao, professor at Jawaharlal Nehru University's Centre for Social Medicine and Community Health and member of the National Population Commission: "There is an urgent need for health and family welfare services as acknowledged by the National Population Policy of 2000. Without meeting this existing need, to think of magic bullets is absurd. What we need is safe, effective, user-friendly and user-controlled contraception and not something which has huge potential for misuse in India's target-driven family planning programme." Clearly, from conception to consensus, the vaccine has some distance to travel.

DEBARSHI DASGUPTA
Outlook, October 29, 2007

National Family Health Survey - III Released

2007-10-20T04:31:00.000-07:00

More than half the women in the country are anaemic and one in three child is underweight.

"Anaemia is disturbingly common among adults. 55 percent of women in India are anaemic and 43 percent of kids below the age of three are underweight," reveals the final report of the National Family Health Survey - III (NFHS-3), released on 11th October.

The 2005-06 National Family Health Survey (NFHS-3) is the third in a series of national surveys; earlier NFHS surveys were carried out in 1992-93 (NFHS-1) and 1998-99 (NFHS-2).

Anaemia among pregnant women during that period has also increased. Even though men are much less likely than women to be anaemic, anaemia levels in men are at around 24 percent," the NFHS survey revealed.

The findings showed that malnutrition continues to be a significant health problem for children and adults in India.

"There has been very marginal change in the percentage of children who are underweight. From 43 percent underweight children in 1998-99 to 40 percent in 2006."

NFHS-3 also found high prevalence of anaemia - 70 percent in children aged 6-59 months. Anaemia is primarily linked to poor nutrition.

"Women and men suffer a dual burden of over nutrition and under nutrition. More than one third of women are too thin, while 13 percent are overweight.

"One-third of men are too thin, and 9 percent are overweight or obese. The states with the largest percentage of overweight women and men are in Punjab, Kerala, and Delhi, especially among the more educated," the survey pointed out.

All three NFHS surveys were conducted under the stewardship of the Ministry of Health and Family Welfare, Government of India, with the International Institute for Population Sciences, Mumbai, serving as the nodal agency. ORC Macro, Calverton, Maryland, USA, provided technical assistance for all three NFHS surveys. NFHS-1 and NFHS-2 were funded by the United States Agency for International Development, with supplemental funding from UNICEF.

NFHS-3 funding was provided by the United States Agency for International Development, the Department for International Development (United Kingdom), the Bill and Melinda Gates Foundation, UNICEF, the United Nations Population Fund, and the Government of India. Assistance for the HIV component of the NFHS-3 survey was provided by the National AIDS Control Organisation and the National AIDS Research Institute.

In NFHS-3, 18 research organisations conducted interviews with more than 230,000 women age 15-49 and men age 15-54 throughout India. NFHS-3 also tested more than 100,000 women and men for HIV and more than 200,000 adults and young children for anaemia. Fieldwork for NFHS-3 was conducted from December 2005 to August 2006.

Setting a precedent for trafficking hazardous waste

2007-10-17T09:12:00.000-07:00

By every rule in the book, this ship, carrying asbestos waste and radioactive elements, should not be in Indian waters, let alone be beached. And yet, despite well-premised objections, the central government persuaded the Supreme Court to rule that Blue Lady be dismantled at Alang.

On 6 September and 11 September, two related judgments in the matter of shipbreaking and hazardous waste were issued by the Supreme Court of India. The Division Bench of Justice Dr Arijit Pasayat and Justice S H Kapadia delivered both the orders. This was the same Bench that was seized with the Le Clemenceau case. The first order is a general order on the issue of ship-breaking. The second order was with specific reference to status of the Blue Lady (formerly SS Norway) -- a ship with known dangers: asbestos and radioactive material, and without clear papers -- currently beached at the Alang shipyard in Gujarat. This order gave a go ahead to dismantling of the Blue Lady.

Dismantling the Blue Lady exposes the mostly Bhojpuri and Oriya speaking causal and migrant workers and the villagers of Bhavnagar panchayats near Alang to toxic exposures. It also threatens their source of livelihood -- fishing due -- to marine pollution. By the government's own admission - a report of technical experts on shipbreaking -- the underground water in Alang is heavily polluted. The ship-breaking industry is already known to have a higher accident rate (2 workers per 1000) than the mining industry (0.34 per 1000). This is considered the worst in the world, and 16 per cent of workers here are suffering asbestos related diseases.

In its order on 11 September, the Honourable Supreme Court advanced "The concept of "balance" under the principle of proportionality applicable in the case of sustainable development…" and ruled that: "It cannot be disputed that no development is possible without some adverse effect on the ecology and environment, and the projects of public utility cannot be abandoned and it is necessary to adjust the interest of the people as well as the necessity to maintain the environment. A balance has to be struck between the two interests. Where the commercial venture or enterprise would bring in results which are far more useful for the people, difficulty of a small number of people has to be bypassed. The comparative hardships have to be balanced and the convenience and benefit to a larger section of the people has to get primacy over comparatively lesser hardship."

The apex court ruled this way even though it also did not dispute that the entry of Blue Lady in Indian territorial waters and its continued presence since June 2006 was itself in violation of court's own order of 14 October 2003. It was also in violation of the Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal, and a number of other international environmental and labour conventions and treaties -- that govern the breaking of contaminated ships - to all of which India is a signatory.

In the 11 September order, the honourable justices refer to former the Attorney General of UK saying, "In his Keynote Address, on 'Global Constitutionalism', reported in Stanford Law Review vol. 59 at p. 1155, Lord Goldsmith, Her Majesty's Attorney General (UK), stated that British Constitution though unwritten is based on three principles, namely, rule of law, commitment to fundamental freedoms and principle of proportionality. European Convention on Human Rights ("ECHR") also refers to the concept of balance."

The 21-page keynote address of Lord Goldsmith has this paragraph that has been referred to in the apex court's order. It reads as follows: "The third principle is that of proportionality. One of the key themes of the ECHR is the concept of balance. The Convention took its lead in this respect from the Universal Declaration of Human Rights-and in particular, article 29 which expressly recognises the duties of everyone to the community and the limitation on rights in order to secure and protect respect for the rights of others. Under the Convention some rights are absolute. They are so fundamental that there can be no compromise on them. We take the view that the prohibition on torture is simply nonnegotiable. I regard the right to a fair trial as another of those fundamentals. That is why we have rejected reducing the burden of proof for terrorism offences and allowing secret evidence in terrorism trials."

It is shocking to note that Goldsmith's speech in question does not appear at all to be relevant to the plight of workers, villagers, environment, ship-breaking industry, steel or hazardous wastes management. Therefore, it cannot be a convincing rationale for knowingly letting a most vulnerable workforce and communities suffer from asbestos and radioactive exposure that will arise from breaking up the Blue Lady.

Verified threat of hazardous waste on-board - radioactive elements

The bench granted permission for the dismantling based on the submission by Gopal Subramaniam, the Additional Solicitor General, to the effect that the ship does not have any more radioactive material and beaching is irreversible. But contrary to the recommendations of the Technical Experts Committee on Hazardous Wastes relating to Ship-breaking, Gujarat Pollution Control Board, Gujarat Enviro Protection and Infrastructure Ltd, (GEPIL) and the ship's current owner Priya Blue Shipping Pvt Ltd., the ship does contain radioactive substances at thousands of places.

In the order passed the apex court merely states, "There was also an apprehension rightly expressed by the petitioner regarding radioactive material on board the vessel Blue Lady. Therefore, an immediate inspection of the said vessel beached at Alang since 16.8.2006 was undertaken by Atomic Energy Regulatory Board (AERB) and by Gujarat Maritime Board (GMB). The apprehension expressed by the petitioner was right. However, as the matter stands today, AERB and GMB have certified that the said vessel Blue Lady beached in Alang no more contains any radioactive material on board the ship."

What changed?

A perusal of the report of the inspection undertaken on 14 August 2007 shows that the entire inspection of 16 floors of 315 meter long ship seems to have been completed within a period of 4 hours (a commendable task no doubt) and the report states that they could detect only 12 smoke detectors containing Americium 241. Having found these 12 smoke detectors containing radioactive materials, the report concludes that the ship "now, does not contain any radioactive material on board".

In my petition, I had referred to a letter sent by one Tom Haugen (who had been the Project Manager for Engineering, Delivery, Installation, Commissioning and later services and upgrades as regards Fire Detection Installation Systems on-board the Blue Lady). Haugen had written to Meena Gupta, Chairman of the Technical Experts Committee (by virtue of being the Secretary at the Ministry of Environment) that the fire detection system on the Blue Lady contained 5500 detection points which included 1100 ion smoke detectors that use radioactive elements composed of Americium 241. Further, in a separate letter to the Prime Minister dated 19 September 2007, Haugen has reiterated the fact about the enormity of radioactive material on the ship given that he himself supervised its installation.

Countering the AERB-GMB report that that ship did not contain any radioactive material after their inspection, Haugen wrote that in most cases, the fire detection systems are not labeled or indicated in any way, as they are typically 'buried' out of sight. According to Haugen, due to the risk of hazardous radioactive exposure, they should only be handled by professionals or certified technicians. "The system and its detectors are very subtly placed and virtually completely hidden in most parts, so it is totally understandable that a non-expert team might miss it during a broader inspection of the vessel," wrote Haugen.

In fact, even though the Technical Experts Committee had put in its 2006 report that there was no radioactive material on the ship, one of the Committee's members Dr Virendra Misra of the Industrial Toxicology Research Centre, Lucknow, had disagreed with the findings. He wrote that, "Presence of radioactive materials should be ascertained well in advance. Though it is mentioned in the report that radioactive material is not available, in my opinion there is possibility of the presence of radioactive materials due to existence of liquid level indicators and smoke detectors on the ship." This was ignored by TEC's then chairman, Prodipto Ghosh. The final report of the Technical Committee was signed by only Ghosh. All of this is in the records of the apex court.

But Additional Solicitor General Subramaniam persuaded the apex court to rely on the report of the Prodipto Ghosh-led Technical Experts Committee. (Ghosh was Secretary at the Environment Ministry and Chairman of the Committee. He has since retired, and his post has been taken over by Meena Gupta.) This is a report that had submitted that there is no radioactive material on the ship, as noted earlier. But following the submission of Tom Haugen's letter to the apex court and our request to the AERB, the AERB team inspected the ship. As noted earlier, it concluded that there are only 12 equipments that have radioactive material in it. Subramaniam was then compelled to partially admit in the hearing to the presence of radioactive material on Blue Lady. But the fact is that there are still over one thousand such equipments in the ship and Haugen has the diagram showing the locations of the equipment.

Verified threat of hazardous waste on-board – asbestos

On the asbestos present in the ship, the court also heard ingenious arguments advanced by the learned Additional Solicitor General Subramaniam that, "In the present case, the vessel does not contain single kilogram of asbestos and/or ACM as cargo". It had never been the stand of the plaintiff that asbestos or Asbestos Containing Material (ACM) was being sought to be brought in as cargo. Asbestos is already built into the ship's structure.

The question of differentiating between inbuilt material carrying asbestos and asbestos cargo had infact already been addressed by a Parliamentary Committee. The Parliamentary Committee on Petitions, on 17 August 2007, issued its report in response to the matter being raised in Lok Sabha by Basudev Acharya (CPI (M), Bankura, West Bengal). Acharya, a senior parliamentarian, had petitioned the Committee, arguing that Blue Lady's entry violates India's sovereignty. Incidentally, the Environment Ministry did give oral evidence before this Committee, but did not disclose the radioactive content of the ship.

The Parliamentary Committee, chaired by Prabhunath Singh (MP-Janata Dal (United), Maharajganj, Bihar), in its response, noted that it was extremely concerned that the ship contains an estimated 1240 MT of ACM and about 10 MT of PCBs as inbuilt material and as a part of its structure. The committee recognised that asbestos fibers when inhaled or when the PCBs on-board are consumed by human beings, the same may cause cancer unless proper precautions are taken for safe handling of these materials by the workers. The report then got into issue of asbestos in the cargo vs. structure, virtually indicting the government: "The committee strongly deprecate (sic) the repeated stand taken by the ministry that since no hazardous waste have been allowed on boards as cargo, there is no violation of the Hon'ble Supreme Court directions. The Committee need not emphasize that hazardous waste whether as cargo or inbuilt material are equally detrimental to the environment and to the human health."

Earlier Kalraj Mishra (MP-BJP, Lucknow), member of the Parliamentary Committee on Industry, had asserted that the French ship Le Clemenceau was sent back, and the Blue Lady, being 50 times more toxic than the Le Clemenceau, should therefore also be sent back.

It appears that the Supreme Court has accepted that 85 per cent of the asbestos, contained in the form of wall partitions, ceilings and the roofing in rooms and galleries in the ship, did not pose a risk if those parts were removed without damaging them. But no mention seems to have been made as regards the balance 15 per cent of the asbestos contained on the Blue Lady, which in itself would come to 186 metric tonnes. Removal of this asbestos is bound to cause grave risks of asbestosis, mesothelioma, lung cancer and other related illnesses to workers.

In my petition, I brought to the notice of the apex court that asbestos waste is banned in India and asbestos itself is banned in some 45 countries and even the World Trade Organisation had passed a verdict against it because of its carcinogenicity at every level of exposure. There is indisputable evidence that safe and controlled use of asbestos is impossible. Despite this, the Additional Solicitor General Subramaniam argued, "Safe use and controlled use of asbestos is possible in India." He said that asbestos waste in the structure of the ship was not hazardous and asserted that asbestos waste is banned in India but that applies to 'virgin' asbestos waste!

The Hon'ble Supreme Court has not yet dealt with the application filed by Bhagvatsinh Haluba Gohil, Sarpanch, Village Sosiya, Tehsil Talaja, and District Bhanvnagar on behalf of 30, 000 villagers and 12 panchayats of Bhavnagar district of Gujarat. The villages are in the vicinity of Alang ship-breaking yard. They sought directions asking the court to "direct that the ship named "Blue Lady" (SS Norway) be not allowed to be dismantled at the Alang Ship-breaking yard." The villagers have argued that "The dismantling of the ship would have hazardous effect on the residents of the villages near the Alang ship breaking yard as the ship contains large amount of asbestos which, when exposed is hazardous to the health of the residents living in the twelve villages."

In August 2006, an acclaimed scientist, a former Union Minister, Prof M G K Menon, and the Chairman of the Supreme Court's High Power Committee on Hazardous Wastes, had written to the Chief Justice of India and argued that the Blue Lady should be sent back to Malaysia or Germany from where it had come without decontamination.

Faulty argument on a beached ship not being refloatable

There's more. Allen Todd Busch, Vice President and General Manager, Titan Salvage, a Crowley Company, and one of the largest and most respected salvage companies, also wrote to the Prime Minister. He said, "The primary reason the court has ruled in favour of breaking the vessel, in its current position, is because there is a belief that the vessel can not be removed from where it now rests." Busch disagreed with that premise. He wrote that his firm had the capability and expertise to refloat the vessel. "Please allow us to present to the Prime Minister and India's Court our credentials, history and experience that there is actually very high probability that the BLUE LADY is not at all in an "irreversible" position, as the esteemed Court has found," wrote Busch. Also the firm Aaage Anderson, which was involved in the Le Clemenceau case, has said in a technical memo that the Blue Lady can be refloated.

Even as it was becoming clearer that the Blue Lady (SS Norway, SS France) can be sent back, the Additional Solicitor General Subramaniam led the court into believing that since beaching is irreversible, that the Blue Lady cannot be sent back. But the Blue Lady, as noted earlier and in previous articles, is illegal traffic as per all relevant laws. There is documentary proof that such ships are required certification for prior decontamination of the ship in the country of export. In the case of Blue Lady let alone decontaminating the ship as per the court's order, it has till date not even been claimed that it has been decontaminated.

Dangerous precedent for globalisation of waste

The list goes on and on. I had also pointed in my petition before the honourable court that the "Prior Informed Consent" convention -- which has been accepted in the Rio Declaration, Basel Convention, Cartegena Protocol, Rotterdam Convention, and the Stockholm Convention, had also been incorporated in Hazardous Wastes Rules 1989. As per this principle, no member state can send hazardous waste to a developing country without its prior consent. This has not been followed in the case of the Blue Lady. Another important convention -- that has been violated -- is that a ship ought to be decontaminated prior to its export for dismantling, which view has been expressed earlier by the apex court itself.

Dismantling of the Blue Lady would set a dangerous precedent. Hazardous and poisonous material does not become non-hazardous and non-poisonous merely because the government -- the Environment Ministry and Additional Solicitor General -- assert so. The Blue Lady story shows how hazardous industries, substances, wastes are being transferred to India in full public glare due to the connivance of Indian authorities who have compelled the highest court to decide matters on technical and humanitarian grounds (the original permission to beach the ship in 2006 was given on humanitarian grounds owing to inclement weather) rather than on a legal basis.

Even though the toxic ship Le Clemenceau was recalled in early 2006 on a verdict by a French court, the Blue Lady story only exposes the conflicted European position on ship-breaking and asbestos. Germany has condoned the Blue Lady's violation of Basel Convention - the contaminated ship left its shores in 2005 - to stay unreversed. This has in turn allowed the ship owners to successfully escape exorbitant decontamination cost in Europe.

P.S.: The recent news report suggesting that dismantling of Blue Lady has begun is far from the truth. In fact it is an effort by the cash buyers to tell the interested ship owners that things have not come to a standstill at Alang. This is to ensure the flow of obsolete ships at Alang. The ship-breakers have not even claimed that they have decontaminated the ship. It appears to be a planted story. In fact it is an effort by the cash buyers to tell the interested ship owners that things have not come to a standstill at Alang. This is to ensure the flow of obsolete ships at Alang. The reasoning presented before the court was an exercise in sophistry. If sustainable development is the reason then why do judges say “Lastly, we may point out that there is no dispute that on 15/16.8.2006 the vessel beached off Alang coast. It is not in dispute that the process of beaching is irreversible.” (Supreme Court order Para 14, 11.9.2007) Their main but insincere reasoning is that it will give jobs to 700 workers and 41, 000 tonne of steel. The real number is 300 workers. But mere 41, 000 tonne is of not at all of significance since India is the world's largest producer of direct reduced iron (DRI) or sponge iron and is the seventh largest steel producer in the world with an overall production of about 40 mt in 2006 . Three-fold rise in steel production capacity to 120 million tonne is going to make the second-largest steel producer in the world in very near future.

Dismantling plan submitted by Priya Blue Shipping Ltd to the Technical Experts Committee (TEC) is simply a paper work that has failed to inform the court as to what it would do for PCBs, incineration ash, ballast water, radioactive material, Lead and other heavy metals. Given the fact that there are casual and migrant workers, the commitment to protect workers is not at all credible. Safe handling of asbestos is not possible, it requires a Astronaut's dress that is not possible to work in heat...in any case even the TEC report has noted that these safety gears are provided to workers only when inspection team visits Alang yards. Riky, the Danish ship has been dismantled and the matter is pending before this very bench but they have decided not to hear the matter so far although it preceded the present ship but showed inexplicable exemplary speed in dealing with Blue Lady. It is quite well known that as long as Gujarat Maritime Board the supervising authority, there would be no safety for the workers and the villagers. As of 15th October, 2007, the 12 village councils (panchayat, a local governance unit) heads were deliberating over ways to protest against the court order. They have scheduled their meeting for 25th October.

Health Promises in National Common Minumum Programme

2007-09-20T07:52:00.000-07:00

National Health Policy 2002 admitted that as a result of
inadequate public health facilities, it has been estimated that less
than 20 percent of the population, avail of services in public hospitals. This is despite the fact that most of these patients do not have the means to make out-of-pocket payments for private health services except at the cost of other essential expenditure for items such as basic nutrition. In order to respond to this situation the United Progressive Alliance (UPA)Government led by Indian National Congress and supported by left parties formulated a National Common Minimum Programme in May 2004 and made health related promises among other things.

The promises are listed as under:

A national cooked nutritious mid-day meal scheme funded mainly by the central government, will be introduced in primary and secondary schools. An appropriate mechanism for quality checks will also set up. The UPA will also universalize the Integrated Child Development Services (ICDS) scheme to provide a functional anganwadi in every settlement and ensure full coverage for all children. The UPA government will fully back and support all NGO efforts in the area of primary education.

The UPA government will raise public spending on health to at least 2-3% of GDP over the next five years with focus on primary health care. A national scheme for health insurance for poor families will be introduced. The UPA will step up public investment in programmes to control all communicable diseases and also provide leadership to the national AIDS control effort.

The UPA government will take all steps to ensure availability of life-savings drugs at reasonable prices. Special attention will be paid to the poorer sections in the matter of health care. The feasibility of reviving public sector units set up for the manufacture of critical bulk drugs will be re-examined so as to bring down and keep a check on prices of drugs.

Malaria, Public Health & Environment

2007-09-15T04:58:00.000-07:00

Spraying of DDT leads to its transfer of residues through food chain resulting in its bioconcentration culminating in its biomagnifications in primary and secondary consumers including man. An editorial “Resurrection of DDT: A critical appraisal” in the July 2007 issue of Indian Journal of Medical Research suggests, “Environmentalists must reassess the situation based on data obtained after its ban in agriculture in India and elsewhere.” This journal is published by the Indian Council of Medical Research.

It further submits, “In India, at present DDT is used against malaria vectors which are susceptible to DDT as in North Eastern States and hilly regions of the country. This regulated use of DDT exclusively for public health showed gains in reduction in DDT residue levels in many items of food. Anopheles culicifacies, major vector of malaria highly resistant to DDT since 1960s, now shows increased susceptibility in Gujarat and other parts of the country where DDT was withdrawn since 1969 (unpublished). These results dispel the misinformation that DDT is no longer effective in entire India.”

Commonly known as DDT, its scientific name is 1,1,1-trichloro-2,2-bis (p-chlorophenyl) ethane was synthesized by Othmar Zeidler in 1874, came to lime light with Paul Muller’s
discovery of its insecticidal properties in 1939. It is claimed that DDT achieved a unique distinction of saving millions of lives by preventing disease outbreaks than any other man made chemical in history for which Muller was awarded the Nobel Prize for medicine in 1945.

The WHO/UNICEF Roll back malaria (RBM) initiative to reduce 50 per cent deaths by 2010 in Africa it involved use of pyrethroid treated nets, pyrethroid IRS and artemisinin. Donor nations for RBM mandated only the use of pyrethroids in place of DDT. In India, the use of DDT in agriculture was banned in 1989 with a mandate to use a maximum of 10,000 tons of DDT per annum for the control of malaria and Kala-azar and this policy is strictly adhered to till date.

The global incidence of malaria is about 500 million cases and according to UN estimate malaria kills one child every 30 sec and more than a million people per annum mainly in Sub Saharan Africa.

One of the eight Millennium Development Goals is to “Halt and begin to reverse the incidence of malaria and other major diseases”. National Health Policy 2002 admits, “Out of the communicable diseases which have persisted over time, the incidence of Malaria staged a resurgence in the1980s before stabilising at a fairly high prevalence level during the 1990s. Over the years, an increasing level of insecticide-resistance has developed in the malarial vectors in many parts of the country, while the incidence of the more deadly P-Falciparum Malaria has risen to about 50 percent in the country as a whole.”

The National Rural Health Mission (NHRM) focuses on providing key attention to 18 Indian states, improving the availability and quality of health care in rural areas, synergy between health and determinants of good health, capacity building and involving the community in the planning process. For 2005-2012, the NRHM identified a list of disease reduction outcomes, including Malaria mortality among other things.

Phanishwarnath Renu in his novel Maila Anchal published in the very year the national malaria control programme captured its impact on the village of Maryganj. The government and global institutions argued that malaria control would increase agricultural productivity.

Malaria almost disappeared by the late 1950s. At the end of 1958, a total of 8,704 malaria squads were in operation who sprayed a total of 438 million houses. The number of recorded cases of malaria fell from 75 million in 1951 to just 50,000 in 1961. The malaria eradication programme employed 1,50,000 people by 1961. Malaria cases accounted for less than 1 per cent of all hospital admissions, an astonishing diminution in the burden of malaria.

There was a resurgence of malaria in the 1960s because of resistance to DDT and to anti-malarial drugs. Reliance on DDT was a consequence of the weakness of India’s health infrastructure. The success of DDT was dependent on medical surveillance that was absent. An active programme of “case-finding” constituted a crucial final stage in malaria eradication that could not be completed.

The development of malaria control policy in the 1950s encapsulates, in many ways, the political culture of public health that evolved after independence. This is, not least, because at its height, between 1959 and 1963, the national malaria eradication programme took up nearly 70 per cent of India’s budget for communicable disease control, itself accounting for nearly 30 per cent of the overall health budget under the second plan.

India became the world’s largest market for DDT. The malaria eradication programme was heavily dependent on outside funding: between 1952 and 1958, the US contributed more than 50 per cent of the cost of the programme, and nearly 40 per cent of the cost of the eradication programme between 1959 and 1961. The national malaria control programme turned into malaria eradication. The memoirs of D K Viswanathan, India’s foremost malariologist at the time refers to the effort as “worship at the altar of science”.

In 1963, the USAID stopped providing DDT to India due to debates in the US about the safety of DDT, following Rachel Carson’s seminal publication, Silent Spring. India was compelled to purchase DDT from US under a long-term loan agreement.

India has spent up to 25% of its health budget on malaria control from 1977-1997, and starting in 1997, India planned to spend $40 million on malaria control, a 60% increase from the previous year. This expenditure is part of a five-year program aimed to target 100 districts where 80% of all P. falciparum cases occur. 70-80% of the malaria control money in India is spent on insecticides.

in 1976, 6.45 million cases were recorded by the National Malaria Eradication Programme (NMEP), highest since resurgence. The implementation of urban malaria scheme (UMS) in 1971-72 and the modified plan of operation (MPO) in 1977 improved the malaria situation for 5-6 years. Malaria cases were reduced to about 2 million. The impact was mainly on vivax malaria. Easy availability of drugs under the MPO prevented deaths due to malaria and reduced morbidity, a peculiar feature of malaria during the resurgence. The Plasmodium falciparum containment programme (PfCP) launched in 1977 to contain the spread of falciparum malaria reduced falciparum malaria in the areas where the containment programme was operated but its general spread could not be contained. P. falciparum showed a steady upward trend during the 1970s and thereafter. Rising trend of malaria was facilitated by developments in various sectors to improve the national economy under successive 5 year plans.

Malaria at one time a rural disease, diversified under the pressure of developments into various ecotypes. These ecotypes have been identified as forest malaria, urban malaria, rural malaria, industrial malaria, border malaria and migration malaria; the latter cutting across boundaries of various epidemiological types.

Further, malaria in the 1990s has returned with new features not witnessed during the pre-eradication days. These are the vector resistance to insecticide(s); pronounced exophilic vector behaviour; extensive vector breeding grounds created principally by the water resource development projects, urbanization and industrialization; change in parasite formula in favour of P. falciparum; resistance in P. falciparum to chloroquine and other anti-malarial drugs; and human resistance to chemical control of vectors.

The US Environmental Protection Agency (EPA) in had special hearings during 1971-1972 regarding the continued use of DDT following which it declared the ban on DDT in 1972 owing to ecological and reproductive health problems. As a result of campaigns by Royal Malaria Foundation International and other agencies to prevent a ban on DDT its use in public health emergencies like outbreaks of malaria was exempted from the ban. During 1970 to 1986, a total of 34 countries mostly from developed nations implemented the ban.

India is a signatory to Stockholm Convention on persistent organic pollutants (POPs) that has identified DDT as one of the 12 POPs that are banned. But DDT ban has certain restrictions applicable to countries that have notified to the secretariat for its continued use. The restriction permits indoor residual sprays of DDT in malaria control as per the WHO specifications for its production and following safety precautions for its proper use and disposal. Phasing out of DDT is delayed till an effective, affordable and safe alternative is available. In such a backdrop, the strong recommendation of WHO for indoor use of DDT to fight against malaria in September, 2006 that gave a clean bill to use of DDT to combat malaria in Africa and other areas where the vectors are still susceptible to DDT is believed to be the result of corporate influence.

The currently used pesticides globally cause about 20,000 deaths annually by accidental and deliberate/intentional poisoning. DDT residues remain in topsoil up to 7-8 cm and being immobile rarely contaminates ground water. Half-life of DDT residues in temperate soil is estimated to be 2-15 yr as against 6-14 months in tropical and subtropical soils.

Union Cabinet clears unorganised sector Bill

2007-09-08T08:53:00.000-07:00

The Union Cabinet today approved the revised Unorganised Sector Workers Social Security Bill, 2007.

The Bill, which will be introduced in the current session of Parliament, will facilitate formulation of social security schemes for the unorganised sector workers.

The Cabinet also approved a health insurance scheme for below-poverty-line workers and their families in the unorganised sector. The scheme will be launched in a phased manner starting from October 2, 2007. States have to formulate projects under this scheme.

“The beneficiaries will be issued smart cards for the purpose of identification,” Information and Broadcasting minister Priyaranjan Dasmunshi said.

The Cabinet also cleared establishment of the National Institute of Science Education and Research (NISER) in Bhubaneswar at an estimated cost of Rs 823 crore. The NISER will function as an autonomous body under the Department of Atomic Energy and will be the first of its kind under the DAE umbrella for undergraduate education in basic sciences.

The Cabinet also approved outsourcing of front-end activities of passport issuance, through an open bidding process, to one or more service providers. It will also set up 68 passport facilitation centres and use the current passport offices as passport back-offices.

The Cabinet Committee on Economic Affairs (CCEA), which also met today, gave its approval for continuation of the Rural Employment Generation Programme (REGP) till the end of the current financial year. It granted Rs 445 crore towards the REGP for the current financial year.

The CCEA also approved continuation of centrally sponsored scheme of Post-Matric Scholarship to students belonging to Scheduled Castes, with an estimated expenditure of Rs 5000 crore during the 11th Plan. Now the scheme has been extended to the free seats of private institutions also. September 07, 2007

Business Standard

Public Health Beyond Medicine

2007-09-02T07:41:00.000-07:00

In an editorial 'Public health in India and the developing world: beyond medicine and primary healthcare' in the Journal of Epidemiology and Community Health, July 2007 reminds, "Public health in India relies primarily on medicine to achieve its goals. Successive governments in India have come up with many schemesfor the provision of safe water, sanitation, nutrition, vaccinationcoverage, education and employment. Despite the many attempts,millions of people do not have access to these basic needs,malnutrition is rampant in children and vaccination coverageis inadequate among the poor."

The National Health Policy 1983 proposed "to provide ‘Health for All by the year 2000 AD’, through the universal provision of comprehensive primary health care services." The National Health Policy-2002 noted, "In retrospect, it is observed that the financial resources and public health administrative capacity which it was possible to marshal, was far short of that necessary to achieve such an ambitious and holistic goal."

The policy of 2000 dealing with the Extending Public Health Services admitted, "While there is a general shortage of medical personnel in the country, this shortfall is disproportionately impacted on the less-developed and rural areas. No incentive system attempted so far, has induced private medical personnel to go to such areas; and, even in the public health sector, the effort to deploy medical personnel in such under-served areas, has usually been a losing battle. In such a situation, the possibility needs to be examined of entrusting some limited public health functions to nurses, paramedics and other personnel from the extended health sector after imparting adequate training to them."

The 2002 policy elaborated on the State of Public Health Infrastructure saying,
"As a result of such inadequate public health facilities, it has been estimated that less than 20 percent of the population, which seek OPD services, and less than 45 percent of that which seek indoor treatment, avail of such services in public hospitals. This is despite the fact that most of these patients do not have the means to make out-of-pocket payments for private health services except at the cost of other essential expenditure for items such as basic nutrition."

The editorial aptly locates Health solutions beyond medicines to which the policymakers, "The survival of the human body is best explained by the materialistexplanation that locates the variation in health and longevityto tangible resources. The reciprocal relationship betweenpoverty and disease had long been acknowledged by public healthreformers who advocated social reform on political, economic,humanitarian and scientific grounds."

Toxic Ship Export to UK Stopped

2007-05-31T22:48:00.000-07:00

Toxic Ghost Fleet Ship Export to UK Stopped
Legal challenge keeps recycling jobs in the U.S.

Indeed the real real victory is that hurndreds of end of life ships are not going to India or China because the UK was trying to open the pandora's box. This has now been closed for ever by Producer Responsibility for ships a reality.

The Bush Administration's plans to export nine ex-naval “Ghost Fleet” vessels from the James River in Virginia to Teesside, England for scrapping has itself been finally scrapped, according to the Able UK company. American environmental groups responsible for first blocking the deal in 2003 hail its final demise as a victory for American recyclers, and for national environmental responsibility and self-sufficiency in toxic waste management.

In October 2003, the Basel Action Network (BAN) and the Sierra Club, represented by Earthjustice, sued the Environmental Protection Agency and the Maritime Administration (MARAD) to prevent the resumption of US exports of highly contaminated decommissioned naval vessels for scrapping abroad. The suit alleged violations of the Toxics Substances Control Act, the Resource Conservation and Recovery Act, and the National Environmental Policy Act.

The US federal district court in DC ruled that four vessels could cross the Atlantic as their export was mandated by Congress, but prohibited the departure of the remaining nine until MARAD completed an Environmental Impact Assessment, obtained proper authorization to export toxic PCBs, and ensured the existence of an adequate dismantling facility in the UK. Now, after three and one-half years, MARAD has finally decided to annul the contract as the intended ship-breaker, Able UK, has been unable to obtain the permits required to conduct its business in Teesside.

“The death of this contract is good news for the environment and for American workers,” said Martin Wagner of Earthjustice. “The management of US toxic waste is a US responsibility. Why dump our trash in other countries when we can take care of it here and create new jobs at the same time?”

It is expected that the nine ships in the James River will now be put up to bid for domestic ship recyclers. Questions remain as to what will become of the four US ships that sit rusting in Teesside, England. The vessels contain many tons of materials contaminated with carcinogenic and highly toxic substances such as PCBs, asbestos, mercury, used fuel, and other toxic substances.

“The Bush Administration’s original plan to undermine international law has failed,” said Jim Puckett of BAN, “They wanted to shunt a few ships off to the UK to set a legal precedent, and then open the floodgates to China, India, or Bangladesh where workers are dying of cancer and where scrapping is done without strong health and safety rules. Instead of dumping them on the rest of the world, we should be turning these old swords into ploughshares of recycled steel here at home.”

The environmental groups will remain vigilant to halt any future plans to export these ships or any other U.S. ships laden with toxic waste and demand they all be scrapped properly in the United States.

Currently there are 238 old ships in the National Defense Reserve Fleet, most located in Texas, Virginia and California, that will need to be dismantled. Some of the ships are in dangerous condition and pose an environmental threat as they have never been emptied of fuels, oils and other hazardous substances.

“Our precious Chesapeake and San Francisco Bays are no place for floating toxic time bombs,” said Michael Town of the Sierra Club in Virginia. “The budget to remove these vessels and have them properly recycled here in America should have been appropriated long ago. Let’s have these ships scrapped as quickly and as safely as possible here at home and close this sad chapter of exporting our problems overseas.”

Groups Say No to Japanese "Toxic" Free Trade Agreements

2007-02-11T10:39:00.000-08:00

Environmental and public health groups from various countries, including India lodged a collective protest against Japanese free trade agreements (FTAs), which they assert is part of Japan's sinister plan to establish waste colonies in Asia.

In a "fax/e-mail action" held in conjunction with the "Kenkoku Kenen-no-hi" or Japan's National Foundation Day, the civil society groups sent letters to Japanese ambassadors, the Secretariats of the Basel Convention, Stockholm Convention on Persistent Organic Pollutants (POPs), Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES), other Multilateral Environmental Agreements, as well as the Human Rights Commission Special Rapporteur on Toxic Wastes, to voice their anxiety and objection to bilateral FTAs that blatantly encourages trade in hazardous wastes.

"We join our Asian neighbors, including our friends in Japan, in standing firm against the illegal and immoral scheme to make our countries dumping grounds for Japanese toxic wastes, technologies and obsolete end-of-life products," said Waste Not Asia coalition in release.

The Manila-based Global Alliance for Incinerator Alternatives (GAIA) described the "fax action" as part of a vigilant campaign to prevent efforts by more powerful countries to exploit nations that are poorer and with weaker regulations and social infrastructures into becoming disposal sites for toxics. \n\n \nTo emphasize its point, the groups cited the case of the controversial Japan-Philippines Economic Partnership Agreement (JPEPA), which contains disturbing provisions that will allow unhindered entry of globally controlled or prohibited wastes and substances from Japan, including extremely toxic materials with heavy metals and persistent organic pollutants such as polychlorinated biphenyls and dioxins. As Japan marks its National Foundation Day, the groups asked the ambassadors and international bodies to relay their demands to Prime Minister Shinzo Abe and the concerned ministries for the removal of waste trade liberalization and other exploitative provisions in the JPEPA and other FTAs that Japan plans to forge with other countries.

The groups further seek Japan's immediate ratification of the Basel Convention's Ban Amendment, which prohibits the export of toxic wastes from developed to developing countries for any reason. Japan signed bilateral FTAs with ASEAN member states such as Singapore in 2002, Malaysia in 2004 and the Philippines in 2006 and is currently working on similar agreements, in various stages, with India, Indonesia, Thailand, South Korea, Vietnam and other countries.

The Manila-based Global Alliance for Incinerator Alternatives (GAIA) described the "fax action" as part of a vigilant campaign to prevent efforts by more powerful countries to exploit nations that are poorer and with weaker regulations and social infrastructures into becoming disposal sites for toxics.

To emphasize its point, the groups cited the case of the controversial Japan-Philippines Economic Partnership Agreement (JPEPA), which contains disturbing provisions that will allow unhindered entry of globally controlled or prohibited wastes and substances from Japan, including extremely toxic materials with heavy metals and persistent organic pollutants such as polychlorinated biphenyls and dioxins.

As Japan marks its National Foundation Day, the groups asked the ambassadors and international bodies to relay their demands to Prime Minister Shinzo Abe and the concerned ministries for the removal of waste trade liberalization and other exploitative provisions in the JPEPA and other FTAs that Japan plans to forge with other countries. The groups further seek Japan's immediate ratification of the Basel Convention's Ban Amendment, which prohibits the export of toxic wastes from developed to developing countries for any reason. Japan signed bilateral FTAs with ASEAN member states such as Singapore in 2002, Malaysia in 2004 and the Philippines in 2006 and is currently working on similar agreements, in various stages, with India, Indonesia, Thailand, South Korea, Vietnam and other countries.

Japanese Ambassador in India was also sent a letter on 10th February, 2006.