Address at the Convocation of the Class of 2010, Asian College of Journalism
In 1876, Lord Lytton, who was then Viceroy of India, decided to arrange a massive celebration in Delhi to mark the accession of Queen Victoria as the Kaiser-i-Hind, Empress of India. The feasting, with all rajas and maharajas in attendance, went on for a week and has been described by one historian as the biggest party in the history of mankind. But 1876 was also the third year of an El Nino drought. Grain prices had reached unprecedented levels.
Grain traders took advantage of recent technological advances — the railways, which allowed rapid transport of large quantities of grain, and the telegraph, which allowed traders to have accurate knowledge of grain prices in distant places — and, instead of selling their grain stocks in the local markets, used these stocks for profiteering. Buckingham, after whom the canal in Chennai is named, who was then the governor, wanted to forcibly release the grain stocks in the local market, but Lytton, a follower of the Reverend Thomas Malthus, forbade him from doing so. During the one week of Lytton’s festivities, a hundred thousand people died of hunger on the streets of Chennai. Dr Ida Scudder of Vellore, then a young girl of six, tried to feed some bread to some starving children, but recorded later that they were too weak to eat what she gave them.
Coming to the present, in the last six years, globally, more children have died of malnutrition and easily preventable illnesses than the number of adults who were killed in the six years of the Second World War. Every three seconds another child dies from malnutrition and preventable diseases. In those three seconds, globally, 120,000 dollars are spent on arms and militarisation that specifically targets civilian populations asserting their rights to equity and protesting against inequity.
Inequity is not a subtle phenomenon. Yet it is only if we have a standpoint that validates political commitment to equity that we see its manifestations and linkages. While it is true that there are none so blind as those who will not see, for those who wish to do so, inequity is a major feature of the global political architecture. As young journalists, it would be good to remember that inequity is not a default option, and keeping inequity in place requires diligent and sustained international effort, supplemented where necessary by military intervention. The state of Chhattisgarh from where I come presents a glaring example of this.
Looking at the overall situation in India, I would like to follow Virchow’s dictum that politics is medicine writ large and read my politics off the bodies of our patients. For the purposes of this address, I have treated hunger as a surrogate for inequity. The National Nutrition Monitoring Bureau (NNMB) tells us that over 33% of the adult population of India has a BMI of less than 18.5 and can be considered as suffering from chronic under-nutrition. If we disaggregate the data, we find that over 50% of the scheduled tribes and over 60% of the scheduled castes have a BMI below 18.5. The total population of Orissa has more than 40% below 18.5. The population of Maharashtra, which is considered to be a relatively “developed” state with a high per capita GNP, has 33% below 18.5. We in Rupantar have carried out censuses in tribal villages in which over 70% of the adults had a BMI below 18.5. All this is, of course, in addition to the mundane reality, to which we have become inured, of 43% of children under 5 being malnourished by weight for age criteria. Reporting on the Mumbai Cohort study, Pednekar found increased mortality in all underweight categories. The WHO says that any community with more than 40% of its members with a BMI below 18.5 may be regarded as being in a state of famine. By this criterion there are various subsets of the population of India — the scheduled tribes, scheduled castes, the population of Orissa — which may be regarded as being permanently in a state of famine.
But there is more good news to follow. Utsa Patnaik, a senior professor of economics at JNU, tells us that there has been a major decline in cereal consumption since 1991 in India — that is, since the onset of globalisation. In 1991, an average family of five consumed around 880 kg of cereals in a year. By 2005, this had declined to around 770 kg., a decline of 110 kg. In fact, at the higher end of the scale, cereal consumption — direct and indirect, i.e. as meat — had increased, so the decline at the lower end of the scale was actually much greater. So not only do we have a chronic famine, but it’s getting worse.
Dispossession: the Situation in Chhattisgarh
It is precisely this section of the population, walking through time with famine by its side, that is today the principal target of a widespread policy of the expropriation of natural and common property resources, in a concerted and often militarised programme run by the state. The adivasis of central India, living in extreme poverty, nevertheless survived through their access to common property resources — the forests, the rivers, and land — all of which are now under a renewed threat of sequestration and privatisation as global finance capital embarks on its latest phase of expansion.
The doctrine of eminent domain vests ultimate ownership of all land and natural resources in the state. Under cover of eminent domain, vast tracts of land, forest and water reserves are being handed over to the Indian affiliates of international finance capital. In many ways, the history of ‘development’ projects in many parts of the Indian republic are illustrative of the way in which the doctrine of eminent domain, which was hotly debated at the sessions of the Constituent Assembly, and finally not included in the final draft that was adopted, has been applied to ensure, for a so-called public interest, major havoc and displacement in the lives of many of the poorest citizens living at subsistence levels.
The tragedy of Chhattisgarh, and of Bastar, is compounded by its richness of resources. One-fifth of the country’s iron ore — about 2,336 million tones averaging 68% purity — is found in the Dantewada, Kanker, Rajnandgaon, Bastar and Durg districts. The Bastar region is one of the richest in mineral resources — not only in iron ore, but also perhaps a host of other unexplored minerals including limestone, bauxite, and even diamond and uranium. When Ajit Jogi became the first Chief Minister of the nascent state of Chhattisgarh, he said that, in the new state, we had the poorest people inhabiting the richest land. Since much of this ‘rich land’ was covered by forest and was difficult to reach in earlier times, there was not much effort to access these riches, and hence not much challenge to the control exercised by the poor people over the rich lands. With increasing industrial and economic development, especially under the impact of globalisation, which is the current avatar of actually existing colonialism, the hold exercised by the poor people over their resources came increasingly under challenge.
Once the nature and scope of the enormous natural wealth, in the form of forest and mineral wealth, deposited and secure in the forest areas of Chhattisgarh became clear, it became imperative for the Indian state to assert its sovereignty over these areas, which had hitherto remained relatively unclaimed by the state, under the law of eminent domain: the principle that, in the final analysis, the state has a preeminent right to all land. In its turn, the Indian state could stand guarantor for the secure sequestration of these resources in the hands of the Indian affiliates of international finance capital, such as, in recent years, the TATAs, Essar, Lafarge, Holcim, and other industrial houses. Land acquired from ordinary people was to be handed over to the industrial houses; gram sabha related procedures were faked, in an attempt to justify the transfer by the letter, if not the spirit, of the existing Laws.
However, what became fairly clear fairly soon was that this process of the assertion of the state’s decisive right was going to be a rough ride. Land acquisition for Essar and Tata was resisted in several places in South Bastar. While land acquisition took place literally at gunpoint in the Bhansi area, several village assemblies (gram sabhas) in the Lohandiguda area are still refusing to sign away their land for the proposed Steel Plant of the TATAs.
Even as the state has forcibly controlled the resistance at several places, the sense of outrage and popular protest has proved difficult to curb. Bastar has a long history of popular resistance to oppression; its ways of defining and asserting property rights are also different from those prevalent in mainstream governance. It also has not helped that, with a few honourable exceptions, the personnel articulating the agency of state power have almost uniformly possessed a colonial mindset. Under these circumstances, one consequence has been that, in conjunction with a pervasive failure of governance, characterised by massive levels of corruption, as well as abysmal levels of ‘development’, there has been a tendency on the part of the enforcement agencies to be quick on the draw. Long before the state government embarked on its current mission to rid Bastar of the ‘Maoist menace’, Praveer Chandra Bhanj Deo, the charismatic ruler of Bastar, who refused to trim his sails to the winds blowing from the capital of Madhya Pradesh, was killed in an ‘unfortunate incident’ during the Chief Ministership of DP Mishra. The Salwa Judum is being characterised by the government of Chattisgarh as well as by its media bandwagon as a ‘spontaneous adivasi response to naxalite oppression’.
It therefore becomes necessary to appreciate that popular resistance to state control and efforts to articulate eminent domain has a history in Bastar, which has a far greater spread, in terms of duration, geographical extent, as well as political and institutional identity, than the current operational entity known as the CPI (Maoist), although the latter is undoubtedly a major political entity in the region. The CPI, for instance, is a political entity with a long history of struggle on the trade union, peasant, adivasi, women’s and student fronts, apart from its parliamentary and electoral identity. In Chhattisgarh , the term ‘Maoist’ has become a catchall attribution that includes anyone whose activities the state finds inimical to its current interests, including self confessed Gandhians like Himanshu Kumar of the Vanvasi Chetna Ashram, human rights groups like the PUCL, and pesky PIL wielding academics. The believers in armed overthrow of the state have been only one stream out of many in the resistance to state policies. It is the systematic dispossession of the people that has polarised the situation beyond immediate rectification.
Based upon carefully differentiated positions, they have gone on to repeatedly indict the widespread and pervasive violence that the state has deployed over widespread areas in this region. Careful reports have been prepared with regard to specific incidents of state violence such as encounter deaths, kidnappings, rape, arson, and custodial maltreatment. Investigations have been conducted and reports have been prepared with respect to starvation deaths, dysentery epidemics, lack of drinking water, and other basic needs. It is the state response that has been singularly undifferentiated. Today, in the months since the launching of operation Green Hunt, Bastar is a war zone, its people dispossessed and scattered, women subjected to brutal rape; violent (and tragic) military encounters shake the foundations of whatever normalcy remains. One is reminded of what Prashant Bhushan said on an earlier occasion.
Those who are going to become homeless and uprooted in this race of so-called development, they will also be finally forced to accept the bitter truth that they cannot stop the loot of their lands and resources by any democratic and non-violent means. This is a dangerous situation. Even a combative organization like “Narmada Bachao Andolan”, which included a large number of educated persons, has accepted the bitter truth that there is no administrative or legal means of preventing the loot of resources. Now it is only through unity and by force that these plunderers can be stopped. That is the reason why today, in Kalingnagar, Nandigram etc. there is a situation of “do or die”. All these struggles are proving to be landmarks in stopping the loot. The people of these areas have firmly resolved that come what may, they will not let any government officer set foot on their land. In these circumstances if the government uses force, violence may erupt.
There is a question that I would like to raise before this assembly, and that is the issue of genocide. Most people think that genocide has to do only with large scale direct killing, but the declaration of the Convention on the Prevention of Genocide — which was issued on 9th Dec 1948, one day before the Universal Declaration of Human Rights — tells us clearly that in addition to killing, the creation of physically and mentally hazardous conditions which could put the survival of particular communities at risk would also come within the ambit of genocide. Evidence that what is happening in central India is tantamount to genocide on a massive scale stares us in the face. What is shocking is the inability of large sections of our leadership to read the writing on the wall.
The Inability to Interpret Evidence: Example from Health Policy
The inability to interpret evidence that is crying out to be recognised and the tendency to lapse into facile and convenient formulae for resolution is a curse that plagues many professions. I would like to give an example from my own, with regard to the formulation of the national policy for the control of tuberculosis. In a country where 33% of the adult population have a BMI below 18.5, and which also has 1/6 of the world’s population and 1/3 of the total global burden of tuberculosis, one would think that the bidirectional association between malnutrition and tuberculosis would be the focus of intense study. This is not the case. India is the single largest contributor to the global burden of morbidity, mortality and drug resistance in tuberculosis. An estimated 8.5 million Indians suffer from tuberculosis. There is an annual incidence of 87,000 cases of multidrug resistant tuberculosis and an estimated annual mortality of 370,000 persons.
And yet, a recent WHO-based systematic review study which established a consistent log-linear relationship between tuberculosis incidence and BMI was unable to include a single Indian study. Similarly, a Cochrane systematic review of randomised control trials of nutritional supplements for people being treated for active tuberculosis did not include a single Indian study in its ambit. But I would like to draw your attention to two studies that do not figure in either review — the first with pride, and the second with shame.
The first study has been formed by my colleagues at the Jan Swasthya Sahyog (People’s Health Support Group), a nonprofit voluntary organisation, which runs a community health program in 53 forest related villages in central India. They have reported an as yet unpublished study on the nutritional status of 975 patients with pulmonary tuberculosis — the largest such study to emerge from India. They report that patients with active pulmonary tuberculosis in rural central India were found to have macronutrient malnutrition, i.e. starvation, almost as a universal association, with less that 5% having weights in the normal range.
Certain groups like scheduled tribes and women fared worst, with life threatening levels of under-nutrition. There was evidence of long-standing under-nutrition with low height for age (stunting) in the majority of patients. The report goes on to conclude, “This report is a stark illustration of the adverse synergy of the epidemics of under nutrition and tuberculosis. The consequences are extensive disease on the one hand and severe wasting on the other, both of which can cause mortality independently and in concert. The need to address the nutritional needs of poor patients with tuberculosis is an urgent imperative on scientific, ethical and humanitarian grounds”.
However, the fundamental architecture of the National Tuberculosis Programme, formulated in 1962, was based on a specific repudiation of this “urgent imperative.” This fundamental architecture has been preserved into the present programme, hence this is a current problem. What was the evidence on which this repudiation was premissed? This brings us to the second study that I had mentioned, published in the Bulletin of the World Health Organisation in 1961. The recent Cochrane review of the effect of nutritional supplements in people being treated for active tuberculosis excluded this paper from their review as “the groups were not randomized to different dietary interventions”. This study was carried out at the Madras Chemotherapy Centre in Guindy. I would like to read out to you the summary of findings of this study.
A study has been undertaken on the diet of 157 patients with pulmonary tuberculosis admitted to a controlled comparison of treatment with isoniazid plus PAS for a year at home with the same treatment in sanatorium. The patients have been drawn from a poverty-stricken section of the community living in overcrowded conditions in Madras City. A comparison has been made of the dietary status of the home and the sanatorium patients before and during treatment, and the role of the diet in the attainment of bacteriological quiescence of the tuberculous disease has been evaluated.
Before treatment the patients in both series had poor and similar diets. During the early months of treatment, the dietary intake of the patients in both series increased. However, the sanatorium patients received a clearly superior diet through the year in terms of total calories, fats, total and animal proteins, phosphorus and several of the vitamins. The home patients were physically more active during treatment than the sanatorium patients, further the accentuating the dietary disadvantage of the home series.
The home patients gained on the average 10.8 lb in weight over the 12-month period, as compared with 19.8 lb for the sanatorium patients. This greater weight gain among the sanatorium patients was not, however, indicative of superior clinical results. The response to treatment (as measured by the radiographic and bacteriological progress) was not directly associated with the level of dietary intake of any of the food factors, either in the patients treated at home or in those treated in sanatorium.
It may be concluded that none of the dietary factors studied appears to have influenced the attainment of quiescent disease among tuberculous patients treated with an effective combination of antimicrobial drugs for a period of one year. The successful initial treatment of patients at home is therefore possible even if the levels of dietary intake are low.
The fact that such a poor study could play such a critical role in determining the architecture of a program of such enormous importance shows how the politics of callousness takes precedence over evidence in such matters.
The Scientific Community and Bhopal
A similar refusal to take a stand on what was correct and so patently obvious characterised the response of the official scientific community in India to the Bhopal gas disaster. Twenty-five years ago, on the night of 2-3 December an industrial accident of massive proportions spewed a huge cloud of methyl isocyanate gas into the atmosphere of Bhopal, the capital of Madhya Pradesh. In the next 72 hours, 8,000 people died of the effects of the gas, and innumerable people were blinded and developed major pulmonary disorder, major psychiatric disorder, abnormal pregnancy outcomes, and a whole host of other acute and chronic morbidity.
The ground water of the factory became contaminated with harmful chemicals, which then leached into the soil and contaminated the water table. This is not the forum to detail all the harm that Union Carbide caused to the people of Bhopal. What I wish to draw your attention to is the role that evidence and scientific information — and the people responsible for dealing with this information — played over the last twenty five years.
Neither the Union Carbide Corporation, nor their successor, the Dow Chemical Company, has ever acknowledged the nature of the chemical that spewed out of their factory. Nor did they ever specify the specific antidote — sodium thiosulphate — that would have made a major difference in the treatment outcomes of a large number of gas affected people if it had been used in time. Strangest of all was the posture adopted by the ICMR. In one of Arthur Conan Doyle’s Sherlock Holmes stories, Holmes says to Watson, “I would like to draw your attention to the curious incident of the dog in the night time.” Watson says, “But the dog did nothing in the night time.” “That” said Holmes, “was the curious incident”.
The ICMR initiated something like 34 research studies in Bhopal. As far as I know, none of these studies was carried through to completion. They were, instead, shut down in batches, and finally in 1994 — 10 years after the incident — the last two remaining studies were terminated by executive fiat, and the entire body of data was quarantined indefinitely. At that time, there were 18 fresh proposals that had been fully approved, but these proposals were also terminated.
The ground water in the area of the accident has been heavily contaminated, but the Government has consistently refused to admit this. Finally, now, the Centre for Science and Environment in Delhi — an independent NGO with a formidable reputation — has come forward to test the water. Their report showed the ground water to be heavily contaminated with highly toxic chemicals.
The Quest for Justice
The Directive Principles of State Policy enshrined in our Constitution are asserted to be “fundamental in the governance of the country”. The Directive Principles clearly mandate that all exercise of state power should be for the reduction of inequity and the promotion of equity.
Article 37 of the Constitution declares that the DPSP “shall not be enforceable by any court, but the principles therein laid down are nevertheless fundamental in the governance of the country and it shall be the duty of the state to apply these principles in making laws”. Viewed in this context, recent trends in the exercise of state power very clearly violate this mandate and have actually resulted in increasing inequities in important areas such as livelihood, education and health.
According to Dr B D Sharma, formerly Commissioner for Scheduled Castes and Tribes, the fifth schedule is like a constitution within the Constitution. It empowers the Governor to intervene in governance on behalf of the interests of tribal people, but we note to our great surprise that there is not a single instance when the Governor of any single state has so intervened. Once again when we look at the operationalisation of PESA, we find that the entire issue of peoples’ sovereignty enshrined therein has been sidestepped in practice. Development in the tribal areas is not only a matter of building roads, buildings and infrastructure. Rather, it is all about the operationalisation of equity, social justice, and the establishment of a genuine peoples’ sovereignty. Everyone today talks of PEACE. Peace cannot mean an acquiescence in an exploitative and unjust social order. A genuine peace can only be the result of a movement for equity and justice. At the beginning of this discussion we considered the essentially political and ethical nature of the concept of equity. In the course of our discussion, I have tried to examine the ways in which evidence influences — or does not influence — the praxis of equity. Evidence is, of course, central to the scientific enterprise. A commitment to evidence is what took Galileo to jail, and a commitment to evidence is what caused Giordano Bruno to be burnt at the stake. Evidence is what democratises the generation of knowledge: without it, all we have is esoteric bodies of dogma, to be passed on from feudal mentor to feudal apprentice.
Equity is a political concept, and an ethical one. Political questions cannot be rephrased in terms of informatics or evidence, although once these questions are adequately formulated, evidence can be used to settle the question one way or the other. The ethical dimension of questions regarding equity means that the answers contain an inbuilt imperative to moral action. As Amartya Sen says in his latest book, The Idea of Justice, “Proclamations of human rights, even though stated in the form of recognizing the existence of things that are called human rights, are really strong ethical pronouncements as to what should be done. They demand acknowledgement of imperatives and indicate that something needs to be done for the realization of these recognized freedoms that are identified through these rights”.
One of the ironies that confront the witness dealing with ‘evidence’ is that one has to appeal for appropriate interventions to the very forces that are at such violent odds with poorest sections of the population. For the student of evidence based policy, this situation raises some challenging problems. One is that in any study of an intervention one ethical assumption is that the intervention is carried out by someone who comes to the table with clean hands, whose bona fides are beyond question. In India today, as in many other places across the world, this is an assumption that is no longer tenable. Cynicism and disengagement may be one response to this situation, but I do not believe that this is the only tenable response. As young journalists at the beginning of new careers, the challenge is upon us to acknowledge the imperatives and recognize that ‘something needs to be done’. We need to ask ourselves on this very important day in our lives whether we are up to accepting this challenge and putting in the response that it demands.
Dr. Binayak Sen is a pediatrician, public health specialist, human rights activist, and national Vice-President of the People’s Union for Civil Liberties (PUCL) based in Chhattisgarh state, India. He has been extending health care to the poorest people, monitoring the health and nutrition status of the people of Chhattisgarh, and defending the human rights of indigenous tribal and other poor people. In May 2007, he was detained in connection with his human rights work, raising global concern about his welfare. In 2008, he was awarded the prestigious Jonathan Mann Award for Global Health and Human Rights for “his years of service to poor and tribal communities in India, his effective leadership in establishing self-sustaining health care services where none existed, and his unwavering commitment to civil liberties and human rights.”