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India at 60 – A Public Health Perspective

Byoliveridley

Well, at least I don’t have to take part in endless parades and listen to speeches any more. But India turned 60 today, and the head of the Indian public health foundation takes stock, and it is sobering.

The Hindu : Persisting public health challenges

Recent health indicators in India are a cause for both celebration and concern. While life expectancy at birth has risen to 63 years, infant mortality rate (IMR) and maternal mortality rate (MMR) are still at unacceptably high levels (57 per 1000 and 301 per 100,000 live births respectively). There is widespread disparity among States with Kerala being the star performer. Within States, the rural areas are way behind the urban segments. Even as our economy has grown rapidly, the nutritional status of children has remained stunted, suggesting that wide income disparities are preventing the poor from becoming the beneficiaries of growth.

Yes, I be the killjoy.

More from Amartya Sen

There is reason enough to celebrate many things happening in India right now. But there are failures as well, which need urgent attention. For example, there is still widespread undernourishment in general and child undernutrition in particular–at a shocking level. The failures include, quite notably, the astonishing neglect of elementary education in India, with a quarter of the population–and indeed half the women–still illiterate.

The average life expectancy in India is still low (below 64) and infant mortality very high (58 per 1,000 live births). It is certainly true that India has narrowed the shortfall behind China in these areas–that is, in life expectancy and infant mortality–but there is still some distance to go for the country as a whole. The problems are gigantic in some of the more “backward” states like Bihar and Uttar Pradesh. And yet there are other states in which the Indian numbers are similar to China’s.

he goes on…

If India has to overcome these failures, it has to spend much more money on expanding the social infrastructure, particularly school education and basic health care. It also needs to spend much more in building up a larger physical infrastructure, including more roads, more power supplies and more water. In some of these, the private sector can help. But a lot more has to be spent on public services themselves, in addition to improving the system of delivery of these services, with more attention paid to incentives and disciplines, and better cooperation with the unions, consumer groups and other involved parties.

Ah, basic and boring infrastructure building!

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    Circumspection on Circumcision – Lessons for India

    Byoliveridley

    Circumcision May Help Protect Against HIV – washingtonpost.com

    Getting circumcised may reduce men’s risk of acquiring HIV, according to a study conducted in Africa. “Our study shows that circumcised men had 53 percent fewer HIV infections than uncircumcised men,” lead study author Robert Bailey, professor of epidemiology at the University of Illinois at Chicago (UIC), said in a prepared statement.

    This study, published in The Lancet (registration and kidney donation required!) adds to the growing body of research suggesting that circumcision significantly reduces the incidence of HIV infection. The doubts on circumcision as a protective factor against HIV are falling away.

    But, is this a viable public health strategy? In context, the US health and human services reports an 85% reduction in HIV risk through condom usage. This is probably a conservative estimate. There’s no indication yet that the gains from circumcision and condom use together are multiplicative.

    Let’s look at India, for instance. Circumcision is not practiced among Hindus. There is no history of circumcision, and when I was growing up, it was clear that circumcision was for Muslims and Muslims only. It was often laughed about and there was a sense of superiority about not having to mutilate. It was a clear distinction setting difference between “us” and “them”. This article by Jaishanker and Haldar provides some perspective on Hindu-Muslim identities.

    Apart from that, the other important identity of Muslim males is circumcision. It is found in many riots that Muslims were victimized based on their religious identity. In the riots if the perpetrators or the police are not able to identify victims with their religion they forcefully remove the pants of the victims to check whether they are circumcised or not. Once they find that the victim is circumcised he is targeted without further analysing which community he belongs to.

    For example in Bombay riot (1992) there is a case of man who was frisked by the police for assessing whether he was a Muslim. However, out of fear he gave his name as Raju (a Hindu name) the officer made him take out his trousers and, noticed that he was a circumcised Muslim, and fired at him.

    No Hindu parent in their right mind would circumcise their male child. It’s that simple. It’s part of the ingrained Hindu psyche that having an uncut member sets us apart from our Muslim brethren.

    Nothing has changed about AIDS prevention strategies. But it’s boring to study the same variables all the time, let’s recap them one more time, shall we!

    Education and awareness: Look at this picture from India (from the NFHS Survey):
    Now tell me that increasing awareness among women and empowering them is not the most important thing you can do!

    Condom use = 85% risk reduction

    Nothing more to say. Continuing to improve access to condoms is important. Avert indicates that condom use is very state dependent, especially among sex workers, with Tamil Nadu having an 80-90% use rate and Mysore in neighboring Karnataka having a 9% use rate.

    Access to antiviral therapy

    India is in a lucky position here with a very well established pharmaceutical industry. So, drugs are likely to be available (patent issues notwithstanding). The issue however is with infrastructure, getting the drugs to the right people at the right time. This 2004 paper from the Indian Journal of Medical Ethics indicates that coverage is spotty at best. India’s National AIDs Control Organization (NACO) recognizes this, but in my opinion does not go far enough to provide free/affordable drugs to infected people, especially to prevent mother-child transmission.

    So, to cut a long story short, circumcision in India is not likely to be a factor in the pantheon of choices available. We have a long way to go with our other major AIDS prevention challenges, and I hope this circumcision issue does not become an increasing distraction.

  • Terrorist Attacks in Uttar Pradesh

    Byoliveridley

    Terror struck Uttar Pradesh on Friday, when militants triggered near-simultaneous blasts in court premises in three cities across the state, killing at least 13 and injuring over 59 others.Six bombs — three in Varansi, two in Faizabad and one in Lucknow — went off within a span of 15 minutes in the crowded court complexes between 1310 hours and 1325 hours. Some of bombs are believed to have been planted on cycles.A little-known outfit, called Indian Mujahideen, has claimed responsibility. UN intelligence agencies said senior UP police officials have received an email in which the outfit has owned up to the attacks.

    Delhi on high alert following UP serial blasts

    Blogged with Flock

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    A Company that Specializes in Profiting from Harm

    Byoliveridley

    The LA Times has an interesting investigation on the activities of Amvac.

    Pesticide maker sees profit when others see risks – Los Angeles Times

    Amvac is a leading maker of organophosphates, a class of older, highly toxic pesticides that has been under regulatory scrutiny since the late 1980s. As larger firms have stopped manufacturing some of their organophosphates, Amvac has bought the rights to make or sell 10 of them since 1989, according to company records and interviews. One of them, mevinphos, was banned in the U.S. in 1994 after a study by the U.S. Environmental Protection Agency found that it was responsible for poisoning more field workers in California than any other agricultural chemical. Amvac continues selling the product overseas, according to company officials. Amvac is by no means the largest producer of pesticides that have attracted regulatory scrutiny, but the company stands out for its willingness to embrace chemicals that other firms have abandoned.

    Amvac Slogan

    Love that slogan, don’t ya’! There are so many loopholes in pesticide regulation that a company like Amvac can post impressive profits by using these loopholes, having a significant say in the writing of the regulation, and effortlessly denying and delaying action. It’s a well researched piece, read in full.

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    One Person's Carbon Offset – Another's Child labor?

    Byoliveridley

    The ‘carbon offset’ child labourers – Times Online

    “Pumping furiously on a foot treadle in the afternoon heat, six-year-old Sarju Ram is irrigating her impoverished family’s field, improving the crop and – without knowing it – helping environmentally sensitive holiday-makers assuage their guilt over long-haul flights to dream destinations.

    But Sarju and her four brothers and sisters working flat out in a clump of trees that provide scant shelter from the sun illustrate a growing argument over claims that British environmentalists’ efforts to curb greenhouse emissions are inadvertently fuelling an increase in child labour.”

    Carbon Offsets are a pricing mechanism setup where people can sign up to pay various companies to compensate for their greenhouse gas emissions by funding mitigation projects, such as planting trees, funding renewable energy projects, and in this case, paying money to farmers (and their families) to pump their water using a foot pump. Terrapass is one such well known company and there are many others.

    I am not so sure I would characterize this as exploitative child labor. There’s plenty of that going around in conventional manufacturing in Asia, not to mention children being used to kill. Compared to this general egregiousness, the prospect of a farmer’s kid, who would be working on the farm anyway, biking away for half an hour so his family can get some extra money does not sound all that bad. Yes, the colonialistic aspects of the story hit me in the face and makes me want to condemn a practice where a rich Westerner pays a poor farmer to pedal away for hours so she can fly to the Galapagos for a eco-vacation.

    But, in the end, these offsets do something. No, they will not do anything to slow (well, maybe a little, imperceptibly, perhaps?) CO2 emissions. Obviously, there’s no substitute to comprehensive worldwide carbon reduction strategy which prices carbon correctly, does not put barriers on technology transfer, and does not transfer greenhouse emissions from the US to Western Europe to China and India in the name of efficiency while doing nothing to ensure that that this manufacturing uses clean technology. Offsets make people aware of their actions, and choices they can make. This makes them (I hope) more likely to support major climate change legislation. It is more about attitudinal change than major change. But calling this child labor and exploitation is, I think, unwarranted.

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    CNN Finds Indian Widows Ostracized – 200 years late on the story

    Byoliveridley

    cnnscreenshot.jpg

    Umm, CNN, not exactly headline or breaking news, is it? Raja Ram Mohan Roy crusaded against it in the 1800s, Deepa Mehta made a movie about it recently. So, why was this on my cnn front page? God knows…

    Shunned from society, widows flock to city to die – CNN.com

    Ostracized by society, thousands of India’s widows flock to the holy city of Vrindavan waiting to die. They are found on side streets, hunched over with walking canes, their heads shaved and their pain etched by hundreds of deep wrinkles in their faces.

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    DMK blinks on Sri Lankan Tamils, LTTE

    Byoliveridley

    Signalling the end of a major crisis that threatened the continuance of the United Progressive Alliance government, Chief Minister M. Karunanidhi assured External Affairs Minister Pranab Mukherjee that he would not precipitate any crisis over the issue of a ceasefire in the Sri Lankan ethnic conflict, even as the island nation assured India that the safety of Tamils in that country was being taken care of.

    via The Hindu : Front Page : As DMK relents, crisis for Centre ends

    So, what happened? The Indian government reacted to Tamil MPs’ ultimatums and issued a statement expressing “concern”. The Sri Lankan government responded by issuing a statement “reassuring” that Tamils would be taken care of. In the end, nothing appears to have changed, except the rather subtle new perception that there could be an increased Indian involvement in possible negotiations.

    We shall see, having been here before.