|

School Meals and Child Death in India

Byoliveridley

Hunger

Like most, I am appalled and saddened by the death of 20+ (and rising) children in Bihar, poisoned by pesticide in their state-provided school lunch. This guardian article has a good run down on the issues that beset the program.

The fear is that attention is being diverted from what is an acute problem in many of India’s state-run or state-assisted schools. While the ruling party in the state looks for excuses, the harsh reality is that food provided to children all over the country is often substandard, and sometimes not even fit for human consumption.

Indias deadly problem with school meals | Kishwar Desai | Comment is free | guardian.co.uk.

What is missing from the analysis is the magnitude of the hunger problem India is trying to solve. It is estimated that over 40% of children are undernourished in India. School meals have large public health benefits if done right. So it is vitally important that this program work, as this Indian teacher so eloquently details in her blog post.

It’s this absence of monitoring, I believe, that’s sabotaging a scheme that’s helped bring millions of children into school. The scheme was originally envisaged as government-run, but community aided and supervised. In practice, because parents and teachers are both busy, the whole system lacks anyone to ensure hygiene and quality.

The entire post is worth a read.

India reduced its global hunger index by about 24% since 1990. But note that Bangladesh’s percent reductions have been higher. As The Week points out, the last thing you want is for parents to pull their kids out of school because their kids will get poisoned, and for this program to end because it cannot be implemented without poisoning the kids.

What is especially egregious in this case was that the children noticed something was amiss, and alerted authorities, who did not listen. India’s authoritarian school institutions do not abide any feedback from children, especially the children of low/no privilege that attend government schools. Hunger and lack of choice probably played a part as well. There’s also early evidence that the school administrator ignored warnings from the cook about the cooking oil, calling it “home made”.

In the end, like everything else in India, it comes down to institutional quality and money. For all the complaints about excessive “regulation”, programs like Food Safe in BC are designed to ensure that people working with food know how to handle food, what to avoid, and how to identify and prevent dangerous situations. It takes effective institutions to ensure that quality and safety are maintained consistently and the people involved do the right thing most of the time. India’s performance in providing reliable services for its poor is also complicated by vast state-to-state disparities in institutional quality. India’s so called growth has also been top-heavy. People living in villages and the urban poor have not been a part of India Shining (or its new incarnation Bharat Nirman).

Can regulations on food safety, quality and delivery be enforced in the absence of a good monitoring and accountability system? Can India use the money it gets from “developing” to provide better services for its people? It will take time, and hopefully, eventually tragedies like the one above will be less frequent.

Similar Posts

  • |

    Smoking ban for N.C. Bars and Restaurants

    Byoliveridley

    The bill approved Wednesday falls short of how it began: a total and sweeping ban on smoking in all public places. But the House's original bill left a wide loophole for bars, an exemption that worried restaurant owners who feared bars would steal late-night customers.

    via House approves smoking ban for N.C. – Politics – News & Observer.

    The bill (soon to become law) still contains the giant “private club” loophole I had mentioned earlier, so, 1.5 cheers. And strange exemption for cigar bars (where smoke is emitted), but not for hookah bars (where water filters quite a bit of the smoke).

    Critically, as Laura Leslie pointed out, the law will allow local health officials to go above and beyond state law. So, a floor was established, not a ceiling, which is good. They were previously forbidden to enact any smoking bans. Now Chapel Hill/Carrboro can do what it has been wanting to do for years and finally kill smoking in all public places.

  • Indian Supreme Court refuses to strike down anti-homosexuality laws

    Byoliveridley

    In a major setback to gay activists, the Supreme Court on Wednesday held that homosexuality or “unnatural” sex between two consenting adults under Section 377 Indian Penal Code would be an offence and this provision did not suffer from any constitutional infirmity.

    http://www.thehindu.com/news/national/homosexuality-illegal-sc/article5446939.ece?homepage=true I am appalled, disgusted and feel for the millions of Indian LGBTQ. India’s laws against homosexuality (section 377) were written by British colonizers in 1860 (pdf) and no parliament since has bothered to strike them down. They are not enforced with vigour, or at all, perhaps, but the very presence of such a law silences, intimidates and oppresses the people of India, and in fact, anyone visiting as well. The LGBTQ in India suffer from oppression and silencing for reasons that go well beyond the presence of a law, but changing laws is often the first step in societal change in India. The Delhi High Court in 2009 did the right thing (and politicians a favour) by ruling the law unconstitutional. The supreme court had other ideas, apparently. The court argues (very disingenuously) that they find nothing nothing wrong with a law that the Delhi court found violated Article 14 of India’s constitution, and that the onus is on the legislature to repeal the provision. Given the idiocy of defending laws that clearly discriminate between different types of sexual activity between consenting adults, who is to blame here?

    • The British: Thanks for imposing your morals on India, no one asked you to.
    • The Congress-led ruling coalition, which initially opposed the Delhi verdict, then supported it, then mounted a tepid defence at the supreme court (like Obama on gay marriage in the US). They had the opportunity to strike the law down legislatively in 2009, and could have used their majority to do so at any point in time, they did not.
    • Indian fundamentalists. The Christians, Muslims and Hindu fundamentalists launched a united front against the ruling and argued in court together.
    • Civic organizations like Prayas, who seem to think that sex between consenting adults has something do with protecting children.
    • The Delhi Commission for protecting children? This is a governmental organization tasked with preventing child abuse. Again, they seem to think that sex between consenting adults and abuse of children are somehow connected. Sexualized abuse of children in India is terribly common and primarily perpetrated by family members,
    • The Supreme Court in India, which by law should not always be deferential to legislative process, especially when the constitution is concerned. It is well within the court’s jurisdiction to look at laws enacted before the Indian constitution and void them if they violate the constitution. The fact that they decided in this case to pretend to “see nothing wrong” indicates that they made up their mind and found a rationalization.

    rainbowWhat next? India’s election is in 4 months, nothing will happen then. Given the congress coalition’s recent weakness, and the BJP’s resurgence, India may be looking at a right wing coalition led by the BJP coming to power. Given their close ties and identification with Hindu fundamentalism, and their social conservatism, the law is likely to stand for a while longer. It will oppress millions.

  • |

    BC Bicycle Helmet Law – NC Connections

    Byoliveridley

    (b.1) that a person operating or riding as a passenger on a cycle on a path or way designated under paragraph (b.3) must properly wear a bicycle safety helmet

    British Columbia Helmet Law

    I got my bike on Thursday and finally, the vile flu that laid me low for a week has decided to sink slowly back into a tuberculotic cough. Blogging should get back to normal speed and topics as I unpack, start biking, and can live life again without being racked by chills and bad dreams.

    Figured I should get back on my bike ASAP, but I decided to first check if BC had any bicycle helmet laws, because we’re like that, we have a lot of what would be considered “paternalistic” laws south of the border. And, it does, and guess what, the project evaluating the law was performed by UNC’s Highway Safety Research Center, small world, ai!

    Apropos nothing, here’s the US list of states and their various bicycle/motorbike laws. Note that only 20 states (and DC) require the use of helmets for motorcyclists, quite insane. Fall on your bare head at 50 miles an hour and you are dead, vegetable, or both. In contrast, All of Canada is under universal motorbike helmet laws. Of course, no U.S state has bicycle helmet laws that cover adults. In contrast, four Canadian provinces have mandatory bicycle helmet laws.

  • | |

    Circumcision and AIDS – Revisited

    Byoliveridley

    condom.jpg

    A post I wrote quite a while back on circumcision and AIDS remains my most commented post ever. In it (if you’re too lazy to click) I said that while research indicating a reduction in HIV infection in circumcised men was promising, there were a couple of concerns. One, that this could be a distraction from the single most effective prevention measure (no, not abstinence!), condom use. And two, that in certain cultures, especially among Hindus, this would be an absolute no no because circumcision is identified with being Muslim.

    Anyway, in a review article, the Cochrane Centre in South Africa summarizes results from a meta analysis of a number of trials indicating a 50% reduction in HIV incidence among circumcised males. At this point in time, it is clear that circumcision is effective in reducing HIV incidence among heterosexual males. Based on this, the institute encourages the widespread use of circumcision as an AIDS prevention strategy.

    So, am I still circumspect? Absolutely. I am still concerned that this research will be misinterpreted in a way that discourages condom use. In fact, the authors note that circumcised men indulged in more risky behaviour. Also, the incidence of HIV in the women these men were sleeping with increased from 9.6% to 13.8%, a 40% uptick. This increase was not statistically significant. No arguing with that, though the study was stopped early once it was clear that the men were helped, never mind the women, or reaching statistical significance in their case.

    Given that it is very unclear what the effects of circumcision are on anything other than circumcised penises, which are only one half of the equation (or less!), I don’t think it is responsible to call for widespread use of circumcision as a public health strategy for the prevention of HIV until its effects on the other parties are known. While people are aware of this issue, I don’t think the science or the cultural landscape promote the use of circumcision as a HIV prevention strategy until its proven that women are not at risk from increased HIV incidence either biologically from a yet unknown mechanism, or socially from increased risk taking.

    Men have more power in most societies to demand and receive sex on their terms. So the male centric nature of this research, and the conclusions drawn are disturbing. How irresponsible is it to encourage a public health strategy that appears to increase risk taking behaviour among men when the effects on the women are yet unknown, with only a statistically “insignificant” 40% increase in HIV incidence among women being observed?

    I am. for very good reason, still circumspect on circumcision.

    Whisky flavoured condoms courtesy bruno  girin’s photostream used under a creative commons license. Now how’s that for a turn on, whisky!

  • Alcohol Retail Privatization and Health

    Byoliveridley

    I had a conversation recently about alcohol retail store privatization where I mentioned that there is quite a bit of research linking privatization of previously public sector alcohol retail outlets and increased incidence of adverse events, especially in alcohol dependent people. Since I’ve forgotten who it was I had this conversation with, here are three studies on this issue, dear conversation partner:

    From British Columbia, where a 2002 decision by a new BC Liberal government to greatly expand private liquor stores was studied. Here’s a link to the full study ($$) and the press release is below:

    http://communications.uvic.ca/releases/release.php?display=release&id=1193

    Excerpting from the study abstract:

    Findings  The total number of liquor stores per 1000 residents was associated significantly and positively with population rates of alcohol-related death (P < 0.01). A conservative estimate is that rates of alcohol-related death increased by 3.25% for each 20% increase in private store density. The percentage of liquor stores in private ownership was also associated independently with local rates of alcohol-related death after controlling for overall liquor store density (P < 0.05). Alternative models confirmed significant relationships between changes in private store density and mortality over time.

    Conclusions  The rapidly rising densities of private liquor stores in British Columbia from 2003 to 2008 was associated with a significant local-area increase in rates of alcohol-related death.

    From Alberta: A study linking greater alcohol privatization with increased alcohol related suicides.

    We examine the impact of privatization of retail sale of alcohol in Alberta, Canada, between 1985 and 1995 on mortality rates from suicide. Privatization took place in three stages: The opening of privately owned wine stores in 1985, the opening of privately owned cold beer stores and the selling of spirits and wine in hotels in the rural area in 1989–90, and finally privatization of all liquor stores in 1994. Interrupted time series analysis with Auto Regressive Integrated Moving Average (ARIMA) modeling was applied to male and female suicide rates to assess the impact of the three stages of privatization. The analyses demonstrated that most of the privatization events resulted in either temporary or permanent increases in suicide mortality rates. Other alcohol-related factors, including consumption levels and Alcoholics Anonymous (AA) membership rates, also affected suicide mortality rates. These analyses suggest that privatization in Alberta has acted to increase suicide mortality rates in that province.

    Here’s a fairly comprehensive review of 17 studies, which was conducted by the American Centres for Disease Control (CDC).

     

    EVIDENCE SYNTHESIS:

    A total of 17 studies assessed the impact of privatizing retail alcohol sales on the per capita alcohol consumption, a well-established proxy for excessive alcohol consumption; 9 of these studies also examined the effects of privatization on the per capita consumption of alcoholic beverages that were not privatized. One cohort study in Finland assessed the impact of privatizing the sales of medium-strength beer (MSB) on self-reported alcohol consumption. One study in Sweden assessed the impact of re-monopolizing the sale of MSB on alcohol-related harms. Across the 17 studies, there was a 44.4% median increase in the per capita sales of privatized beverages in locations that privatized retail alcohol sales (interquartile interval: 4.5% to 122.5%). During the same time period, sales of nonprivatized alcoholic beverages decreased by a median of 2.2% (interquartile interval: -6.6% to -0.1%). Privatizing the sale of MSB in Finland was associated with a mean increase in alcohol consumption of 1.7 liters of pure alcohol per person per year. Re-monopolization of the sale of MSB in Sweden was associated with a general reduction in alcohol-related harms.

    CONCLUSIONS:

    According to Community Guide rules of evidence, there is strong evidence that privatization of retail alcohol sales leads to increases in excessive alcohol consumption.

    This Mothers against Drunken Driving (MADD) document has a comprehensive bibliography, so does the Canadian Centre for Addiction and Mental Health.

    I would characterize myself as part of the majority of people who believe their alcohol consumption is well under control, and as a consequence, does not mind the proliferation of liquor stores open till late, on Sundays, and running promotions. But as a public health issue, the huge costs of alcohol consumption are well known and extensively studied. It is surprising that jurisdictions rush headlong into liquor privatization when this kind of literature showing clear correlation (and good causal relations) between increased retail privatization and adverse outcomes for vulnerable populations is out there.

    References

    1. Stockwell, Tim, Jinhui Zhao, Scott Macdonald, Kate Vallance, Paul Gruenewald, William Ponicki, Harold Holder, and Andrew Treno. “Impact on Alcohol-related Mortality of a Rapid Rise in the Density of Private Liquor Outlets in British Columbia: a Local Area Multi-level Analysis.” Addiction 106, no. 4 (2011): 768–776.
    2. Zalcman, Rosely Flam, and Robert E. Mann. “Effects of Privatization of Alcohol Sales in Alberta on Suicide Mortality Rates, The.” Contemporary Drug Problems 34 (2007): 589.
    3. Hahn, Robert A., Jennifer Cook Middleton, Randy Elder, Robert Brewer, Jonathan Fielding, Timothy S. Naimi, Traci L. Toomey, Sajal Chattopadhyay, Briana Lawrence, and Carla Alexia Campbell. “Effects of Alcohol Retail Privatization on Excessive Alcohol Consumption and Related Harms: A Community Guide Systematic Review.” American Journal of Preventive Medicine 42, no. 4 (April 2012): 418–427.
    4. Provincial Liquor Boards: Meeting the Best Interests of Canadians. Mothers Against Drunken Driving (MADD), 2012.
    5. Alcohol Retail Monopolies and Privatization of Retail Sales. Centre for Addiction  and Mental Health, 2010.
    Wine image from public domain used under a creative commons licence.

5 Comments

Leave a Reply