Monday, 29 July 2013

When growth is another word for violence

The original source of this article can be found here.

When growth is another word for violence 
The single-track hawkish focus on reforms-driven growth with utter disregard for the environment, equity and indigenous livelihoods is not only futile, but almost an assault by a few against the majority at the grassroots, writes Ashish Kothari. 
28 July 2013 - We need faster growth, more investments, more reforms. This is the mantra being chanted by politicians and industrialists, economists and other experts, in an ever-increasing crescendo. We hear it at seminars and workshops, cabinet meetings, business award ceremonies, television and print media, and every other influential forum possible. Almost always, the justification given is that this is the only way to lift Indians out of poverty and deprivation. Interestingly, at none of these forums does one actually see the poor; images from a recent business newspaper’s award functions showed almost every one of the participants wearing crisp three-piece suits. All black, as if in mourning for the loss of a couple of percentage points of economic growth.

If the poor were at these forums, they might have asked some uncomfortable questions.
Why, for instance, are anything between 35 to 55% of India’s citizens still poor, and why does the government accept atrociously low survival criteria to determine poverty?
Can the Planning Commission’s Members live at Rs. 29 per day in Delhi, since they seem to think this is enough to pip the poverty line?
Why, despite 80% investment going into the formal economic sectors, has there been no net growth in employment in them?
Or why is India still stuck amongst the worst-performing countries on UNDP’s Human Development Index, or on the Global Hunger Index of the International Food Policy Research Institute?
Why, despite rip-roaring growth (amongst the fastest in the world), has Gujarat hardly moved in improving the condition of its children (44% were stunted in 1992, 42% in 2005-06)?
Why have upwards of 2 lakh farmers committed suicide, including many in the heart of the Green Revolution?
Why do 10% of rich Indians own over 50% of its wealth; is this where most of the new wealth generated by globalisation is siphoned off to?
Why, as Rural Development Minister Jairam Ramesh recently admitted, has the public health system collapsed, leading to over 70% of health expenditure being private, and forcing a huge chunk of the poor’s meager earnings to go towards paying doctors?
Can all this be due to inadequate reforms, or might it actually be because of the nature of these reforms?

Water harvesting near Bikaner supported by URMUL Setu. Pic: Ashish Kothari
Factor in the issue of ecological sustainability, and the doubts become louder. If the problems were not clear enough already, the recent Uttarakhand tragedy should have made them. Globally, the model of development is the same as in India; it has already degraded over 60 per cent of the ecosystems on which we all depend for our lives, and several of the planetary ecological limits we all are subject to, have been crossed. We are still altering the earth’s climate, with catastrophic results already unfolding.
A 2008 report by the Ecological Footprint Network co-published, interestingly enough, by the Confederation of Indian Industries, estimated that in India we were using twice the biological capacity that could sustain human activity, and we had already halved this capacity in the last few decades. The period of reforms has seen an acceleration of diversion of forest land (2 lakh hectares in just the last 5 years), mining operations, fishery exploitation, and damaging development along the coasts; for the first time in history, parts of the Indian Ocean are showing signs of depletion! We are already firmly on the path of unsustainability, rapidly reducing the chances of next generations to enjoy healthy, fulfilling lives. Not to mention the thousands of species of plants and animals, which are sliding towards oblivion. Even as the Ministry of Environment and Forests named the river dolphin the national aquatic animal a couple of years back, it was clearing dams and industries, effectively sealing its fate.

Handlooms promoted by Jharcraft, Jharkhand. Pic: Ashish Kothari
To add to the mismatch between statements regarding ‘sustainable development’ and actual actions, is the government’s latest decision to set up a Cabinet Subcommittee on Investment. Anyone willing to shell out Rs. 1000 crore is now getting priority treatment, including overruling of ministries (such as Environment and Forests, or Tribal Affairs) if they object to such investments. This is yet another way by which rational and democratic decision-making is being bypassed. Another way in which concerns will be bulldozed to allow construction in the most fragile areas, as was done in Uttarakhand’s chardham areas, with catastrophic results that we can all see now.
Today’s development model is one in which economic growth, which should be a means, has become an end in itself. A ritualized mantra intoned so often by our development high priests that the rest of us have even blindly started believing in it.
Resistance and Alternatives
Not everyone, though, has been hypnotized by the growth mantra. Across the country there are resistance and protest movements from adivasis and farmers, fisherfolk and the urban poor, unwilling to ‘sacrifice’ for a notional ‘national good’ that has only done them bad. They are facing repression and bullets, arrests and vilification (‘anti-national’ being a common label), but not backing down. Attempts to break them by bribing their leaders, or splitting communities with money, are succeeding in some places; in others they are being repulsed by collective action refusing to be lured by cash.
As farmers in Raigarh of Maharashtra told one of India’s most powerful businessmen, who wanted to acquire their area for a Special Economic Zone, ‘land is our mother, we won’t sell it; would you sell yours?’ Or as those to be displaced by the Jaitapur atomic power plant are saying, if you want to feed a power-guzzling Mumbai, build the plant on Malabar Hill or Chowpatty. No longer are many communities willing to be the ‘eggs’ that have to be broken to make an ‘omelette’ (to use a colourful phrase a Sardar Sarovar Project engineer once uttered to me, in justifying the project’s displacement of 100,000 people).
Equally important, there are growing voices showing that human well-being and happiness can be achieved in very different ways, more sustainable and equitable. If food security is a goal, Messrs Singh, Chidambaram and Ahluwalia would do well to look at how Dalit women farmers in 70 villages of Medak district (AP) have achieved it through collective governance of farm resources, organic cultivation of dozens of traditional varieties of millets, and creation of an alternative Public Distribution System fed by local produce.

Narmada demonstration (20th anniversary). Pic: Ashish Kothari
Villages and some urban wards in the driest parts of India, like Kachchh, have demonstrated how water security can be achieved through localized harvesting and sound management, putting a humungous question mark on the justification offered for mega dams like Sardar Sarovar. Communities in Bihar are showing how decentralised renewable sources can quickly provide energy security, not having to wait for unreliable power grid connections from super- polluting super-thermal power stations. So much so that Chief Minister Nitish Kumar wants to commit substantial funding to such sources.
What about non-agricultural livelihoods? Kuthambakkam Village in Tamil Nadu has workshops producing a range of products, as does Prakash Amte’s Anandwan, both providing dignified employment to the poorest and most socially ostracised sections such as Dalits. Producer cooperatives and companies are helping generate decent returns for craftspersons and farmers in Andhra Pradesh, Gujarat, and other states; some even manage their own retail. Communities in Vidarbha of Maharashtra whose right to protect and manage forests has been recognized under the Forest Rights Act are combining it with NREGS and other laws or schemes to make holistic development plans for their villages, and earning substantial revenues by sustainable use of bamboo, tendu, and other forest produce.
Slum dwellers in Bhuj are showing how localized water and housing projects can empower some of the poorest families, while dealing with typical urban problems. Citizens in many urban areas are showing how local water harvesting, garbage management, biodiversity spaces, and other initiatives can reduce the footprint of the city on the countryside, and provide more decent living to city-dwellers. And increasingly many of these initiatives are linking to scale up over larger landscapes or spread to other areas. With some governmental help, as in the case of Jharcraft in Jharkhand, the initiatives can reach lakhs of families.

Farmers of Deccan Development Society, Andhra in a biodiverse field. Pic: Ashish Kothari
Growth Fetish
Though there are far more sustainable and equitable options available to take all Indians towards prosperity, our decision-makers are stuck to the growth fetish. It’s a fetish that makes them blind to anything other than profits. This is why a company listed in London with an NRI as chair, which has been hounding the Dongria Kondh adivasis in Odisha to give up their sacred forested mountain for mining, is given ‘Businessman of the Year’ award. (As an aside, I wonder if he would have been awarded if he had instead pressed for demolition of the Somnath mandir or the Taj Mahal, because there was iron ore beneath it?). No awards for excelling in economic development are given to ‘ordinary’ citizens who demonstrate that livelihood security can be achieved without displacing people and destroying the environment.
It is also a fetish that produces strange schizophrenia. So a prominent businessman writes in the Times of India that we are a “land blighted by … unemployment and sharp inequalities”; he then notes that his company’s “employee strength has been halved due to improved productivity” and outsourcing; and then he argues for more ‘reforms’ and growth completely oblivious to the ‘jobless’ nature of such growth as demonstrated by his own company.
Finally, it is a fetish that is brazenly undemocratic. This is why Telecom Minister Kapil Sibal can get away with blaming his government’s policy paralysis on some of the most important pillars of India’s democracy; at the aforesaid business newspaper’s awards ceremony, he is quoted as blaming “one, the erudition of the CAG; two, the media; and three, the court”. Such irresponsible pronouncements are fodder for state governments like Chhattisgarh who ride roughshod over basic civil liberties of people peacefully protesting forcible land acquisition. The government is even encouraging semi-autocratic governance in Special Economic Zones and private cities (e.g. Lavasa), where several democratic rights of citizens are suspended.
It is in this sense that the blind pursuit of growth is nothing short of violence on both the poor and on nature, and increasingly threatening even much of the middle class with pocket-breaking inflation and expensive private services. The sooner we as Indian citizens realize this, and press for fundamental changes to make social equity, ecological sustainability, and meaningful economic security the central pillars of decision-making, the sooner we will take the country towards true and lasting prosperity.
Ashish Kothari 
28 July 2013
Ashish Kothari is with Kalpavriksh, Pune. His recent book Churning the Earth: The Making of Global India (Viking/Penguin books), with Aseem Shrivastava, deals with the above issues in more detail.
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Tuesday, 16 July 2013

Amartya Sen/ Jean Dreze new book An Uncertain Glory.

Original post can be found here

Amartya Sen: India's dirty fighter

Half of Indians have no toilet. It's one of many gigantic failures that have prompted Nobel prize-winning academic Amartya Sen to write a devastating critique of India's economic boom

The roses are blooming at the window in the immaculately kept gardens of Trinity College, Cambridge and Amartya Sen is comfortably ensconced in a cream armchair facing shelves of his neatly catalogued writings. There are plenty of reasons for satisfaction as he approaches his 80th birthday. Few intellectuals have combined academic respect and comparable influence on global policy. Few have garnered quite such an extensive harvest of accolades: in addition to his Nobel prize and more than 100 honorary degrees, last year he became the first non-US citizen to be awarded theNational Medal for the Humanities.
  1. An Uncertain Glory: India and its Contradictions
  2. by Jean Dreze, Amartya Sen
  1. Tell us what you think: Star-rate and review this book
But Sen doesn't do satisfaction. He does outrage expressed in the most reasonable possible terms. What he wants to know is where more than 600 million Indians go to defecate.
"Half of all Indians have no toilet. In Delhi when you build a new condominium there are lots of planning requirements but none relating to the servants having toilets. It's a combination of class, caste and gender discrimination. It's absolutely shocking. Poor people have to use their ingenuity and for women that can mean only being able to relieve themselves after dark with all the safety issues that entails," says Sen, adding that Bangladesh is much poorer than India and yet only 8% don't have access to a toilet. "This is India's defective development."
Despite all the comfort and prestige of his status in the UK and the US – he teaches at Harvard – he hasn't forgotten the urgency of the plight of India's poor, which he first witnessed as a small child in the midst of the Bengal famine of 1943. His new book,An Uncertain Glory, co-written with his long-time colleague Jean Drèze, is a quietly excoriating critique of India's boom.
It's the 50% figure which – shockingly – keeps recurring. Fifty per cent of children are stunted, the vast majority due to undernourishment. Fifty per cent of women have anaemia for the same reason. In one survey, there was no evidence of any teaching activity in 50% of schools in seven big northern states, which explains terrible academic underachievement.
Despite considerable economic growth and increasing self-confidence as a major global player, modern India is a disaster zone in which millions of lives are wrecked by hunger and by pitiable investment in health and education services. Pockets of California amid sub-Saharan Africa, sum up Sen and Drèze.
The details are outrageous but the outlines of this story are familiar and Sen and Drèze are losing patience (they have collaborated on several previous books) and their last chapter is entitled The Need for Impatience. They want attention, particularly from the vast swath of the Indian middle classes who seem indifferent to the wretched lives of their neighbours. So they have aimed their critique at India's national amour-propre by drawing unfavourable comparisons, firstly with the great rival China but even more embarrassingly with a string of south Asian neighbours.
indian slum An Indian boy defecates in the open in one of New Delhi's slums. Photograph: AP Photo/Kevin Frayer
"There are reasons for India to hang its head in shame. Alongside the success, there have been gigantic failures," says Sen. He is making this critique loud and clear in the media on both sides of the Atlantic ahead of the book's launch in India this week. "India will prick up its ears when comparisons with China are made, but the comparison is not just tactical. China invested in massive expansion of education and healthcare in the 70s so that by 1979, life expectancy was 68 while in India it was only 54."
Sen and Drèze's argument is that these huge social investments have proved critical to sustaining China's impressive economic growth. Without comparable foundations, India's much lauded economic growth is faltering. Furthermore, they argue that India's overriding preoccupation with economic growth makes no sense without recognising that human development depends on how that wealth is used and distributed. What's the purpose of a development model that produces luxury shopping malls rather than sanitation systems that ensure millions of healthy lives, ask Drèze and Sen, accusing India of "unaimed opulence". India is caught in the absurd paradox of people having mobile phones but no toilets.
Even more stark is the comparison with Bangladesh. "Our hope is that India's public policymakers will be embarrassed by the comparison with Bangladesh. On a range of development indicators such as life expectancy, child immunisation and child mortality, Bangladesh has pulled ahead of India despite being poorer.'
What makes this comparison so powerful is that Bangladesh has targeted the position of women not just through government policy but also through the work of non-governmental organisations such as BRAC and the Grameen Bank. As a result, there have been astonishing successes, says Sen, such as a dramatic fall in fertility rate and girls now outnumbering boys in education. All this has been achieved despite having half the per capita income of India.
Other impoverished neighbours such as Nepal have made great strides, while even Sri Lanka has kept well ahead of India on key indicators despite a bitter civil war for much of the last 30 years. Drèze and Sen conclude in their book that India has "some of the worst human development indicators in the world" and features in the bottom 15 countries, along with Afghanistan, Yemen and Pakistan. Seven of the poorest Indian states account for the biggest concentration of deprivation on the globe.
India, Kathputli Street scene in Delhi's Kathputli colony, where the houses have no running water, electricity or sanitation. Photograph: Donatella Giagnori/LatinContent/Getty Images
After this blizzard of facts and figures – and the book is stuffed with them – one might fear reader despair, but the reverse is true. This is a book about what India could do – and should do. Kerala, Tamil Nadu and Himachal Pradesh are held up as good examples of how social investments from the 60s to the 80s have reaped dividends in economic growth. What holds India back is not lack of resources but lack of clear-sighted, long-term policies and the political will to implement them. Sen (still an Indian citizen) is optimistic, pointing to the political mobilisation following the rape of a young woman student on a bus in Delhi last December, which led to the rapid adoption of new measures to combat violence against women. The consciences of the Indian middle classes can be stirred, and, when they are, political action follows.
But he admits "intellectual wonder" at how it is that more people can't see that economic growth without investment in human development is unsustainable – and unethical. What underpins the book is a deep faith in human reason, the roots of which he traces to India's long argumentative tradition going as far back as the Buddha. If enough evidence and careful analysis is brought to bear on this subject then one can win the argument, and it is this faith that has sustained him through more than five decades of writing on human development. It was his work which led to the development of the much cited UN's Human Development Index.
Influential he has certainly been, but he acknowledges he still hasn't won the argument. To his dismay, there are plenty of examples where people seem set on ignoring the kind of evidence he stacks up; in passing he asks: "How can anyone believe austerity with high levels of unemployment is intelligent policy for the UK?"
He laughingly comments that colleagues say his thinking hasn't evolved much, but he dismisses the idea of being frustrated. All he will concede is the astonishing admission that he wishes someone else had written this book on India. "There are a number of problems in philosophy which I would have preferred to tackle – such as problems with objectivity. But this book had to be written. I want these issues heard."
He says that the Nobel prize and the National Medal from President Obama may be "overrated" but they give him a platform, and he unashamedly uses it – giving time to media interviews and travelling all over the world to deliver speeches. That has led to compromises on the intellectual projects he would have liked to pursue, but life has been full of compromises ever since he narrowly survived cancer as an 18-year-old: there are all kinds of food he cannot eat as a result.
He is an extraordinary academic by any account – a member of both the philosophy and the economics faculties at Harvard – and is helping to develop a new course on maths while supervising PhDs in law and public health. He has plans for several more books and no plans to slow down. Mastery of multiple academic disciplines is rare enough but it's the dogged ethical preoccupation threading through all his work that is really remarkable. None of the erudition is used to intimidate; he is always the teacher.
Some argue that Sen is the last heir to a distinguished Bengali intellectual tradition that owed as much to poets as it did to scientists, politicians and philosophers. Sen is the true inheritor of Rabindranath Tagore, the great poet and thinker of the early decades of the 20th century. A family friend, he named Sen as a baby; the only photograph in Sen's Cambridge study is that of the striking Tagore with his flowing white beard.
But on one issue Sen admits he now parts company with Tagore, and instead he quotesKazi Nazrul Islam, Bengal's other great poet who became an iconic figure for the nation of Bangladesh. Tagore was too patient; Nazrul was the rebel urging action. And he repeats a quote he uses in the book: "Patience is a minor form of despair, disguised as a virtue." He wants change and that means he is about to embark on a demanding tour of Indian cities to promote the book. The doctors have told him that if he slows down it will be irrevocable, so he's decided not to. Retirement is not an option.

Thursday, 11 July 2013

Human papillomavirus (HPV) vaccine – identifying and overcoming the challenges to reaching those who need it most

See the published article here.

Posted: 09 Jul 2013 02:54 AM PDT
Women in low and middle-income countries experience the greatest burden of cervical cancer in the world, with more than 88% of the 275,000 deaths annually taking place in these areas. The human papillomavirus (HPV) is the most common sexually transmitted infection globally and is the major cause of cervical cancer. Two preventive vaccines were licensed in 2006 and boast great potential for reducing the burden of cervical cancer. 

Despite the fact that the vaccine has proven to be safe and effective against HPV, there has been a significant lag to delivering it in low and middle income countries (LMICs). Using both a literature review and interviewing experts working in the HPV vaccine field we investigated the current challenges to introducing the HPV vaccine.   

We found that although early research anticipated the biggest challenge to be the sociocultural barriers including potential stigma or concerns to vaccinating girls 9-13 years against a sexually transmitted infection, this wasn’t really the case in the literature or as expressed by experts. The need to communicate and educate or ‘sensitise’ the public, policymakers and various stakeholders on the vaccine, HPV and its link to cervical cancer were important to overcoming and preventing these issues.

The main challenges that were identified included those relating to the logistics and delivery of a new vaccine to a new target group – teenage girls as well as countries’ infrastructure and storage systems. Countries performing demonstration projects have proven that it is possible to reach these girls, vaccinating at schools, health centres, campaigns or often through more than one avenue and have achieved higher coverage of the HPV vaccine than in many high income countries like the United States or the Netherlands. 

Financing of the HPV vaccine has been a topic of much debate worldwide as costs for the vaccine ranges from US$13 to US$100 for each dose, making it unaffordable to most LMICs. Vaccine financing through mechanisms such as the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunisation) are improving access to LICs to vaccines through negotiating lower vaccine prices and co-financing until countries can afford the vaccines. However other costs, including start-up and on-going implementation costs to sustain programmes are still significant challenges.

Finally, the third main challenges were the political barriers and facilitators to introducing the HPV vaccine. Expensive, new public health interventions, such as the HPV vaccine, demand more evidence to convince countries that it is a worthy cause in which to invest their limited resources and represents an important barrier that needs to be overcome. 

Excitingly, many demonstration programmes and pilot projects are currently testing out what works and how it can be made sustainable long term. Our study helps to document not only the challenges that have been identified but how national immunization programmes, demonstration and pilot projects are overcoming and successfully implementing the HPV vaccine, so that others considering its introduction can learn and continue to build upon their experiences.

Further information