Posts Tagged ‘health’
There have in 2016 been several occasions when the work of the Ministry of Women and Child Development has come into the public glare. Not for reasons concerned with the welfare of women and children but instead for the words and actions of its minister, Maneka Sanjay Gandhi, on matters such as abuse of women in social media and paternity leave.
It is however with regard to the subjects that this ministry is concerned with – women and children of Bharat – that the most serious questions arise. As a separate ministry it is only a little over ten years old, having earlier been a department in the Ministry of Education (as the Ministry of Human Resources Development was earlier known) and with the department having been created in 1985.
What does this ministry do? In its own words: “The Ministry was constituted with the prime intention of addressing gaps in State action for women and children for promoting inter-Ministerial and inter-sectoral convergence to create gender equitable and child-centred legislation, policies and programmes.” The programmes and schemes run and managed by the ministry deal with welfare and support services for women and children, training for employment and the earning of incomes, gender sensitisation and the raising of awareness about the particular problems faced by women and children.
The ministry says that its work plays “a supplementary and complementary role to the other general developmental programmes in the sectors of health, education, rural development etc” so that women are “empowered both economically and socially and thus become equal partners in national development along with men”.
In my view there are several problems afflicting this ministry, not only in terms of what it says its work is, but also in how it goes about its work. As was the case in other countries that were once called the Third World (later called “under-developed” or “developing” countries and now called “emerging markets”), the creation of such departments or ministries came about as an adjunct to the worldwide concern about population growth, and which in Bharat had been through a particularly contentious phase in the 1970s.
That in our case a department was turned into a ministry needs to be considered against a background that has become very relevant now, for the year was 2006 and the Millennium Development Goals (or MDGs) had gone through their first set of comprehensive reviews and ‘corrections’. It is relevant because the problems concerning how the Ministry of WCD is now going about its work has to do with the successor to the MDGs, the Sustainable Development Goals (SDGs).
Looking back even only as far as recent weeks, the view, conduct and agency of this ministry calls into question, in my view, the need for it to continue as a separate ministry. Do read TS Ranga who provides a trailer into the bewildering whims and fancies of the minister. And here is a short list of the very substantial problem areas:
1. “Healthy Food to Pregnant Women-Integrated Child Development Services (ICDS)”. This means provision of supplementary nutrition to children (6 months to 6 years), pregnant women and lactating mothers. A variety of measures are needed to ensure provision: ‘Take Home Ration’, a conditional cash transfer scheme to give maternity benefit, ‘Village Health and Nutrition Days’ held monthly at anganwadi centres, tackling iron deficiency anaemia, a national conditional cash transfer to incentivise institutional delivery at public health facilities.
2. “Universal Food Fortification”. Fortification of food items like salt, edible oil, milk, wheat and rice with iron, folic acid, Vitamin-D and Vitamin-A “to address the issue of malnutrition and to evolve a policy and draft legislation/regulation on micronutrient fortification”.
3. “Beneficiaries of Supplementary Nutrition Programme under ICDS”. The increase in the number of beneficiaries is linked to the “Development Agenda for 2016-2030 of the United Nations” (the SDGs). The ministry delivers three of six ICDS services through the public health infrastructure under the Ministry of Health & Family Welfare.
4. “National Plan of Action for Children 2016”. The draft plan is based on principles contained in the National Policy for Children 2013 and categorises the rights of the children under four areas. The draft is being developed by ministries, state governments, and civil society organisations.
5. “ICDS Being Completely Revamped To Address The Issue Of Malnutrition”. The ministry is undertaking a complete revamp of the ICDS programme as the level of malnutrition in the country continues to be high. The digitisation of anganwadis is being taken up for real-time monitoring of every child and every pregnant and lactating mother. The ministry wants supplementary nutrition to be standardised through both manufacturing and distribution.
6. “WCD Ministry and Bill & Melinda Gates Foundation sign Memorandum of Cooperation”. The memorandum is for technical support to strengthen the nutrition programme in Bharat and includes ICT-based real-time monitoring of ICDS services. The motive is for national and state capacities to be strengthened to deliver nutrition interventions during pre-conception, pregnancy and first two years of life. There will be technological innovation, sharing best practices and use of data and evidence.
7. “ICT enabled Real-Time Monitoring System of ICDS”. The web-enabled online digitisation “will strengthen the monitoring of the service delivery of anganwadis, help improve the nutrition levels of children and help meet nutrition goals”. This will help draw the nutrition profile of each village and address the problem of malnutrition by getting real-time reports from the grassroot level. It will start with a project assisted by International Development Association (IDA) in 162 high burden districts of eight states covering 3.68 lakh anganwadis.
8. “Draft National Policy for Women, 2016”. The policy is being revised after 15 years and is expeceted to guide Government action on women’s issues over the next 15-20 years. “Several things have changed since the last policy of 2001 especially women’s attitude towards themselves and their expectations from life”.
9. “Stakeholders Consultations Held For Policy On Food Fortification“. A consultation with stakeholders was held to evolve a comprehensive policy including draft regulations on micronutrient fortification.
What do these tell us?
a) The ministry does not consider either women or children to be part of a family, or an extended family, or a joint family, nor are they part of a village community consisting of peers and elders. The extremely essential months during which women conceive, the post natal period, and the life of the infant until the age of two or three is – under this view – to be monitored and governed by the ministry and its agents. There is in neither of the draft plans mentioned in the points above the briefest mention of culture or community.
b) Such a view, distasteful and profoundly disruptive as it is to the institution of family, has come about because of the influences upon the ministry. Women and children are seen in this view as factors of consumption even within the family, and the decisions pertaining to what they consume, how much and when are to be controlled for lengthy periods of time by implementers and partners of the ministry’s programmes and schemes, which themselves are shaped by an international list called the SDGs in whose framing these women, children and their families played no part.
c) Sheltering behind the excuse of delivering the services of the ICDS, the ministry through its association with the Gates Foundation plans to collect at an individual level the medical data of millions of infants and mothers, for use as evidence. By whom? By the partners of the Gates Foundation and its allies which are the multi-national pharmaceutical industry, the multi-national agriculture and crop science industry and the multi-national processed foods industry. Hence we see the insistence on biofortification, micronutrients, ready-to-eat take-home rations and the money being provided (by the government through cash transfers) to buy these substances. The ICDS budget for the duration of the Twelfth Five Year Plan which ends in March 2017 is Rs 1,23,580 crore – a gigantic sum distributed amongst several thousand projects with a few hundred local implementing agencies including NGOs.
d) These objectives alone are reason enough to have the officials concerned, including the minister, immediately suspended and charge-sheeted for conspiracy against the public of Bharat. It is far beyond shameful that the valid reasons of malnutrition and gaps in the provision of essential services are being twisted in a manner that can scarcely be grasped. The 10.3 million children and women that are in the ICDS ‘supplementary nutrition’ net today form potentially the largest legitimised medical trial in the world, but with none of the due diligence, informed consent and independent supervision required for such trials in the so-called developed countries.
e) The ministry is entirely in thrall to its foreign ‘development partners’ – UNICEF, World Bank, DFID, WFP and USAID. For this reason the ministry has had the closest and cosiest of arrangements, from amongst all central ministries, with non-government organisations (NGOs) foreign and national. The international bodies such as UNICEF and the World Food Program (WFP) and the large national aid agencies (Britain’s DFID and the USA’s USAID) provide programme funding to NGOs international and national who work with and advise the WCD ministry. In the 2000s this was in order to comply with the Millennium Development Goals, now it is for the SDGs, and this is why the policy view of the ministry aligns with the UN SDGs rather than with the needs of our families whether rural or urban.
What is the remedy? The ministry manages several programmes that are critical for a large number of families all over Bharat. However these are programmes that have much in common with the aims and programmes of three ministries in particular: the Ministry of Health and Family Welfare, the Ministry of Consumer Affairs, and the Ministry of Human Resources Development (for matters pertaining to regulation and policy, the Ministry of Law and justice). These three ministries become the natural recipients of the responsibilities borne thus far by the Ministry of Women and Child Development and when such a transfer of allied duties is effected, some of the most important years in the lives of the children and women of Bharat will not become data points and consumption instances for corporations but return to being families.
Feckless EU politicians – the shallow brats of Brussels – have struck a deal between themselves and the agri-bio-technology corporations to sweep away the obstacles to genetically engineered crops in the European Union. This group, greasy fingers firmly in each other’s pocketbooks, want to allow (under limited circumstances, they say) individual EU member states to prohibit the growing of GMO crops on their territory, but to boost GMO crops in the EU overall.
The so-called “compromise pact” is likely to make it easier for the manufacturers of GM crops to win approval while allowing some countries to ban them. Not surprisingly, as the British government slavishly follows the White House line on every matter (except fish-and-chips), the deal was welcomed by Britain, which in a typically obsequious statement said it hoped the pact would allow for more rapid approval of GM crops in the EU.
Oddly, France’s agriculture ministry welcomed the “good news”, which coincided with a decision by the French constitutional court to uphold a domestic ban on GM maize. Just as oddly, Germany praised the deal for allowing “opt-outs”, saying it opened the way for a formal ban in Germany.
This pact came following what is called an indicative vote of EU Member State representatives – taken in a closed meeting (obviously). A formal vote will take place at a meeting of Environment Ministers on June 12 and if agreed – very likely it will be – it will then go to the European Parliament for approval.
That approval (or not) may come in an environment riven by weaknesses in the EU’s GMO assessment and approval system and pro-GMO bias at the centre of the European Food safety Agency (EFSA). There has also been chronic failure to implement an EU-wide and rigorous co-existence and liability regime – to date the EU has only produced non-legally binding recommendations for co-existence (of GM and non-GM crops).
The significance of all this is that it breaks the political stalemate that has largely prevented GMO crops from being grown in the EU. The proposal is based on the deceit that both pro- and anti-GMO countries can have want they want, and the unity of the EU Single Market can remain intact.
This is nonsense because under the proposed terms:
* Before banning an approved GMO crop EU Member States have to seek agreement from GMO companies to having their product excluded from a specific territory.
* If the companies refuse, Member States can proceed with the ban but only on grounds that to do not go against the EU approval and assessment of health and environmental risk – which means that if the EU-wide assessment gives the nod to GM, the country must concur despite its own assessment and public opinion.
* EU Member States nevertheless still have specific grounds for a ban which can include aspects like protection of nature reserves, areas vulnerable to contamination, and socio-economic impacts. So EU ‘unity’ can be overridden, provided smaller and weaker EU members states assert that right.
By the end of 2014 June, a group of cities will cross important population thresholds. This upward procession of population numbers – for districts, cities and states – is scarcely observed by administration or by citizens, but continues apace. There is – in India’s 4,041 statutory towns (large cities included) and 3,894 census towns – little by way of monitoring and regular assessment of their populations.
Such an attitude simply means that policies and measures drawn up by administrations, universities, civic groups and voluntary organisations are out-of-date the instant they are final – because they are based on the population recorded in 2011 by the Indian Census of 2011 (which fixes the population in March of that year).
Measures to control and lower growth rates of population has become a subject on which there appears to be an unmentioned taboo, just as the subject of migration has become taboo, for as long cities and urban areas continue to absorb citizens who are forced to consume more, the growth rate of GDP can be maintained.
The implications of India’s urban population rising unchecked are not forecast or discussed by central and state planning agencies, nor is this done regularly by the many think-tanks and academic research units. Industry does so only insofar as estimating the size of various markets, for example the processed food, consumer finance, vehicle purchasing numbers, or dwelling units.
In 2011 March, the Census of India recorded the country’s population as 1,210.2 million – the rural population at 833.1 million (up by 90.47 million from 2001) and the urban population at 377.1 million (up by 91 million from 2001). The population growth rate for India between 2001 and 2011 was 17.64%, but while the rural population grew over the decade by 12.18% the urban population grew by 31.8%.
At the overall urban growth rates, here are the new population marks to be seen in 2014 June for a set of cities that will be familiar to many:
* Rohtak in Haryana will have a population of 406,400 (it was 294,577 in the 2001 Census); Gaya in Bihar 500,800 (394,945); Patiala in Punjab 501,600 (323,884); Rajahmundry in Andhra Pradesh 502,800 (413,616); Bilaspur in Chhattisgarh 506,400 (335,293).
* Udaipur in Rajasthan 509,900 (389,438; Nanded in Maharashtra 601,800 (430,733); Moradabad in Uttar Pradesh 1,006,400 (641,583); Hubli-Dharwad in Karnataka 1,006,700 (786,195).
* Aligarh in Uttar Pradesh 1,019,900 (669,087); Durg-Bhilai in Chhattisgarh 1,115,600 (927,864); Asansol in West Bengal 1,310,600 (1,067,368); Jamshedpur in Jharkhand 1,430,600 (1,104,713).
* Varanasi in Uttar Pradesh 1,526,500 (1,203,961); Meerut in Uttar Pradesh 1,532,400 (1,161,716); Vijayawada in Andhra Pradesh 1,607,900 (1,039,518); Bhopal in Madhya Pradesh 2,067,300 (1,458,416).
These increases show the immense scale of this residential transformation, as every year several million citizens move to cities and towns. For what we consider a bloc of urban population, there is a band – which is imprecise, rather than a particular forecast, which does not take into account variations in the growth rate after 2011 – that lets us estimate the annual addition to total urban population.
The upper bound is the 3.18% annual urban population growth rate of the 2001-2011 decade, while the lower bound is the 1.76% annual total population growth rate of the same decade. In 2014 June, the total urban population of India will be between 399 and 417 million. Here is the result:
An agency that has been specifically given the task of stabilising the country’s population is the Jansankhya Sthirata Kosh, an autonomous society of the Ministry of Health and Family Welfare.
The Kosh runs activities aimed that help states and districts find ways to stabilise their populations – this means, halt and where possible reverse the growth rates. But the Kosh is also limited in its aims (and possibly its abilities) by what the central government says is the need of sustainable economic growth, social development and environment protection – that ‘growth’ delusion again has intervened in so serious a matter as controlling population growth.
One of the aims of the Kosh is to “facilitate the development of a vigorous people’s movement in favour of the national effort for population stabilisation”. This cannot be done without a clear and firm statement that indefinite ‘growth’ must be abandoned as a central economic idea, for only then will population growth, environmental degradation and humane urban settlements take shape.
The language is clear and blunt. The message continues to be, as it was in 2013 September, that our societies must change urgently and dramatically. The evidence marshalled is, when compared with the last assessment report of 2007, mountainous and all of it points directly at the continuing neglect of our societies to use less and use wisely.
This Fifth Assessment Report (AR5) by the Intergovernmental Panel on Climate Change (IPCC) comes seven years after the last. It has said that observed impacts of climate change have already affected agriculture, human health, ecosystems on land and in the oceans, water supplies, and livelihoods. These impacts are occurring from the tropics to the poles, from small islands to large continents, and from the wealthiest countries to the poorest.
“Climate change has negatively affected wheat and maize yields for many regions and in the global aggregate. Effects on rice and soybean yield have been smaller in major production regions and globally, with a median change of zero across all available data, which are fewer for soy compared to the other crops. Observed impacts relate mainly to production aspects of food security rather than access or other components of food security. Since AR4, several periods of rapid food and cereal price increases following climate extremes in key producing regions indicate a sensitivity of current markets to climate extremes among other factors.”
The IPCC’s Fifth Assessment Report (AR5) contains contributions from three Working Groups. Working Group I assesses the physical science basis of climate change. Working Group II assesses impacts, adaptation, and vulnerability, while Working Group III assesses the mitigation of climate change. The Synthesis Report draws on the assessments made by all three Working Groups.
The Working Group II AR5 considers the vulnerability and exposure of human and natural systems, the observed impacts and future risks of climate change, and the potential for and limits to adaptation. The chapters of the report assess risks and opportunities for societies, economies, and ecosystems around the world.
“Differences in vulnerability and exposure arise from non-climatic factors and from multidimensional inequalities often produced by uneven development processes. These differences shape differential risks from climate change. People who are socially, economically, culturally, politically, institutionally, or otherwise marginalised are especially vulnerable to climate change and also to some adaptation and mitigation responses. This heightened vulnerability is rarely due to a single cause. Rather, it is the product of intersecting social processes that result in inequalities in socioeconomic status and income, as well as in exposure. Such social processes include, for example, discrimination on the basis of gender, class, ethnicity, age, and (dis)ability.”
The Working Group 2 report has said that impacts from recent climate-related extremes (such as heat waves, droughts, floods, cyclones, and wildfires) reveal significant vulnerability and exposure of some ecosystems and many human systems to current climate variability. The impacts of such climate-related extremes include alteration of ecosystems, disruption of food production and water supply, damage to infrastructure and settlements, morbidity and mortality, and consequences for mental health and human well-being. The WG2 has starkly said that for countries at all levels of development, these impacts are consistent with a significant lack of preparedness for current climate variability in some sectors.
“Climate-related hazards exacerbate other stressors, often with negative outcomes for livelihoods, especially for people living in poverty. Climate-related hazards affect poor people’s lives directly through impacts on livelihoods, reductions in crop yields, or destruction of homes and indirectly through, for example, increased food prices and food insecurity. Observed positive effects for poor and marginalised people, which are limited and often indirect, include examples such as diversification of social networks and of agricultural practices.”
Here is how the Working Group II report, and it’s a hefty one indeed, has been organised.
Volume 1 is called ‘Global And Sectoral Aspects’. Its sections and chapters are: Context for the AR5 (01-Point of departure, 02-Foundations for decision making), Natural and Managed Resources and Systems, and Their Uses (03-Freshwater resources, 04-Terrestrial and inland water systems, 05-Coastal systems and low-lying areas, 06-Ocean systems, 07-Food security and food production systems), Human Settlements, Industry, and Infrastructure (08-Urban Areas, 09-Rural Areas, 10-Key economic sectors and services), Human Health, Well-Being, and Security (11-Human health: impacts, adaptation, and co-benefits, 12-Human security, 13-Livelihoods and poverty), Adaptation (14-Adaptation needs and options, 15-Adaptation planning and implementation, 16-Adaptation opportunities, constraints, and limits, 17-Economics of adaptation), Multi-Sector Impacts, Risks, Vulnerabilities, and Opportunities (18-Detection and attribution of observed impacts, 19-Emergent risks and key vulnerabilities, 20-Climate-resilient pathways: adaptation, mitigation, and sustainable development).
Volume 2 is called ‘Regional Aspects’. Its chapters are: 21-Regional context, 22-Africa, 23-Europe, 24-Asia, 25-Australasia, 26-North America, 27-Central and South America, 28-Polar Regions, 29-Small Islands, 30-The Ocean. There is also ‘Summary Products’ which contains: a Technical Summary and WGII AR5 Volume-wide Frequently Asked Questions. There is ‘Cross-Chapter Resources’ which contains: a Glossary, WGII AR5 Chapter-specific FAQs, Cross-chapter box compendium. Finally there is ‘Edits to the Final Draft Report’ which contains: Changes to the Underlying Scientific/Technical Assessment, List of Substantive Edits.
As we had expected in 2013 December, the mutual back-slapping over the WTO ‘deal’ between Indian and the USA evaporated very quickly indeed in the face of American business aggressiveness. For the US industry, business and trade associations and lobbies, ‘partner’ means vassal, ‘deal’ means binding obligation, ‘priority’ and ‘sanction’ become weapons (which hurt the poor and vulnerable the most), and ‘trade’ itself means subservience.
And this is why this week, the last of 2014 February, the National Association of Manufacturers in the USA – which represents some 50 American business groups – asked the US Trade Representative to designate India a Priority Foreign Country in its 2014 report. “This designation appropriately would rank India among the very worst violators of intellectual property rights and establish a process leading to concrete solutions,” NAM said in a letter to US Trade Representative Michael Froman.
In its official foreign policy and business pronouncements on India, the government of the USA, its representatives and its agents adopt a tone reminiscent of the 1950s, when American foreign policy and its agricultural scientists joined forces to bulldoze a green revolution in India. Here and now too, the USA likes to hear itself make statements such as “the promise of the 21st Century depends squarely on a robust US-India commercial and strategic partnership” and “central to this partnership will be the co-development and sharing of our best technologies, as well as free-movement between our economies of our best minds and thinkers”.
But the US doesn’t do diplomacy. America’s manner and approach has always been, my way … or else. And that is why one of the most powerful factors influencing Indo-American business and trade connections, the US India Business Council, through its seniormost officer (Ron Somers, who had worked for the energy company Cogentrix in Karnataka), called “attention to India’s need to calibrate regulations to protect data, or inspire India’s future legislature to adjust its Patent Act to align more wholly with international norms particularly regarding incremental innovation”. The USIBC also bluntly said: “Everyone agrees that India needs to spend more on its healthcare system” and that “evolving ecosystems that reward and protect Intellectual Property will be crucial”.
These disagreements between India and the USA have surfaced anew because the USTR is holding public hearings for its annual report, scheduled to be issued in April. This report will be on countries that the US government thinks are “denying protection of IP rights or fair market access to US firms”. The USTR has said that “India is widely perceived in Washington as a serial trade offender, with US firms unhappy about imports of everything from shrimp to steel pipes they say threaten jobs, as well as a lack of fair access to the Indian market for its goods”.
This is among the most signal, and deliberate, failures of the two UPA terms of government – that its reckless and dangerous chasing of foreign direct investment and its reckless and dangerous opening of domains previously in the public sector to private interests have left Bharat and India in such a crippled state that we as a country tolerate such an insult. There is not the slightest hint of fairness in America’s bullying ways, for it wants nothing less than the capitulation of India’s pharmaceuticals industry, and it wants the handing over of insurance – from life insurance to automotive to weather – to its own freebooting companies whose practices have assisted the plunge of a sixth of America’s population into poverty over the last decade.
What may happen now? There are press reports that India may take the USA to face the WTO’s dispute settlement mechanism if included by the USTR in the ‘Priority Foreign Country’ list for intellectual property rights. American industry and trade lobbies are putting pressure on their government to include India under this list. Thus far, the position held within the central government is that the demand (from the US companies) is “completely wrong” as India’s intellectual property rights are compliant with global laws, including that of the World Trade Organisation (WTO).
It is concerning pharma that the American MNCs are most vociferous. US pharma companies had objected to India’s move to issue a compulsory license in 2012 to Hyderabad-based Natco Pharma to manufacture and sell cancer-treatment drug ‘Nexavar’ at a price over 30 times lower than charged by patent-holder Bayer Corporation.
A delegation from the US International Trade Commission (USITC), described as a quasi-judicial agency, has arrived intending to probe the impact India’s policies on trade and investment have on the American economy (the intention is to supply the USTR with ammunition and to prepare for a WTO dispute confrontation; the Americans involved perhaps cannot see or appreciate the irony of the USIBC also praising India for investing in the USA and creating jobs there).
The USITC has raised the Natco matter, and has also raised the rejection of patent to Bristol-Myers Squibb’s Sprycel and Novartis’ Gleevec. It has stated that Indian IPR laws are not Trade Related Aspects of Intellectual Property Rights (TRIPS) compliant under the WTO. The response of the government of India has been to ask all its officials to stay away from any interaction with the USITC delegation.
But we have stood firm till here. Swiss pharmaceuticals manufacturer Novartis AG had lost a legal battle for getting its blood cancer drug Gleevec patented in India and to restrain Indian companies from manufacturing generic drugs. The Supreme Court had rejected the multinational company’s plea last year in a judgement that was loudly and widely hailed in all countries of the South. This came as a blow to the US-EU pharma MNCs who see the very much larger populations of the South as new markets. Hence the threatening fist-waving by the US government.
The complaint by American companies that India refuses to implement laws to provide data protection and to provide patents for bio-pharmaceutical companies is framed in terms of being against the interest of Americans in terms of jobs and ‘fair’ competition in the global marketplace. To support such nonsense, the US Chamber of Commerce’s Global IP Centers issues what it calls an International Intellectual Property Index, which compares the IP laws and implementation of those laws of 25 countries. In the 2014 Index, India received the lowest overall score, with a score of 0 for ‘Membership and Ratification of International Treaties’ and 0.25 for ‘Trade Secrets and Market Access’.
India’s policy on generic drugs has so far refused to accept ‘evergreening’, a scheme used by pharmaceutical companies to continue having a patent over a drug – even after its patent has expired – by modifying it slightly. India’s decision to grant compulsory licenses (within Indian and WTO rules) to anti-cancer drugs by Novartis and Bayer has infuriated Big Pharma in the US. To retaliate, the USA banned Ranbaxy selling medicines from its fourth plant in the USA – so much for being ‘fair’ at home in America; why does Ranbaxy continue to want to do business there?
India’s generic drug policy is guided by the need to provide cheap medicines to a large population that cannot afford even a fraction of the international patent-protected prices of these medicines, as several authoritative civil society responses to the matter have competently pointed out. This is the practice the judiciary has supported and this is the practice that must not change under any circumstance and regardless of the threats and blandishments by Froman and his shylockian collaborators.
What do and what can rural residents spend on food and the essentials of living in India? This chart gives us an indication. It is based on new data contained in the latest revelation (my word, not theirs) from the National Sample Survey Office and is titled ‘Key Indicators of Household Consumer Expenditure in India’ (the 68th Round of sampling, for those who follow the extraordinary programme of this sterling statistical organisation).
There is data enough in the volume to inform us, clearly and starkly, that the cumulative impact of several years of food price inflation is hurting households more with every passing quarter. Consider what this new data release tells us:
* That the average rural monthly expenditure per person was lowest in the states of Odisha and Jharkhand (around Rs 1,000) and also in Chhattisgarh (Rs 1,027).
* In Bihar, Madhya Pradesh and Uttar Pradesh, the rural monthly expenditure per person was about Rs 1,125 to Rs 1,160.
* In urban India (not shown in this chart, but I will add to this posting with an expanded update) Bihar had the lowest monthly expenditure per person (called monthly per capita expenditure by the NSSO and abbreviated to MPCE) of Rs 1,507.
* In Chhattisgarh, Odisha, Jharkhand, Uttar Pradesh and Madhya Pradesh, urban MPCE was between Rs 1,865 and Rs 2,060. These six were the six major states with the lowest MPCEs for both rural and urban citizens.
But those are averages, and in this data release, the NSSO has divided its usual ten deciles even further for the lowest and highest deciles. (The decile is the surveyed population divided into tenths, with these being classified by expenditure level.) Doing so gives us a better view of the elastic expense trends in the top ten per cent of the population, the class which is so pampered by the central government. For rural India then, the 5th percentile of the MPCE distribution was estimated as Rs 616 and the 10th percentile as Rs 710 – and these are all-India averages.
About half the total rural population is thus estimated to have a MPCE below Rs 1,198. Only about 10% of the rural population reported household MPCE above Rs 2,296 and only 5% reported MPCE above Rs 2,886 (this is using what is called the ‘modified mixed reference period’ or MMRP, in which the person interviewed is asked to recall purchases made over two different lengths of time, for different sorts of goods). The bottom-line is that food accounted for about 53% of the value of the average rural Indian’s household consumption during 2011-12.
This included 11% for cereals and cereal substitutes, 8% for milk and milk products, another 8% on beverages and processed food, and 6.5% on vegetables. Among non-food item categories, fuel for cooking and lighting accounted for about 8%, clothing and footwear for 7%, medical expenses for about 6.5%, education for 3.5%, conveyance for 4%, other consumer services for 4%, and consumer durables for 4.5%.
This ought to be a ringing alarm about access to food for the country’s planners, who are otherwise obsessed with GDP growth and whether India is cosmetically dolled up enough to attract global finance capital. It hasn’t sounded even a muted gong, and even if it had, one stunning inference from this table has been ignored – that this is an indicator of food and multi-dimensional poverty and that millions of rural residents are unable to afford food and basic services.
How so? Look at the chart again. Imagine, at just above the line marking 2,000 rupees, a dotted red line at a level of around 2,070 rupees. That is the equivalent (before the recent fall in the rupee’s value against the US dollar) of USD 1.25 a day, which has (ill-advisedly) been cemented in development wisdom as a poverty line that can be applied in countries like India. Let’s accept that in order to focus on what the new NSSO data tells us.
At the Rs 2,070 level we see that for a relatively prosperous state like Haryana (a former Green Revolution state) about 50% of the rural population cannot spend, per person per month, this amount. The percentage of the rural population below and above this line is similar, more or less, for Punjab (also a former Green Revolution state) and for Kerala (which is not, but has income from economic migrants abroad).
But the entire rural populations of Bihar, Chhattisgarh, Jharkhand and Odisha cannot spend this amount, because they do not earn it. How many is that? Using the 2001-2011 population growth rates (for rural populations of states) this means 98.96 million in rural Bihar, 20.65 million in rural Chhattisgarh, 26.52 million in rural Jharkhand and 36.19 million in rural Odisha are below this line. What of other states with large rural populations?
In Assam, Madhya Pradesh, Uttar Pradesh and West Bengal, 90% of the rural population is below this line and that means 25.23 million in Assam, 49.90 million in Madhya Pradesh, 147.25 million in Uttar Pradesh, and 57.26 million in West Bengal. In Gujarat, Karnataka, Maharashtra and Rajasthan, 80% of the rural population is below this line and that means 28.52 million in Gujarat, 30.66 million in Karnataka, 50.77 million in Maharashtra and 43.55 million in Rajasthan. In Andhra Pradesh and Tamil Nadu, 70% of the rural population is below this line and that means 39.64 million in Andhra Pradesh and 26.56 million in Tamil Nadu.
Taken together those rural populations are 681.72 million (more than twice the population of the USA). They are 78% of India’s 2013 rural population, almost eight out of ten rural citizens.
Evidence, investment, research, commitments and growth. You will find these reprised in the second Global Food Policy Report by the International Food Policy Research Institute (IFPRI, which, as I must never tire of mentioning, is the propaganda department of the CGIAR, the Consultative Group on International Agricultural Research, which, ditto, is the very elaborate scientific cover for control over the cultivation and food choices made especially by the populations of the South). And now, with the dramatis personae properly introduced, let me quickly review the plot.
The GFPR (to give this slick production an aptly ugly acronym) for 2012 follows the first such report and furthers its claim to provide “an in-depth look at major food policy developments and events”. It comes equipped with tables, charts, cases, apparently authoritative commentary (many from outside IFPRI), and is attended by the usual complement of models and scenarios (can’t peruse a report nowadays without being assaulted by these).
In an early chapter, the GFPR 2012 has said:
“Evidence points to a number of steps that would advance food and nutrition security. Investments designed to raise agricultural productivity — especially investments in research and innovation — would address one important factor in food security.”
“Research is also needed to investigate the emerging nexus among agriculture, nutrition, and health on the one hand, and food, water, and energy on the other.”
“In addition, by optimizing the use of resources, innovation can contribute to the push for a sustainable ‘green economy’. Boosting agricultural growth and turning farming into a modern and forward-looking occupation can help give a future to large young rural populations in developing countries.”
Consider them one by one. Whose evidence? That of the IFPRI, the CGIAR and its many like-minded partners the world over (they tend to have the same group of funding donors, this institutional ecosystem). A round-up of food policy by any outfit would have ordinarily included at least some evidence from the thousands of studies and surveys, large and small, humble and local, that discuss policy pertaining to food and cultivation. But, you see, that is not the CGIAR method. What we have then is the IFPRI view which, shorn of its crop science fig leaf, is similar to that of the Asian Development Bank’s view, the World Bank’s view, the International Finance Corporation’s view or the European Bank for Reconstruction and Development’s view (raise your fist in solidarity with the working class of Cyprus for a moment). And that is why the GFPR 2012 ties ‘investment’ to ‘evidence’, and hence ‘research’ to ‘food security’.
What research? Well, into “the emerging nexus among agriculture, nutrition, and health” naturally. This extends the CGIAR campaign that binds together cultivation choices for food staples, the bio-technology mittelstand which is working hard to convince governments about the magic bullet of biofortification (especially where cash transfers and food coupon schemes are already running), and the global pharmaceutical industry. It is really quite the nexus. As to food, water and energy, that is hardly an original CGIAR discovery is it, the balance having being well known since cultivation began (such as in the fertile crescent of the Tigris and Euphrates, about seven millennia ago, now trampled into sterility by ten years of an invasion, or as was well recognised by the peons of central America, an equal span of time ago, and whose small fields are being reconquered by the GM cowboy duo of Bill Gates and Carlos Slim).
What kind of ‘green economy’? Among the many shortcomings of IFPRI (in common with the other CGIAR components) is its studied refusal to incorporate evidence from a great mass of fieldwork that supports a different view. ‘Growth’, ‘modern’ and ‘forward looking’ are the tropes more suited to a public relations handout than an annual review of policy concerning agriculture and therefore also concerning the livelihoods and cultural choices made by millions of households. IFPRI’s slapdash use of ‘green economy’ reflects also its use by those in the circuit of the G20 and by the Davos mafia – they are the hegemons of politics and industry who force through decisions (they use sham consensus and gunpoint agreement) that have scant regard for climate change, biodiversity loss or dwindling resources. Hence the IFPRI language of “optimizing the use of resources”. The idea of unfettered growth as the way to end poverty and escape economic and financial crisis remains largely undisputed within the CGIAR and its sponsors and currently reflects the concept as found in ‘green economy’.
[The GFPR 2012 report and associated materials can be found here. There is an overview provided here. There are press releases: in English, en Français and in Chinese.]
“Building poor people’s resilience to shocks and stressors would help ensure food security in a changing world”, the IFPRI GFPR 2012 has helpfully offered, and added, “In any case, poor and hungry people must be at the center of the post-2015 development agenda”. Ah yes, of course they must be, in word and never mind deed. “International dialogues, such as the World Economic Forum, the G8, and the G20, must be used as platforms to develop this concept, propose policy options, and formulate concrete commitments and actions to reduce poor people’s vulnerability to food and nutrition insecurity and enhance their capacity for long-term growth”.
To call the World Economic Forum, the G20 and the G8 ‘platforms’ and ‘dialogues’ is laughable, for there are no Southern farmers’ associations present, nor independent trade unions, nor members of civil society and community-based organisations that actually pursue, rupee by scarce rupee, the agro-ecological restoration of rural habitats in the face of migration, rural to urban, that occurs through dispossession, nor are there any of the myriad representatives of socialist and humanist groups whose small work has a restorative power greater than that of the CGIAR and its sponsors.
Never part of the CGIAR-IFPRI sonata that is played at these ‘dialogues’, there is ample evidence (since that is the theme) of locally articulated and politically wrested food sovereignty that can be held up as examples with which to reduce poor people’s vulnerability. In the past ten years, countries particularly in South America (we salute you, Hugo Chavez) have incorporated food sovereignty into their constitutions and national legislations.
In 1999 Venezuela approved by referendum the Bolivarian Constitution of Venezuela whose Articles 305, 306 and 307 concern the food sovereignty framework. In 2001 Venezuela’s Law of the Land concerns agrarian reform. In 2004 Senegal’s National Assembly included food sovereignty principles into law. In 2006 Mali’s National Assembly approved the Law on Agricultural Orientation which is the basis for implementation of food sovereignty in Mali. In 2007 Nepal approved the interim constitution which recognised food sovereignty as a right of the Nepalese people. In 2008 Venezuela enacted legislation to further support food sovereignty: the Law of Food Security and Food Sovereignty; the Law for Integrated Agricultural Health; the Law for the Development of the Popular Economy; the Law for the Promotion and Development of Small and Medium Industry and Units of Social Production. In 2008 Ecuador approved a new constitution recognising food sovereignty. In 2009 Bolivia’s constitution recognised the rights of indigenous peoples as well as rights to food sovereignty. In 2009 Ecuador’s Food Sovereignty Regime approved the Organic Law on Food Sovereignty. In 2009 Nicaragua’s National Assembly adopted Law 693 on Food and Nutrition Security and Sovereignty.
This is what true resilience looks and sounds like. For those unfortunate populations that continue to struggle under a food price inflation whose steady rise is aided and abetted by the CGIAR and its sponsors, the alternatives become clearer with every half percent rise in the price of a staple cereal, and with the loss of yet another agro-ecological farming niche to the world’s land grabbers.
The concerns about recession and its impacts on poverty are seen commonly as a question mark over household incomes, over food security and often involve debates about social protection. An aspect that all too often gets ignored in this equation – no doubt because of its complexity – is health and in particular the health of women and children.
This is linked very closely to poverty, however we measure it, and the conditions that either cause poverty to persist (leading to chronic poverty) or cause households at risk to lapse into poverty every now and then (shock). The human development index methodolgy, which is from this year using multi-dimensional indices for poverty for the first time, helps us link health, poverty, income and economic growth (or its opposite).
The question is: is this new understanding, which is more in tune with the way households actually carry on with their lives and are actually affected by wider trends concerning economy, helping integrate the connections? If there is one good reason to ask this question, it is the new study on ‘Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities’.
[The World Health Organization (WHO) has a report and summary of the study on this page – ‘Newborn deaths decrease but account for higher share of global child deaths’]
[The full study is available on PLoS Medicine, 1 August 2011 (Volume 8, Issue 8)]
This has shown that every year, more than 8 million children die before their fifth birthday. Most of these deaths occur in developing countries and most are caused by preventable or treatable diseases. In 2000, world leaders set a target of reducing child mortality to one-third of its 1990 level by 2015 as Millennium Development Goal 4 (MDG4). This goal, together with seven others, is designed to help improve the social, economic, and health conditions in the world’s poorest countries. In recent years, progress towards reducing child mortality has accelerated but remains insufficient to achieve MDG4.
“In particular, progress towards reducing neonatal deaths – deaths during the first 28 days of life – has been slow and neonatal deaths now account for a greater proportion of global child deaths than in 1990. Currently, nearly 41% of all deaths among children under the age of 5 years occur during the neonatal period. The major causes of neonatal deaths are complications of preterm delivery, breathing problems during or after delivery (birth asphyxia), and infections of the blood (sepsis) and lungs (pneumonia). Simple interventions such as improved hygiene at birth and advice on breastfeeding can substantially reduce neonatal deaths.”
The researchers used civil registration systems, household surveys, and other sources to compile a database of deaths among neonates and children under 5 years old for 193 countries between 1990 and 2009. They estimated NMRs for 38 countries from reliable vital registration data and developed a statistical model to estimate NMRs for the remaining 155 countries (in which 92% of global live births occurred).
They found that in 2009, 3.3 million babies died during their first month of life compared to 4.6 million in 1990. More than half the neonatal deaths in 2009 occurred in five countries – India, Nigeria, Pakistan, China, and the Democratic Republic of Congo. India had the largest number of neonatal deaths throughout the study. Between 1990 and 2009, although the global NMR decreased from 33.2 to 23.9 deaths per 1,000 live births (a decrease of 28%), NMRs increased in eight countries, five of which were in Africa. Moreover, in Africa as a whole, the NMR only decreased by 17.6%, from 43.6 per 1,000 live births in 1990 to 35.9 per 1,000 live births in 2009.
To return to my question concerning the understanding of economics, income, health and poverty, does most current analysis see to integrate these elements, or is it still GDP-income driven? A new (2011 May) paper released by the Brookings Institution indicates that the GDP-income route is still favoured. The paper, ‘Two Trends in Global Poverty’, Geoffrey Gertz and Laurence Chandy, has said that while the overall prevalence of poverty is in retreat, the global poverty landscape is changing. “This transformation is captured by two distinct trends: poor people are increasingly found in middle-income countries and in fragile states. Both trends – and their intersection – present important new questions for how the international community tackles global poverty reduction.”
“The increased prevalence of poverty in middle-income countries is in many ways a trend of success. Over the past decade, the number of countries classified as low-income has fallen by two fifths, from 66 to 40, while the number of middle-income countries has ballooned to over 100. This means 26 poor countries have grown sufficiently rich to surpass the middle-income threshold. Among those countries that have recently made the leap into middle-income status are a group of countries – India, Nigeria and Pakistan – containing large populations of poor people. It is their “graduation” which has brought about the apparent shift in poverty from the low-income to middle-income country category.”
This categorisation of middle, low and high income was to an extent useful in the 1970s, when the idea of a human development index was being discussed, but we’ve come a long way since. We know that even in smaller countries (rather, countries with populations that are relatively small compared to those whic bear the sort of burdens studied in the PLoS Medicine research) there is a great deal of income disparity. ‘Income’ itself is a condition with a bewildering number of inputs – social science is quite inadequate to the task of being able to recognise all of these, let alone quantify them and rationalise them across countries and regions – which is exactly what studies like this try to do unfortunately.
“In 2005, when more than half the world’s poor lived in such countries, it made some sense to think about fighting poverty in terms of a single developing country paradigm, based on what worked in countries such as Ghana, Tanzania, Mozambique or Vietnam,” Gertz and Chandy have said. “This logic was evident in two of the major events of that year which continue to shape today’s development agenda: the G8 meeting at Gleneagles and the High Level Forum on Aid Effectiveness in Paris. It was also apparent in Jeffrey Sachs’ influential 2005 best-seller, ‘The End of Poverty’. The legacy of these ideas is scattered throughout the work of the international development community in the design of traditional aid instruments and the standard methods of country engagement.”
The authors of the Brookings paper have said that this approach remains relevant for some countries, but with 90 percent of the world’s poor living in different settings today, its broader application can no longer be justified. Yet they have found that such an admission poses a dilemma. The dilemma exists because one of the reasons the stable low-income paradigm has persisted is because it characterizes an environment in which the international development community feels most comfortable and has the most experience. “The role of external actors in supporting poverty reduction in stable low-income countries is well understood and the standard tools of external assistance – financial and technical assistance – are well suited to them.”
What does this mean? Does it give us a hitherto obscured insight into the inner world of aid agencies and international development departments and how they see ‘poor’ countries’ populations? Does it mean that we are burdened with three decades worth of simplistic labelling of populations at risk simply because labelling them any other way makes it difficult to help them? That’s what it looks like to me and I’d like to thank Gertz and Chandy for revealing this. But it’s way past high time this sort of categorisation was ditched, once and for all. It would do us and the battalions of development professionals a huge amount of good to simply be able to say, every so often, “we don’t know enough”.
It is worth being honest about the state of our knowledge concerning the lives of the the majority of households in ‘developing’ countries. Some of the reasons why such honesty will help in the long term are contained in a thoughtful new publication from the World Bank (whose army of development professionals will benefit from its reading). This collection is entitled ‘No Small Matter: The Impact of Poverty, Shocks, and Human Capital Investments in Early Childhood Development’ (The World Bank, 2011) and it has said that, as the 2008 global financial crisis has again demonstrated, economic crises are an unfortunate recurring event in the world and can have severe consequences for household livelihoods.
‘No Small Matter’ defines economic crises as sharp, negative fluctuations in aggregate income, these being especially common in developing countries, and the frequency with which they occur has been increasing in recent history. We know that declines in household and community resources are not the only risks that arise from an economic crisis because of its aggregate nature. We also know – from fieldwork and by hearing those whom we would wish to help – that at the same time as households cope with the possibility of reduced income from aggregate economic contractions, vital public services may also experience a decline in quality or availability, which in turn may have an additional impact on skill development among children. This is happening now, in more countries than ever before. The economic crisis that hit Latin America in 1982 led to a decrease in public health spending and had a disproportionate effect on the poorest groups. In 2011, the decrease in public health spending exists in many more countries.
A chapter in ‘No Small Matter’, ‘The Influence of Economic Crisis on Early Childhood Development: A Review of Pathways and Measured Impact’, by Jed Friedman and Jennifer Sturdy, is particularly useful.
This has said that “conservative estimates suggest that over 200 million children under five years of age living in developing countries fail to reach their cognitive development potential because of a range of factors, including poverty, poor health and nutrition, and lack of stimulation in home environments”. It is possible, the chapter’s authors have said, that this burden increases during times of crisis as poverty increases and food security is threatened. However, to investigate this claim more carefully it is necessary to understand the pathways through which poverty influences skill acquisition in children.
“The most severe condition affecting ECD (Early Childhood Development) is infant and early child mortality. Sharp economic downturns were associated with increases in infant mortality in Mexico, Peru and India. The mortality of children born to rural and less educated women is more sensitive to economic shocks, which suggests that the poor are disproportionately affected during most economic crises, and perhaps the poor face important credit constraints that bind in tragic ways during large contractions.
The mortality of girls is also significantly more sensitive to aggregate economic shocks than that of boys. This gender differential exists even in regions such as Sub-Saharan Africa that are not particularly known for son preference and indicates a behavioral dimension where households conserve resources to better protect young sons at the expense of daughters.”
Finally, a further note about the extremely valuable PLoS Medicine study ‘Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities’. The authors are: Mikkel Zahle Oestergaard1, Mie Inoue1, Sachiyo Yoshida, Wahyu Retno Mahanani, Fiona M. Gore1, Simon Cousens, Joy E. Lawn and Colin Douglas Mathers (on behalf of the United Nations Inter-agency Group for Child Mortality Estimation and the Child Health Epidemiology Reference Group – World Health Organization, Department of Health Statistics and Informatics; World Health Organization, Department of Child and Adolescent Health and Development; London School of Hygiene & Tropical Medicine; Saving Newborn Lives/Save the Children).
The study found that of the 40 countries with the highest NMRs in 2009, only six are from outside the African continent (Afghanistan, Pakistan, India, Bhutan, Myanmar, and Cambodia). Among the 15 countries with the highest NMRs (all above 39), 12 were from the African region (Democratic Republic of the Congo, Mali, Sierra Leone, Guinea-Bissau, Chad, Central African Republic, Burundi, Angola, Mauritania, Mozambique, Guinea, and Equatorial Guinea), and three were from the Eastern Mediterranean (Afghanistan, Somalia, and Pakistan). Throughout the period 1990–2009, India has been the country with largest number of neonatal deaths. In 2009, the five countries with most deaths accounted for more than half of all neonatal deaths (1.7 million deaths = 52%), and 44% of global livebirths: India (27.8% of deaths, 19.6% of global livebirths), Nigeria (7.2%, 4.5%), Pakistan (6.9%, 4.0%), China (6.4%, 13.4%), and Democratic Republic of the Congo (4.6%, 2.1%). The top five contributors to the 4.6 million neonatal deaths in 1990 were: India (29.5% of deaths, 19.8% of global livebirths), China (12.3%, 18.0%), Pakistan (5.4%, 3.4%), Bangladesh (5.0%, 2.9%), and Nigeria (4.8%, 3.3%).
As the risk of children dying before the age of five has fallen, the proportion of child deaths that occur in the neonatal period has increased. This increase is primarily a consequence of decreasing non-neonatal mortality in children under five from infectious diseases such as measles, pneumonia, diarrhea, malaria, and AIDS. Globally, 41% of under-five deaths now occur in the neonatal period. Over the 20 y between 1990 and 2009, the proportion of global neonatal deaths that occurred in Africa increased. Although Africa is now the region with the highest NMR, the proportion of under-five child deaths that are neonatal remains relatively low in Africa—the fraction increased from 26% to 29% between 1990 and 2009. This apparent anomaly reflects the fact that Africa accounts for approximately 90% of child deaths due to malaria (0.7 million under-five deaths) and HIV/AIDS (0.2 million under-five deaths), resulting in relatively higher post-neonatal child mortality than other regions.