Health, Nutrition and the Commons

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(from Vocabulary of Commons, article 55)

by Dr Mira Shiva M.D

Health, nutrition and the commons

Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well being, an individual or group must be able to identify and to realise aspirations to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well being.

The fundamental conditions and resources for health are: peace, shelter, education, food, income, a stable eco–system, sustainable resources, social justice, and equity. Improvement in health requires a secure foundation in these basic prerequisites. Good health is a major resource for social, economic and personal development and an important dimension of quality of life. Political, economic, social, cultural, environmental, behavioural and biological factors can all favour health or be harmful to it. Health promotion action aims at making these conditions favourable through advocacy for health’.1

With a high economic growth rate of 8%, the health and nutritional status in India was expected to improve significantly as the country was seen as a rapidly prospering nation. However, the poor nutritional status of children, which actually worsened in some places, clearly showed that to improve the nutritional and health status it requires measures which gave priority to public health and nutritional security rather than trade interests. Economic growth that is accompanied by an increase in inequities does not translate into a better situation for all and worse so if it is at the cost of the poor.

The rapid policy thrust at privatisation of the commons is a matter of concern. It is not merely recognition of the air as commons, wateras commons, biodiversity, ecosystems as commons but also the public health systems as common goods whether it is public health services, public distribution system, providing food, or public education system. The privatisation, commercialisation and corporatisation of the public good and commons under all encompassing neoliberal policies at national as well as international levels are posing a major threat to public health, public interest and even sustainable survival of millions.

The inexorable links between people and their environment constitutes the basis for a socio ecological approach to health. The conservation of natural resources throughout the world should be emphasised as a global responsibility. The protection of the natural and the built environments and the conservation of natural resources must be addressed by many as health promotion strategy.

The right to health is just not a right to basic essential health care services and a functioning referral system to deal with more serious medical and health services. It is based on comprehensive understanding of health which recognises the right to health in all its dimensions: physical, mental, social, spiritual and ecological. The health of a small section of society, who have the purchasing power or political clout to access determinants of health and health care services cannot ensure health of the community and society.

State of our health

We are amongst the most malnourished countries when it need not be so. According to the Human Development Report (HDR),2 India’s Human Development Index ranking was 128 in 2007, 126 in 2006 and 127 in 2003, 2004 and 2005. In 2010 it is 119.3 Where the Global Hunger Index is concerned, India ranked 94th in 2007, according to the International Food Policy Research Institute (IFPRI).4 According to the National Family Health Survey (NFHS) 3 report5,6 21.5% infants born in India are Low Birth Weight (LBW) babies even though HDR 2007 gives a figure of 30%. If children in such large numbers do not have the right to survival, food and health care, it is a cause for deep concern regarding continuing national and state priorities that devalues the health and lives of the citizens. Even though India’s Infant Mortality Rate (IMR) has shown a 1% annual decline between 1998–99 and 2005–06, it is unacceptably high compared to many other nations, even when some have worse socio–economic situations. Neonatal mortality continues to be high and reflects the neglect of maternal health and nutrition, safe child birth and post child birth services.

There are several causes of IMR, but a 61.3%7 IMR is considered to be directly or indirectly related to maternal and infant malnutrition. Denial of basic determinants of health, food and safe drinking water, often results in malnutrition, acute repeated and prolonged untreated infections. 70% of the deaths are known to be water related. This is compounded by poor access to health care services, health illiteracy and overall lack of awareness about health, hygiene and sanitation along with poor transport facilities and low purchasing power of services. Together this leads to high mortality rates for children under the age of 5. Access to safe water is critical for health and survival and for decreasing infant mortality. This is a public good and ensuring its access is important.

Forty percent of the malnourished children of the world live in India. Malnutrition in Indian children is worse than in Sub–Saharan Africa. The NFHS 3 data shows that 46% of children under the age of 3 are underweight, (i.e., deficit in weight for age), 38% are stunted, (i.e., deficit in height for age), and 19% are wasted, (i.e., deficit in weight for height).

Causes

Percentage

Premature birth

30%

Pneumonia

14.5%

Respiratory Infection

11%

Anaemia

2.9%

Diarrhoea

2.9%

Early childhood malnutrition has serious long–term consequences because it impedes motor, sensory, cognitive, social and emotional development. Malnourished children are less likely to perform well in school and more likely to grow into malnourished adults and are at greater risk of disease and early death. Knowing well that malnutrition affects not merely physical growth, but also cognitive potential, and that it increases vulnerability to infection resulting in poor health throughout life, the neglect of the child’s nutrition and that of the mother is tragic. The development of a child’s brain and cognitive functions taken place within the first two years of life. Comprehensive efforts are needed for ensuring better nutritional status of communities in general.

As stated succinctly in India’s Undernourished Children: A Call for Reform and Action, HNP Discussion Paper, 2005:

... [t]he prevalence of underweight among children in India is amongst the highest in the world, and nearly double that of Sub–Saharan Africa. Most growth retardation occurs by the age of two, in part because around 30% of Indian children are born with low birth weight, and is largely irreversible. In 1998/99, 47% of children under three were underweight or severely underweight, and a further 26% were mildly underweight such that, in total, underweight afflicted almost three– quarters of India’s children.

Eighty percent of children in the age group 6–35 months are anaemic.8 NFHS 3 has shown worsening of childhood anemia which affects 79.1%. There is significant wasting and stunting of the children. One in three newborn babies are Low Birth Weight (LBW) babies, 36% of women have a very low Body Mass Index (BMI < 18.5), indicating an inter– generational nutrition gap due to poor nutritional status of mothers.

Percentage of young children who are underweight

Region

Percentage

World

27%

Developing Countries

27%

Sub–Sahara Africa

29%

South Asia

46%

India

47%

Source: UNICEF Mapping India’s Children UNICEF in Action p. 24–25, 2004.

India is home to 40% of all LBW babies in the world. Not only are these children at higher risk of dying early in life, but the survivors are liable to have an impaired immune system. These surviving children may suffer a higher incidence of chronic illness such as diabetes and heart disease. There exists a National Nutrition Policy of 1993, a National Plan of Action for Nutrition 1995 and a National Nutrition Mission was set up in 2003. The National Food Security Act 2010 continues to be debated. While universalisation of PDS is denied, poor identification of BPL families continues to deny millions of those below the official poverty line their basic entitlements. Worse is the rotting of food in godowns even as the children of the nation starve.

Discrimination and disparity

In an era where both health care services and food are being treated as tradable commodities with the aim of profit maximisation, when determinants of health are being systematically eroded whether access to safe and adequate water, adequate and nutritive food, education, shelter or security, it is the poor majority that is affected the most. The fact is that 77% of our people are earning less than Rs 20 a day according to the Arjun Sengupta Committee Report10 where prices of food have spiralled, the impact on the poor and the vulnerable is most intense.

Child morbidity in the FOCUS village9

Proportion (%) of sample children who had the following symptoms during the two weeks preceding the survey

Fever

32

Diarrhoea

21

Persistent cough

17

Extreme weakness

11

Skin rash

5

Eye infection

2

None of the above

50

Any of the above

50

Source: FOCUS Survey 2004 (Focus on Children under Six) published by Citizens’ Initiative for the Rights of Children under Six.

With the health budget being less than 1.2% of GDP and 80% being out of pocket (OOP) expenditure, the high health care costs result in either non access of the desperately needed health services or deep indebtedness.11

These averages, however, do not reflect the dramatic differences between people of different regions and socio–economic status. Worst affected are the scheduled castes, scheduled tribes, migrants, rural and tribal areas and where maternal illiteracy is high and social exclusion higher. The disparities between rich/poor and rural/urban and amongst people of different castes and religions are significant and contribute to the nutritional status of the children in these areas. In view of poor birth and death registration and the seasonality of certain diseases, such as diarrhoea and acute respiratory infection, many deaths of the vulnerable sections in unreached areas are not even reported.

Gross gender disparities amongst children who are underweight are not seen anywhere in the world except in South Asia, where 47% girls compared to 44% boys are malnourished and in India worse so in certain states like Punjab, Haryana and Delhi where the sex ratio at birth continues to be skewed reflecting gender discrimination and gender violence. The malnutrition levels amongst schedule caste and schedule tribe children are much higher even as the nutritional status of the rich children is in keeping with western standards. The need for disaggregated data where gender, social and economic inequalities exist becomes extremely important to identify vulnerable and affected sections, to be able to take action to prioritise their health needs.

Bridging the Gap, the World Health Report 1995,12 had for the first time included a new International Classification of Diseases Z59.5 which stands for extreme poverty. The report said there was an increase in extreme poverty and diseases of extreme poverty increasing disparity between rich and poor countries and rich and poor within the countries. There has been an increase in water and vector borne diseases, nutritional deficiencies, sexually transmitted and non communicable diseases, mental health problems, environment related health, occupational health diseases. The links between socio economic status and health status are well known, as are the links between literacy and health. Poverty, health and illiteracy have been worsened by forced displacement, migration and violence whether it is communal, social or gender violence. Unfortunately there is more and more of it.

The state of our health system

Public health is a common good. Costly curative care cannot replace comprehensive primary health care nor adequate food and nutrition. Strong public health infrastructure and services are needed to deal with public health problems such as communicable diseases, whether they are water or vector borne. Outbreaks and deaths from Malaria in Assam, Chattisgarh, Jharkhand, Bihar and Orissa, Japanese Encephalitis in Gorakhpur, Saharanpur and Cholera in Orissa, reflect the unmet public health need and the need for environmental measures at the local level. As preventive public health, there is an immediate need for trained and adequate health personnel, for affordable accessible rapid diagnostic tests to diagnose the health problems, to manage them rationally, with adequate, quality safe affordable essential medicines, vaccines and health education about preventive measures as well as rational care.

Shortages of health personnel are significant for primary health centres. There have been shortages of trained health personnel at multiple levels. According to the latest data on rural health statistics, huge numbers of posts have been lying vacant. Considering the case of primary health centres,13 the details are given below:

Doctors

5,224

Nurses

10,089

HHHealth workers

7,243

Health assistants

1,701

Pharmacists

5,000

Specialists

4,026

Lab technicians

5,591

With 80% health care in private hands and poor quality of care from unregulated, unqualified and even qualified providers, diarrhoea deaths occur even on reaching health care facilities. 80% of medical care sought in slums is from unqualified medical care providers. However, their services continue to be sought as they are accessible, affordable and often actually do provide relief without a long wait and in a more congenial environment though they often also create complications.

While the number of private hospitals and nursing homes has increased, efforts are also being made under the National Rural Health Mission (NRHM) launched on 12 April 2005, by government health functionaries, ANMs, Anganwadi workers and ASHA (Accredited Social Health Activists), to address child health issues. The National Urban Health Mission is being planned, how much of efficacy, rationality, safety and equity it can ensure in provision of health care is to be seen.

A large number of poor migrate to cities and other urban areas in search of work, living in jhuggi jhompris that are periodically razed to the ground. Constantly moving in search of work, these migrants have no permanent address and are unable to obtain the BPL card and the few basic entitlements. There is no access to essential medicines, as medicines for many are unaffordable, highlighting the need to make essential medicines available, at affordable prices, and also ensuring availability of paediatric doses for diseases that afflict little children, also ensuring, rational use of medicines. Non availability of urgently needed medicines to a child, where life ebbs in front of eyes of the mother even on reaching a medical facility is tragic.

The food crisis and corporate–friendly solutions

Citizens have a right to food so that there is no hunger, starvation or nutritional deficiencies. They also have a right to livelihood and fair wages to be able to purchase food which is accessible, affordable and balanced. Chronic hunger and malnutrition are unacceptable. Using village commons and diversion of agricultural land, calling it wasteland, to grow biofuels like Jatropha instead of food crops or grazing land for animals has and will impact food availability.14

Alongside the worsening access to safe drinking water, access to food for the poor has also worsened. Spiralling food prices, loss of traditional and other livelihoods, decreased purchasing power and climate change, have together resulted in droughts and floods and forced migration that have increased vulnerability to malnutrition and infection.

The report of the expert committee set up under chairmanship of NC Saxena by the Ministry of Rural Development has said that over 50% of Indians are below the poverty line on the Caloric Consumption Criteria. The report also demonstrates that where caloric intake is concerned, especially intake of cereals, there has been a steady decline from 1972–73 to 1999–2000. The need for Universal PDS has been argued for by members of the committee as well as organisations and networks involved with the Right to Food Campaign and others.15 The per capita pulse consumption has declined since the 1950s.

As the world is undergoing a serious food crisis, corporate solutions to this crisis are being aggressively pursued. One such solution, the Global Alliance for Improved Nutrition, clearly states as its objectives ‘expanding markets in developing countries’ and ‘creating regulatory friendly environment’, the focus remaining on markets rather than on substantive issues of health and nutrition. It does not address the root cause of the present food crisis—unjust agricultural and trade policies. The crisis has been further compounded by factors caused as often by manmade interventions as by natural causes.

Letting the gen(i)e out

The diverse genetic pool is part of common heritage, its privatisation, commercialisation and genetic pollution is a violence against nature, a common good. Apart from the question of who determines health priorities and the nature and control of research is the issue of the use of genes, how will the adverse effects of genetic pollution when released into the environment be monitored when their full dimensions of biosafety are not even adequately known? When the adverse effects present themselves—as they did in the case of thalidomide, Diethylstilboestrol (DES) only in the next generation, and high dose oestrogen–progesterone, fixed dose combination drugs presented as congenital malformation and other adverse effects—who pays the price in terms of suffering, disability and death? There was a time when it was said that the use of antibiotics in veterinary practice would not affect humans adversely, but very soon the emergence of drug resistance was noticed. When hormones such as oestrogen were used in poultry and animals to make them bigger and to increase profits, the public was told there was no danger—until men consuming poultry that had been given hormones (oestrogen) developed gynaecomastia, i.e. growth of breasts.

Additionally, genetically modified (GM) crops (eg. Bt Cotton) are being actively promoted by states across the country allegedly for higher yields, while reports of decline in consecutive crops as well as deaths of animals who had grazed on post packing Bt Common fields are not highlighted. A large number of GM trials are being undertaken of vegetables such as Bt brinjal, cauliflower, potatoes and ladies finger. Bt Brinjal is on the verge of being released in spite of protests against it, borne out of concerns about public health. The concerns are serious. First the bio–safety studies that have been conducted by the company (Mayhco to Monsanto) are inadequate and very short. These studies fail to show impact on progeny as well as a long term impact. Various studies of animals fed GM corn and potatoes in Austria, Scotland, Russia and Italy by independent researchers have shown increased allergenicity and tumourogenicity effect on the immune system, various organs involving pancreas, liver, kidneys, reproductive organs and effect on offspring having higher mortality, poor growth and infertility. The concern about genetic pollution is the most serious, as this could result in horizontal gene transfer to the existing virus, bacteria in the gut or soil resulting in mutation, creation or increase of virulence of pathological virus bacteria in the gut including pass on of antibiotic resistance as antibiotic resistance marker genes are used besides Bt gene and cauliflower mosaic virus gene.

Implications for children already malnourished, vulnerable to infection are tremendous.16,17 Many groups have also raised concerns about the presence of Bt soya and maize, as well as fructose corn syrup from GM corn, in imported processed foods. A large array of processed foods such as breakfast cereals, juices, chips, etc. are targeted specifically at children. Aggressive marketing of such foods has shown a clear increase in consumption, brainwashing of parents as much as young children.

Creating markets, erasing the commons knowledge

Trials have been undertaken of ‘Probiotics’, on children under 6 months of age. Where exclusive breastfeeding for 6 months has been recommended there is little justification for clearance given to such a process which is violative of the IMS Act (The Infant Milk Substitutes, Feeding Bottles and Infant Food, [Regulation of Production, Supply and Distribution] Amendment Act, 2003).18 Probiotic is being sold commercially (on the pattern of Amway Cosmetics), by aggressively creating buyers. The rationale for promoting this is the presence of the scientific–sounding ‘Lactobacillus’, despite it being found naturally in yogurt, alleging a higher concentration in the commercial version but sold at high cost. This is similar to the aggressive sale of glucose with Vitamin D while Vitamin D is freely available in abundant sunlight.

The pursuance of food–related policies in the direction of processed foods is both subtle and not so subtle. The aggressive promotion and entry of processed foods for children manufactured by food corporate eyeing the child food market through supermarkets has been taking place. Imported processed food contains ingredients around which public health concerns have been raised. There is a concern that commercially processed foods will gain entry rather than hot cooked meals, in the name of child nutrition. As bilateral free trade agreements are being signed, entry into this huge market as government procurement is being aggressively sought. Imports of processed food are increasing and aggressively sold in the urban market with the contents not known, nor their health implication recognised. Doritos, a Pepsi product containing chips made from GM corn was exposed by Greenpeace.

While there has been an extremely aggressive sales push for fortified foods and micronutrients there has been a conspicuous absence in attention given to locally available nutritive food options. This includes the need for education about the nutritive value of foods such as Ragi Mandua (finger millet), which is rich in calcium at 344 mg per 100 gms; Amaranth (Ram dana), which is rich in calcium at 397 mg per 100 gms and protein at 4 gms per 100 gms; and drumstick leaves, fenugreek, chaulai, and bathua, all rich in iron.19,20,21

Growing these nutritive foods and the incorporation of this nutritive value should have been given high priority as part of school health education, and even as part of medical education. Pharmaceuticalisation of nutrition and aggressive promotion of neutraceuticals has taken place. This is obvious from seeing the growth of the sales of vitamins, tonics, health energy process of foods and drinks. The nutritive richness of ‘Satthu’ is long forgotten.

The predatory IPR regime, patenting traditional drought flood and saline resistant seeds through biopiracy is a major food security threat.22,23 ‘Current intellectual property rights regime is suboptimal for global food security’ is the warning by the UN Special Rapporteur on Food in his report on the right to food.24

Mines, minerals and people

The threat of large scale mining in mineral rich tribal areas of Chattisgarh, Jharkhand, Orissa, Bihar involving deforestation of natural prime forests in areas which are sources of food and water for the tribal people is severe. Concern is not merely for the effect on the lives of the original forest dwellers, but also the impact of the deforestation on the rainfall, hydrological cycle, carbon absorption as carbon sinks, erosion of rich biodiversity of plants of therapeutic, nutritive value.

The threat to Nyamgiri hills in Odisha is a case in point. Home to tribals living in the natural forests for thousands of years, existing preventive measures are on the verge of being destroyed. Unless stopped we will be witnessing open mining, destroying water sources, polluting water resources, contributing to negative climate change, with all the expected health hazards and irreversible ecological destruction.

The presence of indigenous people living in India for millennia, their being wiped out as community and as citizens with rights and entitlements, will happen unless resisted. The right of corporations to bauxite mining at the cost of total destruction over and above the right of poor to their hearth, home, livelihoods and right of survival as community is not constitutionally acceptable. Forests are natural carbon sinks, more effective than many overpriced technologies being sold tied to an unjust intellectual property regime.

‘The imbalance between human activity and the ecological system looks more and more ominous’.25 Population growth, the energy intensiveness of lifestyles in developed countries and the misuse of non renewable resources are greatly affecting our planet and its capacity to sustain human life. There is a need to understand the magnitude and the complexity of the threats of climate change. According to Tim Flannery, James Lovelock’s Gaia framework to describe the ‘dynamic’ and ‘systems’ nature of the atmosphere is more useful than the more conventional scientifically reductionist approach.

Energy use, climate change and health

Natural environment is a public good as well as commons. Fossil fuel burning appears to be the underlying cause of global warming as about 6 billion tons of carbon are released in the air annually. The oil based energy lifestyle culture of the west is not only producing far more greenhouse gases than is possible for forests and trees to absorb, but this unsustainable lifestyle is being exported to developing countries, especially to their rich people who are embracing it with open arms, further jeopardising the survival of the people and the planet. The complexity and inter–relationships of the biosphere is not understood, nor are the laws of nature and consequence of violating them. ‘Conquering’ nature for short term benefit is seen as an ‘achievement’. The market and economic growth priority accelerates the ecological disaster as consequence of the environmental degradation and violation of the laws of nature. The price paid is by the poor. Most vulnerable are the poor living in ecofragile areas.

The industrial world accounts for 21% of the world population, consumes 75% of the world energy and is most responsible for the world’s build up of greenhouse gases. The US with a global population share of 4.1% (2003) contributes 24.4% of the world production of carbon dioxide (2000).

Air as commons

People have a right to safe air for breathing. Cutting down trees and forests which provide oxygen and act as carbon sinks are inimical to this balance. The pollution of the air with toxic fumes which are hazardous to health violates people’s right to health. Giving of priority to corporate profits over public health and the rights of the affected majority is unjust. Asthma, bronchitis and allergies of skin are known to occur with gases in the air that corrode the respiratory tract and corrode the skin as in the case of Bhopal. The Bhopal Gas Tragedy highlighted the violation of peoples’ right to clean air and water which are amongst the most important recognised commons.

Water as commons

Since 70% of the health problems are related to water, access to safe and adequate water is closely linked to public health. Subsoil water and rivers as commons were accepted concepts. Providing drinking water to the thirsty travellers was a philanthropic act. There was a royal decree to this effect by King Ashoka.

Acute diarrhoea continues to kill a large number of children. The number is estimated to be much higher than the official figures. Bundelkhand has faced a drought for the past 4–5 years and there have been a significant number of farmer suicides in Vidarbha, Andhra Pradesh, Karnataka and Punjab. As water sources have dried up and water levels have fallen, with monsoons being delayed and inadequate because of climate change, access to safe drinking water has worsened and people have been forced to consume contaminated water. In places where contamination of water by sewage has occurred, it has spread diarrhoea and/or faecal infections, such as typhoid, paratyphoid, cholera, hepatitis (A&E), Amoebiasis giardiasis, and helminthiasis, besides polio. It is the poor, who are heavily dependent on public water supply, who are amongst the worst affected.

Wells and hand pumps while providing water for drinking, cleaning etc. was a great service but is associated in some places with the social exclusion of the Dalits. The caste factor played a negative role and was deeply resented and resisted by many, yet tragically continues in some places. The digging of numerous tube–wells during the green revolution period in Punjab, Haryana and other places, and growing of water intensive crops resulted in overuse of ground water and consequent fall in water levels. As water levels fell, worsened by poor recharging of water because of poor rainfall, or loss of the seasonal rainwater because of inability to conserve when needed, it increased the burden on women to obtain water for the families. They had to fetch it from long distances or draw it manually from wells, where water levels continuously fall.

Added to this is the toxic pollution and poisoning of drinking water besides its overuse for industrial purposes seen in Niyamigiri by POSCO for bauxite mining, Plachimada of overuse and pollution of water in Kerala by Coca Cola, Patencheru in Andhra Pradesh, poisoning subsoil and water. Aluminum production uses bauxite from mines for which forest land of the tribals has been, and is being, taken away. The rights of the poor majority, the tribals to their land, their forests, their air, water are being violated as are their rights to health and nutrition, for which they have depended on their forests and the natural resources. High levels of malnutrition, presence of Falciparum Malaria, Tuberculosis, other water and vector borne diseases in these tribal areas are reflected in the high neonatal, infant, child and maternal mortality. The absence of liability of the polluters is the most offensive aspect of this. Denial of access of water to the community on one hand with overuse and, worse still, poisoning the precious water resources by the corporation involved is truly unjust. The denuding of forests would definitely negatively affect rainfall, worsen soil erosion and make matters worse.

Removal of water pitchers along roads in Delhi in the name of safety and health, where taps are dry for most parts of the day, aggressive promotion of bottled water, has made water out of reach of the workers, labourers and travellers. The Trans Yamuna Cholera outbreak in 1988, outbreaks of Typhoid, para typhoid, hepatitis—I reflect the breakdown of public services of sewage treatment on the one hand and provision of safe water on the other. We needed to recognise all that needs to be done at several levels, through different steps, to ensure health of our citizens, not just of those who have the purchasing power, but also for those who do not have the purchasing power, to sanitary services, adequate safe water, and health and medical services.

While the higher–than–acceptable level of pesticides in colas was highlighted by Centre for Science and Environment (CSE), not only was this issue downplayed, but an alternative study was organised by Tata Energy and Research Institute (TERI, now The Energy and Research Institute) to rubbish the legitimate concerns raised by CSE. To top it all, the head of PepsiCo International was given the Padma Shri Award from the Government of India. Recently she was included in the panel regarding NRI issues by the Prime Minister even as she has consistently espoused the US corporate commercial interest as part of Indo–US Business Alliance. The message that is clearly being sent out to the public is the importance of corporate interests that bring with them Foreign Direct Investment (FDI), among other things, over the health of children in particular and public health in general.

The Third World as toxic waste dumps

With more stringent environmental pollution controls in the US and Europe, many polluting industries are moving into the Third World. There is a proliferation of pesticide units in India in Gujarat, Maharashtra and Uttar Pradesh, and in last few years in Himachal Pradesh and Uttaranchal, discharging their effluents into the river Ganges. The Bhopal leak was a disaster not only because it caused the death and disability of thousands, but because it made obvious the fact that neither the government nor the state authorities, nor the scientific and medical professionals had a clue regarding the toxicity of the chemicals being used or produced as intermediates and final products. They were completely ignorant of their hazardous effects and of how to manage poisoning if it occurred, and fairly ineffective in preventing and managing such toxic hazards.

The 1988 H acid (chemical used in making of dyes) poisoning case of Bichri (Udaipur) in drought–prone Rajasthan is another case in point. Five companies making this chemical were discharging their toxic effluents into Udaisagar canal. Sixty wells were polluted, making the water undrinkable for a five kilometre radius up to a depth of 200 feet. Over 500 acres of land were made uncultivable.

The extensive use of pesticides, many of which are banned in their country of origin, has made cultivation more capital–intensive and also have adverse effects on the food chain. Pesticide resistance is beginning to appear, failed crops made livelihoods perilous and the consequent indebtedness has led to some tragic fall–outs. In 1987 over 60 cotton farmers in India’s prime cotton–growing district of Prakasam (Andhra Pradesh) committed suicide by consuming pesticides.26

Over 200,000 farmers have committed suicide since 1995 because of the high costs of pesticides, seeds and input costs with decrease of output costs, indebtedness and humiliation by the moneylenders.27 Pesticide poisoning cases have also been reported when highly toxic pesticide pellets have been ground with grain for making flour. Thousands of fish in Kuttanad developed sores on their bodies. Similar reports have come in from Malaysia and are related to the presence of industrial chemical effluents in rivers.

Creating dependency, legitimising biopiracy

There is a growing collaboration with corporate interests in decision making. Self reliant options are being systematically destroyed and dependencies created. Basic needs are denied making the future of the poor, especially children, more vulnerable be it in their right to food, water, medicines, medical care, surviving shelter or peace.28

The food crisis is closely linked with policies and agreements pursued by international institutions such as the World Bank and the World Trade Organisation (WTO). A shift to non–food crops for the purpose of exports following recommendations by the World Bank and as part of its Structural Adjustment Programme (SAP) has accentuated the crisis. The increasing trend of appropriation of multi–crop fertile land for SEZs and other industrial projects backed by corporate friendly policies has put greater pressure on land available for agriculture. Trade Related Intellectual Property Rights (TRIPS) is recognised as one of the most unjust International Trade Regimes.

The patenting of seeds, traditional medicine, and traditional knowledge is a matter of concern. The cases of Basmati, neem and turmeric are well known. The most recent acts of biopiracy involve patenting of traditionally used drought resistant, flood resistant and salt resistant seeds. The WTO Agreement on Agriculture (AoA), considered extremely unjust, may now be pushed through to keep the Doha Round alive.

Major policy shifts that have repercussions for nutrition by influencing food availability and affordability at the national level are given below. Many of these are corporate friendly policy shifts.

  • Introduction of the Seed Act, 1988 which allowed entry of multinational corporations (Monsanto, Cargill) in the seed sector.
  • Introduction of the Food Safety and Standard Act, 2006 (FSS Act 2006)29,30 which is a corporate–friendly Act formulated by the Food Processing Industry Ministry. The Act attempted to repeal the Infant Milk Substitute, Feeding Bottles and Infant Food (Regulation of Production, Supply and Distribution) Amendment Act 2003, formulated by MWCD (then under Ministry of Human Resource Development). However, the IMS Act was retained following protests by child health and child rights groups in 2005. The expert committee of FSSA includes ‘experts’ directly or indirectly promoting interest of food corporations such as Nestle, Pepsi and Hindustan Lever.
  • Introduction of the National Biotechnology Regulatory Authority Act, which is in the process of being finalised. This Act, while promoting the growth of the biotechnology industry, would ironically also be responsible for ‘safety’ and ‘regulatory’ aspects while penalising those ‘misguiding’ the public against biotechnology with heavy penalties in terms of fines and jail terms basically to muffle criticisms.

The way forward

Food and nutrition as a major determinant of health is well known for decades, yet it has failed to receive the attention it urgently and consistently deserves.31 The National Food Security Act 2010 Draft is basically about distribution. It is not about ensuring food security. It is basically cereal based, even when the nutritional need for oil, pulses, vegetable, and fruits is well recognised and more so the pitiful nutritional status of our children and women.

Absence of distributive justice is reflected not just in the area of food and water, but health care, education, shelter and livelihoods. The National Health Act is also on the anvil. It recognises the health needs and attempts to show up an Act which has a legal status and some health entitlements. The concern is that with a move towards rapid privatisation of health services, medical education and health insurance, who will provide the preventive health measures which may not be so remunerative, with erosion of basic determinants of health.

Good intentions with an inadequate health budget and non universalistion of health rights, food rights, a neglected public health system targeting only the ‘diagnosed’ poor, while neglecting the ‘undiagnosed’ poor because of poor diagnostic parameters measures and personnel, access to health care and nutrition rights for many would continue to be denied. We had a National Health Policy 1983, which we failed to implement. We have several Acts—which remain unimplemented or mal–implemented, specially if they are pro–poor, or public health, public interest oriented or in any way seen as interfering with commercial or vested interest.

Adequate, safe, nutritious food, encouraging local food production that protects livelihoods of millions is needed. Ensuring that national and international policies of food, nutrition and health are ‘health and nutrition promotive’ as common public good, should be a collective goal and collective effort.32,33 200,000 farmers have already committed suicide, 600,000 tons of food has rotted in government godowns, millions have died of hunger, starvation or illness linked to malnutrition. The issue of food as a basic need, as a fundamental right and food and nutritional security as a common good cannot be emphasised more, demanded more, struggled for more as a right as well as duty.

Endnotes

1 The Ottawa Charter for Health Promotion WHO, 1986.

2 Human Development Report, 2003, 2004, 2005, 2006, 2007.

3 Human Development Report 2010.

4 International Food Policy Research Institute 2007.

5 NFHS 2 National Family Health Survey, Ministry of Health, 1998–99.

6 NFHS 3 National Family Health Survey, Ministry of Health, 2005–06.

6 Save the Children Fund, Campaign for New Born and Child Survival.

7 Rao Veena S. Malnutrition, an emergency what it costs the Nation? CAPART— Council for Advancement of Peoples Action and Rural Technology, Feb. 2008.

8 FOCUS (Focus On Children Under Six) Citizens’ Initiative for the Rights of Children Under Six. Survey 2004.

9 Report on Conditions of Work and Promotion of Livelihoods in the Unorganised Sector, National Commission for Enterprises in the Unorganised Sector 2007.

10 National Council of Applied Economic Research, India Policy Forum 2006/07.

11 Bridging the Gap – The World Health Report 1995.

12 Rural Health Statistics, Ministry of Health & Family Welfare 2009.

13 Soil Not Oil: Securing Our Food in Times of Climate Change by Vandana Shiva, 2007.

14 Peoples Charter for Food&Nutrition Security IBFAN, BPNI, Navdanya, IHES, 2009.

15 Genetic Roulette: The documented health risks of genetically engineered foods by Jeffrey M Smith 2007.

16 Health Hazards Related To Genetically Modified Food With Reference To Bt Brinjal by Doctors for Food and Biosafety. submitted to Dr. Jairam Ramesh, Hon’ble Minister of State Ministry of Environment & Forests (MoEF), GoI 2010.

17 The Infant Milk Substitutes, Feeding Bottles and Infant Food, (Regulation of Production, Supply and Distribution) Act, 1992, Amended in 2003.

18 Nutritive Value of Indian Foods by C. Gopalan, B.V. Rama Sastri & S.C. Balasubramanian revised and updated by B.S. Narashinga Rao, Y G Deosthale and K C Pant, National Institute of Nutrition, 2007.

19 Amazing Amaranth, Navdanya, 2005.

20 Bhoole Bisre Anaj, Forgotten Foods, Navdanya, 2006 reprint 2010.

21 Biopiracy of Climate Resilient Crops Gene Giants Steal Farmers Innovation of Drought Resistant, Flood Resistant & Salt Resistant Varieties. Vandana Shiva, Navdanya 2009.

22 Biopiracy: The Plunder of Nature and Knowledge; Vandana Shiva, 1998.

23 Seed policies and the right to food: Enhancing agro biodiversity and encouraging innovation A/64/170 for Sixty Fourth Session item 71(b) UN General Assembly 2009.

24 McMichael 1993, 2001.

25 Mira Shiva, Environmental Degradation and Subversion of Health, Women, Ecology and Health–Rebuilding Connections–Development Dialogue, Dag Hammarskjold Foundation, 1992;1–2.

26 Vandana Shiva, Kunwar Jalees, Farmers Suicides in India, Navdanya, 2003.

27 Health and Nutrition of Children Under Six—Dr. Mira Shiva: Undoing Our Future– A Report on the Status of the Young Child in India, FORCES, 2009.

28 Food Safety and Standard Act, 2006 (FSS Act 2006).

29 National Biotechnology Regulatory Authority Bill (NBRA), 2008.

30 At a meeting of the Central Council for Health, the former health minister was asked why the health ministry was focusing only on micronutrients such as iron, folic acid and vitamin A when the problem of malnutrition and anaemia in children and women was unacceptably high and why nutritional issues were not being addressed by the health ministry. The Honourable Minister responded by stating that nutrition was under another ministry.

31 Peoples Charter for Health, PHM Global Health Watch 2, 2008.

32 National Profile on Women, Health and Development edited by Dr Sarala Gopalan, Dr Mira Shiva by Voluntary Health Association of India & WHO, April 2000.

33 Baum Fran Ch 14 Global Physical Threats to the Environments and Public Health.

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