Anti-cattle slaughter bans have been brought in with alacrity in several states in India with little attention being given to the nutritional, economic, cultural and social impact of these bans. Overnight people have lost their livelihood and become vulnerable to vigilante groups that, under the guise of protecting the cow, resort to cruel and inhuman forms of human rights abuse. Farmers at once lose their options of selling less efficient cattle and this leads to agrarian distress and a massive problem of hungry stray cattle. 180 million (15%) Indians consume beef in India and this is one of the cheapest sources of animal foods. It contains good quality, highly bioavailable proteins as well as a good amount of several essential nutrients like zinc, Vitamins of the B complex, E, K, calcium, iron, magnesium, phosphorus, potassium, selenium, copper, Omega 3 and omega 6 fatty acids etc.
However, now, vigilante groups have taken law into their hands to lynch people in the name of protecting the cow, but this is simply a way of intimidating and targeting Muslim and Dalit communities. Since 2015, 113 people are known to have been killed by vigilante mobs. Many more remain unknown. Several others have faced harassment, threats and bullying. A culture of fear and discrimination purely based on what religion or caste one belongs to and therefore what one eats, has been created and enabled at all levels of state mechanisms…….Read more here
‘A Sustainable World’ – featuring Dr Sylvia Karpagam!
Dr Sylvia Karpagam is part of the Right to food and Right to health campaigns and works mainly on the social determinants of health. She is often invited to make interviews and podcasts as a health professional and front figure who works for sustainability for all. In other words; including poor and marginalized people who can´t speak for themselves. Since the beginning of the pandemic she has also been involved in health camps for vulnerable communities. Dr Sylvia is a true fighter who speaks with honestly and straightforwardness without polishing the truth.
In a world so strongly influenced by ideology without any direct relation to the reality we live in, people like Dr Sylvia are more important than ever, because nature does not bow to ideology and neither does health. If we want real sustainable change, we need to face truth as it is. So, it´s my true pleasure to introduce you to Dr Sylvia Karpagam in this third interview, as a part of my international interview series A Sustainable World.
This paper highlights the working conditions in two work chains in the public healthcare system: municipal solid-waste management and handling of hospital waste and dead bodies. While COVID-19 has exposed the hazards that workers in these sectors are exposed to, it also lays bare the historical and social hierarchies, the exploitative working conditions and intrinsic discrimination within the public healthcare system.
The Indian model of allopathic healthcare has been hierarchical, with male doctors from dominant caste groups located at the privileged end of the spectrum, who are highly paid and granted a godlike status, and deserve claps, accolades, and flowers (Agrawal 2020). At the other end of the spectrum are workers, mostly from Dalit communities, who have been delegated to “dirty or unclean work” associated with sanitation and waste disposal, often performed in exploitative conditions and in a “socially distanced” manner. In a study on the cleaning staff in public hospitals, Hathi and Srivastav (2020) have documented that, in spite of the public health facilities they visited being in urban or semi-urban areas, cleaning work was assigned to the same marginalised communities that exist in villages, with many workers stating that cleaning work was intergenerational and that others in the family were engaged in similar work. Among the workers we interviewed (Siddharth et al 2020), the cleaning staff and those sweeping the streets were predominantly Dalit women, while the auto-tipper drivers,1 mortuary and crematorium workers were predominantly Dalit or Muslim men….read more
Why communities in India need to reclaim their rich traditional food cultures and push back against a growing global vegan agenda
People from marginalised communities struggle when it comes to the social determinants of health – those non-medical factors that influence people’s health such as access to safe water, sanitation, education, livelihood opportunities, shelter, housing, safety, public transport and good nutrition.
Many from marginalised communities do not get minimum wages and work in exploitative conditions with very little recourse to judicial or legal support. These circumstances, which have been aggravated by the unplanned massive COVID-19 lockdown, affect all aspects of their health….read more Here
The Covid pandemic and subsequent unplanned lockdown has unmasked the deep rooted structural crisis within the country’s healthcare system.
If the healthcare system had been universal, comprehensive, well-regulated and decentralized, its response to the Covid 19 pandemic would have been far more effective with regards to both preventive and curative aspects. However, the Indian model of healthcare, with its rapid move towards large scale privatization, corporatization, centralization is wreaking havoc on India’s poor, with most government “policies” tending to protect commercial interest more than that of its more vulnerable communities. Central and State government health insurance schemes are fragmented, ‘package’ based and continue to create out of pocket expenditure (OOPE), leaving people completely at the mercy of the unregulated private sector.
This was very evident during the pandemic, with people being admitted for Covid 19 in private facilities and being charged almost Rs. 30,000 – 40,000 per day. When people’s livelihoods and basic needs have been shaken by the pandemic and lockdown, a hospital admission is a catastrophic experience for the family and can push their wellbeing back significantly. Shutting down of essential public transport has affected people in numerous ways. It is also important for the Government to acknowledge that the years of damage and neglect to the public health facilities is taking its toll. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) intended to cover the “bottom 40% of poor and vulnerable households”, as identified by the Socio-Economic Caste Census (2011) fails on several fronts – as evident in the 2018-2019 annual report of the National Health Authority. Although claiming to be universal, it doesn’t cover the entire population nor all morbidities. Source: Annual report (2018-19), AB-PMJAY, National Health Authority.
The Swaddle: The Covid19 pandemic highlighted an often-glossed-over issue — the continued lack of attention paid to health and sanitation workers who are placed in harm’s way to do jobs like disposing of biomedical waste without adequate protective equipment. How does the system prevent these workers from advocating for themselves?
Dr. Sylvia Karpagam: Our healthcare system is heavily fragmented and doctor-centric. This doctor is often a dominant caste male doctor, and everyone else is secondary. This is never how a healthcare system should be — for example, it would be very difficult for a doctor to function without a pharmacist or a nurse. Often, the people who are most ignored in this structure are people who work to maintain the hospital — the housekeeping staff, the people working in mortuaries, the ambulance drivers, and the sanitation workers who handle to hospital waste.
Most of these workers are from Dalit communities and are taken on a contract basis. They don’t benefit from labor laws and face exploitation, threats, and harassment if they attempt to unionize. Union leaders are bullied and thrown out of their jobs. Yes, there are social and legal mechanisms that ensure that exploitation doesn’t happen, but many of such mechanisms are not accessible to these workers. This became worse during the pandemic — we spoke to a lot of workers and realized they didn’t have basic even basic PPE kits or ergonomically designed equipment — India may boast about how technologically advanced it is, but look at the carts full of waste that workers have to push. Imagine the effect this work would have on their health. Even then, these workers do not receive work-related healthcare support or insurance, or even basic protective equipment. When these workers died of Covid19, they didn’t receive any compensation either. I think this is a huge issue from both a public health, occupational hazards and a labor laws perspective — a lot of this happens to Dalit women and we need to take cognizance of it.
But none of us see this as a social problem that deserves attention and participation because, well, how many of us are choosing hospitals by virtue of how well they treat their workers?
On International Women’s day, it would be good for Indian decision makers and society to take stock of many gaps in public health for Indian women, particularly those from vulnerable communities (women who are dalit, Adivasi, Muslim, living with disabilities, transgender, employed in so called ‘unclean’ occupations, the elderly, single women, those who have had pre or extra-marital relationships, are victims of rape/abuse, prisoners etc.) The issues faced by women have been particularly evident during the Covid19 pandemic and subsequent lockdown, and these have to be identified and addressed on priority. However, from the recent budget announcement by the Central government it looks like no major lessons have been learned. It therefore becomes crucial that as citizens with voting rights, we constantly foreground demands that will make public healthcare in the country more robust, rational, comprehensive and non-discriminatory….read more
The post COVID-19 lockdown has brought out the worst of vested interests. While corporates are scrambling to acquire land and assets by blatantly pushing the government to tweak or do away with protective legal mechanisms, the government is making decisions that will have adverse and long-term social, nutritional, health and economic consequences.
One of them is the anti-cow slaughter Bill, which the Karnataka government has passed with great urgency, without even a pretence at the due process of democratic consultation, particularly with those who will be the most disaffected by this law. Any reasonable, fairly intelligent voter of the state should challenge this Bill, which is neither evidence-based nor rational, and viewed in the backdrop of the following issues….Read more
Several experts in the fields of economics, health, nutrition, etc. have commented on different aspects of the budget, released by the Government of India on February 1, 2021. This article looks at what the budget could have included if it had to incorporate the true spirit of public health in the Indian setting. The questions need to be answered are:
* Will out-of-pocket expenditure on healthcare reduce or stop?
* Will prevention of disease take priority over expensive curative and rehabilitative care?
* Will healthcare become more accessible to Indians, a vast majority of whom reel between an insufficient public health system and an exploitative, unregulated private healthcare?
* Have lessons on public health been learnt from the COVID-19 pandemic?
Public health – need of the hour
In a heart-rending opening statement to the budget, finance minister Nirmala Sitharaman said, “we could not have imagined that people would have to endure the loss of near and dear ones and suffer the hardships brought about due to a health crisis”. However, the unfortunate truth is that a well-planned and responsive public health system would have anticipated a natural or human-made disaster and been somewhat better prepared for it.