c
 

    





  


  
 !


In 1876, Lord Lytton, who was then Viceroy of India, decided to arrange a
massive celebration in Delhi to mark the accession of Queen Victoria as
the Kaiser-i-Hind, Empress of India. The feasting, with all rajas &
maharajas in attendance, went on for a week, and has been described by
one historian as the biggest party in the history of mankind. But 1876
was also the third year of an El Nino drought. Grain prices had reached
unprecedented levels.

Grain traders took advantage of recent technological advances - the

railways, which allowed rapid transport of large quantities of grain, and
the telegraph, which allowed traders to have accurate knowledge of grain
prices in distant places; and instead of selling their grain stocks in the
local markets, used these stocks for profiteering. Buckingham, after
whom the canal in Chennai is named, who was then the governor, wanted
to forcibly release the grain stocks in the local market, but Lytton, a
follower of the Reverend Thomas Malthus, forbade him from doing so.
During the one week of Lytton¶s festivities, a hundred thousand people
died of hunger on the streets of Chennai. Dr Ida Scudder of Vellore, , then
a young girl of six, tried to feed some bread to some starving children,
but recorded later that they were too weak to eat what she gave them.

Coming to the present, in the last six years, globally, more children have
died of malnutrition and easily preventable illnesses than the number of
adults who were killed in the six year of the Second World War. Every
three seconds another child dies from malnutrition and preventable
diseases. In that three seconds, globally,120,000 dollars are spe nt on
arms and a militarization that specifically targets civilian populations
asserting their rights to equity, and protesting against inequity.

Inequity is a not a subtle phenomenon. Yet it is only if we have a

standpoint that validates political commit ment to equity that we see its
manifestations and linkages. While it is true that there are none so blind
as those who will not see, for those who wish to do so, inequity is a major
feature of the global political architecture. As young journalists, it wou ld
be good to remember that Inequity is not a default option, and keeping
inequity in place requires diligent and sustained international effort,
supplemented where necessary by military intervention. The state of
Chhattisgarh from where I come presents a glaring example of this.


Looking at the overall situation in India, I would like to follow Virchow¶s

dictum that politics is medicine writ large, and read my politics off the
bodies of our patients. For the purposes of this address, I have treated
Hunger as a surrogate for Inequity. The National Nutrition Monitoring
Bureau (NNMB) tells us that over 33% of the adult population of India has
a BMI of less than 18.5, and can be considered as suffering from chronic
undernutrition. If we disaggregate the data, we find that over 50% of the
scheduled tribes, and over 60% of the scheduled castes have a BMI below
18.5. The total population of Orissa has more than 40% below 18.5. The
population of Maharashtra, which is considered to be a relatively
³developed´ state with a high per capita GNP, has 33% below 18.5. We in
Rupantar have carried out censuses in tribal villages in which over 70% of
the adults had a BMI below 18.5. All this is, of course, in addition to the
mundane reality, to which we have become inured, of 43% of children
under 5 being malnourished by weight for age criteria. Reporting on the

Mumbai Cohort study, Pednekar found increased mortality in all

underweight categories. The WHO says that any community with more
than 40% of its members with a BMI below 18.5 may be regarded as
being in a state of famine. By this criterion there are various subsets of
the population of India-the scheduled tribes, scheduled castes, the
population of Orissa- which may be regarded as being permanently in a
state of famine.
But there is more good news to follow. Utsa Patnaik, a senior professor of
economics at JNU, tells us that there has been a major decline in cereal
consumption since 1991, in India ±that is, since the onset of globalization.
In 1991, an average family of five consumed around 880 kg of cereals in
a year. By 2005, this had declined to around 770 kg., a decline of 110 kg.
In fact, at the higher end of the scale cereal consumption ± direct &
indirect i.e as meat-had increased, so the decline at the low er end of the
scale was actually much greater. So not only do we have a chronic
famine, but it¶s getting worse.




" 

 

It is precisely this section of the population, that walks through time with
famine by its side, that is today the principal target of a widespread policy
of the expropriation of natural and common property resources, in a
concerted and often militarized programme run by the state. The adivasis
of central India, living in extreme poverty, nevertheless survived through
their access to common property resources - the forests, the rivers, and
land- all of which are now under a renewed threat of sequestration and
privatization as global finance capital embarks on its latest phase of
expansion.
The doctrine of eminent domain vests ultimate ownership of all land and
natural resources in the state. Under cover of eminent domain, vast tracts
of land, forest and water reserves are being handed over to the Indian
affiliates of international finance capital. In ma ny ways, the history of
µdevelopment¶ projects in many parts of the Indian republic are illustrative
of the way in which the doctrine of Eminent Domain,( which was hotly
debated at the sessions of the Constituent Assembly, and finally not
included in the final draft that was adopted) has been applied to ensure
for a so called public interest major havoc and displacement in the lives of
many of the poorest citizens living at subsistence levels.

The tragedy of Chhatisgarh, and of Bastar is compounded by its richness

of resources. One-fifth of the country¶s iron ore ± about 2336 million
tones averaging 68% purity is found in the Dantewada, Kanker,
Rajnandgaon, Bastar and Durg districts The Bastar region is one of the
richest in mineral resources ± not only in iron ore, but also perhaps a host
of other unexplored minerals including limestone, bauxite, and even
diamond and uranium.. When Ajit Jogi became the first Chief Minister of
the nascent state of Chhattisgarh, he said that in the new state, we had
the poorest people inhabiting the richest land. Since much of this µrich
land¶ was covered by forest and was difficult to reach in earlier times
there was not much effort to access these riches, and hence not much
challenge to the control exercised by the poor peo ple over the rich lands.
With increasing industrial and economic development, especially under
the impact of globalization, which is the current avatar of actually existing
colonialism, the hold exercised by the poor people over their resources
came increasingly under challenge.

Once the nature and scope of the enormous natural wealth, in the form of
forest and mineral wealth, deposited and secure in the forest areas of
Chhattisgarh became clear, it became imperative for the Indian state to
assert its sovereignty over these areas, that had hitherto remained
relatively unclaimed by the state under the law of Eminent Domain; the
principle that, in the final analysis, the state had a pre eminent right to all
land. In its turn, the Indian
state could stand guarantor for the secure sequestration of these
resources in the hands of the Indian affiliates of international finance
capital, such as, in recent years, the TATAs, Essar, Lafarge, Holcim, and
other industrial houses . Land acquired from ordinary people was to be
handed over to the industrial houses, gram sabha related procedures
were faked, in an attempt to justify the transfer by the letter, if not the
spirit of the existing Laws.

However, what became fairly clear fairly soon, was that this process of
the assertion of the state¶s decisive right was going to be a rough ride.
Land acquisition for Essar and Tata was resisted in several places in South
Bastar. While land acquisition took place literally at gunpoint in the Bhansi
area, several village assemblies (gram sabhas) in th Lohandiguda area
are still refusing to sign away their land for the proposed Steel Plant of
the TATAs.

Even as the state has forcibly controlled the resistance at several places,
the sense of outrage and popular protest has proved dif ficult to curb.
Bastar has a long history of popular resistance to oppression; its ways of
defining and asserting property rights are also different from those
prevalent in mainstream governance. It also has not helped that, with a
few honourable exceptions, the personnel articulating the agency of state
power have almost uniformly possessed a colonial mindset. Under these
circumstances, one consequence has been that . in conjunction with a
pervasive failure of governance, characterized by massive levels of
corruption, as well as abysmal levels of µdevelopment¶, there has been a
tendency on the part of the enforcement agencies to be quick on the
draw. .Long before the state government embarked on its current mission
to rid Bastar of the µMaoist menace¶, Praveer Chandra Bhanj Deo, the
charismatic ruler of Bastar,who refused to trim his sails to the winds
blowing from the capital of Madhya Pradesh, was killed in an µunfortunate
incident¶ during the Chief Ministership of DP Mishra. The Salwa Judum is
being characterized by the government of Chattisgarh as well by its media
bandwagon as a µspontaneous adivasi response to naxalite oppression¶.

It therefore becomes necessary to appreciate that popular resistance to

state control and efforts to articulate eminent Domain has a history in
Bastar, that has a far greater spread, in terms of duration, geographical
extent, as well as political and institutional identity than the current
operational entity known as the CPI (Maoist), although the latter is
undoubtedly a major political entity in the region. The CPI, for instance, is
a political entity with a long history of struggle on the trade union,
peasant, adivasi, women¶s and student fronts, apart from its
parliamentary and electoral identity.. In Chhattisgarh , the term
µMaoist¶has become a catch -all attribution that includes anyone whose
activities the state finds inimical to its current interests, including self
confessed Gandhians like Himanshu Kumar of the Vanvasi Chetna
Ashram, Human Rights groups like the PUCL, and pesky PIL wielding
academics. The believers in armed overthrow of the state have been only
one stream out of many in the resistance to state policies. -it is the
systematic dispossession of the people that has polarized the situation
beyond immediate rectification.

Based upon carefully differentiated positions they have gone on to

repeatedly indict the widespread and pervasive violence that the state has
deployed over widespread areas in this region. Careful reports have been
prepared with regard to specific incidents of state violence such as
encounter deaths, kidnappings, rape, arson, and custodial maltreatment.
Investigations have been conducted and reports have been prepared with
respect to starvation deaths, dysentery epidemics, lack of drinking wate r,
and other basic needs. It is the state response that has been singularly
undifferentiated. Today, in the months since the launching of operation
Green Hunt, Bastar is a war zone, its people dispossessed and scattered,
women subjected to brutal rape, violent (and tragic) military encounters
shake the foundations of whatever normalcy remains. One is reminded of
what Prashant Bhushan said on an earlier occasion.

³Those who are going to become homeless and uprooted in this race of
so-called development, they will also be finally forced to accept the bitter
truth that they cannot stop the loot of their lands and resources by any
democratic and non-violent means. This is a dangerous situation. Even a
combative organization like ³Narmada Bachao Andolan´, which included a
large number of educated persons, has accepted the bitter truth that is no
administrative or legal means of preventing the loot of resources. Now it
is only through unity and by force that these plunderers can be stopped.
That is the reason why today, in Kalingnagar, Nandigram etc. there is a
situation of ³do or die´. All these struggles are proving 10 to be
landmarks in stopping the loot. The people of these areas have firmly
resolved that come what may, they will not let any government officer set
foot on their land. In these circumstances if the government uses force,
violence may erupt.´

There is a question that I would like to raise before this assembly, and
that is the issue of genocide. Most people think that genocide has to do
only with large scale direct killing, but the declaration of the Convention
on the Prevention of Genocide±which was issued on 9th Dec 1948, one
day before the Universal Declaration of Human Rights ± tells us clearly
that in addition to killing, the creation of µphysically and mentally
hazardous conditions which could put the survival of particular
communities at risk´ would also come within the ambit of genocide.
Evidence that what is happening in central India is tantamount to
genocide on a massive scale stares us in the face. What is shocking is the
inability of large sections of our leadership to read the writing on the wall.

c      "

#  # 

The inability to interpret evidence that is crying out to be recognized, and

the tendency to lapse into facile and convenient formulae for resolution is
a curse that plagues many professions. I would like to give an example
from my own, with regard to the formulation of the national Policy for the
control of tuberculosis. In a cou ntry where 33% of the adult population
have a BMI below 18.5, and which also has 1/6 of the world¶s population
and 1/3 of the total global burden of tuberculosis, one would think that
the bidirectional association between malnutrition and tuberculosis woul d
be the focus of intense study. This is not the case. India is the single
largest contributor to the global burden of morbidity, mortality and drug
resistance in tuberculosis. An estimated 8.5 million Indians suffer from
tuberculosis. There is an annual incidence of 87,000 cases of multidrug
resistant tuberculosis,and an estimated annual mortality of 370,000
persons.

And yet, a recent WHO-based systematic review study which established

a consistent log-linear relationship between tuberculosis incidence a nd
BMI was unable to include a single Indian study. Similarly, a Cochrane
systematic review of randomized control trials of nutritional supplements
for people being treated for active tuberculosis did not include a single
Indian study in its ambit. But I would like to draw your attention to two
studies that do not figure in either review-the first with pride,and the
second with shame.

The first study has been formed by my colleagues at the Jan Swasthya
Sahyog (People¶s Health Support Group), a nonprofit voluntary
organization, which runs a community health program in 53 forest related
villages in central India. They have reported an as yet unpublished study
on the nutritional status of 975 patients with pulmonary tuberculosis ± the
largest such study to emerge from India. They report that patients with
active pulmonary tuberculosis in rural central India, were found to have
macronutrient malnutrition ie. starvation, almost as a universal
association, with less that 5% having weights in the normal range.

Certain groups like scheduled tribes and women fared worst, with life
threatening levels of under-nutrition. There was evidence of long-
standing under nutrition with low height for age (stunting) in the majority
of patients. The report goes on to conclude, ³ This report is a stark
illustration of the adverse synergy of the epidemics of under nutrition and
tuberculosis.The consequences are extensive disease on the one hand and
severe wasting on the other, both of which can cause mortality
independently and in concert. The need to address the nutritional needs
of poor patients with tuberculosis is an urgent imperative on scientific,
ethical and humanitarian grounds´.

However, the fundamental architecture of the National Tuberculosis

programme, formulated in 1962, was based on a specific repudiation of
this ³urgent imperative.´ This fundamental architecture has been
preserved into the present programme ,hence this is a current
problem.What was the evidence on which this repudiation was
premissed?This brings us to the second study that I had
mentioned,published in the Bulletin of the World Health Organisation in
1961.The recent Cochrane review of the effect of nutritional supplements
in people being treated for active tuberculosis excluded this paper from
their review as ³the groups were not randomized to different dietary
interventions.´This study was carried out at the Madras Chemotherapy
Centre in Guindy.I would like to read out to you the summary of findings
of this study.

µA study has been undertaken on the diet of 157 patients with pulmonary
tuberculsos admitted to a controlled comparison of treatment with
isoniazid plus PAS for a year at home with the same treatment in
sanatorium.The patients have been drawn from a poverty-stricken section
of the community living in overcrowded conditions in Madras City. A
comparison has been made of the dietary status of the home and the
sanatorium patients before and during treatment, and the role of the diet
in the attainment of bacteriological quiescence of the tuberculous disease
has been evaluated.

Before treatment the patients in both series had poor and similar diets.
During the early months of treatment, the dietary intake of the patients in
both series increased. However, the sanatorium patients received a
clearly superior diet through the year in terms of total calories, fats, total
and animal proteins, phosphorus and several of the vitamins. The home
patients were physically more active during treatment than the
sanatorium patients, further the accentuating the dietary disadvantage of
the home series.

The home patients gained on the average 10.8 lb in weight over the 12 -
month period, as compared with 19.8 lb for the sanatorium patients. This
greater weight gain among the sanatorium patients was not, however,
indicative of superior clinical results. The response to treatment ( as
measured by the radiographic and bacteriological progress) was not
directly associated with the level of dietary intake of any of the food
factors, either in the patients treated at home or in those treated in
sanatorium.

It may be concluded that none of the dietary factors studied appears to

have influenced the attainment of quiescent disease among tuberculous
patients treated with an effective combination of antimicrobial drugs for a
period of one year. The successful initial treatment of patients at home is
therefore possible even if the levels of dietary intake are low.¶

The fact that such a poor study could play such a critical role in
determining the architecture of a program of such enormous importance
shows how the politics of callousness takes precedence over evidence in
such matters.

c  ##

A similar refusal to take a stand on what was correct and so patently

obvious characterized the response of the off icial scientific community in
India to the Bhopal gas disaster. Twenty five years ago, on the night of 2 -
3 December an industrial accident of massive propotions spewed a huge
cloud of methyl isocyanate gas into the atmosphere of Bhopal, the capital
of Madhya Pradesh. In the next 72 hours, 8 thousand people died of the
effects of the gas, and innumerable people were blinded, developed major
pulmonary disorder, major psychiatric disorder, abnormal pregnancy
outcomes, and a whole host of other acute and chronic morbidity.

The ground water of the factory became contaminated with harmful

chemicals, which then leached into the soil and contaminated the water
table. This is not the forum to detail all the harm that Union Carbide
caused to the people of Bhopal. What I wish to draw your attention to is
the role that evidence and scientific information - and the people
responsible for dealing with this information ±played over the last twenty
five years.

Neither the Union Carbide corporation, nor their successor, the Dow
Chemical Company, have ever acknowledged the nature of the chemical
that spewed out of their factory. Nor did they ever specify the specific
antidote-sodium thiosulphate ± that would have made a major difference
in the treatment outcomes of a large number of gas affected people if it
had been used in time. Strangest of all was the posture adopted by the
ICMR. In one of Arthur Conan Doyle¶s Sherlock Holmes stories, Holmes
says to Watson, ³ I would like to draw your attention to the curious
incident of the dog in the night time.´ Watson says, ³But the dog did
nothing in the night time.´ ³That´ said Holmes, ³was the curious incident´.

The ICMR initiated something like 34 research studies in Bhopal. As far as

I know, none of these studies was carried through to completion. They
were, instead, shut down in batches, and finally in 1994 - 10 years after
the incident, the last two remaining studies were terminated by executive
fiat, and the entire body of data was quarantined indefinitely. At that
time, there were 18 fresh proposals that had been fully approved, but
these proposals were also terminated.

The ground water in the area of the accident has been heavily
contaminated, but the Government has consistently refused to admit this.
Finally, now, the Centre for Science and Environment in Delhi- an
independent NGO with a formidable reputation -has come forward to test
the water. Their report showed the ground water to be heavily
contaminated with highly toxic chemicals.

c $
 !


The Directive Principles of State Policy enshrined in our constitution are

asserted to be ³fundamental in the governance of the country,´ The
Directive Principles clearly mandate that all exercise of state power should
be for the reduction of inequity and the promotion of equity. 

%  &'of the Constitution declares that the DPSP ³shall not be
enforceable by any court, but the principles therein laid down are
nevertheless fundamental in the governance of the country and it shall be
the duty of the state to apply these principles in making laws.´ Viewed in
this context, recent trends in the exercise of state power very clearly
violate this mandate, and have actually resulted in increasing inequities in
important areas such as livelihood, education and health.

According to Dr B D Sharma, formerly Commissioner for Scheduled Case

and Tribes, the fifth schedule is like a constitution within the constitution .
It empowers the Governor to intervene in governance on behalf of the
interests of tribal people , but we note to our great surprise that there is
not a single instance when the Governor of any single state has so
intervened. Once again when we look at the operationalization of PESA,
we find that the entire issue of peoples¶ sovereignty enshrined therein has
been sidestepped in practice. Development in the tribal areas is not only a
matter of building roads, buildings and infrastructure. Rather, it is all
about the operationalization of equity, social justice, and the
establishment of a genuine peoples¶ sovereignity. Everyo ne today talks of
PEACE. Peace cannot mean an acquiescence in an exploitative and unjust
social order.A genuine peace can only be the result of a movement for
equity and justice. At the beginning of this discussion we considered the
essentially political a nd ethical nature of the concept of equity. In the
course of our discussion, I have tried to examine the ways in which
evidence influences -or does not influence ± the praxis of equity. Evidence
is of course, central to the scientific enterprise. A commitm ent to
evidence is what took Galileo to jail, and a commitment to evidence is
what caused Giordano Bruno to be burnt at the stake. Evidence is what
democratizes the generation of knowledge: without it, all we have is
esoteric bodies of dogma, to be passed on from feudal mentor to feudal
apprentice.

Equity is a political concept, and an ethical one. Political questions cannot

be rephrased in terms of informatics or evidence, although once these
questions are adequately formulated, evidence can be used to se ttle the
question one way or the other. The ethical dimension of questions
regarding equity means that the answers contain an inbuilt imperative to
moral action. As Amartya Sen says in his latest book, ³The Idea of
Justice,´ ³Proclamations of human rights, even though stated in the form
of recognizing the existence of things that are called human rights, are
really strong ethical pronouncements as to what should be done. They
demand acknowledgement of imperatives and indicate that something
needs to be done for the realization of these recognized freedoms that are
identified through these rights.´

One of the ironies that confront the witness dealing with µevidence¶ is that
one has to appeal for appropriate interventions to the very forces that are
at such violent odds with poorest sections of the population. For the
student of evidence based policy, this situation raises some challenging
problems. One is that in any study of an intervention one ethical
assumption is that the intervention is carried out by s omeone who comes
to the table with clean hands: whose bona fides are beyond question. In
India today, as in many other places across the world, this is an
assumption that is no longer tenable. Cynicism and disengagement may
be one response to this situation , but,I do not believe that this is the only
tenable response. As young journalists at the beginning of new careers,
the challenge is upon us to acknowledge the imperatives and recognize
that µsomething needs to be done¶. We need to ask ourselves on this very
important day in our lives whether we are up to accepting this challenge
and putting in the response that it demands.


 is a pediatrician, public health specialist, human rights
activist and national Vice-President of the People¶s Union for Civil Liberties
(PUCL) based in Chhattisgarh state, India. He has been extending health
care to the poorest people, monitoring the health and nutrition status of
the people of Chhattisgarh, and defending the human rights of indigenous
tribal and other poor people. In May 2007, he was detained in connection
with his human rights work, raising global concern about his welfare.

He had a distinguished academic career in Vellore, graduating in Medicine

and later acquiring an M.D. in Paediatrics. From 1976 to 1978, he was a
faculty member at the Centre for Social Medicine and Community Health
at the Jawaharlal Nehru University, New Delhi. He left his academic
appointment to work in a community based rural health centre in
Hoshangabad district of M.P. focusing on problems of tuberculosis. He has
been an active member of the Medico Friend Circle, a national
organization of health professionals working towards an alternative health
system responsive to the needs of the poor.

Binayak Sen worked with mine workers in Dalli Rajahara and helped them
set up and manage their own Shaheed Hospital. He then moved to a
mission hospital in Tilda where he worked in Paediatrics and Community
Health. After the death of Shankar Guha Niyogi with whom he was closely
associated, Binayak moved to Raipur. From 1991, he has worked in
developing relevant models of primary health care in Chhattisgarh. He
was among those who initiated the community based health worker
programme across Chhattisgarh, now well known as the Mitanin
programme. He continues to provide health care to the children of the
marginalised, especially the migrant labourers.

He helped organize fact finding campaigns into human rights violations in

Chattisgarh including custody deaths, fake encounters, hunger deaths,
dysentery epidemics and malnutrition. He brought the large scale
oppression and malgovernance within the so called Salwa Judoom in
Dantewara to national and international attention.

Dr. Sen and his wife, Dr. Ilina Sen, are the founders of Rupantar, a
community-based nongovernmental organization that has trained,
deployed and monitored the work of community health workers spread
throughout 20 villages. Rupantar¶s activities include initiatives to counter
alcohol abuse and violence against women, and to promot e food security.
Dr. Sen is an advisor to Jan Swasthya Sahyog, a health care organization
committed to developing a low-cost, effective, community health
programme in the tribal and rural areas of Bilaspur district of
Chhattisgarh. Dr. Sen was the recipient in 2004 of the Paul Harrison
award for a lifetime of service to the rural poor. In 2007, Dr. Sen was
awarded the R.R. Keithan Gold Medal by The Indian Academy of Social
Sciences. The citation describes him as ³one of the most eminent
scientists´ of India.

In 2008, he was awarded the prestigious Jonathan Mann Award for Global
Health and Human Rights for ³ his years of service to poor and tribal
communities in India, p
 

p  
 
p 
 


 p p 
 
p   


p
   
      

p  p