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'We cannot blindly accept international diktats without understanding ground realities'

By Rashme Sehgal

Public health specialist Dr Ritu Priya critiques government policy on bird flu, as well as HIV/AIDS, polio and tuberculosis

Dr Ritu Priya is a doctor who teaches Public Health at Jawaharlal Nehru University's Centre for Social Medicine and Community Health. She has specialised in the area of urban health and communicable diseases including HIV/AIDS and is also working towards evolving an interdisciplinary academic programme for holistic solutions to health problems. She was part of a team of doctors who brought out the report titled `Gujarat Carnage and Health Services: A Public Health Disaster' in May 2002. She is also a consultant on labour migration and is closely associated with monitoring the health of construction workers in the capital.

You have been an outspoken critic of the way the state and central governments have handled the bird flu crisis in Maharashtra.
The government's reaction to the bird flu crisis was to cull thousands of birds without consulting any of the local traders' associations. This is a method which has been practised in a country like Vietnam where farms are small and scattered and each farmer keeps a few chickens. But in our country, many of these poultry farms have bred lakhs of birds. They should have opted to keep the birds under surveillance and also the workers who looked after these birds. Instead, they just gave a blanket order to cull thousands of birds without consulting any of the local trader associations. Once the birds were culled, the owners of these farms simply sent the workers away instead of keeping them under surveillance. We have not built up a system of social guarantees or an overall support system which is a must, especially in an emergency. Our present health policy is to blindly accept international diktats without understanding local ground realities. The public must understand that bird flu, like HIV/AIDS, is here to stay.

You believe it was a knee-jerk reaction?
Absolutely. Migrant labour is the most vulnerable section of our community. The government should have kept the workers in quarantine. Once they lost their jobs, they returned to their villages where they would -- in case they were infected -- have proved a greater threat to the community. Experience has taught us that unemployment is directly linked to infant mortality deaths. Pre-harvesting periods see the highest amount of infant mortality deaths because the villagers have no money to spare for medical expenses. Unfortunately, we are accepting medical solutions being followed by the international community without trying to temper them to our local situation. This is true of the way we are presently conducting our HIV/AIDS, Pulse Polio and TB campaigns. Take the case of HIV/AIDS. The international effort is geared towards Africa which has 65% of the existing HIV/AIDS cases. We need to gear our campaign to our local scenario because the levels of infection here are different. These blanket policies are putting an end to local initiative.

You have also criticised the growing commercialisation of our health system.
Emphasis on health tourism is likely to distort the perspective of our health providers. Promoting health as a purely commercial venture is creating quality standards which are unaffordable to the vast majority. Our health system has become completely commercialised and that is not the way a system dealing with millions of poor should work. If tertiary hospitals are going to copy Apollo, what happens to the man-on-the-street?

You are also working closely with construction workers in Delhi. Has their health status declined after they migrated from their villages in Rajasthan?
I continue to work closely with construction workers in Delhi. For my PhD, I had studied 30 households in Delhi and another 100 households located in Tonk district of Rajasthan from where they had migrated. I studied their access to food both in their village and in the city. Since many of the migrants were landless dalits, getting away from the practice of untouchability in their villages was a matter of great significance. But the flip side was that in the village, they saw themselves as cultivators, and that self-image carried weight for them. I would say that while their social well-being improved, their health has shown a downward slide. The food they eat is much worse. Earlier, their staple food comprised of jowar mixed with channa, now, they all eat wheat. They have stopped growing gram in the villages, so the nutritive content of their food has gone down. The amount of vegetables and fruits being grown has decreased. Earlier, most farmers kept livestock which provided them with milk and ghee. Now the forests have been cut, fodder has become expensive, and so this whole cycle has been broken. Earlier, they would do a lot more physical exercise, today they all complain that their stamina has reduced. People migrate in search of stable work patterns; steady incomes ensure staple access to food.

Villagers who migrate to cities also start leading a more sedentary life. In Tamil Nadu, for example, films and soaps preoccupy them and determine their lifestyle. They spend their whole day watching TV and that habit is spreading to other areas. Women are also engaged in buying more gold and families get into debt in order to make these purchases. This creates its own levels of stress and hypertension. Families have changed their food habits and are consuming more junk food. The result is a spurt in diabetes, hypertension and other diseases.

We must not forget that there is a complete disjunct between state support to agriculture, which employs the large majority of our population, and industry. The government must take firm steps to boost our agriculture which today comprises 22% of our economy even as it employs 70% of the population. Rural indebtedness has grown while food availability for the poor is declining.

What are the solutions?
I think it is important to boost rural regeneration in order to decrease migration. But the moot question is: what kind of steps should government take to improve living conditions in our villages? The government seems determined to provide urban amenities in rural areas. They talk about providing them piped water supply. Our groundwater levels have already sunk and this is building up to a major crisis. Instead of working towards replenishing our water resources, we are working towards destroying our local ecology. I believe our overall development paradigms must be sustainable. We need to replan our cities and rethink our urban amenities and this must be done in accordance with our present natural resources. There is no point in going ahead and preparing a blueprint that will destroy our local natural resources. We need to move away from mono to multiple solutions.

InfoChange News & Features, March 2006