How the home ministry is imperilling India’s health

The government is acting against national interest by hounding health advocacies.

It takes a special kind of person, endowed with skill and perseverance, to work with prickly government agencies in fields where governance is in a state of collapse and to hold close to his or her heart the interests of India and its people.

Two of those people are K Srinath Reddy and N Devadasan, both doctors who redirected their professional skills to set up health advocacies that work closely with government agencies in finding ways to end a hazard that costs India crores of rupees and millions of lives every year. Yet, Devadasan’s Institute of Public Health had its licence to receive foreign donations revoked in October and Reddy’s Public Health Foundation of India last week, both on fiddly grounds of regulatory compliance and disclosure. Foreign donations are important because Indians are notoriously reluctant to donate money to fuzzy issues like health, however important these might be to national wellbeing.

The issue that appears to have – unofficially – riled the government is anti-tobacco advocacy, and there is some truth to that, but the scale and pettiness of the action betrays the government’s larger ideological weaknesses, which now seem inimical to India’s national interests.

First, let us consider how hobbling anti-smoking campaigns cripples Indians.

If you want to kill yourself, there are few better ways to ensure success than to smoke. About a million Indians die from smoking-related causes every year – or about 114 every hour. “Tobacco use, and in particular smoking, is the largest cause of preventable death among adults in India,” observed a 2012 study in the journal Current Science. Smoking has strong associations to cardiovascular disease, cancer, tuberculosis and respiratory diseases. The health ministry reported in 2011 that Indians aged 35 to 69 spent Rs 1 lakh crore on smoking-related diseases, or about six times the amount the government received as tax from tobacco products the same year.

Anti-smoking campaigns and taxes appear no brainers, but India’s tobacco lobby clearly has an influence on government. Industry lobbying against pictorial warnings on bidi and cigarette packs was revealed when a parliamentary committee managed to stall an increase in the size of the warnings for a year to 2016. Cigarette smoking can be cut by 54% if excise is increased by 370% from present levels, and bidi use by 40% if excise is raised 100%, according to a Public Health Foundation of India policy brief. The government knows this: the Union health secretary is a member of the Public Health Foundation of India’s executive committee. The Institute of Public Health, a much smaller organisation, is the Karnataka government’s anti-tobacco implementing agency, working closely with a host of state departments.

Not in India’s interest

Since both organisations perform quasi-government functions, no tobacco lobby could be strong enough to hobble them so deeply as to set the home ministry – which revoked their foreign donation licences – against the health ministry. That action flows from a stronger lobby, the Rashtriya Swayamsevak Sangh, whose economic affiliate, the Swadeshi Jagran Manch, has acknowledged efforts to rid India of one of its strongest global supporters in improving national health, The Bill and Melinda Gates Foundation, which is one of the funding agencies of the Public Health Foundation of India. “We have met the Union health minister and raised the matter regarding funding of PHFI by BMGF,” Manch co-convenor Ashwini Mahajan told the Indian Express.

The Manch undoubtedly sees the Gates Foundation as an organisation working against Indian interests (it has alleged a nexus between the Gates Foundation and pharmaceutical majors and accused it of influencing health policy-making). It would like Indians to do the work the Gates Foundation does, but there is no Indian organisation currently capable of deploying such finances, expertise and long-term resolve. Unlike other non-governmental organisations that have been hounded, the Public Health Foundation of India and the Institute of Public Health are not even involved in helping victims of the 2002 Gujarat communal riots that left over 1,000 people dead, or those displaced by mining and factories – particular bugbears for this government.

Using the bogey of public or national interest, Prime Minister Narendra Modi has allowed his officials a free hand against non-governmental organisations inconvenient to the government’s policies and ideology, even if these help implement the state’s own laws, fill in for governance failures and assist the most vulnerable. In so doing, it is the government that is acting against national interest.

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