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.

We welcome your comments at
Sponsored Content BY 

Relying on the power of habits to solve India’s mammoth sanitation problem

Adopting three simple habits can help maximise the benefits of existing sanitation infrastructure.

India’s sanitation problem is well documented – the country was recently declared as having the highest number of people living without basic sanitation facilities. Sanitation encompasses all conditions relating to public health - especially sewage disposal and access to clean drinking water. Due to associated losses in productivity caused by sickness, increased healthcare costs and increased mortality, India recorded a loss of 5.2% of its GDP to poor sanitation in 2015. As tremendous as the economic losses are, the on-ground, human consequences of poor sanitation are grim - about one in 10 deaths, according to the World Bank.

Poor sanitation contributes to about 10% of the world’s disease burden and is linked to even those diseases that may not present any correlation at first. For example, while lack of nutrition is a direct cause of anaemia, poor sanitation can contribute to the problem by causing intestinal diseases which prevent people from absorbing nutrition from their food. In fact, a study found a correlation between improved sanitation and reduced prevalence of anaemia in 14 Indian states. Diarrhoeal diseases, the most well-known consequence of poor sanitation, are the third largest cause of child mortality in India. They are also linked to undernutrition and stunting in children - 38% of Indian children exhibit stunted growth. Improved sanitation can also help reduce prevalence of neglected tropical diseases (NTDs). Though not a cause of high mortality rate, NTDs impair physical and cognitive development, contribute to mother and child illness and death and affect overall productivity. NTDs caused by parasitic worms - such as hookworms, whipworms etc. - infect millions every year and spread through open defecation. Improving toilet access and access to clean drinking water can significantly boost disease control programmes for diarrhoea, NTDs and other correlated conditions.

Unfortunately, with about 732 million people who have no access to toilets, India currently accounts for more than half of the world population that defecates in the open. India also accounts for the largest rural population living without access to clean water. Only 16% of India’s rural population is currently served by piped water.

However, there is cause for optimism. In the three years of Swachh Bharat Abhiyan, the country’s sanitation coverage has risen from 39% to 65% and eight states and Union Territories have been declared open defecation free. But lasting change cannot be ensured by the proliferation of sanitation infrastructure alone. Ensuring the usage of toilets is as important as building them, more so due to the cultural preference for open defecation in rural India.

According to the World Bank, hygiene promotion is essential to realise the potential of infrastructure investments in sanitation. Behavioural intervention is most successful when it targets few behaviours with the most potential for impact. An area of public health where behavioural training has made an impact is WASH - water, sanitation and hygiene - a key issue of UN Sustainable Development Goal 6. Compliance to WASH practices has the potential to reduce illness and death, poverty and improve overall socio-economic development. The UN has even marked observance days for each - World Water Day for water (22 March), World Toilet Day for sanitation (19 November) and Global Handwashing Day for hygiene (15 October).

At its simplest, the benefits of WASH can be availed through three simple habits that safeguard against disease - washing hands before eating, drinking clean water and using a clean toilet. Handwashing and use of toilets are some of the most important behavioural interventions that keep diarrhoeal diseases from spreading, while clean drinking water is essential to prevent water-borne diseases and adverse health effects of toxic contaminants. In India, Hindustan Unilever Limited launched the Swachh Aadat Swachh Bharat initiative, a WASH behaviour change programme, to complement the Swachh Bharat Abhiyan. Through its on-ground behaviour change model, SASB seeks to promote the three basic WASH habits to create long-lasting personal hygiene compliance among the populations it serves.

This touching film made as a part of SASB’s awareness campaign shows how lack of knowledge of basic hygiene practices means children miss out on developmental milestones due to preventable diseases.


SASB created the Swachhata curriculum, a textbook to encourage adoption of personal hygiene among school going children. It makes use of conceptual learning to teach primary school students about cleanliness, germs and clean habits in an engaging manner. Swachh Basti is an extensive urban outreach programme for sensitising urban slum residents about WASH habits through demos, skits and etc. in partnership with key local stakeholders such as doctors, anganwadi workers and support groups. In Ghatkopar, Mumbai, HUL built the first-of-its-kind Suvidha Centre - an urban water, hygiene and sanitation community centre. It provides toilets, handwashing and shower facilities, safe drinking water and state-of-the-art laundry operations at an affordable cost to about 1,500 residents of the area.

HUL’s factory workers also act as Swachhata Doots, or messengers of change who teach the three habits of WASH in their own villages. This mobile-led rural behaviour change communication model also provides a volunteering opportunity to those who are busy but wish to make a difference. A toolkit especially designed for this purpose helps volunteers approach, explain and teach people in their immediate vicinity - their drivers, cooks, domestic helps etc. - about the three simple habits for better hygiene. This helps cast the net of awareness wider as regular interaction is conducive to habit formation. To learn more about their volunteering programme, click here. To learn more about the Swachh Aadat Swachh Bharat initiative, click here.

This article was produced by the Scroll marketing team on behalf of Hindustan Unilever and not by the Scroll editorial team.