super powers

A new bill on public health emergencies allows for dubious restrictions of citizens’ liberties

The Public Health Bill allows government authorities to enter houses, examine and treat people during an emergency but does not mention patient consent.

In September 1896, the city that was then called Bombay recorded its first case of the bubonic plague. The disease quickly spread swiftly claiming victims – estimates peg the death toll at 1,900 every week for the rest of the year. The health crisis prompted the British administration of the city to quickly draft the Epidemic Diseases Act in 1897 to prevent the spread of dangerous epidemic diseases.

The Act, considered one of the most draconian pieces of public health legislation, gave sweeping powers to the government authorities. Officials could enter any house and forcibly examine a sick person or someone suspected to carry infection. In her account of the bubonic plague outbreak, historian Mridula Ramanna says that British officials would drag men and women out of their houses and examine their armpits for buboes, which are swollen lymph nodes.

The Epidemic Diseases Act was later modified significantly to allow the government only to detain international travelers suspected of carrying an infectious disease. The measures of this revised regulation were invoked in independent India.

This century-old act is now set to be replaced. The central government drafted the Public Health (Prevention, Control and Management of Epidemics, Bio-terrorism and Disasters) Bill, 2017 and uploaded it online seeking comments. The deadline to submit comments was March 25.

The Bill is more in keeping with the times and includes provisions on bioterrorism, which involves the deliberate release of hazardous biological agents like viruses, bacteria or toxins in the environment. The Bill also has references to different modes of transport such as airplanes and ships, through which disease can spread.

But public health experts feel that the Bill is as draconian as the older law, maybe even more so.

The Bill empowers medical officers to inspect any premises, isolate people, restrict movement, test a patient and mandate treatment or vaccination of a person suffering from disease. The Bill has does not mention the necessity of seeking consent from citizens for any of these measures.

Tough measures

According to the Bill, after a public health emergency is declared, a state government, district authority or local authority can take measures to prevent and control the emergency. They can quarantine people who might have been exposed to the disease, conduct medical examinations, provide treatment and ban any activity they deem “inimical to public health”.

A public health emergency, as per the Bill, is any sudden state of danger to public health including spread of infection, disaster or bioterrorism that mandates immediate action for its prevention, control and management. The Bill lists a schedule of 33 diseases that are “epidemic prone” like dengue, chikungunya and multi drug-resistant and extremely drug-resistant tuberculosis.

This might allow government authorities to invoke extreme powers of entering houses and forcibly treating citizens during any monsoon season when the country witnesses several outbreaks of infectious diseases like malaria, dengue and chikungunya.

The behaviour of Tamil Nadu state health authorities during the recent measles-rubella vaccination campaign in schools provides a glimpse of what such a Bill might allow. When many parents were opposed the campaign because of lack of transparency, the state health minister C Vijaya Bhaskar announced that schools need not seek consent of parents before vaccinating childern. “The Public Health Act allows us to give vaccine without consent,” she told Times of India last month. “If need be, we will make it mandatory.”

The Act Bhaskar was referring to is the Madras Public Health Act, 1939, which is also a colonial Act and gives similar powers to the state. The Act also lists out many duties such as providing clean water, effective drainage systems, medicines, among others.

A patient in Karachi suffering bubonic plague in 1882 when the disease spread from Bombay. (Photo: Wellcome Library, London/Wikimedia Commons)
A patient in Karachi suffering bubonic plague in 1882 when the disease spread from Bombay. (Photo: Wellcome Library, London/Wikimedia Commons)

What is a public health emergency?

Dr Vijayaprasad Gopichandran who teaches community medicine at the Employees’ State Insurance Corporation Medical College in Chennai said that the Bill provides no definition on who will decide that an outbreak is a public health emergency or how it will be declared.

“A system should be in place with a team of epidemiologists, public health experts, policy makers, public health engineers and so on that can decide and declare diseases as public health emergency,” said Gopichandran. Gopichandran is part of Chennai’s Medico Friend Circle, a group that wrote to the Ministry of Health pointing out concerns about the Bill.

He suggested that the Bill should define a system much like the International Health Regulations agreed on by all World Health Organisation member states. The regulations define the process of declaring a disease as Public Health Emergency of International Concern. They require an Emergency Committee to examine unexpected outbreaks of diseases like polio or Severe Acute Respiratory Syndrome also called SARS, outbreaks of unknown diseases and those like cholera, plague, yellow fever and viral hemorrhagic fevers that can cause serious public health impacts. The committee then looks at strengthening national disease surveillance, prevention, control and response systems and responses at the international level.

The Bill is also silent on the duties of the government during a public health emergency. “There is no mechanism stated in the Bill about the responsibilities of the government in ensuring that the measures are evidence-based and effective, that the duration of time of restrictions are appropriate and that the infringement into the privacy of the population is proportional,” said Gopichandran.

Infringement of human rights

The Bill suspends liberties of people while barely holding the government accountable, said experts.

“There is no emphasis on modern methods of outbreak prevention and disease control such as establishment of surveillance system, early warning systems, Geographical Information System mapping of diseases, which are all less intrusive methods of disease prevention and containment,” pointed out Gopichandran.

Anant Bhan, a researcher of bioethics and global health, said that the country does need a law with a framework for mounting a public health response and elaborating the powers of government at such a time.

“However, there has to be balance between government’s role in maintaining public health and human rights, “ he said. “This Bill neglects it completely.”

The restrictive action prescribed in the Bill can alienate citizens and make them lose trust in the public health system. “It is possible that fearing isolation, the patients will not inform the public health system and instead prefer to weather it out,” said Bhan.

History suggests that respectful engagement with the public will work better. “My research showed that if you introduce public health measures gradually with a pursuance campaign, you can deal with the situation better,” said Ramanna. “The authorities have to keep in mind sensibilities, sensitivities and gender before undertaking a public health campaign.”

Provisions of the Public Health Bill for a health emergency

  • Quarantine or restrict the movement of any people possibly exposed to the disease. 
  • Authorise any official or person to enter and inspect, without prior notice, any premises where public health emergency has either occurred or is likely to occur
  • Prohibit any activity “inimical to public health”
  • Isolate people infected from the disease
  • Conduct medical examination on people infected
  • Provide treatment, vaccination, or prophylaxis to infected people
  • Undertake disinfection activities
  • Ban or regulate the purchase, distribution, sale of hazardous or toxic substance
  • Order detention of anyone carrying hazardous substance
  • Order hospitals/clinics to admit, isolate and manage cases arising out of the public health emergency 
  • Disseminate information to the public 
  • Direct any clinical establishment to admit, isolate and manage cases arising out of public health emergencies and to report to the government. 
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Swara Bhasker: Sharp objects has to be on the radar of every woman who is tired of being “nice”

The actress weighs in on what she loves about the show.

This article has been written by award-winning actor Swara Bhasker.

All women growing up in India, South Asia, or anywhere in the world frankly; will remember in some form or the other that gentle girlhood admonishing, “Nice girls don’t do that.” I kept recalling that gently reasoned reproach as I watched Sharp Objects (you can catch it on Hotstar Premium). Adapted from the author of Gone Girl, Gillian Flynn’s debut novel Sharp Objects has been directed by Jean-Marc Vallée, who has my heart since he gave us Big Little Lies. It stars the multiple-Oscar nominee Amy Adams, who delivers a searing performance as Camille Preaker; and Patricia Clarkson, who is magnetic as the dominating and dark Adora Crellin. As an actress myself, it felt great to watch a show driven by its female performers.

The series is woven around a troubled, alcohol-dependent, self-harming, female journalist Camille (single and in her thirties incidentally) who returns to the small town of her birth and childhood, Wind Gap, Missouri, to report on two similarly gruesome murders of teenage girls. While the series is a murder mystery, it equally delves into the psychology, not just of the principal characters, but also of the town, and thus a culture as a whole.

There is a lot that impresses in Sharp Objects — the manner in which the storytelling gently unwraps a plot that is dark, disturbing and shocking, the stellar and crafty control that Jean-Marc Vallée exercises on his narrative, the cinematography that is fluid and still manages to suggest that something sinister lurks within Wind Gap, the editing which keeps this narrative languid yet sharp and consistently evokes a haunting sensation.

Sharp Objects is also liberating (apart from its positive performance on Bechdel parameters) as content — for female actors and for audiences in giving us female centric and female driven shows that do not bear the burden of providing either role-models or even uplifting messages. 

Instead, it presents a world where women are dangerous and dysfunctional but very real — a world where women are neither pure victims, nor pure aggressors. A world where they occupy the grey areas, complex and contradictory as agents in a power play, in which they control some reigns too.

But to me personally, and perhaps to many young women viewers across the world, what makes Sharp Objects particularly impactful, perhaps almost poignant, is the manner in which it unravels the whole idea, the culture, the entire psychology of that childhood admonishment “Nice girls don’t do that.” Sharp Objects explores the sinister and dark possibilities of what the corollary of that thinking could be.

“Nice girls don’t do that.”

“Who does?”

“Bad girls.”

“So I’m a bad girl.”

“You shouldn’t be a bad girl.”

“Why not?”

“Bad girls get in trouble.”

“What trouble? What happens to bad girls?”

“Bad things.”

“What bad things?”

“Very bad things.”

“How bad?”

“Terrible!!!”

“Like what?”

“Like….”

A point the show makes early on is that both the victims of the introductory brutal murders were not your typically nice girly-girls. Camille, the traumatised protagonist carrying a burden from her past was herself not a nice girl. Amma, her deceptive half-sister manipulates the nice girl act to defy her controlling mother. But perhaps the most incisive critique on the whole ‘Be a nice girl’ culture, in fact the whole ‘nice’ culture — nice folks, nice manners, nice homes, nice towns — comes in the form of Adora’s character and the manner in which beneath the whole veneer of nice, a whole town is complicit in damning secrets and not-so-nice acts. At one point early on in the show, Adora tells her firstborn Camille, with whom she has a strained relationship (to put it mildly), “I just want things to be nice with us but maybe I don’t know how..” Interestingly it is this very notion of ‘nice’ that becomes the most oppressive and deceptive experience of young Camille, and later Amma’s growing years.

This ‘Culture of Nice’ is in fact the pervasive ‘Culture of Silence’ that women all over the world, particularly in India, are all too familiar with. 

It takes different forms, but always towards the same goal — to silence the not-so-nice details of what the experiences; sometimes intimate experiences of women might be. This Culture of Silence is propagated from the child’s earliest experience of being parented by society in general. Amongst the values that girls receive in our early years — apart from those of being obedient, dutiful, respectful, homely — we also receive the twin headed Chimera in the form of shame and guilt.

“Have some shame!”

“Oh for shame!”

“Shameless!”

“Shameful!”

“Ashamed.”

“Do not bring shame upon…”

Different phrases in different languages, but always with the same implication. Shameful things happen to girls who are not nice and that brings ‘shame’ on the family or everyone associated with the girl. And nice folks do not talk about these things. Nice folks go on as if nothing has happened.

It is this culture of silence that women across the world today, are calling out in many different ways. Whether it is the #MeToo movement or a show like Sharp Objects; or on a lighter and happier note, even a film like Veere Di Wedding punctures this culture of silence, quite simply by refusing to be silenced and saying the not-nice things, or depicting the so called ‘unspeakable’ things that could happen to girls. By talking about the unspeakable, you rob it of the power to shame you; you disallow the ‘Culture of Nice’ to erase your experience. You stand up for yourself and you build your own identity.

And this to me is the most liberating aspect of being an actor, and even just a girl at a time when shows like Sharp Objects and Big Little Lies (another great show on Hotstar Premium), and films like Veere Di Wedding and Anaarkali Of Aarah are being made.

The next time I hear someone say, “Nice girls don’t do that!”, I know what I’m going to say — I don’t give a shit about nice. I’m just a girl! And that’s okay!

Swara is a an award winning actor of the Hindi film industry. Her last few films, including Veere Di Wedding, Anaarkali of Aaraah and Nil Battey Sannata have earned her both critical and commercial success. Swara is an occasional writer of articles and opinion pieces. The occasions are frequent :).

Watch the trailer of Sharp Objects here:

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This article was published by the Scroll marketing team with Swara Bhasker on behalf of Hotstar Premium and not by the Scroll editorial team.