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Health, development and human rights

The improvement in the indices of health and development for India has been incredible. Yet for millions hunger is routine and the loss of their livelihoods not newsworthy. Some aspects of the problem are highlighted.

While medical services impact the health of individuals, the factors associated with longevity of populations are social and economic (e.g. education, occupation). Education and sponsorship which determine access to work contribute to occupational inequality (e.g. salary, occupational hazards), which, in turn, leads to socio-economic outcomes. These sequences operate as a cycle of relative socio-economic privilege and deprivation transmitting inequalities from one generation to the next.

Health and economic development are dynamically interlinked. Low-income countries, which bear a disproportionate burden of disease, have conditions which favour poor health (e.g. lack of clean water, food scarcity). On the other hand, a high proportion of the population with ill health breeds poverty as these societies lack the basic tools (e.g. medicine, fertilizer, credit) to get out of deprivation through development.

Simon Kuznets hypothesised that the relationship between economic development and income inequality takes the form of an inverted U-curve. Income inequality increases during the early phase of development when the main mechanism of growth is the increase in physical capital and the fact that resources are allocated to those who save and invest. During later stages of development, this inequality reduces on account of mass education, rural-to-urban and agriculture-to-industry migration and also due to social policies of governments of mature economies which invest in human capital. The income inequality during the early phase actually exacerbates poverty. However, rising inequality will eventually put pressure on the governments to rectify the situation using the high incomes attained in the later stages of development. The disparities, as is currently happening in India, tend to split society.

The vibrant economy is a reflection of success of India’s middle and upper classes. They form the engine which is driving the country’s development and evoke the image of a “shining India.” The hope is that the growth of the economy will also uplift the poor, albeit in a trickle-down effect. While poverty based on headcount has reduced, deprivation, defined as the disparity between base and mean consumption, is increasing in Bharat. As the “India shining” roadshow moves on to attract greater investment and capital, the poor barely survive as their homes and livelihoods are under increased pressure. This divide is apparent in the conditions and politics of States like Chhattisgarh.

The neglect of development in this region resulted in the denial of basic rights (e.g. food, education, employment) to large sections for long. The consequent cynicism among the poor in the democratic process provided a fertile ground for the naxalite movement. In fact, the Chhattisgarh State was formed to empower the region and to correct the imbalance.

The State, with its abundance of forests, mineral resources and power, has tremendous potential for development. The government entered into agreements with many industrial houses to tap this wealth and offered land to set up mines and industries. However, the main impediment is that a significant proportion of the population lives on the mineral-rich land which provides home and livelihoods. The requirement to clear the land, to resettle the people and the urgent need to tackle the violence unleashed by naxalites resulted in the now infamous solution, the Salwa Judum, a government supported militia. A significant proportion of the tribal population was moved from the land and herded into camps. The naxalite violence was matched by that of the Salwa Judum, making governance of the State difficult. Unlawful deaths and disappearance of many people terrorised the population. Dr. Binayak Sen, with his peaceful antecedents of healthcare for the poor, found himself in this inflammable situation. Exposing the atrocities of the many parties involved in the conflict, as part of the efforts of the People’s Union for Civil Liberties, posed a big threat to the system. The perceptions that those who fight for human rights are against all forms of development and that those who build bridges have sold out to militancy are common emotional responses.

The World Health Organisation has argued that health and human rights are inextricably linked. Violation of human rights (e.g. violence) can have serious health consequences. Vulnerability to ill-health can be reduced by taking steps to protect such rights (e.g. freedom from discrimination, rights to health, education, housing). It argues that we need to apply a human rights-based approach to health care.

Nevertheless, human rights largely remain the concern of specialist lawyers in India. In recent years, however, there is increased recognition in the public health community that human rights provide a useful framework for ensuring the conditions in which people can be healthy.

Contradictory demands of development and of human rights in India in general and in Chhattisgarh in particular are apparent. As with western societies, who benefited from their colonies or at the cost of their indigenous people, development in India is at the cost of its tribal and rural folk.

The rights of the poor can never compete against the might of the rich. The huge toll on the underprivileged during the initial stages of development needs to be factored into India’s economic planning. Macroeconomic policies which protect sectors of the economy which are not able to face the sudden opening up of markets and a phased and carefully planned changeover, keeping in mind the social costs, will be necessary. Schemes to meet the basic needs, which are basic human rights (e.g. employment, health, education, housing) are mandatory. The rich, who currently have the financial ability to buy these needs, should accept the necessity for a minimum standard for all.

The promotion of the health, social and economic rights of the poor is the most important human rights struggle of our times. We need to think about human rights in the context of India’s public health. Dr. Binayak Sen was ahead of most of us in this process. He was recently conferred the Jonathan Mann Award by the Global Health Council for his work on health and human rights. Unfortunately, the Chhattisgarh government considers him a threat to the security of the State. He was fighting for social justice and for human rights. He is still in prison, a year after his arrest, and is the sacrificial victim of an unresolved ideological conflict related to economic development.

(K.S Jacob is on the faculty of the Christian Medical College, Vellore.)

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