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South Asia

Is India’s national health policy geared towards achieving the Sustainable Development Goals?

7 Apr, 17 | by jbanning

soumyadeep bhaumikThe adoption of Sustainable Development Goals (SDG’s) in 2015 marked a shift in the global development agenda from the earlier Millennium Development Goals (MDGs) era. SDGs are particularly important for the health sector, since they reaffirm the premise of the Alma Ata declaration that health cannot exist in isolation. SDG’s intrinsically link health with actions in several sectors outside healthcare. As a country which missed several of its MDG targets, the SDGs reflect a new set of challenges for India.

At the 2015 United Nations summit, India’s Prime Minister Narendra Modi said that the “Sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet,” while reiterating his confidence that they will be reached. But how well does India’s latest National Health Policy (NHP 2017) released last month, align with the health related SDG’s?

To its credit, the policy, at the outset, recognises the SDG’s to be of “pivotal importance” and has identified seven priority areas outside the health sector which can have an impact on preventing and promoting health. In the section on urban health policy, the NHP calls for “achieving convergence among the wider determinants of health.” The NHP has identified the following determinants specifically: “air pollution, better solid waste management, water quality, occupational safety, road safety, housing, vector control, and reduction of violence and urban stress.” The policy links this with the government’s focus on “smart cities,” seemingly in tandem with SDG 11. This is commendable. But the omission of other traditional determinants of health that are intrinsically linked to other SDG goals of reducing poverty, hunger, promoting quality education, gender equality, and reducing inequalities (SDG 1,2,4-6,10) is surprising.

In its national programmes on maternal and child health, the policy “seeks to address the social determinants through developmental action in all sectors.” It further says that “research on social determinants of health” will be promoted, combining this with “neglected health issues such as disability and transgender health.” It touches on Panchayati raj institutions “to play an enhanced role at different levels for health governance, including the social determinants of health.” In highlighting the need for “an empowered public health cadre,” the NHP explains they need to “to address social determinants of health effectively, by enforcing regulatory provisions.” And while this is not explicitly mentioned as a determinant in the NHP the insertion of gender based violence in national programs, and the call for increased sensitization of health systems to provide care “free and with dignity in the public and private sector,” is another welcome sign. But in its entirety, these issues that are outside of the healthcare sector are reduced to mere mentions, with very little clarity on policy direction or funding. This merits some concern, considering that the NHP in itself, even outside the realm of SDGs, has outlined equity as a key principle.

In transitioning from MDGs to SDGs, the mention of health was reduced from three goals to only one, seemingly in recognition of the need for concerted policies in tandem with related fields in order for them to have a lasting impact on population health. It would have been refreshing if India’s NHP had categorically specified frameworks for integrated action in non-health related SDG’s such as those focused on poverty, hunger, education, gender equality, clean water, and sanitation. Meaningfully executing any multi-sectoral mechanism means building successful partnerships within diverse ministries and with communities. Given all that has been said about the NHP 2017 repeating many of its targets from previous versions, a succinctly articulated vision for governance and financing for inter-ministerial work to address health would have been refreshing.

Soumyadeep Bhaumik is an associate editor for BMJ Global Health and an analysis advisor for The BMJ. He is a medical doctor working in the field of evidence syntheses and program evaluation in India.  Twitter: @DrSoumyadeepB 

Pritha Chatterjee is an MPH candidate at the Harvard T.H. Chan School of Public Health and an Aga Khan International Development Scholar. She is a health journalist from India, formerly with The Indian Express Ltd.  Twitter: @pritha88

Competing interests: We have read and understood BMJ policy on declaration of interests and declare that we have no other relevant conflicts of interests to declare.

Disclaimer: Views expressed are those of the authors and are personal in nature.

Naomi Hossain: The right to food is common sense in Bangladesh

6 Mar, 17 | by jbanning

Horrifying new reports of famine on a vast scale in Yemen, South Sudan, Somalia, and Nigeria are emerging, signalling the lack of a real right to food among tens of millions of people. Climate change and conflict are leading to recurrent food crises. These unfolding episodes resemble the story of the last famine in Bangladesh, which was in 1974. In 1970, the Bhola cyclone killed half a million and left thousands more hungry; this was followed by the war for Liberation in 1971 with its large-scale human rights abuses. And then in 1974, the new nation of Bangladesh was devastated by the famine from which possibly 1.5 million people, already gravely weakened by poverty and recent events, died.

What marks Bangladesh out is that the 1974 famine had a positive outcome: it established a strong right to food that provided the foundation for further progress. Because, after all, what good could development projects do, if people were not eating well enough to survive?

The elite, the rural poor, and aid donors agreed on basic food security as a priority as it provides the foundation for bare survival. And this “subsistence crisis contract” has held up across successive governments of Bangladesh of all parties and regimes. The state, working with aid agencies and NGOs, has strengthened food security, at times by freeing food markets, at others by intervening for the vulnerable. A path towards labour-intensive industry has been followed, and social services have improved. NGOs worked wonders, in the space allowed. And hunger levels and disaster deaths have dropped, even if nutrition remains a moving target.

What Bangladesh has can be termed as the common sense approach to the right to food. This has a strong political foundation in the country’s history, but no formal legal basis to date. Yet this “common sense” right is no trivial matter. It reflects a broad social agreement on the obvious point that every Bangladeshi should be able to eat. It also includes a clear mandate for the state to act to make sure they can. Everyone understands what this means in practice, even if it is not always easy to enforce.

Qualitative research I have been involved with in Bangladesh and nine other countries in which we  looked purposely into how people view the right to food suggests that views elsewhere are similar to those in Bangladesh. Food is widely seen as a natural right, and in times of disaster, protection against hunger is a matter of citizenship, obliging the state to act. We found a legal concept of the right to food was not always meaningful: some people in Vietnam and Indonesia thought it strange or irrelevant, while in Bolivia and Kenya, people with lawful rights to food were disillusioned with the reality of the right to food. I was struck by one popular political theory: that governments usually do their best to tackle subsistence crises because failure is so politically costly. In practice, of course, a government that fails is not easily held to account.

There is much talk, these days, of a lawful right to food to strengthen accountability for protecting against hunger and malnutrition. Human rights organisations like BLAST are championing a framework law to formalise the right to food. But the globalized effects of food price volatility, climate change, and conflict mean that the right to food is a transnational, and not only a national, challenge. With the “threat multiplier” that is climate change which poses an increasingly live threat to food security, Bangladesh has no time to lose in building itself a robust legal and institution framework for the right to food.

Naomi Hossain works at the Institute of Development Studies at the University of Sussex. Her book about the effects of the Bangladesh famine, The Aid Lab, was published in 2017.

Competing interests: None declared.

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