Public policy must launch an assault on capability deprivation and rising unemployment
As the general election approaches, we are reminded of the observation by the philosopher Ludwig Wittgenstein that while raisins may well be the better part of a cake, “a bag of raisins is not a cake”. For, while elections may be an integral part of democracy, surely they cannot be its end. The end is the demos, or the people, and the content of their lives. However, going by the actions of political parties when in power and their pronouncements when they are not, the end of democracy gets overlooked in the political process in India.
In the run-up to the present, indeed through the greater part of the past five years, two constructs have repeatedly been projected by the main political formations in the country. These are nationalism and secularism, associated with the Bharatiya Janata Party (BJP) and the Congress, respectively. As are raisins to the cake, so we might say these two ideals are to Indian democracy. But unlike the fruit which, given to us in a natural state, is not malleable, the concepts of nationalism and secularism have proved to be quite that in the use to which they are put by India’s political parties. This by itself may have proved to be less disappointing if they had not in addition privileged these constructs over everything else.
Actually, it is possible for nationalism and secularism to be part of state policy even in the absence of democracy. Thus both Iran under the last Shah and Iraq under Saddam Hussein ran a secular state, though they were both dictators. The People’s Republic of China is so nationalist that even its socialism is said to be imbued with ‘Chinese characteristics’. Its state is not just secular but avowedly atheist. However, it is not a democracy. What is at stake here is that democracy is meant to be something more than just nationalism and secularism. None of this suggests that these two concepts are unrelated to democracy. Indeed they are of it.
Take nationalism first, once we have imagined ourselves as a democratic community we must defend our national interest. Threats to India come from two sources. There are authoritarian regimes in the region that are hostile to India. Second, the western powers have captured global bodies to promote their economic and political interests, for which think of the multilateral agencies that attempt to prise open India’s market without yielding the West’s to migration.
Take secularism next. Based on first principles, we would say that a democracy cannot allow any religious influence on the state’s actions. However, there is a reality in India today that requires a contextual understanding, and this would require the secular state to go beyond this limited brief to protect religious minorities. The relevance of this is brought home by an incident that took place on Holi day when a gang of hoodlums, attacked without provocation, a Muslim family including young children with iron roads in broad daylight in Gurugram outside the national capital. The video, uploaded on the Internet, makes for horrific viewing. It should leave every thinking Hindu raging with anger that terror is directed at innocent Indians in his or her name.
To accept the relevance of both nationalism and secularism to Indian society does not, however, entail agreement with the use made of these constructs by India’s political parties. We have just completed five years during which a toxic nationalism has been unleashed. In the BJP’s hands, nationalism or national pride has shown itself to be a means to establish Hindu majoritarian rule, a project with potentially destructive consequences for the country. A substantial part of India views this with trepidation.
For its part, over the past 30-plus years the Congress party has often resorted to a sham secularism, the high mark of which came in the form of its response to the Supreme Court ruling on the Shah Bano case. Many citizens, including Muslim Indians, were deeply demoralised. In the State of Kerala, the Congress routinely shares power with sectarian parties while proclaiming its secular credentials. Nobody is fooled.
Of all the leaders India has produced, it is Jawaharlal Nehru who has been the most clear-eyed on the goals of Indian democracy. When asked by the French writer André Malraux as to what he considered his biggest challenge Nehru had replied: “creating a just state by just means [and] creating a secular state in a religious country.” The significance of this was that Nehru saw these goals as challenges to be overcome. Not for him the thought that these tasks were done merely by stating “acche din aane wale hai” or publicised visits to mahants and imams. Some years earlier, at the moment of the ending of colonial rule, Nehru had stated that it was an opportunity to create a “prosperous, democratic and progressive” India. He had read the aspirations of his compatriots astutely. Prosperity was not considered second to progressive thinking, even if the latter meant nationalism and secularism.
Just society by just means
In the close to three quarters of a century since, the goal of Indian democracy had been articulated prosperity is not in sight for the vast majority. On the other hand, a section of Indians has surged ahead economically. Not just the very rich but the middle classes too are now much richer than they were. For the rest of the country, however, it is an ongoing struggle to earn a living. A just society must seem far away to these Indians. But a just society by just means is no longer a pipe dream, it is entirely feasible, and in our times at that. The pathway to it lies in adopting the right public policies, and it is in the hands of India’s political parties to do so.
To address the economic hardship of the majority of Indians, public policy should now shift gear to launch an assault on the capability deprivation which underlies India’s low human development indicators. The poorly educated millions are helplessly caught in the eddies of a market economy. Their skills do not match what is required for them to earn a decent living. Overcoming this requires two actions to be undertaken.
It would require committing resources to education and training and then governing their use. In fact, we elect and then maintain a political class to govern the system. Instead, it acts as if its sole task is to lecture the public on either nationalism or secularism, as the case may be, leaving the task of governance entirely to the bureaucracy. This empowers the bureaucracy in an undesirable way, amounting to its not having to be accountable.
The second task of public policy in India at this moment is to raise the tempo of economic activity. Jobs are an issue. The government cannot create jobs directly but it can create the preconditions. It does so through public investment and macroeconomic policy. For about a decade now, the latter has been conducted unimaginatively. Amateurish economic management is responsible for rising unemployment. India’s political parties cannot say that the pathway to the ends of democracy has not been shown to them. If they fail to take the country there, they must assume responsibility.
Paradigm shift for TB control
Ending TB by 2025 is impossible but sustaining its decline is in the realm of reality
Tuberculosis (TB) remains the biggest killer disease in India, outnumbering all other infectious diseases put together — this despite our battle against it from 1962, when the National TB Programme (NTP) was launched. All hope was pinned on mass BCG vaccination to prevent TB. In 1978, the Expanded Programme on Immunisation (EPI) began, giving BCG to all babies soon after birth and achieving more than 90% coverage. Yet, when evaluated in 1990, the NTP and the EPI had not reduced India’s TB burden.
In 1993, the Revised National TB Control Programme (RNTCP) was launched, offering free diagnosis and treatment for patients, rescuing them from otherwise sure death. However, treatment is not prevention. Prevention is essential for control.
Short on control
Why did the NTP and the EPI fail? Visionary leaders had initiated a BCG vaccine clinical trial in 1964 in Chingelpet district, Tamil Nadu. Its final report (published in the Indian Journal of Medical Research in 1999) was: BCG did not protect against TB infection or adult pulmonary TB, the ‘infectious’ form. By then, the RNTCP was in expansion mode; experts hoped that curing pulmonary TB might control TB by preventing new infections. That assumption was without validation in high prevalence countries.
BCG immunisation does prevent severe multi-organ TB disease in young children, and must be continued but will not control TB.
In countries with 5-10 cases in a lakh people annually, curing TB sustains the low disease burden. In India, with 200-300 cases in a lakh in a year, curing TB is essential to reduce mortality, but is not sufficient to prevent transmission. By 2014-15, the RNTCP was found to be very successful in reducing mortality, but failing to control TB. Why? From when a person becomes infectious to when he/she turns non-infectious by treatment, there is a gap of several weeks during which the infection saturates contacts in the vicinity. Delays in care seeking and diagnosis are the result of lack of universal primary health care.
The way forward to control TB and to monitor its trajectory was proposed in 2009, in an editorial in Tropical Medicine & International Health titled “Paradigm shift for tuberculosis control in high prevalence countries”. According to the editorial, an innovative strategy was necessary.
Tamil Nadu pilot model
True to its reputation as being one of the most progressive in health management, Tamil Nadu is planning to implement this new strategy in one revenue district, Tiruvannamalai. If successful, it will be replicated in all other districts. To ensure public participation — a missing element in the RNTCP — the new model will be in public-private participation mode. The Rotary movement, having demonstrated its social mobilisation strengths in polio eradication, will partner with the State government in the TB control demonstration project.
Tiruvannamalai, a pioneer district in health management, was the first in India (1988-90) to eliminate polio using the inactivated polio vaccine (IPV), under a Health Ministry-Indian Council of Medical Research-Christian Medical College project.
The Directorate of Public Health and Preventive Medicine and the National Health Mission will lead all national, State and district health agencies, district and local administration, departments of education, social welfare and public relations and government medical college. The Rotary will ensure the participation of all players (health and non-health) in the private sector.
Last year we wrote in these columns that TB control requires the slowing down of infection, progression and transmission. Pulmonary TB causes transmission, resulting in infection which leads to progression as TB disease. To transform this vicious cycle into a virtuous cycle of TB control, spiralling down TB prevalence continuously, transmission, infection and progression must be addressed simultaneously — this is the Tiruvannamalai TB mantra.
TB bacteria float in the air, people inhale that air and get infected. The closer one is to a pulmonary TB person, the greater the probability of catching infection. We must reduce chances of transmission by insisting that the TB affected should cover their mouth and nose while coughing and sneezing and not to spit in open spaces. Only when the public at large practise cough and sneeze etiquette and refrain from spitting in the open, can we ensure that the TB affected also will follow suit. The Rotary will spearhead public education for behaviour modification, starting in all schools and continuing through to adults.
Progression to TB disease from infection can be prevented by giving World Health Organisation-recommended short-term ‘preventive treatment’. Infection is silent, but diagnosable with the tuberculin skin test (TST). Testing all people periodically is not possible. Cohorts of schoolchildren (5, 10 and 15 years) can be tested and those TST positive given preventive treatment. This tactic achieves three results at one go — an infected child gets preventive treatment and points to adults with undiagnosed TB in the household. Finally, the annual TST positive rate provides an objective measure of annual infection frequency for plotting the control trajectory.
World TB Day is observed on March 24. In 2019 the slogan was “It’s Time…” to take TB control seriously. On March 13, 2018, the Prime Minister, who was inaugurating the End TB Summit, declared that India would end TB by 2025. On September 26, 2018, the first ever United NationsHigh-Level Meeting on TB declared the urgent agenda “United to end TB – an urgent global response to a global epidemic”. Rhetoric and declarations cannot control TB; a strategy of simultaneously using all biomedical and sociobehavioural interventions can.
Ending TB by 2025 is impossible but pulling the TB curve down by 2025 and sustaining the decline ever after is in the realm of reality. True to the spirit of World TB Day theme, we laud Tamil Nadu for deciding ‘It’s time — to take bold and imaginative initiatives to create a TB control model’. Tamil Nadu, an erstwhile global leader in TB research during the 1960s through the 1990s, will now become the global leader in TB control.
Encouraging secret donations
The electoral bonds scheme needs to recognise the complementary nature of the rights to privacy and information
Despite massive campaign spending in India, there is barely any public scrutiny of such spending because of the opaque nature of the transactions. The electoral bonds scheme amplifies such opacity by not disclosing the identity of the donor.
Recently, in an affidavit countering the CPI(M)’s petition challenging the scheme, the Central government argued that the scheme has a two-fold purpose: one, it enhances transparency in political funding; two, it protects the right to privacy of donors. In reality, the scheme undermines the complementary nature of the rights to privacy and information, namely, to make the state more transparent.
Electoral bonds were introduced in 2017 when the Finance Act amended four different statues: the Reserve Bank of India Act, 1934; the Representation of Peoples Act, 1951; the Income Tax Act, 1961; and the Companies Act, 2013.
The government argued that the use of bank routes would likely reduce under-the-table cash transactions and promote transparency in election funding. It said that transactions through banks would incentivize the use of white money, and KYC requirements of banks would ensure paper trails.
Dismantling previous restrictions
However, the terms of the scheme appear to have disastrous consequences for political transparency. Under the scheme, both the purchaser of the bond and the political party receiving the money have a right to not disclose the identity of the donor.
Also, the policy dismantles several restrictions that checked illegal corporate sponsoring previously — for example, by removing a cap on corporate sponsorship. Donations can now be made by any “artificial juridical person”. This means that even foreign donations are now allowed.
These changes show that access to the paper trails will be outside the scope of public scrutiny as it will lie exclusively with the banks. As bonds can be issued only by public sector banks, the only entity with full knowledge of the transactions will be the Central government. History has shown that money laundering often takes place through banks, so the government’s argument that the use of banks will reduce under-the-table transactions does not hold.
The requirement that a company has to be in existence for three years for it to make political donations has also been removed. This ignores all the concerns regarding the use of shell companies to siphon black money into the system.
Two rights, many wrongs
The Centre informed the Supreme Court that protecting the privacy of electoral bond buyers is vital. While the right to privacy in India safeguards the individual’s autonomy and dignity, it is subject to restriction on the basis of “compelling public interest”. If the information pertains to matters which affect the lives of others, or is closely linked to a public person, it must be disclosed. The policy choices and decisions of public officials have to be brought under public scrutiny to ensure that they have not acted in a manner that unfairly benefits them or their benefactors. The same logic can then be extended to the funding of political parties, where the funder’s actions are bound to have an influence on the policy decisions of the party if the party wins.
A clear conflict of interest would likely arise if important policy decisions are taken that could affect the donors to the party. Let’s imagine that an Indian company decides to make a huge political donation through the electoral bonds scheme and the political party it donates to emerges victorious. What if the government decides to provide favourable deals to the sector in question? The public will have no way of knowing what guided such a biased action.
The Central government in its affidavit further argued that the right to keep the identity of the donor private was an extension of their right to vote in a secret ballot. The Supreme Court has almost unequivocally read a right to information and knowledge implicit in the right to freedom of speech and expression.
The freedom to vote (as different from the right to vote) is seen as an essential facet of Article 19 of the Constitution. It is difficult to understand how a liberal democratic structure can sustain its legitimacy when information is not fully available to voters exercising their choice. The policy on electoral bonds thus needs to recognise the complementary nature of the rights to privacy and information, namely, to make the state more accountable.
India inducts four CH-47 Chinook choppers, joining a long list of 19 countries including the US, UK, Japan, and South Korea that deploys the twin-engined, heavy-lift helicopters.