The Economic and Political Weekly (EPW) is an important source of study material for IAS, especially for the current affairs segment. In this section, we give you the gist of the EPW magazine every week. The important topics covered in the weekly are analysed and explained in a simple language, all from a UPSC perspective.
Topics covered in this article are:
High Time to End Tuberculosis
Gender Justice and Its Impediments
- Who is concerned with Tribal Oppression?
High Time to End Tuberculosis
Focus of the article
- The time to act is now if we want to eradicate tuberculosis by 2030.
- The United Nations’ first-ever high-level meeting on tuberculosis, held on 26 September 2018, has committed to accelerating efforts and increasing funding towards achieving the agenda of the Sustainable Development Goals to end the tuberculosis epidemic by 2030.
- India, which accounts for 27% of the world’s tuberculosis burden, had set its own target at the End-TB Summit in Delhi earlier this year: TB Free India by 2025. Considering the state of India’s healthcare, this may be an unrealistic target.
- Tuberculosis is usually caused by Mycobacterium tuberculosis or various other strains of mycobacterium.
- It is an infectious disease and is air borne. It mostly affects the lungs but also can cause harm to other parts of the body.
- There is also an increasing concern about multi-drug resistant TB (MDR-TB). MDR-TB develops in the host body when the availability of drug is insufficient to kill 100% of the bacteria due to the interruption in the course of antibiotic medicine.
- MDR-TB is resistant to first-line anti-TB drugs and is treated with second-line anti-TB drugs, a combination of multiple medicines.
- Extensively Drug Resistant TB (XDR) develops when the concentration of TB in an area becomes extremely high that it becomes very difficult to control it.
- It is a condition where the strains are resistant to one or two medicines in the second line anti-TB drugs. Owing to poor management of cases and further mutations, there is a resistance to both first line and second line anti-TB drugs which is called Total Drug Resistant TB (TDR).
National Strategic Plan for Tuberculosis Elimination
- The plan aims to achieve a 100% case detection by 2020 and complete elimination of the disease by 2025.
- Four strategic pillars of Detect-Treat-Prevent-Build (DTPB) have been developed for achieving the goals of the national strategic plan. The implementation will be the combined efforts of all the stakeholders.
- It aims at creating a synergy through a shift from a regulatory approach to a partnership approach to streamline the services in the largely unorganized and unregulated private sector.
- Anti-TB drug “Bedaqualine” has been introduced under the Conditional Access Programme (CAP).
- A proposal is made to explore the possibility of development of a first line anti-TB drug in the public sector, under the “Make in India” programme.
- Plan envisions a corpus fund for TB maintained under Bharat Kshay Niyantran Pratishtan (India TB control Foundation)
- E-Nikshay an online platform has been made user-friendly, so as to let the doctors notify the cases as and when they come across the infected patients.
- Various media campaigns have been planned to educate the masses about TB and its prevention. Swasth E- Gurukul is one such initiative of the World Health Organization.
- The overwhelming challenge facing TB control in India remains delayed diagnosis and inadequate treatment, particularly among patients seeking care from private providers. The plan aims to detect and treat 100% of the TB cases and at the same time prevent further spread of the disease by building & strengthening the policies in this direction.
Analysis of the issue
- A centuries-old disease, tuberculosis, previously known as “consumption,” is still the deadliest infectious disease in the world, with patients and their families facing stigma and incurring devastating socio-economic costs.
- The under-reporting of tuberculosis cases has been a perpetual issue hampering efforts at estimating, controlling and treating the disease.
- Though the number of reported cases from India has seen a jump since 2013, largely attributed to increased reporting from the private health sector, the underreporting of tuberculosis cases that have been detected and the under-diagnosis of the disease itself make a treatable and curable disease like tuberculosis deadly and rampant.
- In 2012, when it declared tuberculosis a notifiable disease, India had set up “Nikshay,” an online tuberculosis reporting system for medical practitioners and clinical establishments, with the aim to increase the reporting of tuberculosis, especially from the private sector.
- In the years since it was launched, Nikshay has faced many roadblocks on the ground, such as unawareness of the system, unwillingness to report due to misconceptions about it, inconsistency in reporting, and lack of incentives for those reporting cases.
- The challenge is to use this system consistently and persistently, as is the treatment regimen for the disease.
- If there is no consistent follow-up of treatment regimens and outcomes, tuberculosis patients can easily slip through the cracks, resulting in cases of relapse, and multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis.
- Of the five risk factors for tuberculosis mentioned in the World Health Organization’s Global Tuberculosis Report 2018—alcohol, smoking, diabetes, HIV/AIDS, and undernutrition—it is undernutrition that poses the gravest risk in India, as it does in other poor, developing nations, especially among children.
- The prevention and successful treatment of tuberculosis is closely linked with the overall improvement in nutrition and health indicators, poverty, and access to healthcare.
- The research, development, trials, and the actual use of new methods and drugs take years, decades even. Unless the global community acts now, with India and other tuberculosis-affected countries at the forefront, the 2030 target to eradicate tuberculosis will be far from attainable.
Gender Justice and Its Impediments
- The recent protest by five nuns of the Missionaries of Jesus congregation on behalf of a fellow nun, who has accused the former Bishop of Jalandhar of sexually abusing her several times over the course of two years, has placed the Catholic Church of Kerala under serious moral scrutiny.
- Kerala Police arrested Jalandhar Bishop Franco Mulakkal after three days of interrogation following rape allegations against him by a nun. The arrest was the result of an unprecedented struggle launched by five fellow nuns of the victim against the accused bishop.
Details of the issue
- It has not only revealed the church’s objectionable attitude towards the issue of gender justice, but has also exposed the sceptical approach that the state seems to have adopted regarding it.
- First is the nuns’ protest, which appears unusual on account of their ability to demonstrate exemplary courage against the religious institution to which they belong by faith and practice.
- Second, the nun’s legitimate cry for justice has also sought to galvanise the larger community that stood in solidarity with her.
- Arriving on the heels of the #MeToo movement, and amidst global allegations of sexual abuse of children at the hands of priests and high-level cover-ups, Kerala’s “Church Too” movement locates itself within one of the most divisive crises facing the Catholic Church today.
What is #MeToo movement?
- The Me Too movement (or #MeToo movement), with many local and international alternatives, is a movement against sexual harassment and sexual assault.
- #MeToo spread virally in October 2017 as a hashtag used on social media in an attempt to demonstrate the widespread prevalence of sexual assault and harassment, especially in the workplace.
- It followed soon after the sexual misconduct allegations against Harvey Weinstein.
- Tarana Burke, an American social activist and community organizer, began using the phrase “Me Too” as early as 2006, and the phrase was later popularized by American actress Alyssa Milano, on Twitter in 2017.
- Milano encouraged victims of sexual harassment to tweet about it and “give people a sense of the magnitude of the problem”.
- This was met with success that included but was not limited to high-profile posts from several American celebrities, including Gwyneth Paltrow, Ashley Judd, Jennifer Lawrence, and Uma Thurman.
Support from nuns
- While the matter was being investigated, the victim found unprecedented support from her fellow five nuns. Every day, the five nuns would travel nearly 100 kms to register their protest against the Bishop and the lack of action against him by the church officials. This support triggered a chain reaction, uniting civil society members, jurists, lawyers and activists in support of the victim.
- “We were forced to stage protests because our Church leaders never bothered to deliver justice. Their silence hurt us. We are not trained to lead protests. But we did what we could. Now we don’t fear about the consequences. We believe that we had done what Jesus taught us – tell the truth and stand for the silenced,” Sister Anupama, who acted as the spokesperson of the victim nun, said.
- The nuns sat on a dharna for 13 days and ended their agitation late on Friday after the news of Bishop’s arrest was announced.
- The arrest of the Bishop Franco Mulakkal has shaken the power centres within the Church and power brokers outside.
- For the first time, 2,000-year-old Catholic Church could not explain why was a nun repeatedly raped in a convent for two years and why they failed to take action against the accused.
- Primarily, it tells that there is no system to deliver justice for the victims within the clergy. But nuns’ protests and the arrest exposed the Church which claims gender sensitivity, social justice and love for humanity.
- It also indicates that times have changed and victims would not remain silenced under holy vows. Law always takes its course of action whether holy men like it or not.
Who is concerned with Tribal Oppression?
Muslims, Dalits, tribals and women have been left out of India’s high economic growth. Among them, the worst sufferers are Muslims and Dalits. They are denied drinking water from the village tank and well, disallowed from riding a horse in a marriage or dalit children are made to sit separately from other caste students in schools-discriminations which were faced by Dr.Ambedkar in his early days and unfortunately which still persist.
Muslims are another community at the receiving end of the police as cited by various studies and reports of commissions such as on Bhiwandi, Bhagalpur, Hashimpura and the not so recent Gujarat riots. Unfortunately, in the last four years discrimination, loss of livelihood and physical insecurity have increased for these communities.
Apart from women and tribals having to fight patriarchy at the societal level, they are also discriminated culturally as well as by law. For example, In UP married daughters cannot claim a share of their father’s ancestral property while in Rajasthan, its Tenancy Act places women on par with lunatics. Such laws which discriminate on the basis of gender needs to be abolished.
Among all the marginalised groups, tribals have been the worst sufferers.
Who are Tribals?
Tribal people in India are called adivasi. Adivasi is an umbrella term for a heterogeneous set of ethnic and tribal groups considered the aboriginal population of India. Although terms such as atavika, vanavasi (“forest dwellers”), or girijan (“hill people”) are also used for the tribes of India, adivasi carries the specific meaning of being the original and autochthonous inhabitants of a given region and was specifically coined for that purpose in the 1930s.
The word “adivasi” has developed a connotation of past autonomy which was disrupted during the British colonial period in India and has not been restored.They generally live outside the mainstream of Indian Hindu and Muslim society. Most ordinary Indians known little about them.
There are some 573 communities recognized by the government as Scheduled Tribes and therefore eligible to receive special benefits and to compete for reserved seats in legislatures and schools. They range in size from the Gonds (roughly 7.4 million) and the Santals (approximately 4.2 million) to only eighteen Chaimals in the Andaman Islands. Central Indian states have the country’s largest tribes, and, taken as a whole, roughly 75 percent of the total tribal population live there.
Geographical Spread of Tribals:
Tribal peoples constitute 8.6 percent of India’s total population, about 104 million people according to the 2011 census.This is the largest population of the tribal people in the world.
One concentration lives in a belt along the Himalayas stretching through Jammu and Kashmir, Himachal Pradesh, and Uttar Pradesh in the west, to Assam, Meghalaya, Tripura, Arunachal Pradesh, Mizoram, Manipur, and Nagaland in the northeast.
Another concentration lives in the hilly areas of central India (Madhya Pradesh, Orissa, and, to a lesser extent, Andhra Pradesh); in this belt, which is bounded by the Narmada River to the north and the Godavari River to the southeast, tribal peoples occupy the slopes of the region’s mountains.
Other tribals, the Santals, live in Bihar and West Bengal.
There are smaller numbers of tribal people in Karnataka, Tamil Nadu, and Kerala, in western India in Gujarat and Rajasthan, and in the union territories of Lakshadweep and the Andaman and Nicobar Islands.
The extent to which a state’s population is tribal varies considerably. In the northeastern states of Arunachal Pradesh, Meghalaya, Mizoram, and Nagaland, upward of 90 percent of the population is tribal. However, in the remaining northeast states of Assam, Manipur, Sikkim, and Tripura, tribal peoples form between 20 and 30 percent of the population.
The largest tribes are found in central India, although the tribal population there accounts for only around 10 percent of the region’s total population. Major concentrations of tribal people live in Maharashtra, Orissa, and West Bengal.
In the south, about 1 percent of the populations of Kerala and Tamil Nadu are tribal, whereas about 6 percent in Andhra Pradesh and Karnataka are members of tribes.
Problems of tribals of Central India:
Tribals of Central India have been the worst sufferers. This is due to a defective Forest policy, displacement and lack of governance. Studies reveal that in the last seven decades the access of tribals to forests for their subsistence needs has reduced due to various reasons such as-
- Forest Policy,1952
- Mixed forests being replaced by man-made plantations
- Non-timber forest products (NTFPs) and forests being diverted to industries
- NTFPs being nationalised
- Exploitation by government agencies and contractors in the marketing of NTFPs.
- Defective official land records which ignore tribal occupation.
Till 1990 about 85 lakh tribals of Central India have been displaced due to industrialisation, mega projects, reserving forest land as national parks etc. Tribals number 8.6% of India’s population but makeup 55% of the total displaced people in the country. The devastation wrought on their fragile socio-economic livelihood base has resulted in loss of livelihoods, land alienation and hereditary bondage. Cash compensation has not helped them much because of their unique living style and ethos.
Since agitational politics is unknown to tribals historically, they either suffer in silence or take to arms. Due to their isolation, they are unable to apply pressure on the bureaucracy or political system. Only a few join the fold of the Naxals in anger and assertion.
Unlike the Dalits who have had excellent leaders and administrators contributing to their success, tribals, unfortunately, have lacked any leader of national stature who can speak for, lead and guide them. Efforts of a few civil servants to improve the lot of tribals too have failed due to absence of institutional support.
Though in some rare cases, Naxals have improved tribal livelihoods such as getting minimum wages for tendu leaf gatherers in AP, mostly they have degenerated into a terrorist outfit and brigands who lack any ideological base. Often Maoists and state forces commit violence upon tribals. They also lose educational and health facilities or access to public distribution system due to their area being declared ‘distrubed’.
There are only a few activists and organisations which use social media to openly speak on behalf of tribals and advocate that their exploitation be stopped. But they have limited effectivess. They have failed to reduce the lack of trust between people and the state or improve governance in tribal belts.
The need of the hour is for a more democratic, well-informed, over ground grass root organisation which can effectively fight for the cause of tribals both at the policy-making and implementation levels. Also, tribals need to mobilise and adopt the strategy of agitational politics in fighting for their rights.
For more EPW articles, read “Gist of EPW”.