Editorial 1: Wrestlers’ protest and the shrinking space for dissent
Introduction
- Public protests have long served as a catalyst for social and policy change in India, allowing individuals, classes and communities to voice their grievances and advocate for their rights. Over the past few years, protests have risen with bewildering rapidity. Protests had opened up space for a new era of social activism in the decade.
From Nirbhaya to the present
- In December 2012, people around the world watched as thousands took to the streets in the Central Vista of New Delhi following the brutal gang rape of a 23-year-old physiotherapy student (Nirbhaya). The protests became so intense and the public outrage was so great that the UPA government was compelled to address issues of sexual violence at the policy level, through the introduction of the new Criminal Law (Amendment) Act 2013 to bring stricter punishments and broaden the scope of offences.
- Fast forward to May 2023. Medal-winning wrestlers, who have brought honour to the country, have been on the streets for nearly four months to demand the arrest of the Wrestling Federation of India (WFI) chief who they have accused of sexually harassing women wrestlers and a minor. But the authorities did not respond for weeks. It took the Supreme Court of India’s intervention for Delhi Police to file two first information reports (FIRs).
The protests
- Protests under the current regime are, no doubt, difficult as they are immediately branded as ‘anti-national’.
- Also, activists might feel the futility of protests against a government that does not listen; but the fact is that this regime has been forced to respond to some protests even if it has done so for reasons of political expediency.
- The withdrawal of the controversial farm laws and the back-tracking over the contentious National Register of Citizens (NRC) and the Citizenship (Amendment) Act (CAA) are two recent examples where the government had to back down.
The context of class politics
- Wrestling is deeply ingrained in Indian culture and has a long history, particularly in the rural areas.
- The protesting wrestlers mostly come from modest economic backgrounds; sports has helped them to achieve a measure of social and economic mobility.
- The active participation of the middle classes in the Anna Hazare Andolan (2011) and Nirbhaya protests presents a contrasting picture that highlights the importance given to social activism by this class.
- Their participation in the two movements catapulted them to the centre stage of the political discourse
- The urban middle class is also very well disposed to neo-liberalism; it has benefited from the opportunities available to it from the neo-liberal economy in the past three decades.
- Indeed, middle-class expansion has occurred since economic reforms through the private sector boom powered by economic liberalisation. This is the class that was enamoured by ‘India Shining’.
- Their shifting political loyalties, however, reflect an ideological consistency that characterises the middle class in its combined devotion to neo-liberalism and Hindutva.
- The middle-class opposition to the UPA played a crucial role in discrediting it; now, these very classes strongly back the current dispensation and see no reason to go against it, even on issues of sexual violence.
Conclusion
- Middle-class activism tends to prioritise the issues and concerns that directly impact them, often overlooking the needs and struggles of the disadvantaged classes and communities. This self-focus can perpetuate inequalities and hinders efforts to address broader social issues. Failing to consider the intersections of class, caste, gender, and other factors can result in a narrow understanding of social reality and marginalised voices.
Editorial 2: NCDs plague Keralites’ health
Context
- For a State which takes immense pride in consistently coming at the top in the health index rankings of NITI Aayog every year, the findings of the ICMR-INDIAB study, which puts Kerala right on top with the worst overall indicators for long-term morbidity and mortality due to non-communicable diseases (NCD), has come a cropper.
Non-communicable diseases (NCD)
- Noncommunicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors.
- The main types of NCD are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.
- Causes are Tobacco use, unhealthy diet, harmful use of alcohol, physical inactivity and air pollution are the main risk factors contributing to these conditions.
- According to WHO, over 60.46 lakh people died due to NCDs in India in 2019.
Kerala’s case study
- Kerala has known since the mid or late 90s that NCDs are going to be its biggest health challenge.
- A current diabetes prevalence of nearly 24%, pre-diabetes at 18.1% and hypertension prevalence at a whopping 44%, is certainly not the picture of a healthy State.
- With more than half the State’s population having high cholesterol levels and abdominal obesity, the incidence of cardiovascular diseases and chronic kidney diseases could skyrocket in the near future and have significant impact on the State’s health expenditure as well as private spending on catastrophic illnesses.
- Experts point out that the high incidence of Chronic kidney disease in the State is a direct consequence of the spiraling levels of hypertension, which again is a result of poor adherence to the drug protocol, apart from factors like unhealthy diet and sedentary lifestyle.
Suggestions
- Diabetes management requires the patient to have fair awareness on what makes the blood sugar spike. Limiting carbohydrates, improving nutrition through the increased consumption of vegetables and fruits and daily physical activity are important lifestyle interventions that patients need to imbibe.
- Patients also have to be given affordable choices when it comes to diet and medication advice. Adherence to medication has to be ensured through consistent follow-up and people have to be motivated continuously to ensure that the changes they embrace become a part of their lifestyle.
- Health workers or ASHAs in the field need to be trained better to impart awareness at the grassroots, to follow-up patients rigorously; they should be offered attractive incentives for the same.
Indian initiatives for tackling NCDs
- National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is being implemented under the National Health Mission (NHM).
- The Central Government is implementing the Strengthening of Tertiary Care Cancer facilities scheme to support the setting up of State Cancer Institutes (SCI) and Tertiary Care Centres (TCCC) in different parts of the country.
- Oncology in its various aspects has a focus in case of new AIIMS and many upgraded institutions under Pradhan Mantri Swasthya Suraksha Yojana (PMSSY).
- Affordable Medicines and Reliable Implants for Treatment (AMRIT) Deendayal outlets have been opened at 159 Institutions/Hospitals with an objective to make available Cancer and Cardiovascular Diseases drugs and implants at discounted prices to the patients.
- Jan Aushadhi stores are set up by the Department of Pharmaceuticals to provide generic medicines at affordable prices.
Way forward
- Identifying the scope of the problem and documenting it is the easy part. But stepping in with effective interventions to increase public awareness about NCDs and its long-term consequences and-improving primary prevention of diabetes and hypertension through the promotion of a healthy lifestyle is where most health systems falter.
Conclusion
- The problem is not unique to Kerala. It is a huge challenge to health systems-to create, implement and sustain programmes for the promotion of healthy lifestyles because it is not easy to change people’s attitudes towards self care, their long-term food habits or to inculcate new habits like daily exercise.
