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Development: 'People's Trains' to Start New Public Health Movement

By Sandhya Srinivasan

CALCUTTA, India Nov 30 (IPS) - Amruta S.V. rode a train for four days this week as it made its way across southern and eastern India before reaching this eastern metropolis.

This was no ordinary train journey as all passengers came here to attend a unique gathering of public health activists and people's groups from across the subcontinent, which opened Thursday. It was one of four 'people's health trains' that started from the southern, western, northern and north-eastern corners of India.

The slow-moving trains had picked up their passengers from all over India. ''We would get off at the stops to shout slogans and sang songs along the way,'' says Amruta, who represents Mahila Samakhya, a 10- year-old women's group in southern Karnataka state.

More than 2,000 people like her, from all over India, were in Calcutta for the Nov. 30 to Dec. 1 'Indian Health Parliament' that was being held ahead of the Dec. 4-8 global People's Health Assembly (PHA) in Bangladesh.

The Calcutta conference, the first such meeting in India, would adopt a 'People's Health Charter' and finalise the issues to be taken up by the Indian delegates to the Dhaka health assembly.

Opening the health parliament, Partha De, the health minister of West Bengal state of which Calcutta is the capital, said that the Calcutta conference aimed to create better awareness of public health issues among the people and decision-makers.

De, whose ministry was helping organise the event, said the discussions would help authorities improve the quality of public health services.

This is one of the goals of the Dhaka global health assembly, which is expected to issue a call for ''an accessible, affordable, equitably distributed...health system,'' according to a conference document.

The Calcutta conference marked the climax of a four-month-old consultation process across the country, which involved some 1,000 groups. The exercise has collected a rich body of information on the common illnesses and the quality of public health services in tens of thousands of Indian villages.

The train journeys carried the process forward by bringing together health activists and NGOs from all over India. According to the organisers of the event, while the train journeys ''themselves make a statement,'' they also provided a chance for participants to share experiences ''swap stories and build common agendas for action.''

''It's the beginning of a change, not a huge one, but definitely a meaningful one,'' says Amruta. ''It is instilling a questioning attitude in people, and also getting them involved in helping make change.''

According to Vinod Raina of the All India People's Science Network, one of the main organisers of the Calcutta conference, consultations were held in 500 administrative sub-divisions across the country.

These have developed area profiles on the health problems of people and the private and public health services available.

The exercise also looked at the state of water supply, sanitation and education, which are crucial factors in health care. The aim was to gather popular support for mounting a ''serious challenge'' to current trends in public health and related policies, and to develop alternative models of health care.

''We cannot wish away the problems, the job is to create an alternative force, a model to promote health care,'' he says.

''The idea is to develop a primary health system that derives its direction from the 'panchayats' (elected village councils), education and medical departments as well as local organisations,'' he points out.

Over the two days, 20 separate sessions were to be held on subjects ranging from female foeticide and child malnutrition to medical professional reform, disaster management and child labour.

Traditional medicine systems, health concerns of indigenous people, micro-credit and the impact of new world trade rules on public health, were also to be discussed.

According to Amit Sen Gupta of the People's Science Movement, the Calcutta conference would help people's groups get a better understanding of how globalisation and economic reforms, affect health care in developing nations.

The World Trade Organisation agreements, ''specially those concerning Trade-related Intellectual Property Rights (TRIPS) are likely to affect food security and public health in developing nations,'' said a PHA document.

These would also affect poor nations' ''ability to undertake indigenous technological development, including in the area of essential pharmaceuticals,'' it added.

The conference was also to hear the success story of India's southern coastal Kerala state, where investment in women's education, health and welfare, has produced a ''significant and sustainable impact on the health and social indicators of the whole population.''

''Strong community participation is important not only in securing greater government responsiveness to social needs, but also to mobilise an active, conscious and organised population critical to the design, implementation and sustainability of comprehensive health systems,'' said the PHA document. (END/IPS/ap-dv-he/ss/mu/00)

''India produces and sells drugs at the lowest prices anywhere in the world but the levels of poverty are such that less than 25 percent of India's one billion people can afford medicines,'' says Mira Shiva, leading public health analyst.

''Liberalisation has only widened the gap,'' she adds.

Drug prices in this country have been soaring steadily since India passed legislation to comply with Trade Related Intellectual Property Rights (TRIPS) rules last year.

''India is still battling vector and water-borne diseases but no pharmaceutical company is interested in producing or marketing drugs against these because of the low profit margins while there is competition for diseases such as diabetes and heart problems which mostly affect the affluent,'' Shiva points out. The leading U.S. economist, Jeffrey Sachs, who toured India in April as chairman of the World Health Organisation's (WHOs) 'Commission on Macroeconomics and Health', reported a tremendous unmet health demand in this country.

''It is a paradox that while democracy is more likely to allow poor people better access to health, many dictatorships were doing far better than India in health delivery -- too many people are spending far more than they can afford on health care,'' he noted in his report.

In contrast, India's four-billion dollar pharmaceutical industry is enjoying booming health as it produces and aggressively markets a range of 'life-style' medications, 'mood elevators', vitamins, tonics and other over-the-counter preparations.

Shiva said she was particularly concerned about what all this means for women's health in the country. ''Seventy five percent of Indian women are anaemic and which multinational is going to be concerned with them?'' she asks

''There is now a concerted attempt to impose the U.S. system over the whole world although different countries have different needs. For example, it may be fine for a woman to be infertile in the U.S. but here here she could be thrown out with the garbage for it,'' Shiva said.

Shiva's fears are not without basis. A few months ago, despite years of campaigning by women's rights groups against the contraceptive method, Indian courts allowed a trans-national corporation (TNC) to market an injectable contraceptive.

''The existing health infrastructure is simply not capable of providing the kind of counselling and follow-up that is mandatory for long- acting contraceptives,'' says C. Satyamala, a leading women's health researcher.

Not only did the government permit the marketing of the injectable contraceptive without a public debate on the controversial method, several state governments made this part of their birth control programmes.

''What is really galling is that the government actually left the job of safety certification to the concerned drug company, when it has its own fine research institutions which are capable of doing the job,'' says N.B. Sarojini of 'SAMA', a leading women's rights group.

''Naturally, the company cleared its own product,'' she says.

While economic liberalisation has put many ordinary drugs out of the reach of the poor, the pharmaceutical industry in India, far from collapsing as predicted, has been doing particularly well through favourable government policies.

The incomes of 11 leading drug companies showed a phenomenal 23 percent increase last year.

According to a business analysis of the industry, the profits of two companies, 'Rhone Poulenc' and 'Novartis' grew by 134 percent and 95 percent respectively as a result of price escalations on drugs, which were 'decontrolled' by the government.

The industry is now clamouring for more drugs to be put on the decontrolled list.

Rather than worry about existing price controls at home, the Indian pharmaceutical industry is now trying to earn profits in the international market by investing in research and development and falling in line with international practices.

Others are entering into licensing deals with TNCs to manufacture and market life-style drugs, including 'hormone replacement therapy' which are in increasing demand by the affluent.

Even as fears are being expressed that ordinary people in this country cannot afford treatment against emerging diseases such as HIV/AIDS, several Indian companies are doing a roaring business exporting such medication.

Says Homi Khusrokhan, President of the Organisation of Pharmaceutical Producers of India: ''Even if we can manufacture anti-retrovirals at prices affordable by ordinary Indians, the question remains as to who is going to take care of delivery, maintenance and follow-up of these drugs which need utmost care in handling.'' (END/IPS/ap-he-dv/rdr/mu/00)