India’s risks: forging a new multidisciplinary debate

Photo : Petr Pavlicek / IAEA.
Source: iaea_imagebank / Flickr / cc-by-sa

A prospective superpower, India is grappling with a host of risks that threaten to hamper its progress towards becoming a more economically successful, egalitarian, safe and harmonious society. India's population routinely deals with the risks from HIV/AIDS, earthquakes, floods, industrial accidents and environmental disasters, and more recently the risks and uncertainties brought about by rapid advances in science and technology, such as BT Brinjal (GM Aubergine) and nuclear power.

Social movements in India have long voiced concerns around the processes for deciding whether a risk is 'safe' or 'acceptable' and who is taking these decisions. They have pointed to a noticeable imbalance in the type of knowledge and expertise which has been shaping key policies, legislations and institutions. They have also fought for communities' perceptions of risk and local knowledge to be included in these processes. Uncertainty over where the line should lie between science and politics during the assessment of risks, and how to reconcile divergent risk perceptions, has triggered a large number of protests over the years.

Whilst psychologists, sociologists, anthropologists, political theorists, philosophers and scientists in the West have vigorously debated these various issues around risk over the last 50 years, this multidisciplinary field of academic research on risk has been relatively unexplored in India. Little research and resources have been invested in exploring these issues and Western scholars have also, for the most part, been reluctant to engage with these issues in India. The Journal of Risk Research, for example, has relatively few articles examining risks in developing countries.

In an effort to address this gap in the field, the STEPS Centre and the Centre for Public Policy at the Indian Institute of Management Bangalore initiated a project entitled 'Risk, uncertainty and technology in India', funded by the UK India Education Research Initiative. An international conference was organized at the Indian Institute of Management Bangalore in February 2011 which brought together Indian and Western scholars and practitioners across the fields of psychology, anthropology, law, politics, sociology, public health, philosophy, science and architecture. Together they offered insights on the theory of risk, lessons from the West, and the realities of risk in India. These conference papers have now been revised and updated and included in the recently published volume India's Risks: Democratizing the Management of Threats to Environment, Health and Values, edited by Raphaelle Moor and M.V. Rajeev Gowda (OUP India, 2014).

This volume analyses different but profoundly interdependent risks such as nuclear power, Bt Brinjal, environmental decision-making, maternal mortality, H1N1, HIV/AIDS and post disaster reconstruction through the same analytical framework. It delves into the meaning of risk in India, asking what it signifies for policymakers and different factions of society.

It also probes the political, social, and economic dynamics that have shaped the very different constructions of risk in India. In particularly, we ask how India's aspirations to become the next leading superpower have framed policymakers' assessments of scientific and technological risks? What knowledge and expertise do policymakers tend to consider relevant to include in their risk assessments? And are those risks that they have identified and chosen to address consonant with those constructed by the community?

Examples abound of the recurring mismatches between the government's and communities' construction of risks. This has resulted in ineffective policies, socially destructive conflicts, and the erosion of trust and stability. India's Risks makes the case for urgently forging a new multidisciplinary field in India in order to explore these questions in greater depth. Whether the Western frameworks and models presented will be relevant to the challenges of the Indian context remains to be seen but this wealth of examples and resources provide a useful platform to begin constructively negotiating a new path towards governing risks in India.

by Raphaelle Moor

Raphaelle Moor is a co-editor of the book India's Risks: Democratizing the Management of Threats to Environment, Health, and Values (OUP India 2014). She is a consultant in the area of disaster risk management and climate change adaptation, based in London. Raphaelle managed the UKIERI’s (UK-India Education and Research Initiative) ‘India at Risk’ project at the Indian Institute of Management Bangalore for over two-and-a-half years.

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Book: India's Risks: Democratizing the Management of Threats to Environment, Health, and Values

Project: Risk, Uncertainty and Technology in India

First Sundarbans Health Watch asks 'How healthy are the children of the Indian Sundarbans?'

Professors Barun Kanjilal and Rabindranath Bhattacharya
present a copy of the Sundarbans Health Watch - Series 1

KOLKATA, INDIA - On 1 August 2013, researchers, practitioners, policy makers and media represnetatives gathered to gain a better understanding of the key trends in child health in the Sundarbans region of West Bengal, India. In addition to presenting findings from the first Sundarbans Health Watch, various local and international NGOs -- such as Terre des Hommes, Child in Need, CRY, Save the Children and the Riddhi Foundation -- discussed their current activities in the region.The introductory address by FHS India leader, Professor Barun Kanjilal of IIHMR, presented the Sundarbans Health Watch, which asks 'how healthy are the children of the Indian Sundarbans?'. The study is based on intensive surveys conducted in the Patharpratima Block of the Sunderbans and throws light on some alarming – and largely ignored – facts about the health status of the children of the Sundarbans. It also attempts to explore the 'structural holes' in the service delivery of public health care system and the role of informal providers in filling the gaps.

While the vigorous reproductive and child health care initiatives of the state have been able to protect the rights of children and their mothers to obtain preventive health care (such as, immunisations, ante-natal care, etc.), there are glaring gaps in addressing their rights to easily access quality-assured basic curative care and nutritional services. Repeated climatic shocks and geographical adversities, especially in the remote islands, add to the complexities and make it imperative for the local policy actors to adopt a special child-focused lens to fill in the gaps and reach the hard-to-reach children.

Key findings (which can also be viewed as an infographic) of the study include:

• More than one-third of the children are chronically malnourished. More than one-third of the mothers are also malnourished.
• Children of the Sundarbans face an extra burden of morbidity, with data suggesting that 0.3 million children will be ill in a month and 26,000 children will need hospitalisation in one year in the Sundarbans.
• Prevalence of respiratory infection or gastrointestinal disorders among children is much higher in the Sundarbans than the district or state average.
• A quarter of the children (of surveyed households) aged 0-12 months took birth and spent the first week of their lives without any medical supervision from any health worker.
• The available public health care system is grossly inadequate to maintain child health. Primary Health Centres (PHCs) are not only less available, but many of them run ineffectively with shortage of critical inputs.
• Given the failure of the public health care system to cater to child health care needs, a parallel market has cropped up to bridge the huge gap in the curative care market. Unqualified RMPs dominate this parallel market, which is, obviously, a potential threat to child health. But this scenario also offers an opportunity for the government to challenges these sector through training and other innovative strategies.
• 85 per cent of the outpatient treatment for ailing children is provided by the Rural Medical Practitioners (RMPs) of questionable quality.
• There are many NGO initiatives but too few focusing on child health.

Following the report launch, Terres des Hommes presented on their efforts to combat child malnutrition in disaster prone blocks and convergence with state led Integrated Child Development Services. The Child in Need Institute, a national level implementation NGO, also put forth their initiatives for addressing malnutrition. CRY argued for a child rights approach in addressing child health, while Save the Children called for linking up livelihood and health initiatives especially in climatically challenged zones. The Riddhi Foundation called for an effective and judicious usage of information and communication technologies (ICTs) both in ascertaining the demand and supply of health services in disadvantaged regions for betterment of child health.
Based on these presentations, the former Additional Chief Secretary, M. N Roy, called for close collaboration of the panchayat and the health system for effective delivery of the health services to the children of the poor families in the Sundarbans islands. Additionally, Dr Abhijeet Choudhur, the founder of the Kolkata chapter of Liver Foundation, called for training of the rural medical practitioners (RMPs).

Participants in the meeting agreed that, to improve the lives of children in the Sundarbans, a series of initiatives engaging all types of service providers and innovatively putting pieces of interventions together was required. These initiatives need to come together to create a big push and reach a sustainable, equitable and high level of delivery system. Participants insisted that the time has come to acknowledge the uniqueness of the health care needs of the complex, climatically vulnerable, topographically challenged and economically underperforming region called the Sundarbans and focus on them with special attention.

There have been numerous media reports of the event. The Hindu, for example, notes that 'Sunderbans children highly susceptible to diseases, says study'. And several news organisations, including the Business Standard, carried the story 'Climate change affecting health in Sundarbans'.

Originally posted on the Future Health Systems blog