The ails of the system

Print edition : January 19, 2002

The growing power of the 'free market economy' is affecting the health of people all over the world. At the same time, the gap between the promise and potential of advances in the science and technology of delivery of nutrition and healthcare and the actual health situation of people remains.

THE World Assembly for Mental Health met in Vancouver, Canada, from July 22 to 27, 2001. The Assembly incorporated the 26th Congress of the World Federation for Mental Health, the 83rd Meeting of the Canadian Mental Health Association and the 5th International Symposium of the World Association of Health, Environment and Culture. The theme of the Assembly was 'Respecting diversity in mental health in a changing world'. The president of the organising committee, Dr. Chunilal Roy, Emeritus Professor of Psychiatry of the University of British Columbia, invited this writer to debate the effect of globalisation on health with Fred McMahon of the Fraser Institute, a leading right-wing think-tank of Canada.

Mentally ill people at Erwadi, Tamil Nadu, in a file picture. Twenty-eight such people were charred to death in a fire at a "Mental Home" here on August 6.-K. GANESAN

The participants, who came in their hundreds from all over the world, discussed papers on various aspects of mental health, psychiatry and cultural aspects of mental health, in plenary sessions and workshops on particular areas of specialisation.

The fact that someone like this writer, an outsider to the world of medicine, was invited to debate the motion, 'Free market economy and globalisation do not necessarily improve the health of a nation' was itself an indication that many medical practitioners, administrators and policy-makers felt a great deal of disquiet about the way the increasing power of the so-called 'free market economy' was affecting the health - physical and mental - of people all over the world. This disquiet is taking the form of active protests in Canada, the United States and European countries. The disquiet was also evidenced on July 22, the day the Assembly was inaugurated formally. While the inaugural ceremony was being conducted inside the Convention Centre, a group of demonstrators gathered outside under the banner of 'World Network of Users and Survivors of Psychiatry'. There were men and women wearing T-shirts with labels such as 'Psychiatry labels you & drugs you for profit', 'Psychiatry is a fraud' and so on. There were placards that read: 'Psychiatry: no ethics, no decency', 'Psychiatry: drugging children for profit', 'A brain is a terrible thing to fry'.

According to a flyer distributed by the protesters on July 21, the World Network of Users and Survivors of Psychiatry had passed a resolution which read as follows:

1. Whereas the psychiatric profession has not established that "mental illness" is a medical disease having the properties of demonstrable anatomical and/or physiological defects, such as cancer, diabetes, tuberculosis, or pneumonia,

2. And whereas there is a considerable body of evidence demonstrating that psychiatry's physical "treatments", such as psychiatric drugs, electroshock and psychosurgery, can and often do cause severe, irreparable damage to the brain and other organs of the body,

3. Therefore, the World Network of Users and Survivors of Psychiatry declares its opposition to the administration of any psychiatric physical treatment to anyone against their will or without their genuine and fully informed consent.

The protesters obviously had sympathisers among the community of psychiatrists. They had been registered at the Assembly, and they continued their protests inside the Convention Centre, and raised tricky issues of medical ethics at various sessions. Many practising psychiatrists and hospital personnel, especially women, echoed many of the misgivings voiced by the protesters.

That the protesters had a point about the alliance (not always holy) between drug companies and medical practitioners was obvious as soon as you entered the Convention Centre. Boards or placards displaying the names of some of the biggest companies in the ethical drug industries such as Lilly Wyth-Ayerst, Astra-Zeneca Janssen-Ortho were prominent. They were also sponsors of some specialised workshops. However, the Assembly devoted several workshops to such topics as 'Alternative mental health care', 'Community education', 'Meditation' 'Clinical intervention and spiritual tradition', and 'Consumerism and practice'. There were well-attended plenary sessions on 'Mind, medicine and society', and 'Health, culture and environment'. Many speakers showed that not only was mental health greatly influenced by the socio-economic and cultural background of a person, but that the labelling of some particular types of behaviour was itself a product of specific cultural practices, including the practices of a medicalised mental health profession.

This writer, in his presentation, concentrated on the enormous gap between the promise and the potential of advances in the science and technology of delivery of nutrition and healthcare and the actual health situation of human beings in a major portion of the world population. To take some of the worst examples, in South Asia and Sub-Saharan Africa as many as 50 per cent of the population may be malnourished. In Latin America and the Caribbean also, and increasingly in the Russian Federation a large fraction of the population is suffering from malnutrition. At the same time, as we know painfully from the Indian case, more than 60 million tonnes of food grains are waiting to rot in the storehouses, because of a criminally ideological economic policy.

This is equally true at the international level. Even in countries such as the U.S. and Britain, tuberculosis has become endemic among certain disadvantaged population groups. In the poorer countries of South Asia, Sub-Saharan Africa, Latin America and the Caribbean, and the Russian Federation, the Human Immunodeficiency Virus or HIV has already appeared or is threatening to spread as a pandemic.

Largely as a result of this pandemic, but also because of diseases associated with poverty and malnutrition such as diarrhoea and tuberculosis, the disability-adjusted life years (or longevity) in a number of Sub-Saharan countries such as Zimbabwe, Sierra Leone and Niger have gone below 35 years; in several cases below 30 years. This compares with the longevity of the Japanese or the Canadians, which has gone up to 79-80 years. By contrast with other poor countries, in Cuba, which has been continuously buffeted by illegal international sanctions enforced by the U.S., the longevity has gone up to 75 years or more. Even a beleaguered socialist system delivers better healthcare than the neo-liberal regimes which have been imposed on developing countries by the G-7 nations and their associates.

At the same time, the big transnational corporations (TNCs) are producing 'cocktails' of drugs to lengthen the lives of HIV-infected persons at prices that are several times higher than the per capita annual incomes of the poorer countries of the world. The U.S. government has generally sided with their domestic TNCs in the dispute that has erupted around the issue of profits of drug companies versus lives of human beings. It is only after strong protests and defiance by several countries led by South Africa and Cuba that the TNCs have relented. But the World Trade Organisation (WTO) regime allows the TNCs to monopolise and overprice many of the life-saving drugs for which alternative processes can be invented and thereby prices can be lowered.

It is also common knowledge that intensified competition under the neo-liberal regime and the high degree of stress and insecurity experienced by workers, executives and their families are leading to greater incidence of substance abuse, depression and suicides. The World Health Reports of 1999 and 2000 have projected that the incidence of mental illness will increase much faster than other illnesses, especially in the richer countries. But the poorer countries will continue to suffer millions of excess deaths from preventible communicable diseases such as diarrhoea, tuberculosis, and hepatitis.

Many practioners present at this session confirmed such fears. Many of them even agreed with my general prognosis that a very substantial part of so-called mental illness is the product of inhuman social conditions. While drugs may ameliorate the suffering of the victims, a permanent cure would really require the eradication of poverty and the minimisation of the insecurity of living.

Soon after I returned to India came the news of deaths of a number of mental patients at Erwadi in Tamil Nadu, who could not free themselves from their shackles as a fire broke out in a so-called mental asylum. News of similar cases of brutal treatment of mental patients then poured in from Hyderabad and other parts of the country. Is this treatment according to 'traditional cultural values'? We have to fight against the burden of superstition and the cruelty of traditional hierarchy as well as the greed of the drug companies and those doctors who serve as their agents rather than as genuine healers of disease.

Amiya Kumar Bagchi is RBI Professor of Economics at the Centre for Studies in Social Sciences, Kolkata.

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