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We Drink 90% of our Illnesses

November 5, 2014

In no other country of the world is that admonition from Louis Pasteur more appropriately applied than India. In a country that has emerged from a net importer of grain products to a net exporter via the Green Revolution, and has moved into the enviable position of having the capacity to feed itself, providing sufficient nutrition for the 2nd largest population on the planet, to its centuries old cultural practices of open defecation, render the new UN’s Sustainable Development Goal #6 (SDG) of ‘sanitation for all’ moot. “India’s 162 million children under age 5 are malnourished, but suffering less a lack of food than poor sanitation. Half of its population defecates outdoors, exposing children to a bacterial brew that often sickens them, leaving them unable to attain a healthy body weight no matter how much food they eat. When this happens during the first two years of life, children become stunted and sustain cognitive loss. Particularly disturbing is that the loss of height and intelligence are permanent. UNICEF and other major charitable organizations said in interviews that they believe that poor sanitation may cause more than half of the world’s stunting problems”. 

In terms of adequate nutrition, the UN’s SDG through its ‘Zero Hunger Challenge’ by 2035 will be accomplished.  But changing the culturally accepted practice of defecating outdoors, when “just 1% of Chinese and 3% of Bangladeshis relieve themselves outside compared with half of Indians”, presents an insurmountable hurdle on SDG #6.

There is an enormous difference in infant mortality between “Muslim children in India who are 17% more likely to survive infancy than Hindus—even though they are generally poorer and less educated. Muslims are far more likely to use latrines and live next to others using them”.

In an article which carried a New Delhi Date Line, quoting from The Lancet, it was posited that “premature deaths worldwide can be reduced by 40% before 2035. However, at the 2000-2010 rate of progress, deaths in India before age 70 years would fall by 31% before that date, missing the 40% target”. The article made no mention of poor sanitation as the root cause of target failure.

 The Population Reference Bureau states that India will soon be the most populous country on earth, with 1.5 billion people by 2030. Its cultural practices on basic sanitation belie its role as the 11th largest economy in the world. India is a nuclear power with intercontinental missile launch capabilities. The Federation of Indian Chambers of Commerce & Industry states its Medical Tourism industry is one of the largest service sector industries, with an estimated value of $78 billion, employing 9 million people.  India has been designated as “pharmacy to the developing world” by Doctors Without Borders, providing 80% of antiretroviral products to poor countries.   This past September, it became the first Asian nation to place an unmanned spacecraft in the orbit of Mars, achieving a scientific feat at one-tenth the cost incurred by NASA.

When these considerable scientific and economic attributes are combined, one can reasonably ask why India remains an aid-assisted country, and why is it unable to mitigate the self- induced problems of poor sanitation? The magnitude of the task ahead is expressed through its recently inaugurated $10 billion ‘Clean India Campaign.’ If just 50% of these funds were directed to the 620 million Indians who don’t use latrines, then only $8 per capita over an indeterminate period would be focused on an unacceptable portion of its population that will continue to face irreversible stunting and cognitive development—even though they have sufficient nutritional access. If Indian statistics are applied against Goal #6 and included with all other countries, it will be rather improbable to reduce premature deaths globally by 40% in 2035.

India missed “by a significant margin its 2015 MDGs on infant and maternal mortality due to a lack of government expenditure on the health sector which was barely 1% of GDP.”   Instead of 8 targets under the MDGs, the UN has doubled-down and instituted 16 through the SDGs. This is eerily similar to the OECD/DAC’s Paris Declaration on Aid Effectiveness, which had 12 targets. At its end in 2010, only one was met, “albeit by a narrow margin.”  In November 2011, its proponents reconvened in Seoul, Korea for a High Level Forum to review this dismal record. They concluded their deliberations by proposing 36 targets for the next round of Aid Effectiveness!

When the UN and agencies like the OECD set monumental goals, they immunize themselves from subsequent accountability by stating that they should be measured by their intentions rather than their outcomes.  After all these decades of missed targets, they should assume a touch of humility when setting future ones. Rather, their targets are befitting their illusions.

As long one-half the population in a country soon to be the most populous on the planet continues its cultural practices of ineffectual sanitation, the preponderance of its numbers over all other nations will invalidate SDG #6.  Through a glass darkly, the global health community can see Louis Pasteur’s centuries old adage spring eternal.

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