PHM-Exch> Editorial in the BMJ on Dr Binayak Sen

[Claudio Schuftan]

From: Kamayani <kamayni at gmail.com>


British Medical Journal \2011; 342:d262 doi: 10.1136/bmj.d262 (Published in
online version 19 January 2011)  Pending publication in printed issue of
January 22, 2011
 EDITORIAL

The life imprisonment of Dr Binayak Sen

Last month a district court of the state of Chattisgarh in central India
sentenced Dr Binayak Sen, Indian paediatrician, public health practitioner,
and human rights activist, to life imprisonment in a maximum security cell.
He was pronounced guilty of sedition and conspiracy against the state.1 This
harsh sentence is particularly paradoxical because Sen was recently
recognised by the same state as a respected figure in health and social
planning, and last year he was given the Jonathan Mann Award for Health and
Human Rights from the Global
Health Council.


His crime according to the judgment was being a collaborator for the
underground Maoist movement that is active in the newly created state of
Chattisgarh, which has a large indigenous (Adivasi) population, an abundance
of forests and natural resources, but economic and health deprivation.
Sen, a community physician, and his wife Ilina are known for their work in
primary healthcare among mine workers and indigenous communities. Sen’s
commitment to tackling the deeper social determinants of health has now
brought him into conflict with the state. Moving beyond the biomedical and
clinical model of healthcare,2 Sen began to deal with deprived living
conditions, poor education in children, and alcoholism, and he found it
impossible to disassociate these from the need for community empowerment,
political accountability, and ownership of natural resources. He documented
the levels of starvation in the state,3 and as an active member of the
People’s Union for Civil Liberties he participated in fact finding missions
on violations of rights by state forces and systems, including a state
sponsored armed people’s militia. He provided medical and legal assistance
to people who were undergoing trial, including alleged militants, always
under
supervision of the state authorities. This made him a ready target for
accusation of conspiracy by the state, which recently armed itself with an
antiterrorist law that goes far beyond the national act. Sen, who has been a
critic of both Maoist and state violence now finds himself convicted under a
section of the penal code that was used by the British in colonial times to
convict Gandhi.4
 The recent judgment has received worldwide condemnation. Global voices have
included statements by Nobel laureates Noam Chomsky and Amartya Sen,5
Amnesty International,6 the Global Health Council,7 Human Rights Watch, and
Physicians for Human Rights, and other commentators.4 8 At a national level,
an upsurge of solidarity has included meetings and vigils in all the major
cities of India and statements by eminent jurists, professionals, and
activists.

Although the state has attempted to portray him as dangerous, Sen is
following in the footsteps of generations of social physicians. Like Virchow
in an earlier century, others in more recent years, and charters of health
movements,9 he focuses on the social, economic, and political roots of ill
health. Recent prescriptions from the World Health Organization on primary
healthcare and the social determinants of health have strengthened action
towards equity, rights, and social determinants of health, just the areas
that Sen focused on.10 11
 This misconceived and vindictive application of state power requires
international action. Professional societies in India have an opportunity to
reflect on the larger social and political role of doctors and to express
their support for Sen. Supporters in other countries could urge their
government to apply diplomatic pressure towards justice for Sen and call for
a review of Indian laws on sedition, which have lent themselves to such
abuse.

 In today’s economically driven society, commerce drives international
relations. Foreign direct investment in India is often in mining industries
in states such as Chattisgarh, which have rich natural resources.
Ultimately, such investment comes from shareholders. Better awareness of how
shareholders’ money may drive state policies to the detriment of the
disadvantaged could redirect investment towards more ethical and equitable
projects, especially where funds belong to charitable or philanthropic
institutions.

 Finally the implications for those who are tackling the social determinants
of health must be considered, and we need to enhance our collective voice
against all instances where doctors and health workers are targeted by
ruling elites and vested interests.

 It is ironic that one of Sen’s last public appearances before his
incarceration was at the release of a book that was a critique of current
medical practice and new paradigms of action.12 Notably, in an expeditious
response, the joint Committee on Human Rights of the US National Academy of
Sciences, National Academy of Engineering, and Institute of Medicine has
expressed its reservations about the conviction of Sen and its hope for his
“full exoneration” (personal communication from the chairperson of the
committee, 2011).

P Zachariah, Retired professor of physiology,
Ravi Narayan, Community health adviser,
(chcravi at gmail.com<chcravi%40gmail.com>)

Rakhal Gaitonde, National co-convenor,
Sara Bhattacharji, Professor,
Anand Zachariah, Professor of medicine,
Thelma Narayan, Coordinator
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