<br><br><div class="gmail_quote">From: <b class="gmail_sendername">Kamayani</b> <span dir="ltr"><<a href="mailto:kamayni@gmail.com">kamayni@gmail.com</a>></span><br><br><div class="gmail_quote"><div><div></div><div><div class="gmail_quote">
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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<br>
EDITORIAL <br>
<br>
The life imprisonment of Dr Binayak Sen<br>
<br>
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<br>
Health Council. <br>
<br>
<br>
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. <br>
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<br>
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<br>
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. <br>
<br>
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 <br>
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. <br>
<br>
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.<br>
<br>
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. <br>
<br>
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). <br>
<br>P Zachariah, Retired professor of physiology, <br>
Ravi Narayan, Community health adviser, (<a rel="nofollow" href="mailto:chcravi%40gmail.com" target="_blank">chcravi@gmail.com</a>)
<br>
Rakhal Gaitonde, National co-convenor, <br>
Sara Bhattacharji, Professor, <br>
Anand Zachariah, Professor of medicine, <br>
Thelma Narayan, Coordinator<br> <br></div></div></div></div></div></div></div></div></div>