📰 Needed, a map for India’s foreign policy
In the backdrop of setbacks, especially in the neighbourhood, the country has to reconsider its diplomacy’s trajectory
•Not long ago, India was seen as a natural rising power in South Asia and the Indian Ocean Region. It was the de facto leader of the South Asian Association for Regional Cooperation (SAARC). It has historical and cultural ties with Nepal. It enjoyed traditional goodwill and influence in Sri Lanka and Bangladesh. It had made investments worth billions of dollars in Afghanistan and cultivated vibrant ties with the post-Taliban stakeholders in Kabul. It had committed itself to multilateralism and the Central Asian connectivity project, with Iran being its gateway. It was competing and cooperating with China at the same time, while the long border between the two countries remained largely peaceful.
•Cut to the present. India is perhaps facing its gravest national security crisis in 20 years, with China having changed the status quo along the Line of Actual Control (LAC) in the western sector in its favour. The border saw violent clashes last month, leading to fatalities for the first time in 45 years. SAARC is out of joint. Nepal has turned hostile having adopted a new map and revived border disputes with India. Sri Lanka has tilted towards China, which is undertaking massive infrastructure projects in the Indian Ocean island. Bangladesh is clearly miffed at the Citizenship (Amendment) Act, 2019. When Afghanistan is undergoing a major transition, India is out of the multi-party talks. Iran has inaugurated a railway link project connecting the Chabahar port, on the Gulf of Oman, to Zahedan (which India was to have constructed) without India. How did we get here?
•Specific reasons can be found for these setbacks. Also, foreign policy need not be static. There will be ups and downs depending on the changes in policy as well as the changes in global politics. But what makes the current downturn serious is that there is a relative decline in India’s smart power, especially in the neighbourhood and the extended neighbourhood, which demands a deeper perusal of the foreign policy trajectory itself. And when we dig deep, three problems can be found which are more or less linked to this decline — a closer alignment of policy with the U.S. line, coupling of foreign policy with domestic politics and hubris.
The U.S. line
•India’s official policy is that it is committed to multilateralism. Even after India started moving away from non-alignment, which it calls irrelevant in the post-Cold War world order, New Delhi maintained that strategic autonomy would remain the bedrock of its policy thinking. But there has been a steady erosion in India’s strategic autonomy, which predates the current government. When India started deepening its partnership with the United States (which was a historical necessity), New Delhi began steadily aligning its policies with U.S. interests. The case of Iran is the best example. The agreement to develop the Chabahar port was signed in 2003. But India, under pressure from the U.S., was moving slowly, despite the fact that the project offered India an alternative route to Central Asia bypassing Pakistan. India voted against Iran at the United Nations; scuttled an ambitious gas pipeline project and cut down trade ties drastically. After the Iran nuclear deal was signed in 2015, India immediately stepped up oil purchases and expanded works at Chabahar. In 2016, Prime Minister Narendra Modi travelled to Tehran and signed a trilateral connectivity project with Afghanistan and Iran. But when U.S. President Donald Trump pulled the U.S. out of the Iran deal in 2018 and reimposed sanctions on the country, India toed the U.S. line, bringing down its oil imports to zero.
•This dilly-dallying to the tunes of policy changes in Washington co-existed with India’s deepening defence and military ties with the U.S. Washington wants India to play a bigger role in the Indian Ocean and the Pacific region to contain China’s rise. While India has been cautious of becoming an ally, it has steadily deepened military-to-military cooperation in the recent past — the Logistics Exchange Memorandum of Agreement (LEMOA) is one example. These developments probably altered Beijing’s assessment of India. The border aggression at different points on the LAC could not be a localised conflict; it is part of a larger strategic move, initiated by the top brass of the People's Liberation Army (PLA). One of the reasons for the shift could be Beijing’s assessment that India has already become a de facto ally of the U.S. The forceful altering of the status quo on the border is a risky message as much to New Delhi as it is to Washington.
Domestic politics
•At least two decisions taken by the government mainly keeping its domestic audience in mind have had foreign policy consequences. First, the passing of the CAA. The official narrative has been that India is offering citizenship to the persecuted minorities of select countries in its neighbourhood. There were two problems. One, this is regionalisation of the domestic problems of the countries in India’s neighbourhood, some of which are its long-time friends. These countries are genuinely upset with India’s move. Two, Muslims, including those sub-sects persecuted in neighbouring countries, were by design excluded from the citizenship programme. This drove new wedges between India and the countries that had a Muslim majority and were friendly to India in the neighbourhood. Forget Pakistan, which is a traditional rival. Bangladesh took offence at the CAA and the National Register of Citizens (from which the government has temporarily backed off) and the political rhetoric in India against the “termites” from other countries. Bangladeshi media reported recently that the Indian envoy in Dhaka had tried to fix an appointment with Bangladesh Prime Minister Sheikh Hasina for four months but did not get one. There were anti-India protests even in Afghanistan.
•Second, the abrogation of the special status of Jammu and Kashmir. This was another popular move among those who form the support base of the ruling party. But it led to the suspension of fundamental rights in the Kashmir Valley for a prolonged period that damaged India’s reputation as a responsible democratic power and gave propaganda weapons to Pakistan. The move did not help India quell militancy either as the Valley continues to see violence nearly a year after the decision. More importantly, the change of status quo in Jammu and Kashmir, including the bifurcation and reduction of the erstwhile State into Union Territories, could be another factor that prompted the Chinese to move aggressively towards the border in Ladakh.
The perils of hubris
•Misplaced confidence does not do good for rising powers. Great powers wait to establish their standing before declaring that they have arrived. The Soviet Union started acting like a superpower after it won (with allies), the Second World War. China bided its time for four decades before it started taking on the mighty U.S. Since the 1970s, its focus has almost entirely been on its economic rise. India should learn from at least these modern examples. If it did, it would not have used high-handedness in Nepal during the country’s constitutional crisis and caused a traditional and civilisational ally to turn hostile. The updated political map which India released in November rubbed salt into the wound on the Nepal border.
•To address the current crises, India has to reconsider its foreign policy trajectory. It is a big power with one of the world’s biggest militaries. It is a natural naval force in the Indian Ocean. It does not lack resources to claim what is its due in global politics. What it lacks is strategic depth.
The COVID-19 pandemic may have unwittingly led to some desirable changes; the challenge is to build on this
•The COVID-19 pandemic has massively disrupted our lives. Besides direct devastation of health, the epidemic and the lockdown have had myriad indirect effects, be it on the environment, livelihoods, or supply chains. There has been a lot of discussion around the lack of capacity of our health-care system to fight this epidemic. But the impact of COVID-19 and the lockdown on the ‘business’ of health care has not been examined. This has an important bearing on the larger arena of health care for our citizens in the near future.
Care and the COVID impact
•Indian health care has been increasingly privatised over the last few decades. This has led to intense market competition. A uniquely unregulated form of health care has thrived. It has also been marked by several questionable practices. These have been under the media and public glare leading to a huge trust deficit. Will the changed milieu have an impact on this? How will this affect care of other conditions?
•COVID-19 has led to a dramatic reduction in the numbers of patients seeking care. This is especially true of planned, non-urgent problems including procedures and surgeries. Many patients are scared to visit health facilities fearing COVID-19. While this has caused collateral damage, with the condition of some patients worsening or taking an unfortunate turn, there may indeed be those who have avoided interventions without any deleterious impact. In other words, they have been spared of procedures for debatable indications. For example, the large number of women who undergo an unnecessary hysterectomy has reduced. The incidence of Caesarean sections is reported to have gone down. Similarly, procedures such as coronary stents, knee replacements or cosmetic surgery which reflect supplier-induced demand have almost stopped. ‘Routine’ admissions for ‘observation’ or ‘insurance claims’ have got curtailed.
•Strangely, even emergency medical cases have declined during the lockdown, with a decrease in the cases of heart attacks or strokes presenting to hospitals. While some of these may have been true emergencies involving those who suffered at home, perhaps the unpolluted air, decreased work stress, or home-cooked food has had a bigger impact on health than we assume. Or maybe we were over-diagnosing and over-treating certain emergencies. Investigating these important questions and critically analysing their answers may make future health care more beneficial to patients.
•The cartelisation of health care has been naturally curbed during the pandemic. ‘Cut practice’, with doctors and hospitals prescribing tests, drugs, referrals and procedures in return for commissions, is entrenched in India. This leads to significant negative consequences, be it increased patient expenses, patients not reaching the right doctor or not getting the appropriate investigation, and also an erosion in the doctor-patient relationship and the image of the fraternity. It puts ethical doctors in a quandary, making them cynical about their profession. However, during the pandemic, the availability of doctors, beds and proximity are now the chief drivers for patient referrals, rather than the commission route. Most practices have had to take a forced ‘detox’ of sorts from this addiction.
•Like in life, there are several grey areas in treatment decisions, where doctors are not sure of the best way forward for the patient. For example, terminal patients with widespread cancers are often prescribed chemotherapy, which can cause side-effects worse than the disease, without impact on life span or quality of life. Oncologists often end up prescribing chemotherapy to such patients instead of symptomatic treatment to alleviate the pain and weakness because of the urge to ‘do something’, or even financial imperatives. The dangers of chemotherapy with COVID-19 lurking in the air has made everyone weigh its pros and cons with more caution than usual.
•The widely prevalent practice of a ‘health check-up’ which does not have proven public health value but is a tactic which targets health-obsessed ‘clients’, has also got derailed. The focus has instead fortunately moved back to the basics of preventive health such as diet, exercise, good sugar control, and quitting smoking and tobacco. The pandemic may have finally taught our population the importance of not coughing or spitting in the open. These may indeed have more far-reaching benefits in a much larger population.
The two sides to the churn
•The COVID-19 epidemic has centre-staged the need for a robust public health system and increased investment. While disrupting care, it may have unwittingly lead to some ‘desirable’ changes by the circumstantial curb on unwarranted medical practices. This churning may even lead to genuine reflection among health-care providers. The question is whether this effect will linger on. Will lessons learnt during the epidemic nudge us towards rational and ethical care?
•However, there are dangerous fallouts of the disruption as well. The breakdown of overburdened health-care facilities, negative impact on the morale of health-care workers, and the collapse of private sector institutions (under financial strain) are all real. With hospital and doctors incomes falling during the pandemic, there may be a resurgence of unethical practices with a vengeance as the industry tries to make up its losses. This is already evident in the huge bills that patients with COVID-19 are being slapped with, often by creating additional billing heads. Though prices in the private sector have been capped, loopholes in the system may be found, such as profiteering on personal protective equipment. Artificial demand maybe created in an effort to increase footfall. Thus, the epidemic’s ‘positive’ impact on unnecessary practices may get washed away as ‘normalcy’ is restored.
•In general, the medical fraternity in India has risen admirably to the challenge of COVID-19. The call of duty has led many to don Coronavirus warrior outfits and set aside commerce for now. It has forced them to consider alternative paradigms. Public respect for the profession has also improved. If we can seize this chance to correct undesirable practices, which have become an albatross around our neck, it may help the return of trust in the doctor-patient relationship, which was under severe threat before the pandemic. In the middle of gloom, this is a window of opportunity. Is this just wishful thinking or a genuine possibility? We should know soon.
📰 Modern tools, age-old wisdom
The pandemic presents an opportunity for Sri Lanka and India to focus on the revitalisation of partnerships
•The unique India-Sri Lanka relationship, de jure, is between equals as sovereign nations. But it’s asymmetric in terms of geographic size, population, military and economic power, on the one hand, and social indicators and geographical location, on the other. It is steeped in myth and legend, and influenced by religious, cultural and social affinities. This is an opportune time for Sri Lanka and India to nourish the roots of the relationship using modern toolkits, but leveraging age-old wisdom and experience.
Historical ties
•History reveals that the advent of Buddhism to Sri Lanka during the time of Emperor Ashoka was the result of cross-border discourse. For many centuries in the first millennia, the ancient capital city of Anuradhapura housed an international community which included traders from India, China, Rome, Arabia and Persia. Later, Buddhist monks from Sri Lanka travelled to India, China, Cambodia and Java leaving behind inscriptions. Buddhist temples in Sri Lanka, to this day, contain shrines for Hindu deities. The colonial expansion of European maritime nations reshaped the Sri Lankan economy. Labour from south India was brought to Sri Lanka to work in plantations. The Indian freedom struggle had its influence on Sri Lanka as well. There was cross-border support for the revival of culture, tradition, local languages, spiritual practices and philosophies, and education. Both countries transformed into modern nations with constitutional and institutionalised governance under colonial rule.
•Most aspects of today’s globalisation existed in a different form in the pre-colonial era with free exchange of ideas, trade and intellectual discourse. However, process engineering by colonial powers for identification and categorisation of people was a factor in the emergence of separatist ideologies based on ethnicity, language and religion. This mindset is now ingrained and accentuated in politics. Episodic instances of communal hostility are referenced often to suit tactical political gain. Around the world today, and not just in South Asia, policies and thinking are becoming communally exclusive, localised and inward-looking. The COVID-19 pandemic hit the world against this backdrop, allowing some leaders an opportunity to double down on insular thinking, ostensibly for providing local communities with better economic and social prospects, and security.
•Meanwhile, governance models favoured by nations keep vacillating between fundamental freedoms-based democratic systems and quasi democratic, socialist authoritarian systems. In this regard, the people of Sri Lanka and India have been served well by long years of uninterrupted democratic governance. This has provided long-term stability for both countries and must not be vitiated.
•Sri Lanka’s strategic location makes it apparent that not only economic fortunes but the security of both countries are inextricably linked. Therefore it is heartening that India and Sri Lanka constantly strive for excellence in neighbourly relations, recognising that a calamity in one country can adversely impact the other. Though robust partnerships with other countries must be sought in line with the non-alliance foreign policies of both countries, such efforts must be bounded by an atmosphere needed for peace, prosperity and stability. Among others, freedom of navigation in the Indo-Pacific together with a rules-based international order and peaceful settlement of disputes are of common interest. While avoiding advocacy of zero sum solutions on crucial issues, both countries must seek to harmonise strategic and other interests in line with common values and socioeconomic compulsions.
Addressing issues and imbalances
•The socioeconomic development of Sri Lanka has remained linked to India. But there are many options available to address issues of imbalance and asymmetries. For instance, Sri Lanka can encourage Indian entrepreneurs to make Colombo another business hub for them, as logistical capacities and facilities for rest and recreation keep improving in Sri Lanka. Integrating the two economies but with special and differential treatment for Sri Lanka due to economic asymmetries can be fast-tracked for this purpose. There is immense potential to accentuate or create complementariness, using locational and human resource potential, for harnessing benefits in the modern value chains. Robust partnerships across the economic and social spectrum can promote people-to-people bonhomie. And engagement of legislatures is essential for promoting multiparty support.
•With many countries receding into cocoons due to the pandemic, this is an opportunity for both countries to focus on the renewal and revitalisation of partnerships.
📰 The majority cannot afford a balanced diet
Even millions who are above the poverty line do not have access to healthy or nutritious food in India
•New analysis from the Food and Agriculture Organization (FAO) shows that hundreds of millions of people in India above the international poverty line of $1.90 purchasing power parity (PPP) per person per day cannot afford a healthy or nutritious diet. This analysis confirms the fact that the problem of poor nutrition in India is largely on account of the unaffordability of good diets, and not on account of lack of information on nutrition or tastes or cultural preferences. The large majority of Indians cannot afford a balanced diet.
•Every year, the FAO, in partnership with other United Nations organisations, publishes a report on food security across the world. This year, the State of Food Security and Nutrition in the World 2020 (SOFI 2020) was released on July 13. A new feature of SOFI 2020 is a detailed analysis of the “cost and affordability of healthy diets around the world”.
Types of diets
•Three types of diet are defined. The first is termed a “basic energy sufficient” diet. This is one in which the required calorie intake is met by consuming only the cheapest starchy cereal available (say, rice or wheat). A requirement of 2,329 Kcal for a healthy young woman of 30 years is taken as the standard reference. The second is a “nutrient adequate” diet, one where the required calorie norms and the stipulated requirement of 23 macro- and micro-nutrients are met. This diet includes least cost items from different food groups. The third diet is a “healthy diet”. This is one which meets the calorie norm and the macro- and micro-nutrient norm and also allows for consumption of a diverse diet, from several food groups. Defining a healthy diet is more complex than the other two diets, and the FAO uses actual recommendations for selected countries. The Indian recommendation includes consumption of items from six groups: starchy staples, protein-rich food (legumes, meat and eggs), dairy, vegetables, fruits, and fats.
•Using data on retail prices of commodities in 170 countries, linear programming techniques are used to identify the cost of each of these diets. The following are the findings for South Asia. First, the energy-sufficient diet or eating only cereals to meet your calorie requirement costs around 80 cents a day in South Asia, and is thus affordable to a poor person or one defined as having an income of $1.9 a day. In short, the poor in India and other South Asian countries can get their calories by sticking to rice or wheat alone.
•Second, the nutrient-adequate diet costs $2.12 a day. This is more than the international poverty line. If a person with income just above the poverty line spent her entire daily expenditure on food (ignoring fuel, transport, rent, medicines or any other expenditure), even then she would not be able to afford the nutrient-adequate diet. No one can, of course, survive by spending their entire income on food. The SOFI Report assumes that a person cannot spend more than 63% of total expenditure on food (that is, 37% would be required for non-food essentials).
•Third, the healthy diet costs $4.07 a day, or more than twice the international poverty line. In other words, a healthy diet is totally unaffordable for those with incomes at even twice the poverty line. And what is this healthy diet? It includes 30 gm of cereal, 30 gm of pulses, 50 gm of meat/chicken/fish and 50 gm of eggs, 100 gm of milk, 100 gm of vegetables and fruit each, and 5 gm of oil a day. In short, a balanced and healthy meal but not excessive in any way.
•How does this translate into numbers of people? The SOFI Report estimates that 18% of South Asians (numbering 586 million people) cannot afford the nutrient-adequate diet and 58% of South Asians (1,337 million people) cannot afford the healthy diet.
Affordability of healthy diets
•These eye-opening and shocking numbers have got lost in the daily news of the pandemic. If anything, the number of people who cannot afford a healthy diet will have risen in the last three months, as employment and incomes collapsed for the majority of workers in the informal sector. Note that the Indian poverty line of 2011-12, as defined by the Tendulkar Committee, amounted to Rs. 33 per day in urban areas and Rs. 27 per day in rural areas, and corresponded roughly to $1 a day at international PPP prices. The Indian poverty line (there has been no redefinition in the last decade) is thus lower than the international poverty line used in the SOFI Report.
•Whatever the limitations of the SOFI methodology, there are some clear and simple messages. First, those we officially count as poor in India – with a cut-off that is lower than the international norm of $1.9 a day – cannot afford a nutrient-adequate diet let alone a healthy diet. This result is completely contrary to the view of scholars such as Arvind Panagariya that the poverty line in India “may not permit a comfortable existence, including a balanced diet, (but) allows above subsistence existence.” Second, even those with incomes of twice the international poverty line cannot afford a healthy diet. If we want to reduce malnutrition and food insecurity, we have to address the problem of affordability of healthy diets.
•Should not at least one nutritious meal (with protein, fruits and vegetables) be ensured for the majority of our people, and particularly in this time of crisis? The Pradhan Mantri Garib Kalyan Anna Yojana offers, up to November 2020, an additional 5 kg of wheat or rice and 1 kg of gram or lentils a month free of cost to all households with ration cards. This is welcome, of course, but utterly inadequate to address the massive and growing problem of malnutrition.
