Sunday, July 29, 2012

Is facebook making us stupid?

For tomorrow's weekly column in Eastern Mirror newspaper

‘Is facebook making us stupid?’ What kind of question is this? Isn’t this a more appropriate question for those who are not in facebook? For those who don’t know that there’s a whole new world in the social networking site? Facebook is the place where news breaks faster than satellite TV and it makes newspapers look ancient. From a war erupting in the Middle East, to the college buddy announcing his engagement, to the earthquake in Phek, to that pretty face who is having a boring day; facebook gets you all the latest updates. How can something which is as informative as facebook make anyone more stupid?

Governments, universities, international and local organizations, common interest groups, top honchos, babus and netas, celebrities, aunty next door are all in facebook that it is becoming indispensable to have an account. Facebook is something that cannot be ignored as a time pass fun that young folks indulge in. Some good tangible things that have come out of facebook in our context are: creating a platform for debate and social awareness, the humanitarian works carried out by a Naga facebook group, and re-connecting long lost friends. There are skeptics who are not in facebook, and some others who simply don’t feel the need to be there. Then there are those people who live in facebook and don’t have much of a life beyond it.

As with any technology, either we make good use of facebook, or let it derail our lives. One primary concern that I have is the sheer duration: the number of minutes/hours that we spend in it every day. I have personally suffered the consequences of having spent God-knows-how-many-hours in it doing (on hindsight) nothing. It felt good, and it was fun. But that was it. And only later have I realized that I’ve missed the boat on many other areas. Thankfully, I have completed college before facebook was born. But it is worrying to think how many college students are hooked to facebook, and how many really know how to balance it with studies and classes. I have personally experienced that the number one adverse effect that facebook had on me was that my reading time was severely shortened. I had a small plan that I’d reserve some amount of my salary each month to buy books. Books were bought while the reading fell behind. 

At a deeper level, online social networking can have grave consequences that are not easily discerned. Jaron Lanier, philosopher and computer scientist who is attributed with coining the term ‘virtual reality’ and creating the first immersive avatars, has warnings for us in his book, ‘You are not a gadget’. What goes on in facebook like Comments, Likes, Pokes, Games, Video and Photo tags, etc may seem harmless and trivial, but they have a way of changing the meaning and value of interpersonal communication. We say that facebook has brought people together. We may also say that we have made many friends in facebook. But Lanier says that such so-called virtual ‘friends’ can truly be called ‘friends’ only if the meaning of friendship is reduced. Real friendship involves all the complexities and weirdness that we experience in each other through genuine interactions. But the idea of friendship is reduced if interactions are all through database-filtered social networks. There is a joke that people are always better-looking in facebook profile pictures than in real life. Research shows that this has the power to play with our self-esteem and social self-perception. Lanier explains that digital programs that require humans to interact with computers as if they are persons also entails that humans are also conceived of as a program. And a small tinkering of the program can have profound unforeseen effects on humans using them. Therefore, online social networking has the danger of reducing the meaning and value of human relationships, or even the way we perceive ourselves and others as human beings. It’s shocking to think that with online social networking, there’s a new generation of kids who has a much lower expectation of what a human being should be.

In facebook, I feel the dilemma of wanting to share my concerns and thoughts with others on the one hand, and the fear of being a show-off on the other. It’s a place where I enjoy and learn from the status updates, link posts, pictures, debates, jokes, etc. But facebook also has its share of self-obsessed megalomaniacs who are so full of themselves. Attention-mongering narcissists who cry day and night, ‘Look at me, see how cool I am. See, I’ve been there, done that’. As Chris Hedges put it, ‘We build pages on social networking sites devoted to presenting our image to the world. We seek to control how others think of us. We define our worth solely by our visibility. We live in a world where not to be seen, in some sense, is to not exist’. 

Also, the quality of comments in various discussion forums make me wonder about the depth of what we young people know. Many young Nagas today are much more open-minded than before. They are not afraid to speak their minds. But we see in online discussions that many of the comments are more of emotional responses, comments typed right off the top of their heads or simply ‘googled’ information. Why is it so? I’d like to argue that it’s because we read (books) too less and don’t take time to think before we speak. And facebook may be responsible for that as in my case. If we spend too much time in facebook, we aren’t going to get too much time to read, sit quietly and think, or go out and see what’s real. Facebook, newspaper, and TV, no matter how useful are no substitute to reading books. But kids don’t read comic books anymore. Fewer college students read magazines, novels and other books. It is shocking that our church youths these days have such poor Bible knowledge. And we know it’s difficult to read long stuffs online. A worrying trend is that in the universities, students ‘google’ or quote secondary sources in the internet for their assignments more than real books or primary sources. Baptist Minister and Sociology professor Dr. Tony Campolo in one of his talks quoted about the state of spirituality in America. It’s said that American spirituality is ‘miles wide and knee deep’. To me, that is a very poignant illustration of our state of education. With increased interconnectedness, we now have information overload and there are so many things we know from across the globe that boggles the mind. We know so much more than the earlier generations. But even as our knowledge is miles wide, how deep is our knowledge? We know a little of so much; but we know so little of anything. 

Our knowledge of the world is concentrated on filtered news, chatter, gossips, TV serials, infotainment, scandals, sports news, etc. And what we call ‘knowledge’ simply becomes ‘accumulation of information’ and we can’t make head and tail of what fits in where, and there is no such sense of a big picture of life and where the different jigsaw pieces fit in. Chris Hedges says that our generation is ‘addicted to nonsense’, that our ‘obsessions revolve around the trivial and the absurd’ while we are blind to our society’s and life’s big issues. That, Os Guinness says, is ‘Diversion’, a disease that our generation is suffering from. We need to be entertained all day long, and we cannot sit quietly for once. And the devil makes sure that we are always entertained, making sure that we are always ‘diverted’ from what’s real. 

Facebook is something that we need to use and not the other way round. Facebook has its uses. But it should not be a substitute for genuine human relations. It should not kill our time to read a good book, reflect, or do a good deed in the real world. If it is too much to say facebook is making us stupid, I think it’s safe to say that it’s making us shallow.

Tuesday, July 24, 2012

Social Determinants of Health

A Half-Baked article for my weekly column. 
Health Et Al.The difference between medicine and public health can be illustrated by the analogy of fishes in a pond. Medicine is the study of the fishes while public health is the study of the pond in which the fishes live (they are not water-tight compartments but that is a good way to understand the difference). It is important to study the fishes, their anatomical structures, functions, behavior, etc. in order to care for them and find ways to treat their diseases. But it is also important to study the condition of the pond in which the fishes live; the water salinity, other chemical contents, surrounding vegetations, other organisms that live in the pond, etc.; in order to keep the fishes healthy.

Modern health care has been oriented towards biomedical model, concentrated on hospital based curative care. Ill health is presumed to be something that is fixed at the doctor’s chamber. It is only recent that public health perspectives are taking prominence in health policy and programs. It has been shown that biology alone does not explain why people in some countries are expected to live longer than some others by as much as 40 years. Even within countries, life expectancy difference of up to 20 years has been observed between regions. Health is more than the practice of medicine. It is the conditions in which people are born, grow, live, work, and age which greatly determine the status of health of the people. The social and economic conditions that influence the wellbeing of individuals or people groups are called Social Determinants of Health (SDH). Provision of medical care, no doubt, is absolutely necessary. But it is only one of the many determinants of health, accounting to about 15% of the determinants of wellbeing. In places where health care facilities are inadequate, the lack of health care facilities itself becomes a social determinant.

In Nagaland, variations do exist in the health status between rural and urban population which has nothing to do with difference in biology between rural and urban people. Such differences in health status between tribes, gender, and socio-economic classes are evident. Access to services also differs that according to the National Family Health Survey III (2005-06), 54.3% of mothers in urban areas had birth assisted by a doctor or trained health personnel while it is only 17.9% for rural mothers in Nagaland. Immunization, treatment of childhood diseases, use of modern family planning methods, access to electricity, toilet facility, information, etc. are all higher for the urban areas than the rural according to the survey.

The WHO’s Commission on Social Determinants of Health, 2008 says that such health inequities between regions, people groups, gender, or social classes are matters of social justice, ‘where systematic differences in health are judged to be avoidable by reasonable action (and) they are, quite simply, unfair’. In India, The Planning Commission set up a High Level Expert Group to advise on Universal Health Coverage for India. SDH was not included in the original terms of reference, but the group felt that SDH is crucial to achieve Universal Health Coverage target in India. So, in the report (2011), an entire chapter was dedicated to it. The rationale to include SDH was stated as, ‘The need for action on social determinants emerges from the recognition that there are huge differentials among and between classes and castes, gender gaps and wide regional variations in both disease burden and response by the health system and others concerned with development’.

Malnutrition, lack of water and sanitation, and social exclusion, are detrimental to human health. Malnutrition in early years of life has a bearing on the health status later on in life. Water supply and toilet facilities are important for prevention of communicable diseases like typhoid, acute diarrheal diseases, cholera, viral hepatitis, malaria, etc. The expert group also cites that in rural India, women are three times more likely to go without treatment for long-term ailments, and when they do, money spent on treatment is less than that of men. Such gender discrimination and other forms of social exclusion adversely affect health.
Therefore to enjoy good health, a concerted effort is required to improve the overall living conditions of the people. In England, the WHO commission on SDH has been adapted into six domains as quoted by Michael Marmott in a WHO bulletin article. These are: (i) give every child the best start in life, (ii) improve education and life-long learning, (iii) create fair employment and jobs, (iv) ensure minimum income for a healthy standard of living, (v) build healthy and sustainable communities, and (vi) apply a social determinants’ approach to prevention. South Australia also adopted a ‘Health in all policies’ approach. In all the policies of the government, be it for housing, rural/urban development, agriculture, security, social welfare, employment, labour, disaster management, etc.; health plans need to be put in place.

To carry out any activity in life, good health is essential. The best food is not tasty if one is not healthy to enjoy it. Good music is no music at all if one is too sick to enjoy it. Healthy living conditions along with health services must be ensured. The gaps in distribution of resources between regions and socio-economic and racial groups must be minimized. A public health perspective is needed so that health care goes beyond hospital based medical care. For instance, it is important to know the cause of the diseases, but it is also very important to know the ‘cause of the cause’ of ill health if we want to seek for long term solutions.

Monday, July 9, 2012

At Home in July

The best time of the year to click pictures at Pfutsero, I think is July. Just focus anywhere and click away. The shots turn into beauties!!!

Here are some pictures I clicked yesterday, and some a year back. So, that's July 2011 and July 2012 (to over-repeat myself). Is it the best time to visit Pfutsero? Yes, it's a good time.

Blame it on the speed of internet connection in Nagaland...had to compress as much as possible

Our church bell

On Church dedication day, July 13, 2011.

12 kms away from Pfutsero. Our paddy field. Hard labour, this thing of beauty, then harvest.


Begonia, Pfutsero special

 Sedzu river, between Chakhabama and Kikruma.

Home. with Rukizu colony in the background

 Beauty just anywhere :)
view from the back


Monday, July 2, 2012

Is Health a market commodity?

Patients are no more treated as patients but as business clients. Pharmaceutical companies intrude into doctors’ medical practices. Insurance companies decide who is sick and who is not. 

When it comes to health care, USA is not a country to look up to. It is a terrible thing to fall sick in the US if you are not insured. And about 16% (49 million) of the population do not have health insurance. 26% of Americans face grave problems paying medical bills, 58% delay treatment due to inability to pay, and medical bills are the number one cause of bankruptcy.  Many people could not avail the benefits of safety nets (e.g. Medicaid and Medicare) because they are not poor enough, not old enough, or they are not dying. The poor, who are not destitute poor, the sick who are not suffering from terminal diseases are therefore caught in the middle, of becoming ineligible for these free services and not rich enough to pay insurance. The idea is to exclude as much as possible those who are unable to pay. The poor and the sick are not good business partners and it is best to try not to insure them. Another flipside of insurance in the US which was reported in the media a couple of days back is that some people refuse to buy health insurance and choose to pay penalty as that is cheaper than paying the insurance premiums.

The US spends more on health as percent of GDP than most of the industrialized nations but has poorer health indicators like Infant Mortality Rate, Maternal Mortality Rate, Life Expectancy, etc. The Obama administration tried to reform the health care delivery system but have faced stiff resistance from these private insurance and pharmaceutical companies.

What has gone wrong in the US? The government has sold out its health to private hands in the spirit of free market capitalism. This has resulted in the rise of star-hotel-like hospitals running on for-profit business models and has moved ahead leaving behind a huge chunk of the middle class, the poor and the vulnerable. 

The general trend of the countries worldwide is that where the government has a bigger hand in health care, there is more inclusive coverage, equitable distribution of resources and better over-all health indicators. Examples are Cuba, Sri Lanka, and Canada. 

India, however, has a mixed story. Though health care is more in the public sector, the private sector has been increasing by leaps and bounds especially in the cities and big towns. Corporate hospitals have sprung up along with private insurance companies and big pharmaceuticals. Medical tourism is a booming industry. But because majority of Indians still live in the villages, public sector institutions cater to the health of the majority of the people. Except for charitable mission hospitals, there is hardly any private hospital or nursing home in rural areas. It is not profitable for the private bodies to set up hospitals in the villages. And the public institutions are in a sorry state due to a host of factors like lack of government commitment in spending on health, manpower crunch, geographical hurdles, poor staff motivation, interference of party politics, etc.

The present central government’s increasing commitment to improving health can be felt.  The UPA’s first term’s flagship program National Rural Health Mission (NRHM), despite all its complexities, has been immensely contributing to improving health. The aim to provide free generic medicines in all public institutions; and to increase government spending in health to 2.5% of GDP (from the current 1.4%, which is among the least in the world)  for realizing universal coverage are welcome moves. 

There has not been a commensurate increase in commitment to health in Nagaland. The state budget on health is still small and stagnant and there is no State Health Policy to tell where we came from, where we stand or where we should go from here. Health is a State subject and the commitment of each State government determines to a large extend the level of health care its peoples receive. The public health institutions are still the hope for most of the Nagas. In Nagaland, majority of the population will depend on public health institutions (Sub Centres, Primary Health Centres, Community Health Centres, District Hospitals) for health care at least for a very long time. Private hospitals are concentrated only in Kohima, Dimapur, Mokokchung, and a handful of private clinics in other district headquarters. Preventive health care is almost exclusively in the domain of the government set ups.

Private sector is heterogeneous and the various forms of private agencies cannot be generalized as purely profit motivated or that the ethical standards are the same everywhere. Private sector do have a place in health care and in certain areas, they can do a better job than the government. In private, profit is a necessity for self sustenance and growth. Some components of the government health programs do run in partnership with private and civil society organizations. But the emphasis here is the responsibility of the government to provide basic health care which should not be allowed to be run over by any other agency. If taxes and other sources of the State’s income are used in return for the welfare of the people, health care should be a priority and not an afterthought.

Is Health a market commodity which can be sold and bought from the market? Unlike other market goods, good health is not something that we may choose to buy or not buy. It is an absolute necessity and not something optional. It is as basic as education, housing, employment; it is a basic human need. And therefore basic health care is recognized internationally as a human right as mentioned in the Universal Declaration of Human Rights:

‘Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, and medical care, and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control’.

The preamble of the World Health Organization realizes this:

‘The enjoyment of the highest standards of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, and economic and social condition’.

Such fundamental right should not be made a market commodity; a goods to be sold and bought in the market. Privatization of basic health care will lead to skewed distribution of health services; widen health inequalities by exclusion of people groups; and will be a violation of human rights. The government should not shirk this solemn responsibility of providing accessible and affordable health care to its people.