Health

Doctors Versus Mamata: A Battle of Wits Ends in a Masterclass in Political Manoeuvring

An unprecedented livestreamed meeting between junior doctors up in arms after the R.G. Kar incident and the Banerjee dispensation ended with the former group calling off their fast.

It was David versus Goliath when a group of junior doctors squared off against one of the country’s smartest politicians.

On the one side: young men and women whose colleagues had been on hunger strike for nearly three weeks. On the other: the veteran, the chief minister, Mamata Banerjee, confronting perhaps the biggest crisis of her tenure.

Though the doctors eventually called off their hunger strike – which they were conducting to push for certain demands in the aftermath of the rape and murder of a young doctor at the state-run R.G. Kar Medical College and Hospital – their meeting with Banerjee ended in what is largely being seen as a disappointing outcome.

Yet, the doctors held their own at the meeting, and sparks flew.

“Would you like to have some tea?” asked the chief minister.

“No ma’am. Our friends have been on hunger strike for the past 17 days. We don’t want tea,” a woman doctor responded sharply. This set the tone for the next two hours.

At one point, Aniket Mahato, a third-year resident doctor of R.G. Kar and prominent face of the movement who had just been released from the hospital after fasting-related complications, confronted Banerjee directly, “Ma’am, should we take the side of a rapist or a criminal?”

A video screengrab showing the doctors at the meeting with CM Banerjee.

A surprising move

Banerjee’s move to give in to the live-streaming demand of the doctors, seasoned politician that she is, had surprised many. Joined by the state’s top bureaucrats, she agreed to this meeting despite earlier government objections on legal grounds. Why she had this sudden change of heart, given that the matter was still sub judice, remains unclear.

However, Banerjee held firm on key issues. She backed Narayan Swarup Nigam, the state’s principal secretary of health, dismissing the doctors’ demand for his removal.

“An accused cannot be labeled as such until it is proven,” she said, adding “I’m speaking from a legal standpoint.”

Banerjee, who is known for openly rebuking senior officials in live-streamed meetings, was perhaps not prepared for the sharp rebuttal from protesting doctor Manisha Ghosh at this point.

“If there are allegations, we call someone an accused. If the allegations are proven, we call them guilty. That’s both grammatically and legally correct,” Ghosh retorted.

Also read: A Non-Political Movement Is Uncharted Territory for Mamata Banerjee

Threat culture

Banerjee’s reprimand of medical college principals for suspending students accused of ‘threat culture’ sparked a heated exchange. She also accused the principals of playing politics and expressed dissatisfaction with their recent efforts to clean up the environment in medical colleges.

“I don’t want anyone’s career to suffer. Principals should inform us when they receive allegations. We will do the investigation,” she insisted. However, as per the National Medical Commission, medical colleges are authorised to take strict action against those found guilty of ragging or abetting ragging.

When she specifically criticised Manas Banerjee, the newly appointed principal of R.G. Kar Medical College, for suspending 47 students without informing the government, she was met with fierce opposition from junior doctors. Manas Banerjee’s predecessor Sandip Ghosh is now in CBI custody and often thought of as having been close to Banerjee.

CM Banerjee said, “You have suspended 47 students without informing us. Isn’t this part of a threat culture?”

The question met with immediate opposition from the junior doctors. Kinjal Nanda, a resident doctor of R.G. Kar Medical College and a familiar face of the protests, said, “The earlier principal kept us waiting for hours. Those accused of ‘threat culture’ stopped us from meeting him. We informed the government many times, but nothing happened.”

Aniket Mahato countered her, “Each of the suspended ones are notorious criminals. Sir [Manas Banerjee] took measures after the investigation. If required, you investigate and see.”

Taken aback, Banerjee retorted, “You cannot interfere in the administration.”

Throughout the meeting, the chief minister, not used to counter-arguments in her meetings with state officials, faced multiple interjections and interruptions from junior doctors.

Bristling comments, evasion tactics

Embarrassing the government even further, Mahato said, “Sexual harassment, exploitation, and threats were rampant on campus. Students felt unsafe and unsupported.”

At another point when Banerjee was talking about her government’s achievements, Mahat was heard saying, “Can only speak when she allows us to speak!”

The conversation took an awkward turn when Banerjee urged the men to protect their woman colleagues. “You also have a responsibility, to take care of your sisters. Sisters have the responsibility of taking care of their brothers,” she said, raising eyeballs in the room.

The chief minister faced and evaded another critical question when a doctor from the North Bengal Medical College asked how a principal could fairly represent himself in a committee investigating the complaints against him. Banerjee offered a vague response, “I want all of you to be well and healthy.”

The meeting concluded on a similarly evasive note. While the government agreed to certain demands, such as the implementation of a central referral system, key issues like the removal of the health secretary were dismissed. Banerjee also assured the doctors that student elections at medical colleges would be held by March 2025 – a timeline which gives her administration ample time to manage the fallout.

A strike ends

Two hours after the meeting, the doctors emerged, visibly frustrated by what felt like a masterclass in political manoeuvring.

They joined their colleagues on the ongoing fast-unto-death hunger strike at Dharmatala in the heart of Kolkata. The doctors announced their decision to call off their hunger-strike at the request of the parents of the trainee doctor who was raped and murdered in August.

“The state government’s body language was not encouraging,” acknowledged Debasis Halder, a representative of the West Bengal Junior Doctors’ Forum (WBJDF).

“We are suspending our ‘fast-unto-death’ protest and the planned total shutdown of the health sector on Tuesday. However, this decision is not a result of today’s meeting. We are doing this because of the heartfelt requests from the public and the parents [of the victim].”

GoM Proposes GST Exemption on Term and Health Insurance For Senior Citizens

The insurance premiums for other groups which provide cover below Rs 5 lakh would not attract GST.

New Delhi: The Group of Ministers (GoM) under the convenorship of Bihar deputy chief minister Samrat Chaudhary decided to exempt health insurance premium from GST for senior citizens on Saturday (October 19).

The insurance premiums for other groups which provide cover below Rs 5 lakh would not attract GST. However, if a premium provides a cover above Rs 5 lakh, it would continue to attract a GST of 18%. For senior citizens, the GST has been waived on premiums irrespective of the total coverage an insurance scheme provides.

The final call on all the decisions taken by the GoM would be taken by the GST council headed by finance minister Nirmala Sitharaman. The GoM is expected to submit its report to the council by the end of this month. The Council would meet in November.

The GoM also decided to waive GST on term life insurance premiums. Currently it attracts 18% GST.

According to The Hindu Business Line another GoM headed by Chaudhary also proposed changing rates on a few other products. For packaged water above 20 litre, it has proposed to reduce the rate to 5 % from 18%. For bicycles worth below Rs 10,000 and for notebooks, the GoM suggested the reduction from from 12% to 5%.

On the other hand, the GoM has proposed that shoes worth above Rs 15,000 and wrist watches above worth Rs 25,000 be levied the GST to the tune of 28%.

This rates rationalisation exercise is expected to give a revenue gain of Rs 22,000 crore to the Centre and states

Every GoM member wants to give relief to people. Special focus be on senior citizens. We will submit a report to the Council. A final decision will be taken by the Council,” said Chaudhary.

We’re Still Asking the Wrong Question About Food Insecurity in India

While there is a reduction in hunger narrowly defined as not being on an ’empty stomach’, food security needs to be redefined as ‘having access to safe and nutritious food that meets dietary needs and preferences’.

The United Nations marks October 16th as the ‘World Food Day’. In October every year, since 2006, the Global Hunger Index (GHI) is also released by a group of international organisations – Concern Worldwide, Welthungerhilfe, and the Institute for International Law of Peace and Armed Conflict (IFHV).

India usually ranks poorly. India’s GHI rank for this year 105 out of 127 countries. During the last few years, the GHI caused a lot of controversy in the country with media and opposition parties highlighting the poor rank on the one hand and the Union government strongly rejecting the report entirely on the basis of objections to the methodology and data sources used.

One of the points of discussion is whether GHI reflects ‘hunger’ as we usually understand it, as it is a combined index of the
Food and Agriculture Organization’s (FAO’s) ‘prevalence of undernutrition’ (PoU) indicator along with indicators of child undernutrition (stunting and wasting) and child mortality (under-5 mortality). The latter indicators are determined by multiple factors, including but not just food security. Rather than repeating this debate, what this occasion of World Food Day should be used for is to review the status of food security in the country along with attention to the current priorities and challenges.

A step forward

During the last two decades, India has made a lot of progress in reducing hunger and malnutrition. The prevalence of stunting among children has reduced from 48% in 2005-06 (NFHS-3) to 35.5% in 2019-21 (NFHS-5). PoU has reduced from 21.4% during 2004-06 to 13.7% during 2020-22. Along with better living standards for many, the expansion in government welfare programmes related to food and nutrition over the last 20 years has also made a significant contribution to reducing hunger.

Also read: NHA: What the Health Expenditure Data Tells Us and the Questions That Remain

During the 2000s, many states increased coverage under the public distribution system (PDS) and introduced lower prices of food grains. This eventually culminated in the passage of the National Food Security Act (NFSA) in 2013 which made access to subsidised grains, for 75% of the rural population and 50% of the urban population, a legal entitlement.

Following Supreme Court orders in the ‘Right to Food’ case, which started in 2001, hot, cooked meals in government schools through the mid-day meal scheme was rolled out across the country. Anganwadi centres, which provided supplementary nutrition along with other education and health services to children under six years of age, pregnant and lactating women and adolescent girls, were universalised and an attempt was made to cover all villages and urban slums. The Mahatma Gandhi National Rural Employment Guarantee Act, 2005 (MGNREGA) was passed in 2005 and social security pensions scheme for the aged, single women and disabled was also streamlined across the country.

While some states, especially in South India, had many of these initiatives since earlier, there was a massive expansion across the country during 2004 – 2014, through initiatives of both central and state governments. As a result, these entitlement-based welfare schemes became well entrenched. Following the COVID-19 pandemic, the distribution of grains to NFSA beneficiaries has been made free under the Pradhan Mantri Garib Kalyan Yojana (PMGKAY).

Gaps remain

However, some significant gaps remain. The existing programmes have plateaued in coverage and resources. When it comes to PDS, the number of beneficiaries has not been updated based on population increase as the decennial Census has not taken place since 2011.

Also read: Beyond Food Security: It’s Time India Focus its Policy Efforts on Concerns Over Dietary Diversity

The Union government’s real budgets allocated to school meals and Anganwadis have been consistently falling. Salaries of Anganwadi workers have not been increased. Contributions to social security pensions have remained the same for more than 15 years. Maternity entitlements are still measly (Rs 5,000 per pregnant woman) and child care services (creches) hardly exist. It is perturbing that these programmes are all being neglected despite the evidence showing their significant role in bringing about change.

As we look ahead on what needs to be done for food security, two issues need to be highlighted. First, although there have been improvements discussed above, the goal of ‘food security for all’ is nowhere close to being achieved. While there is a reduction in hunger narrowly defined as not being on an empty stomach, ‘food security’ defined as ‘having access to safe and nutritious food that meets dietary needs and preferences’ is still not a reality for a large section of the population. Child malnutrition levels and micronutrient deficiencies (e.g. anaemia) are still at unacceptably high levels.

Second, across the world and in India, there have been indications of food insecurity over the last few years. Globally, PoU declined from 13.2% in 2002 to 7.1% in 2017, however there has been an increase since to 9.1% in 2023. Corresponding figures for India are 22% in 2002 to 10.3% in 2017 and 13.7% in 2023.

Dipa Sinha is a development economist.

How Social Media Drives Sales of Organic Food

An analysis of social media discussions reveals consumer shift to organic produce in wake of health concerns after the pandemic.

Americans are buying apples and spinach, Canadians have blueberries and raspberries on their list, Japanese can’t have enough matcha tea, and Indians are stocking up on turmeric.

These are just some global favourites from the organic produce sections.

As concerns around health, food safety and sustainability drive dietary choices in a post-pandemic world, the once niche market for organic foods has turned mainstream.

Social media has played a key role in precipitating this consumer behaviour, our research study that analysed 300,000 social media posts on platforms such as Twitter, Facebook, TikTok and YouTube, suggests.

These platforms serve as spaces where information, opinions, and health advice is exchanged, often leading to changes in consumer behaviour.

The analysis of consumer discussions on social media platforms between 2015-2024 reveals that they have indeed been instrumental in shaping food choices.

Niche to mainstream

Pre-covid, organic food consumption was growing steadily, but remained largely confined to niche markets.

Social media conversations were relatively stable, with spikes during festive seasons such as Christmas, or environmental campaigns.

However, when COVID-19 hit, there was a dramatic increase in social media discussions about organic foods, with mentions spiking from 12,000 to 40,000 per month, particularly during major waves of the pandemic.

The fear of infection, coupled with growing concerns about food safety and immunity, fuelled this spike.

Consumers became more aware of what they were eating and sought healthier options to boost their immune systems.

Organic foods, free from synthetic pesticides, genetically modified organisms (GMOs), and harmful fertilisers, offered a safer and healthier option.

The study found that 80 percent of post-pandemic social media discussions were positive, emphasising terms such as “immunity,” “protection,” and “boost.”

This shift in sentiment also translated into real-world behaviour, with a significant rise in sales of organic products globally. .

In countries such as the US, Germany, and Japan, demand for organic fruits, vegetables, and dairy products soared, reflecting growing consumer preference for organic foods.

The shift was not just a fleeting response to an immediate crisis, but reflected a deeper, growing awareness of health, sustainability, and environmental responsibility.

Sustainable consumption

Environmental concerns also played a crucial role in driving organic food consumption.

Consumers became more aware of the environmental impact of conventional farming, which relies on harmful chemicals that degrade soil health and contribute to climate change.

Organic farming, on the other hand, promotes biodiversity, soil conservation, and reduces greenhouse gas emissions.

The research highlights a significant increase in discussions linking organic food consumption to sustainability, especially with respect to SDG 12 (Responsible Consumption and Production) and SDG 13 (Climate Action).

The study also found notable differences in the geographic distribution of discussions on organic food.

Before the pandemic, most conversations were concentrated in North America and Europe.

Post-pandemic, however, there was a marked increase in discussions in Asian countries, particularly in China and India, where organic food consumption was not widespread.

The pandemic also broadened the demographic profile of organic food consumers, with younger generations and a more balanced gender distribution driving the trend.

High costs, limited availability

While the rise of organic food consumption presents a positive outlook for global health and sustainability, the study also highlights several challenges.

A significant issue is the higher cost of organic foods, which continues to be a barrier for many consumers.

Although organic farming has become more efficient, organic products are still more expensive than their conventional counterparts, making them less accessible to lower-income populations.

Moreover, supply chain disruptions caused by the pandemic led to shortages and price hikes, further exacerbating this issue.

Another challenge is the limited availability of organic products in certain regions.

While the US and Europe have well-established organic markets, developing countries still face challenges in terms of production and distribution.

This disparity underscores the need for policies that support organic farming and make organic products more accessible to a broader audience.

Despite the challenges, the future of organic food consumption appears promising.

As the world continues to grapple with the effects of climate change, there is a growing need for sustainable farming practices that protect the environment while ensuring food security.

The insights provided by this study are valuable for policymakers and marketers, as they work to develop strategies that promote organic foods and support the SDGs.

Possible solutions to overcome the challenges of organic food production and consumption include increasing government subsidies for organic farmers, improving supply chain efficiency, and launching public awareness campaigns to educate consumers about the long-term benefits of organic foods.

Social media, of course, will continue to play a crucial role in shaping consumer behaviour, making it an essential tool for promoting sustainable eating practices.

Dr Jolly Masihis Assistant Professor, School of Management, at BML Munjal University, Gurugram. Her research is focused on sustainable food consumption and consumer behaviour.

Originally published under Creative Commons by 360info.

G.N. Saibaba’s 2017 Prison Letter Sheds Light on the Rights of Disabled Prisoners

‘I have refused to be carried to a government hospital outside the prison because I was once treated like baggage.’

Professor G.N. Saibaba wrote a letter to disability rights activist Muralidharan from Nagpur central prison in October 2017.

It had been only a few months since Saibaba, a wheelchair user with over 90% disability, was handed a life sentence under the Unlawful Activities (Prevention) Act. He knew he was in for a long time, and from his past experience as an undertrial prisoner, Saibaba was fully aware of the further harm incarceration would cause to his already fragile body.

Within those few months of stay inside the ‘anda cell’ – an egg-shaped windowless enclosure – of Nagpur Central Prison, Saibaba’s health had already started failing.

In utter desperation, Saibaba wrote:

“My health has further deteriorated. Now I can feel irreparable damage being done to my internal organs. For the last month, I have been suffering from continuous fever. Pains in my stomach, left hand, and leg have reached uncontrollable levels.”

An English teacher facing incarceration for his political beliefs, he wanted to read more literature on disability. In the letter, he sought to understand the aspect of self-dignity that the prison environment had crudely denied him.

“I have refused to be carried to a government hospital outside the prison because I was once treated like baggage.”

He felt that his condition as a disabled man was far worse than that of pet animals in households.

“No dignity is left. One takes a pet to a hospital in a dignified manner.”

A letter from G.N. Saibaba to disability rights activist Muralidharan. Photo: By arrangement.

Saibaba approached Muralidharan because his organisation, the National Platform for the Rights of the Disabled (NPRD), had actively advocated for his release and demanded dignified living conditions for incarcerated persons with disabilities. Muralidharan told The Wire that he was unable to respond to Saibaba’s letter. “I was not sure if Saibaba would receive my letter in jail or if the authorities would actually allow my letter or books on disability to reach him,” he said.

Muralidharan’s apprehension was not unfounded; letters go through several rounds of scrutiny before reaching their intended recipients, and in some cases, they don’t make it at all.

Muralidharan shared that his organisation, NPRD, which is a cross-disability rights group, had approached many forums, including the National Human Rights Commission (NHRC).

NPRD highlighted how Saibaba faced humiliation and indignity in jail, despite India having ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). A team of NHRC officials had, in fact, even visited Saibaba in jail. “But the report was not made public. One doesn’t know what the delegate finally concluded,” Muralidharan said. Similar letters by the NPRD sent to other rights’ forum remained unanswered too.

In his letter to Muralidharan, Saibaba had requested access to the then newly-passed Rights of Persons with Disabilities Act:

“Please send me the new Act and related critical material. I would like to train myself as an activist for disabled people in India.”

The 2016 law harps on dignity. Several legal provisions of this relatively recent legislation lay down punishment for ill-treatment of persons with disability. There were a series of ill-treatment that Saibaba and his wife had put out in public, even written to the judicial bodies. But no action ever came to be taken. Because he was a prisoner under judicial custody, Saibaba’s proper treatment in jail was also the judiciary’s responsibility. But it was overlooked.

Soon after his release in April, Saibaba had said:

“I was in the anda cell for eight and a half years without a wheelchair. It was a daily struggle to use the toilet, take a bath, or even fetch myself a glass of water. The prison doesn’t have a single ramp for people like me. Now my heart is functioning at 55 percent capacity due to hypertrophic cardiomyopathy. I am facing syncope attacks and fall unconscious. I suffered two attacks of COVID-19 and one of swine flu in prison but was not provided emergency medical treatment. A doctor had recommended a sleep study for me seven years ago, but it was never conducted. I was provided medicines sent by my family following my 10-day hunger strike inside the jail. I was refused permission to meet my dying mother or perform her last rites. Is the state’s role to serve people or crush humanity? In jail, I was treated like the biggest terrorist in the world.”

Saibaba’s case is one of the very few known instances of incarcerated persons with disabilities. Before his passing, another widely discussed case was that of Father Stan Swamy, a Jesuit priest arrested in another highly questionable case of “urban Naxalism,” more famously known as the Elgar Parishad case. Swamy, an 84-year-old man with several health complications, including Parkinson’s disease, died in 2021 while in Taloja jail, awaiting timely and adequate treatment after contracting COVID-19.

The cases of Saibaba and Swamy gained public attention due to the activism that followed their arrests and the many petitions filed in higher courts and various rights commissions.

The National Crime Records Bureau, which releases prison statistics every year, includes several details about incarcerated individuals. However, there is no data on physical or mental disabilities among prisoners. Without such data, it is impossible to know how many incarcerated persons are struggling with mental or physical disabilities. Consequently, there is no policy in place to address their needs.

When Saibaba was first arrested, his wife, Vasantha Kumari, time and again insisted that his condition be given special consideration and that arrangements be made to ensure his well-being. Every few weeks, she made desperate appeals to the press, the state, and the judiciary to ensure that Saibaba did not die. Although Saibaba did not die in jail, he passed away months after his release. His death, occurring after his release, will, however, not be included in the NCRB data that records “deaths in prison”.

The Supreme Court intervenes

The Wire has extensively reported on the deaths of individuals in prisons due to inadequate and untimely medical treatment. Treatable illnesses are often ignored for extended periods, leading many to perish while awaiting hospital visits.

In the recent judgement passed in the ‘caste in prisons case’, Justice D.Y. Chandrachud spoke of disability as one of the grounds for discrimination along with caste and gender.

The court, turning a public interest litigation filed by this author, into a suo motu case and renaming it as ‘In Re: Discrimination Inside Prisons in India’, has directed the state governments to come back to court with steps taken to address the issue in three months. But for that, states will have to first acknowledge they have persons with disabilities locked inside prisons, collate data on different kinds of disabilities and then speak of different measures they have taken or will be taking in the future. This is an exercise that states are very unlikely to take up on their own.

Although Saibaba’s health had severely deteriorated by the time he was released, he was keen on working on prison reforms, keeping disability at the heart of these long pending improvements. Muralidharan said that his organisation had been closely working with Saibaba on the same. “In our several rounds of discussions, Saibaba had shared of the many difficulties that an incarcerated person with disability faces in jail. He wanted to dedicate his time to the cause,” he added.

Punjab’s ‘Cancer Train’ Is a Grim Reminder of the Role of Agricultural Chemicals

Cases of cancer are widespread in Punjab and Haryana where groundwater is contaminated by high pesticide use.

At 9.30pm every night, a poorly-lit, 12-coach train pulls out of Bathinda station in the Indian state of Punjab with passengers of all ages and genders.

With their meagre belongings and plastic packets containing sheafs of papers and documents, most talk among themselves in hushed tones.

The destination for an average one-third of the 300 passengers of this train is the Acharya Tulsi Regional Cancer Hospital and Research Centre in the Bikaner district of Rajasthan state.

The train covers about 325km before it reaches Bikaner around 6am. Sometimes the train is delayed by one to two hours. But the passengers do not lose hope.

Over the years, the Bathinda-Bikaner train has earned itself a grim tag as “Punjab’s cancer train” as it ferries hundreds of thousands of cancer patients from this northern Indian state for treatment for this dreaded affliction.

The reason for this interstate migration is the cost of cancer treatment.

The cost of a train ticket is free for any cancer patient while for attendants there is a 75 percent discount on the fare.

Most of the hospitals in the city of Bikaner are covered under Mukh Mantri Punjab Cancer Raahat Kosh Scheme through which patients can get financial assistance up to Rs 1,500,000 ($US1,787). Whereas the scheme is much harder for patients to access in Punjab.

Cancer Capital

The widespread prevalence of cancer in Punjab — and more recently the adjoining state of Haryana — has helped earn India the unenviable title of the world’s cancer capital.

There are many reasons for poor health among Punjab’s population but environmental degradation and water, soil and air pollution are known to be the most common causes of cancer in India.

Cancer cases in the country are at an all-time high, after public officials shared in Parliament earlier this year that there were 1,496,972 cases in 2023 up from 1,461,427 in 2022. There was a record 300 percent rise in cases between 2017 and 2018.

Studies indicated that 1.4 million people had cancer in India in 2020 and the case numbers may rise to 1.57 million by 2025. The reason for this spike may be due to changes in food consumption patterns, increased genetic predisposition to the disease as well as negligence in seeking medical attention at the onset of cancer.

Another report indicates that Punjab saw a four-time rise in cervical, oral and breast cancer cases among people over 30 in 2022.

A Forbes India report indicates that Haryana and Punjab have shown moderate economic growth, notching up per capita net state domestic products of Rs 325,000 ($US3,879 ) and Rs 195,000 ($US2,327) respectively in the financial year 2022-2023.

So rising cancer cases may not be directly linked with economic hardship.

Green revolution’s hidden dark side

Beginning in the 1960s, Haryana and Punjab were two of the prime beneficiaries of the “Green Revolution“ that solved India’s food security problem.

The primary outcome of this scientific and agricultural reform was improvement in crop yields. But this transformation relied extensively on increased use of fertilisers and pesticides.

This excess use of pesticides is known to be the major cause of cancer cases in Haryana and Punjab.

Cancer occurs when a cell keeps on growing and dividing uncontrollably, unlike normal cells which ultimately die. Biochemically, humans have natural protection against cancer through tumour-suppressor genes.

Exposure to certain chemicals can mutate tumour-suppressor genes, switching them off.

Chronic exposure to pesticides can thereby increase people’s risk of developing cancer.

Consuming a staggering 5,270 metric tonnes of pesticides annually, Punjab is the third largest user and has the highest per capita consumption of such chemicals in India.

This high usage results in the accumulation of pesticides in groundwater, drinking water and food. Such contaminants then end up in the human body.

Recent research found pesticide traces in the breastmilk of lactating mothers in Haryana.

Another study showed that in 6.9 percent of cow’s milk samples from Ludhiana in Punjab, the concentration of harmful pesticides such as hexachlorocyclohexane, dichloro-diphenyl trichloroethane or DDT, endosulfan, cypermethrin, cyhalothrin, permethrin, chlorpyrifos, ethion and profenophos were higher than acceptable limits.

Other research indicates the presence of metal pollutants such as arsenic, lead and uranium in the groundwater of Punjab’s Malwa, may also have played a role in the high incidence of cases in the region.

The cancer cost of agricultural chemicals

This raises a dilemma: whether the use of such chemicals for improving agricultural production should be prioritised given their impact on people’s health and quality of life.

This cancer disease burden also comes with an economic cost.

The cost of surgeries related to cancer ranges between Rs 100,000 ($US1,193) to Rs 600,000 ($US7,160) depending on the affected organ.

In 2017-2018, Punjab’s per capita health expenditure was around Rs 1,086 ($US13), lower than the national average at that time. On average, people covered around 69.4 percent of their out-of-pocket health costs, which was higher than the national average of 48.8 percent.

One way of addressing this serious issue is through a One Health approach.

This concept focuses on looking at human health not separately but as part of an integrated and unified whole alongside the health of animals and ecosystems.

An integrated pest management programme complies with this concept and can help address the issue of pesticide overuse by using ecologically sustainable methods to control pests.Agricultural land can be made ecologically inhospitable for pests, requiring minimal pesticide use.

This will reduce the chemical footprint of agriculture and won’t pollute air, water or soil with pesticides.

Such interventions could encounter major challenges from farmers who are used to chemically-intensive agricultural methods and practices, which is why it’s important to understand the ecological conservation behaviour of farmers before implementing such solutions.

But they could be the first step towards a lasting solution to the problem of cancer caused by excessive pesticide use.

Professor Abhiroop Chowdhury is Executive Dean of the Jindal Global School of Environment and Sustainability at O.P. Jindal Global University in Sonipat, Haryana, India. His research interests include blue carbon sequestration, mangrove restoration, climate change ecology, soil pollution assessment and environmental social work.

Originally published under Creative Commons by 360info.

Government Increases Prices of 8 Common Drugs Citing ‘Public Interest’

The National Pharmaceutical Pricing Authority says the drug makers had complained to the government that production was not viable due to increased input costs.

New Delhi: The National Pharmaceutical Pricing Authority of India (NPPA) increased the ceiling prices of eight drugs on October 14, Monday, citing ‘extraordinary circumstances’ and ‘public interest’.

The NPPA comes under the department of pharmaceuticals under the Union Ministry of Chemicals and Fertilizers. The NPPA was constituted in 1997 to regulate the ceiling prices of drugs. It has the power to fix drug costs under what is known as a ‘Drug Price Control Order’ (DPCO) issued by the government under the Essential Commodities Act.

The NPPA fixes ceiling prices of ‘scheduled drugs’ – the ones which are covered under India’s National List of Essential Medicines comprising currently 960 formulations of more than 350 drugs. A drug can have more than one formulation. These drugs cannot be sold at a cost more than what is sealed by the NPPA.

The drugs, the prices of which were increased on October 14, comprise medication like Salbutamol (used for asthma), Streptomycin powder for injection (used in case of tuberculosis), lithium (for bipolar disorder), and Pilocarpine eye drops (for glaucoma), among others. Their prices have been increased by 50% of their current ceiling.

The full list of these drugs is below:

As routine practice, the NPPA increases the ceiling prices every financial year starting April 1, on the basis of Wholesale Price Index (WPI) of the preceding year. For example, the NPPA allowed a price hike to the tune of 0.00551% for medicines to be sold from April 1, 2024, or thereafter, taking the WPI into account.

But on October 14, the NPPA cited ‘extraordinary’ circumstances to effect the 50% hike.

Section 19 of the DPCO gives power to the government to revise the ceiling cost, upwards or downwards, in addition to the annual routine practice. This can be done in extraordinary circumstances.

The Section 19 states:

“Notwithstanding anything contained in this order, the Government may, in case of extraordinary circumstances, if it considers necessary so to do in public interest, fix the ceiling price or retail price of any Drug for such period, as it may deem fit and where the ceiling price or retail price of the drug is already fixed and notified, the Government may allow an increase or decrease in the ceiling price or the retail price, as the case may be, irrespective of annual wholesale price index for that year.” [Emphasis added]

Govt’s rationale

The NPPA has stated that it has increased the prices in the larger public interest. It said that the drugmakers had approached it asking for revision in prices citing a few reasons like “increase in the cost of active pharmaceutical ingredients [ingredients needed to make a drug], cost of production, change in exchange rate, etc.”

The NPPA claimed that these factors have led to “unviability in sustainable production” of drugs, and some of drugmakers, according to it, had even applied for “discontinuation of some of the formulations on account of their unviability.”

The NPPA did not give any further details on this.

Dr Gurinder S. Grewal, a member of the Association of Doctors for Ethical Healthcare (ADEH), and former president of the Punjab Medical Council, said the government’s rationale misses various important details.

“For which of these drugs, on an individual basis, has the cost of production gone and by how much?” Grewal asked.

“What are the contributing factors for the cost of production going up specific to each drug?” Grewal further pressed, saying the rationale given by the government, without specifying these details, appears vague and opaque.

Also read: Prices of Ibuprofen, Paracetamol, Diabetes Drugs and Multivitamins Reduced

He added that these were “poor people’s drugs”, used against common diseases, and often taken for a long period of time for illnesses that are chronic.

The government’s own reports and surveys say that expenditure on medicines is the major driving factor of the escalating healthcare expenses.

Consistent expense, a drug on the decline

The latest National Health Accounts – a report released by the government last month – said out of the current healthcare expenditure, about one-third (30.84%) is incurred as ‘pharmaceutical expenses’. This includes prescribed medicines, over-the-counter drugs, those provided during inpatient or outpatient care, or any other way by which one seeks health services.

In fact among the 17 healthcare functions listed in the report, which included expenses on hospital admission or OPD care, it was on medicines (prescribed and over-the-counter) that people were spending the second highest. The highest expenditure was on in-patient care.

Dr Parth Sharma, a community physician and a public health researcher, questioned the inclusion of one particular formulation in the list of scheduled drugs – highlighting its declining utility in the treatment of the disease it works against.

“According to all the existing guidelines, the tablet formulation of salbutamol [used by asthma patients] should not be given as it is slower in action and is associated with significant side effects,” he said.

“Inhalers, which are known to work better, [instead of tablet form of salbutamol] are out of stock in most government hospitals and cost Rs 300-400 in private pharmacies, which make them unaffordable for poor people,” Sharma said.

Why a Diabetes Drug Fell Short of Anticancer Hopes

Population and animal studies suggested it could treat cancer, but the clinical trials were a bust. Here’s what happened and what potential may remain.

Pamela Goodwin has received hundreds of emails from patients asking if they should take a cheap, readily available drug, metformin, to treat their cancer.

It’s a fair question: Metformin, commonly used to treat diabetes, has been investigated for treating a range of cancer types in thousands of studies on laboratory cells, animals and people. But Goodwin, an epidemiologist and medical oncologist treating breast cancer at the University of Toronto’s Mount Sinai Hospital, advises against it. No gold-standard trials have proved that metformin helps treat breast cancer — and her recent research suggests it doesn’t.

Metformin’s development was inspired by centuries of use of French lilac, or goat’s rue (Galega officinalis), for diabetes-like symptoms. In 1918, researchers discovered that a compound from the herb lowers blood sugar. Metformin, a chemical relative of that compound, has been a top type 2 diabetes treatment in the United States since it was approved in 1994. It’s cheap — less than a dollar per dose — and readily available, with few side effects. Today, more than 150 million people worldwide take the stuff.

The French lilac, Galega officinalis, has been used medicinally since medieval times, including for symptoms associated with diabetes. Investigations of the plant’s chemical galegine led to the development of metformin, a related molecule synthesized in the lab. Photo: Wikimedia commons

Metformin has a variety of effects, such as improving immune function and the body’s responses to insulin, which in turn regulates blood sugar. It can also slow growth of cancer cells in the lab. Many of these benefits seem to stem from metformin’s action in the cell’s powerhouses, the mitochondria, where it slows the production of energy and limits the generation of damaging chemicals called free radicals.

Researchers have considered metformin for treating a plethora of conditions, from glaucoma to polycystic ovary syndrome to pimples. “It really has a reputation of being a potential wonder drug,” says Michael Pollak, an oncologist and researcher at McGill University in Montreal. “There’s still a lot of work to be done on metformin.” (Pollak consults for biotechnology companies interested in metformin analogs as medicines.)

But the latest research has convinced Pollak and some others that treatment of cancers should be taken off the list.

More studies, but no proof

One of the first hints linking metformin to anticancer effects came in a short note in the British Medical Journal in 2005. Researchers analyzed medical records of almost 12,000 people from the Tayside region of Scotland who were newly diagnosed with diabetes between 1993 and 2001. Of those, more than 900 went on to develop cancer. Interestingly, those who’d taken metformin at some point during the study period were 23 percent less likely to have received a later cancer diagnosis.

This finding fueled further research on people with diabetes taking metformin and the risk for breast cancer, liver cancer, ovarian and endometrial cancer, and other types. The authors of a 2013 analysis, covering more than 1 million patients in 41 observational studies like the original one, concluded that metformin “might be associated with a significant reduction in the risk of cancer.” But such associations are not proof.

Researchers went on to explore the link in studies with cells in dishes and in lab animals, finding that metformin slowed growth of blood, breast, endometrial, lung, liver, stomach and thyroid cancer cells. It also seemed to make cancer cells extra sensitive to chemotherapy drugs. In one mouse study, scientists grafted human breast, prostate or lung cancer cells into the animals and treated them with either standard chemotherapy drugs, metformin, or a combination of both. The combination worked best, preventing tumor growth and prolonging relapse.

These findings made sense to researchers. Metformin treats metabolic problems in diabetes, and cancer has also been linked to metabolic issues such as obesity. Even before the 2005 British Medical Journal study, Goodwin had noticed that breast cancer patients with high insulin did worse than those with normal insulin levels.

That logic, plus the promising data, led scientists to conduct a number of randomized controlled trials — the gold-standard experiment in medicine. Researchers would enroll people with cancer and split them into two groups. One group would get standard cancer therapy plus metformin; the other group would get standard therapy plus a placebo, a pill containing no medication.

And metformin flopped, big time. While a number of studies are ongoing, trials for two types of cancer recently reported no benefit overall from metformin. In June 2024, at the American Society of Clinical Oncology meeting in Chicago, researchers reported a Canadian trial with 407 men with low-risk prostate cancer. The enrollees had been diagnosed within six months before starting the trial and had decided to monitor their cancer without starting immediate treatment. Half took metformin and half took a placebo. After biopsies at 18 and 36 months to test whether their disease had progressed, there was no difference between the two groups.

A larger British and Swiss trial including nearly 1,900 patients with newly diagnosed or relapsed prostate cancer that had spread to other body parts was reported at the European Society for Medical Oncology Congress in Barcelona, Spain, in September. This trial also found that metformin plus standard treatment, compared to standard treatment alone, did not improve overall prostate cancer survival in the study population.

A multinational study of breast cancer helmed by Goodwin also led to disappointment. The researchers enrolled more than 3,600 patients between 2010 and 2013; these patients had been diagnosed about a year before enrollment and had already undergone chemotherapy and surgery. In addition to standard cancer treatment, half received metformin and half received a placebo.

By 2016, it was clear that metformin wasn’t doing anything to enhance survival for about 1,100 participants with a particular cancer subtype. When the study wrapped in 2020, the researchers analyzed the rest of the patients, counting how many were alive and free of breast or any other form of cancer. Metformin made no difference in those results, or to survival overall, the team reported in 2022.

Fatal flaws in the research

In retrospect, researchers think they know why earlier studies oversold metformin’s potential. Many of the studies that examined medical records had a crucial flaw, says Samy Suissa, a pharmacoepidemiologist at McGill.

Here’s what happens: Researchers sift through old medical records to see if someone ever took metformin. Then they compare cancer rates among people who took the drug at any point to those who never took it. But you have to be alive to take metformin. Anyone who died, of cancer or other causes, before having a chance at a metformin prescription is left out of the calculations. This skews the results; it’s called the “immortal time bias.” It makes any drug, metformin or otherwise, look like it helps patients to survive because it can only be taken by people who are alive, says Suissa.

Plus, scientists are more likely to publish studies that show metformin is promising than ones where it makes no difference, skewing the scientific literature.

As for those studies of cells in dishes and of lab animals, many experiments used much higher doses of metformin than are used in people. Too much metformin risks a buildup of lactate, a byproduct of low oxygen metabolism that acidifies the blood and can be fatal.

Researchers still suspect metformin might treat specific subgroups of cancer. For example, the authors of the prostate cancer trial presented in Barcelona suggested that metformin might help patients whose cancer has spread to other tissues or multiple sites in their bones. And Goodwin saw a hint in her trial that it might help women whose cancers contain a certain version of a cell-growth gene called ERBB2. But it would require another trial, focused on women with that particular cancer, to prove it.

And there are now better treatments for those patients than there were more than a decade ago when Goodwin started her study, reducing the opportunity to test metformin. Goodwin doesn’t currently have the funding to follow up on this theory.

It may also be that the clinical trials recruited patients with cancers that were too far along. “I always thought we were asking too much of metformin,” says Victoria Bae-Jump, a gynecological oncologist at the University of North Carolina Lineberger Comprehensive Cancer Center in Chapel Hill. “Maybe it just needs to be earlier in the pathway of growth.” Bae-Jump is now testing metformin in women who have early-stage endometrial cancer or a precursor to it.

Others are investigating metformin for people who have precancerous lesions in their mouths. “The idea would be to keep them from progressing, or reverse the tissues to be more normal,” says Frank Ondrey, a head and neck cancer surgeon at the Masonic Cancer Center of the University of Minnesota in Minneapolis. In a small, uncontrolled study of 23 people, metformin halved lesion size in four of them. Ondrey is involved in two ongoing studies, one a randomized, controlled trial, to further test metformin in people with precancerous lesions; these should yield results within a few years.

This article was originally published on Knowable Magazine.

Mental Health in the Union Budget 2024-25: A Step Forward, But Far from Enough

While the Economic Survey stressed on the importance of mental health initiatives, many key programs remain under-funded.

Today, October 10, is recognised as World Mental Health Day.

The Economic Survey for FY 2024-25, for the first time acknowledged the state of mental health in the country. It rightfully recognised mental health as not just a health but an economic issue – one that impacts productivity, economic mobility and health costs. The survey also emphasised a “positive policy momentum” providing tailwinds for action.

A day later, the finance minister announced the Union Budget 2024-25. In our annual Union Budget for Mental Health FY 2024-25 brief, we examined the various provisions for mental health in the budget to determine if the rhetoric was backed by action.

The budget for mental health is allocated by the Ministry of Health and Family Welfare (MoHFW) and Ministry of Social Justice and Empowerment (MoSJE). Over the last three years, this budget has remained stagnant, despite the growing concern around mental health issues in India, where 197 million people live with mental health conditions.

	Budget Estimates
Budget Head	2022-23	2023-24	2024-25
Total Government of India Budget (₹ in crores)	39,44,909	45,03,097	48,20,512
Total MoHFW budget (₹ in crores)	86,201	89,155	90,659
MoHFW budget as % of total budget	~2.2%	~2.0%	~1.9%
Total MoSJE budget (₹ in crores)	13,135	14,072	14,225
MoSJE budget as % of total budget	~0.33%	~0.31%	~0.30%
Direct mental health allocation under MoHFW and MoSJE (₹ in crores) (NIMHANS, LGB Regional Institute of Mental Health, TELE Manas and NAPDDR)*	991	1,230	1,314
Indirect mental health allocation under MoSJE (₹ in crores)	365	280	300
Total budget for mental health (Direct + Indirect) (₹ in crores)	1,156	1,510	1,614
Total mental health budget as % of MoHFW and MoSJE budget	~1.16%	~1.46%	~2%

Institutions get funding, programs lag behind

In this years’ budget, a substantial 91% of direct mental health spending was allocated to two centrally funded institutions, in continuation of a long standing trend. The National Institute of Mental Health and Neurosciences (NIMHANS) received a substantial Rs 850 crore, a rise of 18% from the previous year and double the amount (Rs 434 crore) it received in FY 2020-21.

On the other hand, the National Tele-Mental Health Programme’s (TELE Manas’) budgets were slashed by 33%, from Rs 134 crore in FY 2023-24 to Rs 90 crore this year. This reduction is concerning, given its potential to provide scalable, accessible mental health services across the country. In over a year since its launch, TELE Manas handled over 12 lakh calls, demonstrating a clear demand for services. The decline in funding is attributed to a shift in financial responsibility to the states after initial capital costs. This move risks undermining the program’s impact.

Source: Budget documents.

Similarly, the National Mental Health Programme (NMHP), a flagship initiative is facing budgetary obscurity. Since FY 2022-23, NMHP’s tertiary level funding has been subsumed under the broader Tertiary Care Programme (TCP). Although the budget for TCP has increased in FY 2024-25, it remains unclear how much is allocated for NMHP due to a lack of disaggregated data. For the District Mental Health Programme, approved for 767 districts, central-level funding cannot be traced in the budget.

While the Mental Health Care Act (MHCA), 2017 highlights the need to transition from institutional services to community-based mental health care and rehabilitation, the budgetary allocations do not reflect this.

The National Action Plan for Drug Demand Reduction (NAPDDR), launched by MoSJE in 2018, aims to treat, rehabilitate and socially reintegrate individuals with substance use conditions.

For FY 2024-25, the program’s budget is Rs 314 crore, a slight increase from the previous year. The Deendayal Disabled Rehabilitation Scheme (DDRS) and the Scheme for Implementation of Persons with Disabilities Act (SIPDA) under MoSJE play a vital role in supporting rehabilitation and inclusion for people with mental health conditions.

The DDRS, which funds non-profits for psychosocial rehabilitation, saw a 28% budget increase to Rs 165 crore, while SIPDA faced a 10% cut. However, overall program funding has stagnated in recent years.

Watch | Mental Health Disorders: The Unseen Epidemic

Factors affecting mental health

Mental health cannot be addressed in isolation as it is deeply intertwined with socio-economic factors like poverty, unemployment, and food security. The link between financial distress and mental health is stark, with 7% of all suicides in 2022 attributed to poverty, unemployment, and debt.

The Economic Survey acknowledges that socio-economic stressors exacerbate mental health conditions. To combat poverty, we need strong social protection and livelihood security programs. Unfortunately, this year’s budget has seen cuts to the Pradhan Mantri Garib Kalyan Anna Yojana, and the share of spend on Mahatma Gandhi National Rural Employment Guarantee scheme (MGNREGA) has fallen from 2.1% of the total budget in FY 2018-19 to only 1.3% in FY 2023-24. This, despite rising unemployment and income inequality in the country. Such budget cuts threaten the essential protection systems needed to enhance mental health outcomes.

The disconnect between allocation and action

Even where funds are allocated, poor utilisation hampers progress. Consider the case of NAPDDR. While it has received higher budgetary allocations – up from Rs 280 crore in FY23-24 to Rs 314 crore in FY 2024-25 – the actual utilisation of these funds has been consistently low. For instance, in FY 2022-23, only 48% of the allocated budget was spent, reflecting inefficiencies that hinder implementation.

This trend is visible across many mental health initiatives. In FY 2022-23, MoSJE used only 66.3% of its budget, highlighting the gap between intent and execution. Without improving budget utilisation, even increased allocations will not translate into meaningful progress.

The way forward

The inclusion of mental health in the Economic Survey is a promising step, but it must be backed by concrete policy action and increased funding.

While the survey has put mental health on the national agenda, the Union Budget 2024-25 does not reflect the urgency required to tackle the crisis. Budgetary allocations for community-based care remain inadequate, and the broader socio-economic issues that drive poor mental health outcomes need more attention and funding. For India to make meaningful progress in mental health outcomes, the government must commit to providing accessible, affordable, quality and rights-based services and schemes.

*NIMHANS budget includes funds for psychiatry and neurology with no further information available.

Sayali Mahashur is a research associate and Tanya Nicole Fernandes and Sneha Kaushal are research fellows at the Centre for Mental Health Law & Policy, Indian Law Society, Pune.

Why We Aren’t Comfortable Acknowledging Suicides: The Story of My Brother

In my family, mental health was never a stigma. Yet, we failed to recognise the warning signs in my brother.

Today, October 10, is World Mental Health Day.

It was exactly 12.59 pm on November 26, 2022, when my phone rang. It was a call from Prague. It was brief but shattered my existence forever. I was informed of the unbearable truth that my elder brother had been found dead the previous day. No matter how unbelievable the news, I fiercely wished it was a mistake. But fate had brushed against our lives, leaving behind an emptiness that words can scarcely capture. With that call, the world had ceased to make sense.

The news was just the beginning, little did I know what awaited. It took me 39 days to get the autopsy report, which confirmed that he died by suicide. It took 50 days to repatriate him back to India for the cremation.

Since my senses have been restored, I have been wondering which is the more plaguing thought – that my brother is gone or that he died by suicide. Or perhaps it is the reality of society that I was not fully aware of, which has driven me to speak out. I would like to talk about the immense suffering and pain that is caused by the stigma, ignorance, and apathy that surrounds suicide and how this impacts those who are suicidal, suicide survivors, and those who lose their loved ones to suicide.

The author’s brother, Jayanta, in Prague. Photo: By arrangement.

In my family, mental health was never a stigma. Yet, we failed to recognise the warning signs in my brother, due to their unconventional nature. In his final hours, my brother was ignored by everyone he reached out to for help. Even though it was abundantly clear that he was not well and his statements were alarmingly concerning, no one bothered to follow up, offer assistance, or stay with him during those difficult times. I am setting aside the complexities and multi-level failures involved in driving him to that point. He didn’t fail. His family failed, and the entire society failed.

I am a software engineer in Bengaluru. I grew up in a small town named Krishnanagar in West Bengal. The town may not have been as advanced as Metro cities, but thanks to my brother, my childhood was filled with opportunities that few others had.

Jayanta, my brother, was a Prague-based board-certified doctor recognised by the Medical Council of India and the Medical Council of the Czech Republic, European Union. He was also a qualified nutritionist, a certified fitness trainer, and a bodybuilding instructor recognised by the Ministry of Education, Youth, and Sports in the Czech Republic. Long before any titles came his way, he was a hero to me. What really mattered to him was helping people and leaving an impact. He was the strongest and most optimistic person I knew. He defied convention and never fitted societal norms. His extroverted persona, profound multidisciplinary knowledge, and charming character always ensured that he was surrounded by people.

Since his passing, the people around him have vanished. Those who once relied on him for immediate health solutions began to view him as a failure.

A home that was always filled with visitors when my brother was alive saw no one from his school, college, professional life, or network after his departure. None of his friends – including those who he had contacted in his last hours – attended his funeral, nor did they visit our house. I am certain that this is because they heard that he died by suicide.

This is not just my brother’s story. Many other Jayantas who die by suicide are perceived as losers. It is a stigma beyond comprehension.

Every year, 1.7 lakh Indians die by suicide. Suicide is one of the leading causes of death globally among individuals aged 15-39. Till recently, attempting suicide was considered a crime. Those who did so were considered selfish, cowardly, losers, and so on. Those who die by suicide do so because they feel helpless, hopeless, worthless, and trapped with no way out. They simply want to end the immense emotional pain they are feeling – a pain that may not allow them to sleep, eat, or live a normal life.

Not all suicides stem from mental illness. Suicide occurs due to multiple risk factors, is a complex phenomenon, and may be triggered by sudden rejections, relationship issues, substance abuse, chronic illness, significant events, or external socioeconomic pressures. Getting help at the right time can help prevent suicides. What is most disheartening is that people who are pushed to such extremes are looked down upon instead of asking how we can provide better support. Do we hold the same view for cancer patients who die?

For those suicidal, only therapy and medication may not suffice. A robust support system is essential to provide ongoing assistance for those facing severe challenges. Unfortunately, guidelines or protocols for effective support are seldom shared. Additionally, psychiatrists frequently overlook discussing the potential side effects of prescribed medications. It is unacceptable not to inform patients that antidepressants could exacerbate depression or lead to suicidal ideation, even if the risk is minimal.

What my family endured should not happen to anyone else. And it starts with learning how to recognise signs of suicide and respond with care and kindness. Like the evidence-based suicide prevention “gatekeeper training” that the World Health Organization’s (WHO) recommends. Training gatekeepers will help spot signs, provide support, and persuade those who are suicidal to get help.

While transforming fundamental, deep-rooted beliefs is challenging and requires openness and willingness the key to success may lie in shifting individual perceptions for the better. There was a time when AIDS, menstruation, cancer, or leprosy, were considered taboo or steeped in stigma and those who were suffering didn’t get help. Since suicide is a public health crisis that impacts us all, we need a mass public service campaign that is spearheaded by the government and supported by civil society. As the theme for World Suicide Prevention Day (2024-26) reminds us, the narrative around suicide needs to change and we need to start the conversation now. The journey ahead is long, but the first step could start today to help those suicidal and those families who have lost their loved ones.

Jayeta Biswas is a software engineer.

If you know someone – friend or family member – at risk of suicide, please reach out to them. The Suicide Prevention India Foundation maintains a list of telephone numbers they can call to speak in confidence. Icall, a counselling service run by TISS, has maintained a crowdsourced list of therapists across the country. You could also take them to the nearest hospital.