In his poignant film Nero’s Guests,1 historian P. Sainath describes Tacitus’ account of the burning of Rome in 64 A.D. As Rome was engulfed in civil unrest, Emperor Nero opened his gardens to throw the grandest party the ancient world had seen, as a distraction for those who wielded both power and influence. There was music and fanfare. And to provide ‘nightly illumination’, Nero brought in Christian prisoners and mercilessly set them on fire—scholars and educated elite made merry amidst piercing screams through the inferno.
Last week, as Donald Trump’s motorcade made its way to meet Prime Minister Modi in India, it zoomed past a giant wall, hastily put together in order to hide a large slum. Paid dancers distracted the President so as to not pay heed to the discontent that simmered beyond the barricades. Lavish banquets were held by Modi while his own party spokespersons fanned the flames of pogrom.
For the past week, Delhi has witnessed riots over the controversial Citizenship Amendment Act (CAA) passed by Modi’s government—a piece of legislation that attempts to strip Muslims of their citizenship, and their dignity. It has created a public health disaster, with essential care being restricted, or denied entirely, to anyone who belongs to the Muslim community or protests the act.2 Reminiscent of state-led genocides throughout history, this too may yet unfold—as though supported by us, complacent and, by extension, complicit.
At the time of writing, the capital continues to burn in communal violence, with at least forty lives lost. Countless have been displaced, sowing seeds of unrest and hatred that will take generations to soothe. Modi’s failures as an authoritarian are on display in every direction, for those that care to look. In the North Eastern regions, where the law has been enacted, detention centres are being built where erstwhile citizens are being imprisoned in modern day gulags.3 The lives of people are palpably in danger, a demonstrable public health problem. Yet Modi and his government are quick to dismiss conscience-stricken scientists and advisors, to denounce data, promote religious dogma, and avoid press conferences.4
Such wanton disregard for expert opinion has public health repercussions that are borne by communities. These are often long term and far-reaching. India spends only 1.28% of GDP on public health issues in order to tackle its giant burdens of pollution, hunger, of maternal deaths and childhood stunting.5 Civil unrest further threatens to worsen these numbers. This raises broader questions on the role of physicians in politics: the need for a collective voice acting in the best interests of the public and their health.
As physicians, we have a sacrosanct duty. We refer to evidence-based national and international guidelines when it comes to improving patient’s chances—sometimes by a fraction of a percent. We unabashedly ask our patients to change their habits, their diets, their natural remedies, and disrupt their ways of life to impact their outcomes. Yet, astoundingly, we rarely address what is likely to be a significant contributor to their well-being: their vote. And this is where we might be failing them. Perhaps evidence-based recommendation of political candidates is as important as asking our patient to take their pills.
Political will is the greatest mover of public health metrics all around the world and indeed, our apathy towards politics is arguably the greatest threat to public health. That we have elected enemies of reason and such peddlers of half-truths as Trump, Bolsonaro, Modi, Morrison, and Boris Johnson has meant we have ostensibly threatened entire continents with poorer health outcomes, wars, and environmental disasters through various policies that ignore health data, promote inequity, dismantle publicly funded healthcare systems, and incite violence and pogrom. I am forced to wonder whether my patient’s vote has the potential to contribute to their own and others’ well-being in equal or greater measure than any therapeutic interventions that I can administer.
It is within the gamut of our duties as public health advocates and practitioners to raise the alarm on issues that threaten the wellbeing of our communities. This includes preventing abuses of human rights, of threats to health systems, disruptions to the environment, and perpetuation of the cycle of poverty and illness. We are sworn to not just do good, but also to actively prevent harm. How does one get a clearer understanding on whom to vote for? Where is the objective data that might help us make an informed choice?
A clarion call needs to be sounded for evidence-based political accountability for public health. A credit score, if you will, that takes into account the political body’s previous and promised records on various aspects of health at a local as well as broader level. A grade, by which voters know whom to support, and one which our politicians might aspire towards to meet the needs of populations.
If an independent, multilateral, objective body were able to assign this kind of score to politicians and political entities, we might be able to form a collective consensus on who is best for health metrics at the ballot. Helping choose a government that does not undo carefully established public health initiatives or destroy my patients’ lives is probably the biggest difference I can make—not only for my own community, but also for the world. We must call upon experts in health economics and our political scientists to come together to devise such an instrument, for it to be used more widely in our discourse. If we can come up with complex metrics to predict stock market stability, borrowing power of nations, development indices, then surely such a health-credit rating for political stakeholders is possible.
Because our individual and collective public health actions on changing patients’ behaviors over many years of practice can be so easily washed away by a rogue decision by political forces, the call could not be more urgent. Electing a government in Delhi, for instance, that does nothing about the pollution crisis counteracts decades of anti-smoking measures in a single season. Unwittingly voting for fascists, for another, is tantamount to a collective negligence—and is inexcusable.
When telling the story of Rome, P. Sainath remains apathetic about Nero (the man was, after all, mad) alleging that history has ‘many contenders for cruelty’s crown’. What was puzzling for him, however, was the complicity of the scholarly guests, who popped figs in their mouths and sipped wine as the human pyres were lit.
1. Sainath, P. “Nero’s Guests” (2009). ARTE Productions in Association with Oktober.
2. Ayyub R, “Narendra Modi Looks the Other Way As Delhi Burns” (2020, February 28), Time Magazine. Retrived from: https://time.com/5791759/narendra-modi-india-delhi-riots-violence-muslim [Last accessed: 1 March 2020].
3. Pradhan, B. “Millions in India Could End Up in Modi’s New Detention Camps. Bloomberg News. (2020, February 20) Retrieved from: https://www.bloomberg.com/features/2020-modi-india-detention-camps/[Last accessed 29 February 2020].
4. Mohanty SK, Ladusingh L, Kastor A, Chauhan RK, Bloom DE. 2016 Pattern, growth and determinant of household health spending in India, 1993–2012. J Public Health. 24(3):21529. http://dx.doi.org/10.1007/s10389-016-0712-0
5. “Why PM Narendra Modi Avoids The Media (2017, June 10) Financial Express. Retrieved from: https://www.financialexpress.com/india-news/why-pm-narendra-modi-avoids-the-media/711155/ [Last accessed 2 March, 2020].
Rahul Gandhi