British Medical Journal \2011; 342:d262 doi: 10.1136/bmj.d262 (Published in online version 19 January 2011) Pending publication in printed issue of January 22, 2011 EDITORIAL
The life imprisonment of Dr Binayak Sen Last month a district court of the state of Chattisgarh in central India sentenced Dr Binayak Sen, Indian paediatrician, public health practitioner, and human rights activist, to life imprisonment in a maximum security cell. He was pronounced guilty of sedition and conspiracy against the state.1 This harsh sentence is particularly paradoxical because Sen was recently recognised by the same state as a respected figure in health and social planning, and last year he was given the Jonathan Mann Award for Health and Human Rights from the Global Health Council. His crime according to the judgment was being a collaborator for the underground Maoist movement that is active in the newly created state of Chattisgarh, which has a large indigenous (Adivasi) population, an abundance of forests and natural resources, but economic and health deprivation. Sen, a community physician, and his wife Ilina are known for their work in primary healthcare among mine workers and indigenous communities. Sen’s commitment to tackling the deeper social determinants of health has now brought him into conflict with the state. Moving beyond the biomedical and clinical model of healthcare,2 Sen began to deal with deprived living conditions, poor education in children, and alcoholism, and he found it impossible to disassociate these from the need for community empowerment, political accountability, and ownership of natural resources. He documented the levels of starvation in the state,3 and as an active member of the People’s Union for Civil Liberties he participated in fact finding missions on violations of rights by state forces and systems, including a state sponsored armed people’s militia. He provided medical and legal assistance to people who were undergoing trial, including alleged militants, always under supervision of the state authorities. This made him a ready target for accusation of conspiracy by the state, which recently armed itself with an antiterrorist law that goes far beyond the national act. Sen, who has been a critic of both Maoist and state violence now finds himself convicted under a section of the penal code that was used by the British in colonial times to convict Gandhi.4 The recent judgment has received worldwide condemnation. Global voices have included statements by Nobel laureates Noam Chomsky and Amartya Sen,5 Amnesty International,6 the Global Health Council,7 Human Rights Watch, and Physicians for Human Rights, and other commentators.4 8 At a national level, an upsurge of solidarity has included meetings and vigils in all the major cities of India and statements by eminent jurists, professionals, and activists. Although the state has attempted to portray him as dangerous, Sen is following in the footsteps of generations of social physicians. Like Virchow in an earlier century, others in more recent years, and charters of health movements,9 he focuses on the social, economic, and political roots of ill health. Recent prescriptions from the World Health Organization on primary healthcare and the social determinants of health have strengthened action towards equity, rights, and social determinants of health, just the areas that Sen focused on.10 11 This misconceived and vindictive application of state power requires international action. Professional societies in India have an opportunity to reflect on the larger social and political role of doctors and to express their support for Sen. Supporters in other countries could urge their government to apply diplomatic pressure towards justice for Sen and call for a review of Indian laws on sedition, which have lent themselves to such abuse. In today’s economically driven society, commerce drives international relations. Foreign direct investment in India is often in mining industries in states such as Chattisgarh, which have rich natural resources. Ultimately, such investment comes from shareholders. Better awareness of how shareholders’ money may drive state policies to the detriment of the disadvantaged could redirect investment towards more ethical and equitable projects, especially where funds belong to charitable or philanthropic institutions. Finally the implications for those who are tackling the social determinants of health must be considered, and we need to enhance our collective voice against all instances where doctors and health workers are targeted by ruling elites and vested interests. It is ironic that one of Sen’s last public appearances before his incarceration was at the release of a book that was a critique of current medical practice and new paradigms of action.12 Notably, in an expeditious response, the joint Committee on Human Rights of the US National Academy of Sciences, National Academy of Engineering, and Institute of Medicine has expressed its reservations about the conviction of Sen and its hope for his “full exoneration” (personal communication from the chairperson of the committee, 2011). By P Zachariah, Retired professor of physiology1, Ravi Narayan, Community health adviser2, ([email protected]<chcravi%40gmail.com>) Rakhal Gaitonde, National co-convenor3, Sara Bhattacharji, Professor4, Anand Zachariah, Professor of medicine1, Thelma Narayan, Coordinator5 Author Affiliations 1Christian Medical College, Periyar Nagar, Vellore 632 002, India 2Society for Community Health, Awareness, Research, and Action, Bangalore, 560 034, India 3Medico Friend Circle and Community Health Cell, T Nagar, Chennai, 600 017, India 4Community Health and Development, LCEU/CHAD, Christian Medical College, Vellore 5Centre for Public Health and Equity, Koramangala, Bangalore, 560 034, India References Mudur G. Civil rights groups decry conviction of Indian paediatrician who pioneered community health. BMJ2010;341:c7438. Sathyamala C. Binayak Sen: redefining healthcare in an unjust society [editorial]. Indian J Med Ethics2007;4:104-5. People’s Union for Civil Liberties—Chattisgarh. Investigation report on hunger deaths of Dantewada and Bastar districts 2004 as reproduced in: Indian doctor in jail. The story of Binayak Sen. A report to the nation by doctors in defence of Binayak Sen, Promilla & Co, in association with Bibliophile Asia, 2008:79-82. Anonymous. Binayak Sen’s conviction: a mockery of justice. Lancet2011;377:98. Das SM. Verdict politically motivated. The Times of India2011 Jan 9. http://timesofindia.indiatimes.com/india/Verdict-politically-motivated/articleshow/7244875.cms#ixzz1AptnHLCS. Amnesty International. India: Dr Binayak Sen’s conviction and life sentence mock justice. 2010. www.amnesty.org/en/for-media/press-releases/india-dr-binayak-sens-conviction-and-life-sentence-mock-justice-2010-12-24. Global Health Council. Global Health Council calls for immediate release of Dr Binayak Sen, physician and human rights advocate. 2010. www.globalhealth.org/news/article/13148. Sharma K. Binayak Sen: India’s war on a man of peace. Guardian2010 Dec 28. www.guardian.co.uk/commentisfree/libertycentral/2010/dec/28/binayak-sen-india-british-gandhi . People’s Health Movement. People’s charter for health. 2000 www.phmovement.org/files/phm-pch-english.pdf. WHO. World Health Report 2008—primary health care (now more than ever). 2008. www.who.int/whr/2008/en/index.html. Commission on Social Determinants of Health. Closing the gap in a generation: WHO, 2008. www.searo.who.int/LinkFiles/SDH_SDH_FinalReport.pdf. Zachariah A, Srivatsan R, Tharu S, eds. Towards a critical medical practice: the dilemmas of medical culture today. Orient Blackswan, 2010. Related Article in BMJ News: Civil rights groups decry conviction of Indian paediatrician who pioneered community health Ganapati Mudur BMJ 341:doi:10.1136/bmj.c7438 (Published 30 December 2010) --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- On 1/20/2011 10:09 PM, Kamayani wrote: hi can u copy paste text i cannot access :- ( On Thu, Jan 20, 2011 at 9:59 PM, Rakhal Gaitonde <[email protected]>wrote: > Dear Friends, > > Please follow the link to see the editorial in the latest edition of the > BMJ on Binayak. It is online just now and will appear in the print version > on Saturday. > > > http://www.bmj.com/content/342/bmj.d262.full.html?ijkey=su8HFo4U44rQHnz&keytype=ref<http://www.bmj.com/content/342/bmj.d262.full.html> > > > rakhal > > -- > Rakhal Gaitonde > Co-Convenor > medico friend circle > +91 9940246089www.mfcindia.org > > -- Adv Kamayani Bali Mahabal +919820749204 skype-lawyercumactivist * * *"Nobody is giving up violence. Neither the state nor the Maoists are giving up violence. I am interested in furthering my cause, which is the cause of peace with justice.- DR BINAYAK SEN * *www.binayaksen.net* *PL SIGN ONLINE PETITION: * http://www.petitiononline.com/sen2010/petition.html *DO JOIN THE FACEBOOK GROUP * *http://www.facebook.com/group.php?gid=14205312918* *JOIN THE FACEBOOK EVENT: ONE MILLION FACES http://www.facebook.com/event.php?eid=179177728772740* * * * * -- Rakhal Gaitonde Co-Convenor medico friend circle +91 9940246089www.mfcindia.org -- Adv Kamayani Bali Mahabal +919820749204 skype-lawyercumactivist * * *"Nobody is giving up violence. Neither the state nor the Maoists are giving up violence. I am interested in furthering my cause, which is the cause of peace with justice.- DR BINAYAK SEN * *www.binayaksen.net* *PL SIGN ONLINE PETITION: * http://www.petitiononline.com/sen2010/petition.html *DO JOIN THE FACEBOOK GROUP * *http://www.facebook.com/group.php?gid=14205312918* *JOIN THE FACEBOOK EVENT: ONE MILLION FACES http://www.facebook.com/event.php?eid=179177728772740* * * * * -- You received this message because you are subscribed to the Google Groups "humanrights movement" group. To post to this group, send email to [email protected]. To unsubscribe from this group, send email to [email protected]. For more options, visit this group at http://groups.google.com/group/humanrights-movement?hl=en.
