Category Archives: Health/Medical

Our Opponents’ Actions Show We’re Winning

The People United Will Never Be Defeated from the Free Farm

When in the midst of mass social transformation, it is often hard to see progress until you have the benefit of looking back after success has been achieved. One way we measure success is by recognizing the growing popular movements across multiple fronts of struggle. Another way is by observing the actions of our opponents.

Just as movements organize and develop a strategy to build power, our opponents do the same to weaken popular power. Classic signs that a movement is getting closer to achieving victories are when our opponents try to co-opt the movement, mislead the movement, adopt the language of the movement and position themselves to claim they always supported the goals of the movement, called “victorious retreat.”

In our sixth class on How Social Transformation Occurs, we examine the obstacles that movements confront in achieving social change. One of the tasks of the movement in this stage is to achieve national consensus and overcome the obstacles of the power holders.

Co-Option Can Be Turned To The Movement’s Advantage

New resistance movements have emerged since the Occupy Movement rose up in 2011, including the Fight for 15, Black Lives Matter and Idle No More, to name a few examples of many. Popular Resistance grew out of the Occupy Movement as a vehicle to report on, monitor and help grow the resistance movement.

With the election of Donald Trump, a new “resistance” developed. One example is Indivisible, the activist group rooted in the Democratic Party, which was organized by former Democratic staffers. In May 2017, the biggest Democratic “resister” of them all announced her plans, as reported by CNN, “Hillary Clinton officially announced Monday her post-2016 election plans: A political organization aimed at funding “resistance” groups that are standing up to President Donald Trump.” It is called “Onward Together.”

Clinton lost the presidency because she was an establishment candidate running in an anti-establishment electoral year. The Clinton Foundation was a foundation funded by millionaires and billionaires as well as big business and trans-national corporations. She epitomizes what people are organizing against, yet now she calls herself a leader of the resistance.

It is sadly amusing but ironically makes the point that the resistance is winning. We have grown since 2011 to the point that establishment-elites want to claim to be part of the resistance.  Our job is to let those who joined groups like Indivisible and Onward Together know there is a genuine resistance that Democrats are emulating, which stands for true transformation and rejects the policies of Hillary Clinton and the economic and political elites she and both Wall Street parties represent.

Photo from Education Votes

Stealing Our Language, Another Sign That Victory Is Close

On multiple issues, those in the power structure of elected officials and their think tanks are stealing the language of the movement.

One example is the campaign for National Improved Medicare for All (NIMA). We use that specific language because every word describing it matters. Those who want to protect the status quo use the word “Medicare” to describe fake solutions that do not achieve the real goal. The Center for American Progress, the top Democratic Party think tank that is funded in part by the insurance industry and healthcare profiteers, has put forward “Medicare Extra for All.” This is not NIMA but a public option using the popular word Medicare to fool people. Another fake Democratic plan is a “Medicare Buy-In” or plans that would lower the age for Medicare. These are all false solutions.

Democrats are pushing NIMA-sounding like approaches because 85% of Democratic party voters support a national single-payer system based on improved Medicare. Republicans and businesses are also moving in this direction. If the movement does its job well, by the early 2020s there will be a national consensus across political affiliations and ideologies in support of the solution to the US healthcare crisis, National Improved Medicare for All. Learn more about this at HealthOverProfit.org.

Healthcare is one example. This week, the people of Missouri rejected another false policy put forward by big business in a disguise called “Right to Work.” By a landslide vote, the people of Missouri rejected a right to work voter initiative, which would have eroded workers’ rights to collective bargaining.

This vote comes at a time when the nation needs a national renaissance of worker power. It is time for unions to remake themselves after 80 years of decline. Unions need to become democratic in structure rather than hierarchical. Unions need to do two things to recover from decades of setbacks: (1) break from the Democratic Party and build independent political power, and (2) they need to represent all workers and communities, not just members of their union.  The recent teachers’ strikes which occurred in multiple states showed teachers going beyond the limits set by unions. UPS, where workers voted 92% for what would be the largest strike in US history, is in the throes of debating a new contract, which Teamsters for a Democratic Union believes sells out UPS workers.

Another example is the constant killings of black and brown people by police across the country. National consensus is developing against this brutality thanks to Black Lives Matter and others, as can the ‘take a knee‘ protests in the NFL. Despite pressure from President Trump and team owners, players are continuing to take action against racist policing by patriotically taking a knee during the singing of the national anthem.

Police violence against black and brown people is a long-term problem, going back decades.  In the era of Bill Clinton, the phony solution of community policing was put forward.  It is phony because it failed to give power to the community to reject police who have demonstrated racism and violence. What is needed is community-control of police and community-based solutions to crime and violence. When the people are in control, then the police will do what they should be doing, and some claim to be doing (and some officers actually try to do in a system that does not work) — serve the community.

From Medium ‘How to Build a Movement of Movements.’

Unity, Solidarity and a Movement of Movements Are Keys to Success

The most powerful tactic of the opposition is to divide the movement. The corporate-CIA group, Stratfor, most clearly described this strategy. They divide activists into four types of people: “radicals, idealists, realists, and opportunists.” Their strategy to defeat social movements is to isolate the radicals, offer the opportunists money and access to elected officials, convince the realists to compromise on a non-solution and push idealists to see their ideal cannot be achieved and accept something that looks like a step toward the ideal. The key group is the radicals, who focus on the root of the problem, push necessary transformational solutions and refuse to compromise. Movements need to make a place for radicals and listen to their views so as not to be taken off track.

The problem is that the current system does not work for people but is designed to work for the economic elites. There may be good people in the system, trying to do the right thing, but they cannot overcome the system by working from the inside.

The movement must work to pull people from inside the system into the movement. A police officer’s family needs National Improved Medicare for All.  A black police officer’s son will face racism from police officials just like any other black youth. Youth face outrageous tuition, school debt and wages too low to live on. Business owners know their employees would benefit from health care for all and that they can’t compete with businesses in nations that have national healthcare programs. People in the media see the misleading reporting they are required to produce to advance in their careers and know this is not why they wanted to become a journalist. There are people in every segment of the power structure that see the problems and want to help put in place solutions.

Drawing people to the movement is one of the tactics in building national consensus and a movement that represents all the people while weakening the power structure. We need to develop strategies to keep movements unified, bring people into the movement and connect our different fronts of struggle to build a movement of movements.

We have written about how the next decade provides an opportunity for tremendous social transformation that puts in place progressive policies to meet the necessities of the people and protection of the planet. The people in power also see that change is coming, movements are growing and the status quo is unable to deal with multiple crisis situations that cannot be ignored.

Transformation is on the horizon if we remain clear in our vision for economic, racial and environmental justice, pull people to the movement from the power structure and undermine the tactics of those trying to co-opt, mislead and divide.

Together, we can create transformational change. We are closer than we realize.

Important Update on the Zionist Storming of the Gaza Freedom Flotilla, Al Awda, by Doctor on Board

Events from 29 July when the Israeli Navy stormed the Freedom Flotilla al-Awda hijacked and diverted it from its intended course to Gaza to Israel.

*****

The last leg of the journey of al-Awda (the boat of return) was scheduled to reach Gaza on 29 July 2018. We were on target to reach Gaza that evening. There are 22 on board including crew with US $15,000 of antibiotics and bandages for Gaza. At 12.31 pm we received a missed call from a number beginning with +81… Mikkel was steering the boat at that time. The phone rang again with the message that we were trespassing into Israeli waters. Mikkel replied that we were in International waters and had right of innocent passage according to maritime laws. The accusation of trespassing was repeated again and again with Mikkel repeating the message that we were sailing in international waters. This carried on for about half an hour, while Awda was 42 nautical miles from the coast of Gaza.

Prior to the beginning of this last leg, we had spent two days learning non-violent actions and had prepared ourselves in anticipation of an Israeli invasion of our boat. Vulnerable individuals, especially those with medical conditions, were to sit at the rear of the top deck with their hands on the deck table. The leader of this group was Gerd, a 75 year old elite Norwegian athlete and she had the help of Lucia a Spanish nurse in her group.

The people who were to provide a non-violent barrier to the Israelis coming on deck and taking over the boat formed 3 rows – two rows of threes and the third row of two persons blocking the wheel house door to protect the wheel house for as long as possible. There were runners between the wheel house and the rear of the deck. The leader of the boat Zohar and I were at the two ends of the toilets’ corridor where we looked out at the horizon and informed all of any sightings of armed boats. I laughed at Zohar and said we are the Toilet Brigade, but I think Zohar did not find it very funny. It was probably bad taste under the circumstances. I also would be able to help as a runner and would have accessibility to all parts of the deck in view of being the doctor on board.

Soon we saw at least three large Israeli warships on the horizon with 5 or more speed boats (zodiacs) zooming towards us. As the Zodiacs approached I saw that they carried soldiers with machine guns and there was on board the boats large machine guns mounted on a stand pointing at our boat. From my lookout point the first Israeli soldier climbed on board to the cabin level and climbed up the boat ladder to the top deck. His face was masked with a white cloth and following him were many others, all masked. They were all armed with machine guns and small cameras on their chests.

They immediately made to the wheel house overcoming the first row by twisting the arms of the participants, lifting Sarah up and throwing her away.  Joergen, the chef, was large to be manhandled so he was tasered before being lifted up. They attacked the second row by picking on Emelia the Spanish nurse and removed her thus breaking the line. They then approached the door of the wheel house and tasered Charlie the first mate and Mike Treen who were obstructing their entry to the wheel house. Charlie was beaten up as well. Mike did not give way with being tasered in his lower limbs so he was tasered in his neck and face. Later on I saw bleeding on the left side of Mike’s face. He was semi-conscious when I examined him.

They broke into the wheel house by cutting the lock, forced the engine to be switched off and took down the Palestine flag before taking down the Norwegian flag and trampling on it.

They then cleared all people from the front half of the boat around the wheel house and moved them by force and coercion, throwing them to the rear of the deck. All were forced to sit on the floor at the back, except Gerd, Lucy and the vulnerable people who were seated around the table on wooden benches around her. Israeli soldiers then formed a line sealing off people from the back and preventing them from coming to the front of the boat again.

As we entered the back of the deck we were all body searched and ordered to surrender our mobile phones or else they will take it by force. This part of search and confiscation was under the command of a woman soldier. Apart from mobile phones, medicines and wallets were also removed. No one as of today (4 August 2018) got our mobile phones back.

I went to examine Mike and Charlie. Charlie had recovered consciousness and his wrists were tied together with plastic cable ties. Mike was bleeding from the side of his face, still not fully conscious. His hands were very tightly tied together with cable ties and the circulation to his fingers was cut off and his fingers and palm were beginning to swell. At this stage the entire people seated on the floor shouted demanding that the cable ties be cut. It was about half an hour later before the ties were finally cut off from both of them.

Around this time Charlie, the first mate, received the Norwegian flag. He was visibly upset telling all of us that the Norwegian flag had been trampled on. Charlie reacted more to the trampling of the Norwegian flag than to his being beaten and tasered.

The soldiers then started asking for the captain of the boat. The boys then started to reply that they were all the captain. Eventually the Israelis figured out that Herman was the captain and demanded to take him to the wheel house. Herman asked for someone to come with him, and I offered to do so. But as we approached the wheel house, I was pushed away and Herman forced into the wheel house on his own. Divina, the well known Swedish singer, had meanwhile broken free from the back and went to the front to look through the window of the wheel house. She started to shout and cry “Stop! Stop! They are beating Herman. They are hurting him”.  We could not see what Divina saw, but knew that it was something very disturbing. Later on, when Divina and I were sharing a prison cell, she told me they were throwing Herman against the wall of the wheel house and punching his chest. Divina was forcibly removed and her neck was twisted by the soldiers who took her back to the rear of the deck.

I was pushed back to the rear of the boat again. After a while the boat engine started. I was told later by Gerd who was able to hear Herman tell the story to the Norwegian Consul in prison that the Israelis wanted Herman to start the engine, and threatened to kill him if he would not do so. But what they did not understand was that with this boat, once the engine stopped it can only be restarted manually in the engine room in the cabin level below. Arne, the engineer, refused to restart the engine, so the Israelis brought Herman down and hit him in front of Arne making it clear that they will continue to hit Herman if Arne would not start the engine. Arne is 70 years old, and when he saw Herman’s face go ash colour, he gave in and started the engine manually. Gerd broke into tears when she was narrating this part of the story. The Israelis then took charge of the boat and drove it to Ashdod.

Once the boat was on course, the Israeli soldiers brought Herman to the medical desk. I looked at Herman and saw that he was in great pain, silent but conscious, breathing spontaneously but shallow breathing. The Israeli Army doctor was trying to persuade Herman to take some medicine for pain. Herman was refusing the medicine. The Israeli doctor explained to me that what he was offering Herman was not army medicine but his personal medicine. He gave me the medicine from his hand so that I could check it. It was a small brown glass bottle and I figured that it was some kind of liquid morphine preparation probably the equivalent of oromorph or fentanyl. I asked Herman to take it and the doctor asked him to take 12 drops after which Herman was carried off and slumped on a mattress at the back of the deck. He was watched over by people around him and fell asleep. From my station I saw he was breathing better.

With Herman settled I concentrated on Larry Commodore, the Native American leader and an environmental activist. He had been voted Chief of his tribe twice. Larry has labile asthma and with the stress all around my fear was that he might get a nasty attack, and needed adrenaline injection. I was taking Larry through deep breathing exercises. However, Larry was not heading for an asthmatic attack, but was engaging an Israeli who covered his face with a black cloth in conversation. This man was obviously in charge.

I asked the Israeli man with black mask his name and he called himself Field Marshall Ro…..Larry misheard him and jumped to conclusion that he called himself Field Marshall Rommel and shouted how can he an Israeli take a Nazi name. Field Marshall objected and introduced himself as Field Marshall ? Ronan. As I spelt out Ronan he quickly corrected me that his name is Ronen, and he Field Marshall Ronen was in charge.

The Israeli soldiers all wore body cameras and were filming us all the time. A box of sandwiches and pears were brought on deck for us. None of us took any of their food as we had decided we do not accept Israeli hypocrisy and charity. Our chef Joergen had already prepared high calorie high protein delicious brownies with nuts and chocolate, wrapped up in tin foil to be consumed when captured, as we know it was going to be a long day and night. Joergen called it food for the journey. Unfortunately when I needed it most, the Israelis took away my food and threw it away. They just told me ”It is forbidden” I had nothing to eat for 24 hours, refusing Israeli Army food and had no food of my own.

As we sailed towards Israel we could see the coast of Gaza in total darkness. There were 3 oil /gas rigs in the northern sea of Gaza. The brightly burning oil flames contrasted with the total darkness the owners of the fuel were forced to live in. Just off the shore of Gaza are the largest deposit of natural gas ever discovered and the natural gas belonging to the Palestinians were already being siphoned off by Israel.

As we approached Israel, Zohar, our boat leader, suggested that we should start saying goodbye to each other. We were probably 2-3 hours from Ashdod. We thanked our boat leader, our Captain, the crew, our dear chef, and encouraged each other that we will continue to do all we can to free Gaza and also bring justice to Palestine. Herman, our Captain, who managed to sit up now, gave a most moving talk and some of us were in tears.

We knew that in Ashdod there would be the Israeli media and film crews. We will not enter Ashdod as a people who had lost hope as we were taken captive. So we came off the boat chanting “Free Free Palestine” all the way as we came off. Mike Treen, the union man, had by then recovered from his heavy tasering and led the chanting with his mega-voice and we filled the night sky of Israel with Free Free Palestine as we approached. We did this the whole way down the boat into Ashdod.

We came directly into a closed military zone in Ashdod. It was a sealed off area with many stations. It was specially prepared for the 22 of us. It began with a security x-ray area. I did not realise they retained my money belt as I came out of the x-ray station. The next station was strip search, and it was when I was gathering up my belongings after being stripped that I realised my money belt was no longer with me. I knew I had about a couple hundred Euros and they were trying to steal it. I demanded its return and refused to leave the station until it was produced. I was shouting for the first time. I was glad I did that as some other people were parted from their cash. The journalist from Al Jazeera Abdul had all his credit cards and USD 1,800 taken from him, as well as his watch, satellite phone, his personal mobile, his ID. He thought his possessions were kept with his passport but when he was released for deportation he learnt bitterly that he only got his passport back. All cash and valuables were never found. They simply vanished.

We were passed from station to station in this closed military zone, stripped searched several times, possessions taken away until in the end all we had was the clothes we were wearing with nothing else except a wrist band with a number on it.  All shoe laces were removed as well. Some of us were given receipts for items taken away, but I had no receipts for anything. We were photographed several times and saw two doctors. At this point I learnt that Larry was pushed down the gangway and injured his foot and sent off to Israeli hospital for check-up. His blood was on the floor.

I was cold and hungry, wearing only one tee-shirt and pants by the time they were through with me. My food was taken away; water was taken away, all belongings including reading glasses taken away. My bladder was about to explode but I was not allowed to go to the toilet. In this state I was brought out to two vehicles – Black Maria painted gray. On the ground next to it were a great heap of ruqsacks and suit cases. I found mine and was horrified that they had broken into my baggage and took almost everything from it – all clothes clean and dirty, my camera, my second mobile, my books, my Bible, all the medicines I brought for the participants and myself, my toiletries. The suitcase was partially broken. My ruqsack was completely empty too. I got back two empty cases except for two dirty large man size tee-shirts which obviously belonged to someone else. They also left my Freedom Flotilla tee-shirt. I figured out that they did not steal the Flotilla tee-shirt as they thought no Israeli would want to wear that tee-shirt in Israel. They had not met Zohar and Yonatan who were proudly wearing theirs. That was a shock as I was not expecting the Israeli Army to be petty thieves as well. So what had become of the glorious Israeli Army of the Six Day War which the world so admired?

I was still not allowed to go to the toilet, but was pushed into the Maria van, joined by Lucia the Spanish nurse and after some wait taken to Givon Prison. I could feel myself shivering uncontrollably on the journey.

The first thing our guards did in Givon Prison was to order me to go to the toilet to relieve myself. It was interesting to see that they knew I needed to go desperately but had prevented me for hours to! By the time we were re-x-rayed and searched again it must be about 5 – 6 am. Lucia and I were then put in a cell where Gerd, Divina, Sarah and Emelia were already asleep. There were three double decker bunk beds – all rusty and dusty.

Divina did not get the proper dose of her medicines; Lucia was refused her own medicine and given an Israeli substitute which she refused to take. Divina and Emelia went straight on to hunger strike. The jailors were very hostile using simple things like refusal of toilet paper and constant slamming of the prison iron door, keeping the light of the cell permanently on, and forcing us to drink rusty water from the tap, screaming and shouting at us constantly to vent their anger at us.

The guards addressed me as “China” and treated me with utter contempt. On the morning of 30 July 2018, the British Vice Consul visited me. Some kind person had called them about my whereabouts. That was a blessing as after that I was called “England” and there was a massive improvement in the way England was treated compared to the way China was treated. It crossed my mind that “Palestine” would be trampled over, and probably killed.

At 6.30 am 31 July 2018, we heard Larry yelling from the men’s cell across the corridor that he needed a doctor. He was obviously in great pain and crying. We women responded by asking the wardens to allow me to go across to see Larry as I might be able to help. We shouted “We have a doctor” and used our metal spoons to hit the iron cell gate to get their attention. They lied and said their doctor would be over in an hour. We did not believe them and started again. The doctor actually turned up at 4 pm, about 10 hours later and Larry was sent straight to hospital.

Meanwhile to punish the women for supporting Larry’s demand, they brought hand cuffs for Sarah and took Divina and me to another cell to separate us from the rest. We were told we were not going to be allowed out for our 30 minutes fresh air break and a drink of clean water in the yard. I heard Gerd saying “Big deal”.

Suddenly Divina was taken out with me to the courtyard and Divina given 4 cigarettes at which point she broke down and cried. Divina had worked long hours at the wheel house steering the boat. She had seen what happened to Herman. The prison had refused to give her one of her medicines and given her only half the dose of the other. She was still on hunger strike to protest our kidnapping in international waters. It was heart-breaking to see Divina cry. One of the wardens who called himself Michael started talking to us about how he will have to protect his family against those who want to drive the Israelis out. And how the Palestinians did not want to live in peace…and it was not Israel’s fault. But things suddenly changed with the arrival of an Israeli Judge and we were all treated with some decency even though he only saw a few of us personally. His job was to tell us that a Tribunal will be convened the following day and each prisoner had been allocated a time to appear, and we must have our lawyer with us when we appear.

Divina by the end of the day became very giddy and very unwell so I persuaded her to come out of hunger strike, and also she agreed to sign a deportation order. Shortly after that possibly at 6 pm since we had no watches and mobile phones, we were told Lucia, Joergen, Herman, Arne, Abdul from Al Jazeera and I would be deported within 24 hours and we would be taken to be imprisoned in the deportation prison in Ramle near Ben Gurion airport immediately to wait there. It was going to be the same Ramle Prison from which I was deported in 2014. I saw the same five strong old palm trees still standing up proud and tall. They are the only survivors of the Palestinian village destroyed in 1948.

When we arrived at Ramle prison Abdul found to his horror that he his money, his credit cards, his watch, his satellite phone, his own mobile phone, his ID card were all missing – he was entirely destitute. We had a whip round and raised around a hundred Euros as a contribution towards his taxi fare from the airport to home. How can the Israeli Army be so corrupt and heartless to rob someone of everything?

Conclusion

We, the six women on board al-Awda, had learnt that they tried to completely humiliate and dehumanise us in every way possible. We were also shocked at the behaviour of the Israeli Army especially petty theft and their treatment of international women prisoners. Men jailors regularly entered the women’s cell without giving us decent notice to put our clothes on.

They also tried to remind us of our vulnerability at every stage. We know they would have preferred to kill us but, of course, the publicity incurred in so doing might be unfavourable to the international image of Israel.

If we were Palestinians it would be much worse with physical assaults and probably loss of lives. The situation is therefore dire for the Palestinians.

As to international waters, it looks as though there is no such thing for the Israeli Navy. They can hijack and abduct boats and persons in international water and get away with it. They acted as though they own the Mediterranean Sea. They can abduct any boat and kidnap any passengers, put them in prison and criminalise them.

We cannot accept this. We have to speak up, stand up against this lawlessness, oppression and brutality. We were completely unarmed. Our only crime according to them is we are friends of the Palestinians and wanted to bring medical aid to them. We wanted to brave the military blockade to do this. This is not a crime. In the week we were sailing to Gaza, they had shot dead 7 Palestinians and wounded more than 90 with live bullets in Gaza. They had further shut down fuel and food to Gaza. Two million Palestinians in Gaza live without clean water, with only 2-4 hours of electricity, in homes destroyed by Israeli bombs, in a prison blockaded by land, air and sea for 12 years.

The hospitals of Gaza since the 30 March had treated more than 9,071 wounded persons, 4,348 shot by machine guns from a hundred Israeli snipers while they were mounting peaceful demonstrations inside the borders of Gaza on their own land. Most of the gun-shot wounds were to the lower limbs and with depleted treatment facilities the limbs will suffer amputation. In this period more than 165 Palestinians had been shot dead by the same snipers, including medics and journalists, children and women. The chronic military blockade of Gaza has depleted the hospitals of all surgical and medical supplies. This massive attack on an unarmed Freedom Flotilla bringing friends and some medical relief is an attempt to crush all hope for Gaza. As I write I learnt that our sister Flotilla, Freedom, has also been kidnapped by the Israeli Navy while in international waters.

BUT we will not stop. We must continue to be strong to bring hope and justice to the Palestinians and be prepared to pay the price, and to be worthy of the Palestinians. As long as I survive I will exist to resist.  To do less will be a crime.

• A version of this article appeared in 21st Century Wire.com

Toxic Silence: Public Officials, Monsanto and the Media

Are you being lied to or misled? Environmentalist Dr Rosemary Mason certainly thinks so and has provided much supporting evidence. She has been campaigning against the agrochemical industry for many years (all her work can be accessed here) and has borne witness to the destruction of her own nature reserve in South Wales, which she argues is due to the widespread spraying of glyphosate in the area.

In 2016, she wrote an open letter to journalists at The Guardian newspaper in the UK outlining how the media is failing the public by not properly reporting on the regulatory delinquency relating to the harmful chemicals being applied to crops (read it here). Her assertion was that not only humans and the environment are silently being poisoned by thousands of untested and unmonitored chemicals, but that the UK media are silent about the agrochemical industry’s role in this.

She has now sent a new ‘open letter’ to some major newspapers with a six-page document attached: “The British Government and Monsanto should stand accused of crimes against humanity“.

It has been sent to the editors-in-chief of The Times, The Sunday Times, The Telegraph, The Financial Times, The Wall Street Journal, the London Evening Standard and The Independent as well as the director general of the BBC and its senior executives. Channel 4 News (UK) reporters have also been sent the document, including senior presenter Jon Snow, and a number of prominent UK government agencies and ministers.

The document discusses the lawsuits that have recently been brought against agrochemical and seed giant Monsanto, issues surrounding the renewal of the licence for glyphosate (key ingredient in Monsanto’s multi-billion-dollar, money-spinning herbicide Roundup) in the EU, rising rates of illness and disease (linked to glyphosate and other agrochemicals), the increasing use of pesticides and the lack of adequate testing and epidemiological studies pertaining to the cocktail of chemicals sprayed on crops.

Mason feels the media should be holding officials and the industry to account. Instead, there seems to be an agenda to confuse the public or to push the issue to one side. For instance, she has in the past argued that too many journalists are reinforcing the pesticides industry’s assertion that cancers are caused by alcohol use and that the catalogue of diseases now affecting modern society comes down to individual choice and lifestyle decisions. The media constantly link alcohol consumption with various cancers and this ‘fact’ is endlessly reinforced until people believe it to be true.

This, Mason argues, neatly diverts attention from the strong links between the increasing amounts of chemicals used in food and agriculture and serious diseases, including cancers.

In her various documents, Mason has over the years highlighted how international and national health and food safety agencies have dismissed key studies and findings in their assessments of the herbicide glyphosate, and she has provided much evidence that the chemical industry has created a toxic (political and natural) environment which affects us all. She argues that these agencies are guilty of regulatory delinquency due to conflicts of interest and have effectively been co-opted, enabling companies to dodge effective regulation.

Mason has gone to great lengths to show how a combination of propaganda disseminated by industry front groups and conflicts of interest allow dangerous chemicals into the food chain and serve to keep the public in the dark about what is taking place and the impacts on their health.

Aside from the subversion of democratic procedures, the result is rivers, streams and oceans polluted with agrochemical run-offs, spiralling rates of illness among the public and the destruction of wildlife and biodiversity.

By writing to major news outlets, Mason is pressing for at least one to take up this issue and finally begin holding public officials and agrochemical companies to account. To its credit, the French newspaper Le Monde has on occasion been unafraid to report on the activities of this industry.

Regardless of industry propaganda, it is not that we need the model of agriculture that these companies profit from. The increasingly globalized industrial food regime that transnational agribusiness is integral to is not feeding the world. It is, moreover, responsible for some of the planet’s most pressing political, social and environmental crises.

There are credible alternatives that actually can feed the world equitably (see ‘United Nations: Agroecology, not Pesticides, is the Future for Food‘).

So, isn’t it about time integrity and public health took precedence over profit and vested interest?

The UN special rapporteur on the right to food Hilal Elver says:

The power of the corporations over governments and over the scientific community is extremely important. If you want to deal with pesticides, you have to deal with the companies.

When speaking truth to power, however, perhaps for many well-paid media personnel with careers to protect it is easier to stay silent.

Thriving on Dark Web: The My Health Record and Data Insecurity

Data is rarely inert.  It moves, finds itself diverting, adjusting and adapting to users and distributors. Ultimately, as unspectacular and banal as it might be, data sells, pushing the price in various markets whoever wishes to access it.  Medical data, given its abundance, can do very nicely in such domains as the Dark Web.  With governments attempting to find the optimum level of storing, monitoring and identifying the medical health of citizens, the issue of security has become pressingly urgent.

Britain’s National Health Service is a case in point.  Last year, that venerable, perennially criticised body of health provision, received the full attention of the WananCry virus. Much of this was occasioned by carelessness: a good number of organisations were running on out-of-date Windows XP software.  The principle of insecurity was, however, affirmed.

Last month, the Singaporean government faced the grim reality that 1.5 million health records had been accessed by hackers including, audaciously, the records of Prime Minister Lee Hsien Loong. This well landed blow riled all the more for that state’s heralded insistence on the merits of its own cybersecurity.  In the words of the government statement, “Investigations by the Cyber Security Agency of Singapore (CSA) and the Integrated Health Information System (IHiS) confirmed that this was a deliberate, targeted and well-planned cyberattack.”

Lee, in an obvious effort to reassure, perhaps more himself than anybody else, claimed that his data had nothing of value.  (If a thief takes your goods, make sure they are worthless.)  “My medication data is not something I would ordinarily tell people about, but there is nothing alarming in it.”

Obtaining medical data enables a stealthy plotting for the attacker, hoarding information clandestinely then deploying it with maximum effect.  “Patients who have had their medical information stolen,” goes Aatif Sulleyman for The Independent, “might not realise it’s even happened until the attackers have already set their plans in motion.”

Patient profiles can be built, with credentials mustered for reasons of impersonation to obtain health services.  Medical equipment and drugs can be duly purchased, and claims with insurers lodged.  That prospect is somewhat bleaker than one whose credit card details have been pinched; the bank, at the very least, might be able to put a halt on transactions with immediate effect.

Such excitement turns in anticipation and worried focus to the My Health Record proposition of the Australian government, which, it must be said, belies the usual blissful ignorance about what such an invitation tends to be.  Here, information utopia is paraded and extolled: to have such material in one spot, rather than diffused and intangible; to have the picture of one’s medical being in one location for those providing health care services.

Australia’s political representatives and bureaucrats have assumed a certain cockiness far exceeding health providers in other jurisdictions, making the My Health Record scheme a pinnacle of insecurity in medical care.  A pervasive sense exists that privacy concerns will simply vanish in a bout of extended apathy.  The scheme is astounding for the scope it enables prying of medical data that would otherwise be deemed private.

Deficiencies were spotted early on.  Far from being clinically-reliable as a record, it is dated and far from comprehensive.  Any such record would be, at worse, a distraction in an emergency.  Nor is there a track on who has seen it, except institutions en bloc.

If Australians do not opt out of the centralised medical scheme by October 15, a record by default will be created, stored and used.  This will mean that those in the healthcare provision business, be it pharmacists, nurses or podiatrists, not to mention a whole string of unknown providers, will have automatic access to the medical record without patient consent.  The notions of express and fully informed consent have been given a dramatic, contemptuous heave ho, with a focus on the patient’s volition to avoid the scheme altogether. The Australian government’s refusal to engage the public in any meaningful way, be it through a sustained advertising or information campaign, has been patchy, and, in some instances, entirely absent.

Such an approach flies in the face of such recommendations as those made by the UK Information Governance Review from 2013 acknowledging “an appropriate balance between the protection of the patient user’s information, and the use and sharing of such information to improve care”.  This balance was struck on principles derived in the 1997 Review of the Uses of Patient-Identifiable Information, chaired by Dame Fiona Caldicott. While admitting that information governance might at stages have to give way to sharing confidential patient information for the sake of that patient’s welfare, the principles of data security remain fundamental.

A skirt through the My Health Record system yields the extent of its shabbiness, and the level of its aspiration.  The My Health Record privacy policy is hardly glowing, acknowledging the problems with having such a database in the first place. “In any online platform, including the My Health Record system, there are inherent risks when transmitting and storing personal information.” Then comes the mandatory, if hollow, reassurance: “Despite this, we are committed to protecting your personal information, and ensuring its privacy, accuracy and security.”  A rich opportunity for the prying and the pilfering await.

India Mortgaged? Forced-Fed Illness and the Neoliberal Food Regime

Like many countries, India’s food system was essentially clean just a generation or two ago but is now being comprehensively contaminated with sugar, bad fats, synthetic additives, GMOs and pesticides under the country’s neoliberal ‘great leap forward’. The result has been a surge in obesity, diabetes and cancer incidence, while there has been no let-up in the under-nutrition of those too poor to join in the over-consumption.

Indian government data indicates that cancer showed a 5% increase in prevalence between 2012 and 2014 with the number of new cases doubling between 1990 and 2013. The incidence of cancer for some major organs in India is the highest in the world.

The increase in prevalence of diabetes is also worrying. By 2030, the number of diabetes patients in India is likely to rise to 101 million (World Health Organization estimate). The figure doubled to 63 million in 2013 from 32 million in 2000. Over 8% of the adult male population in India has diabetes. The figure is 7% for women. Almost 76,000 men and 52,000 women in the 30-69 age group in India died due to diabetes in 2015, according to the WHO.

study in The Lancet from a couple of years ago found that India leads the world in underweight people. Some 102 million men and 101 million women are underweight, which makes the country home to over 40% of the global underweight population.

Contrast this with India’s surge in obesity. In 1975, the country had 0.4 million obese men or 1.3% of the global obese men’s population. In 2014, it was in fifth position globally with 9.8 million obese men or 3.7% of the global obese men’s population. Among women, India is globally ranked third, with 20 million obese women or 5.3% of global population.

According to India’s 2015–16 National Family Health Survey, 38% of under-5s are stunted (height is significantly low for their age). The survey also stated that 21% under-5s are significantly underweight for their height, a sign of recent acute hunger. The prevalence of underweight children in India is among the highest in the world; at the same time, the country is fast becoming the diabetes and heart disease capital of the world.

India’s mineral deficient soils haven’t helped. This has been made worse by Green Revolution practices. Green Revolution crops, unlike their predecessors, fail to adequately take up minerals such as iron and zinc from the soil. So even though people might consume more calories (possibly leading to obesity), their intake of these key micronutrients has fallen. A quarter of the world’s population are affected by Green Revolution iron deficiency and research indicates that the condition impairs the learning ability of more than half of India’s schoolchildren.

Many of the older crops carried dramatically higher counts of nutrients per calorie. The amount of cereal each person must therefore consume to fulfill daily dietary requirements has gone up. For instance, the iron content of millet is four times that of rice. Oats carry four times more zinc than wheat. As a result, between 1961 and 2011, the protein, zinc and iron contents of the world’s directly consumed cereals declined by 4%, 5% and 19%, respectively.

While it is true that many other factors, including pollution, poor sanitation, working and living conditions, lack of income and economic distress, lack of access to healthcare and poverty, contribute to ill health and disease, a range of conditions, such as cardiovascular disease, diabetes, certain cancers and obesity, have all been linked to modern food production and diets.

‘Free trade’ and poor health

To improve health, lifestyle change is often promoted, as if poor health is a matter of individual responsibility and personal choice. This message conveniently sidesteps wider issues concerning the global capitalist food regime and how our access to food is shaped.

If we look at the North American Free Trade Agreement, we can see how the subsequent flood of cheap US processed food into Mexico adversely affected the health of ordinary people. Western ‘convenience’ (junk) food has displaced more traditional-based diets and is now readily available in every neighbourhood. Increasing rates of diabetes, obesity and other health issues have followed. This report by GRAIN describes how US agribusiness and retailers have captured the market south of the border and outlines the subsequent negative impact on the health of Mexican people. This could be what is in store for India.

Western agribusiness, food processing companies and retail concerns are gaining wider entry into India and through various strategic trade deals are looking to gain a more significant footprint within the country. The opening of the food and retail sector to more foreign direct investment and the US-India Knowledge Initiative on Agriculture (see page 13 here) have raised serious concerns about the stranglehold that transnational corporations could have on the agriculture and food sectors.

We can already see one outcome in the edible oils sector. India was virtually self-sufficient in edible oils up till the mid-1990s, using healthy practices to extract oil from, for example, indigenous mustard, linseed, ground nut and sesame, all of which are deeply rooted in Indian culture. Due to the unscrupulous undermining of the indigenous edible oil seeds sector  and the influx of cheap subsidised imports, some 70% of the population now consumes a narrower range of oils, not least (rain forest-destroying) palm oil and (GM) soy, processed using unhealthy solvents. To facilitate this, thousands of small-scale food oil processing enterprises were put out of business to make way for grain trader and food processor company Cargill, whose role in drawing up health and safety rules was instrumental in driving the competition out of business.

It is part of the wider push by the global industrial food processing lobby to impose standardised, less nutrient-rich products and manufacturing processes along with unhealthy fats, sugars and chemical additives – courtesy of compliant regulators and policy makers in India – in order to consolidate its grip on the country’s food base. As with the edible oils sector, it entails displacing more diverse, indigenous foodstuffs and healthy low-input food production processes, while robbing hundreds of thousands of their livelihoods.

We not only have Wal-Mart making inroads to complete the global food regime chain from seed to plate in India, but Western style fast-food outlets have already been soaring in number throughout the country. For example, Pizza Hut now operates in 46 Indian cities with 181 restaurants and 132 home delivery locations (2016). KFC is in 73 cities with 296 restaurants, a 770% increase over five years. According to a study published in the Indian Journal of Applied Research, the Indian fast food market is growing at the rate of 30-35% per annum (see this).

Heart disease, liver damage, stroke, obesity and diabetes are just some of the diseases linked to diets revolving around processed ‘convenience’ food. Frequent consumption of this food has been associated with increased body mass index as well as higher intakes of fat, sodium, added sugars and sugar-sweetened beverages and lower intakes of fruits, vegetables, fibre and milk in children, adolescents and adults.

Modern processed food also tends to have higher energy densities and poorer nutritional quality than foods prepared at home and in comparison with dietary recommendations (see this). To further appreciate just how unhealthy today’s food is, a 2015 report in the Guardian reveals the cocktails of additives, colourants and preservatives that the industry adds to our food.

Moreover, in many regions across the globe industrialised factory farming has replaced traditional livestock agriculture. For example, just 40 years ago the Philippines’ entire population was fed on native eggs and chickens produced by family farmers. Now, most of those farmers are out of business.

As world trade rules encourage nations from imposing tariffs on subsidised imported products, they are compelled to allow cheap, factory-farmed US meat into the country. These products are then sold at lower prices than domestic meat. There is therefore pressure for local producers to scale up and industrialise to compete.

Factory farms increase the risk of pathogens like E coli and salmonella that cause food-borne illness in people. Overuse of antibiotics can fuel the growth of antibiotic-resistant bacteria, the use of arsenic and growth hormones can increase the risk of cancer in people, and crowded conditions can be a breeding ground for disease.

The Modi administration’s restrictions on cow slaughter – making it difficult for many livestock farmers to operate – are regarded by some as a tool to facilitate the running down of small-scale livestock farming, paving the way for the industrialisation and corporatisation of the livestock industry.

Green Revolution, micronutrient-deficient soil and human health

We often hear unsubstantiated claims about the green revolution having saved hundreds of millions of lives, but any short-term gains in productivity have been offset. This high-input chemical-intensive model helped the drive towards greater monocropping and has resulted in less diverse diets and less nutritious foods. Its long-term impact has led to soil degradation and mineral imbalances, which in turn have adversely affected human health (see this informative report on India by botanist Stuart Newton – p.9 onward).

Adding weight to this argument, the authors of this paper from the International Journal of Environmental and Rural Development state:

Cropping systems promoted by the green revolution have increased the food production but also resulted in reduced food-crop diversity and decreased availability of micronutrients. Micronutrient malnutrition is causing increased rates of chronic diseases (cancer, heart diseases, stroke, diabetes and osteoporosis) in many developing nations; more than 3 billion people are directly affected by the micronutrient deficiencies. Unbalanced use of mineral fertilizers and a decrease in the use of organic manure are the main causes of the nutrient deficiency in the regions where the cropping intensity is high.

India might now be self-sufficient in various staples, but many of these foodstuffs are high calorie low nutrient, have led to the displacement of more nutritionally diverse cropping systems and have effectively mined the soil of nutrients. The importance of renowned agronomist William Albrecht, who died in 1974, should not be overlooked here and his work on healthy soils and healthy people.

In this respect, botanist Stuart Newton’s states:

The answers to Indian agricultural productivity is not that of embracing the international, monopolistic, corporate-conglomerate promotion of chemically-dependent GM crops… India has to restore and nurture her depleted, abused soils and not harm them any further, with dubious chemical overload, which are endangering human and animal health. (p. 24).

India is losing 5,334 million tonnes of soil every year due to soil erosion because of the indiscreet and excessive use of fertilisers, insecticides and pesticides. The Indian Council of Agricultural Research reports that soil is become deficient in nutrients and fertility.

Newton provides insight into the importance of soils and their mineral compositions and links their depletion to the ‘green revolution’. In turn, these depleted soils cannot help but lead to mass malnourishment. This is quite revealing given that proponents of the Green Revolution claim it helped reduced malnutrition. Newton favours a system of agroecology, a sound understanding of soil and the eradication of poisonous chemical inputs.

Although this system is certainly gaining traction in India – there are encouraging signs for agroecological farming in places like Andhra and Karnataka – what we are also seeing is GMOs illegally creeping into the food system. Recent reports show GMOs are in commonly used food products and GM seeds are prevalent. The fear is that approval by contamination is what the GM industry has desired all along.

There are well-documented economic, environmental, ethical, social and health implications associated with GM. And unlike the Green Revolution, once the GM genie is out of the bottle, it can’t be put back in and the changes to the genetic core of the world’s food will be the legacy bequeathed to subsequent generations.

Pesticides, food and the environment

There are currently 34,000 pesticides registered for use in the US. Drinking water is often contaminated by pesticides and more babies are being born with preventable birth defects due to pesticide exposure.

Illnesses are on the rise too, including asthma, autism and learning disabilities, birth defects and reproductive dysfunction, diabetes, Parkinson’s and Alzheimer’s diseases and several types of cancer. The association with pesticide exposure is becoming stronger with each new study.

In Punjab, pesticide run-offs into water sources have turned the state into a ‘cancer epicentre‘. India is one of the world’s largest users of pesticides and a profitable market for the corporations that manufacture them. Ladyfinger, cabbage, tomato and cauliflower in particular may contain dangerously high levels because farmers tend to harvest them almost immediately after spraying. Fruit and vegetables are sprayed and tampered with to make them more colourful, and harmful fungicides are sprayed on fruit to ripen them in order to rush them off to market.

Research by the School of Natural Sciences and Engineering (SNSE) at the National Institute of Advanced Studies in Bangalore has indicated disturbing trends in the increased use of pesticide. In 2008, it reported that many crops for export had been rejected internationally due to high pesticide residues. Moreover, India is one of the largest users of World Health Organization (WHO) ‘Class 1A’ pesticides, which are extremely hazardous.

Research by SNSE shows farmers use a cocktail of pesticides and often use three to four times the recommended amounts. It may come as no surprise that a recent report about children in Hyderabad are consuming 10 to 40 more times pesticides in their food than kids in the US.

Forced-fed development

In 1978, T.N. Reddy predicted in the book ‘India Mortgaged’ that the country would one day open all sectors to foreign direct investment and surrender economic sovereignty to imperialist powers.

Today, the US-led West, clings to a moribund form of capitalism and has used various mechanisms in the face of economic stagnation and massive inequalities: the raiding of public budgets, the expansion of credit to consumers and governments to sustain spending and consumption, financial speculation and increased militarism.

Under the guise of globalisation, we also see an unrelenting drive to plunder what capital regards as ‘untapped markets’ in other areas of the globe. International agri-capital has been moving in on Indian food and agriculture for some time. But as an agrarian-based country underpinned by smallholder agriculture, it first needs to displace the current model before bringing India’s food and agriculture sector under its control.

Devinder Sharma describes the situation:

India is on fast track to bring agriculture under corporate control… Amending the existing laws on land acquisition, water resources, seed, fertilizer, pesticides and food processing, the government is in overdrive to usher in contract farming and encourage organized retail. This is exactly as per the advice of the World Bank and the International Monetary Fund as well as the international financial institutes.

In return for up to £90 billion in loans, in the 90s India was instructed to dismantle its state-owned seed supply system, reduce subsidies and run down public agriculture institutions and offer incentives for the growing of cash crops to earn foreign exchange. According to the World Bank’s lending report, based on data compiled up to 2015, India was easily the largest recipient of its loans in the history of the institution. To push through the programme, hundreds of millions are to be shifted out of agriculture.

Successive Indian administrations have been quite obliging. While India’s current government talks about ‘make in India’ (self-sufficiency), the reality is subservience to western capital. Agriculture is deliberately being made economically non-viable for small-scale farmers: financial distress and ‘economic liberalisation’ have resulted in between 300,000 and 400,000 farmer suicides since 1997 with millions more experiencing economic distress and over 6,000 leaving the sector each day. This lies at the root of the ongoing agrarian crisis. But it goes much further. We are witnessing not only the structural transformation of India’s rural base but an all-encompassing strategy designed to incorporate India into the US’s corporate-financial-intel architecture.

Whether it involves the displacement of indigenous food and agriculture by a model dominated by western conglomerates or it is the selling of pharmaceuticals and the expansion of private hospitals to address the health impacts of the modern junk food system (in India, the healthcare sector is projected to grow by 16% a year), either way, it’s a lose-lose situation for the population.

But it all forms part of the holy grail of neoliberalism, GDP growth. A notion based on an economic system defined by bad food and ill health, joblessness, mass surveillance, spiralling inequalities, environmental degradation, militarism and debt on one hand; on the other, by bail outs, tax havens, massive profits and subsidies for large corporations and banks.

So, what can be done? Whether we are discussing India or elsewhere, the scaling up of agroecology based on the notion of food sovereignty offers an alternative. Much has been written on agroecology as a model of agriculture but also as a movement for political change. Part of the process involves resisting the dismantling of rural economies and indigenous agriculture and instituting a sustainable food system rooted in local communities, whereby producing for local and regional needs takes precedence over supplying distant markets.

It also entails rejecting the agenda of the WTO which subjugates local agriculture to the needs of global markets (determined by agribusiness interests). And, unlike the current system, it includes supporting healthy and culturally appropriate food, encouraging diversified food production and recognising that food is not simply another commodity to be traded or speculated on for profit.

Of Course, Medicare For All would increase Federal Spending…

Of course, a National Improved Medicare for All (NIMA) system would increase federal spending, but not by as much as they claim. NIMA would create a national health insurance, like most other wealthy countries have, funded only through taxes. This would replace our current complicated, privatized healthcare system, funded through a mix of premiums, out-of-pocket costs and taxes, which is the most expensive in the world. Countries that treat health care as a public good invest in a universal system because they know it improves the health of their people and is the most efficient.

The United States currently spends twice as much as the average wealthy nation, over $10,000 per person each year. Unlike other wealthy nations, though, the US leaves tens of millions of people without coverage and tens of millions more with coverage but still unable to afford care. The US consistently ranks low in comparison to other countries on health outcomes. Life expectancy is declining in the US, now for two years in a row, the first time this has happened in over 50 years. Death rates for infants and mothers in the US are many times higher than in other wealthy countries.

A single payer healthcare system like NIMA would decrease administrative costs and the prices of goods, such as pharmaceuticals, and services dramatically. Rather than having hundreds of different healthcare plans, each with different rules, there is one comprehensive plan with one set of rules. It would relieve families, employers, health professionals and hospitals of the burden of navigating the current complex system. Everyone is in the system for life. If a person needs health care, they see a health professional of their choice, the health professional cares for the patient and submits a bill to the system, or they are paid a salary, and that’s it. Simple. Just as it is in most other industrialized countries.

The Mercatus Center study is flawed in serious ways. First, it analyzes the Senate bill, which was first introduced last September and has significant weaknesses. It would be better to examine the House bill, HR 676, which has been introduced every session since 2003 and is based on the Physicians’ Working Group Proposal by Physicians for a National Health Program, the leading experts on single payer health policy in the US (here is the updated proposal). Second, it grossly underestimates the savings of a single payer system and makes unrealistic assumptions about utilization of services.

There have been many studies over the past few decades on how much money a single payer system would save in the United States. In 1991, the General Accounting Office found “If the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs [10 percent of health spending] would be more than enough to offset the expense of universal coverage.” Since that time, administrative costs have ballooned to one-third of our healthcare spending and the prices of pharmaceuticals have soared, so the savings would be greater.

In 1991 and 1993, multiple analyses by the Congressional Budget Office found that covering everyone under a single payer system might increase spending at the beginning, but it would be offset quickly by the savings. Since then, studies by non-governmental institutions, including one by Ken Thorpe who, since his alliance with Hillary Clinton, now claims the opposite, have all shown that compared to other reforms, NIMA is superior in savings and in the number of people and benefits that are covered.

It is important to distinguish between total healthcare spending and federal spending, the part the US government spends. Buried within the Mercatus Center study is a fact that the corporate media has missed. Although they estimate that federal spending would increase, because all health spending would become federal, they calculate that overall health spending would decrease by more than $2 trillion over ten years.

Single payer systems save money. The only system we can’t afford to maintain is the current one. Private health insurers are insatiable. The government subsidizes them by hundreds of billions of dollars a year, and still they raise premiums and out-of-pocket costs and ask for more. Pharmaceutical companies are increasing their prices by as much as they can get away with. A single payer system is the best way to put private insurers where they belong, on the margins of our healthcare system, and to control the pharmaceutical industry.

So, when you hear someone saying that NIMA would increase federal spending, tell them, of course, it does, that’s the point. Instead of paying premiums, deductibles and co-pays to a private insurer, we all contribute into a federal system that is there when we need it. But if they try to scare you with large numbers, tell them that single payer systems prove time and again they are the least expensive. If we want to talk about scary numbers, let’s look at how much the US spends on the military and have a conversation about priorities – ending lives or saving them.

•   First published in Health Over Profit

Evading Medical Care: Australia’s Refugee Arrangements with Taiwan

It is a credit to the venality of Australia’s refugee policy that much time is spent on letting others do what that particular country ought to be doing.  For a state so obsessed with the idea of a “rule-based order”, breaking those rules comes naturally – all in the national interest, of course.

Canberra’s policy makers, since the 1990s, have been earning their morally tainted fare evading international law with an insistence bordering on the pathological.  The reasons for doing so have been cruel and vapid: target the market of people smuggling by moving it to other regions; harden the Australian electorate against dissolute “queue jumpers” who don’t know their place in the international refugee system; and speak to the idea of saving people who would otherwise drown.

In a tradition reminiscent of secret treaties, clandestine compacts underhand arrangements, Australia has done well for itself. The Turnbull government, spear-tipped by the one-dimensional former policeman Peter Dutton of the Home Affairs Department, has shown itself to be obsessed with the clandestine when it comes to dealing with asylum seekers and refugees.  Its invidious sea operation, termed Operation Sovereign Borders, continues to deter refugee-carrying boats approaching Australia.  Last month, it took the revelations of a Taiwanese official to The Guardian to show that Australia had forged a deal with Taiwan on treating some of the most dire medical conditions afflicting refugees on Nauru.

The memorandum of understanding was made with Taipei in September last year. Since then, some five refugees have been flown to the state – some 5,500 kilometres – to receive treatment.  “The government has been clear,” came the cold, unchanging line from a spokeswoman for the Department of Home Affairs, “that people subject to regional processing arrangements will not be settled in Australia.”

The punitive dimension here has been stressed.  Medical transfer would not be used as “a pathway to settlement in Australia”.  Besides, Taiwan’s medical system was more than adequate, being “consistently ranked as having some of the best hospitals and medical technology in the world”.

There is an element of the police state grotesque about this, a whiff of the tyrant in search of satisfying a sadistic whim.  Those who have found their way to treatment in Taiwan have been in particularly acute medical distress.  There have been questions about incomplete understanding on the part of patients, and problems with informed consent.  But such vulnerability is not one to prompt Australia’s officials to well up.  No excuse will be accepted in permitting resettlement in Australia.

Such conduct continues to rattle human rights advocates who continue skirmishing with the Home Affairs department.  Refugee lawyer David Manne sums up the issue.

The fundamental concern must be the person’s need for medical treatment.  Once again, we see the absurd spectacle of the Australian government searching the globe to hive off its basic obligations… to properly care for people subject to its policies which inflict such devastating harm.

To that end, such individuals as an Iranian woman in need of critical heart surgery was sent to Taiwan to be treated, after which she was returned to Nauru.  (This resembles, in part, the ailing person awaiting execution treated to ensure his good health on being hanged.)  A 63-year-old Afghan man has been offered a similar option in terms of treating his lung cancer, but has been eminently sensible, and damned for that reason, for wanting to go to Australia.

The scrap over outsourcing medical care to third countries, and not merely the processing and housing of refugees, has also received attention in the Australian Federal Court.  Lawyers from the National Justice Project this month won a bid to prevent a 30-year-old Somali woman from being sent to Taiwan.  The lady in question had been a victim of female genital mutilation, and was seeking an abortion.

Expert evidence was given that the Royal Women’s Hospital in Melbourne, or the Westmead Hospital in Sydney, would be appropriate venues to treat victims of infibulation.  The Taiwan Adventist Hospital, it was suggested, would not be up to scratch to supply either the medical expertise or the psychological ballast for the patient. Taiwanese physician Dr Sheng Chiang told the court that experience in performing pregnancy terminations on women with female genital mutilation was conspicuously absent in Taiwan.

In Justice Alan Robertson’s words, “infibulation carries significant emotional and psychological implications and those aspects of care need to be expertly managed.”  Risks also came with later terminations, becoming “increasingly complex and dangerous”.

As for Taiwan’s side of the bargain, Shyang-yun Cheng, deputy representative of the Taipei Representative Office in the UK, has written glowingly about Taiwan’s commitment “to cooperating with like-minded countries to provide high-quality medical support and humanitarian assistance.”  Encouraging, indeed, if for the obvious point that is permits Australia to evade its obligations while showing Taipei to be a good international citizen.

It is about time that Australia withdraws from the Refugee Convention and cognate documents protecting refugees and asylum seekers.  In making arrangements with Taiwan, a non-signatory to the Refugee Convention, the point is clear enough.  At the very least, it would be an honest admission that the legal order of the time is up for dissolution and repudiation.  While US President Donald Trump scours the world for deals to abolish and arrangements to upend, Australia can be looked upon as a prime example of disruption in a field that is now crowded with contenders from the United States to Hungary.  A disturbing accolade indeed.

When Cuban Polyclinics Were Born

As discontent increases with overly expensive and totally inadequate US health care, it is time to look closely at the beginnings of the modern Cuban medical system.  Like the US, Cuba had unintegrated, overlapping medical institutions that failed the poor, especially black, population of the island.  Though several European countries have developed health care systems about 40% cheaper than the US, Cuba was able to craft health care which became more than 80% less costly than the US with a roughly equivalent life expectancy.

When the revolutionary government took the reins in 1959, millions of Cubans went without medical care.  The years 1959-1964 aimed at overcoming the crisis of care delivery as half of the island’s physicians fled.  During the second half of the decade (1964-1969) Cuba began redesigning medicine as a holistic system.  It’s created a model for poor countries that forever changed medicine.  Cuba did so largely by putting the polyclinic at the center of care delivery.

The Policlínico Integral

The term “polyclinic” (or “policlínico” in Spanish) generally refers to a medical facility offering outpatient services.  In 1961, the Cuban Ministry of Public Health (MINSAP) began a study to unify preventive and curative medicine. In May 1964, it opened the first policlínico integral.  The next year, MINSAP spread the model throughout Cuba.

Staff at the new polyclinics included at least a general practice physician, nurse, pediatrician, OB/GYN and social worker.  Nurses and social workers made house calls.  Staff extended services to workplaces, schools and communities.  Community outreach included health campaigns such as mass vaccination programs and efforts to control malaria and dengue.

Vaccination began shortly after the revolution; but the policlínico integral structure vastly increased its effectiveness.  In 1962, 80% of all children under 15 were vaccinated against polio in 11 days.  In 1970, it took one day for the same national effort.  Malaria was eradicated in 1967, as was diphtheria by1971.

Clinic staff coordinated primary care programs (maternal and child care, adult medical care, and dentistry) as well as public health (control of infectious diseases, environmental services, food control, school health services, and occupational and labor medicine.)  In addition to combining preventive and curative medicine the policlínicos integrales provided a full range of services at a single location, coordinated community campaigns and offered social as well as medical services.  Most important, they provided a single point of entry into the system, allowing for a complete record of patients’ medical histories.

Mutualism Withers Away

Post-1965 efforts increased nursing schools as well as training for auxiliary nurses, x-ray technicians, laboratory technicians, sanitarians and dental assistants.  Always attentive to alternative medicine, Cubans integrated healers (curanderos) into the health system.  As dentists were absorbed by the polyclinics, their numbers quadrupled.

MINSAP also addressed the unbalanced number, proportion and location of medical facilities.  Only 22% of Cubans lived in Havana, which had most of the country’s hospital beds.  The Oriente, or eastern part of the island, with a larger black population, was home to 35% of all Cubans but had only 15.5% of hospital beds.  Plans for new beds and doctors were concentrated in the east.

Also problematic was the existence of many small rural hospitals which could not provide a full range of services.  They dealt with the contradiction by decreasing the number of rural hospitals simultaneously with increasing the number of rural polyclinics as well as beds per hospital.

The role of the polyclinic became more central – more patients were initially seen at polyclinics where a physician could refer them to a hospital.  Polyclinic visits doubled at the same time visits to hospitals went down.

Cuban planners confronted a thorny dilemma: How do you cope with an inefficient medical anachronism that is immensely popular?  “Mutualism” had existed in Cuba for 400 years.  It was a pre-revolutionary holdover unable to resolve health issues because of its disheveled array of unconnected services.

Mutualism was similar to insurance, with subscribers paying a monthly fee for hospitalization and medical services.  The type of services covered varied widely from plan to plan and always left something out.  Unlike the new policlínicos integrales, mutualist clinics did not offer preventive medicine, were not adequately linked to hospitals, and did not have a specific geographical area where they provided services.

The revolutionary government was wise to not nationalize mutualist clinics as it did many large, foreign-owned businesses.  Instead, mutualist clinics were required to be increasingly similar to government clinics.  When separate financing for them ceased, their reason for existence withered away.  In 1970, mutualism ended new memberships and monthly dues as it equalized services for members and non-members.  It thereby ceased to exist.

At the same time, private medical practice, while not prohibited, faded into the sunset.  Within 10 or 11 years of the revolution, Cuba had a unified medical system, with a focus on the polyclinic for care delivery and all services guided by MINSAP.

Centralization/Decentralization

Planners carefully studied health systems of the Soviet Bloc.  They were typically overly centralized, leaving little opportunity for creative thought by practitioners or local administrators.  Instead, Cubans developed the concept of “centralization/decentralization.”

Centralization increased with a 1966 statute creating 10 new research institutes.  A centralized MINSAP was overseeing virtually all professional services by 1967.

What may be difficult for non-Cubans to grasp is that decentralization increased conjointly with centralization.  By pulling mutualist clinics into the medical system, MINSAP increased the number of clinics and their decision-making power.  While there was vertical control of programs for tuberculosis, leprosy and venereal disease, their efficiency was improved by the polyclinics’ deciding how to implement them.  The period saw a process of unifying and standardizing the rapidly expanding system of clinics while decentralizing clinic management and increasing autonomy.

At the very beginning of the polyclinic era, the Cuban government charted a course which would ensure their role as the cornerstone of decentralization: The policlínicos integrales became independent of hospital control.  Instead of being administrative branches of regional hospitals, clinics had an administrative position equal to hospitals.

A subtle but important component of elevating the status of the policlínico integral was creation of primary care as a specialty, which addressed everyday medical problems in clinics.  Offering this as an option for post-graduate training put primary care physicians on par with other medical specialties.

Mobilization for a Health Revolution

The role of polyclinics in coordinating health campaigns both enhanced their stature in the eyes of the average Cuban and consolidated their position in the decentralization of health services.  No one knew better than Fidel Castro that a government cannot merely decree that a campaign will occur.  The literacy campaign showed that there must be massive involvement and enthusiasm for it to be successful.

Fidel was a driving force of mobilization.  He motivated physicians, graduating medical students, and the entire country by reminding them that “Public health occupies a prioritized and sacred place in the revolution.”  Fidel pushed for changes that would accelerate training of medical personnel and rotate professors, instructors and residents from Havana to new medical schools.

One of Fidel’s most important contributions was explaining that Cuba could improve upon eastern Europe’s concept of community clinics.  He believed that Cuba needed to create an example of public medicine that could be used by poor and undeveloped countries.

The Committees for Defense of the Revolution (CDRs) were organized in 1960 to guard against sabotage and attacks from the US.  They provided social networks for neighborhoods and soon became intricately linked to public health coordination.

CDRs took on the task of registering the entire population at policlínicos integrales.  Since each policlínico integral had a defined geographical area, 100% enrollment was not an unreasonable goal.  Working in conjunction with policlínicos integrales, the CDRs were deeply involved in establishing social and preventive medicine; educating and mobilizing the population to help combat flies and mosquitoes, control infectious diseases, and donate blood; building schools and parks; and cleaning and repairing streets

The first decade of the Cuban revolution shows that if limited resources are distributed in an egalitarian fashion medical miracles can happen.  The key to Cuba’s medical revolution was (a) dedication and work by all health care professionals under (b) a well-guided structure set forth by MINSAP with (c) decentralized implementation of health campaigns by policlínicos integrales in coordination with mass organizations.

Lingering Issues

Despite Cuba’s having forged a unified medical system with a single point of patient entry into a decentralized policlínico integral, significant issues persisted 10 years after the revolution.  Most disturbing was that infant mortality continued to climb.

Also, the fusion of centralization and decentralization was often not as smooth as hoped.  Even though many revolutionary doctors took positions in MINSAP or as administrators of medical facilities, conflicts still surfaced between those whose primary jobs were re-creating the medical system and those whose daily work focused on care delivery.

While the new ideology proclaimed the importance of preventive medicine, doctors and other clinicians frequently perceived health to merely be the absence of disease.  The changeover in attitudes did occur, largely through the education of the next generation of practitioners.

Doctors tend to be very autonomous, confident that their method is the best.  What happens when their approach diverges from policy, the community and/or colleagues?

There was widespread disagreement over a parent wanting to “live-in” with a hospitalized child.  Most doctors and nurses were very opposed to initiating a policy of letting a parent sleep in a child’s hospital room, fearing that s/he would be a nuisance.  Dr. Ezno Dueñas recalled his experience at Lenin Hospital in Holguín when there was a shortage of nurses: “So we had to have mothers taking care of their children.  Now, the mother is with the child in the hospital and is not upset.”  When the government decided to implement the policy of live-in parents it became very popular and resulted in shorter hospital stays for children.

The stress of going to medical school in Cuba during the 1960s was enough to cause almost half of students to drop out.  One program to keep them enrolled was to create alumnos ayudantes (student assistants or peer tutors).  Dr. María Luísa Lima, who currently teaches at ELAM (Latin American School of Medicine), began medical school in 1965 when she was 17 years old.  She explained to me that ayudantes were those who had done well in basic sciences and were closely tutored by doctors so they could help others through courses.  The ayudantes expanded the reach of professors and were themselves potential new faculty.

Despite all efforts, there was still a shortfall of doctors in 1969.  This unquestionably hurt the ability to provide health care for all.  I asked Cuban historian Hedelberto López how difficult it would have been to implement the changes of the 1960s, including the development of polyclinics, if the counterrevolutionaries had stayed.  He replied that “Of course, the revolution in medicine would have been impossible if doctors had not fled the country.  They would have disrupted everything.”

By the last half of the 1960s, the departure of half of Cuba’s doctors to Miami proved to be a double-edged sword.  One edge slashed into the health care of Cubans, depriving millions of desperately needed health care as the other edge cut off the ability of nay-sayers to hamper the building of a new medical world.

Many lessons of the first decade of Cuban medicine had been assumed or suspected before the revolution confirmed them.  It became clear that medical care could only be improved if a country simultaneously addressed necessities such as food, housing and education; medical campaigns must be based on mass participation; it may be possible to cope with an obstructive institution such as mutualism by creating a better method of delivering care before abolishing the old one; an institution could be improved by undertaking two contradictory processes simultaneously (such as centralizing and decentralizing medicine); despite the short term damage of 3000 doctors leaving, the long term ability to renovate medicine was blessed by their absence.

None of these principles can be applied in a rigid fashion to another country.  They demonstrate that providing health care which genuinely meets human needs must go beyond patching up holes in the old system and completely reconceptualize the system itself.

When Health Care is a Privilege and Physician Shadowing is a Right

As it is presently constructed, the American health care system is predicated on the pernicious idea that good health care is a privilege. Meanwhile, medical students, residents, and other interlopers regard observing patients’ doctor’s visits to be their right, regardless of whether or not the patient’s consent has been obtained. This dichotomy embodies the egregious inequality inherent in the two-tier system, and is indicative of a complete inversion of the way any humane health care system must be ideologically oriented.

The subject of physician shadowing is inextricably linked with unfettered capitalism and the neoliberal project, where the privileged few have a vast array of options in regards to where and with whom they can seek care, while the under-insured masses can spend countless hours – sometimes in vain – searching for the appropriate specialist that takes their insurance. If an under-insured patient is able to find a specialist that takes their insurance, they often fall prey to the scourge of nonconsensual physician shadowing, as they can be coerced into becoming a medical model and teaching tool without their consent.

Physician shadowing must never be done without the patient’s consent, as this constitutes an egregious violation of medical ethics, patient privacy, and the patient’s moral right to meet with a physician in private should they choose to do so. Moreover, once a patient feels that their trust in the system has been violated, it will be extremely difficult, if not impossible, to ever fully restore it.

While a great deal of lip service is paid to “privacy,” “consent,” and “the doctor–patient relationship” in American teaching hospitals, all of these things are summarily jettisoned once medical students and residents get inculcated with the idea that it is acceptable to shadow a physician regardless of whether or not the patient’s consent has been obtained. In actuality, physician shadowing is a privilege that can be granted by one person, and one person only: the patient.

Under the neoliberal project, many physicians have been pulled inexorably into a vortex of amorality. This is because they are trained in an environment whereby the scourge of free market ideology has distorted their thinking and debased any sense of morality. Indeed, many young physicians are inculcated with the shameful idea that unless a patient has an excellent commercial plan privacy, consent, and confidentiality should have no bearing on the care they will receive.

Medical schools compel undergraduate pre-med majors to shadow a physician for a significant number of hours. This practice should be banned, as these students are not officially medical students. Consequently, they are totally unvetted. Allowing high school students to shadow a physician, or observe medical personnel at work in an emergency room or operating room, is an outrage. Having a secretary serve as a “chaperone” – deemed desirable by some physicians, as this can protect them from lawsuits – is likewise unethical and thoroughly repugnant.

The dismantling of the humanities has played a significant role in fomenting dehumanization and moral bankruptcy in health care, because without the humanities, many health care professionals have lost their ability to be compassionate and empathetic. Indeed, without a humanities education, what separates a urologist from a plumber, or an auto mechanic from a gastroenterologist?

In an online discussion on forums.studentdoctor.net titled “Isn’t Shadowing Intrusive?” doctors and medical students nonchalantly discuss physician shadowing. One philistine writes, “If you agree to the student being in the room, how is your privacy being violated? Everyone should stop being so hysterical – if the patients don’t like something, they can speak up.”

While another defends the right of undergraduates to shadow: “Medical training has to start somewhere. There is not (or shouldn’t be) a glaring divide between premedical and medical education. Better to make sure our students are better prepared for medical school and know what they are getting themselves into. And if anything, many patients are happy to have someone else to talk to. It never was a problem when I shadowed.”

Actually, many patients are interested in talking with a physician in private – and without interlopers barbarically violating their privacy. In all the many times I have experienced this at Weill Cornell and Sloan Kettering, never was my consent first obtained. In fact, at Memorial I had to complain dozens of times before my request to meet with my various doctors in private was finally granted. There are certain departments at Cornell where you can issue complaints ad nauseam, yet they will still not allow a patient with inferior insurance to meet with an attending physician in private.

Another morally bankrupt knave writes: “I’ve seen at least 100 patients in shadowing experiences. Not one asked me to leave. If you’re at a teaching hospital, and the patient has been there before, they know the deal.”

“The deal” is that there is a crisis in American health care, where all too often patient privacy is nonexistent. Also, the notion that patients can easily object is deeply fallacious. Would this hold true with the under-insured, who are acutely aware of how limited their options are? Even a patient with the finest insurance may have a hard time objecting to unwanted observers at Sloan Kettering, as Memorial has a policy of denying patients the right to change from one oncologist to another within whatever department they are ensconced in. Moreover, as these comments demonstrate, the cavalier dismissal on the part of many medical students, residents, and attending physicians that nonconsensual physician shadowing could leave patients with real emotional scars, is indicative of an extraordinary degree of insouciance regarding the delicate nature of the doctor-patient relationship, as well as a deep-seated callousness and moral bankruptcy that has metastasized throughout our entire health care system like a cancer.

Once the callow are inculcated with the idea that nonconsensual physician shadowing is an acceptable and everyday part of learning how to be a doctor, what follows? Catheterizing anesthetized patients without their knowledge? Having medical students do practice pelvic and rectal exams on anesthetized patients? Willful nondisclosure of long-term chemotherapy side effects, such as cognitive difficulties and early menopause? Over-prescribing opioids? Psychiatrists overprescribing psychotropic drugs? Indeed, these are things that have already come to pass.

It is unequivocally true that the principal devils in the American health care crisis are the private insurance companies, the pharmaceutical industry, and the hospital administrators. Yet throughout my many long and arduous years as a patient, I have witnessed medical students, residents, and fellows instructed by attending physicians to do things that are undeniably unethical. All too often their medical training is corrupted by the two-tier system and the moral bankruptcy that this spawns.

What kind of doctors will medical students and residents become, when every day they are immersed in an environment where do no harm applies to a privileged few? Where the haves are endowed with an endless array of good options, and the have nots are commodified and railroaded into resident clinics which prey on the under-insured, and which coerce patients into surrendering all vestiges of privacy? Privacy, confidentiality, and consent are foundational to any humane health care system, and once they become a privilege for the few, the very basis of medical ethics is torn asunder.

Capitalism has distorted and inverted our sense of morality – so that rights such as good health care, a good education, equality under the law, safe drinking water, affordable housing, etc. – have become privileges, whereas privileges, paradoxically, have become rights.

Once at Cornell Dermatology, I was subjected to an examination with a resident present and a nurse going in and out of the room, despite my requests to meet with a dermatologist in private. As I am at risk for melanoma and was overdue for a checkup, I deemed the visit to be medically necessary. Moreover, had I elected to go somewhere else (a specious argument frequently posited by anti-privacy ideologues), the other dermatology departments in Manhattan that take my insurance are run in a similar fashion. This is not a coincidence, as those who manage resident clinics are acutely aware of the fact that many of the under-insured who walk through their doors have few if any options.

I often think about this resident, and whether she was cognizant of the fact that she played a role in egregiously violating my privacy, as well as the oath that she took to do no harm. Did she fail to see the double standard – that she was participating in an assault on a patient’s privacy that she would vehemently object to – indeed be mortified by, herself? She has since completed her residency at Cornell, and is now ensconced at the dermatology department at The University of Pennsylvania. While these things may look nice on one’s resume, I can’t help but wonder how many hours she had to spend shadowing, and how much of this shadowing was done without the patients’ consent. I can only hope that now that she is an attending physician, she can use her influence to give patients a choice in regards to whether observers are present during their doctor’s visits, and that this will be done regardless of what type of insurance these patients may have. It is regrettable that for many ambitious young doctors privacy and consent matter little in the face of blind obedience, authoritarianism, and careerism.

Doctors know much more today than they’ve ever known before. Yet ironically, they are trusted and respected less than was the case in the 50’s and 60’s. Losing their autonomy to the private insurance companies, as well as being forced to see an increasing number of patients each day, have undoubtedly played a role in the diminishing of the doctor’s prestige. However, a growing number of patients are acutely aware of how morally compromised many doctors have become, as unfettered capitalism and the profit motive have come to permeate and defile the very soul of our society. Indeed, many physicians that ardently defend nonconsensual physician shadowing, are the first to use their superior health insurance plans to avoid this very thing when it is time to see a doctor themselves.

It is deeply disturbing watching medical students and residents being instructed to obey unethical orders from an attending physician. Only with a single-payer system will we disenthrall ourselves from the barbarism of the two-tier system – a system which destroys the souls of doctors and patients alike.

Dangerous Liaison: Corporate Agriculture and the Reductionist Mindset

Food and agriculture across the world is in crisis. Food is becoming denutrified and unhealthy and diets less diverse. There is a loss of biodiversity, which threatens food security, soils are being degraded, water sources polluted and depleted and smallholder farmers, so vital to global food production, are being squeezed off their land and out of farming.

A minority of the global population has access to so much food that it can afford to waste much of it, while food insecurity has become a fact of life for hundreds of millions. This crisis stems from food and agriculture being wedded to power structures that serve the interests of the powerful global agribusiness corporations.

Over the last 60 years, agriculture has become increasingly industrialised, globalised and tied to an international system of trade based on export-oriented mono-cropping, commodity production for the international market, indebtedness to international financial institutions (IMF/World Bank).

This has resulted in food surplus and food deficit areas, of which the latter have become dependent on (US) agricultural imports and strings-attached aid. Food deficits in the Global South mirror food surpluses in the North, based on a ‘stuffed and starved’ strategy.

Whether through IMF-World Bank structural adjustment programmes related to debt repayment as occurred in Africa (as a continent Africa has been transformed from a net exporter to a net importer of food), bilateral trade agreements like NAFTA and its impact on Mexico or, more generally, deregulated global trade rules, the outcome has been similar: the devastation of traditional, indigenous agriculture.

Integral to all of this has been the imposition of the ‘Green Revolution’. Farmers were encouraged to purchase hybrid seeds from corporations that were dependent on chemical fertilisers and pesticides to boost yields. They required loans to purchase these corporate inputs and governments borrowed to finance irrigation and dam building projects for what was a water-intensive model.

While the Green Revolution was sold to governments and farmers on the basis it would increase productivity and earnings and would be more efficient, we now have nations and farmers incorporated into a system of international capitalism based on dependency, deregulated and manipulated commodity markets, unfair subsidies and inherent food insecurity.

As part of a wider ‘development’ plan for the Global South, millions of farmers have been forced out of agriculture to become cheap factory labour (for outsourced units from the West) or, as is increasingly the case, unemployed or underemployed slum dwellers.

In India, under the banner of a bogus notion of ‘development’, farmers are being whipped into subservience on behalf of global capital: they find themselves steadily squeezed out of farming due to falling incomes, the impact of cheap imports and policies deliberately designed to run down smallholder agriculture for the benefit of global agribusiness corporations.

Aside from the geopolitical shift in favour of the Western nations resulting from the programmed destruction of traditional agriculture across the world, the Green Revolution has adversely impacted the nature of food, soil, human health and the environment.

Sold on the premise of increased yields, improved food security and better farm incomes, the benefits of the Green Revolution have been overstated. And the often stated ‘humanitarian’ intent and outcome (‘millions of lives saved’) has had more to do with PR and cold commercial interest.

However, even when the Green Revolution did increase yields (or similarly, if claims about GMO agriculture – the second coming of the Green Revolution – improving output is to be accepted at face value), Canadian environmentalist Jodi Koberinski says pertinent questions need to be asked: what has been the cost of any increased yield of commodities in terms of local food security and local caloric production, nutrition per acre, water tables, soil structure and new pests and disease pressures?

We may also ask what the effects on rural communities and economies have been; on birds, insects and biodiversity in general; on the climate as a result of new technologies, inputs or changes to farming practices; and what has been the effects of shifting towards globalised production chains, not least in terms of transportation and fossil fuel consumption.

Moreover, if the Green Revolution found farmers in the Global South increasingly at the mercy of a US-centric system of trade and agriculture, at home they were also having to fit in with development policies that pushed for urbanisation and had to cater to the needs of a distant and expanding urban population whose food requirements were different to local rural-based communities. In addition to a focus on export-oriented farming, crops were also being grown for the urban market, regardless of farmers’ needs or the dietary requirements of local rural markets.

Destroying indigenous systems

In an open letter written in 2006 to policy makers in India, farmer and campaigner Bhaskar Save offered answers to some of these questions. He argued that the actual reason for pushing the Green Revolution was the much narrower goal of increasing marketable surplus of a few relatively less perishable cereals to fuel the urban-industrial expansion favoured by the government and a few industries at the expense of a more diverse and nutrient-sufficient agriculture, which rural folk – who make up the bulk of India’s population – had long benefited from.

Before, Indian farmers had been largely self-sufficient and even produced surpluses, though generally smaller quantities of many more items. These, particularly perishables, were tougher to supply urban markets. And so, the nation’s farmers were steered to grow chemically cultivated monocultures of a few cash-crops like wheat, rice, or sugar, rather than their traditional polycultures that needed no purchased inputs.

Tall, indigenous varieties of grain provided more biomass, shaded the soil from the sun and protected against its erosion under heavy monsoon rains, but these were replaced with dwarf varieties, which led to more vigorous growth of weeds and were able to compete successfully with the new stunted crops for sunlight.

As a result, the farmer had to spend more labour and money in weeding, or spraying herbicides. Furthermore, straw growth with the dwarf grain crops fell and much less organic matter was locally available to recycle the fertility of the soil, leading to an artificial need for externally procured inputs. Inevitably, the farmers resorted to use more chemicals and soil degradation and erosion set in.

The exotic varieties, grown with chemical fertilisers, were more susceptible to ‘pests and diseases’, leading to yet more chemicals being poured. But the attacked insect species developed resistance and reproduced prolifically. Their predators – spiders, frogs, etc. – that fed on these insects and controlled their populations were exterminated. So were many beneficial species like the earthworms and bees.

Save noted that India, next to South America, receives the highest rainfall in the world. Where thick vegetation covers the ground, the soil is alive and porous and at least half of the rain is soaked and stored in the soil and sub-soil strata.

A good amount then percolates deeper to recharge aquifers or groundwater tables. The living soil and its underlying aquifers thus serve as gigantic, ready-made reservoirs. Half a century ago, most parts of India had enough fresh water all year round, long after the rains had stopped and gone. But clear the forests, and the capacity of the earth to soak the rain, drops drastically. Streams and wells run dry.

While the recharge of groundwater has greatly reduced, its extraction has been mounting. India is presently mining over 20 times more groundwater each day than it did in 1950. But most of India’s people – living on hand-drawn or hand-pumped water in villages and practising only rain-fed farming – continue to use the same amount of ground water per person, as they did generations ago.

More than 80% of India’s water consumption is for irrigation, with the largest share hogged by chemically cultivated cash crops. For example, one acre of chemically grown sugarcane requires as much water as would suffice 25 acres of jowar, bajra or maize. The sugar factories too consume huge quantities.

From cultivation to processing, each kilo of refined sugar needs two to three tonnes of water. Save argued this could be used to grow, by the traditional, organic way, about 150 to 200 kg of nutritious jowar or bajra (native millets).

If Bhaskar Save helped open people’s eyes to what has happened on the farm, to farmers and to ecology in India, a 2015 report by GRAIN provides an overview of how US agribusiness has hijacked an entire nation’s food and agriculture under the banner of ‘free trade’ to the detriment of the environment, health and farmers.

In 2012, Mexico’s National Institute for Public Health released the results of a national survey of food security and nutrition. Between 1988 and 2012, the proportion of overweight women between the ages of 20 and 49 increased from 25% to 35% and the number of obese women in this age group increased from 9% to 37%.

Some 29% of Mexican children between the ages of 5 and 11 were found to be overweight, as were 35% of youngsters between 11 and 19, while one in 10 school age children suffered from anemia. The Mexican Diabetes Federation says that more than 7% of the Mexican population has diabetes. Diabetes is now the third most common cause of death in Mexico, directly or indirectly.

The various free trade agreements that Mexico has signed over the past two decades have had a profound impact on the country’s food system and people’s health. After his mission to Mexico in 2012, the then Special Rapporteur on the Right to Food, Olivier De Schutter, concluded that the trade policies in place favour greater reliance on heavily processed and refined foods with a long shelf life rather than on the consumption of fresh and more perishable foods, particularly fruit and vegetables.

He added that the overweight and obesity emergency that Mexico is facing could have been avoided, or largely mitigated, if the health concerns linked to shifting diets had been integrated into the design of those policies.

The North America Free Trade Agreement led to the direct investment in food processing and a change in the retail structure (notably the advent of supermarkets and convenience stores) as well as the emergence of global agribusiness and transnational food companies in Mexico.

The country has witnessed an explosive growth of chain supermarkets, discounters and convenience stores. Local small-scale vendors have been replaced by corporate retailers that offer the processed food companies greater opportunities for sales and profits. Oxxo (owned by Coca-cola subsidiary Femsa) tripled its stores to 3,500 between 1999 and 2004. It was scheduled to open its 14,000th store sometime during 2015.

In Mexico, the loss of food sovereignty has induced catastrophic changes in the nation’s diet and has had dire consequences for agricultural workers who lost their jobs and for the nation in general. Those who have benefited include US food and agribusiness interests, drug cartels and US banks and arms manufacturers.

More of the same: a bogus ‘solution’

Transnational agribusiness has lobbied for, directed and profited from the very policies that have caused much of the above. And what we now see is these corporations (and their supporters) espousing cynical and fake concern for the plight of the poor and hungry.

GMO patented seeds represent the final stranglehold of transnational agribusiness over the control of agriculture and food. The misrepresentation of the plight of the indigenous edible oils sector in India encapsulates the duplicity at work surrounding the GM project.

After trade rules and cheap imports conspired to destroy farmers and the jobs of people involved in local food processing activities for the benefit of global agribusiness, including commodity trading and food processor companies ADM and Cargill, there is now a campaign to force GM into India on the basis that Indian agriculture is unproductive and thus the country has to rely on imports. This conveniently ignores the fact that prior to neoliberal trade rules in the mid-1990s, India was almost self-sufficient in edible oils.

In collusion with the Gates Foundation, corporate interests are also seeking to secure full spectrum dominance throughout much of Africa as well. Western seed, fertiliser and pesticide manufacturers and dealers and food processing companies are in the process of securing changes to legislation and are building up logistics and infrastructure to allow them to recast food and farming in their own images.

Today, governments continue to collude with big agribusiness corporations. These companies are being allowed to shape government policy by being granted a strategic role in trade negotiations and are increasingly framing the policy/knowledge agenda by funding and determining the nature of research carried out in public universities and institutes.

As Bhaskar Save wrote about India:

This country has more than 150 agricultural universities. But every year, each churns out several hundred ‘educated’ unemployables, trained only in misguiding farmers and spreading ecological degradation. In all the six years a student spends for an M.Sc. in agriculture, the only goal is short-term – and narrowly perceived – ‘productivity’. For this, the farmer is urged to do and buy a hundred things. But not a thought is spared to what a farmer must never do so that the land remains unharmed for future generations and other creatures. It is time our people and government wake up to the realisation that this industry-driven way of farming – promoted by our institutions – is inherently criminal and suicidal!

Save is referring to the 300,000-plus farmer suicides that have taken place in India over the past two decades due to economic distress resulting from debt, a shift to (GM)cash crops and economic ‘liberalisation’ (see this report about a peer-reviewed study, which directly links suicides to GM cotton).

The current global system of chemical-industrial agriculture, World Trade Organisation rules and bilateral trade agreements that agritech companies helped draw up are a major cause of food insecurity and environmental destruction. The system is not set up to ‘feed the world’ despite the proclamations of its supporters.

However, this model has become central to the dominant notion of ‘development’ in the Global South: unnecessary urbanisation, the commercialisation and emptying out of the countryside at the behest of the World Bank, the displacement of existing systems of food and agricultural production with one dominated by Monsanto-Bayer, Cargill and the like and a one-dimensional pursuit of GDP growth as a measure of ‘progress’ with little concern for the costs and implications – mirroring the narrow, reductionist ‘output-yield’ paradigm of industrial agriculture itself.

Agroecology offers a genuine solution

Across the world, we are seeing farmers and communities pushing back and resisting the corporate takeover of seeds, soils, land, water and food. And we are also witnessing inspiring stories about the successes of agroecology.

Reflecting what Bhaskar Save achieved on his farm in Gujarat, agroecology combines sound ecological management, including minimising the use of toxic inputs, by using on-farm renewable resources and privileging natural solutions to manage pests and disease, with an approach that upholds and secures farmers’ livelihoods.

Agroecology is based on scientific research grounded in the natural sciences but marries this with farmer-generated knowledge and grassroots participation that challenges top-down approaches to research and policy making. However, it can also involve moving beyond the dynamics of the farm itself to become part of a wider agenda, which addresses the broader political and economic issues that impact farmers and agriculture (see this description of the various modes of thought that underpin agroecolgy).

Jodi Koberisnki’s nod to ‘systems thinking’ lends credence to agroecology, which recognises the potential of agriculture to properly address concerns about local food security and sovereignty as well as social, ecological and health issues. In this respect, agroecology is a refreshing point of departure from the reductionist approach to farming which emphasises securing maximum yield and corporate profit to the detriment of all else.

Wei Zhang – an economist focusing on ecosystem services, agriculture and the environment – says:

that ‘worldview’ is important to how you conceptualise issues and develop or choose tools to address those issues. Using systems thinking requires a shift in fundamental beliefs and assumptions that constitute our worldviews. These are the intellectual and moral foundations for the way we view and interpret reality, as well as our beliefs about the nature of knowledge and the processes of knowing. Systems thinking can help by changing the dominant mindset and by addressing resistance to more integrated approaches.

Agroecology requires that shift in fundamental beliefs.

A few years ago, the Oakland Institute released a report on 33 case studies which highlighted the success of agroecological agriculture across Africa in the face of climate change, hunger and poverty. The studies provide facts and figures on how agricultural transformation can yield immense economic, social, and food security benefits while ensuring climate justice and restoring soils and the environment.

The research highlights the multiple benefits of agroecology, including affordable and sustainable ways to boost agricultural yields while increasing farmers’ incomes, food security and crop resilience.

The report described how agroecology uses a wide variety of techniques and practices, including plant diversification, intercropping, the application of mulch, manure or compost for soil fertility, the natural management of pests and diseases, agroforestry and the construction of water management structures.

There are many other examples of successful agroecology and of farmers abandoning Green Revolution thought and practices to embrace it (see this report about El Salvador and this interview from South India).

In a recent interview appearing on the Farming Matters website, Million Belay sheds light on how agroecological agriculture is the best model of agriculture for Africa. Belay explains that one of the greatest agroecological initiatives started in 1995 in Tigray, Northern Ethiopia, and continues today. It began with four villages and after good results, it was scaled up to 83 villages and finally to the whole Tigray Region. It was recommended to the Ministry of Agriculture to be scaled up at the national level. The project has now expanded to six regions of Ethiopia.

The fact that it was supported with research by the Ethiopian University at Mekele has proved to be critical in convincing decision makers that these practices work and are better for both the farmers and the land.

Bellay describes another agroecological practice that spread widely across East Africa – ‘push-pull’. This method manages pests through selective intercropping with important fodder species and wild grass relatives, in which pests are simultaneously repelled – or pushed – from the system by one or more plants and are attracted to – or pulled – toward ‘decoy’ plants, thereby protecting the crop from infestation. Push-pull has proved to be very effective at biologically controlling pest populations in fields, reducing significantly the need for pesticides, increasing production, especially for maize, increasing income to farmers, increasing fodder for animals and, due to that, increasing milk production, and improving soil fertility.

By 2015, the number of farmers using this practice increased to 95,000. One of the bedrocks of success is the incorporation of cutting edge science through the collaboration of the International Center of Insect Physiology and Ecology (ICIPE) and the Rothamsted Research Station (UK) who have worked in East Africa for the last 15 years on an effective ecologically-based pest management solution for stem borers and striga.

But agroecology should not just be regarded as something for the Global South. Food First Executive Director Eric Holtz-Gimenez argues that it offers concrete, practical solutions to many of the world’s problems that move beyond (but which are linked to) agriculture. In doing so, it challenges – and offers alternatives to – prevailing moribund doctrinaire economics and the outright plunder of neoliberalism.

The scaling up of agroecology can tackle hunger, malnutrition, environmental degradation and climate change. By creating securely paid labour-intensive agricultural work, it can also address the interrelated links between labour offshoring by rich countries and the removal of rural populations elsewhere who end up in sweat shops to carry out the outsourced jobs.

Thick legitimacy

Various official reports have argued that to feed the hungry and secure food security in low income regions we need to support small farms and diverse, sustainable agroecological methods of farming and strengthen local food economies (see this report on the right to food and this (IAASTD) peer-reviewed report).

Olivier De Schutter says:

To feed 9 billion people in 2050, we urgently need to adopt the most efficient farming techniques available. Today’s scientific evidence demonstrates that agroecological methods outperform the use of chemical fertilizers in boosting food production where the hungry live, especially in unfavorable environments.

De Schutter indicates that small-scale farmers can double food production within 10 years in critical regions by using ecological methods. Based on an extensive review of scientific literature, the study he was involved in calls for a fundamental shift towards agroecology as a way to boost food production and improve the situation of the poorest. The report calls on states to implement a fundamental shift towards agroecology.

The success stories of agroecology indicate what can be achieved when development is placed firmly in the hands of farmers themselves. The expansion of agroecological practices can generate a rapid, fair and inclusive development that can be sustained for future generations. This model entails policies and activities that come from the bottom-up and which the state can then invest in and facilitate.

A decentralised system of food production with access to local markets supported by proper roads, storage and other infrastructure must take priority ahead of exploitative international markets dominated and designed to serve the needs of global capital.

It has long been established that small farms are per area more productive than large-scale industrial farms and create a more resilient, diverse food system. If policy makers were to prioritise this sector and promote agroecology to the extent Green Revolution practices and technology have been pushed, many of the problems surrounding poverty, unemployment and urban migration could be solved.

However, the biggest challenge for upscaling agroecology lies in the push by big business for commercial agriculture and attempts to marginalise agroecology. Unfortunately, global agribusiness concerns have secured the status of ‘thick legitimacy’ based on an intricate web of processes successfully spun in the scientific, policy and political arenas. This allows its model to persist and appear normal and necessary. This perceived legitimacy derives from the lobbying, financial clout and political power of agribusiness conglomerates which set out to capture or shape government departments, public institutions, the agricultural research paradigm, international trade and the cultural narrative concerning food and agriculture.

Critics of this system are immediately attacked for being anti-science, for forwarding unrealistic alternatives, for endangering the lives of billions who would starve to death and for being driven by ideology and emotion. Strategically placed industry mouthpieces like Jon Entine, Owen Paterson and Henry Miller perpetuate such messages in the media and influential industry-backed bodies like the Science Media Centre feed journalists with agribusiness spin.

When some people hurl such accusations, it might not just simply be spin: it may be the case that some actually believe critics are guilty of such things. If that is so, it is a result of their failure to think along the lines Zhang outlines: they are limited by their own reductionist logic and worldview.

The worrying thing is that too many policy makers may also be blinded by such a view because so many governments are working hand-in-glove with the industry to promote its technology over the heads of the public. A network of scientific bodies and regulatory agencies that supposedly serve the public interest have been subverted by the presence of key figures with industry links, while the powerful industry lobby hold sway over bureaucrats and politicians.

The World Bank is pushing a corporate-led industrial model of agriculture via its ‘enabling the business of agriculture’ strategy and corporations are given free rein to write policies. Monsanto played a key part in drafting the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights to create seed monopolies and the global food processing industry had a leading role in shaping the WTO Agreement on the Application of Sanitary and Phytosanitary Measures (see this). From Codex, the Knowledge Initiative on Agriculture aimed at restructuring Indian agriculture to the currently on-hold US-EU trade deal (TTIP), the powerful agribusiness lobby has secured privileged access to policy makers to ensure its model of agriculture prevails.

The ultimate coup d’etat by the transnational agribusiness conglomerates is that government officials, scientists and journalists take as given that profit-driven Fortune 500 corporations have a legitimate claim to be custodians of natural assets. These corporations have convinced so many that they have the ultimate legitimacy to own and control what is essentially humanity’s common wealth. There is the premise that water, food, soil, land and agriculture should be handed over to powerful transnational corporations to milk for profit, under the pretence these entities are somehow serving the needs of humanity.

Corporations which promote industrial agriculture have embedded themselves deeply within the policy-making machinery on both national and international levels. From the overall narrative that industrial agriculture is necessary to feed the world to providing lavish research grants and the capture of important policy-making institutions, global agribusiness has secured a perceived thick legitimacy within policymakers’ mindsets and mainstream discourse.

It gets to the point whereby if you – as a key figure in a public body – believe that your institution and society’s main institutions and the influence of corporations on them are basically sound, then you are probably not going to challenge or question the overall status quo. Once you have indicated an allegiance to these institutions and corporate power, it is ‘irrational’ to oppose their policies, the very ones you are there to promote. And it becomes quite ‘natural’ to oppose any research findings, analyses or questions which question the system and by implication your role in it.

But how long can the ‘legitimacy’ of a system persist given that it merely produces bad food, creates food deficit regions globally,  destroys health, impoverishes small farms, leads to less diverse diets and less nutritious food, is less productive than small farms, creates water scarcity, destroys soil and fuels/benefits from World Bank/WTO policies that create dependency and debt.

The more that agroecology is seen to work, the more policy makers see the failings of the current system and the more they become open to holistic approaches to agriculture – as practitioners and supporters of agroecology create their own thick legitimacy –  the more willing officials might be to give space to a model that has great potential to help deal with some of the world’s most pressing problems. It has happened to a certain extent in Ethiopia, for example. That is hopeful.

Of course, global agribusiness nor the system of capitalism it helps to uphold and benefits from are not going to disappear overnight and politicians (even governments) who oppose or challenge private capital tend to be replaced or subverted.

Powerful agribusiness corporations can only operate as they do because of a framework designed to allow them to capture governments and regulatory bodies, to use the WTO and bilateral trade deals to lever global influence, to profit on the back of US militarism (Iraq) and destabilisations (Ukraine), to exert undue influence over science and politics and to rake in enormous profits.

The World Bank’s ongoing commitment to global agribusiness and a wholly corrupt and rigged model of globalisation is a further recipe for plunder. Whether it involves Monsanto, Cargill or the type of corporate power grab of African agriculture that Bill Gates is helping to spearhead, private capital will continue to ensure this happens while hiding behind platitudes about ‘free trade’ and ‘development’.

Brazil and Indonesia are subsidising private corporations to effectively destroy the environment through their practices.  Canada and the UK are working with the GMO biotech sector to facilitate its needs. And India is facilitating the destruction of its agrarian base according to World Bank directives for the benefit of the likes of Monsanto, Bayer and Cargill.

If myths about the necessity for perpetuating the stranglehold of capitalism go unchallenged and real alternatives are not supported by mass movements across continents, agroecology will remain on the periphery.