Understanding the poverty amelioration programmes of the congress: the narratives from the Jawaharlal Nehru and Indira Gandhi years

This article explores in details the poverty amelioration programmes which had been initiated by the Congress Party after independence during the Jawaharlal Nehru and Indira Gandhi years.In a period of three decades,there were a number of strategies which were pursued to eradicate the high level of poverty which were prevailing in the rural areas of the country.By the end of the 1950s, there was a definite move to eradicate rural poverty through definite programmes.The absence of proper land reform legislations and the dominance of the upper and middle class leadership of the Congress prevented the Government machinery in initiating plans for the amelioration of the economic status of the small peasants and the agricultural labourers. The Nehruvian logic of an integrated agricultural development found shape in the Twenty Point Programme of the 1970s. These policies had their own successes and weaknesses and they could to some extent reduce the poverty figures by the early 1980s.The most interesting side of this narrative is the states‘ deep involvement with the poverty reduction schemes,which by the early 1980s came to be criticised by a dominant section of the Congress.Such debates were responsible for the shift towards a liberalized market economy in India which instead of reducing poverty, increased the prospects of a rich poor divide in the society.Apžvelgiamos kovos su skurdu programos, įgyvendintos Indijoje 1947– 1984 metais, kai ministro pirmininko pareigas ėjo Džavaharlalas Neru ir Indira Gandi. Vyriausybė ėmėsi populistinių priemponių, kurios būtų naudingos kaimo bendruomenei, o kartu pagausintų Kongreso partijos elektoratą. Programos daugiausia buvo orientuotos į vargšų interesus, nuosekliai laikantis Kongreso partijos rinkimų manifesto – būti vargšų partija, Indijos atstumtųjų visuomenės klasių interesų gynėja. Siekdama šių tikslų ir uždavinių, vyriausybė inicijavo skurdo mažinimo programas, itin palankias pačioms žemiausioms sąrašo (angl. Scheduled) kastoms ir gentims. Nors kai kurios programos buvo gana sėkmingos, šios iniciatyvos nepajėgė pagerinti ribinių Indijos visuomenės grupių gyvenimo. Pavyzdys, atskleidžiantis ydingą vyriausybės kaimo atskirties mažinimo politiką, gali būti Žalioji revoliucija Indijoje. Numatytos programos sukėlė aktyvias diskusijas dėl skurdo, pajamų paskirstymo ir žemės ūkio darbuotojų padėties. Tų metų bendruomenių projektai turėjo įtakos vėlesnėms Indijos vyriausybėms ir jų naujoms skurdo mažinimo programoms. Straipsnis ypač aktualus šiuometiniam tarpsniui, nes nuo paskutinių dvidešimto amžiaus dešimtmečių Indijos valdantieji režimai pirmenybę teikė dviplanei – liberalizavimo ir globalizavimo – ekonominei strategijai. Indija ir toliau ieško vietos tarp besivystančių šalių, kuriose aukštas neraštingumo ir skurdo lygis, nėra tinkamos infrastruktūros sveikatos priežiūros ir švietimo srityse. Pastarieji pora dešimtmečių pažymėti ir vyriausybės pastangomis mažinti konkurencingumo finansavimą, o tai sudaro sąlygas nekliudomam sparčiam kapitalo santykių rinkos augimui. Pažymima, kad nors tokie pokyčiai ir atsiranda dėl ideologinių vyriausybės strategijos pokyčių, negalima ignoruoti populizmo, ne jis efektyviai mažino prislėgtos kaimo bendruomenės skurdo lygį. Būtina pripažinti, kad ši pirmųjų Indijos nepriklausomybės metų politika verta šių dienų Indijos politikos strategų dėmesio, nes buvo sumažinta socialinė atskirtis, išvengta diskriminacijos, kuri plečia turtingųjų ir skurdžių pajamų atotrūkį. Autorius analizuoja istorijos, sociologijos ir ekonomikos tyrėjų, kurie skurdo mažinimo programas interpretavo platesniame politinės ekonomijos kontekste, darbus. Bandoma susieti dešiniųjų ir centristų įgyvendintų programų kritiką ir apibendrintais naratyvais pateikti istoriko faktų vertinimus iš įvairių teorinių perspektyvų. Straipsnyje remiamasi plačia laikraščių ir vyriausybės dokumentų apžvalga

Higher education and participation of indigenous people in India: some reflections

Indigenous people are the most impoverished and socially disadvantaged groups in India. They account for 8.2% of the total Indian population. This group stands at the lower strata of access and participation in higher education despite constitutional protection and strong Government affirmative action policies. The Gross Enrolment Ratio (GER) of these groups has improved significantly during the last decade, but the participation in absolute terms is much below the national average. This paper examines issues concerning higher education access and equity for communities of Indigenous people, gender disparity within this group and also highlights their unique problems which may require divergent policy responses.Etninių grupių atstovai yra labiausiai nuskurdusi ir socialiai diskriminuojama grupė Indijoje. Jie sudaro apie 8,2 proc. visų Indijos gyventojų. Nepaisant Konstitucijoje numatytos paramos ir gausių Vyriausybės skatinamųjų priemonių, ši grupė nepakyla nuo žemiausios pakopos siekdama aukštojo mokslo. Bendra tokių etninių grupių įstojusiųjų asmenų proporcija (The Gross Enrolment Ratio, GER) per pastaruosius dešimt metų ženkliai išaugo, bet absoliutus skaičius rodo žymų atotrūkį nuo nacionalinio vidurkio. Šiame straipsnyje aptariamas aukštojo mokslo prieinamumas ir etninių grupių bendruomenių lygiateisiškumas, lyčių santykis šiose grupėse, pabrėžiamas problemų išskirtinumas ir tai, jog šios problemos reikalauja įvirialypių politinių sprendimų

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Dharmamangalkavya of the Mangalkavya Genre

This paper is an attempt to locate the Dharmamangal texts of the Mangalkavya genre, as a part of Indian historiography as well as to reinterpret the narrative in the context of social history of Bengal. The structure of Indian religion has been based on the distinction between Great and Little Traditions. The Dharmangalkavya belonged to the subgenre of the Mangalkavya tradition and formed a part of the ‘little tradition’. The text was composed between the 16th and the 17th centuries in south‑western parts of Bengal, to glorify Dharmathakur, a folk deity, who was at times identified with Siva, Vishnu and even represented Lord Buddha in the days of Buddhism’s degeneracy in Bengal. In the later years, a wave of Hindu thought transformed the deity into a more semi‑Hinduised cult of the lower orders of Bengal. With this development, a very rich folk literature grew up in the Rarh region of Bengal by the name of Dharmangalkavya. The paper mainly relies on the local Bengali textual sources as well the Dharmamangalkavya as primary sources and some secondary literature based on the social history of Bengal.Cette notice replace les textes du Dharmamangal appartenant au genre Mangalkavya au sein de l’historiographie indienne et réinterprète ces récits dans le contexte propre à l’histoire sociale du Bengale. La structure religieuse indienne a été établie selon une distinction entre les « grandes » et « petites » traditions. Le Dharmamangal appartient au sous genre de la tradition des Mangalkavya et forme une partie de la « petite tradition ». Le texte fut composé entre le xvie et le xviie siècle dans la partie sud‑ouest du Bengale pour glorifier Dharmathakur, une divinité populaire qui fut alors identifiée à Siva, Vishnou et même représentée en Lord Bouddha au moment où le bouddhisme déclinait au Bengale. Dans les dernières années, un courant de pensée hindou transforma la divinité en un culte à demi hindouisé parmi les couches sociales les plus basses du Bengale. Accompagnant ce développement, une très riche littérature populaire grandit dans la région du Rarh au Bengale sous le nom de Dharmamangalkavya. La notice s’appuie principalement sur des sources écrites locales en bengali ainsi que sur le Dharmamangalkavya comme source primaire et sur quelques données issues de la littérature secondaire consacrée à l’histoire sociale du Bengale

Encyclopédie des historiographies : Afriques, Amériques, Asies

Quels rapports les sociétés humaines entretiennent-elles avec leur passé et quels récits font-elles du temps révolu ? Pour ce premier volume de l’Encyclopédie des historiographies. Afriques, Amériques, Asies, 157 spécialistes représentant 88 institutions académiques en France et dans le monde explorent l’univers des productions humaines qui constituent des sources pour l’historien et déchiffrent les nombreuses modalités (« scientifiques », littéraires, artistiques, monumentales…) de l’écriture du passé. Évoquant tour à tour l’Afrique, l’Amérique latine, l’Asie, l’Océanie, les 216 notices de l’ouvrage présentent des matériaux historiques de toute nature, issus de toutes les époques, souvent méconnus, ainsi que l’histoire de leurs usages. L’entreprise collective qu’est l’Encyclopédie se veut novatrice : il s’agit de susciter une réflexion historiographique résolument non-occidentalo-centrée qui complète utilement les démarches épistémologiques traditionnelles. Nouvel outil de connaissance historique forgé à l’heure de la mondialisation, l’Encyclopédie des historiographies est aussi une véritable invitation au voyage.What are the different types of relations that non-Western societies upkeep with their past and how are narratives about the past produced by them? In this first volume of the Encyclopaedia of Historiography: Africa, America, Asia, 157 specialists from 88 international academic institutions explore the wealth of evidence that constitutes source material for historians. They also examine the immensely diverse modes or genres of narrated history: “scientific”, literary, artistic, architectural, etc. 216 entries dealing with Africa, Latin America, Oceania, and Asia, cover a large variety of sources, including many which are unfamiliar to the Western or non-Western reader, along with the history of how they have been exploited. By bringing together for the first time such an abundance of material the reader is offered the possibility of exploring continents and building meaningful connections across space and time. In addition to being a new tool for historical enquiry in an era of globalization, this encyclopaedia is also an invitation to travel the world