A promise for changeBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7554 (Published 17 December 2013) Cite this as: BMJ 2013;347:f7554
These are exciting times in Indian politics. It has been heartening to see the clean sweep (quite literally) in the nation’s capital by the self proclaimed common man’s party. Contesting elections for the first time, they have defied history by overturning the established playfield of age old political parties. What they held was a promise for change. And the masses clung to that and voted in large numbers.
Central to the political manifesto of candidates across India since time immemorial has been the promise of better roads. The change may nevertheless be delivered from a hitherto unexpected corner. Rajasekaran Shanmuganathan, former president of the Indian Orthopaedics Association, has filed a litigation charging the government with gross negligence in the matter of road safety and demanding coordinated action (doi:10.1136/bmj.f6912). With the World Health Organization estimates pinned at 230 000 road traffic deaths in India in the year 2010, road safety has emerged as a pressing public health problem.
An endeavour to reform and repeal the archaic is also reflected in the Mental Healthcare Bill 2013, which calls for decriminalisation of suicide in India (doi:10.1136/bmj.f6975). The bill, however, myopically labels those who attempt suicide as having mental illness. V Bhargavi and others from the Centre for Advocacy in Mental Health lay out in a Rapid Response the varied contexts of suicide in India today as indicative of “protest and desperation in the face of violence and social discrimination, or falling prey to a debt trap.” Being classified as “mentally ill” would woefully undermine their circumstances. As Christopher Dowrick and Allen Frances discuss (doi:10.1136/bmj.f7140), medicalising unhappiness may stigmatise those presenting with sadness or distress, and lead to unnecessary treatment. More deliberation is warranted so the proposed bill doesn’t inadvertently do more harm.
With escalating levels of stress, promotion of psychosocial wellbeing through health and social systems is crucial. Yet, the shortfall of mental health professionals is alarming. India has an estimated 0.3 psychiatrists, 0.047 psychologists, and 0.033 social workers per 100 000 people, imaginably unevenly distributed. Findings from a recent Cochrane review (doi:10.1136/bmj.f7184) that substantiate an important role of non-specialist health workers in mental healthcare, hold promise therefore. To deal with the shortage of health professionals, the Indian Cabinet recently approved a BSc in community health course (doi:10.1136/bmj.f7008). This has been mired in controversy from the start, and we see the divided opinions reflected in the latest BMJ India poll on the issue. Slated to commence in the coming year, I am optimistic of engagement of the medical community to iron out existing differences, keeping the larger goal in sight.
A change for the new is what Rajeev Kumar, from the All India Institute of Medical Sciences, calls for in the field of medical journals too (doi:10.1136/bmj.f7465). Responding to the recent sting where a spoof research paper was accepted by 64 Indian journals (doi:10.1136/bmj.f5975), he contends the problem is not solely of corruption under an “author pays to publish model.” Rather, “lack of good peer review is the most important reason why bad science gets through.” In a revival of efforts, the Indian Association of Medical Journal Editors that convened recently holds the promise of training and supporting editors, reviewers, and authors to report science better.
In the coming year, we, at the BMJ, are excited about a new direction as well. We believe it is time patients are recognised as key stakeholders in deciding the way healthcare is structured: be it in clinical decision making, delivery of health services, or setting the agenda for health research and policy. Heralding our strategy to partner with patients (doi:10.1136/bmj.f2614), we seek to establish a panel of patients and patient advocates to get their voices in content across the journal, and expectantly on platforms that influence healthcare of the future.
So, let’s together embrace and deliver on the promise for change in different spheres in the New Year. And as we celebrate this holiday season, let’s not forget those less fortunate. This Christmas, the BMJ supports the charity Doctors of the World, which is working to rebuild lives of those displaced in Syria (doi:10.1136/bmj.f7374) and the Philippines (doi:10.1136/bmj.f7193). I invite you to give generously to support their efforts.
Cite this as: BMJ 2013;347:f7554