The American Nightmare

This presidential hopeful called Trump
Into politics has made a big jump
His speeches loquacious
Are truly audacious
And may lead to an American slump

The American Dream has seduced millions across the world, ever since the docking of the Mayflower in Provincetown Harbor in 1620 and the establishment of the first settlement at Plymouth, Massachusetts. In recent years, the dream started souring with the 2008 meltdown and a gridlocked Congress which could never agree on legislation. The aftermath of 9/11 also saw the growth of a xenophobic distrust of certain categories of human beings, typified by humiliating airport searches and surveillance of those who did not fit into the neat, comfortable definition of “us”. But never in their wildest dreams would most Americans have ever visualised that a rank pretender to the post of the President of America would not only secure the Republican Party nomination but also be in serious contention for the top job come the eighth of November. Like a master bridge player, Donald has Trumped his Republican opponents and virtually rewritten the rules of political debate. The American Dream is giving way to the American Nightmare, with likely precipitous consequences not only for that nation but for the rest of the world as well.

The bruising election campaign is symptomatic of the strains America has gone through in the first fifteen years of the twenty first century. The nearly two century old Monroe Doctrine has been tested in North America only twice, the first time when the Japanese attacked Pearl Harbor in 1941. The second attack of 9/11 was the first assault on mainland America, with the emphasis moving from state to non-state actors. Since that fateful day, America has seen a gradual, creeping erosion of her preeminent political and economic status, which seemed to have been secured after the collapse of the former Soviet Union. The wars in Afghanistan and Iraq have ended in bloody stalemates and laid the foundations for even more bitter conflicts across the Middle East. Syrian refugees pour into Europe, straining the social fabric of the countries on that continent. The Arab Spring has turned into winter. The Islamic State is still to be comprehensively subdued. And terrorism has truly become a decentralised, cottage industry, when any person with a warped ideological mindset can lay his (and increasingly her) hands on weapons of mass destruction to wreak havoc on unsuspecting (but increasingly fearful) populations.

But it would be naive to believe that the rise and rise of Donald Trump is reflective of only recent trends in the popular mood. In her seminal work “The Authoritarian Dynamic”, Australian academic Karen Stenner has underlined the importance of the prevalence of an “authoritarian predisposition” among segments of a population that extends beyond animosity to just one group, ideology or evolving social value. This predisposition is latent in the individual when economic and social conditions seem stable but is activated when a normative threat is perceived. It then manifests itself in three forms of intolerance — racial (fuelled by ethnic or religious diversity), political (against dissent, as expressed by divergent views) and moral (opposed to deviance in sexuality-related or other issues pertaining to morality). The authoritarian individual’s threat perception is particularly activated by the lack of consensus in society (as reflected in widely varying views on political, social and economic issues) and a loss of faith in the ability of politicians and the prevailing political system and institutions to manage and minimise these differences. This “American authoritarian prototype” (white-male-Protestant-heterosexual) constitutes the core of Trump supporters and its genesis predates Trump’s entry into the political arena.

Since the end of the Second World War, America has been a participant in theatres of armed conflict in Asia, Africa, Europe and Latin America. The less than successful interventions in the new millennium in Afghanistan, Iraq and the Middle East have punctured the myth of American armed invincibility. The Iraq invasion exposed the duplicity and lying of the American political elite as they capitalised on the fear psychosis created by 9/11 to promote narrow partisan interests. The “open society” was riven by suspicion and mistrust, even as accounts of use of extrajudicial measures and human rights violations against prisoners of war created disquiet amongst thinking, sensitive sections of the US public.

It took almost one hundred years after the end of a civil war waged to abolish black slavery to formalise the equal status of blacks in the USA through the Civil Rights Act of 1964. While this legislation has been followed in letter (if not always in spirit), the American authoritarian prototype has never really reconciled to the loss of his erstwhile superior, separate status. The growing presence of blacks in the government and private sectors, including at increasingly higher levels, has raised the hackles of especially those of their white brethren who have lost out in the education and employment sweepstakes. The ascension to the top job in 2008 of a black man only served to reinforce this bitterness and brought to the top the latent anti-black prejudice, as witnessed by the cheap slander of the incumbent President’s personal life and consistent efforts to derail his policies.

The icing on the cake came with the bursting of the housing bubble in 2008. Virtually overnight, working class families were plunged in debt with severe erosion in asset values. The credibility of politicians hit a new low with the common perception that Wall Street got away with murder, thanks to a sympathetic government in Washington, DC. Add to this the fear of loss of jobs to Chinese, Indians and those from a host of emerging economies and you have a situation tailor-made for the appearance of a demagogue: Trump stepped into the breach, virtually hijacking the Republican nomination. Americans have now reached a position where voting for either candidate is seen as a choice between “the devil and the deep blue sea.” Neither is seen as having the ability to heal the growing fissures and discontent in American society, Trump because of his extreme positions on minorities, the economy and foreign policy, and Clinton, because of her perceived links to a tainted political and financial establishment.

Many commentators see the implications of this “authoritarian predisposition” extending well beyond just the current election. If Trump wins, it is extremely doubtful if he will be able to walk his talk, but the continued use of a divisive and demagogic approach to issues will cause irreparable damage to the social fabric of the world’s longest-existing democracy. If Clinton wins, but her Democratic Party fails to gain control of the two Houses of Congress, the US will go through another phase of paralysis in policy-making at a time when it faces global challenges on various fronts. Even if her Presidency is accompanied by Democratic majorities in both Houses of Congress, civil strife could still be a grim reality, given the rising assertiveness of the black minority, the reality of joblessness for the less-educated white population and the
evolution of unipolar challenges to America’s dominance on the world economic and political stage.

Just over a hundred years ago, on the eve of the First World War, British Foreign Secretary Sir Edward Grey presciently observed “The lamps are going out all over Europe, we shall not see them lit again in our lifetime”. Europe is going through the throes of an existential crisis today with the very idea of a liberal democratic system, founded on pluralism, free speech and diversity, being questioned: the Brexit saga was just one of its manifestations. The virus is spreading across continental Europe, exacerbated by the Syrian refugee crisis. Its existence in the New World across the Atlantic shows the resilience of this strain, with the credulous belief that a “strong man” can solve all the problems confronting citizens today. Karen Stenner reaches a rather sobering conclusion in her book “If there are inherent predispositions to intolerance of difference…and if those predispositions are actually activated by the experience of living in a vibrant democracy, then freedom feeds fear that undermines personal freedom, and democracy is its own undoing”. Even the political scientist Francis Fukuyama who, in his book “The End of History and the Last Man”, had been optimistic, in the heady years after the collapse of the Soviet Union, of the prospects for the universal spread of liberal democracy has qualified his optimism by expressing doubts as to whether, having reached the liberal democratic destination, citizens might not again look for new political arrangements. The USA, in 1776, acted as a beacon on the democratic road taken by other countries: we can only hope that 2016 does not set humankind on an altogether different, destructive path.

Improving child nutrition: the way ahead for Maharashtra

The recently released National Family Health Survey (NFHS-4) data on maternal and child health and nutrition outcomes in Maharashtra provides sobering food for thought. This data does not provide the cheer that the 2012 UNICEF Comprehensive Survey on Nutrition in Maharashtra (CNSM 2012) brought to Maharashtra, with the showing of a stunning reduction in under-2 child stunting rates (between 2006 and 2012) from 39% to 23% and a corresponding reduction in under-2 child underweight rates from 30% to 22%. The NFHS-4 figures, which cover under-5 children, show a reduction in stunting from 46% to 34% and in underweight from 37% to just 36% over a ten-year period between 2005 and 2015. More tellingly, the NFHS-4 data reveals that high malnutrition rates are not a feature only in predominantly tribal districts; districts like Parbhani and Yavatmal (with tribal population percentages of 2.2% and 18.5% respectively) show stunting rates over 45%. As many as 13 districts in the state show underweight percentages in excess of 40%. What is disquieting is the fact that districts in Vidarbha, like Buldhana and Washim (apart from Yavatmal), and in Marathwada, like Jalna and Osmanabad (apart from Parbhani), show a high percentage of underweight children. Considering that the campaign to reduce child malnutrition in Maharashtra had its beginnings in Marathwada in 2002, the regression in performance of districts in this region indicates that the gains in child nutrition in the first ten years of this century seem to have been lost in the past few years.

Another noticeable feature of the NFHS-4 data for Maharashtra is the variance of its figures from the ICDS monthly progress reports (MPRs) of the corresponding period. Since the NFHS-4 survey was carried out in mid-2015, a comparison of district-wise under-5 children underweight percentages as shown in the June 2015 ICDS MPR was made with the district-wise figures of the NFHS-4 data. The analysis shows that as many as 20 districts showed ICDS MPR underweight percentages which were more than 25 percentage points below the corresponding NFHS-4 percentages (Table 1). Unless one wishes to contest the accuracy of the results of the NFHS-4 sample survey, the only conclusion that can be drawn is that the ICDS MPR figures are understated. My personal experience, as a former Director General of Maharashtra’s Rajmata Jijau Mother Child Health and Nutrition Mission (“the Mission”), is that there is generally a tendency, on the part of the ICDS machinery (not just in Maharashtra, but in most states) to underreport underweight numbers, both because of lack of emphasis on accurate growth monitoring, as also to avoid criticism.

TABLE 1: MAHARASHTRA – STATE AND DISTRICT VARIATIONS IN UNDERWEIGHT PERCENTAGES
Sources: NFHS-4 (2015-16) and Maharashtra ICDS MPR (June 2015)

The above analysis becomes even more relevant in the context of the recent furore over child deaths in Palghar district (newly carved in 2014 out of the existing Thane district and comprising the predominantly tribal-populated talukas), attributed to the high child malnutrition rates in this tribal region. Why has this state of affairs come about in a state which, barely a few years ago, was in the forefront of efforts to reduce child malnutrition and whose achievements gained national and international recognition?

Over the last five years, during the second phase of the Mission, there was a move away from data monitoring at a disaggregated level ranging from the district down to the Anganwadi. The Mission focused on behavioural change processes at community and family levels and on pilot initiatives to promote nutrition-sensitive projects in association with corporates/nonprofits. While these yielded results at the micro-level, there was no specific focus on scaling up these initiatives or ensuring their sustainability. More importantly, the emphasis on strengthening health and nutrition systems at the cutting edge levels, a significant feature of the operations of the first phase of the Mission, was not stressed in the second phase. Neither was there systematic follow up of the under-5 child nutrition status at the ICDS project level, a measure which is crucial to monitor the high malnutrition burden areas. With little pressure on them to monitor or ensure achievement of key nutrition outcomes, the ICDS machinery at the Zilla Parishad level and below paid little attention to outcomes.

There was also a diminution in the role of the Mission in terms of coordinating the nutrition-specific and nutrition-sensitive activities of different government departments. Departments continued to function in their respective silos; even fundamental activities like the medical facility based treatment of severe acute malnutrition and the community management of acute malnutrition suffered setbacks on account of budgetary cuts and what can only be termed as the absence of a clear policy focus. The lack of coordination in the nutrition-sensitive/specific programmes of different departments is manifest even to date in the manner of implementation of the Abdul Kalam Amrut Aahar Yojana, a maternal nutrition scheme aimed at pregnant and nursing mothers. The ICDS machinery is yet to wholeheartedly take responsibility for making this programme a success; delayed fund transfers to the village level and failure to put in place effective monitoring systems continue to bedevil the programme even a full year after its commencement. Few systematic reviews of the child malnutrition position have been undertaken at the apex levels of the political and administrative hierarchies in recent years.

The need for a mission approach to tackling child malnutrition in Maharashtra arose in the early 2000s out of the perceived inability of the ICDS machinery to make a significant impact on reducing child malnutrition despite almost three decades of its existence: its overwhelming focus on supplementary nutrition, the lack of attention to under-3 children and the failure to adopt a data-based implementation strategy. Frequent transfers of officers at the helm of affairs of the ICDS and the Department of Women & Child Development (DWCD) and absence of accountability for outcomes have bred a “business as usual” approach. The situation on the ground has deteriorated to the extent that over 70% of posts of Child Development Project Officers, the lynchpin of the ICDS programme, lie vacant today, with the DWCD apparently unable to draw up a recruitment policy for this crucial post. The creation of the Mission was expected to engender a sense of purpose in the ICDS, improve its coordination of activities with other departments and enforce accountability for measurable outcomes. This approach, largely successful in the first phase of the Mission till 2010, has been diluted greatly in the second phase.

As matters stand, the government of the day, despite having in hand a clear proposal on the modalities for launching the third phase of the Mission, has not been able to take a decision for over eighteen months. Current thinking seems to be in favour of subsuming the operations of the
Mission within the ICDS Commissionerate, a move that will make the Mission a toothless entity and, in effect, ensure a regression to the status quo prevailing prior to 2005.

Ultimately, any structure to tackle child malnutrition can only be effective if it is staffed with personnel with the passion and commitment to make a difference. The indifferent experience of a number of other states that launched Nutrition Missions based on the Maharashtra model is a clear indication that standard bureaucratic interventions will not work. Maharashtra is free to experiment with any governance structure for addressing the issue of child malnutrition. There are, however, certain fundamental steps that are a sine qua non for making a significant dent on the problem:

  1. Accurate, real-time data has to be the basis for a strategic approach. Both the health department and the ICDS need to use technology to gather real-time data on maternal and child health and nutrition to strengthen systems to tackle underlying causes. Maharashtra made a beginning in 2011-2012 using the Janani and Jatak software systems for individual mother and child tracking to monitor maternal and child health and nutrition outcomes with a view to build service delivery capabilities of the health and ICDS systems. Unfortunately, both departments have not made use of these softwares, specifically customized for Maharashtra, to aid them in efficient service delivery.
  2. A far greater sense of accountability needs to be enforced in the ICDS and public health systems, as well as in other departments with a role to play in reduction of child malnutrition and mortality, from the Secretariat to the village level. A clear political message needs to go out that the death of even one child or the continued prevalence of stunting, underweight and wasting in under-5 children will not be tolerated.
  3. Whether as a Mission or as a high-level council under the Chief Minister, there needs to be an organisational structure that coordinates the activities of government departments/agencies, nonprofits and civil society organisations. This body would plan strategies for high incidence areas, garner financial and other resources for tackling malnutrition, help develop innovative, sustainable programmes and set time-bound, measurable goals.