Reimagining Development - CEPA
27 August 2014

If you are to ask a young Sri Lankan what they want to be when they grow up, the most traditional answer is likely to be a Doctor, an Engineer or a Lawyer1. Given that the majority of the Sri Lankan population sees these professions as powerful and influential, society pressures the young2 to follow what has been set as the norm.  

Meanwhile the local education system provides a syllabus that is stagnant and memorization based with very little practicality3, leaving students reeling when they face the real world. A “learn to get a job” attitude has been cultivated so well that one dares not venture out to create something new. People who don’t conform to this trend and do not measure success by the usual standards of money and fame will be seen as outcasts.

These factors have led to a serious lack of innovative, creative individuals who can think for themselves. Thus very few people leave the herd and find their own calling by creating products or services that people need to make their lives better.

In a rapidly evolving sphere of enterprise, Sri Lankan youth are losing out. More than 66,000 unemployed youth4 provide testimony to it. Dasa Mudalali, Nawaloka Mudalali and Wegapitya of Laughs have created entrepreneurial empires with their business acumen and strategy, the likes of which haven’t been seen since the times of Upali Wijewardena, the legendary entrepreneur who was the richest man in South Asia. Unfortunately, enterprises that address social issues haven’t emerged much or at all. This is due to the misconception that such enterprises do not make a profit5 similar to a traditional profit focused business.

Most often success in our society is measured by the amount of money made by an individual or an enterprise. What if enterprise did not mean something that makes money? What if a successful enterprise was measured by how many people it helped while preserving the environment? What if development meant co-existing in harmony? Would people be satisfied or happy with what they have? With radical and different thinking, enterprises like social enterprises have emerged, targeting not only profits but social issues that affect disadvantaged communities.

An enterprise may be a venture to provide social justice by training persons and providing them with jobs to gain a service. It requires coming out of one’s comfort zone. Embracing change, be it positive or negative is an integral part of being an entrepreneur as it broadens one’s horizons and fosters creativity by addressing the needs and wants of society in reimagined ways.

Our current enterprises with only money in focus have left in their wake, much destruction and despair. The overuse of natural resources and the non-committal clearing of lands have led to development becoming synonymous with pollution and desolation.

An enterprise can be any remarkable venture that has a positive impact on a majority of the society. The Global Poverty Project6 which creates fundraisers while providing tickets to concerts for volunteering hours is one such enterprise, as is the Grameen-Danone7 yogurt enterprise which buys milk from communities to create fortified yogurt and sells it back to them at subsidiary rates. These enterprises not only tackle social issues but also provide long term solutions with added financial benefits.

To create such enterprises, an entrepreneurial eco-system with enabling conditions is now being created in Sri Lanka. A few years ago networking events for entrepreneurs were rare and were reserved for persons who were “connected” socially. Therefore, the success of an entrepreneur from a rural area reaching success was considered to be unusual.

However with seed funds and angel investors8 like Lanka Angel Network and Venture Engine now active in Sri Lanka, any entrepreneur with a great idea can create their own enterprise. Angel investors are successful business owners and individuals who invest in aspiring entrepreneurs. As opposed to traditional investors, Angel Investors provide mentorship, connections, skills and guidance as needed. Thus entrepreneurs can fund and power great ideas while continuously scaling up and improving to iron out any kinks. These networks also assist in finding partners who can consolidate skills to scale up an enterprise to reach global heights.

To gain access to such benefits, an entrepreneur must demonstrate strong commitment and dedication to the tasks at hand as an investor will not work with one who will not give the best at creating a successful enterprise. The entrepreneur must have a clear idea of his/her introduction, value proposition, sales strategy, technical/product/delivery model, competitive analysis, risks and mitigation strategies. Having a clear purpose and understanding of the enterprise ensures credibility and long-term working ability with investors.

Social media9 and the internet provide young entrepreneurs with the necessary exposure and the ability to showcase their ideas to attract more investors and consumers. Using a website and a Facebook page has provided many an entrepreneur with the ability to scale their operations up due to the interest of investors and consumers.

With entrepreneurial learning being offered at university level10, diploma level and online through interactive learning methods, the ability to gain more knowledge about enterprise and one’s own enterprise initiative is more possible than ever before.

Someone once said that entrepreneurs are people who live like no else is willing to live for a couple of years, however they live the rest of their lives like no other person ever can. This is why entrepreneurship is not meant for the faint at heart.

Entrepreneurship is the new frontier of re-imagining development that is both sustainable and beneficial to communities. It provides livelihoods and support for countless beneficiaries while creating an enriching experience for the entrepreneur.

The potential for enterprises contributing to long-term development in Sri Lanka is immense, and with the right ecosystems in place budding entrepreneurs can thrive not only in the region, but also in the larger world.

Therefore, it is vital that we ensure that Sri Lankan entrepreneurs reimagine their wares for development11.







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26 August 2014

The use of urban, rural as well as tourist sites for business purposes has seen an exponential growth during the past few years and constitutes a major component of the informal economy.  For the convenience of this study, these spaces have been categorized into three sections based on their legal status: legal, de facto or semi-legal spaces. Spaces where the occupants possess deeds and legal contracts will be defined as legal spaces whilst de facto spaces denote the exact opposite of the given definition and semi-legal spaces will be defined as spaces where the occupants have to register at a municipal council or make a monthly payment to government institutions for using spaces belonging to the government. 

Currently, urban spaces are being excessively used as informal income earning avenues by a diverse range of people; men, women, adults, youth, -children, abled, disabled, residents and migrants alike. Street vendors who establish  eateries and mini-shops where they sell toys, plastic wares, telephone equipment, fruits, fish, vegetables, wall hangers, incense sticks, camphor by the roadside and pedestrians, railway platforms etc. contribute to the congestion and chaos of the city. Prostitution also thrives; pedestrians on the roadsides stand in disguise, holding babies in their arms and try to attract prospective customers. Meanwhile beggars, who sit by the roadsides or get into buses in search of a living, use urban spaces as a mode to earn an income.

Moreover, certain vendors apply an enormous amount of creativity to attract consumers. For instance there are groups who utilize stacks of old newspaper to make wonderful handicrafts such as flowers, trees and ladders. Some others sell incense sticks, pictures for school children’s scrap books, General Knowledge books, ephemerides etc.

Furthermore, there are quite a few semi-legal spaces within junctions and roadsides where three-wheel drivers and mini-lorry owners have been allowed by the government to sell food. Therefore, they have been able to extend their autonomy as they have been registered in relevant government bodies and have therefore received a certain level of legitimacy.  In this scenario, it is important to note that they are either occupants of de facto or semi-legal spaces and their livelihoods or incomes remain highly vulnerable and unstable. Especially under recent development initiatives both these groups have been expelled from their traditional places and have had to grapple with the issue of making a steady income.

First, we need to understand why people end up with such sporadic jobs. For instance, a few vendors at Delkanda fair used the roads to make an extra living during weekends and went back to their villages to run their cottage businesses such as making incense sticks. Recently they were moved into permanent spaces by the government. Some of the three-wheel drivers also said that they ran their three-wheelers after work to make extra money. They attributed this to the rise in living costs in the recent past that had made it increasingly difficult for them to educate their children and maintain the economic stability on the home front.  In contrast to this there are some people who are permanently involved in the informal sector and use it as their major source of income.

Moreover, there are groups of beggars who have opted for that way of life. A lack of access to mainstream markets also compel these groups to find alternative ways to sell their products. Especially the vendors in Delkanda Street Market come from distant areas such as Wellawaya, Ampara in order to sell their vegetable and fruit harvests because they find it hard to access mainstream markets. However, when you converse with them it is clear that many of them do not prefer their children pursuing the same job. There is a sense of frustration on their part for failing to do well in education due to many reasons ranging from economic, and cultural barriers to ignorance. It is noteworthy that many of the street vendors are dissatisfied with their jobs due to the harsh and unstable conditions they have to undergo. Meanwhile, the three-wheel drivers also believe that running their own three-wheel makes them feel more independent than engaging in other jobs.

Nevertheless, these jobs are extremely unstable and uncertain as they occupy the urban spaces which are not owned by them. There have been occasions when street vendors have been chased away by the municipalities. Meanwhile, in terms of prostitutes there is a great danger of being arrested by police and chased by people in the area as it still remains a taboo in Sri Lankan Society. What many people do not notice is that the prostitutes also provide an essential service to the society and it is crucial to provide them with safety and security. Thus, it is important to explore not only their issues related to economic securitization but also social and health securitization.

The paradox of ‘legal spaces’ that are used for businesses will not always be directed towards the ‘legal’ means of income earning. However, another aspect that we tend to forget is the close link between the people and the de facto occupants of urban spaces. Though street vendors would appear to be a menace, they are still a part and parcel of our everyday life. Street shops are easily accessible, and they provide cheap as well as rare products such as home-made, organic products which are much more nutritious than the products in the super markets. We should also re-think how dull our life would be if we do not get to buy some edibles on our way back home in the evenings from the regular wade, kadala or achcharu vendors.

As mentioned above, those who occupy semi-legal spaces enjoy a certain level of state patronage whilst the others in de facto spaces do not have any form of legitimacy. Thus, it is important to incorporate the needs of both the groups in urban designing plans and establishing employment security networks such as proper registration processes, labor laws, loan schemes and other relevant benefits that any other employer would enjoy. 

25 August 2014

Making the Elderly Count

The Tokyo Institute of Gerontology in Japan is currently developing a ‘Smart City’ for about 400,000 older people. It is inbuilt with all the support facilities needed for them to continue living a life within the community, despite their increasing frailty. Another project of the institute is to find work for people in their 70s –second life careers - such as running a cafe or growing vegetables.[i]

Hogeway[ii], also referred to as ‘the dementia village’, is a similar facility operating in the Netherlands where elderly residents can live a seemingly normal life. Although they don’t realize it, they are being watched all the time by caretakers and staff at restaurants, the grocery store, saloon, theater etc. The simple goal in both these cases is to provide a normal environment that is reminiscent of each individual's former years, and to guarantee they receive the highest quality of life.

The actions of these two countries are significant in the context of today’s world - in a society that has increasingly less time to extend basic compassion and sensitivity to one another; that labels the elderly as an ‘economic burden’; and discards them when they are no longer contributing towards development.

These attitudes are further inflamed in light of the rapidly ageing population across the globe.

 The Imminent Challenges of a Rising Elderly Population

For the first time in history people over 65 years of age will outnumber children below 5 years.[iii] Between the years 2000-2050, the number of people above 60 years will escalate to a mammoth 1.4 billion. In Japan alone the life expectancy has increased by 35 years within a mere 7 decades.[iv]

While high life expectancy implies that medical advancement and economic development has trumped injury and disease, the increasing rates of age-related poverty, non-communicable disease (NCD) and disability worldwide reflect another story. In fact, the ageing population poses a multitude of economic, social and health challenges for the future.

Sri Lanka is facing similar prospects. It is currently the fastest ageing country in South Asia.[v] The life expectancy at birth is 74[vi]years and based on future trends in mortality, fertility and international migration, it is projected that between the years 2010-2041 the elderly population will double from 2.5 to 5.3 million.[vii]  

Due to lifestyle changes taking place in the country – urbanization, industrialization, the rise in living costs, the increase in female labour participation- the extended family structure which traditionally supported the elderly, is beginning to crumble. According to a poverty brief published by the Centre for Poverty Analysis, ‘Sri Lanka is showing a growing trend of nucleation and urbanization of families that is leading to more elderly people living on their own.’[viii] Individualistic attitudes inherently linked to the neoliberal paradigm are creeping in as the double-earner system leaves little room for nuclear families to take care of the older generation. The majority of the aged are being marginalized and dumped into elders’ homes as a result. In Vavuniya, there are approximately 13,000 elderly citizens in need of care. Yet, there are only four elderly homes to cater to these needs.[ix]

From the elderly perspective, ‘loneliness’ is an escalating factor that is disrupting social wellbeing and peace of mind. The Manager of an Elders’ Home in Kotte expressed that despite all the facilities provided for the elderly, they were unhappy because they missed their children.[x] Moreover, a growing body of studies reveals that ‘loneliness is linked to a host of other problems and in itself can kill, typically by raising blood pressure and increasing risk for heart disease and stroke.’[xi] It suggests that a supportive social network is strongly connected to attaining positive health outcomes, whether psychological or physical. It is clear therefore, that many of these problems are intrinsically linked and often serve to trigger the other off.

NCDs have already become the largest contributor to disease burden in Sri Lanka, accounting for 85% of ill health, disability and early deaths[xii]. Furthermore, a regional study proved that South Asians suffer their first heart attack six years earlier than people in other regions, worldwide.[xiii]  It is possible then that many of these ill effects stem from an overall atmosphere of unhappiness and negativity.

Rethinking the Way Forward

Although elders’ homes and day centers appear to be an easy solution, they are a far cry from being the answer to the problem. Merely providing material wellbeing for the elderly does not ensure that they are well taken care of.

The initiatives taken by Japan and the Netherlands look beyond the mere provision of material benefits. The two systems have been designed to make the elderly independent and empowered; to allow them to actively participate and be part of a vibrant community life. Sri Lanka may not have adequate funding to develop such advanced facilities, yet this shouldn’t avert us from drawing inspiration from the notion of placing the overall wellbeing of the elderly at the center of our agenda.

As expected, with an increase in the ageing population a whole new dimension of health problems have arisen and huge costs must be borne. Yet, in Sri Lanka there is little prominence placed on a specialized geriatric care system – with every patient being treated in a common ward. Even more noteworthy is the fact that there are no specialist geriatricians and health care workers in the country, with the skills to manage elderly complaints; as a result delirium, depression and dementia often goes overlooked.[xiv]

Dementia is a condition which affects an estimated 150,000 elderly in Sri Lanka but only 15% of patients ultimately seek medical help.[xv] There are numerous policies and schemes in place – the National Health Policy, the Public Assistance Scheme, the Ministry of Social Services – that provide general facilities to cater to the needs of the people. Yet, it is perhaps more important to establish specialized organizations that target the specific problems likely to heighten with the passing of time.

For instance, Alzheimer Europe is a non-governmental organization (NGO) that has created a mechanism for co-ordination between Alzheimer organizations throughout Europe.[xvi] This type of support system that assists families to cope and handle lifelong illnesses such as Alzheimers is severely lacking in Sri Lanka.  In fact, Help Age Sri Lanka is the only (NGO) in the country that provides leadership to improve the lives of the elderly and help them “claim their rights, challenge discrimination and overcome poverty.”[xvii]

When balancing out the country’s future prospects, the mechanisms already in place seem far from sufficient. It is critical that additional schemes are developed to support the unprecedented rise in the ageing population that is looming ahead.

Although the Protection of the Rights of the Elderly Act was passed in 2000, it has been slow in implementation.  One of the clauses of the act is that children shall not neglect their parents. Another clause emphasizes the non-discrimination of people based on age.[xviii] Through the years, our cultural values of respecting and caring for elders have strongly embodied these ideologies. Yet, at the turn of the century, a majority of us have lost touch with basic sensitivity, patience and compassion – and these age old practices have slipped out of our lifestyles.

From the context of reimagining development, one of the motivations should be to safeguard the long-term physical, mental and social well-being of the elderly. Regardless of whether they are rich or poor their fundamental rights must be upheld. In order to achieve this, an overall change in attitude is required. To purge out the negative mindset prevalent in the country we need to begin viewing the elderly as a source of knowledge and experience as opposed to marginalizing them and confining them because of their age. Instead of proliferating negative attitudes that will result in the continuation of a vicious cycle of illness and unhappiness among the elderly – Sri Lanka needs to channel a rush of positive energy into the system.

It is only by looking at the issue subjectively, through fresh eyes, that we can begin to reverse our attitudes and create an environment  that allows the elderly to play a more active role in the community and ultimately aim to achieve development for ALL.

Where do we start? Perhaps, by accepting our own mortality and the idea that we will never be younger than we are today.  It is inevitable that by the year 2035, one out of five people will be a part of the ageing population[xix]. It could be any one of us.

We must then ask the question: when it is our turn, how would we want to spend the ‘winter’ of our lives?

[v] Poverty and the Challenges of the Elderly , Poverty Brief 12, Centre for Poverty Analysis,

[viii] Poverty and the Challenges of the Elderly , Poverty Brief 12, Centre for Poverty Analysis,

[xviii] Poverty and the Challenges of the Elderly , Poverty Brief 12, Centre for Poverty Analysis,


25 August 2014

‘Energy: The strength and vitality required for sustained mental and physical activity.’

Oxford English Dictionary


The whirring computers, mobile phones and televisions that form a network of connections between human beings; the bulbs that light up houses, the fans that cool the air, the cars whizzing by on the road, the lush green paddy fields, the monsoon winds blowing in the rainy season and even the functioning of our own bodies – although we take it for granted - are powered entirely by this constantly buzzing phenomenon we have termed ‘energy’.  The reality is that if we are cut off from this source of vitality we will cease to exist.


Due to the unprecedented rise in the human population, the increasing demand for goods and services combined with the prevailing environmental crisis, the world is heading towards a catastrophe. Sources used by the International Energy Authority have revealed that there are 1038 billion tonnes of coal reserves left in the world: an equivalent of 130 years of global coal output. Meanwhile, the world Energy Council estimates an equivalent of 109 years of coal output.[i] The case in point: whether it is 50 years down the road or a 100, the world will eventually run out of the major fossil fuels that have powered it thus far – oil, gas and coal.


The concept of ‘going green’ - a movement that encourages people to make environmentally friendly choices in their everyday life - has slowly crept in as a result. Due to the severity of the energy crisis, this idea has pushed governments to look for relatively cleaner energy sources as opposed to relying on fossil-based energy.  For this reason the harnessing of energy through renewable sources such as the sun, winds, water and wave power are being explored extensively.



It was Martin Luther King Jr. who said “If you can't fly then run, if you can't run then walk, if you can't walk then crawl, but whatever you do you have to keep moving forward.” Unfortunately, Sri Lanka seems to be backtracking. By the year 2020, the aim is to reduce our dependency on oil from 32% to 6%. Although this appears to be a positive move, it is rendered futile because the strategy simultaneously aims to shift our dependency on to coal. By the year 2032, 80% of Sri Lanka’s energy mix will be made up of this ‘cheaper’ alternative.[ii] Yet, not only is coal a finite resource, burning coal is the leading cause of smog, acid rain and toxic air pollution. Coal power plants emit high levels of carbon dioxide and this is one of the primary causes for global warming. It is safe to say then that this strategy completely defeats the purpose of ‘going green.’


Despite this, the idea of using clean energy sources does prevail to an extent. The Mahinda Chintana promises to develop Dendro energy projects in the dry zone as an industry, and the aim is to use solar power and wind power to provide electricity to rural areas where grid networks are not feasible.[iii] More significantly, it has set a target to increase the country’s Non- Conventional Renewable Energy (NCRE) to 20% by 2020. Yet due to ill-advised strategic planning; investments being misdirected, corruption; poor leadership and organization alongside various internal and external forces coming in to play, many of these policies have not been implemented. Although Sri Lanka may hit the smaller targets along the way, the lingering problem is that we do not have a long term, overall stance for renewables beyond 2020.


Asoka Abeygunawardena, executive director of the Sri Lanka Energy Forum, points out that if we act now it is possible to avert a potential disaster. According to him we should be burning fossil fuels (investing in coal) now to build a foundation for the future: that is to set up more NCRE power plants. At this moment however, we seem to be headed down the wrong track and we are in fact intent on shifting our dependency over to coal entirely without any clear goal of how to develop our renewable energy sources beyond 2020. He stresses that we should think globally in the context of global warming and finite resources, and act locally to build up our stand for the future[iv]. He emphasizes the notion that although this may be an expensive endeavor in the short run, in the long run it will prove to be more sustainable and cost efficient.


While we continue to depend on the convenience of our faulty oil and coal power plants, countries across the globe are making massive inroads towards developing renewable sustainable energy sources.They are doing this with sometimes larger populations and far less natural resources than what Sri Lanka has. In recent times for instance, Denmark and Germany have experienced a peak in electricity generation through wind and solar power. They have managed to cover much of their countries' need through this and have set the trend for renewable energy systems that do not cost the Earth.[v]

Denmark has ambitious energy goals: by 2050, the country plans to meet 100 percent of its energy requirements with renewables, creating more jobs, increasing exports and reducing its energy dependence. Denmark’s Minister for Energy expressed that he was "100% sure not only that other countries could do it, but that they will do it, simply because of the development of the markets. Each will have to find their solutions, but will it happen? Yes." [vi]

If the willpower to achieve these goals is in place along with an exemplary governance structure –driven by the best interests of the country and its people- any obstacle can be overcome. Instead of investing in the more expensive infrastructure that may be required to generate NCRE, Sri Lanka has taken the easy way out by opting for coal. Yet, we must ask ourselves for how much longer can we rely on such a strategy?

Sri Lanka is a tropical island blessed with an abundance of natural resources – wind and wave power, rainfall, rivers, sunlight. We have the resources and the potential to reap the benefitsof renewable energy and as the Danish Minister of Energy stated, we can develop our own strategy and create our own energy mix instead of following the path taken by ‘historical polluters’ before us.

Effective generation of public awareness about available energy sources could go a long way to developing creative solutions for the problem. For instance, this could foster steps to conserve energy and increase efficiency at the grassroots (in our homes); it could encourage the production of energy using solar panels at domestic level on a wider scale; it may serve towards initiating energy saving and storage schemes; and pave the way for larger numbers of individuals and organizations to incorporate eco friendly methods into their lifestyles. If such collective effort is taken by the general public – for both domestic and industrial energy use - the bigger vision of shifting from coal to renewable energy will become more of a reality.

Germany’s energy collectives mirror the perfect example of this. Their shift to clean energy has been propelled by the action of home owners, small and medium-sized businesses, and farmers. Nearly three quarters of their renewable energy production has been invested in by small private investors. The state owns none of it. An even more intriguing trend is the growing body of citizen led cooperatives that bundle their resources to invest in either a local Photovoltaic farm or a wind power facility[vii]. Their efforts have made it possible for Germany to achieve the dream of powering their country through renewable energy.

Today, science and technology has allowed us to travel off the beaten path. The possibilities are numerous and the innovative solutions we could come up with so diverse, if only we were to seek them out. Engaging in research to develop such novel methods suited to our own environment will undoubtedly help Sri Lanka forge ahead.

Perhaps, we ought to change the way we look at the problem and embrace the myriad of options that are out there. Instead of looking at the energy debate negatively we could seize this opportunity to turn the tables around. By developing our own solar and wind power plants rapidly we may be able to sell energy to other countries in the future: thus we could go from being importers of energy to exporters.

If we fail to take the initiative now when these options are within our grasp -when the world runs out of coal we will be left reeling.

At present we believe that the initial expenditure of investing in renewable resources is daunting and the logical solution should be to turn to the cheaper alternative. We think that our time has arrived to pollute the environment because the ‘developed’ countries had their opportunity before us. We are hesitant to take risks and invest in long term solutions because of the uncertainty that comes with it.

Yet, it is critical that we invest now for the future. That we have a long term cost effective plan in place along with the appropriate infrastructure to ensure that we are prepared when the world eventually runs out of fossil fuels.

For more information visit:

[i] World Coal Association: Coal Statistics, 2014. Online. Accessed June 2014.

[ii]Scribd, 2014. Online. Towards Sustainable Energy in the Power Sector. Accessed June 2014.

[iii] Mahinda Chintana: Towards a New Sri Lanka. Online. Accessed June 2014

[iv] Abeygunawardena, Asoka. Towards sustainable development in the power sector. Online. Accessed June 2014.

[v]Permaculture Magazine: Renewable Energy Generation Hits All Time Highs in Denmark and Germany, 2013. Online. Accessed May 2014.

[vi]Denmark Leads the Charge in Renewable Energy. Online. Accessed May 2014

[vii]Hockenos, Paul, 2012. Germany's Unlikely Renewable Energy Revolutionaries. Online. Accessed May 2014.

25 August 2014

For too long we have swept the problems of mental illness under the carpet... and hoped that they would go away.[i]

Richard J. Codey


Mental illnesses are a reality that has to be dealt with. One in four people suffer from mental disorders. Four of the six leading causes of ‘years lived with disability’ are mental illnesses. Depression is the second highest global disease burden.[ii]

What causes mental disorders? Society has progressed from the days when we believed that mental illnesses are the result of our own wrong doing, witchcraft or evil spirits. Medicine is now able to pinpoint various factors that result in mental illnesses; genetics can cause people to be susceptible to diseases such as schizophrenia and alzheimer’s while environmental and psychological factors can decide if these irregular genes evolve into an illness or not. Infections and toxins can cause diseases like dementia and Obsessive Compulsive Disorder (OCD), while prenatal damage and chemical imbalances can result in disorders like autism and depression respectively. As in the case of physical illnesses, a greater understanding of mental illnesses can only be achieved if medical professionals and states commit their time and resources to research.

It is in the state’s mandate to uphold a citizen’s right to life by means of quality healthcare. The state also benefits from doing so as healthy citizens can actively contribute to society whereas sick and dying citizens are a burden to the state. Therefore, healthcare is already considered a vital component of development and every year countries pour resources into combating any illness that is a threat to public welfare.

Mental illnesses are as big a threat to the public’s welfare as any physical sickness. Suicide is one of the leading causes of death in most countries. In the last 40 years, suicide rates have increased by 40% worldwide, with one person killing himself or herself every 40 seconds. 90% of suicides are the results of a mental illness such as depression, schizophrenia, bi-polar disorder and anorexia.[iii] The mentally sick are not only a threat to themselves but - as seen in incidents such as the Navy Yard tragedy in the United States[iv]- they can also be a threat to others. Considering that mental disordershave the same consequences as physical illnesses, should they not be given the same weightage?

Eventhe world’s most developed and well-resourced countries have yet to combat mental illnesses adequately. In Canada, 1.2 million children are affected by mental illnesses, yet only 25% of them get the appropriate treatment.[v] In Europe 50% of the mentally ill do not get treated for their sickness and inmany developing countries this statisticcan be as high as 90%.[vi]

Culture exacerbates the problemin countries like China where there have been reports of psychiatric wards being used as political prisons andpatientsabused in the form of beatings and electric shocks.[vii]Resources area serious problem in many countries; at the end of 2013, Laos had only two psychiatrists for a population of approximately six million people and there were no psychiatric nurses, clinical psychologists, social workers or occupational therapists working in the country at all[viii]. However, even in the poorest of countries,steps such as equipping communities to deal with common mental illnessescan be taken to abate their impact. This particular method has proved successful in countries such as Uganda, Pakistan and India.[ix]

Sri Lanka has one of the highest suicide rates in the world. The 2004 tsunami and the civil war are two major contributors to the mental illnesses prevalent in Sri Lanka. Over thirty years of brutality and violence has cost our country countless lives and left many people wounded and disabled.  However the war has left more than just physical scars. According to the Daily News, September 10th 2013, 106,000 Sri Lankans committed suicide between 1985 and 2000; this is double the amount that was killed by the war in the same period.[x] In the after-math of the war, our focus on physical casualties and on rapid ‘development’ has evidently overshadowed the great need for psychological care. Despite the widespread mental trauma, Basic Needs, a humanitarian organisation that works in developing countries, stated that Sri Lanka has only one psychiatrist for every 500 000 people, most of whom are in urban areas. Furthermore, while psychiatric help is vital in extreme cases, counselling is a solution for those who suffer from mild mental illnesses. In fact, counselling may help to deter the deterioration of mental illnesses to a state where it is disabling. Unfortunately this solution is not given enough credit by our healthcare system and there is a lack of counsellors available to the public. 

It is important to keep in mind that development is more than simply increasing the economic capacity of a country. Increasingly-in addition to a country’s GDP - other indicators, such as the Human Development Index and Gross Happiness Index are also given prominence when measuring a countries development. Why? Because the world has recognised that social development, mortality rates and general satisfaction of citizens are as important indicators of development as the economic status of a country.

Therefore, development must take place in many spheres; the acceptance of those with mental disorders is social development. Aesthetic development can take place if society creates room for the mentally sick to thrive in the fields that they are adept in. After all, Beethoven suffered from bi-polar disorder,Michelangelo had OCD and Pablo Picasso suffered from clinical depression.[xi]Literature benefitted greatly from men like Charles Dickens, Ernest Hemingway and John Keats, who all suffered from depression. Even in politics, men like Abraham Lincoln[xii]suffered from depression. However, stigma restricts many people from engaging in these fields and from embracing their different abilities.

A country’s economy will also benefit from better mental healthcare; mental illness costs the Canadian economy more than $50-billion a year and research shows that such illnesses hit people hardest in their prime years of work. As Michael Kirby, a former Canadian senator and advocate for better mental-healthcare pointed out, combatting mental illnesses will help governments avoid a “lifetime of problems and costs.”[xiii]

Evidently, the attitudes of states and people towards mental illnesses severely hinder the overall development of countries. 

Thomas Insel, who has led the National Institute of Mental Health, USA, since 2002, stated that one in every twenty people becomes disabled by their mental disability. He feels thatconsidering the fact that 75%of mental illnesses onset by age 24 - the answer to this problem is early detection and intervention. This will prevent mental illnesses from disabling people to the point where they have no quality of life and cannot continue to work. This has worked with heart diseases, which have reduced by 63%, reducing the mortality rate by 1.1 million deaths a year and with AIDs where an average of 30,000 deaths are averted a year.[xiv] He says that the knowledge to cure many mental illnesses exists, and thatthe main problem is stigma.Therefore, to see similar results with mental illnesses, they need to be approached in the same manner as physical illnesses.  The common perception is that people who are mentally ill cannot contribute to development and this stigma makes it difficult for those with mental illness to get jobs and be an active part of society.

For decades, countries and organizations have been focused on creating awareness and an environment of acceptance for those with mental disorders. Unfortunately, people’s perception seemsto be unaffected by campaigns and speeches. The arts on the other hand have a strong influence on culture and views. Instead of simply giving people the information they need, books like ‘the perks of being a wallflower’spark empathy in them.

We may think that we do not conform to these archaic notions and biases against the mentally ill. Unfortunately, this culture is ingrained in all of us. You would have no reservations in telling people that your mother suffered from a heart attack, or that you have diabetes. However, if your mother suffered from schizophrenia or you suffered from depression, would you make that knowledge public?

Governments have a role to play in re-thinking their approach to healthcare; prioritizing combating mental illnesses in their development policies; advocating acceptance through the arts and other effective means; and empowering communities on how to deal with mental disabilities.

However it is our tendency to treat mental illnesses as forbidden secrets that is one of the biggest barriers to progress. Therefore, changing our own perceptions should be the first step. If we can openly and shamelessly admit it if we, or those close to us, have psychological problems, we will begin to oust the stigma in our own social circles. The domino effect is stronger than most people give it credit for; you start treating mental illnesses like you would any physical illness, and others around you will begin to do the same.













12 August 2014

Official figures showing a rise in diseases linked to poverty, such as gout, TB, measles, malnutrition and whooping cough are a barometer of failure and neglect

According to a recent Health and Social Care Information Centre report, we are seeing a return of diseases common in the Victorian era.

The report highlights five conditions: gout, tuberculosis, measles, malnutrition and whooping cough. It has a longer listing of rarer conditions, which also conjure the image of bygone pestilence and depravity – scurvy, mumps, rickets, scarlet fever, cholera, diphtheria and typhoid.

In a time of global public health disasters of biblical proportions, in west Africa and the Middle East, it appears an indulgence perhaps to be concerned about these conditions. We may be tempted to dismiss the report as a novelty. But that would be wrong: a civilized nation with an advanced economy and health system should see some conditions as markers for the failure of its public health policies or services. But which markers?

The NHS has "never events" as quality of care markers. Never events are serious, largely preventable patient safety incidents. They include wrong site surgery, wrong route chemotherapy administration and suicide during psychiatric admission. The time has perhaps come for us to develop never events in public health.

In the HSCIC report, gout is the strongest contender for a returning Victorian disease – it may well be linked to an ageing population, epidemic obesity and excess alcohol consumption; 70% of cases are in the over 60s. There were 86,870 hospital admissions where gout was coded, an increase of 78% on the same period in 2009-10 (48,720). There were 13.5 gout admissions per 100,000 population in the 10% most deprived areas, 8.3 gout admissions per 100,000 population in the 10% least deprived areas, in 2013-14. Formerly the disease of kings, gout is now very clearly associated with deprivation.

Tuberculosis and rickets are the strongest markers of both Victorian disease and public health never events. We should certainly regard tuberculosis contracted in this country, and tuberculosis deaths, as never events. The HSCIC figures show a welcome decline in hospital admissions for tuberculosis. New notifications are also stabilising but at an unacceptably high level, with 8,751 cases reported in 2012, an incidence of 13.9 per 100,000 population. The need to spend time in hospital should be declining as services become better able to treat people at home and cases are hopefully identified earlier and at less infectious stages.

Hospital admissions with a scarlet fever coding doubled, from 403 to 845. Public policy measures to prevent this, and the clinical significance of this change are difficult to determine; historically scarlet fever is a disease of deprivation, tamed by antibiotics. It manifests long cyclical rises and falls over 40 years – the rise may be part of that cycle. But we should be concerned we are seeing a period of enforced deprivation, with the biggest cut in average wages since Dickens' era.

Measles and whooping cough were rampant in Victorian times but remained so until the 1990s – hardly Victorian, but they should be never events as they are completely preventable through immunisation.

Over the past five years there was a 71% increase in hospital admissions where malnutrition was coded, from 3,900 admissions in 2009-10 to 6,690 admissions in 2013-14. Patients are being found to be malnourished on admission to hospital as a result of neglect, in care homes, or at home. The figures may also reflect more complete coding and better awareness of nutrition issues in hospitals.

Rickets is a concern – a lack of vitamin D due to dietary and sunlight deficiency. We may have contributed to this through campaigns to keep people out of the sun. It is more common in dark skinned people, but also in deprived communities, black and white. We could reverse our skin cancer campaigns and encourage little and often sun exposure, or we could correct it by fortifying milk with vitamin D. Scurvy is rare – 72 cases in 2009-10, rising to 94 cases last year, but vitamin C deficiency really must be a marker of failed public health nutrition.

Interpreting the figures, we should be a little cautious about the impact of hospital coding – there has been upward pressure to code everything in the patient's discharge summary for hospitals to pull in maximum payment by results.

The figures do reflect classical diseases associated with mass poverty of Victorian times and so they should be a barometer for us. Gout, malnutrition, scurvy and rickets point us to failures in the nation's diet. Our complacent notion that we have better diets must be thrown out and there must be a national drive for a healthy, nutritious and balanced diet, casting aside the interests of the food industry. Major vaccine-preventable infectious diseases should be prevented.

We should be concerned about these figures – they tell us of a picture of neglect – by government with its active impoverishment of poorer parts of our society and with its complacent neglect of public health nutrition. And neglect too by the health and care system in respect of malnutrition, dehydration, failure to vaccinate and neglect of nutrition.

Republished from The Guardian.

11 August 2014

‘Doctors will rarely ask whether or not you have committed a crime, what your profession is, or how much money you make. They will look at your position inthe line, call out your number, ask for symptoms, produce a diagnosis, and move on to the next person. Lawyers on the other hand, can afford to ask you whether you are innocent, what you do, and how much you are willing to pay. Depending on your answers they will decide whether or not to represent you. 

Tuk tuk drivers must be like doctors. They must take anyone, and everyone, wherever they want to go. Theirs is a job that is fuelled by luck.’

It is clear that the number of three wheelers in Colombo has dramatically increased over the past few years.  In fact the streets seem to be swarming with them.  Parallel to this, since the end of the war, night-time adventures like trips to theatres, restaurants and clubs, have risen because people are no longer afraid to stay outdoors after dark. Safety concerns have considerably lowered.

However, it is odd that public transportation has not seen similar results.

Why then has the number of three wheelers risen? Is it because we now have more places to visit that deviate from the regular bus route? Or – for the average middle and upper  middle class citizen - more money to spend and seemingly less ‘valuable’ time to waste?

Prior to writing this article, these were questions and answers that arose from pure conjecture. Though cases of supply and demand are intrinsically linked and often cyclical in nature, I could only speculate reasons for an increase in demand, while I remained at a greater loss for the rising ‘supply’ of three wheeler services.

I arrived at a simple solution: I thought I’d ask a few tuk tuk drivers. 

Out of the drivers that I spoke to, some said that they had been in the profession for a considerable amount of time; between 5 to 15 years.  Many had initially joined because the vocation brought with it a sense of independence, the freedom to choose their own work hours and routes, as well as the pride of owning their own vehicle.

Most people think that travelling in a tuk tuk is for the privileged. But the truth is the tuk tuk is driven by the poor person. It is also driven for the poor person.’ Driving a tuk tuk gives the driver the flexibility of dropping their children at school, the ability to carry things to and from their homes, to travel through narrow, secluded roads and the privilege of doing something they love all day.

Other drivers who have joined the tuk tuk race within the last 2-3 years echoed similar reasons for their choice of profession. A variety of explanations emerged however, when the following questions were posed:  what did you do before becoming a tuk tuk driver? How did you purchase your three wheeler? And why do you think competition has increased so much over the past few years?

Several replied that they had been engaged in small business activities - the sale of food and beverages from the back of their vans; the exchange of plastic and aluminium materials on the pavements; some had been street vendors selling wholesale  goods across Colombo- but now their shops had been cleared, relocated or discouraged due to urban beautification efforts. Others, who once ran small shops, were adversely affected by economic fluctuations in the country. A few others replied that they had moved out of garment industries, manufacturing companies, saw mills, government offices, IT departments, and other lucrative posts on pension, or due to low/no pay.

A great many of them had already owned a three wheeler, for personal and business purposes. These were immediately put to use on the streets once their luck turned. Since then, they have been struggling to make ends meet with an occupation that had once appeared to be profitable, and easy to tap in to.

In the past two years, local banks and finance schemes have caught on to this ready market of aspiring three wheeler drivers. By allowing them to pay back their loans in instalments, the purchase of a tuk tuk has become easier. This initiative is commendable as it creates job opportunities for hundreds of people who would otherwise be left unemployed. Yet, the irony is that both these loan schemes and the latest models of three wheelers, which are being imported into the country, have the average life span of four to five years.

‘Once the loan scheme is fully paid off, it will be time for me to trade in for a new one. If I am lucky, I will only have to repair and restore parts. If I’m unlucky, between now and then, I’ll have to take out another loan for something else. With or without your three wheeler, the payments go on.’ Along with these schemes, it is also rumoured that large numbers of three wheelers are being provided at substantially reduced rates by politicians and other influential persons.  Therefore, it is hardly surprising that in addition to looking for fulltime jobs, many three wheeler drivers have also taken to the occupation part time -running solely morning and afternoon shifts, or alternating between the day and night - while juggling other jobs in restaurants, public services, and other industries, to earn extra cash.

Moreover, the promise of a demand for three wheelers, in a city that has become dependent on such a service, has brought in an influx of out of town tuk tuk drivers. Many bring children to school, and men and women to work, and with them, a sizeable contribution to the growing numbers of three wheelers running in Colombo. Interestingly enough, their presence has been further facilitated by the introduction of meters to the tuk tuk trade. A comparatively recent initiative, the meter, aside from trying to introduce a sense of fairness and standard to prices, also attempted to draw three wheelers out of their parks and on to the streets. With this new piece of machinery, people have no longer become reliant on parks and familiar faces, but are more trusting and accepting of often unknown three wheeler drivers.

Strikingly, in relation to this new mechanism of ‘fairness’, most three wheeler drivers adamantly disputed their assurance of equality. Out of town drivers, various other drivers and taxi companies were said to be driving for lower (and sometimes higher) prices per kilometre. They could afford the reduced petrol rates outside of Colombo, and were keen on attracting more customers. Repeated suggestions were made that meter rates be standardised, albeit with the understanding that fuel fluctuations should proportionately tally with the meter rate requirements. 

Above all, the three wheel drivers submitted that ‘any policy changes that are made should be both sustainable and current’. Promises which have been made in the past regarding petrol subsidies, remain unfulfilled and difficult to implement, and speed limits that have been allocated for three wheelers have long since been surpassed on the speedo-meters of newer models. Prices for three wheelers, largely due to tax, have dramatically risen in the last few years. While prices for simple parts, remain far above that of their counterparts in India and China.

‘Development should take place without harassment’. Though the conversion of roads to a one-way system has resulted in the price displayed on tuk tuk meters rising, at the same time they have made drivers travel around in circles, miss pick up opportunities and waste large amounts of petrol. Likewise, as roads are being widened, the space tuk tuk parks occupy are being encroached on.  This gradually threatens to keep them running all the time or completely forces them off the road.

The instances and the frequency in which a three wheeler presents itself in Colombo’s everyday scenery, consciously, or unconsciously, has made the three wheeler ever proliferating and iconic. Despite the fact that many drivers have left behind their former jobs, or entered this job due to lack of economic security, as the competition between three wheelers continues to grow, they are finding themselves re-entering a state of uncertainty. Living on daily wages, each morning, for the most part, they must wake up and get on the road.

One day away from the wheel, can mean one week without a meal.’ It remains an occupation of luck and chance. Three wheel drivers are increasingly aware that for every rapid growth, there is a saturation point.

The next time you get on a tuk, be sure to ask your driver for his story. Because everyone has a tale. 

11 August 2014

In mid July, the UN’s Open Working Group proposed a set of Sustainable Development Goals (SDGs): 17 goals and 169 indicators, to be whittled down through negotiations by the UN General Assembly next month, and adopted as official goals in 2015. So now is the perfect time to play spot the difference: the SDGs vs. the doughnut.

This comparison makes sense. The doughnut’s social foundation was crowd-sourced from governments’ social priorities in the run-up to the 2012 Rio + 20 conference. And the doughnut’s environmental ceiling contains the nine planetary boundaries that protect the key Earth-system processes on which humanity’s wellbeing depends, as proposed by Johan Rockström and his fellow Earth-system scientists in 2009. So how do these draft SDGs deliver against the doughnut’s social and planetary boundaries?

The comparison reveals three key points: on priorities, on ambition and on economic growth.

First, on priorities. Taking a big picture perspective, this initial cut of the SDGs has a very doughnutty spirit. Figure 1 maps the proposed SDGs onto the 11 social and 9 environmental dimensions of the doughnut: green rings indicate issues named in the top-tier goals; orange rings indicate those mentioned in the 2nd tier targets (and the numbers identify which goal).

Fig 1. Spot the difference: mapping the proposed SDGs onto the doughnut

 SDGs v donutIt’s clear that every one of the doughnut’s dimensions gets a mention in either the goals or their targets. But the social foundation is more fully and explicitly addressed than the environmental ceiling.

  • Goals 1 to 10 map out the Social Foundation almost word for word (with the sole exception of voice, which only gets a look-in under some scattered targets). Ending poverty and human deprivation is clearly a priority, as well it should be.
  • The SDGs add a new goal to the social foundation, on human settlements. Housing and transport were missing from governments’ top priorities at Rio+20 (and hence from the doughnut) but have now got the attention they deserve.
  • There’s an evident contrast between the near-total coverage of the social foundation in the goals, versus the more patchy coverage of the environmental ceiling. Some environmental priorities are named directly in goals, but most just in the targets, and even then not always explicitly.

Second, on ambition. The doughnut’s boundaries are based on measurable targets for both the social and environmental dimensions. So how do the SDGs compare? Their ambition to end human deprivation by 2030 (ie to get everyone above the social foundation) is focused and clearly defined. But their ambition to address environmental degradation (ie to stay below the environmental ceiling) is more varied and vague.

earth from spaceThe vast majority of social targets have strong ambition, seeking by 2030, to end all forms of poverty, and ensure access “for all” to food, water, sanitation, energy, health care, education, work, housing and more (see Table 1 here Raworth Annex Tables SDG Doughnut). What will success look like? It’s pretty clear: essentially 100% of people will enjoy these rights. Powerful and important stuff.

The environmental targets, by contrast, fall into four clusters, aiming to ‘halt’, ‘restore’, ‘sustain’ and ‘reduce’, and most targets focus on 2020 (see Table 2 here Raworth Annex Tables SDG Doughnut). Some are absolute and time-bound: end overfishing and halt deforestation by 2020. But two key ambitions – to halt biodiversity loss and combat climate change – lack target dates. And for others, the measure of success is unclear. What would it mean to ‘significantly reduce’ nutrient pollution by 2025? To ‘minimize the release of’ hazardous chemicals by 2030? Or to ‘minimize the impacts of’ ocean acidification (by no set date)? The concern among scientists is that the final ambition on targets will now be driven by “political pragmatism, not scientific reality”.

Third, on economic growth. There is a very clear commitment in the proposal to ‘sustained economic growth’. It gets three mentions in the opening paragraphs, and then Goal 8 focuses on promoting ‘sustained, inclusive and sustainable economic growth’. Is this compatible with getting into the doughnut – and with achieving the rest of the SDGs? Only if economic growth (ie an ever-rising GDP) can be recoupled with poverty reduction and decoupled fromenvironmental degradation. And this is where things get more tricky.

For starters, GDP growth will probably look like an out-of-date economic metric by 2030: smart countries will be steering by a wider dashboard of social and economic success by then, accounting for natural and social wealth stocks as well as monetized flows. So let’s not get hooked on pursuing this goal, and certainly not at the cost of any others.

Making GDP growth ‘inclusive’ by recoupling it with poverty reduction is critical for getting into the doughnut. And Goal 10 – to reduce inequality within and between countries – is a crucial part of getting there. Target 10.1 commits that, by 2030, the incomes of the bottom 40% in each country will grow faster than the national average. Progressive stuff: this target must not get lost in the wash.

What about making GDP growth ‘sustainable’? Here, things get fuzzy. Target 8.4 calls on countries to ‘endeavour to decouple economic growth from environmental degradation…with developed countries taking the lead’. Just endeavour?! Let’s be clear. Decoupling can’t be treated as a try-it-if-you-like bonus target. If the aim is to combine ‘sustained economic growth’ with combating climate change, halting deforestation and biodiversity loss, and significantly reducing air, soil and water pollution, then decoupling GDP from resource use is, by definition, absolutely essential – a logical necessity.

And (since the SDGs don’t do it) let’s ask: how much decoupling is needed, in different kinds of countries? It’s the tough question that has stalled the climate negotiations for years. And Figure 2 helps to unpack the key concepts.

Figure 2. GDP growth and resource decoupling: what will it take?GDP and resource decouplingBy 2030, low-income countries need to achieve relative decoupling, backed by international support for energy- and resource-efficient investments – so that their GDP grows faster than their resource use. Upper-middle income countries will need to be on track for absolute decoupling, so that their total resource use starts falling while their GDP grows. And high-income countries that still want a rising GDP will need to achieve sufficient absolute decoupling– strongly reducing their resource use as their GDP grows. Without such decoupling, ‘sustained economic growth’ will push us all right over the environmental ceiling, out of the doughnut, and into an ecological era that is far more hostile to humanity. And if the scale of sufficient absolute decoupling doesn’t look feasible – especially in the high-income countries – then it may be time for them to look long and hard for alternative economic paradigms that do not depend on unlimited GDP growth.

So, will these SDGs get us into the doughnut? They will certainly get us over the social foundation – and that’s well worth celebrating. But they do not face up to what it will take to stay within the environmental ceiling – especially with unlimited GDP growth as the driving economic paradigm.

These Sustainable Development Goals matter. They are humanity’s best chance to envision a shared and lasting prosperity for all. So let’s see what happens in September as the UN General Assembly gets down to negotiating this proposal. And if anyone out there will be at the meeting, please – could you give them doughnuts in the coffee break?…

Republished from Poverty to Power.

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