Economic crimes and the challenge of community medicine practitioners

• Excerpts of an address at College of Community Physicians of Sri Lanka Oct. 2022

For the first time in Sri Lanka’s post-independence history, concerns about economic crimes committed against the citizens have been expressed both internationally and locally.

Economic crimes as raised by UNHRC

Internationally, the UN Human Rights Council, at its 51st session in October 2022, has voted in favour of a 19-point resolution presented by Sri Lanka Core Group headed by UK in the Council (available at: https://www.newsfirst.lk/2022/10/05/unhrc-core-group-produces-19-point-resolution-on-sri-lanka/) that, inter alia, there is a necessity for probing into economic crimes committed in Sri Lanka with a view to establishing accountability. While the resolution has linked the economic crisis to violation of human rights in its Point 3, in Point 13, it has specifically demanded Sri Lanka to address the economic crisis “including by investigating and, where warranted, prosecuting corruption, including where committed by public and former public officials, and stands ready to assist and support independent, impartial and transparent efforts in this regard”.

This resolution is tightening noose on crisis-hit Sri Lanka which has been reduced to the status of a beggar asking for relief funds from the international community including emerging nations like Bangladesh. The issue is not going to disappear on its own with passage of time because it is to be taken up again at the 55th session of the Council. The UK government has immediately welcome the passage of the resolution by the Council expressing its belief that it will ensure accountability in actions of the Sri Lanka Government (available at: https://www.gov.uk/government/news/un-human-rights-council-51-uk-welcomes-resolution-on-sri-lanka).

While the 20 countries which have voted for the resolution are significantly worth for Sri Lanka’s future, the seven countries which have stood with Sri Lanka, except China, are not of any significance in its journey toward resolving the present economic crisis. Therefore, Sri Lanka cannot ignore this loud voice of the international community as it had done in the past.

The position taken by the Government has been that human rights and economic crimes are two unrelated events. Hence, it is claimed that talking about economic crimes is simply an instance of the Council going beyond its mandate. This position of the Government has been accepted only by seven members of the Council, while 20 others have rejected it going by the recommendations of the Core Group. Has the world at large been wrong in its judgement in this case? No, if one looks at the purpose of human rights in helping citizens to attain their ultimate goal of living

SLHRC and civic activists too follow UNHRC

Locally, it is reported that Sri Lanka’s Human Rights Commission has instituted investigations into these economic crimes with the objective of identifying those who are responsible for them (available at: https://www.newsfirst.lk/2022/10/02/hrcsl-to-investigate-causes-of-economic-crisis/). The Commission has specifically emphasised that “investigation is being conducted due to the violation of people’s right to life through the economic crisis”. It will record statements from the officials, present and the past, in the relevant key state organisations that have been responsible for the implementation of the economic policies that have led to the crisis.

In addition, several groups of concerned citizens have raised the matter in the country’s highest court, the Supreme Court, naming according to them, those who had been responsible and therefore should be made accountable. The five-judge bench headed by the Chief Justice on 7 October granted leave to proceed with the case directing the Auditor General to file a special report before the end of November on the matters raised by the petitioners. The judgment on same is awaited.

This is unprecedented and it shows the depth and the gravity of the problem faced by the people of Sri Lanka. It is the first time that economic policymakers have been called to account for their action.

Economists can destroy an economy

This reminds me of a story related to the old Soviet Union when Comrade Leonid Brezhnev was the General Secretary of the Communist Party, a position equal to the Head of the State. Comrade Brezhnev had been receiving in Red Square the guard of honour from the Soviet military at an anniversary celebration of the Bolshevik Revolution. He had seen that along with the march of the soldiers some people in civilian clothes were also marching erratically. Turning to his KGB head, he had asked who those civilians were. The reply had come from the KGB head that they were economists. Angered by this, Comrade Brezhnev had demanded to know what they were doing at his military parade. The KGB head had replied coolly ‘We’ll set them free in the United States. They’ll destroy that economy much faster than any of our conventional weapons’.

This is the track record of economists. They can either make or break an economy. In Sri Lanka’s case, it is the latter that has happened.

Commission of economic crimes is not new

Throughout the world history, there have been instances of countries going through episodes of serious economic depressions leading to loss of jobs, starvations, and death. However, most of them have been due to natural causes beyond the control of people. There are few such instances that have been caused by negligence of those in power or deliberate action taken to impoverish a certain people of a country or a country itself.

In the recent past, in 1943, the colonial British Government in India did such a folly that caused a serious famine and death in Bengal now known as Bengali famine of 1943. According to Britannica, the famine which was a natural event caused some 3 million people to die due to malnutrition or disease because the colonial government failed to open the state for free inflow of foods from the rest of the states (available at: https://www.britannica.com/topic/Bengal-famine-of-1943). Similarly, Kalinga Magha who invaded Lanka in the early 13th century caused the destruction of economic, social, and cultural fabric of the country (available at: http://explosl.blogspot.com/2018/04/the-invasion-of-kalinga-magha-and-fall.html). All these instances have been termed ‘economic crimes committed against citizens’ because they have been brought on people by deliberate action of those who wield power.

For a person to feed himself and his family, he or she should have a livelihood. If livelihood is denied, then, the person affected is being denied meals too. Economic crimes deny people of livelihood. This is the connection between human rights and economic crimes. When economic crimes are committed, there are not human rights too

Sri Lanka Government’s position: Human rights and economic crimes are two different things

But can these economic crimes be a part of human rights about which a country should concern itself? According to Sri Lanka’s Minister of Foreign Affairs, Ali Sabry, who represented Sri Lanka Government at the UN Human Rights Council, they are not. Addressing the Council, he reiterated the position of the Government that it is not ready to act on the resolution that includes accountability for economic crimes too (available at: https://www.youtube.com/watch?v=Im1HAYjXsFs).

Frustrated by his inability to control the events that are unfolding, he even questioned the competence of UNHRC to conduct an inquiry into so called economic crimes (available at: https://www.dailynews.lk/2022/10/06/local/288620/unhrc-cannot-dictate-economic-reforms-sri-lanka-fm). It seems that the Sri Lanka Government has not accepted that there have been serious policy errors made by the administration that has led to the present economic crisis in Sri Lanka.

Sri Lanka Government: UNHRC has exceeded its mandate

The position taken by the Government has been that human rights and economic crimes are two unrelated events. Hence, it is claimed that talking about economic crimes is simply an instance of the Council going beyond its mandate. This position of the Government has been accepted only by seven members of the Council, while 20 others have rejected it going by the recommendations of the Core Group. Has the world at large been wrong in its judgement in this case? No, if one looks at the purpose of human rights in helping citizens to attain their ultimate goal of living.

Self-perfection is the final goal

The worldly goal of living by anyone is to attain self-perfection. Everything which we do are intermediate goals that would facilitate one to reach that goal. Self-perfection is the precondition for reaching what major religions have identified as the goal beyond this world, Buddhism as Nirvana, Christianity as resting in peace, Islam as joining Allah, and Hinduism as joining Brahman. But for a person to attain this goal, he or she should be free from hunger and starvation. Recognising the importance of being free from hunger, the Buddha refused to preach Dhamma, as canonised in Annatara-Upasakavatthu, until a hungry man had his meals (available at: https://www.ancient-buddhist-texts.net/English-Texts/Buddhist-Legends/15-05.htm).

The Buddha then pronounced that hunger is the greatest of afflictions. For a person to feed himself and his family, he or she should have a livelihood. If livelihood is denied, then, the person affected is being denied meals too. Economic crimes deny people of livelihood. This is the connection between human rights and economic crimes. When economic crimes are committed, there are not human rights too.

Sen on human rights: They include freedom from hunger and starvation

This is the broader definition of human rights. Nobel laureate in economics, Amartya Sen in his ‘The Idea of Justice’ has elaborated on this point as follows: “There is something very appealing in the idea that every person anywhere in the world, irrespective of citizenship, residence, race, class, caste, or community, has some basic rights which others should respect. The big moral appeal of human rights has been used for a variety of purposes, from resisting torture, arbitrary incarceration, and racial discrimination to demanding an end to hunger and starvation, and to medical neglect across the globe” (p 355).

He further explains that freedom from starvation is the ethical foundation of human rights. There is a social obligation to promote or safeguard this right. Sen has also described rights as freedoms. These freedoms include economic and social rights, and in some cases the added right called the welfare rights. Welfare here means the context of happiness, well-being, and capabilities and not the welfare rights like pensions, unemployment benefits, and other specific public provisions which are often mentioned. However, Sen has admitted that even these rights eventually become human rights because they help people to be free from deprivations.

There is no question about including freedom for livelihood and earning in broadly defined human rights. Hence, any action done by public authorities to deny these freedoms to people is an economic crime. Accordingly, in a democracy where democratic economic policy is practiced, there is no room for economic crimes. That is because every public action is taken after consulting all the stakeholders and if and only if these stakeholders approve of it

Sri Lanka Government challenges the critics

Therefore, there is no question about including freedom for livelihood and earning in broadly defined human rights. Hence, any action done by public authorities to deny these freedoms to people is an economic crime. Accordingly, in a democracy where democratic economic policy is practiced, there is no room for economic crimes. That is because every public action is taken after consulting all the stakeholders and if and only if these stakeholders approve of it. This is the first principle of following the Lichchavi type policy governance that had been practiced during the time of the Buddha. Hence, it is not alien to Sri Lanka which claims to be Buddhist nation for thousands of years.

At the same time, if any policymaker has violated these principles leading to commission of economic crimes, he or she should be made accountable. This is the purpose of the resolutions of UNHRC, investigations of SLHRC, and the private plaints filed by civic-minded citizens. The Sri Lanka Government, instead of challenging them should support them since they have done a job which the Government has either ignored or failed to do.

Ancient China: Doctors are paid to keep one healthy

Now I would like to turn to community medicine. As you are aware, it is concerned with health of people and aims at protecting and promoting health and well-being of communities. To accomplish this mission, it adopts a primary healthcare approach. It is called primary healthcare approach because its aim is to prevent people from getting sick through preventive medical practices. Following this principle, in ancient China, physicians were paid for keeping their clients healthy and if the client got ill, the payment flow was reversed (available at: https://www.linkedin.com/pulse/paying-doctors-long-keep-you-healthy-ashwin-naik/). This shows the importance of the services provided by community medical practitioners.

Challenge of community medicine practitioners

At a time when Sri Lanka’s economy is going through an unprecedented economic crisis, the first casualty is the healthcare system. Lack of public funds, specifically foreign exchange to import essential medicines and vaccinations, will make the healthcare operations non-workable. This starts from the primary healthcare workers involved in providing community medical services. In my view, the challenge is much more serious than what many of us seem to believe. The crisis will deprive people at large of essential foods and nutrition. It first leads to under-nutrition followed by malnutrition later. The result is the loss of immunity and openness to widespread sickness.

This is a serious situation because it reduces the brainpower of both adults and children –known as the power of the neck-top, in contemporary colloquial language – reducing the nation’s innovative, creative, and learning abilities. The more serious one is what the Nobel Laureate Elizabeth Blackburn came out as the Telomere Effect in her 2017 book under the same title with Elissa Epel. Non-availability of foods, due to both inflation and foreign exchange crisis, will increase the disease-span of a person shortening the health-span. The elongation of the disease-span makes one older irrespective of the age, according to Blackburn. Now we are facing this problem with the spread of diseases and it is the job of community physicians to mitigate the risks through improvement of efficiency and productivity of the services.

It is a challenge which I am sure the community is capable of addressing properly with their expertise, experience, and maturity.

At a time when Sri Lanka’s economy is going through an unprecedented economic crisis, the first casualty is the healthcare system. Lack of public funds, specifically foreign exchange to import essential medicines and vaccinations, will make the healthcare operations non-workable. This starts from the primary healthcare workers involved in providing community medical services. In my view, the challenge is much more serious than what many of us seem to believe. The crisis will deprive people at large of essential foods and nutrition. It first leads to under-nutrition followed by malnutrition later. The result is the loss of immunity and openness to widespread sickness

Adopt new systems

Hence, it is a time at which the medical practitioner should adopt new systems based on local resources keep people healthy. People should necessarily change their food habits to have an intake of nutritious foods. The College of Community Medicine as the body responsible for keeping people healthy should have a nation-wide awareness campaign to impress the people on the need for consuming healthy foods and not costly foods. This challenge is difficult but not impossible.

(The writer, a former Deputy Governor of the Central Bank of Sri Lanka, can be reached at [email protected].)