On Cancer

Permit me to embark on this 7-minute journey with Shakespeare’s muse:
Blow, blow, thou winter wind,
Thou art not so unkind
As man's ingratitude.

Mr. President, crusaders, doctors and wonderful audience:
Another British poet and painter William Blake mentioned:

In seedtime learn, in harvest teach, in winter enjoy.

I must appreciate Dr. Phillip rather than poking holes in his selection of wintertime for a forum on a serious public health issue. Perhaps he enjoys wintertime in launching a crusade against the enemy of humankind.

Implicitly and explicitly, under his leadership the team of philanthropists, oncologists, and physicians deserve a thunderous applause on organizing this event with epic cause successfully. Thus and so, we must proffer bouquets on their endeavor for congregating a moot of professionals, researchers and clinical oncologists. Good show, Dr Phillip!

I am privileged for speaking to this wonderful audience not as a guest of honor but being the part of the majestic cause that is behind this Congress.

Ladies and gentlemen, cancer is a killer disease with more than 100 versions. These versions are characterized by excessive, uncontrolled growth of abnormal cells, which invade and destroy other tissues. It develops in almost any organ or tissue of the body, but certain types of cancer are more lethal than others. Cancer is growing cause of death everywhere. For reasons not well understood, cancer rates vary by gender, race, and geographic region. For instance, more males have cancer than females. Cancer rates also vary globally—residents of the United States, for example, are nearly three times as likely to develop cancer than are residents of Pakistan.

Cancer usually develops gradually over many years, the result of a complex mix of environmental, nutritional, behavioral, and hereditary factors. Scientists do not completely understand the causes of cancer, but they know that certain lifestyle choices can dramatically reduce the risk of developing most types of cancer. Not smoking, eating a healthy diet, and exercising moderately for at least 30 minutes each day reduce cancer risk by more than 60 percent.

The Greek physician Hippocrates first made the connection between disease and natural environmental factors in the 4th century BC. His treatise Airs, Waters, and Places described how diseases can result from way of life, climate, impure water, and other environmental factors. For the next 2000 years, it was the most widely used text on public health and epidemiology.

Epidemiologists and other public health officials attempt to break the chain of disease transmission by notifying people who may be at risk for contracting an infectious disease. While the participants may read technical papers, I must emphasize on the need for awareness campaigns for prevention. Behavioral Change Communication must be used in mass awareness.

People need to know that saturated fats from red meats and other animal products are linked with several cancers; high salt intake increases the risk of stomach cancer; adult obesity increases the risk for cancer of the uterus in women and also appears to increase the risk for cancers in the breast, colon, kidney, and gallbladder.

Cancer of the prostate gland is the most cancer among males. People should be made conscious about the need to consult a doctor when they notice unusual health symptoms, such as, changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or a lump in the breast or any other part of the body, indigestion or difficulty swallowing, change in appearance of a wart or mole, or a nagging cough or hoarseness.

Scientists estimate that more than 60 percent of cancer deaths are preventable through lifestyle changes.

The society must be educated that lifestyle changes and consumption of such foods that have the potential to protect against cancer. I mean foods comprising broccoli, cauliflower, cabbage, tomatoes, soy products, and foods high in vitamins A, C, and E. In addition, green and possibly black teas contain compounds that protect the body from carcinogens. These foods contain substances called antioxidants that block the action of free radicals. Other chemicals in fruits and vegetables are thought to block the cell growth promoting effects of steroid hormones, protecting against cancers of the breast and prostate.

Mr. President, I would specifically be interested to receive the set of papers, which are likely to be read by experts and scholars in subsequent technical sessions. Apart from filling myself with knowledge, I will use necessary data in dissemination.

I epilogue my statement with a Japanese proverb:
One kind word can warm three winter months.

Permit me to modify this proverb as:
One kind deed can gladden the whole winter and the year round and round.
While wishing success to the crusading spirit of this Congress, I thank you for listening.
May God bless you!
Asif J. Mir,
Organizational Transformation

Globalization & the Poor

The urbanization of poverty is being propelled by a tremendous increase in the transnational movement of people and capital. The rapid transfer of money and jobs to cities and countries where cheap labor can be found has fueled by a race to the bottom. For the urban poor who are impacted by this race, there are no winners, and the losers will most likely find themselves among the projected two billion people who will be living in slums by 2030.

Hardest hit by globalization are women and children - the most vulnerable of urban dwellers. Poor women are becoming increasingly marginalized as the feminization of poverty manifests itself in many parts of the world.

The positive aspects of globalization, including greater longevity, increased literacy, lower infant mortality and wider access to infrastructure and social services, mask the unfortunate truth that these benefits are not being shared equally. The effects of globalization on cities – both positive and negative – need to be better understood if public policy is to be effective in bettering the lives of those who live in them.

Under globalization, manufacturing activities in cities have been relocated offshore to the developing economies whose lower labor costs, lower taxes and less rigorous environmental protection enable higher profits. The socio-economic consequences of globalization weaken access to basic infrastructure and housing, fuel the creation and expansion of slums, and reinforce the negative environmental and health impacts affecting the urban poor in many cities.

Demographic shifts, including transnational migration and poor integration of ethnic and racial groups, add impetus to these changes. So, too, does the ability (or not) of households and individual people to cope with rapid economic change. Those on the losing end of these changes can easily find themselves confronted with the loss of jobs, and the consequent sale of assets in order to survive, converting them into the new poor, leaving them even more insecure and vulnerable in the face of economic change.

The last two decades have witnessed a transformation of the global economy, which has led to vast economic, social and political realignments in many countries and cities. The trend towards open markets has enriched some countries and cities tremendously, while others have suffered greatly. World trade in this period has grown from about US$580 billion in 1980 to US$6.3 trillion in 2004—11-fold increase. Flows of capital, labor, technology and information have also increased tremendously.

Among the losers in this race are female workers, whose wage levels and working conditions have declined as a result of the dropping of barriers to footloose industries. This same dynamic is evident inside individual cities as well, leaving many people unable to obtain stable jobs and incomes. This leads to changes in patterns of social inclusion and exclusion across cities, often along racial and ethnic lines.

The distribution of the fruits of globalization reflects private-sector judgments about the expected financial returns to these investments, their security, and the economic and political environments in which they occur. Corporations have tended to concentrate direct investment in ten countries, including China, Brazil, Mexico, Indonesia and Thailand. In stark comparison, the poorest countries have seen no such investment.

The vacuum created by footloose industries is rarely filled by job opportunities for the poor. Rather, any new jobs tend to be in knowledge-intensive industries, many requiring university-level education.

The race also occurs within individual cities, resulting in job losses where large segments of the labor force have to shift from one sector to another. The urban poor are losing jobs and benefits and must now find other income-generating opportunities in the informal sector, which offer no security or benefits.

The loss of secure jobs with secure community roots fosters an informalization of the urban economy, with more people eking out a living in unregulated sectors. Several economic processes converge to informalize employment and other aspects of urban life. The closing of formal-sector enterprises often coincides with the downsizing of ancillary industries and services. As one industry declines – as with light engineering in Karachi - incomes in the city as a whole reduce. Former employees are no longer able to purchase services on the street; hence, street vendors also suffer. Simultaneously, if utility tariffs increase, other enterprises suffer and are forced to reduce their operations or close altogether.

Globalization has set cities against each other in a desperate competition for a share of highly mobile capital and trade. The needs and desires of global capital must be balanced with policies based on the needs of the region’s own inhabitants. Otherwise, any effort to alleviate urban poverty will expire, as meaningless gestures that provide little more than temporary relief – and the gap between rich and poor will continue to grow larger.

Jobs, consumption patterns and opportunities for social mobility are all easily influenced by external factors. This instability can be manifested in both national and local contexts through at least four important channels: patterns of investment, labor markets, prices and public expenditures. Moreover, they occur in different locations within the city, creating patchworks of decay, renewal, and economic revitalization. The challenge for national and local authorities is to identify which kinds of changes are occurring, or better still, which types of changes can be anticipated, in order to consider whether there are measures that can cushion or mitigate these impacts. To do that, changes must be anticipated and capital set aside to deal with them.

While government may feel its budget is severely constrained, it needs to apply discipline to save some of their resources for these future needs. This does not mean borrowing and thereby passing on debts to future generations. It means saving for the future. In reality, this saving is an insurance policy against future unknowns. Having such resources at hand allows decision-makers to face the future more confidently and to smooth out the impacts of volatile changes in the global economy at large. (www.asifjmir.com)

Desperate need for apt policy planning

The stump oratory must have reached people about sharpshooter or inept public managers’ actions, GDP growth rate is declining; foreign exchange reserves are depleting fast, record downfall in exports and of foreign investment. Ipso facto, no previous government in past decades confronted issues like these when financial stability has become a forgotten song, it has miserably. Yes, the government has completely failed in efficient service delivery to the poor. Consequently, it has contributed sweet nothing in reducing poverty and hunger that goes on to sustain stark national inequalities in wealth, assets, incomes and opportunities.

The Asian Development Bank estimates that 40 million people in Pakistan live below the poverty line. In its stated bid to ensure national security, Pakistan is spending more on arms and defense, and less on social security and protection, public distribution systems and welfare programs.

In the direst situations suicide rates among the poor are on the rise. Ironically, while national level defaulters on debt benefit from enhanced facilities to restructure debt and continue borrowing, the overwhelming burden of national debt is borne by the poor.

Lacking job opportunities in rural areas cause migration to urban cities. This takes the form of low quality jobs in the informal economy, or in the case of women and girls, prostitution or domestic service. Migration under conditions of economic stress exacerbates food insecurity. Owing to weak economic and social profile of the country, the adult population could not be gainfully employed, resulting in an 8.3 per cent current unemployment rate (more than 10 per cent in urban areas), plus substantial under-employment. Today, of the current workforce of some 48.40 million- as many as 8 million- are unemployed.

More and more workers, especially women, are being forced from the relatively protected formal sector to the unprotected informal sector. This is accompanied by concentration of assets and resources in the hands of the rich and newly prosperous, who have been able to take advantage of the economic opportunities offered by modernization and globalization.

Graft and corruption in government are a significant cause of continuing poverty and hunger. Despite NAB being there, corruption is on the increase and being accentuated by the companies of the developed countries through their underhand dealings with the national officials.

Sitting in luxurious offices the economic managers of Pakistan juggle with statistics rather than conducting surveys. This is often done to draw statistics acceptable to donors or financial institutions. To duck the WB in 2001, for instance, it drafted the poverty reduction strategy, just about the time when the WB initiated a new line of credit (PRGF) for countries that were equipped with such a strategy.

The increase in the tax-GDP ratio is apparently marginal but in the numerical terms, bulk of the burden has been shifted from direct to the indirect taxes and the share of the regressive sales tax being recovered at the highest rate over the globe has sharply gone up. It is affecting the whole population. The sales tax formed over 44 per cent of the total tax collection during the fiscal 2002-03. The result is that quantum of sales tax has grown from 27.11 in 1998-99 to 42.33 per cent during July 2004-January, 2005.

The Oil Companies' Advisory Committee fixes the prices of various products on fortnightly basis. It is claimed that the committee fixes the prices in a very transparent manner keeping in view the international prices. But the transparent formula was never made public either by the government or the committee. Oil companies have thus been licensed to plunder the poor.

Pakistan currently has about 74 percent of the population living on $1 per day and 86 percent living on $2 per day, implying that one out of every three households going to sleep hungry every day.

The narrow focus on economic growth has not only failed to eliminate poverty, it has also resulted in policies that have created new forms of, or aggravated existing conditions of poverty and hunger. Shaukat Aziz institutionalized policies that opened up economy and shrunk government’s direct responsibility for redistribution of assets and benefits. Public support and subsidies were systematically torn down, and market based price systems were made the primary determinant of allocation and distribution. With privatization and withdrawal of government subsidies for domestic industry, a significant proportion of the work force was shunted into the informal sector. By and large, previous government achieved economic growth at the cost of well being of workers, small-scale agricultural producers and consumers. The greatest beneficiaries of PM Shaukat Aziz’ adjustment programs were the rich, large private producers, distributors, traders, and MNCs.

Poverty and hunger are violations of human rights. They result in exclusion and feelings of hopelessness and helplessness. The human rights of people to housing, water, and sanitation—guaranteed under international law and commitments of development targets made at global summits, including the Millennium Summit and the World Summit on Sustainable Development—drag on to erode. By ratifying a number of international human rights instruments, such as, the International Covenant on Economic, Social and Cultural Rights, Pakistan has voluntarily accepted the obligations to progressively realize human rights to food, health, adequate housing, water and sanitation, which are essential for the well being of its citizens.

Pakistan needs policies that protect the rights of people to water, land, forests, other natural resources, biodiversity and indigenous knowledge. Policies are also needed that ensure people’s access to a services essential to their development especially among the poor and historically marginalized, this includes education, social security, healthcare and information, etc. Access must be equitable and the quality of services must not vary according to socio-economic or gender backgrounds. (www.asifjmir.com)