Hello everyone and welcome to this third interview with Dr Sylvia Karpagam!
(These three interviews were originally posted on my blog Intuitive Living by Ayako Miki and had by 2022 reached the whole world - about 56 countries. I now choose to post them here in order to keep spreading awarenes for a sustainable world, as the blog no longer exist).
Dr Sylvia Karpagam is part of the Right to food and Right to health campaigns and works mainly on the social determinants of health. She is often invited to make interviews and podcasts as a health professional and front figure who works for sustainability for all. In other words; including poor and marginalized people who can´t speak for themselves. Since the beginning of the pandemic she has also been involved in health camps for vulnerable communities. Dr Sylvia is a true fighter who speaks with honestly and straightforwardness without polishing the truth.
In a world so strongly influenced by ideology without any direct relation to the reality we live in, people like Dr Sylvia are more important than ever, because nature does not bow to ideology and neither does health. If we want real sustainable change, we need to face truth as it is. So, it´s my true pleasure to introduce you to Dr Sylvia Karpagam in this third interview, as a part of my international interview series A Sustainable World.
INTERVIEW
Ayako: Please, tell me about life in Karnataka where you live. What kind of people live there and what are their greatest life challenges?
Dr Sylvia: Karnataka is a state in the south of India. It has a rich and diverse culture. The state can boast of a variety of languages, religions, eating practices and cultures. In terms of development indices, although considered a more advanced state, its Human Development Indicators are not very good. It is often considered a laboratory for market driven interventions like Public Private Partnerships, health insurance etc.
Currently there is a right wing government in power so they are bringing in policies and laws that target minority communities. For instance, the government recently passed an Amendment to the anti-cow slaughter bill, while also enabling cow vigilantes. Post Covid lockdown, there has been a dire situation for many communities in terms of livelihood, access to social security schemes (food rations, healthcare, pensions etc). This has led to a nutritional crisis in the state. Further this anti cow slaughter bill will affect peoples’ livelihood and nutrition in much more disastrous ways.
Children dropping out of school has become a huge crisis. Only fairly well-off children with good internet connnection have been able to somewhat access education. There is very little effort by the government to have a more inclusive education system.
Poor education puts children at the same risk as their parents of continuing to work in exploitative low paid jobs. This is also a reinforcement of the age-old hierarchical caste structures.
Ayako: You´re talking about what I see, not only in India but in fact all over the world; people in power making decisions without understanding the consequences and perhaps not even caring about the consequences. They want what´s 'best for themselves' which often is a financial matter, yet do not understand that there is no such thing as an isolated life for the 'privileged.' We all live in this world together, influencing each other's lives, breathing the same air, depending on the same source or life; Mother Nature, which is a part of our own nature.
Ayako: As a doctor you meet many people from marginalized and vulnerable communities. What are the biggest issues when it comes to health and nutrition that you experience in the meeting with these people?
Dr Sylvia: People from marginalised communities struggle when it comes to the social determinants of health like access to safe/potable water, sanitation, education, livelihood, shelter, housing, safety, public transport, nutrition etc. This exposes them to multiple disadvantages. The government policies are mainly on paper but the implementation is poor. We have a large population of Indians in the informal sector of employment and most often their labour laws are violated. They do not get minimum wages and work in exploitative conditions. They have very little recourse to judicial or legal support. This affects all aspects of their health. This has been particularly aggravated after the unplanned massive lockdown by the government without offering people any major social safety net. We are expecting a surge in vaccine preventable diseases, communicable and non-communicable diseases as well as malnutrition related issues. We expect to see - apart from a rise in stunting and undernutrition, manifestation of individual diseases like marasmus, Vitamin A deficiency, rickets etc.
We also see that healthcare has shifted radically from the preventive and primary care model to a very urban centric, commercialised, corporate model. The health insurance and public private partnership model, driven largely by the market forces, creates a fragmented 'package based' health care system that makes it daunting for the poor to access.
That apart, out of pocket expenditure continues to be high and this can often be catastrophic pushing people (further) into poverty.
The association between nutrition and health is often overlooked in India at the policy level. The new report National Family Health Survey (2019) shows some alarming statistics on nutrition which will definitely have an adverse outcome on the population especially the poor and vulnerable.
Here are some examples concerning the State of Karnataka:
Mothers who consumed iron and folic acid for 100 days or more
when they were pregnant 44.7%,
And those who consumed for 180 days or more 26.7%
Children under age 3 breastfed within one hour of birth 49.1%
Children under 6 months exclusively breastfed 61%
Children age 6-8 months receiving solid or semi solid food and breastmilk 45.8%
Breastfeeding children age 6-23 months receiving an adequate diet 11.0%
Non breastfeeding children age 6-23 months receiving an adequate diet 19.5%
Total children age 6-23 months receiving an adequate diet 12.8%
Children under 5 who are stunted 35.4%
Children under 5 who are underweight 32.9%
Women whose body mass index is below normal (<18.%) 17.2%
Men whose body mass index is below normal 14.3%
Women who are overweight or obese (>25) 30.1%
Men who are overweight or obese 30.9%
Children age 6-59 months who are anemic (<11 g/dl) 65.5%
Non pregnant women age 15-49 years anemic (<12 gm/dl) 47.8%
Pregnant women age 15 - 49 years who are anemic (<11 g/dl) 45.7%
Men age 15-49 years who are anemic (<13 g/dl) 19.6%
Ayako: When I look at any social structure in cities, what I see is that it fails to include all. In other words, it´s a disconnected structure and therefore not working. These structures are built on very fixed systems without flexibility, with the consequences that we often experience gaps in the social structures/systems. These gaps exist because we all are individuals, and life is flexible, yet the systems are not. The systems are mind made and mainstream, made to 'fit all,' based on rules - rules that employees try very hard to follow in order to not lose their jobs. Yet there is no such thing as a system or even a 'One Size Clothing' that actually does fit all, is there? So, we need to handle our social structures with more humanity, including all, and less fixed rules. Rules are black and white, life is not. So, the result is simply lacking; marginalized people, poverty, misery, malnutrition and deficiencies etc. And it DOES affect everyone.
You also talk about how healthcare has shifted radically from the preventive and primary care model to a very urban centric, commercialized, corporate model. This is again something I see everywhere; people face things on the wrong end. Health and nutrition are taken for granted; hence we fail to prevent disease and deficiencies.
Ayako: From what I understand, the caste you are born in is very much affecting how you live and which privileges you have. What complications may arise because of this that in your opinion need to be solved?
Dr Sylvia: There are oppressor caste groups which occupy most of the decision-making positions, control the media and are present in most of high paying or lucrative jobs. They have access to most of the resources and own major share of the land in the country. At the other end of the spectrum, are the 'outcastes', 'the untouchables', the 'Polluted' communities that identify as dalit that have engaged in the so called unclean occupations, face exploitation, harassment and several human rights violations. Upward mobility is almost impossible. There is a Constitutional guarantee for affirmative action or inclusive policies, often called ‘reservation’ to which there is a great deal of resistance from the oppressor caste groups and poor implementation at all levels. Therefore, the dalit communities face multiple barriers that are very hard for individuals to overcome because in effect, it is an individual or one family against a society or a structure. This is very often extremely unequal and leads to extreme mental, physical and social stress.
Some of the ways to overcome these barriers:
Implement affirmative action in spirit and bring in regulatory/monitoring mechanisms.
Visas to developed countries for education or work should have a weightage system that gives a higher score for people from oppressed communities.
There should be representation in research, academia, policy making of people from marginalized communities.
Strengthen public healthcare, public education and social security schemes. While these are on paper, the implementation is very poor in most states of the country. This has further deteriorated after the lockdown.
Ayako: Very good suggestions. The problem here is that rich and fortunate people - whether we are speaking of caste or not, are often busy with their own lives - wanting more, better and bigger. Whereas the poor and marginalized people are too busy struggling to survive, to fight for their rights and work for the changes they so badly need. This reminds me of an Einstein quote; "The world will not be destroyed by those who do evil but by those who watch and do nothing." So, we need to stand up for those who cannot stand up for themselves.
Ayako: In the western world, people often believe that most Indians are vegetarians, and Indian cuisine is all about vegetables. Yet this is also related to castes, isn´t it?
Dr Sylvia: Yes, the way India has been projected to the world has been based on a false premise. India has a rich meat-eating culture with different meats eaten in different forms and preparations. The dalit communities have mostly eaten organ meat and have developed very good systems of meat preservation, practices which mainly derived from the subjugation faced from oppressor communities. However, these systems have not been allowed to become modernised because the government does not invest in research or modernising these meat-preserving technologies.
In India, about 20% of the population, mostly from oppressor communities, identify as vegetarian and claim to eat no animal source foods. However, in reality, they consume animal source foods like milk and dairy while abstaining from eggs, poultry, fish and other meats. Natarajan and Jacob (1) point out that 'self-identification' into the categories of vegetarian/non-vegetarian is not reliable because even meat-eating people may self-identify as 'vegetarians' out of social pressure.
The cost of dairy usually makes it unaffordable for the poorer communities who would rather invest in cheaper sources of meat like beef and organ meat. However, meat eating and meat eaters have been viewed as unclean or polluted and this has led to criminalisation and targeting of these communities.
Ayako: This idea of meat being unclean is something we see reflected in many religious, spiritual and ideological believes. Unfortunately, most people are still shaping their lifestyles based on believes rather than reality. It´s easier to create your own truth than facing truth as it is, because in this way you can get around your own shortcomings and fears. However, it´s not going to solve anything, is it? On the contrary, it is harming people and nature.
Ayako: I know you´ve been talking about vegetarian policy makers in India and how this has led to a nutritional crisis. Please explain this.
Dr Sylvia:
Researchers particularly from the same oppressor caste groups with a vegan alliance from the West, have been putting out some very poorly designed and analysed 'studies' where the outcome is decided much before the research is planned. This unethical research with clear conflict of interest, has the potential to cause serious damage.
For example, a 'collaborative study' by the International Food Policy Research Institute (IFPRI), Family Health International (FHI), and the Bill and Melinda Gates Foundation (BMGF) made a very damaging statement about their research that "vegetarian women are more likely to have probability of nutrient adequacy and diet diversity during pregnancy than non-vegetarian women”. First of all vegetarian and non-vegetarian are not scientific, measurable or mutually exclusive categories. Secondly, the State of Uttar Pradesh where this 'study' was conducted has been in the news for its anti-poor, anti-minority and anti-dalit agenda where people are raped, lynched and harassed simply for the caste or religion they belong to. Not surpisingly even the women who identified as meat eaters consumed foods in very low qualities either because they did not disclose their eating practices out of fear or because access has been made difficult by the state. The researchers however breeze through all these confounders and make statements that have an adverse consequence and is irresponsible and unethical to say the least.
These kinds of studies are now rampant and show the global agenda of pushing plant based-foods is forming criminal allyship with casteist forces that anyway want to keep a majority of the Indian population hungry and undernourished.
The predominance of vegetarians in the policy making shows up in their undue focus on cereals and millets as a source of food to the exclusion almost completely of animal source foods. This naturally shows up in the kind of nutritional crisis that the country is now in.
Ayako: Huge issue right now, yes. It is interesting how one can even think of including less nutrients (as you do if you don´t include meat and fish) and then presenting it as "more likely to have probability of nutrient adequacy and diet diversity." It is a fact that including animal source foods brings more diversity and more nutrients to the table. We´re not talking about some hypothesis here. This is basic facts and basic awareness, a matter of physics and even mathematics! Bill Gates may have his own way of thinking, but subtracting nutrients is NOT to add nutrients. I´ve also seen that study and it fails to differentiate very important matters straight from the beginning. They were for instance investigating how much peanuts people were eating... Yet no one was apparently thinking of the difference between roasted peanuts covered with refined oils and refined salt, versus pure, natural peanuts made by nature. There´s a huge difference.
Ayako: Many so-called climate experts in the Western world are now advising us how to eat. So, they´re more or less acting like nutritionists. As a health professional, what´s your opinion of that?
Dr Sylvia: Most climate activists neither have an in depth understanding of climate nor of nutrition. They are more ideologically driven by a plant based agenda rather than any real 'love' for animals or the environment and will use any current crisis to push for this plant based agenda. This 'love' for animals comes without an understanding of the organic relationship that farmers (and rural communities) have with their livestock, where practicalities co-exist comfortably with care and concern for animal welfare.
Firstly, climate change has to be addressed by cutting down on fossil fuel consumption. While climate change is a serious concern, falsely targeting livestock while keeping mum about other polluters is dangerous. There is a need for climate experts to understand nutrition and also the real importance of livestock. Right now, they are pushing for plant-based foods without much thought on the actual benefits vs adverse consequences of this.
Ayako: This is my experience too. In order to fully understand a matter, we have to rise above our own believes and ideology and respect the laws of nature. Few manage to do so. Truth is I´ve never seen a so-called 'climate expert' that does understand nature and nutrition. Yet they don´t mind advising people how to eat...
Again, these 'experts' separate their perspectives and believe that climate is an isolated matter. Hence, they don´t see the whole picture. They separate climate and nature in the same time as they blame nature. Nature is never to be blamed. However, we can learn much from how we treat nature and deal with nature. It´s also very important to differentiate natural sources and unnatural sources. And yes, the consequences of pushing plant-based foods are much more severe than any of them understand. We have children dying, people falling sick, and more use of industrial fertilizers and pesticides. Because well, that´s what most farmers use growing their plant-based crops. And these poisons are destroying both nature and human health, as well as causing huge amounts of greenhouse gas emissions like nitrous oxide, which has a Global Warming Potential about 300 times greater than carbon... (Fossil fuel is also a source of nitrous oxide emissions).
Ayako: I know you are very concerned about children’s health and you’re also the mother of two beautiful boys. As little children can´t speak for themselves and decide what their parents should feed them, they are very much victims of diets that fail to provide them with enough nutrition. What are your greatest concerns regarding how children are fed?
Dr Sylvia: Many people from oppressed communities have identified means of supplementing their (and their children’s diets) with cheap, highly bioavailable animal source foods. These cultural practices often have protected children from extreme forms of malnutrition. However there has been a continuous onslaught on peoples eating practices from communities that are located in more powerful positions.
The dairy consuming 'vegetarians' for instance, push for beef bans, providing 'vegetarian' (read; cereal heavy) foods in the pre-schools, schools, public distribution systems, dietary guidelines etc. This is adversely affecting children not only from a nutritional point of view, but in terms of their connect with their cultural practices. This is highly damaging and amounts to ideological imposition by a minority on the eating practices of a majority.
We have seen this in the mid-day meals provided by the government in schools. Ideally this should have been based on the local cultural eating practices and using local ingredients. However, there is a lobby to push for a centralised system of 'packaged' food which is largely discarded because it is bland and often spoilt in the Indian weather. This lobby pushes for 'sattvik' food which is devoid of the spices (garlic and onion) and animal source foods (eggs and meat) that children are used to eating at their homes. So, although more than 95% children in government schools are mostly poor and from marginalised communities, traditionally used to eating certain spices and animal source foods, these are systematically denied to them on the pretext that it will improve their 'concentration' or reduce 'lust'.
Ayako: Yes, this is a common effect of meat avoidance; people start eating too many carbs because they need to replace the meat with something. And of course, we see the food industry using this as an opportunity to sell more of their cheap, carb-based, industrial products, often added some vitamins etc. (so called fortified foods), in order to make it seem healthier. Yet in nature, the nutrients in a food source are carefully composed because these nutrients work together. Usually, sweet or carb rich foods in nature will naturally also include some magnesium for instance (even honey), for the simple reason that we need magnesium in order to process sugar in our body. If we don´t get enough magnesium from our diet, it's taken from muscles, bones, brain or heart and you´ll have a magnesium deficiency - something which is very common today for natural reasons. We simply eat too much refined sugar and carbs. When we refine carbs we also remove nutrients such as magnesium...
I see governments looking for practical solutions, yet also popular solutions, rather than true sustainable and healthy solutions. And who are the greatest victims of this? The children of course. This is what we see in India today. And regarding 'reducing lust' by avoiding animal source foods, that idea was presented by Ellen G. White and the Seventh-day Adventist Church. They also promoted plant-based food and cereals. As Ellen G. White wrote 1863; “A religious life can be more successfully gained and maintained if meat is discarded, for this diet stimulates into intense activity lustful propensities, andenfeebles the moral and spiritual nature.” Well, studies have shown that meat abstention was associated with poorer psychological health such as depression and anxiety. So, less lust for sure, but not in any positive way...
Ayako: Food production and health directions are today very influenced by companies and business with no expertise regarding diet and nutrition. So, it can be hard to know what to trust and not to trust. What is your advice to people who are confused regarding this?
Dr Sylvia: It is always good to provide foods that are region specific, culturally relevant and produced locally. This has multiple benefits including on climate change. It is also important that one homogenous food is not promoted and diversity in foods has to be encouraged. Also, the focus should be on natural foods that do not have an 'ingredient list'.
In India there are strict legal provisions preventing the entry of corporates into provision of foods to pre-school children. This is a very good policy and should be strengthened and extended to all children.
There is a tendency to address malnutrition with supplements, fortification, packaged and processed foods. Having a balanced diet with foods from multiple food groups would be the best way forward.
People should demand that the government should invest more in technology to improve the efficiency of animal production as well as modern methods of preservation, transporting and supply of animal source foods, keeping in mind animal welfare.
Ayako: Yes, today industrial foods are added so many artificial ingredients that actually make us sick, hence the 'ingredient list,' as you mention. I´ve seen a cake with more artificial ingredients than natural ingredients! But the cake sits there in the bakery, looking beautiful and tasty, and nobody knows what's hiding within, such as trans-fat and E-numbers causing inflammation in our bodies. I sure hope you can help implementing these chances!
Ayako: Those who are in charge of laws, directives and policies in this world are generally very privileged people. There´s a huge gap between these people and those who struggle to even survive. Do you think our leaders are capable of understanding the difficulties of vulnerable communities?
Dr Sylvia: There is very little representation of vulnerable communities at policy making. In India, corporates, multinationals and caste groups collude to make most of the decisions which are mostly exploitative/extractive of natural resources and human labour and doesn't benefit ordinary people. These decisions are not transparent or accountable and often behind closed doors. We see the devastating impact of this in decisions around natural resources, education, livelihood, nutrition, healthcare etc.
There is an urgent need for decentralised planning and also devolution of funds to the states and districts. A homogenous, centralised model that is currently being pushed in India is highly unstable and dangerous. There is currently a push to homogenous language, religion, eating habits and healthcare across the country. There are pockets of resistance but the onslaught is huge.
Ayako: I understand. Again, the privileged few are in charge. Yet in order to create a sustainable social structure, we need to work through all those layers of people, connecting them. Because truth is that everyone matters when it comes to the complete outcome of what we create and how we live. Everyone is a piece of the puzzle and if we leave out some people, our puzzle will not be solved.
Ayako: As a health professional, what do you consider the main factors that we need to work on for a more sustainable world in general?
Dr Sylvia: It would be important that this process is more consultative and inclusive of a wide range of groups and communities, especially those that get left out.
For a more sustainable world we need to move away from a corporate led model of governance because their primary (and often only) agenda is profit and they are neither concerned about people, animals or the environment, though they use these to market their products.
Diversity is very important and we have to nurture/support those practices that communities have followed. If any of these practices are harmful, then change has to be brought about through a combination of legal/social/educational measures. For instance, in India there is a caste-based practice of dedicating young dalit girls as devadasis or temple servants. These women are highly vulnerable to sexual exploitation and abuse. This cannot be encouraged as a 'traditional practice', but efforts have to be put in to bring about social change. Making these women economically independent does go a long way in preventing this practice. However, the solution to local problems cannot be a top down corporate driven, hegemonic, homogenising intervention which is what is currently happening.
Ayako: I absolutely agree.
Ayako: Is there anything else you´d like to add when it comes to health and sustainability?
Dr Sylvia: As far as healthcare is concerned, I feel that we need to focus much more on the social determinants of health rather than a curative or rehabilitative model. These social determinants include caste, gender, education, livelihood, income, public transport, shelter, housing, public safety, nutrition etc. There also needs to be an inclusion of best practices of the other systems of medicine that India has - such as Siddha, Unani, Ayurveda, Yoga, Homeopathy etc.
There needs to be much more regulation of healthcare providers and the drug industry in the country.
Ayako: Simply said; we need to join the dots, include all with better serving solutions regarding what truly matters and open up our minds!
Thank you so much, Sylvia! I´ve truly enjoyed our communication and I hope many will benefit from this interview! I also wish to thank everyone who takes part of 'A Sustainable World' and spreading the words of these experts! Thank you!
Keep an eye on my page 'Interview Series' for more interesting interviews coming up!
Much love and enlightenment, Ayako Miki
Dr Sylvia giving people medical care.
Intuitive Consulting for Happy & Healthy Clients