Impact Interviews

The caste system (and its reflection, untouchability), with thousands of subcastes, is like so many stinking ponds which have polluted life for all those who came in contact with them. What we want is a flowing river with fresh and pure water.
(Sukhadeo Thorat, “Passage to Adulthood: Perceptions from Below”)

As a young boy, Sukhadeo Thorat felt humiliation when an upper caste child slapped his face for inadvertently touching the communal well. As a teenager, he felt anger when he and other local dalits (former untouchables) were slurred or socially shunned at gatherings, and excluded from religious temples.

As one of India’s leading economists and public intellectuals, Thorat has felt compelled to put caste discrimination on the mainstream research agenda, as well as to seek to influence policy and social movements with hard evidence about the ways in which tens of millions of persons remain ‘blocked by caste.’**

Thorat was reared in humble circumstances as a member of the Mahar dalit group in Maharashtra state, northeast of Bombay (Mumbai). By long tradition, Mahars and other dalits in villages across India have been forbidden from living alongside upper-caste residents, and from holding any but low-status, or dirty jobs. In his autobiographical essay, “Passage to Adulthood”* Thorat describes the daily indignities to which Mahars were subjected in his home village. He also tells of a social awakening for himself and others, beginning in the 1950s, under the inspirational leadership of B.R. Ambedkar, the architect of India’s constitution and himself a Mahar.

After struggling to acquire a primary and secondary education in various Christian missionary and other schools that would accept dalit pupils, Thorat enrolled in Ambedkar’s Milind College of Arts in Aurangabad, Maharashtra. There, he joined a student body composed almost exclusively of dalits. He deepened his study of Ambedkar’s writings and Buddhism – a religion to which many lower-caste Hindus converted at Ambedkar’s urging – and assumed leadership roles among dalit student activists. He also became determined to pursue further study on caste discrimination.

In a recent interview at his home on the expansive south Delhi campus of Jawaharlal Nehru University (JNU), Thorat recalled the difficulties he faced in actually bringing his student activism, and his personal understandings of exclusion, to bear in his economic research, beginning in the 1970s. His initially proposed PhD thesis topic, on untouchability and occupational linkages, was declared by JNU’s Economics Department as too far outside the mainstream to be acceptable, he recalled.

He was later accepted for doctoral studies at JNU’s Centre for the Study of Regional Development, but only to study a more traditional topic in agricultural economics. “I joined that center, but I was not able to do research on issues that I wanted to work on. … So, I lost 10 years.”

It was not until he served as a visiting faculty member at Iowa State University from 1989-91 that Thorat had the opportunity to pursue theoretical and empirical studies on economic discrimination, which shaped his research on economic of caste and the problems of excluded communities in India. There, he had access to North American literature on economic discrimination, in particular that directed against African-Americans, as well as some studies of caste discrimination by non-Indian authors. From those sources, and his own intensive study of Ambedkar’s writings and related material, he began developing an approach to market economics that could take appropriate account of caste discrimination.

Ongoing efforts have involved developing concept of caste and untouchability based economic discrimination through market and non market exchange, and its consequences on unequal opportunity and the poverty of the dalits. He also has strived to persuade other economists, as well as grant-funding bodies, that caste discrimination affects economic outcomes in significant ways. In a study on market discrimination in rural area sponsored by the International Labour Organisation, for example, Thorat provided evidence of discrimination faced by dalits in the sale of milk, vegetables, fruit and other farm goods.

In developing and refining measures of untouchability, Thorat and colleagues have conducted similarly fine-grained field research, measuring exclusionary patterns in village schools, primary health centers, shops and in daily activities. A study sponsored by Thorat’s Indian Institute for Dalit Studies revealed that “Private doctors, for example, often avoid visiting or entering the houses of the untouchables. And often the health service providers avoid touching the untouchable child. They ask the untouchable mother to hold the child and do the treatment from the side.”

As Thorat’s work on caste and economic discrimination deepened and became more influential in academic circles, so was he able to exercise some influence over policy. He was instrumental in persuading the Indian government to recognize that the privatization which accompanied the country’s greater economic openness in the 1990s could be a blow to lower-caste persons who had climbed some rungs on the employment ladder through policies of affirmative action. Because such policies were focused on public jobs, the privatization of public enterprises could mean huge employment losses for dalits.

Thorat and colleagues organized workshops on the issue, gave testimony and met with high-level officials. Thorat himself shared his concerns with then-Finance Minister (now Prime Minister) Manmohan Singh.

He also was instrumental in helping to develop affirmative action policy in India’s private sector. “The private sector says ‘we don’t discriminate, we go merit and efficiency.’ Through proper research, we provided the evidence of discrimination in hiring.”

A series of studies followed, including ones which involved sending job applications to private employers that were identical except for different applicant names. Some surnames were associated with Hindu upper castes, some with dalits, and some with Muslims. The dalit and Muslim candidates were invited to interview at far lower rates.**

Ultimately, research, testimony and opinion pieces by Thorat and collaborators was crucial to the development of government-backed, incentive-based affirmative action program for private firms, as well as caste-sensitive policies on government procurement. Thorat noted both as important steps forward, but he also said that recent reviews have found private-firm compliance with affirmative action policies uneven, and that more pressure likely will have to be brought to bear.

Besides impact on government policy, Thorat has made significant contributions to broadening the study of societal exclusion and supporting civil society groups with research. In the early 2000s, he took leave from his duties as a JNU faculty member to develop the Indian Institute for Dalit Studies in Delhi, along with dalit NGO leaders from the National Campaign on Dalit Human Rights (NCDHR). Backed by a grant from the Ford Foundation, initial efforts were focused on providing a research base for the campaign, which sought formal United Nations recognition of caste discrimination as a human rights violation. The NCDHR continues to call attention to caste-based exclusion across India.

Thorat remains integrally involved with the Dalit Studies institute as its Managing Trustee, conducting and facilitating numerous major research projects with Institute members.

Further, as chairman of India’s main higher-education funding body, the University Grants Commission, from 2006-11, Thorat oversaw the creation of 32 Centres for the Study of Social Exclusion and Inclusive Policy at universities around India. “I could see that there was a huge interest now around these subjects, and a group of scholars who wanted to do work but could not find space to do it. Now many of these researchers have opportunities to undertake research on issue related to exclusion and problems of discriminated communities” he said.

Thorat appreciates now how much progress has been made in bringing caste into the mainstream of academic research in economics, which in turn has provided a knowledge base from which important policy concerns can be raised.

“There was nothing by way of economic data much when I started in the early 1990’s,” he said. “The data organizations used to publish only few isolated report on dalits and adivasi [tribal groups] … There were many issues that we were not able to address. So we had to really provide an empirical base.”

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Sukhadeo Thorat has written more than 70 articles and written or edited 19 books on social exclusion and dalit and other excluded groups, with Oxford University Press, Sage and other international publishers.

*Sukhadeo Thorat. 1979. “Passage to Adulthood: Perceptions from Below,” in Sudhir Kakar, ed., Identity and Adulthood (Delhi: Oxford University Press), 65-81.

**Sukhadeo Thorat and Paul Attewell. 2010. “The Legacy of Social Exclusion: A Correspondence Study of Job Discrimination in India’s Urban Private Sector,” in Sukhadeo Thorat and Katherine S. Newman, eds., Blocked By Caste: Economic Discrimination in Modern India (Delhi: Oxford University Press), 35-51.

In this article, Sumaiyah Moolla interviews Professor Alan Fenwick of Imperial College London about his work leading the Schistosomiasis Control Initiative, which delivers cures to diseases afflicting a huge proportion of the severely poor globally. Read more of our Impact Interviews.

Malaria, tuberculosis, HIV/AIDS – all are highly ‘visible’ diseases, well-known on a global scale. Lesser known are a set of parasitic and bacterial infections, referred to collectively as neglected tropical diseases (NTDs), which afflict over one billion persons worldwide.

NTDs are found almost exclusively in the poorest and most deprived regions of the world, where residents face unsafe water, poor sanitation and limited access to basic healthcare. The afflictions form part of a vicious cycle, in which ill health resulting from NTDs helps to anchor millions of people in long-term destitution. Some 500 million people – two-thirds of Africa’s total population – suffer from two or more NTDs and require regular treatment.

The Schistosomiasis Control Initiative (SCI) works with ministries of health in numerous countries to develop, fund and implement in-country control programmes. It aims to manage and eventually eliminate the seven most prevalent NTDs from sub-Saharan Africa, including schistosomiasis (bilharzia), river blindness, roundworm and hookworm infection, and elephantiasis.

Since its inception, the initiative has successfully treated scores of millions of patients in Africa, often dramatically reducing the proportion of those afflicted by NTDs. In Uganda, for example, fewer than three percent of school-age children now suffer from schistosomiasis, compared to more than 26 percent before SCI’s campaign there. We spoke to SCI Director Professor Alan Fenwick about the origins of this tremendously effective impact effort, and the challenges he and his team have overcome and continue to face in reaching those who need treatment.

Q: What motivated you to want to undertake an impact intervention such as this?

A: My motivation was that I had worked in several African countries where I had visited many schools and seen children desperate to learn, and yet I was aware that they all suffered from parasitic infections which hampered their development and affected their health. I also knew that two drugs – praziquantel for schistosomiasis and albendazole for intestinal worms – were available and inexpensive (US 8 cents and US 2 cents respectively in 2002). I therefore wanted to fill the gap – offer as many children as possible access to these drugs and set up ministry of health and education facilities for delivering the drugs on an annual basis. If we could achieve this and monitor the impact, there would be many publications to be written on the results at a never-before-reached scale.

Q: How were you able to launch the initiative?

A: I applied to the Bill and Melinda Gates Foundation in 2001 when I heard about the money available for tropical diseases. I pointed out to the foundation just how many people (200 million) were infected with schistosomiasis (a parasitic disease) and that a drug was available at a reasonable cost. When the foundation agreed to fund the work, I approached Sir Roy Anderson (a leading British expert on epidemiology), who agreed to chair the SCI Board and sponsored me into Imperial College.

Q: What would you say are your most significant successes in the project?

A: The fact that 15 countries now have SCI supported intervention programmes and that we can claim credit for assisting delivery of over 95 million praziquantel treatments and well over 100 million deworming treatments. Most countries now have an NTD master plan which donors have bought into.

Q: What were the most significant challenges you faced in the early days of the project?

A: After receiving funding, the first tasks were to select the countries to benefit from the funding and then to agree memoranda of understanding with the countries’ ministries of health. Then we had to get the ministries to prepare proposals. I convened a technical committee to scrutinise 12 proposals and selected six countries: three in East Africa and three in West Africa. The next challenge was to obtain good quality praziquantel (used to treat infections caused by parasites) at a reasonable price.

Q: What are the most significant current challenges?

A: The current challenges are several and all different. The first is governance: so many African countries seem to have a tendency for civil unrest, which always disrupts health programmes. The second is how to hand over ownership of the programmes to the countries and yet ensure that there is good accountability of donated funds. The third is the expansion into problematic countries, because in order to retain credibility, we have to be reaching out to assist the Democratic Republic of Congo, Nigeria and Ethiopia – all of which present massive challenges.

Q: What do you see as the key to actually making an impact? How do you go about trying to influence policy, and otherwise make it possible for a project such as yours to make a positive difference?

A: We won over and received fantastic support from the World Health Organization. I am passionate in delivering a simple message: 200 million people are suffering from an infection which can be safely and effectively treated for just US 50 cents per person per year. All we need is the drugs and the political will combined with the expertise and logistics to ensure timely delivery.

Q: What would you say to those people – whether they be administrators, academics or others – who say that academics should focus on research, not seek to make direct interventions on specific issues?

A: Mostly they are right, but having an academic institution behind me has helped enormously to give me credibility when approaching governments. Academic research is important, but so is implementation of the results. Research had found the two drugs mentioned above, but no one was delivering them, so we filled the needed gap.

Q: What advice would you offer to an academic who wants to make a more direct contribution?

A: Provided that the project offers something unique, think hard about the mechanism of funding and the home – whether to remain as I did in an academic institution or establish an independent non-governmental organisation; both have advantages and disadvantages.

Q: If you could have done something differently at any point in the project, what would it have been?

A: When I was offered funding from Legatum and Geneva Global, I routed it through the Global Network for Neglected Tropical Diseases, because I felt that the network had something special to offer. The network does offer advocacy now, but that particular funding suffered from too many layers of bureaucracy and I should not have introduced that extra layer, because it proved to be top heavy. I think I lost a bit of management credibility with that decision.

Q: Next steps for SCI?

A: Our project has achieved a lot in terms of saving millions of lives and improving the health of millions more. Now SCI needs to switch from morbidity control to elimination. To achieve this we need to introduce clean water and better hygiene and sanitation in the areas where we offer treatment.

Read more of our Impact Interviews.