Health, hope, and papal selflessness: foundations for peace in South Asia

In 2004, we published a historic theme issue on South Asia (doi:10.1136/bmj.328.7443.777)1 with a grand ambition: “This non-political collaboration may be the beginning of a sustained and combined effort to improve healthcare in the region and, perhaps, promote peace and unity in a part of the world crippled by religious, social, and nationalist divisions” (doi:10.1136/bmj.327.7421.941).2 Despite a worsening relationship between India and Pakistan, the region’s nuclear powers, our conviction in this belief has never wavered.

Six weeks ago we held our South Asia Awards in Delhi—the first time since the pandemic. Previously they were an annual event. The awards recognise clinical and public health excellence. They are judged by members of our South Asia regional editorial board, which includes health leaders from across the region. The awards were a success, and we considered many examples of outstanding work in testing circumstances.

Don’t be fooled by the stereotype of rich doctors making themselves richer in the region. They do exist, but here were the true heroes of South Asia: people committed to working for the public good, gathering data and evidence of improvement, and making lives better—often in areas where healthcare barely exists.

South Asia needs hope. Like Africa, it is a young population with half being under 18 years of age. A recent BMJ collection examined the “alarming state of health and nutrition for adolescents in South Asia,” persistent high rates of undernutrition, poor food regulation that fuels the rise in overweight and obesity, and systematic exclusion of girls and gender norms that underlie persistent patterns of undernutrition and anaemia (doi:10.1136/bmj.r346).3

The collection was clear that “opportunities for addressing the health and nutrition of adolescents are plentiful,” and global evidence on effective interventions is strong. It stressed the importance of tackling social determinants and gender inequities and of implementing supplementation and fortification strategies. Importantly, it argued for national measures to be “complemented by strategies at regional level,” overseen by non-governmental agencies like Unicef and the World Health Organization.

South Asia is overheated, overpolluted, and overpopulated—two billion people, a quarter of the world’s population, cram into less than 5% of the global land mass.4 It is a region of deep poverty intertwined with an affluent middle class. Communicable and non-communicable diseases compete for scale and impact. Religious differences, caste biases, and hardwired inequalities hold back progress. Corruption and politics of division are constants (doi:10.1136/bmj.g4184).5 A damaging legacy of colonialism shapes prosperity, conflicts, and climate disasters. Nuclear war hangs over the region like an apocalypse, anytime now.

Yet South Asian people are resourceful, resilient, and redoubtable. Look beyond the media hyperbole and political bombast and you see common languages, familiar problems, and shared aspirations. You see a joint pleasure in music, poetry, film, food, chai, and cricket (doi:10.1136/bmj.328.7443.843).6 You see the same people under different flags. You see personal friendships and collegiality. You see people deserving of hope and capable of making solutions work. Bengali philosopher, poet, and winner of the Nobel Prize for literature in 1913, Rabindranath Tagore cautioned: “Patriotism cannot be our final spiritual shelter; my refuge is humanity. I will not buy glass for the price of diamonds, and I will never allow patriotism to triumph over humanity as long as I live.”7

Lifetime achievement awards were the highlight of our awards evening. We awarded two. The first went to a Pakistani and was presented by an Indian. The second went to an Indian and was presented by a Pakistani. In reading the citations, each presenter detailed the impressive contributions of their award winner. Each award winner, among other remarks, made a point of the importance of cross border collaboration. And this is the South Asia we wish to see: united in its purpose to improve the lives of its people and committed to an existence of mutual respect and peace (doi:10.1136/BMJ-2021-067384).8

Improving health and wellbeing outcomes, we believe, can be the focus for a safer, more prosperous South Asia. Giving peace a chance is also giving health a chance, and therefore giving more people a chance of a good life. The alternatives are a perpetual state of cross border crisis and terror, and perhaps a headlong descent into a catastrophic nuclear war. Nobody wins in these circumstances, not even India, a regional superpower limited in delivering its full potential through corrosive neighbourly tensions.

When stuck in the day to day of winning media battles, social media spats, political duels, and lucrative deals, it’s easy for leaders of South Asia’s nations to take their eyes off the big picture. Nor is there currently an effective international order, a rules based system, to pull errant countries back from the brink of oblivion. The US, the world’s self-appointed deal maker, reserves the art of the deal for its interests—even as Donald Trump is destroying the US’s much envied infrastructure (doi:10.1136/bmj.r916 doi:10.1136/bmj.r909 doi:10.1136/bmj.r906 doi:10.1136/bmj.r902 doi:10.1136/bmj.r862).910111213

Would a functioning world order and a morally driven global superpower allow the degree of escalation of hostilities we’re seeing in South Asia?14 Would it permit the unconscionable starvation of Gaza (doi:10.1136/bmj.q1018 doi:10.1136/bmj.q619 doi:10.1136/bmj.r941)?15161718 Where everybody sees the harm being done but few international leaders ever mention it—an act of omission, doing nothing, does not absolve you of blame or responsibility. Would it have led us to this exquisitely unsafe moment in the history of humanity; of a nuclear armed world gone rogue (doi:10.1136/bmj.p1682)?19 When the bombs drop, sings Sam Fender in “Hypersonic Missiles,” can you say you’ve lived your life?

What we know for sure, though, is that if nuclear war doesn’t get us, the climate crisis will (doi:10.1136/bmj.r873 doi:10.1136/bmj.p2355 doi:10.1136/bmj.m1103).202122 Pursuit of super power, super wealth, and super hubris has placed us in super peril. There is a way out of this inferno, and it comes with an urgent reorientation of purpose: place the health and wellbeing of people and the planet at the centre of our political and economic thinking and policy making. The primary responsibility of world leaders and their rich backers, but also the responsibility of religious leaders, corporations, and individuals—as the late Pope Francis urged—is to think beyond self-interest. From where we are today to that nirvana, that one shot to save humanity, might seem too distant and fantastical. But we must invest in that slender hope, and not throw away our shot.