THE UNDP report on human development has once again ranked Pakistan 135th out of 177 countries. And a new Social Watch Report, ranking poverty in terms of human capabilities, has placed Pakistan among the 10 most backward countries in the world. That this state of affairs should exist after nearly six decades of independence, eight Five-Year Plans, numerous other programmes, projects and schemes, and a proliferation of social development and anti-poverty schemes, particularly in the last two decades, demands an explanation; since they have straddled the country with an outstanding debt amounting to Rs. 2,000 billion-plus internally and $ 35 billion-plus externally.

Social statistics are not only appalling; there has been a decline in some spheres, placing Pakistan behind even Nepal and Bhutan in a few cases. Statistics apart, the pervasive oppression of and violence against women points to the phenomenon of social regression. The almost once-a-month revelation of an incident of rape or gang rape, some sanctioned by village elders or committed by men in uniform, is a miserable indication of how low Pakistan has gone down the ladder of social development. Worse still are statements from the highest official quarters that not only fail to condemn the crimes against women, but instead tend to hold the victims themselves responsible and ascribe various motives to their predicament.

Perhaps, there has not been much success in social development because the term has never been consciously defined. Or perhaps, the ‘social’ has never been the operative part of ‘development’. Social development is not just about aggregations of literacy, health, water supply and sanitation statistics, but about the consensus that society develops and builds with respect to the kind of entity it wants to be and how it goes about achieving the stated objectives. After all, a house is more than just a structure of four walls and a roof.

Social development is about the values that society adopts, holds and protects. It encompasses values such as a literate and enlightened populace, freedom of the thought and rights of opinion and speech and to worship according to one’s beliefs, tolerance for the views of others, care that the sick and the elderly are not left unattended, a clean and hygienic environment, safety and security for all, particularly women and children, and so on.

These values are rooted primarily in the social contract among all or most members of society and the sense of collective responsibility towards all members of society with respect to a host of issues. That this social contract and the sense of collective civic responsibility is weak in Pakistan is evident in many ways.

At one end, there is no agreement on whether Pakistan should have a liberal or religious dispensation, or on whether the medium of educational instruction should be Urdu or English or whether Kalabagh dam should be built or not or what should be the formula for the NFC Award. At the other end, this failure is evident in the difference between how private and public affairs are conducted.

At the public end of the spectrum, basic laws can be violated, decades-old foreign policies can be reversed over a telephone call, and generals or brigadiers can be appointed heads of universities without much public protest.

At the private end of the spectrum, upper class private homes and businesses are furnished expensively with style and elegance and maintained in a clean and orderly manner. Just outside these premises, the public sphere is marked by pot-holed roads, littered with garbage and overflowing sewage.

Factors in the persistence of social underdevelopment are primarily internal, although external factors cannot be discounted. Two external factors that can be identified are increasing foreign intellectual control over development policy and increased US political and military influence in Pakistan, particularly since the 1980s. The former led to chasing objectives like ‘community participation in service delivery’, when the very concept and definition of community in Pakistan is different from that in the west. The latter led to the installation and support of military dictatorships that drew their internal support from the most socially retrogressive forces in the country.

Beginning in 1979 with the then military regime’s involvement in the US war in Afghanistan and the consequential liberal inflow of foreign aid and loans, the locus of developmental decision making increasingly shifted towards foreign creditor and donor agencies. One such prescription, popular in the 1990s, was the supposed importance of ‘community participation’ in successful and sustainable service delivery. In the donor/creditor conception, ‘community’ implied a collective of households living in close proximity to each other and sharing public services. That is the western construct of community.

In Pakistan, a ‘community’ is defined by caste, clan, religion, sect, etc. As such, a community in Pakistan can be spread over more than one village, town or neighbourhood. At the same time, one village, town or neighbourhood can be inhabited by more than one community. Different communities can also be divided by age-old feuds, precluding any cooperation in so-called community-based management and delivery of public services.

Donors have failed to understand this aspect of community life in Pakistan and it is not surprising that ‘community participation’ remained limited to the community of bureaucrats, NGO-crats and consultants benefiting from donor munificence. This is evident from one example of a town in Punjab, where there exists one hundred per cent enrolment among the upper caste Arain children and zero enrolment among lower class Mussalli children. The mantra of community participation has since faded from the donor agenda, but multilateral creditor organizations have continued to introduce new spins on how Pakistan ought to organize its social life.

The repeated imposition of military rule has by now created a sharp divide between the militarized state and civil society. The absence of meaningful democracy and public participation in national decision-making has not allowed institutions and platforms to emerge, which would have enabled a social contract and a collective sense to develop. Military regimes have tended to depoliticize, and resultantly, fragment the society.

The unholy alliance during the 1980s between the US, the Pakistani military and the religious fundamentalist forces seriously undermined the position of women in society and it has not been possible as yet to repair the damage.

Non-party elections, designed to keep political parties out of the political arena, have served to reinforce narrow caste, tribal, clan, and sectarian divisions. Supported by the US and its allies, Generals Ayub Khan, Ziaul Haq and Pervez Musharraf have all played havoc with social cohesion in the country.

Internal factors are several, ranging from feudalism, tribalism and religious bigotry to inequality and poverty. Together they have created a socio-political environment where the state has no direct interest in social development. This is evident from the low and declining levels of public expenditure on social development; reflecting the low priority that social development has in the state’s overall objectives. The state’s policies have reinforced and enhanced social inequality to a point where there are now two Pakistans: one of the parasitical ashraafia and the other of the labouring poor, with the former feeding off the latter.

Housing and education policies, in particular, have actually created a form of economic and educational apartheid. That this is so should not be surprising, given that the ashraafia are in full control of all levels of state apparatuses and overall social development is not part of their agenda.

The ashraafia’s blatant insensitivity to the collective affairs of society can be held to be primarily responsible for the low levels of social development in Pakistan. The proposed location of the US consulate near the most elite school in Karachi rightly alarmed the parents, who drove in their air-conditioned cars to congregate on the street in protest. Yet, regular news of children who die from falling in open manholes or from drinking contaminated water, or of children who are subjected to sexual abuse and murdered, or of children smuggled to the Gulf states to serve as camel jockeys does nothing to affect the occupancy rate of dining tables in elite restaurants weekend after weekend.

The ashraafia have built palatial houses for themselves in military-promoted elite housing estates and ignore the plight of the poor whose hutments are regularly bulldozed in the name of removing encroachments. The ashraafia own more than one car per household and ignore the absence of reliability, safety or inconvenience that the poor suffer in using a derelict public transport system.

The ashraafia are content with sending their children to expensive elite schools and ignore the abysmal state of affairs in non-elite public and private schools. They have resorted to private solutions to deal with power outages or impure water supply or the breakdown of law and order by installing generators, purchasing bottled water, and hiring private security guards rather than in depending on the state and government to ensure that these vital public services are provided efficiently and equitably.

Pakistan achieved independence in 1947 amidst great expectations. There was hope that society in the new country would be based on the principles of social justice and that the disadvantaged under the colonial era would find equal opportunities in education, employment, and other social, cultural, economic and political fields of life. That dream has clearly not been realized.

Nevertheless, Pakistan is a resource-rich country and there is no reason why poverty, unemployment, illiteracy and disease cannot be removed well within the lifetime of one generation.

However, social development is not merely a function of the amount of resources — domestic or foreign — that is allocated for it. It begins with an agreed social contract or a collective agreement on how society is to be structured and how its affairs are to be managed.

Society and the state will first have to adopt as a goal the creation of an enlightened, progressive and just social order that respects the rights of all citizens, including women and minorities. The precondition for all of the above is the establishment of a rule-of-law based democratic order, premised on equitable distribution of political power. An unequal society, based on injustice, cannot and should not expect meaningful social development.

OCTOBER 2 was observed as mental health day (instead of October 10 on account of Ramazan). As in previous years, the Pakistan Association for Mental Health (PAMH) used the occasion to create awareness about an important area of human health.

This year it decided not to hold a free camp as has been the past practice because it is running a free clinic round the year. The Association instead decided to focus exclusively on creating awareness and informed advocacy to remove the stigma that marks mental illness.

Hence, a walk was held which was a success in that 500 or so people participated and one hopes many more noted the messages on the banners. The key one was, “No health without mental health”. Later a seminar with specialists and physicians was held to sensitize and orientate specialists and general physicians towards mental illness, especially psychosomatic illnesses.

The afternoon saw an interactive session with the families of patients. But the stigma factor was clearly visible in the last session when not many people turned up to avail of this excellent opportunity to learn more about the illness which affects not just one person but throws its dark shadow on the lives of all family members. The meeting was also designed to brief the caregivers on how to handle their patient. Hats off to two patients of depression who turned up and were willing to talk about their problem.

Although the association has, since it started functioning in 1966, been playing an active role in creating awareness and understanding of mental health and illness, it still has a long way to go. The stigma is so strong that in spite of a general understanding that mental illness is like any physical illness, people find it difficult to come to terms with it. Many people, including the educated ones, still believe that mental illness is caused by “evil spirits” taking over a person. Hence, in their opinion the cure lies in driving out these forces by seeking the help of faith healers and others.

It is sad that the widespread prevalence of mental illness is not recognized because families try to conceal it. Hence not enough has been done to provide patients the health care they need. According to Dr Haroon Ahmed, the president of the association, a Harvard and WHO study found that of the 10 illnesses that severely affect the quality of life of people, five are mental disorders. These are schizophrenia, bipolar disorders, obsessive compulsive disorders, depression and drug/alcohol dependence.

In Pakistan the prevalence of depression is as high as 44 per cent. It is unfortunate that Pakistan has barely 350 psychiatrists and 5,000 beds — only 3,000 in the public sector hospitals — for mentally ill people.

With the government gradually disengaging itself from the social sectors, the health delivery system has suffered badly and more so the mental health sector. PAMH says that health is no longer a medical issue. It has become a political and an economic one. It has never received the importance it deserves.

The theme set for the mental health day this year was “mental and physical health across the life span” which underscores the importance of mental and physical well-being of people of all ages. This theme emphasizes two very important dimensions of human health. First, the physical and mental (as well as emotional) health of a person are closely linked and need to be addressed in an integrated manner. This would explain how a physical disease can lead to mental stress and vice versa. It is generally known how terminal illnesses such as cancer and disorders such as diabetes can cause the patient as well as his family members to become depressive.

Secondly, it is important that a person’s health and well-being are taken care of at all stages of life. The health of an individual operates in a continuum from infancy, childhood, adolescence, youth, adulthood through old age. Poor health at any stage can affect the state of health in the subsequent phases of life.

Although it is now generally recognized that psychiatric disorders such as schizophrenia, bipolar disorders and some forms of depression are genetic in origin, a person’s experiences and his capacity to cope with stress determine the state of his mental health throughout life. Hence a lot of importance is attached to the home environment especially factors such as love, stability and security that help in the emotional development of a child.

Today experts believe that stress-related illnesses are on the rise. According to Dr Haroon Ahmed, stress produces two effects. First, those with mental illnesses, who have been cured/are being managed reasonably well, relapse into their earlier state. Secondly, stress can lead to psychosomatic illnesses since it breaks down the defence mechanisms of a person. As a result, the diseases he may contract might be purely physical in nature such as cancer, cardiac problems and so on, or it may be of a psychiatric nature such as depression.

Be that as it may, experts are unanimous on one basic issue. Stress is caused by environmental factors such as a volatile social climate, growing incidence of crime and violence, unemployment, political and economic instability, spiralling inflation, urbanization, exposure to television images of violence, war and crime, gross injustices in society and the breakdown of social networks have led to an increase in stress in the lives of people. Hence the escalation in the incidence of illness — both mental and physical. It is the sense of lack of control over one’s life that can be devastating for the psyche of a person.

Stress management has therefore become the key factor in promoting the mental and physical health of people, says Dr Haroon. The people’s inability to cope with stress has affected their own and their family’s well being. People are now trying to drown their stress using three means. There are those who choose to opt out by taking recourse to drugs, alcohol, cigarettes or other addictive substances.

Others become activists, creative (artists, poets, writers), and productive in their work. Still others — by far the largest group — turn to religiosity. They reconcile themselves to their qismat as the will of God. Rituals assume great importance since they derive peace of mind from performing ceremonial and sacramental rites that help them cope with a crisis in their life. In this state of mind, some of them easily lend themselves to indoctrination of the worst kind showing no compassion for other human beings.

A lot of this can be prevented if government and society are geared to the mental health needs of the people. This would mean that the orientation of the education system has to be changed to ensure that children and youth grow up to be emotionally and mentally adjusted individuals. The media, especially television, will have to reappraise its programmes from the point of view of the impact they make on the minds of children and the youth. There is need to provide women the security and esteem that are their rights as homemakers and caregivers.

Finally, the government will have to be more sensitive about the civic and social needs of the citizens. Poor and corrupt governance creates undue stress in the lives of ordinary people breaking down their defence mechanisms and leading to illnesses.

Worse still, it is transforming the psyche of the nation leading to the erosion of their social and cultural values. Has it ever occurred to us that the rise in intolerance in our people and their tendency to resort to violence on the slightest pretext are on account of the growing stress the people are exposed to?