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Copy of Global Issues Presentation Planner

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Literature Review - Anay, Kashvi and Shlok

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Annotated Bibliography - Anay, Shlok and Kashvi

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The Healthy People 2020 website has been archived. Access archived Healthy People 2020 content on Archive-It .

If you can't access the content you're looking for, visit the CDC National Center for Health Statistics website.

To see the latest Healthy People data and resources, visit the Healthy People 2030 site.

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The Healthy People 2020 website has been archived.

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The Healthy People 2020 website has been archived. Access archived Healthy People 2020 content on Archive-It . If you can't access the content you're looking for, visit the CDC National Center for Health Statistics website. To see the latest Healthy People data and resources, visit the Healthy People 2030 site.

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If a religious leader is tied up with a political party, the political party will try and make sure that the religion the leader is promoting becomes more widespread. For example, Shiv Sena is a dominant political party in Maharashtra, who have been very strict with their nationalist and non secular beliefs, they promote Hinduism along with other political parties like the BJP. Our current Prime Minister, Narendra Modi, is reported to be biased towards Hinduism. If the government is focussing on a certain religion, it is an indicator that there are negative things to come

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A gay man is to take his legal challenge to the ban on homosexual blood donations in Northern Ireland to the UK's highest court.

Earlier this year the North's former health minister Edwin Poots won his appeal against findings that his prohibition was irrational and infected by apparent bias.

Senior judges in Belfast also held there was no basis for concluding that the decision was predetermined by his Christian beliefs. They further ruled that it was up to Stormont, rather than the british health secretary, to decide when gay men can give blood.

But their verdict is now to be scrutinised by the Supreme Court in London.

The case is being continued by a gay man who launched proceedings against the ban on donations from men who have sex with men four years ago.

Granted anonymity in the case, his legal team returned to the Court of Appeal today seeking permission to take their case further.

Although Lord Chief Justice Sir Declan Morgan refused leave, he indicated the Supreme Court may nevertheless identify points it would want to explore. On that basis lawyers are to petition judges in London for a hearing.

A solicitor for the gay man confirmed: "We believe there are arguable points of law of general public importance which should be considered by the UK Supreme Court.

"We will be making an application directly for permission to appeal."

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Case over North's ban on gay blood donations for UK Supreme Court

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A gay man is to take his legal challenge to the ban on homosexual blood donations in Northern Ireland to the UK's highest court. Earlier this year the North's former health minister Edwin Poots won his appeal against findings that his prohibition was irrational and infected by apparent bias.

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Turkey's new constitution will retain secularism as a principle, Prime Minister Ahmet Davutoglu said on Wednesday, playing down comments from the Parliamentary Speaker who triggered a public uproar by calling for a religious national charter.

Speaker Ismail Kahraman said this week that overwhelmingly Muslim Turkey needed a religious constitution, a proposal at odds with the modern republic's founding principles. He later said his comments were "personal views" and that the new constitution should guarantee religious freedoms.

"In the new constitution which we are preparing, the principle of secularism will be included as one guaranteeing individuals' freedom of religion and faith, and the state's equal distance to all faith groups," Davutoglu said in a speech to members of his ruling AK Party.

Kahraman's comments provoked opposition condemnation and a brief street protest, highlighting the schism in Turkish society reaching back to the 1920s when Mustafa Kemal Ataturk forged a secular republic and banished Islam from public life.

Davutoglu also said the government would seek a "liberal interpretation" of secularism, as opposed to an "authoritarian" one.

President Tayyip Erdogan and the ruling AK Party he founded, their roots in political Islam, have tried to restore the role of religion in public life. They have expanded religious education and allowed the head scarf, once banned from state offices, to be worn in colleges and parliament.

The headscarf ban, widely seen by the millions of pious Turks who back the AKP as an authoritarian stricture, was overturned by the ruling party in 2013.

The AKP is pushing to replace the existing constitution, which dates back to the period after a 1980 military coup. As speaker, Kahraman is overseeing efforts to draft a new text.

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Secularism will be in new constitution, says Turkish PM

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Turkey's new constitution will retain secularism as a principle, Prime Minister Ahmet Davutoglu said on Wednesday, playing down comments from the Parliamentary Speaker who triggered a public uproar by calling for a religious national charter. Speaker Ismail Kahraman said this week that overwhelmingly Muslim Turkey needed a religious constitution, a proposal at odds with the modern republic's founding principles.

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A new law in Mississippi makes it legal for physicians and therapists to opt out of care on religious grounds. What does this mean for medicine?

Andrey Popov / Shutterstock / Paul Spella / The Atlantic

Being lesbian, gay, bisexual, or transgender is not a disease. It took a long time, but nearly all medical organizations now agree that queerness is not a "sociopathic personality disturbance," as the American Psychiatric Association once maintained.

"Nearly all" is an important caveat, though. There are still a few organizations-which most doctors and scholars would likely consider part of the fringes of medicine-that challenge this view. Some are dissenting offshoots of mainstream associations. Others are the de-fanged descendants of ex-gay-therapy groups. They're often accused of outright bigotry, but these doctors tend to frame their dissent differently, placing an emphasis on "choice." Patients have a right to choose a therapist who will help them with unwanted same-sex attractions or feelings of gender dysphoria, they say. And physicians and therapists have a right to choose not to provide treatments that conflict with their religious beliefs. These treatments might include sex-change operations, hormone-replacement therapy for transgender people, fertility treatments to same-sex couples, or counseling for patients who are in non-heterosexual relationships.

Some legislators agree. In the first week of April, Mississippi passed a new law making it expressly legal for doctors, psychologists, and counselors to opt out of any procedure or choose not to take on any patient if doing so would compromise their conscience. The law is specifically designed to protect medical professionals who object to gay marriage and non-marital sex. Tennessee's general assembly just passed a similar law, which would only apply to counselors, and a now-dead Florida bill would have protected religious health-care organizations from having to "administer, recommend, or deliver a medical treatment or procedure that would be contrary to the religious or moral convictions or policies of the facility."

This legislation is part of a wave of religious-freedom bills that have been introduced and passed in the past year or so, almost all inspired by objections to homosexuality and same-sex marriage. Some of these measures are just for show-pastors could never be legally compelled to perform a gay-marriage ceremony in the way some bills have suggested, for example. But some represent a relatively novel approach to religious-freedom legislation: They offer legal cover to people of faith who don't want to provide certain goods or services to LGBT people, especially when doing so might seem like a tacit endorsement of their relationships and sex lives.

Medical exemptions, though, deserve to be considered in a category of their own. Doctors and therapists interact with people at their most vulnerable, and their training and expertise gives them incredible power over patients. The advice they provide-or refuse to provide-to an LGBT patient could influence the treatment that person seeks. It could make that person less likely to seek primary care or identify themselves as LGBT to other doctors, which can lead to the "failure to screen, diagnose, or treat important medical problems," according to the American Medical Association. The medical community has a problem: What should hospitals, private practices, and medical associations do about doctors and therapists who say it's against their beliefs to provide care to LGBT patients?

* * *

Paul Church is an evangelical Christian who attends services at a Congregationalist church in Massachusetts. He's a urologist-a surgical specialty focusing on pelvic, urinary-tract, and male reproductive disorders-and has been practicing as a staff doctor and affiliate of various Boston hospitals for nearly three decades. He even had a joint appointment as an assistant clinical professor at Harvard Medical School. After coming into conflict with staff over statements he made about homosexuality, he lost his privileges at two area hospitals, effectively ending his ability to perform surgeries.

As Church tells it, the fight started when he circulated comments on the hospital's internal-communications network-a kind of company intranet. "I was taken aback that a hospital was engaging in, especially, promotions for the gay-pride parade," he said. "All sorts of sordid, vulgar things go on in it." Church claims that a number of doctors employed by or affiliated with the hospital objected to its open support of Pride and other LGBT cultural events. "I took up a letter-writing campaign to the leadership, and I was taken aback that they accused me of harboring some kind of discrimination," he said.

A spokesperson from one of the hospitals, Beth Israel, wouldn't confirm why Church's privileges were revoked, but she did point me to the hospital's harassment policy, which prohibits "verbal or physical conduct that denigrates, belittles, or shows hostility or aversion to an individual" because of, among other things, that person's "sex, sexual orientation, [or] gender identity."

Church framed his objections to homosexuality in moral and religious terms, but he also argued that he has a medical obligation to talk with gay patients, for example, about the risks associated with men having sex with other men. "We are supposed to counsel patients about self-destructive habits like smoking and overeating," he said, "but we're not supposed to place any judgment on behaviors that involve these sexual practices, for fear that we'll be accused of being discriminatory or bigoted."

Most mainstream medical associations would likely agree that physicians should advise their patients about risks associated with specific sexual behaviors. Men who have sex with men, for example, face higher rates of HIV and other STDs and have a greater risk of depression compared to other men. But there's a difference between acknowledging risks and condemning the choices that lead to those risks-or the people who make them. In its ethics guidelines, the American Medical Association states, "Physicians who offer their services to the public may not decline to accept patients because of race, color, religion, national origin, sexual orientation, gender identity or any other basis that would constitute invidious discrimination." While it allows that some doctors may object to performing certain procedures-such as providing fertility treatment to a same-sex couple-"a physician's freedom to act according to conscience is not unlimited," said Jesse Ehrenfeld, a doctor who co-directs the LGBT health program at Vanderbilt and was the first openly gay member of the AMA's board of trustees. "We have a professional obligation, and when we have a specific ethical policy that prohibits discrimination, we expect physicians will adhere to that."

Church resigned his membership in the AMA based on its positions on LGBT issues. He's now involved with an organization called the Alliance for Therapeutic Choice and Scientific Integrity, a former gay-conversion-therapy group known as NARTH that reconstituted itself in 2014. A long-time member of its board, Michelle Cretella, is also the president of the American College of Pediatricians, a group that broke off from the American Academy of Pediatrics in 2002 in protest of the organization's support of adoption by same-sex couples. These groups are part of a small network of medical-professional associations that have formed largely in opposition to mainstream groups like the AMA. They say, like the Mississippi legislature, that physicians should have the choice to not participate in a procedure that violates their conscience.

In the context of medicine, this is a messy moral claim. Doctors constantly encounter patients who might not live in ways they agree with. Treating those patients is not the same as endorsing their behavior; the point of medical care is not to pass judgment, but to help people be healthy. That's the central question in these conscience exemptions: When does providing medical advice become a moral act? For Cretella and others like her, the context-sex and sexuality-seems to be the defining factor. "Physicians who do not wish to celebrate LGBT behaviors-that does not make them anti-gay," she said. "We do not see ourselves as fighting an LGBT community. We see ourselves as fighting a dictatorship of political correctness."

In certain ways, conscience-based exemptions for people in mental-health professions are even more complicated than those for medical doctors. For one thing, the field is much less centralized than medicine. Many people who provide counseling services aren't professional psychologists or psychiatrists. A number of different organizations offer certifications and training in counseling, and licensing standards vary widely state by state.

More importantly, medical doctors primarily focus on patients' bodies. Counselors and psychologists focus on their minds and emotions, talking about everything from relationships to impulses and desires. There are a lot of good reasons-many of which have nothing to do with gender and sexuality-why a therapist might decline a patient relationship: a personal conflict, for example, or a case that goes beyond his or her expertise. Referrals are a central feature of the profession. In dealing with lesbian, gay, bisexual, and transgender patients, though, the line between discrimination and intellectual freedom can be blurry. Take this analogy: "No one really thinks I'm discriminating against you when I say I don't want to be your bankruptcy lawyer because I know nothing about it," said Robin Fretwell Wilson, a law professor at the University of Illinois. "But I may have particular religious difficulty with counseling you on something that I think is going to send you straight to hell."

"There are a range of attitudes toward some of those populations that different people grapple with in different ways," said Clinton Anderson, the director of the LGBT concerns office of the American Psychological Association. "Some of those issues do have a foundation in people's personal religious beliefs." Yet, the APA's ethics guidelines bar "unfair discrimination" and harassment on the basis of sexual orientation and gender identity. They also require psychologists to get the education they need to work with LGBT populations and encourage them to "eliminate ... biases" they might have toward these groups. These guidelines are professionally binding, meaning the APA can censure member psychologists who violate the rules.

Many states directly incorporate ethics codes provided by organizations like the AMA or APA into their laws on licensing and conduct. That may be part of why some legislators feel the need to carve out explicit exceptions for religious people in these professions. The Tennessee Counseling Association has said the state's exemption bill, which applies only to counselors and not psychologists, is unnecessary, bad for clients, and harmful to the profession. "When we choose health care as a profession," the organization said in a statement, "we choose to treat all people who need help, not just the ones who have goals and values that mirror our own."

* * *

Even though the recent wave of LGBT-related laws is new, religious-exemption clauses for health-care providers are not. "Marriage-conscience clauses are an idea from abortion-conscience clauses," said Wilson. Almost immediately after the Supreme Court ruled in Roe v. Wade in 1973, Congress passed an amendment to an existing health-care law clarifying that even hospitals and facilities that receive federal funding don't have to provide abortions or sterilizations if they have religious or moral objections to doing so. A number of states later adopted their own conscience clauses as well.

Related Story

Hating Queerness Without Hating the Queer
LGBT exemptions, though, could have a fatal flaw: They may conflict with federal law. The Affordable Care Act prohibits sex discrimination in any program or facility that gets federal funding for health-care services, which includes Medicaid. Effectively, that means the rule applies to nearly every hospital, insurer, and private practice in the country, although it's not clear whether it applies to religious organizations, according to Wilson. The Department of Health and Human Services interprets gender-identity discrimination as part of sex discrimination and has enforced the rule with that in mind, initiating a number of investigations into complaints against medical providers related to harassment of and lack of coverage for trans people. That interpretation is not expressly written in the law, though. And discrimination on the basis of sexual orientation is not currently banned for all doctors and health-care providers; a proposed update to federal guidelines on that topic is pending.

What this means is that if a doctor in Mississippi refuses to provide fertilization treatments to a husband and wife, and one spouse is transgender, that couple could theoretically sue the doctor for violation of federal law. The particularities matter: The doctor would have to receive money from Medicare, Medicaid, or some other federal source, and the treatments would have to be eligible for coverage. But the potential for these kinds of cases-and litigation-is high.

For the conservatives who advocate these kinds of laws, the parallel between abortion-related exemptions and LGBT-related exemptions seems direct: Health-care providers should have a way to get out of performing procedures or providing advice they find morally problematic, they say. Plus, "there are many patients that want to be able to choose a pro-life doctor or a religious hospital or a mental-health counselor who integrates their emotional and spiritual health together," said Matt Bowman, a lawyer at Alliance Defending Freedom, an advocacy firm that litigates religious-freedom cases largely on behalf of Christians. Particularly for some religious conservatives, finding a therapist who shares their values, for example, may determine whether or not they seek help at all. "Conscience protections are pro-choice in the best sense. They allow different options, different perspectives on health."

The question is whether the alleged advantages of choices in the health-care market outweigh the potential harms of discrimination. In some ways, conscience exemptions for doctors, psychologists, and counselors seem to be in the same spirit as other kinds religious-freedom protections: Individuals or organizations express a sincere moral conflict with a legal obligation; where possible, the law finds a way to accommodate those objections. Compared to new laws that would protect wedding-related businesses, though, medical professionals have a lot more power over the people they provide services to. "When we're talking about doctors or counselors, we are talking about people who are much closer to the patients, in situations that are much more intimate and private and confidential," said Elizabeth Sepper, an associate law professor at Washington University in St. Louis. "The harm of discriminatory denial in those circumstances can be really severe in that one makes oneself vulnerable to one's doctor or one's counselor in a way that you might not when you're coming into a bakery."

Plus, doctors and therapists are experts, trained to provide a service that people need to stay alive and healthy. In getting into those fields, people involved in medicine and mental health are arguably committing to making their personal convictions secondary to their occupational obligations. "These are professionals you direct yourself to because they have the imprimatur of the state," said Wilson. "They have a medical license. It's the state saying they have a sufficient amount of quality, in theory, to be in the marketplace of providers."

That word-marketplace-is at the heart of the debate over LGBT conscience exemptions. Supporters of the exemptions see goods and services like cake baking and medical procedures like fertilization treatment as similar in kind; people should be able to provide and seek them out on their own terms. Individuals and organizations, not the government, they argue, should set the parameters around what is and is not morally acceptable. "It's a notion that you're not discriminated against-you're not harmed-as long as someone else will serve you," said Sepper. "Of course, by that logic, so what if you had to ride on the back of the bus? You still get to your destination." That's the weakness of the free-market argument: It focuses more on the people who selectively want to tag out of interactions rather than those who are still struggling to fully tag in.

The idea that people can't discriminate against others because of who they are-in terms of race, age, national origin, and more-has only been part of U.S. law for 51 years. Since the Civil Rights Act of 1964 was passed, cultural understandings of gender and sexuality have changed, and it's not yet clear whether these characteristics will become fully integrated into federal and state discrimination law. Some progressives predict that LGBT issues will go the way of race, dissipating after initial resistance into nearly universal opposition to overt discrimination. But it's also possible that LGBT conscience exemptions will become as standard as the legal exceptions around abortion-an area of health care where science hits the hard boundary of social mores and morality.

It's more difficult to claim that LGBT conscience objections grow out of ambiguous science, though. For a long time, gay-conversion-therapy groups were the primary champions of a different kind of "choice" for doctors and patients dealing with same-sex attraction and "gender confusion"-they argued that people should be able to choose whether or not they identify as gay. These practices have been widely condemned by the health-care community and largely repudiated by their advocates, in part because they're ineffective. For people who believe abortion is murder, there's a clear, health-based case to be made for not wanting to perform the procedure-they see it as taking a life. The medical justification for refusing to treat LGBT patients is less clear. Trying to change people's sexuality is bad science, and, arguably, opting out of care altogether is bad medicine.

The medical community has largely rejected practitioners who are unwilling to accept LGBT patients in the fullness of their identity. This probably does have a silencing and exclusionary effect on some doctors, therapists, and patients, which is what laws like the one in Mississippi are trying to address. But freedom in medicine is not like freedom in every other sphere of public life. Physicians are not bound to act according to conviction. They are bound to do no harm.

Emma Green is a staff writer at ​ The Atlantic, where she covers politics, policy, and religion.

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The Doctors Who Refuse to Treat LGBT Patients

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A new law in Mississippi makes it legal for physicians and therapists to opt out of care on religious grounds. What does this mean for medicine? Being lesbian, gay, bisexual, or transgender is not a disease. It took a long time, but nearly all medical organizations now agree that queerness is not a "sociopathic personality disturbance," as the American Psychiatric Association once maintained.

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Stephen Schwarzman - CEO of Blackstone, the fabled private equity firm - lives well. He made the news in 2007 when he staged a $3 million 60th birthday party for himself and several hundred of his closest friends at the Armory on Park Avenue. According to Gawker's coverage of the event, "Rod Stewart was paid $1 million to perform for the assembled guests; Patti LaBelle sang 'Happy Birthday.' And the room was designed to replicate Schwarzman's $40 million co-op at 740 Park Avenue."

But Schwarzman believes the government is taking far too much of "his" money. He, like many other superrich people, hates paying taxes.

James Surowiecki, an economics writer for the New Yorker, offered these thoughts on Schwarzman:

He recently grumbled that the U.S. middle class has taken to "blaming wealthy people" for its problems. Previously, he has said that it might be good to raise income taxes on the poor so they had "skin in the game," and that proposals to repeal the carried-interest tax loophole-€"from which he personally benefits-were akin to the German invasion of Poland.

Surowiecki went on to note that other wealthy executives have been voicing similar complaints. Venture capitalist Tom Perkins and Home Depot co-founder Kenneth Langone, for example, each likened populist criticism of the wealthy to the Nazis' attacks on the Jews.

Why do so many wealthy drivers continue to favor lower taxes, even knowing that means further degradation of the nation's infrastructure?

Hatred of taxes by the wealthy has had real consequences. Due in part to lobbying efforts on the part of high earners, for example, top marginal tax rates around the world have gone down dramatically since the 1970s. Rich people paying lower taxes means there's less money for public investment in infrastructure and education. And less public investment is bad for everyone, including rich people.

In my just-published book about luck and success, I describe a simple theory in which tax resistance by the wealthy is rooted in two garden-variety cognitive errors. One implication of this theory is that it would be a surprisingly simple task to persuade the wealthy to view taxes differently.

Why do rich people hate taxes?

Tax revenue is what we use to pay for public goods and services. Everyone agrees, for example, that cars would be of little use without roads and that roads would be of little use without cars. What's harder is to identify the best mix of the two categories. It's fairly easy, however, to see that the current mix in the United States is far from optimal, at least from the perspective of wealthy drivers.

Consider this thought experiment: Which experience would a wealthy car enthusiast prefer - driving a Porsche 911 Turbo (purchase price $150,000) on smooth, well-maintained highways or driving a Ferrari F12 Berlinetta (purchase price $333,000) on roads riddled with foot-deep potholes?

It's an easy question. Although some car buffs might quibble, I'll assume for the sake of argument that the Ferrari would be judged the better car if both could be driven on good roads. But it wouldn't be much better, since the $150,000 Porsche already has most of the design features that affect performance significantly.

The economist's law of diminishing returns operates here with a vengeance. Beyond a certain point, it reminds us, the cost of achieving additional quality improvements rises very steeply. So if the Ferrari enjoys an edge, it's at most a tiny one. How, then, could anyone argue with a straight face that it would be more pleasing to drive the Ferrari on pothole-ridden roads than to drive the Porsche on well-maintained ones?

Yet among the super wealthy, the actual quality mix of cars and highways in the United States more closely resembles Ferraris on potholes than Porsches on smooth asphalt. That's puzzling, since the latter combination could be achieved at much lower total expense.

If most wealthy drivers would prefer driving a $150,000 Porsche 911 Turbo on well-maintained highways to driving a $333,000 Ferrari Berlinetta on pothole-ridden ones, why do so many wealthy drivers continue to favor lower taxes, even knowing that means further degradation of the nation's infrastructure?

This strange position stems from a combination of two cognitive errors. One is the seemingly plausible, but essentially false, belief that higher taxes would make it significantly harder for wealthy people to buy what they want. The other is the tendency for them to underestimate the importance of luck in their own lives. Both errors make it more difficult to perceive and appreciate the possible attractions of high-quality public services financed by higher taxes.

Cognitive error 1: Rich people think higher taxes make it harder to buy desirable things

The first error was on vivid display during a lunchtime conversation several years ago with one of my colleagues. When he asked whether I'd heard about all the new taxes that President Barack Obama had in store for us and I said that I hadn't, he expressed shock at my ignorance. I explained that it just didn't make sense for people like us to worry about such things.

When he asked why, I began by confirming that he agreed with me that there was no chance the government would enact tax changes that would threaten our ability to buy what we needed. (He and I are both authors of widely adopted textbooks, which in a town like Ithaca means we don't spend nearly as much as we earn.)

I then asked whether he was worried that higher taxes would make us less able to buy what we wanted. Yes, that was exactly his worry! But since all our basic needs have already been met, the kinds of things that people like us want are mostly things that there aren't enough of - say, a house with a commanding view of the lake, or a choice slip at the marina.

When attempting to assess how higher taxes might affect his ability to acquire such things, my colleague was probably employing a common cognitive rule of thumb known as the availability heuristic, which says that you make judgments about an event's effect by trying to summon relevant examples from memory.

When smart, hardworking people strike it rich, the availability heuristic leads them to ascribe their success to hard work and talent alone

If tax increases occurred frequently, people would try to assess their effects by trying to recall how they'd felt when taxes had risen earlier. But the extreme infrequency of tax changes makes that strategy impractical. So when people try to imagine how they'd be affected by higher taxes, they probably try to recall how they felt on earlier occasions when they had experienced income reductions.

But most of the income declines that people actually experience - whether from the loss of a job or a divorce or a business reverse or a home fire - are losses that affect only them. So the availability heuristic leads people to think that tax increases will have effects similar to those other income losses. That's misleading because a tax increase reduces not only your income but also the incomes of others like you.

If you lose your job, you really are less able to bid successfully for a home with a view. But when everyone's disposable income declines - as happens when taxes rise - it's a totally different story. The special things that prosperous people want are generally things that there aren't enough of. To get them, we must outbid other people like us who also want them, people with similar tastes and incomes. So if the government raises our taxes, the taxes of those other people go up, too. And that leaves the bidding wars that determine who gets the things we want essentially unaffected. The best home sites and marina slips go to the same people as before.

In short, the effects of a decline in any one person's after-tax income are dramatically different from those of an across-the-board decline. If you alone experience an income decline, you're less able to buy what you want. But when everyone's income declines simultaneously, relative purchasing power is unaffected. And it's relative purchasing power that determines who gets things that are in short supply.

Cognitive error 2: Rich people don't appreciate how lucky they are

Like the failure to appreciate the distinction between unilateral and across-the-board income declines, underestimating the importance of luck is also a totally understandable tendency. When smart, hardworking people strike it rich, the availability heuristic leads them to ascribe their success to talent and hard work alone.

Most highly successful people are very talented and hardworking, after all, and when they construct the narratives of their own lives, the most readily available memories are the difficult problems they've been solving every day for decades. Less salient are the sporadic external events that also invariably matter, like the mentor who helped you during a rough patch in 11th grade or the promotion you got because a more qualified colleague had to turn it down to care for an ill spouse.

Evidence suggests that failure to recognize luck's role in success increases tax resistance by reinforcing the natural sense of entitlement to income produced by the fruits of one's own labor. As the 17th-century British philosopher John Locke wrote, "Every man has a property in his own person. This nobody has any right to but himself. The labour of his body, and the work of his hands, we may say, are properly his." With these words, Locke became the patron saint of tax resisters around the world.

This sense of entitlement to the fruits of one's labors may owe much to the phenomenon known as loss aversion. One of the most reliable findings in behavioral economics, loss aversion refers to the fact that people will fight much harder to avoid a loss than they would to achieve a gain of the same amount. Since most successful people work extremely hard for the money they earn, it feels like they own it, and that makes taxation feel like theft.

But equating taxation and theft is difficult to defend. A country without taxes couldn't field an army, after all, and would soon be overrun by a country that had one. Its residents would then have to pay taxes to that country. A country without mandatory taxation is the political analog of a highly unstable isotope in chemistry.

The philosophers Liam Murphy and Thomas Nagel have argued that there has never been any presumption that citizens are morally entitled to keep their entire pretax incomes. Governments provide services that citizens value, and those services must be paid for. Elected legislators in any democracy vote on what the tax rates should be, and citizens are then entitled to keep only their post-tax incomes.

It goes without saying that few people actually enjoy paying taxes. Yet a world without taxes would be demonstrably worse.

With tens of millions of baby boomers slated to enter retirement during the coming years, fiscal experts warn that we will not be able to balance our budgets and make essential investments going forward without substantial new revenue. And since most of the income gains during the past four decades have accrued to those atop the earnings ladder, most of that revenue would have to come from the wealthy. As Willie Sutton was said to have responded when asked why he robbed banks, "That's where the money is."

The wealthy are poised to resist. Schwarzman and others have been channeling vast sums to political action committees that lobby for still lower top tax rates and even less strict business regulation. And their political power to achieve these aims has increased significantly in the wake of recent campaign finance rulings by the Supreme Court.

The result has been a systemic positive feedback loop of the sort that explains many instances of market success at the individual level. People succeed on a spectacular scale, then use some of their gains to win more favorable tax and regulatory treatment, which increases their wealth still further, enabling them to buy even more favorable treatment, and so on.

One solution: a clearer understanding of how little higher taxes would harm the wealthy

Because positive feedback processes gather steam over time, it's easy for those who favor change to lose hope. But just as hopelessness makes it more difficult to surmount obstacles along individual paths to success, it also inhibits social change. So it's important for advocates of change not to lose hope, provided any reasonable grounds for hope remain.

As President Richard Nixon's chief economist Herb Stein once famously remarked, "If something cannot go on forever, it will stop." But what, exactly, could stop a process that grows steadily more powerful over time? The answer is an opposing process that also grows steadily more powerful over time.

Those lobbying for lower taxes and less stringent regulation are unlikely to change their behavior in response to appeals on behalf of society as a whole. Most of them no doubt sincerely believe that their own interests coincide with society's. Yet compelling evidence suggests that our current patterns of private and public spending have been deeply counterproductive, not just for poor and middle-income families but also for the wealthy themselves.

If the wealthy were exposed to this evidence, many would find it convincing. Fundamental policy change would surely become a much easier sell if more wealthy people realized how poorly current arrangements serve their interests.

An experience some years ago persuaded me that even small shifts in cognitive framing can dramatically transform how people think about such things. During a sabbatical year my family and I spent in Paris, our youngest son, Hayden, came home from school one afternoon in a state of high agitation. He'd been given an avertissement,or disciplinary notice, for something he hadn't done. A playground supervisor had complained that a student had shouted an obscenity at him, but since the supervisor couldn't identify the specific offender, he'd simply filed charges against every student playing nearby, a group that included Hayden.

I've seen even brief discussions of the link between success and luck temper the outrage many wealthy people feel about taxes

Insisting that he'd done nothing wrong, Hayden thought we should demand a hearing. But when I made a few inquiries, I learned that receiving a single avertissement from the school had absolutely no consequences. A notice mattered only for students who had already received three previous ones during the same school year.

I then told Hayden that the French system simply handled things differently than what we were used to at home. I reminded him that even a detailed investigation of the episode wouldn't guarantee that the authorities would get all the facts right.

He seemed to accept that the French system would settle things justly most of the time, since students who got four disciplinary notices in a single year had probably done something wrong. Applying that new cognitive frame to the problem completely defused his moral outrage.

In similar fashion, I've seen even brief discussions of the link between success and luck temper the outrage many wealthy people feel about taxes. At an intuitive level, it's not puzzling that successful citizens like Schwarzman might view mandatory taxation as unjustified confiscation of what's rightfully theirs. But extensive public investment was an essential precondition for the economic prosperity of those very same tax protesters, and we can't have public investment without taxes.

Sensible views about taxes or any other subject do not reliably triumph over less sensible ones in the short run. But we should all take comfort in the fact that the long-run historical narrative bends toward truth. One reason is that when evidence for a particular view becomes compelling, the number of people who embrace it tends to snowball. Beliefs are contagious.

Public opinion shifts one conversation at a time. In my own recent conversations with highly successful people, I've seen opinions change on the spot. Many who seem never to have considered the possibility that their success stemmed from factors other than their own talent and effort are often surprisingly willing to rethink. In many instances, even brief reflection stimulates them to recall specific examples of good breaks they've enjoyed along the way.

So I hope you'll talk with your friends about their experiences with luck. In the process, you may persuade them to support a more ambitious program of public investment. But even if not, you'll almost surely hear some interesting stories.

For example, a college classmate with whom I recently shared a draft copy of Success and Luck sent me this:

You may not know that I was struck by lightning back in '85 and was really dead. (It fades to black, with no lights, music, or angels.) If there hadn't been a man there with CPR and leadership skills, I wouldn't be here. Also, as a small child I ran in front of a 1940 car on main street in Jemison, Alabama. The driver never did see me, so I was hit right in the chest by the bumper. Fortunately, the blow caused my arms to reflexively wrap around the upright member that cars of that era always had. That allowed me to be dragged along without being thrown under the wheels. People on the street saw what happened and chased the driver to get him stopped.

This friend is a highly successful entrepreneur who has always been deeply skeptical about government. Lately, however, he has become refreshingly more willing to talk about specific public investments that he might be able to support.

Robert H. Frank is the Henrietta Johnson Louis professor of management and professor of Economics at Cornell's Johnson Graduate School of Management and the co-director of the Paduano Seminar in business ethics at NYU's Stern School of Business. His latest book is Success and Luck: Good Fortune and the Myth of the Meritocracy. Follow him on Twitter @econnaturalist.
Excerpted from Success and Luck: Good Fortune and the Myth of Meritocracy by Robert H. Frank. © 2016 Robert H. Frank. Published by Princeton University Press. Reprinted by permission.

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How to persuade rich people to pay more in taxes: remind them how lucky they are

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Stephen Schwarzman - CEO of Blackstone, the fabled private equity firm - lives well. He made the news in 2007 when he staged a $3 million 60th birthday party for himself and several hundred of his closest friends at the Armory on Park Avenue.

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Secularism is about more than keeping religious mottoes off our coins or crèches off the courthouse steps. Secularism insists that our public polices be based on reason and evidence, not religious dogma.

The Center for Inquiry and its affiliates, of course, firmly believe in the separation of church and state, and object to any government endorsement of religion by way of religious symbols on public property or otherwise. But at least equally important is the removal of religious influence from our laws and regulations.

This is one reason CFI has launched its campaign to Keep Health Care Safe and Secular. As our campaign website states, "Health care is critical for leading a productive, fulfilling life." Religious interference with the delivery of health care services is a serious matter-in some cases, a deadly serious matter. By all means, getting God off our currency would be a good thing, but frankly, it's more of a priority to get God out of our physicians' offices and our hospitals.

Being secular implies a commitment to using science, not supernatural revelation, as a means of determining the most effective therapies. In the context of health care, sound science implies evidence-based medicine. Sadly, despite the tremendous success of evidence-based medicine, too many individuals rely on pseudoscientific remedies. Here we see another threat to health care, one not derived expressly from religion, but one traceable to a similarly dogmatic mindset. Pseudoscientific remedies have flooded the health care system, whether it's Reiki, homeopathic drugs, naturopathy, or any other sham therapy pulled from medicine's back room of mysticism and magic. It's scandalous that these quack therapies can be peddled with impunity. The Food and Drug Administration largely takes a hands-off approach, declining to test homeopathic drugs for efficacy, and major universities and medical centers push "complementary and alternative medicine" on patients at their clinics. It's a lot easier to make a profit from "alternative medicine" than real medicine.

We need take control of our health care. No church, no religious doctrine should be allowed to interfere with our heath care choices. Likewise, we need to insist that all therapies offered to the public be rigorously tested for safety and efficacy. We need to keep health care both safe and secular.

Ronald A. Lindsay

Ron Lindsay is senior research fellow at the Center for Inquiry, having previously served as president and CEO from 2008 to 2016. Prior to joining CFI, he was in private legal practice in Washington, D.C. for twenty-six years. He received his Ph.D. in philosophy from Georgetown University and his J.D. from the University of Virginia School of Law. Among other works, he is the author of Future Bioethics: Overcoming Taboos, Myths, and Dogmas (Prometheus 2008), the entry on "Euthanasia" for the International Encyclopedia of Ethics (Wiley Blackwell 2013), and The Necessity of Secularism: Why God Can't Tell Us What To Do (Pitchstone Publishing 2014).

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Secularism and Health Care | Center for Inquiry

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Secularism is about more than keeping religious mottoes off our coins or crèches off the courthouse steps. Secularism insists that our public polices be based on reason and evidence, not religious dogma. The Center for Inquiry and its affiliates, of course, firmly believe in the separation of church and state, and object to any government endorsement of religion by way of religious symbols on public property or otherwise.

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Abstract

The new agenda for Public Health in India includes the epidemiological transition, demographical transition, environmental changes and social determinants of health. Based on the principles outlined at Alma-Ata in 1978, there is an urgent call for revitalizing primary health care in order to meet these challenges. The role of the government in influencing population health is not limited within the health sector but also by various sectors outside the health systems. This article is a literature review of the existing government machinery for public health needs in India, its success, limitations and future scope. Health system strengthening, human resource development and capacity building and regulation in public health are important areas within the health sector. Contribution to health of a population also derives from social determinants of health like living conditions, nutrition, safe drinking water, sanitation, education, early child development and social security measures. Population stabilization, gender mainstreaming and empowerment, reducing the impact of climate change and disasters on health, improving community participation and governance issues are other important areas for action. Making public health a shared value across the various sectors is a politically challenging strategy, but such collective action is crucial.

Keywords: Health sector, intersectoral issues, public health, role of government

INTRODUCTION

The practice of public health has been dynamic in India, and has witnessed many hurdles in its attempt to affect the lives of the people of this country. Since independence, major public health problems like malaria, tuberculosis, leprosy, high maternal and child mortality and lately, human immunodeficiency virus (HIV) have been addressed through a concerted action of the government. Social development coupled with scientific advances and health care has led to a decrease in the mortality rates and birth rates.[ 1]

This article is a literature review of the existing government machinery for public health needs in India, its success, limitations and future scope.

CHALLENGES CONFRONTING PUBLIC HEALTH

The new agenda for Public Health in India includes the epidemiological transition (rising burden of chronic non-communicable diseases), demographic transition (increasing elderly population) and environmental changes. The unfinished agenda of maternal and child mortality, HIV/AIDS pandemic and other communicable diseases still exerts immense strain on the overstretched health systems.

Silent epidemics: In India, the tobacco-attributable deaths range from 800,000 to 900,000/year, leading to huge social and economic losses. Mental, neurological and substance use disorders also cause a large burden of disease and disability. The rising toll of road deaths and injuries (2-5 million hospitalizations, over 100,000 deaths in 2005) makes it next in the list of silent epidemics. Behind these stark figures lies human suffering.[ 2]

Health systems are grappling with the effects of existing communicable and non-communicable diseases and also with the increasing burden of emerging and re-emerging diseases (drug-resistant TB, malaria, SARS, avian flu and the current H1N1 pandemic). Inadequate financial resources for the health sector and inefficient utilization result in inequalities in health. As issues such as Trade-Related aspects of Intellectual Property Rights continue to be debated in international forums, the health systems will face new pressures.

The causes of health inequalities lie in the social, economic and political mechanisms that lead to social stratification according to income, education, occupation, gender and race or ethnicity.[ 3] Lack of adequate progress on these underlying social determinants of health has been acknowledged as a glaring failure of public health.

In the era of globalization, numerous political, economic and social events worldwide influence the food and fuel prices of all countries; we are yet to recover from the far-reaching consequences of the global recession of 2008.

ADDRESSING PUBLIC HEALTH ISSUES - THE STRATEGY AND STAKEHOLDERS

To meet the formidable challenges described earlier, there is an urgent call for revitalizing primary health care based on the principles outlined at Alma-Ata in 1978: Universal access and coverage, equity, community participation in defining and implementing health agendas and intersectoral approaches to health. These principles remain valid, but must be reinterpreted in light of the dramatic changes in the health field during the past 30 years. Attempts to achieve "Health For All" have been carried forward in the form of "Millenium Development Goals."[ 4]

Public health is concerned with disease prevention and control at the population level, through organized efforts and informed choices of society, organizations, public and private communities and individuals. However, the role of government is crucial for addressing these challenges and achieving health equity. The Ministry of Health and Family Welfare (MOHFW) plays a key role in guiding India's public health system.

Contribution to health of a population derives from systems outside the formal health care system, and this potential of intersectoral contributions to the health of communities is increasingly recognized worldwide. Thus, the role of government in influencing population health is not limited within the health sector but also by various sectors outside the health systems.[ 5]

ROLE OF GOVERNMENT WITHIN THE HEALTH SECTOR

Health system

Regulation and enforcement in public health

A good system of regulation is fundamental to successful public health outcomes. It reduces exposure to disease through enforcement of sanitary codes, e.g., water quality monitoring, slaughterhouse hygiene and food safety. Wide gaps exist in the enforcement, monitoring and evaluation, resulting in a weak public health system. This is partly due to poor financing for public health, lack of leadership and commitment of public health functionaries and lack of community involvement. Revival of public health regulation through concerted efforts by the government is possible through updation and implementation of public health laws, consulting stakeholders and increasing public awareness of existing laws and their enforcement procedures.

Health promotion

Stopping the spread of STDs and HIV/AIDS, helping youth recognize the dangers of tobacco smoking and promoting physical activity. These are a few examples of behavior change communication that focus on ways that encourage people to make healthy choices. Development of community-wide education programs and other health promotion activities need to be strengthened. Much can be done to improve the effectiveness of health promotion by extending it to rural areas as well; observing days like "Diabetes day" and "Heart day" even in villages will help create awareness at the grassroot level.

Human resource development and capacity building

There are several shortfalls that need to be addressed in the development of human resources for public health services. There is a dire need to establish training facilities for public health specialists along with identifying the scope for their contribution in the field. The Public Health Foundation of India is a positive step to redress the limited institutional capacity in India by strengthening training, research and policy development in public health. Preservice training is essential to train the medical workforce in public health leadership and to impart skills required for the practice of public health. Changes in the undergraduate curriculum are vital for capacity building in emerging issues like geriatric care, adolescent health and mental health. Inservice training for medical officers is essential for imparting management skills and leadership qualities. Equally important is the need to increase the number of paramedical workers and training institutes in India.

Public health policy

Identification of health objectives and targets is one of the more visible strategies to direct the activities of the health sector, e.g. in the United States, the "Healthy People 2010" offers a simple but powerful idea by providing health objectives in a format that enables diverse groups to combine their efforts and work as a team. Similarly, in India, we need a road map to "better health for all" that can be used by states, communities, professional organizations and all sectors. It will also facilitate changes in resource allocation for public health interventions and a platform for concerted intersectoral action, thereby enabling policy coherence.

Scope for further action in the health sector

School health, mental health, referral system and urban health remain as weak links in India's health system, despite featuring in the national health policy. School health programs have become almost defunct because of administrative, managerial and logistic problems. Mental health has remained elusive even after implementing the National Mental Health Program.

On a positive note, innovative schemes through public-private partnerships are being tried in various parts of the country in promoting referrals. Similarly, the much awaited National Urban Health Mission might offer solutions with regards to urban health.

ROLE OF GOVERNMENT IN ENABLING INTERSECTORAL COORDINATION TOWARD PUBLIC HEALTH ISSUES

The Ministry of Health needs to form stronger partnerships with other agents involved in public health, because many factors influencing the health outcomes are outside their direct jurisdiction. Making public health a shared value across the various sectors is a politically challenging strategy, but such collective action is crucial.

Social determinants of health

Kerala is often quoted as an example in international forums for achieving a good status of public health by addressing the fundamental determinants of health: Investments in basic education, public health and primary care.

Population stabilization

There is all round realization that population stabilization is a must for ensuring quality of life for all citizens. Formulation of a National Policy and setting up of a National Commission on Population and Janasankhya Sthiratha Kosh reflect the deep commitment of the government. However, parallel developments in women empowerment, increasing institutional deliveries and strengthening health services and infrastructure hold the key to population control in the future.[ 10]

Gender mainstreaming and empowerment

Women-specific interventions in all policies, programs and systems need to be launched. The government should take steps to sensitize service providers in various departments to issues of women. The Department of Women and Child Development must take necessary steps to implement the provisions of "Protection of Women from Domestic Violence Act, 2005." Training for protection officers, establishment of counseling centers for women affected by violence and creating awareness in the community are vital steps. Poverty eradication programs and microcredit schemes need to be strengthened for economic and social empowerment of women.[ 7]

Reducing the impact of climate change and disasters on health

Thermal extremes and weather disasters, spread of vector-borne, food-borne and water-borne infections, food security and malnutrition and air quality with associated human health risks are the public health risks associated with climate change. Depletion of non-renewable sources of energy and water, deterioration of soil and water quality and the potential extinction of innumerable habitats and species are other effects. India's "National Action Plan on Climate Change" identifies eight core "national missions" through various ministries, focused on understanding climate change, energy efficiency, renewable energy and natural resource conservation.[ 11] Although there are several issues concerning India's position under UNFCCC, it has agreed not to allow its per capita Greenhouse gas emissions to exceed the average per capita emissions of the developed countries, even as it pursues its social and economic development objectives.

The Ministry of Health, in coordination with other ministries, provides technical assistance in implementing disaster management and emergency preparedness measures. Deficient areas include carrying out rapid needs assessment, disseminating health information, food safety and environmental health after disasters and ensuring transparency and efficiency in the administration of aid after disasters. Implementation of Disaster Management Act, 2005 is essential for establishing institutional mechanisms for disaster management, ensuring an intersectoral approach to mitigation and undertaking holistic, coordinated and prompt response to disaster situations.[ 7]

Community participation

Community participation builds public support for policies and programs, generates compliance with regulations and helps alter personal health behaviors. One of the major strategic interventions under NRHM is the system of ensuring accountability and transparency through people's participation - the Rogi Kalyan Samitis. The Ministry of Health needs to define a clear policy on social participation and operational methods in facilitating community health projects. Potential areas of community participation could be in lifestyle modification in chronic diseases through physical activity and diet modification, and primary prevention of alcohol dependence through active community-based methods like awareness creation and behavioral interventions.

Private sectors, civil societies and global partnerships

Effective addressing of public health challenges necessitates new forms of cooperation with private sectors (public-private partnership), civil societies, national health leaders, health workers, communities, other relevant sectors and international health agencies (WHO, UNICEF, Bill and Melinda Gates foundation, World Bank).

Governance issues

In order to ensure that the benefits of social security measures reach the intended sections of society, enumeration of Below Poverty Line families and other eligible sections is vital.[ 7] Check mechanisms to stop pilferage of government funds and vigilance measures to stop corruption are governance issues that need to be attended. The government should take strict action in cases of diversion of funds and goods from social security schemes through law enforcement, community awareness and speedy redressal mechanisms. Social audits in MREGS through the Directorate of Social Audit in Andhra Pradesh and Rajasthan are early steps in bringing governance issues to the fore. This process needs strengthening through separate budgets, provisions for hosting audit results and powers for taking corrective action. Similar social auditing schemes can be emulated in other states and government programs like ICDS, which will improve accountability and community participation, leading to effective service delivery.

CONCLUSIONS

"The health of people is the foundation upon which all their happiness and all their powers as a state depend"

- Benjamin Disraeli, British Prime Minister.

In this changing world, with unique challenges that threaten the health and well-being of the population, it is imperative that the government and community collectively rise to the occasion and face these challenges simultaneously, inclusively and sustainably. Social determinants of health and economic issues must be dealt with a consensus on ethical principles - universalism, justice, dignity, security and human rights. This approach will be of valuable service to humanity in realizing the dream of Right to Health. The ultimate yardstick for success would be if every Indian, from a remote hamlet in Bihar to the city of Mumbai, experiences the change.

It is true that a lot has been achieved in the past: The milestones in the history of public health that have had a telling effect on millions of lives - launch of Expanded Program of Immunisation in 1974, Primary Health Care enunciated at Alma Ata in 1978, eradication of Smallpox in 1979, launch of polio eradication in 1988, FCTC ratification in 2004 and COTPA Act of 2005, to name a few. It was a glorious past, but the future of a healthy India lies in mainstreaming the public health agenda in the framework of sustainable development. The ultimate goal of great nation would be one where the rural and urban divide has reduced to a thin line, with adequate access to clean energy and safe water, where the best of health care is available to all, where the governance is responsive, transparent and corruption free, where poverty and illiteracy have been eradicated and crimes against women and children are removed - a healthy nation that is one of the best places to live in.

Footnotes

Source of Support: Nil

Conflict of Interest: Nil

REFERENCES

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Role of government in public health: Current scenario in India and future scope

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The new agenda for Public Health in India includes the epidemiological transition, demographical transition, environmental changes and social determinants of health. Based on the principles outlined at Alma-Ata in 1978, there is an urgent call for revitalizing primary health care in order to meet these challenges.

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A prominent conservative leader in Afghanistan's government threatened a female journalist when she questioned him about opposition to legislation that will protect Afghan women from violence. His reaction shows what a real "war on women" looks like.

Nazir Ahmad Hanafi, a member of parliament who is committed to a strict interpretation of the Quran, has opposed the Elimination of Violence Against Women Act, which would protect Afghan women against rape, not only from strangers but also from their husbands-something Islam allows, according to fundamental interpretations.

VICE correspondent Isobel Yeung interviewed Hanafi as part of an HBO documentary investigating the rights of women in Afghanistan and the increasing threats they face.

"What if a husband rapes his wife, is that domestic abuse?" Yeung asks Hanafi. "Should the man be punished or should the woman be punished for that, in your opinion?"

Speaking through an interpreter, Hanafi replied, "There is a kind of rape you have and another we have in Islam." When Yeung begins to ask a follow-up question, she's cut off by Hanafi, who tells someone off-camera they should stop the interview. Hanafi then says, "Maybe I should give you to an Afghan man to take your nose off." Others who have heard the clip say the actual translation is "Hand her over to an Afghan man so he can give it to so hard it'll come out her nose."

Others who have heard the clip say the actual translation is 'Hand her over to an Afghan man so he can give it to so hard it'll come out her nose.'

Radio Free Europe/Radio Liberty later confronted Hanafi about the comments, asking whether he was going to apologize to the journalist. Hanafi at first denied even talking to Yeung: "I haven't met such a person, I have no idea about this, and have not said anything," he said. "No one has spoken with me."

When pressed, he continued to deny having done the interview and accused the filmmakers of creating a fake video. "It's very simple to make a video," he said. "There are people who put together a head, a beard, and a body in a video that would look more authentic than the real person."

After further questioning, Hanafi finally admitted to doing the interview but said he never threatened her. "When we were talking about marriage issues, I told her, 'If you want to know about it, you can marry an Afghan man.'" When asked if he would apologize, Hanafi became defiant and demanded an apology from the filmmakers. "Who should apologize? Me or those who distributed [videos] against me? They are plotting against a person who is minding his own business."

'Things Are Very Gloomy for Women'

The producers of the HBO documentary set out to show how women are still denied basic rights in Afghanistan, despite hopeful signs that things had been changing for the better. In 2001, first lady Laura Bush highlighted the struggle for women's rights when she said in a national radio address, "Muslims around the world have condemned the brutal degradation of women and children by the Taliban regime. The fight against terrorism is also a fight for the rights and dignity of women."

'Women are being killed, raped and harassed on a daily basis much more than before - and overtly.'

Since that time, there have been improvements, as millions of Afghan girls are now attending school. Women have served in government, business, and even the military. But despite these advances, Afghanistan remains one of the most dangerous places in the world for women.

"Things are very gloomy for women, and it's getting worse," Wazhma Frogh, the head of Afghanistan's Women Peace and Security Research Institute, told NBC News. "There is much less space for women [in public life]."

"Women are being killed, raped and harassed on a daily basis much more than before - and overtly," she said. She blamed much of this on generalized lawlessness exacerbated by the dramatic drawdown in foreign troops, which leaves women and girls vulnerable to attack and abuse. In fact, the United Nations calls the rates of violence against women in Afghanistan "exceptionally high," with up to 87.2 percent of women having experienced some form of violence.

According to activists, the situation is getting worse, with a 31 percent rise in the cases of violence against women in 2015 compared to the year before. "This is a worrisome development that should be addressed - all the gains women made could be lost," said Soraya Sobhrang, deputy chair of Afghanistan's Independent Human Rights Commission.

Execute the Infidels

Despite lawmakers trying to pass the Elimination of Violence Against Women Act, it has been blocked in parliament by conservative Islamists who believe it violates the teaching of the Quran. Hanafi is one of the dominant voices opposing the act, which creates women's shelters for victims of domestic violence. According to Hanafi, who is from the western Herat province, these shelters are actually "brothels" where revolution can ferment and spread, "killing millions."

If they step outside their homes without a burqa, they become victims of abuse or violence.

Women who are daring to speak out for their rights are being threatened. If they step outside their homes without a burqa, they become victims of abuse or violence. All the women interviewed by NBC, whether they were politicians, teachers, or activists, said they believed their lives were in danger.

Women are not the only ones threatened. Christians are in danger as well. According to Mohabat News, an independent Iranian Christian news agency, Hanafi has stated that converts from Islam to Christianity should be killed according to sharia law.

"Afghani citizens continue to convert to Christianity in India. Numerous Afghanis have become Christians in India," Hanafi said. "This is an offense to Islamic laws and according to the Qur'an they need to be executed."

Hanafi heads the parliament's Legislative Commission and received the highest number of votes in the 2010 parliamentary election. Whether it has to do with women or Christians, the lawmaker has outspokenly defended Islamic law and has pushed back against Western-influenced efforts to "secularize" it in any way.

Islamism's Public Opinion Problem

While secular and "liberal" Muslims have made strides throughout the world to elevate the status of women, the issue of women's rights remains a problem in the Muslim culture, as various regions and sects interpret the Quran in different ways. Central to the conflict regarding the rights of women are passages that clearly say women are not equal to men:

In the United States, 51 percent of Muslims say 'Muslims in America should have the choice of being governed according to shariah.'

"Men have authority over women because God has made the one superior to the other, and because men spend their wealth to maintain them. Good women are obedient. They guard their unseen parts because God has guarded them. As for those among you who fear disobedience, admonish them and send them to beds apart and beat them." Sura 4:34

"...Women shall with justice have rights similar to those exercised against them, although men have a status above women. God is mighty and wise." Sura 2:228

Liberal Muslims do not interpret these in a literal way and believe in separation of mosque and state. They don't want Islamic law to be integrated into state law, and they uphold the rights of women. However, a majority of Muslims do not hold to this position, not only in Afghanistan but in other countries as well. A Pew survey found that "Muslims who want sharia to be the law of the land in their country often, though not uniformly, are less likely to support equal rights for women and more likely to favor traditional gender roles."

Nearly all Muslims in Afghanistan (99 percent) and most in Iraq (91 percent) and Pakistan (84 percent) support sharia law as official law. However, in other countries, especially in Eastern Europe and Central Asia - including Turkey (12 percent), Kazakhstan (10 percent) and Azerbaijan (8 percent ) - relatively few favor implementing sharia law.

In the United States, where Muslims are more secularized, 51 percent of Muslims still say "Muslims in America should have the choice of being governed according to shariah." Also troubling is nearly a quarter of the Muslims polled said, "It is legitimate to use violence to punish those who give offense to Islam by, for example, portraying the prophet Mohammed."

What Sharia Often Means for Women

While Muslim feminists argue that interpretations of sharia that oppress women have no basis in Islam and are merely misinterpretations by men who want to hold onto power, this is not everyone's opinion. As outlined by the Clarion Project, while there are various views regarding the rights of women and marriage laws, there are some constants among those committed to sharia. These include:

A man is entitled to up to four wives, but a woman may only have one husband. In Western societies, a man typically only takes one wife.

The husband (or his family) pays a 'bride price' or 'dower' (mahr, which is money or property paid to the bride) which she is entitled to keep. This "mahr" is in exchange for sexual submission (tamkin). Sexual submission is traditionally regarded as unconditional consent for the remainder of the marriage.

According to conservative interpretations of sharia, a man can divorce his wife by making a declaration in front of an Islamic judge irrespective of the woman's consent. She isn't even required to be there. But for a woman to divorce a man, his consent is required.

The husband is also completely responsible for the financial upkeep of the home, and "temporary marriage" (even for less than a half an hour) is allowed. The arrangement is basically legalized prostitution. A report by the Gatestone Institute charts its development in Britain. Wife-beating is also permitted, according to some scholars. In addition, there is no joint property-the man owns all property (except for what the woman owned before the marriage).

Particularly troubling: there's no specific minimum age for marriage, even though most agree a woman must have reached puberty before she can be wed. Marriage as young as 12 or 13 is not uncommon in Muslim-majority countries. In Yemen in 2013, there was a highly publicized case of an eight-year-old girl who died of internal injuries suffered on her wedding night. According to Al Jazeera, "Nearly 14 percent of Yemeni girls [are] married before the age of 15 and 52 percent before the age of 18." The case prompted calls for Yemen to pass a law setting a minimum age for marriage, although it has not yet done so.

Also, according to Clarion, "Even in the West, where Muslim women have the same legal rights as men, they have been prevented from exercising those rights by their male relatives." Regarding modesty laws, many Muslim women respect the requirement to dress modestly and "freely choose" to conform. But in many Muslim-majority countries, women do not have the choice. If they don't comply, they can be beaten by the police.

One of These Situations Is Not Like the Other

Violations of modesty laws frequently meet with violence in Muslim countries. Western women visiting Muslim-majority countries - for example, Saudi Arabia - are advised to dress modestly and not to travel unaccompanied by a man. Dubai has notoriously strict public indecency laws. Many Western tourists have fallen foul of them in the past.

Additionally, male guardianship applies to all women under strict interpretations of sharia: "A woman becomes subservient to her husband and needs his permission to: 'leave the house, take up employment, or to engage in fasting or forms of worship other than what is obligatory.' An unmarried woman is under the guardianship of her nearest male relative." Human Rights Watch has issued a 50-page report condemning the situation of women in Saudi Arabia alone.

Women are also at risk of genital mutilation. As I wrote in 2014, this is what the real war on women looks like-and it's not just in the Middle East:

Estimates from the Centers for Disease Control and Prevention indicate that at least 150,000 to 200,000 girls in the United States are at risk of being forced to undergo FGM. According to census data from 2000, the number of girls and women in the United States at risk increased by 35 percent from 1990 to 2000. Activists say those numbers continue to rise, and more current statistics need to be gathered. There is no 2010 data. In 2000, states with the highest number of affected girls included California, New York, New Jersey, Virginia, Maryland, Minnesota, Texas, Georgia, Washington, and Pennsylvania.

In light of such horrors, the "war on women" we hear about today in America pales in comparison. Equal pay for unequal work, free birth control, free healthcare, and name-calling in the midst of political debates can hardly be classified as a squabble much less an outright war when compared to what's happening to Muslim women.

American women are living in the lap of luxury and whining about their "rights" while their sisters in Muslim countries-where the Quran is literally interpreted and applied in the political sphere-live in fear of oppression, violence, and death. Many have stopped going to school because they're afraid of being attacked on the streets.

The Dangerous Unity of Mosque and State

One of the fundamental problems with Islam in relation to a free society is the belief that there is no separation between mosque and state. The kingdom of God is one kingdom, and it is the duty of "good Muslims" to establish God's will and his law (sharia) here on Earth. Secularized Muslims reject this interpretation of Islam and believe religion should be separate from the political sphere. However, this is not the case for most Muslims throughout the world.

This point is often ignored by Western feminists who don't want to appear politically incorrect by challenging abusive teachings regarding women. Whether the subjugation of women is the "correct" interpretation of the Quran or not is irrelevant. Who's to decide which is right-the secularists and liberals or the fundamentalists? In the end, it doesn't really matter.

The disturbing reality is many Muslims believe in a conservative application of sharia to one degree or another, and they see it as having a place in political realm. Whether it's a man being able to rape his wife, not letting women have inheritance or custody rights, or simply keeping her covered, the fact remains that this mindset stands in opposition to the principles of liberty and equality that we hold in the United States.

Sharia is incompatible with the U.S. Constitution. Just read this comparison by the Center for Security Policy and you'll see why. Here's one example:

Constitution: Fourteenth Amendment: 'No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.
Shariah: Under dhimmi laws enforced in modern Shariah states, Jews, Christians and other non-Muslims are not equal to Muslims before the law. Under Shariah law, women, girls, apostates, homosexuals and 'blasphemers' are all denied equality under the law.

It is the duty and responsibility of American women to make a stand and push back against any violation of our rights. This threat to women across the globe can't be ignored because we're concerned about offending a religious sect or appearing to be politically incorrect. Lives are in danger. Women and girls (and Christians and homosexuals) are suffering, and it is only getting worse, not only in places like Afghanistan, but in Europe as well.

We would all do well to heed the warning of ex-Muslim Sabatina James, author of " Only the Truth Sets Us Free ": "Sharia is now finally with us. And the victims are primarily women. . . . The religion that causes the most bloodshed is being protected the most. I find that totally paradoxical. And sometimes by those who carry the banner of gender equality, multiculturalism and the right to sexual self-determination. But if Islamists set the tone, freedom of expression, homosexuality and women's rights will soon be finished."

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A prominent conservative leader in Afghanistan's government threatened a female journalist when she questioned him about opposition to legislation that will protect Afghan women from violence. His reaction shows what a real "war on women" looks like.

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"I am an atheist. So does that mean that I lose my right to depose in courts?" asks Thane resident Sunil Bhalerao, an assistant commissioner with the Bhiwandi Nizampura Municipal Corporation.

A Pune couple have filed a public interest litigation in the Bombay High Court seeking adequate directives to swear on Statute while deposing in lower courts. Sunil Mane and his wife Laxmikanta sought directives from the court to allow atheists to take oath under the Constitution.

Currently, as per the Oaths Act 1969, a witness or any person who deposes in the court, can swear in the name of God or by placing hands on a religious book. In a first in the country, Bhalerao, a resident of Kalyan East, was denied to depose before Bhiwandi court by judge DP Kale. The court case dates back to 2014, when during election duty, he found Rs6 lakh in the car after the code of conduct came into effect. He was asked to be present as the prime witness in the court.

"I stood in the witness box and the judge asked me to swear on Bhagwad Gita. I was quick to respond that I am an atheist and I cannot swear on any holy book, but on the Constitution of India. However, the judge did not allow me to do so. I approached the high court and pleaded to conduct enquiry," says the 52-year-old, who lives with his two daughters, wife and father.

"The judge was given a clean chit, so I filed a writ petition in the high court seeking justice and adequate directives to the lower courts," adds Bhalerao.

Bhalerao, who has completed his Master of Laws and holds other degrees, fumes over the judicial system being rigged with religion. "I don't understand whether the Constitution is more important or religion. The courts can ask witnesses to take oath on the holy books, but atheists can't do so under the constitution."

'Oath system for democracy'

The PIL filed by the couple states that the Oaths Act, 1969, needs to be declared as violative of Articles 14, 19 and 21 of the Constitution. "I feel that the oath system should be appropriate as per the spirit of the democracy and it will also not give a communal touch to the proceedings and will solve the problems for atheists while deposing in front of the courts," said Bhalerao.

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Why can't atheists take oath under Constitution?

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"I am an atheist. So does that mean that I lose my right to depose in courts?" asks Thane resident Sunil Bhalerao, an assistant commissioner with the Bhiwandi Nizampura Municipal Corporation. A Pune couple have filed a public interest litigation in the Bombay High Court seeking adequate directives to swear on Statute while deposing in lower courts.