Exposing India’s Inequities
Social Injustice in Pandemic Times
Proximity to metropolitan hubs, the political capital, and major cities is always found to be a better guarantor of social justice to the disenfranchised and marginalised than the interiors, especially in India. The pandemic proved this as never before.
By Dr Rina Mukherji
Proximity and distance can be observed in multiple spheres of life - relationships, but also closeness or distance to infrastructural facilities or power centres. For populations in the developing world, proximity to a power centre, such as a metropolitan city or a district headquarter, can equate to better facilities, especially when it comes to basic needs like healthcare, education, and sanitation. This is often aspirational for those dwelling in smaller cities and towns. Wealth and means can override the disadvantages of small towns, but is not the case for the poor, illiterate or dispossessed.
This is because of the blatant inequality prevalent in India, as reflected in the World Inequality Report 2022. The report, prepared by the world’s top economists, pronounces India to be a poor and unequal country, with an affluent elite. The poor own absolutely nothing, while the middle classes are also quite poor.
Another report, the Oxfam's India Inequality Report 2021, extends these findings further, while emphasising how COVID-19 only exacerbated these inequalities. India’s unequal healthcare system shows that states with higher allocations on healthcare had higher recovery rates. Investing public funds for secondary and tertiary care, which means requiring a higher level of specialty care, without providing primary healthcare has only widened inequalities, with private healthcare providers burgeoning everywhere, according to the report. A survey among those who had or were recovering from COVID-19 revealed how discrimination works in insidious ways. For instance, the percentage of respondents who had to arrange for their transport to hospitals during lockdowns (in the absence of public transport) among higher-income groups was half of those from low-income groups.
The Oxfam study Securing Rights of Patients in India found that the inefficiency in the healthcare system prevented around 43 per cent of the marginalised poor not getting vaccinated at government healthcare facilities due to a lack of free vaccines. With government hospitals often running short of the free vaccine, many remained unvaccinated. On the other hand, the rich and upper classes could afford to get vaccinated at private hospitals, which generally reported adequate supplies.
The plight of the migrant workersMigrant workers form the backbone of the economy, with their skills forming an indispensable part of the construction, textile and hospitality industries. Yet, most are employed in the unorganised and informal sector. The plight of India’s migrant labour came into focus with the pandemic-enforced nationwide lockdown, when, perhaps for the first time, the huge numbers of people employed in this unorganised sector got civil society and the government to take note. When the lockdown was declared in 2020, many establishments downed shutters without paying the migrant workers their dues, as a study by the NGO Aajeevika found out. This was in spite of a Ministry of Home Affairs (MHA) directive to all employers on 29 March 2020 calling on them to pay wages in full during the lockdown, and not to terminate any work contracts - casual or otherwise. Unable to make ends meet, with no means of transport available, and forced into starvation, many migrant workers chose to walk home. According to government estimates, 6.7 million workers returned home following the declaration of a nationwide lockdown. However, realising that there was hardly any work or money in their villages, many returned back to the cities, although 82 per cent of the workers received no food rations, and 70 per cent remained deprived of cooked meals.
Inequalities in healthcareThe inherent inequalities in the Indian health sector were also highlighted during the pandemic. The state of Bihar with limited testing facilities for the COVID-19-infected, high illiteracy and a lack of healthcare facilities saw people resist vaccination and visit quacks for treatment. People in districts of Eastern Uttar Pradesh and in Bihar, bordering Nepal, were reported to take unprescribed drugs as a preventive against COVID-19 every night, since there were no doctors or healthcare facilities for miles around. In the state of Uttar Pradesh, even as many villagers died of breathlessness, fever and cough, there was no confirmation that they had been infected by the coronavirus, due to a lack of testing facilities and doctors. The situation was not too different in any other state of the Hindi belt in northern and central India, because of the lack of adequate sanitation and healthcare facilities.
Effective healthcare is dependent on reliable data, and testing. Thus, the state of Kerala came out on top in handling the pandemic through extensive vaccination coverage, owing to superior healthcare facilities, while the states of Bihar and Uttar Pradesh struggled to cope with the deluge of infected patients.
Most significantly, the pandemic presented inequalities in treatment of the dead. Even as the rich and upper classes managed to give their dead a dignified farewell, the poor were unable to cremate or decently bury their dead. Instead, they took recourse to dumping the bodies into flowing rivers, exposing many others to danger.
Strained labour market situationAlthough there has been a slight improvement in the employment scenario over the last months of 2021 due to an easing of the pandemic and the end of lockdowns, the employment situation continues to be gloomy. Employment has steadily been falling in India. In 2018, the employment rate was at 46.80 per cent of the whole population. Once the pandemic effects on the health of the population were on its height, the decision to shut down whole sectors of industry was catastrophic for the job market all over India. The employment data from the Centre for Monitoring Indian Economy (CMIE) shows that the employment rate - which came down to 40.90 per cent in the third quarter of 2020, picked up to 42.40 per cent in the fourth quarter of 2020.
Beside casual and migrant workers the most affected employees were drivers, maids, and domestic workers. With most households being forced to settle for a thirty to fifty per cent cut of salaries, there was suddenly not enough money to employ and pay drivers. Nannies, were also not needed, since families took care of children themselves. With gated communities becoming cagey about allowing outside workers in, plumbers, electricians and carpenters faced tough times too.
The road aheadSo, does this mean that we are all staring into a bleak future? Fortunately, facts prove otherwise. Even as the pandemic exposed the weaknesses in the Indian health system, it has led to a much needed wake-up call for local and national governments, and increased investments in the health sector. The change is most visible in the state of Bihar, where advanced care hospitals are in the process of being set up in cities like Bhagalpur. Furthermore, the state has pledged to build 1,600 new government hospitals by 2022.
Yet, as the proverbs says “When the going gets tough, the tough get going” – the truly resilient got around their difficulties and rebuilt their lives once again. In the city of Khunti, in the state of Jharkhand, one saw for example tribal women turning micro-entrepreneurs. Cristina Herenj, whose small eatery at the market had to shut down during the lockdown, took to selling farm-fresh vegetables from her village door to door on her motorbike.
Of course, distance continues to prevail, and the chasm between the haves and have-nots will take a long time to get bridged. But the gnawing distance is gradually giving way to more proximity between the haves and have-nots, with many determined to seize opportunities that the pandemic presented to them. Increased investment in education and health by the authorities can help result in a healthier and better-skilled population.