The present crisis could not be thwarted because of structural deficiencies in health governance systems and overall public management
The world is now in the grip of the COVID-19 pandemic. The last most dangerous outbreak that occurred was the 1918-1919 influenza pandemic, almost 100 years ago, that reportedly originated in the US and which coincided with World War-I. According to a report prepared by America’s National Academies of Sciences, Engineering, and Medicine, entitled Global Health and the Future Role of the United States, the influenza outbreak took place in three waves. It infected one-third of the global population and claimed 50-70 million lives. The situation at that time was unmanageable partly because of the devastation caused by World War-I. However, this time, the contagion did not precede, coincide with or follow any war. Even so, the world has lost 3,09,047 lives and the numbers are expected to grow in times to come. However, the panic and economic devastation caused by the pandemic are unprecedented and the very legitimacy of the State has been put to test. In one line, the world is forced to face an uncertain future.
What is evident in all of this is that the crisis could not be thwarted due to structural deficiencies in the health governance systems and overall public management. And, as it appears, no serious thought was given by policymakers around the world, including India, to deal with pandemics, even as in the beginning of the 21st century itself, just in the last 20 years, the world has seen the occurrence of many outbreaks, such as SARS, H1N1, Ebola and the Zika virus. They claimed lives at an unprecedented scale and led to enormous economic losses.
Urbanisation, pandemics and risk society: Pandemics or “crowd diseases” are likely to grow in number and impact, with more urbanisation, choked urban slum settlements, narrow streets and roads, loss in biodiversity and heedless exploitation of natural resources, especially water. In his book Guns, Germs and Steel, Jared Diamond argues that a small population size does not help epidemic diseases evolve of their own. He stresses, “In contrast, the crowd diseases…could have arisen only with the build-up of large, dense human populations. That build-up began with the rise of agriculture, starting about 10,000 years ago and then accelerated with the rise of cities starting several thousand years ago.” With the increase in urbanisation and populations, more cities will be added to the existing ones, opening up the possibility of more pandemic outbreaks. The United Nations’ revised World Urbanisation Prospects, 2018 report, projects that by 2050, a whopping 68 per cent of the world’s population would live in urban areas. By 2030 alone, the world is projected to have 43 megacities, most of them in developing regions. These projections show that the urbanisation juggernaut is unstoppable and in turn is likely to act as a catalyst in the spread of pandemics.
With the future prospects of pandemics and health risks being high, we have no option but to reorganise ourselves and learn to deal with the unfolding “risk society”, a natural offshoot of the so-called modernity-propelled development and production processes. The renowned German sociologist Ulrich Beck has called this phenomenon “reflexive modernisation.”
In his book, Risk Society: Towards a New Modernity, Beck writes, “In the overlap and competition between the problems of class, industrial and market society on one side and those of the risk society on the other, the logic of wealth production always wins…and for that very reason the risk society is ultimately victorious.” He further adds, “The race between perceptible wealth and imperceptible risks cannot be won by the latter. The visible cannot compete with the invisible. Paradox decrees that for that very reason the invisible risks win the race.”
The emergence of risk society is inescapable, thanks to reflexive modernisation. To face it, there has to be a shift in policy focus from a wealth distribution society to a risk society. Beck apprises us, “We do not yet live in a risk society, but we also no longer live only within the distribution conflicts of scarcity societies. To the extent that this transition occurs, there will be a real transformation of society which will lead us out of the previous modes of thought and action.”
Poverty and pandemics: Shift in policy focus from a wealth distribution society to a risk society is not that easy in India, a former British colony, which retains its colonial legacy to a large extent. The typical syndrome that most of the former European colonies still suffer from. German sociologist Robert Michels has termed this syndrome “iron law of oligarchy.” In their book, Why Nations Fail, Daron Acemoglu and James Robinson summarise the iron law of oligarchy saying that in essence “new leaders overthrowing old ones with promises of radical changes bring nothing but more of the same.”
Another syndrome that India suffers from is the new absolutism — that is, communism. In its post-Independence avatar, India tilted towards the communist Soviet system, thus allowing structural space to the communist ideals in the governance system. The authors of Why Nations Fail have rightly pointed out, “It is impossible to understand many of the poorest regions of the world at the end of the 20th century without understanding the new absolutism of the 20th century: Communism…Beyond the human suffering and carnage, the communist regimes all set up various types of extractive institutions…”
The syndromes of the iron law of oligarchy and new absolutism tend to create extractive institutions begetting the vicious circle of poverty and prove counter-productive to the efforts to push the policy focus towards risk society. For economic justice and poverty reduction by redistribution of the nation’s wealth take centrestage in policy priorities. This is not to suggest that there exists a binary opposition between the wealth redistribution society and risk society. What is intended here is that the process of transition from a wealth redistribution society to a risk society needs to be expedited by eliminating poverty and making society just and egalitarian.
Thus, the challenge before the new leadership in India is to do away with the new absolutism thought process and the prevalence of the iron law of oligarchy ingrained in our political and economic system. The extractive institutions need to be weeded out.
Universal Basic Income: Poverty reduction still remains a Herculean task for policymakers in India. Although since Independence, a slew of policy measures has been undertaken by various Governments to reform the economy and enhance its outcome with an aim to take more people out of the poverty trap, it is still miles to go. So what do we do in such a scenario? What are the choices we are left with? Though there cannot be a substitute for a poverty-free society in absolute terms, increase in social security net and implementation of Universal Basic Income (UBI) can provide a kind of a defensive wall in the fight against pandemics, natural hazards and any other unwarranted risks.
A whole chapter was dedicated on UBI in the Economic Survey, 2016-17 which states, “…UBI is a powerful idea whose time even if not ripe for implementation is ripe for serious discussion.” But since this was given a miss in the Union Budget that followed the Economic Survey, the idea failed to generate “serious” discussion on its utility and practicality. Clearly, the UBI at least ensures a minimum income guarantee for beneficiaries. The implementation of UBI will place extra burden on the exchequer but there are definitely ways to implement it in a limited manner just to begin with. Given the tight fiscal space that India has, it may not be prudent to commit the UBI to everyone, just to prove its universality. In his article, Out of my mind: Income for everyone, economist Meghnad Desai suggested: “The allowance (UBI) should be paid to women only. They constitute almost half the population. Many cannot earn as they have to look after their families. When they work for wages, they are underpaid. The criterion cannot be gamed. It would revolutionise Indian society.”
If we have UBI, the need for women and children to migrate in search of work will get reduced. In the wake of pandemics, people, especially migrant labourers and within that bracket, women and children, will not have to march, hungry, thirsty and barefoot, hundreds of kilometres towards their home States, as happened recently soon after the lockdown was announced by the Government. They will have a fighting chance at a life of dignity and independence.
(The writer is a policy commentator)