K.
P. Rajesh
P. Rajesh
Kerala is a small southern state
in India once again captured the attention of the world by the way in which it
has been dealing with the corona epidemic that spread out all over the world.
Two catastrophic incidents happened in this society in the recent past, in
which one was the severe flood affected the society in 2018 and it killed
around 500 people and 140 people were missing. It was one of the worst
disasters in the history of the state. There had been minor floods and
landslides that happened before, but nothing like this had ever happened in the
state after its formation in 1956. Literally the state submerged under water
and the sufferings of the people was inconceivable. The Kerala state machinery
and all sections of the society engaged in a difficult task and rescued as many
people as possible, and the state under the rule of Left Democratic Front (LDF)
took massive measures to rehabilitate the people who lost everything as part of
the flood.
in India once again captured the attention of the world by the way in which it
has been dealing with the corona epidemic that spread out all over the world.
Two catastrophic incidents happened in this society in the recent past, in
which one was the severe flood affected the society in 2018 and it killed
around 500 people and 140 people were missing. It was one of the worst
disasters in the history of the state. There had been minor floods and
landslides that happened before, but nothing like this had ever happened in the
state after its formation in 1956. Literally the state submerged under water
and the sufferings of the people was inconceivable. The Kerala state machinery
and all sections of the society engaged in a difficult task and rescued as many
people as possible, and the state under the rule of Left Democratic Front (LDF)
took massive measures to rehabilitate the people who lost everything as part of
the flood.
The second was the Nipah virus
outbreak in 2018 and how the state was handled the issue was appreciated by
various sections of the global society, including global media. Now, a lot of
attention has been turned into Kerala from the rest of India to know about how
this society and the state is effectively managing the corona epidemic. Nonetheless,
one thing that is not much highlighted in the current discourses around
coronavirus epidemic is that why the European society like Italy and the
celebrated American capitalist model is failing to prevent this epidemic
outbreak whereas a small regional state in the global south succeeded to a
great extent in detecting and controlling the spread of this epidemic. This
question demands a proper inquiry into the way in which the public health
system developed in this society during the last fifty to sixty years unlike
other Indian and global states. In this context, any realistic examination admits
the contribution of the Left parties in imagining and materializing a pro-poor
public health model foregrounded in the political ideal of social justice and
equality informed by a non-capitalist imagination of development.
outbreak in 2018 and how the state was handled the issue was appreciated by
various sections of the global society, including global media. Now, a lot of
attention has been turned into Kerala from the rest of India to know about how
this society and the state is effectively managing the corona epidemic. Nonetheless,
one thing that is not much highlighted in the current discourses around
coronavirus epidemic is that why the European society like Italy and the
celebrated American capitalist model is failing to prevent this epidemic
outbreak whereas a small regional state in the global south succeeded to a
great extent in detecting and controlling the spread of this epidemic. This
question demands a proper inquiry into the way in which the public health
system developed in this society during the last fifty to sixty years unlike
other Indian and global states. In this context, any realistic examination admits
the contribution of the Left parties in imagining and materializing a pro-poor
public health model foregrounded in the political ideal of social justice and
equality informed by a non-capitalist imagination of development.
Public Health
and Kerala’s Development Experience
and Kerala’s Development Experience
Kerala state is perceived in both popular and
policy imagination as the most developed state in India. The period from the
1950s to the first of half of the 1980s has been considered as a period of the
formation and evolution of a distinct development model and trajectory in
Kerala. Scholars like Patrick Heller argues that Kerala marked a distinct
trajectory of “social-democratic development” constituted mainly
through twin factors of a long history of subaltern “class-based
mobilisations and redistributive social policies” (2009, p. 79). Similarly,
Jean Dreze and Amartya Sen have attempted to explore the relationship between
public action and development in their work, Hunger and Public Action (1989). According to them, public action
played a decisive role in making a pro-people developmental and welfare state
in Kerala. Certainly, these two observations evoke some important connections about
the relationship among welfare state, development and living standard of common
people in society.
policy imagination as the most developed state in India. The period from the
1950s to the first of half of the 1980s has been considered as a period of the
formation and evolution of a distinct development model and trajectory in
Kerala. Scholars like Patrick Heller argues that Kerala marked a distinct
trajectory of “social-democratic development” constituted mainly
through twin factors of a long history of subaltern “class-based
mobilisations and redistributive social policies” (2009, p. 79). Similarly,
Jean Dreze and Amartya Sen have attempted to explore the relationship between
public action and development in their work, Hunger and Public Action (1989). According to them, public action
played a decisive role in making a pro-people developmental and welfare state
in Kerala. Certainly, these two observations evoke some important connections about
the relationship among welfare state, development and living standard of common
people in society.
But we know that this model confronted serious crises in
the early 1990s. The crisis can be designated at two levels: one is related to
the low economic growth of the state. The alarming rate
of unemployment, low-income generation, poor investment in economic sectors and
the stagnant material production had adversely affected the economic growth of
the state. Regarding this, many scholars pointed out
that the welfare model is not sustainable if we could not ensure a
corresponding economic growth. The second is related to the deprivation and
marginalisation of Adivasis and Dalits in society. A critical and close
examination of the ‘Kerala development model’ unravels the fact that Adivasis
and Dalits didn’t get anticipated benefit from the model, and it also refers to
the limitations embedded in it. Broadly speaking, this can be characterised as
a crisis in the development model by the early 1990s. But at the same time, it
should be pertinent to mention here that these markers of the crisis are not
adequate to completely reject this model. Furthermore, while accepting the
limitations of this model, it is important to note down that how this model is still
reinventing its strength under the leadership of the Left government in
connection with the catastrophic incidents which I outlined above.
the early 1990s. The crisis can be designated at two levels: one is related to
the low economic growth of the state. The alarming rate
of unemployment, low-income generation, poor investment in economic sectors and
the stagnant material production had adversely affected the economic growth of
the state. Regarding this, many scholars pointed out
that the welfare model is not sustainable if we could not ensure a
corresponding economic growth. The second is related to the deprivation and
marginalisation of Adivasis and Dalits in society. A critical and close
examination of the ‘Kerala development model’ unravels the fact that Adivasis
and Dalits didn’t get anticipated benefit from the model, and it also refers to
the limitations embedded in it. Broadly speaking, this can be characterised as
a crisis in the development model by the early 1990s. But at the same time, it
should be pertinent to mention here that these markers of the crisis are not
adequate to completely reject this model. Furthermore, while accepting the
limitations of this model, it is important to note down that how this model is still
reinventing its strength under the leadership of the Left government in
connection with the catastrophic incidents which I outlined above.
When we look at the health status of the Kerala society one
could see that it has a lot of similarities with the developed economies. The
parameters like increased life expectancy, low level of infant and maternal
mortality rate and nutritional status achieved by the state through developing
a publicly funded health care system in the society. The public health care
institutional structures beginning from primary health care centre at the
grass-root level to the Medical colleges at the state level played a
significant role in attaining this status. A Left imagination on public health
care based on the political ideal of social justice and equity and how they
translated these ideals when conceiving the question of people’s health needs
to be emphasised and highlighted while talking about this model in the current
pandemic circumstances.
could see that it has a lot of similarities with the developed economies. The
parameters like increased life expectancy, low level of infant and maternal
mortality rate and nutritional status achieved by the state through developing
a publicly funded health care system in the society. The public health care
institutional structures beginning from primary health care centre at the
grass-root level to the Medical colleges at the state level played a
significant role in attaining this status. A Left imagination on public health
care based on the political ideal of social justice and equity and how they
translated these ideals when conceiving the question of people’s health needs
to be emphasised and highlighted while talking about this model in the current
pandemic circumstances.
Public Health in the Global Scenario, Neoliberalism and
Counter-Narratives from Kerala
Counter-Narratives from Kerala
The crisis unfolded in the European nations, particularly
in Italy in the context of the widespread corona epidemic should be analysed in
connection with the neoliberal capitalist expansion in the world. A large
number of the Left scholars and activists recurrently pointed out that the
present capitalist expansion is largely benefitting the elites and corporates
in the world and common people are becoming more and more poor and vulnerable.
For instance, according to Giacomo Turci, an Italian socialist leader and a member of the Revolutionary
Internationalist Fraction (FIR), rightly pointed out:
in Italy in the context of the widespread corona epidemic should be analysed in
connection with the neoliberal capitalist expansion in the world. A large
number of the Left scholars and activists recurrently pointed out that the
present capitalist expansion is largely benefitting the elites and corporates
in the world and common people are becoming more and more poor and vulnerable.
For instance, according to Giacomo Turci, an Italian socialist leader and a member of the Revolutionary
Internationalist Fraction (FIR), rightly pointed out:
in the last ten years, public
funding for healthcare in Italy has decreased by about 37 billion euros. Most of these cuts — around 25 billion euros —
took place in the period from 2010-2015, as the country was
under the tutelage of the IMF. Over the last decade, 359 hospitals have been
closed, in addition to the many small hospitals that have been abandoned (From
Leftvoice.org, March 16, 2020).
funding for healthcare in Italy has decreased by about 37 billion euros. Most of these cuts — around 25 billion euros —
took place in the period from 2010-2015, as the country was
under the tutelage of the IMF. Over the last decade, 359 hospitals have been
closed, in addition to the many small hospitals that have been abandoned (From
Leftvoice.org, March 16, 2020).
Contrary to this
larger global scenario, Kerala state under the Left rule accepted the new
health policy in 2019 which they promised in the 2016 election manifesto. This
policy aims to provide
universal, affordable and quality health care for everyone. The policy promised
that the government will aim at raising its current expenditure on health from
the current 0.6% of GSDP to at least 5% by increasing it by 1% every year. The
policy describes that the state spends between Rs 6,000 crores and Rs 8,000
crores on medicines every year. High medicine prices result in a higher overall
cost of healthcare. Therefore, the policy rightly points out that the biggest
public health problem is enormous out-of-pocket expenditure on healthcare.
Besides, the policy described the health care challenges the state faces in the
following words:
larger global scenario, Kerala state under the Left rule accepted the new
health policy in 2019 which they promised in the 2016 election manifesto. This
policy aims to provide
universal, affordable and quality health care for everyone. The policy promised
that the government will aim at raising its current expenditure on health from
the current 0.6% of GSDP to at least 5% by increasing it by 1% every year. The
policy describes that the state spends between Rs 6,000 crores and Rs 8,000
crores on medicines every year. High medicine prices result in a higher overall
cost of healthcare. Therefore, the policy rightly points out that the biggest
public health problem is enormous out-of-pocket expenditure on healthcare.
Besides, the policy described the health care challenges the state faces in the
following words:
medical expenditure has been increasing because of
privatisation and commercialisation of the health sector, advances in
diagnostic technology, rise in prices of essential medicines, a backward public
health sector, no comprehensive free medical care to the poor, a tendency among
patients to seek super-specialty healthcare for all ailments, and a rise in
diseases like cancer that need long-term treatment.
privatisation and commercialisation of the health sector, advances in
diagnostic technology, rise in prices of essential medicines, a backward public
health sector, no comprehensive free medical care to the poor, a tendency among
patients to seek super-specialty healthcare for all ailments, and a rise in
diseases like cancer that need long-term treatment.
In this context, one of the important suggestions
the policy proposed is to introduce a three-tier referral system by
strengthening the public health institutions from the primary health centre to
medical colleges. In this context, it is pertinent to remember the observation
made by the veteran leader of the Communist Party of India (Marxist), late E M S Namboodirippad. While delivering his presidential address in
the first study Congress on Kerala in 1994, he observed:
the policy proposed is to introduce a three-tier referral system by
strengthening the public health institutions from the primary health centre to
medical colleges. In this context, it is pertinent to remember the observation
made by the veteran leader of the Communist Party of India (Marxist), late E M S Namboodirippad. While delivering his presidential address in
the first study Congress on Kerala in 1994, he observed:
Within the limitations
imposed by the global and national structures, we will have to find practical
solutions to the problems that our state faces. We cannot let the present
situation drift, we have got to reach a consensus as to what measures are to be
adopted to accelerate economic growth without sacrificing the welfare gains and
the democratic achievements of the past (1994, 5).
imposed by the global and national structures, we will have to find practical
solutions to the problems that our state faces. We cannot let the present
situation drift, we have got to reach a consensus as to what measures are to be
adopted to accelerate economic growth without sacrificing the welfare gains and
the democratic achievements of the past (1994, 5).
The intervention
of the state in the public health care sector is not merely looking for
immediate practical solutions but it could be seen that they anticipate the
measures by perceiving the questions from a structural point of view. We should
look at the state’s efforts to prevent the corona epidemic by considering this
larger picture, both local and global.
of the state in the public health care sector is not merely looking for
immediate practical solutions but it could be seen that they anticipate the
measures by perceiving the questions from a structural point of view. We should
look at the state’s efforts to prevent the corona epidemic by considering this
larger picture, both local and global.
Corona
Epidemic and Lessons from Kerala
Epidemic and Lessons from Kerala
The corona
epidemic exposed the crisis and vulnerability of the so-called European
societies who embraced the neoliberal paradigm of development. Whereas, a small
southern Indian state in the Global South making all its efforts to prevent the
escalation of the corona epidemic. Though the first three cases of corona
infected patients identified in Kerala in comparison with all the other states
in India, all these patients were discharged from the hospitals in less than a
month. As per the updated statics shared by the state, 40 positive cases have
been identified in the state, in which 37 people are in hospitals. 44390 people
are under observation, in which 44165 are admitted in various government
hospitals and the rest of them (225) are quarantined in their homes. It is also
a radical move to replace the term ‘quarantine’ with ‘care centres’. In
addition to the factors which I narrated above, the first important action was
taken by the state to control the spread of misinformation and utilised all the
institutional and social network facilties to provide the scientific
information about this epidemic to the people. Public health awareness of the
state, local self-government institutions and the various media houses as well
as the civil society groups played a crucial role in unravelling the actual
picture of the epidemic and thereby restricting the possibility to become
panic. Second, the decentralised democratic structures and practices penetrated in the social life, for
instance, local panchayats to schools, helped in a significant way to make the
public aware of how to handle this unprecedented situation. Similarly, it is a
remarkable move that the panchayat raj institutions distribute food for the
people who are under observation in their respective homes. Third, on an
everyday basis, the state evaluated the situation by looking into public health
concerns from the vantage point of social justice and rights of the common
people and citizens in the society. Thus, while concluding this small write-up,
I wanted to re-emphasize an argument that the neo-liberal development models
embraced by the European society should learn a lot of lessons in the current
crisis from Kerala if they are willing to move beyond the illusion of
neoliberalist capitalist globalisation and recognizing the importance of social
justice and pro-poor politics.
epidemic exposed the crisis and vulnerability of the so-called European
societies who embraced the neoliberal paradigm of development. Whereas, a small
southern Indian state in the Global South making all its efforts to prevent the
escalation of the corona epidemic. Though the first three cases of corona
infected patients identified in Kerala in comparison with all the other states
in India, all these patients were discharged from the hospitals in less than a
month. As per the updated statics shared by the state, 40 positive cases have
been identified in the state, in which 37 people are in hospitals. 44390 people
are under observation, in which 44165 are admitted in various government
hospitals and the rest of them (225) are quarantined in their homes. It is also
a radical move to replace the term ‘quarantine’ with ‘care centres’. In
addition to the factors which I narrated above, the first important action was
taken by the state to control the spread of misinformation and utilised all the
institutional and social network facilties to provide the scientific
information about this epidemic to the people. Public health awareness of the
state, local self-government institutions and the various media houses as well
as the civil society groups played a crucial role in unravelling the actual
picture of the epidemic and thereby restricting the possibility to become
panic. Second, the decentralised democratic structures and practices penetrated in the social life, for
instance, local panchayats to schools, helped in a significant way to make the
public aware of how to handle this unprecedented situation. Similarly, it is a
remarkable move that the panchayat raj institutions distribute food for the
people who are under observation in their respective homes. Third, on an
everyday basis, the state evaluated the situation by looking into public health
concerns from the vantage point of social justice and rights of the common
people and citizens in the society. Thus, while concluding this small write-up,
I wanted to re-emphasize an argument that the neo-liberal development models
embraced by the European society should learn a lot of lessons in the current
crisis from Kerala if they are willing to move beyond the illusion of
neoliberalist capitalist globalisation and recognizing the importance of social
justice and pro-poor politics.
The author is Assistant Professor, Tata Institute of Social Sciences, Hyderabad
References
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