Saturday, March 21, 2020

Corona Epidemic and Neoliberal Capitalist Globalisation: A Counter Narrative from Kerala, India


K. 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.


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.    

Public Health 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.

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.

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.  

Public Health in the Global Scenario, Neoliberalism and 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 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).  

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:

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.

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:

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).

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.

Corona 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.    

The author is Assistant Professor, Tata Institute of Social Sciences, Hyderabad




References

Dreze, Jean, and Amartya Sen. 1989. Hunger and Public Action. Oxford: Oxford University Press.

Heller, Patrick. 2009. “Reinventing Public Power in the Age of Globalization: The Transformation of Movement Politics in Kerala.” In Social Movements in India: Poverty, Power, and Politics, ed. Raka Ray and Mary Katzenstein. Delhi: Oxford University Press.

Törnquist, Olle. 2002. Popular Development and Democracy: Case Studies with Rural Dimensions in the Philippines, Indonesia, and Kerala. Oslo: Centre for Development and the Environment.  

Sandbrook, Richard, Marc Edelman, Patrick Heller, and Judith Teichman. 2007. Social Democracy in the Global Periphery Origins, Challenges, Prospects. Cambridge: Cambridge University Press.

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