While the recent news from Delhi is spectacular and disturbing – especially hospital deaths due to lack of oxygen – a quieter crisis has been brewing in the state of Maharashtra for much longer.
For about a year now, we have been reading of hospitals there not admitting patients suspected of COVID-19, dead bodies piling up in the wards, shortage of the remdesivir drug, inadequate cremation facilities and, again, non-availability of oxygen. News has come from Mumbai, Nashik, Nagpur and Ahmednagar, among other cities, indicating that the problem is widespread and not just confined to the metropolis. Above all it speaks of the extraordinary hardship being endured by the people of the state.
Everything suggests that Maharashtra should not have had the experience that it has. While it does have high density regions, such as Mumbai and Pune, leaving it more vulnerable to contagion compared to more rural states, it possesses industrial muscle and has a history of entrepreneurship. Clearly there is something at work ensuring that these are not leveraged in a socially constructive way.
Political competition helps…
Along with private entrepreneurship, present in economic activities ranging from the utilities to manufacturing, Mumbai’s history is closely tied to the public spiritedness of its wealthy who have, starting in the 19th century, given it hospitals, libraries and many other public facilities. That some of this has not entirely evaporated may be seen in the House of Tatas announcing that it plans to import 24 cryogenic containers through special chartered flights to meet the current oxygen shortage.
But private initiative for public causes has generally declined in the city since independence. The reasons are no doubt complex but it may be related, at least in part, to the dominating position assumed by party politics all over India since 1947, which due to its proximity to the state, has edged out all private initiative from the public sphere. In Mumbai, in particular, party politics has been noxious, sapping vitality from the dynamic and cosmopolitan culture of Bombay.
…If welfare commitments prevail
Political competition can play a positive role in promoting the well-being of a population. For instance, the rise of the European welfare state is the result of the competition between the social democratic and conservative forces of that continent, with the former having won. Today, even when the conservatives rule, they dare not dismantle the welfare state, as it holds a special place in the minds of Europeans.
The main instance is that of the UK under Margaret Thatcher, who won four consecutive polls and changed the face of Britain in many ways, but this did not extend to the National Health Service, the envy of even richer countries. In India, democracy never gave rise to a national party with a strong social democratic commitment. The Congress may have been high on rhetoric but any imaginings that it may have nurtured towards the creation of a welfare state floundered at the altar of the personal ambitions of its managers.
But when ‘outsiders’ are the enemy…
Some parts of India always had incipient local aspirations that were not aligned with the national aspirations of the Congress. Two prominent instances were the Dravidian movement in erstwhile Madras and the Shiv Sena in Maharashtra. The Dravidian movement combined the aim of dislodging the primacy of the upper castes in government with challenging what they saw as an attempt of the Aryan north to subjugate the Dravidian south, notably though the imposition of Hindi. The Shiv Sena was not motivated by either of these aims. Its programme was constituted by ethnic and communal politics pure and simple, first to rid Bombay of south Indians and secondly to disempower its Muslims.
While it has taken the party a long time to come to power, it has succeeded in reducing much of what goes for politics in Maharashtra for the past half century to some form of adjustment to its identity politics platform. Naturally, the project of building a society that caters to the well-being of the population went out the window. Public goods, of which the public health system is a prominent example, stood little chance of finding a place in the programme of the Shiv Sena. If ‘outsiders’ are the enemy of the people, then you don’t want to create an infrastructure that will serve them, right? Of course, why the electorate in a democracy chooses a government that does not provide basic public goods remains to be answered.
So, where has a half-century of identity politics orchestrated by the Shiv Sena left Maharashtra? Certainly not in a position to stop the progress of COVID-19, to which it was anyway prone due to the presence of high-density urban conurbations, notably Mumbai. My ongoing work with Sreenath Namboodhiry on the inter-state variation of COVID-19 in India over the past year shows that mortality is inversely correlated with health expenditure.
… Everyone suffers
To be precise, greater public expenditure on health as a share of state gross domestic product (GDP) is associated with a lower mortality rate (measured in three different ways). The Maharashtra experience is true to this pattern. It was the Indian state with the lowest figure for this indicator in 2018-19, with public health expenditure at less that 0.5% of its income (GDP). Of all states, it had on March 31 recorded the highest number of deaths and the highest case fatality rate. Only one other state had recorded a greater number of deaths per million population. The outcome of starving the public health system is reflected in the available infrastructure.
Only three Indian states out of 28 have less allopathic doctors per person than Maharashtra; only eight states have less beds per person and only two have less hospitals per person. It is not as if Maharashtra is poor; there are 21 Indian states that had lower per capita income. When we take all this into account, it is no longer surprising that the state has experienced the health disaster that it has.
Of course it would be naïve to think that expenditure will take care of everything. The oxygen shortages, the absent staff to move dead bodies out of wards, the fire in a hospital at Palghar on April 23 and, in the midst of the shortage, the leaking oxygen tank as patients died due to lack of the very substance at Nashik, all point to administrative incompetence of the highest order.
Maharashtra’s experience with COVID-19 reflects the deadly consequences of identity politics for the “well-being” of a people. When ethnicity is the touchstone of politics, a society loses its capacity to think clearly about its future – let alone make provision for a secure one.
This experience must trouble us as it may not be confined to one state of India any longer. Only till yesterday, as it were, the party governing Maharashtra today was in a coalition with the Bharatiya Janata Party, which governs India. These two formations share almost everything in common. Substituting ‘religion’ for ‘ethnicity’, we would worry about the future of an India in which identity politics is spread like a virus by political parties.
Pulapre Balakrishnan is professor of economics at Ashoka University, Sonipat, Haryana.
With inputs from Sreenath Namboodhiry.