In a Public Health Catastrophe Like COVID, Socialist Thinking Saves Lives

Famed Kerala health minister K.K. Shailaja writes on the 'Kerala Model' of prioritising a public healthcare system through decentralised government.

It is extraordinary that our state democratically elected a communist party to form its very first government.

And in that radical act, the foundations of forward-thinking, social development oriented policymaking were set.

Take the phrase ‘Krishibhoomi karshakanu’, for instance. That line translates to the stance, ‘Farmland for a farmworker’. The underpinning of that Leftist slogan is the principle that a farmer who works on the land must have the dignity of possessing some land of their own.

It’s only when restoring human dignity becomes government policy that real change can occur. Everyone becomes influenced by that thinking. And that is why I say that most Malayalis are socialists at heart and that is what makes Kerala exemplary.

My Life as a Comrade : The Story of an Extraordinary Politician and the World That Shaped Her, K.K. Shailaja and Manju Sara Rajan, Juggernaut, 2023.

Socialism also made its way into our collective psyche through popular culture and literature. There was a play in the 1950s called Ningalenne Communistaki (‘You Made Me a Communist’) by the famous theatre group Kerala People’s Arts Club (KPAC) founded by Thoppil Basi. It tells the story of an upper-caste Hindu man’s metamorphosis into a Communist. The play was staged as a protest against feudalism, amplifying the message that existing systems of oppression must be dismantled. It was later made into a popular film by the same name.

So, if you ask me how other states can emulate the Kerala Model of development, I would say you have to begin with overall social development. Everything is interconnected: people need the basics of food, income and access to education; then they can start thinking of the next aspect: their quality of life. The health sector, or any sector for that matter, cannot operate in a vacuum. In many states, ensuring food for all through the public distribution system and focus on education are not prioritized.

What is the point of discussing healthcare for people who don’t have adequate food to eat? Therefore, a macro approach and micro planning are vital.

In this regard, the southern states of the country have made considerable headway. As a communist, I can’t think of a scenario that doesn’t begin with breaking the bonds of a feudal system. We believe that society cannot evolve without developing wholly and, as far as possible, equally. On the other hand, feudalism doesn’t allow a human being to step outside their circumstances. You can follow a capitalistic economic model, but the feudalistic social set-up must be dismantled. In many northern states of our country, we see that instead of breaking down these oppressive systems, the political set-up has turned feudal and caste associations into vote banks.

Capitalism cannot save people whose daily lives are frozen by caste strictures. At the administration level, decentralized governance is an integral part of our system. Accelerated land reform and decentralized planning went hand in hand in the initial years. Local self-governments are now extremely strong in our state, and there is a fundamental belief that local problems can be best understood by local people.

Also read: Why Kerala’s Response to COVID-19 Has Positive Lessons for India

An offshoot of that same principle is decentralized public healthcare. Even though the central government’s public health policy says a family welfare health subcentre with a nurse and junior health inspector must be present in any place with a 5,000-strong population, PHCs [public health centres] like that do not exist in many states. Whereas in Kerala, this directive has been enforced effectively.

From its humble beginnings, the primary healthcare sector in the state has had incremental improvements, with the most dramatic changes beginning in 2016. And in our integrated decentralized healthcare system the public has choices because every panchayat also offers alternative medical care. People can also choose between Ayurveda, homoeopathy, Unani and Siddha lines of treatment.

With health and land reforms, together with education, the social development index in Kerala improved. People are more aware and understand how to take care of their health, and so life expectancy in Kerala today is seventy-six years, in contrast to the national average which is below seventy years. One element works with another for overall enhancement of the quality of life.

Health is only one part of social development. If poverty is rampant, there is no point focusing on health. The health department does not stand in isolation, and infrastructure alone does not guarantee a healthy population. But all of that begins with intention, and if the intention is the overall betterment of a population, you will get somewhere.

Critics of socialistic thinking believe the government should not be trying to do everything, producing everything from meat to oxygen, both of which are part of government-run efforts in Kerala. But when a large portion of your population is disadvantaged and when that disadvantaged population is not a profitable consumer base for private companies, who should these people turn to?

Private companies are motivated by profit. But governments cannot behave that way, especially in the health segment. If COVID has taught us anything it is that ensuring the safety and health of our population is an economic and financial necessity as much as a social and ethical one.

This is part of the Kerala Model.

Also read: Why Kerala Reported More COVID-19 Deaths Than Any Province in the World in Last 28 Days

It is about the structure and, yes, personality of the system that infuses our form of governance. The benefits of thinking for the weakest sections of society are most evident in times of disasters. We can never truly progress by leaving behind the majority among us. No matter how many gated communities we build in this country, poverty and negligence are always going to be waiting just outside. Because of our history of caste bias and colonialism, a great many among us have been left behind for centuries – and need a leg-up.

So, increasing access to public services, especially healthcare, is really the only option. No matter how much support and tax breaks a government provides the private sector, it doesn’t translate to social commitment. Private healthcare is important, but it won’t treat a pandemic, infectious diseases or a natural disaster as a priority, because these do not come with high-value treatment protocols. Afflictions like tropical diseases are not profitable to treat, plus these ailments take long and intense care to heal, so there’s little motivation for private hospitals to focus on them.

Which is why in places like Kerala, having a solid public healthcare system is so important. As author Arundhati Roy says, ‘for the greater common good’ the government must invest in the public healthcare system. That is the Kerala difference. In our socialistic model, essential services and tools for the public healthcare system are provided by the state itself. Kerala’s self-sufficiency model has saved it in times of crises. The central government’s policies promote privatization, and while there is a case for that too in certain situations, as far as we are concerned, the Left believes in government ownership. And in crisis situations, such as a public health catastrophe, socialist thinking saves lives.

Nothing illustrates this better than Kerala’s handling of the COVID crisis.

K.K. Shailaja is a former health minister of Kerala. She had been the commander-in-chief of the state’s fight against COVID-19.

The above is an excerpt from My Life as a Comrade: The Story of an Extraordinary Politician and the World That Shaped Her, by K.K. Shailaja and Manju Sara Rajan, Juggernaut, 2023.