T. Sundararaman, Daksha Parmar and S. Krithi

We are in the midst of one of the most severe crisesin global public health that the world has ever faced.India is one of the worst affected countries, with the Covid-19 pandemic having devastating impactsboth on the health of the population as well as on the country’s economy. As of November 15, 2020, India’s Covid-19 cases stand at over 88 lakhs and
there are over 1.3 lakh deaths. This unprecedented health crisis is not only having an adverse impact on the health of the population, it has also createda profound negative economic impact. Though all sectors and classes are affected, existing poverty and inequality amplifies the adverse effects on the weaker sections and pushes them further into poverty. The immediate negative impact on the lives of all marginalized sections of the population—migrants, farmers, labourers working in insecure and informal jobs in urban and rural areas—is therefore more severe.
Access to medical services has been severely
affected both for Covid-19 and non-Covid-19 health
problems. Public hospitals have been overwhelmed
with the increased number of Covid-19 cases, resulting in huge shortages of beds for Covid-19 patients as well as exacerbating shortages for all other
patients. Failure to isolate and admit Covid-19 paPublic Health and Health Services
as Global Public Goods T. Sundararaman, Daksha Parmar and S. Krithi
tients in time also leads to enhanced risk of infection for the entire population. (JSA-AIPSN, 2020). This crisis is even more acute for those who are already suffering from critical and lifelong illnesses that require sustained medical check-ups and interventions. This is particularly with reference to life-saving services in case of maternal and child
healthcare, chronic illnesses such as diabetes, hypertension, cancer and dialysis services, where the essential medical services were suspended or cut back across most of the public and private health facilities. The pandemic of Covid-19 knocked at our doors when India was in the third decade of its health sector reforms. Since the nineties, under the reforms, public health policy—as reflected in its implementation—has veered towards restricting public provisioning to only those services which the private sector is unable or unwilling to provide, with an understanding that the majority of health services should be left to the market. This had led to systematic neglect of public health services. But in this moment of a health crisis, this for-profit private health sector, which has grown enormously over the last three decades, was largely missing in action. They either withdrew due to fear of infection or, when they did provide services, charged exorbitant rates and restricted to a limited number of beds and services (Raghavan, Barnagarwala and Ghosh, 2020). Public hospitals and public health

By Indrajit Roy

This paper by Indrajit Roy talks about how the social and political exclusion of circular labour migrants in India bars them from fully exercising their basic rights, keeping them from being legitimate citizens of India. There is a general attitude of hostility towards migrant workers, often fostered by powerful politicians, prevailing in India with the workers being labelled as the source of numerous social evils without necessarily finding any evidence. Migrant workers are identified collectively as a ‘floating population’ which, owing to its anonymity, is able to escape consequence for committing heinous crimes. It is against this background that the author conducts ethnographic fieldwork in north Bihar’s Araria district to gain the perspective of the workers, and obtain a better picture of the vulnerabilities they are exposed to.

It is important to acknowledge the role of social and political inclusion in motivating entire populations to migrate. Workers retreat to circular labour migration in the hunt for a life relatively free from social conflict that threatens their very well-being, and one where they may find basic dignity. Migration allows the blurring of lines between previously concrete caste identities, allowing the possibility for a change of status. However, this does not entail that they are liberated from all forms of injustice. Migrant workers, already disproportionately drawn from historically oppressed communities such as Dalits and Adivasis, find their difficulties exacerbated with the low pay they receive, job insecurity and absence of contracts, unrecognised emotional labour, and inhuman working conditions with there being no compensation for working overtime. What makes the nature of their work most precarious is their dependence on employers/contractors for basic amenities, housing, and food provision. Their families are only likely to receive any form of compensation by the State upon their death, and they have no space to articulate their complaints. Policies related to health, education, and labour rights function on the assumption that the beneficiaries live and work in villages where they have been registered. This excludes migrant workers from availing the possible benefits of these policies. Moreover, voting rights are restricted to the places of people’s domicile, not only restricting workers’ capacity to participate in democracy, but also freeing authorities from their duty of supporting the workers.

This state of a “fragmented citizenship” may be overcome by the suggestions made. Migrant workers must be provided legal protection in terms of health and social security. Basic facilities such as financial aid, education, housing and public distribution services must be made accessible for mobile populations as well. These suggestions must be complemented with more ways that could address the political dynamics that underpin their social exclusion.

A study of 15-18-year-old boys and girls in Telangana
By Shantha Sinha

The paper by Shantha Sinha focuses on the lives of 15-18-year-old boys and girls who are no longer attending any educational institution. The study indicates that a majority of these children belong to the marginalized communities mainly scheduled castes (SCs), scheduled tribes (STs) and Muslims. They are poverty stricken and face social exclusion. The proportion of girls not attending schools is bigger relative to boys and the benefits they receive from state schemes are minimal. Other causes of this exclusion comprise of inability to understand what was taught in school due because of absenteeism of teachers, health issues of family members and the inability of parents to sustain and provide facilities because of poverty. The author draws attention to how they are bullied, teased and confront humiliation on usual basis which leads to low self-esteem.

The author notes most of these students switch to working and engaged in unskilled tasks as casual labourers at construction sites and garages, among other informal work sectors. Being on the weaker side of negotiation table, they are exploited and face various health hazards and injuries for which no compensation or safeguards are provided. The movement of girls is confined to their houses and they are married off early. Those who work face various challenges like sexual abuse and lack of toilets and are burdened with household chores.

The state’s scheme benefits haven’t reached these Children and the laws don’t secure them. For instance, adolescent child labour is restricted only in mines, production of explosives and inflammable substances. This allows their employment in other areas. Similarly, the state doesn’t put a satisfactory effort in the education of children after elementary school. The budget has reduced from 600 crores in the year 2013-14 to 400 crores in the year 2017-18 that was allotted to Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (SABLA) under the Ministry of Women and Child Development of the Government of India. The state’s inaction further intensifies the problem of exclusion and marginalization.

Various recommendations have been proposed. The author insists on improving the quality of education provided, covering senior secondary education of children and step up vocational education programs and that children must be tracked and retained in school with zero tolerance of school dropouts. Child labor act must extend its coverage to children unto 18 years who are working in agricultural sector, construction sites or local sites for welding etc. This would ensure they don’t get excluded from schemes and decrease the dropout rate.

By Dipa Sinha, Harsh Mander and Parth Shrimaili

The authors Dipa Sinha, Harsh Mander and Parth Shrimali begin by introducing food as a public good – a good, service or capability that is necessary for a life with dignity. Food as a public good here also connotes the role of the state in facilitating its availability. The authors note that people can secure food with dignity in multiple ways – by growing food, by buying food (this requires adequate income) and/or through state provisioning, however, each of these are critically dependent on state policies and institutions. The authors suggest that due to the existence of rights-based laws such as MGNERGA and NFSA, starvation is popularly believed to be a thing of past. However, the year 2017-18 itself recorded more than 20 starvation deaths across the country.

The study identifies children, women, single women, older people, persons with disabilities, Dalits, Adivasis and Muslims, economically disadvantaged citizens, informal sector workers, homeless persons and people with stigmatized and debilitating ailments as groups excluded from food and nutrition security. In case of children, NFHS-4 records 38.4% children as stunted and 35.7 children as malnutritioned. Malnutrition rates higher compared to sub-Saharan Africa is attributed to the South Asian Enigma- the role given to the poor status of women in South Asian countries. In the case of women, intra-family inequities deprive women of adequate nutritious food even in homes whose food supply would be sufficient for all were it distributed evenly. In families where food is scarce, women and girls often not only get less food to eat, but may also be forced to eat food which is inferior in quality and nutrient content. According to NFHS-4, 22.9% women in the age group of 15-49 have a BMI which is less than “normal”. Due to the undue disadvantages in the access to livelihood and assets, single women are more food insecure while poor and declining health, unfavourable socio-economic conditions, widening inter-generational gaps and non-working status contribute towards the vulnerability of the aged. In the case of persons with disabilities, increased expenditure on health care, basic needs, transportation etc., the lack of adequate employment opportunities and the indirect cost of care borne by the family of the person with disability result in a lesser income for the household and thus greater nutrition vulnerability. The authors note that the incidence of malnutrition is significantly higher among poor households, mothers of children without any education and those belonging to SC and ST social groups. According to the Sacchar Committee Report, Muslim children suffer from the highest rate of stunting and second highest rates of underweight children among all SRCs — SC/ST, Other Hindus, Others. It is also noted that while malnutrition is a problem that plagues all wealth quintiles in the country, there is still a clear gradient showing that the poor are much more affected than the rich. The situation becomes even trickier in the case of informal sector workers – the precarious nature of informal employment, as well as the lack of any employment benefits, shove food security and nutritional intake are at bare subsistence level. While homeless persons are largely invisibilized and thus excluded from any assistance, persons with ailments like HIV AIDS, TB, mental illness have special nutritional requirements and are often excluded from food and work schemes due to the stigma associated with their illness.

The authors note that phenomenon of mortality and morbidity associated with malnutrition represent a direct loss in human capital and productivity for the economy. The report highlights some ‘good practices’ followed by states like School Meals, PDS reforms and Amma Canteens followed in Tamil Nadu and Fulwaris in Chhattisgarh. To conclude, the authors give recommendations like the universalisation of the PDS system, adequate allocations for ICDS and MDM, maternity benefits and provision of creches, pension schemes especially for elderly women and community kitchens to reduce the burden of unpaid work on women while also providing nutritious meals.

By Navsharan Singh, Harsh Mander and Anirban Bhattacharya

The paper by Navsharan Singh, Harsh Mander, and Anirban Bhattacharya highlights how, despite the principles and laws laid down in the Constitution, the hegemony of the Hindu majority bars minorities from effectively demanding and receiving justice in cases wherein they have been subject to gross mistreatment and organised violence. An investigation into the records and outcomes of various cases allows the authors to recognise patterns in the role of the state machinery in the inadequate addressal of severe cases. Episodes of communal violence against religious minorities are characterised by two features: (1) universal impunity to aggressors belonging to the majority community, and (2) a failure to offer survivors the opportunity to restore their lives. Drawing from these observations, one understands how the applicability of constitutional safeguards depends on the individual’s identity. One is compelled to wonder whether the system is deliberately designed in a way that it damages the cause of the minority.

Marginalised communities are vulnerable to the unfair politics of justice deliverance. Strategies employed by state bodies to dilute a case involve writing delayed and ambiguous FIRs. Similarly, the investigation carried out by the police often omits important information that was easily accessible. This supposed lack of evidence is unquestioningly accepted as sufficient justification for the premature closure of the case. The bodies often selectively delay the arrests of the aggressor from the majority community, and permit bail soon after. The aggressor may also file a “cross-case” against minority complainants and coerce them to withdraw their case. Other methods to pressure them, such as money offers and violent threats, specifically target economically dependent groups. The unfamiliarity of the complainant with the law is exploited to limit the role of the lawyers to watching counsel. This only exacerbates the inherent bias in court, wherein complainants are encouraged to “compromise” and proceedings are endlessly delayed.

The authors offer suggestions to make the system less flawed. Firstly, there must be a new crime of dereliction of duty so as to emphasise the responsibility of the public officials. Secondly, new laws must be made to accommodate crimes of gender violence that cannot be acknowledged properly under the umbrella term of ‘rape’. A defined compensation must be provided to the afflicted parties to make the rehabilitation process slightly smoother. Special fast-track courts must be instituted to handle hate crimes within a period of six months to a year, and room should be made for complainants to file complaints against the police to increase their accountability. A comprehensive anti-discrimination law must also be enacted with an Equal-Opportunity Commission to keep it in check. Finally, there must be stronger penalties—such as disqualification and deregistration of parties—for spreading religious hatred to gain support during elections.

Abdul Kalam Azad

The author begins by introducing the example of Baharuddin Ali to highlight the geographical, ecological and political isolation and violence faced by Assam’s Char residents. For the purpose of this study, the author deploys in-depth interviews, focus group discussions in Char areas of six district: Dhubri, Goalpara, Bongaigaon, Barpeta, Kamrup (R), Morigaon and Darrang and conducted surveys in the three char villages of Sipajhar of Darrang district.

Describing the formation of Chars, the author notes that they are the natural result of the complex ecological processes of the Brahmaputra. The chars in Brahmaputra valley are extremely unstable and can be wiped out by erosion during recurrent floods. Despite this constant ecological threat, the Char region in Assam spreads out to 4.6% of the total geographical area with an estimated population of 25 lakhs and double the population density as compared to the rest of the state.

The demographic of the Char community is composed of Miya Muslims or Muslims of Bengali origin in majority along with Mishing, Deori, Sonowal, Kochari, Nepali, Bengali Hindu among others. Ecological calamities like flood and erosion as well as lack of infrastructure has restricted their socio-economic growth. Despite the presence of Disaster Management Authority in every district in Assam, the state fails to provide any relief to the community in the face of a calamity. Often, either it provides minimal and disproportionate support or fails to recognize the camps set up by the community, leaving it to fend for itself.

The community survives without fundamental human rights. As per recent Human Development report of Assam, 2016, the Mean Year of Schooling (MYS) in char areas of Assam is 4.76 years- lowest amongst all marginalized communities. This extraordinarily high level of exclusion can be attributed to the lack of educational services in the region as well as their poor quality. The Government’s merging scheme called Siksha Khetra has led to concentration of schools in some areas and lack of any in Char regions. The community, also lives without the aid of any state sponsored health care and has only 52 primary health centres for a population of 2.5 million. 91% of the population does not have access to safe drinking water, using unfiltered flood or river water and only 1.4% has access to sanitary latrines. Moreover, the community faces systematic political persecution with questions being raised on their racial identity. They’ve been branded as “illegal Bangladeshi immigrants” encroaching on land occupied “unlawfully”. Multiple governments have tried to evict them, the most recent ploy being their exclusion from the 2018 draft of National Register of Voters. This exclusion has given rise to serious anxieties of losing citizenship and deportation, with many committing suicide due to the fear.

To conclude the author recommends the following policy changes: streamlining the NRC process by bringing accountability and reducing prejudice, making Foreigner Tribunal independent of the government, amendment of Disaster Management Act (2005) to include erosion as a natural calamity and making the development schemes of the area disaster resistant.

By Dinesh Mohan

Dinesh Mohan in this paper observes the social exclusion in transport (public good). A report published by government. of U.K in 2003 stated that problems with transport and the location and delivery of services contribute to social exclusion by preventing people from participating in work or learning and from accessing healthcare, food shopping and other local, social & cultural activities, and that people in deprived communities also suffer the worst effects of road traffic through pollution and pedestrian accidents. There can be a number of reasons of social exclusion due to transport problems, like travel distance, cost of transport, availability and physical accessibility of transport, safety and fear of crime and harassment on the road while walking/bicycling and in buses and metros. These are compounded by the associated problems faced by individuals because of caste and class, religion, gender, age vulnerabilities and discrimination based on physical disabilities.

After 2nd world war, most cities around the world followed CIAM’s prescriptions, which was objected because it would lead to isolation and community breakdown but Planners in India are still obsessed with provision of more and faster means of transport, that divide communities and make walking and bicycling more time consuming, tiring and unattractive and that’s why whenever we think of public transport we only think of buses and metros.

In this chapter, Dinesh Mohan point towards the Modes of travel in India, Indian city structures and social exclusion and its components. The chapter stated that, in the past two decades, vehicle ownership has increased substantially in Indian cities. Delhi has by far the highest ownership levels with 15-20% of Delhi’s families owning a car and about 35% a motorcycle at a very low average per capita income level of about Rs. 50,000 per year. The Census of India 2011 data informs us that for all urban areas combined the proportion of people who reported walking to work was 31 per cent and those cycling 18%. People using buses were reported to be 15% and tempos, taxis, autos 6 %. Women travelling to work constituted only 16 per cent of the total, or there were five times as many men travelling to work in urban areas as women. And the proportion of people spending more than two hours per day in commuting would be: walking-16 percent, bicycle-13 per cent and mechanised modes 12-27 percent. Ideally people should be spending much less than two hours per day on their commute to work. It appears that more than a quarter of people are spending undesirable amounts of time in their commute to work. Exclusion takes place when people are forced not to travel, limit their travel, or spend too much time or money.

Low income groups are also forced to travel long distances in metropolitan cities as many of them are displaced to peripheries of the city in ‘slum clearance’ policies and campaigns promoting ‘world class cities’. Transport accessibility also deteriorated as distance to bus stops increased for 72% of the households and the bus frequency decreased, on average, from 5 minutes to 63 minutes (almost 13 times). The mobility indicators for travel to work – distance, time and cost – increased for 83%, 82% and 61% of the households respectively.

This chapter concludes by highlighting the role of state and some policy recommendations, natural surveillance (lighting in public places, physical activities and people) can help in crime prevention, to introduce efficient bus service in cities subsidized by local revenue generation and low income group allowed to live all over our cities and not displaced to the periphery. But in the case of women, minorities, Dalits, not only technical fixes can work.

By Barbara Harris-White

This chapter by Barbara Harriss-White looks at the life-worlds of most vulnerable workers in the Waste Economy (WE) of a small town in South India, one of India’s 7400. It looks at the diversity of urban waste, waste-work and processes of stigmatised disadvantage, discrimination, exclusion, expulsion and dehumanisation associated with vulnerable workers of both genders in this town. It also examines the informal practices of the local state, its non-policies for waste, its own practices of social exclusion. The paper examines waste-world in this small town through research interviews with government officials, public activism involved in Dalit activism, party politics, legal activism and social movements, in addiiton to about 84 workers in waste management.

Looking at the work experiences of disadvantaged waste-workers, the paper draws profiles and cases from people dealing with infectious health waste, dump-yard workers and women workers. It traces how waste-workers as a whole group face social exclusion and discrimination, ascribed disadvantages as an outcome of their status as birth (scheduled caste or scheduled tribe), and even denial of equal social, political and economic citizenship provided by public goods and services. These discriminations have played out in the everyday lives of this vulnerable group, in terms of stigma faced by the whole community, denial of basic dignity and respect in everyday experiences from the rest of the town citizens. There is workplace discrmination, prevention of children of waste-workers’ access to higher education, denial of housing and land ownership rights and expulsion from public spaces. On the policy and government end, reservations for SC and ST categories in higher posts are not filled, and the informalised nature of this work heightens vulnerabilities. The author, therefore, draws on their field notes, legal and policy research to bring attention to the complete dehumanisation of certain groups in this town based on caste and work, and their perceived status as second-class citizens.

Paaritosh Nath, Usman Jawed Siddiqi, Atul Sood

This chapter of the India Exclusion Report Report examines employment and work for all as a public good, irrespective of one’s social location. This is a public good because, as the authors Atul Sood, Usman Javed and Paaritosh Nath point out, work has a signal importance in modern society for two reasons. One is that it is through work, or employment, that one can acquire the means of sustenance, of material and social reproduction. The second, drawing on critical traditions of social science and philosophy is the understanding that it is through work (or labour more appropriately) that in modern society human beings can find self-realisation. ‘Much of our identity, our sense of self, our relationship with other humans and with the natural world around us is shaped through labour. This is meant not just in an individualistic sense, but in a collective sense and hence has social and political implications.’ The role of the state in job creation is central. Whether jobs are created in the market, or directly by the state, or a combination of both the actual availability of work and its nature and conditions, are all the outcome of the design and implementation of economic policies across a wide range, of the state.