Sabina Yasmin Rahman. Health Sociology Review. Volume 29, Issue 2. 2020.
Introduction
What the novel coronavirus does to our delicately balanced bodies and sense of health, the COVID-19 pandemic has wrought to our fragile human existence. It infiltrates our unsuspecting systems, slowly undoing every supposed solution that we may have put in place as a modern society. It belies our every effort to institutionalise values that we, as communities, may have deemed worthy of striving for. By exposing the vulnerabilities of our systems in more than one way, the pandemic also makes a mockery of the standards that we regularly employ to measure our successes or advances as a civil society. In the context of India, we had all the early signs to pause and recalibrate: whether it was our electoral system crumbling or democracy turning rogue as we elected a majoritarian Hindu supremacist leader to the head of the state—not once, but twice. In recent times, India has witnessed a sharp rise in social inequities and economic precarity with the unemployment rate reportedly at its highest in four decades (Jha, 2019), and discontent and public outrage ensuing state repression escalated with every new piece of legislation (Agrawal & Salam, 2019). Yet the Indian government, when not obfuscating, directed its resources at more aggressive handling of risks rather than looking for truly viable and sustainable alternatives.
This article explores the scope of ‘social distancing’ in the Indian context, and how social realities unique to that country enrich the metaphors used for pandemic-time politics. Further, by employing Turner’s (1992) notion of somatic society, the article seeks to analyse how the broader social dysfunctions of the Indian society continue to operate, impacting public health responses and mitigation strategies adopted by the state. Far from trying to achieve any form of social solidarity, under the strain of the current global health crisis India exemplifies at a societal level what the coronavirus (SARS-CoV-2) is to an infected individual at the level of their physiology.
New Infectious Disease as a Threat to Social Order
According to Strong (1990), the immediate public reaction to new epidemics is marked by ‘fear, panic, stigma, moralising and calls to action … Societies are caught up in an extraordinary emotional maelstrom which seems, at least for a time, to be beyond one’s immediate control’ (p. 249). Turner (2008) posits that even as mainstream sociology today has largely moved away from its earlier more causal relationship between social and natural phenomena, as a discipline we are still somewhat influenced by legacy of philosophical anthropology that views humans as deficient beings characterised by ‘instinctual deprivation’; that is,
They have no finite or specific instinctual equipment to a given environment, and require a long period of education in order to adapt themselves to the social world. This state of incompleteness compels them to become creatures of discipline […]. (Turner, 2008, p. 9)
It is not surprising therefore that such a notion would put social institutions at the very core of human existence and societal functioning. The emergence of SARS-CoV-2 towards the latter part of 2019 however presented a new threat to social order, disrupting the universe of familiar risks and management strategies and forcing societies to shape social and political responses to different aspects affected by the epidemic in ways that could restore a semblance of certainty and enable action.
Institutions in Indian society seem to be grappling with the challenge of devising practical action, as the country undergoes its fifth extension of nationwide lockdown. While the Indian economy is seen to be gradually opening up, the public healthcare continues to crumble under the weight of ‘highest single-day spike’ in COVID-19 cases every day.
Even as the Indian government declared the COVID crisis as a national disaster, it fell short of displaying necessary administrative tact and wisdom to aid infectious disease prevention; so much so that the Prime Minister’s theatrics in the face of the ongoing human tragedy have repeatedly drawn widespread criticism locally and internationally (Bardhan, 2020). Barring a few exceptions, at best, India’s response to the pandemic has largely been unplanned and experimental: at worst, it has been violent, stigmatising and fatal. India is perhaps one of the countries that is currently furthest away from achieving the WHO’s Sustainable Development Goal (SDG)-3 that seeks to ‘Ensure healthy lives and promote wellbeing for all at all ages’. Modi government’s use of coercion to cover up for poor planning and preparedness has further compounded the existing social inequalities of caste, class, religion, race/ethnicity and gender of our society. India is extremely heterogeneous, not merely by fact of an accident, but also by design (Kumar, 2008). Such an arrangement is fixed largely on the basis of social location at birth, which ensures that certain communities—such as the Mainland Indian upper caste elite—are allowed to thrive at the cost of other oppressed identities, who are expected to perpetually succumb or accept oppression as their natural predicament. Thus, while at a surface-level we hear of policymakers calling for unprecedented action to mitigate an unprecedented emergency, at closer scrutiny the government responses often seem to reproduce the familiar patterns of conflict over resources and access to power, with the privileged accumulating maximum benefits.
Within days of announcing a nationwide lockdown to enable social distancing norms, India saw a series of assaults on its poor as well as religious and racial/ethnic minorities. Indian economists lamented the lack of planned action and globally coordinated strategy. According to Ghosh (2020), the inefficient and repressive response of the state was at the root of acute economic distress facing the urban migrant poor that transformed into a simultaneous humanitarian crisis alongside the pandemic. India’s social distancing measures have been brutally top-down and draconian from the very start. A total lockdown began on 24 March 2020, when COVID-19 crisis was declared as a national emergency. The sudden lockdown brought everything to a grinding and indefinite halt, and people were not sufficiently prepared for it. It has led to untold miseries in the lives of the daily-wage earners who were stranded without a means of subsistence as the economy came to a standstill. The lockdown also left young students and professionals working away from home utterly without support.
At this point, virus testing was still extremely low and the numbers unreliable. The poor seeking to carry out their livelihoods in the absence of a comprehensive and immediately accessible economic relief package to enable social distancing became the first targets of police brutality. By the month of May, India reported over 300 cases of death of migrants trying to return on foot to their home villages, thousands of kilometres away. The return of migrants also carried the risk of community spread that could overwhelm the limited health services in their respective states. Most states went back and forth on the issue of opening up state borders and making essential transit possible, thereby, further protracting this humanitarian emergency. Appalled by the government’s callous response, experts and activists called upon the state to announce financial relief packages to ensure food security and self-quarantining for all.
Public Health Infrastructure and COVID-19: The Indian Chapter
In the wake of the COVID-19 pandemic, public health authorities in India presented a contradictory picture between their role in assisting the state to mitigate the global crisis and dealing coercively with the needs of its diverse populations. The public health system in India is poorly managed and under-funded. Regional disparity between states, urban-rural, and access to quality healthcare between the rich and the poor all pose serious difficulties to nationwide containment of infectious diseases (Narain, 2016). By mid-June, with its death toll nearing 10,000, India’s caseload ranked fourth highest in the world with over 343,091 confirmed cases, preceded only by Russia, Brazil, and the United States. The rate of testing in India even now is far from ideal and the country is inching towards becoming the COVID nightmare that experts had warned about. Given the generally dilapidated state of public healthcare that sees less than 1 per cent of the country’s GDP spending—lower than neighbouring states of Bhutan (2.5%), Nepal (1.1%) and Sri Lanka (1.6%)—unavailability of resources among large swathes of our population to enable social distancing, and the reverse migration to the villages threaten to set Indian economy back by decades (Nair, 2020).
Moreover, among those confirmed positive or kept under observation, there have been several instances of patients fleeing isolation wards in government hospitals. Chetterje (2020) has identified one of the primary reasons for people escaping hospitals and quarantine facilities to be trust deficit in the public healthcare in many parts of the country. Other factors include fear of isolation and stigma. One of the ways in which experts opine that the trust deficit could be reversed is by increasing expenditure in the public health sector and focusing efforts on infectious disease surveillance and timely detection, and countering stigma through thoughtful messaging. In India, the communist state of Kerala has drawn on its experience from the 2018 Nipah virus outbreak and emerged as an effective model for quality healthcare during this pandemic. With extensive testing, contact tracing, and community mobilisation towards containment and maintaining a very low mortality rate, it has set an example for preparedness and successful emergency response to COVID-19 at state-level for others in the country to follow.
Metaphors of Exclusion: Social Distancing Exposes Enduring Inequities
The Indian experience illustrates how, even during a pandemic, ‘social distancing’ is not an apolitical notion. It becomes a measure for the state to co-opt scientific interventions of risk mitigation and relay them to people as a metaphor for exclusion, thereby exacerbating deeper structural inequities around which access to health and wellbeing of the population is organised. There were at least three distinct events that speak volumes about India’s many social problems, emanating from its underlying caste- and colourism-based patriarchal structural arrangement, which is easily also its most enduring epidemic. The manner in which the Indian state responded to the targeted communities on the eve of the nationwide lockdown gives us a fair idea that the crisis has caused lasting damage to elements that facilitate social solidarity and cohesion.
The first, and certainly the worst incident, that raises grave concerns about Indian government’s priorities during the handling of the global health crisis, was the Tablighi Jamaat congregation at the Nizamuddin Markaz. Religious congregations, not explicitly banned at this point, were still taking place with permissions from the police or other relevant authorities. The Tablighi Jamaat’s international conference that was held in New Delhi’s Nizamuddin was declared the first ‘super-spreader’ in India, infecting over 400 people (Slater, Masih, & Irfan, 2020). However, the anti-Muslim bigotry that is the core of the ruling party [and its supporters’] politics ensured that the incident was also blown out of proportion, targeting Muslims across the country. The ensuing hate crimes and stigmatising discourse allowed the government to distract public attention from its failures in disaster planning and preparation. It was evident that the pro-Hindu right wing government was more than willing to capitalise on any occasion to further entrench existing social divides and polarise public on religious lines for political gains even as the world reeled under the pressure of the virus.
The pandemic has also witnessed the use of fake news to fan anti-Muslim sentiment and violence. According to The Lancet (2020), a major threat to the COVID-19 response in India is ‘the spread of misinformation driven by fear, stigma, and blame’. A collection of 400 scientists voluntarily came together to form the Indian Scientists’ Response to COVID-19 (ISRC), with the aim to counter such widespread disinformation, which was threatening to tear into bits the very delicate fabric of Indian society. At a time of an epidemic when self-preserving instincts are high and social relations are strained due to unnatural scarcity, fear and anxiety, India’s fake news industry was doing its best to pit vulnerable communities against each other and spread the politics of hate and target violence at those that it constructs as the ‘Other’. After about two days of running vicious social media campaign against the Jamaat attendees with anti-Muslim slurs—‘human corona bombs’, ‘coronajihad’—and humiliating Muslims, the government backed elements created a divisive atmosphere that allowed blame for lack of action and failed mitigation to be deflected unto Muslim bodies that needed medical attention.
The second, equally disturbing trend that emerged in parallel with the global anti-Asian and anti-Chinese sentiments, was racism against migrant communities from the Northeastern (NE) region in Mainland India. While Northeast Indians are routinely perceived as foreigners—usually Chinese—and subjected to derogatory name-calling, now they were being called ‘corona’ (Kipgen, 2020). This community—mostly constituting of students, professionals and service industry workers—have historically been at the receiving end of racist discrimination in Mainland India, owing to their phenotypic features and distinct lifestyles and culture. Ahead of the formal imposition of the lockdown, people from the NE region in metropolitan cities were already facing discriminatory attacks and unprovoked violence by housing societies, but also, from complete strangers. Not that being Chinese would ever make racism any more justifiable or less condemnable, but there is a need to underline such racism in India has until today barely received any academic attention. The pandemic responses of the larger Indian society unwittingly point towards the glaring gaps in our socialisation processes that have enabled systematic exclusion of certain demographics from the purview of mainstream schemes of knowing. Once the lockdown was imposed unilaterally, reports started emerging online about how NE students and migrants were denied entry inside grocery stores in various cities because these were meant only for ‘Indians’. Politically, however, this attitude is rather consistent with the structural neglect and military oppression that NE tribes and indigenous communities have lived with ever since India was constituted into a modern republic.
Finally, the most heart-wrenching aspect of the pandemic, which has caused maximum preventable deaths outside of COVID, is the plight of poor rural migrants who constitute the larger chunk of the unorganised sector. Despite being the backbone of the Indian economy, the majority of workers in this sector are often temporary, with employers bearing minimum liability towards their welfare or social security. Most of these individuals live on a hand-to-mouth basis in cities with inadequate housing or food security. This social crisis was worsened due to different parties trying to score political points, and states issuing conflicting protocols regarding movement of migrants across inter-state borders. The lockdowns and the prospect of being exposed to virus when away from home indefinitely resulted in panic and uncertainty that forced thousands to set on their homeward journey on foot in the absence of any other means of transport. Indian cities and industrial towns suddenly saw thousands of migrants appear on the streets demanding to be allowed to go home. They are otherwise the invisible bodies that keep the wheels of the urban India economy turning.
The other related, but hitherto largely unaddressed demographic, is that of the begging and homeless population. They too form an inevitable part of the urban Indian landscape, so much so that they are indeed part of the clichéd metropolitan experience of the Global South. The begging and homeless communities of our cities occupy that ironic space in our imagination where they are simultaneously the most ostensible and invisibilised of city dwellers. The pauperisation of daily wage earners is an everyday phenomenon in Indian cities, and begging communities live at high risk of violence (Rahman, 2019) and disease with or without a pandemic (Rimawi, Mirdamadi, & John, 2014). Unlike the privileged tourists—the ‘frequent flyers’—who are the carriers of the virus, the fluid nature of the migrant poor of our cities is a sign of structural inequality and their ability to conform to social distancing norms is subject to the state recognising how socioeconomic vulnerability impacts personal agency. However, the neglect with which this community has been treated and the manner in which the poor have been exposed to the state repressive apparatus for no fault of their own during the pandemic has become a prime example of how public health in India has failed to engage with the social context underpinning disease prevention.
Instead, in unleashing its most mechanical form of control on its vulnerable citizens, the Indian state seemed to be suggesting that its real interest lay in surveillance: to discipline and produce docile bodies, meaningful only as long as they continued to be a productive resource for the neoliberal state. The body in any other way embodied resistance and presented a threat to the rationality of the state. Further, one sees in the use of coercion to deal with state failure in adequately responding to the COVID crisis what Goffman (1959) explained by way of using the body metaphor of saving/not losing ‘face’. The fact that being unsheltered and exposed during a lockdown in an extremely unequal state makes one the target of disproportionate police brutality, points to the grimmer reality of how ‘social distancing’ could easily serve up as a metaphor for a punitive politics of disciplining and exclusion of ‘unruly’ bodies.
Cautioning against the usage of the term ‘social distancing’, noted Ambedkarite scholar and Indian sociologist Kumar (cited in Prakash, 2020) says: ‘Social distancing in India was maintained during birth, death and menstruation. Social distance is the totality of interactional distancing barring all cultural and physical engagements’. Caste, present to a varied degree across the country, is undoubtedly the oldest disease that legitimises the practice of physical and social distancing or ‘untouchability’ against the Dalit community in India. Casteism, although a phenomenon distinct from racism, often comes with overtones of colourism and racism as well. The Tablighi Jamaat, as the caricatured representation of all Muslims, became the embodiment of the national enemy—especially so during a national disaster—the ultimate threat to majoritarian social solidarity, and thereby, the virus itself. Interestingly, the process of construction of the enemy on each occasion involved regulation of the bodies of those deemed to be the Other. Thus, the spike in cases of hate crimes and the sense of purity/pollution associated with caste often overlapped with the non-pharmaceutical interventions to contain the infectious disease. Moreover, these complexities made prescribed socially responsible behaviour a luxury for millions of structurally disadvantaged people in India.
Public Health is Political: Regulating Bodies during a Pandemic
Conventionally, public health is viewed as an evidence-based profession above politics. Yet national response to COVID reveals the embeddedness of health and illnesses in the larger politics of the state. According to Brown (2013, p. 10), public health is not only a unique skill-based profession, but also one ‘which implies contemplation of its mission in broader frames, including the political’. As a field, it must continually renew itself by meaningfully engaging with social determinants that shape notions of health—such as, income distribution, housing, employment and social inclusion—and include welfare agendas of that state, which may occupy administrative and conceptual arenas distinct from healthcare. Further, Brown argues that health policies are an amalgam of technical knowledge and politics; that is, it is not merely a product of scientific evidence, but also requires familiarity with policymaking that enables instituting a goal/output-driven approach.
There have been many instances of people speaking of COVID as a great leveller, claiming that the virus makes no distinction between the rich and the poor: everyone is in this together. However, such views refuse to acknowledge how structural inequities play a greater role in determining not just susceptibility to the virus, but also chances of recovery based to people having control over their own bodies or sense of wellness. One of the major factors that impact the health of the society is health policy and politics that govern the factors as to who is able to gain access to what health resources and when (Amzat & Razum, 2014). In the light of the fact that not all bodies are capable of exercising agency in the same way, or how manifestation of our comorbidities too may be structural, the generalisation of the virus being a leveller appears to be a flawed one, and less than benign in retrospect. Nor does it reflect Beck’s (1992) understanding of ‘new international inequalities’ in the risk society:
The extreme international inequalities and the interconnections of the world markets move the poor neighborhoods in the peripheral countries to the doorsteps of the rich industrial centers. They become the breeding grounds of an international contamination, which—like the infectious diseases of the poor in the cramped medieval cities—does not spare even the wealthy neighborhoods of the world community … Inequalities in class and risk society can therefore overlap and condition one another: the latter can produce the former. (Beck, 1992, p. 44)
Hence, under the current circumstances it may be meaningful to remind ourselves that we have always inhabited a somatic society. From this perspective, human societies are ‘structured around regulating bodies’ (Turner, 1992, pp. 12-13). Our understanding of social health and well-being of the society is deeply intertwined with, and derived to a large extent from, notions of health and pathology centred around the human physiology—often that of an abled-bodied cis-heterosexual man—with its power to harness and dominate surrounding environment for the purpose of human survival and progress. Dingwall, Hoffman, and Staniland (2012) alerts readers to the very nature of pandemics and emerging diseases which effectively disarms societies by exposing them to instability and precarity, thereby, forcing them to lay bare all opaque social systems that are ordinarily beyond the scope of investigation. Herein also lies the scope to redefine public health agendas:
As societies respond to these challenges, features that we have taken for granted suddenly become transparent. For a moment, our own world can become anthropologically strange. This is at the core of the contribution made by the sociological imagination to policy and practice, of understanding how social arrangements can, and must, change when biological environments change. (Dingwall et al., 2012, p. 167)
Even though the risk of coronavirus emerges from the more privileged among mobile bodies having access to multiple continents and time-zones, the overwhelming number of bodies exposed to the risk of contracting the virus are the pauperised migrants and urban poor whose mobility is aggressively contained by the state ideological and repressive apparatuses. The leveller hypothesis fails to reckon with the reality that ultimately the rich are able to project the fallout of exercising privilege onto marginalised bodies, who often come to represent the parasitic by no fault of their own. These bodies have become dispensable during this crisis in much the same way as the individuals living with comorbidities, who despite being more vulnerable are not the focus of COVID therapies.
The public health challenge that India currently faces, therefore, is to be able to prevent the state response to the pandemic from devolving into mechanisms of coercion and control that consolidate structural inequities and become metaphors of social exclusion. Further, recognising the underlying scheme of a somatic society allows us as sociologists to analyse public health as yet another framework for the state to regulate citizens’ bodies as it deems fit. A successful health policy would therefore require the state to overcome its repressive tendencies and structural bias to be able to cater to the health and welfare needs of its most invisibilised subjects.