India’s pandemic response needed Ambedkar’s vision of social security and public health

Birds fly over a statue of BR Ambedkar, who is also regarded as the architect of the constitution, on Constitution Day at the Parliament House in New Delhi, on 26 November 2019. Ambedkar’s writing as well as the policies he legislated allows us to see how he might have dealt with the public health crisis and humanitarian crisis that India presently finds itself in. Manish Swarup/AP Photo
24 August, 2020

As the COVID-19 pandemic spread across India in March, the Narendra Modi government imposed the harshest lockdown in the world, exposing and exacerbating the country’s socio-economic inequalities. The pre-existing societal divisions based on caste and class resulted in the marginalised communities suffering the most under the lockdown. Migrant workers were left unemployed, struggling to pay rent, afford medical expenses or buy food. Many were unable to return home. Besides migrants, the lockdown proved to be a period of struggle for farmers, Scheduled Caste and Schedule Tribe communities, as well as women and religious minorities. The Indian government systematically failed to ensure food security, labour security and protection for marginalised communities, besides failing to slow the spread of the pandemic and ensure the equipment or manpower required to treat it efficiently. At such a time, Bhimrao Ambedkar’s ideas on social security and public health are instructive on how the country could have been better prepared to deal with a disease of this scale.

Ambedkar—commonly called Babasaheb within Dalit communities—was perhaps one of South Asia’s most prolific authors when it came to understanding and advocating public policy measures. In his oeuvre of over 20 books, countless speeches and newspaper articles, Babasaheb extensively discussed India’s serious lack of food security, labour security, feeble healthcare system and government apathy towards ensuring the welfare of its poor and marginalised communities. Much of his trenchant critique is as true today as when he wrote it. Babasaheb also enacted a range of welfare policies in his various tenures in government. Collating both Babasaheb’s writing as well as the policies he legislated allows us to see how he might have dealt with the public health crisis and humanitarian crisis that India presently finds itself in. While the full breadth of Babasaheb’s policy studies is not easily explored in a short essay, here I shall look at his food policy, his labour policy and his broader approach to the government’s role in health interventions.

Babasaheb’s ideas on social security and public health sought to address these social realities through state efforts that could help bridge the inequalities that are deeply embedded in Indian society. His idea of a democracy emphasised a state that would intervene to break down structural divisions. His conception of public goods—such as health and education—were inclusive and equitable, seeking an equal distribution of and access to public health and social security, in order to ensure the overall well-being of the masses.

Babasaheb’s idea of the government’s role in public health went beyond building medical infrastructure or advocating particular medical interventions against certain diseases. Babasaheb argued that the state’s role was to improve the social determinants of health such as nutritious food, stable income and access to clean drinking water, the lack of which caused ill health. In addition, Babasaheb argued that the removal of caste and class inequalities in access, not only to medical institutions, but to the determinants of health was an essential responsibility of the state. Health required not just medicines and hospitals, but a grappling with India’s grossly unequal social reality.

In Babasaheb’s writing, state-backed food security was an essential requirement for public health. Even in his earliest writing of comparative economy—such as the tenth volume of the 17-part series, Dr Babasaheb Ambedkar Writings and Speeches—the relationship between food security and public health is fundamental. Babasaheb writes, “Although, through various reasons, including a low birth-rate, the economic condition of the inhabitants of countries like England and America is superior to that obtaining in this country—poverty prevents many of our countrymen from obtaining a nourishing food—still it is far from satisfactory. Even there, many find it difficult to maintain a standard of life necessary for perfect health.”

Food security in his understanding is not an end in itself, but also a tool to end caste-based inequality. “The Depressed Classes have no economic independence in most parts of the Presidency,” he writes. “Some cultivate the lands of the orthodox classes as their tenants at will. Others live on their earnings as farm labourers employed by the orthodox classes and the rest subsist on the food or grain given to them by the orthodox classes in lieu of service rendered to them as village servants.” In Babasaheb’s understanding, inequality in itself worsens the public health capabilities of a nation.

In July 1942, Babasaheb was appointed as the member for labour in the Viceroy’s Executive Council—the cabinet of the government of British India. During this tenure, Babasaheb was able to formalise and execute the food security policies he had written about. The tenth volume of Babasaheb’s collected speeches and writings describes the multiple visits he made to the Jharia coalfields and industries in Dhanbad, both in present day Jharkhand, where he ensured that boards were set up that would universalise subsidised grain for workers and even ensure that workers were members of these boards. He set up central food advisory committees for each state in which workers were put into decision making positions. As member for labour, he also urged the British government to set up free labour canteens in every industrial cluster in the presidencies.

Seventy-eight years later—amid a pandemic—India’s food security system seems worse than the one Babasaheb wrote about. Since the announcement of the lockdown, widespread hunger was reported, including several hunger deaths. The public distribution system failed at providing a safety net both in urban and rural India. This failure in food security also particularly affected SC and ST communities. According to an extensive survey of migrant workers conducted by ActionAid—an international NGO working against poverty—only a sixth of respondents said that their food consumption was “sufficient.” During the lockdown, only 63 percent of those surveyed said they were eating at least two meals a day.

Babasaheb also argued that a robust system of labour security was essential for the growth of public health. Across his writing, he asserts the role of the state in ensuring safe work conditions, fair wages and employment protection for workers. In 1938, during a debate on the Industrial Disputes Bill in the Bombay legislature, a law that set up Industrial courts and banned strikes, Babasaheb said, “A democracy which enslaves the working class, a class which is devoid of education, which is devoid of the means of life, which is devoid of any power of organisation, … I submit, is no democracy but a mockery of democracy.” In the same debate, he concluded, “Real equality between employers and employees can be brought about only by incorporating these two provisions. The employer must be compelled to disclose his budget and the government must cease to use the police force against the workers merely because there is breach of peace. Without this there can be no equality between capital and labour as to bargaining power.”

Babasaheb saw the state’s role as essential for the maintenance of a healthy workforce. As recorded in the tenth volume of his writings and speeches, when he was the labour member in the viceroy’s council, Babasaheb emphasised that “if Government was to help the industry it would not allow the industry to exploit labour.” He added that “labour must be assured a living wage, fair conditions of employment and general welfare, in the interest of maintaining Labour Welfare.” In his tenth volume Babasaheb argued for a state backed life insurance scheme which would be given to all industrial and agricultural workers.

During his various tenures in office Babasaheb passed a slew of labour reforms that are still active today. It was Babasaheb who instituted the eight-hour work day in India, as well as dearness allowances, labour welfare funds, revisions of scales of pay for employees, leave benefits for workers and a minimum wage. Babasaheb set up the first employees state insurance, a social security and health insurance scheme for workers, in South Asia. Further, he passed The Indian Trade Union (Amendment) Bill of 1943 which called for the compulsory recognition of trade unions by the government. The legal framework for strikes used till today was formulated by Babasaheb. He also passed a range of laws protecting female workers including the Women and Child Labour Protection Act, the Maternity Benefits Act, the Mines Maternity Benefits Act and created the Women Labour Welfare Fund, which was used to safeguard the health and safety of working women.

Since Babasaheb passed these laws, the lack of labour security is perhaps more pronounced now, during the pandemic, than ever before. According to the ActionAid survey, 81 percent of migrant workers reported losing their jobs during the lockdown. In April, the Centre for Monitoring the Indian Economy—an economic analysis think tank—said that India’s unemployment rate had reached a record 23.5 percent. Migrant and informal workers were the hardest hit, with no access to food, and many thrown out of their only shelter.

The lockdown economic crisis has exposed the precarity endemic to the lives of informal labourers. The informal job market in India is overwhelmingly populated by the oppressed castes. Their labour is not only underpaid and unregulated, but also carries a deeply rooted caste stigma. Most government policies fail to address the social security of workers in the informal sector. These workers thus carry the double burden of caste and class, and are met with spectacular violence when they try to speak up for their rights.

The exploitation of rural labour, particularly from Dalit communities, has increased too. State government welfare boards for construction workers have completely failed to provide labour security or even basic welfare measures for them. Meanwhile, industrialists and employers have gone on to make demands that are reminiscent of the now illegal bonded labour system, such as opposing the right of workers to return home during the pandemic. The government of India has several health-insurance schemes for poor and daily-wage labourers, all of which look lofty on their website, but are not reaching their intended beneficiaries. A survey, by the online news portal IndiaSpend, found that over 90 percent of sanitation workers in the country, who come almost exclusively from the Dalit community, lacked any form of health insurance.

Rather than strengthen labour laws to help workers during the pandemic, several state governments diluted them. On 8 May, the government of Uttar Pradesh passed the Uttar Pradesh Temporary Exemption from Certain Labour Laws Ordinance, 2020. The ordinance exempted all businesses, factories and other establishments from nearly every labour law, such as the Minimum Wages Act, Trade Unions Act, Industrial Disputes Act, and Contract Labour Act. On 10 May, the government of Madhya Pradesh also passed a similar ordinance diluting a range of labour laws.

India’s failure to address labour concerns is tied to its inability to recognise the migrant workers’ right to respect and dignity of their labour. In 1945, during a discussion with the constitution of National Service Labour Tribunals to train personnel for efforts in the Second World War, Babasaheb wrote, “Whatever the pressure from employers, the war emergency should not be the occasion for deteriorating labour conditions or lowering the dignity of labour.” Babasaheb had also frequently argued that the question of the dignity of labour was inseparable from the necessity to annihilate caste. The labour classes are stridden by casteism. Their work is either inadequately paid, respected or recognised. Labour, caste and social status are inseparable, with the work of twice-born sections respected by birth, and that of the working castes treated with contempt.

Alongside advocating the increase of access to subsidised food, clean water, safe and fair employment and housing, Babasaheb also spoke about the need for better funding into the medical system. In November 1945, speaking at the seventh Indian Labour Conference, Babasaheb spoke about government spending in defence which could have been allocated to public welfare. He said:

Labour may well ask statesmen to say how many houseless persons could have been decently housed, how many naked persons could have been properly clothed, how many hungry men and women could have been given full nourishment, how many uneducated persons could have been educated, how many sick persons could have been restored to health, if the money spent on war had been spent on public welfare? Labour may ask monied classes a very pertinent question saying, if you do not mind paying taxes to meet expenditure on war, why do you object to raising funds when their purpose is to raise labour standards?  

In 1938, as a member of the Bombay legislature, Babasaheb addressed the house to increase expenditure on public health infrastructure:

The total expenditure this Province incurs on public health is a paltry sum of Rs 31,48,000. It works out at the rate of 25 percent on our total expenditure. Now, Sir, village water supply is a crying need; there are hundreds of villages which have no water supply at all. Anyone who goes to the villages will mark that every village in this Province is nothing else but a dung heap. It is a misnomer to call it a village, it is a misnomer to call it a place fit for human habitation. The improvement of the insanitary condition and the abomination that exist in villages is certainly the crying need of our Province. Hundreds of people are dying from malaria, are dying from all sorts of diseases. There are hardly any dispensaries. There is hardly any provision made for distribution of medicine or medical treatment.

India’s present situation is not very different from the one Babasaheb describes. In the financial year 2019–20, the centre and the states spent a mere 1.29 percent of India’s gross domestic product on healthcare—far lesser than international counterparts such as Afghanistan which spends 11.78 percent or Brazil at 9.47 percent, according to the World Bank factbook.

Now more than ever, Babasaheb’s policies in ensuring public health must be protected and enacted. Interpreting his broader idea of social security, health care should be a fundamental part of human rights, not just for those privileged who can afford it. The government must provide health insurance to its citizens as matter of universal public policy. In particular, those living below the poverty line should be the first beneficiaries of insurance. No one should be left out and money should not be the reason they lack the heath care they deserve. The government should be held accountable and answerable to the public. This sort of basic social security should be non-negotiable in a democracy.