Election watch

Gujarat’s model of development has done little to improve health of its people

The state’s health indicators are only middling to poor when compared with other states.

In May, the Indian government told the World Health Organisation that it had confirmed three cases of Zika in Ahmedabad, Gujarat. The first case had been recorded in January by the Union health ministry’s Zika surveillance programme but neither the local health authorities nor the people in neighbourhoods where these cases were detected had been alerted to this. In fact, an official with the Ahmedabad Municipal Corporation told Scroll.in, “We got to know about Zika cases in Ahmedabad after reading about it on the WHO website.”

The episode shows the poor state of preparedness of Gujarat – a “model state”, if India’s government is to be believed – for a possible public health emergency. The state, like many others in India, has also failed to contain outbreaks of seasonal infectious diseases like dengue, chikungunya and swine flu. Gujarat recorded the highest number of swine flu cases this year, and the second-highest number of deaths after Maharashtra.

If the much-touted Gujarat model of development has been a success and is being held up as one for the rest of the country to emulate, then it should not be floundering on a basic parameter like healthcare.

Several experts have pointed out that the Gujarat model is a “classic case of a corporate-led development model facilitated by the state which involves increasing prosperity for the rich, but very little benefit… to the wider population”. This includes reduced political attention to and decreased investments in social sectors like healthcare. As a mill worker student told researchers in 2012: “There are roads, big malls, there are big cars, but if you look at the people, the support that people used to get from the government [before BJP came to power], Narendra Modi has reduced it to half … .they [government] wanted to show that there are no poor people in our state.”

Supporters of the Gujarat style of policymaking argue that living conditions of the wider population would improve in the long term once economic growth is achieved and consolidated. If these benefits have indeed trickled down to the poor, marginalised and rural communities of Gujarat, following splendid industrial and business growth, then the state should by now be among the top performers in social indices. But, it is not.

For example, with respect to the fundamental economic indicator of per capita income, Gujarat is nowhere near the top: among the bigger states, Tamil Nadu, Maharashtra, Kerala, and Karnataka are ahead of it. As for Gujarat’s healthcare performance, it is not model in any sense of the term. While bad performance in a few basic indicators could reflect extraordinary circumstances or problematic statistics, Gujarat shows a consistently poor performance in almost every important health indicator.

The following table displays the 13 most populous states (population more than 30 million, except Andhra Pradesh/Telangana) in terms of their performance in some of the important healthcare indices covered in the National Family Health Survey 2015-’16. Gujarat is nowhere at the top and occasionally at the bottom.

Best to worst performance on health services in India's 13 most populous states.
Best to worst performance on health services in India's 13 most populous states.
Best to worst performance on child health outcomes in 13 most populous states.
Best to worst performance on child health outcomes in 13 most populous states.

The table below looks at four conditions which are commonly associated with poverty and deficient basic healthcare, and again the 13 states are arranged in terms of their performance, best to worst. The data for this table is derived from the recently released India state-level disease burden project.

Best to worst performance on basic healthcare in 13 most populous states.
Best to worst performance on basic healthcare in 13 most populous states.

By failing to draw adequate attention to such failures in healthcare that affect common citizens, the Opposition has perhaps lost an important political opportunity. For example, Gujarat is the only state in India aside from Uttar Pradesh where tuberculosis incidence actually increased over the past decade. More embarrassingly, almost 40% of kids in Gujarat below 5 years of age are stunted. Gujarat has more child stunting than even the poorer states of Odisha and Assam. Gujarat also has the worst record among the large states in immunizing its children, being bettered by even Uttar Pradesh, Bihar, Jharkhand, and Odisha.

A recent report by the Comptroller and Auditor General confirms the presence of the skewed priorities of the Gujarat model and the neglect of people’s healthcare. Following are some excerpts from the report which help us understand what kind of healthcare system a common Gujarati encounters today:

“Availability of beds in DHs [district hospitals] was neither as per IPH standards nor in consonance with the requirements...Audit observed instances of highly congested wards and patients lying on the floor; two patients were accommodated on one bed for transfusion of iron sucrose.... The required stocks of essential drugs such as amoxicillin, diclofenac sodium, Hepatitis B vaccine, injection ceftazimide and insulin were not available for more than four months.. Patients were forced to purchase medicines from the open market… Accident, Emergency and Trauma care services were either not available or were not equipped with essential equipment in test-checked DHs.”

— CAG Report No 2 of 2016 – General and Social Sector Government of Gujarat.

Observers have noted that Gujarat’s social and healthcare indicators are mediocre to poor because Narendra Modi, since he became chief minister, ​diverted government funding for social sectors and development of the poor to the development of big industry: through easy​​ access to land, credit, and infrastructure​, ​as well as tax breaks and subsidies ​for the latter.

Economist Amartya Sen, whose constant warnings that Gujarat should refrain from purely capitalist conceptions of development have never been heeded, says that with the policies of India’s current government, we are the only country in the world trying to become a global economic power with an uneducated and unhealthy labour force. The Gujarat model has failed to substantially improve basic social sector indicators compared to the rest of India and yet the BJP continues to push this substandard model aggressively as a template for the entire country. How Gujarat vote in the upcoming elections will heavily influence India’s future path.

The writer is a medical doctor and health policy graduate, and currently a doctoral student of the history of medicine at Harvard University.

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Swara Bhasker: Sharp objects has to be on the radar of every woman who is tired of being “nice”

The actress weighs in on what she loves about the show.

This article has been written by award-winning actor Swara Bhasker.

All women growing up in India, South Asia, or anywhere in the world frankly; will remember in some form or the other that gentle girlhood admonishing, “Nice girls don’t do that.” I kept recalling that gently reasoned reproach as I watched Sharp Objects (you can catch it on Hotstar Premium). Adapted from the author of Gone Girl, Gillian Flynn’s debut novel Sharp Objects has been directed by Jean-Marc Vallée, who has my heart since he gave us Big Little Lies. It stars the multiple-Oscar nominee Amy Adams, who delivers a searing performance as Camille Preaker; and Patricia Clarkson, who is magnetic as the dominating and dark Adora Crellin. As an actress myself, it felt great to watch a show driven by its female performers.

The series is woven around a troubled, alcohol-dependent, self-harming, female journalist Camille (single and in her thirties incidentally) who returns to the small town of her birth and childhood, Wind Gap, Missouri, to report on two similarly gruesome murders of teenage girls. While the series is a murder mystery, it equally delves into the psychology, not just of the principal characters, but also of the town, and thus a culture as a whole.

There is a lot that impresses in Sharp Objects — the manner in which the storytelling gently unwraps a plot that is dark, disturbing and shocking, the stellar and crafty control that Jean-Marc Vallée exercises on his narrative, the cinematography that is fluid and still manages to suggest that something sinister lurks within Wind Gap, the editing which keeps this narrative languid yet sharp and consistently evokes a haunting sensation.

Sharp Objects is also liberating (apart from its positive performance on Bechdel parameters) as content — for female actors and for audiences in giving us female centric and female driven shows that do not bear the burden of providing either role-models or even uplifting messages. 

Instead, it presents a world where women are dangerous and dysfunctional but very real — a world where women are neither pure victims, nor pure aggressors. A world where they occupy the grey areas, complex and contradictory as agents in a power play, in which they control some reigns too.

But to me personally, and perhaps to many young women viewers across the world, what makes Sharp Objects particularly impactful, perhaps almost poignant, is the manner in which it unravels the whole idea, the culture, the entire psychology of that childhood admonishment “Nice girls don’t do that.” Sharp Objects explores the sinister and dark possibilities of what the corollary of that thinking could be.

“Nice girls don’t do that.”

“Who does?”

“Bad girls.”

“So I’m a bad girl.”

“You shouldn’t be a bad girl.”

“Why not?”

“Bad girls get in trouble.”

“What trouble? What happens to bad girls?”

“Bad things.”

“What bad things?”

“Very bad things.”

“How bad?”

“Terrible!!!”

“Like what?”

“Like….”

A point the show makes early on is that both the victims of the introductory brutal murders were not your typically nice girly-girls. Camille, the traumatised protagonist carrying a burden from her past was herself not a nice girl. Amma, her deceptive half-sister manipulates the nice girl act to defy her controlling mother. But perhaps the most incisive critique on the whole ‘Be a nice girl’ culture, in fact the whole ‘nice’ culture — nice folks, nice manners, nice homes, nice towns — comes in the form of Adora’s character and the manner in which beneath the whole veneer of nice, a whole town is complicit in damning secrets and not-so-nice acts. At one point early on in the show, Adora tells her firstborn Camille, with whom she has a strained relationship (to put it mildly), “I just want things to be nice with us but maybe I don’t know how..” Interestingly it is this very notion of ‘nice’ that becomes the most oppressive and deceptive experience of young Camille, and later Amma’s growing years.

This ‘Culture of Nice’ is in fact the pervasive ‘Culture of Silence’ that women all over the world, particularly in India, are all too familiar with. 

It takes different forms, but always towards the same goal — to silence the not-so-nice details of what the experiences; sometimes intimate experiences of women might be. This Culture of Silence is propagated from the child’s earliest experience of being parented by society in general. Amongst the values that girls receive in our early years — apart from those of being obedient, dutiful, respectful, homely — we also receive the twin headed Chimera in the form of shame and guilt.

“Have some shame!”

“Oh for shame!”

“Shameless!”

“Shameful!”

“Ashamed.”

“Do not bring shame upon…”

Different phrases in different languages, but always with the same implication. Shameful things happen to girls who are not nice and that brings ‘shame’ on the family or everyone associated with the girl. And nice folks do not talk about these things. Nice folks go on as if nothing has happened.

It is this culture of silence that women across the world today, are calling out in many different ways. Whether it is the #MeToo movement or a show like Sharp Objects; or on a lighter and happier note, even a film like Veere Di Wedding punctures this culture of silence, quite simply by refusing to be silenced and saying the not-nice things, or depicting the so called ‘unspeakable’ things that could happen to girls. By talking about the unspeakable, you rob it of the power to shame you; you disallow the ‘Culture of Nice’ to erase your experience. You stand up for yourself and you build your own identity.

And this to me is the most liberating aspect of being an actor, and even just a girl at a time when shows like Sharp Objects and Big Little Lies (another great show on Hotstar Premium), and films like Veere Di Wedding and Anaarkali Of Aarah are being made.

The next time I hear someone say, “Nice girls don’t do that!”, I know what I’m going to say — I don’t give a shit about nice. I’m just a girl! And that’s okay!

Swara is a an award winning actor of the Hindi film industry. Her last few films, including Veere Di Wedding, Anaarkali of Aaraah and Nil Battey Sannata have earned her both critical and commercial success. Swara is an occasional writer of articles and opinion pieces. The occasions are frequent :).

Watch the trailer of Sharp Objects here:

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This article was published by the Scroll marketing team with Swara Bhasker on behalf of Hotstar Premium and not by the Scroll editorial team.