How chronic labour health could undermine India's war on Covid-19

Reverse migration is one side of the story. Workers with chronic ailments residing within States can also pose a risk

Labour as a factor of production is a valuable service rendered by a human agent in the production of goods and services. The outcome is generation of wealth and welfare. In common parlance, the term labour would cover manual and other kinds of services. Even in this day and age of increased automation in the production process, labour remains an important component. In India, the labour market basically constitutes the formal (organised) and informal (unorganised) sector. As per the Economic Survey 2019-20, total formal employment in India increased from eight per cent in 2011-12 to 9.98 per cent in 2017-18. Thus, the informal sector still provides substantial employment.

The lockdown measures to tame the spread of the virus required businesses to close and the undesired resultant outcome that followed was the laying off of workers – and, as a consequence, wide-scale reverse migration. Large-scale stoppage of economic activity and the fear of loss of livelihood, combined with little or no social protection increased the vulnerability of the labour force, especially those employed in the informal sector. Uncertain about their future, they were unwillingly forced to flee to their native place. The plight of migrant workers making their reverse migration to their native states has attracted a lot of attention nation-wide exposing their vulnerability. The economic plight of these migrant workers and their vulnerable health conditions are matters of grave concern. 

Covid and co-morbidity 

The rate at which persons with existing chronic conditions or compromised immune systems have been dying has been observed not only in India, but across the world as well. According to the information from the Ministry of Home Affairs, 70 per cent of Covid-19 fatalities in India were patients with co-morbid conditions. Several studies have also shown that there is very high correlation of co-morbidity with Covid fatality. One such study is by Jing Yang et al titled “Prevalence of co-morbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis” which concluded that underlying disease, including hypertension, respiratory system disease and cardio vascular disease, may be risk factors for severe patients compared with non-severe patients. Taking care of chronic conditions has become critical right now as Covid-19 raises the risk for people with underlying medical issues. 

Why the labour class is susceptible 

In this context the physical health of the labour force is of prime concern, as it affects not only in terms of productivity but also how it plays out in time of pandemics like the current one. To put forth, we analysed the data of the 75th Round of the National Sample Survey Organization (NSSO) on “Household Social Consumption: Health, 2017-18”. Since this particular NSS survey round referred above does not separately collect information on migrant workers with chronic ailments, we cannot specifically comment on its prevalence among them. However, there is no denying the fact that migrant workers are always at a disadvantage position either in terms of income, shelter and their accessibility and affordability to healthcare facilities which make them more prone to chronic diseases. 

The Survey estimated that 3.66 per cent of the total Indian population suffers from some form of chronic ailments. Of this, 9.27 per cent is the labour force working in various public and other types of work. Andhra Pradesh (19.11 per cent), West Bengal (17.07 per cent), Kerala (16.42 per cent), Tamil Nadu (12.43 per cent), Maharashtra (7.21 per cent) and Uttar Pradesh (7.16 per cent) are States where chronic ailments are reported by a larger section of the labour work force. These six States along with Punjab, Orissa, Rajasthan and Madhya Pradesh constituted 91 per cent of the labour work force with chronic ailments. Ironically, as per Government data, around 70 per cent of the India’s Covid-19 cases have been reported from these ten States. Noteworthy is also the fact that at the all India level, almost three-fourths of the labour force with chronic ailments falls in the productive age of 25- 59 years. State-wise, in the age group of 25-years, the range varies between 63 per cent in Punjab and 88 per cent in Rajasthan of labour force with chronic ailments. Since, most of the labour force is engaged in the unorganised and informal sector with little or no social or healthcare protection, it becomes all the more vulnerable.

Figure: Percentage share of labour force with chronic ailment by top ten states

Magnitude of the problem

The wave of reverse migration amid the current pandemic and the fear that they may carry the virus and infect the population in their native state is just one side of the story. Labour force with chronic ailments residing within the States can also pose similar risk in terms of infections and the risk of high fatalities because of their vulnerable health conditions. The challenges posed by the combined effect of reverse migration and wide spread chronic ailments amongst the labour force warrant immediate focus. The option to shield high-risk people by more intensive physical distancing through quarantine measures may be have limited impact. 

The question is how will this determine our future public healthcare policy both in the short run and long run? In the present context of the Covid-19 pandemic, it becomes all the more critical to understand the significance of its impact. States have their task cut off to not only contain the spread of infection that the incoming native worker might carry but also to tame the infection rate of the labour force within the State. 

Till now, the general trend have shown that Covid-19 has comparatively affected the urban and semi urban population more on a wider scale than amongst the rural population. Also we know that majority (more than 82 per cent) of the labour work force resides in rural area only. But with the rise in the reverse migration of workers coupled with the nature of the virus being highly contagious, the risk of its aggressive spreading in the rural areas should be a matter of concern for the healthcare authorities. This get compounded by the fact that the Government have been easing the lockdown and gradually open more economic activities. 

The Covid pandemic and the chronic health conditions of the labour force deserves equal and dedicated attention in terms of public healthcare policy especially in these times when the healthcare systems are already being overwhelmed. The Government would have to delicately balance the critical management of the pandemic considering that a large section of the labour force are chronically ill with the potential of large scale infection and at the same time provide immediate gainful employment. Keeping in mind that approximately 80 percent of the labour force are in the rural areas and the overdependence in the public healthcare facilities which are often inadequate in terms manpower and resources, the States would need to have a relook at their strategies. A robust and coordinated policy, with special attention to the age group of 25-59 age, would be required especially in those States which have a considerable section of their labour force with chronic ailments. We do understand that formulation of a comprehensive and pragmatic healthcare policy is a time consuming process but the need to have one is becoming all the more urgent and critical especially when we are entering ‘Unlock 1.0’. 

(Palash Baruah is Senior Research Analyst, National Council of Applied Economic Research (NCAER), New Delhi. And D L Wankhar is a retired Indian Economic Service Officer. Views and opinions expressed are personal)