Caring about air

At what point will we start caring about the quality of our air? I used to imagine that almost the only lever left with which to drive Indian government policy in any positive direction was the threat of national humiliation in the eyes of the world. But the national capital, and large swathes of the country, are now widely known as having poisoned air and it looks increasingly likely to become a comic stereotype for India — as if we didn’t already have enough of those — and yet it does not seem, that we are moving swiftly enough to deal with the problem. 

I take almost for granted the notion that a massive public health crisis will not in and of itself cause the Indian state to make necessary changes. But the very fact that India is failing to deal with air that significantly harms people, especially children, and that causes people to think twice about visiting the nation’s capital, suggests that as a democracy ours is broken in some fundamental way. I do not approve of comparisons to the People’s Republic of China in general, but in this case the difference is truly troubling. When the air in Beijing and some other Chinese cities was a fraction as bad as in India’s it became the focus of citizen anger and even the authoritarian government was forced to respond. Yes, because of the nature of the Chinese state its response was naturally more effective. But it nevertheless demonstrated greater responsiveness and co-ordination between different power centres. That has been notably missing in the Indian case. 

There is a larger question here about health and politics that we must engage with. Why is it that public health in general is rarely high on the list of what Indian voters care about? We know that it matters greatly in their personal lives. The cost of healthcare is the number one reason for people falling back into poverty if they have managed to somehow scrape their way above the poverty line. You only have to take one trip to a publicly-run hospital in one of India’s poorer states in order to realise first, that the conditions are awful, and second, that people are far from satisfied about it. Frequently, hapless healthcare professionals have to face mob anger and even violence from a dissatisfied public. But that does not translate into healthcare being an issue at election time. 

Yes, the Aam Aadmi Party is hoping that things will be different in the coming Delhi elections. It is worth considering for a moment how much the party has transformed itself from an anti-corruption insurgent into a regional party that has sought to create a new template for the provision of public goods — not unlike other regional parties in other parts of the country. Because this is Delhi, however, which has the advantages of relative affluence and manageability over many other states, the public goods it has been able to carve out an identity around are education and health. The question is whether its performance has been distinctive enough and its narrative around the subject emphatic enough to convince voters that have not traditionally voted around issues such as healthcare and education. 

Overall, however, it is dismayingly clear that issues such as healthcare will only become publicly identified as government responsibilities with electoral salience if politicians themselves take responsibility for them first. The template here, I feel, is sanitation. There too — since at least the Mother India controversy that so irked Mahatma Gandhi —  India has had a globally poor reputation. There too, the negative effects on public health were high. But till central governments took responsibility for the problem, first through the Nirmal Bharat programme of the United Progressive Alliance and then, with far greater political resonance, through the Swachh Bharat Abhiyan of Narendra Modi, it seemed to be something that voters did not care to hold politicians accountable for. 

We therefore must hope for a similar template to take hold in healthcare. If the AAP goes to the people talking about healthcare, and the Bharatiya Janata Party is forced to respond by claiming that AAP’s delivery has been insufficiently effective and that it will do a better job, then that at least might set up a virtuous cycle for politics going forward. What one must hope for now is that this is replicated somehow at the national level. We need to start talking about the successes and failures of the new universal healthcare programme, and whether it is being genuinely effective. If “Modicare” becomes a talisman for the prime minister’s second term, then perhaps a similar virtuous cycle could take hold at the national level. 

But, even if hospitalisation costs are perhaps on the verge of getting on the national agenda, it is also clear that very few want to take responsibility for air pollution. Naturally the Delhi Chief Minister has to talk about it, but that’s not enough. Until public anger across states is stark and unmistakable, it is difficult to see how the problem will be seriously tackled. And the fact is that, in spite of red eyes and sore throats across north India, we’re not there yet.