Don’t ignore urban-rural links

The economic and lifestyle changes of the past three decades mean that rural and urban economies and lives have become increasingly intertwined. As the world is facing a global pandemic we can only hope that India will not have to regret the fact that we had not gone into a more extensive shut-down at a larger scale earlier on.

The impact of the current pandemic is different because it is a problem that, in the first phase, has struck cities that tend to have greater global linkages. The next phase is likely to be the most worrisome. The nature of our economic linkages means that once the pandemic reaches the inevitable community transmission stage in India, its ramifications may be disastrous for a country of more than 1.3 billion people.

Factors of large scale transmission

It is well known that millions live in our teeming cities. But, what is often overlooked is that many millions visit these cities on a daily basis for their economic needs. Invariably, India’s large cities (like our seven megacities) have multiple entry and exit points through which millions of migrant and daily wage workers living in neighbouring areas enter and exit on a daily basis. The distances travelled varies and is directly correlated to the transportation facilities available, size of the urban centre, geographic location and available opportunities.

The case of Bengaluru city itself is illustrative-- thousands of workers travel from Andhra Pradesh to work as daily wagers or lower-level employees. This excludes the many thousands who come to such large cities to sell their produce due to the better price discovery possibilities in such large markets – like the flower growers from Chittoor district of Andhra Pradesh who sell their produce in Bengaluru’s City market and return after completion of the task. Additionally, large cities host innumerable migratory workers who may have relocated on a longer-term basis from villages for economic reasons. It is common for such residents to visit their homes for either social occasions, festivals, or other reasons.

As our economy has grown, it is now impossible to live in islands of isolated self-sufficient village economies. The reality of non-metro life is such that the visits vary and depend on the economic purpose as well as the cost of goods to be purchased. In short, any transmission can happen both ways with one feeding on the other.

Poor health infrastructure

It is an understatement that India’s healthcare infrastructure is bad. As per government records, India’s government health service infrastructure consists of 1,58,417 sub-centres, 25,743 Primary Health Centres and 5624 Community Health Centres and a total of 25,778 government hospitals apart from 122 Railway and 155 ESI hospitals at the end of March 2018 with a cumulative capacity of about 7.5 lakh beds. Given the poor state of rural healthcare infrastructure, visits to hospitals from rural areas tend to be across different areas – beginning with the nearest small town and culminating in a visit to the district hospital or large hospitals in cities, thereby leaving a footprint and even transmission across large areas. NSSO data shows that in India 46% people in rural areas use government hospitals of which about 45% related to infections and respiratory problems.

Considering the poor state of preparedness, economic linkages and the magnitude of the problem, it may be more prudent for citizens and governments, both Centre and those in states, to wake up to the reality that social distancing, self-isolation are good theoretical concepts but may be impractical in a country where only about 10% live in houses with more than three rooms.

(The writer is an Independent Researcher based in Andhra Pradesh)