Financial Crisis, Mental Health and ...

The current financial meltdown, with its epicenter in the United States, has been having serious global repercussions. The 30-share sensitive index (Sensex) of the Bombay Stock Exchange which had peaked to 21,206.77 in January 10, 2008 has fallen to 7,697.39 at 1330 hours before stabilizing at 8509.56 by the end of the day on October 27, 2008. On the eve of Diwali (October 28, 2008), this belies hope.

This will have serious implications on the mental health of the population. Particularly so, for those directly involved in the financial/stock market. There are already indications that sale of over-the-counter anti-depressants have increased. A possible fallout is increase in incidence of self-harm (suicides). The earlier East Asian Crisis and earlier financial crisis are witness to such occurrences. In India, as well as elsewhere, the public health system, the medical fraternity (particularly Psychiatrists) and other civil society groups like The Samaritans, Mumbai. Sooner or later such incidences would come to the media's notice. Before reporting, they should have a look at the World Health Organization's Preventing Suicides: A resource for Media Persons.

True, despite the unprecedented fall in the Sensex, the levels are still around what was reigning in October 2005. Some say, the correction was necessary, as the higher levels was more on account of an hype in the financial sector, rather than being in sync with good fundamentals in the real sector. It is the unregulated greed that has led to this situation.

A question that comes to mind is why such a fall would be associated with mental health leading to self-harm. An anecdote cited in some discussions on farmers' suicides would help. A farmer while comparing his situation to that of a labourer indicated that the latter has been living under dire circumstances, and of course needs attention, but our situation is akin to a fall in level. Recourse to self-harm is complex and multifaceted. But, if reductions in level is one of the risk factors then this is definitely the case with the current financial crisis.

It is also worth mentioning that the current financial crisis, the ethnic strife that one sees within the country as also elsewhere in the world, and the larger agrarian crisis which manifested in a food crisis globally are not independent occurrences. They are part of the larger scheme of things, which as some commentators say, involves displacement of people as well as displacement of ideas.

The agrarian/food crisis and the ethnic strife do reflect that something is fundamentally wrong in the real sector; it is not people-centric. The problem was accepted, but instead of addressing the problem the solutions tried to address the symptoms. Or, to put it in a different perspective, the emphasis was on means rather than the ends. To conclude, one would state "Business as usual is no longer an option." (IAASTD)

PS: The Interactive Panel of the United Nations General Assembly on the Global Financial Crisis, 30 October 2008, United Nations Headquarters had presentations by Joseph Stiglitz, Sakiko Fukuda-Parr, Prabhat Patnaik, Pedro Páez, Calestous Juma, and François Houtart.

Agrarian Crisis and Farmers’ Suicides in India

The larger agrarian crisis has two dimensions. On the one hand, there is a livelihood crisis that threatens the very basis of survival for the vast majority of small and marginal farmers as also for agricultural labourers. On the other hand, there is an agricultural developmental crisis that lies in the neglect of agriculture arising out of poor design of programmes and allocation of resources and having resulted in declining productivity and profitability. This twin dimensions could also be equated with the developmental discourse where the former is about displacement of people and the latter is about displacement of ideology. The outcome is that planning is not people-centric.

In monsoon India, abundance or paucity of water has always been considered as a major source of agricultural uncertainty. Today, this yield risk could also be because of spurious inputs or inappropriate use of technology. Increasing costs, price volatility, non-availability of credit from formal sources and other risks further compound it. Social responsibility of education, healthcare and marriage instead of being normal activities add to the burden. All these would even put the semi-medium farmer under a state of transient poverty.

An extreme response to this distress is the increasing incidence of farmerss suicides. Between 1995 and 2006, more than 190,000 farmers have committed suicides, 83 per cent of these being males. The suicide mortality rate (SMR, suicide death for 100,000 persons) for male farmers increased from 10.5 to 19.5 whereas that of male non-farmers has more or less remained around 13. The major states with SMR for male farmers greater than the all India average of 18 during 2001-06 are Kerala (233), Maharashtra (53), Chattishgarh (47), Karnataka (39), Andhra Pradesh (35), Tamil Nadu (31) and West Bengal (21). It is to be reiterated that suicide is a symptom of the larger crisis, and its absence does not in any way indicate the absence of a crisis.

It is only in Kharif 2008 that one observes a substantial increase in the minimum support prices of the 16 major crops. In fact, the absolute increase would be almost equal to increments in the entire decade. Though welcome, this vindicates the established fact that returns to agriculture had turned out to be abysmally low. Per-capita per day returns to farmer households from cultivation in 2002-03 was eight rupees. Another recent public policy intervention has been the Rs.70,000 crore debt waiver package. This is just a book keeping exercise and at best will reduce the burden from formal sources. Indebtedness, like suicides, is another symptom.

Risk mitigation has to go beyond suicides and debt. What is more important is to spruce up public investments that will increase returns to cultivation. Skill enhancement and linking of opportunities to local resources are required to increase non-farm income. Success of the credit and input markets require effective regulation. There is a case of encouraging technological and financial products that would reduce costs while increasing returns. Institutions that can organize farmers are required.

My earlier blog on a related theme is Indian Agriculture in Doldrums.


Selected Readings:

Bhaduri, Amit (2008), Predatory Growth, Economic and Political Weekly, 43 (16), 10-14.

Government of India (2007), Report of the Expert Group on Agricultural Indebtedness, Chairman: R Radhakrishna.

Mishra, Srijit (2007), Agrarian Scenario in Post-reform India: A Story of Distress, Despair and Death, Orissa Economic Journal, 39, (1 & 2), 53-84. IGIDR Working paper version is WP-2007-001.

Mishra, Srijit (2008) Risks, Farmers’ Suicides and Agrarian Crisis in India: Is There a Way Out? Indian Journal of Agricultural Economics, 63 (1), 38-54. IGIDR Working paper version is WP-2007-014.

Reddy, D. Narasimha and Srijit Mishra (eds.) (2008) Agrarian Crisis in India, Oxford University Press, forthcoming.

This is the abstract of a presentation at a one day international seminar, “Environmental degradation and food crisis – Lessons for India” being organized by Greenpeace India on 24 October 2008 at India International Centre, Lodhi Road, New Delhi, India.

Public Health in India

There are a number of equity related issues, rather inequities, in health in India.

India is perhaps one of the few countries where public expenditure on health is less than one per cent of Gross Domestic Product (GDP). There is a lot of variation in the public provisioning of health care - a state subject. Poor states are hard pressed for funds.

Diseases- or disability-wise specificity in states or even districts/blocks with emphasis on seasonal and subgroup (age, caste, gender or income) differences will help attune public policy to improve access and utilisation.

The question of access to and utilisation of care also needs to address the availability of caregivers. The outflow of trained caregivers (referred to as brain drain) and the growing private corporate sector will reduce their availability in the public sector.

With four-fifths of health care expenses being out-of-pocket, the increasing usage of private unregulated care that gives rise to supplier-induced demand (unnecessary medical intervention) is worrying. This, on one hand increases cost, and on the other, leads to misallocation of scarce health resources. It is not only inefficient and iniquitous, but medically speaking it compromises an important aspect – quality.

Regulation of cost and quality in the private sector should not be restricted to caregivers. It should extend to private players involved in non-clinical services and diagnostics, pharmaceutical industry, insurance providers, NGOs and public caregivers. A prerequisite for the success of privatisation is effective regulation. Policies that encourage privatisation but give regulation the go by will be detrimental.

Be it regulation or monitoring of cost and quality, access to or utilisation of healthcare, or analysis of epidemiological patterns - public health has to get out of anecdotal evidence and increasingly rely on scrutiny of ‘hard facts’. This requires the availability of real-time data in the public domain. Its analysis will help design locally relevant public policy.

For details see Srijit Mishra (2005), Public Health in India, in Kirit Parikh and R. Radhakrishna (eds), India Development Report 2004-05, Oxford University Press.

Society over Self

The self versus society question has been a matter of intense discussion among thinkers. The current purpose is not go into that aspect, but to highlight thoughts of two Odia (Oriya) thinkers/social reformers who espoused the cause of society over self.

One is among the famous lines from the well known poet laureate (kavi samrat) Upendra Bhanj. It reads as follows.

Mo jibana pache narke padi thau,
jagata udhara hau

Translated to English it means:

Let my life be consigned to hell,
Let the universe be saved (redeemed of all ills).

Some critiques interpret it too literally and say if the universe is redeemed of all ills then the poet would also benefit from this and not be consigned to hell. In my interpretation, the poet is indicating that he wants to sacrifice his self for the benefit of the larger society, nay universe.

The other saying that I take is from Gopabandu Dash, a social reformer and freedom fighter from Odisha (Orissa). Once he left his ailing/dying son to address the call of his motherland. One of his famous lines reads as:

Misu mo deha a desha matire,
Desha basi chali jaantu pithire

Translated to English it means:

My body should become one with my country's land,
Let countrymen walk over my back (to get freedom)

The author does not mind becoming one with mother Earth so that people can walk over him to get freedom. Here again the sacrifice of the self over the larger good is espoused.

Loss of the Unseen

There is no fetal heartbeat. This news was shocking for Nandini and me when we had gone for a normal check up to the health centre on 7th September. Into the 10th week of pregnancy we were looking forward to completing the first trimester. But fate had something else in store...

Medically as also for religious purposes this cannot be termed as death, as this was not preceded by birth. For us (more so for Nandini and to a lesser extent for Nerika, our four year old daughter, and me) this was not so. For Nandini, it was life that had started growing in her. Yes, another life. A life that was not seen but felt in each and every moment.

Nerika was very excited. It was her need for a sibling, particularly a baby sister, that had led us to consider for this second child. Once we shared her the news after conception she would talk about the baby, give a kiss to her Amma's pota, keep a hand on Amma's pota while reciting the Gayatri Mantra before going to bed. When she heard the news on returning from school, she cried for a few minutes.

The first thought that crossed our minds was whether we did not do something properly. Were we not as carefully as we were during Nerika's time? Was my going away from Mumbai at this crucial juncture not the correct thing? Should we have done the sonography a week or ten days earlier? Were we little complacent in thinking that nothing would go wrong this time? Our doubts only remained as doubts because the Doctor as well literature indicate that such instances of miscarriage happens in 25-30 per cent of the cases. We went for a second opinion, not exactly hoping for a miracle, but just to reconfirm. That done, we were left with the question of why us?

Left with no answer we think that it is perhaps in the larger scheme of things, which is not known. This personal loss of the unseen was not of one unknown. It was from one among us who lived with us for those ten weeks. Equally disparaging is the loss of the seen and the (un)known* in Kosi ravaged Bihar.

* Unknown form a personal point of view but known to us from a larger humanitarian perspective.

Communal Strife in Kandhamal, Orissa

After a gap of one-and-a-half years I visited Bhubaneswar in the last week of August 2008. The reason was personal (my father has not been keeping well) as well as professional (to attend a workshop at the University). Apart from these personal and professional aspects, two things have drawn my attention - the communal strife in Kandhamal and some positive changes in Bhubaneswar.

On the wee hours of August 24 while Janmashtami (festival associated with the birth of of Lord Krishna) preparations were on way Swami Laxmanananda, a Vishwa Hindu Parishad (VHP) member, and four of his associates were killed by unidentified gunmen in an Ashram in Kandhamal district. The Government's immediate reaction was that this was the handiwork of Maoist whereas some others thought that this was the work of some Christian groups. This led to communal strife in Kandhamal and other parts of the state.

Kandhamal has about 52 per cent tribals (more than 90 per cent of these being Kondha - hence, the name of the district as Kandhamal) and 17 per cent scheduled castes (nearly 80 per cent of them being Panos). The political power is with the scheduled castes - one parliamentary seat and one assembly seat (both for Phulbani, the district headquarters) whereas the scheduled tribes have two assembly seats (Baliguda and Udayagiri). The overall economic situation is not good. It is a district in the southern region (the poorest across the three regions as per the National Sample Survey Classification with 73 per cent rural and 55 per cent urban being considered as poor). The district wise human development index of 2001 indicates that Kandhamal ranks 29 across 30 districts.

The communal divide in Kandhamal is not new. There were similar instances in December 2007 and also earlier. It seems that the communal divide, asF. G. Bailey stated almost 50 years ago, is a continuation of the caste-tribe divide. Different sects of Christianity have been working among both tribals and scheduled castes. Some Hindu group have also been working in this district. A recent write-up by Angana Chatterji seems to indicate that Swami Laxmanananda had a greater impact on the tribals and a conflicting situation with Christian scheduled castes did exist. The situation is definitely complex - poverty, caste-tribe divide, religious differences are some of them. The challenge before the state government is to address all these on a continuous basis. This will help in the long run to bring about progress.

While talking about progress, I was quite impressed by some developments in Bhubaneswar, the state capital. I was told that this is the handiwork of the Municipal Corporation. Well-kept roads, signs indicating directions at junctions, zebra crossings, vending zones, cycling paths, and painting in public walls depicting the multiple cultural ethos of Orissa. We need some similar out-of-the-box thinking for Kandhamal.

Rains and the Spirit of Mumbai

July and August are monsoon months in India. The showers are needed not only to cool down the summer tempers but also to cater to water requirements for the whole year. As per 2001 census, nearly 12 million persons were residents of Mumbai and its suburbans (note that another six million reside in urban Thane). Despite its advantages, heavy downpours cause inconvenience to road, rail and air commuters. It brings in the picture of 26th July of 2005, a nightmare for Mumbaites. This year, 1st July was somewhat close. I was to catch a 10 O' clock flight to Thiruvananthapuram (Trivandrum). I could not make it on time. However, what I encountered on my journey was the spirit of Mumbai.

It had been raining the previous night and I decided to leave early for the airport. I joined my and daughter in the latter's school trip. I had thought of getting an auto or a taxi at Dindoshi, but no one was willing to go. Luckily, I had shifted my luggage to a bad, so I started walking till the Western Express highway bus stop. While waiting here a rental car on its way back stopped and I popped in with another bystander. After hitting the Goregaon flyover we realized that the traffic is stranded. We could not reach Hub even after 45 minutes. My co-passenger as well as driver offered their mobiles through which I could pass the message to Nandini that I am still in Goregaon and that she could pass on the message to other colleagues who were also traveling with me to Trivandrum and had issued the boarding pas on my behalf. My co-passenger paid the taxi driver, who was refusing to take any money. I got down and started walking to find the road flooded. While wading through water, it was a truck driver who came to my rescue. He signaled that I hang while he drove across the submerged part. Once on the other side, I hitched on to a bike which took me near Andheri. After walking for some time, I again got the help of another biker who tried all tricks to take me as near to the airport and when he realized that he could not go further he wished me luck and I started walking through a traffic jam and submerged road till I got a BEST bus. Got down near the airport and started my walk again. By the time I reached the check-in counter the doors of my flight was closed and it was queued for taxing. I was accommodated in a Kochin flight from where I took a taxi to the Alwaye railway station and from there a train to Trivandrum and reached the dinner gathering for the conference after 13 hours of traveling. This was possible because many people, whose names I do not know, who helped. I thank them and the rains for making me witness the spirit of Mumbai.