Despite showing tremendous improvements in the public healthcare system over the years – by eradicating several life-threatening diseases like polio, yaws, and tetanus – India still falls far short of ensuring effective public healthcare for all the citizens in the country. The country is bracing itself for difficult times in the face of the new coronavirus disease (COVID-19) which continues to wreak havoc in different parts of the globe. As of the morning of March 25, India has registered 539 positive cases. The number of infections and casualties appear extremely low in India – as compared to the gigantic size of its population. However, experts warn India that an avalanche of cases is likely in the coming days. As the pandemic proves far beyond any normal crisis India has experienced in the past, it can, in the absence of timely and effective intervention, potentially overwhelm the country’s public health infrastructure.
While there is no doubt that India’s health infrastructure is inadequate and needs considerable improvements, the real success of dealing with a crisis of this magnitude and scale depends to a large extent upon dealing with certain other sociocultural factors that go beyond the physical infrastructure of health centers, dispensaries, hospitals, and so on. Beyond the over-stretched public healthcare apparatus, social practices, public attitudes and behavior are factors that have a strong bearing on the spread of the virus and therefore require considerable attention in framing policy measures to tackle the crisis.
Complicating Sociocultural and Religious Factors
Unlike many countries that the virus has affected, the case of India presents unique concerns owing to its geographical vastness and the complexity of its cultural and religious diversity, beliefs, and practices coexisting with poor social indicators, such as lower life expectancy, higher fertility, and high child mortality. Wide illiteracy, poverty, poor sanitary conditions, open defecation and manual scavenging further add to its woes. These health and social indicators underscore the gravity of the situation that can worsen conditions in the face of a massive community outbreak. All of this demonstrates the glaring reality of a vulnerable population that can potentially worsen the situation.
While globally there is health misinformation circulating rapidly across various social media platforms, India has its own culturally rooted and domestically-driven misinformation and misconceptions that are adding fuel to the fire. Unfortunately, some of this misinformation is being spread by public figures and government agencies, advanced in part by cultural and religious underpinnings that increase the traction of such misinformation.
Misguidance in the form of suggesting cow urine as a protection against the virus; religiously-oriented obligations that discourage social distancing; and mass disregard and refusal to adhere to rules restricting and in some cases prohibiting altogether cultural gatherings suggest that such behavior escapes the particularity of any one religious, cultural and geographic identity.
Home remedies and dubious advisories that are rapidly spreading through WhatsApp and other social media platforms also weaken the resolve for preventive behavior. Moreover, the Indian government’s Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), released an advisory on January 29 which carried shockingly serious medical misinformation at a time when COVID-19 cases were rapidly spreading in different parts of the world. The advisory made claims regarding the ability of traditional Indian medicinal practices like homeopathy, ayurveda, and unani in fighting the spread of the virus. No serious scientific evidence exists to corroborate such claims.
India’s strong cultural and religious tradition of communal celebrations as well as close interactions with extended family members and neighbors constitute major social and behavioral factors that pose serious challenges. This week saw a call by Prime Minister Narendra Modi to deliver thanks to the health workers by clapping hands from home without breaking the practice of curfew and social distancing ended in celebration in the streets in many parts of the country. The Ram Navami celebration in Ayodhya, which attracts tens of thousands of devotees stands canceled but is still likely to be celebrated in different parts of the country. Muslim congregational prayers, Sunday church services, and similar mass gatherings among different religious communities can further expose the country to the lethal virus and trigger community spread.
The Way Forward
All of this points to the significance of ensuring dissemination of the right form of awareness and dispelling pseudoscientific practices. At the same time, global grassroots policy experiences suggest that in contexts such as in India, health-related information alone helps little. It is imperative to bring behavioral changes to reap maximum benefits from public health interventions. To what extent such changes can be brought about in a short period is debatable, yet it holds critical sense as the outbreak is expected to linger.
Social and behavior change communication (SBCC) may be employed as a potential strategy to increase awareness of the effectiveness and the necessity of preventive measures – such as home quarantine and social distancing – under the broad framework of health communication. SBCC employs mass media, community-level activities, interpersonal communication, ICTs, and new media to carry out its objectives. Such evidence-based communication programs can help enhance knowledge, shift attitudes, and change public behaviors. Preventive behaviors such as home quarantine and social distancing must be combined with efforts at dispelling rumors and misinformation as well as efforts to allay fears and concerns.
Needless to say, fighting the COVID-19 crisis essentially requires a holistic approach that sufficiently integrates the infrastructural, social, behavioral, psychological aspects to prepare us for any emergency response. As things transpire, this is going to be a long battle with an emerging, and potentially reemerging, pathogen. It needs to be fought with good science and proper health care. In the long run, India must increase its public health spending to build a robust health care system and deal effectively with overriding religious considerations, social beliefs, and cultural practices to enhance the scientific temper of the people.
Mufsin P. P. is a Ph.D. candidate in public policy and management at the Indian Institute of Management (IIM) Calcutta, India. He holds a Master’s degree in sociology from the University of Hyderabad, and MPhil in planning and development from the Indian Institute of Technology, Bombay, India.
Muhsin P. P. is a Ph.D. candidate in political science at the University of Hyderabad, India.