The Indian health care infrastructure is drastically unprepared and millions living in disadvantaged communities with poor access to health services and information are caught off-guard. In the absence of sufficient (remedial) medical care, the quick adoption of preventive health behavior is crucial to fight against the widespread outbreak of COVID-19.
To the credit of research by development economists (including the Abdul Latif Jameel Poverty Action Lab based in South Asia), there already exists an accumulation of evidence-based policy insights from field research that could greatly assist in getting information and health support to the most vulnerable groups in India (Kremer and Glennerster, 2011). Effectively containing the virus requires, first and foremost, tackling the low awareness of the pandemic. Imperfect information is considered to play an important role in the lack of disease preventative behavior on the part of households in developing countries (Dupas, 2011).
Even with world-class information technology and access to health experts, many around the world misjudged the severity of the coronavirus, leading to an endless global chain of infections. Households in rural communities are also likely to underestimate the disease burden of the virus and the expected benefits of investing in prevention (Jalan and Somanathan, 2008). Rigorous evidence from the field has also shown that communicating comprehensive information on health risks and how to prevent them instead of simply encouraging extreme avoidance may be more effective in take-up of preventive behavior. Effectiveness of information may be enhanced by making sure the health advice also reaches the female heads of households (Dupas, 2011).
Another important empirical question then is how to reach and inform as many individuals and communities as possible. Mobile infrastructure has bridged the connectivity-divide between urban and rural India significantly and should be a cheap and fast way to reach millions of households. Research suggests that communicating comprehensive information may not be sufficient when the change in behavior comes at a cost (Dupas, 2011). The good news is that preventive health behavior necessary to fight COVID-19 does not require a costly technology. The bad news is that social distancing is not an option for those whose daily sustenance is interdependent with the lives of many others and for whom it may be a luxury to have access to water (not to mention clean drinking water).
To fight against the coronavirus pandemic, the Government of India under Prime Minister Narendra Modi has used a similar strategy as it did when applying the sudden demonetization in 2016. With a mere four hours’ notice, the Prime Minister announced a total lockdown of life and economic activity across the nation, causing much anxiety and panic. Although such an emergency response from Prime Minister Modi may seem sensible from the point of view of the privileged and salaried classes, hunger is likely going be the killing factor – not COVID-19 – for the millions living on the brink of poverty. Besides, India’s age distribution is highly skewed towards the younger at-low-risk groups. Employing the same restrictive COVID-19 measures currently in place in richer countries is simply not sustainable.
For the necessary behavioral health response, it is key to understand what is on people’s minds. Unlike the invisible coronavirus, income and food-insecurity of daily-wage workers and migrant workers from rural India is undeniably real and will continue even after the fight against COVID-19 is over. The long-run fight against poverty and future pandemics in India may require that basic provisions and public safety nets are in place, and it may even require a change in values and priorities by top-layer decision makers.
Puja Singhal (DIW Berlin and FU Berlin)
Jalan, J. and E. Somanathan. 2008. The importance of being informed: Experimental evidence on demand for environmental quality. Journal of Development Economics 87 (1): 14 – 28.
Dupas, Pascaline. 2011. Health Behavior in Developing Countries. Annual Review of Economics 3: 425 – 449.
Kremer, Michael, and Rachel Glennerster. 2011. Improving Health in Developing Countries: Evidence from Randomized Evaluations. In Handbook of Health Economics, Vol. 2, edited by Mark V. Pauly, Thomas G. McGuire, and Pedro Pita Barros, 201–315. Amsterdam: North-Holland.
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