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The pursuit of happiness

To many policymakers Gross National Happiness doesn't sound like a serious framework to measure progress by, says Swarna Rajagopalan. But isn’t it the welfare state alone which has the capacity to attempt the scale of intervention and programming required to assure each Indian’s welfare?

Gross National Happiness
Children in Bhutan pushing up their Gross National Happiness

Channel-surfing, I stopped the other day to watch the Fourth Hiren Mukerjee Lecture being delivered by Bhutan’s Prime Minister, Lyonchhen Jigmi Thinley. Speaking about measurements of progress, he said:

    “The use of this indicator as the singular driver of development resulted in our pursuit of limitless growth in a finite world being measured, especially among so-called developed and emerging economies, on a quarterly basis… Here I am reminded of economics Nobel Laureate, Joe Stiglitz, who remarked ‘what you measure is what you get’. And what do we get?
      “Our present GDP-based measures, literally report more fossil fuel combustion (and therefore more greenhouse gas emissions) as economic gain. The faster we cut down our forests and haul in our fish stocks to extinction, and the more excessively we consume and deplete scarce resources, the more GDP grows. Even pollution, crime, war, sickness, and natural disasters make GDP grow, simply because these ills cause money to be spent. And GDP grows even as inequality and poverty increase.”

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He went on to describe the unique approach that Bhutan has adopted since the early-1970s: Gross National Happiness. Happiness is what every human wants, and therefore, the state should create conditions for humans to be happy. And what does it mean to be happy? Prime Minister Thinley listed nine domains of happiness: living standard; health status; educational standard and relevance; ecological diversity and resilience; cultural diversity and resilience; community vitality; time use; psychological well-being; and governance quality. He cited a recent national census as finding that 45% of Bhutanese were very happy; 52% were happy and only 3% said they were not very happy. But having said this, Prime Minister Thinley stressed that Bhutan had a long way to go but:

    “What is however, different between Bhutan and most other countries is that we are serious about the pursuit of happiness and long-term survival. Happiness in Bhutan is the basis of all public policies and resultant decisions on resources allocation.”

I have been thinking about this business of happiness for a few weeks now. What is our commitment to happiness in our society?

It is fashionable in my professional circles to be somewhat scornful of ideas like “the power of love” (Kenneth Boulding) and Gross National Happiness. I guess they don’t sound like serious policy frameworks to serious policy experts. And although defending Boulding and Bhutan in seminars is a battle I choose not to fight, I have never silenced the voice in my heart that says, “Er… but… what’s wrong with love and happiness?” After all, Bentham, whose ideas about the purpose of political organisation presaged the welfare state, described this purpose in terms of “the greatest happiness of the greatest number”.

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I have been thinking about welfare states a great deal.

In October, when my niece was born, my sister experienced unexpected childbirth complications. They necessitated emergency surgical interventions and a massive blood transfusion. She was in intensive care, and had to remain in hospital a few days. This happened in the Netherlands.

What happened to my sister happens to a very tiny percentage of women who give birth. But whether in developing countries or advanced industrial states, happy endings are uncommon in the circumstances.

We were extremely anxious when we first heard about the complications, of course, and particularly anxious about the blood transfusion. After all, in Indian cities, finding enough usable blood is always a challenge. But then, in the weeks that followed, we got to see how good systems animated by good, dedicated people can turn around the odds in a person’s favour. We got to see how a good welfare state is meant to work, and we are still gushing.

Doctors were decisive in their emergency actions. Facilities were ready and available. They were compassionate, with a familiar nurse staying on in the operation theatre just to offer my sister moral support. They took care of my brother-in-law and the baby. When my sister came out of intensive care, they made sure that she got enough rest, taking care of the baby as necessary. But of course, this can happen even in India. After all, one reason that India is turning into a health tourism hub is the quality of care that patients receive.

The real difference began with the return from the hospital. Within 24 hours, the Dutch welfare state had sprung into action. Early the first morning, we were awakened by the arrival of the maternity nurse. Yes, the maternity nurse. The most basic healthcare safety net offers new mothers a few days of help when they go home. Just about three hours a day, but for a new mother—no, I should write new parents, because fathers also get leave in the Netherlands for childbirth—this is someone experienced to help them take care of the newborn and themselves in those difficult first days. The maternity nurse offers both practical and moral support, reassuring the new parents on a dozen counts. But even for this, I would have had admiration and appreciation but stopped short of gushing, had it not been for the level of preparation. This was also true of the midwife who stopped by thrice that week, and the paediatric nurse who visited, and the family doctor who stopped by to visit.

India has excellent doctors and nurses, and perhaps the best quality of healthcare in India is that where it exists, it retains a humane quality. But our experience in the Netherlands showed how combining excellent documentation, systemic efficiency, professional preparation and humane care can really transform a very traumatic experience.

My sister’s experience was documented minute-to-minute. That documentation was instantly provided to every single actor in the huge Dutch healthcare complex—doctors, nurses, hospitals, clinics, social workers, just everyone. This is what I cannot get over—everyone read the documentation before their interaction with her. This spared her the burden of narrating and re-living an experience that she had barely wrapped her mind around. They could just pick up and move on from that base. Across the healthcare chain she had interacted with, people who did not need to interact with her also made a point of touching base to see how she was.

Every service she needed was scheduled into a system that also locks in her baby’s immunisation appointments for a four-year period. By the way, my niece received her retirement and social security account papers within a day of her arrival at home!

We came away filled with admiration and gratitude. And in my heart, a prayer adapted from Tagore’s: Into that heaven of compassionate and efficient care, my Mother, let all people awake!

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As I said, I have thought about welfare states a great deal in the last few months. The first welfare state I knew was that designed to promote a ‘socialistic pattern of society’ in India. I do not scoff, in spite of the quotation marks. I was socialised to understand the rationale behind progressive taxation, rationing and quotas for this and that. I do believe it is the work of the state to promote social equity. I do believe justice is a core social value. The second welfare state I knew was the one in my political science textbooks, whose distant echo lay in the wonderful writing of Fabian George Bernard Shaw.

Surprisingly, the third welfare state I have known is the United States. I had a social security number, paid taxes into social security, etc. But it was a welfare state like a sieve. Now you had security, now you didn’t. I happened to work in places where health insurance was available, but others did not. There was nothing like equity in salaries—an engineering research assistant made five times more than a humanities teaching assistant. But when you were lucky, you could glimpse how life is supposed to be when you reach that place ‘somewhere over the rainbow’. And you could also see how that could end up being its own parody, as you waited six months to see a doctor or dentist for an appointment you had sought in acute agony over a twisted foot or a hurting tooth. But if you wanted a routine annual check-up or a refill on your renewed prescription, it was clockwork in pristine, professional settings… if you had insurance, of course.

Last year, on a visit to Norway, we marvelled as the tour guide pointed to islands in Oslo fjord with a dozen homes and described the multiple ferry services that had been made available to them. Yes, Norway is oil-rich, but consider how under-used or ill-used that money could be!

Back to basic social services and India, one appreciates that one can actually see a doctor when one is ill. One appreciates that healthcare workers are by and large doing their best in circumstances that at their best are sub-optimal. One appreciates the population pressure on existing services. One appreciates the plurality of medical systems to which one has access. One appreciates doctors who make house-calls and whose private practice in a corner of their homes welcomes all patients and ailments. One appreciates doctors who know three generations of family medical history. But one also despairs, as a new patient in a new city, of doctors who don’t keep records. Of clinics and labs that have ‘adjusted’ their cleanliness standards. Of having to repeat one’s story to everyone in the healthcare facility, from the receptionist to the doctor to the accountant. One despairs because so often the ailment seems preferable to the process of healing.

And if these are the complaints of a cranky middle-aged, middle class writer, the real question is: Why doesn’t everyone have it as good as she does? The right to welfare implies the right to complain about the conditions and standards of its delivery.

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By almost any measure of development, other than growth, India fares poorly—worse, in fact, than most of its neighbours. No non-state actor has the access to resources or what Michael Mann calls the ‘penetrative power’ of the state. Realistically, only the state has the capacity to attempt the scale of intervention and programming required to assure each Indian’s welfare. And if the theme of 2011 has been corruption, it is a theme which resonates because poor governance (including but involving more than corruption alone) has been the main barrier between Indians and their well-being. But it is not the only barrier.

There is one other that I think about: compliance. The creation of a system depends on people complying with its rules and requirements. Taxation, traffic rules, not giving a bribe, using public facilities where provided and usable… sometimes I wonder whether we are capable of following rules and systems the way Americans and Europeans do. Is finding a way around any system just firmly ingrained now in our psyches? By celebrating jugaad, are we saying that working the loopholes is our special genius? It’s not just high-bracket taxpayers that evade taxes, after all? How many times are you asked to pay cash so you and the vendor can avoid paying sales tax? Evasion or non-payment of indirect taxes is also a reality. There are a thousand reasons we can come up with for littering or open defecation, but that does not change the fact that it is an abuse of public spaces. The list is endless and I will not dwell on it.

Moreover, in recession-hit Europe, welfare states are being forced to cut down on services that two generations have taken for granted. The expansion of services, the expansion of demand and the shrinking of the resource base are fuelling social and political debates about immigration, citizenship and entitlement. An Indian welfare state will also have to deal with these issues, as we can see from Indian debates about reservations and creamy layers.

In recent years, in India, many have become cynical about the state’s role in delivering welfare. Years of inefficient delivery and poor governance have obfuscated the fact that ensuring the welfare of the citizenry is intrinsically a good thing. The result is a discourse around welfare measures and programmes that is polarised between the continuing appeal of social welfare populism around election season; sections of civil society that seem equally suspicious of state interventions in development as they are of state withdrawal from the economy; and free-market advocates for whom the welfare state is anathema. But can we afford to throw the baby out with the bathwater? Don’t all human beings deserve the best of life’s most basic needs?

Endnotes

Lyonchhen Jigmi Thinley, Gross National Happiness: A Holistic Paradigm for Sustainable Development, Fourth Professor Hiren Mukerjee Lecture, New Delhi, December 21, 2011, accessed at http://www.bhutanobserver.bt/fourth-prof-hiren-mukerjee-lecture-lyonchhen/ on December 28, 2011.

Infochange News & Features, January 2012