(Critical theorist and writer Rukmini Bhaya Nair is a professor at IIT Delhi. She is the author of several academic books, three volumes of poetry and a novel recently long-listed for the DSC Prize.)
Budget Day in Mumbai was rainy and grey. Dalal Street must have been abuzz but fewer than usual of the city's inhabitants were out on the streets. Those who were, though, would be dwarfed by huge hoardings of Deepika Padukone everywhere.
Up there on the skyline, Deepika exudes a supreme, rain-defying confidence. Yet, only a couple of months ago, I remember reading her on the subject of depression. Not other people's depression but her own. "People talk about physical fitness, but mental health is equally important." she says in a newspaper report. It is this issue of mental health and its under-advertised import that I want to discuss this sober, post-budget week.
India spends about 1% of its national budget on health, in comparison to China's expenditure of 3% and the United States' healthcare spending of over 8%. These figures are worryingly well-known. In the 2015 budget, there is no upward revision of the standard one-percent allocation, although the opening-up of the insurance sector could be seen as an indirect contribution to citizens' control over their own health.
Whether insurance is always the best medical remedy in a country where maybe a third of the population remains in such monetary distress that every single rupee is a decision point is a separate debate. What I want to do is argue for a more basic proposition to do with Ms. Padukone's recent disclosure.
All good budgets, we know, aim to be 'balanced', but it is possible that a 'lack of balance' more accurately describes what many Indian citizens feel today. In the present budget, place has in fact been made for two interesting aspects of public health. First, yoga has been fore-grounded as a metaphor for India's contribution to healthy living worldwide; second, the announcement of a national university dedicated to 'disability studies' has signalled the importance of the area. Both moves are encouraging. However, the high-profile plea by Ms Padukone could be just as urgent.
Mental health is an essential component of public health. Especially where the demographic profile of a country is young, aspiring and restlessly shifting between rural and urban borderlands, where the power of glorious images can often overshadow darker truths, health cannot but be understood in terms of mental as well as physical 'symptoms'.
Consider the familiar sentence: 'tension mat lena, behen-ji'. Many of us will admit to having heard variants of this utterance over the last decade or so. Inexorably, the English word 'tension' has migrated into Indian languages and done some pretty heavy-lifting. 'Tension' has, I believe, been imported into the Indian languages because it fills a psychological lacuna. It signifies a commonly experienced mental dissonance. The rise of the word 'tension' in our country, where it is used at least as often by women as by men, can be linked, I think, to certain robust findings in the arena of public health.
A chilling, large-scale 2012 study which appeared in the premier British medical journal 'The Lancet' finds that, across India, suicides are poised to overtake childbirth complications as the foremost cause of deaths among young women. Overall, the study concludes that among both men and women "suicide death rates in India are among the highest in the world." (Read more about the study)
Finally, a 2011 Thomson Reuters survey in 21 countries, consisting of 'advanced' as well as 'emerging' economies, has found Indian women the most stressed. The survey states: "An overwhelming 87% of Indian women said they felt stressed most of the time, and 82% had no time to relax."
Presumably, the super-high stress-levels reported by Indian women reflect their conflicting need to reconcile 'traditional' roles with more 'modern' functions. Further, Indian women confessed that a primary strategy they used to cope with stress was to spend, apparently showing how growing markets influence behavioural patterns. In budgetary terms, the seductions of high spending seem to have replaced the satisfactions of saving. Nest-eggs for the future are out.
Indeed, the future itself appears to be a commodity that is risky for women to trade in at such a time of transition. Mexican (74%) and Russian (69%) women figure next on the high-stress list and such configurations of stress are mostly put down to the rapid but uneven pace of development in these societies.
Tellingly, high stress as an emotional factor is found in the survey to be connected to high hopes for the future. This mental seesaw of stress and hope appears to me to be reflected in our current wide-spread use of the word 'tension'.
The pride of place occupied by 'tension' in Indian users' lexicons is indicated by the fact that it has already been translated into Hindi as 'mansik tanaav' (mental stress), though no one actually uses this formal equivalent! Hindi-Urdu words in the semantic vicinity of 'tension' like 'fikr' (worry) and 'chinta' (concern) are also not employed in similar contexts. Instead, I find people relate 'tension' to other borrowed English words like 'adjust' and 'worry' as if the foreignness of these words allows for changed meanings in new living spaces. If you agree to 'adjust', you 'take' less tension; if you do not 'adjust', you 'give' tension, causing 'worry'. In short, 'tension' is an inter-subjective concept in India. Other people are always involved. The 'lena-dena' (give and take) of tension thus creates a community which shares common burdens.
Living under conditions that include an endemic lack of access to clean water and air, to electricity, to affordable housing, to decent education, to a reliable income and, last but not least, to a safe and secure environment, the ordinary person who bravely creates new vocabularies to deal with new stresses has to be the true hero of any budgetary narrative in our country. It is in this respect that any budget in India must address 'the ordinary' in a fundamental sense, reaching out to the common citizen. Current evidence seems to indicate that this ordinary Indian is headed for a mental health crisis sooner rather than later.
In the piece I read by her, Ms. Padukone perceptively distinguishes between stress and depression. Unlike 'tension', a concept which allows for some interactive sharing, for hope, depression is isolating, anti-hope. Today, depression and tension are both growing apace in India. The message for those planning our future public health systems? Perhaps it's time we begin to take mental health issues seriously.
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