India already fares poorly relative to other emerging and developed economies in terms of per capita availability of hospital beds.
On World Population Day (July 11), the buzzwords are “population” and “demographic dividend”. The Economic Survey 2019 tells us that India is set to witness a sharp slowdown in population growth in the next two decades, and that although the country as a whole will enjoy the “demographic dividend”, some states will start transitioning to an ageing society by the 2030s.
But the word to watch out for is “migration”.
Though India’s fertility rate — that is, the average number of children a woman expects to have in her lifetime — is going down, it is not going down at the same rate everywhere in the country. Disparities continue between various states on not just the rate at which their population is growing or not growing, but also in the pace of their development.
“Population growth will halve over the next two decades in Chhattisgarh, Uttar Pradesh, Rajasthan and Madhya Pradesh. Bihar alone will have a population growth rate of one per cent. Nonetheless, together with Jharkhand, these states will account for nearly two-thirds of the increase in India’s population during 2021-41, with just Uttar Pradesh and Bihar accounting for over 40 per cent of the increase,” the economic survey points out.
The demographic dividend is a population bulge in the working-age category.
The survey tells us that in 11 out of 22 major states, including the southern states, the size of the working-age population will start to decline during 2031-41. On the other hand, those of working age and looking for jobs will continue to rise through 2041 in states lagging behind in the demographic transition, notably Bihar, Uttar Pradesh, Madhya Pradesh and Rajasthan. “In principle,” the survey says, “the latter states with rising working-age population could meet the labour deficit in many of the former ageing states.”
For example, Tamil Nadu’s population growth is expected to decline during 2031-41 unless offset by inward migration. Population growth is also projected to be close to zero in Andhra Pradesh and as low as 0.1-0.2 per cent in Karnataka, Kerala, Telangana, Himachal Pradesh, West Bengal, Punjab and
But in practice, things are a lot more complicated when people move from poor and populous states to those more developed and with lower populations.
This is what academic Chinmaya Tumbe calls “The Great Indian Migration Wave” in his thought-provoking book, India Moving: A History of Migration. This migration, Tumbe tells us, will veer southwards because of high north-south wage differentials.
This is already happening.
God’s Own Workforce: Unravelling Labour Migration to Kerala, a report by Benoy Peter and Vishnu Narendran published by the Kerala-based Centre for Migration and Inclusive Development, offers a fascinating peek into the profile of migrant labourers in Kerala.
The researchers found migrants from 194 districts across 25 Indian states/Union territories working in Kerala during 2016-2017. More than four-fifths of these districts are in eight Indian states. Migrant labourers came from not just neighbouring states in the south such as Tamil Nadu and Karnataka, but also from Odisha, Jharkhand, Bihar, Uttar Pradesh, West Bengal and Assam.
Kerala’s relatively high wage rates, direct trains from “source” states, the ease with which money can be transferred home and the penetration of mobile phones that reduced the disconnect with their homes were found to have influenced the migration, says the study.
Construction, hospitality, plantation, iron and steel, wooden furniture, marine fishing, mining and quarrying, plywood, textile and apparel, seafood and footwear are some of the sectors in Kerala that depend heavily on migrant workers.
Migration is inherently fluid, and trends can vary. But the study tells us that major construction sites in almost all districts in Kerala had workers from Bihar when the survey was conducted. Migrant labourers from Bihar were found in places as varied as the nakas (informal labour markets) in Ernakulam district as well as in brick kilns in Wayanad, Kollam and Alappuzha, and plantations in Idukki. In many instances, migrants were accompanied by their families. Workers from West Bengal form one of the largest proportions of the "footloose labour" in Kerala. They were available at the labour nakas in all the districts along with workers from Tamil Nadu.
Uttar Pradesh is another “source state”. Migrant workers to Kerala were mainly from the Rohilkhand and Poorvanchal regions in addition to Saharanpur, according to the study. Primarily, these were single men in search of a livelihood. We learn that craftsmen from Saharanpur, famed for their wood carving skills, work in the furniture industry in Kerala. Artisans from Saharanpur, dominantly Muslims, can be spotted in Kasaragod and Malappuram districts in addition to Ernakulam.
Significantly, of the five districts in India with the largest Scheduled Caste population according to Census 2011, four have evolved as district-level corridors of labour migration to Kerala, the study tells us.
It’s not just Kerala. Since southern India on the whole is ageing faster than northern India, there is a projected need for large numbers of people who can be part of the “care economy”.
“The Bhojpuri-speaking belt will continue to send out migrants, as it has for centuries, and in many other regions, there will be a transition from seasonal to semi-permanent and then to permanent migration,” writes Tumbe in his book.
I agree with Tumbe that as a matter of principle India should embrace the rising mobility that would add to its diversity. But policymakers need to be alert to potential nativist sentiments and start planning well in advance so far as basic amenities and infrastructure go.
Access to healthcare is already a major challenge in the country. The latest Economic Survey tells us that if India’s hospital facilities remain at current levels, rising population over the next two decades (even with slowing population growth rates) will sharply reduce the per capita availability of hospital beds across all major states. India already fares poorly relative to other emerging and developed economies in terms of per capita availability of hospital beds. States with high population growth are also the ones with the lowest per capita availability of hospital beds.
This means that not only are more hospitals needed, there is also a need for more medical doctors and trained health workers. A joust for competing resources and amenities often stoke anti-migrant sentiments. This is already happening in many parts of the country. Migration is unavoidable and not necessarily bad. But unless adequate public resources are provided in fields such as healthcare and education, it can lead to the politics of resentment that provides short-term dividends to some even as it bodes ill for India.