Editorial 1: Public health — insights from the 1896 Bombay Plague

Context

This historical episode offers insights for the present as contemporary public health strategies should be rooted in empathy, equity, and evidence.

 

Introduction

Understanding the interplay between public health crises, surveillance, control, and ethical governance is paramount in addressing today’s global health challenges. Historical epidemics provide valuable case studies to examine how authorities have navigated these complex dynamics. The 1896 Bombay Plague serves as a compelling example, illustrating how colonial authorities utilised mapping and policing not merely as tools for disease management but as instruments of surveillance and control. By analysing the strategies employed during this epidemic, we can glean insights that are highly relevant for modern public health policy and practice.

 

The plague and its impact on Colonial India

• The Bombay Plague of 1896–97 was a catastrophic epidemic that profoundly affected colonial India.
• Originating in Bombay through trade networks with the Far East, the plague rapidly spread throughout the Bombay Presidency and neighbouring princely states, eventually permeating across the subcontinent.
• By September 1899, the epidemic had claimed over 370,000 lives, as documented by the Indian Plague Commission.
• Response to the Epidemic: The outbreak exposed significant deficiencies in the public health infrastructure of colonial India.
• Indian Plague Commission: In response, the colonial authorities established the Indian Plague Commission in November 1898, under the chairmanship of T.R. Fraser from the University of Edinburgh.
  • The Commission embarked on an extensive investigation, conducting over 70 sittings and examining 260 witnesses, culminating in five volumes of detailed documentation.
• Challenges in Understanding the Plague: Despite the wealth of data collected, the Commission struggled to draw definitive conclusions regarding the plague’s origins and transmission.
  • This difficulty reflected the colonial administration’s framing of the plague less as a public health issue requiring community-based solutions and more as a matter of controlling the population and maintaining order.

 

Emphasis on control over cases

• A notable aspect of the Commission’s work was its utilisation of maps.
• Divergence from John Snow's Approach: Unlike the iconic spot map employed by John Snow during the 1854 cholera outbreak in London, which pinpointed the locations of affected individuals to identify patterns of disease spread, the maps produced by the Indian Plague Commission diverged significantly in purpose and design.
• Purpose of the Maps: Rather than detailing the residences of plague victims or clusters of cases, the Commission’s maps emphasised railway lines, inspection stations, quarantine zones, and police cordons.

 

Key Maps Produced

• Railway Plague Inspection Stations Map: Highlighted railway networks and inspection points, focusing on monitoring movement rather than disease incidence.
• Chausa Observation Camp Plan: Detailed the layouts of observation camps with prominent police lines, reflecting a militarised approach to quarantine.
• Khanpur Station Map Showing Disinfecting Lines: Showcased disinfection zones and the role of police in maintaining these areas.

 

Characteristics of the Maps

• Vibrant Colouring: These maps were unusually vibrant in colour for administrative reports of the time, perhaps intended to present control efforts as more effective and to obscure the epidemic’s severity.
• Shifted Focus: This cartographic approach shifted the focus from who was affected by the plague to where the disease could infiltrate, mirroring the colonial authorities’ framing of the epidemic as a problem of mobility and security.
• Prioritisation of Control: The emphasis on control points over cases indicated a prioritisation of state mechanisms of surveillance and control rather than epidemiological understanding and community health needs.

 

Policing and the management of the plague

• Central Role of Policing: Policing played a central role in managing the plague, enforcing quarantine measures, monitoring population movements, and collecting plague-related data.
• Colonial Framing: This approach aligned with the colonial framing of the plague as an issue of maintaining order and controlling mobility.
• Observation Camps: Observation camps operated by the police were established at railway stations to enforce inspections and quarantines, reflecting a militarised approach to public health.
• Military Ward Orderlies: The Bombay Government introduced military ward orderlies in Parel hospital and municipalities, legitimising military control as an effective way of controlling the disease.
• Plague Data Collection: Police stations served as primary nodes for collecting plague data, with local watchmen(chaukidars) reporting deaths to the police, who then relayed information up the administrative chain.
  • Continuity in Statecraft: This practice persists in parts of India, where police still contribute to death registration, illustrating a continuity in statecraft.

 

Colonial Policing and Public Health Initiatives

• Policing and Military Measures: The reliance on policing and military measures underscored how public health initiatives were intertwined with colonial policing strategies, associating disease control with surveillance and enforcement.
• Epidemic Diseases Act, 1897: The 22nd Law Commission of India, in its review of the Epidemic Diseases Act, 1897, observed that the “unbridled and incongruous powers of the State” under colonial rule led to misuse of power instead of effective disease control.
• Shift in Public Health Strategies: Modern times have seen a shift toward medical professionals assuming surveillance roles, reflecting evolving public health strategies and ethical considerations regarding the appropriate functions of police versus medical personnel.

 

Role of Maps in Shaping Perceptions

• Design and Presentation of Maps: The design and presentation of the plague maps played a significant role in shaping perceptions of the epidemic and the effectiveness of control measures.
• Emphasis on Control Points: By emphasising control points such as railway lines and police cordons, the maps directed attention toward state mechanisms of control rather than the disease’s impact on individuals and communities.
• Vibrant Colours and Surveillance Infrastructure: The visual presentation of the maps, with their vibrant colours and detailed depictions of surveillance infrastructure, may have served to present control efforts as more organised and effective.
  • Downplaying Severity: This could have potentially downplayed the epidemic’s severity and the harsh measures imposed on the populace.

 

Power Dynamics and State Priorities

• Reinforcement of Power Dynamics: The maps reinforced power dynamics by highlighting surveillance and policing measures, serving as visual representations of the state’s priorities.
• Masking the True Crisis: By influencing perceptions, the maps may have masked the true scale of the crisis and the suffering of individuals, reinforcing the colonial agenda of maintaining order and control.
• Shift in Focus: This approach illustrates how authorities were more interested in where the disease could attack from rather than who was affected, shifting the focus from individual experiences to broader control strategies.

 

Broader implications for health surveillance and policy today

• The historical use of mapping and policing during the Bombay Plague offers valuable insights into the relationship between public health surveillance, policy, and state control, with implications for contemporary practices.
• Evolution of surveillance mechanisms: The integration of policing into health surveillance has evolved, with modern practices increasingly favouring medical professionals in these roles.
  • This shift raises questions about how and why responsibilities have transitioned from police to health-care workers, reflecting changes in professionalisation, ethical standards, and public expectations.
• Framing of health problems: The historical shift from mapping affected individuals to emphasising control points underscores the impact of problem-framing on policy and action.
  • Recognising this helps us understand the importance of framing health issues in ways that prioritise individual and community well-being.
• Ethical considerations: The historical focus on control over care highlights the need for transparency and respect for individual rightsin public health policy.
  • Modern strategies must balance effective surveillance with ethical obligations to avoid infringing on personal freedoms.
  • Policymakers must continually ask: Who benefits, and who is harmed?

 

Power Dynamics and Representation

• Recognising how maps and data can reinforce power structures helps us understand similar dynamics today.
• There is a need to critically assess how data is collected and used, ensuring it does not perpetuate inequities or serve as a tool for undue control.
• Continuities and Changes: Examining the continuities and changes from past to present reveals how historical practices influence modern governance and public health strategies.
  • For instance, advanced population registers in some countries now eliminate the need for censuses, reflecting an evolution in state surveillance and data collection methods.
• Understanding these developments can inform more equitable and effective public health policies.

 

Conclusion

The examination of the mapping and policing strategies employed during the 1896 Bombay Plague provides a nuanced understanding of how public health crises intersect with surveillance, control, and ethical governance. These historical practices highlight the importance of framing health issues appropriately, prioritising community well-being, and maintaining ethical standards in surveillance and control measures. As we develop more sophisticated surveillance systems in response to contemporary health challenges, it is essential to ensure they promote public health objectives without reinforcing inequitable power dynamics or infringing on personal freedoms. Learning from the past enables us to create public health policies that are both effective and just, fostering trust and collaboration between authorities and the communities they serve.

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Editorial 2: Building on the revival of the manufacturing sector

Context

Strong reforms are needed for India to fully capitalise on its manufacturing potential.

 

Introduction

India’s journey to becoming a global manufacturing hub has gained momentum with the government’s strategic policy initiatives, particularly the Production Linked Incentive (PLI) scheme. This scheme has been instrumental in transforming the manufacturing landscape in sectors such as mobile manufacturing, electronics, pharmaceuticals, automobile, and textiles, among others, through enhanced production, exports and job

• Impressive performance of the PLI scheme: The scheme’s impressive performance has been mirrored by the results of the Annual Survey of Industries (ASI) for 2022-23, released recently, which reveals a positive correlation between PLI scheme incentives and sectoral performance.
• Key findings from the ASI data (2022-23): In the ASI data, manufacturing output registered a robust growth rate of 21.5%, while gross value added (GVA) grew by 7.3%.
• Impact of the PLI scheme on sectoral expansion: This expansion comes on the back of the PLI scheme’s success, showcasing that many sectors benefiting from the scheme have performed particularly well.
• Contribution of sectors covered under the PLI scheme: Basic metal manufacturing, coke and refined petroleum products, food products, chemicals and chemical products, and motor vehicles — many of which are covered under the PLI scheme — collectively contributed 58% to the total manufacturing output.
• Overall growth in sectors benefiting from PLI: These sectors registered an output growth of 24.5% in 2022-23.

 

Recovery of the manufacturing sector

• Overview of ASI Surveys: ASI surveys are a vital source of data on the registered, organised manufacturing sector in the economy.
  • They include factories with 10 or more workers using power, and those with 20 or more workers, without power.
• Key findings from ASI 2022-23: The results of the ASI 2022-23 show a healthy double-digit expansion in the growth rate of manufacturing sector output — at 21.5% —
  • despite a high base of 2021-22 which saw a sharp rebound as the economy emerged from the COVID-19 pandemic-induced slump.
  • The impressive growth in output and value added in 2022-23, as compared to the pre-pandemic period, indicates that the manufacturing sector is slowly but steadily turning the corner after the disruptions in recent years.
• Manufacturing sector's path to becoming a plobal Powerhouse: The performance of the manufacturing sector shows that the stage is set for India to become a global manufacturing powerhouse.
  • However, strong reforms are needed to fully capitalise on the manufacturing potential.
• Expanding the scope of the PLI Scheme: The success of the PLI scheme underscores the need to expand its scope beyond the traditional industries where manufacturing activity is concentrated.
  • Extending PLI incentives to labour-intensive sectors such as apparel, leather, footwear, and furniture, as well as sunrise industries such as aerospace, space technology, and MRO could unlock new growth frontiers.
  • There are also sectors with high import dependency but untapped domestic capabilities such as capital goods.
  • This can help in reducing vulnerability to global demand fluctuations and supply chain disruptions.
• Focus on green manufacturing and advanced technologies: Promoting green manufacturing and incentivising research and development in advanced manufacturing technologies can further enhance India’s manufacturing competitiveness.
• Divergence between output growth and GVA growth: The striking gap between manufacturing output growth (21.5%) and GVA growth (7.3%) — as the ASI data show — is largely driven by soaring input prices, which surged by 24.4% in 2022-23.
  • This divergence suggests that while production volumes are rising, industries are grappling with elevated input prices, which have eroded their value addition.
• Addressing High hnput costs: With bulk of the inputs being imported, it is pivotal to bring down their landing costs in the country.
  • To bring this to fruition, a more streamlined import regime that simplifies tariffs into a three-tier system, with 0 – 2.5% for raw materials, 2.5% – 5% for intermediates, and 5% – 7.5% for finished goods, could help mitigate these input costs, enhance competitiveness, and improve India’s integration into global value chains.

 

A concentration of industrial activity

• Concentration of industrial activity in select states: The regional imbalance in manufacturing activity, with Maharashtra, Gujarat, Tamil Nadu, Karnataka, and Uttar Pradesh, collectively accounting for over 54% of total manufacturing GVA and 55% of employment, highlights the concentration of industrial activity in a few States.
• Impact of regional imbalance: This regional imbalance not only hinders equitable development across the country but also limits the sector’s overall growth potential.
• Need for active participation of states: For India to fully capitalise on its manufacturing capacity, it is essential for States to be an active participant in India’s growth story by implementing the fundamental factor (market reforms) in areas such as land, labour, and power in addition to developing infrastructure, and promoting investments.

 

Focus must move to MSMEs and women

• For manufacturing to serve as a true catalyst for inclusive growth, special attention must be given to micro, small and medium enterprises (MSME) and increasing women’s participation in the workforce.
• MSMEs contribute around 45% of India’s manufacturing GDP and employ about 60 million people.
• Tailoring PLI incentives to accommodate MSMEs, by lowering capital investment thresholds and reducing production targets, would empower these enterprises to scale up, innovate, and integrate more effectively into value chains.

 

Enhancing Female Workforce Participation

• Enhancing female workforce participation is an untapped opportunity for boosting manufacturing growth.
• The World Bank’s latest South Asia Development Update estimates that India’s manufacturing output could rise by 9% if more women join the workforce.
• Developing supportive infrastructure such as hostels, dormitories, and childcare facilities near factories could significantly boost women’s participation in manufacturing, driving output and inclusive development.

 

Conclusion

To transform the Indian economy into a developed economy by 2047, the manufacturing sector ought to play a critical role. As in the CII’s own estimations, its share in the GVA has a potential to rise from the current 17% to over 25% by 2030-31, and to 27% by 2047-48 if sustained efforts to boost domestic manufacturing capabilities and domestic value addition continue. Apart from boosting its competitiveness by improving ease of doing business and bringing down cost of doing business, seizing the current moment by leveraging on the slew of policy measures will be imperative for the manufacturing sector.

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