Abstract
Tronto’s care as a public value is meaningful in diagnosing the problem of care deficit in contexts such as India. Nevertheless, this chapter suggests that care transcends Tronto’s focus on institutions to a broader understanding of global dependencies reflected in hierarchies of health care in India. Such concerns cannot be entirely remedied through the lens of situated citizenship but require cosmopolitan situatedness. Yet, cosmopolitan models such as those of Appiah and Nussbaum overlook interdependence, given their emphasis on individual citizenship. Hence, they cannot remedy the deficit of care. Rather than a determinate individual or nation, cosmopolitan care would have to be fastened to Butler’s embodiment of unstable and unpredictable interdependence. Arguing for the latter, the discussion reimagines both cosmopolitanism and care from the perspective of mutual dependencies highlighted by the migration crisis of Indian health care workers.
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Notes
- 1.
See Qadeer quoted in Soman and Dasgupta (2003, 4942). Yet, there were also exceptions to such institutionalized regimentation under colonization. For instance, Deepak Kumar notes that W.M. Haffkine had a deep knowledge of Indians and did not regard them all as superstitious. He did not endorse bureaucracy that prevented access to health institutions and felt that in such cases “men” should intervene (see Soman and Dasgupta 2003, 4943).
- 2.
- 3.
In 2005 it rose to 82% for outpatient visits, 58% of inpatient expenditure and 40% of births in institutions.
- 4.
Between 1950 and 1951, the average expenditure of the annual budget on health was 0.22%, while it has improved to approximately 1% at present.
- 5.
- 6.
Its declaration of change through Yoga also reveals its commitment to alternative medicine—particularly those coming from a specific cultural-religious context. It also does not propose a system of health taxation in order to address the burgeoning health issues confronting India. The shift in responsibility is also from comprehensive to primary health care (Qadeer and Chakravarthi 2010, 56).
- 7.
Henceforth, MVT.
- 8.
- 9.
As Sengupta notes, a shoulder operation would cost £10,000 in the United Kingdom under private care or would require a long wait under the National Health Service (NHS); in India, it can be done within ten days for £1700 (2005). The economy has linked private hospitals in India with firms and public institutions in the West (Apollo with the NHS in the United Kingdom) (Reddy and Qadeer 2010).
- 10.
See Block (2018).
- 11.
India is short of 1.94 million nurses. In 2006, the WHO regarded India as facing an impending crisis as the figures for public health workers fell way below the standard limits (Walton-Roberts et al. 2017). There were heavy waves of migration in 1993 and between 2003 and 2009 (Walton-Roberts et al. 2017). This is due to low recruitment in India, migration and dropouts in nursing schools.
- 12.
Groenhout has articulated an analogical set of push factors with reference to Ghana.
- 13.
- 14.
- 15.
Tronto observes that the care worker’s plight in the West is analogous to those of foreigners in Moore’s Utopia (2005, 131–132). For Moore slaves—both criminals from within the nation and foreigners—perform tasks that require cleaning and nurture. In his blueprint, such slaves are treated well by the citizens of Utopia, but then they have to perform arduous labor to be a part of the Utopia, which they could leave, if they wanted to.
- 16.
The social encompasses both the private and the public sphere.
- 17.
Tronto notes that property does not ground contemporary citizenship (2005, 139) Rather, the simultaneous notion of the welfare state has led to envisaging citizenship along the lines of the worker with “support staff” (139), the latter being feminine household labor for the most part. However, this in turn has become redundant with the gains of feminism that has led to women’s participation in public work.
- 18.
Tronto revises her earlier position which analyzed care as devalued by politics as banal and as too profound for politics, given that it requires benevolence which is not available in politics (2005, 41). This assumes a realist and masculinist notion of politics which she rethinks.
- 19.
Cosmopolitanism is an old notion going back to the Cynic Diogenes who proclaimed himself to be a world citizen (Kleingeld 2013; Beck and Grande 2007, 11). However, as Beck and Grande note the idea of cosmopolitanism is marshaled every time Europe is in a crisis with coping with difference. In the contemporary context, cosmopolitanism is seen as an alternative to the hegemony of the capitalist economy and the nation-state (Beck and Grande 2007, 11–12). See Deleixhe and Raillard, 2014 for grounding residence in cosmopolitanism.
- 20.
Beck and Grande note cosmopolitanism does not follow the post-modern route of advocating absolute otherness, despite its suspicion of pre-modern hierarchical responses to difference (15). However, their argument overlooks Derrida’s claim that cosmopolitanism has the challenge of acknowledging the radically other. This challenge also confronts Razavi’s transnational institutionalised care (2015).
- 21.
It could also force women to do tasks that they were not doing earlier.
- 22.
- 23.
- 24.
See Ittyipe (2017) for an account of these problems.
- 25.
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Acknowledgments
I thank Petr Urban, Lizzie Ward and Maurice Hamington for their helpful detailed feedback on this chapter. I have benefited from the inputs by Joan Tronto and the participants at the conference “Caring Democracy: Current Topics in the Political Theory of Care” organized by the Institute of Philosophy, Czech Academy of Sciences, Prague, on November 23–24, 2017. I am obliged to Arunima Kaushik and Biraj Mehta for their elaborate discussions on this chapter. My gratitude to Anshu Kulkarni and Aarti Valia for relevant inputs on medical technicalities.
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Mahadevan, K. (2020). Cosmopolitanism, Care Ethics and Health Care Worker Migration. In: Urban, P., Ward, L. (eds) Care Ethics, Democratic Citizenship and the State. International Political Theory. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-41437-5_10
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