Decoding inequality in a digital world

Technological changes in education and health are worsening inequities

May 11, 2021 12:02 am | Updated 11:32 am IST

Virginia Eubanks’ widely acclaimed book, Automating Inequality , alerted us to the ways that automated decision-making tools exacerbated inequalities, especially by raising the barrier for people to receive services they are entitled to. The novel coronavirus pandemic has accelerated the use of digital technologies in India, even for essential services such as health and education, where access to them might be poor.

Economic inequality has increased: people whose jobs and salaries are protected, face no economic fallout. The super-rich have even become richer ( the net worth of Adani has increased ). The bulk of the Indian population, however, is suffering a huge economic setback. Several surveys conducted over the past 12 months suggest widespread job losses and income shocks among those who did not lose jobs.

Worse than the immediate economic setback is that well-recognised channels of economic and social mobility — education and health — are getting rejigged in ways that make access more inequitable in an already unequal society.

The switch in learning

For a few, the switch to online education has been seamless. Notwithstanding the Education Minister’s statement in Parliament that no one had been deprived of education because of online learning , at least two young students took their own lives because they could not cope — a college student studying in Delhi and a 16-year-old in Goa whose family could not afford to repair the phone he used.

According to National Sample Survey data from 2017, only 6% rural households and 25% urban households have a computer. Access to Internet facilities is not universal either: 17% in rural areas and 42% in urban areas . Sure, smartphones with data will have improved access over the past four years, yet a significant number of the most vulnerable are struggling. Surveys by the National Council of Educational Research and Training (NCERT), the Azim Premji Foundation, ASER and Oxfam suggest that between 27% and 60% could not access online classes for a range of reasons: lack of devices, shared devices, inability to buy “data packs”, etc. Further, lack of stable connectivity jeopardises their evaluations (imagine the Internet going off for two minutes during a timed exam).

Besides this, many lack a learning environment at home: a quiet space to study is a luxury for many. For instance, 25% Indians lived in single-room dwellings in 2017-19. If between two and four people share a single room, how can a child study? For girls, there is the additional expectation that they will contribute to domestic chores if they are at home.

Peer learning has also suffered. When students who did not study in English-medium schools come to colleges where English is the medium of instruction, they struggled. Yet, surrounded by English speakers, however falteringly, many managed to pick up the language. Such students have been robbed of this opportunity due to online education.

While we have kept a semblance of uninterrupted education, the fact is that the privileged are getting ahead not necessarily because they are smarter, but because of the privileges they enjoy.

Need a bed? Have an app

Something similar is happening with health care. India’s abysmally low public spending on health (barely 1% of GDP) bears repetition. Partly as a result, the share of ‘out of pocket’ (OOP) health expenditure (of total health spending) in India was over 60% in 2018. Even in a highly privatised health system such as the United States, OOP was merely 10% . Moreover, the private health sector in India is poorly regulated in practice. Both put the poor at a disadvantage in accessing good health care.

Right now, the focus is on the shortage of essentials: drugs, hospital beds, oxygen, vaccines. In several instances, developing an app is being seen as a solution for allocation of various health services. It is assumed that these will work because of people’s experience with platforms such as Zomato/Swiggy and Uber/Ola. We forget that those work reasonably well because restaurants/food and taxis/drivers are available for these platforms to allocate effectively.

Patients are being charged whatever hospitals like, and a black market has developed for scarce services (such as oxygen). The sensible response to such corrupt practices would be to clamp down on the handful who indulge in them. Instead, those in power are looking for digital options such as making Aadhaar mandatory.

Digital “solutions” create additional bureaucracy for all sick persons in search of these services without disciplining the culprits. Along with paper work, patients will have to navigate digi-work. Platform- and app-based solutions can exclude the poor entirely, or squeeze their access to scarce health services further.

In other spheres (e.g., vaccination) too, digital technologies are creating extra hurdles. The use of CoWIN to book a slot makes it that much harder for those without phones, computers and the Internet. There are reports of techies hogging slots, because they know how to “work” the app. The website is only available in English.

Online sharks

It is also alarming if the pandemic is being used to create an infrastructure for future exploitation of people’s data. The digital health ID project is being pushed during the pandemic when its merits cannot be adequately debated. Electronic and interoperable health records are the purported benefits. For patients, interoperability (i.e., you do not have to lug your x-rays, past medication and investigations) can be achieved by decentralising digital storage (say, on smart cards) as France and Taiwan have done. Yet, the Indian government is intent on creating a centralised database. Given that we lack a data privacy law in India, it is very likely that our health records will end up with private entities without our consent, even weaponised against us (e.g., private insurance companies may use it to deny poor people an insurance policy or charge a higher premium). There are worries that the government is using the vaccination drive to populate the digital health ID database (for instance, when people use Aadhaar to register on CoWIN). No one is asking these questions because everyone is desperate to get vaccinated. The government is taking advantage of this desperation.

The point is simple: unless health expenditure on basic health services (ward staff, nurses, doctors, laboratory technicians, medicines, beds, oxygen, ventilators) is increased, apps such as Aarogya Setu, Aadhaar and digital health IDs can improve little. Unless laws against medical malpractices are enforced strictly, digital solutions will obfuscate and distract us from the real problem. We need political, not technocratic, solutions.

More than 10 years ago, we failed to heed warnings (that have subsequently come true) about exclusion from welfare due to Aadhaar. Today, there is greater understanding that the harms from Aadhaar and its cousins fall disproportionately on the vulnerable. Hopefully, the pandemic will teach us to be more discerning about which digital technologies we embrace.

Reetika Khera is Associate Professor (Economics) at the Indian Institute of Technology Delhi. The views expressed are personal

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