India is the third largest producer of e-waste, and approximately 90% of it gets processed in the unorganized sector. A report by the National Commission for Enterprises in the Unorganized Sector (NCEUS) from 2007 highlighted that the Muslim community is overwhelmingly concentrated in the unorganized sector and engaged in self-employed activities to meet their livelihood needs. The unorganized e-waste processing sector is an example.
This piece attempts to shed light on certain aspects of the public healthcare system that make it inaccessible to young male workers (many of them aged 24 years or less) who process e-waste in the unorganized sector of a south Indian city.
Social position, precarious work, and related health problems
In India, processing of e-waste is mostly carried out by young, poorly educated Muslim men. Indeed, while waste processing in general is traditionally carried out by the low caste groups in India owing to its rootedness in the notion of purity and pollution, e-waste processing is carried out mostly by deprived Muslim communities.
A related quote from the abovementioned NCEUS report sheds some light on this:
“While men and women from the upper castes and other religious groups were most likely to get organised sector jobs, Muslims, both Other Backward Classes (OBC) and others, both men and women, were least likely to do so. While the high levels of education among the upper castes explained this difference, in the case of Scheduled castes (SCs) and Scheduled Tribes (STs) affirmative action in their favour led to better access to organised sector jobs (even if they were at the lower levels) compared to Muslims.” – the NCEUS report.
Workers in the unorganized waste processing sector in general and the e-waste processing sector in particular are neither recognized, registered, nor protected. Their employment and working conditions are not regulated. Hence, most of them are either self-employed or casually employed without any written/verbal contract, with no fixed wages. They also work for long hours, do not have any paid leave, and work under unsafe conditions with no safety equipment. Their social position entraps them in precarious work.
The evidence suggests that such precarious conditions themselves make workers vulnerable to work-related injuries and diseases. Workers in our study (conducted in 2020-21) reported injuries, low back pain, and skin-related conditions and attributed these to their work.
One of the private healthcare providers detailed how activities involved in e-waste processing expose workers to injuries: “Cuts are frequent when they strip wires using the knife. Crush injuries are common when they use a hammer to dismantle the scrap. Amputation of fingers results from the machine used to cut the wires. So, injuries to hands and toes are common in scrap workers. There are also cases of eye injuries”.
Even if lack of (/non-use of) safety equipment is known as one of the proximal risk factors for injuries, workers avoided using safety equipment altogether as it causes discomfort and delays their work (which is valued at a piece rate). Though the importance of safety equipment is undeniable, merely asking everyone to wear it without taking into account their work process, the type of material they deal with, the appropriateness of existing safety equipment, and especially the precarity of their job, will thus not address the root cause of the problem.
Inaccessible public health care system
Precarity associated with their work not only makes them vulnerable to work-related injuries/diseases, it also contributes to downplaying the seriousness of the same by delaying care seeking. The inability of the public healthcare system to address their basic healthcare needs adds another layer to their existing vulnerability.
The Commission on Social Determinants of Health recognizes the healthcare system as one of the crucial determinants of health. It has been argued that while a healthcare system can play a significant role in reducing inequity, conversely a poorly functional healthcare system can perpetuate inequity. More in particular, in our study urban primary health centers (UPHCs) remained inaccessible to workers as they believed it only cared for women and children.
“See, only females are there. How could we go there? You should ask the doctor of this UPHC to put a board outside in which it is written that this UPHC is for males also.” – a 26-year old male worker
In addition, prevalent gender and cultural norms also restricted them from discussing their issues with community health workers (ASHAs) who are women. Interestingly, even ASHAs echoed the same. One of them stated, “Men are strong; they don’t need care as much as women and children do”. The inconvenient opening times of the UPHC, and the long waiting time further restrained workers from approaching these centers.
Even though it is a mandate of the UPHC to provide routine care, historically the focus has remained on the provision of maternal and child health services. The inability of the system to recognize the precarious nature of work that marginalized groups are involved in, makes male workers perceive it as limited to providing services for mothers and children.
The indifference of the public healthcare system pushes workers to seek care from private clinics/hospitals. These clinics/hospitals largely provide curative care, which is exploitative, costly, and further impoverishes workers. Frequent tetanus toxoid (TT) injections are the only preventive care they provide for injuries. Many workers reported getting an injection once every two months by paying an amount ranging between 30 and 200 INR per injection. The publicly funded health insurance schemes appear irrelevant as they only cover hospitalization costs without any provision for outpatient treatment of everyday illnesses affecting these male workers. Multiple studies have documented challenges workers in the unorganized sectors encounter while accessing healthcare services.
Though we have not directly looked into the role played by caste/religion with respect to access to health care services, a recent book on health inequities in India has extensively documented how social determinants (caste/religions and their intersection with gender, socio-economic status, sexuality etc.) shape access to health care services among different communities in India. While arguably many of these challenges have been discussed at the policy level and various policy initiatives have been taken for unorganized sector workers (including e-waste workers), the reality on the ground remains grim.
Existing evidence demonstrates the contribution of the public healthcare system in reducing health inequity by addressing the healthcare needs of various underserved communities. However, when it remains gender blind and fails to consider precarity associated with the occupation of a minority group, as is clear in this case, it probably contributes to the perpetuation of health inequity.