Modes of Inclusion (Democratic): Elections as States of Exception

This is the final post thinking about an important recent lecture given by the former Chief Election Commissioner of India, S. Y. Qureshi, at the Center for South Asia Studies at the University of California, Berkeley. A first post focused on what I termed narratives and practices of heroic inclusion; a second on the experimental transformation of the EPIC voter identification system into a biometric database, and the resulting conflicts between government agencies over their own administrative data preserves. The general point is to think about the range of sites where specific registers of “inclusion” operates as a dominant mode of governance, about the sites of conflict between modes of inclusion, and about the forms of lives and worlds and politics that come into being around these particular modes.

The Chief Election Commissioner talked at some length about the Model Code of Conduct, and so I want to follow his lead and think carefully about this “model code” in relation to law.

Not law but model

What is a model code of conduct? The term raises legal questions I will defer for now but will want to return to. Here I look at sections of the 2007 Model Code of the Electoral Commission.

At the outset, I want to think about several points made in the lecture:

(1) the Model Code is not statutory: it is not, that is, a body of law. It lacks the force of law. And, presumably, it lacks the checks and balances put in place in and with the law. Or put conversely, it has the power of a body of law-like codes, norms, and practices that are effective precisely in the exceptional condition of being outside the law.

I think here of the work of many scholars, including Laura Nader on mediation in the US and Katherine Lemons on a range of law-like forms of marital and religious judgment and counseling in India that stand outside the formal apparatus of Personal Law. I think also of the UIDAI itself: the debate over it, particularly when administrative preserves of data and control over these are at stake, is of course that it, too, lacks statutory authority: that Universal ID as a form of governance is not grounded in law, or only barely, depending on who and what one reads.

So my interest, in part, lies in the formal congruities (and their limits) between the EC and UID as exceptional apparatuses of inclusion through identification and information capture.

(2) The model code is powerful in its promotion of order: Dr. Qureshi offered multiple examples of how the EC and it’s code were able to trump the usual “nexus” of politicians, parties, police, and what in India are often termed “vested interests.” He spoke again and again of the importance of “order” in providing fair and accessible democracy. He referred to a critic of the model code’s many rules forbidding posters, loudspeakers, and other advertisements for a candidate near a polling station, who he said complained that the EC had taken “the carnival” out of democracy.  He responded, he told the audience, that he would be happy to bring the carnival over to her home and to see how she then felt.

The form here is reminiscent, again, of debates over privacy and UID. UID is charged with violated privacy rights: its defenders and architects suggest that such concerns are elitist and that the aam aadmi, the ordinary person, cares about food, shelter, and clothing. The elite critic who presumably lives in a sheltered environment can easily call for the carnivalesque: the stakes for those who strive for non-existent order are otherwise. The point, again, is not to accede to this claim but to attend to the ubiquity of the form.

The idea of a firm order outside of law that guarantees the law is suggestive of a series of debates in political theory about sovereignty leading from Carl Schmidt to Hannah Arendt to Giorgio Agamben. If sovereign is he [sic] who wields the exception, if the sovereign can kill without that death being either a crime (negative value) or a sacrifice (positive value), then the conception of a sovereign entails a form of life that can be ended as if it carried none of the distinguishing qualities of human life within a legal, ethical, and civil frame, as if it were just “bare life.” For Agamben, in a formulation that would later be carefully qualified, a classical conception of the sovereign demanded a distinctive “zone of indistinction” in which the difference between civil life (that cannot be killed without it being a sacrifice or crime) and bare life (that can be killed without what I am terming a shift in value) could not be maintained. Famously, Agamben would reread Foucault’s concept of biopolitics as a radical enlargement of the zone of indistinction between civil and bare life in the figure of the statistically established population.

This last paragraph is a quick rehash: the point is to open up thinking about what kind of exception the model code might entail, and to what extent if any it addresses “life” in ways relevant to this line of thinking. What is intriguing about the EC is its own standing in some kind of legal exception. The model code of conduct emerges as more powerful, in the time of elections, than the nexus of interests itself, the latter ever threatening to deform civil society: it emerges as the sole bulwark against the nexus. And yet the model code, guaranteeing law (and, as the Chief Election Commissioner repeatedly noted, “order,” stands in arguable exception to the rule of law, lacking as he noted firm statutory authority. As I noted above, the form of the exception is repeated, perhaps, in the often debated status of UIDAI as lacking statutory authority. But whereas the EC is celebrated as the bulwark of democratic norms set agains the ever present threat of the nexus, and the forces of disorder that this ubiquitous figure invokes, the UID troubles and affirms in equal measure, depending on the interlocutor.

The Idea of a Model

What may be important is the general form of a “model” code, in and around law and specifically in and around the law of India. Caught in the moment of ignorance (the general modus operandi of this blog as it lurches from topic to topic), let me reflect for now on the temporal register, in general, of a model as coming after a pre-existing form (as in a scale model of something, say a ship or the Taj Mahal) or before, anticipating and preparing for a possibility (as in the modeling that plans for structures and events). The dominant register of the model code is the latter: the code serves as the model for a democratic practice it anticipates and (re)forms. But it may, in a particularly (and familiar) post-colonial idiom, evoke an imagined order of colonial liberal governance as a rationalized system of order ever keeping the nexus at bay.

Models also, as the figure of the ‘scale model’ above illustrates, play with the scale of the gigantic and miniature. I am not sure how to think with this feature of modeling, save that the lecture that this blog draws from kept moving from enormity (India itself, and the realized demand for the inclusion of its “mass” population) to minuteness (the single voter in a far-off jungle reserve, or the tiny outpost in the Himalayan vastness).

The Model Code Itself

Let me close with a few sections of the code, with brief notes.

A Party is that which agrees to Norms

The primary actor here is the Party and then the Candidate. What is at stake here is a grammar of the nexus.

Impersonation and intimidation: two logics of nexus power

Impersonation is a particular form of duplication; intimidation acts on the original. If the EC sees its exceptional powers as operating on both registers, UIDAI arguably focuses on the former, as technically remediable, and evades the latter.

The biopolitical double

I conclude with this Question and Answer within the FAQ section that is far longer than the formal Model Code itself.  Can an administration, ruled by a particular Party running for office during an election, hold an event designed to save or preserve mass life? Here the question is in regards to tuberculosis. These sorts of questions appear regularly during election seasons, and the reportage holds open a tension between a political system that is thanatopolitical–that is, that does nothing effective to address the mass morbidity of a governed population for most of the non-electoral season–and an EC that is overstepping its commitment to its Code–that is, that would prevent a life-saving event in the name of abstract norms that do not take into account the precarious life of most citizens.

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Killer App: UID, Public Health Defaulters, and the Smartphone Theory of the State

Continuing on the theme of UID as public health tool, today I want to look briefly at a Working Paper on that topic available on the official UIDAI website. The paper makes a case for UID as enabling the expansion of varied welfare schemes using the metaphor of a smart phone.

Choose your metaphor, then…

I am particularly interested in the question of mobility, given the use of UID to address adherence failure due to mobility and migration.  And though I am cautious about overly relying on the logic of the metaphor, the conception of the state as a mobile smartphone is a productive one to work through.

Acknowledgements: I am grateful to Ian Harper and Bharat Venkat, both anthropologists and formidable scholars of TB treatment regimes, for comments they sent me on TB. Ian has critically studied and worked on DOTS [directly observed therapy] programs in Nepal and worldwide for many years; Bharat works in Chennai in a site critical for the formation of what would eventually become DOTS. And earlier comments and contributions by Jerome Whitington, Maria Ekstrand, Ashveer Singh, and Tulasi Srinivas addressed some of the issues at stake here.

The Excluded and the Defaulters: Ian points out: “the ‘migrant labourer’ and the issue of movement has been a particular problem with the DOTS programme from the start, and research in Delhi indicated that unless a patient could prove that they had a ‘permanent’ address, (even with staff visiting their address site to verify that they were there), then they could be denied treatment from the off through the public system… If started, then when they move, and given the lack of follow-up capacity in the government system, then they become categorised as ‘defaulters.’ High numbers of such ‘defaulters’ is one way through which programmes are evaluated by the WHO and described as poorly performing.”

Proof of permanent residency in the Delhi example Ian mentions becomes the basis for triage: a specific guarantee of territory, to continue the conceptual language of the preceding posts, is necessary for inclusion in the state’s pharmaceuticalization. If that guarantee may presume identification papers, it can extend as Ian suggests to a physical audit of their claims to proper residence. Improper or absent claims presumptively lead to abandonment. (These terms, developed by Joao Biehl, have generated intensive and productive debate). Types of claims on territory are used as proxies for knowledge of future patient mobility.

The flip side of the territorially excluded are the “defaulters” and here the audit at stake is not that of the state/corporate/multilateral organization/NGO apparatus of drug delivery auditing the prospective drug recipient but rather that of the multilateral organization (here WHO) assessing India and finding it wanting.

If the diagnosis offered in the Lancet cited in yesterday’s post framed the locus of failure at the nation state and its deficit of political will and regulatory capacity, here we see that the very privileged position of the European auditor (whether the medical journal of record or the WHO) is part of the feedback loop that leads the state TB administration to weed out the inadequately territorialized from the outset in order to improve its audits.

In such a context, UID makes a promise of transforming the reckoning of “adequate territorialization.” As will all such UID/Aadhaar promises, I want methodologically to avoid the hermeneutic of intense suspicion I and others are often drawn to produce. If I ended yesterday’s post with the suggestion that UID only addresses the minority of persons with MDR-TB [multi-drug resistant tuberculosis], one could argue that the point of the registration of the TB patient under UID will be to transform the ecology of multilateral audit and the logic of what I have called the feedback loop, leading to fewer disincentives against the exclusion of improperly territorialized persons diagnosed with MDR-TB (sorry for the quadruple negative in that last sentence, these blog posts are quick and dirty productions). In other words, if UID transforms the defaulter into an acceptably mobile drug recipient it might allow as well for the formerly abandoned to be included within the pharmaceuticalization regime.

Inclusion/abandonment: All this is speculation on my part at the level of the document or press report, at this point. But beyond TB, it points to tensions across the board in the imposition of UID that are framed in this binary of inclusion and abandonment: of elderly pensioners to be included in UID or whose fingerprints fail to register and whose motives are distrusted; of the Bangladeshi migrant who is to be more effectively surveyed as a Resident under UID or whose threat to the citizenship that differentiates Assam from the Bangladeshi prevents this inclusion and leads in due course to the entire state of Assam being temporally excluded from the UID program; and of transgender women whose community leaders have fought for inclusion under the census and other institutions of state identification but are divided and arguably deeply ambivalent about the value of inclusion under the surveillance of Aadhaar.

I am not satisfied with the conceptual payoff of this binary, but will let it stand for now.

Okay, why the smartphone?

I briefly cite the working paper I mentioned at the outset. It is symptomatic of all of the promise and confusion surrounding Aadhaar; as I pointed out much earlier on this blog, UIDAI officials seem as confused as anyone else about what UID is, does, and implicates. Here I break the document up into themes (ignore for now the many acronyms for particular state bureaucracies and entitlement schemes):

The unique and non-duplicated: “The Unique Identification (UID) project is a historic venture that seeks to provide a unique registration code to every Indian citizen. We surmise that the starting point would be to aggregate records from various population databases such as the census, the PDS system, voter identity systems, etc, while dealing with the challenge of duplication.”

The killer app as a figure of consumer/behavioral incentive: “Existing data bases would probably still leave a large percentage of the population uncovered. Therefore every citizen must have a strong incentive or a “killer application” to go and get herself a UID, which one could think of as a demand side pull. The demand pull for this needs to be created de novo or fostered on existing platforms by the respective ministries. Helping various ministries visualise key applications that leverage existing government entitlement schemes such as the NREGA and PDS will (1) get their buy-in into the project (2) help them roll out mechanisms that generate the demand pull and (3) can inform a flexible and future-proof design for the UID database. It will also build excitement and material support from the ministries for the UID project even as it gets off the ground.”

Public health will succeed if it can develop its own killer app: “Health, and health related development schemes could offer a killer application for the UID. After years of neglect, public health in India is seeing a revolution both in terms of (1) greater commitment towards government financing of public and primary healthcare (2) pressure to meet the MDG goals (3) consequent creation of large supply platforms at national levels such as the NRHM, RSBY and complementary state level initiatives such as the Rajiv Arogyasri insurance scheme in Andhra Pradesh. In health there is a cumulative historic gap both in terms of demand and supply. The UID could further help catalyse a revolution in India’s health outcomes.”

The participation of the new subject of UID (here termed a citizen by UIDAI, but as the official UIDAI website points out the subject of UID is a Resident and not a citizen: call this a constitutive confusion) is a matter of incentive, participation served by reforming governance as the promotion of self-interested participation in large-scale institutions, a broadly neoliberal figure for the condition of a scaled-up, arguably collective, social form. Jerome Whitington early on pointed me to Jim Ferguson’s very rewarding paper on this theme, “The Uses of Neoliberalism.”

Incentive is to be produced by each governmental agency. The new entitlement programs marking the last decade of Congress Party dominated rule, the extension of a prior development state electoral populism into a new form of state-corporate-NGO-multilateral governance, are here conceived of as killer apps for a generic platform, the UID.

Apps have become a powerful vehicle and metaphor. My Berkeley colleague Jim Holston is part of a collaboration thinking carefully about “social apps.”  Here I want to focus on the idea of a platform. What does it entail that UID is framed as a general platform for the “killer app”?

A real killer

“The Mumbai Episode”: Big Data in the Wake of the Total Failure of Tuberculosis Treatment

This post continues the previous one’s focus on the just announced registering of all TB patients nationally through the UID/Aadhaar program, as a disease control measure for a national population increasingly conceived of as migratory or “deterritorialized.” It is also a response to Peggy Trawick’s comment on that earlier post suggesting that programs like UID miss the point and that tackling TB must focus on the fundamental conditions of the physical milieus in which people live.

Drug-resistant TB patient in Mumbai (Deccan Chronicle photo)

It begins by engaging a similar article to the one discussed yesterday, from the Asian Age newspaper of 7 July 2012. It then develops a reference to the disastrous “Mumbai episode,” reading a recent article in the Lancet.

TB patients to get UID number

Starting July 15, patients suffering from tuberculosis will be given a unique identification number by the state government, to keep tab on the spread of the disease.  A specialised software will connect all facilities treating tuberculosis patients, to avoid duplication of cases. Already 60 data entry operators working in the government, have been trained to use the specialised software, where the data of each and every TB patient in the state will be uploaded. “After the Mumbai episode, we had proposed a common software across all states. The government of India has already designed a common software for all states, in which the data of each TB patient will be uploaded,” said Dr Pradeep Gaikwad, joint director, tuberculosis and leprosy…

According to state health officials, the software will help the state trace the patient, even if he migrates to other states or other parts of the state. Having common data will also help avoid duplication of cases. “The major reason for the rise in resistant tuberculosis is because of defaulter patients, who stop their treatment mid-way. If a patient goes to another state, he/she can give his unique identification number to the doctor; this will help the doctor understand his/her case history and give the required medication to him/her,” Mr Gaikwad added. The patient’s contact number, Aadhar card number and other medical details will also be uploaded in the software, so that doctors can trace him/her, even if he/she stops coming to the hospital. Mr Gaikwad, however, warned that owing to the active case finding intervention, the number of tuberculosis cases in the state could rise.

According to the state health department records, of 1.35 lakh tuberculosis patients, 25 per cent fall under the multi-drug-resistant tuberculosis [MDR-TB] category.

This article offers a clearer rationale for the new program than the earlier article: centrally at stake is the tracing of TB patients to ensure that they complete the course of their medication. UID/Aadhaar becomes an extension of DOT, Directly Observed Therapy, a massive up-scaling of a surveillance intervention focused on local knowledge and intimate observation to ensure drug regime adherence. This tracing includes not only migration but also non-compliance in place, as it were.

Of note is the relation of the Aadhaar/UID number to residence information, a much debated feature of its data set. Like the banking and finance industries, the public health establishment requires location-specific data of Aadhaar. But one of the promises of UID early on was its deterritorialization, that is, its naming and characterizing an individual not through his or her native place or father’s village or town but through mobile biometrics. Implicit in the deterritorialization was an understanding of corruption (say, the cut a local official may exact of someone’s pension) that presumes that mobile identity allows individuals to evade this intimate and localized corruption.

With TB, as with finance, trust however depends on the ability to locate the registrant. UID promises the doctor that she or he can find the UID subject using the data encoded and linked to his or her UID number.  This spatial legibility is tied both to data and to use. For those who want UID to include spatial data, actual residence is included and available to those agencies with access to UID information. But UID number use itself produces a trace of location, much as a credit card would. To the extent more and more “minimal entitlements” from ration cards to employment guarantees to more and more state/private/NGO outlays are linked to UID, life itself becomes impossible without one showing up on a database somewhere in India or through its consular extensions.
That the public health state can trust locational data is critical as it must respond to its own massive failure, here the somewhat vague reference to the “Mumbai episode.”

For now, I am assuming that this episode is the much reported finding, early in 2012, that several cases of entirely multi-drug resistant tuberculosis had been found in Mumbai. Here is the Lancet of 21 January 2012:

India reports cases of totally drug-resistant tuberculosis

Samuel Loewenberg

Mismanagement of tuberculosis in Mumbai has led to the emergence of India’s first known cases of a totally drug-resistant form of the disease, say doctors. Samuel Loewenberg reports.

Researchers in Mumbai have identified 12 patients with a virulent strain of tuberculosis that seems to be resistant to all known treatments. The cases of so-called totally drug-resistant tuberculosis (TDR-TB) have been detected in the city in the past 3 months. Worldwide, the only other episodes of TDR-TB reported were in Iran in 2009 and Italy in 2007.

What then follows is a social diagnosis: a miserable state system drives persons to mostly untrained clinicians whose prescription patterns drive increased drug resistance: the state fails entirely either to regulate the latter or to address the failures of the state system.

“Basically, it is a failure of public health, and that has to be accepted in this country”, said Zarir F Udwadia, who has been treating the patients at the P D Hinduja National Hospital and Medical Research Centre, and who, along with colleagues, described four of the cases in a letter published online in Clinical Infectious Diseases. “The public doctors and private doctors are equally to blame”, he said. The city’s health officials reject these charges. “State TB care and health care in Mumbai is excellent”, Anil Bandiwadekar, the Executive Health Officer of the Public Health Department of the Municipal Corporation of Greater Mumbai, the city’s governing body told The Lancet.
Government health officials attribute the problems with drug-resistant tuberculosis to the city’s unregulated private doctors who prescribe inappropriate drugs. Privately, some senior officials acknowledge that much of the public have a negative perception of government-run health facilities, due to long waiting periods, rude treatment, and the stigma associated with tuberculosis. The result is that many infected people avoid the government tuberculosis programme and seek relief from private doctors, only some of whom have medical training. The government says that it is considering regulating tuberculosis drugs, but it has not yet taken action.
Mumbai would seem to be a prime breeding ground for drug-resistant infections. The city, home to more than 12 million people, is beset by poverty, overcrowding, and harsh living conditions.
Udwadia says that although the DOTS (Directly Observed Therapy, Short Course) programme has generally been successful for people with normal tuberculosis who do access it, for those with drug-resistant tuberculosis, it causes more than 8 months of delay as people are forced to go through standard treatments before they are diagnosed. All the time, they are generating further resistance.
The article concludes again stressing the failure of administrative capacity and political will, given the cost of treating MDR-TB, and uses the language of caste to characterize the forms of triage.
Presently, there are only 171 people enrolled in the DOTS-plus programme that has been in effect in Mumbai since 2010 to treat drug-resistant tuberculosis, according to the office of Bandiwadekar. Tuberculosis was estimated to have accounted for at least 15% of the deaths in Mumbai in 2010. India has one of the world’s highest burdens of drug-resistant tuberculosis, (around 100 000 people), according to WHO. The failure of the government to provide treatment for all of these patients is due to the cost—about US$4000 per patient, a high cost for India, which spends only $45 per head on health care. Udwadia says that the government passes its actions off as “health policy real politik”, which in effect means it ignores most of the patients with drug-resistant tuberculosis. “They have become the untouchables of the Indian medical system”, he said.
In fact, health centres and hospitals could be a contributor to the growth in resistance, said Nerges Mistry, the director of the Foundation for Medical Research in Mumbai. There is “poor infection control at most of these settings”, said Mistry, and people with resistant tuberculosis could well be infecting patients with a regular tuberculosis infection. A 5-year study done by the Foundation with the Wellcome Trust found that most patients were resistant to two or three of the first-line drugs, and some to all four. The city could have as many as 3500 cases of multidrug-resistant tuberculosis (MDR-TB) each year, but lacks the laboratory infrastructure in the public system to identify and confirm the diagnosis, said Mistry.
Exposure to MDR-TB is intensified in the city’s giant slums, described here as “notorious.”
Meanwhile, the patients with TDR-TB are walking the streets. Udwadia says that isolation is not practical due to cost and lack of hospital beds. He notes that four of the patients come from Dharavi, a notorious Mumbai slum with a population of 2·5 million people.
So far, three of the TDR-TB patients have died, one of them after lung surgery. One of the patients has passed on her infection to her daughter. Udwadia is trying any treatment he thinks might work. This includes a double-dose isoniazid, the harsh antibiotic linezolid, the anti-leprosy drug clofazamine, the anti-psychotic drug thioridazine, and meropenem and clavunate, which reportedly had some effect on tuberculosis in mice. “We are clutching at straws here”, he admits.

In this context, how to make sense of the turn to Aadhaar, to the new promise of Big Data? What is not addressed is the state’s failure, assuming the arguably inflationary language of the Lancet piece is acccurate, to enroll most persons with MDR-TB or to regulate the conditions of common treatment. Rather, those few persons already in the MDR-TB treatment pipline are to be more effectively surveilled through the UID number.
Or is there a more sustained argument to be made for the utility of UID. given this double failure, of routine TB treatment and of the enrollment of most persons with MDR-TB in treatment?