Resilience in Action: Empowering India’s Informal Workers Through Crisis and Adaptation
Q&A with Satchit Balsari, MD, MPH
Dr. Satchit Balsari, Associate Professor at Harvard Medical School and the T.H. Chan School of Public Health, focuses on the impact of crises on vulnerable populations. His lab develops digital tools for data-driven responses to public health emergencies, ensuring marginalized communities are part of recovery efforts. He co-directs CrisisReady.io, a platform aiding health systems in responding to climate-driven displacement. At Harvard, he leads courses on climate, disasters, and problem-solving, directs the Climate and Human Health Fellowship, and curates Hum Sab Ek, an exhibition on India's informal economy workers.
Keith Forman: Thank you Satchit for sitting down with the Social Impact Review. Let's talk about a project that took you back home to India and introduced you to SEWA (Self Employed Woman’s Association).
Satchit Balsari: I'll start with the work with SEWA, the inspiration for the exhibition. For the past two decades, I’ve studied disasters and complex humanitarian emergencies, working very closely with Professor Jennifer Leaning, and in recent years, with Professor Caroline Buckee. What we’ve done repeatedly is study the impact of disasters, humanitarian emergencies, war, and natural disasters on populations, particularly the most distressed communities. We have focused on the ability of these communities to survive the impact on their lives, health, morbidity, and mortality, and increasingly on their livelihoods. Through the range of disasters, we have noticed the impacts beyond the acute consequences. It's not just that there was torrential rainfall or a hurricane. There are prolonged impacts on life and on livelihoods that continue to affect people for many years to come. We saw this in Hurricane Sandy. We saw this in Hurricane Maria. The prolonged impact is from the disruption of social safety nets, access to jobs, access to healthcare. And that's what my team has been studying for the last several years.
The Covid pandemic was even more complex because of how universal it was. What was particularly unique about the pandemic as a disaster was its global impact. Many of the safety nets and political, economic, and social structures were affected locally, regionally, and internationally, and the usual protective mechanisms were hard to fall back on. It was in this context that SEWA asked me if I would consider doing an impact ascertainment of the pandemic on SEWA members as well as help analyze and evaluate SEWA’s response. It started as an organic conversation about the range of activities and projects that SEWA had to launch for its members to survive the pandemic. It quickly became obvious to me that there was something unique about their multi-pronged responses that adapted to gaps in state or societal pandemic responses. I thought it would be a fascinating project, given that it covered women working in the informal sector, which is very large in India.
Ninety percent of India's labor force is in the informal sector, and yet it is a very invisible community. Often those who are in power, who influence decisions, do not see these people. A lot of the economic calculations do not factor in their labor or their economic contributions. As evidence as to how bad it is, just a couple of months ago, the Indus Valley Blume report was released and celebrated in the technocrat circles in India. It referred to this class of people as India “3”. There was also a statement on a PowerPoint presentation that summarized the report describing these one billion people as “beyond the pale.” That's how those with means unfortunately sometimes see those without. This is the crisis that we're in.
It was very clear that this would be very interesting work and worth looking into. And I felt confident that the tools I had used in the past would suffice. So, armed with quantitative and qualitative study instruments, we went in with talented grad students to survey the households.
We surveyed a thousand households, comprising 4,000 to 5,000 individuals, to study the impact of the pandemic and SEWA’s assistance on their health, education, jobs, and savings. We wanted to augment that information with qualitative surveys. I went to test the instrument before others on the team could administer it. I quickly realized that the survey instrument I prepared would not work. The women spoke extemporaneously and substantively. Keith, you yourself have seen this, the confidence with which they speak. The interviews had a substance to noise ratio that I think many on this campus should be envious of. It quickly became clear to me that the questionnaire was not going to work and that I could not keep up with writing down what they were saying. I began to use some basic recording equipment - nothing more than a tripod to put my iPhone on.
I’ll confess that when I did that, I was not consciously planning to do anything more with these recordings other than to use them in lieu of my notes. The idea was just to be more thorough. I appreciated that the tone and delivery would be important while interpreting this, and that text can be very dry, and I didn't want to lose that. I thought, it's best to record all this. But when I was listening to these recordings again, it became obvious that what I was bearing witness to were oral histories from very disadvantaged but extremely powerful women in the early 21st century who were navigating the greatest public health emergency of our times, when dominant political, social, and economic structures failed to protect the most vulnerable. Their investment in their communities over the past five decades allowed them to thrive. There were lessons there in their experiences for all of us to learn as we prepare for the uncertain futures that we are facing with the changing climate. That was the point when I recognized that this is important, that it should be shared widely. It was very clear that this should not be confined to my hard drive, that others should hear their testimony.
I went back to SEWA, which convened a leadership meeting. I presented these interesting findings to them and asked, “How would you like me to share these findings? Where do we tell the story?” Their response was very clear - “Tell the ILO (the International Labor Organization) about us; go to the big cities and tell the Indian diaspora, the wealthy Indians, about us; make them realize the impacts their actions or inactions have on our lives. Come to the villages, tell our neighbors what we do and tell them about SEWA.” They wanted this story to be told widely. A dry, peer reviewed manuscript would not have achieved that purpose. I think such a paper is an extremely important and a credible output, but one that couldn't be the end point. We felt that the story needed to be shared more widely.
I came back to campus, and I've been talking to anyone who would listen. I have spoken with a lot of colleagues, especially faculty I have enjoyed teaching with and whom I have discussed interdisciplinary approaches. I spoke with graduate students from across campus without whom I would not have had the vision to attempt what we did. They felt that we could embark on the storytelling through a traveling exhibition centering on the voices of women and building a narrative around it, drawing people into the spaces inhabited by the working poor.
These are stories of cooperation. SEWA describes it as an economy of nurturance. What does it mean to build communities that are resilient? There is so much talk about diversity, inclusion, and equity on our campuses. At the medical and public health schools we talk about social determinants of health. It is not clear to me that we are convincingly demonstrating to students what it means and how hard this is. These are not PowerPoints or tweets. Achieving these goals of inclusion and decentralization takes not years, but decades of hard work in the communities. I think studying SEWA helps illuminate what that process can look like. Simple policy levers don't result in resilient communities: merely injecting cash isn’t the solution. Rethinking what it means to have codependent or cooperative societies is important. There is a story here that is particularly relevant for communities that are going to be even more vulnerable to, and possibly displaced by, climate change.
Forman: You hit on a couple of words that intrigue me. Resilience and adaptation. I really like resilience because you're not just taking the punch and getting off the floor, but you're resisting. You're being responsive to external forces. On a campus like Harvard or Vanderbilt and some others I’m familiar with in the climate world, economists are coming up with taxation policies, political scientists with new political orders, law schools advocate working within our existing laws and constitutions at national and local levels to effectuate a lower carbon emission world. Then you go to the activist world, and it gets more simplified. There are bad actors, and bad actors must be put out of business or vilified. If you mention the words resilience or adaptation, you're complicit with the problem. Have you sensed this?
Balsari: That’s a disingenuous debate that largely happens in the West. The vast number of the world's vulnerable who are already seeing the impact of climate change - largely through extreme weather events and unseasonal weather phenomena that directly affect their livelihoods, that directly impact agriculture - are not waiting around for us to mitigate climate change. They have begun adaptation, and they began it yesterday. Our exhibition introduces the story of the salt pan workers of the Little Rann of Kutch in our exhibit. They were affected by the same weather phenomenon that flooded Dubai. By the time those rains reached the Rann of Kutch, they flooded the salt pans and the salt that had been raked for six months had been ripe and ready to be harvested. Fifteen thousand families lost six months of labor. They're now indebted by $4,000 per family. There is nothing they can do. There are no social protections in place. There's no insurance that'll cover this. They must live with this. They aren't waiting for us to mitigate our way out of climate change. Any serious scientist will agree that even if we hit all our emission targets, it'll still be a long time before we reverse the negative impacts.
Daily wage earners are losing their wages because it's too hot to work. We're talking about people who earn so little that every day after work, they go to the market and buy their sustenance. Many of them have no refrigeration; they cook meals with the wages they have earned that day. If they lose their wages, they will go hungry. They aren’t sitting around waiting for us to cool the planet. SEWA recently launched the world's first heat insurance product. They are working with a range of partners including the Climate Resilience Center set up by Arsht-Rock and the Atlantic Council and Climate Resilience for All. They have developed parametric heat insurance products that pay cash to daily wage earners when extreme heat thresholds are reached. There are bigger questions around this: Who decides what the threshold temperature is? What duration of exposure? This brings us to some of the work that we're engaged in. How do you think about these adaptations, whether they're financial such as the insurance product, behavioral such as changing work hours, or technological such as cool roofs, solar pumps instead of diesel pumps, what’s working, what is not working? What is the impact we should measure when we put on a cool roof? Is it enough to reduce the temperature in the room by x degrees? Or is it sufficient that you sleep better? What is the desired outcome? How do you measure success? How do we know that 45C for three days is worse than 40C for 20 days? Are warm nights more harmful? These are all relevant questions.
Forman: You need to consider humidity as well.
Balsari: Right, which can be devastating. How do you think about these questions? While they may be theoretical to us, they are literally life and death for tens of millions of people around the world.
Forman: It seems as if hundreds if not thousands of teams would be needed to evaluate the complexity of the issues confronting these populations. South Asia is so large, both in the scale of the area and of the population. In addition to the regionalized issues, we've been talking about there is sea level rise to consider. Particularly affecting Bangladesh. And the melting of the glaciers, glaciers representing 70% of the stored fresh water on Earth. Almost all those glaciers providing drinking water to people are in the Himalayas and they're melting. We're going to have a major water crisis as well.
Balsari: There are phenomena we know to expect - sea level rise, arid lands, drought. There are also unseasonable rains that wreak havoc to agriculture in India. The rains are starting sooner or coming later, affecting crop cycles. When you think about how agriculture is conducted in India, with the vast majority being still small land holdings and individual families, these kinds of weather events can have fatal consequences. We’ve been dealing with increasing farmer suicides. They are operating on such small margins that there is no buffer for unseasonal rains. You talked about multiple teams working on it. I think this is someplace where Harvard can really step in. A lot of this work needs interdisciplinary approaches. Let’s go back to the salt pans for example. When we were watching Jamnabai rake the salt, she looked at us and said, “I heard there are very smart people in the college you come from.” She added, “why am I still doing this in 2024? Can you not invent equipment whereby I don't have to do this?” She then had three asks. “Every October when we come back to the salt pans, we come back to the Rann of Kutch to dig holes to pump up the briny water. These holes are very expensive to dig, about a thousand-rupee per foot, 5 or 6 wells need to be dug until they hit water. You must have an instrument which will tell me where the water is?” We do. This equipment doesn't reach the people who need it. She then pointed to her shelter, and said, “This does not withstand the heat here. It's 100, 110 degrees, 120 degrees sometimes.” The temporary shelter they put up disintegrates. She doesn't have privacy. When this happened the last time, there was a heat wave, and the women started getting UTIs and rashes because they did not have privacy for sanitation. She raised this issue and asked, “It can't be that hard for someone to invent cheap, portable shelters?” And finally, she asked, “why am I still doing this? Can’t the raking be automated?”
So how do we get our universities in the Global South to stop educating their students to invent things for the West? And how do we get universities in the West that want to commit to decolonizing their enterprise to invent with, and for, the most vulnerable in the world?
Forman: Music to my ears, an interdisciplinary approach. Let's come back to this concept of economy of nurturance. Maybe it should be the Eleventh Commandment. What was your takeaway when you heard that for the first time?
Balsari: I think it turns the economic model on its head. It’s very pragmatic in the sense that it does not talk about maximizing profit. It talks about maximizing collective well-being. Not individual profit. These are often dismissed as platitudes, especially in large academic institutions. This isn't an ideology. They've lived it for 50 years. I think what the exhibition illustrates are concrete examples of how an economy of nurturance allowed them to survive the pandemic. When the weavers and the home-based artisans who were embroidering designer gowns were informed of the lockdown, SEWA was decentralized enough where they were able to pivot within days, not weeks or months, to making masks. They got all the cloth that the weavers had and continued to give business to the weavers. They learned how to make three ply masks through YouTube videos. They made 80,000 masks in the first few weeks and distributed them to all their members.
About 70 to 80% of SEWA households received masks. This is a community that pivoted to meet its needs. It was able to sustain its businesses. None of this was charity and people were able to sustain their livelihoods. SEWA bank stepped in when daily wage earners lost their jobs and offered zero interest loans, which were all paid back when the economy had regenerated enough for people to start their businesses again. That flexibility and adaptability to use resources at hand is something very few of us in the laptop and latte world can boast of.
Forman: When I think of your passion for SEWA, and their representatives I've had the fortune to see in action, I could only think more people had to be in the know. I hope some of these grad students take it upon themselves to put this to video in the form of a documentary by following an individual, a family, people in the field. These aren't the stories of my youth where we watched humanitarian disasters unfold in front of our eyes, which elicited sadness and motivated people to go trick or treating and ask for money to be put in a box. There is the sadness of rains washing away six months of work, but there's the uplift of the community coming together and seeing those 15,000 affected people through that hardship. These stories have moments of heartbreak, but also have moments to celebrate. I hope SEWA gets the recognition it deserves.
Balsari: I think SEWA is well recognized around the world and certainly within the labor movement and the women's movement circles. This is an organization that has been around for half a century. The founder Ela Bhatt was one of the founding members of the Elders group, along with Nelson Mandela.
People have asked “Why are they not everywhere? Or why are they not a much larger movement?” I think they would point out that they are a collection of trade unions and cooperatives, and what they do takes a long time to build. This is not an NGO. It is not top down. You can't just open a branch office and get started. It takes a long time to build the linkages of trust in communities. They are in several countries now.
Forman: Let us conclude by discussing the Salata Institute grant your team has been awarded. How did this come about? How did the team get together?
Balsari: I’m so delighted with the team we have; it has grown to involve so many people. We started off with Caroline Buckee, Jennifer Leaning, Tarun Khanna, Dan Schrag, and Peter Huybers. Each member brings their unique perspectives and subject matter expertise to apply to what is clearly an interdisciplinary problem set. We've had two major conferences, one in Cambridge, one in India, bringing together stakeholders and conversations these gatherings have spawned several different streams of work. One that we are most excited about is studying the impact of heat on the lives of the working poor in their living environments. Climate models and projections say that South Asia will get very hot, however, it is unclear what that means. A look at heat maps shows a big crimson swath across all of Afghanistan, Pakistan, India, and Bangladesh.
A billion people live there, leading very diverse lives. What we wanted to do is tease out how different the impact of heat was going to be for the vast number of communities that inhabit this area. They are across all socioeconomic and demographic groups; in particular, the poor. The poor often work outdoors. They do not have the financial or the material means to protect themselves from heat. The impact of heat is not just the direct impact on their health, but it's the indirect impact on their well-being and their livelihoods. It’s too hot to work. It's too hard to be able to grow what they're growing, and so on. That was the hypothesis. We and some wonderful Harvard undergrads spent a summer in Ahmedabad putting micro sensors in the environments in which the poor lived. We found a significant difference between the weather station data that is being remotely sensed, and the actual temperatures in the homes and working environments of the poor.
It has ramifications on understanding heat exposure. What is the ground truth that should be influencing policies set to protect people from heat? What are the numbers? the thresholds? If you say we'll implement it at 45 degrees C, suppose it's already 50 degrees C indoors? How much needs to be empirically measured, how much can be deduced through modeling etc.? What is particularly fascinating about this project is that it was co-created with the community with SEWA members playing an important role. What are the traits and adaptations they want to study? SEWA is a true collaborator in this project. We’re hoping that we leave behind a toolkit that can be used in the Global South to study these adaptation interventions quickly. We don't have time to do ten-year randomized controlled trials (RCT’s) to study adaptations. These communities need answers here and now.
Forman: What is the deliverable? Typically, when I think of research projects, I’m waiting for the Journal Nature to publish a paper year from now.
Balsari: Within a year a lot of the data will have been collected and enable the design of community specific interventions and initiate implementations. We're thinking of four categories of adaptations: behavioral, financial, technical, and legal policy. It should be obvious that 114 degrees at a point in time is not everybody's 114 degrees based on ground radiation, heat retention of your dwelling, air circulation, or varied humidity. With the universality of digital devices, there might be clever ways to infer this, particularly with the improved power of computing.
Forman: Michael Chu advocates for the power of the handheld phone from a medical and economic development perspective. Having a digital device near your body as a data collection device, even if you need to type in the circumstances of your surroundings, is invaluable data.
Balsari: We're just beginning to scratch the surface of what we can do with these novel data streams. My personal interest, however, is not to sit with the data and then then see what questions I can ask. My group is focused on identifying and prioritizing what problems exist in the most vulnerable communities. What is the problem worth solving? Then work backwards to see whether we can provide these communities with access to the information that they need to make better decisions.
Forman: I can only imagine that the advances in AI computing will enhance the interpretation of the data you are collecting.
Balsari: With data, it's always garbage in and garbage out. The more informed your data is, the wiser your outputs are going to be. Machine learning approaches must be paired with ground-truthing. You need qualitative inputs as well to understand what is going on. A project that you and I have talked about is Climateverse. The data needed to make cogent decisions, both research and policy decisions, about climate change and the impact of climate change in the global South are not easily accessible. They either don't exist, are siloed, or outdated. The global South, the communities, and the governments need a better handle on where these data are. Climateverse tries to annotate every relevant data set we think is important for work related to climate change to make it more easily accessible, the kind of information that local communities need. Machine learning will play a huge part in helping analyze qualitative reports and trends. There are vast troves of post-disaster qualitative research, policies, after action reports from around the world, news articles, etc. that we have access to. Until now, at best, when you did qualitative research, you could extract frequencies of events and phrases, but with natural language processing, I think we have an opportunity to really plumb these archives, to start recognizing patterns that can then either augment or be buttressed by quantitative data and patterns that we see from novel data streams.
Forman: And prioritize interventions. That's what I keep thinking.
Balsari: For instance, there’s a wildfire in the Central Valley in California. Which way are people most likely to go? If you talk to people at FEMA, they will tell you that when people move and where people move is very location dependent. So, during a hurricane in Louisiana and Mississippi, people may have very different but predictable behaviors of how they respond to disasters. How people move after a wildfire is very different, and how people will move after a rainstorm on the east coast versus the west coast of India is very different; It's dependent on so many local factors, ranging from whether you have livestock to the level of trust you have in government.
About the Author:
Keith Forman is a Harvard Advanced Leadership Initiative Senior Fellow with over four decades of experience in leadership positions in the energy industry. He currently serves as the Chairman of Capital New Energy Carriers L.P., a shipping company based in Greece. Over the years, he has advised global infrastructure and private equity funds on midstream energy investments, served as the CEO for renewable energy companies, and held positions as a senior financial executive in large midstream energy companies.
This Q&A has been edited for length and clarity.