Why the WHO Action Plan on Physical Activity Is Out of Touch With the Indian Reality

Padma Prakash

First published in The Wire

Some years ago, I asked Bagibai, the woman who comes to clean my house, whatshe did in her ‘leisure’ time, using the word ‘phursat’ for leisure. This was for a short piece I was writing on women’s work. Here’s how the conversation went.

She didn’t understand my question and looked at me blankly. I tried to explain leisure using synonyms in other languages she knows, to no purpose. So, I askedher to describe all her activities in the course of a typical workday. With a painedpatience, she said:

“I get up in the morning, I make tea for everyone; then walk to the public toilet. Then I collect water from the public tap for our daily use; then make rotis for my husband to take to work;and for the children to eat at lunch. Then I come to your ‘building’(apartment block)and work in two houses.”

What kind of work do you do?

“You know the kind of work! Sweeping and swabbing the floor, dusting; washing the dishes; folding washed clothes and making tea…in some houses,making rotis, rice and a sabji. After that, I walk for 15 minutes to the otherapartment complex where I work in three houses. Then I come back to your building to work for a second time in one of the houses here,and cook dinner. Then I walk home.”

What about your lunch?

“Oh, I have tea sometimes; and maybe some food in one of the households.But I don’t like to eat before I finish work”.

What do you do when you get home?

“What else?! I cook the evening meal– rice and maybe some dal, and if I buy vegetables on the way home,I cook that.Once in a while we have fish,but not often.”

And after dinner?

“I wash the dishes outside the house; walk to the toilet and back. If there is water flowing in the public tap, then I wash some clothes and put them out to dry.”

And then, what do you do?

Bagi laughed aloud.“Then I go to sleep!”

To millions of women like Bagi, leisure is an alien concept. Exhausting physical labour is an integral part of their workday. All they want to be able to do at the end of the day is to rest, not exercise. But will the state and the powers-that-be let Bagi rest?

Towards‘active’societies:WHO report on physical activity

WHO’s 2018 initiative, Global Action Plan on Physical Activity 2018-2030: MoreActive People for a Healthier World (GPAP), set out four strategic objectives:active systems (such as, national policies for physical activity); active societies(such as national communications campaigns, mass physical education events);active environments(infrastructure design policies and legislation for safe walking, cycling), and active people (creating opportunity for physical activity atwork,play,etc.).Noticeably absent is any reference to the nature of people’s work or leisure time.

And yet, GPAP estimated the global cost of inactivity to be $54 billion per year indirect health care and an additional $14 billion attributable to “loss ofproductivity”. The report said, “societies that are more active can generate additional returns on investment including a reduced use of fossil fuels,cleaner air and less congested, safer roads.”

WHO’s systematic interest in physical activity is fairly recent and caught theworld’s attention for several reasons. One was the fact that by global reckoning,communicable diseases, although still a serious concern, no longer account for thehighest proportion of the disease burden even in the developing world. Non-communicable diseases (NCDs) like diabetes, cardiovascular diseases, certaincancers, respiratory diseases, some mental health diseases, and others were becoming major concerns,especially because healthcare systems in these countries are not equipped to deal with them adequately on a large scale yet.

Moreover, NCDs require lifelong care and lifestyle changes – that includes food,work, and leisure – and cannot be controlled or eliminated easily bypharmaceutical responses such as antibiotics or immunisation, as are infectious diseases.

So a shifting of priorities from communicable diseases to NCDs has taken place at international levels even as many developing countries are still coping with a huge burden of illness due to communicable diseases.

Physical activity has become a prime concern since it significantly impactsNCDs. Secondly, the major worry in international health circles now appears tobe the global financial burden imposed by NCDs.

Estimating public health care costs,a2023article in theLancetGlobalHealth warns “499.2 million new cases of preventable major NCDs would occur globally by 2030 if the prevalence of physical inactivity does not change.

The global cost of inaction on physical inactivity would reach approximately $47.6 billion per year. And significantly, “although 74% of new cases of NCDs would occur in low-income and middle-countries, high-income countries wouldbear a larger proportion (63%) of the economic costs.”

The article, among many others, urges policy makers to invest in policy action toencourage and enable people to be more active, especially in these countries. This has given rise to much discussion on how best to measure physical activity in order to surveil them better in developing countries.

To sum up, the drive to get populations to be more active appears to rest on the following anxiety: while NCDs are rising overwhelmingly in low- and middle-income countries, the cost of care of NCDs, much higher than it had been to control communicable diseases, is largely borne by the upper income countries(presumably via the WHO).

The WHO First Global Status Report on Physical Activity 2022 gravely notes that physical activity targets set four years ago were far from being achieved in most of the developing world. Only two policy targets had been implemented in over three-quarter countries. Across countries, 44% women and 25% men above 18 years were found to be inactive with little improvement in the indices overtime.

India launched its own systematic survey of physical activity in 2013, the Indian Council of Medical Research-India Diabetes(ICMR-INDIAB)study.Phase1of the ICMR-INDIAB study covered four regions–Tamil Nadu, Maharashtra, Jharkhand and Chandigarh–with a combined population of 213 million people and the study population was individuals above 20 years of age.

The data showed that 54.4% of the study population were classified as inactive, with those in the lower income group registering the lowest proportions. Of particular concern is the fact that a larger proportion of women than men – 59.6%in rural areas and 71.2%in urban areas – are found to be inactive. Overall, 91.9% of the study population did not undertake recreational physical activity.

Significantly, for both men and women, most of the time spent in moderate to vigorous intensity activity was at the workplace. Other surveys from China,Brazil and Vietnam also report similar results.

So, how do men and women spend their time?

India’s National Statistical Office conducted the country’s first Time Use Survey(TUS)in two decades, in 2019. TUS is directed at providing a means to construct indices for measuring progress towards Sustainable Development Goal no 5.4 that is aimed at recognising and valuing “unpaid care and domestic work through the provision of public services, infrastructure and social protection policies and the promotion of shared responsibility within the household and the family as nationally appropriate”.

While the survey has attracted much critical comment on its methodology and categorization, it is useful in that it provides hard data on women’s work. Women spend 19.5 hours a day in ‘unpaid domestic/care giving services for household members and another 1.7 hours in ‘other unpaid work’.

Add to this the time women spend in the ‘production of goods for own use’, which is 1.9 hours a day. Men spend 2.1 hours, 2.5 hours and 3.3 hours a day respectively in the same categories. By age group,85.8%women in the18-29 years age group are engaged in unpaid domestic services and 39.8% in unpaid caregiving. This means that the entire burden of looking after the household and sustaining the family falls on the women. In addition, women are involved in expenditure-saving activities, i.e., productive work within the family, over and above domestic chores and carework(DeshpandeandSingh2021).It is of course Well known that women bear the burden of social production and reproduction. But in these worsening years of ‘welfare’ capitalism women’s labour participation has been stubbornly low, declining, and highly volatile, even as the much touted ‘social safety net’ has frayed.

Women are compelled to move in and out of work, not because of childbirth or motherhood, but because of the dearth of appropriate work that would allow them to fulfil their socially designated role of service provider and caregiver in the family.

Ironically, in recent years the small rise in labour force participation rates for women, that is, paid work, is accounted for by work in the domestic sphere. –Cleaning, cooking and care–work is not only tedious but time and high-energy consuming, also often making for uncertain incomes with few contractual obligations on the part of the employers.

All this means is that women would have to forgo rest after a long hard day of labour in order to indulge in any sort of recreational activity– especially more physical exertion! For both men and women of the labouring classes, physical activity is a fact of life; it isn’t an indulgence of leisure time.

Against this picture of people’s workday, the WHO’s concern about the low levels of physical activity, especially the abysmal levels of activity among women in India, while, undoubtedly serious, presents a dilemma of sorts: Women’s work, especially the unpaid unrecognized work in domestic service and care, leaves them with little leisure and even less time for regulated physical activity. To undertake the latter, women’s work hours need to shrink, without affecting their incomes. This means the elimination of unpaid domestic work, shorter work hours with the same income and consequently, more leisure time.

In the case of men, we come up with a conundrum: The only way that working class men may have leisure time is to shorten their working day, without affecting their earnings. In other words by limiting their physical labour during work, they can, notionally, have more time for recreational physical activity.

There is no denying the fact that lack of physical activity impacts health. But it is surely obvious that the lack of improvement in physical activity times among people is not because of the non availability of space, or safe roads or appropriate legislations or even mass drills as the status reports suggests.

Shouldn’t the WHO’s primary concern be the lack of leisure in low income countries, especially among women, because of the long hours of work? India according to an Indian Labour Organisation (ILO) report, has the longest workdays in the world, with the lowest income levels!

Leisure in women’s lives

Interestingly, women have found ways to extract the space and time for a variety of recreational physical activities even in a world of time constraints. In doing so, women lay claim, however tentatively, to the right to leisure, knowing that this is also a way to expand their autonomy to reclaim endered spaces and activities.

An innovative, telling, and rather poignant in parts, is the tale unfolding on Surabhi Yadav’s Instagram-based photo project on leisure. Basanti: Women at Leisure provides glorious evidence of what women regard as leisure. And yes, they play field games as well as board games. They chat, they exercise, and knit. They grab every occasion that is ‘socially sanctioned’, as for instance religious celebrations or cultural festivals, to indulge in physical and mental recreation to dance and sing! As Dipanjali Singh, writing about the project comments: “The apparent lack of accessible resources makes moments of leisure gloriously radical.”

'Why Loiter? Women and Risk on Mumbai Streets (based on a wide-ranging,multi-layered ethnographic study in Mumbai by Shilpa Phadke,Sameera Khan and Shilpa Ranade) describes the many ways women indulge in leisure activities,often in defiance of social constraints.

And yet, even though women in big cities like Mumbai may have the access to public spaces, they do not have the right to it. Some go regularly to the church or temple because that is their socially sanctioned space. In one instance, an open playground’s compound wall becomes a women’s space for the short duration when they wait outside a school to fetch their children. And yet at other times it is solely occupied by men.

In another locale, women actively, enthusiastically, and determinedly participate in the festivities the week before Holi, laying claim to that public space with dance, music, and games.

Why Loiter advocates for women’s right to loiter without purpose or aim, to not just seek access to public spaces but to claim a right to them. But why not attempt more than that? Why not create safe spaces for women to express themselves in whatever ways they want through music, dance, games, exercise?

This of course, is a far more difficult concept to visualise and execute than tamely recommending the 150 minutes of daily activity,or introducing mandatory periods for physical exercises in offices and other working places, as the WHO recommends.

Because, these innovative initiatives would require, more than anything else, a recognition of women’s agency and an acknowledgement of women’s right to the public space, as well as their ability to decide on the activity, whether it is play, dance or exercise. It is this fluid, imagined, as yet largely untenanted space that we need to plan to expand so as to afford women the right to play, or simply to rest.

Working women’s voices have historically been heard demanding higher sustainable wages, wage parity, benefits, maternity leave, even safer workplaces; but why have we not specifically raised our voices demanding the right to leisure, more time to play? The claim to leisure is a radical feminist project. Such a demand would implicitly mean challenging gender norms; it would mean that the work that women do at home would need to be supported by state services for domestic work, for child rearing and the care of the elderly that most often falls on women.

It would need to acknowledge women’s work and its contribution to the economy. If physical literacy were to be achieved for women, then it is these demands that must be met. Only then will women like Bagi recognise the concept of leisure, using it in the way they like best, dancing, singing, playing, chatting, walking, watching TV or going to the movies or even just sitting on the stoop. Or, for that matter, exercising their right to play and access sports.

The right to play, among the ‘central capabilities’ advocated by Martha Nussbaum, Amartya Sen’s collaborator, for “every decent political order” to ensure to their citizens, is also associated with the realisation of several SDGs.The Indian state tacitly endorses this right.

But to expand play time, especially women’s, requires that the state address theissue of women’s labour in producing and reproducing social relations and facilitate their agency in defining work, leisure, and play.

[With grateful thanks to Simon Darnell for his critical comments on an earlier draft.]


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