The preceding chapters raise three issues that are crucial to understanding the politics of healthy ageing. First, older voters are not as powerful nor as unified as many politicians, think tanks and commentators often believe. While some elderly voters have preferences for policies that are in their own interests or in the interests of their children and grandchildren, older voters are not sufficiently homogeneous to act as a voting bloc. Indeed, even if they were, it is not clear that their influence on policy would be substantial because policy decisions are not simply determined by voters’ demand. Second, in those few contexts where political conflict over policies is framed intergenerationally, the wellbeing of older people can be preserved without being at the expense of other groups, particularly those of working age. Reframing the debate in this way helps societies move from policies which individualize the responsibility of being healthy – by withdrawing government investment – to an emphasis on healthy ageing which seeks to establish cross-class/cross-generational coalitions. Third, inequalities in healthy ageing are structured according to other kinds of inequality in the social determinants of health, and these upstream inequalities are best understood when situated in a life-course perspective which recognizes that inequalities in ageing are the product of inequalities that manifest at much earlier stages in life. Not everybody gets to be old.

Chantal Mouffe makes a strong case for ‘Left populist’ mobilisation in building radical democracy. By Left populism, she refers to a populist mobilisation based on an expansive construction of a ‘people’ that works towards deepening equality and social justice for multiple marginalised groups. Taking cues from Laclau's works on populist reason (2005, 2006; Laclau and Mouffe 2014), she argues that radical politics requires deepening the idea of democracy so that ideas of freedom and equality are no longer confined to the domain of the liberal. They ought to be reworked so as to transform social relations towards realising substantive freedom and equality. Our narrative of the developmental trajectory of Tamil Nadu suggests that populist mobilisation around a non-essentialised Dravidian-Tamil identity and a demand for ‘social justice’ has indeed worked to expand freedom and reduce inequities across castes. Operating within a constitutional democratic framework, the state's experience highlights the democratic possibilities that can be opened up within such a structure. This is particularly important in postcolonial societies where mobilisations have often drawn upon essentialised and exclusionary constructions of ‘people’ that tend to undermine prospects for democratising social relations. The state's political experience suggests that it is indeed possible to institutionalise an inclusive populist mobilisation leading to a comparatively egalitarian developmental trajectory in the Global South.

There are thus two distinct contributions that our analysis of the state's development makes to the literature on subnational development and politics in the Global South. First, we establish that an inclusive populist mobilisation can generate sustained developmental outcomes for the marginalised social groups even when national-level interventions have an elite bias. Populist mobilisation and institutionalisation of that populist logic in the state apparatus have fostered better developmental outcomes in Tamil Nadu than in most states in the country. Such outcomes have been embedded in a growth process that has managed to structurally transform the state's economy and livelihoods. In fact, such outcomes have fed into the broad-basing of opportunities for entry into expanding modern productive sectors. Second, we have also demonstrated how an emphasis on status-based inequality has shaped this process. We thus call for greater attention to this source of inequality in the Global South.

In contrast to other political mobilisations that focused merely on classbased inequality, the Dravidian movement conceptualised injustice emanating from caste hierarchies to be more central in India. Piketty's recent work (2020) only affirms such a conception.

The freedom to seek employment outside the household is systematically denied to women in many cultures, which is in fact a violation of women's liberty. In several instances, the denial is implicit through the power of convention and conformity. To break the ‘social barriers’ and to bring working outside the household ‘centre stage’ as the ‘new normal’ for women requires complementary efforts by non-market institutions, especially for the marginalized sections of society like that of the fishing communities. The fishing communities in Kerala are marginalized sections with very high levels of poverty. Hence, in the absence of organizations like Self Employed Women's Association (SEWA), the participation of women of fishing communities in south Kerala in marketing/vending fish is in one way a reflection of the entrepreneurial spirit triggered by poverty and lack of livelihood options. Participating in markets can be liberating and empowering for women, not only economically but also at the individual level of enhancing their capabilities and thereby aspirations. Mobility associated with paid work outside the household has a capability-enhancing effect. However, many times, owing to exploitative conditions of the work, this may not result in human flourishing. The trajectory from work to welfare is non-linear.

For the analysis of mobility, autonomy, and agency of women in informal work, I chose women fish vendors as the second group of workers in the fisheries sector because of the very unique nature of the work of the women vendors, which makes them one of the most mobile groups of informal workers in fisheries. They are in direct contrast to the peeling workers who are based in a factory setting. Moreover, as an informal self-employed group of workers, women fish vendors have a critical role in the fisheries sector as well as in the society. They are a reflection of the entrepreneurial spirit in fisheries.

Power of convention versus power of market: case of women fish vendors

Fish vending is an important informal activity in the fisheries sector. In Kerala, women entered into the men's bastion of fish vending around thirty-five years ago. It is still confined to the districts of south Kerala, namely Thiruvananthapuram, Kollam, and Alappuzha.

Despite the alleged bias towards older people in many political institutions in Europe, this chapter argues that policymakers often do not introduce the most effective policies for supporting healthy ageing. The following pages show that while public spending on older people (e.g. pensions, old age care) remains more extensive and insulated from cuts than other forms of spending, in many (not all) countries policymakers do not introduce policies that would help people age in a healthy way. These latter policies, which include spending on the poorest older people, ensuring access to high quality services and investing across the life-cycle to enable people to enter old age in good health, are often limited.

In this book, by conceptualizing transformational mobility (TM) as capability, I have unravelled the linkages between mobility and autonomy of women in the context of informal work. Though mobility as capability has been acknowledged by scholars in the lists of capabilities (Robeyns, 2003; Nussbaum, 2005), not much in-depth research has been done to analyse its multiple domains in the context of gender. The studies in the areas of gender–mobility–capability can have important consequences for research in gender and justice which can help in analysing issues of social exclusion, gender discrimination, and inequalities (Kronlid, 2006) that persist in developing economies. My re-conceptualization of mobility (TM) as capability by operationalizing the capability approach (CA) has recognized work mobility as a ‘functioning’ for women, which is a survival necessity for poor informal workers. It is only TM which is a ‘capability’ that enhances the opportunities and improves the well-being freedoms of women workers. Paid work outside the household does not necessarily improve the overall mobility and autonomy of women workers.

I have adopted CA not in an atomistic or individualistic manner in analysing women workers but rather to analyse their mobility and autonomy in a relational sense given the cultural context of Kerala. I have captured the domains of gendered mobility as experienced by women in the sociocultural context of India, which reflects ‘bounded capabilities’, that is, capability bounded by social norms and patriarchal authority. By using the mobility ladder and examining the social, spatial mobility of women workers to reach TM as capability, I have brought forth the intrinsic importance of mobility for women and how patriarchal structures can dominate the mobility spaces of women. To view ‘development as freedom’ (Sen, 1999), it is important to recognize the value of TM of women workers, which enhances the freedoms and choices for women within the household and which can lead to autonomy and agency outside the household. Though paid work can be said to improve agency (Sen, 1999), the situation of informal women workers in paid work in fisheries demonstrates that the associated mobility is ‘bounded capability’ in the context of low paid informal work which does not necessarily promote agency.

We too often form our perspectives or design policies based on simplistic notions of generational warfare or stereotypes. Precise definitions and examination of data on the life conditions of older people lead us to the same conclusion as a quick contemplation of our own lives: the situations, goals and behaviours of older people are very diverse.

If social justice, as the Dravidianists imagined, was rooted in a process of inclusive modernisation, what does it mean for the process of capital accumulation? There are two interpretations of the unfolding of the process of accumulation in the state. According to one, both Dravidian parties have focused on welfare politics, leaving the elites to dominate the realm of capital accumulation (Harriss and Wyatt 2019). Harriss (2003) in fact observes that the prominent business leaders have continued to remain at the top for decades. Harish Damodaran (2008), though not exactly contesting this position, argues that there has been a ‘democratization of capital’ in southern India including Tamil Nadu, due to certain historical factors. Drawing upon works by historians like Mahadevan (1992, 2017), Damodaran argues that the absence of a dominant trading community (Vaishya) in the south allowed for entrepreneurs from lower castes to emerge, bringing about a process of ‘democratisation of capital’. He thus attributes this ‘democratisation’ to a combination of opportunities opened up by colonial commerce and the ability of specific lower castes rooted in particular geographies to take advantage of these opportunities. In other words, this process has happened independent of any deliberate policy interventions. On a similar note, while Swaminathan (1994) suggests a relative absence of entrepreneurship in the state, Sinha (2005) argues that there has been inadequate state support for industrialisation. Partly contesting these propositions, in this chapter we make a case for the role of state intervention backed by a political imagination in facilitating and ‘democratising’ capital accumulation in Tamil Nadu.

According to ideologues of the Dravidian movement, there were two factors that hindered democratising capital accumulation in the region. First, they held that the caste system rendered actors from some castes ‘born capitalists’ and those from others ‘born labourers’ (Vidiyal 2017: pp. 737–38). Addressing railway workers in 1952, Periyar called upon the workers to understand that it was being born into a specific caste that made them a part of the working class while members of the upper castes become capitalists by virtue of their birth. Their struggle should therefore be to destroy the institution that generates and sustains this class divide. Second, the dominance of Marwari (‘north Indian’) capital in the country and in the region was seen to prevent modernisation of the economy and entry of ‘Tamils’ into business (Annadurai 2017 [1949]).

India compares poorly with other developing countries on health parameters despite being among the fastest growing economies in the world (Balarajan, Selvaraj, and Subramanian 2011). In fact, compared to other developing countries, India has one of the lowest expenditures on health as a proportion of its gross domestic product (GDP) (A. Chakraborty 2019). As a result, citizens incur one of the highest out-of-pocket expenditures on health among countries with similar levels of income. Importantly, the increase in economic growth has not been matched by corresponding increases in human development in India. This is a paradox in a country where democratic practices have been better institutionalised as Evans and Heller (2018) point out. Countries with such democratic institutions are expected to invest additional resources towards welfare interventions in education and health compared to more authoritarian regimes that may emphasise growth at the expense of investments in human development.

As in the case of education, scholars use the elite bias hypothesis to explain this paradox (Das Gupta 2005). The Indian health system is biased in favour of elites as it focussed on curative health more than public health. Elites relied on curative medicines to insulate themselves from communicable diseases while neglecting public health, that is, to prevent exposure to such diseases for the rich and poor alike. Tamil Nadu is one of the few states that has, however, managed to work against this bias and build a robust public health infrastructure. The state for example, has already achieved the Millennium Development Goals (MDGs) of reduction in infant mortality rate (IMR) and maternal mortality ratio (MMR) (Vaidyanathan 2014). Given the macro-bias against healthcare, the state's achievements that we map in the next section clearly stand out. What made such outcomes possible?

This chapter traces a set of interventions in this regard, starting with the creation of a separate department for public health in the early-20th century. It goes on to identify factors contributing to the dramatic decline in fertility rate in the state including interventions focusing on maternity and early child care. The state, as mentioned in the previous chapter, is known for launching the nutritious noon meal scheme, a forerunner to similar schemes launched at the all-India level. The chapter also therefore discusses the history of processes instituted and the health implications of the nutritious noon meal scheme.