3. When Hammer Misses the Nail: Health Aspirations and Internal Migration in India

As the COVID-19 pandemic rages through the world, public health systems in India continue to fail the poor, most notably migrant labourers and their families. The historical levels of death and economic damage have strengthened support for investment in health infrastructure. However, calls for investment in health infrastructure overlook the role of the agency of migrants in effective health systems. This chapter elaborates on the links between health aspirations and migration decisions of rural households. Through a case study of seasonal migrants in Nuapada, Odisha, this chapter argues that precarity of seasonal migrants deprioritizes health aspirations for a life that “they have a reason to value”. Using a framework based on the capacity to aspire and the capabilities approach, I find that rural households in the sample have generally low health aspirations for their children. These aspirations—including levels of health and debt for health expenses—are further lower for girls than for boys. While debt related to health expenses is a key factor in creating debt traps that sustain high-risk low-return seasonal migration, lower health aspirations impair any investment in health or access to health systems. This chapter cautions against a singular focus on building infrastructures, and argues for thoughtful integration of the agency of migrants to develop effective health systems in the future.