The missing business case for ending Tuberculosis

August 24, 2026 Leave a comment

Tuberculosis (TB) presents one of the most enduring paradoxes in global health. It is preventable, diagnosable, and curable, yet it remains among the world’s deadliest infectious diseases. Every year, millions of people fall ill, and more than a million lose their lives to a disease that medicine has known how to treat for decades. The burden is concentrated overwhelmingly in the Global South, particularly in countries such as India, Indonesia, Pakistan, Nigeria, Bangladesh, and the Philippines. Yet despite this enormous human and economic cost, TB continues to attract only a fraction of the funding mobilised for many other global health challenges. The question is not whether TB is a public health emergency, but rather why a disease with such a high burden struggles to attract sustained investment.

The answer lies less in epidemiology and more in economics. Global health financing is often driven by a combination of political attention, public visibility, strategic interests, and commercial incentives. Diseases that threaten wealthier populations, generate public fear, or offer lucrative opportunities for innovation tend to attract substantial resources. Tuberculosis does none of these particularly well. It is largely a disease of poverty, affecting populations with limited political influence and weak purchasing power. As a result, the market signals that typically drive investment remain weak, even when the social need is overwhelming.

This disconnect is evident in the global financing landscape. Governments meeting at the United Nations High-Level Meeting on Tuberculosis in 2023 committed to mobilising US$22 billion annually for TB prevention, diagnosis, treatment, and care by 2027, alongside US$5 billion annually for research and development. Yet current financing remains far below these ambitions. Many high-burden countries continue to face significant resource shortages, and funding gaps persist across national TB programmes. Research funding is even more constrained. Global investment in tuberculosis research remains only a fraction of what experts estimate is necessary to develop better diagnostics, shorter treatment regimens, and more effective vaccines. The world has repeatedly declared its intention to end TB, but its financial commitments suggest otherwise.

A major reason for this shortfall is the narrow donor base supporting the global TB response. Unlike some other health sectors that benefit from a broad coalition of governments, foundations, corporations, and private investors, TB relies heavily on a small number of actors. The Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFTAM) remains the largest external financier of TB programmes worldwide. A handful of bilateral donors and philanthropic organisations account for much of the remaining support. Outside this relatively small circle, engagement is limited. Family foundations, corporate social responsibility programmes, impact investors, and development finance institutions have yet to embrace tuberculosis as a priority issue at scale.

This concentration of funding creates vulnerability. Any reduction in donor commitments, shifts in geopolitical priorities, or fiscal pressures in donor countries can quickly undermine progress. Recent debates around development assistance budgets and declining aid commitments have highlighted the fragility of the current model. The reality is that the global TB response rests on a financial foundation that is both narrow and uncertain.

The deeper challenge, however, is that tuberculosis has never been successfully positioned as an investment opportunity. Unlike cancer therapies, medical technologies, or chronic disease management solutions, TB offers limited prospects for commercial returns. The populations most affected are often served by publicly funded health systems or donor-supported programmes. Pharmaceutical companies face uncertain revenue streams, while investors struggle to identify scalable business models capable of generating attractive financial returns. In a world increasingly shaped by market logic, tuberculosis suffers from a lack of investability.

Yet this perception obscures a much larger economic reality. Tuberculosis may be one of the highest-return investments available in international development. The disease primarily affects people during their most productive years, reducing labour force participation, household earnings, and economic mobility. Children leave school to care for sick relatives. Communities lose workers, caregivers, and local leaders. The economic impact extends far beyond health systems, affecting productivity, human capital formation, and long-term development outcomes. Every case prevented and every patient cured generates benefits that ripple across households, communities, and economies.

The problem is that these returns are largely social rather than financial. The benefits accrue to governments, employers, families, and society as a whole rather than to any single investor. Economists describe this as a classic market failure. The social return on investment is extraordinarily high, but the private return remains relatively low. As a consequence, the market underinvests in solutions despite their obvious public value.

This is precisely why tuberculosis requires a different financing narrative. For decades, the disease has been framed primarily as a public health challenge. While this framing is accurate, it is insufficient. Tuberculosis should also be understood as a development challenge, a labour market challenge, and a human capital challenge. Countries across Asia and Africa are investing heavily in education, skills, entrepreneurship, and economic growth to capitalise on their demographic dividends. Yet the continued prevalence of tuberculosis silently erodes these investments by reducing productivity and weakening workforce participation.

Reframing TB as an economic issue rather than solely a health issue could unlock new sources of capital. Development finance institutions could view TB investments as essential components of economic resilience. Corporate CSR programs could recognise tuberculosis as a workforce and community development issue. Family offices and philanthropists interested in inclusive growth could support interventions that strengthen human capital among vulnerable populations. Impact investors could explore opportunities in diagnostics, digital adherence technologies, and community-based healthcare delivery. Innovative financing mechanisms, including blended finance and outcome-based funding, could help bridge the gap between social value and financial participation.

Such approaches would not replace traditional public health financing, nor should they. Governments must remain the primary funders of national TB responses. However, relying solely on governments, multilateral agencies, and a handful of foundations is unlikely to generate the scale of resources required to end the epidemic. The financing ecosystem must expand, and that expansion will only occur if the narrative changes.

Perhaps the most troubling aspect of tuberculosis is that its persistence is no longer primarily a scientific problem. The tools to diagnose and cure the disease already exist, and innovations are emerging. What remains missing is sufficient investment and political commitment to deploy these solutions at scale. In an age that celebrates technological breakthroughs and billion-dollar innovation ecosystems, the continued burden of a curable disease reflects not a failure of medicine but a failure of financing.The global community has largely treated tuberculosis as a charitable cause. It is time to recognise it as an investment in human productivity, economic resilience, and social stability. Until funders, policymakers, and investors view tuberculosis through this broader lens, the gap between disease burden and financial commitment will persist. The missing business case for ending tuberculosis is not a lack of evidence that the returns are absent.

(Disclaimer: The opinions expressed are those of the author and do not purport to reflect the views or opinions of any organisation, foundation, CSR, non-profit or others.)

Cover image is generated using AI

First Published on LinkedIn: 26 June 2026

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Why rural digital entrepreneurs matter

August 10, 2026 Leave a comment

When policymakers in India discuss infrastructure, they usually refer to roads, electricity, telecommunications, railways, and industrial corridors. These investments are undeniably important. Yet there is another form of infrastructure that receives far less attention despite its growing importance in connecting citizens with markets, government services, and economic opportunities, which is rural digital entrepreneurship.

Across India, thousands of rural entrepreneurs are quietly performing functions that neither government offices nor private companies can efficiently deliver on their own. They help citizens access digital services, complete applications, make online payments, obtain certificates, access welfare schemes, receive medical advice, connect with markets, and navigate an increasingly digital economy. In doing so, they have become an essential layer of last-mile infrastructure.

India’s digital transformation has been remarkable, especially in the last 10 years or so. Digital public infrastructure, including Aadhaar, UPI, DigiLocker, and numerous online government services, has created unprecedented possibilities for inclusion. However, access to digital platforms does not automatically translate into digital participation. Millions of citizens still face barriers related to literacy, language, confidence, connectivity, documentation, and procedural complexity.

For many rural households, the challenge is not the absence of technology but the absence of trusted intermediaries who can help them use that technology effectively. This is where rural digital entrepreneurs play a critical role. A villager seeking to apply for a government scheme, update land records, register a grievance, obtain a certificate, access telemedicine, or complete an online transaction often relies on a local entrepreneur who understands both the technology and the community. These entrepreneurs bridge the gap between sophisticated digital systems and the realities of rural life.

Their contribution extends beyond service delivery. They generate local employment, build trust in digital systems, reduce transaction costs for citizens, and create pathways for financial and social inclusion. In many communities, they serve as informal advisors, helping citizens navigate an increasingly complex administrative landscape.

The importance of this role is likely to increase rather than diminish. As artificial intelligence, digital governance, online education, telehealth, e-commerce, and digital financial services continue to expand, the demand for local assistance will remain substantial. Contrary to the assumption that digitalisation eliminates intermediaries, experience often shows that new technologies create demand for new forms of facilitation and support.

The success of India’s digital future therefore depends not only on technological innovation but also on human infrastructure. However, rural digital entrepreneurs continue to operate largely at the margins of policy discourse. While considerable attention is paid to startups, MSMEs, and technology companies, relatively little focus is placed on strengthening the ecosystem that supports last-mile entrepreneurs. Access to affordable finance, business development services, training, digital tools, market linkages, and growth pathways remains uneven.

Women entrepreneurs face additional challenges in the form of social norms, mobility constraints, and limited access to resources, which restrict their ability to expand their enterprises. However, where these barriers are addressed, women-led digital enterprises often become powerful catalysts for household income growth, community trust, and social change.

Therefore, a more deliberate policy approach is needed. Rural digital entrepreneurs should be recognised as a strategic component of India’s development architecture. Their role goes beyond commerce, as they enable access to rights, services, and opportunities. Entrepreneurship development programs should move beyond one-time training and focus on long-term business viability. Mentorship, market access, technology support, and peer learning networks are often more important than short-duration capacity-building interventions. Partnerships between government, civil society, and the private sector can create sustainable service ecosystems. Rural entrepreneurs are uniquely positioned to deliver a wide range of services, from financial inclusion and digital literacy to telemedicine, skilling, and e-commerce support. Finally, impact measurement frameworks should capture not only income generation but also the broader social value created through improved access, reduced exclusion, and enhanced citizen participation.

India’s development story has often been driven by investments in physical infrastructure. The next phase may depend equally on investments in human infrastructure—people who connect citizens to systems, opportunities, and institutions. As India advances toward a more digital, inclusive, and knowledge-driven economy, these rural digital entrepreneurs deserve greater recognition not merely as service providers but as builders of development infrastructure. Their work may not be visible in satellite imagery or national construction statistics, but its impact is felt daily in villages where citizens gain access to opportunities that were once beyond reach.

The future of inclusive development will not be determined solely by the technologies we create. It will also be shaped by the people who help others use them.

If this essay made you reflect on digital infrastructure, rural entrepreneurship, and human potential, subscribe to my blog for one new article in your inbox every week. It’s free!

(Disclaimer: The opinions expressed are those of the author and do not purport to reflect the views or opinions of any organisation, foundation, CSR, non-profit or others.)

(Photo: A rural digital entrepreneur from Jharkhand)

First published in LinkedIn on 9th June 2026

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Why change cannot be delivered

July 27, 2026 Leave a comment

Five years ago, I met Priyanka, a young woman from a small village in the Latehar district of Jharkhand. Like many women in rural India, her world was defined by invisible boundaries. Opportunities were limited, mobility was constrained, and the digital revolution that was transforming urban India felt very distant from her daily reality. When she joined a rural digital entrepreneurship programme, she did not see herself as an entrepreneur. She simply wanted to learn how to use a laptop and perhaps earn a modest income.

Today, Priyanka runs two digital service centres in her village and around. On any given day, she helps scores of people access government schemes, apply for jobs, update documents, pay utility bills, and navigate digital platforms that would otherwise remain out of reach. Villagers who once travelled long distances and spent an entire day completing simple administrative tasks now walk a few minutes to seek her assistance. More importantly, young girls in the village consider her as their role model and hold upward career aspirations. They see someone who looks like them using digital tools to build a livelihood and create value for her community.

What changed in Priyanka’s life was not merely her income but her sense of agency. She stopped being a passive recipient of charity and became an active participant in shaping the future of her community. Her story reminded me of a lesson that I have encountered repeatedly over the past twenty years in development. Lasting change does not happen when we deliver solutions to people. It happens when people gain the confidence, capability, and opportunity to create solutions for themselves.

After 20+ years in development sector, this is the lesson I carry with the greatest conviction that change cannot be delivered to people. It emerges when people discover their own power to create it. We often treat it as something that can be designed, funded, managed, monitored, and delivered. We create theories of change, strategic plans, annual targets, dashboards, and impact indicators. We write proposals describing how communities will evolve over the next three or five years and convince ourselves that social transformation can be engineered with enough resources, expertise, and discipline. Yet the longer I have worked in this sector, the more I have realised that change is far more organic, unpredictable, and human than our project documents suggest.

When I began my career, I believed what many young professionals entering the development sector believe, that poverty could be reduced through good Programs alone, that social problems could be solved through smart interventions, and that institutions with the right intent could create pathways for people to improve their lives. I still believe in all of those things. What has changed is my understanding of where transformation actually comes from. After working across livelihoods, entrepreneurship, environmental sustainability, women’s empowerment, public health, education, and digital inclusion, I have come to a simple conclusion that development succeeds when people gain the agency to shape their own futures.

One of the first assumptions I had to unlearn was the idea that communities are primarily defined by what they lack. Development discussion is filled with the language of deficits. We identify needs, vulnerabilities, gaps, and constraints, and catalogue problems and design interventions to address them. While these exercises are important, they can also blind us to a more powerful reality. Communities possess knowledge, resilience, social capital, aspirations, and capabilities that outsiders frequently underestimate. Over the years, I have met women who built successful enterprises despite social barriers, farmers who adapted to environmental challenges long before climate resilience became a policy priority, and young people who created opportunities where experts saw only limitations. What distinguished these individuals was not the assistance they received but the agency they exercised. The most successful development programs I have witnessed were those that helped people discover their own capacity to act.

This may sound obvious, yet much of the development sector still operates as though change originates from institutions rather than individuals. We often speak of empowering communities as if empowerment is something that can be handed over like a grant or a training manual. Experience has taught me that empowerment is not delivered, but is unlocked. People change their lives when they begin to see themselves not as beneficiaries of someone else’s program but as active participants in shaping their own future.

Another lesson that I took years to fully appreciate is that projects produce outputs, while ecosystems create change. Development organisations have become increasingly sophisticated in measuring activities and outputs. We know how many people attended training programs, how many households received services, how many entrepreneurs were supported, and how many villages were covered. These numbers and accountability matter as funders and stakeholders deserve evidence that resources are being used effectively. Yet some of the most transformative changes I have witnessed had little to do with what was captured in a monitoring framework.

I have seen projects with impressive numbers disappear almost entirely once funding ended. I have also seen relatively modest initiatives continue creating value years after external support had ceased. The difference was rarely the size of the budget or the quality of the project design. More often, it was whether the intervention had strengthened the local ecosystem or not. Sustainable change emerges from relationships, institutions, markets, networks, and leadership. It emerges when communities develop the capacity to solve problems collectively, and when local actors begin driving progress themselves. 

This is particularly true in the field of livelihoods and entrepreneurship, where I have spent much of my professional life. For decades, development programs have focused on training individuals, providing assets, or facilitating access to finance. These interventions are valuable, but they are rarely sufficient. Entrepreneurship does not flourish simply because someone acquires a skill. It flourishes when an entire ecosystem supports risk-taking, innovation, market access, mentorship, and growth. The future of development, especially in rural economies, lies in building environments where success becomes possible for many.

One of the more surprising lessons from my career concerns money. Having spent years raising resources for social programs, I have a deep appreciation for the role of funding in creating impact. Without resources, good ideas often remain aspirations. Yet after helping mobilise hundreds of crores for development initiatives, I have come to believe that development is rarely constrained primarily by money. That may sound like an unusual statement coming from someone whose responsibilities have included fundraising and partnership development, but experience repeatedly points in that direction.

Many social challenges that appear to be funding problems are, in reality, leadership problems, institutional problems, capability problems, or trust problems. Additional funding can accelerate progress when strong systems exist. It can also magnify inefficiencies when those systems are weak. Some of the most effective organisations I have come across were not the wealthiest. They were the ones who built credibility, nurtured talent, fostered partnerships, learned continuously, and remained deeply connected to the communities they served. Development ultimately depends on institutions, as strong institutions outlive projects, preserve knowledge, adapt to changing circumstances, and create platforms through which future generations can continue the work. Sustainable change requires institutions capable of sustaining momentum long after a grant agreement expires.

Another belief I have gradually become sceptical of is the sector’s fascination with innovation. Few words are used more frequently in development conversations today. Every conference, funding call, and strategy document seems to emphasise innovation as the pathway to impact. New technologies, new models, and new approaches are often celebrated as solutions to deeply entrenched social challenges. Innovation undoubtedly has value, and many important advances have emerged from creative thinking. Yet the longer I work in development, the more I believe that adaptation is often more important than innovation.

Communities do not need solutions that look impressive in presentations; rather, they need solutions that work within their realities. The most successful initiatives I have known were not necessarily the most innovative. They were the most adaptive and respected local contexts rather than attempting to impose external models. The development sector is full of examples where brilliant ideas failed because they ignored the realities of the people they were intended to serve. It is also full of examples where relatively simple approaches succeeded because they were grounded in local ownership and practical wisdom.

Perhaps the most important lesson of all is that ownership is the ultimate measure of impact. For many years, I believed that scale alone represented the highest aspiration in development. Reach more people, expand into more geographies, and increase the numbers. Scale is important, and the magnitude of global challenges demands ambition. Yet scale without ownership is fragile. Programs that depend indefinitely on external actors are vulnerable by design. Lasting change occurs when communities begin to see an initiative as their own, when local leaders emerge, when institutions take root, and when progress continues without constant external direction.

This requires a profound shift in how we think about our role as development practitioners. Too often, organisations position themselves as providers of solutions. A more useful role may be that of a catalyst, connector, facilitator, and investor in human potential. The objective is not to become indispensable, but to create the conditions under which communities can thrive independently. Success is not measured by how long people depend on us, but by how effectively people progress without us.

As I reflect on my 20+ years in this sector, I remain optimistic despite the scale of the challenges before us. Climate change, inequality, unemployment, public health crises, and social exclusion remain formidable problems. Yet I have seen enough examples of human ingenuity, resilience, and determination to believe that meaningful progress is possible. I have seen individuals transform their circumstances, communities build collective solutions, and institutions evolve into powerful vehicles for social change. These experiences have reinforced my conviction, which has only grown stronger with time.The future of development will not be determined solely by larger budgets, more sophisticated frameworks, or more ambitious programs. It will be determined by our ability to strengthen local institutions, nurture entrepreneurship, build resilient economic ecosystems, and trust communities to shape their own destinies. If twenty years have taught me anything, it is that change is not something we deliver to people. Change is something people create when they have the opportunity, confidence, and freedom to act. Our responsibility is not to direct that process. It is to help create the conditions that make it possible and then have the humility to step aside.

Disclaimer: The opinions expressed are those of the author and do not purport to reflect the views or opinions of any organisation, foundation, CSR, non-profit or others.

(Cover image is generated using AI)

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Building Demand for Development

July 13, 2026 Leave a comment

India’s rural development dialogues have treated health, education, and income as parallel priorities often pursued through separate policy silos. Budgets are allocated, schemes are launched, infrastructure is built, and targets are set, all with good intent. However, one foundational truth remains insufficiently acknowledged, that increasing rural incomes is not merely an economic goal but one of the most effective demand-side interventions for health and education. Without income security, even the best school education systems and local health facilities struggle to translate access into outcomes. With income growth, aspirations gain purchasing power, the choice basket expands, and human development accelerates in ways no standalone welfare program can achieve.

The constraint on health and education in rural India is rarely a lack of awareness alone. Most families understand the value of a healthy body and an educated child, but they cannot act on that understanding consistently. Irregular incomes, seasonal employment, debt cycles, and exposure to shocks force households into a constant state of prioritising needs and what is immediately affordable. In such conditions, preventive healthcare is postponed until illness becomes unavoidable, and education becomes negotiable once opportunity costs rise. When incomes increase, particularly when they become predictable rather than sporadic, this calculus begins to shift fundamentally. I have witnessed this change countless times among the families from rural livelihood and entrepreneurship development programs across multiple states of India, from the north to the northeast.

The first visible change that accompanies rising rural income is in health-seeking behaviour. As disposable income grows, households move from reactive to preventive care. They begin to spend on nutritious food intake, diagnostics, maternal health, and timely treatment rather than relying solely on home remedies or last-resort interventions. This is observable across rural belts where livelihoods have stabilised through dairy cooperatives, non-farm employment, or entrepreneurship opportunities. Increased income reduces the psychological cost of seeking care. A doctor’s visit no longer feels like a financial gamble, and medicine is no longer a choice between recovery and indebtedness. Over time, this shift translates into lower morbidity, higher productivity, and a virtuous cycle of income and wellbeing.

Education follows a similar but slightly delayed trajectory. At very low-income levels, schooling competes with survival. Children’s labour, whether on farms, in family enterprises, or in caregiving roles, has immediate economic value. As incomes rise, the opportunity cost of schooling declines. Families are more willing to keep children in school, invest in better quality institutions, often private schools in their own villages or neighbouring towns, and support supplementary learning such as tuition or digital tools. Crucially, income growth often changes learning outcomes and ambition, and not just enrolment. Education stops being about literacy alone and starts being about mobility, including English proficiency, technical skills, credentials, and pathways beyond the village economy.

This transition from survival to investment is critical as human capital investments respond strongly to income thresholds. Below a certain level of income, households simply cannot afford to plan long-term, and above that critical level, behaviour changes rapidly. Rural India today stands at precisely this inflection point. Decades of infrastructure expansion, electrification, and digital penetration have laid the groundwork. What remains uneven is sustainable income enhancement pathways at scale. Where it happens, demand for health and education services rises organically, often faster than supply systems can respond.

However, increased income alters expectations and does not merely increase consumption. Rural households with higher incomes begin to demand quality, accountability, and outcomes. They compare schools, question teaching standards, seek second medical opinions, and are willing to pay for reliability with profound implications. It challenges the assumption that rural citizens will accept poor service quality indefinitely. It also creates space for private, social, and hybrid service models like low-cost clinics, diagnostic centres, skill academies, and ed-tech platforms that were previously unviable due to weak demand. Income growth can enable choice for households, who would increasingly adopt mixed strategies of using public facilities for some services and private providers for others. This duality can, if managed well, improve overall system performance. 

The ripple effects of income-driven demand can extend beyond individual households. As spending on health and education will increase, local economies will diversify. Teachers, health workers, lab technicians, transport providers, and service support staff will find employment closer to home. Women’s participation in the workforce will rise as care responsibilities will reduce and aspirations will expand. These multiplier effects will strengthen rural markets, making income growth more resilient and less dependent on a single sector like agriculture.

However, income growth alone is not sufficient, as demand without supply will lead to frustration, not development. In many rural areas, rising incomes have resulted in out-migration for services, with families travelling long distances or relocating temporarily to access quality healthcare and education. This is not a failure of income-led development, but a failure to anticipate and respond to it. Both public and private supply systems must be designed to scale alongside income growth. Physical access, skilled personnel, digital connectivity, and trust are essential if local ecosystems are to capture the benefits of rising demand.

Livelihood programmes and social sector investments are often conceived independently. Income-generation schemes focus on outputs like jobs created and enterprises supported, while health and education programmes focus on inputs like schools built, staff hired, and beneficiaries enrolled. What is missing is an integrated demand-supply lens. Rural income enhancement should be explicitly recognised as a human development strategy, with parallel investments planned in service delivery capacity. When livelihoods improve in a region, health and education infrastructure should be strengthened proactively, not reactively.

For corporate social responsibility (CSR) and philanthropy, this insight could be particularly valuable. Rather than choosing between livelihoods and social services, funders should see them as sequential and reinforcing investments. Supporting rural entrepreneurship, value chains, or digital livelihoods creates the conditions for sustained demand for health and education. Complementing this with investments in service quality of teacher training, primary healthcare strengthening, telemedicine, or skill education will maximise impact. Fragmented interventions will yield fragmented outcomes, while integrated strategies can create lasting change.

When rural citizens earn more, they become more vocal stakeholders in the local political economy. They demand better governance, transparency, and responsiveness. Health and education, being highly visible services, often become focal points of this demand. Income growth thus strengthens democratic accountability. It shifts the relationship between the state and citizens from charity to entitlement, from gratitude to expectation. 

India’s development journey offers ample evidence of this dynamic. States like Gujarat, Tamil Nadu, and Maharashtra that have successfully diversified rural incomes through improved irrigation, manufacturing clusters, or services consistently outperform others on health and education indicators. The lesson is that the effectiveness of social spending is amplified when households have the means to engage with it meaningfully. Supply creates possibility, and income creates participation.

As India looks ahead to the next phase of rural transformation, the question is no longer whether to invest in health, education, or livelihoods, but how to sequence and integrate them. Treating income growth as the foundation of demand generation reframes the debate. It reminds us that people are not passive recipients of services, but active decision-makers whose choices shape outcomes. Empowering those choices through income security may be the most humane and pragmatic development strategy to have. This has the potential of unlocking a chain reaction that will turn latent needs into effective demand, services into systems, and welfare into wellbeing. Healthier bodies and educated minds do not emerge in isolation, but they grow where households have the freedom to choose them. And that freedom, in rural India, begins with income.

If this essay made you reflect on how income shapes opportunity, choice, and human potential, subscribe to my blog for one new article every week in your inbox. It’s free!

(Disclaimer: The opinions expressed are those of the author and do not purport to reflect the views or opinions of any organisation, foundation, CSR, non-profit or others.)

The cover image is generated using AI

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Why everyone says, I am fine 

July 6, 2026 Leave a comment

There is a performance that many people have mastered in modern life, of looking completely fine while quietly falling apart. It has become one of the most refined social skills of our time. You show up to work on time, reply to emails with professional warmth, attend weddings with coordinated outfits, post cheerful holiday photos, laugh at dinner parties, and reassure everyone that ‘all is well’ while your internal monologue resembles an emergency board meeting. Rent is rising, parents are ageing, careers feel uncertain, relationships are complicated, your back hurts for reasons your doctor politely describes as stress related, and you have not felt truly rested since sometime before the pandemic. Yet when someone asks how you are doing, the answer remains remarkably consistent, ‘Good, good. Just busy.’

Across the world, people are becoming increasingly fluent in this language of polished distress. Social media has trained us to curate competence, while professional culture rewards composure, and families often value stability over vulnerability. Entire societies function because millions of people continue showing up despite private exhaustion. But this performance feels particularly pronounced among Indians who are living both within India and across the global diaspora, where social expectations are often complex, relentless, and efficient at producing outward success alongside inward strain.

The Indian social script remains deeply achievement-oriented. From childhood, most of us are introduced to a familiar sequence of expectations that feels both culturally specific and globally recognisable, which includes performing well in school, attending a branded university/college, entering a respectable profession, earning well, marrying appropriately, buying property, caring for parents, raising successful children, and maintaining family honour while appearing effortlessly grateful for the opportunity. There are, of course, regional, class, and generational variations, but the broad architecture remains remarkably durable. Even among progressive urban families, conventional expectations often survive in modern packaging. Instead of explicit pressure to become a doctor or engineer, there may be subtle comparisons with cousins working at Google, Amazon, or investment firms in London. Marriage pressure may sound softer, but family Whatsapp groups can still function as passive-aggressive reminder systems.

The emotional burden becomes even more complicated because these expectations are rarely framed as pressure, as they are often presented as love, sacrifice, duty, and practical wisdom. Parents who invested heavily in their children’s education may genuinely believe they are guiding them toward security. Extended families may see their involvement as care. Communities may celebrate conformity because it appears stable. But good intentions do not eliminate psychological consequences. Many young professionals in Mumbai, Bengaluru, Delhi NCR, and Hyderabad are managing demanding careers while quietly navigating family expectations around marriage, caregiving responsibilities, home ownership, and financial support. They are often simultaneously trying to be globally competitive professionals and culturally responsible children. It is a difficult balancing act, made harder by the fact that neither side fully acknowledges the strain.

For Indians living overseas, the pressures often become even more complex. The immigrant success story remains one of the most celebrated narratives in many diaspora communities. The child of immigrants in the United States, Canada, the United Kingdom, or Australia may be expected to succeed professionally in highly competitive societies while also preserving cultural identity, supporting family back home, and remaining deeply connected to traditions that often become more rigid in migration. This produces a strange phenomenon where individuals feel pressure to excel in two worlds while fully belonging to neither. You are expected to understand tax laws in Seattle, maintain emotional fluency in Bihari family politics, and explain to relatives why you are still unmarried at 32 despite having what appears, on paper, to be an excellent and successful life!

Weddings deserve special mention as global showcases of curated wellbeing. Few events demonstrate collective emotional theatre quite like the fat Indian weddings. Families spend enormous amounts of money celebrating joy while quietly navigating interpersonal tensions, financial stress, unresolved conflicts, and logistical chaos. Guests arrive dressed magnificently, smiling for photographs that suggest a flawless communal celebration. Beneath the choreography, there may be sibling rivalries, debt, parental anxieties, and relatives evaluating everything from the food menu to life decisions. And though the wedding album looks immaculate, the emotional spreadsheet rarely does.

Professionally, employees are expected to remain productive through layoffs, economic uncertainty, technological disruption, and burnout. In India’s startup hubs and global financial centres alike, people casually describe 80-hour workweeks as ambition while quietly experiencing anxiety, insomnia, and emotional depletion. The language of hustle culture has simply provided respectable branding for exhaustion. Saying ‘I am slammed’ has become shorthand for importance. Saying ‘I am overwhelmed’ remains harder.

Social media has amplified all of this by turning life into a continuous public relations exercise. Platforms reward milestones like promotions, vacations, engagements, anniversaries, fitness transformations, children’s achievements, and entrepreneurial announcements. They are less enthusiastic about ambiguity, grief, stagnation, infertility struggles, career confusion, loneliness, or ordinary dissatisfaction. The result is a digital ecosystem where everyone appears to be thriving. You scroll through photographs of destination weddings in Udaipur, startup exits in San Francisco, babies in matching outfits, and beachfront holidays in Bali while sitting with your own uncertainty and wondering whether everyone else has somehow figured out adulthood.

Many people who appear successful are privately negotiating debt, loneliness, marital strain, workplace anxiety, fertility struggles, caregiving responsibilities, mental health challenges, or the exhausting task of meeting expectations they never consciously chose. The colleague who seems composed may be supporting parents through medical crises. The cousin posting anniversary photos may be managing deep relationship problems. The entrepreneur celebrating funding rounds may be unable to sleep. The family friend who constantly asks why you are not married may have spent years trapped in an unhappy marriage themselves. Human beings are remarkably skilled at editing their visible narratives.

Indian society’s combination of collectivist expectations, rapid economic change, intergenerational obligations, and intense social comparison creates a particularly sophisticated ecosystem of invisible pressure. What makes this dynamic especially difficult is that many people feel guilty for acknowledging it. After all, they may have stable jobs, supportive families, educational privilege, or material comfort relative to previous generations. Gratitude becomes weaponised against honest emotional reflection. ‘What do you have to complain about?’ remains one of the most efficient ways to shut down vulnerability in many households. 

The irony is that a genuine connection often begins the moment someone drops the performance. When one friend admits they are burnt out, another confesses they are anxious. When someone speaks honestly about marriage pressure, career confusion, depression, caregiving exhaustion, or loneliness, others often respond with relief rather than judgment. The collective illusion begins to weaken. Perhaps the challenge of modern adulthood is not learning how to appear fine. Most people have already mastered that skill. The real challenge is building lives, friendships, workplaces, and families where ‘I’m not okay right now’ does not feel like a social failure.Behind many polished LinkedIn profiles, family portraits, wedding photographs, and cheerful Whatsapp updates lies the same truth that everyone looks fine because that is what society often rewards. But many are carrying far more than they show, and sometimes the most radical act of honesty is answering ‘How are you?’ with something closer to the truth.

If this article made you pause, reflect, or quietly say, ‘this feels familiar,’ you are not alone. Share it with someone who always says, ‘I am fine,’ and maybe start the kind of conversation we all need more of. Subscribe to my blog for one reflective article every week in your mailbox. It’s free!

(The two images used are generated using AI)

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