Aatmanirbhar Bharat hinges on human capital formation

 

Dr. Devendra Kothari

Population and Development Analyst

Forum for Population Action

 

 

Self-reliance increases self-confidence. 

Current thinking about economic development has not bettered global livelihoods. Without a solid model based on human development, economic development models produce hit-and-miss successes. “Economically, the lives of billions are lived out in misery and despair while many tools of better living are readily available. At a very basic level all of us suffer because social justice is not being achieved,….” noted by Paul Godfrey, Director of the Melvin J. Ballard Centre of Economic Self-reliance at Brighten Young University, Provo, UT. [1] 

Here the concept of   ‘Atmanirbhar economy’ or ‘self-reliant economy’ could be a great help.  ‘Aatmanirbharata’ (‘self-reliance’) has become a buzzword in India after Prime Minister Narendra Modi mentioned it in his address to the Nation on May 12, 2020. He said that his version of self-reliance “does not imply isolationism and inward-orientation”. We think that his vision of ‘Aatmanirbharata’ or ‘self-reliance’ [2] will inject greater self-confidence in the people in making an empowered economy in the next 15-20 years. It must, however, be backed by a concrete action plan; otherwise, this chance may slip away. This post aims in this direction. 

The Self-Reliant Economy (SRE) represents a different way of thinking about the processes and outcomes of economic development. It is “an individual’s ability to garner and hold economic resources in excess of their basic needs.  In addition, individuals who are economically self-reliant have greater resilience in the face of negative economic shocks (like Covid-19 pandemic). Those with greater resilience will suffer lower intensity (less severe) or shorter duration (quicker recovery). In other words, SRE represents a type of insurance against the disruptions caused by adverse economic events. More important than its insurance value, SRE provides a solid platform from which people can develop and reach their full human potential. 

How to achieve self-reliance? Available literature suggests that countries attempting to reach their objectives of ‘Aatmanirbharata’  should pursue policies that foster productivity growth. Increases in productivity allow countries to produce greater output for the same level of input (and goods become competitive in the global market), earn higher revenues, and ultimately generate higher Gross Domestic Product and wellbeing. 

One of the best examples of this is China’s economic story. Economists generally attribute much of China's rapid economic growth to two main factors: large-scale capital investment (financed by large domestic savings and foreign investment) and rapid productivity growth by investing in people.[3]   

As such, labour productivity is crucially dependent on the level of investment in knowledge (Human Development) and innovation (R&D), and even the success of various    structural reforms to generate jobs. 

This suggests that developing countries like India, in attempting to achieve SRE, should pursue policies that foster labour productivity growth.  For India to be truly self-reliant and self-confident, public investment in the components of human development like education, health, gender equality and of course population stabilization efforts have to increase immediately. It is, therefore, an investment in people, especially those who are deprived, is a need of the hour. This is the way through which a number of other countries in the region, such as China, Japan, Taiwan, Thailand and Vietnam, boosted their national economies through a successful human development agenda. 

Human capital lies in the individual-intangible quadrant and represents the final form of capital that helps individuals develop economic self-reliance. Human capital is the sum total of attitudes, cognitive abilities, and deployable skills possessed by an individual. It is the ability to work with little or minimum supervision. Also it can be defined as the ability to depend on oneself rather than relying on other people to achieve the goal. In other words, human capital can be described as what is in an individual’s head (knowledge), hands (skills), and heart (attitudes). 

Human capital arises from two sources: (1) our own efforts, talents, and skills and (2) our relationships with family, government, and macro-social systems. In a system which is dominated by poverty and inequality, the role of government or macro-social systems are very important in promoting self-reliance. In other words, the macro-social systems and government have catalytic power to boost human capita. 

So what is India waiting for? 

The central government must set an overall action agenda for a self–reliant economy and human capital formation in consultation with the states, and its implementation, however, should be left on states. The Centre must give the states greater leeway to take decisions to achieve these. 

In addition, India needs well-governed and well-managed smaller states for better governance. There are 28 states in India at present.   Their populations range massively in size – the largest, Uttar Pradesh, holds around   200 million people, the smallest, Sikkim, just over half a million. About half of the country's population lives in five States, namely, Uttar Pradesh, Maharashtra, Bihar, West Bengal and Andhra Pradesh in 2011; and ten most populated states or super states of India contribute more than three- fourth of India's population . 

There is a widespread perception that splitting super states into smaller ones will improve administration and governance by bringing power centres closer to the people, thus paving the way for a self-reliant economy. 

The population of India is projected to increase from 1390 million in 2020 to 1700 million in 2051, as per the Population Reference Bureau that is in the next thirty-two years – an increase of 540 million. As a consequence, the total population of 10 most populous or super-states of India will increase from 927 million to 1366 million. And this fact must be kept in mind while redrawing the map of the Indian Union.  As such, division of the existing super-states is a must. For governance and socio-economic reasons, the total population to be carved out smaller States should not exceed more than 50 million each with administrative friendly inter-state boundaries not like existing boundaries in Uttar Pradesh, Maharashtra, Madhya Pradesh, West Bengal or Rajasthan. 

Now the question arises as how to boost human capital formation?  The policy monograph - Nurturing Human Development: A Strategy for New India [4]  proposes such a strategy to unlock the human potential based on the ‘capability’ approach; and it is christened as “HDPlus” (Human Development Plus).  It is a dynamic agenda based on a ‘whole child’ concept, that is a school-going child and his/her family (that is HDPlus family) should be the fulcrum of human development efforts. The concept is being described by policies, practices, and relationships which ensure that each child is healthy, educated, engaged, supported and encouraged. For this, integrating the child and his or her family more deeply into the day-to-day life of school and home activities represents an untapped instrument for raising the overall achievements including learning skills and health parameters, and hence improving the  overall productivity of the future workers. In other words, creating an enabling environment at family and school levels is a way to empower people.  

It’s now or never situation not only for India alone but also for PM Modi. In my article: Decoding Modi’s Resounding Victory (June 2019), I concluded that “what India does in the next five years will determine not only the destiny of the country but also of PM Modi”. [5] A person like Modi knows about it that the people elected him with immense hope that he will change their lives for better. Investments in education, health, living environment and its determinants – the social sector – therefore, should be made a priority in the coming years to lay the foundation for a developed India by 100th birth anniversary of India. For this, PM Modi must use unmatched political capital to make it happen today!   

The vision of ‘Atmanirbhar Bharat’ or ‘Self-Reliant India’ could be “The Roaring Twenties” for India.   But that cannot be achieved without peace, stability and effective governance. India has to create an environment for the fundamentals of progress: infrastructure development, human capital formation, rule of law, and so on. Interestingly, it also frees up resources, both financial and human, that would otherwise be diverted to controlling violence or maintaining law and order. Further, we have to recognise that the solidarity of people is a prerequisite for a Self-Reliant Economy. Here the issue of communal harmony is very important.   Lastly, any action agenda to achieve self-reliance must be based on a participatory dialogue between Centre and States

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[1] Godfrey, Paul. (2013). More than Money, Stanford: Stanford University Press.

[2] The Oxford panel has now chosen 'Atmanirbharta' (self-reliance) as the Hindi word of 2020. "It validated the day-to-day achievements of the countless Indians who dealt with and survived the perils of a pandemic,” the Panel noted. “It gives a voice to the strength displayed by young and old alike in dealing with extended periods of isolation, lack of familial support, loss of livelihoods and other difficulties through sheer determination and self-reliance", the panel further added. Previous Oxford Hindi words of the year are Aadhar (2017), Nari Shakti (2018) and Samvidhaan (2019). Read more at: https://in.news.yahoo.com/atmanirbharta-named-oxford-hindi-word-of-2020-094259960.html

[3] Morrison, Wayne M.  2019. China’s Economic Rise: History, Trends, Challenges, and Implications for the United States, Congressional Research Service, Washington DC. 

[4] For details, see:  Kothari, Devendra. 2019. Nurturing Human Development: A Strategy for New India, New Delhi: Paragoan International Publishers.

 

[5] Kothari, Devendra, Decoding Modi’s Resounding Victory, India Currents dated June 21, 2019. Read more at: https://indiacurrents.com/decoding-modis-resounding-victory/

 

Is India paving way for a creation of Khalistan?

 

Dr. Devendra Kothari

Population and Development Analyst

Forum for Population Action

The stalemate over the three-farm laws continued for the 67th day today (January 31, 2021) around the border of the national capital where thousands of farmers are protesting in open against the new legislation passed hurriedly by the Parliament in the last September. The farmers from all over India are participating in the agitation but it is heavily dominated by the farmers from the state of Punjab. 

At a time when farmers are protesting against the three farm laws, Prime Minister Narendra Modi said on December 15, 2020 that a conspiracy is going on in and around Delhi to confuse farmers. Other BJP leaders took clue from this statement and linked the farm agitation to Khalistan sympathizers. “Khalistani link” was alleged by Haryana Chief Minister Manohar Lal Khattar. Several experts and political parties have strongly condemned Haryana CM Khattar’s statement terming protesting farmers as “Khalistanis”.  “This is a conspiracy to defame the farmers and their agitation to pave the way for its repression with brutal force,” said Sukhbir Singh Badal, President of Shiromani Akali Dal, and former close supporter of the Modi Government. 

Such statements by the ruling BJP party may really push the people of Punjab towards the Khalistan movement, which has already created troubles in the past. 

What is the Khalistan movement? The fight for a separate Punjabi State owes its origins to the Punjabi Suba Movement. The Akali Dal – Sikh- dominated political party-sought to create a separate Sikh province or state.  When the State Reorganisation Commission, constituted to assess the demand for separate states by the linguistic groups, made its recommendations, it rejected the Akali Dal’s demand. 

But after a series of violent protests, the Indira Gandhi government relented in 1966. The existing state was trifurcated into Punjabi-majority Punjab, Hindi majority Haryana and the Union Territory of Chandigarh. Some hilly regions of the state were merged into Himachal Pradesh. However, the seeds of Khalistan had been seeded. 

Before we discuss the current farmers’ agitation and causes behind it, let us briefly deliberate on the Green Revolution.

 

The Green Revolution in India began in the mid-1960s marking a transition from traditional agriculture in India and the introduction of high-yielding varieties of seeds and the associated agricultural techniques. High yielding varieties of seeds were first introduced in the Indian states of Punjab, Haryana and parts of western Uttar Pradesh, the leading Campaigners of the current agitation. 

Among the Indian states that is said to have benefited most from the green revolution in India was the state of Punjab, where food-grains production increased from 5.37 million tonnes in 1965-66 to 32 million tonnes in 1995-96. 

Most of the state lies in a fertile alluvial plain with many rivers and an extensive irrigation canal system. Despite covering only 1.53% of its geographical area and  less than 2.5% of India’s population, Punjab makes up for about 20% of India's wheat production, around 12% of its rice production, and around 10% of its milk production, and  thus  Punjab became the    'India’s breadbasket'. 

At the international level, this represents three per cent of the global production of wheat and rice. And, Punjab became the most developed state of India. Its per capita income in 2006 was 28,605 was way ahead of the national average of just Rs. 6,929. Punjab also claimed a 100 per cent rural electrification as well as almost 99 per cent connectivity of villages by paved road against the national average of just 44 per cent. 

In 1990, when I was exploring reasons behind the Blue Star Operation, I noted that the newly achieved prosperity prompted many Punjabis, especially the youth to think in terms of a separate country of Khalistan. It was argued that by selling agricultural products like wheat to India and others, Punjab could become  a developed country like the USA and Canada. And, such sentiments were used by the extremists like Jarnail Singh Bhindranwale, who was reportedly backed by Pakistan's ISI, had made his demands clear - he wanted the Indian government to pass a resolution which would allow India to be divided, thereby creating a new country for Sikhs called 'Khalistan' -  the land of pure. 

Radical separatist Bhindranwale had started laying the groundwork for his demand in 1982, and by mid-1983 managed to gain support for his plan to divide India. In mid-1983, Bhindranwale and his armed militant group entered the Golden Temple and took over its control. They then set up a base inside. Taking back the control of the Golden Temple from armed militants and preserving its sanctity was not easy. Being the holiest site for Sikhs made the decision even tougher to take. However, after nearly a year of consultations and trying to negotiate, then Prime Minister Indira Gandhi decided that the only option left was to carry out a military operation against the militants.  This led to the Operation Blue star. It was carried out between June 1 and 10, 1984 to capture Bhindranwale   and his armed followers. [1]

Now the question arises why the farmers from Punjab among others are agitating against the three farm laws? 

While the Green Revolution provided some solutions to the problem of food security in India, Punjab began to face a completely new range of problems: Decaying soil, pest-infested crops and indebted farmers. Further, the price Punjab has paid for India’s food security comprises cancer, renal failure, stillborn babies and birth defects. A large-scale use of pesticides and synthetic nitrogen fertilisers has magnified this situation. 

As a result, the economy of Punjab has been facing problems. Now its economy is the 15^th largest state economy in India with ₹5.75 lakh crore (US$81 billion) in gross domestic product and a per capita GDP of ₹167,000 (US$2,300), ranking 16^th amongst Indian states. Punjab ranked first in GDP per capita amongst Indian states in 1981 and fourth in 2001, but has experienced slower growth than the rest of India in recent years, having the second-slowest GDP per capita growth rate of all Indian states and UTs between 2000 and 2010, behind only Manipur. The state's economy is mainly dominated by agricultural production and small and medium-sized enterprises. 

In Punjab, mainly the two cereal crops, wheat and rice, are grown in rotation during a year. Rice is the principal crop of the Kharif season and wheat is the principal crop of Rabi season. 

Here the concept of Minimum Support Price (MSP) is a great support to farmers and their economy. MSP is set by the government for certain agricultural products like wheat and rice, at which the products would directly be bought from the farmers if the open market prices are less than the cost incurred. In other words, when the market price falls below the declared MSP, the government would purchase the entire quantity from the farmers at MSP. (For the MSP calculation, the Swaminathan Committee, 2007 suggested a formula: cost of production + 50 %.) The chief objectives of setting up MSP are:

 

1. Support farmers from distress sales
2. To procure food grains for public distribution 

Why are farmers against the three farm laws? It is because the passed law does not cover MSP for their products and they feel that in the absence of MSP, the corporate sector will exploit them. 

The government of India’s refusal to make the MSP as a part of the laws has deepened doubts of the farmers.   

Even after Prime Minister Modi's repeated assurance that these farm laws will neither end the minimum support price regime nor the mandi system, thousands of farmers have been staying put in the bitter cold  (around freezing poin) outside Delhi. The former Agricultural Minister and a farmer itself, Shared  Pawar said the new laws will adversely impact the MSP procurement infrastructure thereby weakening the mandi system. MSP mechanism has to be ensured and strengthened further, he added. 

Further, the Bharatiya Kisan Sangh (BKS) and the Swadeshi Jagran Manch (SJM), both are part of the ruling party BJP and RSS, have urged the Modi government to ensure that MSP, which guarantees a certain level of returns on produce, it should be   a part of purchases inside and outside mandis. 

After so many days of protest in Delhi and several rounds of meetings, the government is still adamant that it will not withdraw the farm laws. The farmers have hardened their stand on repealing the laws. Where is this protest heading with no conclusion in sight? 

When the government of India and its ministers say openly that   the present farm agitation, initiated by the farmers of Punjab, has been managed by the Khalistan sympathizers, what does it mean? Anyone can conclude that the government is preparing a ground for the reemergence of Khalistan movement? 

The government should not blame the Khalistani sympathizers; I understand opposing parties’   leaders can talk like this but not the ruling party. 

Three passed Bills are needed to make the farming profitable, but in the way they were cleared create doubts. I suggest that the Modi government should pass the fourth Bill and make MSP mandatory for next three years. It will give sufficient time to the farming community to adjust with the new realities. 

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[1] Brar, K.S. (1993). Operation Blue Star: the true story.  UBS Publisher's Publishers Pvt. Ltd. Also refer article (2018): 34 Years On, A Brief History About Operation Bluestar, And Why It Was Carried Out” at: https://www.ndtv.com/india-news/operation-bluestar-34th-anniversary-a-brief-history-about-operation-bluestar-and-why-it-was-carried--1863385

 

 

Save the Earth: the Corona Pandemic warning (पृथ्वी बचाओ: कोरोना महामारी की चेतावनी)

 

                                                                                                                           Dr. Devendra Kothari

Population and Development Analyst

Forum for Population Action

 “Humans face risks that give no second chances — Covid-19 is a warning to us”

Toby Ord

The outbreak of novel coronavirus (Covid-19) has created an unprecedented situation around the world. A joint statement by ILO, FAO, IFAD and WHO, issued on 0ctober 13, 2020, stated that the COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge to human existence. The statement further states that millions of enterprises face an existential threat. As breadwinners lose jobs, fall ill and die, the food security and nutrition of millions of women and men are under threat, with those in low-income countries, particularly the most marginalized populations, which include small-scale farmers and informal workers, being hardest hit. 

Toby Ord, Senior Research Fellow at Oxford University’s Future of Humanity Institute, writes about the existential risks that now confront human beings. ”We face possible catastrophes which threaten the permanent destruction of humanity’s potential, such as human extinction or an unrecoverable collapse of civilization.” These are known as existential catastrophes. [1]  

 

Pandemics such as coronavirus are the result of humanity’s destruction of nature and the world has been ignoring this stark reality for decades. The Covid-19 pandemic may be considered as a reminder that there are ‘limits to growth’. With awareness of climate change, food insecurity and biodiversity decline on the radar, such a statement sounds reasonable. It is therefore considered the covid-19 as a subtle warning from a smart teacher- Mother Nature.

 

The authors of the iconic book - The Limits to Growth (LTG) did say this almost fifty years ago. The LTG is a 1972 report on the exponential economic and population growth with a finite supply of resources, studied by computer simulation. The study was commissioned by the Club of Rome. The study concluded that if the present trends in world population, industrialization, pollution, food production, and resource depletion continue unchanged, the limits to growth on this planet will be reached sometime within the next 100 years. 

Time is running out. Humans need to colonize another planet within 100 years or face the threat of extinction, high-profile physicist Stephen Hawking has warned us in a  BBC documentary called “Stephen Hawking: Expedition New Earth”[2] He stressed: “with climate change, overdue asteroid strikes, epidemics and population growth, our own planet is increasingly precarious.”

Previously, Hawking theorized that humanity probably has around 1,000 years left before it becomes extinct. His timeline appears now to have shortened.

Hawking is not the only major figure in the technology and science world that has warned about the threat to human existence. Earlier, Elon Musk (Tesla CEO) and Jack Ma (Founder of Alibaba) warned that society could because of the disruption caused by new technology (like AI) and the internet.

The Corona pandemic continues to convey roughly the same message today, but with slightly more urgency. Today, we are at a point in human history where habits that once worked well don’t work anymore,  argued by Dennis Meadows, one of the authors of the LTG, at the United Nations University recently.

The coronavirus is a reminder to us all of our weak state. Regardless of our social standing and our financial position, we are helpless. Situations like this remind me the preaching or sermon of Lord Krishna when he said to Arjuna    in Bhagavad Gita (Chapter IV, verses 7 and 8): "Whenever there is a decline in righteousness and an increase in unrighteousness, at that time I manifest myself on earth".  

Should we wait for God to clear the mess created by us? 

Instead of looking for ways to leave this planet, shouldn't we instead try and solve the problems that surround us? I'm not a scientist, but personally I feel as though leaving the planet or putting in preparations to leave is almost like giving up. 

As we step into 2021, humanity must   address the danger of its own existence by changing the way of living. Humanity must think seriously about the un-intellectual industrialization, urbanization, deforestation, environmental degradation, resource depletion, and population explosion. In sum, it is a warning that climate change is real and we must urgently reduce global warming. 

On the last day of the year 2020, one of my friends asked me: What is there to smile in the Corona year? No doubt, there was no satisfaction or happiness but much yearning. But if one thinks a little bit differently, you will find reasons to smile. 

The Bhagavad Gita emphasised: “Whatever happened, happened for the good. Whatever is happening, is happening for the good. Whatever will happen, will also happen for the good.” 

This applies so accurately to the present situation.  We must change our way of living which has become very manipulating to our selfish advantages.   Think how much we have damaged Mother Nature!  So change the way of living and you will find hundreds of reasons to smile. 

Time is running out. Virus attacks, disease epidemics and catastrophic climate change are fast approaching threats to our beautiful green and blue home.

 Wishing you a Happier New Year!

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[1] Ord, Toby (2020). The Precipice: Existential Risk and the Future of Humanity, Bloomsbury Publishing Company Limited. Also, refer at: https://timesofindia.indiatimes.com/humans-face-risks-that-give-no-second-chances-covid-19-is-a-warning-to-us/articleshow/80063414.cms 

[2] https://www.bbcstudios.com.au/shows/expedition-new-earth/  Also refer article by Arjun Kharpal of CNBC (2017) Stephen Hawking says humans must colonize another planet in 100 years or face extinction at: https://www.cnbc.com/2017/05/05/stephen-hawking-human-extinction-colonize-planet.html

 

 

 

 

Donald Trump’s defeat is actually a blessing in disguise for democracy

 

 

Dr. Devendra Kothari

Population and Development Analyst

Forum for Population Action

 

Donald Trump’s defeat in the election is a million times better for the US, a billion times for the rest of the world.

 

On January 20, 2017, I posted an article entitled: Why American elected Trump as President of USA? [1]  And, this post explores why Donald Trump lost

“LIBERAL democracies, while not exactly on the brink of a descent into fascism, are facing a period of crisis throughout the world,” wrote The Economist on the victory Donald Trump in the 2016 Presidential election.  [2]

 

There would be few to question 2020’s credentials as the year from hell. But towards its fag end the world’s luck could be turning, with the Biden-Harris ticket winning landmark US presidential elections that had the world at the edge of its seat.[3]

 

On November 3, 2020, when Americans went to the polls, many of us were praying that President Donald Trump should be defeated. His presidency (2016-2020) was dispensed with the notion that his talking points should bear any resemblance to truth, and he had routinely taken measures in office which had violated the spirit or letter of the law and constitution.

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[1]  Refer post by the author - Why American elected Trump as President of USA? at: https://www.blogger.com/blog/post/edit/3578136436068731910/2988296529100427376

 

[2] The Economist (Nov. 7, 2016).  How strong are the institutions of liberal societies? Refer at: https://www.economist.com/free-exchange/2016/11/07/how-strong-are-the-institutions-of-liberal-societies

 

[3] Refer article by Swagato Ganguly - Turning the corner: Disaster is averted with Joe Biden’s victory at: https://timesofindia.indiatimes.com/blogs/all-that-is-solid-melts/turning-the-corner-disaster-is-averted-with-joe-bidens-victory-but-donald-trump-has-changed-america/

 

India: the state of healthcare

 

Dr. Devendra Kothari

Population and Development Analyst

Forum for Population Action

 “At the moment, India is on the edge and it can take two routes. It can take a route of investing in health and investing in its people and creating a thriving and flourishing future for India which has a part to play in world affairs or  it can do what it is doing now and ignore health in which case it will see epidemics sweep across the country creating an unsustainable future and destroying national security.” 

Dr. Richard Charles Horton (2018)

The Lancet's editor-in-chief

 Healthcare has the potential to lead to economic growth and to alleviate poverty. It is because health is a relative state in which one is able to function well physically, mentally, socially, and spiritually in order to express the full range of one’s unique potentialities within the environment in which he/she is living. In other words, “health is primarily a measure of each person’s ability to do and become what she wants to become.”   It is, therefore, an important component of human capital formation responsible for the higher level of productivity. It can enhance workers’ productivity by increasing their physical capacities, such as strength and endurance, as well as their mental capacities, such as cognitive functioning and reasoning ability.

By the dawn of the 21^st century, non-communicable diseases are sweeping the entire globe, with an increasing trend in developing countries like India where, the transition imposes more constraints to deal with the double burden of infective (communicable) and non-infective (non-communicable) diseases in a poor environment characterised by ill-public health systems. That may be the reason, why the world's most revered medical journal - The Lancet - has censured severely Government of India for ignoring health sector and has warned that India is on the “verge of a collapse under the weight of its own ill health”.[1]

 

One of the serious negative impacts of this situation will be the slow formation of human capital. Available literature reveals a positive relationship between health and productivity for both unskilled and skilled workers, and evidence of this link is increasing at the microeconomic level.

 

So it is generally said that health is wealth.  To be healthy and fit one needs to eat properly and live in a hygienic or clean environment. Because living in polluted and dirty area impacts negatively on health. In addition, availability of basic health services is fundamental in improving the health outcomes.   It means health in a broader sense includes not only health services but also sanitation. A growing body of research has documented the positive impact of health and sanitation on earnings and economic growth by raising the productivity. 

Although India’s productivity improvements are impressive, the process of catch-up with other developing/ developed nations still has a long way to go. India's labour productivity is about 40 per cent of that of China. In fact, India recorded one of the lowest productivity in the world. There are many reasons behind this slow growth in the labour productivity including a sluggish progress in achieving the mission of “Health for All”.

The paper discusses a variety of mechanisms through which the vision of ‘Health for All’ (HFA) or Universal Health Care (UHC) could be achieved within a decade. The positive health outcomes ultimately contribute to better educational outcomes and a more productive and higher-skilled labor force. India, therefore, must convert its young population to a competitive advantage.

 

Emerging health scenario: India’s current state of health is appalling as brought out by the coronavirus pandemic and the lockdown it triggered. The data released by the MoHFW indicates that it had severe impact on routine health care services. Several national goals, including the programme to treat TB, malaria and non-communicable diseases such as heart diseases, diabetes and cancer, has suffered a severe setback.

 

The ministry figures have revealed the enormous price incurred in healthcare deficits by non-COVID patients between April and June, 2020 compared to the same period last year. Immunisation dropped 27 per cent, institutional deliveries 28 per cent, major surgeries fell 60 per cent, outpatient treatment for heart ailments and cancer by over 70 per cent, and 51 per cent  fewer acute cardiac emergencies were performed. Treatment for ailments like tuberculosis, diabetes and asthma, screening of newborns for birth defects etc were also badly affected. 

 

It appears that the Indian healthcare structure is not geared up enough to face the unexpected calamities, which are going to be a frequent phenomenon in coming times due to climate change and arising poverty. More than half of the 1.4 billion people are poor and the income inequality is widening.

 The pollution is the leading environmental cause of death in India. The US-based Health Effect Institute (HEI) paints a grim picture for India. Overall long-term exposure to outdoor and household air pollution contributed to over 1.67 million annual deaths from stroke, heart attack, diabetes, lung cancer, chronic lung diseases, and neonatal diseases in India in 2019. The pollution also contributed to the deaths of more than 1, 16,000 Indian infants in their first month of life last year. More than half of these deaths were related with outdoor PM2.5. Air pollution deaths in India are the highest among the South Asian countries – it is 9 times higher than neighbouring Bangladesh and 8 times higher than Pakistan.

In addition, India faces a double curse on the disease front: lifestyle diseases that are the bane of the rich world, as well as the traditional communicable diseases of the developing world, as reported by the study entitled: Health of the Nation’s States: India State-Level Disease Burden.[2]  The key metric used for calculating the burden of diseases is disability-adjusted life years (DALYs), which is the sum of the number of years of life lost due to premature death and a weighted measure of the years lived with disability due to a disease or injury.

Of the total disease burden in India measured as DALYs, 61 per cent was due to communicable, maternal, neonatal, and nutritional diseases (termed infectious and associated diseases in this summary for simplicity) in 1990, which dropped to 28 per cent in 2016. There was a corresponding increase in the contribution of non-communicable diseases from 30 per cent of the total disease burden in 1990 to 62 per cent in 2016, and of injuries including suicides from 9 per cent to 10 per cent.

While the burden of most infectious and associated diseases has reduced in India from 1990 to 2016, five of the ten individual leading causes of disease burden in India in 2016 still belonged to this group: diarrheal-diseases, lower respiratory infections, iron-deficiency anemia, preterm birth complications, and tuberculosis. According to the National Health Profile 2019, over 50 per cent of all deaths due to communicable diseases in 2018 were because of respiratory diseases and pneumonia. As a result, deaths from communicable diseases in India are much higher than the global average, latest data from the Global Burden of Disease Study shows.

 

The burden caused by these conditions generally continues to be much higher in the eight socioeconomically less developed states of Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal and Uttar Pradesh, referred to as the Empowered Action Group (EAG) states  than in the other states, but there are  notable variations between the states within these groups as well.

The contribution of most of the major non-communicable disease groups to the total disease burden has increased all over India since 1990, including cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, cancers, musculoskeletal disorders, and chronic kidney disease, having greater impact on productivity. Among the leading non-communicable diseases, the largest disease burden or DALY rate increase from 1990 to 2016 was observed for diabetes, at 80 per cent, and ischaemic heart disease, at 34 per cent.

The contribution of injuries, which includes road injuries, suicides and non-fatal outcomes of self-harm, to the total disease burden has increased in most states since 1990. The highest proportion of disease burden due to injuries is in young adults. 

In sum, one can draw the conclusion that India at present faces a combination of communicable diseases and non-communicable, with the burden of chronic diseases has exceeded that of communicable diseases. Projections nevertheless indicate that communicable diseases will still occupy a critically important position up to 2030 or even 2040. 

India's position in the middle of the transition from a poor, healthcare-deficient country to an advanced country is brought out starkly when compared with examples from other countries. In Niger, one of the poorest countries in the world, with a per capita gross domestic product less than one-fifth of India's, eight of the top ten causes of death are communicable diseases. At the other extreme, Norway, with per capita gross domestic product over ten times that of India, has just one communicable disease — lower respiratory tract infections — among its top ten, with the other nine being non-communicable diseases. 

China, which started off from conditions similar to India, has moved much further towards the advanced end of the transition. It too has only one infectious disease among its top ten causes of death. 

In conclusion, while the disease burden rate in India has improved since 1990, it was 72 per cent higher per person than in Sri Lanka or China in 2017. It means India has failed to achieve in healthcare goals, badly lagging behind China, Sri Lanka and even Bangladesh in terms of accessibility and quality. 

To put things in perspective, the Global Burden of Disease (GBD) study published in the Lancet said that “newborns in India have a lesser chance of survival than babies born in Afghanistan and Somalia”.

 

In the GBD rankings for healthcare access and quality (HAQ), India has fallen 11 places as compared to last year, and now ranked 154 out of 195 countries in 2017, far behind its neighbours like China (48), Sri Lanka (71), Bangladesh (133), and Bhutan (134). In 2016, India was ranked 143 among 188 countries. 

The preceding discussion underline the urgent need to improve both access to and quality of health care across service areas and for all populations; otherwise, health systems could face widening gaps between the health services they provide and the disease burden experienced by local communities. Moreover, our policymakers have to mark that why ‘one size fits all’ doesn’t work in health and education. 

What does India need to do to create a vibrant, dynamic and progressive 21st century public health system, as will be discussed t in the next post?

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[1] Refer at: http://timesofindia.indiatimes.com/india/Brtish-medical-journal-Lancet-to-take-Modi-to-task-for-ignoring-health-sector/articleshow/49484703.cms. 

[2] Health of the Nation's States - The India State-level Disease Burden Initiative. New Delhi, India: ICMR, PHFI, and IHME; 2017.