Economic survey on Health and Fertility

• According to economic survey 2016-17, despite overall growth, there is a striking evidence of divergence or widening gaps in income as well as consumption across the Indian states.
• This pattern is opposite to many other countries in the world including China. Across the world, the poorer countries are catching up with richer countries. Across China, the poorer Chinese provinces are catching up with richer ones, but in India, the less developed states are not catching up; instead they are on average falling behind richer states.

Important highlights:

• Life expectancy of Indians has improved, but mother and children are bearing the brunt of a weak health system.
• Despite growing rapidly on average, there is sign of growing regional inequality among the Indian states.
• This is puzzling because the underlying forces in favour of equalization within India — namely strong and rising movements of goods and people — are strongly evident.
• One of the possible reasons is that there might be governance traps that impede the catch-up process.
• But why such traps persist if competitive federalism is forcing change upon the lagging states remains an open question.
• The central message of this survey is that life expectancy has gone up- although it is hugely affected by interventions other than health like education, unemployment etc.
• Despite of low level of health expenditures, there has been convergence on key health indicators among states in India. Two of these key indicators are Life expectancy (LE) and Infant Mortality Rate (IMR).
• Two possible primary reasons for convergence in key health indicators could be: Firstly, the worse initial situation but progress occurred because many medical technologies such as antibiotics and other medical practices. These are commonly available across the world and India but despite such availability the progress is comparatively slow;
• Secondly, There are much clearer bounds on health indicators which would naturally lead to convergence. For example: once a country has reduced its IMR to near zero, it’s almost impossible for it to further reduce, while countries with high IMR have much more room for improvement.
• The survey finds that as far as fertility is concerned, India has done exceptionally well. This is evident from the fact that 12 out of 23 reporting states have reached below replacement level of fertility (2.1).
• Thus, as in case of LE and IMR, there is evidence of strong convergence across the states.
• Further, compared globally all Indian states (Except Kerala) are performing much “better” than countries on average in reducing TFR. These developments have strong implications for demographic dividend in future.
• There seems to a broad brush because the survey does not look at morbidity or mortality caused by infectious and non-communicable diseases (NDCs).
• While IMR is a central outcome, that alone has been factored in with years lost or economic cost of NCDs and infectious disease not even figuring. In fact, it makes no mention of NCDs at all, which is among the biggest disease burdens in India.

By: Vishal