China’s almost meteoric transition from a being a low income to a middle income country within a span of four decades is often perceived as a miracle analogous to the post Second World War Japanese economic development experience.
In a life peppered with tragedy, Mary Shelley wrote in 1818, “Have I not suffered enough, that you seek to increase my misery?” That this accurately sums up the fate of many women in South Asia who suffer a major health shock such as a serious illness or a disability or both, is hard to dispute.
In an inaugural lecture at the Radcliffe Institute at Harvard University, Amartya Sen began with a swipe at Queen Victoria who complained to Sir Theodore Martin in 1870 about & quote: this mad, wicked folly of 'Woman's Rights’ ", as in her rarefied world nobody could trample upon her rights. The world has of course changed dramatically and women’s rights are widely acknowledged but injustices persist. Our concern here is with health injustices that are widely prevalent in India. These take multiple forms: female foeticide, widespread morbidity and denial of access to good quality healthcare until a critical condition develops. Our focus here is on vulnerability of women to non-communicable diseases (NCDs) and their limited access to good quality healthcare in India.
On a cold night in December 2012, a ghastly crime was committed in New Delhi which stunned the world. Six men dragged helpless Nirbhaya-a 23-year-old female physiotherapy intern- to the back of the bus and raped her one by one. As she kept fighting off her assailants by biting them, one of the attackers inserted a rusted rod in her private part, ripping her genital organs and insides apart. She died a few days later. One of the accused died in police custody in the Tihar Jail
. The juvenile was convicted of rape and murder and given the maximum sentence of three years' imprisonment in a reform facility, and subsequently released. The Supreme Court awarded the death penalty but legal complications have prevented its execution.
Depression is often distinguished from other non-communicable diseases or NCDs (e.g., cancer, diabetes, cardio-vascular diseases, hypertension) because of the stigma attached to it. Among other consequences, those suffering from depression are often denied access to medical care. Indeed, the latter is an outcome of interaction between supply of and demand for medical care. On the provider side, stigmatizing attitudes by service providers are identified as a barrier to access. On the demand side, stigma and low mental health literacy by community members are just as emphatically reported as barriers to accessing care.
Old age morbidity is a rapidly worsening curse in India. The swift descent of the elderly in India (60 years+) into non-communicable diseases (NCDs e.g. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) could have disastrous consequences in terms of impoverishment of families, excess mortality, lowering of investment and consequent deceleration of growth.
A disquieting finding of The State of Food Security and Nutrition in the World 2017, Building resilience for peace and food security, or (SFSN2017), Rome, is that, in 2016, the number of chronically undernourished people in the world increased to 815 million, up from777 million in 2015 although still lower than about 900 million in 2000. Similarly, while the prevalence of undernourishment rose to 11 percent in 2016, this is still well below thelevel attaineda decade ago. Whether this recent rise inhunger and food-insecurity levels signals thebeginning of an upward trend, or whether itreflects an acute transient situation calls for a close scrutiny.
Lack of diet diversity is viewed as the major cause of micronutrient malnutrition in Sub-Saharan Africa. Imbalanced diets resulting from consumption of mainly high carbohydrate based-diets also contribute to productivity losses and reduced educational attainment and income. Consequently, micronutrient malnutrition is currently the most critical for food and nutritional security problem as most diets are often deficient in essential vitamins and minerals. In Tanzania, for example, most rural and urban households consume mainly staples as their main food, which are high in carbohydrates, but low in micronutrients and vitamins. Staple food items increase energy availability but do not improve nutritional outcomes if not consumed together with micro-nutrient rich foods.
Although difficult to ascertain whether it is a trend reversal, two recent FAO reports (2017a, b) show a rise in hunger globally as well as in Africa. The number of undernourished (NoU) in the world suffering from chronic food deprivation began to rise in 2014 –from 775 million people to 777 million in 2015 – and is now estimated to have increased further, to 815 million in 2016. The stagnation of the global average of the proportion of undernourished (PoU) from 2013 to 2015 is the result of two offsetting changes at the regional level: in Sub-Saharan Africa, the share of undernourished people increased, while there was a continued decline in Asia in the same period. However, in 2016, the PoU increased in most regions except Northern Africa, Southern Asia, Eastern Asia, Central America and the Caribbean. The deterioration was most severe in Sub-Saharan Africa and South-Eastern Asia (FAO 2017a,b).
Have demonetisation and the GST aggravated income inequality?
With the Gujarat State elections barely a few weeks away, the debate on the Indian economy has become increasingly polarised. While the official view of demonetisation unleashed in November 2016 elevates it to a moral and ethical imperative, the chaos caused by the goods and services tax (GST) launched on July 1, 2017
, is dismissed as a short-run transitional hiccup. Both policies, it is asserted, are guaranteed to yield long-term benefits, unmindful of large-scale hardships, loss of livelihoods, closure of small and medium enterprises and slowdown of agriculture. Critics of course reject these claims lock, stock and barrel. Lack of robust evidence is as much a problem for the official proponents of these policies as it is for the critics. Hence the debate continues unabated with frequent hostile overtones.
Many recent accounts tend to dismiss productive employment of youth in rural areas in Africa as a mirage largely because they exhibit strong resistance to eking out a bare subsistence in dismal working and living conditions. We argue below on recent evidence of agricultural transformation that this view is overly pessimistic, if not largely mistaken.
Undernutrition is widespread and a key reason for poor child health in many developing countries. In Sub-Saharan Africa, around 40 percent of children under the age of five suffer from stunted growth, that is, severely reduced height-for-age relative to their growth potential. Stunting is a result of periods of undernutrition in early childhood, and it has been found to have a series of adverse long-term effects in those who survive childhood. It is negatively associated with mental development, human capital accumulation, adult health, and with economic productivity and income levels in adulthood.
Implementation of the Mental Healthcare Act will require a restructuring of health-care services
The Mental Healthcare Bill, 2016, which was passed in the Lok Sabha on March 27, 2017, has been hailed as a momentous reform. According to the Bill, every person will have the right to access mental health care operated or funded by the government; good quality and affordable health care; equality of treatment and protection from inhuman practices; access to legal services; and right to complain against coercion and cruelty. The Bill also empowers a mentally ill person to choose a treatment and her/his nominated representative, decriminalises attempted suicide, prohibits the use of electroconvulsive therapy (ECT) to mentally ill adults without the use of muscle relaxants and anaesthesia, and contains provisions for care, treatment and rehabilitation for those who have experienced severe stress and attempted suicide. While these are laudable and ambitious objectives as they address major concerns of mental health care, there have been some critiques drawing attention to the lack of funds, trained personnel, and insufficient emphasis on community care. The ground reality, however, suggests that these objectives are not just overambitious but an overkill.
Old age is often characterised by poor health due to isolation, morbidities and disabilities in carrying out activities of daily living (DADLs) leading to depression.
Imminent demise of small farmers is predicted as they are not competitive in a context of transforming agrifood markets. Most important is the transformation of the "post–farm gate" segments of the supply chains.
After Adam Smith and Amartya Sen, Angus Deaton, this year’s Nobel laureate in economics, has contributed most to broaden and enrich our understanding of human well-being. His brilliant and path-breaking contributions to the theory and measurement of consumption, poverty, inequality, nutrition – and, more recently, aging, morbidity and suicides – have inspired a generation of economists to carry out reformulations, refinements and extensions.