‘‘The slow improvement in the health status of our people has been matter of great concern. We have paid inadequate attention to public health.’’ – Dr Manmohan Singh, April 2005 India has been widely heralded as a success story for globalization. Over the past two decades the country has moved into the premier league of world economic growth; high technology exports are booming and India’s emerging middle-class consumers have become a magnet for foreign investors. As the Indian Prime Minister has candidly acknowledged, the record on human development has been less impressive than the record on global integration. The incidence of income poverty has fallen from about 36 pc in the early 1990s to somewhere between 25 pc and 30 pc today. Precise figures are widely disputed because of problems with survey data. But overall the evidence suggests that the pick-up growth has not translated into a commensurate decline in poverty. More worrying, improvements in child and infant mortality are slowing and India is now off track for these MDG targets. Some of India’s southern cities may be in the midst of a technology boom, but one in every 11 Indian child dies in the first five years of life for lack of low-technology, low-cost interventions. Malnutrition, which has barely improved over the past decade, affects half the country’s children. About 1 in 4 girls and more than 1 in 10 boys do not attend primary school. Perhaps the starkest inequality is revealed by this simple fact: girls aged 1-5 are 50 pc more likely to die than boys. This fact translates into 130,000 ‘‘missing’’ girls. Female mortality rates remain higher than male mortality rates through age 30, reversing the typical demographic pattern. These gender differences reflect a widespread preference for sons, particularly in southern states. Girls, less valued than their brothers, are often brought to health facilities in more advanced stages of illness, taken to less qualified doctors and have less money spent on their healthcare. The low status and educational disadvantage suffered by women have a direct bearing on their health and their children’s. About one-third of India’s children are under weight at birth, reflecting poor maternal health. Inadequate public health provision exacerbates vulnerability. Fifteen years after universal childhood immunization was introduced, national health surveys suggest that only 42% of children are fully immunized. Coverage is lowest in the states with the highest child death rates, and less than 20% in Bihar and UP. India may be a world leader in software, but when it comes to basic immunization services for children in poor rural areas, the record is less impressive. Gender inequality is one of the most powerful brakes on human development. Women’s education matters in its own right, but it is also closely associated with child mortality. The under-5 mortality rate is more than twice as high for children of illiterate mothers as for children whose mothers have completed middle school. Apart from being less prone to undernutrition, better educated mothers are more likely to space births — all factors positively associated with child survival. As well as depriving girls of a basic right, education inequalities in India translate into more child deaths. State inequalities interact with gender and income based inequalities. Four states account for more than half of child deaths: Bihar, MP, Rajasthan and UP. These states also are marked by some of the deepest gender inequalities in India. Contrasts with Kerala are striking. Girls born in Kerala are five times more likely to reach their fifth birthday, are twice as likely to become literate and are likely to live 20 years longer than girls born in Uttar Pradesh. The differences are linked to the chronic underprovision of health services in high-mortality northern states. Human Development in a nutshell • In India, the death rate for children ages 1-5 is 50 per cent higher for girls than for boys. Expressed differently, 130,000 young lives are lost each year because of the disadvantage associated with being born with two X chromosomes. • Somebody born in India can expect to live 14 fewer years than somebody born in the US. • China and to a more modest degree, India are on the front ranks of high growing globalising countries. Yet the annual progress in cutting child deaths has slowed in both countries since 1990 even as economic growth has grown. • Looking to the future, Africa faces the gravest HIV/AIDS related risks to human development. But new threats are emerging. Serious epidemics have emerged in several Indian states. • Kerala has an urban infant death rate lower than that for African Americans in Washington DC • For India, the reduction in child mortality would reduce overall deaths by about 1.4 million. In just three countries — Bangladesh, India and Nepal— half a million of the lives saved would be of children in the first month of life • Brazil, India and Thailand have successfully challenged the legality of EU sugar subsidies, with a WTO panel ruling that these subsidies are not in compliance with WTO rules. • One estimate for India suggests that costs to households associated with higher prices for medicine will increase by some $ 670 million, almost double current spending on all antibacterial medicines. • Consider the software sector in India, which accounts for 16 per cent of exports and provides jobs to half a million people. Two thirds of exports go to the United States and another quarter to Europe. Almost half of these exports - valued at more than $3 billion in 2002 - are delivered on site by professional staff. Delivery depends on market access.
