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Economic growth & health of poor children in India.

Sir,

The prevailing wisdom to improve the health of Indians, as repeatedly emphasized by the Prime Minister of India Dr Manmohan Singh (1), is based on economic growth. Can India rely solely on the trickledown process of economic growth to improve the health of its population, especially its children from socio-economically disadvantaged backgrounds? India experienced substantial economic growth with an average growth rate of 6.4 per cent between 1992/93 and 2005/06 (2), with approximately a 50 per cent increase in its growth rate. During the same time, the decrease in the prevalence of underweight among children was sluggish with negligible reductions especially in the poorest quintile of household wealth (Fig. 1). At the ecological level, there was no association between per cent increase in per capita income of the state and per cent change in underweight among children in the poorest wealth quintile (Fig. 2). This appears to be in line with a recently published study (3) that examined and found no effect of economic growth on the child's risk of being undernourished in data pooled across all wealth quintiles.

As the economist-philosopher Amartya Sen continues to remind us, economic growth is neither a necessary nor a sufficient condition to improve population health (4). The discussion of the merits of economic growth as a primary policy instrument to improving the health of the poor has to also consider the questions of what type of economic growth is needed, i.e., is the process generating growth 'inclusive' involving and benefiting all sections (especially its poorer citizens) of the society; and how are the anticipated increases in public revenue that accrues as a result of economic growth being allocated to different programmes? Existing evidence for an inclusive economic growth (5), or for increased public spending on health (6), in India is, however, not encouraging. Taken together, the evidence suggests that sole reliance on economic growth as a policy instrument may not be sufficient to reduce the burden of poor health among children from disadvantaged households in India. Simultaneous and direct health investments may be necessary to reduce the high levels of child undernutrition in India, especially given the strong intergenerational effects of poor nutrition in India (6).

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

Support: No funding was available for this study.

Conflict of interest: Authors declare no conflict of interest.

References

(1.) Zakaria F. GPS: Interview with Manmohan Singh. Available from: http://archives.cnn.com/TRANSCRIPTS/0911/22/ fzgps.01.html, accessed on February 3, 2011.

(2.) Basu K, Maertens A. The pattern and causes of economic growth in India. Oxford Rev Econ Policy 2007; 23 : 143-67.

(3.) Subramanyam MA, Kawachi I, Berkman LF, Subramanian SV. Is economic growth associated with reduction in child undernutrition in India? PLoS Med 2011; 8 : e1000424.

(4.) Sen A. Learning from others. Lancet 2011; 377 : 200-1.

(5.) Dev MS, Ravi C. Poverty and Inequality: All-India and States, 1983-2005. Econ Polit Wkly 2007; 42 : 509-21.

(6.) Kumar AS, Chen LC, Choudhury M, Ganju S, Mahajan V, Sinha A, et al. Financing health care for all: challenges and opportunities. Lancet 2011; 377 : 668-79.

(7.) Subramanian SV, Ackerson LK, Davey Smith G. Parental BMI and childhood undernutrition in India: an assessment of intrauterine influence. Pediatrics 2010; 126 : e663-71.

(8.) IIPS. National Family Health Survey (MCH and Family Planning), India 1992-93. Bombay: International Institute for Population Sciences; 1995.

(9.) IIPS. Macro-International (2007) National Family Health Survey (NFHS-3), 2005-2006: India:, vol. I. Mumbai: International Institute for Population Sciences; 2007.

S.V. Subramanian * & Malavika A. Subramanyam **

* Department of Society, Human Development & Health, Harvard School of Public Health &

** Center for Integrative Approaches to Health Disparities, School of Public Health, University of Michigan, USA

* For correspondence: Dr S.V. Subramanian Associate Professor, Harvard School of Public Health, 677 Huntington Avenue Boston MA 02115, USA svsubram@hsph.harvard.edu
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Title Annotation:Correspondence
Author:Subramanian, S.V.; Subramanyam, Malavika A.
Publication:Indian Journal of Medical Research
Geographic Code:9INDI
Date:Jun 1, 2011
Words:637
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