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 Health is Wealth
Do we need a health ministry?
The Indian Express, India Monday, August 2, 2010

Bibek Debroy
According to Ghulam Nabi Azad, India will become the most populous country by 2030, as the rate of growth of population is 1.4 pecentage when compared to China's 0.6 percentage. He has certainly not read the horror stories in Paul Ehrlich's "the Population Bomb" or Ashish Bose's "Head Count". India was the first to implement family planning, but has it worked? Population is an asset rather than a liability, writes Bibek Debroy in The Indian Express.

Inflation, railways, India-Pakistan talks, Kashmir, CBI, Sharad Pawar, Bhopal — there is plenty of stuff for MPs to discuss during the monsoon session. In addition, the health minister wants an entire day (or half a day) to discuss population stabilisation. He has written a letter to the prime minister to that effect, stating: “Over the last decade, the family planning programme per se lost focus, adversely impacting our ability to achieve the desired level of population growth. Of particular concern is the high fertility that continues to persist in almost all the northern states and Orissa.”

Here is the horror story according to Ghulam Nabi Azad. Between 2005 and 2010, China’s annual rate of population growth has been 0.6 per cent, against India’s 1.4 per cent. Around 2030, India will become the most populous country on earth — with a population of 1.6 billion by 2050. Gujarat and Haryana will reach replacement levels of fertility in 2012, Assam in 2019, Rajasthan and Bihar in 2021, Chhattisgarh in 2022, Madhya Pradesh in 2025 and Uttar Pradesh in 2027. I wonder if the health minister has read Paul Ehrlich’s The Population Bomb. If not, he should. And he should recommend it as mandatory reading for all MPs. In 1968, Ehrlich wrote: “India couldn’t possibly feed two hundred million more people by 1980.” And: “I have yet to meet anyone familiar with the situation who thinks that India will be self-sufficient in food by 1971.”

I wonder if the health minister has read Ashish Bose’s Head Count, published in 2010. If not, he should. And he should recommend that as mandatory reading to all MPs too, because he might obtain some new insights on demographic transition. But before Bose, no doubt the health minister knows that the First Five Year Plan document, in a chapter on health, had a sub-section titled “Family Planning”. This said: “The recent increase in the population of India and the pressure exercised on the limited resources of the country have brought to the forefront the urgency of the problem of family planning and population control... The main appeal for family planning is based on considerations of the health and welfare of the family. Family limitation or spacing of the children is necessary and desirable in order to secure better health for the mother and better care and upbringing of children. Measures directed to this end should, therefore, form part of the public health programme.”

Thus, way back in 1951, India was the first country in the world to talk about family planning. Everything that Azad wants now — late marriages, delayed first children, proper spacing — was on the agenda in 1951 too. The health ministry’s website, in the section on family welfare, has slogans like “Control Population” and “Have Fun with One”. This also has the National Population Policy, which tells us that in 1952 India was the first country in the world to introduce family planning.

Has this not worked and why has it not worked? A quote floats around, “Development is the Best Contraceptive”. It’s not very clear who first coined it. It may have been Dr Karan Singh, as minister for health and family planning, at the First World Population Conference in Bucharest in 1974. It may have been Indira Gandhi, or it may have been Ashish Bose. There may be high rates of population growth in some smaller states or union territories. But the key ones are larger states mentioned in the health minister’s letter — Bihar, UP, MP, Rajasthan and Orissa. In attitudes towards population bombs, one detects an element of paternalism on part of those who formulate policies and they are naturally those who aren’t poor. The poor don’t know what is good for them. They breed like rabbits. There must be coercive contraceptive practices. Hence, there is sneaky admiration for forcible sterilisation during the Emergency and China’s one-child policies. Such coercion not only distorts population pyramids, it also tends to be anti-women. We have had coercion after a fashion in panchayat elections in Haryana, Rajasthan, Andhra Pradesh, Orissa, MP and Himachal Pradesh and there are studies to show how these have restricted women’s choice. Therefore, there are understandable reasons why Maharashtra, Gujarat, Delhi and UP have not experimented with coercion.

Why is population a liability rather than an asset? Why was Ehrlich wrong? In part, because he failed to anticipate India’s Green Revolution. There is a second green revolution every prime minister and every government since 1991 have talked about. This includes Dr Manmohan Singh in several speeches and interviews. With a second green revolution, we should have no food security issues. Nor should we have issues connected with water, land, or other natural resources, and even urban planning. Unless we assume we won’t be able to reform and will continue to use land, natural resources and labour inefficiently, population shouldn’t be a problem. There is a quote ascribed to Mao, about every mouth coming with two hands attached. We can’t have it both ways. Logically, we can’t deride a large population and simultaneously salivate at the demographic dividend, which will accrue in the BIMARU states, with Orissa added. Implicit in paternalistic beliefs is a mindset that poor people aren’t productive. They don’t contribute to the GDP. Therefore, by extrapolation, murders of poor people are good for the cause of the GDP.

Since 1976, the Chinese adopted a policy of “later, longer, fewer”, which eventually became the coercive one-child policy. Surely, we don’t want to follow China in becoming a country that becomes grey before it becomes wealthy, with all its adverse consequences. As it is, India’s demographic dividend will whittle away beyond 2040. Of course, one wants “later, longer, fewer”, but that should be the outcome of natural and voluntary choice. BIMARU and Orissa fare ill on every development indicator — urbanisation, education (including women’s literacy), skills, physical infrastructure, drinking water, poverty, health (mortality, morbidity). Several of these are outside the health ministry’s ambit. But some, like infant mortality rate (IMR) and couple protection rates are under Azad’s purview. Why are IMR figures (for 2002) 61 in Bihar, 85 in MP, 87 in Orissa, 78 in Rajasthan and 80 in UP? Why are couple protection rates 21.2 per cent in Bihar, 45.9 per cent in MP, 37.6 per cent in Orissa, 36.1 per cent in Rajasthan and 38.0 per cent in UP? If there is going to be a debate in Parliament, let’s have one on why these numbers aren’t dropping fast enough. Let’s pin the health ministry down on outlays versus outcomes. If these are state subjects, let’s debate on whether we need a Central health ministry.

This article was published in the The Indian Express on Monday, August 2, 2010. Please read the original article here.
Author : Mr Debroy is a noted economist, based in New Delhi.
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