Despite
the nod given to ''human development'' indicators,
policy makers and even the general public persist
in viewing GDP growth as the primary indicator of
progress, whether in India as a whole or in different
states. This is arguably not just inadequate but possibly
even misleading, as it is possible for relatively
high rates of GDP growth to be combined with stagnant
or even worsening conditions of life for a substantial
segment of the population, even the majority.
Obviously, therefore, employment conditions (such
as access to productive employment, wage rates and
conditions of work) should have equal if not greater
importance in any assessment of economic progress.
But one obvious set of indicators that is only casually
examined by even serious and well-meaning observers
relates to health.
There is no doubt that it is hard to assess morbidity,
especially when the database for such analysis is
poor and much depends upon self-perception. However,
we do have relatively good data on the most basic
health outcome indicators of all - infant mortality
and maternal mortality - that allow us to assess the
differential performance of states of India across
time.
The Sample Registration Surveys (SRS) of the Registrar-General
of India provide the most reliable source of such
data. The most recent results of the SRS relate to
2009, and they allow us to look at both the current
conditions as well as changes over the previous decade.
While in general the infant mortality and maternal
mortality indicators track the general level of economic
development, the matches are not exact by any means.
In fact, these data provide a somewhat different picture
of the conditions of life in different states and
the progress in the past decade, than is generally
perceived.
Consider infant mortality rates, which are globally
considered to be the primary indicator of basic health
conditions in a population. Chart 1 shows that these
vary widely across states, and that some states with
relatively high per capita incomes do not perform
well in this regard. Chart 2 shows that even performance
over time is not necessarily related to increases
in per capita GDP over the decade.
Chart
1 >> Click
to Enlarge
Thus
Maharashtra, which has one of the highest per capita
incomes of all major states, is only a moderate performer
with respect to IMR, although it has decreased relatively
more than the Indian average (Chart 2). The poor performance
of states like Uttar Pradesh, orissa and Madhya Pradesh
is expected, but the relatively rapid decline of IMR
in Jharkhand is less expected (though it must be noted
that the IMR in Jharkhand is still well above the
Indian average).
Two positive examples are Tamil Nadu and West Bengal,
both of which have shown relatively rapid declines
in IMR over the decade and had IMR very significantly
below the Indian avergae in 2009. In the case of West
Bengal, a middle income state, this is even more notable.
Kerala has long been held as an example in terms of
health conditions, and its IMR is many times less
than the Indian average, so it is all the more creditable
that it managed to reduce the low IMR even further
over the period.
The negative example comes from Gujarat, a state which
for some reason is otherwise being presented as a
model of development in various corporate and other
quarters. Not only was the IMR in 2009 close to the
Indian average despite the much higher per capita
income in that state, but progress over the previous
decade was meagre. In 2009, the IMR in Gujarat was
only slightly lower than in much poorer and less developed
Bihar, and actually higher than in Jharkhand.
Delhi is the richest state in the country, but its
performance in terms of IMR has been disappointing,
with no improvement and even a slight decline in the
decade under consideration. Similarly poor health
performance is evident from another rich Northern
state, Haryana, which shows higher than average IMR
and low rate of reduction. Haryana’s IMR in 2009 was
higher than in much poorer states like West Bengal,
Andhra Pradesh and Jharkhand.
Chart
2 >> Click
to Enlarge
Chart 3 describes rural and
urban IMRs, and here too the results are interesting.
Some states show very large gaps, and clearly rural
IMRs remain very high even in some relatively rich
states like Gujarat and Haryana. But urban IMRs also
do not run along completely expected lines. For example,
it is surprising to note that the urban infant mortality
rate in Delhi is clearly higher than in Tamil Nadu
and West Bengal!
Chart 4 gives an idea of the extent of the location-specific
gap in IMRs, by showing the rural IMR as a percentage
of the urban IMR. Predictably, the gap is lowest in
Kerala, but Tamil Nadu, West Bengal and Chhattisgarh
also perform well in this regard. The largest gaps
are in Rajasthan (with a 40% difference!) and Assam.
Once again Gujarat is among the states with a very
large rural-urban gap in IMRs, along with Maharashtra
- both indicating gaps even larger than in poor states
like Madhya Pradesh and Jharkhand.
Chart
3 >> Click
to Enlarge
Chart
4 >> Click
to Enlarge
The other critical indicator
of health conditions - and of the overall condition
of women in society - is the maternal mortality rate.
Data for this also come from the Registrar-General’s
office, for periods of three year averages. They are
described in Charts 5 and 6.
Chart
5 >> Click
to Enlarge
Chart
6 >> Click
to Enlarge
Once again the north-central
belt performs poorly, with Uttar Pradesh, Rajasthan,
Madhya Pradesh and Bihar showing the highest rates
of maternal mortality as well as relatively low rates
of reduction. The biggest improvement in maternal
mortality among the major states appears to have occured
in West Bengal. As a result, by 2009, West Bengal
appears more like a southern state with respect to
this indicator, as MMRs are relatively low in all
the southern states. Among the richer northern states,
Punjab and Haryana show little or no imporvement,
and Gujarat also underperforms with respect to this
indicator.
Such evidence clearly needs to be much more widely
publicised and taken seriously by our policy makers,
who need to move away from their current obsession
with GDP alone. If sheer survival is seen as at least
one valid indication of the overall human condition,
the various states in the country should be ranked
quite differently, both in terms of policy direction
and public perception.
