Measuring changes in human development can help us understand how the economy, and well-being of a country, is changing. The chapter on human development in this year’s Economic Survey emphasises the many schemes and programmes that have either been introduced or updated in the areas of education, health, and skill development. In this post, Coffey and Spears discuss the need for independent data and regional disaggregation.
The first volume of the 2019-2020 Economic Survey contains chapters titled “Undermining markets: When Government intervention hurts more than it helps” and “Targeting ease of doing business in India.” Tucked at the end of the second volume, the final chapter of the Economic Survey covers “Social infrastructure, employment, and human development.”
Economists increasingly understand human development to be at the core of economics. The health, education, and capabilities of a population – and especially of its children once they become adults – are where ideas and productivity come from. These forms of human capital are critical to economic growth. Health, education, and capabilities also matter as ends in themselves – healthier, better educated people tend to live happier, more fulfilling lives. Therefore, measuring changes in human development can help us understand how both the economy, and more broadly, well-being, are changing.
The chapter on human development emphasises improvements: “India’s ranking [among countries] in Human Development Index improved to 129 in 2018 from 130 in 2017.” It also emphasises the many schemes and programmes that have either been introduced or updated in the areas of education, health, and skill development. Implicit in the list of bullet-pointed government programmes is a suggestion that policy is related to these improvements. Have these policies and expenditures accelerated the pace of improvement in human development?
Need for independent data and regional disaggregation when studying human development in India
There is much that nobody knows about many of the important details. Almost every statistic in the chapter is drawn from the government’s own administrative records or monitoring surveys. Across many domains, these have been challenged by subject-matter experts. And, even if experts were not disputing so much of India’s official quantification, independent measurements of human development outcomes would still be needed to understand changes in well-being in any country.
One important data source is the National Family Health Survey (NFHS), India’s version of the global Demographic and Health Survey. These data are of high quality, are independent of any government program or policy, and were most recently collected in 2015 and 2016. Perhaps the most important contribution of these data is to measure early-life mortality. Knowing how many children die early in life can tell us a lot about the disease environment into which they are born, and also about the health of their mothers. It is therefore striking that the chapter on human development, to which health is central, mentions the word ‘mortality’ only twice, when it presents maternal and infant mortality numbers from the Sample Registration System, but omits to discuss them.
Another surprising omission is that the chapter does not report health statistics by state or region. Presenting figures for all-India – or even split only by rural and urban – obscures important regional inequalities. In the 2015-2016 NFHS, 45 of every 1,000 babies born in Uttar Pradesh died in the first month of life, compared with only 4 per 1,000 in Kerala. Such variation is important, and not only because the deprivation and disparity it reveals are a call for policy action. These regional differences also guide the search for explanations and for solutions: they highlight the social inequality and low state capacity in the populations where children are likely to die.
What the chapter mentions, what the chapter omits
Here, we highlight a few of the issues – some of which the chapter mentions, and some which it omits – that we have studied and that we find to be important to early-life health and human development. A common theme is that better data are needed even for the simplest statistics and that further progress will require a focus on social inequality.
Female labour force participation
The chapter usefully points out that women in India are less likely to work in the paid labour force than in other countries. The authors ask why female labour force participation is declining? The chapter cites important research on this question: “It could also be because the household incomes have risen in rural areas on account of higher wage levels which is dragging women out of the labour market (Himanshu, 2011). The female LFPR could be low also due to cultural factors, social constraints and patriarchal norms restricting mobility and freedom of women (Das, 2006, Banu, 2016).” One important possibility that is not explicitly mentioned is that these two mechanisms interact: cultural forces establish married women’s non-participation in the labour force as socially desirable, and economic growth means that more households consume the ‘normal good’ of women not working as they become richer and better able to afford it. This matters because, if true, further economic development may make some women even less likely to work.
The one mention of open defecation in the chapter is in the context of a 10-year strategy to “focus on sustaining the sanitation behaviour change that has been achieved under the Swachh Bharat Mission Grameen”. The effort to sustain what was achieved must not overlook what was not achieved. Open defecation indeed fell more quickly over the past five years than before in rural India. But survey data from rural populations in five large northern states show that this change is fully statistically explained by the rapid provision of toilets and increase in latrine ownership (Gupta et al. 2019). The probability that a latrine owner nevertheless defecates in the open did not change. Moreover, many rural households, especially in north India, still lack a toilet or latrine. Without ongoing independent statistics, it is difficult to assess how much open defecation remains. Yet, it is clear from the brief discussion in the chapter that the priorities and attention of policymakers has moved on from open defecation. If policy attention ever returns to this source of disease and drain on India’s human capital, then completing the job will require a focus on behaviour change and latrine use.
All of the world’s most air-polluted cities are now in India. Air pollution is mentioned in the context of agricultural stubble burning in Chapter 6 on ‘Sustainable Development and Climate Change’, but is not mentioned in the Human Development’ chapter. Air pollution causes respiratory infections, prompts heart attacks, and slows children’s growth. It is perhaps the most important threat to India’s human capital and development today. Its omission from a chapter covering health is therefore striking.
Clean cooking fuel
Air pollution from cooking with biomass (wood, cow dung, and crop residue) is an important source of disease, especially for women and children. Because even rural homes are often densely sited together in India’s villages, neighbours are impacted when other families burn dung or wood to cook: cooking fuel has health externalities (Gupta 2019). The Ujjwala scheme provided LPG (liquefied petroleum gas) connections and cylinders to many families before the past election. Now the challenge is to ensure that the gas is used and that refills are plausibly feasible. Many households now combine using clean fuel sometimes and traditional fuel for other tasks (Gupta et al. 2020). Changing this behaviour – which depends, in part, on the fact that it is women whose duty it is to cook – will be required to reap the health benefits of Ujjwala.
Success and failure; clear trends and unknown details
In a recent review article, Devesh Kapur asks one of the most important questions about Indian policy-making: Why does the Indian state sometimes succeed and sometimes fail? (Kapur 2020) This puzzling bimodalism is especially clear in health and human development policy.
We should celebrate progress, even though it is has been uneven across regions. Comparing today with what India’s 1998 or 2005 National Family Health Surveys reveal, there is much human development progress to celebrate. But Kapur’s open question is an important one, and the unavailability of regular, credible, independent data makes it even more difficult to answer.
Kapur’s explanation leans towards “understaffing of local government, ... and India’s `societal failures' manifest in caste and gender discrimination” (p. 50), among other causes. Local government capacity is important for achieving labour-intensive goals, such as, encouraging households to use clean cooking fuel or latrines. And caste, gender, and other dimensions of social inequality indeed drive many of India’s human development inequalities and challenges.
Kapur’s article offers important insights. Their importance will not soon fade. As Ujjwala and the Swacch Bharat Mission have shown, the Indian state can succeed at constructing or buying objects and distributing them to households. Translating these investments into human development will often require behaviour change and commitment to independent measurement. Human development belongs in an economic survey, but it also depends on social forces.
- Pradhan Mantri Ujjwala Yojana (PMUY) is a centrally sponsored scheme launched by the Ministry of Petroleum & Natural Gas in May 2016 to provide LPG connections to Below Poverty Line (BPL) households.
- Coffey, Diane and Dean Spears (2017), Where India Goes: Abandoned Toilets, Stunted Development, and the Costs of Caste, HarperCollins.
- Coffey, Diane and Dean Spears (forthcoming), “Neonatal Death in India: Birth Order in a Context of Maternal Undernutrition”, The Economic Journal.
- Coffey, Diane, Michael Geruso and Dean Spears (2018), "Sanitation, disease externalities and anaemia: evidence from Nepal", The Economic Journal, 128(611): 1395-1432.
- Government of India (2020), ‘Economic Survey 2019-2020’, Ministry of Finance, Department of Economic Affairs, January 2020.
- Gupta, Aashish (2019), “Where there is smoke: Solid fuel externalities, gender, and adult respiratory health in India”, Population and Environment, 41(1):32-51.
- Gupta, A, N Khalid, D Desphande, P Hathi, A Kapur, N Srivastav, S Vyas, D Spears and D Coffey (2019), ‘Changes in open defecation in rural north India: 2014-2018’, IZA – Institute of Labor Economics Discussion Paper No. 12065.
- Gupta, Aashish, Sangita Vyas, Payal Hathi, Nazar Khalid, Nikhil Srivastav, Dean Spears and Diane Coffey (2020), “Persistence of Solid Fuel Use in Rural North India”, Economic & Political Weekly, 55(3):55.
- Kapur, Devesh (2020), “Why Does the Indian State Both Fail and Succeed?”, Journal of Economic Perspectives, 34(1):31-54.
- Spears, Dean (2019), “India’s Deadly War on Experts”, Foreign Policy.
- Spears, D (2019), Air: Pollution, Climate Change, and India’s Choice between Policy and Pretence, HarperCollins.