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73

But how does India compare with the critics favourite countries Bangladesh and China? Table 5.1 provides vital statistics for these countries and India, as reported in the 2011 World Health Organization (WHO) publication.
TABLE 5.1: SELECTED INDICATORS: BANGLADESH, CHINA AND INDIA, 2009

Health Indicator

India

China

Bangladesh

Per capita income, 2009 (current dollars) Life expectancy at birth in 2009 (years) Stillbirth rate (per 1000 total births) Infant mortality, 2009 (per 1000 live births) Maternal mortality, 2008 (per 100,000 live births) Death from malaria, 2008 (per 100,000 population) Per cent children stunted, 2000-09 Per cent children underweight, 2000-09

1192 65 22 50 230 1.9 47.9 43.5

3744 74 10 17 38 0 11.7 4.5

551 65 36 41 340 1.8 43.2 41.3

Source: WDI of the World Bank for per capita GDP and World Health Organization (2011) for the remaining indicators.

Take Bangladesh first. Without discounting its achievements, we must deflate them relative to those of India, refuting the unwarranted encomiums for Bangladesh and the exaggerated criticisms directed at India. The performance of Bangladesh relative to that of India in terms of health indicators is significantly more equivocal than has been reported by the critics. India and Bangladesh enjoy the same life expectancy at birth. Bangladesh has a lower infant mortality rate than India (41 per 1000 live births against the latters 50) but its rate

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Indias Tryst with Destiny

of stillbirth more than offsets the difference (36 per 1000 births against Indias 22): an inconvenient fact that almost all observers emphasizing the lower infant mortality in Bangladesh ignore.2 The maternal mortality rate in Bangladesh is, in fact, much higher than in India. Mortality due to malaria is almost similar while Bangladesh edges out India only marginally on nutrition indicators. In comparing Bangladesh and India, we must also take into account history. According to the United Nations (World Population Prospects, the 2010 revision), life expectancy in Bangladesh during 1950-55 was forty-five years compared to just thirty-eight years in India. The 1971 war led to a major dip in most health indicators of Bangladesh but they recovered in the following decades. At least some of the accelerated progress Bangladesh has achieved during the 1980s and beyond is therefore to be attributed to its return to the initial conditions. This point is reinforced when we compare Bangladesh to West Bengal, with which it has a shared history and geography. Not only are the two entities located in the same region; they were once part of the same larger state in pre-independence India. It turns out that West Bengal outperforms Bangladesh in terms of health indicators. During 2002-06, it enjoyed a life expectancy at birth equalling sixty-five years. And its infant mortality rate at 33 per 1000 live births in 2009 and maternal mortality of 141 during 2004-06 were considerably lower than the corresponding rates reported for Bangladesh in Table 5.1.3

2. For example, see the recent attack by Dreze and Sen (2011) on the health achievements of India as compared to Bangladesh and other South Asian countries. 3. We may also add that in terms of the United Nations Human Development Index (HDI), India ranks ahead of Bangladesh by ten places. It may be recalled in this context that it was Amartya Sen, a leading proponent of the
(Contd.)

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Turn next to the India-China comparison. Some critics of Indian performance on health argue that despite acceleration in growth since the 1980s, India has done poorly relative to China in improving its health indicators. Such assertions are misleading for at least two reasons. First, growth in the 1980s, 1990s and early 2000s has been much faster in China than in India.4 And second, like Bangladesh, China has enjoyed a historical advantage over India. For example, China had already gained much of its lead over India in life expectancy by the early 1970s (See Figure 5.2). Indeed, the gap in life expectancy between China and India has steadily declined in recent decades, falling from 13.2 years at its peak in 1971 to 9.3 years in 2009. It is ironic that Amartya Sen, who has been deploring India for its poor achievements in health vis-vis China, had himself made this point in 2005 stating, The gap between India and China has gone from fourteen years to seven (since 1979) because of (China) moving from a Canada-like system to a US- like system.5

(contd.)

view that Bangladesh has outdone India in terms of human development, who helped the United Nations Development Programme design the HDI. Oddly, as Panagariya (2011b) pointed out, Sen (2011) neglects to cite this statistic in his critique of India in relation to Bangladesh. Indeed, any references to the index remain conspicuously missing even from Dreze and Sen (2011), which was published well after Panagariya (2011b). 4. It is odd that authors disparaging India often applaud Bangladesh for doing well in health outcomes despite its lower per capita income but gloss over the much larger per capita-income gap India suffers vis--vis China when they compare it to the latter. 5. See An Annie Hall Moment: A Nobel Prize-winning economist spouts off, and a Chinese survivor sets him straight, originally published in The Wall Street Journal, 21 February 2005, and available at http://www.parrikar.org/ misc/amartya-wsj.pdf (accessed on 3 March 2012). According to the report, speaking in Hong Kong, Sen had argued that while China had made great
(Contd.)

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Life expectancy at birth in years

FIGURE 5.2: LIFE EXPECTANCY IN INDIA AND CHINA, 1960-2009

Source: Based on the data from World Development Indicators of the World Bank.

(contd.)

strides in medicine during the Cultural Revolution, the move to a privatized system in recent years had made the system less fair and efficient. It so happened, however, that the audience included a Hong Kong banker, Weijian Shan, who had lived through the Cultural Revolution and had been one of Maos barefoot doctors. The report notes that Shan was surprised by Sens comments and went on to state to the audience, I observed with my own eyes the total absence of medicine in some parts of China. The system was totally unsustainable. We used to admire India. He added that when he observed medical school graduates in Taiwan serving in the countryside in the 1980s during a visit there, he thought, China ought to copy Taiwan. Shan further stated that had Maos medicine system been made optional, nobody would have opted for it.