As 2017 kicks in, there is no dearth of forecasts. The year marks the 40th anniversary of John Kenneth Galbraith’s The Age of Uncertainty. Geo-politically, there is disruption and turmoil. It is hard to say what will be the top-grosser in the public imagination — Donald Trump or a new Forrest Gump. Here in India, demonetisation retains its top slot as the most fiercely debated and polarising saga.
Since columnists are allowed futuristic reveries at this time of the year, it is tempting to wonder aloud about demonetisation’s parallel narrative — the attempt to leap forward to a cashless or less-cash society from one where cash was king. Is cash really on its way out? How long till it becomes a collector’s item like vinyl records and film cameras? Or a fad among hipsters? If there can be artisanal cheese, why not artisanal money?
Perhaps cash is here to stay in the foreseeable future as my neighbourhood golgappawallah tells me, in stark contrast to Niti Aayog boss Amitabh Kant’s prediction that by 2020, even ATM cards will be redundant and all transactions will be completed in 30 seconds through Aadhaar-enabled technology.
Back to reality. And the only certainty is the huge spell of uncertainty ahead of us. How should India navigate this period of hyper-uncertainty?
In an increasingly tough and competitive ecosystem, the one thing we can’t afford to ignore is human capital. We need infrastructure, we need good regulations, we need laws, but at the end if we don’t have healthy, educated and skilled people, specially the youth, we will not be able to tap into our demographic dividend nor cope with the technological transformations that the world and this country are undergoing.
This is not an original thought. It has been said before, even during more placid times. But a few weeks before the Budget, it bears repetition.
Some of us are clever. Some of us are very clever. But that isn’t good enough for India to realise its full potential. If millions across the country don’t even get the chance to live till their fifth birthday or complete high school, our aspirations in a progressively more demanding world will get dashed, like it or not. Technology can help us leapfrog, but to be able to make the leap, we still need to stand on a strong base — pathetic learning outcomes and poor health don’t help.
Here are some sobering statistics.
The number of Indians falling below the poverty line (BPL) due to health spending may run as high as 63 million, almost seven per cent of the nation’s population. And with most people having to pay for their own medical treatment, things are not getting better. The ministry of health reported that 18 per cent of households faced catastrophic health costs in 2011-12, as compared to 15 per cent in 2004-05. The vast majority of healthcare-related impoverishment takes place in villages, during outpatient care. But talk to any middle class family in a city with elderly family members or someone who has a life-threatening disease and you will sense the palpable fear too.
Those in government have their medical expenses covered. Those working in the formal sector often have some sort of health insurance, which pays for hospitalisation but not all medical expenses. Most people have to pay for their medicines. The fact is that the vast majority in this country still work in the informal sector and live in mortal fear of falling ill. A visit to a private hospital could shave off huge chunks from the family budget. That is the reality.
Here is another indicator — infant mortality rate (IMR). Due to a slew of government initiatives, our record has improved on this score in the past two decades, but it is still woeful, even when compared with many countries in the developing world. According to latest data, in 2015 in India, 37 babies died for every 1,000 that were born. The corresponding figure for China was 12, for Brazil 18, for Thailand nine, and for our neighbour Sri Lanka eight.
What should be of equal concern — the huge disparities between states on IMR as in so many other health indicators. Madhya Pradesh reported India’s highest IMR with 50 infant deaths per 1,000 live births.
Despite this issue, which affects so many millions directly, the tragedy is that healthcare is not a serious talking point in the national discourse nor a political issue. It does not figure in stump speeches as five states in the country, including Uttar Pradesh with 200 million people, head towards Assembly elections. It is time for voters to demand high-quality affordable healthcare for which they don’t have the travel miles and miles.
Take another basic indicator — education. There is a crisis in education, specially palpable in the four populous BIMARU states — Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh. All four have literacy rates below the national average of 74 per cent. When the last census was taken in 2011, Bihar had a literacy rate of 61.8 per cent, Rajasthan 67.1 per cent, Uttar Pradesh 67.7 per cent and Madhya Pradesh 70.6 per cent.
The situation is actually far worse, as a look at female literacy figures will show. This is critical, because it is clear that for any development to take place, women’s education is a vital first step.
The bottom line — we invest far too little in building human capital and we pay far too little attention to the high cost of low investments in human capital.
No country that has become an economic miracle or successful for a length of time has done so without investing in the basics — education and health for all its people, both men and women. There are always multiple factors behind success stories, but be it the rise of Germany and Japan from the ashes of the Second World War, or the meteoric rise of South Korea in the second half of the 20th century after being one of the poorest countries in the world and most recently the rise of China, there is a common thread. Even during crises and uncertainty, these countries have worked very hard at strengthening their human capital. It is time India woke up.