Our greatest achievement: longer lives

The 60th anniversary of indepen-dence launched a thousand colum-ns on the achievements and failur-es of the last six decades. Some extolled our democracy and rise as an IT power. Others bemoaned the collapse of governance and appalling lack of basic services in rural India. I personally opined that we could give one-and-a-half cheers but not three for our performance over 60 years.

On further reflection, I think all of us columnists have ignored what has arguably benefited Indians more than anything else. Nothing is more preci-ous than life. It is infinitely more important than the wages we earn, the calories we consume, or the years of schooling we get. It is so precious that we dare not put a value on it: the very act of valuation would demean it.

Yet, because it cannot be valued, we ignore what we have achieved. Life expectancy in India is estimated to have gone up from 31 years in 1947 to 64 years in 2005. The death rate, which used to be around 45 per thousand, is down to just about 8 per thousand. Hundreds of millions who would have died in earlier times are alive.

You might think that is cause for celebration, but we saw no sign of it on Independence Day. Indeed, many people still talk gloomily about the population explosion, and come close to implying that India would be better off had millions more died.

Statisticians who measure GDP and poverty are silent about the rise in life expectancy. They are interested only in what can be measured and valued in rupees. An increase in years of life cannot be converted into rupees. And so the most precious thing of all is ignored.

Indeed, our measurement of GDP and poverty looks absurd when we consider matters of life and death. If a young couple has two children, per capita income is halved. That shows up statistically as an economic disaster that possibly pushes the couple below the poverty line. Yet, the couple will feel doubly blessed by their two children, not impoverished at all.

If on the other hand, the couple owns a cow that gives birth to a calf, statisticians will record that as a jump in their income. Our conventional way of measuring GDP per head regards the birth of a calf as a blessing, but the birth of a child as a tragedy. Further, the death of a calf is a tragedy (since it reduces measured wealth) but the death of a child is a boon (since it raises income per capita). How farcical!

Several studies show that people spend all they have and get deep into debt to stave off death and stay alive. In the US, 90% of a person’s lifetime expenditure on health is typically spent in the last year of life. Life is so precious that people spend decades worth of income to live a few months more.

In the US, Professor William Nordhaus of Yale University has attempted to create what he calls health income as a way of measuring additional longevity. The methodology is controversial: any attempt to value life is bound to raise eyebrows. Yet, ascribing some value to life, no matter how controversial, is surely better than ascribing no value at all, which is what we currently do.

Disparities in income have risen substantially between rich and poor countries, and between rich and poor states in India. But disparities in life expectancy have shrunk, sometimes dramatically. In 1950, life expectancy in India (31 years) was less than half that in the US (68 years). But by 2005, India (64 years) was not far behind the US (77 years).

In terms of per capita income, the richest major state, Maharashtra is four times as rich as Bihar. Yet, life expectancy in Bihar (61 years) is only slightly behind that of Maharashtra (66.4 years). Indeed, Bihar is almost on par with the national life expectancy of 62.7 years.

So, there is a case for arguing that increased longevity has been the greatest single benefit to Indian citizens since independence, a benefit spread across all states and income levels.

However, much of the improvement is due to new drugs, vaccines and oral rehydration. Notwithstanding some public health successes (like malaria control), the overall quality of government medical services has been deplorable. Public health spending is 1% of GDP, among the lowest in the world, and its quality is terrible.

Research by economists Das and Hammer shows that a government doctor spends barely one minute per patient, and has a 50% chance of prescribing the wrong medicines. Poor people would rather pay a private doctor than rely on government health centres.

India’s life expectancy may have more than doubled since independence, yet it is no higher than in Bangladesh (64 years), barely higher than in Nepal (63 years), and well behind Indonesia (68 years) or China (72 years). Indians can be thankful for longer lives. But they should thank global medical advances rather than government effort for this happy outcome.

Indeed, the globalisation of modern medicine and medical practices has globalised high life expectancy too. It depends so little on good governance that even the most corrupt, inefficient countries have gained precious years of life. Caveat: AIDS has globalised a new form of death too.

What do you think?