Economic growth & health of poor children in India
Economic growth & health of poor children in India
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经济增长
DOI：
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
M. Subramanyam
中科院分区：
文献类型：
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作者：
S. Subramanian;M. Subramanyam
先生,
正如印度总理曼莫汉·辛格博士反复强调的那样，改善印度人健康的普遍智慧是以经济增长为基础的。印度能否仅仅依靠经济增长的涓滴过程来改善其人口的健康，特别是来自社会经济不利背景的儿童的健康？印度经历了相当大的经济增长，1992/93年至2005/062年度的平均增长率为6.4%，增长率增加了约50%。与此同时，儿童体重不足的发生率下降缓慢，降幅微乎其微，特别是最贫穷的家庭财富的五分之一(图1)。在生态层面上，国家人均收入的增加百分比与最贫穷财富五分之一儿童体重不足的百分比变化之间没有关联(图2)。这似乎与最近发表的一项研究一致，该研究检查了所有财富五分之一的数据，发现经济增长对儿童营养不良的风险没有影响。
图1
1992/93年和2005/06年按家庭财富的五分之一计算的0至36个月印度儿童体重不足的加权患病率。资料来源：作者使用印度全国家庭健康调查1992-938年和2004-05年的数据进行了计算。
图2
1992/93年至2005/06年期间，在最贫穷的五分位数的0至36个月的印度儿童中，邦人均收入增加百分率与儿童体重不足患病率变化百分率之间的生态联系。资料来源：...
正如经济学家兼哲学家阿马蒂亚·森不断提醒我们的那样，经济增长既不是改善人口健康的必要条件，也不是充分条件。在讨论经济增长作为改善穷人健康的主要政策工具的优点时，还必须考虑需要什么样的经济增长的问题，即，产生增长的过程是否“包容”社会各阶层(特别是较贫穷的公民)并使其受益；经济增长所产生的预期公共收入增加如何分配给不同的方案？然而，现有证据表明印度实现了包容性经济增长，或增加了公共卫生支出，这并不令人鼓舞。综上所述，证据表明，仅仅依靠经济增长作为一种政策工具，可能不足以减轻印度贫困家庭儿童健康状况不佳的负担。可能需要同时和直接的保健投资，以减少印度儿童营养不良的高水平，特别是考虑到印度营养不良的强烈代际影响6。
Sir,
The prevailing wisdom to improve the health of Indians, as repeatedly emphasized by the Prime Minister of India Dr Manmohan Singh1, is based on economic growth. Can India rely solely on the trickle-down process of economic growth to improve the health of its population, especially its children from socio-economically disadvantaged backgrounds? India experienced substantial economic growth with an average growth rate of 6.4 per cent between 1992/93 and 2005/062, with approximately a 50 per cent increase in its growth rate. During the same time, the decrease in the prevalence of underweight among children was sluggish with negligible reductions especially in the poorest quintile of household wealth (Fig. 1). At the ecological level, there was no association between per cent increase in per capita income of the state and per cent change in underweight among children in the poorest wealth quintile (Fig. 2). This appears to be in line with a recently published study3 that examined and found no effect of economic growth on the child's risk of being undernourished in data pooled across all wealth quintiles.
Fig. 1
Weighted prevalence of underweight among Indian children aged 0 to 36 months by quintiles of household wealth in 1992/93 and 2005/06. Source: Authors’ calculation using data from the Indian National Family Health Surveys of 1992-938 and 2004-05 ...
Fig. 2
State level ecological association between per cent increase in state per capita income and per cent change in child underweight prevalence between 1992/93 and 2005/06 among Indian children aged 0 to 36 months in the poorest wealth quintiles. Source: ...
As the economist-philosopher Amartya Sen continues to remind us, economic growth is neither a necessary nor a sufficient condition to improve population health4. The discussion of the merits of economic growth as a primary policy instrument to improving the health of the poor has to also consider the questions of what type of economic growth is needed, i.e., is the process generating growth ‘inclusive’ involving and benefiting all sections (especially its poorer citizens) of the society; and how are the anticipated increases in public revenue that accrues as a result of economic growth being allocated to different programmes? Existing evidence for an inclusive economic growth5, or for increased public spending on health6, in India is, however, not encouraging. Taken together, the evidence suggests that sole reliance on economic growth as a policy instrument may not be sufficient to reduce the burden of poor health among children from disadvantaged households in India. Simultaneous and direct health investments may be necessary to reduce the high levels of child undernutrition in India, especially given the strong intergenerational effects of poor nutrition in India6.