Demographic convergence and its linkage with health inequalities in India

This thesis comes out at a time when the debate on between-state and social group demographic and health inequalities continues to be largely debated based on most recent available information. However, analyses based on the recent demographic and health data have serious limitations in terms of understanding the true trajectories of between-state and social group inequalities. With the changing demographic scenario and most demographic indicators progressing towards the final stages of transition, the major concern in India has been heterogeneity across region and socioeconomic groups. While the demographic heterogeneity in India is well known, how far the differences are converging or diverging has been a matter of great interest. This study attempted to develop a comprehensive framework to study the demographic transition, convergence and its linkage with health inequalities in India. It advances the empirical examination of demographic convergence assessment by assessing convergence not only in the averages, but also in the absolute and relative inequalities in population and health indicators. The analyses foster that while economic variables are diverging, fertility variables are converging in recent years. Perhaps, it re-affirms the fact that fertility transition is not critically related to economic factors in India. The mortality convergence has some setbacks in recent years. The child health care utilization has shown converging although at a lesser magnitude. Moreover, fertility decline is associated with increasing in child health inequalities in a context where there are pre-existing socioeconomic inequalities. Inequality is often a consequence of progress. Not everyone gets rich at the same time, and not everyone gets immediate access to the latest life-saving measures. Further, growth, inequality, and catch up are the both sides of the same coin. The dark side is what happens when the process is hijacked, so that catch-up never comes. Powerful and wealthy elites have choked off demographic and health progress before, and they can do so again if they are allowed to undermine the institutions on which broad-based demographic and health progress depends. Now, it is confirmed from this study that a mere reduction in the number of children or fertility convergence in averages are not helping in distributing the fruits of demographic progress equally among the children of different states and socioeconomic groups. How far children and their development (particularly in terms of health) are faring during the progress of demographic transition is an important concern for population policy in India

Conundrums in public distribution system in India: an assessment by states and social groups

Growing number of studies accentuated enigmas in PDS system, many of them provided evidences based on National Sample Survey (NSS) and other official statistics, more particularly by major states. Many of them also highlighted theoretical and operational difficulties in existing policy strategies for only major states. Alternatively, this study emphasized key issues and provided evidences based Indian Human Development Survey (2004-05) for all the Indian states and major socio-economic groups. Additionally, this study provides reasons for not using ration card and major hurdles in PDS ration offtake. All-encompassing, this provides number of critical insights on conundrums in public distribution system in India by maximum Indian states and social groups

Demographic convergence and its linkage with health inequalities in India

This thesis comes out at a time when the debate on between-state and social group demographic and health inequalities continues to be largely debated based on most recent available information. However, analyses based on the recent demographic and health data have serious limitations in terms of understanding the true trajectories of between-state and social group inequalities. With the changing demographic scenario and most demographic indicators progressing towards the final stages of transition, the major concern in India has been heterogeneity across region and socioeconomic groups. While the demographic heterogeneity in India is well known, how far the differences are converging or diverging has been a matter of great interest. This study attempted to develop a comprehensive framework to study the demographic transition, convergence and its linkage with health inequalities in India. It advances the empirical examination of demographic convergence assessment by assessing convergence not only in the averages, but also in the absolute and relative inequalities in population and health indicators. The analyses foster that while economic variables are diverging, fertility variables are converging in recent years. Perhaps, it re-affirms the fact that fertility transition is not critically related to economic factors in India. The mortality convergence has some setbacks in recent years. The child health care utilization has shown converging although at a lesser magnitude. Moreover, fertility decline is associated with increasing in child health inequalities in a context where there are pre-existing socioeconomic inequalities. Inequality is often a consequence of progress. Not everyone gets rich at the same time, and not everyone gets immediate access to the latest life-saving measures. Further, growth, inequality, and catch up are the both sides of the same coin. The dark side is what happens when the process is hijacked, so that catch-up never comes. Powerful and wealthy elites have choked off demographic and health progress before, and they can do so again if they are allowed to undermine the institutions on which broad-based demographic and health progress depends. Now, it is confirmed from this study that a mere reduction in the number of children or fertility convergence in averages are not helping in distributing the fruits of demographic progress equally among the children of different states and socioeconomic groups. How far children and their development (particularly in terms of health) are faring during the progress of demographic transition is an important concern for population policy in India

Conundrums in public distribution system in India: an assessment by states and social groups

Growing number of studies accentuated enigmas in PDS system, many of them provided evidences based on National Sample Survey (NSS) and other official statistics, more particularly by major states. Many of them also highlighted theoretical and operational difficulties in existing policy strategies for only major states. Alternatively, this study emphasized key issues and provided evidences based Indian Human Development Survey (2004-05) for all the Indian states and major socio-economic groups. Additionally, this study provides reasons for not using ration card and major hurdles in PDS ration offtake. All-encompassing, this provides number of critical insights on conundrums in public distribution system in India by maximum Indian states and social groups

India’s COVID-19 Episode: Resilience, Response, Impact and Lessons

Despite the commonality of loss of lives, every pandemic has played a role in shaping the socio-economic and public health outcomes depending on the nature and the magnitude of the outbreak. In this study, we have attempted to make a preliminary assessment of COVID-19 impact on India and commented on the country’s resilience, response, impact and draw the lessons for the future. Although lockdown was necessary to stop the transmission, is showing and will show a greater impact on all spheres of human life considering the country’s poor resilient socio-economic institutions. Our concurrent assessment in the middle of the outbreak predicts that the socio-economic, demographic and health costs in India would be much higher than developed countries. Initiation of timely action from the very beginning (when the first case reported in Kerala) could have plummeted the potential transmission in every corner of the country to a large extent and could have avoided socio-economic crises that presently surfaced in the country. The study provides a strong message for initiating sector-specific measures alongside relief packages to reduce the damage not only for now but also to build a resilient system for socioeconomically vulnerable groups, health care services, and education infrastructure to face future pandemics. Otherwise, the pandemic like this can cost more

India’s COVID-19 Episode: Resilience, Response, Impact and Lessons

Despite the commonality of loss of lives, every pandemic has played a role in shaping the socio-economic and public health outcomes depending on the nature and the magnitude of the outbreak. In this study, we have attempted to make a preliminary assessment of COVID-19 impact on India and commented on the country’s resilience, response, impact and draw the lessons for the future. Although lockdown was necessary to stop the transmission, is showing and will show a greater impact on all spheres of human life considering the country’s poor resilient socio-economic institutions. Our concurrent assessment in the middle of the outbreak predicts that the socio-economic, demographic and health costs in India would be much higher than developed countries. Initiation of timely action from the very beginning (when the first case reported in Kerala) could have plummeted the potential transmission in every corner of the country to a large extent and could have avoided socio-economic crises that presently surfaced in the country. The study provides a strong message for initiating sector-specific measures alongside relief packages to reduce the damage not only for now but also to build a resilient system for socioeconomically vulnerable groups, health care services, and education infrastructure to face future pandemics. Otherwise, the pandemic like this can cost more

Demographic Change and Private Savings in India

India is on the edge of a demographic revolution with a rapidly rising working-age population. For the first time in this study, we investigate the role of the rising working-age population on per capita small savings in post offices and banks net of socio-economic characteristics using state-level panel data compiled from multiple sources for the period 2001-2018. Our comprehensive econometric assessment with multiple robustness checks provide three key findings: (1) Per capita private savings is increasing because of India’s growing working-age population, thus the ‘economic life cycle hypothesis’ is supported. (2) The demographic factors contribute around one-fourth of the per capita private savings inequality across Indian states. (3) The demographic window of economic opportunity for India can yield maximum benefits in terms of private savings when accompanied by favourable socio-economic policies on education, health, gender equity, and economic growth

Familial Power Relations, Popularity of Female Sterilization and Fertility Decline in Andhra Pradesh: A Cultural Understanding

Andhra Pradesh is the first state in India, to reach the replacement level fertility in spite of having high infant and child mortality; high illiteracy and other unfavorable factors. This is an effort to assess such endeavors both theoretically and empirically. Results indicate that though current use of contraception has increased from 41 percent in 1992-93 to 68 percent in 2005-06, the contribution of female sterilization alone is 63 percent and almost 83 percent of women with two living children are sterilized. Status of sterilized women is higher than women using other methods of contraception. Women status in family increases with increasing years after sterilization. Findings suggest a positive association between sterilization at early age, lower fertility and women status. To surmount the intra-familial controls on them, the women is responding remarkably to family planning program herself by ending reproductive span to get higher status in the family ladder

Potential demographic dividend for India, 2001 to 2061: A macro-simulation projection using the spectrum model

This paper projects potential demographic dividend for India for the period from 2001 to 2061 by using simulation modelling software, Spectrum 5.753 which integrates demographic and socio-economic changes. Two key findings, after checking their robustness, from the simulation modelling are: First, the effective demographic windows of opportunity for India is available for the period between 2011 and 2041, giving India roughly 30 years of demographic bonus. It is the period where the maximum of the first demographic dividend can be reaped before the ageing burden starts. Second, favourable demographic changes alone provide a demographic dividend of over 165,000 rupees (almost an additional 43 percentage) in terms of GDP per capita by 2061 when integrated with supporting socio-economic policy environment in terms of investment in human capital, family planning, decent employment opportunities, the rapid pace of urbanization, and agricultural growth

Health insurance and health care in India: a supply-demand perspective

India’s health care and health financing provision is characterized by too little Government spending on health, meager health insurance coverage, declining public health care use contrasted by highest levels of private out-of-pocket health spending in the world. To understand the interconnectedness of these disturbing outcomes, this paper envisions a theoretical framework of health insurance and health care revisits the existing health insurance schemes and assesses the health insurance cover in relation to the pattern of health care use using data from myriad official statistics and the recent NFHS, 2005-06. Theoretical exploration of the axis of supply-demand determinants unfolds that a complex of factors such as sparse health financing options, self-obstructing heavily risk protected insurance market and weak consumer demand contribute to the measly level of health insurance penetration in India. Health insurance cover is found to be a strong determinant of modern health care use. Regional and rural-urban disparities in health insurance and health care are significant. Health insurance coverage is positively related while public health care use is negatively related with household economic condition and education status. The complex axis of critical supply side imperfections and considerable demand side weaknesses necessitate a major health care reform with the viable financing and health care options