The association between never poor and mild burden of NCDs is positive, implying lowest burden of NCDs is associated with greater likelihood of being never poor, relative to those not suffering from any. However, it is associated with lower likelihood of escaping poverty. Or, those with mild disabilities find it harder to escape poverty. But their prospects of being always poor are lower. A similar pattern is observed for those with high prevalence of NCDs: greater prospects of being never poor, lower chances of escaping poverty and lower likelihood of being always poor, relative to those without. A clue to these seemingly intriguing results is that high prevalence of NCDs is just as likely among the most affluent as among the least affluent. High prevalence of NCDs among the most affluent is largely due to life-style factors: sedentary living, rich diets and excess alcohol consumption. By contrast, the least affluent are also highly vulnerable largely because of lack of sanitary and hygienic conditions, lack of nourishing diet and limited access to medical services.
The associations between poverty transitions and high prevalence of disabilities are somewhat weak and patchy. However, one robust finding is that households with high disabilities are more unlikely to be never poor, relative to non-disabled. A related finding is that those with multiple disabilities are not just more likely to not work but also more unlikely to work for long duration (at least 250 days in a year).
Relative to those unconnected, connected households are more likely to be never poor; more unlikely to escape poverty, but also more unlikely to be always poor. Well-connected households are more likely to be never poor; less likely to escape poverty; more likely to descend into poverty; but less likely to be always poor.
Much larger health outlays than proposed in the Budget 2020-21 are of course a priority but more important is reorganisation of the health care system and effective regulation. A fully integrated population-based health care system that brings together the public and private sectors and the allopathic and indigenous systems, and is well-coordinated at different levels of service delivery platforms — primary, secondary and tertiary — is likely to be more effective. The Ayushman Bharat Yojana, launched in 2018, is a partial but ambitious response, given its overemphasis on secondary and tertiary health care and neglect of primary health care. Besides, strengthening of social cohesion through networks is challenging too but likely to mitigate impoverishment of the elderly, lonely and women inflicted with NCDs and disabilities.
Kulkarni is a lecturer in Sociology, University of Pennsylvania, USA; and Gaiha is a research affiliate, Population Studies Centre, University of Pennsylvania, and (Hon.) professorial research fellow, Global Development Institute, University of Manchester, England