Poverty, health and social networks

Notwithstanding leakages, conjectures and hastily constructed estimates of poverty, the poverty narrative during the NDA regime abounds in assertions that are often contradictory, and mostly fail to inform, if not mislead. With growth hollowing out for lack of domestic demand, compounded by the devastation wreaked by COVID-19 not just in India but globally, and a lacklustre Budget for 2020-21 that has squeezed health and social safety net outlays, the prospects of any economic improvement for large segments of the population are becoming grimmer by the day. Our analysis focuses on associations between poverty transitions and health deprivation that call for reprioritisation of health expenditure, and strengthening of social networks (for instance, self-help groups, women’s associations) that could help mitigate market and government policy failures by facilitating upward income/expenditure transitions.  

Based on India Human Development Survey 2015, a nationally representative panel survey, we conducted a detailed analysis of household poverty transitions between 2005 and 2012. These transitions are captured through the four categories: Never poor (not poor in 2005 and 2012); Escaped poverty (poor in 2005 who ceased to be poor in 2012); Descended into poverty (not poor in 2005 who became poor in 2012); and Always poor (poor in both 2005 and 2012). Our remarks are confined to associations between poverty transitions and health indicators (non-communicable diseases or NCDs and disabilities) and participation in social networks, as these associations remain largely neglected. Longevity, for example, adds to productive years and savings; and absence of disabilities enables individuals to be more active economically and productive. As the health sector is rife with both market and government failures, norms of reciprocity, trust and cooperation are likely to help the elderly, lonely and women who are sick and disabled and unable to access medical services.

The majority of households between 2005 and 2012 comprised never poor (about 66 per cent), followed by those who escaped poverty (about 16 per cent), those who descended into poverty (over 10.5 per cent), and then always poor (under 8 per cent).

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

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