Lifestyle diseases are the new normal; how this is affecting the average and even deprived sections

People born before the 1970s or 1980s have witnessed a changing gamut of “normal”. Earlier owning a land-line phone in a household was a luxury. This later became “normal” for any household and now owning a smart 4G phone is the “new-normal”. While such transition is clear in the urban and sub-urban India rural areas are also experiencing leap transitions by their benchmarks. But alas this changeover to “new-normal” applies to diseases too. Many diseases associated with lifestyle such as hypertension diabetes heart-related—and earlier prevalent among the affluent section of the society—are now “new-normal” and are affecting the average and even deprived sections. For one of the research papers that we are working on we have obtained the evidence of this phenomena from the surveys conducted by the National Sample Survey Office (NSSO) on “morbidity in India” in 2004 and 2014. We have attempted to examine the distribution pattern of a range of diseases across per capita consumption expenditure of persons by plotting a pseudo-Lorenz curve for morbidity.

A standard pseudo-Lorenz curve of income plots the cumulative percentage of income from source on vertical axis and cumulative percentage of population ranked by household income or consumption expenditure on horizontal axis. Such pseudo-Lorenz curves may be attempted for other items and we have chosen morbidity for this study. Naturally the curve lies below the Line of Equal Distribution for items which belong disproportionately more to rich than to poor like income and in our case lifestyle diseases. However the curve lying above this line points towards the case when the items disproportionately belong more to poor than to rich.

Accordingly we have classified the diseases into “affluent” “normal” and “deprived” based on the values of pseudo-Lorenz ratios and Lorenz ratios for per capita consumption expenditure distribution. While affluent (or deprived) diseases hit rich people (or poor people) more than they hit poor (or rich) normal diseases are the ones which proportionately affect all economic sections of the society. We have found that in 2004 the incidence of diseases prevailing proportionately among all sections (normal) of the society in rural India was 28.2%. This proportion increased to 34.6% in 2014 clearly suggesting that many more people are now getting struck with “normal” diseases than they used to in 2004. This increase is much more in the case of urban India where incidence of diseases rose from 36% in 2004 to 49.6% in 2014.

For instance heart-related diseases or diabetes which were earlier associated with the affluent are now prevalent among other sections too. Particularly in rural areas of the total reported morbidity in 2004 1.9% of the population suffered from heart diseases and now this proportion has risen to 2.6%. The expenditure elasticity for this disease also shows that earlier it hit rich or affluent people more than it did the normal and poor people whereas now it is proportionately prevailing among all economic sections and is a “new-normal” disease. Similar phenomena is evident diseases like diabetes and hypertension. The incidence of these three diseases was 7.7% in 2004 shooting up to 17% in 2014. Similarly diseases earlier more common among the deprived section of the society are now affecting the other sections further expanding the “new-normal” horizon. The data reveals that in 2004 64% of the diseases were associated with the deprived section in rural India. This percentage has gone down to 48.6% in 2014.

For this research study we are working on unit-level data to assess the morbidity dynamics at the state-level. Our preliminary results show that states with significantly high proportion of “new-normal” diseases are Kerala (rural) and Andhra Pradesh (urban). The high level of morbidity burden affecting a broader section of society calls for a nationwide expansion in health services. As a consequence this also warrants for a possible enhanced budget allocation towards health services. This could also propel insurance companies to tap a wider customer base.

Poonam Munjal is fellow and Palash Baruah is research analyst National Council of Applied Economic Research (NCAER) Delhi

China, India helped Asia achieve more than other regions:Book

New Delhi Nov 8 (PTI) Propelled by China’s growth and more recently joined by India Asia has achieved in a generation what has taken other regions much longer says a recent NCAER book.

The latest NCAER (National Council of Applied Economic Research) book by Rajat Nag titled ‘The 21st Century: Asia’s?’ further says that Asians today are richer healthier living longer and more educated than even four decades back.

However the book also pointed out that as recent events keep reminding us in the midst of rising plenty Asians still suffer significant deprivations and indignities economic think-tank NCAER said in a statement.

The book was launched today here followed by a panel discussion with Nag former foreign secretary Shyam Saran and secretary general of FICCI Sanjaya Baru it added.

Forecasting growth in times of transition

As per official data released on 31 August 2017 the Indian economy grew at 5.6% in the first quarter of the current fiscal year – in congruence with forecasts of National Council of Applied Economic Research. Based on the quarterly and annual models of NCAER Bornali Bhandari discusses recent trends in key economic indicators and future growth forecasts.
India has undertaken several policy measures in a space of less than a year. The two key initiatives that had the largest immediate impact were the demonetisation exercise carried out in November 2016 and the implementation of the Goods and Services Tax (GST) in July 2017. The economy is still adapting to the new tax system and there have been implementation challenges. It is a perilous task to forecast the growth rate of a country in these transitioning times.
Impact of demonetisation
On the face of it the impact of demonetisation seemed transitory with the worst being over by January 2017. The NCAER (National Council of Applied Economic Research) Business Sentiments Survey showed that the Business Confidence Index after falling by 16% in January 2017 recovered by 24.6% in April 2017 on a quarter-on-quarter basis falling again by 2.5% in July 2017.
However there were two consequences: First on the agricultural sector; and second on the macroeconomy − setting off a chain of events. The 4th advance estimates released on 16 August 2017 by the Department of Agriculture indicate record foodgrain production (275.5 million tonnes). Foodgrain production during the Rabi season is estimated to be higher in 2016-17 versus 2015-16. Total production of oilseeds cotton and jute are estimated to be higher in 2016-17 relative to 2015-16. However sugarcane and mesta production are estimated to be lower in 2016-17 versus 2015-16.  The agricultural sector has come under distress partly because of the paradox of plenty: surplus food means lower prices for farmers putting a downward pressure on their income. Agricultural infrastructure such as cold storage in India remains work-in-progress at best. The Economic Survey 2016-17 indicates that small farmers (with holdings less than 2.5 hectares) depend much more on informal sector credit than those with larger landholdings. The second factor was the cash and credit squeeze in the agricultural economy between September 2016 and May 2017 (Economic Survey 2016-17). These factors worked together to put the agricultural sector in distress. To alleviate agricultural sector distress farm loan waivers were announced in Uttar Pradesh Karnataka Maharashtra Punjab and Tamil Nadu (Economic Survey 2016-17). This in turn affects states’ fiscal deficit adversely.
The second consequence of demonetisation was on the macroeconomy. Excess liquidity was injected into the system which continues to persist. Liquidity was in excess of US$2500 billon even in the last week of June 2017 (Economic Survey 2016-17).
Recent trends in economic indicators
Meanwhile a stable macroeconomic environment being labelled as one of the fastest-growing countries and political uncertainty in the US and UK has made India attractive to foreign investors especially in terms of debt flows. Foreign Portfolio Investment showed year-on-year (y-o-y) growth of 654.5% in the first quarter (Q1) of 2017-18. The Sensex continues to show double-digit growth in Q1 of the current fiscal year (Table 1). Foreign reserves have soared growing by 7.7 % in June 2017 (Table 1). Consequently Q1 saw appreciation of the rupee by 3.6%.
The Index of Industrial production (IIP) has fallen continuously between March 2017 (4.1%) and June 2017 (-0.1%). Weak investment activity continued to plague the Indian economy. Gross Fixed Capital Formation as a ratio to GDP (gross domestic product) had fallen from 31% in 2016-17:Q1 to 28.5% in 2016-17:Q4. The IIP of capital goods has been in recession in 2017-18:Q1 and IIP of infrastructure goods grew barely by 0.2% and 0.6% in May and June of 2017 respectively. Further the growing problem of banks’ non-performing assets continues to act as a drag on the Indian economy.
However the services sector remains optimistic as evidenced by tourist arrivals cargo traffic in railways and ports and aviation passenger traffic. Bank credit to the commercial sector (BCC) was very weak in the first quarter (Table 1).
This first quarter showed significant weakening of inflation. International crude oil prices showed a sharp fall from US$50.9 per barrel in May 2017 to US$46.9 in June 2017.   CPI (Consumer Price Index) food and fuel inflation were at -0.9% and 5.3% in 2017-18:Q1.
 Last but not the least while merchandise imports showed persistent strong growth merchandise and services exports showed signs of weakening in May and June 2017. Service sector exports grew barely by 0.1% in first quarter and imports by -6.6%.
In sum the first quarter showed weak inflation and industrial activity. Some service sectors like tourism aviation traffic and cargo carried by railways showed resilient growth. The agricultural sector continued to show distress.
All the indicators in the quarterly model have been updated to 2011-12 base prices. The trade-off is that all the variables are available only from April 2012 thereby significantly limiting the degrees of freedom1. With this caveat the forecasts from the quarterly model are used. However it did a better job of anticipating the slowdown in the first quarter than the annual model.
Growth estimates

The results from the quarterly model are presented in Table 2. The model forecasted 6.6% growth for 2017-18. The forecasts were a significant downward revision from earlier estimates of 7.2% in June 2017. The abysmal performance of the industrial sector had a significant downward impact on GVA (gross value added)2 estimates. The quarterly model correctly predicted on 24 August 2017 that first quarter growth of GVA at Basic Prices at 2011-12 prices would be 5.6%.

The following are the assumptions for 2017-18 growth forecasts of the quarterly model:
  • Prices: The WPI (Wholesale Price Index) inflation is predicted separately using statistical modelling3. It is predicted to be 1.9% for this fiscal and 2.3% for 2017-18:Q1.
  • Rainfall: For 2017-18 based on IMD (India Meteorological Department) forecasts 98% of the Long Period Average is assumed here. It shows y-o-y growth of 0.9%.
  • Bombay Stock Exchange: The assumption is revised upwards from 10% y-o-y increase in 2017-18 to 12.9% given the first quarter data. The y-o-y growth in the first quarter was 16%.
  • BCC: The BCC y-o-y growth is assumed to be 6.9% this year. The y-o-y growth in the first quarter was 5.7%.
  • Total expenditure at the Central level: A y-o-y growth of 6.6% is assumed here based on Union Budget documents.
This article is based on the forecast that was presented at the NCAER Quarterly Review of the Economy on 24 August 2017. Views are personal and do not necessarily represent those of the organisation that the author is affiliated with.

Did note ban induce firms to adopt digital payment?

The Government of India (GoI) announced the withdrawal of legal tender notes of Rs 500 and Rs 1000 denominations on November 8 2016. As per the GoI notification dated  November 8 2016 this was necessitated to tackle counterfeiting of Indian banknotes effectively nullify black money hoarded in cash and curb funding of terrorism with fake notes. Further on November 12 2016 the Reserve Bank of India (RBI) issued a press release stating that while efforts to change currency were afoot the public was encouraged to switch to alternative modes of payment such as prepaid cards …

A Pilot Impact Assessment of the Digital-India Land Records Modernisation Programme

This report focuses on assessing the performance of the Digital India-Land Records Modernisation Programme (DI-LRMP) scheme in the state of Himachal Pradesh, and the achievement exhibited by the state in computerising and modernising land records. It is part of a study in which pilot impact assessments were carried out by NCAER in Himachal Pradesh, NIPFP in Rajasthan, and IGIDR in Maharashtra.

The imperative for a land record management and modernisation initiative has been driven by the huge rise in the number of pending court cases relating to land disputes. Improvements on this front would not only help reduce property litigation, but also boost efficiency in land markets thereby facilitating the ease of doing business in the country. The Government of India recognizes the relevance and significance of land record management, which is reflected in its efforts to computerize the land records since late 1980s. In 2008, Department of Land Resources (Ministry of Rural Development), Government of India, merged the two existing land record computerization schemes to launch National Land Records Modernization Programme (NLRMP), which was revamped to Digital India-Land Records Modernisation Programme (DI-LRMP) in 2014. The immediate objective of the programme is to establish a modern, efficient land records management system in the country with real-time updated land records and it ultimately aims to achieve a system of conclusive titling that would ensure conclusive proof of the ownership of a land.

The program has been in existence for many years, but had not hitherto been evaluated in detail in the field. In this context, pilot impact assessments were carried out in the three states. NCAER coordinated this effort and also prepared an overall synthesis report.

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