Inclusive Growth: Growth with a Twist

THE PEOPLE AND THE ECONOMY:

There are two types of poor in India: the millions packed into India's growing urban slums and the even greater number eking out life in its rural heartland. The conundrum the country faces is that improving the situation in the countryside will likely make matters worse in the city."What do migrants want?" They want diversity of income, sanitation, drinking water, power, roads. But even when they get those, they will still want the life they see on their televisions. Human beings like to live in cities; they have done so for thousands of years".It is no secret that India needs to make its tremendous economic growth more equitable, to spread it more fairly among society - not just wealth, but infrastructure and educational opportunities. Roughly one quarter of Indians live below the poverty line, and almost 70% of Indians live in rural areas, where desperate farmers too often find solace in suicide.The rising discontent of these have-nots has already produced a political backlash. A radical Maoist insurrection, Naxalism, has spread through some states while, across the country, regional political parties are growing in strength, upsetting the dominance of national parties and forcing them to cobble together coalition governments - like the one now in power in New Delhi.

The proliferation of coalition governments that rely on consensus decision-making could also have a diminished ability to formulate and implement effective policies. "Coalition government has its own compulsions and its own limitations". "It can delay decisions".To achieve a broader mandate and regain political momentum, national parties need to boost regional chapters to embrace local interests; likewise, regional parties need to develop more robust national agendas.Achieving inclusive economic growth is a priority for India's current government. Its latest budget includes a 31% increase in spending on rural infrastructure - 15% of public infrastructure funds are expected to be allocated to rural irrigation and broadens access by farmers to credit. In doing so, it is helping to plug a gaping hole in funding for connecting rural Indians to the mainstream economy.


THE CORPORATE LOBBY (BANKS,FINANCIAL INSTITUTIONS )
The private sector is also making great strides through microfinance, providing rural development capital while freeing many rural people from the grip of moneylenders. Instead, microfinance offers the rural poor a way to leverage their own industry and thrift by popularizing not only debt but also savings accounts. "The bank account has become a status symbol in the villages".To realize the potential microfinance has tapped, however, India needs greater deregulation. Existing rules, for example, prevent bankers from tying up with telecommunications companies to use established cellular customer networks to distribute financial services.Bankers concede, however, that their industry is also guilty of holding back. Microfinance typically charges relatively high interest rates, yet default rates among micro-borrowers remain near zero, indicating what bankers say is excessive caution on the part of micro-lenders. Part of that caution, they say, stems from the fact that there is no credit bureau to keep track of rural borrowers, nor a reliable way - such as driving licenses or birth certificates - to even identify them. Some have called for the government to issue national voter registration cards.Bankers also have an important role to play in filling the rural education gap, by teaching rural Indians the basics of finance. To be sure, education often serves as a politically correct panacea in debates about poverty relief.Improved vocational training is singled out as a critical necessity for India that would address its growing shortage of skilled trades workers while recognizing that a higher degree may not be a realistic aspiration for the bulk of the country's youth. Vocational training is an area, moreover, where companies can get more immediate returns on their investment, either by conducting their own training, financing vocational programmes or helping to develop curricula.

PAST-PRESENT-FUTURE
The good news for India is that its economy is largely driven by domestic demand as opposed to exports. The rural population, therefore, represents a critical source of new labour for India's services-led growth.But solving the riddle of how to raise income levels in the countryside without accelerating the rush to the cities requires new thinking on what urbanization means. In short, convincing rural Indians not to move to big cities will require moving the city closer to them. "If we can take opportunities to rural India, there's no reason why rural India would wish to come like lemmings to urban India".

Industries that rely on rural inputs - food processing, biofuel production and handicrafts - should move closer to their production centres. Doing so will encourage the creation of new urban centres, turning villages into towns, and towns into small cities. Technology can also be used to turn rural India into a service centre for urban India in the same way that India has become a service centre for the world. "The war for talent is such that we have hundreds of millions of people who cannot monetize their skills today because we haven't connected them".It's in everyone's interest that we unleash that capability and that talent".

Ultimately, it may take a more concerted push by government to make this shift out of the cities happen. Regulations and incentives may be needed to encourage companies to "ruralize". But it is clear that India can no longer afford to let investment and commerce remain confined within the city limits. "Rural and urban are not separate; both are connected !! "Until we see that, India will become prosperous and Indians will remain poor".

Ageing India: An asset or liability?

With India's health standards and services being a big concern for the state. Population ageing is kept in darkness so far.Population ageing has emerged as the grand challenge of this century: for policymakers, care providers and society as a whole.The proportion of the elderly in the total population had increased from 5.63 per cent in 1961 to 6.58 per cent in 1991 and to 7.5 per cent in 2001. India has thus joined the rank of “Greying nations” with over seven per cent of its population in the 60-plus years segment Currently, there could be around 100 million ‘senior citizens' in India.

PROBLEMS

It could be generalized that elderly people in India suffer a double-whammy effect; the combined burden of both communicable (usually infectious) and non-communicable (usually chronic and lifestyle related) diseases. This is compounded by an impairment of special sensory functions like vision and hearing that decline with advancing age. Thus, elders have a considerable burden of both infectious diseases like tuberculosis and chronic illnesses such as diabetes mellitus, ischemic heart disease, and cancer.Notably, the majority prefer to use private health-care services, even though they are more expensive, service quality being an important reason for such a preference.While aging is not synonymous with disability, a large proportion of the Indian aged population is disabled, the severity of disablement increasing day by day.

ISSUES IN MODERN INDIAN SOCIETY

Traditionally, the joint family in India took care of its elderly. These traditional care arrangements have been lost in the context of rapid urbanisation and an exodus of people from rural to urban areas and from urban areas to foreign countries. In the absence of such community support in the form of kinsmen or the extended family, and an inability to continue to earn their living, the elderly are often rendered destitute, if not financially, from a pragmatic perspective. While these problems plague most traditional societies that are in transition, their rapidly enlarging scope and scale, demand and necessitate an urgent response from our policy makers.

The Government India, supported actively by civil society, unveiled its National Policy on Older Persons (NPOP) over 50 years after Independence. A comprehensive document covering every aspect of the elder's life, ambitious, with a clear cut action plan, it proposed a role for the State in the elder care: health, shelter, financial security and protection against abuse. It recognised the need for affirmative action favouring the elderly, viewing them as national resources, creating opportunities for their development. Training, empowerment and partnership with elderly were seen as important in providing equality and dignity to all groups of elderly. Unfortunately, a decade later, the NPOP awaits complete implementation in all States and Union Territories of India, much of its promise remaining unfulfilled, prompting the Government of India to seek its revision to suit contemporary needs.

Discussions among civil society groups and concerned senior citizens in the run up to a re-organised NPOP, reveal many consensus points for the future organisation of elder health care. There is little doubt that the care of the elder must remain vested within the family unit and based within the community the elder resides in. Incentives for families that care for their elders are necessary; as are the development of community health-care resources; doctors, nurses and paramedics specialised in elder health care; and rehabilitation facilities for those with disability. The importance of Government and civil society partnerships needs to be underscored here; as is regulation of such elder health-care services for quality and cost. While the focus is often on in-patient (hospitalisation) care, there is a clear need to develop other models relevant to the elder: out-patient care, day care, palliative care, rehabilitation care, respite care and step down care. Developing community level health-care worker pools that will both screen the elderly for risk factors, disease and disability; and provide simple home based interventions is necessary; as is tiered access for the elderly to a range of professionals: from generalist to specialist doctors. Most importantly, perhaps, those working in this area feel the need for unitary, sustainable and replicable models of screening and assessment: health checks that would address apart from routine risk factors like hypertension and diabetes, areas of potential disability: vision, hearing, falls, bone and joint, respiratory and cardiac disability etc.

PRESENT SCENARIO & CONCERNS

The majority of Indian elders are in potentially vulnerable situations without adequate food, clothing, or shelter.Providing health care that givesAvailability, Affordability, Accessibility, Acceptability and Accountability to such a large vulnerable group, is a challenge that has to be confronted. Insurance cover that is elder-sensitive is virtually non-existent; insurance premiums increase in an unsustainable manner with age and there is rampant age-discrimination in the health insurance sector.Further, pre-existing illnesses are usually not covered, making insurance policies unviable for the elder. Indeed, senior citizens point out that they pay far more for health insurance than their utilisation justifies; and that elders end up subsidising the care of younger citizens, who form the bulk of health insurance consumers.

The elder citizen is a national treasure; one who has contributed to both national growth and familial development. As they approach the autumn of their lives, they experience diminishing ability to generate income, increasing vulnerability to illness and disability, and increasing dependency on their families and communities. Rather than view this dependence as a burden to be endured, we must as a society embrace it whole-heartedly, as a pay back opportunity; to thank senior citizens for their many unconditional contributions. The organisation and delivery of elder health care must therefore be approached with enthusiasm, altruism and generosity. Mature health policy for the elder combined with a generous dose of pragmatism in organising, delivering and funding health care services is the need of the hour.We should be reminded about the challenge of population ageing; the looming burden of elder disability; and the need for a comprehensive and pragmatic National Policy for Older Persons.