HDR 2005: Child Mortality

The UN Human Development Report 2005 was released last month. A few India centric quotes.

India is widely off track for the child mortality target. The annual rate of decline in child mortality fell from 2.9% in the 1980s to 2.3% since 1990 -- a slowdown of almost one-fifth. As in China, the slowdown has occurred during a period of accelerating economic growth. Developments in India and China have global implications. India alone accounts for 2.5 million child deaths annually, one in five of the world total. China accounts for another 730,000 -- more than any other country except India.

Why has the rate of progress slowed? One view is that a slowdown in the rate of decline in child mortality is inevitable. Expanding public health provision through immunization programmes and other services can yield big public health gains, especially in reductions from high levels of mortality. Once these "low hanging fruits" have been collected, so the argument runs, the problem becomes more concentrated in populations that are harder to reach, more vulnerable and less accessible to public policy interventions, driving up the marginal costs of saving lives and dampening progress.

Applied in the current context, the low hanging fruit argument lacks credibility. Some countries -- Malaysia is an example -- have accelerated the rate of reduction in child mortality from already relatively low levels. Others have sustained rapid progress over time, even during periods of low growth. In 1980 Egypt had a higher child mortality rate than Ethiopia does today. At its current rate of progress it will reach Sweden's level by 2010. Egypt has already achieved the MDG target.

Low income is not a barrier to progress. Viet Nam and Bangladesh have both accelerated the pace of child mortality rate reduction. Indeed, at a lower level of income and a comparable rate of economic growth, Viet Nam has now overtaken China on improvement in child mortality. Similarly, at a lower level of income and with far lower growth, Bangladesh has overtaken India. These differences matter. Had India matched Bangladesh's rate of reduction in child mortality over the past decade, 732,000 fewer children would die this year. Had China matched Viet Nam's, 276,000 lives could be saved. Clearly, there is still a huge scope for rapid reductions in child death in India and China.

For both countries child mortality trends raise wider questions for public health and the distribution within developing countries of the benefits from globalization. Integration into global markets has manifestly enhanced wealth creation, generated economic dynamism and raised living standards for many millions of people in India and China. At the same time the human development benefits of economic success have been slow to trickle down to large sections of the population -- and the trickle appears to be slowing in some key areas of public health.

Changing this picture will require public policies that address deep-rooted inequalities between rich and poor people, between men and women and between more prosperous and less prosperous regions. These inequalities are rooted in power differences -- and they are perpetuated by public policy choices. Were India to show the same level of dynamism and innovation in tackling basic health inequalities as it has displayed in global technology markets, it could rapidly get on track for achieving the MDG targets. There are encouraging signs that public policy may now be moving in the right direction. During 2005 the announcement of ambitious new programmes aimed at overhauling the health system and extending services in poor areas appeared to mark a new direc tion in policy. Economic success has expanded the financial resources available for these programmes -- and some states have shown that rapid progress can be achieved. The challenge is to ensure that effective reform takes root in the states and areas that account for the bulk of India's human development deficit.