Saturday, October 21, 2006

Diseases of Poverty, Diseases of Affluence

I've been meaning to blog again about the rising rates of diabetes in India. My previous discussion, with some links to other bloggers' views on the issue, can be found here and here.

I think there is no doubt that the rise of diabetes is, in part, a function of changing lifestyles among the relatively small part of the Indian population that is reaping the benefits of the country's economic growth. There is another potentially important factor, and I will blog at greater length about that soon.

In this post I want to point out the dialectical nature of globalization (or economic liberalization, if you like). Only under the logic of globalization can a country experience both diseases of affluence and diseases of poverty. In a Marxian sense, this may be another important historical contradiction, or perhaps simply another manifestation of the central contradiction of capitalism (its simultaneous need to expand and its unsustainable exploitation of labor). Globalization, after all, as some argue, is merely the latest phase of capitalism.

This idea occurred to me as I read "The Hungry Bellies of South Asians..." at pass the roti. Commenting on the 2006 Global Hunger Index, a report issued by the Deutsche Welthungerhilfe and the International Food Policy Research Institute that uses three indicators to measure the extent of hunger in 97 developing countries and 22 countries in transition, Desi Italiana quotes the following from an article at Outlook
“Another value of the index is to demonstrate which countries have not been able to use their available economic resources effectively in reducing under nutrition,” Ms. Wiesmann noted.” High income inequality is one of the factors that causes countries to have higher levels of hunger and under nutrition than would be expected based on the gross national income per capita.”
Weisman, the IFPRI researcher who developed the index, does not go on to explain why high income inequality would exacerbate the problems of malnutrition and hunger. Perhaps the reason is obvious, but I will state it anyway: income inequality translates into disparities in power (not just economic, but political and even cultural power); and those with power work to maintain the status quo.

>Look at this optimistic headline from the Hindustan Times: "India shows improvement in tackling malnutrition: Index." But the article goes on to note that:
The hunger index for India has shown that from a score of 41.23 in 1981, it dropped to 32.73 but is holding steady at 25.73 for the years of 1997 and 2003. Bangladesh on the other hand would show its hunger index dropping from a score of 44.40 in 1981 to 28.27 in 2003.
I would be willing to bet that there is a pretty close correlation between the beginning of India's economic rise (and thereby the beginning of its growing income inequality and power disparity) and the slowing of the decline of its score on the Global Hunger Index. I am not arguing that globalization does not reduce poverty. I believe it does. But I also believe that it reduces poverty at a slower rate than alternative approaches.

Consider the following quote, from an article on Expat that draws from Welthungerhilfe’s f="">press release on the report:
Ingeborg Schaeuble, Welthungerhilfe's chairwoman, said stable countries like Ghana have managed to reduce hunger, malnutrition and the child mortality rate ... "It is, however, wrong to think that economic progress alone is enough to reduce hunger," said Schaeuble, who is the wife of German Interior Minister Wolfgang Schaeuble.

"These countries cannot make headway without investing in agriculture, health and education. This is particularly applicable to countries which have endured acute crises and war," she said.
This is precisely my point. Currently, India's investments in agriculture largely benefit the economic elite, and its investments in health and education are dismally inadequate. Now, back to diabetes. Type 2 diabetes, at least to the extent that it is linked to the diet and lifestyle of affluent people, is likely to get the attention of India's political leaders.

Globalization is slow to reduce poverty because it operates under the same logic of, or arguably is the same as, capitalism. This logic privileges continued growth of the system above all else. Social or environmental problems are never dealt with sufficiently unless there is the potential for profit in their solutions. Yet in the constant push for growth, internal conflicts emerge. Marx focused on class struggles. Perhaps coexisting diseases of poverty and affluence are part of the synthesis of the dialect.

For Marx, or Hegel for that matter, dialectics consist of a thesis, antithesis, and synthesis (a term not preferred by Hegel). The coexistence of diseases of poverty and diseases of affluence could be viewed as part of the dialectic nature of globalization. But it might be that their coexistence is actually part of the synthesis of the dialectic of capitalism. In other words (bear with me as I simplify some of Marx's thoughts), the ever increasing exploitation of the labor class by the capitalist class, and the ever increasing income inequality that comes with this exploitation, is resolved through universal sickness.

The ultimate resolution, of course, will depend on whose sickness does them in first. Presumably, the "haves" will use their economic power to manage their diseases of affluence while the "have nots" continue to suffer. This is certainly, more or less, what the medical system in the U.S. looks like. Perhaps India will follow a different path.

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kuffir said...

'But I also believe that it reduces poverty at a slower rate than alternative approaches.'

the journey towards globalisation by india..since the early nineties has actually reduced poverty faster according to official estimates than during earlier periods when..alternative approaches were the norm. perhaps you have a different view on what constitute alternative approaches? could please expand on your ideas?


" Perhaps India will follow a different path." Do you see some signs which suggest this?

Steve Zavestoski said...

Re: "...alternative approaches" (kuffir) and "a different path" (anandaswarup)

Yes, the evidence suggests that globalization--specifically, economic liberalization beginning in 1991--has reduced poverty more quickly than previous alternative approaches. One must remember, however, that the previous approaches were undertaken in the context of a rather decimated post-colonial society.

But there are many other approaches that have not yet been tested. Perhaps the pendulum swung too far to the free market side. Some of India's recent growth, which has resulted from the opening up of its economy, could be harnessed by the Central Government and invested into social infrastructure like municipal water systems, health care more broadly, and education. Another alternative approach is to balance massive development projects with more microfinance. One final "alternative" would be to undertake massive government reform to eliminate corruption, thus ensuring that less of India's economic growth gets concentrated into the hands of economic and political elites.

Will India follow a path (with respect to health care) that avoids further stratification of an already unequal society? Right now I don't see any signs of this. On the other hand, unlike the U.S., India has a number of tradition systems of healing that are far less expensive that western-style health care. A combination of these less expensive approaches (e.g., Ayurveda) and conventional medicine could offer comprehensive prevention, diagnosis and treatment of disease at very reasonable cost.

Madhukar Shukla said...

"the evidence suggests that globalization--specifically, economic liberalization beginning in 1991--has reduced poverty more quickly than previous alternative approaches..."

This is not an entirely accurate state of affairs. Normally the two indicators of prosperity/poverty are (1) the number of people living below the poverty-line, and (2) the GDP.

Both are calculated differently now, and therefore, comparisons to past, or inferences about the impact of policy changes, cannot be made.

In mid-90s, the Govt changed its methodology of defining/ calculating poverty, which showed that poverty came down from 36% (in 93-94) to 26% (in 99-00). But in reality, the two numbers are not comparable, since they are calculated differently. One can't really use them to make any inference about the impact of changes in Indian economic policies since '91.

Similar changes have been made in calculating the GDP and GDP growth. During last decade or so, the Govt changed the base year for calculating the GDP growth, increased the weightage of fast-growing sectors in calculation, and started including some economic activities in unorganised sector, which were not added in GDP calculation previously.

To a large extent, the decrease in BPL population and increase in GDP are artefacts of these methodological changes.

kuffir said...


yes they did change the way poverty etc., was calculated.. but i don't the changes have radically altered the growth rates - some would like to think so..i don't. because i've seen 'growth' in the 70s and 80s and...the figures were much more fanciful back compared with reality on the ground.


How does one get to know about this 'reality on the ground'? About different regions of India and perhaps an overall picture?

Madhukar Shukla said...


Actually, the changes in methodology made a huge difference in calculating the number of poors.

The ealier poverty calculations were done on 'nutritional norms' (2400cal for rural and 2100cal for urban). The new norms are based on consumption pattern (or its recall by the respondent), which fixes approx Rs327/month and Rs454/month as poverty line for the rural and urban population... and correspondingly 26% people below BPL.

However, if one calculates the money required to buy the basic nutritional requirements, then around 74% Indian population lives below poverty line (there is an incisive analysis of this change in poverty calculation by Jaya Mehta in an EPW article, which you will find on the net).

Re the perception of 'growth' since '70s and '80s, I would agree with you if the ground reality is the urban middle(and uppe) class India. I have seen it during '60s as well;0)... Things have definitely changed for the better - more opulence, and more choices. However, if you are refering to the rural ground reality, then things have either not changed much, or have took a downward dip... there is no 'trickle-down' that has happened (if anything, it is 'bottom upward' flow of wealth)

So we have two different India - almost like two different planets.... which perhaps explains why we have a high malnutrition as well as 15% (and growing!)obese population.... and all the growth statistics and farmers' suicide, growing Maoist movement, etc. happening side-by-side.


Steve Zavestoski said...

Thank you so much to Madhukar Shukla for noting the article by Jaya Mehta and Shanta Venkatraman in the Economic & Political Weekly. It is titled "Bermicide's Feast"" and makes me ashamed not to have thought more carefully about changes in the measurement of poverty over time. In social science terms, the problem is that you have a change in a measurement instrument, rather than the independent variable, producing a change in the dependent variable. In the social sciences, where there are frequent debates about how best to measure a phenomenon, this occurs all too often.

In any case, thank you again, Madhukar, for alerting me to this article.

gaddeswarup said...

After your comments n I googled about Kerala and fnd that Kerala has the highest rate of sucdes among the Indian states:
Suicides among farmers seem to be less than n states like A.P.
Devinder Sharma mentions that commercialzation of agriculture has been happenning in Kerala too:

kuffir said...


the change in poverty line measurement methodology has generated much dispute in india in the last few years..may i direct you to another link, a paper by dr.surjit bhalla, who represents, in a way, the other side of the ideological spectrum ? the link is - . you might also be interested in a discussion on the other india blog, a few months ago - .


ground reality? one little snippet of information that might give you an idea on what it is - there are, or were, over 2 ration cards in andhra the possession of around 1.68 crore households.
the narasimha rao govt tried to make the pds more targeted..which again had engendered a huge 'debate'.
the best place for you to gauge the ground realities in india is to visit the site of the 'national advisory council' ( ), which until a few months ago was chaired by sonia gandhi. the concept papers etc., prepared by members and 'experts' present an admission of the failures of the indian government.. please check some of the papers presented by dr.jayaprakash narayan, the ex-ias officer we had talked about earlier on my blog. he has now launched (on october 2nd) a political party, lok satta (yes, in the same name as the ngo he used to head), that aims to make education and healthcare mainstream electoral issues.

gaddeswarup said...

Pl. also see the paper "Data and dogma: the great Indian Poverty debate" by Angus Deaton and Valrie Kozel. It ight have already appeared elsewhere but is still available at
Angus Deaton has several other papers on poverty estiates (including one with Jean Dreze) and some of these are available at

Thanks for the reply and link.

Shivam said...

where have you disappeared?