National well-being and the counts that matter
Context: As decennial census operations are limited, India needs new ways to know its cumulative human capital and potential.
Background:
- Since India’s crimes data recording system is not built to capture subtleties, we do not know what proportion of pregnancies in India start-off without the consent of the woman, even though the veil of marriage may cover it legally and culturally.
- While physical and mental violence can be ascertained by a sensitive clinician, the intergenerational impact of a regretful and anxiety-loaded pregnancy is inadequately quantified by current clinical or epidemiological tools.
- Measuring and tracking matters of import is critical to individual, community as well as national well-being.
Parameters that are valuable
- If we equally value all Indians, we should not stick to decennial census operations alone and count ourselves the way we do — on lines that tell us how we can be sorted and addressed in the political economy; rather, we should do so to understand what our cumulative human capital and potential look like.
- What is valuable is measured frequently, at different life stages, and at disaggregated levels: birth weights; the heights and weights of our children when they enter school; school completion rates; perhaps the age, height and weight of a first-time pregnant woman; and most definitely, the number of women in the formal workforce who are on a par with men in terms of earning.
- Underage marriage of girls must become history. Ensuring secondary school completion of every child, especially girls in rural areas, has far-reaching impact, and needs to be pursued single-mindedly. Provisioning separate, functional toilets and sanitary pads for girls, and teaching boys biology and gender differences (of their own and female) are key enablers to ensuring gender parity in school completion rates.
- Teaching school-leaving girls and boys the notion of consent, and the basics of contraception, will ensure that the start of every pregnancy will be a desired and happy one.
Births in the country
- A desired pregnancy is to be supported by a fully functional health-care system, able to anticipate complications before time and facilitating a safe delivery. Current stillbirth numbers in India are hard to pin down, but after accounting for background losses and abortions, there remain a distressingly large number of stillbirths, sometimes mis-recorded as early neonatal deaths.
- Despite the trend towards nuclear families, pregnancies in India still are familial events — outcomes are eagerly anticipated by more than just the parents, and stillbirths are a rude end to many fond wishes.
- A birth weight is much more than a number — it is a complex outcome, telling of how well the woman and her family eats, her status among them, and also of any particular condition that the individual mother or newborn child has.
- Tracking average birth weights by district and sub district on a regular basis is a fair proxy for food security, the status of women and the delivery of primary health care.
- For a nation with plans to assign digital health IDs to everyone, this is not a tall ask — what is additionally required is the making of this moving average data live and visible to the people and their government. It should also put to rest all debate about whether some Indians are born more equal than others.
Height-weight proportions
- Parental hopes of a child growing up, going to school and becoming successful hit a major hurdle if the height-weight proportions at age five are not normal. Ensuring this marker is recorded for every child who enters school will also allow for a correlation with birth weights at the district level — giving a better understanding of multi-dimensional property.
- If India is to be truly taking advantage of its large birth cohort in the form of a demographic dividend, then the correlate of birth weight and five-year height-weight needs to be reviewed at the highest political levels regularly.
Improved learning
- Schooling is a socio-economic and gender parity springboard if school completion rates show no gender, rural-urban or parental income divides.
- Consequently, India may not only bring down its maternal mortality ratios but also improve neonatal and under five mortality rates, through delayed marriages and exercising of reproductive choices by its empowered young women.
- Grading cognitively ill-equipped or ill-taught children on standardised tests is as much a waste of effort as letting large numbers of young people graduate through courses, which are hopelessly out of sync with the expectations of the job interview board.
- The recently unveiled new education policy seeks to remedy this. It will be a while before we can measure any of the talked about, and hopefully intended, outputs or impact of this policy.
- Improved learning should translate into better completion rates at post-secondary and baccalaureate levels but need not necessarily correspond to universal, meaningful employment. It is for the government and the corporate world to make opportunities and workplaces happen, irrespective of their gender.
Timely data helps
- Together, these measurements will tell us far more about where we are, and where we as a nation will go. The tools to get these measurements exist; we just have to see them in real time to be able to take corrective actions where needed.
- Public health is about people, their continued well-being, and not just about controlling disease outbreaks. Data helps; timely, disaggregated, multidimensional data helps immensely in ensuring collective well being, physical, mental and social.
- Hopefully the 2017 edition of the national health policy and the new education policy unveiled last month will be the twin rails that India rides towards a true demographic dividend.
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