Half the book, roughly, is data. Cold data, that paint an unmistakable picture: India might be enjoying the second highest GDP growth of any country on the planet, but across a vast number of measures it is scoring no better than sub-Saharan Africa.
Social indicators not only lag countries of India's GDP per capita level, but are simply abysmal. Here's an example: outside of sub-Saharan Africa, India is the sixteenth poorest country per capita. The authors turn the stats on their head by defining those sixteen countries as India's peer group. Among them, to be clear, India is the richest. Regardless, there are barely any measures, from life expectancy at birth, to child immunization, to access to a toilet (55% of Indians have to defecate outdoors, if you must ask) where India can hold its head up high compared with earthly paradises such as Vietnam, Moldova, Uzbekistan and Laos, not to mention how backward it's made to look by much poorer Bangladesh and three times poorer Nepal.
Moreover, India seems to be rapidly falling behind. The authors rank India, Bangladesh, Bhutan, Nepal, Pakistan and Sri Lanka on 12 measures, including per capita GDP, life expectancy, infant mortality rate, under-5 mortality rate, etc. and compare 1990 figures with 2011. India's average rank has only improved on a single measure (it has gone from fourth to third in GDP per capita) and has regressed or stagnated across the 11 remaining measures.
The numbers themselves make you cry:
43% of children are underweight
26% are never immunized for measles
26% of young women (15-24) can't read
It gets worse than that. India is far from uniform. There are states that look almost like the rest of the world, such as Kerala (human development index 0.97) and states that don't bear looking at. In Bihar, female literacy is 37%, a mere 44% of children can pass a simple reading test, 84.8 out of 1,000 children under 5 will die before they reach that age, in part because only 32.8% are fully immunized, and more than half the population is below India's unfathomably low poverty line.
What's to be done?
Education is a good starting place. At the time of India's liberation from the British, very few could read. The literacy rate was 18%, quite unbelievably. So the task was momentous, but India did not prove up to it. Much poorer Nepal (adult literacy rate 9% in 1960, versus 28% in India) has caught up, for example, with a 60% adult literacy score in 2011 versus 63% for India. Even today, some 20% of kids in India never attend school and in many of the schools (12% to be precise) there's only one teacher. He is a state employee and earns on average three times more than their parents, but often as much as six times. Half the teaching hours go wasted on average due to 20% teacher absenteeism and 33% student absenteeism. And in a study quoted by the authors, half the schools visited by an inspector did not have a head teacher at the time of the visit.
The authors blame Gandhi and Nehru, who allegedly believed it was more important for the youth to learn a craft than to acquire an official education. Whatever the case might be, those leaders have not been in power for decades and there's something that needs to be done. The authors note that there is enormous divergence between states. Therefore, studying what the states have done that have the good results ought to be an excellent starting point. No surprises, then, those are the states where the government has taken seriously the task of educating the young. Places like Tamil Nadu and Himachal Pradesh. The authors have nothing against private education, but follow basic economic theory, which states that for goods with high positive externalities and high incidence of market failure, there is a strong case to be made for government intervention. Other important contributions come from the hot meal that both nudges pupils to attend and helps them concentrate, on top of forcing pupils of all backgrounds to mix and offering work to the women who prepare it. Standardized evaluation, famous for all its sundry drawbacks, is in the authors' opinion entirely appropriate for the current state of Indian education.
Healthcare is another important issue that needs to be addressed. The current healthcare situation is a crisis. The authors don't mince words here. They lay the blame squarely on the American-style private healthcare system. India only spends 1.2% of GDP on healthcare, less than half the percentage China spends, for example. In numbers, 39 dollars per citizen per annum. This evidently does not go a long way. 74% of preschool kids in India suffer from anaemia, 61% from Vitamin A deficiency. 46% are more than 2 standard deviations lighter in weight than they ought to be. The list goes on. When it comes to healthcare, the authors are downright categorical as to where the answer lies: with the much-maligned Integrated Child Development Services and equally maligned Primary Health Centres. Yes, they often deserve all the criticism they get, and more. However, the statistics could not be more clear: where these services are taken seriously by the state, the standards of healthcare are head and shoulders above the rest of the land. Getting these two already existing programs to work should take first precedence. However, this will entail a fight against the business interests of private medicine. Should these interests prevail, the authors believe that it will be a one-way street to an American style health system which (uniquely for this book, which is jam-packed with data) they reject pretty much in principle as inappropriate for this stage in India's development.
Poverty, Inequality (across class, caste and gender) and corruption are the three other big problems the authors identify. Again, they mostly see the state as the first line of attack on all these fronts (for example through the monthly distribution of the 35kg of rice to poor families), but their arguments are more nuanced and subtle here than for healthcare and education. They don't see how things can change overnight, but they observe very happily that attitudes are changing. Practices that used to be normal are now frowned up.
The book sometimes drifts into philosophy, which I found fascinating. Consider, for example, how democracy served India better than dictatorship served China in the fifties and sixties. Mao let millions starve during the Great Leap Forward. This was impossible to do in democratic India. These days, on the other hand, China's more efficient dictatorship can be credited with delivering its subjects from poverty, bringing them education and assuring them healthcare, while India's democracy has spawned corruption and to a great extent failed its citizens.
The authors choose to emphasize two further issues above all.
First, progress relative to the survival of girls versus boys is being reversed. Depending on how hot it is in a country, babies conceived are anywhere between 900 girls for 1000 boys and 960 girls for 1000 boys. Girls are better survivors, so at birth they're typically doing better. Call it 940 girls per 1000 boys on average. By age 6 in older days when medicine was not advanced, the numbers would totally even out. Not in India. Girls suffer at every step of the way. More so in the upper classes, too. And more so today than ten years ago. In 2011 there's 914 girls age 6 for every 1000 boys in India, down from 927 in 2001. While the poor states are improving (so Punjab has improved from 798 to 846, which represents great improvement) in West Bengal (where you'll find Kolkata) the presumed use of selective abortion among the rich has brought the number down from 960 to 950. The authors struggle to propose a solution to this awful problem.
Second, and equally disturbing, none of the topics discussed above seem to be part of the public discourse. While India enjoys a genuinely free press, which the authors are proud of and, indeed, celebrate, it is very uncomfortable discussing the problems that afflict the vast majority of Indian citizens. The authors believe that the top echelons of society live in a parallel world where the plight of the poor majority is a taboo that never gets discussed. As with every argument they make in the book, they provide the full set of statistics
The result is that the wherewithal of the state is wasted on subsidies to the lower strata among the affluent. Subsidized fuel for their automobiles, subsidized fertilizer etc.
So the book has three purposes:
1. To air in public all the issues that never get discussed
2. To suggest that the newly found GDP growth is an opportunity that needs to be harnessed
3. To expose that the tax take from this newly created GDP needs to be funnelled from the state to those who really need it.
Contrary to what other reviews here seem to suggest, I believe it succeeds at all three levels.
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