households surveyed in Udaipur, Rajasthan identified health expenditure as
their major source of financial stress (Banerjee and Duflo, 2007). In 2005–06
OOPs alone caused an estimated additional 3.5 per cent of the population, or
35 million people, in India to fall below the poverty line.
One common solution is for the government to provide health care to all and
fund it through the tax system, so in effect making insurance compulsory and
having the healthy subsidize the unhealthy. The following sections discuss
policy interventions for developing countries that go far beyond a narrow focus
on improving health care.
Nutrition
Mortality from tuberculosis in developed countries declined by 80 per cent
before there was any effective treatment of the disease. Some have argued that
nutrition was the historical key to improved health and mortality (Fogel, 1997).
Contrary evidence, however, shows that calorie consumption actually declined
after the seventeenth century in England and the pattern of consumption (a
switch to tea and sugar) actually worsened in nutritional terms (see Chapter 1).
This is compounded by phenomenon of ‘missing women’ in India and beyond
(discussed in Chapter 4) where it is common to find even in income-rich, food-
abundant households that women and children show poor nutritional outcomes
(Mukhopadhyay, 2012).
Public health
If economic growth were the sole reason for improved health, countries would
ov er time move along the Preston Curve, which traces the positive relation
between GDP and life expectancy. For a given level of income people today
live longer than they did in the past. China in 2000,for example, had the
income level of the US in the 1880s but the life expectancy of the US in about
1970 (about 72 years). Preston (1975) calculated that about 85 per cent of the
increase in life expectancy between the 1930s and 1960s was a result of factors
other than rising incomes. Big efforts to promote public health in developed
countries did not really begin until the wide acceptance of the germ theory of
disease in the 1880s and 1890s. There were subsequently dramatic reductions
in water- and food-borne diseases such as typhoid, cholera, dysentery and non-
respiratory tuberculosis. These diseases were virtually eliminated in the US by
1970 and one study shows that water purification can explain half of the
mortality reduction in the US in the first third of the twentieth century (Cutler
and Miller, 2005). There have also been big achievements in public health
interventions in developing countries. Since the 1920s one hallmark of the
Chinese communist government’s approach to health care has been the mobi-
lization of the populace to maintain public hygiene, immunization and to fight
parasitic diseases. These efforts have improved levels of public cleanliness and
by the 1960s ensured that yellow fever, diphtheria, polio and smallpox were
marginal concerns. Despite only a modest improvement in per capita food
consumption between 1956 and 1978 there were striking gains in average
136 Sources of Growth in the Modern World Economy since 1950