2011 UCL Lancet Lecture by Prof Jayati Ghosh: Economic growth and women’s health outcomes

>>It’s a great pleasure
and honour to be here. I want to talk about
this relationship between economic growth and
women’s health outcomes. And of course you will
ask, why women’s health? Why not health in general? The reason is because, you
know, I do believe this that especially in the
developing world, what happens to women’s health is in a
sense the critical indicator. The health of women
and girls is the ultimate indicator of
the health of that society. We know that many parts of the developing world, not
just South Asia, but a lot of other places that,
you know, patriarchy and gender discrimination
are quite widespread. And that in turn means that
women’s health indicators, or those of young girls,
are typically the worst. So if you can actually
bring those up, you know that the health of the
society in general is improving and I think
that’s why I would like to focus specifically
on women’s health, and particularly on two
critical indicators: the infant mortality rate for
girls, that is under the age of one, and the maternal mortality rate. These are reflections not just
of the overall status of women in that society but the
ability of that society to look after all of its citizens. And that’s why it’s very
useful to look at these very, very fundamental indicators. We know that there is widespread
gender discrimination in India. And of course one of the ways in which this is manifest nowadays,
it’s very clear, is in the child sex ratio,
the ratio of girls to boys in the age of zero to six years. This is the — it’s an
unbelievable thing for many of us, but this has
been progressively worse for the last 30 years. We’ve been seeing progressively
declining child sex ratios, which is a reflection
really of technology. And we find that the worst
child sex ratios are in fact in the best off communities,
and the richest sections of India are precisely those
who exercise the greatest, shall we say, discretion
in choice of the gender of the child. This is true in China as well. We know this. But it’s particularly
much in India. So it tells us that yes, we
are operating in a world, a set of societies where there’s
widespread discrimination against women. And it’s in this
context that I want you to consider specifically
women’s health outcomes. Now what I wanted to do
was to really look at women’s health outcomes. The point is that
Asia is growing, Asia is dynamic, Asia is
emerging and so on and so forth. Right? We all know about this
wonderful continent rising up and about to swallow up the
rest of the world and all that. [ Laughter ] So here is Asia, here are some
of the most successful economies of Asia – I haven’t taken China
here for a very obvious reason, China has not only sort of rich
to middle income status, now, well ahead
of all these, but also has had
significantly better women’s health
indicators for 30 years. So I’m leaving China out of this.
But these are four countries which have performed rather well in per capita growth
terms if you look at it. And Vietnam is by far the
best, that is an annual rate of nearly six per cent
over 20 years. But India is pretty good
too, it’s five per cent almost over 20 years, which amounts
to a very large increase, a tripling above capital
incomes over this period, okay? Sri Lanka, Bangladesh, lower
than India but also pretty good. If you look at the
second part of this graph, the National Income per
capita, this is in terms of US dollars in 2010. It’s only Sri Lanka
which has achieved what is called
middle income status. That is to say, it’s now
recognised as a country that is above the $2,000
per capita mark. That’s sort of the standard
definition of middle income. India is still well below but
slightly higher than Vietnam, and Bangladesh is still
very much a poor country. Okay. Now, let’s
look at what’s happened to female infant
mortality rates: as I told you, one of
the basic indicators. And this is– after they’ve
already been weighted out in terms of being able
to be get born or not. Okay, this is after
they have been born. How many of them survived? And what is remarkable here,
I think, it’s not just the fact that Vietnam, which is
still poorer than India and has had a lower rate of growth, has had
significant reduction in infant mortality
rates and also began with a much lower base rate. But I think the really striking
thing here is what has happened to Bangladesh. As you will see,
Bangladesh started out with significantly higher
and is now significantly lower. Despite the fact that
it is much poorer, still, and its rate of growth has
been slower than that of India. So I mean, clearly, India
here is a bad performer. If you look at maternal
mortality, well yes, Bangladesh is worse than India. The rate of reduction in Bangladesh however is
faster than India, okay. If you’ll– they begun much
higher and they are still much, they are still higher but the
rate of reduction is higher. And of course as you
will see, Vietnam and Sri Lanka are way ahead. Sri Lanka has almost
developed-country indicators in both infant morality
and maternal mortality. So definitely on
this front too India, just clearly a poor performer. Well, one obvious explanation
for this is in terms of public health
spending as a share of GDP and as you can see,
India’s is abysmal. Okay? So, it turns
out, is also Bangladesh but it is definitely
abysmal. It was mentioned earlier that India has developed
a highly privatised and fragmented system
of healthcare, something like nearly
three quarters of total health spending
in India is out of pocket spending
by households. And this has become a very
important reason for example, for families falling into
poverty or going into debt, this desperation to
get private health care to ensure the survival of their
family members in a situation where the public sector
is completely inadequate. Now this low percent
of GDP translates into a laughable amount in terms of the per capita health
spending in dollar terms. So, we spend the princely
amount of 12 dollars, 78 cents – equivalent in Indian
rupees per year in terms of the public health, okay? Now this is really not –
even if you take into account that things
are cheaper in India – this is really not an amount of
money that can be significant in terms of providing
minimum facilities, okay? So the unwillingness, not the
inability, the unwillingness of the Indian government
to spend on public health is a
very critical element in the overall poor
indicators that we have seen. And of course, we end up
having massively lower absolute spending than, say, Vietnam,
which is a much poorer country at the current present time. And of course, this translates
into what happens in terms of public health
delivery as well. So if you’re looking at the
percent of births that occur with skilled personnel, we have
really low, still less than half of our mothers are able to
actually give birth to children with access to skilled
personnel. In Bangladesh, it’s
really very low which explains the high maternal
mortality still in Bangladesh. But as you can see in
Vietnam, it’s universal. In Sri Lanka, it’s
close to universal, 88%. If you take another indicator,
I’m taking measles immunisation as the basic indicator
here because, you know, the others, you
get different results, but it’s a kind of,
it’s a good proxy for the overall immunisation. And Bangladesh does so
much better than us. I mean imagine, 71%
only of immunisation. There are some states in
India, some rather rich states like Gujarat and so on, where immunisation rates
have actually been falling for children and you have less than 50% immunised
for very obvious – there’s a resurgence of
polio in the city of Mumbai because of the lack
of immunisation. But of course, India
is a huge place. It is actually a subcontinent. It’s, you know, as you can
imagine it’s really ridiculous to talk about one
India in that sense and this gives you some idea about the very large
variation across states. I’d just like to point out
a few things for you. Oh, it’s shocking me
that I can’t use this. Yes, Kerala, very low, almost developed-country
style indicators, certainly on par with Sri Lanka and
has continued to reduce. And Kerala has always
been an outlier. In Kerala, it’s just a
combination of a long history of relatively greater
egalitarianism, land reforms from the 1930s onwards, as
well as a fairly long tradition of Left governments and
Left-oriented policies which have been responsible. But some good news, the
biggest decline has occurred in Tamil Nadu, which has gone
down very significantly. Another very big decline
has occurred in West Bengal and you had a reasonably
good decline also in some other states,
although it’s rather high in many others. Maharashtra is the other one
where there’s been a decline. It’s still high but there’s
been more action, shall we say, in the last decade in terms
of an overall decline. What does this relate to? Well, one of the big
reasons for high mortality, for poor health conditions,
for the inability to survive is actually
poor nutrition.>>And undernutrition
helps to explain a lot. As you will see across the
states – I don’t want to bore you with too many
of these details – but you will see how the
child mortality rates here. This is the children under five. The mortality rates here
work quite strongly in terms of the relationship, in
terms of the proportion of underweight children as well. So it’s really the fact
undernutrition is a very important factor in
overall child mortality. Of course, there’s also
access to health services. There’s also a number
of other things but nutrition plays
a very big role. And that will also tell
us why overall health, we are performing so poorly. I mean, this is per capita
food grain availability in the country. And what it tells us – by the way, I should,
00:10:57,806 –>00:10:59,336
I want to emphasise
this a little bit because there’s a widespread
perception in the world thanks to George Bush
and Condoleezza Rice, who first raised this during
the global food crisis of 2008, that food prices
are rising because the Indians and the Chinese are eating more. [ Laughter ] And you know, in fact they said,
you know, we’re happy for them. You know, it’s good that
they’re eating more. You know, they were
poor countries but naturally we know that when
lots of large populations start
eating more then the world’s, foods prices will go up. But they’re not. Both China and India,
average food consumption and total food consumption, food grain consumption,
have fallen. They have not gone up, okay? Which is an extraordinary,
I mean, I think it’s a huge
indictment of the growth process but nonetheless,
that’s what happened. Now this is actually the per
capita grain availability per person in the country but it
refers to direct and indirect. In other words, this is not
just what the households consume as grain because it’s looking at
the total availability of grain in the country and dividing
it by the population. So it includes the grain that
therefore gets consumed by animals and food stock
and so on and so forth. It’s both direct and
indirect consumption, just so that people realise. And the extraordinary thing
is that, in this period of high growth in
the last two decades, there’s an overall trend decline in both total food grains
and in cereals alone. And this decline has actually – the average in the latest
period is significantly lower than the average at the
beginning of this period. Well, let’s say around here if you take the first
half of the 1990s. So it’s a very, very
significant decline in terms of per capita food
grain availability. This is bad news because
another thing that has happened, which all of you probably know, is that global food prices
have been zooming up again. Now it’s not just that
they’re zooming up now but that they have
been extremely volatile in the last four years. This is from January
2007 onwards. And you will see how the food
price zoomed up massively, fell again, almost to back
where it was in the beginning, rose marginally for another year
and then has zoomed up again until early 2011, has been
falling slightly right now. This kind of volatility in
global food prices is nothing to do with demand and supply, regardless of what anybody
may try and tell you. The IMF has come up with
an extraordinarily apologetic statement recently saying that
yes, there’s all this volatility but in fact, you know, that’s
because of temporary supply shocks and
temporary demand shocks. This is nonsense because the
world agriculture market is one of those few places that
doesn’t have seasonality. A harvest somewhere
else is a lean period in another part of the world. And so, there’s always harvest
coming in and therefore, grain in particular,
wheat, rice and so on, pretty much you get all
year round the supply. There is no seasonality. If you look at these prices, the
volatility is largely explained by a growing financialisation
of the commodities market, a growing involvement
of financial speculators in the global food grain market. And increasingly, these prices
are completely correlated with global stock market prices because commodities have
become a financial asset like many others. And it is this other aspect of
the deregulation of finance, the growing role of
the financial class in different aspects
of our lives which is inadequately recognised because here we are not just
talking about any old market, we’re talking about food. A similar thing is
also happening in global fuel markets,
in the oil market. But this is food, which affects
lots of people across the world, which affects, you know,
the ability of many, many poor countries to import
and certainly the ability of many poor people in
moderately well off countries to actually consume food. And this works particularly in
India because as you can see, it’s very strange in India. When the global wheat
price rises, the Indian wheat price rises. The global price comes down, ours doesn’t really come
down, ours keeps going up. So we have a very strong
path through in India of the positive effect. That is when the world price
is rising, our prices rise. When the world price
falls, ours doesn’t fall. When if prices rise
again, our price rises. Now, I’d– one thing I
just want to explain to you about this graph, this is
dollars per kilogramme, okay? Which means, this is the global
trade price, the blue line, in dollars per kilogramme. These are Indian retail
prices in Delhi and Mumbai in dollars per kilogramme. The remarkable thing is that
we now have our prices higher than world prices, in
dollars per kilogramme. We’re talking about a country with much lower per
capita income. We’re talking about a
population where 60% have half of the per capita income
and yet we have higher than global prices for food. Is it any surprise that
they’re eating less? Okay, it’s not only food. It’s also sanitation and
that’s a very big part of health conditions overall. And here’s another major, major
failure of the Indian project. As you can see, 70% of our
population does not have access to improved sanitation
facilities. I don’t know if I can bring home
to you how significant that is. That means, you’re condemning
more than 2/3 of your population to the indignity and the lack of minimal health involved
in open defecation. In fact for
women and girls, that are also safety issues
in this kind of thing. I can’t begin to describe
to you what it means that you’re not providing
basic sanitation to more than 2/3 of your population. It’s an unbelievable thing to
have left out, if you like, in terms of the minimum access
of citizens to basic services. Okay, now I’ve given
you all these graphs. I’m not gonna keep boring
you with more graphs. The question then is,
why is this happening? What’s going on? What explains this
extraordinary dichotomy between economic growth and
these disastrous conditions in terms of nutrition, health,
sanitation, and so on? There are several
reasons for this. There is clearly
an unwillingness of the Indian state to put their
money where their mouth is, if you like, in terms of
these basic things. We talked about that, per capita
public spending and so on. So we’ve seen that there
isn’t enough in terms of that kind of spending. But, why isn’t there
enough of that spending? would be the next
question, surely. Why is this a government that is
still spending around 1% of GDP on all public health despite
the fact the GDP is growing? Because GDP growth is supposed
to allow you spend more. It’s supposed — first of all, your absolute amounts
will grow anyway. But secondly, as the GDP
grows, your tax revenues grow and you have more what is called
fiscal space to actually spend on these essential areas. So why is it not being spent? Well, one explanation which is
in a sense, if you like the systemic reason,
the structural reason in India, I would argue, is
that our history and present of the caste system has
given Indian society a deeply unfortunate
tolerance of inequality. We are willing to live
with inequality in a way and to an extent that
is really not acceptable in most other societies. So I think that’s, if you like,
a broad underlying thing which is certainly a
major part of the problem. But that’s not the only part
of the problem because there is in turn the experience of the
last two decades and that’s, well, another problem has, if you like, got added
to this first one, this inability, this lack
of recognition of let’s say, 80% of the population as having
the same rights as the top 20%. The second very big thing which
has become a critical feature in the last 20 years,
I would argue, is the overall growth
strategy itself. So the point I want to make here, which is possibly a
controversial point, is that India’s inability
to have growth affect and improve the health outcomes
of women and girls is the result of that growth strategy itself. It’s not that, you know,
you have the growth but you didn’t spend
enough on health. It’s just, it’s
that the pattern of growth you
chose prevented you from spending more on health. So the two are
very closely linked. They are not separate, it’s not that you have the growth
thing here but, you know, you just spend a bit more and
come on, be good now and so on. No. You really have to actually
think of that growth strategy in terms of what it’s based on
and what it is able to deliver. What is it based on? It’s based on two ideas. The first is that
growth must be delivered by the private corporate sector
and that’s the basic agent of growth, that’s
the basic factor. And therefore to promote growth, you have to promote
private corporate activity which basically means you
have to provide incentives, you have to create,
investor confidence, you have to provide them
subsidies, very large subsidies. One major form of subsidy
in India is in terms of effective tax reductions. The government’s own
estimate of tax reduction, tax benefits to the
large corporate sector — the government’s own not some
crazy woman from New Delhi but the government’s own
estimate of the tax benefits it has given to large
private corporates in the last five years is
three and a half per cent of GDP every year on average. That is more than our public
health spending and our spending on primary education
put together. Okay, so we are talking
about a very, very dramatic reorientation
of priorities here. So growth has to be delivered
by the private corporate sector. That in turn means you must do
everything you can to promote that private corporate sector:
deregulation, tax subsidies, et cetera, et cetera,
the entire range of things and it also means that you
cannot enter into areas where the private sector
may also have an interest. Because how does the private
corporate sector grow? By entering activities and
making everything marketable by commercialising activities. So you have to stay
away from things where they might
want to get in too. So if you create good
public hospitals, there will be less candidates
for all those private hospitals. If you create good
public schooling, there will be less candidates
for all the private schools and so on and so forth. So it’s part of that
overall strategy which is fundamentally based
on promoting private activity. The other aspect
of Indian growth which is often not recognised,
everyone thinks that’s, you know, how should I put it? There’s a perception in India
that Indian growth is based on real factors, whereas,
you know, in the US, it was financially — it was
the whole property bubble led by sub-prime housing. In the UK also, there
was a property bubble. In Spain and Greece as
we now know there was a property bubble. Well, guess what everybody. In India also, we have a
credit driven property bubble. We’ve had– we got discovered, if you like,
by the international investors around 2003. And from about 2009, we’ve
been flavour of the month. You know, India is a
very hot destination for international capital and so we’ve received
very large inflows of some foreign direct
investment but mostly financial
flows: of credit flows and portfolio in capital flows. This has created a boom
– did create, right now we’re going to
recession like all of you. It created a boom in the
Indian property market, in Indian stock markets
and of course, it led to the enrichment of
a significant middle class. Remember that 20% of the Indian population is already
more than 200 million people. So it would amount to a pretty
large economy on its own. So this large, new, growing
middle class is a minority of the Indian population but it constitutes a
huge market in itself. There has been a
significant increase in credit driven consumption, a
massive increase in credit cards, in what is called retail
credit, borrowing for houses, for cars, for consumer
durables in general and all of that kind of thing. And the middle class, which as
I said is a very large number in absolute terms, has
dramatically increased its spending as a result. We do know what happens to credit driven
bubbles in the end, okay? When the end comes exactly, of
course we don’t know. Because that– we’d all be very rich if we could predict
exactly when it comes. But we do know that they do
eventually come to an end. So it’s not in that sense a particularly sustainable
pattern of growth. But the Indian growth story, the success in the last decade
has been dominantly based on a credit driven bubble,
on exports which are driven by Chinese manufacturing. China is our biggest market now. We are exporting raw materials
and intermediate goods to China, we are importing finished
products from China. China is our biggest
trading partner, it’s our biggest export market and the biggest source
of our imports. But we are caught therefore in
the Chinese export to the north because then we are
part of that system. And the domestic
growth is based on, as I said, this credit
driven bubble. That’s why we are able to
have a significant expansion of growth even though we
have all these dreadful and deteriorating
nutrition indicators. Even though employment
has not grown, we now have the worst
employment growth in post-independence history, ever since we started
collecting the data. The last five years has given
us the worst employment growth, where more than half of all
our workers are self-employed in petty production, which mean
they can’t find employers. It’s not because people
like to be self-employed, it’s because you don’t get
a job or you lose your job so you take some bananas and
shove them on the cart and go out and sell them, okay? So it’s this extraordinary
combination of very, very high growth
with displacement of traditional livelihoods
and activities and reduction in wages that has — in a sense
is the story of the Indian boom. The other thing which is often
not — well I suppose it follows, you know, because
you are basing all your hopes on corporate activity for growth, you tend to promote profits
as a share of income. So we now have one of the
lowest shares of wages to national income in the world. In manufacturing, production,
the wage share of the value added
of output is now eight per cent. And if I give you some idea, in
England you’re all jumping up and down and getting
very excited because yours has
fallen to 20%. It’s bad. I’m with you. [ Laughter ] I agree with you that
it’s bad and you know, it should not fall, et cetera. But eight percent, okay? We are really now– we
have in a sense, we have squeezed the working
class for pretty much as much as they can be squeezed. And of course, those are the
sections of the working class or the middle class, whose real
incomes may be squeezed in real wage terms, are able
to access credit. So they can buy more
through credit. Very similar story to what was
happening in the United States when real wages were falling but
they had more and more access to credit and so they
borrowed to consume. So that’s the Indian
growth story. I think it’s fairly clear that
this is not sustainable, okay? It’s not sustainable
economically. As we’ve seen, credit
driven bubbles don’t last. Secondly, it’s not sustainable because the entire export driven
model is under threat today. I mean, we
know that the Eurozone is, euphemistically putting
it, is facing problems. [ Laughter ] We know that the United
States is in such a mess that the politics is not going
to allow much traction there in terms of any real attempt
to get over the recession. There’s not going to be any
fiscal stimulus coming from the US. So these are
the two largest markets for developing Asia. The United States
and Europe are more than 50% of
Asian exports. Yes, we have diversifying, China
in particular is diversifying. But even so the shift of weight of these two markets is going
drag down this dynamic region. So the export — and of
course, it’s not just that the absolute market is
shrinking but also that as that market shrinks and as
more jobs are lost here and in the United States, there
will be more protectionism, there will be more attempts to set barriers that
prevent cheaper imports from coming in and to save jobs. These are all inevitables. So that particular export
led model is also no longer really feasible. It’s not sustainable
environmentally, this particular project,
because we really in this short period have
already done such massive damage to our environment, such
major strains on our ecology, that we’re already
facing these limits. There are parts of India where the soil quality
has actually fallen by 40% in 20 years. There are parts of India where the rivers are no longer
usable by humans and so on. So we have already destroyed our
environment to such an extent that it’s become a constraint on
production, on human activity. So for all of these reasons,
this is not sustainable. And of course finally,
it’s also bad news because, as I said, it
delivers bad news in terms of health outcomes, okay? It’s therefore not
particularly desirable, quite apart from not being sustainable. The good news, finally
[laughs], you could say, the good news is that
there is an alternative, that there is another
way of doing things, there is another set
of economic policies and an overall
macroeconomic strategy that can give you better
results and is feasible. Okay? I would call this
broadly speaking a kind of wage and employment based strategy
where your focus is not on the private corporate
sector for delivering growth but on expanding the consumption
and the conditions of life of the mass of the population because that will
create the market that will create incentives
for private activity.>>Now this requires
a set of things. The things — for example, one of
the things it requires most of all is to improve the
viability of small producers. I’ve already mentioned that,
you know, that the dominant form of production in India, in
the whole of South Asia, in most of developing Asia,
small producers are dominating in terms of the numbers. Most people are employed
in small scale production. Let’s improve the
viability of that. There’s lot of ways
of doing that. I won’t go into the details now. But also, we really have to have a massive increase
in social spending. Spending on health, nutrition,
sanitation, education, okay? And that’s not because
it’s a good thing to do. Not because it will even
improve your, you know, long term growth prospects,
that’s what often people say, that you invest in humans now and they will give you a more
productive workforce 20 years from now. Not because of that but
as a growth strategy. The reason is because
if you spend, if you actually provide
more public employment in these areas, this
creates what we call multiplier effects. That is the incomes that these
people get from this employment, they go out there and
spend in their local area. That generates more economic
activity and a local market, which creates more jobs
and so on and so forth. So you actually can create not
just a counter-cyclical buffer, not just something that prevents
you from suffering in a period of recession, but an aggregate
growth strategy which is based on improved incomes
and consumption of the people as a whole. This I believe is not just the
desirable and the, you know, the preferable way of
approaching macro-economic and growth strategy in
developing countries and, dare I say it, even in
some developed countries today. I believe it’s going
to be the only way because the other way is
not working, we know that. And it’s going to be working
less and less and less. So I really do believe
that focusing on women’s and girls’ health, among other
things, and putting public money into that, putting more
employment, better conditions, better facilities
into that, is part of an overall growth strategy. It’s not just part of
a welfare strategy. And if we look at it that way,
then we see that economic growth and women’s health outcomes need
not be a very sharp division. And to be sustainable,
they really have to be growing together. Thank you very much. [ Applause ] [ Inaudible Remark ]>>Well, that was wonderful. Thank you very much indeed
for a superb lecture. And it shows how those of us
in the health community, sadly, because we take a very
narrow health approach to many of these problems, why we often fail to get our
messages through to politicians because we don’t
look at these broader socio-economic strategies. So we have an opportunity to– we have good time
for discussion actually and so why don’t we start
off with some questions from the audience and
see where we go. Who’d like to start first? We have microphones
in the aisles.>>I wanted to ask
you if you are aware of the EU-India free trade
agreement that is being rushed through right now with the
deadline in February 10th. It’s going to devastate
workers here because the single thing
that India is asking for their side is for
companies to be able to send in cheap Indian labour
into this country. On the other side and from
what you’re talking about, really devastating because
of the access of the transnational finance
to public procurement. Like you say, once that is
the situation then the public cannot be– the public
side cannot be promoted and the tightening of
intellectual property on generic medicines that has been
forced on India, liberalisation of banking, insurance,
financial services, access for all the
dodgy financial services that we had here. You obviously do know what I’m
talking about.>>Yes.>>Yes.>>Unfortunately speaking, it’s
been completely secret here, I know it’s been quite secret in India
but it has burst out, yeah.>>Yes, well I completely
agree with you. It’s absolutely disastrous. And in fact the problem with
many of these free trade — so called free trade
agreements is that they’re entirely
corporate driven. So what is being
defined as the interests of India are really the
interests of Indian corporates, which is why we have allowed
a lot of openness in all of these areas of
investment activity because the private corporates
are interested in that too, reciprocally. The implications on the
people are horrific. And there has been some noise
about it in India but as — I don’t know what your rules
are but in India, unfortunately, the government doesn’t have to take this to parliament
or do anything. They can negotiate it secretly. They can sign it secretly. And they can present the
results to the people.>>It’s worse here because it’s
done in Brussels.>>Oh, yes. That’s true. [Laughter]>>Oh God, Europe. Europe’s raised its head. Okay, so down here and
then up– back there.>>Yeah.>>Thank you. I’m Michael Anderson from
the British Department for International Development. I wanted to ask you a
question about– you said you weren’t going to
compare with China because they’re very different. India became a middle
income country in 2008, China much, much earlier. But 30 years ago,
China was way ahead. And I wondered if
you could speculate on why those differences
existed back then when there’s a very
different model of growth. I wonder if it’s
connected to– Bangladesh is able to achieve
even better results than India in many indicators, including
a number you didn’t put up, with less money. And I wondered if there’s
something there to probe and I’m gonna offer a hypothesis: the National Rural
Health Mission in India, every year money is
returned from the states back to the centre because the states
are unable to spend the money that the centre allocates. So there’s a lack of
ability to deliver which at the moment is
not very well explained.>>Yes. Okay, 3 sort
of– shall I?>>Please.>>– 3 very big questions. China– look, I mean, public provision I do believe
has a very, very large role to play in China and,
particularly by the 1980s well before the reform
process started, it was a largely egalitarian
society with very extensive
public provision of health and education services. I do believe universal
public provision is a key. I don’t think any
society has done it without universal
public provision and I think it was
essential in China. If anything, in the growth phase in China health conditions
deteriorated slightly, because they actually
allowed a lot of privatising and they started
charging higher user fees and all that kind of thing. It’s only very recently that they’ve realised
what they’ve done and they’re putting more money
into that big health package. So I’d– I believe, I
mean if you have to ask me for one answer for China, I
would say public provision– universal public provision. Bangladesh is a more interesting and more complicated
story because, of course, it’s also one of those
more aid dependent societies in the sense where a large part of the aid has also
gone into health. So in addition to the
public, you also have the role of international aid in
providing some health services. Nonetheless, I’m
not– also by the way, Bangladesh nutrition
indicators are much better and that’s a big
thing for infants. Infant mortality, as
we saw both nutrition and immunisation are better
in Bangladesh than in India on the whole and both
of those play a role. Maternal mortality
is still very high. It’s come down but
it’s still very high. And I think, part
of that is related to the relative absence
of public provision. I think that does
play a big role. I think the National Rural
Health Mission is a bit of a disaster. I do believe that it is
part of the overall strategy of the central government to try
and provide health on the cheap. Because it is based on
a model that uses ASHAs, Accredited Social
Heath Activists, who are basically village
women, who earlier weren’t supposed to be paid at all, now
they are paid the princely sum of 500 rupees a month, in some cases, it’s a
thousand rupees a month, to take the burden of
public health care. I think that’s obscene. I think — I don’t see
why Indian citizens can’t get public heath care
through a proper public service with public employees and
facilities and all of that. So I don’t think the
National Rural Health Mission was well conceived. I also do not think that
health services should be seen as a scheme or a mission. I think that they are
part of what, you know, societies have to
provide to people. The states not being
able to spend has also to do a significant amount
with this bureaucratic issue of centre to
state transfer. These have come up in all
of these large schemes like the employment guarantee
and a number of others where there are such
stringent rules put on utilisation
certificates and so on that states are not able
to fulfil them in time. But in any case even if
they did spend them all, I mean it’s peanuts. The money is so little. And it’s based as I said on the
underpaid labour of local women that it’s really not
likely to deliver that much.>>Thank you very much.>>The argument you put forward
this evening was compelling. But really, it’s not new
and you’ll be the first to say that it’s not new, it’s fairly fundamental economics. And so I wonder if I could ask
the million rupee question and ask you, how do we
get governments to listen? If a major banking crisis only
puts the Conservative government in power and has us cutting
deficits to grow our way out of recession, if
we have these ‘stupid’, to use your technical phrase. [ Laughter ]>>Stupid economic
policies that we are all throwing all
of our weight behind when all of the evidence is telling us>>Yeah.>>to do just the opposite. So how, when your arguments
have been around for decades, if not centuries, do we get them
to listen in spite of it all?>>[Laughs] It’s the million
rupee and the million renminbi and the million euro
and the million dollar and the million pound question. Yes. You know, I used to also
be quite despairing especially when after — in the aftermath of the big financial
crash of 2008, when we thought that financial
markets had so thoroughly exposed themselves, you end up with this great
resurgence of finance and they’re back, they’re
dancing on our graves. If you see what I mean. [ Laughter ]>>Yes. But I– you know, the last few months have been
a little bit less gloomy, I do believe. I think that there was a phase
when the immediate aftermath of crisis, job loss, panic,
et cetera was used by finance which had basically
taken and which was– which is the cause of all
of these large deficits today, by the way,
in the government. It was used by finance
and the media, which plays a really bad role,
to impose a set of policies and persuade everyone that
there’s no alternative. But when you look at the
history of past crises, this is not the first
time this has happened. This goes through these
phases, it goes through a period of about four or five years
before people get it. And they say, no enough, okay. And I think we’re getting
there because you know, now history is telescoped
always. It’s much faster now. I think it’s beginning
to happen. I mean whether it is
in terms of you know, various Occupy
movements or it is in terms of the wider protests
in southern Europe, whether the indignados
and so on, or it’s the protests in Chile
against the privatisation of education or it’s the protests
in Thailand which, you know, is demanding more
worker rights and so on. I think — I think
there’s a change. You know, I
think, I mean okay, we — all we can do is hope. But it doesn’t happen easily. Governments don’t do it because
they think it’s the right thing. They do it because
they’re forced to do it. And maybe we’re getting
to that point. Fingers crossed [laughs].>>Okay, I’m trying to go
to left and right but there’s– oh, yes, I think we’ve got somebody
here on the fourth row.>>Yeah, this is Devet Vari and I have just submitted
my PhD with Jawaharlal University in July.>>Wow, very good. [ Laughter ]>>It’s nice to meet you here. [ Laughter ]>>My question is like if
National Rural Health Mission is a disaster in India, then Janani
Suraksha Yojana – it’s a part of National Rural
Health Mission which is to provide cash
incentives to the pregnant women for delivering in health
institutions – and according to the RCH and DLHS
round three, institutional delivery has
actually increased, like doubled or tripled, in most of the low
performing states in India, and that credit has been given
to Janani Suraksha Yojana. So it — like the Janani
Suraksha Yojana part of National Rural Health Mission
is actually performing good.>>You know, I, okay, this
is the trouble with anything that happens is that there can
always be two interpretations of why it happened. But let me put it this way. If you do not have a good
public institution, what’s the point of a woman
being able to go to it, right? So — and 500 rupees is really
too trivial an amount for that woman to be able to access a good
private institution. So what you are really
saying is that, that 500 rupees will
enable the woman to provide herself nutrition
or do something or the other and so on. I actually resisted this Janani
Suraksha Yojana very strongly because it was actually
presented as a choice. Do we give 500 rupees
to every pregnant woman? Or do we provide more in
terms of the Anganwadi, you know the women
workers and helpers in the ICDS, the Integrated Child
Development Scheme. You know, if you don’t provide
good public services then there is no incentive and
there’s no advantage in forcing women to go to them. So I would say
the first job is to make public health
services for, you known, delivery and child care
et cetera, good, which means
you have to spend money on them. When you look at
where cash transfers have worked, Brazil and Mexico for example, they were accompanied by
increasing public spending on these child care
facilities, health facilities and so on, education facilities. So you have to spend more
money on that, make them good. And I don’t know, I mean,
wherever I have gone in rural areas, women
are happy to go to institutional
delivery if it’s good. But you look at the
conditions, they’re three to a bed in some of these hospitals. Why force women to
go through that? You know. [ Inaudible Question ]>>Yes, yes. To me, it is not self
evident that 500 rupees in a private sector
shop is going to necessarily give
you better, you know — Let me put it this way,
I wouldn’t want my — I wouldn’t want to
go though it myself. I certainly will not put
my daughter through that. To me, that’s the bar [laughs].>>Now I was going to say the
gentlemen in the orange t-shirt, but half the audience is wearing
orange t-shirts [laughter] so whoever is the guy who’s got
the microphone can speak.>>Hi there.>>Hi.>>I’m William Birch, I’m a Third year medical student studying International Health. as my BSc. What
strategies do you know that are effective in
tackling the deep social issues which are causing gender selection
of newborn social in India?>>Yeah. This is
a really big one. I wish I knew. I tell you what doesn’t
seem to work much are these cash incentives. You know, many state
governments have done this. You get a thousand rupees
when the child is born and then you get, I think 5,000
if she survives ’til age 5 and then you get 21,000
when she gets to 21. No, when she marries
or some such thing, I forget. These do not work. In all the states
that have done them, the child sex ratio has
fallen farther, okay? So these don’t work. What works, oh God
I wish I knew, you know this a really
tough one [laughs]. How do you get societies
to value women more and how do you reduce
son preference? It’s a really tough one. I don’t know. I do know what doesn’t work. It’s the cash incentives
that doesn’t work.>>Thank you very much for
the very interesting lecture. There is usually a very close
correlation between infant and maternal mortality and
morbidity, and female education but you haven’t mentioned it. I just wondered if you could
say whether that’s an intermediary in some of these things or not
in India and whether we know.>>You know, it’s
true that a number of studies have found, well, they haven’t looked at education
so much as just literacy and they found a
strong correlation. But the really strong
correlation is with nutrition. And I think, that’s one of
the problems is that we have – it’s basically an
undernourished population and it’s undernourished
in critical years, you know, in the reproductive
years and that affects the child and the mother’s
mortality and all of that. Yes, education does
make a difference. At the district level,
it’s been found that there is some
degree of, you know, that women now are more able. This is what the ASHAs
are supposed to do in the National Health
Rural Mission. They’re supposed to go and give
women effectively what they would have got if they had been
literate in terms of, you know, knowledge about healthy
practices and sanitation and so on and so forth. And yes, it does play
a role but as I said, the dominant role
is nutrition.>>There was — over here. A lot of hands going up. I will get to you all if we
keep the questions running.>>Yes.>>Suzanne Gallagher. So I’m just wondering
about whether or not you can be guaranteed that spending more money
will definitely ensure better services because, I don’t
know, you cited Brazil there and Mexico that there
had been improvement. I’m not an expert
myself but I known in the UK with the doctors,
the NHS managers. I’ve discussed this with,
increase in spending in the NHS does not mean increase in
services and there has been doubling in last 10-15 years but
has the service improved? The general consensus in
rooms I’ve been in is no. So, I’m more interested
on the implementation side like how do you ensure that
there will actually be an impact on women’s health, infant mortality,
all the issues you have cited tonight?>>No you’re absolutely right. That’s a very important question
and certainly that’s the case, that there is no one
to one relationship. The US has the most
expensive health system in the world and not
very good, you know, health indicators relative to
a number of other countries. So its not only the
amount of money but it is — at this level of spending,
it’s a necessary condition. I mean, yes, in addition to spending more
money, you have to make sure that that money is spent in
a way that is effective. But you can’t do it
without spending. You can’t do it on $12
a year per citizen, which is what we’re
trying to do. So I think at this level,
we are really talking about money being a
necessary condition, certainly not sufficient, I
completely take your point, lots of other things
to be doing with that. But you know, the government
basically says, Oh, well, you know, we will
reorganise and restructure and reform the health system
while spending this tiny amount. That’s not good enough.>>Okay, Anthony then Sarah. And so you say it [laughs].>>I think I’m right that>>during the 2008–>>Yeah>>– food crisis that the Indian
finance ministry did suspend the ability of hedge funds to
speculate on food commodities and futures and then later
rescinded that for reasons that are not altogether clear. And alone amongst
all the Western leaders, Nicolas Sarkozy has
been the only one who is really given
a voice to doing this. I’m just wondering why there
isn’t more upward pressure in India through the media
and through the electorate for this kind of action, given
the effects of food inflation on their spending power.>>Well, you know the Indian
government banned forward trading in six important commodities,
essential food items in 2006 before the
financial crisis. And they did this because of
pressure from the left parties who at that point were
supporting that UPA government. So they did it and
they rescinded it when they were no
longer– not for all of them, it’s only wheat. They have kept the ban on the
others but they have allowed it for wheat, which is the price which has been going
up the fastest. Just when they won, they came
back the second time around without the left support in 2009. So there is still very strong
feeling about this because, you know, it’s absurd that it
would benefit farmers. Most Indian farmers do
not access commodity futures markets
and so on [laughs]. And it really– as
we have seen it does the opposite
of benefit consumers. In India there is a fairly
strong opinion against it, including among the bureaucracy. There’s also a very strong
financial lobby which is pushing for it as you can imagine
and it is one of the things, part of the EU FTA as well which the European Union
has decided to demand. I wish there was more of an
outcry also publicly here. In fact a year ago, I actually
came to London and lobbied with a whole lot of MPs with
the World Development Movement to make this more
of a public issue. It doesn’t seem to have
become one but I’m told that there is now– I saw a report
on this in the Independent that there is now a
set of little TV, not TV, online programmes,
parodying George Osborne
with sort of a caricature of him playing various roles
but highlighting the fact that he’s not doing
the right thing about commodity speculation. Maybe something will work.>>Hello my name is Sarah Hawkes
from the Institute of Global Health here at UCL. I just want to ask you a little
bit about the right hand side of your title, the Women’s
Health Outcome side and link it to the question previously
about how do you get people– policy makers to pay attention? And just kind of as an
outside the box thought: WHO figures clearly show
that the biggest burden of disease globally, and the
South Asian regions is no exception, is in men. The only figure where that
is different in South Asia is in injuries related
to domestic fires, for all the reasons
that you know better than I. And I just wonder
whether you think that you might have more success
in lobbying for additional funds to be spent on health outcomes if they were people’s health
outcomes rather just women’s health outcomes. Partly because you will get
civil society more on board, you’ll get men supporting the idea that it’s worth
investing in health. But also because I
think conceptually, people find it easier to
see that it’s important to preserve men’s health,
to promote men’s health if you want an economically
sustainable workforce.>>Yeah, okay. Well, you know one is I
don’t think this was intended as a sort of lobbying slogan because what I was doing was
using women’s health as a proxy for the overall health, on the grounds that if the
women’s health is improving, you know everybody’s
health is improving. The burden of disease issue
is a little bit more complicated, isn’t it? Because, you know, if a lot
of women’s health issues arise because of the child
bearing thing and that’s not, you know, disease as such. So it’s– I really am not familiar
sufficiently with, you know, how these statistics are
collected to capture this but I’m not so sure that that
would capture the actual health positions, especially
in a number of relatively poor
developing countries, in Sub-Saharan Africa,
in South Asia, and so on, with high maternal
mortality rates that would adequately
capture the health challenges
faced by men and women. But I completely take your point
that obviously what we’re caring about is the health
of everybody. Do we see it only because it’s
the health of the work force? I would say, no. I would say that the way to
pitch it politically would be to say listen, this is not about
improving your workforce health so that they become
more efficient workers but it’s a means
of creating demand to allow your economies to
get out of the mess they’re in. So currently I would
picture it in terms of an economic strategy, as
a macro-economic solution to economic recession
and stagnation.>>Okay, lady over there. And then the gentleman over there.>>Hello, hello.>>Hello, I’m Ruth Bell
from the Department of Epidemiology and
Public Health from UCL. So you’ve discussed the
dominant role of nutrition in infant mortality
and maternal mortality. And I wondered how
optimistic you are that the current food
security bill that’s going through the Indian parliament will help in that situation to
improve food security in India?>>[Laughs] You know,
this is one of those bills that we spent many
years lobbying for and then the version which
is up in parliament is so bad that it’s better that– it’s
better not to have a law than to have the version
that is being proposed. But fortunately, the fight
goes on and I don’t believe that the eventual bill
that we get is going to be the terrible version
which is currently in play. You know, the Indian parliament has
actually been quite progressive on a number of issues in terms
of the Employment Guarantee Act, for example. The government wanted to
put a very watered down version and intense lobbying
with the MPs was able to actually produce
a much better act. And I’m hopeful also with
the food security bill. Also because, you know,
the recent rise in prices in India has been very,
very– in 2 years prices — food prices have
gone up 45%. It’s the biggest issue;
parliament was stalled for three days last week, just
because of food prices. So I think there is now a general
political outcry to a degree which might create a better act. If it is an act that actually
provides a near universal, minimum amount of grain
to every household which is what is proposed, then it’s a step
forward, shall I say. It doesn’t solve the
problems of course but it’s definitely
a big step forward.>>I’m intrigued
by the sex ratio and the very disturbing
data that the more developed or economically developed a state in India is, the
worse the situation is and the presumption
being that it’s access to antenatal ultrasound
and selective termination. And I’m interested in
Kerala and the question as to matriarchal society
and women’s education on the one hand versus economic
development on the other, and the fact that Kerala’s
economics has rather declined recently and more and more people are going to
the Middle East and presumably, therefore coming back with
overseas money and all of that pressure that
the non-resident Indian when returning has
for gated communities and separate — So one suspicion is that
Kerala may well go the way of all these states where
selected abortion is common. What’s happening in
Kerala with the sex ratio? What’s happening with
the GD coefficient? What’s happening with health as Kerala is changing
its economics?>>Okay, another big question. You know, Kerala is not
really a matriarchal society. One caste in Kerala is
matrilineal which is to say that you get from the main line but it’s really the mother’s
brother who controls everything. And in fact, if you talk
to any women from Kerala, they will tell you that
patriarchy is alive and well and flourishing in Kerala. You know, so it’s
not in that sense. However it has been a more
egalitarian society and it has been a society
which has educated girls for a fairly long time, there’s been universal
primary education now for about three decades really. The sex ratio in India has
improved in only two states. It’s Kerala and West Bengal. And it’s also two state
that happen to have a very large presence of
the Left movement, have been run by Left governments for–
well in Bengal until this April for 35 years and Kerala, on and
off over the last three decades. So I mean, you know,
perhaps it is also the over all, you know, culture of– broader egalitarian culture which has promoted the
slightly better attitude. But you’re absolutely right, that yes, Kerala is also a very
migrant society at the moment but it’s interesting,
a large part of this migration is female. And it’s females going
abroad to work in the service sector. You know, migration is
highly gendered in Asia. The men go for construction
and manufacturing, the women go for services. The care sector dominantly
from Kerala but, you know, from poorer families they will
go and work in domestic service and otherwise they go into what
is broadly called entertainment. But in Kerala, they go
dominantly into nursing. And it doesn’t necessarily
therefore reinforce, you know, regressive social trends. It actually perhaps, you know, because the women then
get different exposure, they come back with the
different — in that sense it’s
not such bad news. [Laughs] Yeah.>>Question right at the
back there, please.>>Hi there. I’m Kelly Clarke. I’m a PhD student at the
Institute for Global Health.>>I was just wondering–>>Just wave so we can–>>Oh, thank you. Okay–>>I’m not sure I want everyone
to turn around and look but– [ Laughter ]>>I was just wondering, in what
way you felt the International Community, the INGO or the non-governmental
organisations, international aid, can engage with and support
the alternative macro-economic strategy that you
put forward.>>Well, I mean there’s
no question we need all the help
we can get, right? [Laughs] From whichever direction. It’s no longer the
case that the– well, this is the other problem, you see, that in India because
it is so-called emerging and the government feels
very rich right now, it pushes everybody, aid
donors and so on are basically, treated
like– you know — a word which I will not mention. So it’s difficult I would say. It is difficult for
international NGOs to get into a campaign unless
they are very– are working very closely
with local partners because there is a growing
distrust across the region of voices from abroad. And there’s a growing perception that we can do it
ourselves better. To actually influence
governments, it may not be a good idea to
speak directly to governments. It may be a much better idea
to support local movements that are making the same demands
and I think this is a mistake a number of aid agencies have made. You know, because you can’t
anymore have – anywhere in the developing world – you can’t anymore have
these fellows, you know, whether it is a
World Bank sticker or an Oxfam sticker,
it doesn’t matter anymore. You know, really there
is a general resentment of the outside opinion unless
it is very strongly merged with the local, you know,
local mobilisation, shall I say. Okay?>>We’re coming to a close now and we have three people who have
been very patient down here. Man in the greenish
jumper, in white shirt and then gentlemen,
seated here. So first, yes. Yeah.>>Nicholas Maxwell at
01:03:29,356 –>01:03:29,466
Science and Technology Studies, UCL. I want to make a suggestion about
the one billion dollar question. Perhaps academia has
some responsibility for the situation.
We’ve inherited from the past this idea
that the basic proper aim of academic inquiry
is knowledge. First of all, you acquire
knowledge and then you apply it to help solve social problems. But if we took seriously the
idea that academia is all about helping us, helping to
promote human welfare, helping us to achieve what is of
value to us in life. The basic problems we have to
solve are not really problems of knowledge but problems of
living, problems of action. And if academia was
rationally organised, it would give intellectual
priority surely to articulating our problems
of living and proposing and critically assessing
possible solutions. And out of this would
kind of emerge such a technology
and feedback into it. And if it were
organised in that way, then maybe academics will
be able to shout from the rooftops,
when governments and other big powerful
institutions in the world start pursuing
very harmful policies, that they are pursuing
harmful policies and that they should
mend their ways and they might also
get through to the public better. But if the basic aim is– the basic idea is that
we’re acquiring knowledge. Then this doesn’t really
equip us to do that. And if you look at the academia,
you’ll see it’s terribly sort of broken up into
specialties without any idea of what the coherent
enterprise is, so it seems to me, possibly
we academics, have some responsibility
for the situation.>>Yes.>>Do you agree?>>Here, here. [ Laughter ] [ Pause ]>>I’m Patrick Carol. I’m a actuary. And I know you’re using
measures of maternal mortality, measures of infant mortality but
you don’t refer to expectations of life as a measure of
mortality across the ages. Is there some reason for
cautioning India for using it– about using that measure?>>Actually, no. It’s just that I’ve–
I chose this– these as very basic indicators. I mean, I could have also
taken life expectancy but there is a lot of debate about our life expectancy
figures and so– [ Inaudible Remark ]>>Yeah. Because it’s
all questiondc, I mean, I don’t really know the details but how you smooth the curve
and stuff like that. So there’s a lot of–
there’s a big fight going on. And I didn’t want to
get into that one.>>Ah, very interesting. [ Laughter ]>>Okay. Just two
rows in front you.>>Hello. Andrew Follmer
from the World Bank, we’ve been mentioned a
couple of times. So– [ Laughter ]>>You’re a brave man to
disclose yourself.>>No, I’m– [ Laughter ]>>– happy to take it on. The WDR, the World Development
Report was released in September, as you’re probably
aware, on gender. And the UK launch
was last week. And it tackles and
looks at women at the centre of development
very much through a parity around economic opportunity. Now that is if you’re
convinced by that argument and you take it forward – you
may not be convinced by it – but that’s what convinced the
Ministry of Finance to change their policy choices and
their spending decisions. That’s one of things
they answer to. I welcome your views
on that and how that place out in the Indian context. So providing economic
opportunity to women can change
the situation in which they find themselves. If you put that
opportunity with women they normally make much better
decisions for their family and their children than
if you put that money in the hands of the man. Secondly, just I think the– one of the issues that came when
you were answering earlier on was about the paucity of
data that’s disaggregated for gender. And I think that’s
one of the key things that the World Bank
team struggled with, with preparing this report. It just isn’t out there. So the academic opportunity–
community rather, the NGO community,
the World Bank community need to change the way
they capture data so we can actually measure
this issue and then tackle it with the policies
that we implement.>>Yeah. You know, to take
the second one first, I couldn’t agree with you more. You know, I have been on
International Commissions of the Department of Advancement
of Women and ILO and UNIFEM and et cetera for 20 years we have been asking for this
gender disaggregated data. Maybe now that you’ve asked
for it, maybe we’ll get it, I don’t know. I mean, I hope so
because yes, absolutely. But you know, despite the fact
that we’ve been asking for it, it haven’t come for
a quite a while now. But there’s always hope. On the issue of employment
of women, yes, of course. I mean, definitely, you
know, economic opportunities for women are desirable
in themselves and give various other outcomes. I don’t think there’s
any dispute about that. There is of course the
other question though that economic opportunities
for women should not come at the expense of, you
know, the lack of provision of the care work that
women end up doing, the significant amount
of unpaid housework that women are involved
in because of the whole double
burden issue which I’m sure you’re aware of. And so, yes, we know that economic opportunities
improve the conditions of women. We also know that they have– there are other issues
associated with that because it depends not
just on the very factor of paid work but the
conditions of that work, the remuneration of
that work and you know, whether that work
is taking place with minimum safety
and other conditions. So it’s not a
straightforward thing. It is definitely a
positive thing but it has to be seen in context. So just the fact that
there are more women in paid employment
is not a cause of unqualified celebration. You would first have to look at
the entire range of conditions of that work and
then decide, I think.>>Last question. Right on the front row here. [ Laughter ]>>Thank you. My name is Amina. I’m doing a PhD in the
Department of Epidemiology and Public Health
where Ruth is. And I’m looking at nutritional
outcomes in women in India and China amongst
other countries, and looking at how they vary
by wealth and eduction. But my question is completely
unrelated and I wanted to push you a little bit
and ask you if you’d be able to give a– which single
recommendation would you support if the 99% was to speak up
and make a single request from all governments to try and
tip the balance a little bit? What would it be? I don’t
know, you must know in Europe the Tobin tax
proposal has been put forward. And Ha-Joon Chang who’s
an economist– development economist
in Cambridge has stated that the financial sector
needs to be less efficient, not more efficient. Would you support a
proposal for taxation of financial transactions?>>Oh, sure, yes. But you know, that’s
a tiny little thing. I mean it’s good
and I’m all for it. But it’s not going to change,
you know, this power balance that you talk about. One proposal you want, one little proposal
or a broad strategy? If you want a slogan, I don’t
know how you would put it. But you know, there
was that film, “Honey, I Shrunk the Kids”,
or something. We have to shrink finance. [ Laughter ]>>So slogan: shrink finance. It’s too large. It is too large for the
good of the economy. It’s too large for the
good of the people. And there are many
ways to shrink finance but it has to be shrunk.>>Thank you. [ Laughter ]>>Thank you very much. Now, I’d like to thank the– [ Background Applause ]>>– Jayati for a splendid lecture. Thank you. [ Inaudible Discussion ]

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