Why it is hard to deliver health for all, how the world is growing older, what is holding back India's solar ambitions and how Twitter took the FT on. Also a fun maths problem for those who trying to reopen schools and offices.
The many woes of PMJAY: Customers of Government of India’s PMJAY - a state funded health insurance scheme for India's poorest - are a disgruntled lot. There is a difference between people’s expectation (cashless) and the reality (less cash). Like most insurance policies, PMJAY covers different treatments only up to a certain limit so when hospital bills exceed that customers are asked to cough up the difference. This is to be expected of course, but the real issue here is one of messaging. Since the key message around PMJAY is “muft upchar” or free treatment, people who’d like to get that are understandably very unhappy. Given how widespread and aggressive the advertising around the scheme has been, and who the intended customers are - I wouldn't just blame it on people missing the fine print.
See also this great blog by CGDev on the importance of knowing the costs of providing healthcare. When you don't know what it costs to provide different kinds of treatment, how do you deliver a scheme like the PMJAY cost-effectively? Heck, how do you deliver it at all?
Because the government does not know what it costs to deliver different treatments, it is unable to negotiate prices at which private providers are able and willing to deliver them. You have unhappy (and non-participating) private hospitals, not enough coverage and just ineffective delivery.
Read also this on the political economy of the PMJAY, arguing that without adequate regulations and investments in public healthcare, the scheme will divert public funds to private institutions. Read also this for 4 common myths around private healthcare in India.
If you’d like to read still more on healthcare, here’s a long read by HBR on how to solve the cost crisis, and a whole book (downloadable) here by Amanda Glassman and others on principles that countries with limited resources can apply to design their healthcare packages. (spoiler – they will need to know their healthcare costs).
See also this on how Covid-19 and shrinking economies are putting pressure on the budgetary space for healthcare spending across the world, especially in the low and middle income countries. These are further exacerbated by shrinking and uncertain aid budgets.
The sun may be shining but we’re far from making hay: As Prime Minister Modi inaugurates Asia’s largest solar power project, read a good piece here on the opportunities and challenges around India’s solar ambitions. See also this on how sourcing for under-construction projects and accessing raw materials for domestic manufacturing will be a challenge given recent tensions with China. India imports about 85% of solar equipment from China.
Read this for the many paradoxes of India’s solar energy sector such as,
Consumption rates can only go up and foreign capital continues to flow in - but mainly because it has nowhere else to go
The Prime Minister is keen to reduce imports of solar cells from China and encourage domestic manufacturing by levying custom duties - but current capacity meets only about a fifth of the annual demand and duties will only drive up prices;
And even as India makes all the right noises around solar - its traditional power utilities continue to struggle with the country’s deep structural issues that no one is talking about.
Also, if you want to know just how determined India is to create domestic manufacturing capacity in the sector, read this on how the Ministry of New and Renewable Energy turned itself into a pretzel several times over to award the world’s largest solar tender.
“The bid deadline had to be extended more than seven times with only one bidder interested.”
Be careful what you wish for: We’ll soon have to think of a new fall guy as a ‘population’ may no longer be the reason why everything in the world is upside down. See this BBC piece on how fertility rates and population growth are declining across the world. World population is set to substantially decline by 2100. This is mainly because women are having fewer children.
Fertility rates (the average number of children a woman has) are falling globally mainly due to improvements in women’s education, their increasing participation in the workforce, and increased access to contraceptives.
India’s SRS (Sample Registration System) Survey for 2018 (most recent data) reflects the trend. See this one how barring 8 states, all Indian states have achieved “Replacement Fertility” i.e. an average of 2.1 children over a woman’s lifetime which means that the population will stop growing, and only replace itself over time.
Bihar is now the only Indian state where a woman in 2018 was likely to have over three children in her lifetime.
Also, more old people: Many southern Indian states have had replacement fertility rates for some time now and are now facing a different issue – a higher share of senior citizens in their populations. The Lancet study suggests that this is the way countries are going globally too.
Now why is that a problem?
Simply (perhaps even a little simplistically) put, fewer people in the working age group will mean smaller economies and lower growth - but not necessarily smaller needs. There will be more dependent adults for every working-age person who needs work, pay taxes and fund an increasing need for pensions.
If this issue interests you, I recommend you read the original Lancet study – or at least the discussion at its end.
New Report on Global Food Security: The latest edition of the State of Food Security and Nutrition in the World was published this week. Produced jointly by an alphabet soup of global institutions - FAO, IFAD, UNICEF, WFP, and WHO - this is the most authoritative global study tracking progress towards ending hunger and malnutrition. You can read the summary findings here. My even shorter summary is this: We are far from solving the hunger crisis.
The world is not on track to achieve Zero Hunger by 2030.
If we continue on our current trajectory, 9.8% of the world's population will be affected by hunger by 2030 - with Africa being home to more than half of the world’s chronically hungry.
Remember that these are the projection without accounting for Covid-19.
A Story in 3 Charts: In a great example of how you need to be a critical consumer of content on the internet, Adam Tooze (Historian, Columbia University) recently called out the Financial Times for a chart in this piece. The FT piece carried the following chart on global CO2 emissions.
Now unless you’re familiar with these numbers, this chart will tell you that while total global emissions since 1900 have surged, per head emissions have stagnated. This means, it is rising populations that have driven CO2 emissions up, even as each person is adding only as much as they always did. (If I may translate loosely, this would mean that poor countries with their many people are responsible for rising pollution).
This is factually incorrect. Per capita CO2 emissions have more than quadrupled over this period.
It is economic activity that has driven the surge in global CO2 emissions. Not just more people on the planet.
But the chart, you ask? The pink line (tonnes) in the chart above is climbing up - but because it is plotted on the same axis as the blue line (billion tonnes), it has been squished! This is why you add a secondary axis. Or make a separate chart. Or anything, but this.
Hannah Ritchie of the University of Oxford also pointed out that CO2 emissions have grown at a much faster rate than population.
The FT responded and now the new chart in the story looks like this:
This is why you should not trust everything you read on the internet.
As an aside, the second chart also made me look up the Kaya Identity - which is a neat way of articulating the human impact on the environment, and the more general I = PAT formula which says that human impact on climate is function of Population, Affluence and Technology.
Finally, if you enjoy maths, here is a great geeky piece on how a question that has occupied history’s greatest mathematicians is now central to how we can safely open schools, offices and public spaces. What is the most efficient way to arrange circles in the plane, or spheres in space?
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