Linkage of Health With Development
Health, in its comprehensive or holistic sense, refers to the state of completephysical, mental, social and spiritual well being of a person. It does not merelyrelate to the absence of diseases and infirmity. This definition encompasses allcomponents of welfare in terms of physical (i.e. organic and biological), mental andspiritual sides of life. It signifies happiness, satisfaction and social well-being requiredfor harmonious living with the surroundings. Since all these aspects of life areinterconnected with each other, even if one component is disturbed, the equilibriumof health is affected. Health can therefore be regarded both as a means and asan end of development.Like health, development also connotes a wider understanding.
It is multi-dimensionalencompassing many aspects of human welfare at the centre of which is the healthof the people. When people are healthy they are more productive. Higher productivity ensures two important processes which are fundamental to economic growth: betterpurchasing power signifying better propensity to consume and save. Savings in turnpromote investment and capital formation. In an economy where this chain ofconsumption and investment is weak, the process of development gets retarded.Such economies tends to be characterised by features of under development likehigh infant and child mortality rates, lack of infrastructure (e.g. non-availability ofsafe drinking water, poor sanitation, inadequate transportation facilities, lack ofelectricity, etc.) and low level of education marked by high proportion of illiterates.For rectifying this situation, the country needs to invest in priority sectors like healthand education.
The basic assumption is that a healthy and educated workforce isan important and essential input to economic growth with welfare. There was alsoa widely believed hypothesis that the benefits of growth will percolate to all layersof the economy (trickle-down hypothesis). However, experience and evidence haveshown that this does not always happen without the focused attention of planningrequired for ensuring the welfare of weaker sections of the society. Investment inhealth services assumes critical importance in this regard.Till 1970s, development took note of mainly its economic aspect. It was consideredsynonymous to economic growth and was considered to reflect in the per-capitaincome of the country. A sharper distinction between growth and developmentcame to be made in 1970s, with growth considered to merely show the performanceof the economy and development identified with the end or the outcome of growth.Development in this sense reflected the distribution of benefits of growth across thedifferent sections of the society with concerns of equity duly addressed. Acomprehensive indicator of economic growth with development was introduced inthe early 1990s in which the larger issue of quality of life was given due weightage.
This was articulated in the World Development Report of 1991 which asserted asfollows: "the challenge of development is to improve the quality of life which goesbeyond mere economic growth.....it encompasses better education, higher standardof health and nutrition, less poverty, a cleaner environment, more equality ofopportunity, greater individual freedom and a richer cultural life". The transitionfrom 1970s to 1990s thus saw the replacement of physical quality life index (PQLI,developed in 1979 taking into account the three variables of life expectancy at age1, infant mortality rate and literacy) by the more comprehensive human developmentindex (HDI). The latter (i.e. HDI) was also based on three related aspects but withwider and extended connotations viz.
(i) longevity measured by life expectancy atbirth,
(ii) knowledge measured by the weighted average of adult literacy (two-thirds) and combined primary, secondary and tertiary gross enrolment ratio (one-third).
(iii) the standard of living measured by per capita real income adjustedfor purchasing power parity. Its focus was thus on the ends of development (longevity,knowledge and material choice) rather than on the means of development.
HDI isalso used to measure the relative position of development (inter-regional or sub-national and international) on a more comparable basis.Health and development are thus closely interrelated with a potential to influenceeach other strongly. In recognition of this fact, health has been accorded a distinctstatus in the measurement of the level of development of an economy. Healthcontributes to the process of human capital formation making a major contributionto raising the productivity of labour. Due to these strong forward and backwardlinkages, investment in health increases the returns on other investment in humancapital such as in education by contributing to ones' learning abilities. The net resultis a positive return in terms of increased productive years of life.