Lessons From Low-Income India

by Meghan Rosen

One month ago, our new House of Representatives passed the long-awaited, much-heralded spending bill, H.R.1: Full-Year Continuing Appropriations Act, 2011.  Its name was bland but its purpose was bold. This was the bill that would usher in an era of fiscal restraint, rein in out-of-control government spending, and, in the words of Speaker John Boehner,  ‘liberate our economy'.  Freed from the shackles of costly governmental programs, House Republicans argued that jobs would flourish, and our economy would finally be allowed to grow. 

The bill’s official title was long-winded and mildly vague, but overall, it appeared to represent routine, if not benign, spending policy: H.R.1: “Making appropriations for the Department of Defense and the other departments and agencies of the Government for the fiscal year ending September 30, 2011, and for other purposes.”

In non-legislative terms, the title suggested simple funding provisions for defense and governmental programs.  It sounded tame; it sounded reasonable. (Although any bill that specifies appropriations ‘for other purposes’ is likely anything but straight forward.) The bill’s title provided not a hint of the outrage it would provoke on one side of the aisle, or the fervent acclaim it would see on the other.

Boehner took to twitter to tout the bill’s historic nature. He tweeted that H.R.1 would cut discretionary spending by $100 billion.   He tweeted that the House GOP would stop job-crushing debt.  He tweeted that the bill’s passage was for the good of our economy and democracy.  His words were strong and his use of hashtags was prodigious.  It was the GOP’s #pledge to bring #jobs back to America, and this bill was going to get us there. 

On February 19th, the day of the bill’s passage, the GOP partyline was nearly unbroken.  Only 3 of 238 Republicans voted against H.R.1.  According to Boehner’s twitter account, ‘the People’s House had worked its will’ by passing one of the largest spending cuts in history.  In the People’s House, not a single Democrat voted aye.

Why the hardline opposition?  Though the bill was titled H.R.1, Democrats christened it with a pithy nickname, one that caught on quickly and, for many, stripped the bill of its meaningless bureaucratic wrapping to expose its true intentions.  They called it:  “The War on Women.”

Among Boehner’s boasted billions in savings were cuts to family planning programs for low-income women, reduced funding for women’s and children’s healthcare, and slashes to nutrition programs for new mothers and infants.

For Democrats, the cuts were not only an affront to women, but also fiscally irresponsible.  If the goal is to reduce the deficit, they argued, it makes little sense to cut services that save money in the long term; Representative Louise Slaughter (D-NY) pointed out that every dollar invested in family planning saves taxpayers four dollars down the road.  Similarly, a penny saved today on a low-income infant’s food only postpones the higher healthcare costs that accompany a childhood of poor nutrition.

For Republicans, the cuts were not so much an attack on women as a necessary measure to reduce the deficit, and, as Boehner trumpeted on Meet the Press, “create a better environment for economic growth & job creation.”  In their view, cutting back on government spending translates into more money for taxpayers, which can be invested into businesses, which create jobs, which bolster the economy.  And since a thriving economy is linked to higher wages and quality of life, the need for government support programs (like those singled out in H.R.1) is nullified.

In essence, it’s a win-win cycle that starts with shrinking the government.  After all, their thinking goes, why pay for programs to help the poor when reducing spending could, ultimately, have the same effect?  There’s a bit of labyrinthine logic to this line of reasoning, but does it have a kernel of truth?  Do House Republicans have a point?

It is true that countries with high average incomes score better on many measures of health; higher life expectancies and reduced infant mortality are generally hallmarks of a strong economy.  However, a recent analysis of childhood nutrition in India casts doubt on the theory that a strong economy triggers meaningful changes in the lives of those living at low incomes.

Two weeks ago, the scientific journal PLoS Medicine published a study that sought to define the relationship between economic growth and the pervasive problem of undernourished Indian children.  In India, 25-50% of the deaths of children between 6 months and 5 years old are due to inadequate food intake.  This slow, sustained starvation causes stunted growth and puts children at greater risk for infection and disease. 

The primary policy tool to combat chronic childhood undernutrition has been economic development, but despite two decades of booming growth, the average calorie intake in India has actually declined.  Indeed, the authors found that there was no link between economic growth and childhood undernutrition; stagnant or thriving, the status of a state’s economy had no effect on its number of underweight children.

So, what can the U.S. learn from India?  The study’s authors conclude that improving childhood nutrition is dependent on ‘direct investment in health and health-related programs.’  The undernourished children of India were the unfortunate participants in a decades-long experiment that disputes the idea that market-driven solutions can answer poverty-based problems.

References:
1. Deaton A (2003) Health, inequality, and economic development. Journal of Economic Literature 41:113–158.
2. Reddy KS (2011) Equity Must Accompany Economic Growth for Good Health. PLoS Med 8(3): e1000426. doi:10.1371/journal.pmed.1000426
3. Subramanyam MA, Kawachi I, Berkman LF, Subramanian SV (2011) Is Economic Growth Associated with Reduction in Child Undernutrition in India? PLoS Med 8(3): e1000424. doi:10.1371/journal.pmed.1000424