04-19-2005, 02:02 PM
<b>Continuation</b>
The New York Review of Books: Passage to China
Volume 51, Number 19 · December 2, 2004
<b>Passage to China
By Amartya Sen</b>
6.
The connections between India and China in public health care are
both significant and little-known. After Fax-ian arrived in India in
401 AD, he took considerable interest in contemporary health
arrangements. He was particularly impressed by the civic facilities
for medical care in fifth-century Patna:
All the poor and destitute in the country...and all who are
diseased, go to these houses, and are provided with every kind of
help, and doctors examine their diseases. They get the food and
medicines which their cases require, and are made to feel at ease;
and when they are better, they go away of themselves.[14]
Whether or not this description was too flattering of the clinics in
fifth-century Patna (which seems very likely), what is striking is
Faxian's desire to learn from the provisions for public health in
the country he visited for a decade.
Two and half centuries later, Yi Jing also became interested in
health care, and he devoted to it three chapters of his book on
India. He was more impressed with Indian health practice than with
Indian medical knowledge. While giving India credit for some medical
treatments, mainly aimed at lessening pain and discomfort
(e.g., "ghee, oil, honey, or syrups give one relief from cold"), he
concluded, "In the healing arts of acupuncture and cautery and the
skill of feeling the pulse, China has never been surpassed [by
India]; the medicine for prolonging life is only found in China." On
the other hand, he wrote, there was much to learn from India about
health care: "The Indians use fine white cloth for straining water
and in China fine silk should be used," and "in China, people of the
present time eat fish and vegetables mostly uncooked; no Indians do
this." While Yi Jing returned to China pleased with his country of
origin (he even asked rhetorically: "Is there anyone, in the five
parts of India, who does not admire China?"), he still made a point
of evaluating what China could learn from India.
7.
Public health is a subject about which one country can learn from
another, and it should be clear that India today has much to learn
from China. Indeed, life expectancy has been longer in China than in
India for many decades. However, the history of progress in
extending life expectancy in the two countries tells a more
interesting story. Shortly after the revolution, Maoist China made
an early start in providing widespread health care, and there was
nothing comparable in India at the time. By 1979, when Deng
Xiaoping's economic reforms were first introduced, Chinese on
average lived fourteen years longer than Indians.
Then, after the economic reforms of 1979, the Chinese economy surged
ahead, growing much faster than India's. Despite China's much faster
economic growth, however, the average rate of increase in life
expectancy in India has, since 1979, been about three times as fast
as that in China. China's life expectancy is now about seventy-one
years, while India's is sixty-four years; the life-expectancy gap in
favor of China, which was fourteen years in 1979 (at the time of the
Chinese reforms), has now been halved to seven years.
Indeed, China's life expectancy of seventy-one years is now lower
than that in some parts of India, notably in the state of Kerala,
which, with its 30 million people, is larger than many countries;
Kerala has been particularly successful in combining Indian-style
multiparty democracy (including public debates and widespread
participation of citizens in public life) with improvements in
health through state initiatives of the type that China undertook
after the Revolution.[15] The advantage of that combination shows
itself not only in achievements in high life expectancy but also in
many other fields. For example, while the ratio of women to men in
the total population in China is only 0.94 and the Indian overall
average is 0.93, Kerala's ratio is 1.06, exactly the same as in
North America and Western Europe. This high ratio reflects the
survival advantages of women when they are not subjected to unequal
treatment.[16] The fall in the fertility rate of Kerala has also
been substantially faster than in China, despite China's coercive
birth-control policies.[17]
At the time of the Chinese reforms in 1979, life expectancy in
Kerala was sightly lower than in China. However between 1995 and
2000 (the last period for which firm figures for life expectancy in
India are available), Kerala's life expectancy of seventy-four years
was already significantly higher than China's last firm figure of
seventy-one years in 2000.[18]
Moreover, since the 1979 economic reforms, the infant mortality rate
in China has declined extremely slowly, whereas it has continued to
fall very rapidly in Kerala. At the time of the Chinese reforms in
1979 Kerala had roughly the same infant mortality rate as China-
thirty-seven per thousand. Its present rate is ten per thousand, a
third of China's thirty per thousand (which has not changed much
over the last decade).
Two factors, both of which bear on the issue of democracy, help to
explain the slackening of Chinese progress in prolonging life,
notwithstanding the positive effects of China's extremely rapid
economic growth. First, the reforms of 1979 largely eliminated free
public health insurance, and most citizens had to buy private health
insurance (except when it was provided by the employer, which
happens only in a small number of cases). This withdrawal of a
highly valued public service met with little political resistance -
as it undoubtedly would have in any multiparty democracy.
Second, democracy and political freedom are not only valuable in
themselves; they also make a direct contribution to public policy
(including health care) by bringing failures of social policy under
public scrutiny.[19] India offers high-quality medical facilities to
the relatively rich, including foreigners who come to India for
treatment, but the basic health services in India are poor, as we
know from the strong criticisms of them in the Indian press. But
intense criticism also provides opportunities to make amends. In
fact, the persistent reports on the deficiencies of Indian health
services, and the resulting efforts to improve them, have been a
source of India's strength, reflected in the sharp reduction in the
gap between China and India in life expectancy. This strength is
reflected as well in what Kerala has achieved by combining
democratic participation with radical social commitments. The link
between public communication and health care can also be seen in the
terrible effects of the secrecy surrounding the SARS epidemic in
China, which started in November 2002 but was kept secret until the
following spring.[20]
So while India has much to learn from China about economic policy
and also about health care, India's experience with public
communication and democracy could still be instructive for China. It
is worth recalling that the tradition of irreverence and defiance of
authority that came with Buddhism from India to China was singled
out for particularly strong criticism by the Chinese in the early
denunciations of Buddhism.
Fu-yi, a powerful Confucian leader, submitted in the seventh century
the following complaint about Buddhists to the Tang emperor. It has,
in fact, some similarity with the recent attacks on the Falun Gong:
Buddhism infiltrated into China from Central Asia, [in] a strange
and barbarous form, and as such, it was then less dangerous. But
since the Han period the Indian texts began to be translated into
Chinese. Their publicity began to adversely affect the faith of the
Princes and filial piety began to degenerate. The people began to
shave their heads and refused to bow their heads to the Princes and
their ancestors.[21]
Fu-yi proposed not only a ban on Buddhist preaching but a new way of
dealing with the "tens of thousands" of activists rampaging in
China. "I request you to get them married," Fu-yi advised the Tang
emperor, and "then bring up [their] children to fill the ranks of
your army." The emperor, we learn, refused to use this approach to
eliminating Buddhist defiance.
With stunning success, China has become a leader of the world
economy, and from this India-like many other countries-has been
learning a great deal, particularly in recent years. But the
achievements of democratic participation in India, including Kerala,
suggest that China, for its part, may also have something to learn
from India. Indeed, the history of China's attempts to overcome its
insularity-especially during the second half of the first millennium-
has continuing interest and practical usefulness for the world today.
[22]
Notes
[1] In spelling Chinese names in English, I am using the "pinyin"
system, which is now standard, even though the literature cited also
uses many other spellings. Faxian has also been referred to as Fa-
Hsien and Fa-hien; Xuanzang as Hiuan-tsang and Yuang Chwang; and Yi
Jing as I-tsing and I-Ching, among other variations.
[2] Two insightful recent books draw on Xuanzang's travels and their
continuing significance today: Richard Bernstein, Ultimate Journey:
Retracing the Path of an Ancient Buddhist Monk Who Crossed Asia in
Search of Enlightenment (Knopf, 2001), and Sun Shuyun, Ten Thousand
Miles Without a Cloud (HarperCollins, 2003).
[3] Joseph Needham, Science and Civilization in China, Vol. 2
(Cambridge University Press, 1956), p. 427.
[4] An interesting example of the transmission of mathematical ideas
and terms can be seen in the origin of the trigonometric
term "sine." In his Sanskrit mathematical treatise completed in 499
AD, Aryabhata used jya-ardha (Sanskrit for "chord half"), shortened
later into jya, for what we now call "sine." Arab mathematicians in
the eighth century transliterated the Sanskrit word jya into the
proximate sound of jiba and then later changed it to jaib (with the
same consonants as jiba), which is a good Arabic word, meaning a bay
or a cove, and it was this word that was later translated by
Gherardo of Cremona (circa 1150) into its equivalent Latin word for
a bay or a cove, viz., sinus, from which the modern term "sine" is
derived. See Howard Eves, An Introduction to the History of
Mathematics (Saunders, sixth edition, 1990), p. 237. Aryabhata's jya
was translated into Chinese as ming and was used in such tables as
yue jianliang ming, literally "sine of lunar intervals." See Jean-
Claude Martzloff, A History of Chinese Mathematics (Springer, 1997),
p. 100.
[5] See Needham, Science and Civilization in China, Vol. 3, p. 202;
see also pp. 12 and 37. A general account of Indian calendrical
systems is presented in my "India Through Its Calendars," The Little
Magazine, No. 1 (Delhi, 2000).
<b>[6] The term "Mandarin," from the Sanskrit word mantri, or special
adviser (the Indian prime minister is still called pradhan mantri,
or principal adviser), came much later, via Malaya.</b>
[7] John Kieschnick, The Impact of Buddhism on Chinese Material
Culture (Princeton University Press, 2003).
[8] Needham, Science and Civilization in China, Vol. 3, pp. 146-148.
[9] Martzloff, A History of Chinese Mathematics, p. 90.
[10] Apart from other reasons, John Kieschnick points to "the
ephemerality of palm leaves and birch bark" on which "most writings
in ancient India were inscribed"; see The Impact of Buddhism on
Chinese Material Culture, p. 166.
[11] It appears that there were early attempts at printing by Indian
Buddhists as well. Indeed, Yi Jing, the Chinese scholar who visited
India in the seventh century, apparently encountered prints of
Buddhist images on silk and paper in India, but these were probably
rather primitive image blocks. A little earlier, Xuanzang is said to
have printed pictures of an Indian scholar (Bhadra) as he returned
to China from India. On this early history, see Needham, Science and
Civilization in China, Vol. 5, Part 1, pp. 148-149.
[12] Kieschnik, The Impact of Buddhism on Chinese Material Culture,
p. 164.
[13] Wm. Theodore de Bary, "Neo-Confucian Education," in Sources of
Chinese Tradition, compiled by Wm. Theodore de Bary and Irene Bloom
(Columbia University Press, second edition, 1999), Vol. 1, p. 820.
[14] From the translation of James Legge, The Travels of Fa-Hien or
Record of Buddhist Kingdoms (Patna: Eastern Book House, 1993), p. 79.
[15] Kerala has, however, been less successful in achieving a high
growth rate of gross domestic product through an expansive economy.
Its GDP growth is similar to the overall average of India and lower
than that of a number of more growth-oriented states in India. Even
though the World Bank's estimates have tended to show that Kerala,
in addition to its achievements in education and health care, has
had one of the fastest rates of reduction of income poverty in
India, it still has a lot to learn from China about ways to increase
economic growth. On these comparisons and the causal factors
underlying them, see my joint book with Jean Dreze, India:
Development and Participation (Oxford University Press, 2002),
Section 3.8, pp. 97-101.
<b>[16] I have discussed the casual factors underlying the phenomenon
of "missing women" in "More Than 100 Million Women Are Missing,"</b> The <b>(For Rajesh)</b>
New York Review, December 20, 1990; "Missing Women," British Medical
Journal, Vol. 304 (March 7, 1992); and "Missing Women Revisited,"
British Medical Journal, Vol. 327 (December 6, 2003). They also
discuss the economic, political, and social lessons from Kerala's
experience, including the reach of radical but democratic politics
and the role of education and the agency of women.
[17] On this see my "Population: Delusion and Reality," The New York
Review, September 22, 1994, and "Fertility and Coercion," University
of Chicago Law Review, Vol. 63 (Summer 1996).
[18] See National Bureau of Statistics of China, China Statistical
Yearbook 2003 (Beijing: China Statistics Press, 2003), Table 4-17,
p. 118. The Chinese big cities, in particular Shanghai and Beijing,
outmatch the state of Kerala, but most Chinese provinces have life
expectancy figures far lower than Kerala's.
[19] This connection is similar to the more prominent observation
that major famines do not occur in democracies, even when they are
very poor. On this, see my "How Is India Doing?" The New York
Review, December 16, 1982, and jointly with Jean Dr?, Hunger and
Public Action (Oxford: Clarendon Press, 1989). Large famines, which
continued to occur in British India right up to the end (the Bengal
famine of 1943 was just four years before India's independence),
disappeared abruptly with the establishment of a multiparty
democracy in India. In contrast, China had the largest famine in
recorded history during 1958-1961, when nearly 30 million people, it
is estimated, died.
[20] It is possible that the sharp increase of economic inequality
in recent years in China may have also contributed to the slowing
down of the progress in life expectancy. There has, in fact, been
some increase in economic inequality in India as well, though
nothing as large as in China; but it is interesting that the
increase in Indian inequality seems to have had a major part in the
defeat of the ruling government in New Delhi in the elections held
in May. Among the other factors contributing to the defeat was the
violation of the rights of the Muslim minority in the sectarian
riots in Gujarat. (It is of course to the credit of a deliberative
democratic system that majority voting can respond to the plight of
minorities.)
[21] Translation from Prabodh C. Bagchi, India and China: A Thousand
Years of Cultural Relations (Calcutta: Saraswat Library, revised
edition, 1981), p. 134.
[22] A longer essay on these themes will be included in a collection
of essays, The Argumentative Indian, to be published by Penguin
Books in London in early 2005. For helpful suggestions, I am most
grateful to Patricia Mirr-lees, J.K. Banthia, Homi Bhabha, Sugata
Bose, Nathan Glazer, Geoffrey Lloyd, Roderick MacFarquhar, Emma
Rothschild, Roel Sterckx, Sun Shuyun, and Rosie Vaughan.
The New York Review of Books: Passage to China
Volume 51, Number 19 · December 2, 2004
<b>Passage to China
By Amartya Sen</b>
6.
The connections between India and China in public health care are
both significant and little-known. After Fax-ian arrived in India in
401 AD, he took considerable interest in contemporary health
arrangements. He was particularly impressed by the civic facilities
for medical care in fifth-century Patna:
All the poor and destitute in the country...and all who are
diseased, go to these houses, and are provided with every kind of
help, and doctors examine their diseases. They get the food and
medicines which their cases require, and are made to feel at ease;
and when they are better, they go away of themselves.[14]
Whether or not this description was too flattering of the clinics in
fifth-century Patna (which seems very likely), what is striking is
Faxian's desire to learn from the provisions for public health in
the country he visited for a decade.
Two and half centuries later, Yi Jing also became interested in
health care, and he devoted to it three chapters of his book on
India. He was more impressed with Indian health practice than with
Indian medical knowledge. While giving India credit for some medical
treatments, mainly aimed at lessening pain and discomfort
(e.g., "ghee, oil, honey, or syrups give one relief from cold"), he
concluded, "In the healing arts of acupuncture and cautery and the
skill of feeling the pulse, China has never been surpassed [by
India]; the medicine for prolonging life is only found in China." On
the other hand, he wrote, there was much to learn from India about
health care: "The Indians use fine white cloth for straining water
and in China fine silk should be used," and "in China, people of the
present time eat fish and vegetables mostly uncooked; no Indians do
this." While Yi Jing returned to China pleased with his country of
origin (he even asked rhetorically: "Is there anyone, in the five
parts of India, who does not admire China?"), he still made a point
of evaluating what China could learn from India.
7.
Public health is a subject about which one country can learn from
another, and it should be clear that India today has much to learn
from China. Indeed, life expectancy has been longer in China than in
India for many decades. However, the history of progress in
extending life expectancy in the two countries tells a more
interesting story. Shortly after the revolution, Maoist China made
an early start in providing widespread health care, and there was
nothing comparable in India at the time. By 1979, when Deng
Xiaoping's economic reforms were first introduced, Chinese on
average lived fourteen years longer than Indians.
Then, after the economic reforms of 1979, the Chinese economy surged
ahead, growing much faster than India's. Despite China's much faster
economic growth, however, the average rate of increase in life
expectancy in India has, since 1979, been about three times as fast
as that in China. China's life expectancy is now about seventy-one
years, while India's is sixty-four years; the life-expectancy gap in
favor of China, which was fourteen years in 1979 (at the time of the
Chinese reforms), has now been halved to seven years.
Indeed, China's life expectancy of seventy-one years is now lower
than that in some parts of India, notably in the state of Kerala,
which, with its 30 million people, is larger than many countries;
Kerala has been particularly successful in combining Indian-style
multiparty democracy (including public debates and widespread
participation of citizens in public life) with improvements in
health through state initiatives of the type that China undertook
after the Revolution.[15] The advantage of that combination shows
itself not only in achievements in high life expectancy but also in
many other fields. For example, while the ratio of women to men in
the total population in China is only 0.94 and the Indian overall
average is 0.93, Kerala's ratio is 1.06, exactly the same as in
North America and Western Europe. This high ratio reflects the
survival advantages of women when they are not subjected to unequal
treatment.[16] The fall in the fertility rate of Kerala has also
been substantially faster than in China, despite China's coercive
birth-control policies.[17]
At the time of the Chinese reforms in 1979, life expectancy in
Kerala was sightly lower than in China. However between 1995 and
2000 (the last period for which firm figures for life expectancy in
India are available), Kerala's life expectancy of seventy-four years
was already significantly higher than China's last firm figure of
seventy-one years in 2000.[18]
Moreover, since the 1979 economic reforms, the infant mortality rate
in China has declined extremely slowly, whereas it has continued to
fall very rapidly in Kerala. At the time of the Chinese reforms in
1979 Kerala had roughly the same infant mortality rate as China-
thirty-seven per thousand. Its present rate is ten per thousand, a
third of China's thirty per thousand (which has not changed much
over the last decade).
Two factors, both of which bear on the issue of democracy, help to
explain the slackening of Chinese progress in prolonging life,
notwithstanding the positive effects of China's extremely rapid
economic growth. First, the reforms of 1979 largely eliminated free
public health insurance, and most citizens had to buy private health
insurance (except when it was provided by the employer, which
happens only in a small number of cases). This withdrawal of a
highly valued public service met with little political resistance -
as it undoubtedly would have in any multiparty democracy.
Second, democracy and political freedom are not only valuable in
themselves; they also make a direct contribution to public policy
(including health care) by bringing failures of social policy under
public scrutiny.[19] India offers high-quality medical facilities to
the relatively rich, including foreigners who come to India for
treatment, but the basic health services in India are poor, as we
know from the strong criticisms of them in the Indian press. But
intense criticism also provides opportunities to make amends. In
fact, the persistent reports on the deficiencies of Indian health
services, and the resulting efforts to improve them, have been a
source of India's strength, reflected in the sharp reduction in the
gap between China and India in life expectancy. This strength is
reflected as well in what Kerala has achieved by combining
democratic participation with radical social commitments. The link
between public communication and health care can also be seen in the
terrible effects of the secrecy surrounding the SARS epidemic in
China, which started in November 2002 but was kept secret until the
following spring.[20]
So while India has much to learn from China about economic policy
and also about health care, India's experience with public
communication and democracy could still be instructive for China. It
is worth recalling that the tradition of irreverence and defiance of
authority that came with Buddhism from India to China was singled
out for particularly strong criticism by the Chinese in the early
denunciations of Buddhism.
Fu-yi, a powerful Confucian leader, submitted in the seventh century
the following complaint about Buddhists to the Tang emperor. It has,
in fact, some similarity with the recent attacks on the Falun Gong:
Buddhism infiltrated into China from Central Asia, [in] a strange
and barbarous form, and as such, it was then less dangerous. But
since the Han period the Indian texts began to be translated into
Chinese. Their publicity began to adversely affect the faith of the
Princes and filial piety began to degenerate. The people began to
shave their heads and refused to bow their heads to the Princes and
their ancestors.[21]
Fu-yi proposed not only a ban on Buddhist preaching but a new way of
dealing with the "tens of thousands" of activists rampaging in
China. "I request you to get them married," Fu-yi advised the Tang
emperor, and "then bring up [their] children to fill the ranks of
your army." The emperor, we learn, refused to use this approach to
eliminating Buddhist defiance.
With stunning success, China has become a leader of the world
economy, and from this India-like many other countries-has been
learning a great deal, particularly in recent years. But the
achievements of democratic participation in India, including Kerala,
suggest that China, for its part, may also have something to learn
from India. Indeed, the history of China's attempts to overcome its
insularity-especially during the second half of the first millennium-
has continuing interest and practical usefulness for the world today.
[22]
Notes
[1] In spelling Chinese names in English, I am using the "pinyin"
system, which is now standard, even though the literature cited also
uses many other spellings. Faxian has also been referred to as Fa-
Hsien and Fa-hien; Xuanzang as Hiuan-tsang and Yuang Chwang; and Yi
Jing as I-tsing and I-Ching, among other variations.
[2] Two insightful recent books draw on Xuanzang's travels and their
continuing significance today: Richard Bernstein, Ultimate Journey:
Retracing the Path of an Ancient Buddhist Monk Who Crossed Asia in
Search of Enlightenment (Knopf, 2001), and Sun Shuyun, Ten Thousand
Miles Without a Cloud (HarperCollins, 2003).
[3] Joseph Needham, Science and Civilization in China, Vol. 2
(Cambridge University Press, 1956), p. 427.
[4] An interesting example of the transmission of mathematical ideas
and terms can be seen in the origin of the trigonometric
term "sine." In his Sanskrit mathematical treatise completed in 499
AD, Aryabhata used jya-ardha (Sanskrit for "chord half"), shortened
later into jya, for what we now call "sine." Arab mathematicians in
the eighth century transliterated the Sanskrit word jya into the
proximate sound of jiba and then later changed it to jaib (with the
same consonants as jiba), which is a good Arabic word, meaning a bay
or a cove, and it was this word that was later translated by
Gherardo of Cremona (circa 1150) into its equivalent Latin word for
a bay or a cove, viz., sinus, from which the modern term "sine" is
derived. See Howard Eves, An Introduction to the History of
Mathematics (Saunders, sixth edition, 1990), p. 237. Aryabhata's jya
was translated into Chinese as ming and was used in such tables as
yue jianliang ming, literally "sine of lunar intervals." See Jean-
Claude Martzloff, A History of Chinese Mathematics (Springer, 1997),
p. 100.
[5] See Needham, Science and Civilization in China, Vol. 3, p. 202;
see also pp. 12 and 37. A general account of Indian calendrical
systems is presented in my "India Through Its Calendars," The Little
Magazine, No. 1 (Delhi, 2000).
<b>[6] The term "Mandarin," from the Sanskrit word mantri, or special
adviser (the Indian prime minister is still called pradhan mantri,
or principal adviser), came much later, via Malaya.</b>
[7] John Kieschnick, The Impact of Buddhism on Chinese Material
Culture (Princeton University Press, 2003).
[8] Needham, Science and Civilization in China, Vol. 3, pp. 146-148.
[9] Martzloff, A History of Chinese Mathematics, p. 90.
[10] Apart from other reasons, John Kieschnick points to "the
ephemerality of palm leaves and birch bark" on which "most writings
in ancient India were inscribed"; see The Impact of Buddhism on
Chinese Material Culture, p. 166.
[11] It appears that there were early attempts at printing by Indian
Buddhists as well. Indeed, Yi Jing, the Chinese scholar who visited
India in the seventh century, apparently encountered prints of
Buddhist images on silk and paper in India, but these were probably
rather primitive image blocks. A little earlier, Xuanzang is said to
have printed pictures of an Indian scholar (Bhadra) as he returned
to China from India. On this early history, see Needham, Science and
Civilization in China, Vol. 5, Part 1, pp. 148-149.
[12] Kieschnik, The Impact of Buddhism on Chinese Material Culture,
p. 164.
[13] Wm. Theodore de Bary, "Neo-Confucian Education," in Sources of
Chinese Tradition, compiled by Wm. Theodore de Bary and Irene Bloom
(Columbia University Press, second edition, 1999), Vol. 1, p. 820.
[14] From the translation of James Legge, The Travels of Fa-Hien or
Record of Buddhist Kingdoms (Patna: Eastern Book House, 1993), p. 79.
[15] Kerala has, however, been less successful in achieving a high
growth rate of gross domestic product through an expansive economy.
Its GDP growth is similar to the overall average of India and lower
than that of a number of more growth-oriented states in India. Even
though the World Bank's estimates have tended to show that Kerala,
in addition to its achievements in education and health care, has
had one of the fastest rates of reduction of income poverty in
India, it still has a lot to learn from China about ways to increase
economic growth. On these comparisons and the causal factors
underlying them, see my joint book with Jean Dreze, India:
Development and Participation (Oxford University Press, 2002),
Section 3.8, pp. 97-101.
<b>[16] I have discussed the casual factors underlying the phenomenon
of "missing women" in "More Than 100 Million Women Are Missing,"</b> The <b>(For Rajesh)</b>
New York Review, December 20, 1990; "Missing Women," British Medical
Journal, Vol. 304 (March 7, 1992); and "Missing Women Revisited,"
British Medical Journal, Vol. 327 (December 6, 2003). They also
discuss the economic, political, and social lessons from Kerala's
experience, including the reach of radical but democratic politics
and the role of education and the agency of women.
[17] On this see my "Population: Delusion and Reality," The New York
Review, September 22, 1994, and "Fertility and Coercion," University
of Chicago Law Review, Vol. 63 (Summer 1996).
[18] See National Bureau of Statistics of China, China Statistical
Yearbook 2003 (Beijing: China Statistics Press, 2003), Table 4-17,
p. 118. The Chinese big cities, in particular Shanghai and Beijing,
outmatch the state of Kerala, but most Chinese provinces have life
expectancy figures far lower than Kerala's.
[19] This connection is similar to the more prominent observation
that major famines do not occur in democracies, even when they are
very poor. On this, see my "How Is India Doing?" The New York
Review, December 16, 1982, and jointly with Jean Dr?, Hunger and
Public Action (Oxford: Clarendon Press, 1989). Large famines, which
continued to occur in British India right up to the end (the Bengal
famine of 1943 was just four years before India's independence),
disappeared abruptly with the establishment of a multiparty
democracy in India. In contrast, China had the largest famine in
recorded history during 1958-1961, when nearly 30 million people, it
is estimated, died.
[20] It is possible that the sharp increase of economic inequality
in recent years in China may have also contributed to the slowing
down of the progress in life expectancy. There has, in fact, been
some increase in economic inequality in India as well, though
nothing as large as in China; but it is interesting that the
increase in Indian inequality seems to have had a major part in the
defeat of the ruling government in New Delhi in the elections held
in May. Among the other factors contributing to the defeat was the
violation of the rights of the Muslim minority in the sectarian
riots in Gujarat. (It is of course to the credit of a deliberative
democratic system that majority voting can respond to the plight of
minorities.)
[21] Translation from Prabodh C. Bagchi, India and China: A Thousand
Years of Cultural Relations (Calcutta: Saraswat Library, revised
edition, 1981), p. 134.
[22] A longer essay on these themes will be included in a collection
of essays, The Argumentative Indian, to be published by Penguin
Books in London in early 2005. For helpful suggestions, I am most
grateful to Patricia Mirr-lees, J.K. Banthia, Homi Bhabha, Sugata
Bose, Nathan Glazer, Geoffrey Lloyd, Roderick MacFarquhar, Emma
Rothschild, Roel Sterckx, Sun Shuyun, and Rosie Vaughan.