Ashok Kotwal interviews Jean Drèze in Ideas for India.
My paper with Aashish, “Health externalities of India’s expansion of coal plants: Evidence from a national panel of 40,000 households,” is now available open access at JEEM at this link. Here’s the abstract:
Coal power generation is expanding rapidly in India and other developing countries. In addition to consequences for climate change, present-day health externalities may also substantially increase the social cost of coal. Health consequences of air pollution have proven important in studies of developed countries, but, despite clear importance, similarly well-identified estimates are less available for developing countries, and no estimates exist for the important case of coal in India. We exploit panel data on Indian households, matched to local changes in exposure to coal plants. Increased exposure to coal plants is associated with worse respiratory health. Consistent with a causal mechanism, the effect is specific: no effect is seen on diarrhea or fever, and no effect on respiratory health is seen of new non-coal plants. Our result is not due to endogenous avoidance behavior, or to differential trends in determinants of respiratory health, either before the period studied or simultaneously.
You should also check out Kelsey Jack’s overview paper in the same issue on “Environmental economics in developing countries.”
In most countries around the world, marital rape may be prosecuted (see box 11 on page 113 of this UN report). But in India, marital rape is not classified as a crime. Recently the Government of India filed an affidavit in the Supreme Court in support of keeping things the way they are: criminalizing marital rape, the Government reasons, would “destabilize the institution of marriage, apart from being an easy tool for harassing husbands.”
Understanding the consequences of legally permitting marital rape requires, in part, understanding whether it is common or rare. As writers and experts have reacted to the Government’s statement this week, they have often cited one of the few population-level statistical studies of this question: “Reporting and incidence of violence against women in India,” by r.i.c.e.’s Aashish Gupta. Aashish summarizes:
Using data from the National Crime Records Bureau and the National Family Health Surveys, this article estimates, conservatively, the under-reporting of violence against women in India. I calculate under-reporting of sexual and physical violence, both for violence committed by “men other than survivor’s husband” and violence committed by husbands. In 2005, only about six of every hundred incidents of sexual violence committed by “men other than the survivor’s husband” are estimated to be reported to the police. Most incidents of sexual violence, however, were committed by husbands of the survivors: the number of women who experienced sexual violence by husbands was forty times the number of women who experienced sexual violence by non-intimate perpetrators. Less than 1% of the incidents of sexual violence by husbands were reported to the police. Similarly, only about 1% of the incidents of physical violence by other men, and 2% of the incidents of physical violence by husbands were reported. These striking findings shed further light on the presence of endemic violence against women in India, and reveal the extent of the obstacles confronted by women in reporting violence.
This research was originally discussed in 2015 in an op-ed in The Hindu by Aashish and Kanika Sharma. This week it has again been widely reported and discussed:
- “Statistically, Nearly All The Sexual Violence Indian Women Experience Is Within The Marriage” by Rukmini in the Huffington Post.
- “Government’s refusal to criminalize marital rape is unjust, inconsistent” by Roshan Kishore at Mint.
- “Indian government files legal papers to try to stop marital rape being outlawed” by Ben Kentish at the Independent.
Aashish’s research used India’s most recent Demographic and Health Survey for which data have been released. But those data are from 2005-2006. Sexual violence is yet one more topic on which badly needed understanding is obstructed by India’s enduring bipartisan opposition to what, in other comparable countries, counts as minimally adequate demographic data collection and transparent public release.
The book and the SQUAT survey are both quoted in an article in the Asia section of this week’s issue of The Economist: “Indian officials are humiliating people who defecate outdoors: Building lots of toilets does not guarantee they will be used.”
The subtitle is, of course, a point we have emphasized repeatedly here on the r.i.c.e. blog. The main title is something we perhaps have not talked enough about. There have been reports of not only humiliation but even some cases of violence in efforts to get people to use latrines. In our own fieldwork we have met people who have told us that local government officials have threatened to take away their ration cards if they do not comply with the SBM. It is no surprise that the victims are often low-ranking people in socially excluded groups.
One of the issues we raise in the book is that bad consequences are predictable when states try to get people to do something that they do not want to do — especially in large programs designed by socially distant administrators in physically distant capitals. This suggests the question of whether the benefits are worth the costs. Of course, open defecation has many bad consequences, too. Conceptually, the solution is a modest focus on finding ways to encourage people to want to use latrines (by addressing the reasons they do not); in practice that is difficult. An ambitious public goal of eliminating open defecation quickly may have some motivational benefits, but these must be weighed against the costs of eliminating the political space for learning and for navigating the subtleties of changing many people’s behavior without abusing the state’s ability to coerce.
In homage to the people who posted photos of On What Matters on top of things, a post on Where India Goes has been the past few days. I won’t start by commenting on the “subtle art” of book curation that must have inspired the shopkeeper who arranged the store in the photo.
A reader has sent me a photo of Where India Goes alongside a newspaper article on a sanitation strike:
Where India Goes went to Azim Premji University on Thursday, where a great groups of students asked insightful questions:
And Where India Goes went to a dance party and a shopping mall in Gurgaon on Friday — and then to the entertainment section:
Where India Goes is back in the Kindle store. I know that some of you pre-ordered the book for Kindle, only to have it mysteriously canceled the other day when it was supposed to be delivered. In fact, that happened to me, too. I’m sorry about that. I wrote the publisher, and they assure me that it is fixed.
You can also get a free Kindle sample that includes Professor Deaton’s foreword and the first few pages of chapter one. I successfully ordered it and had it delivered yesterday.
Thank you, also, to the India Human Development Survey for featuring Where India Goes in its recent IHDS newsletter. Many analyses in the book would not have been possible without the IHDS.
We are delighted to announce that a grant window — in partnership with 3ie and the WASH team at the Gates Foundation — is now open for projects that can help us learn about how to promote the use of affordable pit latrines in rural India! The Indian government, in its Swacch Bharat Mission, has announced plans to build about 100 million latrines throughout rural India. This project is about finding ways to encourage people to use these latrines — strategies that build upon what is now known and being better understood about the social forces of caste, purity, pollution, and untouchability that prevent people from using and emptying normal latrine pits, and strategies that are affordable under the behavior change budget that is in principle allocated alongside the SBM latrine construction.
We are especially interested in interdisciplinary teams of social scientists, sanitation experts, and others all working together: perhaps an epidemiologist expert on sanitation, a sociologist familiar with the norms of caste in Indian villages, and an implementing organization with experience in making projects like this happen. Our goal is to fund several projects at the same time so that we can compare and contrast what different teams are learning in different places with different strategies. Importantly, we are including funding for qualitative fieldwork, both in the design of the particular interventions and in the final research.
Open defecation in rural India is a large and special human development challenge, so it is important that the opportunity presented by the latrine construction of the SBM be put to the best possible use. Exploring various suggestions about how to do this is what this grant window is all about. Please apply!
Two pieces of news today. First, a new paper in PNAS by Francis Dennig, Mark Budolfson, Marc Fleurbaey, Asher Siebert, and Robert H. Socolow: Inequality, climate impacts on the future poor, and carbon prices. It is available for free at that link.
Economists use computer models to figure out how policy today should optimally take into consideration the threat of climate change making people worse off in the future: it’s obvious that we should reduce our carbon emissions, but by how much? How much of the economic benefit that people enjoy today should be sacrificed to prevent harm in the future?
What Dennig and coauthors realized is that the leading models of climate policy treat everybody living in a place the same way, and therefore don’t incorporate the likelihood that climate change could hurt poor people most. If it is true that climate change will hurt the poor the most, they show, then governments today should be doing even a lot more to prevent climate change than we thought.
The second is a piece of mine published today in Business Standard: Preventing climate change is pro-poor. I review a recent book published by the World Bank — Shock Waves: Managing the Impact of Climate Change on Policy by Stephane Hallegatte and coauthors (that’s a link to a PDF of the whole book) — with special attention to policy in India.
I’ll post my review below, but first I wanted to ask readers a question about this article in today’s New York Times: Beijing, With Red Alert for Smog in Full Force, Closes Schools and Limits Traffic. Evidently Beijing is essentially shut down with an air quality index of 308. That number is awful, and a serious response is appropriate. But since we at r.i.c.e. got our own air quality monitors and started measuring, we have found worse air quality here in Delhi routinely and in our house. Although our meter is elsewhere, on an air quality measurement yatra, I don’t doubt that is true today, too. My question is: why are powerful people in Delhi, whose families cannot be protected from this harm, not responding in democratic India with the same outrage now seen in China?
Preventing climate change is an economic priority for India’s poor
In some circles in India, the World Bank has a bad reputation for acting in the name of the poor, but in the service of the global business elite. Anyone who believes that this is always the case should read the important new book Shock Waves, by Stephane Hallegatte and coauthors, published by the World Bank and freely available online. Shock Waves establishes an urgent thesis: preventing destructive climate change is a policy priority for the world’s poor. The world’s progress against poverty would be seriously set back by climate change — which is likely to hurt the poor most. Reducing the chances of a climate disaster is both feasible and pro-poor, and can be done without sacrificing human development.
In a world where opposition to preventing climate change is closely tied to business interests, some readers may be surprised to read a prominent book by international economists arguing that “the key finding of the report is that climate change represents a significant obstacle to the sustained eradication of poverty, but future impacts on poverty are determined by policy choices.” But this should be no surprise, because the economics is clear. Shock Waves is valuable for its careful compilation of this evidence, especially on two points.
First, climate change will hurt the world’s poor people and the world’s fight against poverty. “Ending poverty will not be possible if climate change and its effects on poor people are not accounted for and managed in development and poverty-reduction policies.” Poor people are vulnerable to natural disasters and to the heat. Climate change will hurt the health and economic productivity of the poor much more than it will hurt a computer worker in an air conditioned office.
Second, there is no essential trade-off between preventing climate change and alleviating poverty: “Many recent studies support the idea that providing those who are currently extremely poor with access to basic services would not jeopardize climate mitigation.” Part of this is because achieving human development outcomes are not first and foremost about spending money — as is demonstrated in the terrible gap between India’s economic growth and its infant health.
Some people worry that India cannot afford to contribute to avoiding climate change, and it is certainly right to be concerned about achieving human development in India. India lags behind its regional neighbors and other poorer countries on many important measures of human development: neonatal mortality, open defecation, maternal nutrition, child stunting. But GDP growth through building more coal plants is not the way to solve these problems, as demonstrated by the simple fact that so many poorer countries do so much better than India on these measures. To be sure, long run economic growth in India requires energy, and preventing climate change will raise the money price of that energy. However, economists have taken this into consideration when they conclude that, all things considered, carbon-intensive fuels are more expensive when all costs are counted for all Indians, especially future Indians and today’s poor.
Fueling growth through burning coal or other carbon-intensive strategies does not make economic sense. Of course, coal costs less money than other energy options to the people who buy it, but this ignores costs imposed on other people. The first lesson on the first day of the introductory economics class that I teach policy students is that public “costs” do not just mean money — they means everything that society sacrifices.
Any economics textbook would agree: not all costs are money. If India is going to avoid climate change that is going to hurt all future Indians — especially the poor — then its policy makers must consider the full social costs of burning coal — not just the money costs paid by businesses and some people. As Shock Waves shows, doing so is feasible, is pro-poor, and makes economic sense.
Switching away from coal would eventually cost Indians less suffering overall, but it would cost more money in the short run. Shock Waves is clear on this point, too: it is entirely appropriate that such money costs should be borne by richer people rather than poorer people within developing countries, and mainly by people in richer countries. But there is no international government that can force such cost-sharing, and unfortunately the average person in India will be hurt much more than the average person in North America if such an international deal does not occur.
So, successfully negotiating such a deal takes us out of the clarity of the economics of climate change and into politics. If India were to be a leader in a serious international coalition involving the rest of the world, perhaps politicians and business interests in the U.S. could be compelled to cooperate. For example, it is possible that an international trade regime, with India among its leaders, that uses tariffs to punish polluting countries outside of the coalition could be successful. But assembling this coalition may require demonstrating a willingness to make reasonable and appropriate domestic emissions cuts.
Shock Waves does not consider the politics of such an agreement. It sticks to the unambiguous conclusions of public economics: climate change would be a disaster for India’s poor. These are real social and economic costs, which no policy maker pursuing the public interest can ignore, or attempt to conflate with the money costs to some private individuals or business.
Perhaps as much as any in other large country, it is in the people of India’s interest that climate change be averted. This can be done without derailing human development priorities, and should and could be relatively easily funded by the world’s rich, some of whom are also India’s rich. This would require a smart and ethical global deal, if politicians can reach it. India’s leaders have the power to hurt the whole world by obstructing such a deal — but doing so may well hurt future poor people in India most of all.
Today the Indian Express published my op-ed: Question from a future India. The question I imagine is from the future Indians who will be so profoundly impacted by the decisions at this week’s climate summit in Paris: who was politically representing them?
The science of climate change is unambiguous. So is the public economics: carbon emissions have terrible social costs, and these externalities should be reflected in price. The only question is the politics.
A climate summit like this week’s in Paris emphasizes the international dimension of climate politics. But, as philosopher Stephen Gardiner has emphasized, this obscures two other dimensions of climate politics. The first is within countries, such as between the Democratic U.S. presidents and Republican U.S. legislatures which demography tells us we can expect for much of the coming years of crucial climate politics. Or, between richer metropolitan Indians with air conditioners and airplane flights and poorer Indians with inadequate electricity and high infant mortality.
The second dimension of climate politics that an international summit obscures is perhaps the most important, and is the focus of my op-ed: the relatively few people in the present generation against the (I hope) many, many people of future generations. They have no political power of any kind. There is nothing that people who will be born in 2115 can do to reward or punish today’s politically powerful people. Yet, they are profoundly at our generation’s mercy. It is difficult to imagine an inequality of power that has ever existed that has been so imbalanced, for so many people, of such importance. Humanity has characteristically failed quite badly at much less lopsided cases.
One point that I emphasize in my op-ed is that, perhaps as much as for any other 2015 country, it is especially important to future Indians to avert or reduce climate change. Climate change will hit India hard.
Here are some links behind some of the claims in the literature that I mention in the op-ed:
- For a worst case scenario, this paper discusses how much of the world (and their maps include much of India) could become very difficult for humans to live in if temperature change is large.
- The recent World Bank book Shock Waves, available for free as a PDF online, emphasizes the message from the economics literature that, in more moderate climate change scenarios, the poor will suffer considerably.
- William Nordhaus’ discussion of climate clubs presents a strategy whereby trade policy could be used to incentivize the U.S. to limit emissions. I am surprised that his figure of U.S. mitigation costs is so low ($11.9 billion), but the general points that a smart political alliance might be able to accomplish something like this — and that India is made better off in every scenario — are important.
The full text of the op-ed is below the link.
This week, Economic and Political Weekly published my review of Joshua Greene’s book Moral Tribes. The review begins by considering the arguments Greene makes for the implications of moral psychology for ethics: perhaps many of our ethical intuitions are as psychological explicable as our faulty responses to optical illusions (such as the one pictured) and are equally (un)creditworthy.
I then consider the special implications of Greene’s research for India. Part of Greene’s argument is that we should expect people to have a posture of automatic cooperation with people whom they consider fellow members of an in-group, but not with people whom they consider to be part of an out-group. Perhaps, because India is so thoroughly socially partitioned by caste, religion, gender, age, and hierarchical rank of all types, this psychological research gives reason to expect that many people’s automatic moral intuitions may be less cooperative or charitable in India, on average, than in less fragmented societies. The exact same moral psychology could produce a different outcome if exposed to a different level of social fragmentation.
Beyond its implications for India, Greene’s project has considerable significance for some of the most important issues of our times. For example (as Greene is certainly not the first to note) climate change may not tug at our emotions because many of the people who will suffer most will live decades or centuries from now, perhaps in different places (or, never have the chance to be born at all). But that is no argument that their well-being should not be taken into consideration.
You can read my review here, on the r.i.c.e. research page.
Diane and I just finished teaching a weeklong workshop at the Indian Statistical Institute in Delhi, where we taught about how to write empirical papers using demographic datasets in Stata. In particular, we focused on demographic decomposition techniques as a transparent way to write about interesting and important empirical facts. This sort of paper embraces paradoxes, puzzles, and otherwise messy correlations.
As part of the course, I made this model do file that collected what the class learned. In case it is of use to you, I thought to post it here online. You can modify the program to help write your own decomposition paper.
The do file made the graph included with this blog post. The motivating example is to use Bangladeshi DHS data to ask how much of the difference in average child height between rural and urban Bangladesh can be accounted for by differences in mothers’ education.
In the preface to his magisterial 2013 book The Great Escape, Angus Deaton thanks his teachers. “Richard Stone was perhaps my most profound influence,” Deaton writes, “from him I learned about measurement – how little we can say without it and how important it is to get it right.”
Important, indeed. And difficult – but well worth doing. On Monday afternoon, the Nobel committee recognized the importance of measurement when they awarded Professor Deaton the 2015 Nobel Prize in economics.
We know what it feels like to owe much to a special teacher. Professor Deaton passed Stone’s lesson on to his own students, including us. Deaton’s career has been wide ranging. Most recently, he has helped the world understand its ongoing, incomplete, but nonetheless dramatic great escape from poverty and early death. When Angus was born in Scotland, around 6 percent of babies there died before their first birthday; today, this infant mortality is under half of one percent. But over 4 percent of babies born in India still die in their first year, and the infant mortality rate among the many babies born in the northern plains states exceeds that of Scotland 69 years ago. Fully 8 percent of children die in infancy who are born in Sitapur district of Uttar Pradesh, where we have worked since 2011 and where the population is 85 percent as large as Scotland’s today.
One important part of Deaton’s research over the last decades has focused on poverty and well-being in India. In this work, he has been resolutely empirical: he focuses on what the data can tell us, and what they sometimes cannot. The paradoxes of development in India have been fertile ground for Deaton’s data-minded approach. India is a place where good things do not always come together, and where conventional development stories are often inverted.
Despite rapid economic growth, and significant but slower improvements in poverty, children in India are shorter, on average, than children in sub-Saharan Africa, who are poorer. As Indian households have become richer over the past decades, they have eaten fewer and fewer calories, on average – a puzzle seemingly at odds with the basic rules of household economics. In some of his most recent work, Deaton has shown that poor people in Africa, where health outcomes are very bad, do not tend to see improving health as a policy priority – a puzzle that may be reflected in Delhi’s apathy to its lethal air pollution. Such paradoxes, Deaton taught us, are opportunities to learn something important.
This all adds up to a central message of Deaton’s work: that becoming richer is not necessarily the same thing as becoming better off. This, too, is an important lesson for India, where infant mortality and other basic measures of human development are considerably worse than what other countries with similar levels of GDP per capita experience. Indeed, India’s “excess” neonatal mortality – above what its per capita GDP would predict in international comparison – is greater than total neonatal mortality in China.
Professor Deaton was working on what is now called “evidence-based policy” before it was a hot topic: in the 1990s he published definitive work helping researchers sort out how to use household surveys to measure consumption in poverty. But notice what he includes in “evidence”: careful, statistical descriptions based on survey data designed to be informative about populations. Angus reminds economists – and, still, us – that there is no substitute for such careful thinking.
Nor is there a substitute for usefully designed, representative survey data. Perhaps such data were part of what drew Deaton’s focus to India. India historically had a long tradition of outstanding sample surveys, which Deaton has drawn upon again and again to teach India and the world about the well-being of individuals in the country that represents a large fraction of any international statistic.
Some of our own work built upon Angus’ surprising observation that GDP is uncorrelated with height across developing countries, in Demographic and Health Survey (DHS) data.But Deaton, the 2015 Nobel laureate, has never written a paper about the height of people in India using data collected since 2005. We are sure that he would love to, and that it would teach the world important things about well-being in India, but no new DHS has been released for India in the past decade. The government has not collected it. Yet, in this same time period, Bangladesh has released two DHSs. The meager data that are eventually released in today’s India, such as the Rapid Survey of Children, are often made publicly available only as summary statistics of averages, not household level data; Deaton helped economists realize that such aggregated numbers overlook inequality and obscure details of household behavior.
India has slowly transformed from a world leader in the availability of survey data to a place where meaningful statistics simply are not available. These days, nobody really knows the height of India’s children, or how much weight the average woman gains in pregnancy, or what fraction of people in rural India defecate in the open. The dimming of the historical light of Indian statistics matters for the world: one-fifth of all humans are born here.
As Deaton’s most recent work in development reminds us, development economics has political implications. Credible, independent data are critical not only for research, but for democracy. As Deaton noted in his Princeton University press conference on Monday afternoon, government choices not to collect or release data often reflect vested interests.
Deaton’s work shows that useful measurement of well-being in India is not only possible – it is practical and informative. It is indispensible. As we congratulate Professor Deaton on this deserved honor, we should remember that somewhere an economics student in India is now beginning a career in which she could make Nobel prize-worthy contributions to the well-being of the next generation of Indians. India should make sure that she has the data she will need to do this work. She, too, can say little without measurement.
Everyone concerned about the prospects of the Swachh Bharat Mission should check out this new paper in BMC Public Health by lead author Parimita Routray and some of the top thinkers in sanitation, available at this link here:
They reach many of the same conclusions as our team did in our qualitative study that we did around the same time as the SQUAT report. In particular, they argue that government latrine construction programs that fail to take into consideration culturally-influenced constraints on demand for latrine use are unlikely to be enough to importantly reduce open defecation:
I am particularly delighted to see the call for more efforts to understand these issues. We don’t know enough yet as a sector about how precisely we can design a rural sanitation effort around these issues that can succeed.
One way that this paper contributes to understanding the culture of purity and pollution around rural sanitation is by documenting how, in the population they study, defecation rituals differ across caste categories and ranks, and within these for men and women. In a detailed table that crosses caste rank by sex and age, they describe, for example, that Brahmin men (the highest castes) wear a special garment to defecate in the open: “This cloth is usually kept outside the living area, away from the main house and away from the reach of children and adults, so that no one touches it.” About high-caste women, they write “For those with latrines, stepping over the squatting pan is considered chuan (i.e. getting impure) and both the body and clothes worn get impure. They are forbidden from entering the house wearing impure clothes.” These rules, the authors describe, do not necessarily apply in the same way to lower castes. But, in so far as people in lower castes aspire to be socially higher ranking, they often seek to emulate the practices of higher castes. One memorable description of this practice is in Valmiki’s Joothan, where the author recounts his regret at neighboring dalits’ abandonment of pig raising — an important economic activity for their livelihood — in an attempt at social mobility.
One aspect of the paper that surprised me was the emphasis on access to water as a binding constraint and solution to the impurities of open defecation. There is a similar conclusion in a recent NBER economics working paper about health effects of sanitation, focusing on the same part of India, rural Orissa — it is also well worth reading. One reason this surprises me is that water is not a constraint that people describe as important in north India, where we have done most of our field research. Another is that in a range of national and international data sources, water doesn’t seem to correlate much with open defecation (that’s an evolving work in progress). Many data sources show that Muslims in India have less access to piped water but are less likely to defecate in the open. Other countries with much worse access to water have much less open defecation, so if improving water access would play a special role in reducing open defecation in rural India it would indeed be a special role, different from what the same intervention would do in other countries and cultural contexts.
But, different places are different, even (especially!) within India. According to the new 2012 IHDS data, 95% of households in rural Uttar Pradesh and 97% of rural Bihar report as their main water source public piped water, a tube well, or a hand pump. In these very large states, about 80% of households with such improved water report defecating in the open. Only 75% of households in rural Orissa report similarly good water supply: 20% of households there report getting water from an open well, compared with less than 5% in rural Uttar Pradesh. So, maybe the water constraints are different.
What strikes me as most important is that the consequences of purity and pollution are so much the same. To me, all of this calls for even more active hands-on work to test out solutions carefully designed — as this important new paper calls for — around the implications of purity and pollution for open defecation in rural India.
Diane got bit by a dog a little the other day. She’s really quite fine, it was nothing. There is every reason to believe this dog doesn’t have rabies, but we decided to get Diane the post-exposure prophylaxis (she already had the pre shots, so she only needed the two follow-up shots). Things have much progressed from the horrifying shots into the belly that I remember seeing pictures of in a library as a little boy: now it is just a shot in the arm.
Surprisinly often, people tell me that we shouldn’t be complaining about the improbability of India’s Swatch Bharat Mission eliminating open defecation in the next 4.5 years, because the government has formulated such perfect, optimal guidelines. But I’m increasingly persuaded that writing optimal guidelines is a deeply suboptimal approach: instead, we should be attempting to design robust policies, doing our very best to admit challenges at the outset and design systems to fail well and to achieve something valuable in a wide range of realistic scenarios.
Anyway, apparently both nurses, at two separate facilities, very much wanted to give Diane her rabies shot in what the WHO guidelines delicately call the gluteal region. It turns out, this is not what you are supposed to do; luckily, Diane was able to persuade both to go for her arm instead.
But there is a point to the story, which is that it turns out the Ministry of Healthy and Family Welfare of the Government of India has written optimal guidelines for rabies vaccine, and these guidelines are well aware of this rule (page 13). Problem solved! The rest is just implementation — which I guess is someone else’s problem. How much more energy, time, attention, and other resources should the development business be pouring into fancy conferences and prestigious careers, spent supporting the government’s recycling of optimal lists of rules?
This afternoon in Washington DC, IFPRI will release its new 2014-2015 Global Food Policy Report. The report covers an impressive range of important topics. Among them, is a chapter that I was honored to be asked to contribute, in collaboration with Lawrence Haddad: our chapter reviews the accumulating new evidence for the old observation that sanitation policy can be — and should be — part of nutrition policy.
Much of the new evidence that has emerged in the last year or so is from careful observational studies, such as Derek Headey and John Hoddinott’s work about Nepal, or Audrie Lin and coauthors in Bangladesh. But a new — and surprising large — set of intervention studies is also emerging.
One of the central points of our chapter is a reflection on a special challenge for intervention studies: you can only learn about the anthropometric consequences of a change in open defecation if you succeed in changing open defecation. That is what the arrow diagram above is about: even if all you care about is the “second stage” effect of open defecation on child height, your ability to learn about it depends on your ability to achieve a “first stage” effect on open defecation. Put bluntly, we would learn nothing about the effect of open defecation on child height from not changing open defecation.
This matters because we wouldn’t expect the effect of open defecation on child height to be the same everywhere: unsurprisingly, the association between open defecation and child height is steeper where population density is greater, on average. But open defecation is very dense in India, a place where changing “first stage” open defecation behavior has proven very difficult. As a result, the evidence collectively available from everybody’s intervention research may systematically miss the places where the effect of open defecation on nutrition will be most important.
One useful recent paper takes this “first stage” problem seriously. Paul Gertler, Manisha Shah, Maria Laura Alzua, Lisa Cameron, Sebastian Martinez, and Sumeet Patil have combined data from three field experiments to construct an “Instrumental Variables” estimate of the effect of open defecation on child height. Such an approach takes into consideration the first stage effect of an intervention on sanitation behavior. (We didn’t include it in our IFPRI chapter because the paper wasn’t out yet.)
Their average results combine three experiments, from India, Mali, and Indonesia. Although we should keep in mind that we might actually expect the effect to be different in these different places, it is still important to note their summary estimate: a village switching from everybody defecating in the open to nobody defecating in the open would make children about 0.44 height-for-age points taller. This is strikingly similar to the 0.45 effect size necessary for open defecation to completely statistically account for the India-Africa average child height gap. Of course, we shouldn’t take any of these numbers too literally (for example, there are differences in population density and rural or urban settings), but the point is that their method uses randomized data to produce an effect that is big and important, and very closely matching what we see in population level data.
Yet, as our chapter concludes, the best solution to the problem of weak first stages is to get serious about learning how to change open defecation behavior in rural India!
I’m often asked why I work in India rather than other places. When I answer that it is substantially because there are so many people here, people sometimes react as though that is bafflingly irrelevant.
I’m thinking of this today because I have been editing our paper that uses joint rural households to identify an effect of women’s social status and empowerment on their children’s health (that old draft will be replaced soon, with any luck). This is a very important question: many development programs are built on the belief that empowering moms is a good way to improve their children’s outcomes, but it turns out to be very difficult to conclusively show.
In our paper, we were resisting the urge to apologize and wring our hands over the fact that, of course, not every Indian child lives an a joint rural household. We are zooming in on a special case that we think we can learn from. However, I stopped feeling apologetic when I realized that the number of children under 5 living in joint rural households in India is over 7 million — approximately the total number of people of all ages living in Diane’s and my home states of Connecticut and Oklahoma, combined.
Diane Coffey‘s new article “Prepregnancy body mass and weight gain during pregnancy in India and sub-Saharan Africa” was published today in the Proceedings of the National Academy of Sciences. Diane’s article is important because it shows that maternal nutrition in India is even worse than previously believed: 42.2 percent of women who become pregnant are underweight in India, compared with 16.5 percent in Africa. Weight gain in pregnancy is too low in both India and Africa, but the result is that women in India end pregnancy weighing less, on average, than women in Africa do when they begin pregnancy. “In India, young newly married women are at the bottom of household hierarchies,” Diane said to Gardiner Harris of the New York Times. “So at the same time that Indian women become pregnant, they are often expected to keep quiet, work hard and eat little.” Check out more coverage of this research:
- “Study says pregnant women in India are gravely underweight.” New York Times.
- The Hindu
- “Maternal Health in India Much Worse than Previously Thought.” Princeton University’s Woodrow Wilson School.
- “Maternal health in India worse than sub-Saharan Africa.” Business Standard.
check out Diane’s recent note summarizing our field research on the exceptional persistence of open defecation in rural India, online at the CLTS knowledge hub. As she writes, uncomfortable conversations about sanitation policy are going to be necessary if we are going to prevent many deaths and stunted lives.
I’ll paste it below. The concerns he raises have been at the front of our minds here at r.i.c.e. – alas, we see that “the control of infectious disease” made his list of domains in which policy-making appears disconnected from evidence.
Perhaps there is little reason to be surprised at all of this. Yet, it stands in glaring contrast to the stories we tell ourselves, especially in international development after the evidence revolution. We write about our policy impact if we are grant recipients, or we request reports if we are donors, and we all convene to talk about it six times a year. These expenses – and livelihood choices – are surely well-justified if evidence is changing policy to improve or even save lives (even if the effects are uncertain). But if not, we should think deeply about Krugman’s observations.
Krugman highlights one candidate explanation from politics: many political actors reason backwards to their beliefs from their policy convictions, and many of these convictions favor the privileged. It is not difficult to find cases which are surely just that.
But this cannot be the whole story. While Krugman focuses on the cases where the evidence is unambiguous, I think we also learn something important from the cases where evidence is incomplete. Sometimes, based on the evidence, the right answer is “I don’t know.” But that is no way to get promoted, to get your next grant, or to impress your government contact. You have to say something, and once you say something, you are likely to stick with it. I was in a meeting recently which came to a crashing halt when I made the social blunder of explaining that, despite having been thinking about open defecation in rural India for most of the last three years, I have often been wrong, and I now have essentially no certainty about how to stop rural open defecation in India on a large scale.
I like to make the comparison with HIV/AIDS research in the mid 1980s, the period covered in And the Band Played On. Researchers knew a lot of things, but they did not know as much as is now known about how to treat AIDS. Humanity would not have been served by pretending that AIDS then was a solved problem. Of course, Krugman would surely point out that the ups and downs of that story were not only about career and institutional incentives – broader politics mattered then, too.
It’s now official: 2014 was the warmest year on record. You might expect this to be a politically important milestone. After all, climate change deniers have long used the blip of 1998 — an unusually hot year, mainly due to an upwelling of warm water in the Pacific — to claim that the planet has stopped warming. This claim involves a complete misunderstanding of how one goes about identifying underlying trends. (Hint: Don’t cherry-pick your observations.) But now even that bogus argument has collapsed. So will the deniers now concede that climate change is real?
Of course not. Evidence doesn’t matter for the “debate” over climate policy, where I put scare quotes around “debate” because, given the obvious irrelevance of logic and evidence, it’s not really a debate in any normal sense. And this situation is by no means unique. Indeed, at this point it’s hard to think of a major policy dispute where facts actually do matter; it’s unshakable dogma, across the board. And the real question is why.
Before I get into that, let me remind you of some other news that won’t matter.
First, consider the Kansas experiment. Back in 2012 Sam Brownback, the state’s right-wing governor, went all in on supply-side economics: He drastically cut taxes, assuring everyone that the resulting boom would make up for the initial loss in revenues. Unfortunately for his constituents, his experiment has been a resounding failure. The economy of Kansas, far from booming, has lagged the economies of neighboring states, and Kansas is now in fiscal crisis.
So will we see conservatives scaling back their claims about the magical efficacy of tax cuts as a form of economic stimulus? Of course not. If evidence mattered, supply-side economics would have faded into obscurity decades ago. Instead, it has only strengthened its grip on the Republican Party.
Meanwhile, the news on health reform keeps coming in, and it keeps being more favorable than even the supporters expected. We already knew that the number of Americans without insurance is dropping fast, even as the growth in health care costs moderates. Now we have evidence that the number of Americans experiencing financial distress due to medical expenses is also dropping fast.
All this is utterly at odds with dire predictions that reform would lead to declining coverage and soaring costs. So will we see any of the people claiming that Obamacare is doomed to utter failure revising their position? You know the answer.
And the list goes on. On issues that range from monetary policy to the control of infectious disease, a big chunk of America’s body politic holds views that are completely at odds with, and completely unmovable by, actual experience. And no matter the issue, it’s the same chunk. If you’ve gotten involved in any of these debates, you know that these people aren’t happy warriors; they’re red-faced angry, with special rage directed at know-it-alls who snootily point out that the facts don’t support their position.
The question, as I said at the beginning, is why. Why the dogmatism? Why the rage? And why do these issues go together, with the set of people insisting that climate change is a hoax pretty much the same as the set of people insisting that any attempt at providing universal health insurance must lead to disaster and tyranny?
Well, it strikes me that the immovable position in each of these cases is bound up with rejecting any role for government that serves the public interest. If you don’t want the government to impose controls or fees on polluters, you want to deny that there is any reason to limit emissions. If you don’t want the combination of regulation, mandates and subsidies that is needed to extend coverage to the uninsured, you want to deny that expanding coverage is even possible. And claims about the magical powers of tax cuts are often little more than a mask for the real agenda of crippling government by starving it of revenue.
And why this hatred of government in the public interest? Well, the political scientist Corey Robin argues that most self-proclaimed conservatives are actually reactionaries. That is, they’re defenders of traditional hierarchy — the kind of hierarchy that is threatened by any expansion of government, even (or perhaps especially) when that expansion makes the lives of ordinary citizens better and more secure. I’m partial to that story, partly because it helps explain why climate science and health economics inspire so much rage.
Whether this is the right explanation or not, the fact is that we’re living in a political era in which facts don’t matter. This doesn’t mean that those of us who care about evidence should stop seeking it out. But we should be realistic in our expectations, and not expect even the most decisive evidence to make much difference.