r.i.c.e.

Different places in India are voting in national elections on different days. Diane and I wrote these thoughts about the election together.

Today, India is preparing for an election which will shape the lives of more people than any election ever has before. Hundreds of millions of people will vote. Of course, the two of us personally will not vote in this election. We are privileged to be guests here in India, as visiting economics researchers.

But we are not the only ones who will not be voting. Millions of Indians will not be able to vote in this election. Indeed they will live their whole lives, and die, never having been able to vote even once. These lifelong disenfranchised citizens live in every state and every district of India – perhaps you have even met some of them.

Who are these millions of excluded Indians? They are children and babies who will die in their first few years, or days, or minutes of life. It is well known that even as India has been experiencing exceptional average economic growth, the population suffers from surprisingly poor early life health.

Thousands of babies will die between today and the day the ballots are counted. We will never know how these babies would have someday voted. But when you decide how you will vote, you can keep these babies in mind. What policies would they be voting for? How could your vote help keep more of them alive?

These are complicated questions, and we do not pretend that there is any one right answer. The only certainties are that the problem is profound and its scale is vast. So many die, and so many suffer, that even a small improvements the problems that contribute to infant mortality—such as poor sanitation, maternal malnutrition and indoor air pollution—would mean many lives would be saved between this election and the next.

In India, between 4 and 5 percent of babies die before their first birthday, compared with much less than 1 percent in Europe or North America. However, this figure averages over all of India, a diverse country where one-sixth of all humans live. Some Indian babies are born into enclaves as glamorous as any address worldwide; yet, hundreds of millions of people live and die in districts as large, as poor, and as unhealthy, and sometimes even unhealthier, than many sub-Saharan African countries.

For instance, the state of Uttar Pradesh has a higher infant mortality rate than the developing countries of sub-Saharan Africa. Additionally, many Indian districts match or exceed African countries in both population and infant mortality. If Indian districts were countries, 5 of the world’s worst 10 countries for infant mortality and 13 of the worst 20 would be Indian districts. Tens of millions of Indians are living in big places with infant mortality as bad as anywhere on earth.

Millions of preventable child deaths are bad enough. However, the tragedy is compounded by the fact that early-life health has lasting economic consequences for those who survive. Medical scientists and economists are accumulating research that shows that the disease and nutritional environment to which children are exposed before birth and in infancy shapes their physical and cognitive development. Put simply, healthy babies are more likely to reach their full potentials. An economy where babies are developing to their potential is an economy which will one day have healthier and more productive workers. So, early-life health matters for everyone.

What sort of changes could keep more babies alive and growing healthily? The answers are simultaneously easy and vastly challenging. Make a healthier disease environment, with better sanitation and less infection. Make pregnancy a healthier time for mothers and babies, with plenty of good nutrition and less indoor air pollution, and follow it with exclusive breastfeeding for six months, and the timely introduction of complementary food. Take on the grand challenge of placing the problems of early-life health front and center on the national stage.

Although we will never learn it, each of the disenfranchised babies is entitled to her own views on how to achieve these goals. You are entitled to yours, too. To be clear: if there is one right answer, we don’t know it. But, as India reflects on which directions to take next, we are certain that this is one of the most important questions to be asking. Between this election and the next, millions of Indian children will die unnecessarily. Many, many more will be sent into life irreversibly limited by early life disease and deprivation. They will not have the opportunity to vote next month for better early life health in India. But you will.