China and India collectively represent more than 35 percent of humanity. Both countries have lifted hundreds of millions of people out of poverty in the last two decades. However, the developmental challenges that India and China have yet to surmount are mammoth. The public health sector is a crucial part of this challenge.
India and China ranked 95th and 75th respectively in the Social Progress Index’s ‘Health and Wellness’ segment, while the corresponding rankings in the ‘Nutrition and Basic Medical Care’ were 97th and 68th; both figures are unflattering. In the more popular UN’s Human Development Index (HDI), which encompasses health, education, and income variables, India and China ranked a miserable 136th and 101st in 2013. Whichever way one looks at it, the indications betray an absolute health policy failure in two of the world’s most populous states.
Both India and China share lacklustre state participation in the health sector. While public health expenditure as a percent of GDP in the U.S. is in excess of 7 percent and anywhere between 6 to 8 percent in EU countries, in India and China the corresponding figures were respectively a meagre 1.4 percent and 2.3 percent in 2012.
India: The Uninsured Billion
Out of pocket payments (OPP) refer to the direct cash outlays by patients/individuals/families to the healthcare provider. In India, OPP comprise of more than 70 percent of total health-related spending, compared to less than 12 percent in the U.S. There is a near-complete absence of a wide-ranging state-sponsored insurance program in India, even as targeted health programs for the poor suffer from inefficiency, corruption, ill-equipped hospitals, and ill-trained professionals. India has opened up its health sector to the private insurance players, but the latter play an insignificant role in either the health insurance market or the larger healthcare sector. Whatever little of public health insurance exists is in the form of employer-contributed schemes. Naturally, these apply only to the marginal share of population engaged in the urban formal sector.
The idea of a ‘Right to Health’ is now being discussed in India. Under this scheme, health sector spending is likely to be increased to 3 percent of GDP (still likely to be insufficient) and universal access to healthcare made a reality. But there is a proclivity among Indian policymakers to limit their commitments to mere promises.
China: Soaring Health Inequality
Currently, about 50 percent of China’s population pays out of pocket for healthcare facilities. In absolute numbers, this amounts to more than 600 million people. But colossal as it might sound, this does not capture the essence of the Chinese problem fully.
In 2005, 179 million rural Chinese had health insurance coverage, up from a mere 8 million in 2003. Officials proclaimed recently that 800 million individuals are now covered by the country’s New Rural Cooperative Medical Scheme (NCMS). Official data show that nearly 90 percent of the population in China are insured. But the problem lies with the hundreds of millions of (by some accounts 250 plus million) rural-to-urban migrants who are left in the lurch as neither urban insurance schemes nor rural insurance programs apply to them. As proof of identity/citizenship eludes these migrants, they are deprived of any state-sponsored healthcare. Also, city-based insurance programs apply only to formal sector workers, leaving dependents and informal sector workers to fend for themselves.
Moreover, because urban and rural health insurance schemes are operated separately, there are significant differences in risk protection and premium collection (which are sometimes too high in urban areas). Premium collections have steadily risen over the years. The extent of income-related health inequality in China is very high. Studies have also found urban populations to be more vulnerable to diseases and this might have to do with absurd levels of pollution in China’s cities on the back of rapid industrialisation. If a health crisis in urban centers is to be avoided, focusing policy attention on the urban poor and migrants is the need of the hour.
Out-of-pocket health spending among the poor increases poverty rates in developing countries, as a large portion of their lifetime savings is wiped out, thus pushing them back into the below-poverty zone. One has to bear in mind that even a 0.5 percent increase in poverty means 6.15 million people in India and 6.75 million people in China. These are big numbers.
If development in the global south is truly to be achieved, health should take policy precedence. Malnutrition, poor hygiene, and lack of clean drinking water are critical areas of policy focus. Finally, the needs for South-South cooperation in these areas by way of exchange of knowledge and experience are high and need to be tapped. These include sharing technical expertise and exploration of joint R&D prospects in the pharmaceutical sector and public health infrastructure.
Abhirup Bhunia is research analyst with the Institute of Economic Growth, New Delhi and holds a Master’s in International Political Economy from Sussex University, UK. His upcoming book is tentatively titled Sino-Nigerian Developmental Ties and Issues.
This article was originally published in the Diplomatic Courier's July/August 2014 print edition.
But it’s difficult to think about value when we have no buoy for understanding it outside our traditional lenses: for example, our time, our job, and what others tell us they are worth in cash. This, largely, is the world’s paradigm for value so far. But understanding what value really means changes everything—and will be at the center of the decentralized revolution in global coordination that will unfold over the next decade. So, where do we begin?
Let’s start with gold.
Gold is an inherent value. When backing a market, gold allows us to grow a balanced economy well into the trillions. But why does it allow for massive stable markets to form around it? It is gold's permanence that creates stability. We understand that gold will always have value, because it is inherent in all of us, not just in one part of the world, but everywhere, not just today, but tomorrow and for the long haul.
In the 1930s when the gold standard was removed, we learned that the U.S. dollar didn’t need gold to back its economy to flourish. We learned that it was just a symbol for U.S. citizens to decentralize their coordination around the United States economy.
It turns out, common agreement is a philosophy for building shared economy.
And so it seems inherent value is a marker for us to begin exploring what the future could look like—a future beyond gold and the existing realm of credit. And so what else has inherent value? Is education as valuable as gold? What about healthcare? What about a vote that can’t be tampered with? What about an ID that can’t be stolen or erased? What about access to nutrition or clean water? You will find value everywhere you look.
It turns out, we’ve already done the legwork necessary to uncover the most elemental inherent values: The Sustainable Development Goals are commitments grown out of the drive to bring to life basic tenets of the Universal Declaration of Human Rights—the closest possible social contract we have to a global, common agreement.
We’ve already agreed.
Our agreements are grounded in deep value centers that are globally shared, but undervalued and unfulfilled. The reason for this is our inability to quantify intangible value. All of these rich, inherent values are still nebulous and fragmented in implementation—largely existing as ideals and blueprints for deep, globally shared common agreement. That is, we all agree education, health, and equality have value, but we lack common units for understanding who and who is not contributing value—leaving us to fumble in our own, uncoordinated siloes as we chase the phantoms of impact. In essence, we lack common currencies for our common agreements.
Now we find ourselves at the nexus of the real paradigm of Blockchain, allowing us to fuse economics with inherent value by proving the participation of some great human effort, then quantifying the impact of that effort in unforgeable and decentralized ledgers. It allows us to build economic models for tomorrow, that create wholly new markets and economies for and around each of the richest of human endeavors.
In late 2017 at the height of the Bitcoin bubble, without individual coordination, planning, or the help of institutions, almost $1 trillion was infused into blockchain markets. This is remarkable, and the revolution has only just begun. When you realize that Blockchain is in a similar stage of development as the internet pre-AOL, you will see a glimpse of the global transformation to come.
Only twice in the information age have we had such a paradigm shift in global infrastructure reform—the computer and the internet. While the computer taught us how to store and process data, the Internet built off that ability and furthered the conversation by teaching us how to transfer that information. Blockchain takes another massive step forward—it builds off the internet, adding to the story of information storage and transfer—but, it teaches us a new, priceless and not yet understood skill: how to transfer value.
This third wave kicked off with a rough start—as happens with the birth of new technologies and their corresponding liberties. Blockchain has, thus far, been totally unregulated. Many, doubtless, have taken advantage. A young child, stretching their arms for the first couple times might knock over a cookie jar or two. Eventually, however, they learn to use their faculties—for evil or for good. As such, while it’s wise to be skeptical at this phase in blockchain’s evolution, it’s important not to be blind to its remarkable implications in a post-regulated world, so that we may wield its faculties like a surgeon’s scalpel—not for evil or snake-oil sales, but for the creation of more good, for the flourishing of commonwealth.
But what of the volatility in blockchain markets? People agree Bitcoin has value, but they don’t understand why they are in agreement, and so cryptomarkets fluctuate violently. Stable blockchain economies will require new symbolic gold standards that clearly articulate why someone would agree to support each market, to anchor common agreement with stability. The more globally shared these new value standards, the better.
Is education more valuable than gold? What about healthcare or nutrition or clean water?
We set out in 2018 to prove a hypothesis—we believe that if you back a cryptocurrency economy with a globally agreed upon inherent value like education, you can solve for volatility and stabilize a mature long lasting cryptomarket that awards everyone who adds value to that market in a decentralized way without the friction of individual partnerships.
What if education was a new gold standard?
And what if this new Learning Economy had protocols to award everyone who is helping to steward the growth of global education?
Education is a mountain. Everyone takes a different path to the top. Blockchain allows us to measure all of those unique learning pathways, online and in classrooms, into immutable blockchain Learning Ledgers.
By quantifying the true value of education, a whole economy can be built around it to pay students to learn, educators to create substantive courses, and stewards to help the Learning Economy grow. It was designed to provide a decentralized way for everyone adding value to global education to coordinate around the commonwealth without the friction of individual partnerships. Imagine the same for healthcare, nutrition, and our environment?
Imagine a world where we can pay refugees to learn languages as they find themselves in foreign lands, a world where we can pay those laid off by the tide of automation to retrain themselves for the new economy, a world where we can pay the next generation to prepare themselves for the unsolved problems of tomorrow.
Imagine new commonwealth economies that alleviate the global burdens of poverty, disease, hunger, inequality, ignorance, toxic water, and joblessness. Commonwealths that orbit inherent values, upheld by immutable blockchain protocols that reward anyone in the ecosystem stewarding the economy—whether that means feeding the hungry, providing aid for the global poor, delivering mosquito nets in malaria-ridden areas, or developing transformative technologies that can provide a Harvard-class education to anyone in the world willing to learn.
These worlds are not out of reach—we are only now opening our eyes to the horizons of blockchain, decentralized coordination, and new gold standards. Even though coordination is the last of the seventeen sustainable development goals, when solved, its tide will lift for the rest—a much-needed rocket fuel for global prosperity.
“Let us raise a standard to which the wise and the honest can repair.” —George Washington