Gaiha, Raghav
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Publication Growing Burden of Non-Communicable Diseases in India(2018-08-29) Yadav, Pratima; Kulkarni, Vani S.; Gaiha, RaghavThe present study provides detailed evidence on NCDs and their covariates. This is particularly relevant in the present Indian context, as the elderly population ≥ 60 years is growing three times faster than the population as a whole. It is projected that the percentage of elderly people will more than double between 2010-2050. Alongside, old age morbidity (NCDs and their multi-morbidities) has risen significantly during 2004-2014. Using National Sample Survey data for 2004 and 2014, and ordered probit models, the underlying covariates are uncovered. There is a marked shift of NCDs and multi-morbidities from the younger to the old population. Some of the covariates associated with lower prevalence of NCDs and their multi-morbidities include women, education, physical activity, drinking water through tubewells and hand pumps, Scheduled Castes/Scheduled Tribes (the lowest rung of socio-economic hierarchy), while those associated with higher prevalences include urbanisation, widowed and divorced/separated, and being affluent. Above all, there is a (residual) positive time effect confirming higher prevalences of NCDs and their multi-morbidities. On current evidence, given the increases in life expectancy, it is uncertain whether the additional years have translated into healthier and longer lives or longer years of morbidity. The policy challenge, however, is daunting, requiring greater funding for health care, reorientation of the health care system to serve the old better and tackle the growing burden of NCDs and their multi-morbidities, expansion of pension and health insurance, and behavioural changes (e.g., curbing of alcohol consumption, smoking and lifestyle changes) necessary for healthy living.Publication Changes in Subjective versus Objective Well-Being in India(2021-05-12) Kulkarni, Vani S.; Kulkarni, Veena S.; Imai, Katsushi S.; Gaiha, RaghavAlthough there is abundant literature on subjective well-being (SWB), there is virtually none for India. Growing recognition of the validity and accuracy of measures of SWB of well-being underlies the rapid growth of literature on SWB in recent decades but it has mainly focused on developed countries. Ours is, to our knowledge, the first study of SWB at the all-India level, and one of the few on developing countries, with a rigorous validation of the results. Applying robust OLS and ordered probit models to the India Human Development Survey (IHDS) panel data in 2005 and 2012, we assess SWB changes in 2005-2012, based on a self-reported measure of changes in economic well-being, as a function of household and state covariates in 2005. This is in sharp contrast with earlier studies’ focus on the levels of SWB. Another point of departure of our study and an innovative extension is to compare the covariates of SWB changes with those of objective well-being (OWB) changes, proxied by the relative growth in real per capita household consumption between 2005 and 2012. Households with an older and educated head in a larger household, located in urban areas or affluent states in 2005 tend to experience further improvement in both SWB and OWB between 2005 and 2012. On the contrary, households with a female household head, with more male members in the labour market, with regular access to mass media, without members suffering from non-communicable diseases or disability are more likely to be better off subjectively without experiencing corresponding improvement in OWB. The policy challenges raise serious concerns.Publication Non-communicable Diseases and Depression: Evidence from South Africa(2019-07-17) Pandey, Manoj K.; Kulkarni, Vani S.; Gaiha, RaghavAlthough there are numerous studies of depression and its linkages with non-communicable diseases (NCDs), most rely on a single cross-section or a single wave of the National Income Dynamics Study (SA-NIDS) for South Africa, which does not allow for incorporation of individual unobservable effects. Such effects are potentially significant as it is frequently observed that there is considerable variation in depressive symptoms even when an old person suffers from common NCDs. We use correlated random effects probit model on the first 5 waves of SA-NIDS panel data collected every two years between 2008-2016/17 to examine the reverse association from Depression to selected NCDs, controlling for socio-economic and demographic characteristics. The analysis yields useful insights into the complex relationships between NCDs and depression. Policy options that focus on biological and behavioural links in the co-occurrence of NCDs and depression are examined. Of particular importance is integration of depression and NCD care in primary health care with a view to increasing prevention, screening, self-management, treatment and rehabilitation in order to achieve equitable, efficient and quality health services in South Africa.Publication Persistence of Non-Communicable Diseases, Affluence and Inequality in India(2019-12-05) Kulkarni, Veena S.; Kulkarni, Vani S.; Gaiha, RaghavThis study builds on the extant literature by highlighting the persistence of non-communicable diseases (NCDs), their cross-associations, and how these diseases are linked to different forms of inequality-socio-economic, gaps in affluence measured by asset quartile, and in the overall economic environment, based on a nation-wide panel survey, India Human Development Survey 2015. A multinomial probit specification is used to analyse NCD outcomes. Those at the bottom of the caste hierarchy and least wealthy exhibit lowest vulnerability to NCDs despite their deprivation and limited access to healthcare facilities while those at the higher end of the caste hierarchy and the wealthiest are most vulnerable. However, overall economic inequality, using Piketty’s (2013) measure, is insidious as it corrodes social cohesion and support, and the capability to live a healthy and productive life. New light is thrown on whether social networks are associated with better NCD outcomes. So policy interventions have to be not just medical but much broader in scope.Publication Aging, Depression, Non-Communicable Diseases and Disabilities in South Africa(2018-07-16) Pandey, Manoj K.; Kulkarni, Vani S.; Gaiha, RaghavThis is the first study that offers a comprehensive analysis of depression among the old (60+ years) in South Africa. This study uses four waves of a panel survey of the South Africa National Income Dynamics Study (SA-NIDS) during 2008-2014. A state-of-art econometric methodology has been used to unravel the factors underlying depression among the old over the period 2008-2014. Depending on whether the dependent variable is binary (self-reported depression for ≥ 3 days in a week) or continuous (as in measures of overall depression and severe depression), we use random effects probit with Mundlak adjustment or simply random effects with Mundlak adjustment. Among the old, those more likely to be depressed are: those in their sixties, Africans and Coloureds, women, those suffering from multimorbidity, those with multiple limitations in ADLs, those in lower asset quartiles and individuals who suffered family bereavements. Factors that attenuate depression include marriage, pension, affluence, trust in a community and familiar neighbourhoods. An important feature of our study is the robustness of the key results. To reduce their depression, more public and private health care investment in the health and well-being of aged in South Africa is recommended.Publication Change in Subjective Well-Being, Affluence and Trust in Judiciary in India(2022-05-12) Kulkarni, Vani S.; Kulkarni, Veena S.; Imai, Katsushi S.; Gaiha, RaghavThe present study tests the hypothesis that trust in the lower judiciary in India - comprising High Courts at the state level and District Courts at the lower level - is associated with improvement in subjective economic well-being. The analysis is based on the India Human Development Survey (IHDS) 1 and 2 in 2005 and 2012, a large nationally representative household panel dataset. Using 2SLS and Lewbel IV models to take into account the endogeneity of trust in the lower judiciary, our analysis confirms that trust in the lower judiciary has a positive association with the change in SWB. The policy significance of this result is substantial as the pace of judicial reform tends to be slow in developing countries, such as India. Attention is drawn to specific reforms to reduce the pendency of cases. These include repeal of long outdated and dysfunctional laws, greater funding for expansion of the judiciary and, more importantly, for increasing the productivity of judges through the creation of a specialised administrative agency to support the judiciary and more effective use of IT in case management. This also has the potential for reducing rampant corruption, frequency of adjournments in court hearings as well as in ensuring autonomy of the judiciary.Publication Poverty Transitions, Health, and Socio-Economic Disparities in India(2020-07-07) Kulkarni, Veena S.; Kulkarni, Vani S.; Gaiha, RaghavSDGs offer an inclusive and just vision for 2030, in which the interrelationships between (near) elimination of poverty, health reforms and elimination of socio-economic disparities play an important role. The present study focuses on the associations between poverty transitions over a period, and health indicators such as NCDs, disabilities, socio-economic disparities, state affluence and inequality in income distribution. These health indicators reflect their growing importance in recent years. We have used a Multinomial Probit specification which is an improvement on the methodologies used in earlier research. The analysis is based on panel data from the India Human Development Survey 2015. What our analysis emphasises is that changes in the prevalence of poverty/headcount ratio over time do not throw light on how poverty has evolved: whether there were escapes from poverty, whether there were descents into poverty, whether segments persisted in poverty, and whether (the relatively) affluent remained largely unaffected. A significant contribution of this study is to explore the relationships between such poverty transitions and NCDs and disabilities, socio-economic disparities and other covariates. The analysis confirms these linkages. Drawing upon this analysis and other relevant research, policy challenges in achieving the SDG vision of an inclusive and fair economy are delineated.Publication Rural Poverty and Disability in LMICs(2020-05-27) Gaiha, Raghav; Mathur, Shantanu; Kulkarni, Vani S.Disability is neither a purely medical nor a purely social phenomenon. Rather, it is an outcome of their interplay. The main contributions of our study are two-fold: (i) a synthesis of the extant literature on the links between poverty and disability in LMICs. However, the studies focused on these links in rural areas are sparse. (ii) As rural economies-specifically, agriculture- continue to play an important role in economic growth, it is necessary to deepen our understanding of factors associated with rural disabilities, their association with rural employment and, finally, whether disabilities are associated with rural poverty. We use panel data for India and Ethiopia to illustrate these linkages, using rigorous econometric methodology. In particular, an important contribution is to corroborate the bidirectional association between disability and poverty, noted in many but validated in a few. The CRPD has ensured a concomitant shift in global initiatives, most notably the 2015 Sustainable Development Goals (SDGs) which explicitly recognise disability as a major impediment to elimination of poverty and hunger. In the current development discourse, disability has thus acquired high priority. Although there is a plethora of legislation banning discrimination against the disabled in LMICs-including India and Ethiopia and other LMICs-discrimination against disabled women and elderly is rampant. While it is imperative to fix the policy failures, a remedial strategy has to mainstream the disabled in a sustainable rural development framework, with a key role of the community and mass media in dismantling the barriers to the participation of the disabled in the political, economic and social spheres. Although the challenges are formidable, our study offers grounds for optimism.Publication The Role of Public Trust in People's Subjective Well-Being(2021-04-14) Kulkarni, Vani S.; Gaiha, RaghavKenneth Arrow, perhaps the most influential economist after John Maynard Keynes in the 20th century, viewed trust as a lubricant that fosters cooperative behaviour and thus facilitates mutually advantageous economic exchanges in the presence of incomplete contracts and imperfect information. Recent research has confirmed the beneficial effects of trust in government on economic performance. The obverse, that an erosion of trust in public institutions (state, judiciary and police) has deleterious effects on economic performance, is equally true. Various recent accounts do not just corroborate an erosion of trust in governance, but also point to the imperative of strengthening it to break out of the deep recession that India’s economy is in. The fiscal stimulus has been too little, too late.Publication Trust in Hospitals-Evidence from India(2019-10-02) Kulkarni, Vani S.; Kulkarni, Veena S.; Gaiha, RaghavVarious explanations have been offered for outbursts of violence against doctors and other staff in India, drawing attention to growing supply-demand imbalance in healthcare, quality deterioration, overburdened doctors, weak security for medical staff, high expectations of patients who come in advanced stages of chronic and other illnesses, overcrowding of public hospitals with limited sanitary facilities. But underlying all these explanations is lack of trust in doctors and hospitals-especially public. Our focus here is on trust and its covariates over the period 2005-2012. The motivation stems from the fact that the existing evidence is patchy and scattered. Our aim, therefore, is to build on the empirical evidence through a systematic state-of-art analysis of trust in public and private hospitals and doctors. Combining our analysis with other evidence, we identify specific challenges to build patient-hospital trust and how these could be overcome.