Policy Wise

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Policy Wise has argued previously that ”it is the dynamics of competition whose benefits are likely to be far more relevant in assessing the overall net benefits of NANO”. Barely a month after the launch of Nano, TATA group has announced its support for a car which would run on compressed air with zero emissions.

The car will be driven by compressed air stored in carbon-fibre tanks.

The tanks, built into the chassis, can be filled with air from a compressor in just three minutes - much quicker than a battery car.

Alternatively, it can be plugged into the mains for four hours and an on-board compressor will do the job.

For long journeys the compressed air driving the pistons can be boosted by a fuel burner which heats the air so it expands and increases the pressure on the pistons. The burner will use all kinds of liquid fuel.[link]

Whether the technology is feasible or not remains to be seen. But the very fact that the TATA group is prepared to back such an ambitious venture is an indication that the small car market is here to stay. No doubt, it is hard to predict its size especially because some of the interest in smaller cars–especially in America–is due to rising gas prices. It remains to be seen if the interest would be sustained if there is a correction in gas prices.

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A new study by the World health organization warns that smoking could potentially kill one billion people in the 21st century. An article in The Economist details some of the challenges governments face in attempting to control smoking especially in the developing world,

The practical argument for action is simpler: the tobacco industry is getting the world’s poor hooked before governments can respond. In recent years, as rich countries have clamped down on smoking, tobacco firms have shifted their focus to poorer places. A study by Britain’s Bath University found that by using aggressive tactics, such as targeting women, international tobacco firms had helped to double smoking rates in Russia since 1991.

The tobacco industry is regrouping in order to focus on “promising” markets and escape the pesky lawsuits it is likely to face in rich, litigious countries. For example, Altria, a global tobacco concern based in the United States, plans to spin off Philip Morris International as a stand-alone foreign entity in late March. China is now home to more than a quarter of the world’s smokers; it will soon be manufacturing Marlboro cigarettes for Philip Morris, and the firm will be exporting Chinese tobacco to other countries.[link]

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April Harding at the Global Health Policy blog responds to the Economist article (linked here) and makes a few telling comments,

As noted in The Economist, the interventions assessed included simultaneous free distribution of bednets and free distribution of artemisinin drugs - the highly-effective malaria treatment. So these reviews do not shed light on the relative effectiveness of bednet coverage interventions.

While the review can’t shed light on bednet coverage interventions, the very high mortality reductions in Ethiopia, Rwanda and Zambia from the dual (bednet/ drug) intervention are striking. These findings should be examined as quickly as possible to inform malaria programs being designed now.

Unfortunately, the WHO review mentioned in The Economist is not published or available for review - so it is not possible to judge the quality of the analysis[link]

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A story in the Economist questions the conventional wisdom that giving away free goods is not the best way to advance public policy,

Dr Kochi and his team reviewed antimalaria operations in Ethiopia, Ghana, Rwanda and Zambia, looking mainly at under-fives, who are most threatened by the disease. WHO says that over 1m people die each year of malaria, mostly in Africa. In Ethiopia, the amount of childhood malaria reported at clinics fell by 60% and the death rate halved within two years of the beginning of the mass-distribution programme. In Rwanda, things were even more spectacular: both cases and deaths dropped by two-thirds within a single year. In Zambia the fall in both was around a third. Only in Ghana were the data equivocal. Cases fell by an eighth and deaths by a third, but that was against a background of generally improving health in which the amelioration rates for malaria were worse than those for non-malarial illness and death. In other countries, the rate of malaria tracked the general disease rate until the programmes began, and then fell suddenly.[link]

With Malaria still a huge public health challenge in India and other developing countries, the success story in Africa can be instructive. However, it would be wise not to conclude that Malaria was controlled only because the nets were given away free; among other things, the team also rolled out a nation wide campaign to educate people. To replicate the success elsewhere, other elements including constant monitoring and evaluation may also be necessary.

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(Co authored with Pratik Mhatre.)

It is time the issue of urban transport is addressed in a holistic manner.

Five years ago, Ratan Tata made a tryst with destiny. He promised a car for Rs one lakh-a people’s car-and he has delivered. The new Tata Nano has been widely praised for its indigenous design, engineering skills and aesthetics. In the process, TATA’s have contributed to the maturing of a host of ancillary suppliers which can be expected to contribute positively to India’s manufacturing capabilities. The TATA’s have gone to extraordinary lengths to meet the price target; yet, NANO is reportedly capable of meeting the stringent EURO 4 pollution norms and has passed all required safety tests. Moreover, in an era where the issue of fuel efficiency has gained increasing salience, Nano’s claimed mileage of 50 miles/gallon is comparable to the best hybrid cars in the market including Toyota Prius.

Nano is not competing with any existing car model in the Indian car market. Its nearest competitor-Maruti 800- at Rs 2 lakh is almost double its price. By providing existing two wheeler drivers with a realistic and affordable option of owning a car, it can help expand the car market to the relatively lower middle class. Over two decades ago, Maruti 800 redefined the car market in India; Nano can take the automobile revolution to the next level. More importantly, Nano can spur product and process competition among the car industry not only in India but also abroad. Similar incentives would be present in the still-growing two-wheeler segment as well. It is the dynamics of competition whose benefits are likely to be far more relevant in assessing the overall net benefits of NANO.

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In a rather rambling article in the Hindustan Times, Lalita Panicker attacks the ”theory” that medical tourism can help the Indian public health system,

But, we hold that medical tourism is a panacea to the ills that beset our public health system. Let us look at the figures. Today, 150,000 foreigners come to India for healthcare and spend about Rs 1,500 crore. In ten years, this will rise to Rs 10,000 crore. Anticipating this rush of patients, the private health sector has effectively lobbied for lower tariffs for equipment and tax breaks. Already 100 per cent FDI is allowed in health-related services. Be assured that a considerable amount of this equipment will be to cater to the needs of foreign clientele and that this will in all likelihood push up costs even for the well-off Indian patient.[link]

Panicker is right of course: the trickle down benefit for the public health system would be minor and should be discounted. But the question is who exactly holds this view that medical tourism is the panacea for all ills of the Indian public health system? One is not sure even the medical industry would hold such extreme views.

As far as tax subsidies are concerned, government has long followed that logic. Private hospitals in Delhi and other metropolitan cities are alloted land at throwaway prices on the condition that they will reserve certain % of beds for the poor. This policy has been a disastrous failure. The reasons are not far to seek as inefficiency is inbuilt into the system: the benefits accruing to the hospital (cheap land, waiver of property taxes e.t.c) are a one time benefit while public cost of these subsidies can only be recovered in the long term. Therefore, the hospitals have an incentive to flout the law and due to a weak regulatory framework, they are rarely held accountable. The solution is pretty simple: abolish all subsidies and force the hospitals to acquire land at market prices. Indeed, it is exactly this model the Delhi Development Authority has recently adopted in Delhi.

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The emigration of health professionals from developing world to member countries of the Organization of Economic Cooperation and Development (OECD) remains a highly contentious issue. In America itself, according to the American Medical Association (AMA), International Medical Graduates (IMGs) constitute approximately 25% of the physician population. Indians are by far the largest group-nearly 20% of American physicians were trained in India. According to some calculations, of the nearly 24,000 medical graduates India produces every year, 1200 eventually emigrate.

A new paper by Kaushik et al has approached physician emigration from a slightly different angle. The researchers have looked at physicians trained at India’s premier medical school, All India Institute of Medical Sciences (AIIMS), and have concluded that nearly 54% of its graduates (1989-2004) currently reside abroad. Focusing on quality of physicians emigrating, they have shown that general category students (those who did not benefit from reservations) are more likely to leave India for greener pastures abroad.

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A new report by Mckinsey and company estimates that US can reduce the emission of greenhouse gases by half at a manageable cost,

The United States could reduce GHG emissions in 2030 by 3.0 to 4.5 gigatons of CO₂e using tested approaches and high-potential emerging technologies. These reductions would involve pursuing a wide array of abatement options with marginal costs less than $50 per ton, with the average net cost to the economy being far lower if the nation can capture sizable gains from energy efficiency. Achieving these reductions at the lowest cost to the economy, however, will require strong, coordinated, economy-wide action that begins in the near future.[link]

Download the full report here.

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As reported by the New York Times’ health blog, a University of Wisconsin study confirms what many people already suspect.

Healthy eating really does cost more.

That’s what University of Washington researchers found when they compared the prices of 370 foods sold at supermarkets in the Seattle area. Calorie for calorie, junk foods not only cost less than fruits and vegetables, but junk food prices also are less likely to rise as a result of inflation. The findings, reported in the current issue of the Journal of the American Dietetic Association, may help explain why the highest rates of obesity are seen among people in lower-income groups. (link)

Apart from the various factors talked about in the study, transportation is a major issue (as mentioned by a commentator in the NYT post, as also found from studies by co-blogger Rohit). In most US cities, low-income, inner-city areas lack proper supermarkets and rely on corner stores which do not stock up on the healthiest of foods.

Additionally, I wonder how much the health food craze of recent times have contributed to the market driving up prices. Anyone who has stepped into a Whole Foods Market shop will tell you, the so-called healthy alternatives often cost about double the regular stuff, but the stores are still very crowded.

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A new study conducted in Punjab by the Chandigarh based Post-Graduate Institute for Medical Education and research has shown high rates of mutated DNA,

Preliminary results from a two-year study commissioned by the Punjab Water Pollution Control Board found mutated DNA in blood samples of 65 percent of the people tested. The study also found high levels of arsenic and mercury in the tap water.[link]

Apparently, there is only one functional sewage treatment plant in Punjab.

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