Offl ine: Nightmare on Downing Street

Professor Jayati Ghosh gave the 2011 UCL-Lancet lecture in London last week. An economist at Jawaharlal Nehru University in New Delhi, Prof Ghosh is an adviser to India’s Prime Minister, leads a network of economists critical of mainstream neoliberalism, and last month won the International Labour Organisation’s Decent Work Research Prize. Her subject was the relation between women’s health and economic growth. In a warmly delivered and provocative lecture, she asked why, despite economic success, India still has some of the worst health outcomes in the world—catastrophic under-5 child mortality, appalling numbers of maternal deaths, and widespread lack of access to safe sanitation. Her answers were profoundly disturbing. First, India’s caste system has created a pervasive tolerance to inequality. India’s people are too often indiff erent to their own predicaments. Second, the growth strategy adopted by the country’s political lead ers is itself a direct cause of impoverishment. Growth in India is predicated on encouraging the private sector to thrive. But that policy is a disincentive for governments to invest in a national, publicly funded, health service. To do so would be to undermine the private sector’s ability to create a market in health. India’s economic model therefore destroys health—that is, health conceived as a public good. There is an alternative—a wage-employment-based growth strategy, combined with substantial investments in the public sector health system. When asked how she might sum up her philosophy of economics and health, her answer was simple: “shrink fi nance”, by which she meant the grip of the fi nancial sector, an industry she has, elsewhere, called stupid and astonishing.