Visualization and the NFHS

A very quick post today, because the end of the year is proving to be anything but a holiday, alas.

My third post in the series about NFHS was going to be about a pet theme (and peeve) of mine: our inability to get better visualization for our data, and indeed better reporting of data in general. But there is good news on this front, finally – there is now an excellent resource that we can use to visualize the results of the NFHS-5 survey.

Here’s just one chart to whet your appetite: blood sugar level among adult women (high, or very high or taking medicine). Note that the chart for men is largely similar.

https://geographicinsights.iq.harvard.edu/nfhs-tracker-districts

This is great work, and kudos to everybody associated with this visualization project! 🙂

H/T: Shashank Patil

What is the story that NFHS-5 is telling us?

… is, if you ask me, a question that we should ask ourselves, rather than have this question be answered for us by somebody else.

What I mean by that is that I could tell you what I think of the results, or I could point you to articles written by others that tell you what they think of the results. But the results are out there for us to analyze, easily available and fairly readable in terms of accessibility.

Here is the India fact sheet, and here is where you can access data split by states.


I would recommend that you not take the easy way out, by reading what other folks have written. Sit instead, with these reports, and take a look at the big picture – the all India level data. Then begin with the Indian state that you call home, and check how it is doing. Compare India’s performance and your state’s performance with some states that you think ought to do well, and some that you think might be relative laggards on health parameters.

See if the data matches your intuition. And if it doesn’t, ask if you should suspect the data or your intuition (or both!). Begin to build, no matter how long it takes, a picture of India’s health status in your head.

Ask questions about India’s population, its split by gender, ask about our obesity rates and split those up by states. Ask about whether men are doing better than women on some parameters, and if so which – and eventually, why. Ask if there are major changes between the 4th and the 5th round, and ask if the rate of improvement between the 4th and the 5th is different from the rate of improvement between the 3rd and the 4th. Then ask if these numbers are comparable at all, given that there is a difference of ten years in the latter case, but only 5 in the former.


Try to come up with a list of ten points at the all-India level that seem noteworthy to you. And once you’re done with the list, then take a look at what the newspapers and columnists and op-eds are saying.

Is the story that you have come up with similar to theirs? If not, why? Might it be because they’ve done a better job in highlighting relevant material, or might it because they’re biased in some ways? Do you think they’re biased because of what they’ve written in the past, or because their interpretation of NFHS-5 differs from yours, or both? What is the probability that you are biased against them, rather than they being biased while writing whatever it is that they have written? How can one tell, really?

The bottom-line is this: if you consider yourself a student of economics, don’t form your opinions and biases by mirroring and mimicking the opinions and biases of folks you like. Begin with the data, form your own opinions, and then test them against those of others. Defend your ideas and conclusions by pitting them against those of others, and by engaging in respectful debate.

It’s a good way to study our country! 🙂

Update: Please take a look at this excellent Twitter thread about the history of NFHS. H/T: Sumita Kale.

Understanding the idea behind the NFHS

Why should you, as an informed citizen of this country, be aware of how well India is doing in terms of health?

The question isn’t rhetorical. For its own sake is a more than good enough answer, of course, but here are additional reasons for keeping track of how well we’re doing as a country in terms of health:

  • If you think that the Solow model is a good way to start to think about the long term growth prospects of our nation, then thinking about the health of that workforce is important
  • If you think it is possible that different states may have different health outcomes, it makes sense to try and understand whether this is the case.
  • It also makes sense to dig into the data and try and understand the particulars of these differences. (A state may do poorly on life expectancy in comparison to other states, for example, but better along other dimensions. Why might this be so is an excellent question to ask, and this is just one of many possible questions.)
  • This is true for many other ways to “slice” this data. Are there different outcomes by, say, gender? By urban/rural divide?
  • The answers to each of these questions is important because it helps us understand how to build a framework to answer the mot important question of them all: if we have to improve India’s health, where should we start?

And for all of these reasons (and so many more) it makes sense for all of us to be aware of the results of the NFHS survey.


What is the NFHS Survey?

The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India. The NFHS is a collaborative project of the International Institute for Population Sciences(IIPS), Mumbai, India; ICF, Calverton, Maryland, USA and the East-West Center, Honolulu, Hawaii, USA. The Ministry of Health and Family Welfare (MOHFW), Government of India, designated IIPS as the nodal agency, responsible for providing coordination and technical guidance for the NFHS. NFHS was funded by the United States Agency for International Development (USAID) with supplementary support from United Nations Children’s Fund (UNICEF). IIPS collaborated with a number of Field Organizations (FO) for survey implementation. Each FO was responsible for conducting survey activities in one or more states covered by the NFHS. Technical assistance for the NFHS was provided by ICF and the East-West Center.

http://rchiips.org/nfhs/about.shtml

Why is the NFHS important?

Why do we have something like NFHS? To obtain data on health and nutrition, disaggregated to the level of districts. We want to take stock of developmental targets at a single point in time and wish to track improvements (or deterioration) over time.

https://www.newindianexpress.com/opinions/columns/2021/dec/13/nfhs-andwhy-surveys-are-better-than-asking-a-cab-driver-2394809.html

How often is the NFHS carried out?

That’s a little tricky to answer, but I can tell you that there have been five rounds so far. The first one was in 1992-93, the second in 1998-99, the third in 2005-06, the fourth in 2015-16 (and this decade long gap is why this question is a little tricky to answer) and the fifth in 2020-21.

OK, so we can use this data to see how health in India has evolved over time?

Um, not exactly:

To gauge improvements over time, ideally, we should have what statisticians and economists call a panel. In a panel, across time, questions are asked to the same individuals/households. For something like NFHS, that’s not possible. In addition, for NFHS-5, compared to NFHS-4 (2015–16), additional questions have been asked. For those questions, gauging improvements over time is naturally impossible.

https://www.newindianexpress.com/opinions/columns/2021/dec/13/nfhs-andwhy-surveys-are-better-than-asking-a-cab-driver-2394809.html

Then what can we use the data for?

Especially because the answer to the first question in this series included this: “wish to track improvements (or deterioration) over time.”

Well, yes, it did. And we do use this data to see how health in India has evolved over time. But it’s not a perfect comparison, because we aren’t tracking the same households over time, and it therefore isn’t an apples to apples comparison. But the perfect shouldn’t be the enemy of the good, especially in public policy! The fifth round has in fact been structured in such a way so as to make the results as comparable as possible.

How many households are covered?

NFHS-5 fieldwork for India was conducted in two phases, phase one from 17 June 2019 to 30 January 2020 and phase two from 2 January 2020 to 30 April 2021 by 17 Field Agencies and gathered information from 636,699 households, 724,115 women, and 101,839 men

http://rchiips.org/nfhs/NFHS-5_FCTS/India.pdf

What questions are asked in this survey?

That’s a great question to ask!

Four Survey Schedules – Household, Woman’s, Man’s, and Biomarker – were canvassed in local languages
using Computer Assisted Personal Interviewing (CAPI).

In the Household Schedule, information was collected on all usual members of the household and visitors who stayed in the household the previous night, as well as socio-economic characteristics of the household:

water, sanitation, and hygiene; health insurance coverage; disabilities; land ownership; number of deaths in the household in the three years preceding the survey; and the ownership and use of mosquito nets.

The Woman’s Schedule covered a wide variety of topics, including the woman’s characteristics, marriage, fertility, contraception, children’s immunizations and healthcare, nutrition, reproductive health, sexual behaviour, HIV/AIDS, women’s empowerment, and domestic violence.

The Man’s Schedule covered the man’s characteristics, marriage, his number of children, contraception, fertility preferences, nutrition, sexual behaviour, health issues, attitudes towards gender roles, and HIV/AIDS.

The Biomarker Schedule covered measurements of height, weight, and haemoglobin levels for children; measurements of height, weight, waist and hip circumference, and haemoglobin levels for women age 15-49 years and men age 15-54 years; and blood pressure and random blood glucose levels for women and men age 15 years and over. In addition, women and men were requested to provide a few additional drops of blood from a finger prick for laboratory testing for HbA1c, malaria parasites, and Vitamin D3.

http://rchiips.org/nfhs/NFHS-5_FCTS/India.pdf

Whoa, that’s… a lot!

Indeed it is! If you haven’t clicked through to those PDF’s that have been linked to in the previous question, take the time out to go and do so. Conducting one of these surveys isn’t easy. All of these, and across these numbers (636,699 households, 724,115 women, and 101,839 men) is pretty tough, and kudos to the team that did the work.

So how are these households selected?

Another excellent question. From the interview manual (and if you are a student of statistics, this manual ought to be mandatory reading):

All 29 states and seven union territories (UTs) will be included in NFHS-5. NFHS-5 will provide
estimates of most indicators at the district level for all 707 districts in the country as on 1 March
2017.

For NFHS-5, the sample consists of approximately 30,456 clusters (small geographically defined
areas) throughout the country. The households in each of these clusters have recently been listed or
enumerated. A sample of households was then scientifically selected to be included in NFHS-5 from
the list in each of the clusters. Each of these households will be visited and information obtained
about the household using the Household Questionnaire. Women and men within these households
will be interviewed using an Individual Questionnaire. Women age 15-49 years will be interviewed
using the individual Woman’s Questionnaire. Men age 15-54 years will be interviewed using the
individual Man’s Questionnaire. We expect to complete interviews with about 7,45,488 women and
1,19,501 men in 670,032 households in this survey.

http://rchiips.org/NFHS/NFHS5/manuals/NFHS-5%20Interviewer%20Manual_Eng.pdf

And how are the surveys conducted?

During NFHS-5 fieldwork, you will work in a team consisting of one field supervisor, three female
interviewers, and one male interviewer. Each team will be provided with a vehicle and driver for
travelling from one Primary Sampling Unit (PSU) to another to conduct the fieldwork.
In addition, the team will include two health investigators. These individuals will be responsible for
drawing blood from eligible persons for testing for anaemia status, blood pressure, and blood glucose. In
addition, the health investigators will collect blood drops from a finger stick on filter paper cards,
which will be tested for malaria, HbA1c, and Vitamin D3 in ICMR laboratories. They will also be
responsible for the anthropometric measurements of eligible women, men, and children. The supervisors
will also receive some biomarker training so that they can supervise the health investigators and assist
them as needed. All interviewers will be trained to assist the health investigators in taking the
anthropometric measurements(height, weight, and waist and hip circumference measurements).
Each team supervisor will be responsible for his/her team of interviewers and health investigators.
The specific duties of the supervisor are described in detail in the Supervisor’s Manual.

http://rchiips.org/NFHS/NFHS5/manuals/NFHS-5%20Interviewer%20Manual_Eng.pdf

This PDF, the one that I have excerpted from, is 182 pages long. I am not for a moment suggesting that all of you must read every single word. But I’ll say this much: if you are currently studying either statistics or economics, you should go through it more than once. It is one thing to learn from textbooks, and quite another to understand the on the ground realities.


In tomorrow’s post, let’s dig in and take a look at the data itself, and see what the NFHS-5 results tell us about our country’s health.

Notes from National Health Profile (NHP) of 2019

India releases reports on our National Health Profile, the latest of which came out in the year 2019.

Some notes from that report:

  • 8.5% of our population is above the age group of 60:

    Age group-wise distribution of population of the country projected for 2015 and 2016 are given at Table No. 1.1.4(a) and Table No. 1.1.4(b) respectively. Accordingly to Table No. 1.1.4 (b), 27% of the total estimated population of 2016 were below the age of 14 years and majority (64.7%) of the population were in the age group of 15-59 years i.e. economically active population and 8.5% population were in the age group of 60 to 85+ years.

  • Here is the death rate by age group. The chart doesn’t mention this clearly, but this should be per ‘000 people.
  • I got to learn about the Integrated Disease Surveillance Project (page 128 and 129 on the National Health Profile report)
  • Public expenditure on health as a percentage of GDP was 1.02% in 2015-16. There is no significant change in expenditure since 2009-10. (Table 4.1.2)

  • The Centre-State share in total public expenditure on health was 31:69 in 2015-16. (Figure 4.1.1)

  • Around 48 crore individuals were covered under any health insurance in the year 2017-18. This amounts to 37.2% of the total population of India. 78% of them were covered by public insurance companies. (Table 4.3.5)

  • Overall, 80% of all persons covered with insurance fall under Government sponsored schemes. (Table 4.3.5)

  • Our spending on health as a % of GDP vis-a-vis other countries:
  • And a more specific comparison:
  • Number of Registered allopathic doctors possessing recognized medical qualifications (under MCI Act) and registered with state medical council for the years 2017 and 2018 were 43,581 and 41,371 respectively. At present average population served by Government Allopathic Doctor is 10,926 number of persons served per allopathic doctor. (Table 5.1 and 5.3)

  • There are 20,48,979 Registered Nurses and Registered Midwives (RN & RM) and 56,469 Lady Health Visitors serving in the country as on 31.12.2017

  • Medical education infrastructures in the country have shown rapid growth over the past few years. The country has 529 medical colleges, 313 Dental Colleges for BDS & 253 Dental Colleges for MDS. The total number of admissions for academic year 2018-19 in Medical Colleges is 58756.

  • There are 4035 hospitals and 27951 dispensaries to provide Medical care facilities under AYUSH by management as on 1.4.2018.

  • Health-care is the right of every individual. 60% of population lives in rural India. To cater the health needs of these rural populations there are 158417 Sub Centers, 25743 Primary Health Centers and 5624 Community Health Centers in India as on 31st March 2018

  • There are 43 government mental hospitals in this country. Table 6.2.7, on page 273 of the report

 

If there are other government reports that you know of that you think people should know about, please comment or email them in. I’ll share ’em here.

Information about the Coronavirus in India

What is the corona virus?

There isn’t one specific coronvirus.

Coronaviruses are a large family of viruses which may cause illness in animals or humans. In humans, several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).

By the way, the’re called corona viruses because they look like coronas, or crowns.

Coronaviruses are named for their appearance: Under the microscope, the viruses look like they are covered with pointed structures that surround them like a corona, or crown.

The most recently discovered virus causes the disease COVID-19.

How does it spread?

People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets. This is why it is important to stay more than 1 meter (3 feet) away from a person who is sick.

WHO is assessing ongoing research on the ways COVID-19 is spread and will continue to share updated findings.

 


 

When and how did it reach India?

As best we can tell, 30th January, 2020. This chart below shows you the spread since then.

Data and visualization can be tricky, and later on in this post, keep an eye out for another visualization about the corona virus.

Where does one get official data from in India?

The Ministry of Health and Family Welfare (MoHFW) is the official source that you should begin with. This is their website, this is their Twitter ID. At the moment of writing, the website reports 110 confirmed cases in India.

How is testing being done in India?

On the MoHFW website, there is a link about when to get tested for the corona virus in India. Shown below is a screen grab of that link.

Two things stand out:

  1. The second bullet point uses the word “and“. Having the symptoms is not enough, you must necessarily have traveled to any of the countries listed above. Other than whatever has been said in the previous sentence, you qualify for testing if you are a contact of a laboratory confirmed positive case. Unfortunately, “contact” isn’t clearly defined, at least on this page.
  2. Testing will currently be done by government laboratories only.

Which immediately leads to the next question:

What is our capacity to test for the coronavirus?

India has activated 67 laboratories for conducting the first test, and 51 of those are equipped to conduct confirmatory tests, which is not even one lab per district. India has 732 districts.

At present, cases are being reported from 13 States and Union Territories. In a country with a population of 1.3 billion, till now, only 6,500 throat swab samples from 5,900 individuals have been sent to these labs; at least 107 have tested positive.

That is from the Hindu Business Line, in a report that came out yesterday.

This is the COVID-19 page on the ICMR website. These are the locations of the testing laboratories in India. These are the locations of the sample collection laboratories.

 


 

OK, but 110 cases, how bad can that be?

Exponentials are hard. Anybody who has taught math or statistics will tell you that. Look at the graph(s) below:

A golden rule that I always teach my students in statistics: first look at the axes! On the horizontal axes here, we have the lag in days behind Italy. But the vertical axis is the more important thing to look at, because it is not linear. We go from 1 to 10, from 10 to 100, and from a 100 to a 1000 (and so on). Each tick on the vertical axis is a 10x increase.

In English? Every country where the virus has spread has seen a 10x increase. If you ask a data scientist to take a look at these data points, and then ask the about the trajectory in India, there’s only one possible answer: we probably go from a 100 to a 1000, and from a 1000 to 10,000. I hope not, of course, and mitigation is possible – social distancing is key!

By the way, if you want to play around with the data, click here to go to the Github page.

OK, so the numbers will go up rapidly, maybe. But the fatality rates are low, right?

Two important things to note:

Two numbers that you need to keep in mind when you think about the corona virus. The R0 and the fatality rate. The R0 for the coronavirus seems to be about two, although of course that number can vary because of a lot of factors. But a baseline R0 of 2 seems to be a reasonable estimate.

In English? If you get it, you will on average spread it to two other people. That’s why the quarantine and the social distancing measures are so very important. It’s not just because you shouldn’t get it yourself – it is more because you shouldn’t be giving it to others.

Now, the answer to the question itself: are the fatality rates low?

The Case Fatality Rate (CFR) for COVID-19 is 3.48 percent.

But as an statistician, it is important to state that the correct answer is it depends!

Unfortunately, it is common to report the CFR as a single value. But the CFR is not a biological constant. The CFR is not a value which is tied to the given disease, but is instead reflective of the severity of the disease in a particular context, at a particular time, in a particular population.

The probability that someone dies from a disease is not only dependent on the disease itself, but also the social and individual response to it: the level and timing of treatment they receive, and the ability of the given individual to recover from it.

This means that the CFR can decrease or increase over time, and that it can vary by location and by the characteristics of the infected population (age, sex, pre-existing conditions).

The real problem is rapidly overwhelmed medical facilities

Read the entire thread, not just the tweet quoted above. The point of sharing that tweet is to help you realize that opportunity costs will come into play very, very quickly at medical centers in India. Whom do I treat – patients with the coronvirus or other patients? And soon enough, it’ll be whom do I treat, this coronavirus patient or that one?

Worst of all, there is no treatment per se, yet. There’s encouraging news on the front from all over the world, India included, but there’s time for a recognized cure to be acknowledged and made widely available. Best to proceed on the assumption that there won’t be one, and prepare accordingly. That’s just good strategy in times like these: budget for the worst case scenario.

OK, so what can we do?

Follow government instructions! We’re all in this together, so whatever your local/state/national government is telling you ought to be followed, no questions asked.

Social distancing is key, and that’s fancy English for avoiding going out. Stay at home as much as possible over the coming days, and cooperate with local authorities. Classes, colleges, schools, clubs, restaurants, malls, gyms – anything in the nature of a public gathering ought to be avoided as much as possible.

Panic is not going to solve anything, but precautions will go a long way towards helping.

Stay home, stay safe!

Where can I learn more?

Here’s a list of resources:

Myth-busters from the WHO.

WHO’s advice for the public.

The Situation Update Report from the WHO (I have posted the latest update at the time of writing, but keep checking for more up to date ones as the days go by)

The WHO dashboard.

Read the Wikipedia article on the Epidemic Diseases Act.

A useful article about the how to think about exponentials.

A request: please email me at ashish at econforeverybody dot com with any resources that you think may prove useful. I’ll do my best to share the more useful ones with everybody.


 

Coming up tomorrow: technology in the times of COVID-19.

 

 

 

 

India: Links for 7th October, 2019

  1. This was a fascinating read. I was aware of the flu and its impact on India, but had no clue about the extent, the severity and the multiple what-might-have-beens. For example:
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    “y 1918, Gandhi was being seen in intellectual circles as a future leader of the nation, but he lacked grass-roots support. That spring, in his native state of Gujarat, he had organised two of his first satyagrahas, but these were followed by thousands of people, not hundreds of thousands. When the flu returned that autumn, he was struck down, as were other leading members of the independence movement who shared his ashram, notably Gangabehn Majmundar, the formidable spinning teacher, and Shankarlal Parikh, who had helped organise one of those early satyagrahas. Gandhi was too feverish to speak or read. He could not shake a sense of doom. “All interest in living had ceased,” he wrote later, in his autobiography.”
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  2. Professor Jayanth Varma is less than impressed with benchmarking for loans, and the rules associated with them:
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    “In the next few years, India needs to work on creating both a better banking system and better financial markets. One of the pre-requisites for this is that regulators should step back from excessive micro-management. For example, the RBI Master Directions require the interest rate under external benchmark to be reset at least once in three months while elementary finance theory tells us that if the floating rate benchmark is a 6-Months Treasury Bill yield, it should reset only once in six months. Either banks will refrain from using the six month benchmark (eroding liquidity in that benchmark) or they will end up with a highly exotic and hard to value floating rate loan resetting every three months to a six month rate. Neither is a good outcome.”
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  3. “The Socioeconomic High-resolution Rural-Urban Geographic Platform for India (SHRUG) is a geographic platform that facilitates data sharing between researchers working on India. It is an open access repository currently comprising dozens of datasets covering India’s 500,000 villages and 8000 towns using a set of a common geographic identifiers that span 25 years.”
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  4. “Prime Minister Narendra Modi, through “Make in India”, has the right idea when he says he wants to make India a global or regional manufacturing hub. But this cannot be accomplished by keeping an inefficient domestic industry shielded behind import barriers forever. Until something is done to change that, the industry will continue to lurch from crisis to crisis, and no lessons will have been learned.”
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    Rupa Subramanya and Vivek Dehejia in Livemint on what ails the automobile industry, and how to correct it.
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  5. Speaking of which
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    “For a car financed to the extent of Rs 6 lakhs and driven for 1500 km every month the effective cost of ownership/operations, with a driver is probably in the region of Rs 28 per kilometre. Shared mobility wins hands down against this arithmetic of ownership costs.”

RoW: Links for 11th September, 2019

  1. “Bangkok has 9.7 million automobiles and motorbikes, a number the government says is eight times more than can be properly accommodated on existing roads”
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    As an Indian, this is a somewhat reassuring read, in the sense that misery loves company!
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  2. A little vague, but I got to learn what sanuk means.
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  3. “The rapid expansion of the middle class among India’s 1.3 billion people has prompted Thai authorities to upgrade their estimates of Indian visitors. At least 10 million are now expected to arrive in 2028, a more than five-fold increase on 2018 visits. That sort of growth trajectory would mimic the rise of Chinese tourists, who jumped from 800,000 in 2008 to more than 10 million last year.”
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    I can account for three out of those 2 million.
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  4. “Obesity has reached alarming levels in Thailand, which ranks as the second-heaviest nation in Asia, after Malaysia. One in three Thai men are obese, while more than 40 percent of women are significantly overweight, according to Thailand’s national health examination survey.”
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    This was, to me, rather surprising.
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  5. “A couple of generations ago, Thais were rural folk who ate at home and took pride in offering food to the monks, but as they have moved to the cities they are likely to grab a polythene bag of curry on the way home to reheat. There is almost a stigma attached to cooking for yourself. “There is an embarrassment about spending time in the kitchen, it is seen as old-fashioned and a sign that you haven’t made it.”
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    On why Thai street food in Bangkok is so delicious. The article is about much more than that, but this was my main takeaway.

Links for 20th May, 2019

  1. “The debate could have been depoliticized if the CSO was more sensitive to criticisms, and had made proactive disclosures on the error estimates of different sub-sectors of GDP, with explanations for why output estimates for some sectors were more reliable than that of others. In fact, the first national account estimates presented by Mahalanobis after India’s independence carefully noted the data gaps and limitations of the estimates, as well as the error margins associated with each sectoral estimate. Providing such error estimates would also have drawn wider attention to data gaps, and could have helped MoSPI garner the requisite resources to fill those gaps.”
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    An article entirely worth reading if you are interested in India’s statistical organizations – from independence until today, the tale has been one of slow and painful deterioration.
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  2. “In short, Indian agriculture has undergone a phenomenal change over the last decade that it is no more dependent on just foodgrain or one sector. In fact, it has emerged as a versatile sector that still provides employment to over 50 per cent of the country’s population (per 2011 census) and keeps the economy ticking in rural areas despite the vagaries of weather.”
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    A useful place to get a good summary of Indian agriculture over the last decade or so. But I would argue that the key point is that there are far too many people employed in this sector – and that is the real problem.
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  3. “The four main factors they identify are as follows. First, there are historical institutions such as slavery and colonial rule. Second, the impact of cultural norms linked to religion, trust, family ties and beliefs. Third, there are geographical factors such as the terrain, temperature shocks and the frequency of floods. Fourth, historical accidents, such as the way national boundaries are drawn, also have an impact. These four factors together play an important role in the development trajectory of a country through time. The question is, what can be done to overcome these constraints in case they are a barrier to development? Can anything be done at all?”
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    Using cricket to learn about development economics. Or is it the other way around? Exactly the kind of article the world sees far too little of!
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  4. “The state legislators who are passing these bills know they will be challenged in court. They also know they will probably lose. But their sights appear to be set higher than their state jurisdictions: With a solidly conservative majority on the Supreme Court, anti-abortion advocates are eager to seed the challenge that could one day take down Roe v. Wade, the 1973 opinion that legalized abortion up to the point of fetal viability. At the very least, they hope the Supreme Court will undercut Roe and subsequent decisions that reaffirmed abortion rights, the idea being that each legal challenge makes it a little harder to obtain an abortion in the United States.”
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    Have you heard of Roe vs. Wade? Might you be curious to learn about what exactly culture has to do with economics, as we discussed in the link above? A useful, if unfortunate example is this article.
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  5. “What concerns health practitioners is the high transmissibility of the bug. “We studied the fungus in January, 2017, when we found it had colonized the skin of a patient who was referred to the Trauma Care ICU from another hospital. But within four days, it (bug) had spread to all the other patients admitted in the unit. All nine of them,” said professor Arunaloke Chakrabarti from Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh.”
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    Just in case your Monday wasn’t depressing enough. Be afraid – be very afraid.

Links for 25th April, 2019

  1. “Singapore appreciates the relative strengths and limits of the public and private sectors in health. Often in the United States, we think that one or the other can do it all. That’s not necessarily the case.”
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    It is always a good idea to learn about Singapore’s healthcare system, and this Upshot column from the NYT helps in that regard. Each of the links are also worth reading. If you spend time reading through the article and all the links therein, you might be a while, but it is, I would say, worth it.
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  2. “With Nobel laureate Daniel Kahneman, he collected evidence on happiness that remains my benchmark for social scientists’ ability to shed light on wellbeing. Prof Kahneman once warned me that expert advice can go only so far. Much happiness and sadness is genetically determined: “We shouldn’t expect a depressive person to suddenly become extroverted and leaping with joy.” Those words are much on my mind this week.”
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    Tim Harford remembers Alan Kreuger, and helps us understand a lot about the man, his work, happiness and much else in the process. Entirely worth reading.
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  3. “The Captain Swing riots are thus one more example, an especially vivid one, that new technologies which cause a lot of people to lose a way of earning income can be highly disruptive. The authors write: “The results suggest that in one of the most dramatic cases of labor unrest in recent history, labor-saving technology played a key role. While the past may not be an accurate guide to future upheavals, evidence from the days of Captain Swing serve as a reminder of how disruptive new, labor-saving technologies can be in economic, social and political terms.”
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    One, because reading something you hadn’t read before is always interesting. Two, because unemployment because of automation isn’t new. Three, makes for very relevant reading today (in multiple ways: automation itself, but also untangling causality.)
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  4. “He says he was inspired by the depth of the nun’s commitment to India’s least fortunate—but he was unwilling to emulate her approach, and not simply because of its material sacrifices. Although Shetty often performed free surgeries for the poorest of the poor, he reasoned that the only way to sustainably serve large numbers of people in need was to make it a business. “What Mother Teresa did was not scalable,” he says—perhaps the first time venture capital jargon has been applied to the work of the Angel of Calcutta.”
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    Interested in healthcare, or economics, or both? A lovely read, in that case. Also a good explainer of the challenges in front of Modicare.
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  5. “The argument in favour of having Tribunals is that they offer a specialised and dedicated forum for settling specific categories of disputes which are otherwise likely to get stuck in the regular judicial channels. But this assumption holds only if the regular judiciary exercises restraint and does not insert itself into the proceedings pending before Tribunals. ”
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    The problem with laws in India isn’t their framing – it is their implementation. Read this to find out more.

Links for 23rd April, 2019

  1. “Obviously, there are many more novels and memoirs that mention long lists of books than are included here, but I’m limited, as ever, by time, availability of data, and the demands of maintaining sanity. So below, please find twelve books that are filled to the gills with mentions of other books, and feel free to add further suggestions in the comments.”
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    If you, like me, are fond of bookmarking lists that will prove to be useful at some undefined point of time in the future, you might find this useful. Books that contain lists of other books worth reading is an interesting enough article by itself – as an academician, I’d argue it’s the very best way to include a bibliography.
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  2. “Alas, if only healthcare policy were so simple. The reality is messy and there is no magic bullet. Singapore’s success in healthcare is built on a panoply of measures developed and refined over decades. The measures employ a variety of policy tools that both individually and collectively target the market and government failures afflict the healthcare sector. For a comprehensive understanding of health policy in Singapore, we need to understand all the policy tools used and how they operate individually and in relation to each other.”
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    A very readable PDF about what makes Singapore’s healthcare system so very awesome. Truly worth a read to find out how it evolved, and as an Indian, to understand how far we have to go.
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  3. ““You will hardly find women with wombs in these villages. These are villages of womb-less women,” says Manda Ugale, gloom in her eyes. Sitting in her tiny house in Hajipur village, in the drought-affected Beed district of Maharashtra’s Marathwada region, she struggles to talk about the painful topic.”
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    Speaking of a long way to go
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  4. “Facebook’s powerful network effects have kept advertisers from fleeing, and overall user numbers remain healthy if you include people on Insta­gram, which Facebook owns. But the company’s original culture and mission kept creating a set of brutal debts that came due with regularity over the past 16 months. The company floundered, dissembled, and apologized. Even when it told the truth, people didn’t believe it. Critics appeared on all sides, demanding changes that ranged from the essential to the contradictory to the impossible. As crises multiplied and diverged, even the company’s own solutions began to cannibalize each other.”
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    A very long article about the troubles at Facebook, but you can never read too much about the how’s and what’s at Facebook.
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  5. “If that’s an equally unpleasant prospect, consider Andreessen, who’s 47, the perfect messenger. From showy check-writing to weaponizing his popular blog and (before Trump) Twitter account to hiring an army of operational experts in a field built on low-key partnerships, he’s one of Silicon Valley’s poster boys for upending the rules. And it’s worked: In one decade, Andreessen Horowitz joined the elite VC gatekeepers of Silicon Valley while generating $10 billion-plus in estimated profits, at least on paper, to its investors. Over the next year or so, expect no less than five of its unicorns—Airbnb, Lyft, PagerDuty, Pinterest and Slack—to go public.”
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    a16z is a firm everybody should know more about – this article helps. By the way, their podcast is good as well.