By Shaffi Fazaludeen Koya/Sushant Kumar
The Lancet, September 16: We read with interest the Editorial by The Lancet asking for greater transparency and integrity from India’s Government leadership. We would like to reiterate the need for greater data transparency to ensure health equity by highlighting the case of the delayed 2021 Indian census.
Apart from some disruption during the war years, India’s decadal census has never been stalled and the 2021 population enumeration was originally planned to begin from February, 2021.
Understandably, the COVID-19 pandemic delayed the plans, but the Government had informed parliament that the new population figures would be available before the 2024 national elections.
However, the house listing has not happened yet, and as such, the census was postponed indefinitely.
This delay will affect the healthcare planning and programme cycle, particularly health needs assessment and resource allocation. Also, population figures are pertinent to design various nationally representative surveys, which inform health problems, disparities, inequities, and progress and achievements at the population level.
Most importantly, the census provides the basic population data required for welfare programme planning. However, several of these welfare programmes—which address important determinants of health—continue to use 2011 census data.
For example, the public distribution system (PDS), which provides subsidised rations to families in poverty, could not add more beneficiaries in several states as the number of ration cards is capped as per the 2011 census.
This has resulted in many beneficiaries being denied their due share of subsidised ration food grains even during the pandemic. This assumes importance considering that India has seen substantial job loss—first following demonetisation in 2014 and then the pandemic—clearly indicating a higher demand for welfare schemes like free ration.
India’s ranking in the Global Hunger Index plummeted from 99 in 2014, to 107 in 2022, particularly due to worsening child wasting and stunting. According to global multidimensional poverty index estimates, more than 80% of people with low income in India belong to Scheduled Castes, Scheduled Tribes, or Other Backward Class households, and therefore, substantial numbers of beneficiaries were excluded from the Public Distribution System due to delays in the census belonged to these social categories. This will undoubtedly perpetuate the vicious cycle of hunger, ill health and poverty among these marginalised groups.
Data show that childbirth registration is low among mothers who are illiterate, Muslim households, and the poorest wealth quintile, reflecting the underlying inequities.
The census—which captures all births and deaths—is still the most reliable source for studying demographic changes including fertility rates. Furthermore, the census is the most reliable source of information on various social determinants of health including literacy, housing, employment, and migration.
In many Indian States, job losses in cities have forced people to return to agricultural labour, and an increase in government employment guarantee scheme beneficiaries supports this trend. Without the census, an accurate picture of the rural–urban population distribution, income, employment, and migration patterns remains unclear, which might badly affect resource allocation.
Many State elections, which are mammoth exercises, were held in the last 2 years without any hurdles. The Government’s decision to delay the census, therefore, raises suspicions.
The census might reveal the true toll of the pandemic, and this could reinforce the widely held belief that the Government was under-reporting COVID-19 deaths. Furthermore, under-reporting is important given the concerns around the Indian Government’s recent pattern of ignoring or rejecting unpleasant data provided by international surveys and rankings and the decision to discontinue National Sample Survey Organization(NSSO) unemployment surveys.
The proposed e-census, designed as a partly passive self-reporting system replacing the existing active house-to-house survey, is a good way forward. But the e-census needs to be flexible and inclusive enough to address the vast inequities in internet access and literacy, which might otherwise result in exclusion of some groups from the census figures.
It will be in the best interest of the country to get all hands on deck and complete the census without any further delay.
Updated, transparent, and reliable data informed policy making can go a long way in improving the health and living conditions of the Indian population. With India in its historic G20 presidency year, this is also an important political statement expected from the largest democracy in the world.
For the Global Hunger Index see https://www.globalhungerindex.org/india.html
We declare no competing interests.
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