by Amartya Sen
All the poor and destitute in the country … and all who are diseased, go to these houses, and are provided with every kind of help, and doctors examine their diseases. They get the food and medicine which their cases require, and are made to feel at ease; and when they are better, they go away of themselves.36
Whether or not this description was over-flattering to early fifth-century Patna (which seems very likely), what is important is the involvement with which Faxian wanted to observe and learn from the arrangements for medical care in the country he visited for a decade.
Yi Jing too, two and a half centuries later, was very engaged in examining health care, to which he devoted three chapters of his book on India. He was more impressed with Indian health practice than with Indian medicine. While giving India credit for some medical treatments, mainly aimed at palliation (such as ‘ghee, oil, honey, or syrups give one relief from cold’), he concluded: ‘In the healing arts of acupuncture and cautery and the skill of feeling the pulse, China has never been surpassed [by India]; the medicament for prolonging life is only found in China.’ On the other hand, there were things to learn from India on health behaviour, such as ‘the Indians use fine white cloth for straining water and in China fine silk should be used’, and: ‘in China, people of the present time eat fish and vegetables mostly uncooked; no Indians do this.’ While Yi Jing returned to China happy enough with his country of origin, he did not omit to discuss what China could nevertheless learn from India.
Public Health and Public Arguments
The extensive intellectual relations between China and India in the first millennium are of obvious narrative significance both for the history of a big part of humanity and for the relevance of these deliberations in the global history of ideas. The need to study these relations is made even stronger by the way this rich history has tended to be ignored in the contemporary understanding of our global past. Many of the concerns and interests that linked China and India in the first millennium (varying from mathematics and science to literature, arts and public communication), with interactions across the borders, have continued to exert their influence in the thousand years that have passed since the first millennium.
There are, however, additional questions of conjectural interest about the light that Sino-Indian intellectual engagements in the first millennium may throw on political, social and economic discussion in the world today. Is the old history of these cross-border interactions between China and India of any relevance to the present-day concerns in these countries, and more broadly, in the contemporary world? For example, does the overcoming of national or civilizational insularity have continuing interest? Is there any contemporary relevance in the traditions and practices in the two countries that, to varying extents, engaged both countries in the first millennium, such as ‘the art of prolonging life’ or the extent to which ‘public arguments’ are to be encouraged?
Public health is a subject in which learning from each other can indeed be extremely important, and this – as we saw earlier – was a subject of concentration in Sino-Indian relations even as early as the fifth century. While Chinese commentators were particularly engaged in asking what China could learn from India in the ‘art of prolonging life’, in the modern context it is much easier to see what India can learn from China, rather than the converse. The lessons for India from China will be a particular focus of attention in Essay 9. In fact, China has enjoyed a life expectancy that is significantly longer than India’s over quite a few decades now (in fact, from shortly after the Chinese revolution and India’s independence, respectively).
However, the history of progress in life expectancy in the two countries tells a much richer story than that overall summary comparison can reveal. Maoist China made an early start in widespread health care shortly after its revolution, in the form of some health insurance for all, delivered by the state or by the collectives or communes in the rural areas. There was nothing comparable in India at that time. By the time economic reforms were introduced in China in 1979, China had a lead of fourteen years over India in longevity. The Chinese life expectancy – around 68 years by 1979 – was almost a decade and a half longer than India’s puny figure of 54 years, at the time of the Chinese economic reforms.
With the reforms of 1979, the Chinese economy surged ahead spectacularly and grew much faster than India’s more modest performance (even though India’s growth rate from the 1980s onwards was higher than her own past performance). However, despite China’s much faster economic growth, the rate of extension of life expectancy in India has been about three times as fast, on the average, as that in China, since 1979. China’s life expectancy, which is now just about 71 years, compares with India’s figure of 64 years, so that the life-expectancy gap in favour of China, which was fourteen years in 1979 (at the time of the Chinese reforms), has now been halved to only seven years.
Indeed, China’s life expectancy of 71 years is now significantly lower than that in parts of India, most notably in the state of Kerala. It is particularly instructive to look at Kerala, despite the fact that it is just one state within a large country. In fact, with its 30 million people, Kerala could have been a country on its own, but more importantly, Kerala’s experience has been particularly distinguished in combining Indian style multi-party democracy with social intervention of the type in which pre-reform China was perhaps the world leader. The advantage of that combination shows itself not only in achievements in high life expectancy, but also in many other fields. For example, while the female–male ratio in the total population in China is only 0.94 and the Indian overall average is a little lower, namely 0.93, Kerala’s ratio is 1.06, exactly as it is in North America and Western Europe (reflecting the survival advantages of women in the absence of unequal treatment).* The fall in the fertility rate in Kerala has also been substantially faster than in China, despite the coercive birth-control policies used in the latter.†
At the time of the Chinese reforms in 1979, Kerala’s life expectancy was slightly lower than China’s. However, by 1995–9 (the last period for which firm figures for life expectancy in India are available), Kerala’s life expectancy of seventy-four years was already significantly higher than China’s last firm figure of seventy-one years for 2000.‡ Going further into specific points of concern, the infant-mortality rate in China has declined extremely slowly since the economic reforms, whereas it has continued to fall very quickly in Kerala. While Kerala had roughly the same infant-mortality rate as China – 37 per thousand – at the time of the Chinese reforms in 1979, Kerala’s present rate, 10 per thousand, is a third of China’s 30 per thousand (where it has stagnated over the last decade).
A couple of factors, both of which link to the issue of democracy, can help to explain the slackening of Chinese progress in the art of prolonging life, despite being helped by its extremely rapid economic growth. First, the reforms of 1979 led to the ending of free public health insurance, and it was now necessary to buy private health insurance at one’s own cost (except when provided by the employer, which covers only a small minority of cases). This retrograde movement in the coverage of health care, with the withdrawal of a highly valued public facility, received little political resistance – as it undoubtedly would have met in any multi-party democracy.
Second, democracy also makes a direct contribution to health care by bringing social failures into public scrutiny.* India offers high-quality medical facilities to the Indian rich and to rich foreigners, but basic health services in India are quite bad, as we know from elaborate criticisms of these services in the Indian media. But the possibility of intense criticism is also a social opportunity to make amends. In fact, vigorous reporting of the deficiencies of Indian health services is, ultimately, a source of India’s dynamic strength, which is partly reflected in the sharp reduction in the China–India gap in life expectancy and the better achievements of Kerala by combining democratic participation with a radical social commitment. The terrible effects of the secr
ecy surrounding the SARS epidemic, which surfaced in China in November 2002 but information about which was suppressed until the following spring, also bring out the link between public communication and health care.†
So while India has much to learn from China about health care (especially from the powerful public commitment of the early post-revolutionary period) and about economic policy making (from China’s post-reform experience), the relevance of public communication, which is central to democracy, is a general lesson that India can still offer to China. Interestingly, it is the tradition of irreverence and defiance of authority which came with Buddhism from India that was singled out for a particularly strong chastisement in early anti-Buddhist criticisms in China. Fu-yi, a powerful Confucian leader, submitted in the seventh century the following complaint about Buddhists to the Tang emperor (almost paralleling the contemporary ire of the Chinese authorities about the disorder generated by the present-day Falungong):
Buddhism infiltrated into China from Central Asia, under a strange and barbarous form, and as such, it was then less dangerous. But since the Han period the Indian texts began to be translated into Chinese. Their publicity began to adversely affect the faith of the Princes and filial piety began to degenerate. The people began to shave their heads and refused to bow their heads to the Princes and their ancestors.37
Fu-yi proposed not only a ban on Buddhist preaching, but also quite a novel way of dealing with the ‘tens of thousands’ of activists rampaging around in China. ‘I request you to get them married,’ Fu-yi advised the Tang emperor, and ‘then bring up [their] children to fill the ranks of your army’. The emperor, we learn, refused to undertake this imaginative programme of eliminating Buddhist defiance.
China has joined – and become a leader of – the world economy with stunning success, and from this India, like many other countries, has been learning a great deal, particularly in recent years. The insularity of the earlier Indian approach to economic development needed to be replaced and here the experience of China has been profoundly important. There are great lessons also from China’s early move to universalized health care and basic education. But the role of democratic participation in India suggests that some learning and understanding may go in the other direction as well.
As it happens, India is the only country in the outside world to which scholars from ancient China went for education and training. The overcoming of cultural insularity that we can observe both in China and in India in the first millennium has continuing interest and practical usefulness in the world today. When Xuanzang put a profound rhetorical question about human knowledge to his teachers in Nālandā, ‘Who would wish to enjoy it alone?’, he was pointing to a foundational issue the relevance of which reaches far beyond Buddhist enlightenment in particular. Indeed, that concern and commitment remain as relevant today as they were in Xuanzang’s world in the seventh century. India and China learned a lot from each other in the first millennium, but the significance of that epistemic process has not dried up even at the beginning of the third millennium.
PART THREE
Politics and Protest
9
Tryst with Destiny*
It was a thrilling moment. On 14 August 1947, on the eve of India’s independence, we glued ourselves to the radio in our little school a hundred miles from Calcutta. It was almost exactly four years after the terrible famine we had seen as young children (with millions dying), which gave many of us, unaffected by the famine, the enduring thought that ‘there, but for the grace of class divisions, go I’. Those were terrible days, but August 1947 was a different and a joyous time. In celebration of independence and in welcoming a democratic India, Jawaharlal Nehru’s voice roared loud and clear over the radio, telling us about India’s ‘tryst with destiny’. The ‘task ahead’ included ‘the ending of poverty and ignorance and disease and inequality of opportunity’. We heard with rapt attention and we felt powerfully inspired.
The Pledge and the Record
Rather more than half a century has passed since then, and it is not too soon to ask what came of that ‘tryst’ with destiny, and of the ‘tasks ahead’. The answer is not altogether simple.1 In line with Nehru’s formulation, we can split the evaluation into three broad fields: (1) practice of democracy, (2) removal of social inequality and backwardness, and (3) achievement of economic progress and equity. We must also ask how the successes and failures in these different fields interconnect and relate to each other.
There are reasons for satisfaction in the first area.* While the correspondent of The Times in 1967 did report, with some sense of absolute certainty, that he had just witnessed ‘the last general elections’ in India (Indian democracy, he confided, could not but end very soon), the doom did not come as anticipated. Systematic elections have continued to happen with regularity and reasonable fairness.† Political parties have come into office after winning elections, and have left after losing them. The media have remained largely free, and the press has continued to report, scrutinize and protest. Civil rights have been taken seriously, and the courts have been fairly active in pursuing violations.‡ The military has stayed well inside the barracks.
This is largely a story of success. And yet the achievements of Indian democracy have been far from unblemished. While political movements have been very effective in dealing with some wrongs, other wrongs have not received anything like sufficient redress or even serious engagement. Since democracy is not only a blessing in itself, but can also be the most important means to pursue public ends, it is not enough to make sure that Indian democracy survives. While we must give credit where it is due, Indian democracy has to be judged also by the strength and reach of public reasoning and its actual accomplishments. After discussing the other areas of concentration identified by Nehru, I shall come back to these concerns about democracy which are more complex than the mere survival of democracy.
The second field – that of social progress and equity – has fared much worse than democracy itself: not quite an immeasurable failure, but certainly a measurable underperformance.2 Educational progress has been remarkably uneven. Even though India has many more university-educated persons than China has, China has made remarkable progress towards universal literacy, while India is still far behind. The proportion of literates among adult males is still below 75 per cent in India (in comparison with China’s above 90), and only about half of Indian women are literate (compared with China’s 80 per cent or more). Life expectancy at birth in India has climbed to around 64 years (from being near 30 at the time of independence), but it is still significantly below China’s life expectancy of 71 years.* Further, mortality rates in India sharply differ between different states, and also between classes and between urban and rural areas. Many rural residents, especially the poorer villagers, are still far removed from decent medical attention.† Inequalities between women and men in economic and social opportunities, and often even in health care, remain quite large.3
What about the third field – that of economic progress? India’s economic expansion was particularly slow before the 1980s, especially in comparison with the spectacular performance of Asian economies further east, such as South Korea or Taiwan. After the quickening of Indian economic growth from the 1980s, India has done comparatively better, not just in the aggregate movement of the gross national product (GNP) and gross domestic product (GDP), but also in terms of reduction of income poverty. The economic reforms introduced in 1992, led by Manmohan Singh (then the Finance Minister, and now the Prime Minister of India since the spring of 2004), have led to considerable liberalization and freeing of international trade, and to some replacement of what used to be called the ‘licence Raj’ (with pervasive bureaucratic control over private economic initiatives).4 This has greatly added to business opportunities in India and has also helped to consolidate India’s faster economic growth. Liberalization, which still has some distance to go, has helped to free Indian entrepreneurs to seek global trade, and the s
uccess has been especially large in specific sectors such as the development and use of information technology.5 The overall performance of the economy may not have matched that of post-reform China (with its sustained growth rate of 8 to 10 per cent a year), but India’s move from the rigid box of a 3 per cent growth rate to the 5 to 8 per cent arena is certainly not a negligible development.
The proportions of the Indian population with incomes below the standard poverty lines seem to have fallen over the 1980s and 1990s, even though there are disputes about the extent of this decline, and some doubts about the social reality that lies behind these statistical figures.6 What is, however, clear enough is that India’s reduction of poverty has been far less rapid than what has occurred in China since the economic reforms.
Poverty and Social Opportunity
There is indeed much about the process of economic growth and development that India can learn from the experience of China.* Making good use of global trade opportunities is among the lessons that China offers to India, and the lessons here can be critically important for India’s economic progress. A similar message had already emerged from the economic success of other East Asian economies, including South Korea, but given China’s size and the intensity of its pre-existing poverty, China’s experiences are particularly relevant for India’s economic policy-making. The general lesson that good use can be made of global opportunities of trade and commerce to enhance domestic income and to reduce poverty has emerged very clearly from the success of economies in East and South East Asia – led now by China.