Unhealthy states

For the fourth year running, Kerala has emerged as the best performer among large states on NITI Aayog’s Annual Health Index, which ranked the performance of states and Union Territories for 2019-20, incorporating 24 key indicators. Kerala had a composite score of 82.2 out of 100, followed by Tamil Nadu (72.42) and Telangana (69.96). The top performers have remained unchanged, with some of them only swapping places in the top-10. Unsurprisingly, the bottom of the list for large states finds Uttar Pradesh at the 19th spot, with a score of 30.57. Bihar (31), Madhya Pradesh (36.72) and Rajasthan (41.33) are above UP. All of them have retained their lowly positions since the previous survey, confirming their reputation as the incorrigible laggards.

The index softens the blow for UP by placing it on top of the list of states which have made the greatest improvement since the 2018-19 index. But Bihar, again with great room for improvement, is only 11th on this particular list, Madhya Pradesh is sixth and Rajasthan a disappointing 17th with a fall of 0.55 in its score. While experts have picked holes in the criteria of the index, anecdotal evidence of people’s experiences during the Covid-19 pandemic bear out the rankings — patients in the southern states were delivered better services by the public healthcare system.

However, it may not be prudent to treat UP — with a population of around 20 crore — and Kerala (3.3 crore) with any degree of equivalence. The lowest-ranked states on the index are also the poorest in the country, with the lowest per capita income, lowest per capita GDP and lowest Human Development Index scores. But the example of Odisha proves that change is possible with political will and a focused approach. The state has shown improvement on all indices in recent decades. The Bimaru states — Bihar, MP, Rajasthan and UP — must study the Odisha model if they are serious about changing the lot of their people.