Heart Disease in India

Indians are the most likely people in the world to have heart related problems. To those Indians whose close ones were at one time or another affected by heart disease, this may not be that much of a suprise. While a great deal of attention is (appropriately) being focused on the AIDS epidemic in India, heart disease is not given much priority. The accounts from doctors are alarming.

• http://in.rediff.com/getahead/2005/may/16heart.htm
  "By one estimate, 60 percent of the world's coronary heart patients will be in India by 2010"
  
• http://www.rediff.com/news/2007/nov/29heart.htm
  "India has the highest incidence of heart related diseases in the world and the number of those affected is likely to double in the coming years"

The size of the problem is staggering. Even if the above predictions turn out to be inflated, India is ill equipped to deal with problems on such a colossal scale. The cost to India in terms of rupees spent, human resources lost and emotional, will be colossal.

Part of the problem may be that we Indians don't have a central health information resource specific to the Indian population. Even for a third-world country, this is surprising. When we try to find information online, we are assured by websites for Americans or Europeans that until we are in our 40s, we are safe and need not worry about heart problems. However, this is true only for American and European populations. Indians are susceptible from the time they enter their 30s.

India needs premier central health institutes that can fund research into the epidemiology of medical problems, disseminate information that is relevant to the Indian population, and track the progress of strategies to counter the spread of such problems in the Indian population. Existing institutions such as AIIMS currently provide the best medical care, but do not have large-scale, nationwide epidemiology programmes. Of course we need hospitals, but without epidemiologic knowledge, we are simply shooting in the dark.

Is Caste Causally Responsible for Poverty?

Caste is, of course, a very good indicator of poverty in India. In the past, people were denied access to certain facilities based on their caste. This meant that certain castes weren't allowed to develop in certain ways, and it became the root cause of today's poverty structure, which is overwhelmingly biased against certain castes.

But I want to ask the question: does caste continue to be causally responsible for poverty? More specifically, conditional on the situation prevailing say 10 years ago, is caste still being used to deny opportunities to people today? Or, are we confusing the effect of the socio-economic stratum for the effect of caste?

Let's be even more specific. Descendants of poor families are more likely to be poor than descendants of rich families. Descendants of both poor and rich families are also likely to retain their caste, since caste is hereditary and inter-caste marriage is still relatively rare. Thus descendants with castes which are poorer today are likely to be poorer than descendants of castes which are richer today. In statistical terms, the wealth of the family at the start of the time period under study is a confounder for the effect of caste.

The right way to ask the question is: take two families with similar economic conditions but with different caste; is one of the families likely to have richer descendants, say 50 years in the future?