In economic literature, the stories of how now-rich countries developed can allow us to picture, even if not predict, how India's development might look. These are, as I said, not predictive pathways - India's manufacturing journey, for instance, is one such example of a well-marked path that we have not taken. But in many other areas, we can see India's future in other countries' shadows.
On the same lines, the levels of development of the richer and poorer states within India are so markedly different, that we can map some of these same journeys here too - on some aspects, the future of today's central and eastern states can be seen in what has already happened in the richer southern and western states.
When it comes to health and mortality, there are undoubtedly signs for the future. As people get richer, deaths from communicable diseases become more preventable and less common. As a result, the relative share of deaths from non-communicable diseases such as heart disease and cancer begins to rise. India is in the midst of this transition, a moment that in public health is called the epidemiological transition, as I wrote about in my work on the changing landscape of disease in India.
The extent of this shift varies by region within India. India's richer states are further along in their epidemiological transition, having reached the point where non-communicable diseases account for the majority of deaths two decades ago. In India's poorer states, on the other hand, the epidemiological transition is much more recent. Communicable diseases still account for over 30% of deaths in India's poorest states, while in India's better off states, communicable diseases now account for fewer than 20% of deaths.
This is a major shift - non-communicable diseases need a radically different medical and policy approach than communicable diseases. For India's poorer states, the writing is on the wall - they need to prepare for a non-communicable disease future. There is also the opportunity to avoid path dependency; if India's richer states did not move quickly enough on prevention, screening, testing, public education or insurance coverage of NCDs, the poorer states can see what lies ahead, and hopefully course correct.
