A Drink to Gujarat’s Health

Gujarat’s abysmal Health indices that were elaborated upon in the article Gujarat: In a Sorry State are a matter of shame for a state that is otherwise outshining its worthy adversaries in most other sectors. Fortuitously, there exists a solution that can not only provide the so-called second-phase surge economists talk about, it can bring Gujarat closer to Kerala’s enviable health indices in no time. No, it does not involve stealing money or bringing some of it back from Switzerland, nor does it entail sorcery or voodoo.

Can Gujarat do it? It can if every time Mr Modi talks of Public Health at a rally, Gujarat’s Infant Mortality Rate flashes before his eyes. It can if every second Gujarati pregnant woman he meets tells him she never underwent a first trimester check-up. It can if a child suffering from Kwashiorkor wraps his shrivelled palm round Mr Modi’s index finger and doesn’t let go of it. It can. But for it to happen, Gujarat must rid itself of one thing and one thing only: Prohibition.

Prohibition – a remnant of the famous Gandhi quote, “I would rather have India without education if that is the price to be paid for making it dry” – has managed to find a quiet corner even in our Constitution: “The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health”.

As a doctor troubled by Gujarat’s Health indices, I now suggest, dismissing the irony, that the only way for Gujarat to raise the level of nutrition and the standard of living of its people and the improvement of public health is for it to abandon Prohibition altogether. No newspaper-wrapped quarter bottles, no medicinal purposes bunkum – just get rid of it lock and stock, and bring back the barrel. Allow me to explain.

The states, if they are to spend money, must first make it. One easy way is to demand from its citizens a tax every time they drink. This levy, also called State Excise in India, is imposed mainly on liquor sale, for which reason it is also commonly called Liquor tax. A few analysts incorporate Sales tax along with Excise when reporting revenue from alcohol sales, but most including state finance departments don’t. As one state report makes it clear: The revenue receipts of State Excise come mainly from Country Spirits, Country Fermented Liquors, Malt Liquor, Liquor, Foreign Liquors and Spirits while a small contribution is from Commercial & Denatured Spirits & Medicated wines, Medicinal and Toilet preparations containing alcohol and opium, Opium, hemp and other drugs, and Fines and Confiscations.

Indeed, the 2012 Finance Report of the Government of Karnataka, that begins by informing its citizens of an important detail: “The hon’ble Excise Minister is holding the portfolio of Excise”, goes on to define the true Mission of the Excise Department: “To provide wholesome liquor to gullible man who cannot resist drinking which, in the process mobilize Revenue to the State Exchequer.”

Mobilising revenue to the State Exchequer is the key here. The Finance Minister of Tamil Nadu O. Panneerselvam, who began his 2012 budget speech thus: “Courage, generosity, knowledge and zeal in boundless measure are four-fold traits natural to rulers. With the blessings of the benevolent leader, our Hon’ble Chief Minister Puratchi Thalaivi J Jayalalithaa, who is the embodiment of all the above four virtues of an ideal ruler viz., courage, generosity, sagacity and zeal as enshrined in Thirukkural, the universal doctrine, I rise to present the Budget Estimates of the Government of Tamil Nadu for the year 2012-2013 before this august house”, then went on to declare revenue from liquor to be as high as Rs 11,473 crore (later revised to Rs 12,473 crore), an increase of 16% over the previous year.

Karnataka and Tamil Nadu are not alone. As Table 1 shows, most large states – and certainly the states we are comparing Gujarat with – are becoming progressively richer from liquor tax.

Excise Revenue figures are in Rs crores and from the RBI annual reports. Figures for the year 2003-04 and 2012-13 are revised estimates; all others are actuals. Year-wise Population estimates, in millions, are shown in brackets.

A clearer picture can be had if one analyses the Liquor revenue gained per capita for each state (Table 2).

Excise Revenue figures are in Rs

While Gujarat worries sick about Bapu’s quotes, and her goats graze the X-axis, her competitors are getting obese. In 2011, Liquor tax made up 17% of Karnataka’s total revenue (Table 3). The figures for Punjab and Tamil Nadu were 12.29 and 13.8% respectively. Contrast now the ten year liquor revenue of these states. The numbers are astonishing. Compared to Gujarat, Karnataka and Tamil Nadu, with a five-year average Excise growth rate of 18.8 and 21.2% respectively, have had an extra Rs 59,000 crore each to spend as they wish.

It is clear as day: Gujarat is bleeding. The blood isn’t visible as her economy is performing fabulously regardless, but it does make one wonder what all that extra money could have done for Gujaratis if it was returned to them through increased Health spend.

Drinking is evil. For more than 50 years, the land of Bapu’s birth has held on to such anachronisms. It is time for Gujarat to see sense and join with mainstream India, time to abandon this finicky devotion to a Gandhian quote, devotion that all but three states have long abandoned. The evidence is overwhelming. Prohibition brings with it more ills than one can imagine – bootlegging, liquor mafia, police corruption, political sleaze, illicit liquor industry – and lastly, enormous loss in revenue. If all this wasn’t bad enough, Prohibition also impacts tourism. According to one operator, “Most foreign tourists refuse to take the risk of even having their customary drink in a hush-hush manner”. Dinesh Hinduja, a Gujarati businessman who organised the gloriously named Malt March, echoes the sentiment. As reported by India Today, “Prohibition”, he says, “is a millstone around Gujarat’s neck which is not just impeding its progress as a vibrant state but is also the single biggest source of corruption and hypocrisy in the name of Gandhism.” To be sure, Gujarat has relaxed the rules recently. Curious looks notwithstanding, foreigners can now obtain a drinking permit from the airport arrival lounge itself.

Meanwhile, bootlegging is rampant. 57,227 units of country-made liquor and 94,256 units of foreign liquor were seized in Ahmedabad city alone in 2011. The figure in 2012 was 69,623 units and 50,883 units respectively. There is a view that Prohibition has encouraged mafia-controlled haftas and that police-raids are superficial attempts at good publicity.

Bootlegging, hafta, mafia, gambling is one thing, cold-blooded murder quite another. In July of 2009, as many as 136 Gujaratis died after consuming hooch, the country-made liquor sold in plastic pouches as potli. Brazen bootleggers continued to peddle the poisonous brew even as reports of scores succumbing to this tragedy spread across Gujarat’s towns. Outraged relatives came out on the streets and attacked buses with sticks and stones, forcing the police to arrest some 800 bootleggers. These disasters are bound to recur, especially as hooch is consumed only by the poor and the destitute.

Proponents of Prohibition, however, are quick to make the counter argument that it results in much lower figures for crime, domestic violence, sexual assault, and road accidents. But the 2012 National Crime Statistics do not support this view in its entirety (Table 4). Gujarat fares modestly, not managing to come out top in any category. What’s more, Punjab – which increased its 2012 liquor revenue by a remarkable 38% over the previous year – trumps Gujarat in seven of the eight categories.

All data is for 2012 and adjusted to cases per million state population. Data  from National Crime Records Bureau. Cognisable crimes are the total number of crimes registered under sections of IPC and SLL. Crimes against women include: Rape, Kidnapping & Abduction, Dowry deaths, Cruelty by husband or his relatives, Assault on women with intent to outrage her modesty, Insult to the modesty of women, Importation of girls from foreign country, Sati, Immoral trafficking, Indecent representation of women, and dowry. Violent crimes include: Murder, Attempt to commit murder, Culpable homicide not amounting to murder, Rape, Kidnapping & Abduction, Dacoity, Preparation and assembly for dacoity, Robbery, Riots, Arson, and Dowry death. Crime against Property includes: Robbery, Burglary, Theft, Dacoity, and Preparation and assembly for dacoity. 

Gujarat, Mizoram, and Nagaland are the only states that continue to ignore such evidence. Even Andhra Pradesh abandoned Prohibition in the Nineties as, according to its Excise Minister, N Raghuram, “Despite our best efforts, the prohibition-related offences, particularly illicit distillation and smuggling, had been steadily increasing in the state”.

Let us assume for a moment that Gujarat is no longer a dry state. How much money would it earn through liquor sale? The closest estimate would be the same as Karnataka – almost identical population numbers as well as a comparable rural to urban distribution. Judging by its five year average Excise growth rate of 18.8%, one can estimate Karnataka’s Liquor revenue for 2013-14 to be Rs 13,424 crore, for 2014-15 to be Rs 15,947 crore, and for 2015-16 to be Rs 18,945 crore.

What if Gujarat were to put this revenue directly into Public Health & Nutrition? Recall that Gujarat and Karnataka have been spending roughly similar amounts per capita on Health over the past decade, 24.7% and 22% respectively.

Table 5 shows the projected Health spend of various states assuming that escalation is in accordance with the average rate increase in expenditure and that Gujarat’s Health spend for 2013-16 now includes liquor revenue.

Public Health & Nutrition expenditure figures are in Rs crores and from the RBI annual reports. Figures for the year 2003-04 and 2012-13 are revised estimates; all others are actuals. Year-wise Population estimates, in millions, are shown in brackets.

Finally, Table 6 below shows the revised per capita Health spend, with all other states except Gujarat – with its freshly inoculated liquor revenue – following the trajectory commensurate with their rate of increase in per capita expenditure.

There it is, at long last – the second-phase surge. Up she goes, freeing Gujaratis from disease and suffering and unacceptable mortality rates, made possible through Gujarat’s own money and crucially, without touching budgetary allocations for other sectors. A few years of this and Kerala would come into view. A few more and Kerala could well be left behind. What greater pride can there be for Gujarat than to flaunt its health indices along with its economic ones?

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems.

It is time for Gujarat to imbibe this Gandhi quote and let go of the other.