FEATURE

  The New Power Centres of the Global Economy:  
A Study on the BRIC countries with special reference to India
                                                                                     
                                                                                                    * Prof. Dr. G.R Krishnamurthy
                                                                                                    ** Prof. Dr. Norbert Koubek
The world economies are going through the most adverse global recession in the post world war history.  However, Asian renaissance economies of China & India & South East Asia are fast pacing!

   According to the Asian Development Bank report, recently released, “Asia will play a very important role in the global economy domination reform”.  In addition to Asian giants, China & India, Russia, in Euro-Asia, & the Brazil in Latin America is poised to lead a new world order, for which “G-20” becomes a steering committee.  

Yes, BRIC countries (Brazil, Russia, India & China) are leading the Global recovery.  

The BRIC, we would like to rechrision as CIRB (China, India, Russia & Brazil) in their order of importance, for their pace and speed of economic growth and volume of trade & business.  In other words The BRIC/ CIRB are going to be levers of world economic growth in the cold war II era.

     In short 3 economic growth centres appear to be emerging:

The USA, with its unique leverages and with her designs of economic imperialism world over, still remains the major economic power.  On the other, the China with her incomparable fast pace of growth is emerging as the second largest economic growth centre.

India is equally poised (though with some limitations & constraints) to emerge as the 3rd largest economy by 2050.  Thus 3 economic-growth-centres nay-nodal growth centres will be the USA, China & India.  Goldman Sach (2006) predicts that by 2050, these 3 will be the largest economies most probably replacing the European Union and Japan, where India will be first followed by China and U.S.A.

     In this scenario of tumultous economic change in the world, the BRIC countries are going to play a crucial role in the recovery of world economy.  

The BRIC countries Comparison:  The Basic Facts:

 China with a landmass of roughly 9500 milsqm habitates around 133 crore population, while India with hardly 1/3rd of landmass of China (3288 mil sq m) has a population of 115 crores.  Brazil with 8500 milsqm has hardly 19 crore population.  However, Russia with a landmass of 17,000 milsqm, has around 15 crore population.

Both China and India show around 10% growth in 2010 while Brazil registered 7.5% growth.  Russia’s growth was only 4%.

Changing Realities and Emerging Trends:

Foreign Direct Investment 2010:

 The Glaring Index of China’s upsurging economy is her FDI amounting to more than 1,00,000 billion USD while Russia has done fairly well attracting FDI of more 75,000 billion USD.  Also, both Brazil and India have done well by attracting around 40,000 billion USD each.

The ‘U’ turn trends:

 OECD study shows that the share of global GDP was 70% to 80% from emerging economies (like China and India) upto year 1000 AD.  This trend continued more or less upto year 1820 AD.  However, strangely and dramatically, Asian economies share in the global GDP declined to about 40% by year 1930 AD, while European economies, or today’s developed economies share rose up to 60% in the same year.  Also, this trend continued upto 1950.  By 2005 the share of global GDP was 50:50 both of emerging economies and developed economies.

The largest economies by 2050:

The Goldman Sachs (2006) estimates that by 2050 China is going to have around 50,000 trillion USD, while the US will be somewhere near 40,000 trillion USD.  However, India will be 3rd largest economy with nearly 30,000 trillion USD by 2050.  These 3 will be replacing present day European Union, Japan, Russia and others.

 In this dramatically changing scenario of economic growth and recovery, China leads with a consistent percentage of real GDP, ranging from 10-12% (1992) up to again 10% in 2010.  However, India, starting from 5% in 1980’s, came down to 2.5% in 1992 and strongly rose to 8% to 9% by 2008/2010.  Russia starting at minus 15% in 1992 shot up to 10% by 2000.  However, it fell down in real GDP to minus 5% in 2010.

 Coming to Capital account, FDI outflows show that China has highest, 90 billion USD by 2010.  While India has 12 billion USD FDI outflows in the same year.

The scoreboard of competitiveness shows that the USA still maintains the 1st position from 2006 to 2011 though it slided to 3rd position in 2010.  Ofcourse, UK retains the 20th position in the 2011 from 21st position in 2011.  But however, Germany improved her competitiveness position in 2011 to 10th from 26th in 2006.

China retained 19th position from 2006 to 2011.  However India improved her position form 42 in 2006 to 32 in 2011.  Russia failed badly by standing in 49th position in 2011.

Yes, competitiveness comprising the political structures, management skills, industrial systems, trade-laws, individual and national values, cultural and religious factors determine the competitive position of the country in the world economy.  More than this, they act as levers of economic growth and development, within the countries.

The BRIC countries:  Some Challenges:

The rise of emerging markets in China, India, Brazil and South Africa may pose some new challenges to the world such as:

Rise of EM/BRIC poses new challenges to the world

•Environmental issues reach a new dimension

•Political systems in China and Russia vs Western democracy paradigm

•BRIC/EM trade and financial strength increases protectionist pressures

•Political, regulatory risks become strategic as companies deploy own capital

in EM

• BRIC story captures imagination because it is proxy for shifting world

power centres

• But: Global power shift should not be overestimated

- BRIC’s growth and development trajectories will likely not be linear

- G-3 will retain the lead for a while yet

 Thus, the BRIC countries are emerging as the new centres of economic and political power in the global economy through their improved and hightend competitiveness.  The study also reveals the rise a
and fall of the wealth of nations over the past TEN CENTURIES (SECOND MILLINEUM).

  *A.J. Institute of Management, 

Mangalore,  India.

                                                                                    ** Schumpeter School of Business & Economics,  

                                                                                         University of Wuppertal, Germany.

Dignity, fair wages, justice – 

can we give that to our domestic workers?

“Oh, our housemaid Meena did not come today. She can never understand how difficult it is if she decides to take the day off without informing in advance,” grumbled my former colleague in an international technology firm in Bangalore. Remarks like hers are not uncommon from people belonging to the middle or upper-middle income segments, irrespective of whether they are employed or not. This is primarily because part-time janitors, cooks and child-and-elder-care providers are an integral part of urban Indian households that can pay for such services. Collectively known as domestic workers, they are often women who hail from low-income families and belong to the unorganized workers’ sector.

It is obvious that women like Meena are indispensible to families who utilize their services. “Domestic workers perform chores such as cleaning, babysitting, preparing meals et al on everyday basis in a professional manner. In many houses, the number of tasks they perform sometimes increases without a change in their salary or other benefits,” says Sister Celia, a social worker based in Bangalore who has for over 18 years championed the cause of domestic workers and other women employed in the informal economy. It was Celia who motivated domestic workers in the state to launch the Karnataka Domestic Workers’ Union (KDWU) in the early 1990s. KDWU was formally registered in 2003-04 as a trade union. Presently, it has 2000 members from various areas in east Bangalore, the Cantonment area and towns in the northern parts of the state such as Bijapur and Gulbarga.

KDWU encourages domestic workers to seek dignified treatment at their work places, a living wage proportionate to inflation, a weekly holiday, sick leave and annual vacation without deduction of salary and notice period or a month’s wages for termination of services. In many cases, domestic workers in Karnataka have been successful in making ‘days off with payment’ as a standard employment condition. However, domestic workers tend to be the first suspects and are often penalized when money or other valuables are misplaced or lost. For instance, Kokila, a young worker form Byapannahalli in Bangalore was falsely implicated in a robbery case by her employer of two months. KDWU managed to petition and convince the office of the Labour Commissioner to have the complaint against the woman dropped. Kokila was given three months salary as compensation.

“Domestic workers lack fundamental employee rights as their place of work is more than one; that is, multiple houses, usually. Further, employers fear that granting domestic workers or ‘servants’ (as many people still refer to them) even basic respect or humane treatment could pose a threat to the authority inside the home. Hence, it is tough to define or control our job from outside, unlike in other unorganized sectors,” says Sharanamma, a long-time domestic worker, who in her forties is the KDWU president. The union is initiating efforts to gather information through the RTI Act about how many police stations have pending complaints against domestic workers. Additionally, the women plan to determine the number of colleagues or workers jailed for theft.

Having started as a saving group of around 25 women, KDWU advises members about the importance of pooling money collectively and loaning to a member, if necessary. All members receive identity cards with photographs and relevant information as well as assistance in accessing government benefits and entitlements such as Rashtriya Swasthya Bima Yojana or National Health Insurance Scheme, the Rajiv Awas Yojana or Rajiv Housing Scheme and Social Security for Unorganised Workers Act 2008. Pushed by prolonged demands, the International Labour Organisation finally passed a resolution (C189) to identify domestic work as labour with necessary regulations and provisions, on June 16, 2011. The International Domestic Workers Network, to which many domestic workers’ unions from all over the world are affiliated, proclaimed the day as International Domestic Workers Day to bring the ground realities of the group into focus. It serves as a reminder to everyone about the unheralded contribution of domestic workers to the Gross Domestic Product of a country, in addition to the significance of their occupation.

According to Sashikala, another long-time domestic worker and former head of KDWU, a few years ago the Labour Department in the Government of Karnataka had constituted a Karmikara (Workers) committee and invited representatives of various unorganised professions to be a part of it. For the past three years, she has been one among the 19 worker members of the committee that meets every month with the state minister for labour, bureaucrats and other relevant officers from the government. “Previously I had no courage to talk in the open about our problems. Now I am able to convince other domestic workers to fight for their rights and entitlements,” Sashikala points out.

Unlike trade unions in factories or other organizations and institutions, members of KDWU do not go on strike when their demands are not met. But the women have staged public meetings to create awareness about the challenges they face and to seek support for such campaigns. The activities focus on the need for dignified treatment of domestic workers, fair wages and benefits. Another task that KDWU undertakes is the running of an informal job placement system that usually functions by word of mouth. Members have learnt to negotiate payment and timings in keeping with workload. KDWU has an executive body of 15 elected members who convene on a monthly basis to review the status of ongoing activities and other administrative tasks. Many of the members try to meet every week in their respective neighourhoods to identify and intervene if any local problems such as gender-related harassment arise, and try to mobilize new members. Each quarter, women from all the areas gather to discuss specific issues they encounter and provide feedback on some of the initiatives taken. The union has links with their counterparts in Tamil Nadu as well as international domestic workers and other labour unions and women’s movements which enables them to build solidarity across geographical boundaries. It pays off when they have to struggle against common issues such as gender discrimination and advocate for legislations that impact their lives and livelihoods.

Sejal and Pulkit Parikh, a young couple who lived in Bangalore and were employed in the IT industry in the city before they moved to Delhi two years ago, had sourced their domestic worker through a workers’ union that operates from south Bangalore and a few other towns in Karnataka. Their observation: “The terms set by the union were reasonable, favourable and acceptable to us and the lady who did our household work. We also realized the issues that many domestic workers continue to face, like exploitation and oral and physical abuse from their multiple employers and their own families that typically consist of irresponsible alcoholic husbands.” It is heartening that at least a small percentage of domestic workers get such understanding and supportive employers, some of whom also provide financial assistance for the education of their children or during medical or other emergencies.

                                                                                                                                        -Grassroot 

India: Healthcare needs intervention

Patralekha Chatterjee

A cosmetic dentist from Toronto blogs that stripped of pretence, doctor-prestige and professional posturing, ‘dentists are basically tooth carpenters and dental hygienists are gum gardeners.’ It is an interesting thought. If dentists are nothing but ‘tooth carpenters’ or ‘gum gardeners,’ can carpenters and gardeners be equipped with basic dentistry skills in a country that is woefully short of dentists?

Facetious as it may sound, the argument goes to the heart of a raging debate in India.

The past week provided snapshots of the multiple failures of India’s public health system. Television channels showed us a ward boy (who reportedly doubled up as a janitor) undertaking a surgical procedure in a government hospital in Uttar Pradesh. Barely had that image registered, there were similar reports from other places — a cleaner without surgical gloves assisting in an operation in another UP government hospital; a generator operator treating patients in Bihar and a janitor caught administering sutures to a patient at West Bengal’s largest and eastern India’s premier medical research institute.

In the beginning, it was shock and outrage. Everyone was appalled though there was little in those images that we did not know or suspect. The reactions follow two distinct schools of thought. The first slams the medical establishment for tolerating such a state of affairs and demands action. The second posits that instead of demonising the ward boy and the hospital administrations, we should actually be lauding them because India’s alarming shortage of physicians and health workers means we have to innovatively use whatever human resources that are available.

The two viewpoints may appear to clash. But they can make common cause.

Everyone knows that India’s healthcare system is in shambles and this is partly due to the desperate shortage of human resources. A recent report by the Federation of Indian Chambers of Commerce and Industry pointed out that in the next 10 years, the number of doctors needs to be doubled from its current figure of 0.75 million; nurses need to be tripled from 3.7 million and paramedics and technician assistants need to be quadrupled from 2.75 million.

Dealing with this problem is not easy but it is not rocket science. States like Tamil Nadu and Gujarat have shown how scarcity of medical and health professionals can be handled through better management and innovative steps. Proposed changes in the medical education system will have an impact in the long run. But till then, we have an emergency on hand.

What should be done? First, as the dentist blogger said, we have to start demystifying the medical profession. An MBBS doctor is not vital for every task in every health setting. It is not just the paddy farmers in China, trained to be Barefoot Doctors, who have proved so, there are many indigenous examples. Community workers in the tsunami-ravaged Nicobar Islands who underwent training in Integrated Management of Neonatal and Childhood illness saved many newborns amid death and destruction.

‘Task shifting’ is an idea whose time has come. My grouse is that we are passing up a valuable opportunity to address the issue seriously. High decibel outrage has led to the shunting out of the Chief Medical Superintendent of the Bulandshahr government hospital and suspension of the ward boy who was carrying out tasks meant for medical personnel. Both are knee-jerk, damage-control measures.

Instead of that, we should be task shifting, especially when there is a shortage of doctors or in an emergency situation. Yet, we must have minimum standards and agree on non-negotiables in a health centre or hospital. We can train people who don’t necessarily have MBBS degrees to do many tasks that doctors traditionally undertake. But such people must first go through a standardised paramedic training course that has a proper syllabus and certification. Shortages and resource constraints notwithstanding, any institution offering healthcare has to maintain minimum standards in critical areas and be open to continuous monitoring. This does not mean we should turn a blind eye to doctor absenteeism.

The Clinical Establishments (Registration and Regulation) Act, 2010, is a step in this direction. But it is being vigorously opposed by various doctors’ bodies. They call it undue interference. Then, there is the hypocrisy from many policymakers and policy commentators — demanding a functioning healthcare system but resenting any attempt to invigorate it through additional funds. So, the circular arguments continue. It’s time to get beyond that. India’s healthcare system needs surgery, medication and stitching up. They do not have to be done by the same set of people.

         The author is a Delhi-based writer. patralekha.chatterjee@gmail.com 

Bedside Medicine

                                                                                                         Prof. B. M. Hegde,

                                                                                                         hegdebm@gmail.com

Examination of the cardiovascular system:

Although for the convenience of learning and teaching single system diseases are discussed separately the student should remember that no system could work independently in the dynamic human system that works in tandem with the human mind and its environment.

Cardiovascualr system diseases that manifest predominantly with signs in the system have certain presenting features that need to be specially elicited in the course of talking with the patients.

They are:

• Pain in the chest.

• Shortness of breath.

• Oedema of the ankles,

• Dizziness

• Palpitations

• Syncope

• Fatigue

Pain in the chest:

• Where is the pain-exact location?

• How severe is the pain?

• Can you describe the pain in your own words? This gives the examiner an opportunity to asses its severity as well as its significance.

• Does the pain radiate any where else?

• Is the pain associated with any heaviness, tightness or a feeling a rope being tied round your chest?  Significant angina pain is preceded by wall motion abnormality resulting in transitory pulmonary oedema giving rise to these symptoms. They make the diagnosis of angina certain

• How long did the pain last? Any chest pain lasting longer than half an hour is unlikely to be simple angina.

• How did the pain get better? Did you take any medicine? Exertional stable angina could get better on its own at rest. Relief of chest pain after taking nitrates indicates the diagnosis of cardiac ischaemic pain.

• Was the pain related to (deep) breathing? If yes, it is likely to be plural pain and not angina.

• Did the pain come at rest? This denotes many of the intermediate coronary syndromes.

• Was the pain coming on only on exertion-usual or unusual?

• Was the pain related to emotional upsets?

• Did the pain get relieved by rest or change of position? Angina decubitous.

• How long did it take for the pain to ease after taking rest? Long standing non stop pains are not likely to be cardiac in origin.

• Was the pain associated with nausea? Possible stimulation of the autonomic nervous system, more likely to be a myocardial infarction rather than angina.

• Was there profuse sweating? Another of the above signs.

• Was there a sense of impending doom with the pain coming on?

• While there are plenty of causes for casual pain in the chest, 

• The pain of myocardial ischaemia has certain characteristic features that the patient would be able to give the details of the pain when probed. The student should take care not to lead the patient in any particular direction having prejudged the diagnosis. The pain could vary in its severity from very mild to the most severe unbearable pain. Although it is usually central chest pain, it could occasionally dominantly be felt in the left hand, upper abdomen, and pinna of the ears, lower jaw and, even in the back of the chest. However, mild pain is always present in the central chest region along with other distributions just described.

The tell tale feature of cardiac myocardial ischaemic pain is the tightness in the chest invariably associated with the pain. The pain fibres are only present in the pericardium and not inside the myocardium. As such a significant wall motion abnormality resulting from ischaemia produces sheer stress stretching of the pericardium giving rise to pain in the chest. The wall motion abnormality produces increased end diastolic left ventricular pressure which in turn gets transmitted to the lungs producing transitory pulmonary oedema giving rise to the tight feeling or even shortness of breath along with the pain. This is very characteristic of chest pain due to cardiac ischaemia. 

Anginal pain does not last more than half an hour and gets relieved on its own. Any prolonged pain suggests either intermediate coronary syndrome (unstable angina) or a full blown myocardial infarction.

Shortness of breath:

Another very important symptom of a compromised heart function. Classically, it is on unusual exertion gradually progressing to breathlessness on less and less exertion to eventually settle down to breathlessness at rest if untreated. Rarely one could become suddenly breathless if there has been a massive myocardial infarction resulting in a large chunk of the heart muscle getting damaged suddenly or if there is a sudden large mitral leak due to the same cause as above or a sudden large ventricular septal defect.

Shortness of breath of varying grades is a sine-quo-non of any genuine myocardial ischaemic (angina) pain. Chest pain without this added symptom is of doubtful origin and might not be true ischaemic pain that needs further evaluation. Any significant area of myocardial ischaemia does produce wall motion abnormalities of the left ventricle resulting in acute temporary pulmonary oedema.

Shortness of breath and its severity bears a close parallel with the seriousness of the underlying cause and gives a clue to its progress either way. Instead of having artificial classification of breathlessness as is usually done it is better to record individual patient’s exertional capacity top keep a tab on the progress of the disease or its regression after treatment. Breathlessness is very individualistic as it also depends on the person’s previous exercise tolerance.

Shortness of breath:

• What do you mean by breathlessness? Psychological breathlessness could be differentiated by this story. Most of the time it is just sighing and not true breathlessness.

• How long have you been having this breathing difficulty?

• Has it been getting worse over a period of time? Suggests seriousness of the present episode.

• Is it related to exertion and if so what type of exertion? Depending on the answer one could classify shortness of breath into four New York Classification.

• Do you get breathless while going about your normal daily chores?

• Does the breathlessness restrict your activities?

• Is the breathlessness associated with chest pain?

• Are you breathless at rest?

• Can you sleep comfortably at night? To find out if paroxysmal nocturnal dyspnoea is present or not.

• How many pillows do you use at night?

• Did you ever have to get up with acute shortness of breath wanting to have some fresh air? Classical description of paroxysmal nocturnal dyspnoea.

• Was the breathlessness preceded by dry cough for days or weeks? Evidence of early transitory pulmonary oedema.

• Does emotional upset bring on breathlessness?

• Do you have palpitations associated with breathlessness attacks? Suggests cardiac arrhythmias.

• Do you get relieved after taking rest?

Oedema of ankles:

Dependent oedema is not unusual in those obese patients especially if they also have varicose veins. But in others who are otherwise healthy conspicuous oedema around the ankles and feet is a sign that all is not well either with the heart or the kidneys. To make the distinction the following questions would help.

• How long have you been having this swelling?

• Does it disappear in the mornings when you get up from bed? Early heart failures.

• Is it associated with any swelling of your lower eyelids? When present it might suggest renal origin of the oedema.

• Do you pass enough urine as before?

• Do you get sharp pain in the calf muscles when you dorsiflex your feet? A sign of deep vein thrombosis, but it is usually unilateral.

• Is the swelling gradually increasing in severity?

• Do you feel any fullness in the tummy? To look for ascites.

• Has this ankle swelling been associated with shortness of breath on exertion?

Dizziness:

• Dizziness means different things to different people. It is helpful to ask the patient to explain what s/he means by dizziness. The following questions then will make sense.

• Do you have this feeling when you get up from a sitting or lying position? Rule out positional vertigo.

• Is the feeling related to change in the position of your neck and head?

• Does it get better on its own? 

• Do you go round in circles or does the world goes round around you?

• Have you ever fallen down with sudden dizziness?

• Do you feel dizzy on exertion only-usual or unusual?

• Do you feel dizzy when you suddenly get up from the chair after sitting for a long time or getting up from the bed? This could happen in elderly people because of decreased autonomic control, it could happen in people on large doses of anti-hypertensive drug therapy, or in the elderly after a large meal, or in diabetics with advanced neuropathy.

Palpitations:

In the true sense of the word palpitation means that the patient is aware of his heart beating. Anxiety is probably the cause of palpitations in the vast majority of patients. Palpitations due to heart disease are due to either a sudden onset of a new arrhythmia, marked left ventricular hypertrophy, or extreme tachycardia. The following questions will get you the diagnosis.

• How did the palpitation start? A sudden start and an abrupt cessation is a very good sign of PAT-paroxysmal atrial tachycardia. It is otherwise called alarm clock palpitations.

• Does it start gradually and then taper off also gradually. Most of the time anxiety related.

• Can you tap on my table to denote how you felt the palpitation? This tells the examiner if the arrhythmia is regular or irregular when the patient taps on the table top with his finger tips.

• Did you ever have sweating, dizziness, and profuse urine output after an attack of sudden palpitation? Typical of atrial tachycardia.

• Is the palpitation related to emotional upset?

Syncope:

Syncopal attacks are very difficult to decipher unless there has been good eye witness evidence. One might have to resort to Holter monitoring to finally decide. However, majority of syncopal attacks could be deciphered on the bedside.

• How did you know that something had happened to you? Was there an eye witness? If yes, it would help to interrogate the eye witness as well.

• Did you have any premonition of the impending attack of syncope?

• Do you think you had a fit? Did you have any froth in the mouth when you came to your senses or did you hurt yourself in any way?

• Is there is any special circumstance that brought on the attack or did it come like a bolt from the blue?

• Did you have any unusual exertion preceding the attack? Syncopal attacks due to obstructive cardiomyopathy could be preceded by exertion but arrhythmic attacks do not have any such need. Most of the time intermittent complete heart block produces the Stokes Adams attacks, but runs of tachy-arrhythmias come do the same.

• Rarely do people, especially hypochondriacs, might feign a syncopal attack and might derail the doctor’s enquiry into the episode.

• A detailed drug history is very important here. Large doses of cardio-selective beta-blockers might be one of the causes of syncopal attacks due to heart blocks or extreme bradycardia.

Contd. in next issue......