BACKGROUND: Population health is vital to a nation's overall well-being and development. To achieve sustainable human development, a reduction in health inequalities and an increase in interstate convergence in health indicators is necessary. Evaluation of the convergence patterns can aid the government in monitoring the health progress across the Indian states. This study investigates the progressive changes in the convergence and divergence patterns in health status across major states of India from 1990 to 2018. METHODS: Sigma plots (σ), kernel density plots, and log t-test methods are used to test the convergence, divergence, and club convergence patterns in the health indicators at the state level. RESULTS: The result of the sigma convergence suggests that life expectancy at birth has converged across all states. After 2006, however, the infant mortality rate, neonatal mortality rate, and total fertility rate experienced a divergence pattern. The study's findings indicate that life expectancy at birth converges in the same direction across all states, falling into the same club (Club One). However, considerable cross-state variations and evidence of clubs' convergence and divergence are observed in the domains of infant mortality rate, neonatal death rate, and total fertility rate. As suggested by the kernel density estimates, life expectancy at birth stratifies, polarizes, and becomes unimodal over time, although with a single stable state. A bimodal distribution was found for infant, neonatal, and total fertility rates. CONCLUSIONS: Therefore, healthcare strategies must consider each club's transition path while focusing on divergence states to reduce health variations and improve health outcomes for each group of individuals.

Center for Applied Economic Research Faculty of Management and Economics Tomas Bata University in Zlin Zlín Czech Republic

Department of Humanities and Social Sciences National Institute of Technology Rourkela Odisha India

Faculty of National Economy University of Economics in Bratislava Bratislava Slovak Republic

Zobrazit více v PubMed

Preston SH. The changing relation between mortality and level of economic development. Popul Stud. 1975;29(2):231–248. doi: 10.1080/00324728.1975.10410201. PubMed DOI

Preston SH. The changing relation between mortality and level of economic development. Int J Epidemiol. 2007;36(3):484–490. doi: 10.1093/ije/dym075. PubMed DOI

Sen A. Mortality as an indicator of economic success and failure. Economic J. 1998;108(446):1–25. doi: 10.1111/1468-0297.00270. DOI

Mackenbach JP. Convergence and divergence of life expectancy in Europe: a centennial view. Eur J Epidemiol. 2013;28(3):229–240. doi: 10.1007/s10654-012-9747-x. PubMed DOI

Deaton A. The Great Escape: Health, Wealth, and the Origins of Inequality. New Jersey: Princeton University Press. 2013.

Singh GK, Kogan MD, Slifkin RT. Widening disparities in infant mortality and life expectancy between appalachia and the rest of the United States, 1990–2013. Health Affairs. 2017;36(8):1423–1432. doi: 10.1377/hlthaff.2016.1571. PubMed DOI

Götmark F, Andersson M. Human fertility in relation to education, economy, religion, contraception, and family planning programs. BMC Public Health. 2020;20(265):1–17. PubMed PMC

Reidpath DD, Allotey P. Infant mortality rate as an indicator of population health. J Epidemiol Community Health. 2003;57(5):344–346. doi: 10.1136/jech.57.5.344. PubMed DOI PMC

Derindag OF, Lambovska M, Todorova D. Innovation development factors: Switzerland experience. Pressburg Econ Rev. 2021;1(1):57–65.

Wyshak G. New insights into the determinants of the total fertility rate, infant mortality rate and life expectancy. Int J Sustain Dev World Ecol. 1999;6(3):155–166. doi: 10.1080/13504509909470006. DOI

Woolf SH, Schoomaker H. Life expectancy and mortality rates in the United States, 1959–2017. JAMA. 2019;322(20):1996–2016. doi: 10.1001/jama.2019.16932. PubMed DOI PMC

Bongaarts J. How long will we live? Popul Dev Rev. 2006;32(4):605–628. doi: 10.1111/j.1728-4457.2006.00144.x. DOI

Wang H, Liddell CA, Coates MM, Mooney MD, ELevitz C, et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9947):957–979. PubMed PMC

Burney PGJ, Patel J, Newson R, Minelli C, Naghavi M. Global and regional trends in COPD mortality, 1990–2010. Eur Respir J. 2015;45(5):1239–1247. doi: 10.1183/09031936.00142414. PubMed DOI PMC

Kabir H. Notion of belonging in the nation-state: gendered construction of international migration aspirations among university students in Bangladesh. Migr Lett. 2021;18(4):463–476. doi: 10.33182/ml.v18i4.1158. DOI

United Nations . Revision of World Population Prospects. 2022.

Marmot M. The health gap: the challenge of an unequal world. Lancet. 2015;386(10011):2442–2444. doi: 10.1016/S0140-6736(15)00150-6. PubMed DOI

Ottersena T, Norheim OF. Making fair choices on the path to universal health coverage. Bull World Health Organ. 2014;92:389. doi: 10.2471/BLT.14.139139. PubMed DOI PMC

Vorobeva E, Dana LP. The COVID-19 pandemic and migrant entrepreneurship: responses to the market shock. Migr Lett. 2021;18(4):477–485. doi: 10.33182/ml.v18i4.1400. DOI

Romer PM. The origins of endogenous growth. J Econ Perspect. 1994;8(1):3–22. doi: 10.1257/jep.8.1.3. PubMed DOI

McMichael AJ, McKee M, Shkolnikov V, Valkonen T. Mortality trends and setbacks: global convergence or divergence? Lancet. 2004;363(9415):1155–9. doi: 10.1016/S0140-6736(04)15902-3. PubMed DOI

Moser K, Shkolnikov V, Leon DA. World mortality 1950–2000: divergence replaces convergence from the late 1980s. Bull World Health Organ. 2005;83(3):202–209. PubMed PMC

UNDESA, P. World population prospects: the 2015 revision. New York: UNDESA Population Division. 2015.

UNDESA P. World population prospects: the 2019 revision. New York: UNDESA Population Division. 2019.

World Bank. World development indicators 2020. The World Bank. 2020. https://datacatalog.worldbank.org/search/dataset/0037712

Pereira MA, Camanho AS, Marques RC, Figueir JR. The convergence of the World Health Organization Member Statesregarding the United Nations’ Sustainable Development Goal ‘Good health and well-being. Omega. 2021;104:102495. doi: 10.1016/j.omega.2021.102495. DOI

Dorius SF. Global Demographic Convergence? A Reconsideration of Changing Intercountry Inequality in Fertility. Popul Dev Rev. 2008;34(3):519–537. doi: 10.1111/j.1728-4457.2008.00235.x. DOI

Wilson C. Understanding Global Demographic Convergence since 1950. Popul Dev Rev. 2011;37(2):375–388. doi: 10.1111/j.1728-4457.2011.00415.x. DOI

Goli S, Moradhvaj, Chakravorty S, Rammohan A. World health status 1950–2015: converging or diverging. PLoS ONE. 2019;14(3):e0213139. doi: 10.1371/journal.pone.0213139. PubMed DOI PMC

Bloom DE, Canning D. Mortality traps and the dynamics of health transitions. Proc Natl Acad Sci U S A. 2007;104(41):16044–16049. doi: 10.1073/pnas.0702012104. PubMed DOI PMC

WHO . Tracking universal health coverage: first global monitoring report. 2015.

Ladusingh L, Gupta AK, Yadav A. Ecological context of infant mortality in high-focus states of India. Epidemiol Health. 2016;38:e2016006. doi: 10.4178/epih.e2016006. PubMed DOI PMC

Dhirar N, Dudeja S, Khandekar J, Bachani D. Childhood morbidity and mortality in India – analysis of national family health survey 4 (NFHS-4) findings. Indian Pediatr. 2018;55(4):335–338. doi: 10.1007/s13312-018-1276-6. PubMed DOI

Grumstrup EJ, Sorensen T, Misiuna J, Pachocka M. Immigration and voting patterns in the European union. Migr Lett. 2021;18(5):573–589. doi: 10.33182/ml.v18i5.943. DOI

Singh A, Pathak PK, Chauhan RK, Pan W. Infant and child mortality in india in the last two decades: a geospatial analysis. PLoS ONE. 2011;6(11):e26856. doi: 10.1371/journal.pone.0026856. PubMed DOI PMC

SRS . Office of Registrar General of India (2019) Sample Registration System Yearbook. 2019.

Lerch M. Fertility decline in urban and rural areas of developing countries. Popul Dev Rev. 2019;45(2):301–320. doi: 10.1111/padr.12220. DOI

Gupta MD. Population, poverty, and climate change. World Bank Research Observer. 2014;29(1):83–108. doi: 10.1093/wbro/lkt009. DOI

Edenhofer O, Pichs-Madruga R, Sokona Y, Minx JC, Farahani E, Kadner S, et al. Climate Change 2014 Mitigation of Climate Change. New York: Cambridge University Press. 2014.

Crist E, Mora C, Engelman R. The interaction of human population, food production, and biodiversity protection. Science. 2017;356(6335):260–264. doi: 10.1126/science.aal2011. PubMed DOI

Štefančík R, Némethová I, Seresová T. Securitisation of migration in the language of slovak far-right populism. Migr Lett. 2021;18(6):731–744.

Casterline JB. The pace of fertility transition: national patterns in the second half of the twentieth century. Popul Dev Rev. 2001;27:17–52.

Bongaarts J, Hodgson D. Country Fertility Transition Patterns. Switzerland: Springer. 2022.

Arokiasamy P, Goli S. Fertility convergence in the Indian states: an assessment of changes in averages and inequalities in fertility. Genus. 2012;68(1):65–88.

Bongaarts J, O'Neill BC. Global warming policy: Is population left out in the cold? Science. 2018;361(6403):650–652. doi: 10.1126/science.aat8680. PubMed DOI

United Nations . The Sustainable Development Goals Report 2022. 2022.

IIPS, ORC Macro. National Family Health Survey (NFHS-5), 2019-21. ; 2019-21.

Goli S, Arokiasamy P. Maternal and child mortality indicators across 187 countries of the world: converging or diverging. Global Public Health. 2014;9(3):342–60. doi: 10.1080/17441692.2014.890237. PubMed DOI

Drèze J, Sen A. Putting Growth in its Place. 2012.

Drèze J, Sen A. An Uncertain Glory: India and its Contradictions. New Jersey: Princeton University Press. 2013.

Siddiqui MZ, Goli S, Rammohan A. Testing the regional Convergence Hypothesis for the progress in health status in India during 1980–2015. J Biosoc Sci. 2021;53(3):379–395. doi: 10.1017/S0021932020000255. PubMed DOI

Sen A. Development as Freedom. New York: Oxford University Press; 1999.

Ortiz I, Cummins M. Global Inequality: Beyond the Bottom Billion-A Rapid Review of Income Distribution in 141 Countries. 2011.

Goli S, Arokiasamy P. Trends in health and health inequalities among major states of India: assessing progress through convergence models. Health Econ Policy Law. 2014;9(2):143–168. doi: 10.1017/S1744133113000042. PubMed DOI

Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A, et al. Global health 2035: a world converging within a generation. Lancet. 2013;382(9908):P1898–1955. doi: 10.1016/S0140-6736(13)62105-4. PubMed DOI

Aksan AM, Chakraborty S. Life expectancy across countries: convergence, divergence and fluctuations. World Dev. 2023;168:106263. doi: 10.1016/j.worlddev.2023.106263. DOI

Nag A, Pradhan J. Does club convergence matter? Empirical evidence on inequality in the human development index among Indian states. Humanit Soc Sci Commun Volume. 2023;10(25):1–11. PubMed PMC

Phillips PCB, Sul D. Transition modeling and econometric convergence tests. Econometrica. 2007;75(6):1771–1855. doi: 10.1111/j.1468-0262.2007.00811.x. DOI

Phillips PCB, Sul D. Economic transition and growth. J Appl Econ. 2009;24(7):1153–1185. doi: 10.1002/jae.1080. DOI

Young AT, Higgins MJ, Levy D. Sigma convergence versus beta convergence: evidence from U.S. county-level data. J Money Credit Bank. 2008;40(5):1083–1093. doi: 10.1111/j.1538-4616.2008.00148.x. DOI

Morales-Lage R, Bengochea-Morancho A, Camarero M, Martínez-Zarzoso I. Club convergence of sectoral CO2 emissions in the European Union. Energy Policy. 2019;135:111019. doi: 10.1016/j.enpol.2019.111019. DOI

Barro RJ, Sala-i-Martin X. Economic Growth and Convergence across The United States. National Bureau of Economic Research. Cambridge: Working Paper, No 3419. 1990.

Barro RJ, Sala-i-Martin X. Convergence. Journal of Political Economy. 1992;100(2):223–251. doi: 10.1086/261816. DOI

Barro RJ. Economic growth in a cross section of countries. Q J Econ. 1991;106(2):407–443. doi: 10.2307/2937943. DOI

Mankiw NG, Romer D, Weil DN. A contribution to the empirics of economic growth. Q J Econ. 1992;107(2):407–437. doi: 10.2307/2118477. DOI

Islam N. Growth empirics: a panel data approach. Q J Econ. 1995;110(4):1127–1170. doi: 10.2307/2946651. DOI

Sala-i-Martin X. Regional cohesion: evidence and theories of regional growth and convergence. Eur Econ Rev. 1996;40(6):1325–1352. doi: 10.1016/0014-2921(95)00029-1. DOI

Solow RM. A contribution to the theory of economic growth. Q J Econ. 1956;70(1):65–94. doi: 10.2307/1884513. DOI

Swan TW. Economic growth and capital accumulation. Econ Record. 1956;32(2):334–361. doi: 10.1111/j.1475-4932.1956.tb00434.x. DOI

Ki Inada. On a two-sector model of economic growth: comments and a generalisation. Rev Econ Stud. 1963;30(2):119–127. doi: 10.2307/2295809. DOI

Baumol WJ. Productivity growth, convergence, and welfare: what the long-run data show. Am Econ Rev. 1986;76(5):1072–1085.

Barro RJ, Sala-i-Martin X. Economic Growth: The MIT Press Cambridge, Massachusetts. 1995.

QIN X, HSIEH CR. Economic growth and the geographic maldistribution of health. China Economic Review. 2014; 31: 228-246.

Cui X, Chang CT. Distribution dynamics, regional differences, and convergence of elderly health levels in China. Sustainability. 2020;12(6):2288. doi: 10.3390/su12062288. DOI

Schnurbus J, Haupt H, Meier V. Economic transition and growth: a replication. J Appl Econ. 2017;32(5):1039–1042. doi: 10.1002/jae.2544. DOI

Strulik H, Vollmer S. The fertility transition around the world. J Popul Econ. 2015;44(1):31. doi: 10.1007/s00148-013-0496-2. DOI

Pagan A, Ullah A. Nonparametric Econometrics: Cambridge University Press; 1999.

Rosenblatt M. Remarks on some nonparametric estimates of a density function. Ann Math Stat. 1956;27(3):832–837. doi: 10.1214/aoms/1177728190. DOI

Quah D. Empirical cross-section dynamics in economic growth. Eur Econ Rev. 1993;37(2–3):426–434. doi: 10.1016/0014-2921(93)90031-5. DOI

SRS . Office of Registrar General of India (2018) Compendium of Sample Registration System Year Books (1981–2018) 2018.

Edwards RD. Changes in world inequality in length of life: 1970–2000. Popul Dev Rev. 2011;37(3):499–528. doi: 10.1111/j.1728-4457.2011.00432.x. PubMed DOI

Hum RJ, Verguet S, Cheng YL, McGahan AM, Jha P. Are global and regional improvements in life expectancy and in child, adult and senior survival slowing? PLoS ONE. 2015;10(5):e0124479. doi: 10.1371/journal.pone.0124479. PubMed DOI PMC

Liou L, Joe W, Kumar A, Subramanian SV. Inequalities in life expectancy: an analysis of 201 countries, 1950–2015. Soc Sci Med. 2020;253:112964. doi: 10.1016/j.socscimed.2020.112964. PubMed DOI

Wagstaff A. Inequalities in Health in Developing Countries: Swimming against the Tide? World Bank: Policy Research Working Papers; 2002.

Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, et al. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet. 2011;378(9797):1139–65. doi: 10.1016/S0140-6736(11)61337-8. PubMed DOI

NHP . National Health Policy, 2017. , Ministry of Health & Family Welfare, Government of India. 2017.

NRHM . The National Rural Health Mission. , Ministry of Health and Family Welfare, Government of India. 2005.

PM-JAY . Pradhan Mantri Jan Arogya Yojana (PM-JAY). , National Health Authority, Government of India. 2018.

JSY . JananiSurakshaYojana (JSY). , National Health Mission, Ministry of Health and Family Welfare, Government of India. 2005.

PMSSY . Pradhan Mantri Swasthya Suraksha Yojana (PMSSY). , Ministry of Health and Family Welfare, Government of India. 2023.

NPP . National Population Policy 2000. , Family Planning Programme, Government of India. 2000.

Janssen F, Van den Hende A, De Beer J, van Wissen LJ. Sigma and beta convergence in regional mortality: a case study of Netherlands. Demogr Res. 2016;35(4):81–116. doi: 10.4054/DemRes.2016.35.4. DOI