Healthy Industries and Unhealthy Populations: Lessons from Indian Problem-Solving

The Indian health industry, ‘Supplier to the World’ is arguably the most industrially successful amongst developing economies. Yet many Indians remain without access to these medicines, vaccines, and diagnostics. While state capacity and governance –well established orthodoxy now-have been used for some time as frameworks to understand these types of developmental outcomes in late industrializers, evolutionary frameworks in political economy have not. This paper argues for exploiting more systematically the insights of co-evolutionary institutions in the analysis of the health industry across nations and time to make sense of the political and moral dilemmas of technological advance and access. The analytical approach here draws on prior work that situates three evolutionary dimensions along which to consider the industry and to understand market regulation. The paper dives into detail of the first of several market environments to analyze why a nation so capable in the production side of the industry should be so wanting in others. Specifically a focus on problem-solving rather than the more diffuse notions of state capacity and governance, clarifies some aspects of the vital development difference between access in principle versus access in practice.