the critical question is, what is going to have been because this will not happen spontaneously. but it will require are things that secretary clinton spoke about when she introduced the possibility of november 2011 at the nih other generation. a lot of people, a lot of countries come a lot of regions have a lot to do from country ownership, capacity building, strengthening, increased commitment to current partners involving new partners, get rid

of what does work and removed the legal political and stigma barriers. always done, only then will this occur. [applause] selected back to this dreaded map. i mentioned in the beginning of my talk but i have the opportunity to present at every one of them 18 meetings. this is a map to what i hope for her over the coming meetings of the international aids society is to be able to start to show a map that goes like this and this and this until finally we can say that we are the generation that opens the door to our scientific endeavors in our implementation to an aids free generation. thank you. [applause]

>> introduced in our present speaker, please welcome, as ben johnson, ceo of presumption and member of the helena network. [applause] >> good morning. first is a woman from the united states, and so pleased to welcome you back and graduate the list of the travel ban.

[applause] but as of black women residing in washing nbc, where we face the highest rate of hiv and were black women are the epicenter of vulnerability, it is a pleasure to welcome back the call of action. [applause] it is my pleasure to introduce for the u.s., bill wilson. bill wilson is president and ceo of the black aids institute. the black aids institute is the only national hiv/aids in the united states, focused exclusively on ending the aids pandemic in the black community by engaging in mobilizing black institution in individuals and effort to confront hiv by interpreting public and private

sector policy, conducting training, providing technical assistance and disseminating hiv/aids advocacy. from a uniquely and unapologetic black perspectives. wilson previously served as the coordinator for the city of los angeles and director of policy and planning for project los angeles and cochair of the los angeles health commission and as an appointee for the advisory committee. he has been involved in a myriad of agencies from their inception across the united states. they include the national black and leadership forum, the national task work on a, the chris riley hospice, the aids health care foundation, the national minority aids council, taubensee county color consortium, and mr. wilson has

also worked very extensively across eastern western europe in sub-saharan africa, india and mexico. in 2001, phil wilson was named as changing the world recipient. he received the discovery health channel medical honors. he has also been named as the 2005 black history makers in the making i black television. he is in newspaper writing. please welcome to the stage. thank you. [applause] [cheers and applause] >> i am both honored and humbled to share my talk with you this

morning. but i'm also intimidated by one of the greatest heroes in this movement. and i'm always been a little nervous to stand between neo and one of the highlights of this conference, secretary of state, hillary clinton. i'm thinking something between a rock and a hard place. but on behalf of the estimated 1.1 early in americans, with hiv and tens of thousands of doctors, nurses, researchers, activists and volunteers of service i work every day to end the aids epidemic in this country, welcome back to our house. [applause] 22 years is a long time and we miss you. i'm welcome to the first international aids conference, where we know that we can and in spirit or gears up to 50 users

discovered right here in this country, we finally have the right combination of tools and knowledge to stop the epidemic. no, we don't have a cure for a vaccine yet, but david only had a slingshot and he killed goliath. our tools are not perfect, but they are good enough to get the job done if, and this is a big if, if we use them efficiently, effectively, expeditiously and compassionately. and that is what i want to talk to you about is learning. i'm an openly gay and who has been living with hiv for 32 years. [cheers and applause] treatment may be prevention, but i approve their treatment as treatment.

[applause] when half of the people living with hiv in this country are black and over 60% are men who have sex with man come i understand why the organizers of this meeting would invite someone like me to give this talk. you see, i am black, i'm gay, i'm hiv positive and according to aarp, a live off the senior fund as well. [applause] it is not lost on me all the things that i am not. i am not a one-man, a straight man. i am not in asian pacific islander, latino, native american, wiser emigrant. i don't speak spanish, creole or vietnamese. , homeless or the victim of

domestic violence. i don't live in the rural south and i've never even been to anchorage or bismarck. but i know this, i know that we will not in the aids epidemic in this country unless some of those phrases are included. [cheers and applause] all of what i am and am not have to be a part of the conversation. the united states stands nine time zones and a population of over 300 billion people come and speak in three languages and 14 million american households english is not the primary language. even i think the united states has a d.c. and in some ways we do. we have great universities that generate an ashburn doral and experience and were wealthy. but even so, many of our

residents live in debilitating spots with unacceptable levels of homelessness, addiction and mental health illness. we have large numbers of people with hiv's who suffer from other diseases such as hepatitis c and ian are marginalized and stigmatized. we not only have the largest epidemic in this world, we have one of the most concentrated epidemics in the entire world. we faced gigantic challenges, challenges that demand we rely on lessons learned in many other countries, lessons learned to you in this room and challenges that offer the possibility for learning last-in that can be applied all over the globe. approximately 50,000 people get infected each year in the united states. that's a dramatic decrease for where we were in the mid-80s. but efforts have been stalled for at least the last 50 years.

demographically or epidemic of 75% male and 25% female. estimated hiv prevalence among person range from 14% to 59%. and epidemic is 43% black, 34% white, 19% latino, 1% asian pacific islander and 1% native american and hawaiian. 44% of the epidemic was in 12 cities, the new hiv infections are rapidly rising number of communities, especially the south. the u.s. epidemic is primarily a concentrated epidemic, but in certain populations, where generalized epidemics. for example, the backer in hiv of almost 3% and 835 new hiv infections in 20 time, the aids

epidemic in washington d.c. right here is a generalized and is one that is worse than the aids epidemic. black man who has sex with men are engulfed in a page of generalized epidemic. according to a new report released by the national black gay man, the research group and institute, black men or an elevated risk for hiv and action regardless of age. the odds that a black man will be infected increases from one in four, one and four at age 25259.3% chance by the time he reaches 40 years old. let's think about that for a minute. by the time a black gay man reaches 40 years old, nearly 60% of them, six out of 10 will be hiv positive. the aids epidemic in america is a tale of two cities.

that seems to be a theme this week. it is definitely the best of times and the worst of times. we have a system that can work very well for some of last, but for many of us, the system is terribly, terribly broken. the other day, i saw to my friend david would not in the aids foundation of chicago about his friend louise, a mexican immigrant who lived the last nine years of his life in the united states. he worked six and sometimes seven days a week of the busboy and dishwasher dishwasher at two restaurants. he pays taxes and otherwise obeys the law. he is silly and loves to dress in drag, don't we all. [laughter] his health declined rapidly and tragically in 1995 at the age of 25, luis died of complications.

his friends pulled together the resources to bury him, but what follows next shot to everyone who knew him. his name was not louise. that was an alias he assumed for workpapers, social security and medicaid. he lived the most secretive life of all. in fact, his sister who traveled from mexico to collect learned only after his death that her brother was to nine and had aids. the weise's deception helped him in other ways he could not afford, but denied him a chance to live and die in dignity. laurent stopwords is in the evidence today. he was 70 years old he was positive. there's only one mistake to become a personal reality for

him. lawrence's father once he found out his son had hiv react to it by going to the bathroom and closing the door. courts eventually got link to care, found a job working in hiv. unfortunately his job didn't offer health insurance and did not pay enough for his own treatment. said he was forced to choose between working or a stain on medication. what kind of choices that? luis and lawrence are not isolated examples. this next model first described by the university of colorado asked amazed how many people with hiv in the u.s. are engaged in the various tasks in the continuum of care from diagnosis to viral suppression. there are three things in this life does strike me most. first, 80% of hiv-positive people in the united states know

their status. now we can do better, but that's not too bad. second, once we get people on antiretrovirals, allow 71% get suppression. i can't, we can do better. but the real problem is in this middle section here. we do a terrible job of moving people to the non-antiretrovirals. train testing positive in berlin in antiretrovirals, we have is 54% of people with hiv. remember, these are people for whom we have some kind of contact. bottom line, and the richest nation on the planet, and at, and at a quarter of the people with hiv aren't fully effective treatment. more than 70% are either not on treatment at all. that is bad for them and it's bad for everyone else because when they are not, they are

much, much more likely to spread the virus. we, you and i and the people in the global villages, people doing work back at home every day who couldn't afford have to change that. luckily there are people and programs showing us how. right here in this city, the community education group, a small not-for-profit organization serves predominantly black neighborhoods offers hiv tests and a whole lot more. of the people in the sense that turn out to be positive, 95% -- 95% are confirmed to be received hiv care and treatment services. [applause] rather than giving individuals the paper referral, the immediate personal ax court if

needed by financial incentives to go is provided. this new technology will conduct written assessment and the road community members to insurance programs and/or medicaid. they also provide patient follow-up such as text messaging and indications of when they have medical appointments. something else happens here in washington d.c. it's called affordable care act, better known as obamacare. [applause] because of this law, no insurance company can deny coverage because you have a preexisting condition. jack up your raise her job because you get sick or because your care costs to match. for people with hiv and names,

these provisions are absolutely life-saving. leadership matters. two years ago, president obama released the first-ever comprehensive hiv/aids strategy in the united states. according to the vision, the united states would become a place where new hiv infections are rare and when they do occur, every person, regardless of age, gender, race or ethnicity, orientation, gender identity or social economic circumstance will have better access to high-quality, life extending care, free from stigma and discrimination. [applause] to gather, we can manifest that vision if we do the following names. first, we must fully implement the affordability care act.

[applause] this will deliver health coverage to more than 30 million people who are currently uninsured. single childless adults who are typically not eligible for medicaid, a critical failure in epidemic concentrate among low income, gay men. other than the affordable care act, ever want to have a means to pay for life-saving treatment. [applause] this most important piece of legislation over the last 40 years has generated a lot of opposition and misinformation. aids advocates must be at the forefront of opposing any effort, and the effort to roll back reforms on affordability care act. [applause] we need to be sure that the mac will benefit pass under the

legislation include an annual physical for everyone, in hiv test at every physical, including a least two annual hiv test for high-risk individuals, twice a year for people living with hiv and comprehensive coverage of arv for treatment and prevention. [applause] second, abreu one living with hiv must come out. we all have come out, living openly and proudly with hiv nathalie conference hiv stigma, but it also helps build demand for essential services. openly hiv-positive people serve as a living, reminders of the importance of knowing one's hiv status. and that is also communicating that is possible to live a full,

healthy life with hiv and that's important. [applause] when you come out about your hiv status you not only save your life, but she's a mother lives as well. my family is here in this room this morning. my brother, my dad and my mom. when i was 24, i gave my mother a book called loving someone gay. and she said today, why did she give me this book? i don't love anyone gay. yes you do i set. he loved me. and i was right. i'm alive today because i have the love and support of family and friends. [applause]

that they could not support me if i denied them a chance to truly know me, not just some one-dimensional "avatar" of me, but all of me, despite the story of our lives that are largely untold and i notice, we want our families to love us and to support as. but they cannot love us at a don't know us and they can't know us if we hide it from them. [applause] now, i am not naïve. i know it's too dangerous for a semester come out right now. but some of us can. and if we do, others will join us later. third, we need to put as much emphasis on building the treatment as we do access.

our health care system has long been a source of shame. the united states is the only industrialized country that does not guarantee health coverage for citizens, but through a combination of programs such as medicaid and the care act, we actually build a robust system of care for people living with hiv. it only about one in four people with hiv in our country are now receiving the care they need and deserve. if we demand it, they will come. health services aren't beautiful unless their use. too many people are terminated by those system. to many believe a positive hiv test is a dead ringer and too many people believe that hiv treatment requires a fistful of pills every day with horrible side effects. we need a massive investment into community education in hiv science to keep literacy. we need a army of patience,

navigators that link individuals to the care they need. fourth, we need to integrate the biomedical and behavioral prevention intrude gaffers. some people continue to recess the so-called medical aids, while others promote biomedical tools and the panacea. neither perspective is correct. these new biomedical strategies, the treatment has prevention and others still to be developed are more powerful than anything we've ever had and are too busy for. [applause] back to work, these powerful biomedical tools will need to connect with actual people. those who deliver them and those who use them. our biomedical interventions won't be good as people are frustrated by the complexity of our medical delivery service systems. and they give out. if they don't understand that

adherence to the supply of measurement or if they are providers or judgment alert displays that they don't unders and what our lives are like, over the course of this epidemic, we've learned a lot about how to influence human behavior and we need to apply these lessons as we put our new biomedical tools and to crack this. the crucial point here is that it is not an either or, they both and. the biomedical model only works with education, counseling, and behavioral change and support are all they are. the whole epidemic has shown us that while education and social and behavior intervention are necessary, they are absolutely not sufficient. if they were, the epidemic would be over already. if the addition of biomedical

intervention that can lead us to the promise of ending name, we must turn this tide together. finally, the fifth thing we need to do instead is organizations need to refuel themselves to rapidly revolving aids landscape. communities will always remain fiscal to her ability to end aids, but most of our community based organizations have focused their expertise and behavioral interventions only. if you have meaningful scientific expertise and fewer still actively delivered health care services. with biomedical tools you become a critical part of our aids response. i was affordable care act, off of the terrain for health and social services, aids organizations, risk becoming wholly irrelevant. fortunately, some visionary organizations for birdie begun to retool.

as it actively works to adapt to dynamic environment, readying itself for a state advocate reforms and shifts in the nation's health care system. it began as a small organization but today's is a federally qualified health system with 3000 patients. harlem united connects the dots between medical care and social services. eric de la torre is also here this morning. he is a health advocate or,a. social service advocate serving by building an infrastructure that connects prevention and treatment and science. eeg and vms star are three examples of what effective aids service organizations must look

like if her point and the aids epidemic. i have a reoccurring dream with the little boy is a wise old woman. what did you do in millions of people were dying from aids? i always wake up before the wise old woman has a chance to answer. i am afraid i wake up because i'm afraid of the answer. i'm afraid the answer will be not enough. idler for a tiny organization and for all i know they may close our doors next week heard that this week, this week with our 30 black advocates in our black scientists, did speak with our journalists we are going to squeeze every drop of information. [cheers and applause] my worst nightmare is that we will squander the historic opportunity. and this is what i know.

the day will come in this epidemic will be over. and when it does, it is important for them to know that we were not all monsters, that we were not all powers, but some of us dare to care in the face of it. some of us dare to fight because of it and some of us -- some of us dare to love in spite of it because it is in the care renowned fighting and the love and that we forever. this is our time. this is our deciding moment. together we are greater than a. [cheers and applause] >> now come u.s. assistant secretary for health, howard koh talks about the a's strategy would set a goal of reducing the rate of new and actions 25% by 2015. his remarks are 20 minutes.

>> the next speaker is my pleasure to introduce dr. howard koh. he is the assistant secretary of health of the united states department of human and health services. a former commissioner of public health, the commonwealth of the state of massachusetts, he has also served as a professor of medicine and associate dean at the harvard school of public health. a graduate of yellow college and medical school, he is the author of over 200 papers and the recipient of numerous awards. it was not until 2010 that the united states had its first national aids strategy introduced by president obama. this strategic plan has shaped the public held response for our country over the last two years. so now i will come dr. howard

koh to address building on success, a national strategy t save lives. [applause] >> dear friends and colleagues, i am so honored to join you this morning on behalf of the united states government to present the status of our commitment for an aids free generation. in particular, i am so pleased to review the development and implementation of the first-ever comprehensive u.s. national hiv/aids strategy, which addresses many of the domestic challenges already reviewed this conference. this strategy also incorporates

lessons learned among many domestics and global partners. it was more than 30 years ago when the first hiv cases were identified in the united states. during this critical time, i was beginning my tenure as the chief medical resident at boston city hospital. i will never forget the patience we lost and the way they suffer. since then, more than 640,000 americans have lost their lives to aids. and today, an estimated 1.1 million people are living with hiv in the united states. one in five is unaware of his or her infection. while the u.s. incidence remained relatively stable in recent years with approximately 50,000 new infections annually,

this figure is unacceptably high. we also know that in the united states the burden of hiv is not shared equally by population or by region. populations most affected include men who have back with men of all races, in particular african-americans and latino men, women of color and women, people who use drugs and young people, especially young, black men who have back with men. the regions most affected include urban areas, the north east and the south. none of this is acceptable. so many in our country have contributed to building a system of early detection that by providing linkages to watch or care leads to viral suppression.

but in the united states, only one in four people living with hiv currently achieves a level of viral suppression needed to preserve health and reduce the risk of hiv transmissions to and infect partners. national strategies are critical to affect his country leadership on hiv. national strategies outline framework for responding to hava in ways that reflect each country epidemiology, burden and trend and they demonstrate the importance of country ownership and the need to maximize efficiency and effectiveness of hiv aids programs. in 2009, president obama made it

a top priority of his administration to develop a live national hava strategy. when drafting a plan, the white house office of national aids policy consulted with people living with hiv, community-based programs, health care providers, researchers, public health asked earth than others. the white house office of national aids policy is also consulted with pepfar interviewing hiv strategies from various countries to the global north and south. pepfar has long prioritized supporting countries as they develop and implement national strategies. maximizing efficiency and effectiveness of our programs is a shared area of emphasis between pepfar and domestic hiv

efforts. the following year, 2010 when president obama unveiled the national hava's strategy, he noted and i quote, the actions we take now will build upon a legacy of global leadership, national commitment and sustained efforts on the part of americans from all parts of the country and all walks of life debt and the hiv epidemic in the united states and allow the world. [applause] this process for community dialogue continues today. the white house recently across the nation were ideas for implementation at the local level would discuss with key

stakeholders. the national strategy has reinvigorated our efforts and reenergized our community under a unifying set of goals. in a short period of time, we have demonstrated progress on the national strategy of three key goals. in particular, each of the goals is guided by strong science, solid evidence of what works best. we have the benefits of the world's leading scientists and researchers at the national institute of health. they and other researchers at the u.s. and across the world have contributed in many scientific breakthroughs that provide but the knowledge and tools that and aids. national strategies first goal is to reduce new hiv infections because after all, this is a preventable disease. by the year 2015, we seek to

lower new infections by 25%. we plan to do this by reducing hiv transmission rates and increasing the percentage of people living with hiv who note the zero sadness. to reach these targets as well as support similar global efforts to produce hiv, nih continues to confess and cutting-edge prevention research related to vaccine. and we are so pleased to see greater emphasis on the use of treatment as prevention. also, last week's approval after about a by the u.s. food and drug administration marks a milestone for preexposure prophylaxis and adds another tool to her at first you reduce incidents.

as part of the national strategy, all the department of health and human services these are charged with real adding federal dollars that concentrate on both geographic areas and populations with the greatest ease. the control and prevention apartments have high strategies in the most heavily affected populations and is promoting its recommendation that every adolescent adult get tested for hiv at least once in his or her lifetime and the increased risk get tested every once per year. for example, the center, the centers for disease control and prevention has released a new social marketing campaign called testing makes us stronger. that was designed for and in consultation with african-american gay and men, the fastest growing for hiv

infection. meanwhile the department of health resources administration of 8100 publicly funded community health centers are skilled at hiv testing of low income people leading to a 13% increase last year alone. in communities implementing more strategies. here in the nation's capital, the district of columbia, department of health takes hiv testing available at the department of motor vehicles so customers waiting in line for driver's license or other services for a free hiv tests. after 35 people are taking advantage of this resource every

day. we need to continue to build on this effort and others to reach people in nontraditional settings. the second goal of the national strategy is to increase access for care and improve health outcomes for people living with hiv in fewer than 50% retained and consistent care. currently, health resources and service administration's ryan white come hiv programs, federal government program that provides services to low-income people and publicly funded are working together to expand nationwide access care for people living with hiv. in addition, a new health care lot signed by president obama two years ago is crucial for hava and implementing the national hava strategy.

[applause] thanks to the affordable care act, we are putting into place commonsense rules that prevent insurance companies from blocking people with hiv/aids out of the market, by tapping their care or refusing to sell review these in their conditions. [applause] specifically, the preexisting condition ban will apply to all americans by january 1, 2014 and rd in effect for children. the affordable care act will soon expand access to services including making hiv aids screening available for women at no cost. [applause]

and in 2014, it will extend coverage to millions more americans that will result in a dramatic expansion of coverage to people living with hiv. recently, the united states secretary of human services, kathleen sebelius announced two important actions relevant to the national strategies second goal. first, the secretary announced nearly $80 billion in new grant awards that will expand care to an additional 14,000 low income people living with hiv and based on estimates provided by state administrators, will eliminate any waiting list for aids drug treatments. [applause] also, secretary sebelius announced that the department is working in partnership with the pilot or the grand that will use mobile phone tag needs to

provide important steps and reminders about management to people living with hiv. ..

gender based violence often goes hand in hand with the disease. women and girls are all too frequently victimized by intimate partner violence and sexual assaults. this not only increases risk for acquiring hiv, it also blocks women and girls from seeking prevention options and treatments. this is unacceptable.

[applause] >> so in an effort to address gender disparate, the white house recently established an interagency working group on with section of hiv aids, violence against women and girls and gender relate health disparities. this will foster opportunities for partnership. finally, we know that stigma drives discrimination and disparity. as a result too many americans avoid finding their hiv status or disclosing their status or seeking care. our center is a campaign called "let's stop hiv together." which features people living

with hiv, standing with family and friends and calling on all americans to join the fight against the disease. this national communications effort will not only address stigma associated with the infection but also complacency about the epidemic. we must prevent the next generations from suffering the burdens we witnessed in the past in conclusion we're making important progress in the first two years of the national hiv/aids ahead strategy but much more lies ahead. we can succeed by making our international public health community even stronger. over the years the united states has been part of efforts to build that community, along with so many domestic and global partners. and in particular, --

coordinated it, planning, coordinating and collaborating to save lives. so as we go forward, let us reflect on the past but accelerate our effortsed in the fight against hiv/aids ahead for the future. here in the united states, we believe the national hiv/aids strategy can bring us closer to a vision of a society where new infections are rare and everyone receives the care they need and deserve. you can follow our effort0s implement the strategy on aids.gov. my hope is that together, we can seize this moment of opportunity and channel its momentum towards achieving our goal of an

aids-free generation. thank you very much. [applause] >> the library bear of congress has a new exhibit called books that shaped america.

88 books were selected for their influence on america and american culture. here's a brief interview about the exhibit and how you can join in on an online chat about the library's christwhat books you think should be included. >> we actually chose books that shaped america at opposed to other words like changed america. we think that books slowly have an impact on american society. so many books have had such a profound influence on american culture, and society, and indeed the very essence of what america is. the earliest book is actually ben franklin's book on electricity, and of course thomas payne's book that sparked the mesh revolution. -- the american revolution. novels are part of the american culture. many identified who we were becoming, the as separations as a nation. others told about experiences

that we had uniquely as americans. we also thought it was very important to look at nonfiction and books that either were self-help or kind of broke barriers. we looked for many books that were innovative, that kind of showed america as an innovative country, that used books and stories to inspire going into the frontier, and that could be literally or intellectually. >> if you want to participate in an online discussion, one that we will then air on book tv, we'd like to hear from you. e-mail us at book tv @c-span2.org. >> arvind subramanian spoke

today. this is an hour and a half. >> good morning. i'm the director of the south asia center at the atlantic council, and on behalf of president fred kemp and my colleagues i'd like to welcome alloff you and thank you for coming in, despite the weather. we are delighted to host arvind subramanian to speak on india's economy, an unusual path and uncertain future. it's not as uncertain as the title suggests, and maybe arvind will be able to spend some time helping us understand that, but i can't think of a better person to do this. i'm delighted to welcome him

also as a former colleague at the imf, but arvind is currently a senior fellow, jointly at the peterson institute for international economics and the center for global development. he is the author of other book called "eclipse, living in the shadow of china's transformation." about china's economic domination. he wrote, now understanding the economic transformation in 2008." i should note that foreign policy named him one of the world's top 100 global thinkers in 2011. while india today nominated him as one of the top, quote, 35 masters of the mind, unquote. over the last 35 years. that is a very heavy burden that i'm sure he is bearing extremely well. but he has been an assistant director at the research department of the international

monetary fund, and he is also worked at -- on the uruguay round of trade negotiations. started the harvard university kennedy school of government and at johns hopkins school of international studies, and he contributes frequently to the financial times and to other groups, and of course he is educated in india at st. stevens college and then at the institute of -- taking his master in ph.d from oxford. i think with that background, we expect nothing but the best from him, so, i'm sure that all of you will have many questions, and i'm going to request arvind to speak for 20-25 minutes, and then we'll have a conversation with him. i would request the conversation is on the record, and i would request those of you that have cell phones to please switch them off. we are also delighted to welcome

the c-span audience because this event is going out live and so we don't want any undo interruptions so with your help we should be able to begin and end on time and in an orderly manner. arvind, welcome, and the floor is yours. [applause] >> thank you for that very kind and generous introduction. it's a great honor to be here at the atlantic council. august is not the most heavily trafficked month in terms of talks and events in d.c. i'm delighted to be here. i suspect some of the interest in india now is because of the blackout that we saw a couple of weeks ago, and i will kind of talk about that in passing as

well. let me quickly get -- since i've only 20-25 minutes and a rather long power point, let me get straight to it. this is a very much kind of economist's perspective on india. politics and security are basically way above my pay grades, but economics with some political economy background is better. i've called this unusual economic past and uncertain future. i realize that the interest is more in what's happening now and what's likely to happen in the near or medium term but i do want to stress there is a certain continuity and in some sense the uncertain and challenges come from india's unusual economic past. so that's my india book, my recent china book, and in some sense the more i talk about

india, there is a simple missty -- the kind of contrast with china which ill will allude to from time to time, and i have a book on both countries. i do want to emphasize that there's an interesting contrast with china i think should inform us. so, i'm going spend the first half of the lecture talking about what i call the unusual economic model, the precautious india model. and what i mean by precautious is that india has been doing things that it is not meant to be doing at stage of its development. it's doing things which the much more advanced in terms of development, and there's a plus side it to but also a kind of drag that comes from this which is going to inform my assessment of the challenges going forward. and then we can talk about the macro challenge, and i do want to spend a couple of minutes on

the really big picture on india, what i call the everything challenge. there's a lot going on here. but normally when i present something on india, i begin by emphasizing something i think people overlook. this is a graph which shows india's gdp per capita and there have been three phases in india's growth and development. the first phase we call the hindu rate of growth. india grew at 3% a year for 30 years after independence, which is about 1.8% per capita. recall that the hindu rate of growth because people thought indians are not more obsessed with the hereafter than the -- and therefore india -- that's is what supposedly hinduism teaches one. that is utter and complete nonsense. beginning in 1980, the economy turned around. i think i want to emphasize this because many people think that growth actually took knopf india

after 1991. it certainly is true the reforms took off in india after 18991 -- 1991 but growth took off around 1979 and 1980. so india has had 30 years of fast economic growth. so, the contrast within india and china is not that china began in '78 and india begannin' '91 but that we both -- both countries good-began at the same time except that china did everything twice the pace of india. so for 22 years we have had 5-1/2, 6% growth, and between 2002 and 2008, '8, '9, '10; 11, a rapid takeoff chinese style growth rate, and that is what i think created this buzz about shining india, the last seven or eight years, and one could argue, which i'm going to later on, that now the question is, are we actually in a fourth

statement which makes the third phase look like an aberration and that india is actually doomed because of all it's been doing to actually slightly slow growth rates over the medium term than other countries. so by way of background, the first aspect of the precautious india that everyone knows and talks about but i want to highlight if you plot democracy against development, india's just a massive on the right side and china on the wrong side. given indias level of per capita gdp this is the modernization hypothesis and begin the gdp india doesn't deserve to be a -- and china is right at the bottom, and all the states to the right of china are oil exporting countries, and india will rightly claim this as an

achievement but this is something that needs to be highlighted in terms of how precautious india has been in its political development. but the point i want to emphasis next is that in terms of economics, i think what has really been unusual about india, it's been a skilled based model of development rather than unskilled base model. india has abundant labor supply and has not used it. instead it has intensively used its skilled labor, and that creates a number of complications. the number of manifestations of this, it's not just that india does more services than manufacturing, which is true, and certainly much more services than manufacturing than china does. but within manufacturing, too, india does much more skill based manufacturing than most countries at this stage of development. here's a chart i want toship wish i knew -- oops -- i don't know where the pointer us but i wish i could show you -- the

graph on the lest is india. the right is china. it's broadly on the same scale and you can see where manufacturing in india is way below that in china, and you see services is way above china. so this is one example of the precautious india phenomenon, and what i find more unusual is that i think what people don't -- the most striking aspect of this skill-based development of india is the fact that india exports skilled fdr internationally. if you think about the international division of labor, it was meant to be that the rich countries produce skills, technology, up a trip knew and finances, and the poor countries provide the lay job and resources and they how the international pattern of specialization has been formed, and if you look at this chart, this is -- so countries like india and china are meant to

import, not to export. but india actually exports much more fdi in the share of its gdp than china. now, not only is that the case. chinese fd i is to africa, so i call that normal fdi because it's downhill and goes from rich countries to poor country. indian fd i is uphill fdi, goes from a poor country, a lot of it goes to the advanced countries which is meant to happen and in highly specialized and skill intensive sectors. this was not meant to happen in the way we thought about the world economy but this is what is happening in india, which is that this is very, very unusual. it shows that india has actually comparative advantage in some things that the advanced nations have, like skill, entrepreneurship and so on. so, having said that india --

these are aspects of what call precautious india. other dimensions of india the can talk about in which either india is different or not so different from the average developing country. i don't want to spend a lot of time on that but i'm sure people will be interested. unlike china, we have a domestic demand based model of development. not expert based mod -- export based model of development. that's not precautious. some poor countries do that. richer countries, but india is different from china and also as a share of -- in terms of integration, india is less integrated than china, and also been growing very rapidly, and india found out that it, took was much more integrated on trade and finance that many countries, but many people in india blood. it still lags china substantially. on social indicators, india is not bad on inequality. it's much less unequal than, say, china. it's above par on life

expectancy. and it's horrible on child malnutrition. i'm saying all these things because on these social outcomes there is no consistent pattern about india. it's good on some, not so good 0 ons but these are general characteristics, not characteristics of a precautious india. this is a kind of -- skip this and come back to this later. i think there are two major near-term challenges which is that at the moment india is macroeconomic include very vulnerable. it's vulnerable because amongst the modern emerging markets it has the highest and most persistently high inflation. inflation has been at, above or close to double digits for two years or more. its external position is becoming more vulnerable and it has very high fiscal deficits. i mean, these are the macroeconomic realities that all of us have been reading in the press for almost six to eight months because the rupee has

been under pressure, foreigners have been fleeing which leads to the second challenge of the slowdown in growth and we'll talk about that in a different context. now, inflation is very high. the really interesting thing about india is that it's aggregate fiscal -- consolidated states is 8% of gdp, which is very high, on most u.s. levels of fiscal deficits. and the really -- i think the point i would make on the fiscal deficits, it was a tragedy, almost a policy catastrophe, that in the years of high growth, when india is growing -- [cell phone ringing]

>> i'm terribly sorry. the cat strife was i think in the rapid growth years, growth was very high, interest rates were very low, and yet we didn't consolidate sufficiently. that was the major policy error on the fiscal side. now, the way i put -- now i want to go to the growth challenge, is the most interesting picture here. that's in some ways one could argue -- in the last two to three quarters, india's growth has slipped from the chinese, 8 or 9% to 6-6-1/2% so the big question in india is what's going wrong? how do we responsibility? and one could make the argument that in fact, as -- that in fact the 89% of the boom years were the aberration and that in some ways india did not deserve to

grow like that given all the things india hasn't done. if you look at any measure of reform, policy reform, any measure of policy reform for india and china, i did an absolute changes or in changes across time, india and china are lag gerts. the countries with the most poly reform are those in africa and latin america, and yet china and india grew much more rapidly than all these countries. so, i want to be careful here. it's not that india and china did not reform but the magnitude of the reform and how controlled and closed their economies are, not compared between china and india and all these other countries. so my proposition that maybe india didn't deserve to grow so much in the first place. so it's not why india is slowing down by white india grew so rapidly in the first place, and the fact we have high inflation in india could be signaling that supply capacity in india is not

keeping pace with demand. now, i would argue -- and this is why i've spent a bit of time on the precautious india model. one could make the case that this is because india's precautious model is unsustainable. and what do i mean by that? we have developed based on skill labor, which is actually very scarce. this myth that india is a lot of skilled labor is just not true. skilled wages have been growing at about 14-15% for ten to 15 years, and we have a completely dysfunctional system of higher education which just does not elicit the supply that the economy needs. so, the fact that we use -- what we have abundantly we don't use, because of the labor laws and other limits, and very little chance going forward we'll be able to use it. and then we have a situation

where scarce social -- call it government institutions, corruption, whatever, that is getting eroded progressively. the big governance of india, which is an important interdevelopment, that is being undermined through corruption and criminality, and what is happening is that land which is meant to be a relatively factor of production in india has become the focus of corruption in india. so we have a situation where, if you take these four factors of production, what we're using is running out of it, what we don't use intensively we have abundant amounts of and it important governance and land are becoming real sources of corruption and a problem. so this is a chart that people have been using a lot because i put it up. if you look at power losses in india, which is a kind of proxy

for not just what is wrong with the power sector in india but governance more broadly. this is a measure of transmission and distribution process and india's way above any emerging market country. india's 5 to 6 times as inefficient and corrupt or weakly governed in power than china or brazil and africa. so this is a kind of metaphor for governance problems in india. the medium-term challenge is actually what -- one can summarize it in terms of two themes. fiscal pop ulimp with the nation that over the last five or ten years we need to give away goodies and freebies in the form of subsidies. oil sub days, food subsidies, power subsidies, and they last seven or eight years and the government induced a scheme, so

the notion that fiscal pop ulimp is an electoral vote winner in india is kind of -- has a lot of whole attraction in india and that contributing to the macroeconomic challenges in india. what is also happening from a growth point of view, we moved from 'one of india's great statesmen, man called -- he said india was a -- he did not like the model but i think now some of those things have come down. we have been called a rent -- i said in a piece there are three kinds of rents, spectrum, allocation, disaster, a big source of corruption, the biggest scandal was rent. terese treal land. the allocation of land is a big source of corruption and that

comes in the way of extracting coal which affects power and infrastructure and growth, and then we have subterranean rents which is a phenomenon in india where we cannot get access to coal because the divining rights again are really a disaster. so, in the medium-term in some ways, fiscal pop -- populism and this rent fraud is a prevention to growth. you wake up and say, well, there is the other side to india as well. and i can make a case. how can you keep india down? i.e. that india will actually grow at 8 to 9% over the next 20-30 years and what are the course -- counterarguments? india is still actually very poor. it's 8% of u.s. per capita gdp and so catching up to the

economic frontier is enormous. you have to do very little to actually be able too grow rapidly and maybe india has crossed that threshold of having done the minimum and you have a big market and so on. so maybe we'll have rapid growth going forward. everyone talks about the demographic, which is a social dynamism in terms of labor force, and then i think what is happening in india is that although there have been no reforms in india, no serious reforms this way the indian economy has been doingwell because because of a growth dynamic. it becomes a very aattractive place and my favorite example is that if you look atletry -- elementary schools inmarks teacher an september teism is 50. 50% of the time the teachers don't show up. but what has happened in the last ten years is that because of growth, the demand for

education has risen so rabidly that even in these rural areas private schools have come up. not the best solution but in those districts and states where the public education system is the most difference functional is where you see the most rapid rise of private schools in india and that's a response to growth. it's not that there have been independent reforms but growth begets reform. and i think finally what i really think is where the promise for india lies is two-fold. it's a combination of the dynamic of competition between states. take power. very bad on average but some states are doing very well, and that creates both a demonstration and effect, and capital and labor move in a way that puts pressure on other states within india. and -- but it's not just that

there is a dynamic of competition, but that is increasingly being combined with, i would call-the-most heartening phenomenon is that politics at the state level i responding to economic governance and neck delivery, and so in the long run, if politics, democratic pot -- politics could reward good neck governance, that's india's hope. indians are very wisconsinful about we wish we could have chinese authority. i say that's nonsense because i believe in the donald rumsfeld rule you go to bat with the political system you have, not the one you wish you have. india will never have the chinese political system but if through democracy we can overcome economic governance problems, that's -- in the last two or three election cycles you see more and more broadly

governance being rewarded by re-election at the state level and men examples which we can go into. so, all this translates into the fact that india is a nation of hustlers so the private sector is doing well. skill labor is in good supply and you get this response of skills, maybe unskilled labor is a demographic we have come by. maybe even in terms of governance, if you find this responsive politics, maybe some of this -- partially overcome. we have a vibrant civil society in india. so that's the positive spin on the medium-term challenge. i'm completely agnostic about whether i believe in the pessimistic view in india or just think we can talk about that in the discussion. i want to end -- i think i'm still within my time limit. speak about the long-term challenges. i think -- i mean, i've alluded

to this so far. i think there is a race between rot and regeneration and i don't know which one is going to win. can tell you all the reasons why economic govern yeah, economic institutions, political institutions, are deteriorating in substantial and very disturbing rates but i acles give you examples of regeneration. and the whole democratic responsive politics. so i'm a little agnostic but this is a big long-term challenge. if politics can respond there's a chance of overcoming what is a serious deterioration in economic institutions. another way to think about india in a very kind of broad picture sense, i think india -- the historian says what is unique about india is that we have many, many more axes of

differences and discord than your average developing country. you have -- it's true that this is getting inequalities is accentuating this sores of discord but it's not very interesting because many countries have that. we can talk about the inequality problem. i think if you look at the other axes, language is -- was an axes of discord in the early years. india is by and large overcome this problem. this is not a serious issue in anymore. so that's a plus check for india. cast. here rein -- horrendous discord. i but i would make the case that amongst these axes, at least india is finding a way of overcoming this -- the caste because simple. electoral politics and numbers means the caste have applied political power and found economic opportunity, just a lot

of subsidies and so on, but they have found a way of overcoming partially all the baggage that was put upon them by the historical -- the hideous historical hierarchy in india of caste. the most famously democratic part for many years, so just a number have worked in their favor. and while i don't mean at all to suggest that the caste problem in india is over. all i can say the water level in the cup is rising. i think the two axes of discord we have installed is religion, and what i would call the geography and the tribal problem. if you look at indicators, i think the hindu muslim problem, the economically -- i think the backward caste are seeing

improvements in their assasin of living, opportunity and so on. we don't see that to the same extent for muslims in india and that's an axis that is a potential source of problem always in india. and finally i think the big one we haven't cracked is the tribe problem. a geography axis because most of them live in a heavily forested band. a band in eastern india where they're basically tribal and actually not participated in the market economy and of course it is the hot bed of maoist incentury rex -- incentury rex, the indian state is not run in this part of india. 20-25% of india, it is not run, and these people are marginalized, out of the system, and therefore, always a force of

problem for india. now, i think the really -- there is -- i had this big -- the security angle, the whole eric angle and i'm not at expert but a big long-term challenge is resources, especially land and especially water, which is becoming scarcer and scarcer, and so there's a whole geo political angle with china on this, the climate change angle. i think water is going to be a real source. so, let me end by saying that you can wake up on any one day and put on the optimistic hat about india or the pessimistic hat about india, and i usually end talks with my favorite quote from this great book called the hindus and she says -- i think india is like a san script word, and every san script word means itself and its opposite. so, john robertson said of india

everything is opposite and everything is true about india so everything is opposite is also true about india but every sans script word represents a god and a position in sexual intercourse so that i think in some ways is what i think about india, that it is both itself and not itself. thank you very much. [applause] >> thank you very much, arvind. as advertised, and at promiseds, i knew you deliver. wide-ranging talk and i'm sure there are going to be tons of questions that i'm sure you will have answers to. just remind, after your last few comments, about whether the glasses half full or half empty.

of the way about the ambassador in pakistan, for united kingdom, high commissioner, once described -- talking about pakistan, when we were discussing the future of the country, and he said, it's not a question of whether the glasses half full or half empty. the question -- and he used his engineering background. he said whether the glass is too big. and so i'm wondering whether the glass in india is growing too fast. >> correct. >> to keep up with. one of the opinions -- points you mentioned at the begin is the fact that india relied on a domestic growth model rather than export growth model, which is what international organizations have been purveying the world, particularly the developing word, for decaded. what do you see is a the one or two key elements in that?

will there need to be a greater infrastructure investment when they need to be an opening up to foreign direct investment in the indian economy? and what are the prospect office these? >> so, india has shown that -- a country can grow rapidly without being a manufacturing-export led model. the big difference to india other countries has been that we've used labor, not been a manuuring exporter but it's not been based on investment, and not been based on heavy reliance on foreign models. now, i think that this model is sustainable. going forward it's not the case that we necessarily need lots of foreign investment and so on but

i think -- let's take infrastructure. a good for example. and take power in particular. now, it bothers me that routinely people say, oh, india needs 500 billion in foreign resources for the infrastructure. and that most of it has to come from abroad. i don't agree with that because for one thing china has shown all the friction is not based on foreign savings. china has foreign in. some manufacturing but in the infrastructure it has been domestic. the reason i get a little irtraited with that is because one plays into this conventional washington view that we need more globalization and investment. the problem of infrastructure and india is simple play government problem. let me make it very, very simple.

people don't pay for power in india. that's the bottom line. and if people could be persuaded to pay more, private investment, domestic and foreign, would come rushing in. and at the moment, when foreign investment comes in, guarantees because people don't pay and then the state boards are run bad and the problems like enron come up so it's a governance and political problem where the notion that every politician of any strife routinely the first thing he will promise is free or subsidized power. and the conundrum is this. why is it that people buy this process? because the history of this promise of free and subsidized power is a history of no power or uninterrupted -- or interrupted power. so why does politics not change? and as i said, the opening i see

now is that as more and more states start delivering power with payment, and people then say, well, it's a much better model. and in fact one of the really interesting experiments is there are two farmers have the choice of two sources of power. cheap power, no guarantees on reliability, more expensive power, guaranteed. and we shall see and looks like more and more farmers will opt for the last option. so coming back to your question, i don't think it's globalize a's and inadequate global usingation, i think it's a governance issue. the solutions to which are entirely domestic. >> a lot of people say that india has an insatiable an tied

for energy. but in the medium-term, if india is unable to make the shift in governance is there a possibility of takeing a regional approach, a different relationship regarding water and power...

pakistan, china and all countries there. for she reasons, one of courses that, you know, china controls the water cable and increasing they can control the water table. so i think that has to be it. other elements of courses many of these and pakistan have a big potential in power, which you think india should use in substitute. so for the climate change problem and for the water problem, i think we need a much more regional solution of scope. >> thank you, arvind. i'm going to open it up to the audience. i will recognize u.s.a. ceo. if i miss you, please be patient with me.

please wait for the microphone, identify yourself and ask your question. >> thank you or tracy shea from brookings. i wanted actually to extend the first question that sushi asked about the appropriate model for india's future economic growth. you suggest that the broker shows india model may not be sustainable. i think reading between the lines of your presentation, you also suggest a conventional model rooster with agriculture and graduate with textiles may not be adequate for a country of india's style, but textile certainly has been an important set. are we looking a time when when india is going to need to experiment with different approaches? or perhaps more fundamentally, follow the logic of what works

in an economy where the private sector has already begun doing more and use that to try india's future development while concentrating on things that governments and education? >> i think i would separate your question into two parts. one is, you know, the private sector was a government led model approach. and the other is where the kindness skilled base versus unskilled. or to analytically distinct face in their extremely important and very good questions. let me take the latter one first. my view is that india has a job to do this model for a number of historical policy choices. would it be desirable to go back

and use our unskilled labor more intensively? i think undoubtedly it would be because that is where the needs are and so on. is it going to have been? i don't think it's going to happen in because the pattern of specialization is for titanic. it's not easy to change that. just to give an example. routinely now you go to manufacturers in india and you'll find a situation where the advent of substituting robots for unskilled labor. you read a book with examples of that. so as much as they named that she would accommodate unskilled labor, i don't think it's a matter of history and persistence that's going to happen. the sad unfortunates and unsaid tragedy of that is were going to persist with this model development and hopefully india's skill level will

capture. but the consequence is a member of one or two cohorts of unskilled labor will not benefit from the office. that is just a sad and inevitable patcher. so my urge that therefore it should be of course we shouldn't proofread paper roster of unfree labor, but given a choice, i would focus much more on getting skills and the economy, improving higher education because that's where the demand is going to be going forward. so that is sunny economic analytics. on the other are versus market-based model, here is my slightly controversial. i think people forget that growth requires a healthy public

which performs all these basic functions in the dynamic private sector. india has achieved or is in the process of achieving the latter. the problem is that the public sector is a drag. the reason i feel pessimistic is because i feel that in the long run, history and experience, history of economic development is that it's much easier to create a defendant is to create and maintain an efficient public or that delivers basics -- the basics of maintaining law and order come the basics of maintaining property rights in stabilizing the economy and legitimizing the economy by transfers, et cetera, et cetera. these are all very demanding attributes, that very important attributes. western europe in the united states took a long time and i was in some ways the prospective. i often say in mumbai as it is

in california. that's not the problem. there is no growth of market. race, you name it. but we don't want to do the mumbai slums because the basic infrastructure that government provides law and order, et cetera. that is eroding in india and is much more difficult to reverse. so that is where we stand. no problem in the private sector is all. in many parts of the world, but it's the basic provision that the public sector has to provide that is a much more equality in india going forward. >> in india and pakistan the one thing in both countries

>> i think that -- to be totally candid, i find it a little bit because they rely a lot and let the government does and does not provide. its law and order. that's exactly the kind of discourse and conversation but i think bothers me about what happened then much of the region. it's overbearing unintrusive. they should do a few things, but that's not happy name. the backlog of cases in the state in 20 years.

>> thank you. another question here. >> thank you. on this governments, which i agree with the issues today and tomorrow -- >> could you identify yourself? >> sushi martian, american university. witnesses say the discourse is in fact that they are lots of people i could name that are friends of mine who are recalling the provisions of the constitution come recalling what was achieved by government in the 60s in the face of enormous challenges. the demand for good government is growing and i agree with you

that we underscore the public. i mean -- [inaudible] >> so that's why i say there is a race between regeneration. i think the road one can see, the regeneration is partly because of what she said that, you know combated demand for governance increases people become richer and demand more. i think the other reason about being hopeful about regeneration is that the fact that india is so open and transparent and civil society dedicates more creatures in all these things come to life, but of course that never happened. so there is a lot going on. and as i said, more and more good governance, the

regeneration power. but both are happening. >> sorry i missed. i'll get to all the others that i recognize. >> poly- nyack, independent consultant. i wanted to ask two questions. one is to what extent do you think the export of investment by the high-end indian companies is a function of push rather than pull? obviously they calculate their relative opportunities and economic terms. what is there a governance issue and it makes more sense, more secure and predict it will in other venues. that's been going on in the 70s with some of india's best corporations. the second part of my question, which relates to governance is what role do you see for popular anticorruption movements in the

transformation or you hope future transformation of government in india. >> again, on the export of sdi, it is true and this is something that's actually happening to an extent in china, where because of uncertainty about the domestic regime, the notion that capital is kind of insurance and push, i think it's only part true for india because the period over which this actually searched this phenomenon was the period in which india was growing rapidly and foreign capital came flooding into india. so i think what the export of sdi until recently, things are changing to some extent because of insurgency in india. until recently over a ten-year period, most of it was because

indian entre nous ayers and management showed they were capable of running world companies not just domestically, but internationally. i was there to push has been relatively mutual until recently and therefore on the popular corruption, i am not an expert on this and certainly i think the pattern as the fact there's so much globalization and consciousness, are unambiguously good. the point is how to secure channel subsequently? and that has always been a problem, even with the latest in his sorry movement, the whole thing, the fact that we don't actually see a concrete manifestation of that is a bit discouraging. and you know, the fact that people are not really sure

that's the way forward. so i often say in india u.k. accountability come you don't get ongoing accountability and these movements, episodic thoughts of accountability. but you know, i wish he would get more into basic structure and institutions changing. we get more ongoing. thank you. >> good morning. i am a member of the atlantic council. it's quite an interesting debate. i wish i could have more time with you to discuss. the question for you is question and comment. global courage and corporate control and imagine many times the segregation between skilled workforce. why do we have to concentrate on not because i do not believe it. every individual has some thing

scares, so we should go to the transition to secure work for us. not everybody is going to go to courage obviously, but may be on the road they would have been interested go to college. another comment in question for you. why we cannot create stronger private public record shifts in those countries, including india, which is very critical. thank you. >> i don't wish to have some might say that -- make a judgment about skills are good and unskilled is bad. i just think that the way the modern economy functions in the late india shifts the economic state has traveled that the demand in the economy is more

skilled, not that much our unskilled people. so the question is how do you address? how do you address that? one misery to do what china did, which is to actually the pattern demands more unskilled labor, which is actually what the country has. in india's case, that's not the case. i was trying to say earlier the choice is coming you make the state move, turn around and move towards unskilled specialization, or do you operate scale? i think in india's case one would have to up grade skills. but the same governance we have an infrastructure, so skilled degradation is not easy to do either. there's some kind of value judgment. you know, on public-private partnerships, it's become one of these terms that is almost a

fat. i don't really know what it means. every economic activity is the public or the partnership. you know, the indian case, essentially what it's become, especially of infrastructure sector is the government saying look at the land and we look after the land problems we have in the rest is yours. now if that's the way of going forward, i am all for it. but in the indian case, it's not that successful because the whole allocation of land become such a source of corruption and sometimes you wonder whether it's desirable or not. so i'm all for it whatever that means. i just don't do what it means. >> in many ways this is the government wanting to continue, keeping a hand on the sailor in the till, so maybe best way to

describe it. the gentleman in the stripe shirt. he succumbed to all the others also. if you could identify or so please. >> my name is wendy r. sheikh. x executive director and pakistan. but that you draw your attention to the effect or pure blackout is everybody's mind. was it an accident? was expected to happen? in the region and knowing about electricity problems in india, i knew for a long time the electricity grid was an issue. there is large frequency oscillations from east to the west and it was alarming. and so, there was a need for infrastructure development to

support the network and it didn't happen. where do you assign the blame or where do you think the problem occurred? looking back at the california prices, we find that it could've been easily fixed and there were some problems we just haven't paid attention to it. could you please comment on blackout in india? >> i am not an expert on the technical aspects. so what -- i don't have much to say. i only know as much as you know in terms of the approximate causes for this problem, which seemed to be that some states overture because of the drought and the fact that watch people come down and partially filled this year. the demand for power had come up and clearly what had happened was the government's problem comes back in the sense that

technically there were limits on how much each state controls, but clearly those reflected in those reflected probably in public professions. and that set off the trigger. so that's how i know. i don't know very much more. to me, the much bigger problem -- the amazing thing was that got fixed so quickly compared to the problem we saw, but i don't think that is the real issue. the power is the chronic undersupply and governance and that is the bigger problem. >> guest: gentleman in the way shirt. >> i am with the american

league. [inaudible] anyway, you mentioned so many opinions were very enlightening for me. how far successfully india managing its population because the population and infrastructure can give tremendous difficulty to take up and the other thing as, what is the number of people in india who follow quality lines in the nation's security is nothing but the objection and the defense budget of india is the policy of reconciliation is the top

chicken and yet reflects a softer image, won't it be very helpful than diverting money resources to improve the quality of life living conditions? thank you. >> let me take this in order. population pressures, you know, the world over has been a big shift in the conversation on population, right? in the 60s and 70s, we spoke about population being a problem. and then you had family-planning , the control all these things. certainly with the east asian military and thereafter, the low question became can a certain structure of population actually be a source of dynamism. so the focus was shifted on a little population to the structure population and now people are saying that india has a demographic dividend because

it has a young and growing labor force, which can save more, keep competitive and that's what happened in east asia, china and not that happens conversely a gene as a burden, even though you may have a smaller population. it's actually a problem. and i think in india we have the same situation where you think there's a huge source of buoyancy in india's fact they'll have a population. as much of a statement about what's actually going to happen. the fact you have a capacity for dynamism doesn't mean the hub opportunities to actually fulfill that. so the government still has a big challenge ahead to convert opportunity into capacity and

jobs informed and so on. nevertheless it's a source of pressure. it's a source of dynamism. do they not not recognized as india is actually very, very different demographically within india. many southern states are now inside heading towards aging. much of the demographic is going to be the most populous part of india and generate the biggest and trees in this population and the other states are actually going to start aging soon. the india is a very interesting mix even in terms of democracy -- democracy. the two things i would say is india's property is come down the block. it's a very controversial subject. about 20% to 25%.

but it's not as bigger reduction. india has the 90s and 2000 has been an experienced in the 80s because there's much my agriculture. on missile defense and development question, i mean, i think it an ideal world, if all countries, if all countries, if all countries, if all countries, everyone's better off, but there's little question of what are the biggest security issues in the region. and also can you do this unilaterally or whether you have

to do this in concert with other countries. i would certainly be -- the problem with india to be of her show, the big strategic. i don't expect defense spending to decline. he is increasing the defense budget in the united states and therefore there is going to be collateral effects on india train to match china. so i'm not up domestic about as much as i would think i would hope that's the way all countries to go, but i think we're going that direction. >> i'm robert from the treasury. i agree governance is really

important, but i think it's a decades long process as much an output of growth development and input. were all in the policy business and i wonder if you talk a little bit about what importance you think that this is a policy change have in spurring growth and also retarding growth in india. and if they are important, whether cisco for policies that could lead to sustained growth of a reasonable period of time. >> you know, since he go from the treasury, but may be provocative. he often says the way the u.s. they go to developing countries and say change policies. the nike of roche, just do it.

and then you talk about improvement in the u.s. you understand congress is this and this is bad. all these issues are raised. those are absolutely and equally true like india. i'm a complete believer and the need for policy reform. governance is an endorsement. i think the way it happened his democratic politics has to make policy reform a lecturer at a popular and qualitative. in some accent is happening. politics are to put a different

a degree of maneuver to kind of unilaterally end is not as great as outsiders might think. that's the understanding and people have to have like india and china and a much more top sense. and they are increasingly to public opinion and so on. i think it really is a conflict and business policy reform or at least it's as complicated in india as it is united states. >> there are countries in which grow slows substantially. i will go out on a limb and say it seems to be associated with episodes of policy change at the real question for all of us in this business is how do you get

there and how do you get to me. were you raised a growth rate, development create and sustain it over time and what are the lovers? it may be the policy isn't dodging ice, but if it is, they are really a despair durability that's one ability to change things. >> i mean, there's no doubt in my mean that policy forms are associated. i think that's unobjectionable. you know, the question is how many independent leaders to theaters have to pull. you can either despair or because of what is happening. and i think that's the reason for despair, or you could take as i was trying to say that as more and more states in india, more and more state-level leaders start getting reelected

because they're doing better governance and delivering, that's positive and i don't think that's the source for change. so there's not only the demonstration, that india had been a common market is i think the endogenous source of optimism india, not washington consensus, nike, just do it, change doesn't change that. i am less and less empathetic to them. >> i think you're pointing to political science and economics. gentleman, behind mr. shane. >> from india medical today. i came to listen to you. you do point out son very thought provoking things than actually my questions are based on what you said. he said the notion of past players.

i found it quite degrading because what is in india is surviving on today and that same thing would have been called here, innovation and someone would have had a different way of looking at it. so is jabari not a form of regeneration and set of herat? and the second thing that got my attention was you downplay and ridicule the rule of honorary when he was in the political party. in india cannot accept a man in the street making or proposing a mosque, said the man has to get into the political system. >> so on the point about you don't like to use the term hustler. i mean, i was trying to use it in a completely descriptive

sense. many come in many people would use the same term in the history of the united states from after the civil war to 1914 and it has the positive side and negative side. and i think the thing to remember is that it is a response of the second best word. so that's the way you look at iraq. ideally they should not have reason to overcome all the obstacles by government or the environment, but given this obstacles exist and that people are creative enough to overcome them. so i don't mean it in a pejorative sense at all. i think i slain is a good thing. i mean, even though it may have some are sure to dimensions are aspects to it. i didn't mean to downplay at

all. i think the nice thing about india as people want to talk political parties, all the power to them. my only thought was an trained to respond to every think it's going to be a site is, that's my comments. as i said, will episodic shedding of the spotlight on these problems be useful? yes, but it becomes, you know, sustainable useful only when he gets calculated to changes and structures in the two shins. and by the way, all that i said, i place all my hopes and democratic politics in india because that the only game in town, whether it's through policy reform or on corruption. >> the gentleman who has his hands straight. >> thank you for a very entertaining presentation.

>> please identify yourself. >> alejandro from development office. from the policy firm, i would say my experience has been that you see happening more undersea to circumstances. the invite me to read it time when opportunities arise because you have growth and therefore you can make changes because everybody's identifying or change where you need to a response because circumstances are such that we need to do something. i don't know what to accent either those circumstances would apply to india. two questions for you. one on the low labor scale issue to be somewhat optimistic to the extent india can meet the demographic. but at the same time, the country is largely based on domestic demand and domestic demand would include expansion of manufacturing and services. so there would seem to be the lower level of skills to be

employed in satisfying domestic demand. the questionnaire, to what extent do you see that possible and to what extent given the difference in demographic can migration help redistribute the excess labor supply for the structure we don't have that much and therefore it doesn't really happen. the second question for the international dimension. you mention reconfiguration and how they can benefit in the integration. at edp we've been strongly supporting integration and in some areas, and central asia we have seen success in the battle, but south asia is one of the regions where we see slower progress and more to cozzi and integration. i appreciate your views whether that is also your assess and ended so, what makes this region more difficult as an area for regional integration?

>> just an answer to your question i want to say i have a set of circumstances when reforms happen. one is a crisis, to assume leadership and the endogenous growth. i said for example, gross takes off in demand for education increases. so that dynamic as well. on the low skilled domestic demand migration, one of the things i have been struck by between india and china is all this talk of india as a place because in some of my -- i was presenting some in london last year were bronco hard and i was telling them that the fact that one of the underappreciated

legacies of the old economics was the fact that once you establish the idea of india, i.e. that india is a political entity with national identity, one economic benefit of that is that migration becomes a much more politically sustainable proposition . people don't realize that there's this politician in maras who is anti-muslim. he began his life. he marched to anti-muslim much later because they used to migrate, but i think because the idea of india has been established, that's much less of a problem now and therefore as a base says for sustaining the growth model of india, i think it's part of my thing. because as i said, one of the

ways in which critics fear men's travel or get replicated as people move. we saw that, but now it's happening more and more. but what surprises me is how little migration you've had in india compared to china. china has just been featuring factory in terms of migration. that is one of the underrecognized aspects, but a part of that explanation is that in china because growth rates were so rapid that the prospects of such increases are the big cost of moving. in india that's only happened recently. would you go for%, 5% come in the attraction of moving does not increase. what you were 9%, the increase in standards that you expect to gain and that is why think it's slow to happen in india, but it's happening.

i've seen study after study santa claus integrated than the rest of the world. there are two reasons. east asia because douglas rapidly than most trade with each other. they're going to be economic integration. that is so not much policy integration in east asia as well. socialist effect of rapid growth, trade-based growth and allow within the reason that you get this endogenous integration. some policy measures have been out slowly. so had she not had that rapid growth and external demand before. and the second thing is in pakistan. you know, south asian division is not going to be proceeding, simple as that, unless we find ways to crack the india-pakistan situation and summaries or the other, that's going to be a part. thank you.

>> two questions here. >> can dylan, cnc press. click challenges does climate change posed to the indian economy and how do you see india responding quiet >> so i thought a alluded to the fact that climate change because they think the whole water situation in via, what is going to be a vital resource, it's going to become a scarce resource, especially with china controlling, now how is india responding? i think india is not responding very well. a number of things, wasteful water use, you know, all the pure subsidies, means that we

use more diesel to generate power as opposed to hydro another things come which means much more environmental pollution. the kerosene and india we have this black carbon phenomenon, which is co2, and additional complications causing worming. it was not responding very well. the standard explanation or excuse would be were still a poor country, we need energy and we can do all these things come which is partly true because there's also things that still need to be done. but my next focus on climate change. my colleague and i are going to read a book on climate change between developing industry countries. i think what is a clamor of hope in india is exactly this recognition that there is a china issue with water and you know, three years ago, a river

and re-hide just changed course in such a dramatic fashion that it brought home to a policymaker the fact that climate change can have these catastrophic consequences. and so, the awareness that in via needs to do more and climate change, for climate change and worming is gaining more traction. translated into action is going to be the next thing. >> if you could keep it short because were about to run out of time. i want to make sure we get everyone in. >> the legislative weary public private partnership. >> power to you. >> speaking along the lines of skilled labor. a lack of liberalization are somewhat sad but liberalization of markets. thinking specifically the legal market. i wonder, can you give us your

thoughts on the potential it has for future growth in india. is that a drive? about a long-term drought? >> it's a question i guess it's a drag, but is there responsive? related to the fact that india is close to foreign professional. and then there's a supreme court case. you know better than i do. i think god he isn't closed, but i see that there is a little more domestic on not because in all these things when a country recognizes expert in its own labor, the whole symmetry of that changes. so the more india realizes we could also let freedom to shoot

people abroad, therefore the regime was india's export of skilled labor and fbi, the more the pressure in india would be to open a period and i think also that a lot of this protection that comes from the fact we have competency, standard vested interests, but the demand for skill is stripping the supply. so they have to go to participating change. >> thank you. first, they congratulate you. >> identify yourself. >> i am an intern. -- [inaudible] all the questions and also let you set in each of the debate in india is coming back this whole governance issue. to get the price is right to use an old term, you need to get the

politics right. the question is how. i was wondering whether you might like to speculate on whether indiana's fiscal administrative structure is outdated, that there is still -- that is still too centralized. i mean, do we need something like the finance commission? or should be that states like in this country raised their own income tax and make a central pool much smaller? so that the central government's role is much more manageable? i wonder if you'd like to comment. >> that's a great question. that's a great question. it's a great talk because -- i think it's a wonderful question because it's what i say about india. the advantage of having established the idea of india is that then you can let states go,

right? because the basic theme is not technical. so in my model of states-based growth, though whole states doing informed experimentation being awarded, normally that is exactly what you see coming that you need a bunch more federal economic and tax structure, but i see india eventually as a model, whereas the basis for dynamism is actually decentralization. and a very interesting contrast with europe, and europe all the tendencies are centralizing as a way of overcoming the crisis. india is exactly the opposite. in some ways india looks like what the united states was maybe 17 to 100 years ago, that basically you have the energy being unleashed in a decent

passion, and of course in the u.s. unit of the civil war to establish the idea that the united states is a viable political entity. in india at that the great legacy. the idea of india is unleashed decentralizing forces, which also means that fiscal federalism has to be much more decentralized. and that is a necessary chronology of my conception of where india has to go in terms of units economics and politics. >> the bottom line to hear from you. is the option going to be to battle through, to kind of let go and growth rate to about life%, 6% a year? how does that affect the battling population? or is the option going to be to make those changes and policy, investments in infrastructure,

education, et cetera so you can then go back up and challenge china for economic domination? >> nothing bold is going to happen. no big bang reform, no bold reform. as most countries it's going to be trying to muddle through. you know, try and muddle through whereas we get towards decentralized form of decision-making and experimentation, i can balance one thing to hope for. there will always be problems, always be crises, always difficulty. but i think india is still -- people forget that you're so far away from the frontier, there's a lot more scope than i think that basic dynamism that india will exploit for the next 20, 30 years. so always end up with wendy dawn nagar, with the policy audience, everything is up to others true

meaning. good way to end this. thank you again, arvind for the wonderful top. i want to thank my colleagues that helped put this thing together and make a run so smoothly. ii think the audience for being important part of this conversation. >> now part of today's "washington journal." we talked to a "washington post" reporter about economic issues in the presidential came came. >> well, we have a question as a front-page story from wednesday in "the wall street journal," written about don help mossadegh went paletta, better i've seen framing the election. and damien paletta is on the phone this morning for "the wall street journal." you hearken back to ronald reagan's famous moment in october of 1980 and the debate, where he asked this question about her spirit will play that

clip for a little historical context. let's watch. >> next tuesday, all of you will go to the polls and stand there in the polling place and make a decision. i think when you make that decision it might be well if you ask yourself, are you better off than you were four years ago? is it easier for you to go and buy things in the stores than it was four years ago? is there more or less unemployment in the country than there was four years ago? is america as respected throughout the world as it was? do you feel that our security is as safe? that we are as strong as we were four years ago? if you answered all of those questions yes, well then i think your choice is very obvious who you will vote for. if you don't agree, if you don't think that this course we've been on for the last four years

is what you would like to see us follow for the next four, then i could suggest another choice that you have. >> on the phone, talking to voters in key states on election. mr. paletta, let me ask you your stories accompanied by lots of charts and graphs alexa historical averages, but ronald reagan frameless is a very personal question to individual voters or does this have people are processing this year? >> guest: i think so. this is a good gut check question of modernity that checkpoint in the economic recovery, were a lot of folks are almost back to where they started four years ago and they've been doing a good job about taking care of their personal data and companies have been able to type about forget back on firmer footing. but there hasn't been much progress beyond that. obviously there's been a lot of frustration with democrats and republicans on the pace of the

economic recovery and a lot of folks wonder now, where every? could we be doing better? or should we be thankful the financial crisis wasn't worse than it was. in her conversations with voters we heard a lot of people say on the one hand i am better off. obviously i still have my job for the job market is still in a little bit. housing prices have gone back up, but on the other hand we've had to make tough choices at home or in our business. we are going out to eat as much, we are buying a new car we wanted to. there's a real kind of uneven sand among americans right now about where they are and what the next tigers will take them. >> let me just run through for a good grasp on your story and after we look at them at some historical data. you look at gdp with inflation adjustment and the black line if president obama compared to predecessors and president

carter and his was the lowest growth over the 16 terms, up 5.2%. pretax per capita income asked putting government benefit, the lowest is 8%. now where's comes in the middle layer, an increase of 10.6%. household real estate in placement adjustment values lewis at 12% as opposed to when he took office. when people look at those numbers, what is the context they place this presidency and at his responsibility for these numbers? >> well, a lot of voters from both parties recognize the blunt trauma that the first year and a half, two years that the country went through, the financial crisis really pushed the stock market down heavily. we were down below 7000 in the early part of 2009. now we are up above 13,000.

housing prices fell off quite sharply. people's disposable income, obviously when you have high unemployment that takes a big toll as well. folks realize that the first two years things have really hard for businesses and americans to regain their footing. what is kind of complicated as the recovery has been slow. we have had spurred the strongest three-month, six-month periods, but they have been met with tough headwinds. so the recovery has really kind of painful for a lot of americans. obviously none of this presidency mentioned kind of entered off in the face of a financial crisis that president obama did. the question a lot of voters will have come is this recovery we've endured the kind of thing we can build on and improve the next few years, or is it time to change course and try something different? >> in the minds of voters, how

much culpability turns to congress? at this fall, the other financial urgent items with not much progress. >> guest: i mean, that is a huge question and i think the white house is counting on, you know, voters kind of pinning the blame on congress and they're making the case. president obama is on the campaign trail every day saying congress needs to get the act together and doing the best he can does by congress. the question is, does the buck stop with him, or will americans buy into this idea that congress has been kind of obstructionist and getting is going? so that will be a key decision. the election could hinge on who they blame for the recovery and coming to know, there's not that much time left to voters on make up their minds to. >> host: damian paletta has been trying to ascertain the question, are you better off than four years ago?

>> i think we have this myth that is two guys in their dorm room. they crafted code it all falls into place and you end up with facebook. you don't see friends. myspace, all laying on the side of the road, not having achieved success.

>> tonight on c-span 2, highlights on the eighth conference >> we are showing some of the recent 19th international aids conference held in washington and talking with david brown of the washed impose to cover the conference. david brown, was the significance of the event being held in washington? >> guest: well, it was the first time it'd been hot in the united states in 22 years, which is a very long time, particularly in the narrative and has area of the hiv epidemic. almost everything has changed from our understanding of the disease to his therapeutics and the prognosis of people with the

infection. it had been essentially banned from the united states because of the restriction on hiv-infected people from entering the country and the witch was part of what was an immigration regulation and the international aids society, which runs the conference had decided that this was a form of stigmatizing exclusion, that they did not agree with and until the united states changed a comment there would not be any conferences held in the united states of these international aids conferences. and it was lifted by president obama very early in his term. >> host: you wrote the subject of money is always a big topic at these aids conferences, particularly at this one. why is that? can you tell us how much the u.s. contributes each year to the fight against aids

worldwide? >> guest: the u.s. contributes about $6 billion to the overseas aid effort. ..

the. >> i would not say a consensus but more options they and their have been ever before. this so-called treatment as prevention. if someone is infected and you treat them very early, the amount of virus in their bloodstream goes

off and that they ariza jolie non defect station on infectious. is a rare but the ada is as soon as everybody is diagnosed is put on the drug's, it is usually reduced. there are other ideas like circumcision and prophylactic drugs. for those who are at a high risk to acquire cable worth the risk. >> host: president clinton one of the major speakers. how has his vacation been successful to drive down the price of the aids drugs? >> his foundation has a huge

effect on the international response helps the market for generic anti-retrovirus list. the makers a.m. that consumers together say if we can assure you there is this demint that this system will be seamless and deficient in

to once the producers knew the market to they can ramp up and produce hot higher-quality is adolor price. >> host: what is your sense what is left to be dead in the fight against aids? >> there's still room for the price of the drugs to come down. in the united states some will save us potentially over $1 billion per year but if doctors and patients can make the small adjustment to the drug regimen to. you cannot force anyone but perhaps make it easier for

people to start the therapy yearly. -- early. but then and there it is the brand name for putting all pregnant women who on the and director of rival drugs. in the past with the pregnancy and breast feeding to stop the drug but of them there disease progresses. when maladjusted for getting a. get them on the drug's. >> host: david brown reported on the 19th annual aids conference.

go to "washington post".com for their comments in [cheers and applause] >> thank you very much. thank you. her thank you very much for the introduction in.

thank you for your leadership as president of the international aids society i wish you and your successor well. you gave one heck of a speech by the way. [applause] hi wide to talk about where we go from here at and how prepared into 2015 -- 2015. how can we achieve it? when the aids conference first to replace a passionate group of activists, researchers, shou ting silence equals death to

make the world listen the first cancer drug azt with a total of 5,000 people in europe and the united states at a prohibitive high cost. zero long way with 8 million people on treatment and the ability to treat all those who need it to. [applause] back then aids was a death sentence. for those of us were fully grown have memories of our friends who did not survive. we could not imagine in then to the you have created the possibility we could have

the aids free generation. we still have a good place to go says bill gates but we have come a long way. everything isa comes from the perspective the foundation has done before their was fending zero or t20 we had to raise money could to buy country to cut costs and have a working delivery system to save lives. but now throughout the world to achieve your -- universal access, and cut new infections and half by 2015. we can do that.

but it will not be easy. just last week by programs in africa i saw a amazing programs and leaders committed to help anyone. and a willingness to eliminate child transmission. and i met with program managers who cannot know where the money will come from. to achieve universal access we have to increase the number of people on treatment by 30% per year. in 2005 there were only 10,000 treatment on children. thinks too many of you and

also other special units the global movement for treating children is 500,000 today. [applause] but to reach the goal we have to have 1.5 million more. we need to test and treat women earlier and keep them on longer through breast-feeding win that many live miles said miles from the place of investments such to employment treatments a combination of programs. [applause] we can save a lot of lives.

but we've will half to do it together with maximum impact it is worth remembering did you know, of has not been made of this budget to the $16 invested a newly first time in my memory, more than half comes from the affected countries themselves. they deserve the enormous amount of credit for that. [applause] universal access is achievable we could do it with less money. >> we have a steady with five african difference more

than other treatment facilities. i fain to the leaders of these countries and all health care personnel to take it seriously and the prod -- progress they have made. and it was the largest of its kind in to mr. -- treatment cost just $200 per patient per year including testing, personnel, outpatie nt and drugs. no excuse for failing to provide treatment to to those in the the. [applause] there are real opportunities for cross our foundation

within two years saved $792 million from what they were spending. japan and 330 -- 340,000 to the treatment roles. is $125. is a good drug. the savings of that drug alone is $500 million. i have to be candid meeting the goals will require some activities especially

community programs. you have to get to the numbers down at '02 five -- at the owe. we can meet and those goals. and we should. we know smart investments save money. united states center of disease control shows the strategy for key populations and accelerating the scale for others not only saves lives but lowers cost within five years. where will we find the money? said global fund had to

postpone funding because they were short on cash. brigades foundation and japan and saudi arabia stepped up with america of fulfilling the three year commitment. secretary clinton said the west will be to the 2015 gold. [applause] i am hopeful other donors will do the same. big countries and their growing family is. with elton's john day shelton jones presents a bill gates presence in there will be more to be spent. government even in this

difficult time i believe will do more if a maximize the impact. the united kingdom follows a strict austerity program without cutting the development system. an astonishing fact. [applause] we work with irish come in regions coming governments, australia who are all giving in this difficult time. finally, we need to make something good out of what is not a good development for those playing god those who have more would give rich and would give more if

they knew the possibility that we have more private giving with more progress. [applause] we can also learned from unicef that has saved hundreds of thousands of lives in my experience to put children we need more innovative financing. immunizations cover a good model for brute, they issue bonds of the capital market that are backed by the donors. they can buy now but pay later.

putt to applying this model to implement accelerated treatment, the prevention means infection and cost is lower when they pay back their money. if we keep producing results. i believe the money will be there. i am committed the programs to make the most of the money. from what was said in 2003 it was $2,000 per person per year is $200 today.

further cost savings are coming. first, we can target the money more effectively. in two african countries where 30% of new infections less than 1% of the prevention dollars were spent to reach those in most need of services. we can do better them back. [applause] last year unaids published guidance to prioritize national strategy is. the focus on the greatest impact. a tool i like to see more.

the next maybe controversial but a new level of openness however elastin dollar is spent down to the ngos. >> you cannot expect program managers to make the decision if trapped. >> but i believe they should make the spending records open and available. not to be embarrassed but we can see who is doing better and we can copy. [applause] we could have a much bigger impact with the dollars that we have.

but to help drive those spending decisions. [applause] to meet the school's we have to incur ridge to shut down the programs that are not working. for the evidence based interventions better working. finally, we have to make sure we pay for services. win businesses start to operation they help to get the work off the ground. but management responsibility is transferred. we have reached a point* we

have to do more of that. to transfer from local governments to the ngos. i do not want to imply spending can go to zero. many need to support to grow and sustainability of the structure to run their own programs effectively. but today for the cost of one day of consulting we could put three people on treatment for one year to to -- . [applause] that means we have got to know what we're doing

otherwise but let me say but it here is catching on to save money and go capacity for pro but far has announced its intentions for national governments. i am very grateful. her last week a new announcement to drastically reduce overhead. i applaud the efforts more can, should come must be done around the world.

having said that, money is not the only impediment. two years ago we heard about prevention and we agreed of the impact of male circumcision with increasing played to of care technology. we did not know how to implement these programs but if they are willing or eager to have to but there are many hard questions to remain.

how do you find people earlier? or get to information they need? how do we improve retention and care? what treatments as prevention our best. if we do it especially for prevention. these questions are important. but we know what we have to do. in 2003 the 3 by 5

initiative and some said if we cannot treat everybody then woes we be better off just doing universal precaution -- prevention? we responded to the challenge now there are 8 million people -- people on treatment. [applause] sometimes you have to make a commitment before you get there. countries have intended to contribute to scale. the prevalence and 26% are would be impressed this is the only way they will achieve their goal and the focus is on how.

having severe resource constraints, they made the decision to put to all pregnant women on treatment for life. wrote they made a commitment. the president showed wisdom and strength to do it. we should be grateful to her. [applause] doubt everyone the view can say if she is not waiting, carl can of the rest of us? you may fade it is my youth but if you build it they will come, the money will be

there to fund it if you do. [applause] >> but identifying patients earlier, where they live live, treating diseases but kill people like meningitis meningitis, we have best practices and the note the importance of decentralizing services. and if we provide testing at the point* of care but if nurses pay a larger rollout including