If only metaphors could heal. It’s been 32 years since the late demographer Ashish Bose coined that famously disparaging phrase ‘Bimaru states’, in a one-page report to the then prime minister Rajiv Gandhi. The acronym for Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, which referenced the Hindi word for ‘sick’, would now be seen as a form of naming and shaming, done perhaps with the intention of prodding the guilty into trying to change. But this burden of guilt—if we assign it to human failure, which is what a failure of vision and commitment in governance would be—is not an easy one to redress. The term continues to cause offence, and there are periodic claims of this state or that having escaped the infamy, but the harsh reality is that, at the root, the sickness seems endemic—and it endures.

Review the medical condition as it obtains now. What Bose was referring to in 1985—to bundle all development indices into a simple demographic—was the huge ratio of the poor in these states, accounting for nearly 40...