A global report highlights a significant rise in unhealthy food consumption in India, surpassing intake of vegetables, fruits, and other nutritious foods.
Global Food Policy Report 2024: Food Systems for Healthy Diets and Nutrition was released by “theInternational Food Policy Research Institute (IFPRI)”.
About CGIAR:
CGIAR (formerly the Consultative Group on International Agricultural Research) is a global partnership uniting organizations engaged in research for a food-secure future.
Focus: Its mission focuses on reducing poverty, enhancing food and nutrition security, and improving natural resources and ecosystem services.CGIAR conducts research and partners with other organizations to transform global food systems and ensure equitable access to sustainable, healthy diets.
Emerging Trends in India:
Increase in consumption of unhealthy food: There is a significant increase in the consumption of unhealthy foods such as salty or fried snacks compared to nutritious options like vegetables and fruits. About 38% of the population consumes unhealthy foods, while only 28% consume all five recommended food groups.
The consumption of processed foods and ready-made convenience foods is rising. From 2011 to 2021, malnutrition in India increased from 15.4% to 16.6%.The prevalence of overweight adults rose from 12.9% in 2006 to 16.4% in 2016.
Processed food consumption is on the rise in India
South Asian Highlights
Processed Food Consumption: Increasing intake of processed foods like chocolates, salty snacks, beverages, and ready-made meals in India and other South Asian countries.
Malnutrition Rates: High levels of undernutrition and micronutrient deficiencies coexist with rising rates of overweight, obesity, and diet-related noncommunicable diseases (NCDs).
Food Budget Trends: Packaged food spending in India’s household food budgets nearly doubled from 6.5% to 12% between 2015 and 2019.
Issue of Double Malnutrition:
Double malnutrition refers to the coexistence of undernutrition and micronutrient deficiencies with overweight and obesity, or diet-related noncommunicable diseases (NCDs).
High levels of undernutrition (stunting and wasting) and micronutrient deficiencies persist even as overweight and obesity rates increase.
More than two billion people, especially in Africa and South Asia, cannot afford a healthy diet.
Dietary Guidelines by ICMR:
The Indian Council of Medical Research (ICMR) released 17 dietary guidelines to promote healthy eating.
Guidelines emphasize reading food labels to make informed choices and minimizing the consumption of high-fat, sugar, salt, and ultra-processed foods.
The guidelines highlight the importance of diverse diets over cereal-centric agriculture and food policies.
ICMR advises against the misleading information often presented on packaged foods.
Way forward:
Strengthen Nutritional Policies: Develop and enforce policies that promote the consumption of nutritious foods. Implement taxes on unhealthy foods and subsidies for fruits, vegetables, and other micronutrient-rich foods.
Regulate Processed Foods: Implement strict regulations on the marketing of unhealthy foods, especially targeting children.
Mains PYQ:
Q How far do you agree with the view that the focus on the lack of availability of food as the main cause of hunger takes the attention away from ineffective human development policies in India? (15) (UPSC IAS/2018)
The National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India’s premier mental health institution, has been honoured with the “Nelson Mandela Award” for Health Promotion by the World Health Organization (WHO) for 2024.
About National Institute of Mental Health and Neuro-Sciences (NIMHANS)
Details
Location
Bangalore, India
Affiliation
Autonomous institute under the Ministry of Health and Family Welfare, Government of India
Ranking
Ranked 4th best medical institute in India by the “National Institutional Ranking Framework (NIRF)”
History
Founded in 1847 as the Bangalore Lunatic Asylum.
Renamed as the Mental Hospital in 1925.
Amalgamated with the All India Institute of Mental Health (AIIMH) in 1974 to form NIMHANS.
Conferred with deemed university status by the University Grants Commission in 1994.
Declared an Institute of National Importance by an act of parliament in 2012.
Governance
Operates with academic autonomy under the “Societies Registration Act”.
Prioritises service, manpower development, and research in mental health and neurosciences.
A multidisciplinary integrated approach was adopted for translating research results into practice.
Funding
Receives resources for academic and research activities from national and international funding organisations.
Outreach
Engages in mental health outreach initiatives including critiquing mental health reports and collaborating with government agencies for training and counseling.
Known for diagnosing and treating various mental health conditions including depression and neurobiological disorders.
Back2Basics: Nelson Mandela Award for Health Promotion
Aspect
Details
Establishment Year
1995
Presented by
World Health Organization (WHO)
Purpose
Recognizing outstanding contributions and achievements in health promotion worldwide
Namesake
Nelson Mandela, former President of South Africa
Criteria for Recognition
Innovative approaches
Sustainable Impact
Dedication to health equity and social justice
Recipients
Individuals, organisations, institutions, or communities
Selection Process
Based on significant strides in health promotion
Consideration of efforts in disease prevention and well-being improvement, especially among disadvantaged populations
Presentation
Occurs during special ceremonies or events
Often coincides with key health promotion initiatives or milestones
Significance
Symbolises recognition and encouragement for ongoing efforts in health promotion
Highlights the importance of collective action and collaboration in addressing health challenges and achieving public health and sustainable development goals
PYQ:
[2021] We can never obtain peace in the outer world until and unless we obtain peace within ourselves.
Health officials of the World Health Organization (WHO) aim to finalize over two years of negotiations on new pandemic response rules when they convene in Geneva next week.
About the ‘Pandemic Treaty’
The pandemic treaty is a new legally binding agreement being negotiated to improve the global pandemic response. The treaty aims to address the shortcomings revealed during the COVID-19 pandemic, such as inequitable vaccine distribution.
Article 12, a critical and contentious part of the treaty, proposes reserving around 20% of tests, treatments, and vaccines for WHO distribution to poorer countries during emergencies.
The treaty would be the second major health accord after the 2003 Framework Convention on Tobacco Control.
Convention n Tobacco Control
Govt. of India ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2004, the first-ever international public health treaty focusing on the global public health issue of tobacco control.
The FCTC is a legally binding treaty that requires countries bound by the treaty — or Parties to implement evidence-based measures to reduce tobacco use and exposure to tobacco smoke.
How will Global Health Rules Change?
Updates to the existing International Health Regulations (IHR) include a new alert system for different risk assessments of outbreaks, replacing the current single-level emergency declaration.
A new “early action alert” stage will be introduced, along with a potential “pandemic emergency” category for the most severe health threats.
Obligations for countries: Strengthened obligations for countries to inform the WHO about public health events, changing the language from “may” to “should”.
How do the countries view this pact?
Developed Countries
Wealthy countries are often cautious about sharing resources such as drugs and vaccines.
There is significant political pressure, especially from right-wing groups, fearing that the treaty could infringe on national sovereignty.
These countries are concerned about the financial implications, debating whether to set up a new fund or use existing resources like the World Bank’s $1 billion pandemic fund.
Underdeveloped Countries
Poorer countries emphasize the need for equitable access to treatments and vaccines, reflecting experiences of “vaccine apartheid” during the COVID-19 pandemic.
They advocate for stronger commitments from wealthier nations to support global health infrastructure and emergency response capabilities.
Future Scope of the New IHR Rules and the Pandemic Accord (Treaty):
More robust framework: The IHR updates and the pandemic treaty has designed to complement each other, creating a more robust framework for global health emergencies.
Promotes cooperation: The new rules aim to ensure faster, more transparent information sharing, and better co-operation during health crises.
Next steps for treaty negotiations: Next week’s World Health Assembly will focus on planning the next steps for the Treaty Negotiations, with a full agreement unlikely to be reached immediately.
Defenses against future pandemics: The successful implementation of both the IHR updates and the pandemic treaty could significantly strengthen the world’s defenses against future pandemics, addressing gaps exposed by COVID-19.
Conclusion: While there is a shared understanding of the treaty’s importance, countries’ views are shaped by their National interests, Financial concerns, and Political pressures, leading to complex and protracted negotiations.
Mains PYQ:
Q Critically examine the role of WHO in providing global health security during the Covid-19 pandemic. (UPSC IAS/2020)
The prevalence of Congenital Anomalies and Neurological Challenges in newborns highlights the need for adequate Antenatal and Perinatal care to address them.
Key observations made by the National Family Health Survey (NFHS-5):
Perinatal mortality rates stand at 32 for 1,000 pregnancies, neonatal mortality rates at 25 for 1,000 live births, and hypertensive disorders in pregnancy remain a leading cause of maternal death.
Cause of Maternal and Perinatal Mortality:Preeclampsia (PE) is a significant cause of maternal and perinatal morbidity and mortality, with early onset PE posing higher risks.
Combination of Maternal factors and Biomarkers: Screening based on maternal risk factors alone has suboptimal performance, while a combination of maternal factors and biomarkers like mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor can improve detection rates significantly.
Early Intervention with Aspirin Prophylaxis: First-trimester screening models, like the FMF prediction algorithm, have been effective in identifying high-risk pregnancies for preterm PE, allowing for early intervention with aspirin prophylaxis to reduce the incidence of preeclampsia.
What is Pre-eclampsia?
Preeclampsia is a complication of pregnancy. Preeclampsia, high blood pressure, and high levels of protein in urine indicate kidney damage (proteinuria), or other signs of organ damage.
Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had previously been in the standard range.
Challenges to cure Pre-eclampsia (PE):
Complex Screening Protocols: Effective screening requires a combination of maternal history, demographics, color Doppler ultrasound, mean arterial pressure, and placental biomarkers, which may not be uniformly available or implemented.
Limited Resources: Not all healthcare facilities have access to advanced screening tools and technologies like color Doppler ultrasound and placental biomarker testing.
Lack of Awareness: Pregnant women may not be aware of the symptoms and risks associated with pre-eclampsia, leading to delayed presentation and diagnosis.
Delayed Intervention: Identifying high-risk pregnancies early is crucial, but delays in screening and diagnosis can lead to missed opportunities for timely intervention.
Pharmacological Challenges: Ensuring timely pharmacological intervention, such as aspirin prophylaxis, requires adherence to established protocols, which may only sometimes be followed.
Logistical Issues: Implementing widespread screening and management protocols involves logistical challenges, including training healthcare providers and ensuring the availability of necessary equipment.
Complexity of the Disorder: The systemic nature of pre-eclampsia, affecting multiple organs, complicates its management and requires a multidisciplinary approach.
Programs in India:
“Samrakshan” program: The Indian Radiological and Imaging Association’s (IRIA) “Samrakshan” program aims to reduce pre-eclampsia from 8%-10% to 3% and fetal growth restriction from 25%-30% to 10% by the end of the decade.
The program focuses on spreading awareness, screening for pre-eclampsia and fetal growth restriction, and ensuring comprehensive care throughout pregnancy.
Way Forward:
Early Detection and Management: Early detection through regular prenatal care, including blood pressure monitoring and urine testing for protein, is crucial in managing pre-eclampsia.
Timely intervention can help prevent severe complications and ensure the well-being of both mother and baby.
Promoting Awareness and Education: Raising awareness about the signs and symptoms of pre-eclampsia among pregnant women is essential for early recognition and prompt action.
Education on risk factors, preventive measures, and the importance of regular antenatal check-ups can significantly impact maternal and neonatal outcomes.
Ensuring Access to Quality Maternal Healthcare: Access to quality maternal healthcare services, including skilled antenatal care, monitoring, and timely interventions, is vital in addressing pre-eclampsia and reducing maternal mortality rates.
Empowering healthcare providers with the knowledge and resources to manage pre-eclampsia effectively is key to ensuring safe motherhood.
Collaborative Efforts for Maternal Health: Collaboration between governments, healthcare institutions, non-profit organisations, and the private sector is essential in implementing comprehensive maternal health programs that prioritise the prevention, early detection, and management of pre-eclampsia.
Conclusion: By spotlighting pre-eclampsia and emphasising the importance of early detection, awareness, access to quality care, and collaborative efforts, we can strive towards ensuring safe motherhood for all women, safeguarding the health and well-being of mothers and their babies.
Mains PYQ:
Q Identify the Millennium Development Goals (MDGs) that are related to health.Discuss the success of the actions taken by the Government for achieving the same.(UPSC IAS/2013)
[2022] The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them?
[2020] Critically examine the role of WHO in providing global health security during the Covid-19 pandemic.
Note4Students:
Prelims: NA
Mains: Hypertension, WHO’s HEARTS Strategy, India’s Hypertension Control Initiative (IHCI)
Mentor’s Comment: Hypertension, a major but overlooked risk factor for heart attacks and strokes, causes 10.8 million preventable deaths annually, surpassing risks like tobacco use and high blood sugar. The WHO’s 2023 report reveals that 1.3 billion adults globally have hypertension, with 46% unaware of their condition. In India, 311 million adults suffer from hypertension, triple the number with diabetes.
Let’s learn___
Why in the News?
Over the past three years, the COVID-19 vaccine has attracted significant public attention as a potential risk factor for blood clot formation, leading to sudden cardiac arrest.
What is Hypertension?
Hypertension (high blood pressure) is when the pressure in your blood vessels is too high (140/90 mmHg or higher). It is common but can be serious if not treated. Eating a healthier diet with less salt, exercising regularly and taking medication can help lower blood pressure.
WHO Report on Hypertension
2023 WHO Report: In 2023, the World Health Organization (WHO) released its first-ever report on hypertension titled “Global Report on Hypertension: The Race against a Silent Killer.”
Silent Killer: Hypertension is often called a silent killer because people are usually unaware of their high blood pressure until they develop complications.
Leading Cause of Death: High blood pressure causes more deaths than other leading risk factors, such as tobacco use and high blood sugar.
Rising Numbers: The number of adults with hypertension nearly doubled since 1990 to reach 1.3 billion.
Awareness and Control: Globally, an estimated 46% of adults with hypertension are unaware of their condition, and less than half (42%) are diagnosed and treated. Only one in five adults (21%) with hypertension has it under control.
Hypertension in India
Prevalence in India: The Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study estimates that in India, 311 million people (or one in every three adults) have hypertension.
Comparison with Diabetes: In India, adults with hypertension are threefold of the estimated 101 million people living with diabetes.
Dietary Salt and Hypertension
Impact of Excess Salt: Excess dietary salt intake (five grams or more per day) is a key risk factor for hypertension and contributed to two million cardiovascular disease deaths in 2019.
Benefits of Reducing Salt Intake: Research shows that reducing salt intake can reduce cardiovascular disease risks by 30% and mortality by 20%.
Salt Consumption in India: Indian adults consume on average eight to 11 grams of salt per day, which is approximately twice the WHO-recommended daily intake.
Deaths Due to High Salt Intake: High salt intake is responsible for an estimated 175,000 deaths in India.
Hypertension across Socio-Economic Groups
Universal Impact: Hypertension affects all socio-economic groups.
Health Camps Findings: A Delhi-based NGO, Foundation for People-centric Health Systems, conducted 50 health camps in five localities of Delhi and Gurugram from October 2023 to March 2024, screening and treating around 12,000 people.
Detection in Low-Income Groups: Many were women, migrant workers, and rickshaws and taxi drivers from low-income groups. A large number were found to have diabetes and hypertension, with most cases detected for the first time in these camps, indicating gaps in awareness, detection, and treatment.
Back2Basics: India’s Hypertension Control Initiative (2021):
Objective: India aims to put 75 million people with hypertension and/or diabetes on standard care by 2025.
Initiation and Expansion: The IHCI, a collaborative project of ICMR, Ministry of Health and Family Welfare/Directorate General of Health Services, WHO India, and other partners, was initiated in November 2017 in 25 districts across five states and expanded to 140-plus districts of India in 2023.
Strategies: IHCI follows five simple and scalable strategies implemented through primary health care:
-Simplified drug and dose-specific treatment protocols for primary-care settings. -Strengthening the drug supply chain by including protocol-based drugs in the State essential drug list, forecasting drugs based on morbidity, and ensuring adequate budget allocation in annual plans. -Team-based and decentralized care. -Patient-centric measures such as dispensing 30 days of medicine during each patient visit. -Use of information systems for program monitoring.
Programmatic Learnings from IHCI
Access and Utilization: Nearly six years of IHCI implementation has resulted in two major learnings:
Simple treatment protocols with fewer drugs, reliable drug supply, linking patients to facilities closer to home for follow-up, and engaging teams increase access and utilization of health services from government facilities.
Simplified program monitoring makes performance assessment quantifiable and actionable.
Recognition: The IHCI won the 2022 UN Interagency Task Force and WHO Special Programme on Primary Health Care Award.
Future Goals and Prevention
Global Goals: Seventy-six million cardiovascular deaths and 450 million disability-adjusted life years (DALYs) could be avoided if countries achieve 50% population hypertension control by 2050.
India’s Targets: An estimated 4.6 million deaths can be prevented in India by 2040 if half the hypertensive population has its blood pressure under control, helping to achieve targets under the National Health Policy and global commitments like universal health coverage.
Way Forward
Raise Awareness: Educate the public about the risks and long-term adverse impacts of untreated hypertension. High blood pressure can affect multiple organs, including the heart, kidneys, brain, and eyes.
Scale Up Evidence-Based Interventions: Expand successful programs like IHCI. Use strategies and lessons from such experiences to design interventions for other lifestyle diseases like diabetes and chronic kidney diseases.
Focus on Non-Modifiable Risk Factors: Address non-modifiable risk factors such as family history, age over 65 years, and pre-existing comorbidities like diabetes and/or kidney disease. Focus on healthy adults with known non-modifiable risk factors.
Reduce Dietary Salt Consumption: Implement strategies like “SHAKE the salt habit” under WHO’s HEARTS strategy:
Surveillance to measure and monitor salt use.
Harness industry to promote and reformulate foods with less salt.
Adopt standard labelling and marketing.
Educate and communicate to empower individuals to eat less salt.
Support environments that promote healthy eating.
Conclusion: As hypertension continues to exact a heavy toll on global health, concerted efforts are needed to raise awareness, implement evidence-based interventions, and promote healthier lifestyles. By prioritizing hypertension control initiatives and fostering a culture of preventive healthcare, we can mitigate the devastating impact of this silent killer on communities worldwide.
On the occasion of World Immunisation Week observed from 24th to 30th April, the Indian Academy of Paediatricshas launched a campaign to focus on routine immunization as the ‘Birth Right’ of a Child.
About Measles Vaccination
This vaccine protects against 3 diseases: Measles, Mumps, and Rubella (MMR).
Centre for Disease Control and Prevention (CDC)recommends children get two doses of MMR vaccine, starting with the first dose at 12 -15 monthsof age, and the second dose at 4-6 years of age. Teens and adults should also be up to date on their MMR vaccination.
Indian Government Initiatives:
World Immunization Week: The Indian Academy of Paediatrics (IAP) launched a campaign during World Immunisation Week (April 24-30) focusing on routine immunization as a fundamental right of every child. IAP urged the government to expedite the introduction of the HPV vaccine and typhoid conjugate vaccine to address significant public health burdens.
Vaccination made within the country:
DTP Vaccine: 93% of surviving infants received the third dose of the DTP vaccine.
Measles Vaccine: 90% of infants received the second dose of the measles vaccine. The measles vaccine has been the most significant in reducing infant mortality, accounting for 60% of lives saved through immunisation since 1974.
Present issues include inequitable distribution of vaccines, inability to reach 90% coverage, human resource gaps, and financing problems. In 2022, 33 million children missed a measles vaccine dose, with 22 million missing the first dose and 11 million missing the second dose.
Impacts of Immunisation Globally:
Lives Saved: Immunisation efforts have saved an estimated 154 million lives globally over the past 50 years, equating to six lives every minute of every year.
Infant Mortality Reduction: 101 million of the lives saved were infants. Vaccination against 14 diseases has reduced infant deaths by 40% globally and by over 50% in Africa.
Diseases Targeted: Vaccines have contributed to reducing deaths from diseases like Diphtheria, Haemophilus Influenzae Type B, Hepatitis B, Japanese Encephalitis, Measles, Meningitis A, Pertussis, invasive Pneumococcal disease, Polio, Rotavirus, Rubella, Tetanus, Tuberculosis, and Yellow fever.
Conclusion: Immunisation saves lives, reduces infant mortality, and prevents outbreaks by protecting against infectious diseases, ensuring healthier communities, and securing a better future for children worldwide.
Mains PYQ:
Q What is the basic principle behind vaccine development? How do vaccines work? What approaches were adopted by the Indian vaccine manufacturers to produce COVID-19 vaccines? (UPSC IAS/2022)
According to the National Institute of Nutrition (NIN), approximately 56.4% of India’s overall disease burden is linked to poor dietary habits.
Guidelines by the National Institute of Nutrition (NIN):
The NIN, operating under the Indian Council of Medical Research (ICMR), has issued comprehensive guidelines on nutrition for vulnerable groups, including pregnant and lactating women, children, and the elderly.
Preventive Measures: A healthy diet coupled with regular physical activity can prevent 80% of Type 2 diabetes cases and significantly reduce the burden of heart disease and high blood pressure.
Nutrition for Mother and Child: Proper nutrition from conception to the age of 2 years is crucial for optimal growth and development, preventing undernutrition, micronutrient deficiencies, and obesity in both mothers and children.
Suggested general dietary principles: The guidelines recommend getting required nutrients from at least eight food groups, including vegetables, leafy vegetables, roots and tubers, dairy, nuts, and oils.
Group-Specific Guidelines:
Pregnant women: Small frequent meals for those experiencing nausea and vomiting. It recommends the consumption of lots of fruit and vegetables, especially those high in iron and folate content.
Infants and children: For the first six months, infants should only be breastfed, and must not be given honey, glucose, or diluted milk. After the age of 6 months, complementary foods must be included.
Elderly: The elderly should consume foods rich in proteins, calcium, micronutrients, and fiber. Apart from pulses and cereals — with at least one-third as whole grains — at least 200-400 ml of low-fat milk or milk products, a fist full of nuts and oilseeds, and 400-500g of vegetables and fruit should be consumed.
Key concerns as per the National Institute of Nutrition (NIN):
Rising Noncommunicable Diseases (NCDs) Among Adolescents and Children: Due to poor dietary habits led to diseases like cardiovascular disease, cancers, and diabetes are increasingly affecting adolescents and even children in India.
Focus on Healthy Dietary Habits: The guidelines emphasize the importance of reducing salt intake and avoiding highly processed foods like packaged snacks, cookies, and sugary treats, which are linked to unhealthy diets and disease burden.
High Prevalence of Lifestyle Conditions: The Comprehensive National Nutrition Survey 2019 highlights a concerning prevalence of lifestyle-related conditions even among children, including overweight or obesity, diabetes, pre-diabetes, and abnormal cholesterol levels.
Cholesterol Levels: The survey indicates high levels of bad cholesterol (LDL and triglycerides) in children aged 5-9 and pre-teens and teens aged 10-19, along with low levels of good cholesterol in a significant portion of children and adolescents.
Other concerns related to the “Dual nutrition challenge”
Incidence of micronutrient (zinc, iron, vitamins) deficiencies ranged from 13% to 30% of children between ages 1 and 19. But still, the prevalence of anemia is at 40.6%, 23.5%, and 28.4% in children under age 5, ages 5-9, and 10-19 respectively.
However severe forms of undernutrition such as marasmus (a deficiency of macronutrients such as carbohydrates and proteins) and kwashiorkor (deficiency of proteins) have disappeared from the country.
Conclusion: Implementing these guidelines effectively can significantly contribute to achieving Sustainable Development Goal (SDG) targets, particularly SDG 2 (Zero Hunger), SDG 3 (Good Health and Well-being), and SDG 12 (Responsible Consumption and Production).
Mains PYQ:
Q How far do you agree with the view that the focus on the lack of availability of food as the main cause of hunger takes the attention away from ineffective human development policies in India? (15M) UPSC 2018
Two recent reports reveal some important facets of India’s Development.
The Human Development Report 2023-24, published by the UNDP, takes a comparative perspective and maps the achievements in the area of human development.
A paper published by the World Inequality Lab in March 2024 provides long-term trends in income and wealth inequality in India between 1922 and 2023.
About HDI:
The Human Development Index (HDI) is a measurement system used by the United Nations to evaluate the level of individual human development in each country. It was introduced by the U.N. in 1990.
How is the HDI measured?
The HDI is the geometric mean of the three dimensions above, with indices calculated separately for each country using data on life expectancy, schooling and per capita income. The final result always gives a value between 0 and 1 which defines, according to the UNDP, the four degrees of human development detailed below:
Very high: countries with a HDI above 0.80.
High: countries with a HDI between 0.70 and 0.80.
Medium: countries with a HDI between 0.55 and 0.70. (India is here)
Low: countries with a HDI below 0.55.
India’s poor ranking in HDI:
Regional Trends: India’s HDI ranking has improved marginally over the years, but it still lags behind several countries, including Bhutan, Bangladesh, Sri Lanka, and China. In 2022, India ranked 134 out of 193 countries.
Low HDI Value: Despite the incremental improvement in ranking, India’s HDI value remains relatively low. The HDI value increased from 0.633 in 2021 to 0.644 in 2022.
Gender Inequality Index (GII): While India showed improvement in its GII ranking in 2022, moving from 122 out of 191 countries in 2021 to 108 out of 193 countries in 2022, significant gender disparities persist. Notably, India faces one of the largest gender gaps in labor force participation rates, with a substantial difference between men (76.1%) and women (28.3%).
Medium Human Development Categories: India’s HDI ranking places it within the medium human development category alongside countries like Myanmar, Ghana, Kenya, Congo, and Angola.
Key concerns related to Human Development:
Increasing Disparity Between Countries: The report underscores a concerning trend of growing inequality between countries, particularly between those at the upper and lower ends of the Human Development Index (HDI).
Economic Concentration: The concentration of economic power in a few countries is exacerbating global inequality. Nearly 40% of the global trade in goods is controlled by just three or fewer countries
Tech Company Dominance: The dominance of large technology companies further exacerbates inequality, with the market capitalization of the top three companies surpassing the GDP of the majority of countries.
Widening inequality:
Income Disparities in India: The study from the World Inequality Lab reveals stark income disparities in India, with the bottom 50% of the population receiving only 15% of the national income.
Conversely, the top 1% earns on average 23 times more than the average Indian, and the top 10,000 individuals earn 2,069 times the average Indian.
Reduction of Middle-Class size: During the period from 2014 to 2022, the incomes of the middle 40% of the income distribution have grown slower than the bottom 50%. This trend suggests a potential reduction in the size of the ‘middle class.
High Household Debt and Low Savings: Household debt levels in India have reached a record high of 40% of GDP, while net financial savings have plunged to 5.2% of GDP.
Way Forward:
Promote Inclusive Growth Policies: Implement policies that prioritize inclusive growth, focusing on reducing income disparities, and enhancing access to education, healthcare, and economic opportunities for all segments of society.
Enhance Social Safety Nets: Strengthen social safety nets to provide support to vulnerable populations, including targeted welfare programs, universal healthcare coverage, and unemployment benefits.
Mains PYQ:
Q Despite the consistent experience of high growth, India still goes with the lowest indicators of human development. Examine the issues that make balanced and inclusive development elusive.(UPSC IAS/2019)
The UGC chairperson announced that students with four-year undergraduate degrees can now appear for the National Eligibility Test (NET), an exam that certifies eligibility for lectureship in colleges and universities in India, and PhD programs.
Key Implication of this Announcement:
Lowering of Standards: Allowing students with four-year undergraduate degrees to appear for the National Eligibility Test (NET) and pursue PhD programs without a Master’s degree may lead to concerns about the lowering of academic standards.
Quality of Teaching: Concerns arise regarding the quality of teaching in universities and colleges if fresh undergraduate students are recruited to teach other undergraduate students.
Impact on University Rankings: The decision may have implications for the rankings and reputation of Indian universities, particularly those with prestigious tags like the Institution of Eminence and high NAAC ratings.
Dilutes the perception: Allowing candidates to pursue a PhD in a subject unrelated raises concerns about the diversity and interdisciplinary nature of research.
The decision to broaden access to PhD programs may be aimed at dismantling the perception of PhD as an elite qualification.
However, critics may argue that diluting the entry requirements for PhD programs could undermine the rigor and prestige associated with earning a doctorate.
Impact on Research Culture: Lowering the barriers to entry for PhD programs may have implications for the research culture and scholarly integrity within academic institutions.
Measures to maintain standards for the National Eligibility Test (NET):
Retain Postgraduate Degree Requirement: Maintain the requirement of a postgraduate degree for appearing in the NET to ensure that candidates have a solid foundation in their respective fields of study.
Reintroduce MPhil Programs: Reinstate MPhil programs to provide an intermediary step between postgraduate and doctoral studies. MPhil programs offer an opportunity for students to further develop their research skills and prepare for doctoral-level research.
Enhanced Mentoring and Preparation Period: Implement a structured mentoring program for NET aspirants to help them transition from undergraduate to postgraduate and eventually doctoral-level research.
Specialized Entrance Exams for PhD Programs: Instead of eliminating separate entrance exams for PhD programs, consider introducing specialized entrance exams that assess candidates’ research aptitude, subject knowledge, and suitability for doctoral-level research
Way Forward:
Promote Interdisciplinary Research: Encourage interdisciplinary research by providing opportunities for collaboration and exchange across different academic disciplines.
Maintain Research Standards: Uphold rigorous standards for doctoral research and teaching positions to ensure the quality and integrity of academic programs. Implement quality assurance mechanisms to monitor and evaluate the standards of the NET and PhD programs.
Mains PYQ:
Q The quality of higher education in India requires major improvement to make it internationally competitive. Do you think that the entry of foreign educational institutions would help improve the quality of technical and higher education in the country. Discuss.(UPSC IAS/2015).
Q) Appropriate local community-level healthcare intervention is a prerequisite to achieving ‘Health for All’ in India. Explain. (UPSC IAS/2018) Q) To enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss. (UPSC IAS/2020)
Note4Students:
Prelims: Right to life; Right to health; Right to die with dignity;
Mains: Judicial Intervention in Health Care sector;
Mentor comments:Death is inevitable, the one certainty in life. When the time comes, and if you have an incurable disease, how would you like to go? Would you prefer your bed in your home, with your loved ones around you? Or would you prefer being all alone in an Intensive Care Unit (ICU) with a tube in every orifice, hooked to machines that measure the functioning of every vital organ in your body, with each malfunctioning organ supported artificially? When facing an incurable illness, the choice between passing away at home surrounded by loved ones or in an ICU on life support is deeply personal (Right to Privacy). Some prefer the comfort and intimacy of home, while others seek every medical intervention, even if alone. There have been long debates on euthanasia and Palliative care for old people to protect their rights. Courts, through various decisions, have recognized the right to die with dignity as a fundamental right and an integral part of the right to life under Article 21.
Let’s learn
—
Why in the News?
Ronald Reagan, the 40th President of the USA, died at 93 in his home surrounded by his family members (2004). However, India’s former PM Atal Bihari Vajpayee died (2018), nine years after a stroke that had left him non-ambulant.
Hence, communicating end-of-life wishes is crucial to ensure one’s final moments align with their values.
What is the difference between Life support System and Palliative Care?
Life support System
Palliative Care System
What is it?
It aims to prolong life by artificially maintaining vital bodily functions.
It focuses on improving quality of life by relieving symptoms, pain, and distress, regardless of prognosis.
Treatment
It involves invasive medical interventions like ventilators, dialysis, and feeding tubes.
It emphasizes comfort-oriented, non-curative treatments to alleviate suffering.
Goals
To sustain life, even if it means prolonging the dying process.
To enhance quality of life and provide comfort, even if it means foregoing life-prolonging treatments.
Timing
Used in critical, end-stage illness when curative treatment is no longer possible.
Can be provided at any stage of a serious illness, even alongside curative treatments.
End-of-Life Practices: West vs. India
West Scenario: Advance directives for common, terminally ill allowed Natural Death by withdrawing life support.
Europe Scenario: Only 10.3% die on life support, others shifted to Palliative Care.
Indian Scenario:
70% of incurable patients die on life support in ICUs, alone.
The remaining 30% die through “Left Against Medical Advice” – ethically questionable. A survey in Pune showed 83% prefer to die at home.
What is the LAMA/DAMA Practice?
Left Against Medical Advice/Discharged Against Medical Advice (LAMA/DAMA) refers to a patient leaving the hospital against the advice and recommendation of their treating healthcare providers.
Its Causes: Financial constraints, Belief in alternative therapies, Dissatisfaction with care, Terminal/advanced illness, and Lack of understanding about the treatment process. It adversely affects patient outcomes, increasing the risk of mortality and the need for readmission.
The practice is considered ethically questionable, as it represents unplanned treatment limitations without a formal shift to palliative care.
Challenges in Indian Context:
ICU Routinisation:
Society has a mistaken belief in prolonging life at all costs and accepts ICU death as normal
In recent years, a lack of adherence to ethical principles and routinization of intensive care deaths has become more common.
Lack of Legal Clarity:
Lack of death literacy and inability to make informed decisions plays a major setback in Indian Society.
Further, the absence of a Legal Framework for End-of-life Care in India creates wider challenges for hospital staff and patients.
The term “Passive Euthanasia” isconsidered a misnomer by ICMR. Withholding or withdrawing life support in futility is not euthanasia but allowing natural death.
Initiatives taken on Palliative Care and Living Wills:
By WHO:
WHO defines health as “physical, social, and mental well-being” beyond just the absence of disease.
World Health Day (April 7) has passed and the theme for 2024 was “My health, my right”.
By India (through Judicial intervention):
SC in 2018 recognized passive euthanasia and the ‘Right to die with dignity’ as a fundamental right subject to guidelines.
India’s Supreme Court (three-member Bench) ruled that the ‘Right to Health’ includes the ‘Right to palliative care’.
SC verdict of 2023 recognizes advance medical directives and withdrawal of life support in futility cases.
Conclusion: The Lancet Commission Report 2022 speaks on the Value of Death and that modern society has become death-illiterate. Therefore, it is much required to bring awareness in our Indian Society on the value system of “dignified death”.
