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GS Paper: GS2-13.Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

  • India seeks inclusion of Traditional Medicine on WHO’s ICD List

    Central Idea

    • The Centre seeks to include traditional Indian medicines in the 11th revision of the World Health Organisation’s International Classification of Diseases (ICD).
    • The traditional Indian medicine system is categorized into Ayurveda, Siddha, Unani and Yoga, Naturopathy, and Homoeopathy

    About International Classification of Diseases (ICD)

    Purpose Standardized system for classifying and coding diseases, health conditions, and related information.
    Established 1893, by International Statistical Institute (WHO’s predecessor)
    Authority Developed and maintained by the World Health Organization (WHO).
    Scope Covers a wide range of diseases, health conditions, injuries, and health-related factors.
    Coding System Assigns unique alphanumeric codes to each health condition for consistent recording and reporting.
    Global Applicability Internationally recognized and used for health data collection, analysis, and reporting.
    Updates Periodically updated to reflect advances in medical knowledge and changing health trends.
    Latest Version ICD-11 became effective in January 2022.
    Uses Clinical diagnosis, health record documentation, research, health policy, and resource allocation.

    India’s quest to update ICD-11

    • Universal Language: The ICD provides a universal language that enables healthcare professionals worldwide to share standardized information.
    • Traditional Medicine Module: The 11th revision includes a module dedicated to traditional medicine conditions, offering a standardized way to collect and report data on these conditions internationally.
    • Formal Recognition: Ayurveda and related Indian traditional healthcare systems are formally recognized and widely practised in India, making a strong case for their inclusion.
    • Chinese Medicine Inclusion: After a decade of consultations, ICD-11 included Module-1, covering traditional medicine conditions originating in ancient China.

  • Shortage of Doctors in India

    What’s the news?

    • The demand for doctors exceeds the supply in large parts of India.

    Central idea

    • The demand for doctors in India consistently surpasses the available supply, while the pursuit of medical education often outstrips the number of seats available. Reducing this demand-supply gap in medical education has proven to be a challenging endeavor, with potential implications for the availability of healthcare professionals.

    Expanding Medical Education

    • Over the last decade, India has made significant strides in expanding medical colleges and seats at both undergraduate (UG) and postgraduate (PG) levels.
    • UG seats have nearly tripled, PG seats have almost quadrupled, and the number of medical colleges has doubled since 2010-11.
    • Despite this expansion, in 2021, India had only 4.1 medical graduates per lakh population, falling behind countries like China, Israel, the US, and the UK.

    Challenges in scaling

    • Regulatory and Financial Constraints: On average, Indian medical colleges offer 153 UG seats per college, significantly fewer than Eastern Europe (220) and China (930). This discrepancy is a result of regulatory and financial constraints.
    • Infrastructure Limitations: Expanding UG seats in a public medical college from 150 to 200 required additional resources, such as a larger library, increased daily outpatient department (OPD) footfalls, and more nursing staff, as per the draft guidelines for establishing new medical colleges in 2015.
    • Quality Maintenance: Concerns that disproportionate scaling can impact the quality of pedagogy and, subsequently, the quality of doctors produced
    • Faculty Shortages: Both public and private colleges face teaching faculty shortages, despite better remuneration structures in public colleges. Scaling up can further strain the already limited pool of qualified teaching staff.
    • Economic Viability for Private Colleges: Investing in scaling can be risky for private colleges if seats remain vacant and costs aren’t recovered. This can lead to high capitation fees and price distortions.
    • Curriculum Limitations: The nature of the competency-based curriculum dictates constraints on scalability. For example, there can’t be more than 15 students surrounding a bed or in any other practical class.
    • Equity Concerns: The goal of producing doctors evenly across regions might not result in efficient production. Migration of doctors from states with higher production can be an issue.

    Value addition box

    Innovations from the US

    • India’s competency-based curriculum is akin to that of the US, which has successfully scaled up the production of doctors by optimizing resource utilization.
    • Innovations, such as involving practicing MD doctors as mentors for medical students and integrating interprofessional education (IPE) into the curriculum, have enhanced the quality of education and reduced the faculty requirements.

    Quality vs. Scale vs. Equity: A triad of challenges

    • Quality:
    • Ensuring the highest standards of medical education, which translates into competent, skilled, and ethical practitioners.
    • The competency-based curriculum in India requires small-group teaching to ensure a thorough understanding and hands-on experience for students.
    • There’s a concern that rapid scaling could lead to a decline in the quality of education and subsequently the quality of doctors produced.
    • Quality assurance becomes even more critical given the life-and-death implications of medical practice.
    • Scale:
    • Increasing the number of medical graduates to meet the country’s healthcare needs.
    • Despite the expansion of UG and PG seats in medical colleges, the demand-supply gap persists.
    • Regulatory, infrastructural, and financial constraints pose significant challenges in scaling up.
    • Equity:
    • The National Medical Commission prioritizes an even distribution of medical colleges and seats. They aim for localized doctor production to ensure different regions have adequate healthcare.
    • Policies such as the cap on UG seats and the location restrictions of new colleges highlight this focus.
    • However, this might not lead to efficient doctor production due to phenomena like interstate migration of doctors.

    Way forward

    • Regulatory Reforms: Streamline regulations to facilitate the establishment and expansion of medical colleges while ensuring quality standards.
    • Faculty Development: Prioritize investment in faculty development programs to address shortages and retain experienced educators.
    • Technology Integration: Embrace technology to enhance scalability and access to medical education, including e-learning and telemedicine tools.
    • Competency-Based Curriculum: Continue to implement competency-based curricula to produce doctors with practical skills and real-world readiness.
    • Incentives for Rural Service: Develop and implement policies that incentivize medical graduates to serve in underserved rural areas, addressing healthcare disparities.
    • Public-Private Collaboration: Foster collaboration between public and private sectors to expand the availability of medical education seats and improve educational infrastructure.

    Conclusion

    • Bridging the gap between the demand for doctors and the supply of medical education is a multifaceted challenge in India. To meet the growing healthcare needs of the population, policymakers must carefully consider the trade-offs between quality, scale, and equity in medical education.

  • Abortion Rights in India: Legal Complexities and Ethical Dilemmas

    abortion

    Central Idea

    • CJI DY Chandrachud said that India’s abortion law was liberal, pro-choice and far ahead of other countries.
    • SC is hearing the case of a married woman who wants to medically terminate her 26-week pregnancy.
    • This raises critical questions about a woman’s autonomy in deciding to abort and the existing legislative framework.

    Woman’s Perspective

    • Unplanned Pregnancy: A 27-year-old married woman, already a mother of two, contends that her pregnancy was unplanned.
    • Financial Strain: She argues that her family’s income is inadequate to support another child, and she is undergoing treatment for postpartum depression after her second child’s birth.

    Court Decisions and AIIMS Report

    • Initial Approval: A two-judge Bench initially allowed the termination, reasoning that an unplanned pregnancy due to contraceptive failure is akin to a forced pregnancy, permitting abortion up to 24 weeks.
    • AIIMS Concern: AIIMS, Delhi, raised questions about whether foeticide (stopping the foetal heart) could be performed before termination since the foetus is currently viable.
    • Three-Judge Bench: The case was transferred to a three-judge Bench, led by Chief Justice of India (CJI) D Y Chandrachud, which called for a fresh medical report to assess the foetus’s health and the woman’s medical condition.

    Understanding the Abortion Law

    • Medical Termination of Pregnancy Act (MTP Act): The MTP Act allows termination of pregnancy in three stages.
      1. Termination up to 20 weeks with the advice of one doctor.
      2. Pregnancy at 20-24 weeks requires the opinion of two registered medical practitioners, under specific conditions.
      3. After 24 weeks, a medical board in approved facilities assesses the termination based on substantial foetal abnormalities.

    Court’s History of Allowing Late-Term Abortion

    • Several Precedents: The court has previously permitted terminations beyond 26 weeks in various cases, often in cases of rape or consensual relationships.
    • Marital Status Factor: The current case distinguishes itself by the woman’s marital status, implying that the conception is consensual and not a forced pregnancy.

    Balancing Rights: Woman vs. Unborn Child

    • Ongoing Debate: The CJI-led Bench oscillates between prioritizing a woman’s rights over abortion and the need to balance the rights of the unborn child.
    • Liberal Approach: India’s law on abortion is considered liberal and pro-choice, with courts often favouring the woman’s autonomy.

    Comparisons with International Standards

    • Foetal Viability: The concept of “foetal viability” as a benchmark for abortion approval is relatively new in India. It aligns with international standards.
    • US Roe v Wade: The landmark 1973 US Supreme Court case, Roe v Wade, allowed abortion until foetal viability. In 1973, viability was at 28 weeks, now lower due to scientific advancements.
    • Criticism of Indian Law: Some critics argue that India’s law lacks clarity as the decision to terminate after 20 weeks falls on doctors rather than the women, leading to frequent court interventions.

    Autonomy vs. Unborn Child’s Rights

    • Legislative Gap: While the Indian legal framework supports a woman’s autonomy in reproductive decisions, gaps persist, especially concerning last-minute interventions.
    • Ethical Debate: The Indian law leans toward women’s autonomy, but ethical dilemmas arise regarding the rights of the unborn child.
    • Legal Precedents: Cases like Nand Kishore Sharma versus Union of India have debated the constitutionality of the MTP Act concerning the right to life of an unborn child.

    Conclusion

    • The ongoing Supreme Court case highlights the intricate legal and ethical considerations surrounding abortion in India.
    • While the law supports a woman’s right to choose, the challenge lies in finding a delicate balance between individual autonomy and the rights of the unborn child.
    • As the court grapples with this complex case, it underscores the need for continued legal discourse and potential legislative amendments to address evolving reproductive rights issues.

  • India ranks 111/125 in Global Hunger Index, 2023

    Central Idea

    • India has been ranked 111th out of 125 countries in the Global Hunger Index-2023, a stark decline from its 107th position in 2022.
    • The index highlights a concerning statistic – India reports the world’s highest child wasting rate at a staggering 18.7 percent.
    • Interestingly, India’s neighboring countries, including Pakistan (102nd), Bangladesh (81st), Nepal (69th), and Sri Lanka (60th), have performed comparatively better in the index.

    Global Hunger Index (GHI)
    Publication Jointly published annually by Concern Worldwide and Welthungerhilfe.
    Scale Measures hunger on a 100-point scale, with 0 as the best (no hunger) and 100 as the worst score.
    Purpose Comprehensively measures and tracks hunger globally, regionally, and at the country level. Aims to trigger action to reduce hunger worldwide.
    Indicators 4 key indicators for each country:

    1. Undernourishment (reflects inadequate food availability): Share of the population that is undernourished.

    2. Child Wasting (reflects acute undernutrition): Share of children under five with low weight for their height.

    3. Child Stunting (reflects chronic undernutrition): Share of children under five with low height for their age.

    4. Child Mortality (reflects inadequate nutrition and unhealthy environment): Mortality rate of children under five.

     

    Hunger in India: Fact Check

    • Serious Hunger Levels: India’s score of 28.7 in the Global Hunger Index-2023 places it in the “serious” category, according to the report.
    • Child Wasting: India’s child wasting rate, the proportion of undernourished children measured by weight relative to their height, stands at an alarming 18.7 percent, signaling acute undernutrition.
    • Undernourishment Rate: The rate of undernourishment in India is reported at 16.6 percent, further highlighting the gravity of the issue.
    • Child Mortality: Under-five mortality in India is recorded at 3.1 percent.
    • Anemia Among Women: The report underscores a significant concern, with 58.1 percent of women aged 15 to 24 in India being affected by anemia.

    A report to bully India

    • Disputed Ranking: The Indian government has rejected the GHI 2023 ranking, citing serious methodological concerns and suggesting a malicious intent behind the report (considering elections).
    • Methodological Issues: The WCD Ministry asserts that the GHI 2023 report suffers from significant methodological issues. It contends that 3 out of 4 indicators used for calculation pertain to child health, which does not represent the entire population.
    • Sample size issue: It is questionable that only small sample size of 3,000 is used for the “Proportion of Undernourished Population” indicator for crores population in India.
    • Child Wasting Discrepancy: The ministry highlights a significant disparity between the child wasting rate as per the Poshan Tracker (consistently below 7.2 percent) and the 18.7 percent reported in GHI 2023.
    • Undue link with Child mortality: It also challenges the notion that child mortality is solely an outcome of hunger.

    Conclusion

    • India’s ranking underscores the persistent challenges in addressing hunger and undernutrition.
    • The report serves as a stark reminder of the critical need to comprehensively tackle these issues, especially child wasting and undernourishment, to ensure the well-being of the nation’s population.

  • Supreme Court’s divided on Abortion: A Complex Legal Dilemma

    Central Idea

    • A Division Bench of two judges of the Supreme Court grappled with divergent views regarding the abortion of a 26-week pregnancy and the government’s stance to protect the “unborn child.”
    • The judges, unable to reach a consensus, opted to refer the case to the CJI to convene a three-judge Bench for further deliberation.

    Woman’s Plight for Abortion

    • A mother of two with her youngest child just a one-year-old infant, she asserted her desire for a medically induced abortion due to her mental health condition and her inability to care for a third child.
    • Her lawyer stressed the court should prioritize the mother’s well-being.
    • He emphasized the threat to her privacy and dignity and her conscious decision to not proceed with the pregnancy.

    Government’s Stance

    • Legal Argument: The Additional Solicitor General contended that the woman did not possess an “absolute right of autonomy” to exercise her reproductive rights in a manner that would compromise the rights of the unborn child.
    • MTP Act of 2021: Reference was made to the Medical Termination of Pregnancy (Amendment) Act of 2021, which extended the abortion deadline to 24 weeks in “exceptional circumstances,” primarily to save the mother’s life or in the case of fatal foetal deformity.

    Legal Debate

    • Bodily Autonomy vs. Foetal Rights: The core of the debate centred on whether, once a viable baby exists, the woman’s right to bodily autonomy or integrity should yield to the Act, curbing her fundamental right to choose.
    • Court’s Earlier Decision: On October 9, the Bench had initially permitted the medical termination in line with the woman’s wishes, following a report from an All India Institute of Medical Sciences (AIIMS) medical board.

    Government’s Reversal

    • Government’s Appeal: Subsequently, the Union government filed an application, citing an expert doctor’s opinion received on October 10, which advocated for giving the child a chance to survive.
    • State’s Responsibility: The argument was that a categorical medical opinion had emerged, offering hope for the child’s survival, and placing a responsibility on the state.

    Judicial Opinions

    • Justice Kohli’s Stance: One judge aligned with the government’s position that the woman should not be allowed to terminate the pregnancy.
    • Justice Nagarathna’s Dissent: In contrast, the other judge dissented, asserting that the woman’s decision should be respected, considering her socio-economic circumstances, mental health, and the young age of her second child.

    Conclusion

    • The Supreme Court’s divided opinion on this intricate abortion case underscores the challenging balance between a woman’s right to make decisions about her body and the state’s interest in protecting the unborn.
    • As the case proceeds to a three-judge Bench, it raises broader questions about the legal and ethical complexities surrounding reproductive rights and foetal interests in India’s legal landscape.

  • Threat posed by cardiovascular diseases (CVD)

    What’s the news?

    • World Heart Day, observed globally on September 29, serves as a crucial reminder of the escalating threat posed by cardiovascular diseases (CVD) and the need to promote heart-healthy lifestyles.

    Central idea

    • World Heart Day, an annual event, initiated by the World Heart Federation in collaboration with the World Health Organization (WHO) in 2000, seeks to heighten awareness, engage communities, and advocate for universal access to CVD prevention, detection, and treatment. Tackling the silent epidemic of cardiovascular diseases in India demands a multi-pronged approach.

    Public Awareness Efforts on CVD

    • On World Heart Day, several English-language national dailies published full-page advertorials, which are advertisements designed to resemble written articles. These advertorials aimed to raise awareness about cardiovascular diseases (CVD) and promote heart-healthy lifestyles.
    • The content of these advertorials seemed to provide information about CVD rather than directly promoting a product.
    • Notably, there was limited involvement or a meaningful campaign by public health agencies like the Union Ministry of Health in raising awareness about CVD on this occasion.
    • These advertorials were sponsored by the diagnostics, devices, and pharmaceutical industries, indicating a partnership between these industries and media outlets for public awareness efforts.
    • Additionally, clinicians from high-end corporate tertiary care hospitals contributed by providing lifestyle modification advisories as part of the public awareness campaign

    Alarming Data on Hypertension

    • Data from the National Family Health Survey-5 (2019–2021) and the 2017-18 National NCD Monitoring Survey (NNMS) in India reveals concerning statistics about hypertension.
    • The NFHS-5 data shows that 18.3 percent of the country’s population has hypertension, while the NNMS reports a higher rate of 28.5 percent among individuals aged 18-69.
    • These percentages translate to significant numbers, given India’s large population.
    • Both surveys highlight low levels of awareness, treatment, and control of hypertension.

    Treatment Gaps and Disparities

    • The NNMS data indicates that only 28 percent of those with hypertension were aware of it.
    • Among those aware, 52 percent were receiving treatment, and a smaller percentage had their blood pressure under control.
    • Disparities exist based on factors such as education, income, and geographic location, with better access to healthcare services in south India.
    • Vulnerable groups, including males, illiterates, those with lower income, rural residents, smokers, and alcohol users, were less likely to be part of the treatment cascades.

    Efforts in India

    • India launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) in 2010, expanding its implementation.
    • The program primarily focuses on screening and treatment.
    • India is committed to the principles of primary healthcare and Universal Health Coverage (UHC), as outlined in the 2018 Astana Declaration.

    Challenges

    • Challenges include inadequate awareness, limited healthcare access in various regions, and disparities in healthcare access and outcomes. More resources are needed for primary healthcare.
    • Contemporary approaches to managing CVD heavily emphasize risk factors, particularly lifestyle-related ones like diet, physical activity, smoking, and obesity.
    • Epigenetic modifications may emerge as a consequence of a lifetime of disadvantage, structural inequalities, and discrimination, thereby influencing future generations.
    • There is a challenge in retaining rural health workers.

    The Need for a Holistic Approach

    • Contemporary approaches to managing cardiovascular diseases (CVD) emphasize lifestyle risk factors.
    • The WHO’s Commission on Social Determinants of Health highlights that these risk factors often result from systemic compromises rather than individual choices.
    • The Commission emphasizes addressing socioeconomic factors that affect health across an individual’s lifespan and calls for equity and social justice in healthcare.

    Conclusion

    • As the WHO rightly asserts, Reducing health inequities is… an ethical imperative. Social injustice is killing people on a grand scale. World Heart Day serves as a stark reminder that the battle against CVD must continue with renewed vigor and a holistic perspective.

  • We need evidence-based traditional medicine

    What’s the news?

    • The recent case where a manufacturer of indigenous drugs filed a lawsuit against a medical practitioner over a social media thread has ignited discussions in medical circles.

    Central idea

    • The recent case prompts us to explore the broader questions surrounding the role of traditional medicine in our modern world, the principles of evidence-based medicine, and the steps governments should take to ensure the health of their populations.

    The Evolution of Modern Medicine

    • Early Medical Practices: In ancient civilizations, various cultures developed their own medical systems, often rooted in traditions and observations. These practices formed the foundation upon which modern medicine would later build.
    • Scientific Renaissance: The Renaissance period in Europe marked a resurgence of interest in science and inquiry. This era laid the groundwork for the scientific approach that modern medicine would adopt.
    • 19th Century Advancements: The 19th century witnessed significant strides in medical science and technology. Innovations such as the microscope, anesthesia, and surgical techniques transformed medical practices.
    • Evidence-Based Medicine: Modern medicine became truly science-based in the late 19th century, when advances in technology allowed for a more accurate understanding of human physiology, health, and disease. The adoption of evidence-based approaches has become a hallmark of modern medical practice.
    • Technological Marvels: The 20th century saw unprecedented developments in medical technology, including the advent of diagnostic imaging, organ transplantation, and the establishment of pharmaceutical research. These advancements revolutionized patient care.
    • Global Collaboration: The latter half of the 20th century and the early 21st century have been characterized by increased global collaboration in healthcare. Medical knowledge, research, and innovations have transcended geographical boundaries, leading to improved healthcare outcomes worldwide.

    The Global Nature of Modern Medicine

    • Global Scientific Collaboration: Researchers worldwide work together to advance medical knowledge and develop innovative treatments.
    • Access to Innovations: Patients globally benefit from medical breakthroughs, ensuring wider access to cutting-edge treatments and technologies.
    • Healthcare Diplomacy: Many countries engage in healthcare diplomacy, offering aid and expertise to regions in need and fostering goodwill.
    • International Healthcare Workforce: Healthcare professionals from diverse backgrounds contribute their expertise globally, addressing healthcare disparities.
    • Cross-Cultural Integration: Modern medicine respects diverse healthcare approaches, integrating traditional medical systems and practices from different cultures.
    • Pandemic Response: The COVID-19 pandemic highlighted global health interconnectedness, emphasizing collaborative efforts in vaccine development, information sharing, and medical aid distribution.

    Traditional Medicine in the Modern World

    • Traditional medicine, which includes systems like Ayurveda, Unani, and Siddha, continues to coexist alongside modern medicine. These traditional systems have a long history and cultural significance. However, their place in the modern world is subject to several challenges:
    • Scientific Scrutiny: Traditional medicine often lacks the rigorous scientific validation that modern medicine adheres to. This can hinder its integration into the mainstream healthcare system.
    • Safety and Quality Control: Ensuring the safety and quality of traditional medicines can be a concern. Contaminants, inconsistent formulations, and a lack of standardized production processes can lead to safety issues.
    • Lack of Standardization: Traditional medicine formulations can vary widely from one source to another, making it difficult to assess their efficacy consistently.
    • Cultural and Ethical Considerations: Traditional medicine is deeply rooted in cultural and traditional beliefs. Balancing cultural practices with modern medical standards can be complex, as some treatments may hold cultural significance but lack scientific validation.
    • Education and Training: There is a need for comprehensive education and training programs to ensure that practitioners of traditional medicine are well-informed about modern medical standards and safety protocols.

    Challenges in Evaluating Ayurvedic Medicines

    • Complex Formulations: Ayurvedic medicines often consist of multiple herbs and ingredients, making it challenging to isolate and study the specific active components responsible for their effects.
    • Diverse Combinations: Ayurvedic formulations can vary widely in their combinations of herbs and minerals. Understanding how these components interact and their individual contributions to treatment can be complex.
    • Lack of Standardization: There is a lack of standardized protocols for the production and quality control of Ayurvedic medicines, affecting the consistency and safety of products.
    • Integration with Modern Science: Bridging the gap between traditional Ayurvedic knowledge and modern scientific methods is essential. Developing research methods that respect Ayurvedic principles while adhering to contemporary scientific standards is a challenge.

    The government’s role in promoting evidence-based medicine

    • Regulation and Oversight: Governments should establish regulatory bodies to oversee traditional medicine practices, ensuring they meet safety and quality standards. This includes setting guidelines for the manufacturing, labeling, and marketing of traditional medicines.
    • Research and Funding: New investigational methods and trial designs that can evaluate Ayurvedic therapies without undermining the classical basis of administering them must be worked out. The Ministry of AYUSH must facilitate this.
    • Public Awareness: Governments can educate the public about the benefits and limitations of traditional medicine, promoting informed choices when seeking healthcare.
    • Integration with Modern Healthcare: Promoting collaboration and integration between traditional and modern healthcare systems can provide patients with a more comprehensive range of treatment options.

    Way forward: Maintaining an Open Mind

    • Balanced Perspective: Maintain a balanced view when assessing traditional medicine alongside modern healthcare, considering both potential benefits and limitations.
    • Open-mindedness: Embrace open-mindedness in exploring traditional practices for potential insights, fostering an environment of curiosity and exploration.
    • Informal Verifications: Acknowledge the value of centuries of informal verifications in traditional medicine, recognizing that these practices have been refined through generations of use.
    • Cultural Significance: Traditional medical systems are often deeply intertwined with cultural heritage and beliefs. Respecting and acknowledging this cultural significance is essential when considering their place in modern healthcare.
    • Historical Insights: The reference to artemisinin, a Nobel-winning anti-malarial drug derived from a 1,600-year-old text of Traditional Chinese Medicine, underscores the potential for valuable discoveries when traditional knowledge is integrated with modern scientific methods.
    • Collaboration: Encourage collaboration between traditional practitioners and modern scientists, promoting dialogue and cooperation for the advancement of healthcare.
    • Evidence-based Approach: Subject traditional knowledge to rigorous scientific evaluation to ensure safety and efficacy, aligning with the principles of evidence-based medicine to validate its effectiveness.

    Conclusion

    • The coexistence of traditional and modern medicine systems is a testament to the diversity of human healthcare practices. It is crucial to embrace a nuanced approach that recognizes the strengths and limitations of each system, fostering an environment where science and tradition can collaborate for the betterment of public health.

    Also read:

    Homeopathy and associated issues

     

  • India’s Unemployment Rate Declines: PLFS 2022-2023

    Central Idea

    • The latest findings from the Periodic Labour Force Survey (PLFS), conducted by the National Sample Survey Office (NSSO), reveal a decrease in India’s unemployment rate for the period between April and June 2023.
    • This encouraging trend is accompanied by improvements in the Labour Force Participation Rate (LFPR) and the Worker-Population Ratio (WPR), signifying positive shifts in the country’s labor market.

    About Periodic Labour Force Survey (PLFS)

    Objective Collect comprehensive labor market data in India.
    Conducted by Ministry of Statistics and Programme Implementation (MoSPI), Government of India.
    Replacement for Replaced earlier employment-unemployment surveys by NSSO.
    Frequency Conducted periodically, with rounds typically spanning a year.
    First Round Conducted in July 2017-2018, marking the survey’s initiation.
    Data Categories Employment status, unemployment rate, sector-wise employment, income, demographics, and more.
    Sampling Methodology Sample survey approach with data collected from households and individuals through a scientific sampling process.
    Policy Impact Informs government policies related to employment, labor market interventions, and economic planning.

     

    2022-23 Survey Overview

    • Scope: The national survey compiled data from 5,639 first-stage sampling units (FSUs) and encompassed 1,67,916 individuals residing in 44,190 urban households.
    • Age Group: The survey focused on individuals aged 15 years and above.

    Improvements in Urban Labour Force Participation

    • LFPR Uptick: The LFPR in urban areas exhibited growth, rising from 47.5% in April-June 2022 to 48.8% in the corresponding months of 2023 for individuals aged 15 years and above.
    • Gender Disparities: While the LFPR remained stable at approximately 73.5% for males during this period, it notably increased for females, climbing from 20.9% to 23.2%.

    Enhanced Worker-Population Ratio

    • WPR Gains: In urban areas, the WPR increased from 43.9% in April-June 2022 to 45.5% during the same period in 2023 for individuals aged 15 years and above.
    • Gender-Specific Improvements: For males, the WPR progressed from 68.3% to 69.2%, and for females, it surged from 18.9% to 21.1% over this timeframe.

    Decrease in Unemployment Rate

    • Declining Unemployment: The PLFS reported a diminishing trend in the Unemployment Rate (UR) for individuals aged 15 years and above in urban areas.
    • UR in Urban Areas: It decreased from 7.6% in April-June 2022 to 6.6% in April-June 2023.
    • Gender-Based UR: For males, the UR dropped from 7.1% to 5.9%, while for females, it decreased from 9.5% to 9.1% during this period.

    Comparative Analysis

    • Positive Trends: The report highlights improvements in key labor market indicators in urban areas when compared to the pre-pandemic period (April-June 2018 to October-December 2019).
    • LFPR Improvement: The LFPR ranged from 46.2% to 47.8% during the pre-pandemic period and has now reached 48.8%.
    • WPR Enhancement: Pre-pandemic WPR figures ranged from 41.8% to 44.1%, while the current WPR stands at 45.5%.
    • Lower UR: Unemployment rates during the pre-pandemic period fluctuated between 7.8% and 9.7%, with the latest survey reporting a lower UR of 6.6%. This rate is deemed favorable compared to the unemployment rates observed in the quarters preceding the pandemic.

    Conclusion

    • The Periodic Labour Force Survey (PLFS) results reflect positive developments in India’s labor market, marked by a decreasing unemployment rate, improved labor force participation, and enhanced worker-population ratios.
    • These trends indicate a resilient labor market recovery and may signify the nation’s progress towards economic stability and job creation.

    Back2Basics:

    • Labour Force Participation Rate (LFPR): LFPR is defined as the percentage of persons in labour force (i.e. working or seeking or available for work)in the population.
    • Worker Population Ratio (WPR): WPR is defined as the percentage of employed persons in the population.
    • Unemployment Rate (UR): UR is defined as the percentage of persons unemployed among the persons in the labour force.
    • Activity Status- Usual Status: The activity status of a person is determined on the basis of the activities pursued by the person during the specified reference period. When the activity status is determined on the basis of the reference period of last 365 days preceding the date of survey, it is known as the usual activity status of the person.
    • Activity Status- Current Weekly Status (CWS): The activity status determined on the basis of a reference period of last 7 days preceding the date of survey is known as the current weekly status (CWS) of the person.

  • Mental health and the floundering informal worker

    What’s the news?

    • World Mental Health Day, observed on October 10, underscores the theme of ‘mental health as a universal human right.’

    Central idea

    • While the World Mental Health Day theme highlights the importance of mental health for all, it’s crucial to address the often-overlooked mental health challenges of India’s informal workers. This necessitates proactive policies aligning with the Sustainable Development Goals (SDGs).

    The Global Perspective

    • According to the International Labour Organization (ILO), approximately 15% of working-age adults globally live with a mental disorder.
    • Decent work can positively influence mental health, but unemployment, unstable employment, workplace discrimination, and unsafe working environments pose significant risks to mental health.
    • Informal workers, particularly those in low-paid and precarious jobs, often face psychosocial risks that compromise their mental well-being.

    India’s Informal Workforce

    • India’s informal workforce constitutes over 90% of the total working population. These workers endure unsafe conditions, work long hours, and have limited access to social and financial protections.
    • Discrimination and gender disparities are prevalent, with over 95% of working women engaged in informal, low-paying, and precarious employment.
    • The mental health of informal workers is further undermined by patriarchal structures and practices in their social and familial spaces.

    Challenges faced by the informal workforce in India

    • Lack of Formal Protections: Informal workers often lack legal and social protections. They work without employment contracts, job security, or access to benefits like health insurance and paid leave.
    • Unsafe Working Conditions: Many informal workers labor in hazardous environments, increasing their risk of occupational health and safety issues.
    • Long Working Hours: Informal workers frequently work long hours, often without clear boundaries between work and personal life, affecting their physical and mental well-being.
    • Limited Access to Social Protections: These workers have limited access to social safety nets, making them vulnerable to economic shocks such as illness or job loss.
    • Gender Disparities: Gender disparities are pronounced in the informal sector, with many women engaged in low-paying and precarious employment. Discrimination and patriarchal structures exacerbate these challenges.
    • Precarious Employment: Informal work is characterized by its precarious nature, including irregular income, job insecurity, and uncertainty about future employment.
    • Income Inequality: Informal workers often earn lower wages than their formal sector counterparts, contributing to income inequality.

    Youth and Unemployment

    • Youth unemployment is a pressing issue in India, significantly affecting mental health.
    • Many young workers are forced into precarious and informal work due to desperation, accepting lower pay and poorer working conditions.
    • Unemployment rates are particularly high among educated young women, reaching 42%.
    • Given India’s demographic dividend, it is crucial to prioritize employment quality and long-term social security for this population.

    Aging Workforce and Vulnerability

    • India is expected to become an aging society in two decades, yet there is no clear social security plan for this growing demographic group.
    • The Census of India 2011 reveals that 33 million elderly individuals continue working in informal sectors post-retirement.
    • This vulnerable group lacks financial and health-care security, which can severely impact their physical and mental health.

    Social Security and Mental Health

    • Informal workers face mental distress due to accumulating debt and rising health-care costs: Informal workers often experience financial strain due to their precarious employment, leading to the accumulation of debt and increased healthcare expenses.
    • Interconnectedness of Economic and Mental Health Factors: Mental health and well-being are interconnected with factors such as food security, access to livelihoods, and financial stability. These factors play a significant role in determining the mental health of informal workers.
    • Post-COVID-19 Recovery Challenges: A study conducted among informal workers in Delhi, primarily migrants, reveals that the recovery post-COVID-19 remains uneven among different cohorts of informal workers. Many still report food insecurity, skipped meals, or reduced consumption, which can have detrimental effects on their mental health.
    • Impact of Government Schemes: While some social security schemes have received increased funding, others, like the MNREGS, have seen reductions in funding. Adequate funding of employment guarantee programs can positively impact the mental health outcomes of informal workers.
    • High Suicide Rates Among Daily Wage Earners: The National Crime Records Bureau (NCRB) reported that in 2021, 26% of people who died by suicide were daily wage earners. This statistic highlights the mental health challenges faced by this group and the need for better support and social security measures.
    • Types of Social Security Measures: Social security measures can take various forms, including:
      1. Promotional: Aimed at augmenting income.
      2. Preventive: Intended to forestall economic distress.
      3. Protective: Designed to ensure relief from external shocks.
    • The Code on Social Security 2020: It is necessary to revisit the Code on Social Security 2020, highlighting that it doesn’t explicitly state the goal of universalizing social security in India, particularly for informal workers.

    Way Forward: Improving Mental Health Care

    • Low Budgetary Allocation for Mental Health: India’s budgetary allocation for mental health currently stands at less than 1% of the total health budget. This allocation has predominantly focused on digital mental health programs.
    • Importance of Community-Based Care: The World Mental Health Report 2022 emphasizes the need to strengthen community-based care as part of a comprehensive mental health approach.
    • Human Rights-Oriented Care: To address mental health effectively, it is important to provide people-centered, recovery-oriented, and human rights-oriented care.
    • Urgent Need for Proactive Policies: There is a pressing need for proactive policies that not only recognize the importance of mental health but also take concrete actions to improve mental health care in India.
    • Basic Human Right to Good Health: Mental health is a basic human right, and it emphasizes the need to uphold this right by providing access to quality mental health care.

    Alignment with Sustainable Development Goals (SDGs)

    • SDG 3: Good Health and Well-Being: Improving mental health care aligns with SDG 3, which aims to ensure good health and well-being for all.
    • SDG 8: Decent Work for All/Economic Growth: Addressing mental health issues among informal workers is crucial for advancing SDG 8, which focuses on decent work for all and economic growth.

    Conclusion

    • Proactive policies and comprehensive social security measures can uplift the mental well-being of this marginalized group, promoting a society where mental health is indeed a universal human right. Achieving this goal will contribute to the realization of the Sustainable Development Goals and ensure a healthier, more equitable future for all.

  • Ageing World: Addressing Mental Health Challenges in the Elderly

    Elderly

    Central Idea

    • The world’s elderly population is larger than ever before, with 1.1 billion people aged 60 and above in 2022, constituting 13.9% of the population (UNFPA report).
    • By 2050, this number is projected to rise to 2.1 billion, accounting for 22% of the global population.

    Why discuss this?

    • India’s Scenario: India is no exception to this trend, with 149 million older adults (10.5%) in 2022, expected to increase to 347 million (20.8%) by 2050.
    • Longevity: People are living longer lives than ever before, underscoring the need to understand healthy ageing and address mental health issues in the elderly.

    Misconceptions about Ageing and Mental Health

    • Ageing as a Process: Ageing is a natural physiological process encompassing physical, social, and psychological dimensions. However, misconceptions and fears about ageing, particularly mental health concerns like depression, anxiety, and dementia, persist.
    • Heterogeneity: The ageing process varies among individuals, influenced by factors such as genetics, lifestyle, environment, and diseases. Not all older adults experience the same physical or mental changes.

    Social Challenges Faced by the Elderly

    • Social Isolation and Dependency: Many elderly individuals grapple with increased dependency, social isolation, poverty, ageism, and feelings of pessimism and nihilism.
    • Abuse and Neglect: Elderly individuals are vulnerable to emotional, physical, sexual, and financial abuse, often perpetrated by family members.
    • Inaccessible Infrastructure: India’s towns and cities often lack elder-friendly infrastructure, including ramps, handrails, pavements, and adequate public transport, making healthcare access a challenge.
    • Lack of Purpose: Many elderly men, especially after retirement, may feel unproductive and lost. Developing diverse interests earlier in life can mitigate the sense of purposelessness in retirement, reducing the risk of depression.

    Psychological Aspects of Ageing

    • Psychological Growth: As individuals age, they are expected to gain wisdom and a broader understanding of life’s challenges through personal or vicarious experiences.
    • Erik Erikson’s Theory: Erik Erikson proposed ‘Ego integrity versus Despair’ as the final psychosocial development stage in human life. It emphasizes viewing one’s life accomplishments positively to avoid despair.
    • Indian Cultural Emphasis: Indian culture underscores the importance of accepting the limitations that come with old age and renouncing responsibilities without suffering.

    Mental Health Challenges

    • Prevalence: Approximately 15% of elders in India (22 million individuals) experience serious mental illnesses such as depression, anxiety, dementia, and substance use disorders.
    • Treatment Gap: A significant treatment gap of 90% exists, largely due to a lack of awareness among the public and healthcare professionals.
    • Stigmatization: Stigma associated with both ageing and mental illness often leads to reluctance to admit mental health issues and seek treatment.
    • Poverty and Access: Many elderly individuals lack access to mental healthcare services due to poverty and limited availability of interventions, particularly in rural areas.

    Case Study: SCARF Partnership

    • Community Initiatives: The Schizophrenia Research Foundation (SCARF) has partnered with the Azim Premji Foundation to raise awareness about elder mental health in rural areas of Tamil Nadu, benefiting over 350 villages.
    • Indian Tradition of Joint Families: While joint families are becoming rarer, they offer advantages in terms of multi-generational interactions and support for elders.

    Preserving Cultural Traditions

    • Importance of Festivals and Rituals: Cultural traditions, including festivals and rituals, encourage socialization and cognitive engagement among elders.
    • Risk of Tradition Loss: Neglecting these traditions risks losing their potential protective effects on elderly mental health.

    Way forward

    • Individual Planning: Planning for old age with financial savings and lifestyle adjustments is crucial.
    • Educational Initiatives: Introducing the concept of healthy ageing in school curricula can promote awareness.
    • Community Services: Accessible mental health services for elders should be available at the community level.
    • Role of Retirement Homes: Retirement homes and elder care facilities, while providing care and reducing social isolation, need to address mental health issues urgently.
    • Collective Responsibility: Caring for the elderly is a collective responsibility that requires the concerted efforts of individuals, families, civic society, private organizations, NGOs, and the government.

    Conclusion

    • The ageing world presents both opportunities and challenges, with a growing elderly population that demands a holistic approach to mental health care, community support, and cultural preservation.
    • Addressing the mental health needs of the elderly is not only a matter of compassion but also a responsibility that encompasses various stakeholders and sectors of society.