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GS Paper: GS2

  • India and the ‘managed care’ promise

    PYQ Relevance

    Q Public health system has limitations in providing universal health coverage. Do you think that the private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)

    Q 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? (UPSC IAS/2022)

    Mentor Comment: Health insurance, now central to India’s UHC policy, is being enhanced by digital advancements, enabling reforms akin to the U.S. but with cost-effective local adaptations. A South Indian healthcare chain recently integrated insurance and care provision, forming an Indian-style MCO. This prompts reflection on MCOs’ potential to extend universal health care in India significantly.

    Let’s learn_ _ 

    Why in the news?

    Universal healthcare poses a multifaceted challenge, yet managed care organizations may offer a piece of the solution that Indian healthcare requires.

    What is a Managed Care Organization?

    • A Managed Care Organization (MCO) is a health care company or a health plan that is focused on managed care as a model to limit costs, while keeping quality of care high.

    The background of Managed Care Organizations (MCOs) in the United States and India:

    Evolution of MCOs in the United States:

    •  MCOs have their origins in rudimentary prepaid healthcare practices in the 20th century.
    • The mainstreaming of MCOs gained momentum in the 1970s due to concerns over healthcare costs.The economic slowdown post-1970s made high insurance premiums less attractive to purchasers.
    • A shift occurred towards integrating insurance and healthcare provisioning functions. Focus areas included prevention, early management, and cost control, all under a fixed premium paid by enrollees.
    • MCOs have evolved through multiple generations and forms, deeply penetrating the health insurance market. While evidence of their effectiveness in improving health outcomes and prioritizing preventive care is mixed, they have been effective in reducing costly hospitalizations and associated costs.

    Evolution of MCOs in India:

    • The first public commercial health insurance emerged in the 1980s.The focus has primarily been on indemnity insurance and covering hospitalization costs.
    • There is a significant market for outpatient consultations, valued at nearly $26 billion.
    • Health insurance in India has traditionally lagged behind life and general insurance. The sector faces issues such as lack of innovation and high, often unsustainable, operational costs.
    • As per Thomas (2011), Health insurance has played a secondary role to other forms of insurance. The industry’s operational inefficiencies and high costs have been persistent issues.

    Challenges in India:

    • Lack of Natural Incentives for Cost Control: The evolutionary trajectory of Indian health insurance has not incentivized consumer-driven cost control.
    • Target Demographic: Health insurance has mainly targeted a thin, urban, well-off segment, neglecting broader demographics.
    • Informality in Outpatient Practices: There is widespread informality among outpatient practices, complicating efforts to standardize and regulate care.
    • Lack of Clinical Protocols: The absence of widely accepted clinical protocols hampers the quality and consistency of care.
    • Economic Viability: Unprofitable operations and unaffordable premiums pose significant economic challenges, preventing sustainable growth and systemic improvement.
    • Limited Impact on UHC: Private initiatives, despite their potential, are unlikely to significantly contribute to Universal Health Coverage (UHC) without public support.
    • Insufficient Control Over Patient Journeys: Health insurers have little control over the patient’s journey before hospitalization, limiting their ability to manage early interventions and reduce costs through comprehensive outpatient care.

    Prospective Solutions and Remaining Issues:

    • Potential for Big Healthcare Brands: Large healthcare brands with loyal urban patient bases and substantial resources may initiate successful managed care projects.
    • Need for Public Patronage: Exploring managed care with cautious and incremental public patronage could be promising, indicating a need for government involvement to achieve broader impacts.
    • Underutilization of Outpatient Insurance: Given the low share of insurance in outpatient care spending and the average of three consultations per year per person, there is significant potential to reduce healthcare costs through early interventions and comprehensive outpatient care coverage.

     NITI Aayog Report:

    • Outpatient care insurance scheme: In 2021, NITI Aayog released a report advocating for an outpatient care insurance scheme based on a subscription model to enhance savings through improved care integration.
    • Yield significant benefits: A well-functioning managed care system can yield significant benefits, including consolidating practices, streamlining management protocols, and emphasizing preventive care in the private sector.
    • Catering for the beneficiaries of PMJAY: The report highlights the potential of incentives under the Ayushman Bharat Mission to encourage the establishment of hospitals in underserved areas catering to beneficiaries of the Pradhan Mantri Jan Arogya Yojana (PMJAY).

    Conclusion: While Managed Care Organizations are not a perfect solution, they can play a role in addressing the complexities of achieving Universal Health Coverage (UHC) in India by being part of a broader strategy.

  • Does inequality lead to growth? | Explained

    Why in the news?

    Studies conducted by researchers from “the Paris School of Economics” indicate that inequality in contemporary India surpasses that of colonial times.

    How does Inequality harm Democratic processes?

    • Concentration of Power: Inequality can lead to the concentration of monopoly power among a few capitalists relative to the labor force. This concentration allows dominant business groups to set prices, resulting in lower real wages and reduced purchasing power for the majority.
    • Impact on Consumption and Welfare: High inequality can negatively impact consumption and welfare due to higher mark-ups and lower real wages.
      • Lower real wages mean that workers can afford fewer goods, which reduces overall consumption and welfare.
    • Effect on Democratic Processes: Economic inequality can translate into unequal political power, undermining democratic processes.
      • Those with significant wealth can have disproportionate influence over political decisions, policies, and elections, leading to governance that favours the wealthy over the general populace.

    How Redistribution and Growth Can Work Together

    • Wealth Taxes and Redistribution: Taxing wealth and redistributing it can enhance economic growth by increasing incomes and consumption among the lower and middle classes, who have a higher propensity to consume.
    • Multiplier Effect: Redistribution can strengthen the multiplier effect, where an initial increase in investment leads to a greater overall increase in income and consumption. Higher incomes among workers and goods-sellers lead to more purchases, driving further economic activity and growth.
    • Investment and Profit Expectations: Investment is driven by future profit expectations rather than past wealth. Therefore, taxing wealth does not necessarily reduce investment.
    • Creation of New Entrepreneurs: Redistribution can support the emergence of new entrepreneurs by providing financial resources and reducing dependence on wage employment. This can foster innovation and competition, further contributing to economic growth.
    • Curtailing Monopolies: Reducing monopolistic power through redistribution and other policy measures can lower prices and increase real wages. Higher real wages boost demand, leading to increased investment and economic expansion.

    Conclusion:  Addressing inequality through redistribution can promote inclusive growth, empowering marginalized communities and advancing progress towards a more equitable society, essential for fulfilling SDG Goal 10 (Reduced Inequalities).

     

    Mains PYQ:

    Q How did land reforms in some parts of the country help to improve the socio-economic conditions of marginal and small farmers? (UPSC IAS/2021)

  • [3 June 2024] The Hindu Op-ed: The message from the Andhra Pradesh bifurcation

    [3 June 2024] The Hindu Op-ed: The message from the Andhra Pradesh bifurcation

    PYQ Relevance:

    Mains: 
    Q) The political and administrative reorganization of states and territories has been a continuous ongoing process since the mid-nineteenth century. Discuss with examples. (UPSC CSE 2022)
    Q) In the context of the diversity of India, can it be said that the regions form cultural units rather than the states? Give reasons with examples for your viewpoint. (UPSC CSE 2017)

    Note4Students: 

    Prelims: State Reorganization Acts; 

    Mains: Governance Issues; Regional Disparities; State Reorganization; 

    Mentor comment: In India, the phenomenon of ‘Regional Disparity’ has been a persistent challenge since independence, with some regions experiencing rapid growth while others lag. These disparities manifest in various forms, such as differences in culture and language, per capita income, access to infrastructure development. The same case evolved in 1956 in the form of ‘state reorganization’ on the linguistic lines. Andhra Pradesh was the first state in India after independence to be formed on a linguistic basis. However, after 2014 bifurcation of Andhra Pradesh into – Andhra Pradesh and Telangana created new governance and political doubts in the minds of policy makers. The question is now whether the organization of states should be on a linguistic basis or an administrative basis.

    The bifurcation of Andhra Pradesh which took during 2014 has led to a significant decline in nostalgia (the pain from an old wound) for the shared history of the two regions. People from both sides are now moving on, with little emotional attachment to their past unity.

    Let’s learn.

    –

    Why in the News?

    On June 2, 2024, 10 years will be completed for the bifurcation of Andhra Pradesh and Telangana. At the 10th year, Hyderabad ceases to be the common capital of Andhra Pradesh and Telangana.

    • However, several critical issues related to various corporations and common institutions between residuary Andhra Pradesh and the new state of Telangana still need to be solved.

    About the AP Reorganization Act of 2014:

    • The Andhra Pradesh Reorganisation Bill, 2014 was introduced in Lok Sabha on February 13, 2014, by the Minister for Home Affairs, Mr. Sushil Kumar Shinde.
    • The Bill also proposes consequential amendments to The Representation of the People Act, 1950, the Delimitation of Parliamentary and Assembly Constituencies Order, 2008, and the First and Fourth schedule of the Constitution of India.
    What were the provisions led under the APR Act, of 2014?

    Formation of Telangana: The Bill carves out a separate state called ‘Telangana’ comprising 10 districts of the existing state of ‘Andhra Pradesh’.
    Andhra Pradesh and Telangana will have a common capital, Hyderabad, for 10 years.  After this period, Hyderabad shall be the capital of Telangana only. 

    Role of Governor: The Governor of the existing state of Andhra Pradesh shall be the common Governor for both states for a period determined by the President.  
    As part of the administration, he shall be responsible for (i) security of life, liberty, and property, (ii) law and order, (iii) internal security, (iv) security of vital installations, and (v) management and allocation of government buildings.

    Representation in Parliament: After the bifurcation, Andhra Pradesh will have 11 seats in Rajya Sabha, and Telangana will have 7.  In Lok Sabha, Andhra Pradesh will have 25 seats and Telangana will have 17 seats.

    Representation in the Legislative Assembly and Council: 
    The total number of seats in the Legislative Assembly for Andhra Pradesh will be 175, and for Telangana will be 119.  
    Further, the Governor may nominate one member each, from the
    Anglo-Indian community to the LAs of the successor states.  The Legislative Council (L.C.) of Andhra Pradesh will have a maximum of 50 members, and Telangana, 40 members.

    High Court: The High Court at Hyderabad shall be the common High Court for the successor states for some time.  Following this, it shall become the High Court for the state of Telangana, and Andhra Pradesh shall get a new High Court. 

    Revenue Distribution: The resources allocated by the 13th Finance Commission to the existing state of Andhra Pradesh will be apportioned between the two successor states based on population ratio and other parameters.  

    Treasury and bank balances: The cash and credit balances of the existing state of Andhra Pradesh will be divided between the two successor states based on population ratio by adjusting the credit balances of the two states in the books of the Reserve Bank of India.

    Polavaram Irrigation Project: The central government will execute the irrigation project in consultation with the governments of Andhra Pradesh and Telangana.

    Centre’s assistance for police forces: The central government will assist the two successor states in raising additional police forces.  
    The Greyhound and OCTOPUS forces of the existing state of Andhra Pradesh shall be re-distributed between the two successor states.  

    The Message from the Andhra Pradesh Bifurcation:

    • Regional Economic Disparities (Economic): The economic disparities between the two regions have not been bridged, with Telangana outperforming Andhra Pradesh in terms of per capita GSDP. This gap has remained relatively constant over the years.
      • Urban centers and their surrounding districts are contributing a larger chunk of state revenues, while the agricultural-based regions’ share is negligible.
      • However, the GCRs (Gini Coefficient Ratio) decreased in sectoral district domestic production for all three sectors (Agriculture, industry, and services). The Gini coefficient is often used to measure income inequality.
    • Question on Regional Fault Lines (Administrative): The bifurcation of Andhra Pradesh has exposed regional fault lines, including political, historical, and lifestyle differences.
      • The two regions were under different political authorities for 150 years. During the late medievals, the Nizam gave away the ‘coastal’ and the ‘ceded’ districts (Rayalaseema district) to the European powers. 
      • They were ruled from Golconda and Hyderabad for a long time. However, after the independence, they were together after 1956 (the creation of the first state on a linguistic basis).
      • Such parting of ways has not yet happened with the Kannada-speaking area of the Nizam’s Hyderabad State, nor did it happen as yet with its Marathi-speaking area. 
      • Therefore, the question arises, of unity based on language being frailer compared to those of the shared visions of Kannada and Marathi elites.

    Challenges around the Federal and Future Scope:

    • Future of Centre-State Relations: The distribution of political power in the central legislature could become a point of friction among states, particularly if there are changes in delimitation that favor certain regions.
      • Andhra Pradesh had 42 Lok Sabha seats and was the largest State in south India. But now, with a mere 25 seats, it is smaller than Tamil Nadu which has 39 seats, and Karnataka which has 28 seats. Telangana, with 17 seats, is smaller than Kerala, thus becoming fifth in the pecking order in the south. 
      • In our federal structure, numbers do matter but grossly unequal sizes among the units can render some regions irrelevant and others more relevant in deciding who holds power at the Centre. This may result in undesirable strains in the federal structure of our Republic.
    • Future of Linguistic States: Andhra Pradesh, in its first five years after the division, got bogged down in its attempt to build for itself as a ‘world-class’ capital, that would overcome the loss of Hyderabad. The next five years were consumed by profligate Direct Benefit Transfer (DBT) welfarism.
      • Therefore, the Indian Republic may need to look for alternative organizing principles, such as size or population.

    Conclusion: The government needs to underscore the importance of federalism in addressing regional disparities and promoting more inclusive governance. The experience of Andhra Pradesh bifurcation offers valuable lessons for policymakers, highlighting the need to address regional disparities and adapt governance structures to changing regional dynamics.

    https://www.thehindu.com/opinion/lead/the-message-from-the-andhra-pradesh-bifurcation/article68243934.ece

    https://oar.icrisat.org/6224/1/Local_Economy_1-13_2012.pdf

    https://prsindia.org/billtrack/the-andhra-pradesh-reorganisation-bill-2014-telangana

  • Andhra’s Koya tribe faces brewing conflict over sacred Mahua flower

    Why in the news?

    The Koya tribe in Andhra Pradesh is facing a cultural crisis due to stricter liquor regulations enforced by the Special Enforcement Bureau (SEB).

    About Koya tribe 

    • Koya are one of the few multi-racial and multi-lingual tribal communities in India.
    • They live in the forests, plains, and valleys on both sides of the Godavari River which lies in Andhra Pradesh. Many also live in the states of Madhya Pradesh and Orissa.
    • They believe their main deity still resides in a cave in the Bastar region.

    Cultural Crisis (Disruption of Traditions):

    • Mahua liquor is brewed from the flowers of the Mahua tree which is integral to Koya cultural and religious ceremonies including naming ceremonies, weddings, and death anniversaries.
    • Police raids and seizures of Mahua liquor disrupt these traditions causing cultural shocks within the community. For example, recently the naming ceremony of Madakam Janakamma’s child was held without Mahua liquor due to SEB raids.

    Tribal Rights (Legal Challenges and Rights):

    • The Andhra Pradesh Prohibition Act, 1995, does not exempt the Koya tribe from brewing and storing Mahua liquor, despite its cultural significance.
    • The Panchayat (Extension to Scheduled Areas) Act (PESA), 1996 empowers the gram sabha to protect tribal traditions and culture but its implementation is questionable as SEB raids continue unabated.
    • Koya villagers are often coerced into paying bribes to avoid legal charges, highlighting the tension between law enforcement and tribal rights.

    Impact on Collection(Economic Consequences):

    • Many Koya households have ceased Mahua flower collection due to fear of police raids, significantly affecting their primary source of income.
    • Destruction of freshly collected flowers during raids further disincentivizes collection, reducing the supply of Mahua flowers to weekly markets (shandies) where they are exchanged for essential goods.

    Guardians of Culture (Preservation of Heritage):

    • The Koya tribe, especially those not displaced by the Polavaram irrigation project, are seen as custodians of their culture. However, displacement and integration with non-tribal communities threaten their cultural identity.
    • Local leaders and activists argue for the need to empower Koya women with training in producing value-added products from Mahua flowers, rather than undermining their traditional practices and economic activities.

    Legal and Policy Measures

    • Amend the Andhra Pradesh Prohibition Act, 1995: Introduce exemptions or special provisions that recognize and protect the traditional brewing and usage of Mahua liquor for cultural and religious purposes by the Koya tribe.
    • Strengthen Implementation of PESA Act: Ensure that the Panchayat (Extension to Scheduled Areas) Act (PESA), 1996, is fully implemented. Empower Gram Sabhas to have a greater say in protecting tribal traditions, including the brewing of Mahua liquor.

    Conclusion: The enforcement actions by the SEB, while aimed at regulating liquor, pose a significant threat to the Koya tribe’s cultural heritage and economic well-being. Balancing legal regulations with respect for tribal traditions and rights is crucial to preserving the Koya way of life.

    Mains PYQ:

    Q What are the two major legal initiatives by state since Independence, addressing discrimination against Scheduled Tribes (ST) ? (UPSC IAS/2017)

  • 38% Indians consume fried snacks and processed foods, only 28% consume healthy food

    Why in the news?

    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 “the International 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)

  • NIMHANS bags WHO’s Nelson Mandela Award for Health Promotion for 2024

    Why in the News?

    • 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.

  • Blaming court vacation for pendency misses the real problem

    Why in the news?

    A casual remark from a member of the Prime Minister’s Economic Advisory Council has reignited the debate on judges’ working hours and vacations.

    Reports on Case Pendencies:

    According to the “India Justice Report”, as of June 2020, cases remain pending for an average of three years in subordinate courts and five years in high courts, highlighting the extensive backlog.

    Issues of unfilled vacancies and lack of infrastructure/ Present challenges:

    • Overburdened Judiciary: Judges and courts are overburdened with excessive government litigation, new legislation adding to the workload, and the rising tide of litigation across various domains.
    • Infrastructure Deficits: Shortages in courtrooms and support staff, with national averages showing a 26% deficit in support staff. Insufficient infrastructure hampers the smooth processing of cases.
    • Quality Deficits: Uneven proficiency in language and legal knowledge among lawyers and judges contribute to procedural delays and suboptimal outcomes. Lengthy pleadings, paper books, and judgments further exacerbate the problem.
    • Vacancy Crisis: Many courts, including high courts and lower courts, face a significant shortage of judges, with vacancies averaging around 30% in high courts and 22% in subordinate courts. Some states, like Bihar and Meghalaya, have vacancies exceeding 30% for over three years.
      • Lack of administrative support and outdated procedures impede the efficient management of cases and court operations.

    What can be done?

    • Address Vacancies: Expedite the appointment process for vacant judicial positions and strive to achieve full complement in courts to alleviate workload pressures.
      • Set higher standards for judicial appointments and legal practice to ensure competence and proficiency among legal professionals.
      • Establish Permanent Administrative Secretariats (PAS) led by qualified court managers to assist judges in case management and administrative tasks.
    • Invest in Infrastructure: Build more courtrooms, hire additional support staff, and invest in technology to streamline court processes and enhance efficiency.
      • Allocate adequate resources to the judiciary to improve infrastructure, enhance administrative capabilities, and ramp up efficiency in justice delivery.
    • Prioritize Judicial Reform: Undertake comprehensive judicial reforms to address systemic issues, streamline processes, and enhance access to justice for all citizens.
      • Implement specialized courts, pre-trial mediation, and other alternative dispute resolution mechanisms to expedite case resolution and reduce backlog.

    Mains PYQ:

    Q Critically examine the Supreme Court’s judgement on ‘National Judicial Appointments Commission Act, 2014’ with reference to appointment of judges of higher judiciary in India. (UPSC IAS/2017)

  • The Tobacco Epidemic in India

    Why in the News?

    Tobacco is a leading preventable cause of disease which affects nearly 26 crore Indians and 60 lakh industry workers, posing significant health risks.

    Reports on Tobacco Consumption in India

    • According to the Global Adult Tobacco Survey (GATS), there is a general decline in tobacco use, except for an increase in women between 2015-2016 and 2019-2021. (above 15 years)
    • According to the Global Youth Tobacco Survey (GYTS), tobacco use among students aged 13-15 years indicates a reduction in tobacco use in this demographic.
    • The National Family Health Survey (NFHS), which captures data on tobacco use in people above 15 years of age, aligns with the GATS findings, showing a decrease in tobacco use except among women.

    What is the WHO Framework Convention on Tobacco Control (FCTC)?

    • The WHO Framework Convention on Tobacco Control (FCTC) is an international treaty adopted by the World Health Organization (WHO) in 2003. It is a legally binding treaty.
    • It means that countries that have ratified it are obligated to implement the measures outlined in the convention within their national jurisdictions.
    • It addresses the global health risks associated with tobacco use and provides a comprehensive framework for governments and organizations to implement effective tobacco control policies and strategies.

    Challenges in India: Lobbying by the Tobacco Industry

    • The tobacco industry exerts substantial influence on policy-making to maintain low tax rates and evade stricter regulations.
    • Government Engagement: Both in-service and retired government officials often engage with the tobacco industry. Example: A retired Indian Administrative Services officer joined the board of Godfrey Phillips as an independent director.
    • Government Stake: The Central government holds a 7.8% stake in ITC Ltd., India’s largest tobacco company.
    • Tax Exemptions:  Continuous exemptions of cess on bidis and smaller tobacco manufacturers. Persistent extensions of these exemptions despite the harmful effects of tobacco.

    Tax Measures and Lobbying

    • Current Tax Burden:  Cigarettes 51%, Bidis 22%, Smokeless Tobacco Products (SLTs) 64%
    • FCTC Recommendation: At least 75% tax on tobacco products.
    • Challenges at affordability level: Low taxes relative to income growth have kept tobacco products affordable, with cigarettes and SLTs becoming more affordable over the past decade due to the transition to the Goods and Services Tax (GST).
    • Thus, India’s score has worsened since 2021, indicating increased interference by the tobacco industry in governance.

    Initiatives taken by the Government:

    • Cigarette and Other Tobacco Products Act (COTPA) 2003: It regulates the advertisement, promotion, and sponsorship of tobacco products, prohibits smoking in public places, mandates pictorial health warnings on tobacco product packaging, and sets rules for the sale of tobacco products to minors.
    • Awareness on Media: India is the first country in the world to implement the larger steps through implementing warnings on OTT platform content when actors are seen using tobacco products.
    • Awareness of Product: India has implemented prominent and graphic pictorial health warnings on tobacco product packaging.

    Challenges in Implementation

    • Poor Enforcement: Existing measures are not strictly implemented, leading to widespread non-compliance, especially among smokeless tobacco products (SLTs).
    • Indirect Advertisements: Surrogate advertisements (e.g., using elaichi to promote tobacco brands) circumvent direct advertising bans, undermining control efforts.
    • Inadequate Fines: Penalties for violations of COTPA regulations have not been updated since 2003, making them ineffective deterrents.

    Way forward:

    • Update COTPA Fines and Penalties: Revise and significantly increase fines for violations of COTPA regulations to create a stronger deterrent.
    • Strengthen Border and Market Surveillance: Improve customs and market surveillance to combat smuggling and illicit trade of tobacco products.

    Mains question for practice:

    Q Discuss the various measures undertaken by the Indian government to control tobacco consumption. Evaluate the effectiveness of these measures and suggest improvements. 15M

     

    Tobacco Board of India

      • The Tobacco Board is a statutory body established under the Ministry of Commerce and Industry.
      • Hq: Guntur, Andhra Pradesh.
    • Functions:
      • To regulate the production and curing of Virginia tobacco by improving the yields and quality of tobacco.
      • To facilitate the sale of tobacco through e-auctions, undertaking various grower welfare measures and export promotion of tobacco.

  • [pib] India Hosts Digital Health Side Event at World Health Assembly

    Why in the News?

    • India hosted a side event on Digital Health during the 77th World Health Assembly.The event saw participation from Quad countries (Australia, Japan, and the United States of America) and delegates from over 100 countries.

    Key Highlights of the 7th WHA:

    • Transformative Role: India highlighted digital health’s role in ensuring equitable and accessible healthcare services, contributing to Universal Health Coverage and SDG 3.
    • India’s Advancements: WHA noted India’s success in implementing digital public infrastructure at scale, including Aadhaar for digital identities, Unified Payments Interface (UPI) for financial transactions, and Co-WIN for health service delivery during the pandemic.
    • Transition to UWIN: Co-WIN is being transformed into UWIN for the National Immunization Programme, facilitating immunization records for millions of newborns and mothers, as well as Anganwadi and school health records.
    • Ayushman Bharat Digital Mission (ABDM): India highlighted efforts under ABDM to create a robust national digital health ecosystem, with over 618 million Unique Health IDs (ABHA IDs) generated, 268,000 registered health facilities, and 350,000 healthcare professionals enlisted.
    • National Health Claims Exchange (NHCX): GoI is launching NHCX as part of ABDM to transform the insurance payments ecosystem, enabling real-time settlements with auto adjudication of claims through public-private partnerships leveraging digital public infrastructure.

    About World Health Assembly (WHA):

    Details
    Establishment Established in 1948 as the decision-making body of the World Health Organization (WHO)
    Frequency Typically meets annually in Geneva, Switzerland
    Membership Includes all 194 member states of the WHO, as well as certain international organizations as observers
    Role and Functions
    • Setting Health Policies
    • Adoption of Resolutions
    • Reviewing Reports
    • Collaboration and Partnerships
    Decision-Making Process Decisions made by a simple majority vote of member states present and voting
    Themes and Agendas Each session focuses on specific global health priorities, addressing a wide range of health topics
    Notable Achievements Development and adoption of international health instruments and initiatives, including:

    • International Health Regulations (IHR),
    • Framework Convention on Tobacco Control (FCTC),
    • Global Vaccine Action Plan (GVAP), and
    • Global Strategy for Women’s, Children’s, and Adolescents’ Health.
    Challenges Resource constraints, geopolitical tensions, need for greater inclusivity and transparency in decision-making

     

    PYQ:

    [2016] ‘Doctors Without Borders (Medecins Sans Frontieres)’, often in the news, is

    (a) A division of World Health Organization.

    (b) A non-governmental international organization.

    (c) An inter-governmental agency sponsored by European Union.

    (d) A specialized agency of the United Nations.

  • [30 May 2024] The Hindu Op-ed: India, liberalism and its crisis of legitimacy

    PYQ Relevance:

    Mains: 

    Q. Explain how the foundations of the modern world were laid by the American and French revolutions. (UPSC IAS/2016)

    Q. “Refugees should not be turned back to the country where they would face persecution or human rights violation”. Examine the statement concerning the ethical dimension being violated by the nation claiming to be democratic with an open society. (UPSC IAS/2021)

    Prelims:
    Which one of the following objectives is not embodied in the Preamble to the Constitution of India?  (UPSC IAS/2017)
    (a) Liberty of thought
    (b) Economic liberty
    (c) Liberty of expression
    (d) Liberty of belief

    Note4Students: 

    Prelims: Liberalism; Constitutional Values;

    Mains: Liberalism; Democratic System;

    Mentor comment: Since all of us are the form of Nature, we all are equal in a moral sense. Thus Liberalism started as a progressive idea. It aimed at giving liberty and protecting people from coercion. Once the capitalist class could establish themselves in power, their revolutionary fervor had gone. From a progressive philosophy, it was limited to the economic doctrine. It came to be dominated by utilitarians. Liberalism came to be criticized as ‘a pig’s philosophy’ because of utilitarians. Liberalism/utilitarianism became the basis of justification for the extreme exploitation of workers. There were protests against such policies. It has led to the growth of left movements. It forced liberals to change. Liberalism has been the longest-surviving ideology because of its flexible nature. Every ideology represents the interest of a particular class. Liberalism is an ideology of the middle classes. (emerging capitalist class). Liberalism is a philosophy of modern times. Liberalism is a by-product of the Renaissance, reformation, and scientific revolution. 

    Let’s learn.

    –

    Why in the News?

    Indian liberalism faces challenges from both left and right, with criticisms of elitism, individualism, and Western colonialism.

    • India’s tryst with liberalism began in the 1990s, but it has faced criticism and a decline in support.
    • The rise of populist and authoritarian leaders has led to a decline in liberal democracy, with only 34 countries maintaining it in 2022.

    Attacks by the left and the right

    • Left Criticisms
      • Elitism: Liberalism is seen as prioritizing individual interests over collective needs, promoting inequality and corporate interests.
      • Individualism: The left views individualism as a dangerous doctrine that widens the gap between the haves and have-nots, marginalizes the disadvantaged, and prioritizes corporate interests over social justice.
      • Contradiction with Egalitarian Democracy: The left argues that the commitment to egalitarian democracy is incompatible with the individualistic market capitalism promoted by liberalism.
    • Right Criticisms
      • Emphasis on Individual Freedom: The right sees individual freedom as a Western colonial import that has no connection with traditional Indian values and way of living.
      • Disconnection from Tradition and Identity: The right argues that liberalism is disconnected from Indian traditions and identity, prioritizing individual freedom over community and social values.
    Liberalism is deeply ingrained in Indian society:

    Amartya Sen has pointed out, the key values of liberalism like an emphasis on individual liberty, freedom, social justice, and societal harmony, have been deeply ingrained in Indian society since ancient times. 

    Liberal values can be found in our civilizational traditions and cultural beliefs, with giants such as Raja Ram Mohan Roy, Swami Vivekananda, M.G. Ranade, Gopal Krishna Gokhale, Gurudev Tagore, and B.R. Ambedkar situating their critique of colonial rule within a liberal framework. 

    Radical liberal thinkers such as Jyotirao Phule and Ambedkar argued that progress could be achieved through better (and more representative) political instruments rooted in liberal ideals. 

    What are the proposed solutions for making liberalism more inclusive in India?

    Indian liberalism needs to evolve to address the challenges it faces, and the time to start this process is now.

    • Syncretic Liberalism: Engage with tradition and identity in a more comprehensive and sustained manner to address the feelings of marginalization and overlook that have driven populist success.
      • This involves recognizing the importance of community and tradition in Indian society and incorporating these values into liberal thought.
    • Economic Reforms: Adopt a more inclusive and socially just approach to markets, balancing free enterprise with social justice through welfare.
      • This includes ensuring that economic growth benefits all sections of society, not just the privileged few.
    • Political Reforms: Revive representative institutions to restore public trust in democracy.
      • This involves decentralizing power, improving representation, and addressing issues of government overreach and surveillance.
    • Consensus: Develop a basic consensus among liberals to address criticisms and work together effectively.
      • This involves recognizing the vast areas of agreement among liberals and focusing on these rather than contesting each other’s political commitments