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Centre wants States to make Snakebites a Notifiable Disease
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Notifiable Diseases
Why in the News?
The Union Health Ministry has urged states to make snakebites a Notifiable Disease, meaning both private and public hospitals must report it to the government.
Snakebites Menace in India:
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What are Notifiable Diseases?
- Notifiable diseases are those that must be reported to the government for effective public health monitoring and management. These are typically:
- Infectious diseases likely to cause outbreaks.
- Diseases that result in deaths or require quick action to prevent wider transmission.
- Legal Basis:
-
- According to WHO’s International Health Regulations, 1969, disease reporting is mandatory for global surveillance.
- The primary law governing notifiable diseases is the Epidemic Diseases Act, 1897 which outlines the reporting requirements for diseases considered a public health threat.
- However, the specific list of notifiable diseases can vary across different states and is typically determined by the respective state governments under their individual public health acts.
- Common examples of notifiable diseases include tuberculosis, HIV, cholera, malaria, dengue, and hepatitis.
Why snakebite is considered a Notifiable Disease?
- Snakebites can cause severe health issues, including paralysis, fatal hemorrhages, and tissue damage, making it crucial for timely intervention.
- Victims need immediate antivenom treatment to prevent death and long-term effects.
- In 2009, the WHO added snakebite to its list of Neglected Tropical Diseases (NTD), acknowledging its widespread impact on public health.
- Making snakebites a notifiable disease will enhance surveillance, help track case numbers, and improve treatment strategies across the country.
- It will ensure the availability of adequate antivenoms in regions where snakebites are frequent.
- Medical staff will receive training to handle snakebite cases effectively, reducing mortality rates.
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[pib] Jan Aushadhi Kendra’s by PACS
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Pradhan Mantri Bhartiya Jan Aushadhi Kendras
Why in the News?
- The Government has empowered Primary Agricultural Credit Societies (PACS) to operate Pradhan Mantri Bhartiya Jan Aushadhi Kendras (PMBJK), aiming to provide generic medicines at affordable prices to underserved rural areas.
About Pradhan Mantri Bhartiya Jan Aushadhi Kendras (PMBJK) by PACS:
| Details |
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| Aims and Objectives | To provide affordable medicines, promote healthcare equity, and reduce medical expenses for farmers, while generating local employment and ensuring PACS’ financial sustainability through the sale of medicines and allied products. |
| Structural Mandate and Implementation |
Implementation:
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| Features and Significance |
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PYQ:[2015] Public health system has limitations in providing universal health coverage. Do you think that private sector could help in bridging the gap? What other viable alternatives would you suggest? |
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Indians need the right to disconnect
Note4Students
From UPSC perspective, the following things are important :
Mains level: Issues related to women;
Why in the News?
After an EY employee’s death allegedly linked to work pressure, a report highlights Indian women in professions like IT and auditing exceeding 55-hour workweeks, with marginalized unorganized sector workers facing varied hours.
What are the present issues arising at Workplaces in India?
- Long Working Hours: Many Indian professionals, especially women in sectors like auditing and IT, work over 55 hours per week, contributing to high levels of stress and burnout.
- Mental Health Impact: A significant percentage (49%) of Indian workers report that workplace stress negatively affects their mental health, highlighting the urgent need for better work-life balance.
- Lack of Legal Protections: Unlike several countries that have implemented laws to protect employees’ right to disconnect from work outside official hours, India lacks specific legislation addressing this issue.
- Cultural Attitudes: There is a pervasive workaholic culture where employees feel compelled to remain available outside working hours, often leading to a blurring of boundaries between personal and professional life.
What benefits and challenges would India face in enforcing a ‘right to disconnect’ law?
Benefits:
- Improved Employee Well-Being: Enforcing a right to disconnect could help mitigate stress and improve mental health among employees, leading to a healthier workforce.
- Enhanced Productivity: Research indicates that allowing employees to disconnect can lead to increased productivity during working hours as they can focus better without after-hours distractions.
- Work-Life Balance: Such legislation would promote a more balanced approach to work, allowing employees to prioritize personal time and family life.
Challenges:
- Economic Concerns: Implementing a right to disconnect may b e seen as detrimental to economic growth in a competitive landscape like India, where companies often push for extended working hours.
- Resistance from Employers: Many employers may resist such regulations, fearing it could hinder their operational flexibility and responsiveness.
- Cultural Shift Required: There would need to be a significant cultural shift within organizations to embrace the right to disconnect, moving away from the expectation of constant availability.
How does the concept align with India’s economic growth and competitive landscape?
- Boosting Productivity: Recognizing the right to disconnect could enhance overall productivity by fostering a healthier work environment. This aligns with India’s goal of becoming the third-largest economy by 2030.
- Attracting Talent: A commitment to employee well-being through such legislation could make Indian companies more attractive to skilled professionals, particularly in competitive sectors like technology.
- Global Competitiveness: As global standards for employee rights evolve, India risks falling behind if it does not adapt its labor laws. Implementing a right to disconnect could position India favorably in the global market.
Way forward:
- Legislative Framework: Introduce comprehensive laws recognizing the right to disconnect, ensuring strict enforcement mechanisms and sector-specific guidelines to accommodate diverse workplace needs while safeguarding employee well-being.
- Cultural Transformation: Promote awareness campaigns and organizational policies to shift workplace culture towards respecting personal time, emphasizing the long-term benefits of work-life balance for productivity and economic growth.
Mains PYQ:
Q What are the continued challenges for Women in India against time and space? (UPSC IAS/2019)
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Frontline nutrition workers foster disability inclusion
Note4Students
From UPSC perspective, the following things are important :
Mains level: Issues related to disabled people;
Why in the News?
December 3, International Day of Persons with Disabilities, promotes awareness of their rights, inclusion, and needs, emphasizing support for one of the world’s most marginalized and underrepresented communities.
What are the barriers faced by individuals with disabilities in accessing nutrition services?
- Physical Accessibility: Many individuals with disabilities face challenges in accessing physical locations where nutrition services are provided, such as grocery stores or health clinics. This includes barriers like lack of ramps, inaccessible transportation, and inadequate facilities.
- Lack of Knowledge and Skills: Individuals with disabilities may have limited knowledge about nutrition and cooking skills, which can hinder their ability to prepare healthy meals. This is often compounded by the need for assistance from caregivers who may not be well-informed about nutritional needs.
- Financial Constraints: Economic factors play a significant role; many individuals with disabilities experience financial instability, limiting their ability to purchase nutritious food. This is particularly true in low-income households where resources are scarce.
- Social Isolation and Stigma: People with disabilities often face social isolation and stigma, which can affect their access to community resources and support networks that provide nutritional assistance or education.
- Complex Health Needs: Many individuals with disabilities have specific dietary requirements or face challenges related to feeding, swallowing, or digestion, making it difficult to meet their nutritional needs without tailored support.
- Inadequate Public Health Support: In many regions, public health systems fail to provide adequate nutritional support for individuals with disabilities, particularly in low- and middle-income countries (LMICs) where resources may be limited.
How can nutrition programs be adapted to ensure they are inclusive of individuals with disabilities?
- Tailored Nutritional Education: Nutrition programs should include educational components that cater specifically to the needs of individuals with disabilities, focusing on accessible cooking methods and meal planning that accommodate various dietary restrictions.
- Accessible Service Delivery: Programs should ensure that nutrition services are delivered in accessible locations and formats, including home visits for those unable to travel or online platforms for remote consultations.
- Community Engagement: Involving individuals with disabilities in the design and implementation of nutrition programs can help ensure that their unique needs are met. This could include feedback mechanisms to adapt services based on community input.
- Training for Caregivers: Providing training for caregivers on the specific nutritional needs of individuals with disabilities can enhance meal preparation and dietary management at home.
- Financial Assistance Programs: Implementing subsidies or financial assistance programs can help alleviate the economic burden on families caring for individuals with disabilities, enabling them to purchase healthier food options.
- Integration with Health Services: Nutrition programs should be integrated with broader health services to provide comprehensive support that addresses both nutritional needs and overall health outcomes.
What role do Anganwadi workers play in promoting disability inclusion in their communities?
- Early Identification and Referral: Anganwadi workers play a crucial role in the early identification of disabilities among children through monitoring developmental milestones and referring families to appropriate health services.
- Community Education: They engage communities through initiatives like podcasts (e.g., “Nanhe Farishtey”) to raise awareness about disabilities and promote inclusive practices within local settings.
- Nutrition Service Delivery: As frontline community nutrition providers, Anganwadi workers deliver vital nutrition services tailored to the needs of children with disabilities, ensuring they receive adequate dietary support.
- Collaboration with Other Health Workers: Anganwadi workers collaborate with Accredited Social Health Activist (ASHA) workers to create a network of support for families dealing with disabilities, facilitating access to medical care and government benefits.
- Capacity Building: Ongoing training on disability inclusion through protocols like the ‘Anganwadi Protocol for Divyang Children’ equips workers with the knowledge necessary to support children with disabilities effectively.
- Advocacy for Rights and Resources: They advocate for the rights of persons with disabilities within their communities, helping families navigate available resources such as disability certificates and pensions.
Way forward:
- Strengthen Inclusive Infrastructure and Services: Develop accessible infrastructure, including Anganwadi centres and transportation, while integrating nutrition programs with health services to provide tailored support for individuals with disabilities.
- Empower Community and Frontline Workers: Enhance training for Anganwadi workers and caregivers, promote community engagement to address stigma, and ensure financial support for families to improve access to nutritious food and essential services.
Mains PYQ:
Q The Rights of Persons with Disabilities Act, 2016 remains only a legal document without intense sensitisation of government functionaries and citizens regarding disability. Comment. (UPSC IAS/2022)
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India’s cities, their non-communicable disease burden
Note4Students
From UPSC perspective, the following things are important :
Mains level: Health Care issues in India;
Why in the News?
The recent cardiac arrest and subsequent death of a Bengaluru Metropolitan Transport Corporation (BMTC) bus driver while on duty has sparked conversations about worsening health outcomes in urban areas.
What are the primary risk factors contributing to the rising NCD burden in urban areas?
- High-Stress Work Environments: Many urban workers, including bus drivers, face high levels of stress due to long hours, erratic schedules, and demanding job conditions.
- The BMTC study indicated that over 40% of its employees aged 45-60 are at risk for cardiovascular diseases, exacerbated by factors like continuous driving and poor eating habits.
- Poor Nutrition and Lifestyle: Workers often lack access to healthy food options and exercise opportunities, leading to increased rates of obesity, hypertension, and diabetes.
- The BMTC workforce has shown alarming rates of these conditions, which are often linked to lifestyle choices made under stressful work conditions.
- Lack of Health Insurance and Support: Many informal workers do not have health insurance or access to regular health screenings. This lack of support can lead to delayed diagnosis and treatment of NCDs, increasing the risk of severe health events like heart attacks.
- Socioeconomic Marginalization: A significant portion of the urban population lives in slums or informal settlements, where access to healthcare is limited. This socioeconomic status contributes to poor health outcomes and a higher prevalence of NCDs.
How can urban health systems be strengthened to effectively manage NCDs?
- Improving Access to Primary Healthcare: Urban health systems must focus on making primary healthcare services more accessible to marginalized communities. This includes expanding facilities in underserved areas and ensuring that services are affordable and culturally appropriate.
- Implementing Regular Health Screenings: Regular health evaluations for high-risk populations, such as bus drivers and other transport workers, should be mandated. These screenings can help identify risk factors early on and facilitate timely interventions.
- Integrating Health Services with Employment Policies: Employers should collaborate with health departments to create programs that promote employee wellness, including stress management workshops and nutrition education tailored for their workforce.
- Community-Based Health Promotion: Local organizations can play a crucial role in educating communities about NCD risks and promoting healthy lifestyles through workshops and outreach programs that engage residents directly.
What role do public awareness and community engagement play in combating NCDs?
- Raising Awareness About NCD Risks: Public campaigns can educate individuals about the importance of regular health screenings and lifestyle changes that reduce the risk of NCDs. Awareness initiatives can empower communities to take charge of their health.
- Encouraging Community Participation: Engaging community members in health promotion activities fosters a sense of ownership over their health outcomes. Community-led initiatives can effectively address local health issues by tailoring solutions to specific needs.
- Utilizing Technology for Monitoring Health: Digital tools can facilitate real-time monitoring of health metrics for at-risk populations, enabling proactive management of conditions like hypertension and diabetes.
- Creating Support Networks: Building networks among workers can provide emotional support and share resources for managing health issues collectively, which is particularly beneficial for those facing similar challenges in high-stress jobs.
Way forward:
- Strengthen Urban Primary Healthcare: Expand access to affordable and culturally relevant primary health services, implement regular screenings for high-risk groups, and integrate wellness programs with employment policies for vulnerable workers.
- Promote Community-Led Health Initiatives: Engage local organizations and residents to raise awareness about NCD risks, encourage healthy lifestyles, and utilize digital tools for real-time health monitoring and proactive care.
Mains PYQ:
Q “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. (UPSC IAS/2021)
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How should India tackle diabetes load?
Note4Students
From UPSC perspective, the following things are important :
Mains level: Health Issues; Challenges faced by society due to NCDs;
Why in the News?
On International Diabetes Day (November 14), the Lancet shared a global study showing over 800 million adults have diabetes, and more than half aren’t receiving proper treatment.
What is the controversy over the numbers and the difference in Testing Methodology?
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What are the issues raised in the Lancet study?
- Global Inequalities in Treatment: The study highlighted significant disparities in diabetes treatment access, particularly in low- and middle-income countries where treatment rates are stagnating despite rising diabetes cases. This raises concerns about long-term health complications for untreated individuals.
- Rising Rates of Diabetes: The findings underscore that diabetes rates have increased dramatically, especially Type 2 diabetes, which poses a growing public health challenge. This trend is alarming given that many affected individuals are younger and at risk for severe complications.
- Complications and Healthcare Burden: With a large number of individuals requiring treatment, there is a looming healthcare crisis regarding complications such as kidney failure, heart disease, and vision loss, which could overwhelm healthcare systems.
What steps need to be taken? (Way forward)
- Enhanced Awareness and Education: There is a pressing need for widespread education on diabetes prevention through nutrition and physical activity. Public health campaigns should focus on promoting healthy lifestyles to mitigate risk factors associated with diabetes.
- Policy Changes: Governments must implement policies that restrict unhealthy food options while making healthy foods more affordable. This includes subsidies for nutritious foods and initiatives to create safe spaces for physical activity.
- Targeted Interventions for Vulnerable Populations: Special attention should be directed towards vulnerable groups, particularly women who may be at higher risk post-pregnancy or during menopause. Tailored interventions can help address specific risk factors prevalent in these populations.
- Investment in Healthcare Infrastructure: To effectively manage the rising burden of diabetes, there must be significant investment in healthcare infrastructure, especially in low- and middle-income countries where resources are limited.
- Long-Term Strategic Planning: A comprehensive long-term strategy is essential to combat the growing diabetes epidemic, requiring collaboration between governments, healthcare providers, and communities to ensure sustainable health outcomes.
Mains PYQ:
Q Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)
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What is High-Altitude Sickness?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: High-Altitude Sickness
Why in the News?
The tragic death of a trekker scaling Garur Peak in Uttarakhand, underscores the dangers of high-altitude sickness in the Himalayas.
What is High-Altitude Sickness?
- Causes: High-altitude sickness, or Acute Mountain Sickness (AMS), occurs when the body struggles to acclimatise to elevations above 8,000 feet (2,400 metres) due to reduced oxygen levels.
- Symptoms: Early signs include headache, nausea, fatigue, and shortness of breath. If untreated, it may escalate to:
- High-Altitude Pulmonary Edema (HAPE): Fluid in the lungs, causing breathing difficulties.
- High-Altitude Cerebral Edema (HACE): Fluid in the brain, leading to confusion, hallucinations, and coma.
Prevention and Treatment
- To prevent AMS, experts recommend a slow ascent with rest days every 3-4 days above 3,000 meters and avoiding sleeping elevation increases of more than 500 meters per day.
- Medications:
- Acetazolamide: Aids acclimatisation.
- Dexamethasone: Reduces severe inflammation.
- Nifedipine: Prevents HAPE in high-risk individuals.
Note: Medications are not foolproof and are to be taken under medical guidance.
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[pib] Ayushman Vay Vandana Yojana
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Features of Ayushman Vay Vandana Yojana
Why in the News?
Within just three weeks of its launch, over 10 lakh senior citizens have enrolled for the Ayushman Vay Vandana Yojana.
| Note: Pradhan Mantri Vaya Vandana Yojana (PM-VVY) is a pension scheme and insurance policy for senior citizens in India. One must not get confused with Ayushman-VVY. |
About Ayushman Vay Vandana Yojana:
| Details | |
| Features and Provisions | • Cashless health coverage up to ₹5 lakh per year for senior citizens aged 70 and above. • Beneficiaries receive an Ayushman Vay Vandana Card, which grants them access to free treatment in empaneled hospitals across India. • Coverage includes medical consultations, treatments, pre- and post-hospitalization expenses, and complex procedures such as angioplasty. |
| Structural Mandate | • Administered under the PM-JAY framework, ensuring structured implementation and integration with India’s health insurance network. • Implemented across empaneled hospitals in both urban and rural areas, ensuring nationwide reach. • Centralized digital system tracks treatments, patient details, and expenses for transparency and accountability. • Specifically designed for senior citizens, addressing their unique healthcare needs. |
| Aims and Objectives | • Universal healthcare for senior citizens, ensuring access to essential medical treatments without financial strain. • Seeks to reduce out-of-pocket expenditure for elderly citizens and their families. • Encourages preventive care and early medical intervention to address age-related health conditions. |
| Eligibility Criteria | • Open to all Indian citizens aged 70 and above. • There are NO income/ family size restrictions, making it accessible to all senior citizens, regardless of their economic status. • Beneficiaries must be Indian citizens. • Seniors need to register under PM-JAY to receive the AVV Card and avail of the benefits. |
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Growing epidemic
Note4Students
From UPSC perspective, the following things are important :
Mains level: Biotechnology; Health sector; Diseases and it’s policies in News;
Why in the News?
Global diabetes cases surged from 200 million in 1990 to over 800 million in 2022, with adult prevalence doubling from 7% to 14%, according to The Lancet report.
What are the WHO’s targets for diabetes diagnosis and management by 2030?
- The World Health Organization (WHO) aims for 80% of people with diabetes to be diagnosed.
- The target is for 80% of diagnosed individuals to achieve good glycemic control, which is crucial for preventing complications associated with diabetes.
What is the current state of diabetes prevalence in India?
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What strategies can India implement to achieve these targets?
- Targeted Screening and Lifestyle Interventions: India can adopt Finland’s approach of identifying high-risk individuals through targeted screening and offering lifestyle interventions, including dietary changes and exercise, to prevent diabetes.
- Enhance Public Awareness Campaigns: Community-based implementation and awareness programs align with SDG 3 (Good Health and Well-being) by promoting healthy lifestyles, preventing diabetes, and ensuring equitable access to healthcare for all, especially vulnerable populations.
- Improve Access to Healthcare Services: Ensure that diagnostic facilities for blood glucose testing are widely available and affordable. Strengthen primary healthcare services to facilitate easier access to diabetes care and management.
Steps taken by the government:
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Way forward:
- Strengthen Preventive Healthcare: Focus on early detection through widespread screening, robust public awareness campaigns, and targeted interventions for high-risk groups, emphasizing healthy lifestyle promotion.
- Enhance Integrated Care Systems: Scale up access to affordable diabetes care, strengthen primary healthcare services, and integrate technology for monitoring and management to achieve WHO’s glycemic control targets by 2030.
Mains PYQ:
Q Stem cell therapy is gaining popularity in India to treat a wide variety of medical conditions including leukaemia, Thalassemia, damaged cornea and several burns. Describe briefly what stem cell therapy is and what advantages it has over other treatments. (UPSC IAS/2017)
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[pib] Decline in Out-of-Pocket Expenditure (OOPE) in Health in India
Note4Students
From UPSC perspective, the following things are important :
Prelims level: NHA estimates
Why in the News?
National Health Accounts (NHA) data for 2021-22 shows a decline in Out-of-Pocket Expenditure (OOPE) on healthcare due to increased government health expenditure (GHE) and an enhanced public healthcare framework.
What are NHA estimates?
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Key Observations from the NHA 2021-22 Data:
| Details | |
| Decline in Out-of-Pocket Expenditure (OOPE) | OOPE has decreased due to increased government investment and improved public healthcare infrastructure, making healthcare more accessible and affordable. |
| Rise in Government Health Expenditure (GHE) | GHE as a percentage of GDP rose from 1.13% in 2014-15 to 1.84% in 2021-22. GHE’s share of overall government spending increased from 3.94% to 6.12%, reflecting the government’s commitment to public healthcare. |
| Increase in Per Capita Health Spending | Per capita health spending tripled from ₹1,108 in 2014-15 to ₹3,169 in 2021-22, allowing for more investment in infrastructure, workforce, and services. |
| Expansion of Social Security Expenditure (SSE) | SSE on healthcare grew from 5.7% to 8.7% of Total Health Expenditure (THE), helping protect individuals from catastrophic health expenses and reducing OOPE. |
| Growth of Government-Funded Insurance Schemes | Programs like Ayushman Bharat and state-level health insurance schemes increased healthcare access for economically vulnerable populations, reducing reliance on personal funds. |
| Foundation for Universal Health Coverage (UHC) | The decline in OOPE and increased public health spending are integral to achieving UHC, aiming for equitable healthcare access for all citizens. |
PYQ:[2021] “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. [2019] In India, the term “Public Key Infrastructure” is used in the context of: (a) Digital security infrastructure (b) Food security infrastructure (c) Health care and education infrastructure (d) Telecommunication and transportation infrastructure |
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APOBEC (Apolipoprotein B mRNA Editing Catalytic Polypeptide)
Note4Students
From UPSC perspective, the following things are important :
Prelims level: APOBEC
Why in the News?
Since smallpox was eradicated in 1980, research on mpox has highlighted how the virus mutates, particularly through the APOBEC family of immune system proteins.
About APOBEC
- APOBEC (Apolipoprotein B mRNA Editing Enzyme, Catalytic Polypeptide-Like) is a family of proteins involved in regulating the genetic material of viruses and cells.
- They are part of the human immune system and play a crucial role in protecting against viral infections by editing RNA and DNA.
- APOBEC consists of several enzymes, with APOBEC1, APOBEC3 family members being the most well-known.
- There are 11 identified members of the APOBEC family, primarily named APOBEC1, APOBEC2, and APOBEC3, with APOBEC3 being the most studied due to its antiviral properties.
- It has a Zinc Finger Domain, which is essential for their enzymatic activity and ability to bind to DNA or RNA.
- APOBEC proteins are found in various tissues and cells, but they are notably present in the immune cells such as T-cells, B-cells, and macrophages.
- Role in Immune Defense:
- APOBEC proteins contribute to the innate immune response by editing viral genomes, preventing the replication of viruses, and reducing the ability of viruses to establish infections.
- They are known to be cytosine deaminases, which means they modify cytosine bases in nucleic acids to uracil, leading to mutations that can prevent successful viral replication.
- APOBEC proteins target the genomes of several viruses, including retroviruses (like HIV), hepatitis B virus, and poxviruses (such as mpox and smallpox).
Functions of APOBEC Proteins:
- DNA Editing: APOBEC proteins can deaminate cytosine bases in single-stranded DNA, converting them into uracil, which can lead to mutations.
- This introduces errors in the viral genome and inhibits replication.
- RNA Editing: Some APOBEC proteins, like APOBEC1, are involved in editing mRNA. In the case of APOBEC1, it helps edit the mRNA of apolipoprotein B, which is crucial for lipid metabolism.
- Antiviral Activity: APOBEC3 proteins, particularly APOBEC3G, inhibit the replication of HIV and other retroviruses by editing viral DNA during reverse transcription.
- They also reduce the replication of poxviruses (such as mpox), making them crucial in controlling infections caused by these viruses.
- Cytosine Deamination in Viral RNA: APOBEC proteins induce mutations in viral RNA, reducing the virus’s ability to efficiently replicate and spread. This helps prevent viral evolution and adaptation.
- Inhibition of Viral Resistance: By causing mutations in viral genomes, APOBEC proteins prevent viruses from easily developing resistance to the immune system’s defenses.
- Interaction with Other Immune Mechanisms: APOBEC proteins work in concert with other immune mechanisms, like interferons, to enhance antiviral responses and limit infections.
PYQ:[2016] In the context of the developments in Bioinformatics, the term ‘transcriptome’, sometimes seen in the news, refers to: (a) a range of enzymes used in genome editing (b) the full range of mRNA molecules expressed by an organism (c) the description of the mechanism of gene expression (d) a mechanism of genetic mutations taking place in cells |
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IDF working on new guidelines to treat Type 2 Diabetes
Note4Students
From UPSC perspective, the following things are important :
Prelims level: International Diabetes Federation, Type 2 Diabetes
Why in the News?
- The International Diabetes Federation (IDF) is developing new Type 2 diabetes treatment guidelines in collaboration with a global expert panel.
- These guidelines aim to integrate scientific evidence and clinical practice, adapted to the healthcare environment of specific countries.
What is Type 2 Diabetes?
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About International Diabetes Federation (IDF):
| Details | |
| About |
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| Aims and Objectives |
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| Key Programs |
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| Diabetes Types Covered |
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Sleep Apnea contributes to Dementia in older adults
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Obstructive Sleep Apnea (OSA)
Why in the News?
A recent study from Michigan Medicine found that Obstructive Sleep Apnea (OSA), a common sleep disorder, increases the risk of dementia (loss of cognitive functioning) in adults, especially in women.
What is Obstructive Sleep Apnea (OSA)?
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Recent Findings on OSA and Dementia Risk
- A study from Michigan Medicine found a link between OSA and increased dementia risk, especially in older adults over 50.
- Women with known or suspected OSA were found to have a higher likelihood of developing dementia compared to men, with dementia diagnoses increasing as women age.
- Another study by NIMHANS focused on the link between stroke and OSA.
- 105 stroke patients over the age of 50 were studied using polysomnography (PSG), which tracks brain waves and sleep breathing patterns.
- Results showed that 88% of stroke patients had sleep apnea soon after their stroke, with 38% having severe OSA.
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What is Chronic Wasting Disease (CWD)?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Chronic Wasting Disease (CWD) and its spread
Why in the News?
A case of Chronic Wasting Disease (CWD) was confirmed in the US.
About Chronic Wasting Disease (CWD)
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Symptoms of CWD:
- Symptoms: Drastic weight loss, lack of coordination, drooling, listlessness, and excessive thirst. Infected animals may also show drooping ears and lose their fear of humans.
- Prevention: To prevent the spread of CWD, avoid handling or eating sick animals, use synthetic lures, dispose of carcass waste in landfills, and report any sick or unusual deer to local wildlife authorities.
PYQ:[2012] Vultures which used to be very common in Indian countryside some years ago are rarely seen nowadays. This is attributed to: (a) The destruction of their nesting sites by new invasive species (b) A drug used by cattle owners for treating their diseased cattle (c) Scarcity of food available to them (d) A widespread, persistent and fatal disease among them |
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World Polio Day: How India managed to eradicate polio?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: World Polio Day
Mains level: Polio Eradication
Why in the News?
October 24 is recognized as World Polio Day, a commemoration established by Rotary International to honor the birth of Jonas Salk, who spearheaded the development of the first vaccine against polio in the 1950s.
What key strategies contributed to the successful eradication of polio in India?
- Comprehensive Vaccination Campaigns: India implemented large-scale vaccination drives starting in 1972, which expanded under the Universal Immunisation Programme (UIP) in 1985.
- Community Engagement and Awareness: Targeted awareness campaigns were crucial, utilizing local health workers to administer oral polio drops, which made vaccination accessible.
- Effective Messaging: The slogan “do boond zindagi ki” (two drops of life) resonated well with the public. Utilizing celebrities like Amitabh Bachchan and integrating health messages into popular media further amplified awareness.
- Robust Surveillance System: A multilayered surveillance mechanism was developed to monitor acute flaccid paralysis (AFP) cases, enabling prompt immunisation of affected populations. This system involved local informers, including community health workers and doctors.
- Targeted Interventions for High-Risk Areas: By 2009, efforts were concentrated in specific regions, particularly in Uttar Pradesh and Bihar, where most cases were reported. This targeted approach was critical in reducing transmission rates.
- Collaboration with International Agencies: The eradication campaign was supported by various international bodies such as WHO, UNICEF, and the Bill and Melinda Gates Foundation, ensuring financial and logistical backing.
How did India address the challenges of vaccine hesitancy among specific communities?
- Engagement with Community Leaders: To address religious concerns and misinformation, influential figures such as imams and local leaders were involved. Their endorsements played a significant role in countering myths about the vaccine.
- Targeted Communication Strategies: Awareness efforts were tailored to specific communities, focusing on dispelling myths surrounding the vaccine, such as fears about impotence and cultural taboos against its ingredients.
- Culturally Sensitive Messaging: Messaging was crafted in local languages and through community-specific narratives, ensuring that it resonated with the cultural context of various groups.
What lessons can be learned from India’s polio eradication efforts for future public health campaigns?
- Importance of Community Involvement: Engaging local leaders and community members is vital for building trust and addressing vaccine hesitancy effectively.
- Flexibility in Implementation: Tailoring vaccination drives to accommodate local cultural practices, work schedules, and geographic challenges can enhance participation rates.
- Sustained Awareness Efforts: Continuous education and awareness campaigns are essential, especially in the face of evolving misinformation and cultural resistance.
- Data-Driven Decision Making: The use of robust surveillance systems and data analytics to identify and target high-risk areas can help streamline public health interventions.
- Collaboration with Multiple Stakeholders: Building partnerships between government agencies, international organizations, and local communities can strengthen public health responses and resource mobilization.
Conclusion: Need to establish sustainable platforms for continuous dialogue between healthcare providers and community leaders to address health concerns, build trust, and ensure community-specific health initiatives are effectively communicated and implemented.
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Issues in the treatment of ‘rare diseases’, and what the govt can do?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Definition of Rare Diseases
Mains level: Issues related to rare disease;
Why in the News?
The Delhi High Court recently issued directives to enhance the availability of “orphan drugs” to combat rare diseases.
About the Delhi High Court Verdict:
- The Delhi High Court issued directions aimed at improving the availability of “orphan drugs,” which are used to treat rare diseases.
- This intervention seeks to address challenges related to the high cost of these treatments and the barriers to access for patients with rare diseases in India.
Rare Diseases in India and Their Classification:
- Definition: According to the World Health Organization (WHO), rare diseases are debilitating, lifelong conditions that affect 1 or fewer individuals in 1,000.
- Conditions Recognized as Rare Diseases in India: Approximately 55 conditions, including Gaucher’s disease, Lysosomal Storage Disorders (LSDs), and certain muscular dystrophies, are classified as rare diseases.
- National Registry: The Indian Council of Medical Research (ICMR) manages the National Registry for Rare and Other Inherited Disorders (NRROID), which has documented 14,472 patients with rare diseases.
Classification of Rare Diseases in India:
- Group 1: Diseases that can be treated with a one-time curative procedure (e.g., certain enzyme replacement therapies).
- Group 2: Conditions requiring long-term or lifelong treatment, which are relatively less expensive and have documented benefits. Regular medical check-ups are necessary for patients.
- Group 3: Diseases for which effective treatments are available, but they are highly costly and require ongoing, lifelong therapy. Selecting beneficiaries for these treatments presents a challenge due to the high costs.
Current Funding Policy in India:
- National Policy for Rare Diseases (NPRD) 2021: Launched to provide financial support for the treatment of rare diseases. Patients receiving treatment at designated Centres of Excellence (CoE) can get financial assistance up to Rs 50 lakh.
- Centres of Excellence: The CoEs include institutions such as AIIMS in Delhi, PGIMER in Chandigarh, and the Institute of Postgraduate Medical Education and Research at Kolkata’s SSKM Hospital.
- Crowdfunding and Voluntary Donations Portal (2022): The Health Ministry launched a digital platform that allows donors to contribute toward the treatment of rare disease patients at CoEs. The portal provides details about patients, their conditions, estimated treatment costs, and bank account information of the CoEs.
Did you know?
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Challenges Associated with Orphan Drugs:
- Limited Treatment Options: Therapies are available for fewer than 5% of rare diseases, resulting in less than 10% of patients receiving disease-specific treatment.
- High Treatment Costs: Many existing therapies for rare diseases are prohibitively expensive, putting a significant financial burden on patients and their families.
- Regulatory Delays: Approval processes, such as those from the Drug Controller General of India (DCGI), can be slow. For instance, delays in approving US-based Sarepta Therapeutics’ medicines in India have affected the timely availability of treatments.
- Bureaucratic Hurdles: Decision-making delays and administrative red tape further complicate access to necessary drugs, impacting patient care.
- Challenges in Beneficiary Selection: Due to high treatment costs, identifying and prioritizing beneficiaries for financial assistance is difficult, potentially leaving some patients without support.
Way forward:
- Streamline Regulatory Approvals: Expedite the approval process for orphan drugs by reducing bureaucratic hurdles and establishing a fast-track mechanism for essential treatments, ensuring timely access to life-saving medications.
- Increase Financial Support and Expand Coverage: Enhance the funding cap under the National Policy for Rare Diseases and extend financial assistance to more patients, while encouraging public-private partnerships and innovative funding mechanisms like insurance coverage for rare disease treatments.
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Rise in life expectancy has slowed dramatically: New study
Note4Students
From UPSC perspective, the following things are important :
Mains level: Life Expectancy and related challenges,
Why in the News?
After decades of steady increases in human life expectancy due to advancements in medicine and technology, recent trends suggest that these gains are starting to slow down, according to a new study.
The Key Findings of the Study:
- Slowing of Life Expectancy Gains: After decades of rising life expectancy due to medical and technological advancements, the pace of these increases has slowed significantly. The study suggests that human life expectancy has nearly plateaued, with dramatic extensions unlikely without breakthroughs in anti-aging medicine.
- Regional Analysis: The study analyzed life expectancy data between 1990 and 2019 from regions with the longest life spans, such as Australia, Japan, and Sweden.
- Even in these regions, life expectancy increased by only 6.5 years on average over the 29-year period.
- Challenges of Radical Life Extension: Researchers found that while people live longer due to improvements in healthcare, the human body’s aging process—marked by the declining function of internal organs—limits life span. Even if diseases like cancer and heart disease are eliminated, aging itself remains a barrier.
- Low Probability of Reaching 100: The study estimates that girls born in the longest-living regions have only a 5.3% chance of reaching 100 years, while boys have a 1.8% chance. Thus, despite medical advancements, reaching 100 years remains rare without interventions to slow aging.
- Aging as the Primary Barrier: Researchers argue that extending average life expectancy dramatically will require breakthroughs that slow the aging process rather than just better treatments for common diseases.
- Some experimental drugs, like metformin, have shown potential in animal studies, but human trials are needed.
India’s Present Status:
- Lower Life Expectancy: As of 2024, India’s average life expectancy is around 70 years, In contrast, countries like Japan and Switzerland boast life expectancies exceeding 83 years.
- Healthcare Advancements: While India has made significant progress in combating infectious diseases and improving maternal and child health, chronic illnesses and lifestyle diseases (such as heart disease and diabetes) are emerging as leading causes of death.
What Needs to Be Done: (Way forward)
- Focus on Anti-Aging Research: India must invest in research on aging and regenerative medicine, exploring ways to slow down the aging process rather than just treating diseases.
- Strengthening Healthcare Systems: Expanding access to quality healthcare and preventive medicine to manage age-related diseases can enhance the quality of life in later years, even if life expectancy does not rise dramatically.
- Policy Support for Longevity Research: There is a need for policies supporting medical research into life-extension technologies, including drug trials and clinical studies focused on aging.
- Public Health Interventions: Improved public health measures targeting lifestyle diseases (obesity, diabetes) and better management of age-related conditions can enhance life span and overall well-being.
Mains PYQ:
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)
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[pib] WHO declares that India has eliminated Trachoma as a public health problem in 2024
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Trachoma; Its causes and treatment
Why in the News?
- The World Health Organization (WHO) has declared that India has successfully eliminated Trachoma as a public health problem.
- This makes India the third country in the Southeast Asia Region to achieve this milestone.
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What is Trachoma?
- Trachoma is a bacterial infection that affects the eyes.
- It is caused by the bacterium Chlamydia Trachomatis.
- It is contagious, spreading through contact with the eyes, eyelids, or secretions from the nose or throat of an infected person.
- If untreated, Trachoma can lead to irreversible blindness.
Trachoma in India: A Historical Perspective
- In the 1950s and 1960s, Trachoma was one of the leading causes of blindness in India.
- To tackle this, India launched the National Trachoma Control Program in 1963.
- Later, these efforts were integrated into India’s National Program for Control of Blindness (NPCB).
- In 1971, the rate of blindness due to trachoma was 5% in the country.
- Due to various interventions under the National Programme for Control of Blindness & Visual Impairment (NPCBVI), the rate has now dropped to less than 1%.
What are the key measures taken to eliminate Trachoma?
- India implemented the WHO SAFE strategy across the country. This strategy includes:
- Surgery
- Antibiotics
- Facial hygiene
- Environmental cleanliness
- Although by 2017, India was declared free from infective Trachoma, it continued surveillance of Trachoma cases from 2019 to 2024.
PYQ:[2018] Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. |
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[pib] World Cerebral Palsy Day
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Cerebral palsy
Why in the News?
- The World Cerebral Palsy Day was celebrated on October 6 with the theme ‘#UniquelyCP’.
- It celebrates the uniqueness of individuals living with cerebral palsy by emphasizing that they are not defined by their disability.
About Cerebral Palsy:
| Details | |
| Condition | A group of neurological disorders affecting movement, muscle tone, and posture. |
| Cause | Abnormal brain development, usually before birth; can also occur due to injury during birth or early childhood. |
| Types | – Spastic CP: Stiff muscles, difficulty with movement (most common, 70-80% of cases). – Dyskinetic CP: Uncontrolled movements affecting limbs. – Ataxic CP: Poor balance and coordination. – Mixed CP: Combination of symptoms from different types. |
| Symptoms | Motor skill difficulties (crawling, walking); Muscle stiffness or looseness; Poor coordination and balance; Speech or swallowing difficulties; Seizures in some cases. |
| Diagnosis | Physical examination, MRI scans, developmental monitoring (usually diagnosed within first 2 years). |
| Risk Factors | Premature birth; Low birth weight; Multiple births; Maternal infections; Lack of oxygen during birth. |
| Treatment | – Physical, occupational, and speech therapies. – Medications to reduce muscle stiffness. – Surgery in severe cases. |
| Life Expectancy | Normal life expectancy in many cases, depending on severity and associated complications. |
| Prevention | Some causes are preventable with proper maternal care, but many are not. |
| Policy Support | Niramaya Health Insurance Scheme:
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PYQ:[2020] In order to enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss. |
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United Nations Programme on HIV/AIDS (UNAIDS)
Note4Students
From UPSC perspective, the following things are important :
Prelims level: UNAIDS and its functions
Why in the News?
According to the UNAIDS Director, without India’s significant contribution, the world is unlikely to achieve the Sustainable Development Goal (SDG) of ending AIDS as a public health threat by 2030.
What is HIV/AIDS?
India’s progress in reducing HIV Infections
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About UNAIDS (Joint United Nations Programme on HIV/AIDS):
| Details | |
| Established | In 1996, by United Nations Economic and Social Council (ECOSOC) |
| Headquarters | Geneva, Switzerland |
| Main Purpose | To coordinate global action to combat HIV/AIDS, prevent infections, and support those affected |
| Mandate | • Coordinate the global response to HIV/AIDS • Support countries in HIV/AIDS prevention and treatment strategies • Advocate for human rights and equality in access to HIV services |
| Principle | Greater Involvement of People Living with HIV (GIPA), endorsed by the UN in 2001 and 2006 |
| Global Targets | 90-90-90 targets: 90% diagnosed, 90% on treatment, 90% virally suppressed by 2020 |
| Global AIDS Strategy | 2021-2026: Aim to end inequalities driving HIV and ensure 30 million on treatment by 2025 |
| Cosponsors | 11 UN organizations, including UNICEF, WHO, UNDP, UNESCO, World Bank |
| Key Areas of Focus | Supporting countries to meet SDG 3: End AIDS by 2030.
• HIV prevention |
| Funding | Donors include governments, private foundations, and corporations |
| Key Campaigns | World AIDS Day (December 1), global awareness and advocacy efforts |
| Achievements | Significant progress toward the 90-90-90 targets, especially in countries like South Africa, Cambodia, and Eswatini |
PYQ:[2013] Which of the following diseases can be transmitted from one person to another through tattooing?
Select the correct answer using the codes given below: (a) 1 only |
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Preparing for the next pandemic: what NITI Aayog report says
Note4Students
From UPSC perspective, the following things are important :
Mains level: Management in Pandemic situation;
Why in the News?
Four years after the onset of Covid, an expert group formed by NITI Aayog has proposed the establishment of a comprehensive framework to handle future public health emergencies or pandemics effectively.
Lessons Learned from COVID-19:
- Gaps in Legal Frameworks: Existing laws like the Epidemic Diseases Act (1897) and National Disaster Management Act (2005) were insufficient for handling large-scale health emergencies. These laws lack clarity on definitions of epidemics and provisions for managing public health crises, drug distribution, and quarantine measures.
- Delayed Response and Coordination: The COVID-19 pandemic exposed weaknesses in coordination between central and state governments, highlighting the need for a more organized response mechanism.
- Inadequate Surveillance: Insufficient disease surveillance and early warning systems delayed the identification of threats. The role of zoonotic diseases, especially viruses linked to bat species, underscored the need for better monitoring of human-animal interactions.
What specific recommendations does the NITI Aayog report make?
- Enactment of PHEMA: Introduce the Public Health Emergency Management Act for a more robust legal framework to manage pandemics and other health emergencies.
- Empowered Group of Secretaries (EGoS): Establish a central committee to oversee pandemic preparedness, governance, R&D, surveillance, and response efforts.
- Strengthened Disease Surveillance: Create a national biosecurity and biosafety network and monitor human-animal interfaces, especially for zoonotic diseases.
- Emergency Vaccine Bank: Develop a stockpile of vaccines for rapid access during health crises, sourced domestically or internationally.
- Early Warning and Research Network: Build a forecasting and modelling network, along with Centres of Excellence (CoEs) to advance research on priority pathogens and preparedness.
How can India enhance its pandemic preparedness framework? (Way forward)
- Strengthening Legal and Institutional Frameworks: Enact a Public Health Emergency Management Act (PHEMA) and establish an Empowered Group of Secretaries for coordinated pandemic response.
- Enhancing Surveillance and Early Warning Systems: Build a robust disease surveillance network, biosecurity system, and epidemiology forecasting for early detection and response to outbreaks.
- Investing in Health Infrastructure and Vaccine Stockpiles: Develop public health cadres, boost healthcare infrastructure, and create an emergency vaccine bank for rapid deployment during health crises.
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Was animal fat present in Tirupati laddus?
Note4Students
From UPSC perspective, the following things are important :
Mains level: Adulteration issues in India;
Why in the News?
The ghee samples used by ‘Tirumala Tirupati Devasthanams’ for ritual offerings and ‘Laddu Prasadam’ were found to contain foreign fats, including fish oil, beef tallow, and lard, as per the NDDB’s analysis report.
What did the ALF of the National Dairy Development Board find in the Tirupati laddus?
- The Centre for Analysis and Learning in Livestock and Food (CALF) of the National Dairy Development Board found that ghee samples supplied to the Tirumala Tirupati Devasthanams (TTD) for preparing laddus were adulterated with various fats.
- Adulterants detected included:
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- Plant-based fats: soybean, sunflower oil, rapeseed oil, linseed, wheat germ, maize germ, cotton seed, coconut, and palm kernel fat.
- Animal-based fats: fish oil, beef tallow, and lard (pig fat).
Existing Laws:
Implementation Gaps:
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Why maintaining a good baseline data (specific to Indian conditions) is necessary?
- Biological Variation in Indian Cows: Baseline data specific to Indian cows is needed for accurate results. Indian cows may have different genetic and biochemical profiles compared to European cows, meaning the existing international standards for detecting adulteration (like the ‘s-values’) may not accurately reflect the composition of Indian cow ghee.
- Adulterants Unique to Local Conditions: The types of adulterants commonly used in India, such as certain vegetable oils or animal fats, may differ from those in other regions. Establishing baseline data for Indian adulterants would improve the precision of detecting the specific types of foreign fats used in India.
- Accurate Interpretation of Results: Without specific data on the composition of Indian cow ghee, it becomes difficult to interpret the results from methods like gas chromatography. Customized baseline data ensures that the detection methods yield accurate and meaningful conclusions in the Indian context.
Way forward:
- Strengthen Enforcement Mechanisms: Increase resources for testing facilities and train personnel to implement FSSAI standards more effectively, ensuring regular checks for sophisticated adulteration.
- Develop India-Specific Testing Protocols: Create testing standards based on baseline data specific to Indian cows and local adulterants to improve accuracy in detecting food adulteration.
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Hepatitis E Virus (HEV)
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Hepatitis E Virus (HEV)
Why in the News?
Recent research indicates that pigs may act as a transmission vehicle for a strain of the hepatitis E virus (HEV) commonly found in rats, known as Rocahepevirus ratti, or rat HEV.
Role of Pigs in Transmission
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About Hepatitis E Virus (HEV):
- Hepatitis E is caused by the Hepatitis E Virus (HEV), which is a positive-sense, single-stranded, non-enveloped RNA virus.
- HEV is classified under the family Hepeviridae, genus Orthohepevirus.
- It was first identified during an outbreak among Soviet soldiers in Afghanistan in 1983.
- The earliest well-documented HEV epidemic occurred in New Delhi, India, in 1955, retrospectively identified as HEV.
- Transmission:
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- The primary route of transmission is fecal-oral, especially through contaminated water and food.
- Zoonotic transmission is possible with genotypes 3 and 4, commonly spread through undercooked meat or direct animal contact.
- Symptoms:
-
- Jaundice, nausea, fatigue, and elevated liver enzymes.
- Severe cases can lead to liver failure, especially in pregnant women and immunocompromised individuals.
- Prevention and Cure:
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- A vaccine, HEV 239, is approved for use in China, but no vaccine is widely available or approved in most countries, including the United States.
- There is no specific antiviral treatment for acute HEV.
- Prevention relies on improved sanitation, safe drinking water, and proper food handling.
PYQ:[2019] Which one of the following statements is not correct? (a) Hepatitis B virus is transmitted much like HIV. (b) Hepatitis B, unlike Hepatitis C, does not have a vaccine. (c) Globally, the number of people infected with Hepatitis B and C viruses are several times more than those infected with HIV. (d) Some of those infected with Hepatitis B and C viruses do not show the symptoms for many years. |
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Arogya Sanjeevani Policy
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Arogya Sanjeevani Policy
Why in the News?
The “Arogya Sanjeevani Policy” serves as a reference point for choosing health insurance for hospitalisation.
About Arogya Sanjeevani Policy:
| Details | |
| Launch Date | April 2020 |
| Issued by | Insurance Regulatory and Development Authority of India (IRDAI) |
| Objective | To provide basic and affordable health insurance coverage to all citizens |
| Sum Insured | ₹1 lakh to ₹5 lakh per policy year |
| Coverage | Hospitalization, pre and post-hospitalization expenses, daycare procedures, AYUSH treatments, COVID-19 coverage |
| Pre-Existing Conditions | Coverage after 4 years of continuous policy renewal |
| Co-Payment | 5% co-payment on all claims |
| Premium | Varies based on age, sum insured, and insurer |
| Waiting Period | 30 days for new policies; 48 months for pre-existing diseases |
| Daycare Procedures | Covers over 50+ daycare treatments |
| Room Rent Limit | Up to 2% of the sum insured per day (maximum ₹5,000 per day) |
| ICU Room Rent | Up to 5% of the sum insured per day (maximum ₹10,000 per day) |
| AYUSH Treatments | Covers Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy treatments |
| Maternity Coverage | Not covered |
| Network Hospitals | Cashless facility in network hospitals |
| Eligibility | Individuals aged 18 to 65 years |
PYQ:[2019] Performance of welfare schemes that are implemented for vulnerable sections is not so effective due to the absence of their awareness and active involvement at all stages of the policy process – Discuss. |
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Amoebic Meningoencephalitis
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Primary Amoebic Meningoencephalitis (PAM); Naegleria fowleri.
Why in the News?
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- This year, Kerala faced a sudden surge in Amoebic Meningoencephalitis cases, caused by free-living amoebae (FLA) found in freshwater ponds, lakes, and rivers.
- Kerala also saw a diverse range of amoebic infections, caused by Naegleria fowleri, Vermamoeba vermiforis, and Acanthamoeba.
What is Primary Amoebic Meningoencephalitis (PAM)?
- PAM is caused by the Naegleria fowleri, often referred to as the “brain-eating amoeba“. It destroys brain tissue, causing severe swelling and is fatal in most cases.
- An amoeba is a type of cell or unicellular organism with the ability to alter its shape, primarily by extending and retracting pseudopods.
- Higher temperatures of up to 115°F (46°C) are conducive to its growth and it can survive for short periods in warm environments.
- The amoeba enters the body through the nose, typically during activities like swimming, and travels to the brain, causing severe damage.
- PAM is also non-communicable.
- Symptoms: Headache, fever, nausea, vomiting, stiff neck, confusion, seizures, hallucinations, and coma.
- According to the US Centers for Disease Control and Prevention (CDC), most people with PAM die within 1 to 18 days after symptoms begin. It usually leads to coma and death after 5 days.
Diagnosis and Treatment:
- Currently, there are no established effective treatments for PAM.
- Diagnosis involves PCR tests of cerebrospinal fluid, though detection can be challenging due to the rarity of PAM.
- Treatment follows CDC guidelines, including miltefosine, Azithromycin, and Amphotericin B, with miltefosine recently procured by the State Health Department from Germany.
- Medical interventions typically involve a combination of drugs, including amphotericin B, azithromycin, fluconazole, rifampin, miltefosine, and dexamethasone.
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Cabinet approves ₹5 lakh Health Cover for Senior Citizens
Note4Students
From UPSC perspective, the following things are important :
Prelims level: AB PM-JAY and its beneficiaries
Why in the News?
The Union Cabinet has approved health coverage of ₹5 lakh for all senior citizens aged 70 years and above, regardless of their income, under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
About Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)
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Eligibility Criteria:
- All senior citizens aged 70 and above are eligible for the scheme, receiving a ₹5 lakh health cover on a family basis.
- Additional Benefits:
-
- Senior citizens belonging to families already under AB PM-JAY will get an extra top-up of ₹5 lakh, exclusively for their personal healthcare.
- Those with private health insurance can also avail of the scheme.
- Senior citizens covered under other public health insurance schemes, like CGHS, ECHS, or CAPF, must choose between their current plan and AB PM-JAY.
- All eligible beneficiaries will be issued a distinct health card for easy access to the scheme’s benefits.
PYQ:[2012] With reference to National Rural Health Mission, which of the following are the jobs of Asha, a trained community health worker? 1. Accompanying women to the health facility for antenatal care checkups 2. Using pregnancy test kits for early detection of pregnancy 3. Providing information on nutrition and immunization 4. Conducting the delivery of baby Select the correct answer using the codes given below: (a) 1, 2 and 3 only (b) 2 and 4 only (c) 1 and 3 only (d) 1, 2, 3 and 4 |
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The grave threat from AMR
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Antimicrobial resistance;
Mains level: Reason behind the AMR Increasing;
Why in the News?
Ahead of the UN General Assembly High-Level Meeting on antimicrobial resistance, WHO published its first-ever guidance on Antibiotic pollution from manufacturing.
Common Pathogens Found in IndiaThe three most common pathogens associated with antimicrobial resistance (AMR) in India, as reported by the Indian Council of Medical Research (ICMR), are:
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What is Antimicrobial Resistance (AMR) and Why is it a Cause for Concern?
- Antimicrobial resistance (AMR) occurs when pathogens evolve to survive despite the presence of antimicrobial drugs, rendering standard treatments ineffective. This situation arises mainly due to the misuse and overuse of antibiotics, leading to the development of resistant strains or “superbugs.”
- According to the WHO, emergence and spread of AMR could significantly undermine the effectiveness of antibiotics globally, impacting healthcare outcomes, especially for patients with multiple diseases.
Why is AMR Increasing?
Several factors contribute to the increasing rates of AMR in India:
- Self-medication: Many individuals self-prescribe antibiotics for conditions like fever without proper medical consultation, often for viral infections where antibiotics are ineffective.
- Prescribing habits: A significant percentage of antibiotics are prescribed not for treating infections but for prevention. Doctors often resort to broad-spectrum antibiotics without conducting necessary diagnostic tests, leading to inappropriate usage.
- Lack of regulation: The management of pharmaceutical waste from antibiotic manufacturing is largely unregulated, contributing to environmental pollution and the spread of resistant bacteria.
What needs to be done?
- Prevention of Infections: Implementing better hygiene practices, improving sanitation, and promoting vaccinations can help reduce the incidence of infections, thereby decreasing the reliance on antibiotics.
- Education for Healthcare Providers: Train doctors to prescribe antibiotics judiciously, reserve stronger antibiotics for hospital patients, and emphasise the importance of diagnostic testing, which can help ensure appropriate antibiotic use.
- Regulatory Improvements: Strengthening regulations around antibiotic manufacturing and waste management is crucial for controlling antibiotic pollution and preventing the emergence of resistant strains.
Mains PYQ:
Q Can overuse and free availability of antibiotics without Doctor’s prescription, be contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved. (UPSC IAS/2016)
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Policy paralysis, a weakened public health sector
Note4Students
From UPSC perspective, the following things are important :
Mains level: Issues in the health sector
Why in the News?
Primary care remains underdeveloped, while the private sector has seen significant growth in secondary and tertiary care.
What are the major necessities in Public Health?
- Diseases of Poverty: This includes health issues predominantly affecting the poor and vulnerable populations, such as tuberculosis, malaria, undernutrition, maternal mortality, and illnesses caused by food and water-borne infections like typhoid and diarrheal diseases.
- Addressing these needs is critical not only from a health perspective but also as a matter of human rights.
- Middle-Class Health Concerns: The second category focuses on health issues related to environmental pollution, including air and water quality, waste management, and food safety.
- These issues are often exacerbated by inadequate infrastructure and poor market regulations, leading to chronic illnesses and road traffic accidents.
- Curative Care Needs: The most visible public health needs are those related to curative care, which is divided into three levels: primary, secondary, and tertiary care.
- The poor often rely on public primary health care for affordable services, while secondary care remains historically neglected.
- Tertiary care is primarily addressed through government schemes like the Pradhan Mantri Jan Arogya Yojana (PMJAY) under Ayushman Bharat, aimed at providing coverage for serious health issues.
How do the private hospitals become a real beneficiary in present times?
- Limited Coverage: India’s health insurance primarily covers only hospitalisation expenses, leaving out outpatient and primary care services. This benefits private hospitals as they can monopolise high-cost medical treatments, while the larger uninsured population faces commercialised care at market rates.
- Weakening of Public Health Sector: The government’s shift in focus from strengthening public sector health care to outsourcing via insurance schemes like PMJAY indicates a failure to build adequate secondary and tertiary public health services.
Threats to Public Healthcare:
- Neglect of Secondary and Tertiary Care: The inadequate investment in strengthening secondary- and tertiary-level health care in the public sector, leads to a reliance on private hospitals.
- Transformation of Primary Health Centres (PHCs) and Sub-centres: The conversion of sub-centres and PHCs into Health and Wellness Centres (HWCs) has undermined their original role in preventive and promotive health care.
- Loss of Trust in Public Healthcare: Due to overcrowding, poor infrastructure, and inadequate funding, public health institutions are losing credibility. Coupled with the commercial interests of private providers, this creates a dual crisis of access and quality in the healthcare system.
- Rebranding of Health Centres: The recent renaming of HWCs as “Ayushman Arogya Mandirs” raises concerns about cultural relevance and secularism in public health institutions, especially for non-Hindi-speaking populations, further undermining trust in the system.
Way forward:
- Strengthen Public Healthcare Infrastructure: Invest in enhancing secondary and tertiary care facilities in the public sector to reduce dependence on private hospitals.
- Integrate Health Insurance and Primary Care: Expand health insurance coverage to include outpatient and primary care services, and ensure that public health centers retain their focus on preventive and promotive care.
Mains PYQ:
Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
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Crime, health-worker safety, and a self-examination
Note4Students
From UPSC perspective, the following things are important :
Mains level: Issues in the healthcare sector;
Why in the News?
- The recent brutal rape and murder case in Kolkata has sparked widespread calls for the death penalty for the accused.
- The Justice J.S. Verma Committee, formed in response to the 2012 Delhi gang rape, recommended against the death penalty for rape, even in the rarest of rare cases, arguing that it would be a regressive step.
Deeper problem in the Health Care Sector:
What does the Justice K. Hema Committee report say on the Culture of Assault?
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Need to Rethink Violence in Healthcare:
- Understanding the Multi-faceted Nature of Violence: Violence in healthcare settings is not limited to patient assaults on healthcare workers, it also includes institutional and managerial violence. This encompasses horizontal violence among healthcare providers and the systemic issues that create a hostile work environment.
- Implementing Comprehensive Safety Measures: While immediate responses such as improving security and legal protections are necessary, they must be part of a broader strategy that includes training healthcare workers on conflict resolution, mental health support, and creating a culture of safety within healthcare institutions.
About Justice J.S. Verma Committee Recommendations
Recommendations on |
Explanation |
| Rape | • It recognized rape as a Crime of Power, not just passion. • Expand definition to include all forms of non-consensual penetration. • Remove marital rape exception; marriage should not imply automatic consent. (European Commission of Human Rights in C.R. vs U.K) |
| Sexual Assault | • Broaden definition to include all non-consensual, non-penetrative sexual acts. • Penalty: Up to 5 years of imprisonment or fines. |
| Verbal Sexual Assault | • Criminalize unwelcome sexual threats. • Punishable by up to 1 year in prison or fines. |
| Sexual Harassment at Workplace | • Include domestic workers under protections. • Replace internal complaint committees with Employment Tribunals. • Employers to compensate victims of sexual harassment. |
| Acid Attacks | • Propose a 10-year minimum punishment, separate from grievous hurt. • Establish a compensation fund for victims. |
| Women in Conflict Areas | • Review AFSPA; exclude government sanction for prosecuting sexual offenses by armed forces. • Appoint special commissioners to monitor offenses. |
| Trafficking | • Comprehensive anti-trafficking laws beyond prostitution. • Protective homes for women and juveniles overseen by High Courts. |
| Child Sexual Abuse | • Define ‘harm’ and ‘health’ in the Juvenile Justice Act to include both physical and mental aspects. |
| Death Penalty | • Opposed chemical castration and death penalty for rape. • Recommend life imprisonment. |
| Medical Examination of Rape Victims | • Ban the two-finger test; victim’s past sexual history should not influence the case. |
| Reforms in Case Management | • Set up Rape Crisis Cells, increase police accountability, allow online FIR filing. • Encourage community policing and increase police personnel. |
Need for a Comprehensive Approach:
- National Task Force: Improving hospital security and infrastructure alone may not be sufficient to address the problem. The national task force constituted by the Supreme Court should devise a comprehensive road map to prevent and arrest medical corruption, particularly in the public sector.
- Need Expertise: The task force should include experts from public health, medico-legal, and other allied fields, along with the participation of the larger governing and administrative community.
Note: Recently some states have taken steps to empower women. For example, the Himachal Pradesh Assembly passed a Bill on Tuesday to increase the minimum marriage age for women from 18 to 21 years.
Mains PYQ:
Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC CSE 2018)
Q We are witnessing increasing instances of sexual violence against women in the country. Despite existing legal provisions against it, the number of such incidences is on the rise. Suggest some innovative measures to tackle this menace. (UPSC CSE 2014)
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WHO investigating new Polio strain in Meghalaya
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Polio and its eradication
Why in the News?
The World Health Organization (WHO) is investigating a suspected new strain of polio in a two-year-old child from Tikrikilla, Meghalaya.
What is Vaccine-Derived Polio?
|
About Polio:
| Details | |
| Nature of Disease | Crippling and potentially deadly viral infectious disease affecting the nervous system. |
| Types of Poliovirus | – WPV1 (Wild Poliovirus type 1) – WPV2 (Wild Poliovirus type 2, eradicated globally) – WPV3 (Wild Poliovirus type 3, eradicated globally) |
| Current Status | WPV1 remains in circulation in Afghanistan and Pakistan. |
| Transmission | Primarily through the faecal-oral route or contaminated water/food. |
| Affected Population | Largely affects children under 5 years of age. |
| Impact | Virus multiplies in the intestine, may invade the nervous system, causing paralysis. |
| Prevention | – No Cure: Preventable through immunization. – Vaccines: – OPV: Oral Polio Vaccine given at birth, with doses at 6, 10, 14 weeks, and a booster at 16-24 months. – IPV: Injectable Polio Vaccine given with the 3rd dose of DPT under UIP. |
| India’s Status |
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PYQ:[2016] ‘Mission Indradhanush’ launched by the Government of India pertains to: (a) immunization of children and pregnant women (b) construction of smart cities across the country (c) India’s own search for the Earth-like planets in outer space (d) New Educational Policy |
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Do doctors need a Central protection Act?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Need for Central protection law for healthcare workers;
Why in the News?
Resident doctors across India are on strike, demanding safety laws after a young doctor was tragically raped and murdered at R.G. Kar Medical College in Kolkata on August 9.
Why are Healthcare Workers Protesting?
- Response to Violence: The protests were triggered by the brutal rape and murder of a young doctor at R.G. Kar Medical College and Hospital in Kolkata on August 9, 2024.
- Demand for Safety: Healthcare workers are demanding laws and measures that ensure their safety while on duty.
- Historical Context: Violence against healthcare workers is not a new issue in India. Previous incidents, such as the case of Aruna Shanbaug, a nurse who was sexually assaulted in 1973, underscore a long-standing pattern of violence in healthcare settings.
Working Conditions of Junior Doctors, Interns, and Nurses
- Poor Working Environment: Junior doctors, interns, and nurses often work in ill-lit and poorly secured hospital environments.
- Long Shifts and Exhaustion: Many healthcare workers, including the victim of the recent incident, are subjected to excessively long shifts—in this case, a 36-hour duty shift—without adequate rest or safe spaces to recuperate.
- Mental Health Concerns: The stressful working conditions, combined with the threat of violence, have raised significant concerns about the mental health and well-being of healthcare workers.
Key Demands of the Protesters
- Central Protection Act: The Indian Medical Association (IMA) is advocating for a Central protection law specifically for healthcare workers, similar to measures in other countries that classify assaults on medical staff as serious offenses.
- Enhanced Security Measures: Protesters are calling for hospital security protocols that match those of airports, including the installation of CCTV cameras, deployment of security personnel, and improved lighting in hospital corridors and wards.
- Safe Work Environment: There is a demand for immediate systemic reforms to improve working conditions, including better security arrangements and the establishment of healthcare facilities as safe zones.
- Accountability and Justice: The IMA has requested a thorough investigation into incidents of violence against healthcare workers, with a focus on timely and professional handling of cases and ensuring that perpetrators face exemplary punishment.
- Government Response: Following the protests, the Ministry of Health and Family Welfare issued an order mandating that any violence against healthcare workers must be reported and acted upon swiftly, with institutional FIRs to be filed within six hours of an incident.
Sole responsible for the safety of Health workers:
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Way forward:
- Implement a Central Protection Law for Healthcare Workers: The government should fast-track the enactment of a Central law specifically designed to protect healthcare workers from violence.
- Improve Working Conditions and Mental Health Support: Hospitals should prioritize creating safe and well-secured environments for healthcare workers, including reasonable shift hours, adequate rest periods, mental health support, and robust security protocols to prevent future incidents of violence.
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Freedom from dependence, a new era in health care
Note4Students
From UPSC perspective, the following things are important :
Mains level: Challenges in the Indian healthcare system;
Why in the News?
India’s healthcare since globalization has improved greatly, and is globally recognized due to skilled professionals, effective policies, and strong institutions which draw patients from over 147 countries.
Economic implications of being a preferred Medical Destination:
- Foreign Exchange Savings: India saves billions in foreign exchange as fewer Indians need to travel abroad for advanced medical treatments.
- Revenue Generation: The influx of international patients generates over $9 billion annually, contributing to economic growth.
- Job Creation: The medical tourism sector creates employment opportunities in healthcare, hospitality, transportation, and pharmaceuticals.
- Cost-Effective Treatments: India’s affordable yet high-quality medical services attract patients globally, further boosting the economy.
What are the challenges?
- Shortage of Healthcare Professionals
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- Current Shortage: India is estimated to be short of around 600,000 doctors, leading to a doctor-patient ratio of approximately 0.7 doctors per 1,000 people, which is significantly lower than the World Health Organization’s recommended ratio of 1 doctor per 1,000 people.
- Future Demand: By 2030, the demand for healthcare professionals in India is expected to double, driven by an ageing population and the increasing burden of non-communicable diseases.
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- Inadequate Public Healthcare Spending
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- Low Expenditure: As of 2021-22, India’s public healthcare expenditure stood at 2.1% of GDP, which is significantly lower than that of many developed countries, For instance, countries like Japan and France spend about 10% of their GDP on healthcare, while the United States spends 16.9%.
- Comparison with Neighbors: Even neighbouring countries like Bangladesh and Pakistan allocate over 3% of their GDP to public healthcare.
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- Unequal Access to Healthcare
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- Urban-Rural Disparity: There is a stark disparity in healthcare access between urban and rural areas. Rural regions often lack basic healthcare facilities, leading to limited access to quality services for a significant portion of the population.
- Healthcare Infrastructure: India’s healthcare infrastructure is inadequate to meet the growing demands of its population. For instance, India has one of the lowest per capita bed counts in the world, with only about 0.5 hospital beds per 1,000 people, compared to the OECD average of 4.7 beds per 1,000 people.
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- High Out-of-Pocket Expenditure
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- Financial Burden: Approximately 75% of healthcare expenditure in India is borne out-of-pocket by individuals and families.
Need for a Strong Vision (Way forward)
- “Heal in India” Initiative: The Prime Minister’s vision of “Heal in India” emphasizes positioning India as a global healthcare leader. This initiative is not merely a slogan but a strategic approach to enhance India’s reputation as a preferred medical destination.
- Youth Engagement: Inspiring the youth to pursue careers in healthcare is crucial for sustaining growth in this sector. By encouraging innovation and entrepreneurship among young Indians, the country can ensure a robust healthcare system.
- Investment in Public Healthcare: Increase public healthcare spending to improve infrastructure, especially in rural areas, and bridge the urban-rural disparity.
- Focus on Medical Device Manufacturing: Promote domestic production of medical devices under the “Make in India” initiative to reduce dependency on imports.
Mains PYQ:
Q Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)
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WHO declares Mpox as Public Health Emergency of International Concern
Note4Students
From UPSC perspective, the following things are important :
Prelims level: PHEIC, Mpox
Why in the news?
The World Health Organization (WHO) has declared mpox as a “public health emergency of international concern” (PHEIC).
What is a PHEIC?
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What is Mpox?
- Mpox is a disease caused by the orthopoxvirus, related to the smallpox virus.
- First detected in humans in 1970, it is endemic in central and West Africa.
- Transmission: Spread from animals to humans (zoonotic) and between humans via close contact, respiratory droplets, or contaminated materials.
- Symptoms: Fever, rash, swollen lymph nodes; can lead to severe complications or death.
- Vaccination: WHO recommends vaccines, widely used in Nigeria and the Democratic Republic of the Congo (DRC) to control outbreaks.
Recent Developments:
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PYQ:[2014] Consider the following diseases 1. Diphtheria 2. Chickenpox 3. Smallpox Which of the above diseases has/have been eradicated in India? (a) 1 and 2 only (b) 3 only (c) 1, 2 and 3 (d) None |
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Hidden dangers of irrational use of antibiotics on microbiome
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Antibiotics resistance;
Mains level: Concerning aspects of Antibiotic use;
Why in the news?
While vital for treating infections, antibiotics can disrupt the microbiome by indiscriminately killing both harmful pathogens and beneficial gut bacteria, especially broad-spectrum types.
Various roles played by Antibiotics (Applications):
Treatment of Infections |
Antibiotics are essential for treating bacterial infections, significantly reducing mortality rates associated with infectious diseases |
For example, penicillin and other antibiotics, the mortality rate from strep throat dropped dramatically from 1% to less than 0.1%. |
Preventing Disease Spread |
Treating bacterial infections, antibiotics can prevent the spread of disease to other individuals |
For instance, during the 2009 H1N1 influenza pandemic, antibiotics were used to treat secondary bacterial pneumonia, which was a major cause of death. |
Reducing Complications |
Antibiotics can reduce the risk of serious complications from bacterial infections. |
For instance, In the case of urinary tract infections (UTIs), untreated infections can lead to kidney damage or life-threatening conditions like sepsis. However, with prompt antibiotic treatment, the risk of complications is greatly reduced |
Supporting Medical Procedures |
Antibiotics are used prophylactically to prevent infections before certain medical procedures |
For example in surgery |
Concerning Aspects of Antibiotic Use
- Dysbiosis: The disruption of the microbiome, known as dysbiosis, can lead to severe health issues, including inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).
- Increased Infection Risk: Antibiotics can reduce colonization resistance, which is the microbiome’s ability to prevent pathogenic microorganisms from establishing infections. This reduction increases the risk of infections by harmful bacteria, such as Clostridioides difficile.
- Antimicrobial Resistance (AMR): Overuse of antibiotics contributes to the development of antimicrobial resistance, making it more challenging to treat infections. The global crisis of antibiotic resistance is exacerbated by the enrichment of antibiotic resistance genes within the gut microbiota due to antibiotic exposure.
- Long-term Health Consequences: Repeated antibiotic use can prevent full recovery of the microbiome, leading to chronic health issues. Research shows that children who receive multiple courses of antibiotics are at higher risk for developing conditions like IBD later in life.
- Impact on Other Organ Systems: Dysbiosis can affect various organ systems through gut-organ axes, influencing conditions such as mental health disorders (via the gut-brain axis), liver diseases (via the gut-liver axis), and skin conditions (via the gut-skin axis) due to altered immune responses and increased permeability.
Government initiatives:
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Way forward:
- Antibiotic Stewardship Programs: Implement and promote antibiotic stewardship programs in healthcare settings to ensure antibiotics are prescribed only when necessary and with the appropriate dosage and duration.
- Probiotic Supplementation: Encourage the use of probiotics alongside antibiotic treatments to help maintain a healthy microbiome and mitigate the risks of dysbiosis and related health issues.
Mains PYQ:
Q Can overuse and free availability of antibiotics without Doctor’s prescription, be contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved. (2014)
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Why Silica Dust could become the ‘New Asbestos’ Health Risk?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Silicosis and its health implications
Why in the News?
UK researchers suggest stricter daily silica dust exposure limits in industries could save 13,000 lives as per British Medical Journal Thorax.
What is Silicosis?
- Silicosis is a lung disease that results in the hardening of the lungs. It is caused by inhaling silica dust or crystals, commonly found in soil, sand, concrete, mortar, granite, and artificial stone.
- Silicosis is a chronic disease that develops slowly, often after 10 to 20 years of exposure.
- Silicosis can lead to other severe conditions, including lung cancer, tuberculosis, and chronic obstructive pulmonary disease (COPD).
| Note: Silicosis is a recognized disease under the Mines Act (1952) and the Factories Act (1948). |
Causes of Silicosis:
- Workers in industries such as construction, mining, oil and gas extraction, kitchen engineering, dentistry, pottery, and sculpting are at high risk.
- The cutting, drilling, or breaking down of materials containing silica releases fine dust into the air.
As per National Programme on Elimination of Silicosis in India
Remedies for Silicosis:
Currently, there is no cure for silicosis, and treatment focuses on managing symptoms and preventing complications.
Preventive measures:
- Water Suppression Techniques: Using water or foam to suppress dust at the source.
- Proper Ventilation: Ensuring adequate airflow in work environments to reduce dust accumulation.
- Personal Protective Equipment (PPE): Providing workers with masks and respirators that filter out fine particles.
- Regular Monitoring: Implementing regular health checks for workers and monitoring air quality in workplaces.
Case study related to reducing Silica Dust Exposure
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PYQ:[2019] Why is there a great concern about the ‘microbeads’ that are released into environment? (a) They are considered harmful to marine ecosystems. (b) They are considered to cause skin cancer in children. (c) They are small enough to be absorbed by crop plants in irrigated fields. (d) They are often found to be used as food adulterants. |
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Trichophyton indotineae: A drug resistant fungal infections
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Trichophyton indotineae
Why in the News?
The increase in drug-resistant fungal infections, especially Trichophyton indotineae, is becoming a major health problem in India.
What Is Trichophyton Indotineae?
- Trichophyton indotineae is a dermatophyte commonly known as ringworm or jock itch.
- First identified in India, this fungus has now spread to several countries worldwide.
- It belongs to genotype VIII within the T. mentagrophytes/T. interdigitale species complex, found in regions including Australia and Oman.
Factors causing its spread
- Patients often present with persistent, treatment-resistant rashes that can be mistaken for eczema or other skin conditions.
- Misdiagnosis leads to the use of ineffective treatments, prolonging patient suffering and allowing the infection to worsen.
- Trichophyton indotineae has shown resistance to terbinafine due to genetic mutations, with growing resistance to itraconazole also a concern.
- The unregulated sale of steroid-containing combination creams further complicates treatment efforts.
Treatments available
- Alternative to terbinafine and Itraconazole are available but often come with significant side effects, requiring close monitoring by healthcare providers.
- Integrating comprehensive skin care regimens can enhance treatment efficacy, including maintaining skin hydration and using barrier creams.
PYQ:[2014] Lichens, which are capable of initiating ecological succession even on a bare rock, are actually a symbiotic association of: (a) algae and bacteria (b) algae and fungi (c) bacteria and fungi (d) fungi and mosses |
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A Budget that places health on the margins
Note4Students
From UPSC perspective, the following things are important :
Prelims level: About PMJAY
Mains level: Challenges to the Inclusivity of PMJAY
Why in the news?
- With the worst of the COVID-19 pandemic behind us (though the World Health Organization warns the virus still lingers), the Union Budget shifted focus to economic growth levers like infrastructure and employment.
- It was also hoped that recognizing population health as crucial for economic growth would lead to continued investment in strengthening health systems.
| A budget estimate refers to the initial allocation of funds designated for various programs, departments, or projects within a fiscal year. It represents the government’s expectations regarding how much money will be required to meet planned expenditures.
In contrast, revised estimates come into play later in the fiscal year. After assessing the actual expenditures and needs after the first six months, the government may adjust the initial budget estimates based on how much of the allocated funds have been utilised and what additional resources may be necessary. |
Comparisons with Previous Years
- Budgetary Estimates: The comparison of the Budget Estimates (BE) for health between 2023-24 and 2025-25, reveals minimal increases:
- Overall Health Ministry Budget: 1.98% increase
- National Health Mission (NHM): 1.16% increase
- PMJAY: 1.4% increase
- Overall Health Ministry budget: The present allocation made in the current Budget is deemed to be inadequate for expanding health coverage services and enhancing the impact of flagship health programs, particularly in light of rising non-communicable diseases and the goal of universal health coverage by 2030.
- Misleading Comparisons: When we compare the Budget estimates with the previous Revised estimates (RE) the budgetary increase of nearly 12% is misleading, as the RE reflects actual spending rather than the program’s needs.
Missed Opportunities
- Health Workforce Development: While the budget mentioned an increase in new medical colleges, it failed to address the critical need for a multi-layered, multi-skilled health workforce.
- Drug Pricing Mechanisms: Although customs duties were waived on three anti-cancer drugs. However, the budget missed the chance to implement price controls and pooled procurement strategies that could have lowered drug costs across both public and private healthcare sectors. Establishing such mechanisms could enhance the affordability and accessibility of essential medications.
- Climate-Resilient Agriculture: While the budget committed to climate-resilient agriculture, which is crucial for food security, it did not sufficiently link these efforts to health outcomes, such as nutrition and public health, which are critical in the context of rising health challenges.
Challenges to the Inclusivity of PMJAY
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Way forward:
- Targeted Funding for Flagship Programs: Need to allocate a more substantial increase in the budget for the National Health Mission (NHM) and Pradhan Mantri Jan Arogya Yojana (PMJAY) to the eradication of non-communicable diseases, tuberculosis elimination by 2025.
- Strengthen Primary Healthcare: Govt. should ensure adequate funding for primary healthcare services, which form the foundation for preventive and community health initiatives.
Mains PYQ:
Q The 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? (2015)
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Why are dengue cases on the rise worldwide?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: How dengue spread?
Mains level: Are urbanisation and climate change fuelling dengue spread in the world?
Why in the news?
In recent weeks, there has been an increase in dengue cases, notably in Karnataka, with rising numbers also observed in Kerala and Tamil Nadu.
What is the global situation of dengue?
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Are urbanisation and climate change fuelling dengue spread in the world?
Urbanization:
- Increased Population Density: Urban areas provide optimal conditions for the Aedes aegypti mosquito due to the availability of breeding sites like stagnant water in containers, tires, and other urban infrastructure.
- Expansion of Cities: Rapid urbanization leads to unplanned growth, inadequate waste management, and inadequate water supply, creating breeding grounds for mosquitoes.
- Human Movement: Urbanization facilitates increased human mobility, enabling the spread of the dengue virus through infected individuals travelling between urban centers.
Climate Change:
- Temperature and Rainfall Patterns: Warmer temperatures and altered rainfall patterns associated with climate change create favourable conditions for mosquito breeding and survival.
- Shifts in Geographic Distribution: Changing climate allows Aedes mosquitoes to expand their range to new regions previously unaffected by dengue, including temperate climates.
- Extreme Weather Events: Increased frequency and intensity of extreme weather events like hurricanes and floods provide breeding opportunities for mosquitoes and facilitate virus transmission.
Impact:
- Health Impact: India accounts for an estimated 33 million clinically apparent dengue cases each year, contributing to a third of the global dengue burden
- Economic Impact: A cost analysis study in southern India estimated the direct medical costs per hospitalized dengue patient at around ₹20,000 in 2017-18, with costs soaring to over ₹61,000 for complications requiring intensive care.
- Impact on Individuals: Dengue can cause a wide spectrum of illness, from mild flu-like symptoms to severe complications like internal bleeding, organ impairment, and potentially death if not treated promptly.
Way forward:
- Enhance Urban Infrastructure: Improve urban planning to include effective waste management, regular clearing of stagnant water sources, and sustainable water supply systems to reduce mosquito breeding grounds.
- Public Awareness Campaigns: Launch comprehensive public awareness campaigns focusing on urban populations to promote community involvement in mosquito control measures and encourage responsible waste disposal practices.
Mains PYQ:
Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
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Breaking the taboo around men’s reproductive health
Note4Students
From UPSC perspective, the following things are important :
Prelims level: World Health Organization (WHO)
Mains level: Data related to infertility and What are the actual causes of infertility?
Why in the news?
Following World Population Day (July 11), amidst discussions on global population dynamics, it is essential to highlight a topic often overlooked in conversations about reproductive health: male infertility.
World Health Organization (WHO) Global Perspective on infertility:
- Prevalence: WHO estimates that 60 million to 80 million couples worldwide experience infertility.
- Male vs. Female Infertility: Globally, male infertility accounts for approximately 50% of all infertility cases.
Issues Specific to India:
- Data Deficiency: Unlike global estimates, specific prevalence data for infertility in India are outdated (from ICMR guidelines in 2005) and not comprehensive.
- Male Infertility: In India, male infertility constitutes a significant portion of all infertility cases, estimated to be around 50%, mirroring global trends.
- Contributing Factors: Unique challenges in India include environmental pollution, pesticide exposure in agriculture, lifestyle changes including late marriages and stress, which contribute to rising infertility rates.
- Access to Treatment: Disparities in access to advanced infertility treatments exist, with urban areas having better access compared to rural regions.
- Cultural and Social Stigma: Infertility remains stigmatized in Indian society, affecting mental health and social well-being of affected couples, and hindering open discussions and seeking timely medical help.
What are the actual causes of infertility?
- Male Factors: Low sperm count (oligospermia) or poor sperm motility (asthenozoospermia). Anatomical issues such as blocked sperm ducts or varicocele. Hormonal imbalances, genetic factors, and environmental influences like exposure to toxins.
- Female Factors: Ovulation disorders, including hormonal imbalances like PCOS. Structural issues like blocked fallopian tubes or uterine abnormalities. Endometriosis, is a condition where tissue similar to the lining of the uterus grows outside the uterus.
- Shared Factors: Age-related decline in fertility. Lifestyle factors such as smoking, excessive alcohol consumption, and obesity. Medical conditions like cancer and its treatments, autoimmune disorders, and certain medications affecting fertility.
Treatment options
- Semen Analysis: Essential for diagnosing male infertility, conducted after a period of sexual abstinence.
- Medical Consultation: Vital to identify underlying causes, whether physical (e.g., blocked sperm flow, anatomical issues) or genetic.
- Corrective Surgeries: Address issues like blocked sperm ducts, undescended testicles, or anatomical abnormalities affecting sperm production and flow.
Assisted Reproductive Technologies (ART):
- Intra Cytoplasmic Sperm Injection (ICSI): Effective for cases of severe male infertility where sperm count is extremely low.
- Intrauterine Insemination (IUI): Suitable when sperm motility is good but count is low, facilitating fertilization within the uterus.
- In vitro Fertilisation (IVF): Used when both sperm count and motility are low, involving fertilization outside the body before implantation.
- Donor Sperm Insemination or Adoption: Options for couples where male infertility is irreparable, providing alternative paths to parenthood.
Way forward:
- Enhanced Data Collection and Research: Update and expand prevalence data on infertility in India through national surveys and research initiatives. This should include both urban and rural populations to understand regional disparities.
- Public Awareness and Support Programs: Launch nationwide campaigns to raise awareness about infertility as a medical condition, debunk myths, and reduce stigma.
Mains PYQ:
Q In order to enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss. (UPSC IAS/2020)
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Indigenous HPV vaccine, the rhetoric and the reality
Note4Students
From UPSC perspective, the following things are important :
Prelims level: About human papilloma virus (HPV)
Mains level: Present trends of cervical cancer prevalence in India and the Globe
Why in the news?
Recent discourse suggests HPV vaccination prevents cervical cancer, but evidence linking HPV to cancer is inconclusive and most infected individuals don’t develop cancer, raising doubts about vaccine necessity.
What is Cervical Cancer?
Cervical cancer is a type of cancer that starts in the cells lining the cervix, which is the lower part of the uterus that connects to the vagina. It is usually a slow-growing cancer that may not have symptoms in its early stages.
Present trends of cervical cancer prevalence in India and the Globe
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Recent debate – How does vaccination against HPV prevent cervical cancer and consequent death?
- Efficacy Against HPV Infection and Cervical Cancer: HPV vaccines target high-risk HPV types, notably types 16 and 18, which are responsible for a significant proportion of cervical cancer cases worldwide.
- Clinical trials and real-world data consistently demonstrate the effectiveness of HPV vaccines in reducing HPV infection rates and preventing cervical cancer.
- Public Health Impact and Benefits: Countries with high HPV vaccination coverage have observed significant declines in HPV infection rates and cervical cancer incidence among vaccinated populations.
- Vaccination programs aim to achieve herd immunity, thereby reducing overall transmission of HPV and protecting unvaccinated individuals.
- Debate and Challenges: Debate surrounds the universal versus selective vaccination strategies, with considerations on cost-effectiveness, accessibility, and cultural acceptance.
- Challenges include vaccine hesitancy, particularly in some regions, as well as affordability and logistical barriers to widespread vaccination coverage.
Challenges Prevalent in Vaccine Manufacturing
- Complex Manufacturing Processes: Vaccine manufacturing involves complex biological processes and stringent quality control measures.
- Developing and scaling up production requires specialized facilities and skilled personnel, which can be costly and time-consuming to establish.
- High Regulatory Standards: Vaccines are subject to rigorous regulatory scrutiny to ensure safety, efficacy, and consistency.
- Meeting regulatory requirements in multiple jurisdictions adds complexity and may delay the approval and market entry of new vaccines.
- Supply Chain and Distribution: Maintaining a reliable supply chain for vaccine components and ensuring cold chain storage and distribution are critical challenges.
- This becomes even more pronounced in resource-constrained settings or during global health emergencies where demand surges.
Its Impact on India
- Delayed Access to Affordable Vaccines: India’s capability to produce vaccines at scale is hindered by stringent patent laws and complex regulatory requirements.
- This delays the availability of affordable vaccines domestically, impacting public health initiatives and access for vulnerable populations.
- Economic and Health Implications: High costs associated with vaccine development and production limit affordability and accessibility, exacerbating healthcare inequalities.
- This affects India’s ability to address preventable diseases effectively, impacting public health outcomes and economic productivity.
Unavailability of Competing Vaccines and Future Scope
- Lack of Market Competition: Despite the expiration of earlier patents, there is a notable absence of competing HPV vaccines from domestic manufacturers in India.
- This limits options for consumers and healthcare providers, potentially leading to higher prices and reduced accessibility, particularly in the private market.
- Potential for Future Development: Several Indian biotech companies had announced plans to develop HPV vaccines, indicating a future scope for competition and potentially lower prices.
- However, these initiatives have not materialized into market-ready products, highlighting challenges in vaccine development and commercialization in India’s regulatory and economic environment.
Way forward:
- Promote Research and Development Incentives: Encourage and support Indian biotech companies through research grants, tax incentives, and streamlined regulatory pathways for HPV vaccine development.
- Enhance Public-Private Partnerships: Foster collaborations between government entities, academic institutions, and private-sector vaccine manufacturers to improve vaccine accessibility and affordability.
Mains PYQ:
Q What are the research and developmental achievements in applied biotechnology? How will these achievements help to uplift the poorer sections of the society? (UPSC IAS/2021)
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Scientists find proof that Pain-Sensing Cells are either Male or Female
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Nociceptors, Sexual dimorphism in pain perception
Why in the News?
Recent research has uncovered significant differences in how male and female nociceptors (pain receptors) are activated, paving the way for more precise, sex-specific pain management therapies.
About Pain and Differences in Perception:
- The International Association for the Study of Pain defines it as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
- Subjectivity: Pain perception is highly personal and varies among individuals.
- Scientific Findings: Recent research by the University of Arizona Health Sciences demonstrated functional sexual dimorphism in nociceptors, the nerve cells responsible for perceiving pain
Why do we perceive Pain?
- Role of Nociceptors: Nociceptors are nerve cells with bare endings found throughout the body. They detect extreme pressure, temperature, and chemical signals, converting them into electrical signals sent to the brain via the spinal cord.
- Activation Mechanism: Nociceptors in both men and women produce similar pain perceptions but are activated differently.
- Normally, they respond to high-intensity stimuli, but their activation threshold can decrease under certain conditions, causing low-intensity stimuli to trigger pain.
Nociceptor Response Threshold
- Gender Differences: Females generally have a lower nociceptor response threshold than males.
- Peripheral Nociceptor Sensitisation: External factors can lower the pain threshold, causing nociceptors to react to stimuli they would normally ignore.
The Old Vs New Study
- Previous research showed that the hormone prolactin increases pain responses in female rodents, while the neurotransmitter orexin B sensitized male rodents to pain.
- According to the New study, the Prolactin hormone increased nociceptor activation in female mice, while orexin-B had a similar effect in male mice. These findings were consistent across monkeys and humans.
- Nociceptors in males and females can be differentially sensitized, leading to varying pain thresholds.
Significance of this Pain Research
- Sex-Specific Pain Treatment: Current pain management often overlooks the patient’s sex, despite differences in pain conditions between men and women.
- Conditions like irritable bowel syndrome, migraines, and painful bladder syndrome are more common in women, while cluster headaches and gout are more frequent in men.
| PYQ:
[2021] What are the research and developmental achievements in applied biotechnology? How will these achievements help to uplift the poorer sections of the society? |
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Hepatitis A vaccination will be cost-effective in Kerala: study
Note4Students
From UPSC perspective, the following things are important :
Prelims level: About Hepatitis A, B, C ;
Mains level: Diseases and their successful case studies in Federal states;
Why in the News?
- Hepatitis A infection in Kerala is shifting from early childhood to adolescents and young adults due to better sanitation and hygiene practices.
- The inclusion of hepatitis A vaccination into the mainstream immunization program for both one-year-old children and 15-year-old individuals in Kerala shows cost-effectiveness and success.
Present State in Kerala and Overall India:
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About Hepatitis A infection:
- The infection is usually mild or asymptomatic in children under six years but can be symptomatic and severe in older children, adolescents, and adults, occasionally leading to liver injury and fatalities.
- India has recently launched its first indigenously developed hepatitis A vaccine, called Havisure:
- Havisure was launched in January 2024 by Indian Immunologicals Limited (IIL), a subsidiary of the National Dairy Development Board.
- IIL plans to manufacture up to 1 million doses of Havisure per year initially, focusing on the domestic market first.
| Types of Hepatitis | Cause | Vaccine |
| Hepatitis A (HAV) | Spread through ingestion of contaminated food or water. | Hepatitis A vaccine (e.g., Havrix, Vaqta) |
| Hepatitis B (HBV) | Spread through contact with infectious body fluids (blood, semen, etc.) | Hepatitis B vaccine (e.g., Engerix-B, Recombivax HB) |
| Hepatitis C (HCV) | Spread primarily through blood-to-blood contact, often via injection drug use or unsafe medical procedures. | No vaccine is available currently. Treatment focuses on antiviral medications |
| Hepatitis D (HDV) | Requires HBV as a co-infection to cause illness. | No specific vaccine for HDV. Prevention relies on hepatitis B vaccination. |
| Hepatitis E (HEV) | Spread through ingestion of contaminated water, similar to HAV | A vaccine is available in some regions (e.g., Hecolin in China), but not widely used. Prevention mainly involves improving sanitation and safe drinking water |
Benefits of Hepatitis A Vaccination in Kerala:
- Lifelong Immunity: Vaccination provides lifelong immunity against the hepatitis A virus, protecting individuals from severe infections and health complications later in life.
- Less Out-of-Pocket Expenditure: Studies have shown that vaccinating children aged one year and adolescents aged 15 years in Kerala using either live attenuated or inactivated vaccines is cost-effective.
- Vaccination prevents future healthcare expenditures associated with treating hepatitis A infections.
- Increase in Household savings: Implementing vaccination for adolescents could save Kerala ₹5,872 million to ₹10,553 million over five years, depending on the type of vaccine used.
- Equal and Universal Accessibility: Due to the inclusion in the universal immunization program, these vaccines are accessible throughout all sections of society, whether rich or poor.
Government Initiatives:
- National Viral Hepatitis Control Program (NVHCP): The Ministry of Health and Family Welfare launched the NVHCP in July 2018 to prevent and control viral hepatitis in India.
- The program aims to combat hepatitis and achieve country-wide elimination of hepatitis C by 2030, reduce morbidity and mortality associated with hepatitis B and C, and reduce the risk, morbidity, and mortality due to hepatitis A and E.
- State-Level Initiatives: Some states like Punjab, Assam, Manipur, Tripura, and Haryana have started free or subsidized hepatitis C treatment programs.
- Haryana launched its own Hepatitis Control Program in 2013 at PGIMS Rohtak, which was later expanded to all district civil hospitals in the state in 2017.
What is the Prime challenge?
- Achieving high vaccination coverage among adolescents, who are not covered under the universal immunization program, remains a challenge. Strategies such as school-based vaccination campaigns are proposed to enhance this kind of coverage.
Conclusion: Implement targeted vaccination campaigns in schools and communities to ensure high coverage among adolescents aged 15 years, who are not currently included in Kerala’s universal immunization program. This can be achieved through collaboration with schools, healthcare providers, and community organizations to raise awareness and facilitate easy access to vaccinations.
Mains PYQ:
Q What is the basic principle behind vaccine development? How do vaccines work? What approaches were adopted by the Indian vaccine manufacturers to produce COVID-19 vaccines? (UPSC IAS/2022)
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Issues with ‘mandir’ tag for Ayushman Health and Wellness Centres
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Ayushman Arogya Mandirs, AB-NHPM
Why in the News?
Following Mizoram and Nagaland, Meghalaya has also refused to rename its health and wellness centres as Ayushman Arogya Mandirs as per the Centre’s directive.
Context: Demographic composition of NE and its implications on policy decisions
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About Ayushman Bharat Health and Wellness Centres (AB-HWCs)
- AB-HWCs were launched to move away from selective health care to a more comprehensive range of services spanning preventive, promotive, curative, rehabilitative and palliative care for all ages.
- There are 1.6 lakh such centres across India under this initiative.
- The National Health Policy of 2017 envisioned these centres as the foundation of India’s health system.
- The Union Health Ministry renamed AB-HWCs as Ayushman Arogya Mandirs (AAM) with the tagline ‘Arogyam Parmam Dhanam’.
- States and Union Territories were urged to complete the rebranding by the end of 2023.
Back2Basics: Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY)
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| Health Benefit Package |
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| Nucleus Agency |
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PYQ:[2022] With reference to Ayushman Bharat Digital Mission, consider the following statements:
Which of the statements given above is/are correct? (a) 1 and 2 only (b) 3 only (c) 1 and 3 only (d) 1, 2 and 3 |
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An Ageing India: The Magnitude and the Multitude
Note4Students
From UPSC perspective, the following things are important :
Mains level: Magnitude and Multiplication of aged population
Why in the News?
The phenomenon of ageing stands out as one of the most significant developments of this century, characterized by notable advancements in human longevity alongside historically low reproduction rates.
About the Magnitude and Multiplication of the aged population
- The magnitude of Aging Population: The 21st century is witnessing a significant demographic shift marked by a notable increase in human longevity.
- Improved healthcare and living conditions have contributed to a rise in life expectancy, leading to a larger elderly population. By mid-century, India is projected to have around 319 million elderly people, growing at a rate of approximately 3% annually.
- Multiplication of Aging Phenomenon: Despite longevity gains, there is a simultaneous decline in fertility rates, leading to an ageing population with a lower proportion of younger generations.
- This demographic shift poses challenges related to healthcare, social security, and economic sustainability. The elderly population is becoming increasingly feminized, with a higher prevalence of elderly women due to longer life expectancy and higher widowhood rates.
Aged Population as per the 2011 Census:
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Issues and Challenges
- Vulnerabilities of the Elderly: Many elderly individuals in India face significant vulnerabilities, including limitations in activities of daily living (ADL), multi-morbidity, poverty, and lack of financial security.
- A substantial proportion of the elderly report poor health conditions, with a high prevalence of chronic diseases such as diabetes and cancer.
- Mental health issues, particularly depression, are also prevalent among the elderly population.
- Social and Economic Insecurities: Food insecurity affects a notable percentage of the elderly, with reports of reduced portions or skipped meals due to economic constraints.
- Lack of legal protection: Awareness and access to welfare measures and legal protections for the elderly are low, with limited knowledge about schemes like IGNOAPS, IGNWPS, and Annapurna.
- Abuse and Neglect: Elder abuse is a significant concern, especially for elderly women in rural areas who often experience neglect and mistreatment within their families and communities.
- Social exclusion and limited opportunities for productive engagement exacerbate feelings of insecurity and marginalization among the elderly.
Way Forward:
- Enhancing Social Support and Welfare Measures: Strengthening awareness and accessibility of welfare schemes and legal protections for the elderly. Implementing social security measures to ensure financial stability and improve quality of life for ageing populations.
- Healthcare and Mental Well-being: Prioritizing healthcare interventions tailored to the needs of the elderly, including preventive measures against chronic diseases and mental health support. Promoting healthy ageing through lifestyle interventions and healthcare policies that address the unique challenges of an ageing population.
- Empowerment and Social Inclusion: Fostering social inclusion through community engagement and initiatives that empower the elderly to contribute actively to society. Developing innovative institutional frameworks that value the elderly as assets and promote their participation in societal development.
Mains PYQ:
Q. Critically examine the effects of globalization on the aged population in India. (UPSC IAS/2013)
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Why the Centre has extended the Digital Health Incentive Scheme?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Digital Health Incentive Scheme
Mains level: Why has the scheme been extended?
Why in the News?
The central government has granted a one-year extension to the Digital Health Incentive Scheme (DHIS), aimed at digitizing patients’ health records and integrating them with the Ayushman Bharat Digital Health Account (ABHA ID).
About the Digital Health Incentive Scheme:
- The National Health Authority (NHA) launched the Digital Health Incentive Scheme on January 1, 2023, to implement the Ayushman Bharat Digital Mission (ABDM) to create a digital health ecosystem in the country.
- ABDM intends to support different healthcare facilities like clinics, diagnostic centers, hospitals, laboratories and pharmacies in adopting the ABDM ecosystem to make available the benefits of digital health for all the citizens of India.
- It encourages the adoption of digital health solutions like Health Management Information Systems (HMIS) and Laboratory Management Information Systems (LMIS) by offering financial incentives for each additional record digitized beyond a specified threshold.
- Benefits of the Digital Health Incentive Scheme:
- Earn incentives for Digitization: Reimburse the expenses incurred for digitization to all the participating healthcare facilities and digital Solution Companies.
- Efficiency in Healthcare Delivery: Seamless access to patient’s longitudinal health records; Removes hassles in the healthcare process (registration, appointment, consultation, IPD admission, discharge, etc).
- Building a Robust Digital Health Ecosystem: Building a robust digital health ecosystem across different levels of healthcare facilities.
- Improved Quality of Care: Evidence-based, accessible, and good quality care. Patient’s ease of access to digitized health records and improved healthcare delivery.
Why has the scheme been extended?
- The extension aims to sustain momentum in the adoption of digital health technologies. By providing additional time, the scheme supports more healthcare providers, both public and private, in overcoming financial barriers associated with digitization and promoting a digital-first approach to healthcare delivery.
- Extending the scheme allows for incorporating feedback from stakeholders and refining its implementation based on operational insights. This iterative process ensures that the scheme remains effective in enhancing healthcare efficiency, patient care, and accessibility to medical records across the country.
How many Hospitals and Digital Health Companies have availed of the incentive?
- Registered Facilities: A total of 4,005 healthcare facilities have registered for the Digital Health Incentive Scheme (DHIS). This includes 1,085 private healthcare facilities.
- Digital Solution Companies (DSCs): There are 41 digital solution companies (DSCs) registered under the scheme, out of which 36 are private companies.
- Availed the Scheme: Among the registered facilities and companies, 584 healthcare facilities have availed the scheme so far. This includes 83 private healthcare facilities. Additionally, 12 DSCs, including 10 private companies, have also availed the incentive.
How can it be beneficial for the patients?
- Quick Registration: Patients can benefit from quicker OPD registrations through digital systems, reducing waiting times at hospitals and clinics.
- Digital Transactions: Digital health records enable easier access to medical history and facilitate seamless sharing of information between healthcare providers, ensuring continuity of care.
- Reduced Redundancy: Digital records help in avoiding duplicate tests and procedures due to lost or misplaced paper records, which is particularly beneficial for patients who move between healthcare facilities or states.
- Better Coordination: Healthcare providers can access comprehensive patient records quickly, leading to more coordinated and effective treatment plans.
- Prevention of Additional Costs: By reducing the need for repeat tests and administrative overheads associated with paper-based records, patients are less likely to incur unnecessary expenses.
- Clear Communication: Patients can securely view, access, and share their health records with healthcare providers, promoting transparency and informed decision-making about their care.
- Secure Storage: Digital health records stored under the Ayushman Bharat Digital Health Account (ABHA ID) ensure data security and privacy, adhering to regulatory standards.
Do you know what is ‘ABHA ID’?
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Conclusion: The extension of the Digital Health Incentive Scheme aims to boost adoption of digital health solutions, benefiting patients with improved access and care coordination. Challenges include ensuring equitable access and addressing digital literacy barriers.
Mains PYQ:
Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)
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Tackling the Fatty Liver Disease Epidemic
Note4Students
From UPSC perspective, the following things are important :
Prelims level: International Fatty Liver Day
Mains level: India's Growing Burden of Fatty Liver Disease
Why in the news?
This year’s theme for International Fatty Liver Day, an awareness initiative observed annually in June, is ‘Act Now, Screen Today’. This theme holds more urgency now than ever before.
Liver Diseases in recent times
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India’s Growing Burden of Fatty Liver Disease
Note: MASLD, or Metabolic dysfunction-associated steatotic liver disease, is a reclassification of what was previously known as non-alcoholic fatty liver disease (NAFLD).
- High Prevalence Rates: The global prevalence of Metabolic dysfunction-associated steatotic liver disease (MASLD) is estimated at 25-30%. In India, a 2022 meta-analysis revealed that the pooled prevalence of fatty liver among adults was 38.6%. Among obese children in India, the prevalence was around 36%.
- Progression of Disease: The continuous damage caused by fatty liver leads to more severe conditions such as steatohepatitis and cirrhosis, often requiring liver transplants.
Causes of Growing Burden of Fatty Liver Disease
- Lack of Early Detection: Fatty liver disease often goes undetected in early stages due to lack of symptoms. Diagnosis usually occurs at an advanced stage, when significant liver damage has already taken place.
- Diet and Insulin Resistance: Excessive consumption of carbohydrates, especially refined carbs and sugars, leads to metabolic problems. High carbohydrate intake results in persistently high insulin levels and insulin resistance, promoting the conversion of excess glucose into fatty acids, which are then stored in the liver.
Initiatives Taken by the Government
- Integration with NPCDCS: The Ministry of Health & Family Welfare launched operational guidelines for integrating NAFLD with the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in February 2021.
- Health Promotion and Prevention: The Ayushman Bharat- Health and Wellness Centres (AB-HWCs) are being used to promote healthy living and screen for hypertension, diabetes, and other common NCDs.
Personalization is the Key
- Tailored Screening Tests: The selection of screening tests and their frequency should be based on individual risk factors, including family history, lifestyle, and pre-existing health conditions.
- Avoiding Generic Assumptions: Clinicians should not rely solely on age or physical markers; instead, they should consider a comprehensive risk profile. Non-communicable diseases are increasingly affecting diverse populations, including children.
- Integrated Health Strategies: Combining dietary modifications, regular physical activity, and effective weight management to mitigate liver disease risks.
- Frequent Screenings: Regular monitoring of liver health through non-invasive tools like vibration-controlled transient elastography. Continuous assessment of liver stiffness to detect early stages of liver fibrosis and monitor treatment responses.
- Active Health Management: Emphasis on the importance of individuals taking control of their health by being aware of their diet and lifestyle choices.Encouragement of frequent health screenings to detect and manage liver disease early.
Way Forward:
- Awareness Campaigns: Government initiatives focus on raising awareness about the importance of liver health and the risks associated with MASLD.
- Health Screenings: Programs promoting comprehensive health screenings that include physical examinations, blood tests, and abdomen ultrasounds to detect liver diseases early.
Mains PYQ
Q The 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)
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IRDAI’s new health insurance rules
Note4Students
From UPSC perspective, the following things are important :
Prelims level: IRDAI and its composition
Mains level: The recent rules highlighted by IRDAI
Why in the news?
Recently, the Insurance Regulatory and Development Authority (IRDAI) introduced a set of reforms in the health insurance sector aimed at significantly enhancing service standards for policyholders.
The recent rules highlighted by IRDAI (Insurance Regulatory and Development Authority of India) include:
- Cashless processing: Insurers are mandated to accept or reject cashless claims immediately, within one hour, and settle such claims on discharge within three hours. Any delay beyond this period would result in the insurer bearing the additional costs, if any.
- Claim settlement: Insurers cannot repudiate a claim without the approval of their claims review panel. Documents for claim settlement must be collected from hospitals or third-party administrators, not from the insured.
- Policyholders with multiple health policies: They can select the policy under which they want to make a claim, with the primary insurer coordinating the settlement of the balance amount from other insurers.
- Reward for No claims: Policyholders with no claims during the policy period may receive either an increased sum insured or discounted premium amounts.
- Renewal policies: All individual health policies are renewable and cannot be denied based on previous claims, except in cases of fraud, non-disclosures, or misrepresentation. No fresh underwriting is required for renewal policies unless there is an increase in the sum insured.
- Portability requests: Stricter timelines are imposed on portability requests via the Insurance Information Bureau of India portal.
- Customer information sheet: Insurers are required to include a customer information sheet as part of the policy document, explaining all customer-facing details such as policy type, sum assured, coverage details, exclusions, deductibles, and waiting periods.
Challenges related to health insurance in India
- Opaque Policy Details and Claim Processes: Policyholders often struggle to understand the intricacies of insurance contracts, leading to uncertainty about coverage entitlements and reimbursement procedures.
- Claim Rejections: Policyholders frequently face claim rejections due to inadequate documentation and ambiguous claims processes.
- Delays in Claim Settlement: Insurance companies often take a long time to process claims, causing inconvenience and financial stress for policyholders
IRDAI and its composition:
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Conclusion: IRDAI’s recent health insurance reforms aim to improve service standards by mandating timely cashless claim processing, transparent claim settlement, and policyholder rewards for no claims. These changes address challenges like opaque policies and claim rejections, enhancing customer trust. IRDAI plays a vital role in ensuring a fair and efficient insurance sector.
Mains PYQ:
Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
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[pib] CSIR’s PI-CHeCK Project
Note4Students
From UPSC perspective, the following things are important :
Prelims level: PI-CHeCK Project, Phenomes
Why in the News?
- The Council of Scientific and Industrial Research (CSIR) celebrated the completion of the initial phase of its groundbreaking health monitoring project, ‘Phenome India-CSIR Health Cohort Knowledgebase’ (PI-CHeCK).
What is Phenome?
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What is the PI-CHeCK Project?
- PI-CHeCK launched on Dec 7, 2023, assesses risk factors for cardio-metabolic disorders in the Indian population.
- ‘Phenome India’ health check-up camp targets CSIR employees, pensioners, and spouses across 17 states, and 24 cities.
- Nearly 10,000 volunteers provide comprehensive health data.
Objectives:
- Developing India-Specific Algorithms: The project highlights the necessity of developing risk prediction algorithms tailored to India’s diverse genetic and lifestyle landscape, as existing algorithms may not accurately represent the Indian population.
- Advancing Precision Medicine: CSIR’s commitment to advancing precision medicine is evident through the project’s focus on Predictive, Personalized, Participatory, and Preventive healthcare.
- Catalyzing Nationwide Initiatives: By generating a comprehensive phenome database, PI-CHeCK aims to catalyze similar initiatives nationwide, ensuring more accurate risk prediction algorithms for India’s diverse population.
PYQ:[2021] “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. [2018] Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. [2011] Aspartame is an artificial sweetener sold in the market. It consists of amino acids and provides calories like other amino acids. Yet, it is used as a low-calorie sweetening agent in food items. What is the basis of this use? (a) Aspartame is as sweet as table sugar, but unlike table sugar, it is not readily oxidized in human body due to the lack of requisite enzymes. (b) When aspartame is used in food processing, the sweet taste remains, but it becomes resistant to oxidation. (c) Aspartame is as sweet as sugar, but after ingestion into the body, it is converted into metabolites that yield no calories. (d) Aspartame is several times sweeter than table sugar, hence food items made with small quantities of aspartame yield fewer calories on oxidation. |
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The delicate balancing of health-care costs
Note4Students
From UPSC perspective, the following things are important :
Mains level: Private Healthcare System in India
Why in the news?
With growing health disparities and inconsistent access to medical services, the need for fair and sustainable healthcare policies has never been more pressing.
Private Healthcare System in India
- Private hospitals in India, especially those accredited by the Joint Commission International (JCI) and National Accreditation Board for Hospitals (NABH), are hubs of specialised care and innovation.
- These institutions invest heavily in top-tier infrastructure and advanced technologies, significantly enhancing patient outcomes, particularly in complex procedures. Integration of telemedicine and remote care is common, broadening access and building patient trust.
Price Caps, Quality, and Innovation
- Affordability vs. Quality: The Supreme Court’s deliberation on standardising medical procedure rates across government and private sectors highlights the tension between affordability and quality. A study indicates a 15% increase in patient dissatisfaction in hospitals under financial pressure from price caps
- Impact on Innovation: Price caps could slow the development of new treatments and technologies, particularly in high-investment fields like cancer research and robotic surgery. Value-based pricing, where payments reflect health outcomes rather than service volume, is proposed as a potential solution.
- Economic Implications: Properly implemented rate standardisation can alleviate healthcare disparities but must avoid destabilising providers’ economic health. Dynamic pricing models, which adjust based on medical complexity and patient financial status, are recommended. Thailand’s tiered pricing system is cited as a successful example.
Legal and regulatory challenges
- No regulation on Rate Fixation: States like Rajasthan and Tamil Nadu have identified significant gaps in the provisions for rate fixation, indicating a need for more robust legal frameworks to ensure fair and standardised pricing across different regions.
- Inadequate Laws as per Local Conditions: Current laws may not adequately consider local demographic and economic conditions, necessitating reforms that allow for more customised approaches to healthcare cost management.
- Lack in uniform regulation: Moreover,” the Clinical Establishment Act of 2011″, aimed at setting standards for quality, transparency, and accountability, has been adopted by only a few states, and its implementation remains lax. This lack of uniform regulation allows for wide disparities in service costs and quality.
Role of Data in Shaping Policies
- Data-Driven Insights: Predictive analytics can foresee the long-term impacts of rate fixation on healthcare innovations, helping policymakers adjust regulations to encourage innovation and accessibility.
- Pilot Projects: Implementing pilot projects in select districts can gauge the impact of rate caps on healthcare quality and innovation.
Way Forward
- Balanced Pricing Models: Implement value-based pricing where payments are linked to health outcomes rather than the volume of services provided.
- Supporting Innovation: Allocate government subsidies and grants for research and development in private hospitals.
Mains PYQ
Q Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)
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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.
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Women often outlive men but in poorer health: what new Lancet study says
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Lancet Report;
Mains level: Women Issues in Indian Society; Health Issues;
Why in the news?
Over 30 years, a study examining 20 diseases revealed minimal advancements in narrowing the disparity between genders as per “the Lancet Public Health Journal”.
What does the New Lancet report say?
- On Health Disparities: The study highlights that women tend to suffer more from lower back pain, depression, and headaches, while men have shorter life expectancies due to higher rates of road accidents, cardiovascular diseases, and, recently, COVID-19.
- On Health Burden: Women spend more time in poor health, while men are more likely to die prematurely from severe conditions.
- Overall Global Analysis: The analysis examines differences in the 20 leading causes of illness and death globally, considering all ages and regions.
What Causes the Differences in Diseases Between Women and Men? (Observations)
- Biological Factors:
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- Hormonal Differences: Hormonal fluctuations in women, such as during menstrual cycles, pregnancy, and menopause, can influence susceptibility to certain conditions like migraines, depression, and autoimmune diseases.
- Genetic Variations: Variations in genes and genetic predispositions may contribute to differences in disease susceptibility and severity between sexes.
- Anatomical Variances: Physiological differences, such as in skeletal structure and hormonal regulation, can affect the manifestation of certain diseases like lower back pain and reproductive disorders.
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- Societal and Gender Norms:
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- Healthcare-Seeking: Societal norms and gender roles may influence healthcare-seeking behaviors, with men often less likely to seek medical attention for mental health issues due to perceived notions of masculinity.
- Occupational Hazards: Occupational differences between genders can lead to varying exposures to health risks, with certain professions associated with higher rates of injury or exposure to harmful substances.
- Socioeconomic Factors: Disparities in socioeconomic status can impact disease prevalence and outcomes differently for women and men.
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- Healthcare System Bias:
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- Diagnostic Bias: Gender biases in healthcare may result in underdiagnosis or misdiagnosis of certain conditions in women, leading to delays in treatment and poorer health outcomes.
- Treatment Disparities: Differences in treatment approaches and responses may exist between sexes, with women sometimes receiving less aggressive treatment for cardiovascular diseases or being undertreated for pain conditions.
- Research Bias: Historically, medical research has often focused on male subjects, leading to a lack of understanding of how diseases manifest and progress differently in women.
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- No Improvement in Care for Women Over Time
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- Stable Gender Gap: Despite overall health improvements, the disparity between male and female health conditions remains stable.
- Conditions Affecting Women: Conditions like lower back pain and depressive disorders have shown little to no decrease over time compared to male-dominated conditions.
- Reproductive Focus: Global health systems have historically focused on women’s reproductive health, neglecting other significant health issues affecting women.
What Needs to Be Done (Way Forward)
- Better Data Collection: Governments should consistently collect and categorize health data by sex and gender to better understand and address health disparities.
- Targeted Health Interventions: Specific health interventions should be developed and implemented based on detailed sex and gender data.
- Increased Funding: More financial resources should be allocated to underfunded conditions that disproportionately affect women, such as mental health.
- Addressing Healthcare Bias: Efforts should be made to eliminate biases in healthcare to ensure women receive appropriate and timely treatment for their conditions.
Mains PYQ:
Q Can the vicious cycle of gender inequality, poverty and malnutrition be broken through microfinancing of women SHGs? Explain with examples. (UPSC IAS/2021)
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NIMHANS bags WHO’s Nelson Mandela Award for Health Promotion for 2024
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Nelson Mandela Award, NIMHANS
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 |
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| Governance |
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| Funding | Receives resources for academic and research activities from national and international funding organisations. |
| Outreach |
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Back2Basics: Nelson Mandela Award for Health Promotion
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PYQ:[2021] We can never obtain peace in the outer world until and unless we obtain peace within ourselves. |
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[pib] India Hosts Digital Health Side Event at World Health Assembly
Note4Students
From UPSC perspective, the following things are important :
Prelims level: World Health Assembly (WHA)
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:
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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 |
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| 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:
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| 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. |
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Still no sign of the language of equity and inclusion
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Minority sections and Government Initiatives;
Mains level: Minority sections; National Programme for Prevention and Control of Deafness
Why in the news?
The ECI’s election announcement lacked sign language interpreters, highlighting the everyday exclusion of Deaf and Hard of Hearing (DHH) citizens.
Present Issue:
- India’s societal and structural framework often neglects the needs of Deaf and Hard of Hearing (DHH) citizens.
- This exclusion is evident in various aspects of daily life, such as the absence of sign language interpreters during major public announcements and inadequate accessibility in public services.
Sign Language versus Oralism
- The Indian education system predominantly employs “oralism,” which emphasizes teaching deaf individuals to use their voices and lip-read, rather than using sign language.
- This approach has been criticized for perpetuating social isolation and failing to remove barriers that hinder the integration of DHH individuals.
- In contrast, using sign language has been shown to aid cognitive development and prevent linguistic deprivation.
- Over 70 countries recognize their national sign languages legally, promoting accessibility and inclusion for deaf citizens.
Present Scenario:
What Does the 2011 Census Say?
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The National Programme for Prevention and Control of Deafness
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- The program was initiated in the year 2007 in pilot mode in 25 districts of 11 States/UTs. It has been expanded to other districts too after the 12th five-year plan.
- The Program was a 100% Centrally SponsoredScheme during the 11th Five-year plan. However, as per the 12th Five Year Plan, the Centre and the States will have to pool in resources financial norms of NHRM.
- However, it falls short of addressing the quality of life for DHH individuals. This program has been expanded to 228 districts of 27 States / U.Ts in a phased manner.
Objectives of the program:
- To prevent avoidable hearing loss on account of disease or injury.
- Early identification, diagnosis, and treatment of ear problems responsible for hearing loss and deafness.
- To medically rehabilitate persons of all age groups, suffering from deafness.
- To develop institutional capacity for ear care services by providing support for equipment and material and training personnel.
Components of the Programme:
- Manpower Training & Development to grassroots level workers.
- Service Provision Including Rehabilitation – Screening camps for early detection of hearing impairment and deafness.
- Awareness Generation for early identification of the hearing impaired.
- Monitoring and Evaluation.
What Needs to be done?
- Official Recognition of ISL: ISL should be recognized as an official language, and its use should be integrated into educational systems and public services. Teaching ISL in schools, colleges, and to the general public will promote inclusivity and fluency.
- Inclusive Health Care: Health care systems need to be updated to ensure accessible communication for DHH patients. This includes training more ISL interpreters and reducing barriers for DHH individuals pursuing healthcare professions.
- Media and Public Communication: Media channels should incorporate ISL interpretation and subtitles, especially in Hindi and regional languages. Government event announcements should have live ISL interpreters to ensure accessibility.
- Employment Opportunities: Creating more employment opportunities for DHH individuals, beyond low-skilled jobs, is essential. This includes training and employing DHH individuals as ISL instructors and ensuring accessible workplaces.
Conclusion: To ensure inclusivity for DHH citizens, India must officially recognise ISL, integrate it into education and public services, improve healthcare accessibility, and expand employment opportunities and mental health support.
Mains PYQ:
Q How have digital initiatives in India contributed to the functioning of the education system in the country? Elaborate your answer. (UPSC IAS/2020)
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How close is the World Health Organization to agreeing on pandemic response rules?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: WHO; Healthcare Initiatives;
Mains level: Health Care; Convention on Tobacco Control; Global Health Rules;
Why in the News?
Health officials of the World Health Organization (WHO) aim to finalize over two years of negotiations on new pandemic response rules when they convene in Geneva next week.
About the ‘Pandemic Treaty’
- The pandemic treaty is a new legally binding agreement being negotiated to improve the global pandemic response. The treaty aims to address the shortcomings revealed during the COVID-19 pandemic, such as inequitable vaccine distribution.
- Article 12, a critical and contentious part of the treaty, proposes reserving around 20% of tests, treatments, and vaccines for WHO distribution to poorer countries during emergencies.
- The treaty would be the second major health accord after the 2003 Framework Convention on Tobacco Control.
Convention n Tobacco Control
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How will Global Health Rules Change?
- Updates to the existing International Health Regulations (IHR) include a new alert system for different risk assessments of outbreaks, replacing the current single-level emergency declaration.
- A new “early action alert” stage will be introduced, along with a potential “pandemic emergency” category for the most severe health threats.
- Obligations for countries: Strengthened obligations for countries to inform the WHO about public health events, changing the language from “may” to “should”.
How do the countries view this pact?
- Developed Countries
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- Wealthy countries are often cautious about sharing resources such as drugs and vaccines.
- There is significant political pressure, especially from right-wing groups, fearing that the treaty could infringe on national sovereignty.
- These countries are concerned about the financial implications, debating whether to set up a new fund or use existing resources like the World Bank’s $1 billion pandemic fund.
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- Underdeveloped Countries
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- Poorer countries emphasize the need for equitable access to treatments and vaccines, reflecting experiences of “vaccine apartheid” during the COVID-19 pandemic.
- They advocate for stronger commitments from wealthier nations to support global health infrastructure and emergency response capabilities.
Future Scope of the New IHR Rules and the Pandemic Accord (Treaty):
- More robust framework: The IHR updates and the pandemic treaty has designed to complement each other, creating a more robust framework for global health emergencies.
- Promotes cooperation: The new rules aim to ensure faster, more transparent information sharing, and better co-operation during health crises.
- Next steps for treaty negotiations: Next week’s World Health Assembly will focus on planning the next steps for the Treaty Negotiations, with a full agreement unlikely to be reached immediately.
- Defenses against future pandemics: The successful implementation of both the IHR updates and the pandemic treaty could significantly strengthen the world’s defenses against future pandemics, addressing gaps exposed by COVID-19.
Conclusion: While there is a shared understanding of the treaty’s importance, countries’ views are shaped by their National interests, Financial concerns, and Political pressures, leading to complex and protracted negotiations.
Mains PYQ:
Q Critically examine the role of WHO in providing global health security during the Covid-19 pandemic. (UPSC IAS/2020)
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Naegleria fowleri: the Brain-eating Amoeba
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Naegleria fowleri, Amoeba
Mains level: NA
Why in the news?
- A five-year-old girl in Kozhikode, Kerala has succumbed to primary Amoebic Meningoencephalitis (PAM), caused by Naegleria fowleri.
- India has recorded 20 reported cases of PAM, with the recent case marking the seventh infection in Kerala.
What is Primary Amoebic Meningoencephalitis (PAM)?
- PAM is a rare brain infection caused by Naegleria fowleri, a free-living amoeba found in warm freshwater and soil worldwide.
- An amoeba is a type of cell or unicellular organism with the ability to alter its shape, primarily by extending and retracting pseudopods.
- Higher temperatures of up to 115°F (46°C) are conducive to its growth and it can survive for short periods in warm environments.
- The amoeba enters the body through the nose, typically during activities like swimming, and travels to the brain, causing severe damage.
- PAM is also non-communicable.
- Symptoms: Headache, fever, nausea, vomiting, stiff neck, confusion, seizures, hallucinations, and coma.
- According to the US Centers for Disease Control and Prevention (CDC), most people with PAM die within 1 to 18 days after symptoms begin. It usually leads to coma and death after 5 days.
Treatment Challenges
- Currently, there are no established effective treatments for PAM.
- Medical interventions typically involve a combination of drugs, including amphotericin B, azithromycin, fluconazole, rifampin, miltefosine, and dexamethasone.
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IFPMA Report on Antimicrobial Resistance
Note4Students
From UPSC perspective, the following things are important :
Prelims level: AMR, Initiatives mentioned;
Why in the news?
The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) released a report titled “From Resistance to Resilience: Reinforcing the Response to Antimicrobial Resistance,” emphasizing the urgent need for enhanced Antibiotic development.
Report Highlights: Current State of Antibiotic Development:
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What is Antimicrobial Resistance (AMR)?
- Antimicrobials are substances designed to eliminate or suppress the growth of microorganisms.
- This category encompasses antibiotics, fungicides, antiviral drugs, and agents targeting parasites.
- AMR occurs when microbes such as bacteria, viruses, parasites, and fungi become resistant to antimicrobial treatments to which they were previously susceptible.
- Microorganisms that develop resistance to antimicrobials are sometimes referred to as “superbugs”.
Global Status of AMRA recent report from the Global Research on Anti-microbial Resistance (GRAM) project found that:
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What are the factors that cause AMR?
- Over-prescription of Antibiotics: Frequently prescribing antibiotics for conditions that do not require them, such as viral infections, accelerates the emergence of resistance.
- Incomplete Treatment Courses: Patients not completing their antibiotic courses as prescribed can leave surviving bacteria that adapt to become resistant.
- Self-Medication: Individuals using antibiotics without a prescription, especially in regions where they are available over the counter, increases misuse and drives resistance.
- Lack of New Antibiotics: The slow pace of new antibiotic development fails to keep up with the rate of bacterial evolution, reducing effective treatment options.
- Hospital Settings: Hospitals are critical hotspots for the spread of resistant infections due to the high use of antibiotics and the concentration of vulnerable patients with open wounds, invasive devices, and weakened immune systems.
- Global Travel: International travel allows for the rapid spread of resistant mutant strains between communities and across borders.
India’s efforts to combat AMR:
| Description | |
| National Action Plan on Antimicrobial Resistance (NAP-AMR) |
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| New Delhi Declaration on AMR |
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| National Anti-Microbial Resistance Research and Surveillance Network |
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| National Programme on Containment of Antimicrobial Resistance |
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| Red Line Campaign |
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| National One Health Program for Prevention and Control of Zoonoses |
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Niti Aayog report finds ‘huge gap’ in cancer screening at Ayushman centres
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Ayushman Bharat Scheme
Mains level: Reason behind the 'huge gap' in cancer screening at Ayushman Bharat Health and Wellness Centres (HWCs)
Why in the news?
Ayushman Bharat insurance scheme reached 5.47 crore users, but cancer screening at Health and Wellness Centers (HWCs) faces significant gaps, reports NITI Aayog.
Objective of Ayushman Bharat Scheme:
- Besides providing a Rs 5-lakh insurance cover, the scheme aimed to upgrade primary health centers to HWCs, offering annual screening for Non-Communicable Diseases (NCDs) including oral, breast, and cervical cancers for individuals aged 30 years or older.
Coverage of Ayushman Bharat Scheme:
- Over 5.47 crore users have utilized the Ayushman Bharat insurance scheme, making it the world’s largest medical insurance scheme.
The ‘huge gap’ in cancer screening at Ayushman Bharat Health and Wellness Centres (HWCs):
- NITI Aayog Report Findings: A report from NITI Aayog, based on visits to HWCs in 13 states, highlights a significant gap in cancer screening services.
- Limited NCD Screening: Although NCD screening is underway in most HWCs, yearly screening is largely absent, with less than 10% of facilities completing a single round of NCD screening.
Reason behind the ‘huge gap’ in cancer screening at Ayushman Bharat Health and Wellness Centres (HWCs):
- Methods of Screening: Official protocol mandates distinct screening methods for oral, cervical, and breast cancers. However, implementation of these methods faces challenges.
- Lack of Awareness and Capacities: The gap in cancer screening is attributed to low awareness levels and lack of capacities among healthcare providers.
- Implementation fell short: Auxiliary Nurse and Midwife (ANMs), medical officers, and staff nurses were supposed to be trained in cancer screening methods, but implementation fell short.
- Suboptimal Screening Activities: Screening for breast cancer relies on beneficiary education for self-examination, while cervical cancer screening remains to be operationalized. Oral cancer screening is performed on a case-by-case basis.
- Infrastructure and Basic Devices: HWCs generally adhere to infrastructure standards, with basic devices and medicines available free-of-cost. However, the focus remains on improving cancer screening services to align with the government’s prevention and early detection efforts.
Way forward:
- Awareness Campaigns: Launch comprehensive awareness campaigns to educate the public about the importance of cancer screening and early detection. This can involve community outreach programs, workshops, and informational sessions.
- Utilize Technology: Integrate technology solutions such as telemedicine and mobile applications to facilitate easier access to screening services, especially in remote areas. Digital platforms can also aid in data management and monitoring of screening activities.
- Performance Monitoring: Implement robust monitoring and evaluation mechanisms to track the implementation of cancer screening programs at HWCs.
Mains PYQ:
Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain.
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Meeting Nutrition challenge: What new guidelines prescribe?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Data related to disease due to poor dietary habit
Mains level: Concerns and guidelines as per the National Institute of Nutrition (NIN)
Why in the news?
According to the National Institute of Nutrition (NIN), approximately 56.4% of India’s overall disease burden is linked to poor dietary habits.
Guidelines by the National Institute of Nutrition (NIN):The NIN, operating under the Indian Council of Medical Research (ICMR), has issued comprehensive guidelines on nutrition for vulnerable groups, including pregnant and lactating women, children, and the elderly.
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Key concerns as per the National Institute of Nutrition (NIN):
- Rising Noncommunicable Diseases (NCDs) Among Adolescents and Children: Due to poor dietary habits led to diseases like cardiovascular disease, cancers, and diabetes are increasingly affecting adolescents and even children in India.
- Focus on Healthy Dietary Habits: The guidelines emphasize the importance of reducing salt intake and avoiding highly processed foods like packaged snacks, cookies, and sugary treats, which are linked to unhealthy diets and disease burden.
- High Prevalence of Lifestyle Conditions: The Comprehensive National Nutrition Survey 2019 highlights a concerning prevalence of lifestyle-related conditions even among children, including overweight or obesity, diabetes, pre-diabetes, and abnormal cholesterol levels.
- Cholesterol Levels: The survey indicates high levels of bad cholesterol (LDL and triglycerides) in children aged 5-9 and pre-teens and teens aged 10-19, along with low levels of good cholesterol in a significant portion of children and adolescents.
Other concerns related to the “Dual nutrition challenge”
- Incidence of micronutrient (zinc, iron, vitamins) deficiencies ranged from 13% to 30% of children between ages 1 and 19. But still, the prevalence of anemia is at 40.6%, 23.5%, and 28.4% in children under age 5, ages 5-9, and 10-19 respectively.
- However severe forms of undernutrition such as marasmus (a deficiency of macronutrients such as carbohydrates and proteins) and kwashiorkor (deficiency of proteins) have disappeared from the country.
Conclusion: Implementing these guidelines effectively can significantly contribute to achieving Sustainable Development Goal (SDG) targets, particularly SDG 2 (Zero Hunger), SDG 3 (Good Health and Well-being), and SDG 12 (Responsible Consumption and Production).
Mains PYQ:
Q How far do you agree with the view that the focus on the lack of availability of food as the main cause of hunger takes the attention away from ineffective human development policies in India? (15M) UPSC 2018
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Widal Test: Flaws of Typhoid Diagnosis
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Diseases; Widal Test, Salmonella Typhi Bacteria;
Mains level: NA
Why in the news?
Patients with fever in India often undergo testing and treatment for typhoid fever, primarily relying on the Widal test.
- The Widal test, though widely used, has several limitations that affect its accuracy and reliability.
Typhoid diagnosis using Widal Test
- The Widal test is used primarily to diagnose typhoid fever.
- Typhoid fever, caused by Salmonella Typhi and related bacteria, presents with symptoms like high fever, stomach pain, weakness, and gastrointestinal issues.
- It detects antibodies in the patient’s blood against the O (somatic) and H (flagellar) antigens of Salmonella Typhi.
- Procedure:
- The presence of these antibodies is detected through an agglutination reaction.
- The test involves serial dilution of the patient’s serum.
- The highest dilution at which agglutination occurs indicates the antibody titer, with higher titers suggesting an active infection.
Diagnostic Challenges:
- The gold standard for diagnosing typhoid involves isolating the bacteria from blood or bone marrow cultures, which is time-consuming and resource-intensive.
- Widal test is commonly used due to its convenience and accessibility. However, the Widal test’s interpretation is complicated by factors like the need for multiple serum samples, variations in cutoff values, and potential cross-reactivity with antibodies from other infections or vaccines.
Challenges with Widal Test:
- Impractical: A single positive Widal test does not confirm typhoid.
- Complicated result interpretation: High background antibody levels and variability in test cutoff values.
- Cross-reactivity with antibodies from other infections and false negatives due to prior antibiotic therapy undermine test reliability.
Consequences of Widal Test Use:
- Erroneous results obscure the true burden of typhoid in India, leading to inappropriate treatment and financial strain on patients.
- Overuse of antibiotics based on Widal test results contributes to antimicrobial resistance, exacerbating the challenge of treating typhoid.
PYQ:[2016] Which of the following statements is/are correct? Viruses can infect 1. Bacteria 2. Fungi 3. Plants Select the correct answer using the code given below. (a) 1 and 2 only (b) 3 only (c) 1 and 3 only (d) 1, 2 and 3 |
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The unseen effects of Climate Change on Mental Health
Note4Students
From UPSC perspective, the following things are important :
Prelims level: What is schizophrenia?
Mains level: Key concerns on health due to Extreme Heat as per the report
Why in the News?
Studies show that individuals with schizophrenia are more likely to experience fatal effects from extreme heat compared to those with kidney or heart problems as per Geo Health report.
What is schizophrenia?As per the National Institute of Mental Health, Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which can be distressing for them and their family and friends. |
Effects of Extreme Heat as per the Geo Health Report:
- Schizophrenia Heat-Related Deaths: GeoHealth in 2023 revealed that an extreme heat event in British Columbia in 2021 led to more fatalities among individuals with schizophrenia compared to those with kidney and heart diseases.
- Mental Health Conditions: People with mental health conditions, including schizophrenia, anxiety, and bipolar disorder, were identified as being at higher risk of succumbing to heat-related deaths during extreme heat events.
- Impact of Extreme Heat Event: British Columbia experienced an eight-day extreme heat event in 2021, with temperatures soaring as high as 40 degrees celsius, significantly above the average temperature of around 20 degrees celsius. The region recorded approximately 740 excess deaths during this heat wave.
- Researchers analyzed the data based on various medical conditions, including heart disease, schizophrenia, chronic kidney disease, dementia, depression, Parkinson’s disease, and osteoporosis.
- Higher Risk of Schizophrenia: Contrary to expectations, the study reported a 200% increase in the prevalence of schizophrenia diagnoses during the extreme heat event in 2021 compared to a summer without recorded heat waves.
Key challenges for treating Schizophrenia:
- Dysfunction of the Hypothalamus: The dysfunction of the hypothalamus, a structure deep in the brain responsible for maintaining bodily homeostasis, may contribute to increased vulnerability to heat stress among individuals with schizophrenia.
- Impact of Antipsychotic Medications: Certain antipsychotic medications prescribed for schizophrenia can interfere with the functioning of the hypothalamus, potentially raising body temperature. This side effect, when combined with high ambient temperatures, can lead to fatal outcomes.
- Psychotic Symptoms and Anosognosia (unable to be aware of the symptoms): Individuals with schizophrenia often experience psychotic symptoms such as hallucinations, delusions, disorganized thinking, and memory loss. The anosognosia, a condition where individuals are unaware of their illness can further complicate treatment efforts.
Way Forward:
- Enhanced Monitoring and Support Systems: Implement enhanced monitoring and support systems for individuals with schizophrenia during extreme heat events.
- Education and Awareness Campaigns: Conduct education and awareness campaigns to inform individuals with schizophrenia and their caregivers about the risks of heat-related distress and the importance of staying cool and hydrated during extreme heat events.
- Tailored Treatment Plans: Develop tailored treatment plans for individuals with schizophrenia that take into account the potential impact of antipsychotic medications on body temperature regulation.
Mains PYQ
Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
With inputs from:
https://agupubs.onlinelibrary.wiley.com/doi/10.1029/2022GH000729
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[pib] May 5: World Pulmonary Hypertension Day
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Pulmonary Hypertension, 75-25 Initiative
Mains level: NA
Why in the news?
Every year on May 5, pulmonary hypertension organizations and groups around the world participate in World Pulmonary Hypertension Day.
What is Pulmonary Hypertension?
- Pulmonary hypertension (PH) is a condition characterized by high blood pressure in the pulmonary arteries, which are the blood vessels that carry blood from the heart to the lungs.
- This elevated pressure in the pulmonary arteries can lead to various symptoms and complications, affecting the heart’s ability to pump blood effectively to the lungs and the rest of the body.
Here are some key aspects of pulmonary hypertension:
Causes:
- Idiopathic Pulmonary Arterial Hypertension (IPAH): In many cases, the exact cause of pulmonary hypertension is unknown, and it is referred to as idiopathic. IPAH is a subtype of PH without an identifiable cause.
- Secondary Pulmonary Hypertension: PH can also develop secondary to other underlying conditions, including:
- Chronic obstructive pulmonary disease (COPD)
- Interstitial lung disease
- Sleep apnea
- Connective tissue diseases such as scleroderma and lupus
- Congenital heart diseases
- HIV infection
- Liver disease (cirrhosis)
- Genetic Factors: Some forms of PH may have a genetic component, with mutations in certain genes predisposing individuals to the condition.
Features:
- Symptoms: Symptoms of pulmonary hypertension may include:
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- Shortness of breath, especially during physical activity
- Fatigue
- Chest pain or pressure
- Dizziness or fainting spells
- Swelling in the ankles and legs (edema)
- Bluish lips or skin (cyanosis)
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- Diagnostic Tests: Diagnosis of pulmonary hypertension typically involves a combination of medical history review, physical examination, and diagnostic tests, including:
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- Echocardiogram (ECG)
- Right heart catheterization
- Pulmonary function tests
- Chest X-ray
- CT scan or MRI of the chest
- Blood tests
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- Treatment: Treatment for pulmonary hypertension aims to relieve symptoms, improve quality of life, and slow disease progression. Treatment options may include:
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- Medications such as vasodilators, endothelin receptor antagonists, and prostacyclin analogs
- Oxygen therapy
- Pulmonary rehabilitation
- Surgery or a lung transplant in severe cases
Hypertension Control Initiatives in India:
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PYQ:[2021] In the context of hereditary diseases, consider the following statements : 1. Passing on mitochondrial diseases from parent to child can be prevented by mitochondrial replacement therapy either before or after in vitro fertilization of egg. 2. A child inherits mitochondrial diseases entirely from mother and not from father. Which of the statements given above is/are correct? (a) 1 only (b) 2 only (c) Both 1 and 2 (d) Neither 1 nor 2 |
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A computer science conundrum that could transform healthcare
Note4Students
From UPSC perspective, the following things are important :
Prelims level: P versus NP Problem
Mains level: Application of Science and Technology for Healthcare;
Why in the News?
Indian Health Care system faces a new set of complex problems that seem to be harder to solve because of their inherent complexity and the constraints they threaten to impose on resources.
Quick Problems versus Complex Problems in Health Care:
- Healthcare is filled with complex problems. Consider scheduling in a hospital: assigning doctors and nurses to shifts, booking operating theatres for surgeries, and organizing patient appointments.
- It is an intricate puzzle that requires considering various factors — staff availability, urgency of medical cases, etc. — and potential changes such as emergency cases and cancellations.
- The Quick Problems vs Complex Problems in Health Care question is this: there can be a shortcut to solve ‘Complex Problems’ problems as quickly as ‘Quick Problems’ problems.
- The implication is that if Quick Problems equals Complex Problems, we could quickly find the optimal solution to these scheduling problems, thus significantly improving patient care.
Implications for the Healthcare System:
- Impact on Antibiotic Resistance: Quick analysis of bacterial genomes and prediction of resistance patterns could lead to more effective antibiotic prescriptions, improving patient outcomes and combating antibiotic resistance.
- Advancement in Cancer Treatment: Swift identification of the optimal treatment for individual cancer patients could save lives by effectively tackling the complexity of cancer mutations and treatment options.
- Optimization of Insurance Decision-Making: Insurance companies grappling with ‘NP’ problems in determining premiums and packages could benefit from a shortcut provided by solving the P versus NP problem. This could lead to fairer and more accurate premiums and conditions for customers.
- Better utilization of Government health sector funding: Efficiently solving complex problems could lead to better utilization of government spending on healthcare, minimizing leakage and contributing to achieving universal health coverage.
- Resource Constraint Reduction and Improved Health Outcomes: By solving complex healthcare problems more efficiently, there is the potential to dramatically reduce resource constraints and improve health outcomes broadly.
Way Forward: Governments can enact policies and regulations that promote the responsible use of technology in healthcare and incentivize the adoption of evidence-based practices. This includes establishing standards for data privacy and security, fostering transparency in algorithmic decision-making, and ensuring equitable access to healthcare services.
Mains PYQ
Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
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Court’s nudge on Hospital charges, a reform opportunity
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Health; Government Initiatives;
Mains level: Challenges in benchmark for pricing
Why in the news?
The SC while hearing a PIL in February’24, directed the Central Government to find ways to regulate the rates of Hospital Procedures in the Private sector.
- The SC also warned against applying Central Government Health Scheme (CGHS) rates for treatment services at private healthcare facilities until standardized rates are set.
About Central Government Health Scheme (CGHS) Rates:CGHS is a health care scheme provided by the Indian Government for its central government employees and pensioners.
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Benchmark for Pricing:
- Standard Treatment Guidelines (STGs): These can establish relevant clinical needs, the nature and extent of care, and the costs of total inputs required.
- They address confounders and ensure clinical autonomy while enabling the valuation of healthcare resources consumed for precise cost determination.
- Pooled payments by government: Formulating and adopting STGs require providers’ revenues to be tied to fewer payers.
- This necessitates reimbursements from pooled payments with low Out-Of-Pocket (OOP) payment levels, supported by the government.
- Coordination between payers and providers: Governments can support the agreement on pricing that provides a reasonable and sustainable surplus over input costs.
- However, the ability of providers to access markets with OOP payments could hinder this effort.
Challenges faced during benchmarking of the price:
- Private sector issues
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- Private sector dominance: In India, over half of the total health expenditure is OOP, with the private sector predominantly composed of small-scale providers. Standardizing rates faces implementation uncertainties, and enforcement mechanisms for adherence remain unclear.
- Resistance from providers: Concerns arise about the feasibility of regulatory measures if providers do not adhere to prescribed procedure rates, as seen in various health schemes.
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- Weak implementation
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- Limitations of regulations: While price caps can influence behavior in the short term, weak enforcement mechanisms lead to temporary effects as the overall environment remains unchanged.
- Enforcement challenges: Despite suggested measures, enforcement remains weak, with only a fraction of states and union territories implementing the Clinical Establishment Act.
- Data-related issues: Although the insurance industry initiated STGs for hospitals in 2010, progress was hindered by a lack of representative and accurate costing data due to limited participation from private hospitals.
Government Initiatives:
- Developing STGs: The Pradhan Mantri Jan Arogya Yojana and the Department of Health Research have made significant strides in developing STGs for common conditions and adopting a comprehensive costing framework.
- Efforts are also ongoing to create an Indian version of Diagnostics-Related Groups (DRGs)
Way Forward:
- Addressing anticipated challenges: Anticipated challenges in implementing rate standardization policies need to be identified and addressed proactively to ensure successful outcomes.
- Evidence-based policy: Conduct rigorous research and evaluation to generate evidence on the impact of regulatory measures on affordability, care quality, and provider behavior, informing future policy decisions.
- Ensuring broader stakeholder participation: It is essential to involve a wide range of stakeholders in the development and implementation of rate standardization policies to increase their effectiveness and acceptance.
Mains PYQ
Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
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Glycemic Index of Diets: Importance beyond Diabetes Control
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Glycemic Index, Glycemic Load
Mains level: NA
Why in the news?
Understanding and managing Glycemic Index (GI) in diets is crucial for promoting long-term health and mitigating the risk of chronic diseases.
What is Glycemic Index (GI)?
- Prof. David Jenkins of the University of Toronto introduced Glycemic Index (GI) in 1981.
- GI measures how quickly a food raises blood glucose levels compared to a reference food, typically glucose or white bread, which is assigned a value of 100.
GI Classification and Glycemic Load (GL):
- Multiplying GI by the amount of carbohydrate consumed gives the Glycemic Load (GL).
- Accordingly, foods are classified as:
- Low GI (below 55): Brown rice, steel-cut oats, legumes (such as lentils and chickpeas), most fruits (like apples, berries, and oranges), vegetables, nuts, and seeds.
- Medium GI (56-69): Whole wheat products, such as whole wheat bread and pasta, some types of rice (like basmati rice), and certain fruits like pineapple and mango.
- High GI (70 or above): Refined carbohydrates and sugary foods such as white rice, white bread, refined flour products, potatoes, sweetened drinks (like soda), candies, cookies, and sugary snacks.
Debate and Perspectives:
- The Prospective Urban Rural Epidemiology (PURE) study, spanning 20 countries including India, revealed the link between high GI diets and cardiovascular events and mortality.
- Evidence supports the association between high GI diets and increased risk of type 2 diabetes, cardiovascular disease, and mortality.
Relevance to India
- In South Asia, where diets are rich in high GI foods like white rice, efforts to reduce GI and GL are crucial.
- Lowering GI and GL can help prevent not only diabetes but also premature cardiovascular disease, which is prevalent in India.
PYQ:[2011] Regular intake of fresh fruits and vegetables is recommended in the diet since they are a good source of antioxidants. How do antioxidants help a person maintain health and promote longevity? (a) They activate the enzymes necessary for vitamin synthesis in the body and help prevent vitamin deficiency (b) They prevent excessive oxidation of carbohydrates, fats and proteins in the body and help avoid unnecessary wastage of energy (c) They neutralize the free radicals produced in the body during metabolism (d) They activate certain genes in the cells of the body and help delay the ageing process |
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IRDAI removes Age Bar for purchasing Health Insurance
Note4Students
From UPSC perspective, the following things are important :
Prelims level: IRDAI, Evolution of India’s Insurance Industry , LIC
Mains level: NA
Why in the news?
- The Insurance Regulatory and Development Authority of India (IRDAI) abolished the age limit for purchasing health insurance policies, effective April 1.
- Individuals aged above 65 were ineligible previously for new health insurance policies.
About Insurance Regulatory and Development Authority of India (IRDAI)
- IRDAI is the apex regulatory body overseeing the insurance sector in India.
- It is an autonomous entity responsible for regulating and developing the insurance sector in India.
- It was established under the Insurance Regulatory and Development Authority Act, 1999. It was formed on April 19, 2000.
- Headquarters: Located in Hyderabad, Telangana.
- Composition:
- IRDAI is a 10-member body including the chairman, five full-time and four part-time members appointed by the government of India.
- The authority is supported by various departments and divisions responsible for different aspects of insurance regulation, including life insurance, non-life insurance, reinsurance, and actuarial matters.
Regulatory Functions
IRDAI’s primary role is to regulate and promote the insurance industry in India through:
- Licensing and registration of insurance companies and intermediaries.
- Framing regulations and guidelines for insurance operations.
- Protecting the interests of policyholders.
- Promoting fair competition and innovation in the insurance sector.
- Monitoring the financial performance and solvency of insurance companies.
- Resolving disputes between insurers and policyholders.
- Promoting insurance awareness and education among the public.
Insurance Sector of India: A Timeline
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PYQ:[2012] Consider the following:
The employees of which of the above can have the ‘Social Security’ coverage under Employees’ State Insurance Scheme? (a) 1, 2 and 3 only (b) 4 only (c) 1, 3 and 4 only (d) 1, 2, 3 and 4 |
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The advent of a holistic approach to ‘one health’
Note4Students
From UPSC perspective, the following things are important :
Prelims level: National One Health Mission; Lumpy Skin disease;
Mains level: Healthcare in India; National One Health Mission;
Why in the news?
In the past, we have seen that there is interdependence between humans, animals, and the environment has been made increasingly evident with the emergence of pandemics such as COVID-19.
- It is not just humans who are affected by pandemics but also livestock — an example being the outbreak of lumpy skin disease that has spread across countries.
Why an integrated idea like the ‘One Health’ Mission is needed?
One Health is an interdisciplinary approach that recognizes the interconnectedness of human health, animal health, and environmental health. It emphasizes collaboration across various sectors, including medicine, veterinary science, ecology, and public health, to address health challenges comprehensively.
Key features of National One Health Mission:
- Intersectoral Collaboration: The mission aims to coordinate, support, and integrate all existing One Health initiatives in the country, including the Ministries of Health and Family Welfare, Fisheries, Animal Husbandry and Dairying, Environment, and Science and Technology
- Integrated Disease Surveillance: The mission implements integrated disease surveillance within and across human, animal, and environmental sectors to address communicable diseases, including zoonotic diseases, and improve overall pandemic preparedness and integrated disease control.
- Consolidation of data: The mission creates an integrated, science-based environment where researchers from various disciplines can use laboratories as necessary and generate requisite inputs for One Health Science, including databases and models with a consolidated approach of ecologists, field biologists, epidemiologists, and other scientists.
Challenges in National One Health Mission
- Limited Database: There have been limited efforts to develop databases and models with a consolidated approach of ecologists, field biologists, epidemiologists, and other scientists to understand and respond to the drivers that threaten health and optimize the effectiveness of public health systems in achieving these goals within each sector.
- Lack of Awareness and Understanding: The lack of awareness and understanding of the One Health concept among stakeholders hinders collaborative efforts required to address complex public health issues
- Funding Constraints: Funding constraints are a significant barrier to implementing One Health interventions, especially in low- and middle-income countries that may need more resources to invest in One Health initiatives
Conclusion: To address challenges in the National One Health Mission, efforts must focus on enhancing data collection, raising awareness among the stakeholders, and securing adequate funding. These measures are essential for effective implementation and holistic health management.
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Health Sector can’t ignore Telemedicine’s Green Gains, study shows
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Teleophthalmology
Mains level: Technology in News; Significance of teleophthalmology
Why in the news?
Recently a study by researchers at the L.V. Prasad Eye Institute (LVPEI), Hyderabad, has found that around 70-80% of people who visit an Eye Hospital can benefit from teleconsultations because their problems aren’t serious enough to require attention at a hospital.
Key points as report:
- Telemedicine in High-Income Countries: Studies in high-income countries have shown that telemedicine is both patient- and environment-friendly for delivering healthcare services.
- Carbon Emissions from the Healthcare Sector: According to the International Comparison of Healthcare Carbon Footprints analysis, India’s healthcare sector emitted 74 million tonnes of carbon dioxide in 2014, around 3% of India’s total emissions of the gas that year.
- Carbon Neutrality in Healthcare: The healthcare sector should aim for carbon neutrality to mitigate its environmental impact. Teleophthalmology is cited as an efficient and effective tool to help achieve this goal, as demonstrated by the lead author’s remarks.
The teleophthalmology process:
What are Telemedicine’s Green Gains?
- Reduced Carbon Footprint: Teleophthalmology significantly reduces the need for patients, especially those from rural areas, to travel long distances to access healthcare services. This leads to a substantial reduction in carbon dioxide emissions, contributing to environmental sustainability.
- Economic Gains: Teleophthalmology results in significant cost savings for both patients and healthcare systems. Patients save money on travel expenses
- Easy Accessibility: Teleophthalmology improves access to eye care services, especially for individuals living in remote or rural areas where access to healthcare facilities is limited. It allows patients to receive timely consultations without the need for extensive travel.
- Targeted Care Gains: Teleophthalmology is particularly beneficial for patients with minor eye problems like mild refractive errors or regular preventive eye check-ups. It enables healthcare providers to target specific demographics and deliver personalized care more effectively.
Conclusion: The recent study highlights teleophthalmology’s potential in reducing carbon emissions and improving accessibility to eye care, emphasizing its role in achieving carbon neutrality and delivering cost-effective, targeted healthcare services, particularly for minor eye issues.
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Implementing Universal Health Coverage
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Government Schemes and Policies in News; National Health Policy, 2017;
Mains level: Social Issues and Justice; Health Issues in India; Government Schemes and Policies in News;
Why in the news?
On the eve of World Health Day (7th April), many countries aim to implement UHC (Universal Health Coverage) in the same way as India introduced its National Health Policy, in 2017. However, there exist challenges in India too for implementing it.
Background:
- On December 12, 2012, the UN General Assembly unanimously endorsed a resolution urging countries to accelerate progress towards UHC.
- In India, the high-level expert group report, submitted to the Planning Commission in 2011, outlined a government intent to increase public financing for health to 2.5% of India’s GDP during the 12th Plan (2012-17).
BACK2BASICS:About National Health Policy, 2017:It aims to achieve Universal Health Coverage and deliver quality healthcare services to all at an affordable cost. It focuses on improving health status through preventive, promotive, curative, palliative, and rehabilitative services with an emphasis on quality. |
What are the challenges in the Implementation of UHC in India?
- Federal Issue: Health is a state subject in India, but UHC policy is envisaged at the national level. This can lead to challenges in coordination between the central government and state governments.
- While the Directive Principles of State Policy provide a basis for the right to health, the absence of a specific constitutional guarantee may create challenges in ensuring consistent and enforceable healthcare rights.
- Migrant Population and Urban Slums: Due to issues such as overcrowding, poor sanitation, and limited infrastructure, a significant portion of the population living in urban slums face issues with the availability and accessibility of Primary Health Services is hard to provide.
- Lack of Finance: Implementing UHC requires significant financial resources. Reducing out-of-pocket expenditure and strengthening primary healthcare services necessitate substantial investments, which may strain government budgets and require innovative financing mechanisms to ensure sustainability.
- Lack of Healthcare Infrastructure and Human Resources: India faces shortages in both infrastructure and human resources, particularly in rural and underserved areas, which hinders efforts to improve healthcare accessibility and quality.
- The vicious cycle of poverty: The vicious cycle of poverty and poor health perpetuates inequality in various spheres of life which eventually leads to the accessibility of health services.
Suggestive Measures:
- Addressing Urban Migrants’ Health Needs: Establishing mobile healthcare units or clinics that can reach migrant communities in urban and peri-urban areas, providing essential primary healthcare services.
- Reducing Out-of-Pocket Expenditure: Simplifying the reimbursement process by digitizing healthcare payment systems and integrating them with government identification or mobile banking platforms to facilitate easy reimbursement for medical expenses.
- Creating Inclusive Health Systems: Introducing multilingual and culturally sensitive health information materials and services to bridge language barriers and ensure accessibility for diverse urban populations.
- Implementing Community-Based Primary Healthcare: Establishing community health centers or clinics in urban and peri-urban areas staffed by trained community health workers who can provide basic healthcare services and referrals.
Conclusion: Building Constitutional backing, enhancing coordination, and federal with fiscal consensus with adequate infrastructure in addressing urban health needs can improve the reach of the Universal Health Program in India.
Mains PYQ
Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
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[pib] Ayushman Bharat Health Accounts (ABHA)
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Ayushman Bharat Health Accounts (ABHA), AB-PMJAY
Mains level: NA
Why in the news?
This newscard is an excerpt from an explainer published in the PIB.
Ayushman Bharat Health Accounts (ABHA)
- ABHA, an integral part of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), serves as a link for all health records of an individual.
- It is a sub-component of the Ayushman Bharat Digital Mission launched in September 2021.
- It is a 14-digit id employed to uniquely identify individuals, verify their identity, and connect their health records (with their consent) across various systems and stakeholders.
Features of ABHA
- Cashless Transactions: ABHA enables cashless transactions for eligible beneficiaries, reducing the financial burden during medical emergencies.
- Electronic Health Records (EHR): It integrates electronic health records, facilitating storage, and retrieval of patient information for streamlined healthcare delivery.
- Portability: ABHA accounts are portable across various healthcare providers under the Ayushman Bharat scheme, ensuring seamless access to services.
- Real-time Monitoring: Incorporating real-time monitoring mechanisms to track fund utilization, ABHA ensures efficient allocation and prevents misuse.
Various Components
- Beneficiary Identification: ABHA involves the identification and registration of eligible beneficiaries under the Ayushman Bharat scheme, assigning a unique health identification number (UHID).
- Funds Management: It manages the allocation and disbursement of funds for healthcare services, ensuring prompt and secure transfers.
- Claim Settlement: ABHA processes and settles claims submitted by healthcare providers, verifying authenticity, and disbursing payments.
- Audit and Oversight: Incorporating audit mechanisms to monitor fund utilization, ABHA ensures compliance with regulations and maintains system integrity.
Back2Basics: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
| Details | |
| Umbrella Scheme |
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| Launch Year | 2018 |
| Components |
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| Pradhan Mantri Jan Arogya Yojana (PM-JAY) |
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| Coverage |
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| Beneficiaries | Identified through Socio-Economic Caste Census (SECC) data |
| Funding |
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| Nodal Agency | National Health Authority (NHA)
State Health Agency (SHA)
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PYQ:2021: “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse.
Practice MCQ:Consider the following statements about the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): 1. 3 days pre-hospitalisation and 15 days post-hospitalisation. 2. Includes diagnostic care and expenses on medicines. 3. No restriction on family size, age, or gender. 4. Beneficiaries are identified from national family health survey. How many of the above discussed features is/are correct? (a) One (b) Two (c) Three (d) Four |
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Two States: a comparison on access to life-saving C-sections
Note4Students
From UPSC perspective, the following things are important :
Prelims level: NA
Mains level: Health Governance;
Why in the News?
The study released by IIT Madras highlights the concerns related to high rates of C-section deliveries among women in Tamil Nadu, particularly in private hospitals.
- This indicates the necessity for corrective measures to address the situation.
What is a Caesarean section?It is also known as C-section or cesarean delivery, which is the surgical procedure by which one or more babies are delivered through an incision in the mother’s abdomen. It is often performed because vaginal delivery would put the mother or child at risk. |
Changes in the share of births delivered by C-sections in public and private sector hospitals in India, Tamil Nadu, and Chhattisgarh between 2015-16 and 2019-21.
- High C-section Rate in Public Hospitals: In public sector hospitals in Tamil Nadu, nearly 40% of women underwent C-sections during 2019-21.
- High C-section Rate in Private Hospitals: Close to 64% of women underwent C-sections in private sector hospitals in Tamil Nadu during 2019-21, which is significantly higher than both the national average of around 50% and Chhattisgarh’s rate of 59%.
- Higher than the National Average: The rate of C-section deliveries in Tamil Nadu’s public sector hospitals is substantially higher than the national average, which is approximately 16%. Additionally, it surpasses the rate in Chhattisgarh, where it stands at 10%.
Reasons behind the increase in C-section rates despite a decrease in pregnancy complications:
- Regional Disparities: In Chhattisgarh, the likelihood of a woman undergoing a C-section in a private hospital is ten times higher than in a public hospital. This suggests potential disparities in access to high-quality healthcare services between public and private sectors, with implications for maternal health outcomes.
- Socioeconomic Factors: The study assumes that poorer households opt for public hospitals while richer households prefer private ones for deliveries. This socioeconomic divide may contribute to inequitable access to healthcare services at the national level.
- Higher Likelihood in Private Health Facilities: Women delivering in private health facilities are more likely to undergo C-sections compared to those in public facilities, with a notable disparity observed in Chhattisgarh.
- Maternal Age and Weight Status: Factors such as maternal age (35-49) and overweight status increase the likelihood of C-section delivery.
- High gap between Poor and Rich: In India, the gap in C-section prevalence between the poor and non-poor narrowed in private facilities, but Tamil Nadu exhibited a concerning trend where a higher percentage of the poor underwent C-sections compared to the non-poor.
Recommendations by the World Health Organization (WHO): Cesarean delivery rates should ideally not exceed 10-15% to achieve the lowest maternal and neonatal mortality rates. When C-section rates go beyond 10%, there is no significant decrease in maternal mortality. In 2021, global C-section rates surpassed 20%, and they are projected to increase to 30% by 2030.
Conclusion: Access to C-sections in Tamil Nadu shows disparities, with high rates in both public and private hospitals. Addressing regional, and socioeconomic factors and adhering to WHO recommendations are crucial for equitable maternal healthcare.
PYQ Mains
Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)
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The ART of India’s HIV/AIDS response
Note4Students
From UPSC perspective, the following things are important :
Prelims level: HIV Drugs
Mains level: Objectives of India's National AIDS Control Programme (NACP)
Why in the news?
On April 1, 2004, the Indian government launched Free Antiretroviral Therapy (ART) for Persons living with HIV (PLHIV). This decision has been one of the most successful .
Emergence of HIV drugs
- First Antiretroviral Drug Approval: In March 1987, the US FDA approved the first antiretroviral drug, AZT (zidovudine), offering a glimmer of hope for treatment.
- Additional Drug Approvals: Three more antiretroviral drugs were approved shortly after in 1988, expanding treatment options for HIV/AIDS patients.
- Introduction of Protease Inhibitors: A significant milestone occurred in 1995 with the introduction of protease inhibitors, a new class of antiretroviral drugs.
The evolution to free ART
- Millennium Summit Declaration: In 2000, world leaders at the UN General Assembly’s Millennium Summit set a goal to stop and reverse the spread of HIV.
- Formation of the Global Fund: The Global Fund to Fight AIDS, Tuberculosis, and Malaria was established in 2002, advocating for universal access to HIV prevention, treatment, care, and support services.
- High HIV Prevalence in India: In 2004, India had an estimated 5.1 million PLHIV, with a population prevalence of 0.4%. However, very few were receiving ART, with only 7,000 PLHIV on treatment by the end of the year.
- Free ART Initiative: The Indian government’s decision to provide free ART to all adults living with HIV in 2004 was groundbreaking. This initiative aimed to address the barriers of cost and geographical access to treatment.
- Expansion of ART Facilities: Over two decades, the number of ART centers in India expanded significantly, from less than 10 to around 700. Additionally, 1,264 Link ART centers have provided free ART drugs to approximately 1.8 million PLHIV.
- ART Eligibility Criteria Evolution: The criteria for initiating ART evolved over the years, starting from CD4 count less than 200 cells/mm3 in 2004, to less than 350 cells/mm3 in 2011, and less than 500 cells/mm3 in 2016. Finally, in 2017, the “Treat All” approach was adopted, initiating ART regardless of CD4 count.
- Rapid ART Initiation Policy: In 2021, India adopted a policy of rapid ART initiation, starting individuals on treatment within seven days of HIV diagnosis, and sometimes even on the same day. This swift initiation aimed to improve treatment outcomes and prevent transmission.
- Complementary initiatives to stop the HIV epidemic: Provision of free diagnostic facilities; attention on prevention of parent to child transmission of HIV (PPTCT) services; prevention, diagnosis and management of opportunistic infections including management of co-infections such as tuberculosis (TB).
Objectives of India’s National AIDS Control Programme (NACP) phase 5 by 2025
Ambitious 95-95-95 Targets: The NACP phase 5 sets ambitious targets known as the 95-95-95 targets, aligned with global targets agreed upon by UNAIDS. These targets aim for:
- 95% of all people living with HIV to know their HIV status.
- 95% of all people diagnosed with HIV infection to receive sustained antiretroviral therapy (ART).
- 95% of all people receiving antiretroviral therapy to achieve viral suppression.
- These targets are aligned with global targets agreed by the UNAIDS.
Challenges
- Delayed Enrolment to ART Facilities: Late presentation poses challenges to timely initiation of treatment and optimal disease management.
- Missed doses : Patients often start feeling better after initiating ART, leading to missed doses or discontinuation of treatment that lead to drug resistance
Measures
- Sustained Supply and Availability of ART: Ensuring consistent and uninterrupted access to ART drugs across all regions of the country
- Private Sector Engagement: Enhancing engagement with the private sector in the care of PLHIV .
- Training and Capacity Building: Continuous training and capacity building of healthcare staff are essential to ensure high-quality service delivery.
- Integration with Other Health Programs: Strengthening integration with other health programs, such as hepatitis, non-communicable diseases (NCDs
Conclusion
India’s ART initiative, launched in 2004, has been pivotal in combating HIV/AIDS. With evolving criteria, rapid initiation policies, and ambitious targets, challenges persist, but measures like sustained supply, private sector engagement, and training are being implemented.
Mains PYQ
Q What are the research and developmental achievements in applied biotechnology? How will these achievements help to uplift the poorer sections of the society? ( UPSC IAS/2021)
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Hepatitis B: Everything you need to know
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Hepatitis B
Mains level: NA
Why in the news?
- A recent study by Sir Ganga Ram Hospital, New Delhi, revealed alarming deficiencies in public knowledge (transmission, effects & vaccination) about Hepatitis B in India.
- Despite the availability of a vaccine for over 30 years, HBV infection rates remain high in India, with prevalence estimates ranging from 2% to 8% and approximately 37 million carriers nationwide.
About Hepatitis
- Hepatitis is a medical condition characterized by inflammation of the liver.
- It can be caused by various factors, including viral infections (hepatitis viruses), alcohol consumption, certain medications, toxins, autoimmune diseases, and metabolic disorders.
| Hepatitis A | Hepatitis B | Hepatitis C | |
| Causative Virus | Hepatitis A Virus (HAV) | Hepatitis B Virus (HBV) | Hepatitis C Virus (HCV) |
| Transmission | Fecal-oral route (contaminated food/water) | Blood and body fluids (unsafe sex, sharing needles) | Blood-to-blood contact (sharing needles, transfusions) |
| Vaccine Available | Yes | Yes | Yes |
| Chronic Infection | No (usually acute) | Yes (can become chronic) | Yes (often becomes chronic) |
| Symptoms | Mild flu-like symptoms, jaundice | Variable, from none to severe symptoms | Often asymptomatic, but can lead to liver damage |
| Chronic Complications | None | Cirrhosis, liver cancer | Cirrhosis, liver cancer |
| Preventable by Vaccine | Yes | Yes | No |
| Treatment | Supportive care | Antiviral medications | Antiviral medications |
PYQ:
Which one of the following statements is not correct? (2019) (a) Hepatitis B virus is transmitted much like HIV. (b) Hepatitis B, unlike Hepatitis C, does not have a vaccine. (c) Globally, the number of people infected with Hepatitis B and C viruses are several times more than those infected with HIV. (d) Some of those infected with Hepatitis B and C viruses do not show the symptoms for many years.
Which of the following diseases can be transmitted from one person to another through tattooing? (2013) 1. Chikungunya 2. Hepatitis B 3. HIV-AIDS Select the correct answer using the codes given below. (a) 1 only (b) 2 and 3 only (c) 1 and 3 only (d) 1, 2 and 3
Practice MCQ:
Consider the following statements regarding Hepatitis C virus: 1. It is spread mainly through contaminated water and food. 2. It primarily affects the functioning of respiratory system. Which of the statements given above is/are correct? (a) Only 1 (b) Only 2 (c) Both 1 and 2 (d) Neither 1 nor 2 |
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Global Spread of H5N1 Bird Flu
Note4Students
From UPSC perspective, the following things are important :
Prelims level: H5N1 Bird Flu
Mains level: NA
Why in the news?
- Since 2020, the highly pathogenic H5N1 bird flu has been spreading globally, posing a significant threat to both birds and mammals.
H5N1 Bird Flu: Details
- H5N1 originated from a virus outbreak on a goose farm in China in 1996 and has since evolved into a highly pathogenic strain.
- The virus quickly spread from Europe to Africa, Asia, North America, and South America, and most recently, it reached mainland Antarctica.
- H5N1 is a subtype of the influenza A virus that causes severe respiratory disease in birds, known as avian influenza or “bird flu”.
- Influenza A viruses are classified by subtypes based on the properties of their surface proteins, with H5N1 being one subtype.
How widespread is it?
- The virus has affected birds in over 80 countries, resulting in mass culling of poultry and wild birds.
- Furthermore, it has now begun infecting mammals, including seals, sea lions, and marine mammals.
- While humans rarely contract bird flu, those at risk are typically individuals who have extensive contact with infected birds at poultry farms.
- Bird flu first broke out in Maharashtra in 2006.
- The H5N1 virus led to the culling of millions of poultry so as to contain the virus. But it has resurfaced from time to time.
Impact on Animals
- Bird Species Affected: Numerous bird species, including Great Skuas and Barnacle Geese, have experienced significant mortality rates due to H5N1.
- Endangered Species Threatened: Endangered birds like the California condors have been severely affected, with a notable percentage of the population succumbing to the virus.
- Mammalian Casualties: H5N1 has crossed species barriers, infecting mammals such as foxes, pumas, skunks, and marine mammals like sea lions and dolphins.
- Devastating Consequences: Mass mortalities of marine mammals, particularly elephant seals, have been reported, raising concerns about the long-term ecological impact.
Factors behind Spread
- Climate Change: Some scientists attribute the large-scale spread of bird flu to climate change, which alters bird behavior and facilitates the transmission of the virus.
- Warmer Seas: Warmer sea temperatures have weakened marine mammal populations, making them more susceptible to disease outbreaks.
PYQ:
2015: H1N1 virus is sometimes mentioned in the news with reference to which one of the following diseases? (a) AIDS (b) Bird flu (c) Dengue (d) Swine flu
Practice MCQ:How many of the given statements about H5N1 Virus is/are correct? 1. It is a type of influenza virus causing highly infectious, respiratory disease in birds. 2. It is highly contagious in humans. 3. Seals, sea lions, and other marine mammals are vulnerable to this Virus. Select the correct codes from below – (a) One (b) Two (c) Three (d) None |
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On the resurgence of Mumps in Kerala
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Science and Tech; Diseases
Mains level: Science and Tech; Diseases; Measures to control
Why in the news?
Mumps, an acute viral infection that historically affects children, has been spreading like wildfire in Kerala, for the past few months.
Context:
- Despite being a vaccine-preventable disease, mumps has never been a part of the Universal Immunisation Programme (UIP) because of the disease’s no-mortality profile and the perception that it has low public health significance.
- According to the World Health Organization (WHO), vaccination strategies targeting mumps control should be closely integrated with existing measles elimination and rubella control.
About: Mumps is an airborne viral disease primarily affecting children and adolescents. It manifests with symptoms like fever, headache, and painful swelling of the salivary glands, particularly the parotid glands on both sides of the face.
Is it a cause for concern?
- Self-Limiting Disease: Mumps is described as a self-limiting disease, meaning it typically resolves on its own with rest and symptomatic management within about two weeks.
- Underreporting: Due to approximately half of infected children developing classical symptoms and around 30% remaining asymptomatic, many cases of mumps go unreported. This suggests that reported cases are likely a significant underestimation of the actual prevalence in the community.
- Public Health Perspective: Historically, measles has been prioritized in public health efforts due to its potential for severe morbidity and mortality, overshadowing the attention given to mumps.
- Emerging Concerns: Despite being less prioritized, recent reports indicate a surge in mumps cases, including complications such as encephalitis, epilepsy, aseptic meningitis, and acute pancreatitis, particularly at Kozhikode Medical College hospital.
- Impact on Reproductive Health: Mumps can affect the gonads (reproductive glands) in both males and females. In males, it poses the rare but significant risk of infertility or reduced sperm count in the long term.
Why is the mumps vaccine not part of the national immunization schedule?
- Lack of Mortality: Mumps typically does not result in fatalities, further contributing to the belief that it may not warrant inclusion in routine vaccination schedules.
- Underestimation of Public Health Significance: Despite arguments from organizations like the Indian Academy of Pediatrics (IAP) that mumps’ public health significance is underestimated, there has been insufficient evidence or data to prompt its inclusion in national immunization programs.
- Poor Documentation and Lack of Studies: Limited documentation of clinical cases, complications, and follow-up data, as well as a scarcity of published studies on mumps, have hindered efforts to fully understand its impact and advocate for its vaccine inclusion.
- Absence of Nationally Representative Data: The lack of nationally representative data on the incidence of mumps in India makes it challenging to assess its burden accurately and advocate for vaccine inclusion based on epidemiological evidence.
- Limited Information on Long-Term Morbidity: While mumps is known to have some impact on reproductive organs, there is very little information available on its actual long-term morbidity profile, further complicating decisions regarding vaccine inclusion.
How can the current outbreaks be controlled?
- Public Awareness Campaigns: Launch comprehensive public awareness campaigns to educate the community about mumps, its symptoms, transmission, and the importance of isolation. Emphasize the significance of vaccination and maintaining good hygiene practices.
- Improve Immunization Coverage: Strengthen efforts to improve general immunization coverage, especially targeting unimmunized children and adolescents. Ensure accessibility to vaccination services in all communities.
- Strict Isolation Measures: Enforce strict isolation measures for mumps patients for the full three-week duration to limit disease transmission. Provide clear guidelines to healthcare facilities and schools on managing mumps cases and preventing spread.
- School Closure: Consider temporary closure of schools during outbreaks to prevent further transmission, especially if a significant number of cases are reported among students. Use the summer break as an opportunity to break the chain of transmission.
- Enhanced Surveillance and Reporting: Implement robust surveillance systems to promptly detect and report mumps cases. Ensure healthcare providers are vigilant in diagnosing and reporting suspected cases to public health authorities for timely intervention.
- Contact Tracing and Monitoring: Conduct thorough contact tracing of individuals who have been in close contact with confirmed mumps cases. Monitor them for symptoms and enforce isolation measures if necessary to prevent secondary transmission.
- Healthcare Provider Training: Provide training to healthcare providers on mumps diagnosis, management, and reporting protocols. Ensure they are equipped to identify and manage cases effectively.
- Community Engagement: Engage with community leaders, schools, and parents to encourage cooperation with control measures. Encourage individuals to seek medical care promptly if they develop symptoms suggestive of mumps.
Way Forward:
- Assessment of Vaccine Effectiveness: Despite the lack of studies on the effectiveness of the mumps vaccine in India, global data suggests that two doses of the MMR vaccine can provide protection ranging from 70% to 95%, provided that coverage is high.
- Integration with Measles and Rubella Control: The World Health Organization (WHO) recommends integrating mumps vaccination strategies with existing efforts for measles elimination and rubella control. This ensures a comprehensive approach to vaccine-preventable diseases.
- Consideration of Regional Factors: Evaluate regional factors influencing vaccine effectiveness, disease burden, and immunization coverage. Tailor vaccination strategies accordingly to address the specific needs and challenges faced in Kerala.
- Consultation with Experts and Stakeholders: Engage with public health experts, immunization specialists, and stakeholders to review the evidence, assess the impact of different vaccination strategies, and determine the most effective approach moving forward.
- Monitoring and Surveillance: Strengthen monitoring and surveillance systems to track mumps cases, vaccine coverage, and vaccine effectiveness. This data will be crucial for evaluating the impact of vaccination strategies and making informed decisions.
- Policy Decision: Based on the evidence and expert recommendations, make a policy decision regarding the inclusion of MMR vaccine in the Universal Immunization Programme. Consider factors such as vaccine availability, cost-effectiveness, and logistics.
Conclusion: Addressing the resurgence of mumps in Kerala necessitates a comprehensive approach, including vaccination integration, public awareness, strict isolation measures, and policy review guided by expert consultation and regional considerations.
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Why has Karnataka banned certain coloring agents?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Colouring agent, harmful chemical
Mains level: Food Safety and Standards Act, 2006
Why in the news?
- Karnataka has become the third state in South India to prohibit the use of specific coloring agents in cotton candy and gobi manchurian due to their identified harmful effects.
Context-
- While the Government plans to create awareness among manufacturers, it has also urged consumers to be aware of what they are consuming.
- The Food Safety and Standards Act, 2006 stipulates a fine of not less than ₹10 lakh and a jail term of a minimum of seven years, extending to life imprisonment, against those using banned chemical substances in food products.
What did the survey results show?/Key findings from the sample testing
- Presence of Harmful Chemicals: Laboratory tests revealed the presence of harmful chemicals in many samples collected from the state.
- Cotton Candy Samples: Out of 25 cotton candy samples collected, 15 were found to be unsafe as they contained added colors, while the remaining 10 were deemed safe as they were made without added colors.
- Gobi Manchurian Samples: Among the 171 samples of gobi manchurian collected, 107 were declared unsafe due to the presence of added colors, while 64 were considered safe as they did not contain added colors.
What were the harmful chemicals?
- Harmful Chemicals: The unsafe samples of cotton candy contained traces of sunset yellow, tartrazine, and rhodamine-b, while unsafe gobi Manchurian samples had tartrazine, sunset yellow, and carmoisine. Rhodamine-b, a suspected carcinogen, is already banned.
- Restrictions on Tartrazine: Although tartrazine is an approved artificial food color, there are restrictions on its usage. It can only be used in specific packed food items, with prescribed amounts. It cannot be used in freshly prepared food items.
- Health Concerns: The Food Safety Commissioner emphasized that prolonged consumption of snacks containing artificial colors can lead to severe diseases like cancer, highlighting the importance of the ban in safeguarding public health.
What are the Penalties?
- Prohibition on Artificial Colors: Rule 16 of the Food Safety and Standards Act prohibits the use of artificial colors in the preparation of gobi manchurian.
- Approved Limits for Food Colors: While certain food colors are allowed within approved limits, non-permitted colors like rhodamine-b should not be used in the preparation of cotton candy.
- Penalties for Offenders: Violators face severe penalties, including cancellation of licenses for commercial activities, hefty fines, and imprisonment. The Food Safety and Standards Act specifies a minimum fine of ₹10 lakh and a jail term of at least seven years, which can extend to life imprisonment, for those found using banned chemical substances in food products.
Way Forward:
- Enforcement and Monitoring: Health safety officials will likely conduct random checks to ensure compliance with the ban on harmful chemicals and artificial colors.
- Public Awareness Campaigns: The government will continue its efforts to raise awareness among manufacturers and consumers regarding the risks associated with harmful chemicals and artificial colors in food products.
- Regulatory Review: There might be a review of existing regulations and standards related to food safety to further strengthen controls and ensure comprehensive coverage of potentially risky food items beyond gobi manchurian, such as kebabs, that may use coloring agents.
- Collaboration with Stakeholders: Collaboration between government authorities, food manufacturers, and other stakeholders in the food industry will be crucial to implement and enforce the ban effectively. This may include consultations, partnerships, and dialogues to address challenges and ensure compliance with regulations.
Conclusion: Karnataka banned certain coloring agents in response to findings of harmful chemicals in food samples. Strict penalties and enforcement measures are in place, alongside awareness campaigns and collaboration with stakeholders to ensure compliance and safeguard public health.
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Changing cancer nomenclature can improve treatment outcomes: doctors
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Genetic causes behind Cancers
Mains level: Menace of Cancer in India and the World
Why in the news?
Physicians have expressed the necessity to categorize Cancers based on their genetic characteristics.
Context:
- An updated classification system could aid patients in comprehending the reasoning behind their treatment.
- While two individuals may share the same type of cancer, their therapies could vary due to differences in the biological mechanisms driving their tumors.
What motivates the need for change?
- Not limited to cancers of a single organ: With technological improvements, doctors are also able to find which genetic mutations are responsible for a tumor in many cases and target them with drugs.
- All cancers from the same organ don’t always share the same mutations, and these mutations aren’t limited to cancers of a single organ
- Access life-saving drugs sooner: This development in precision oncology requires cancers to be classified based on their molecular and genetic characteristics rather than the organ in which they originate, a team of researchers from France has written in a paper.
- This way, according to them, cancer patients can also access life-saving drugs sooner. Oncologists spend a lot of time testing new drugs in clinical trials in a sequential manner, leading to “delay in treatment access”.
Has sequential testing caused delays?
-
- A 2012 clinical trial conducted in the U.S. explored the efficacy of the drug nivolumab across various cancer types, including melanoma and kidney cancer. Nivolumab targets a specific protein receptor found in certain tumors, and it showed promising results by alleviating symptoms in individuals with tumors expressing this protein
- Challenges Due to Traditional Organ-Based Classification-
-
- Hindered by the traditional classification-Despite promising outcomes, the next logical step of testing nivolumab in individuals with tumors expressing the protein, regardless of cancer origin, was hindered by the traditional classification of cancers based on their organ of origin (e.g., breast, kidney, lung).
- Multiple trials needed: As a consequence, researchers were compelled to conduct separate trials for each type of cancer, leading to significant delays in drug accessibility for patients with tumors expressing the targeted protein.
- Time taking trails: Each trial requires substantial time and resources, from recruitment to data analysis, prolonging the process of drug approval and availability for specific cancer subtypes.
Significance of categorizing cancers based on their genetic characteristics-
- Faster drug development and availability: By targeting specific genetic mutations rather than specific cancer types, clinical trials for drugs can encompass all cancer types with those mutations. This approach potentially expedites the trial process, leading to faster drug development and availability.
- Reduces confusion among the patient: The revamped classification system not only accelerates clinical trial timelines but also enhances patient understanding of treatment rationale. Patients often receive different therapies for the same cancer due to diverse underlying biological mechanisms. Aligning cancer names with biological mechanisms reduces confusion and helps patients comprehend the reasoning behind their treatment plans.
- Personalized treatment: Physicians, including Dr. Jobanputra, emphasize the importance of educating patients about the molecular characteristics of their cancers. As the approach to cancer treatment becomes more personalized, understanding these molecular aspects becomes crucial as they directly impact prognosis and treatment costs.
- Reducing the timing in trial-naming cancers based on their biological characteristics rather than their anatomical origin can significantly reduce the time required to conduct clinical trials. This shift eliminates the need for separate trials for each cancer type defined by organ of origin, streamlining the research process
Challenges in Implementing the Proposed Cancer Classification Change:
- Limited Access to Genetic Testing: The accessibility and affordability of genetic testing are major hurdles, particularly in regions like India where many patients cannot afford these tests.
- Without widespread access to such tests, implementing a classification system based on molecular alterations becomes impractical.
- Financial Barriers to Genetic Testing: The cost of genetic testing in Indian labs and abroad is prohibitively high for many patients, further exacerbating the issue of limited access.
- Addressing these financial barriers is crucial for ensuring equitable access to precision oncology.
- Lack of Patients in Clinical Trials: Clinical trials based on molecular signatures require a significant number of patients with each type of cancer to produce meaningful results.
- Without adequate representation across cancer types, there is a risk of generalizing results, limiting the effectiveness of precision oncology approaches.
- Time-taking Process: Transitioning to a new diagnostic nomenclature based on molecular alterations will likely occur gradually and require careful implementation.
- While the proposed change has the potential to improve drug accessibility, its full realization will take time and concerted effort to overcome various challenges.
Conclusion: Categorizing cancers based on genetic characteristics can streamline treatment, improve drug accessibility, and enhance patient understanding. However, challenges like limited access to genetic testing and lack of patient representation in trials must be addressed.
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Understanding dialysis outcome patterns in India through a nationwide study
Why in the News?
Recently, there are some findings from a nationwide private haemodialysis network’, the Lancet Regional Health-Southeast Asia, on the survival of patients receiving haemodialysis in India
Context:
- India has amongst the highest number of patients receiving chronic dialysis, globally estimated at around 1,75,000 people in 2018. Daily, the number of patients on dialysis has been increasing.
- The launch of the National Dialysis Service in 2016 to improve access, and ongoing efforts to develop affordable dialysis systems, are all underlined by the rising incidence of end-stage renal disease in the country.
What is Hemodialysis?A machine filters wastes, salts and fluid from your blood when your kidneys are no longer healthy enough to do this work adequately. |
Key Highlights as per study:
- Survival with Centre- and Patient-Level: The study found that both centre- and patient-level characteristics are associated with survival rates among patients undergoing haemodialysis.
- Unexplained Variation Between Centres: Despite considering various centre-based characteristics, there remained unexplained variations in survival rates between dialysis centres across India. This suggests that factors beyond those accounted for in the study may influence patient outcomes.
- Large Sample Size: The study included a substantial sample size of over 23,600 patients undergoing haemodialysis at any centre in the NephroPlus network between April 2014 and June 2019. This large sample size enhances the robustness of the study’s findings.
- Primary Outcome: The primary outcome of the study was all-cause mortality, measured from 90 days after patients joined a center. This outcome measure provides valuable insights into patient survival rates over time following the initiation of haemodialysis treatment.
- Consideration of Individual-Level Variables: The study accounted for various individual-level variables such as sex, smoking status, medical history (e.g., diabetes, heart disease, hypertension, hepatitis B, hepatitis C), education level, monthly household income, dialysis frequency, and vascular access. These variables offer comprehensive insights into patient characteristics and their impact on survival rates.
- Evaluation of Centre-Level Variables: Centre-level variables, including the frequency of nephrologist visits, number of beds, number of staff, and number of patients, were also considered. These variables help assess the influence of center resources and practices on patient outcomes.
What were the measuring differences?
- Limited Data: The only significant study conducted previously in Andhra Pradesh used claims data from a publicly-funded insurance scheme between 2008 and 2012. It included 13,118 beneficiaries and reported a 10.2% mortality rate within six months of starting hemodialysis.
- Absence of Centre-Level Effects: The previous study did not consider center-level effects on survival, limiting the understanding of differences in survival rates between dialysis centers, as observed in other countries.
- Gaps in Understanding: Major gaps existed in understanding dialysis outcome patterns in India due to the absence of comprehensive studies, hindering efforts to improve patient care.
- Lack of National Benchmark: There was no established national benchmark for survival rates among patients undergoing dialysis in India at the time of the study.
- Need for Further Research: The study highlighted the importance of conducting more extensive research to fill the gaps in knowledge and establish benchmarks for dialysis outcomes in India.
What is the recent issue related to the Mortality rate?
-
- Administrative challenges associated with Mortality:
- Impact of Centre-Level Factors: Including center-level factors such as staffing, care processes, and patient volume in the analysis reduced the variability in survival rates across dialysis centers by 31%. This suggests that center-level characteristics play a significant role in influencing patient outcomes and survival rates.
- Survival Range: After adjusting for multi-level factors, the estimated 180-day survival among patients undergoing hemodialysis ranged between 83% and 97%. This variability indicates differences in survival outcomes across dialysis centers in India.
- Urban-Rural Divide: Patients attending rural dialysis centers experienced a 32% higher mortality rate compared to those at urban centers. This disparity underscores the unique challenges faced by rural healthcare facilities in providing hemodialysis services.
- Administrative challenges associated with Mortality:
- Patient Characteristics Associated with Mortality:
-
- Catheter-Based Vascular Access: Patients using catheter-based vascular access had a higher mortality rate compared to those using arteriovenous fistula or graft access.
- Financial Support: Patients receiving financial support for dialysis treatment through government panel schemes or private insurance had a lower mortality rate compared to those paying out-of-pocket.
- Dialysis Vintage: There was an inverse relationship between mortality rate and dialysis vintage, with patients receiving dialysis for at least a year before joining a center experiencing a 17% lower mortality rate than those starting dialysis less than 30 days before joining.
- Presence of Diabetes: The presence of diabetes was associated with a higher mortality rate among hemodialysis patients.
Way Forward:
- Establishment of National Benchmark: The study proposes the first national benchmark for survival among dialysis patients in India. This benchmark will serve as a reference point for evaluating the quality of care and outcomes across dialysis centres in the country.
- Ongoing Quality Improvement Programs: As dialysis access continues to expand in India, ongoing quality improvement programs are crucial for ensuring that patients receive the best possible care and experience optimal outcomes at the point of care.
- Collaborative Quality Improvement System: The authors emphasize the need for a collaborative quality improvement system across the country to address the increasing demand for dialysis services. This system should involve stakeholders at various levels of healthcare delivery to enhance standards of care and patient outcomes.
- Understanding Multilevel Effects: It is essential to understand the multilevel effects of both centre- and patient-level characteristics on dialysis outcomes. Establishing national standards for dialysis outcomes in India requires comprehensive insights into these factors to drive improvements in care delivery.
- Comparison and Monitoring: Establishing national benchmarks enables comparison and monitoring of dialysis centres’ performances over time. This approach facilitates the identification of variations in practice patterns and outcomes, paving the way for targeted interventions and improvements in healthcare delivery.
Conclusion: The nationwide study on haemodialysis outcomes in India highlights disparities and the need for standardized care. Establishing national benchmarks, ongoing quality improvement, and collaborative efforts are essential for enhancing dialysis care and patient outcomes.
Mains PYQ-
Q- Public health system has limitations in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
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What is the HbA1C Test for Diabetes?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: HbA1C Test, Diabetes (Type-1 and 2)
Mains level: NA
Why in the news-
- India faces a significant burden of diabetes, with an estimated 10.13 crore people affected and an additional 13.6 crore individuals classified as pre-diabetic.
- One of the most commonly-used tests to diagnose pre-diabetes and diabetes (both type 1 and type 2) and to help manage diabetes, is the haemoglobin A1C (HbA1C) test.
What is the HbA1C Test?
- The HbA1C test, or glycated haemoglobin test, serves as a vital tool for diagnosing pre-diabetes and diabetes, offering insights into long-term blood glucose control.
- It measures the percentage of red blood cells coated with sugar.
- It provides a comprehensive view of average blood glucose levels over the preceding two to three months.
- It is recommended for individuals over 30 years and those with specific risk factors, with retests scheduled based on initial findings and individual health profiles.
Evolution and Acceptance
- Initially inconsistent, the test gained recognition for its correlation with blood glucose values and its role in monitoring glycemia, leading to improved standardization and accuracy.
- It is endorsed by medical bodies like World Health Organization (WHO) and the American Diabetes Association and.
- This underscores the test’s diagnostic utility, subject to stringent quality assurance measures.
Interpretation of Results
- Results are typically presented as percentages.
- Normal: Values below 5.7% are considered
- Pre-diabetes: 5.7% to 6.4%
- Diabetes: 6.5% or higher
- Alternatively, results may be expressed in mmol/mol, providing a comparable metric for assessment.
Limitations of the Test
- While informative, the HbA1C test may be supplemented by other tests, particularly in populations with conditions affecting assay accuracy.
- In India, factors like thalassemia prevalence and iron-deficiency anemia may impact test reliability, necessitating caution and additional indices for glycemic assessment.
PYQ:
‘Aerial metagenomics’ best refers to which one of the following situations?
- Collecting DNA samples from air in a habitat at one go
- Understanding the genetic makeup of avian species of a habitat
- Using air-borne devices to collect blood samples from moving animals
- Sending drones to inaccessible areas to collect plant and animal samples from land surfaces and water bodies
Practice MCQ:
Consider the following statements about the HbA1C test:
- It is used in the diagnosis of Sickle Cell Disease.
- It measures the percentage of red blood cells coated with sugar.
- It is recommended for individuals over 30 years.
How many of the given statements is/are correct?
- One
- Two
- Three
- None
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Lyme Disease reported in Ernakulam
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Lyme Disease and its causative borrelia bacteria
Mains level: NA
In the news
- A suspected case of Lyme disease caused by the bite of a tick carrying borrelia bacteria has been reported from Koovapady in Ernakulam district.
What is Lyme Disease?
- According to the Centers for Disease Control and Prevention (CDC), Lyme is transmitted to humans through the bite of infected blacklegged ticks.
- Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans.
- If left untreated, infection can spread to joints, the heart, and the nervous system.
Symptoms of Lyme DiseaseSymptoms of Lyme disease depend on the stage of the condition. (1) Stage 1
(2) Stage 2
(3) Stage 3
|
Try this PYQ from CSE Prelims 2016:
Which of the following statements is/are correct?
Viruses can infect
- bacteria
- fungi
- plants
Select the correct answer using the code given below.
(a) 1 and 2 only
(b) 3 only
(c) 1 and 3 only
(d) 1, 2 and 3
Post your answers here.
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11 African countries sign ‘Yaounde Declaration’
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Yaounde Declaration, Malaria
Mains level: NA
In the news
- Health ministers from 11 African nations grappling with the heaviest malaria burdens have recently signed the Yaounde Declaration.
What is Yaounde Declaration?
| Details | |
| Signed at | Yaoundé conference, hosted by WHO and the Government of Cameroon in Yaoundé, Cameroon (capital). |
| Participants | Ministers of Health, global malaria partners, funding agencies, scientists, civil society organizations, and other malaria stakeholders. |
| Signatory countries |
|
| Pledges |
|
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Children’s Vulnerability to Skincare Products
Note4Students
From UPSC perspective, the following things are important :
Prelims level: NA
Mains level: Health hazards of Skincare Products
In the news
- With the increasing trend of children’s interest in skincare products, concerns have been raised regarding their safety and long-term impact on children’s health.
- Influenced by social media and marketing, parents are seeking skincare routines for their children, often overlooking potential risks.
In this article, we explore the implications of early skincare practices on children and the necessity for regulatory measures to ensure their well-being.
Risks Associated with Children’s Skincare Products
- Vulnerability to Harm: Children’s skin is thinner, more delicate, and less developed than adults, making them more susceptible to adverse reactions from skincare products.
- Exposure to Toxicants: Behavioral patterns like hand-to-mouth activity increase the risk of ingesting harmful chemicals present in skincare products, posing health hazards.
- Biological Susceptibility: Rapid growth rate, developing tissues, and immature immune systems make children biologically more vulnerable to the toxicants present in skincare products.
Insights from Research
- Usage Patterns: Research indicates that up to 70% of children in the U.S. have used children’s makeup and body products, highlighting the widespread exposure to skincare products among children.
- Health Risks: Studies suggest that children’s prolonged exposure to makeup and body products may lead to adverse health effects due to their developing physiology and behavioural tendencies.
Toxins in skincare products can pose risks to health due to their potential adverse effects. Some common toxic ingredients found in cosmetics include:
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Regulatory Imperatives
- Medical Concerns: Dermatologists express concern over the unsupervised use of cosmeceuticals by children, emphasizing the potential harm caused by substances like steroids and hydroquinone present in skincare products.
- Need for Regulation: Regulatory measures are deemed essential to restrict the sale of skincare products containing harmful ingredients and protect children from inappropriate products.
Psychological Impact
- Unrealistic Standards: The promotion of flawless complexion as an ideal standard perpetuates unrealistic beauty standards among children, impacting their self-esteem and body image.
- Ethical Considerations: The ethical implications of targeting young consumers with skincare products, without adequate consideration of their long-term effects, warrant scrutiny and regulation.
Way Forward
- Prioritizing Safety: Parents are advised to prioritize safety, simplicity, and skin health when selecting skincare products for their children.
- Return to Basics: Dermatologists advocate for a return to basic skincare practices, including a healthy diet, proper cleansing, and moisturizing, to maintain children’s skin health.
- Functional Necessity: For child performers and those exposed to heavy makeup, gentle cleansing and hydration are recommended to counteract the effects of makeup and protect the skin’s integrity.
Conclusion
- As the children’s cosmetics market continues to grow, it is imperative to address the risks associated with early skincare practices and implement regulatory measures to safeguard children’s health and well-being.
- By prioritizing safety, simplicity, and skin health, parents can navigate the skincare maze for their children and foster a healthy relationship with skincare that values function over appearance.
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Have India’s health centres really ‘collapsed’?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Primary Health Centres (PHCs)
Mains level: Read the attached story
In the news
- Public health centres in India have long been shrouded in infamy, perceived as symbols of systemic failure.
- The effectiveness of primary healthcare in India has always been a topic of discussion, with calls for strengthening these services through government commitment to accessibility, affordability, and quality care.
PYQ from CSE Mains 2021:
Q. “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. |
Health Centres in India
- Primary Health Centres (PHCs) also known as Public HCs play a crucial role in providing comprehensive healthcare services to the population.
- The first PHC in India was established following the proposal of the PHC concept in a paper submitted to the Executive Board of the World Health Organization (WHO) in January 1975.
- The establishment of PHCs gained further momentum with the International Conference on PHC held in Alma Ata, Kazakhstan in 1978.
- They are a fundamental component of the healthcare system, with Medical Officers at these centers required to hold an MBBS degree.
- India boasts a vast public health infrastructure with 23,391 PHCs and 145,894 sub-centers, serving a substantial percentage of the population.
- PHCs cover a significant portion of outpatient care, including services for non-communicable diseases, maternal health, and child health.
Importance of Health Centres
- Foundational Role: Health centres form the backbone of India’s public health system, providing primary care to millions.
- Access and Affordability: With nearly two lakh centres across the country, they aim to offer accessible and affordable healthcare, particularly in rural areas.
- Impact on Equity: Effective health centres can mitigate social and health inequities, reducing reliance on costly private healthcare and preventing households from falling into poverty due to healthcare expenses.
Unveiling the Reality
- Evidence of Progress: Surveys conducted across five states reveal a pattern of improving quality and utilization of health services over time, albeit at a slow pace.
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- In Himachal Pradesh, functional health centres serve 83% of the population.
- Chhattisgarh has shown a radical expansion in the public provision of healthcare, with increased facilities, medicines, and staff presence.
- Bihar lags behind, with dismal quality of health centres and some sub-centres being dormant or non-existent.
- Policy Interventions: Increased health expenditure, initiatives like the National Rural Health Mission, and state-specific schemes have contributed to incremental improvements.
- The share of health expenditure in the Union Budget increased drastically.
- The National Health Mission’s share shrank from 69% to 44%, while allocations for the Ayushmann Bharat program and new AIIMS hospitals surged.
- COVID-19 led to a sustained increase in patient utilization of public health facilities, indicating growing trust in the system.
Challenges and Gaps
- Underutilization: Despite improvements, health centres still face challenges such as high staff absenteeism, limited services, and poor infrastructure.
- Lacunas: Health workers report irregular flow of funds, lack of facilities like toilets and transport, and inadequate supply of drugs and testing equipment.
- Social Discrimination: Caste and gender dynamics influence access to and quality of healthcare, perpetuating inequalities. Upper-caste doctors display disparaging attitudes towards marginalized communities, while upper-caste families disrespect Dalit ANMs.
- Gender Disparities: Women, particularly frontline health workers, play a crucial role in rural health settings but often face neglect and discrimination.
Way forward
- Holistic Investment: While progress has been made, it remains patchy, with allocations often prioritizing tertiary healthcare over primary care.
- Designated allocations: The composition of the healthcare budget has remained stagnant, with minimal increases in the share allocated to primary healthcare.
- Policy Reform: The paper advocates for substantial support from the central government to enable poorer states to replicate successful initiatives and enhance the role of health centres in public healthcare delivery.
Conclusion
- India’s health centres, though fraught with challenges, embody resilience and potential.
- By addressing systemic gaps and prioritizing primary healthcare, the nation can harness the transformative power of these centres to achieve equitable and accessible healthcare for all.
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A vaccine that prevents six cancers
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Pap smears, Human Papillomavirus
Mains level: proactive measures to prevent cervical cancer
Pyq mains
UPSC IAS/2017
Stem cell therapy is gaining popularity in India to treat a wide variety of medical conditions including leukaemia, Thalassemia, damaged cornea and several burns. Describe briefly what stem cell therapy is and what advantages it has over other treatments? (10)
Pyq pre
Why is it in the News?
- Cervical cancer prevention, particularly through HPV vaccination, has gained attention recently due to several factors. January was observed as Cervical Cancer Awareness Month, drawing focus to the importance of combating this disease. Additionally, March 4 marked International HPV Awareness Day, further highlighting the significance of addressing HPV-related health issues.
What is Cervical Cancer?
- Cervical cancer is a type of cancer that affects the cervix, the lower part of the uterus. It is primarily caused by certain types of the Human Papillomavirus (HPV), which is transmitted through intimate contact.
- If left untreated, cervical cancer can be life-threatening. It is a significant health concern worldwide, with a particularly high burden in lower- and middle-income countries. In India, cervical cancer is the second most common cancer among women, posing a substantial threat to public health.
What is Human Papillomavirus (HPV)?
- Human Papillomavirus (HPV) is a group of viruses that infect the skin and mucous membranes. It’s the most common sexually transmitted infection (STI) worldwide. HPV can cause various health issues, including genital warts and certain types of cancers.
What Facts are explained in the article?
- Prevalence and Impact: Cervical cancer claims the lives of over 300,000 women annually worldwide, with a disproportionate burden in lower-income countries.
- Risk in India: With over 500 million women at risk, cervical cancer is a significant public health concern in India, second only to breast cancer.
- Role of HPV Vaccination: HPV vaccination is identified as a crucial strategy for preventing cervical cancer. It targets the underlying cause of the disease by protecting against HPV infection.
Strategies for Prevention of Cervical cancer
- HPV Vaccination: Implementing widespread HPV vaccination programs, particularly targeting adolescent girls, can significantly reduce the incidence of cervical cancer. Vaccination should ideally occur before the onset of sexual activity to maximize effectiveness.
- Screening for Precancerous Lesions: Regular screening for precancerous lesions, such as Pap smears or HPV DNA tests, can detect abnormalities early and allow for timely intervention. This is crucial for reducing the incidence of advanced-stage cervical cancer.
- Education and Awareness: Increasing education and awareness about cervical cancer, HPV infection, and the importance of vaccination and screening are essential. This includes targeting healthcare professionals, policymakers, parents, and adolescents to dispel myths and misconceptions and encourage uptake of preventive measures.
What are the Challenges?
- Limited Access: HPV vaccination may not be widely accessible, particularly in lower-resourced communities, and is often available at a significant out-of-pocket cost.
- Misconceptions Among Physicians: Some physicians underestimate the incidence and risk of cervical cancer, as well as the safety and effectiveness of HPV vaccines. This can lead to hesitancy in recommending vaccination to eligible individuals.
- Parental Hesitancy: Misinformation and concerns about vaccine safety and efficacy among parents can contribute to hesitancy in vaccinating adolescents against HPV.
| Pap Smears |
|---|
| Description: A screening procedure for cervical cancer involving collecting cells from the cervix to examine for abnormalities. |
| Purpose: To detect precancerous or cancerous changes in cervical cells early for timely intervention and prevention. |
| Procedure: Use of a speculum to visualize the cervix and collection of cells with a brush or spatula. |
| Timing: Typically performed during routine gynecological exams, starting at age 21 or within 3 years of becoming sexually active. |
Facts about HPV Vaccination:
- The HPV vaccine is safe and effective in preventing six HPV-related cancers, including cervical, vulvar, anal, vaginal, throat, and cervical cancers.
- Vaccination is recommended for adolescents starting at age 9 years to maximize its effectiveness.
- HPV vaccination is an essential component of the immunization schedule recommended by the Indian Academy of Pediatrics (IAP).
Best Practices for HPV Vaccination and Cervical Cancer Prevention:
- Effective Communication:
- Provide clear and accurate information to parents about HPV vaccination.
- Address concerns and misconceptions to ensure informed decision-making.
- Timely Vaccination:
- Recommend HPV vaccination for adolescents starting at age 9.
- Encourage vaccination before sexual activity begins for maximum effectiveness.
- Integration into Immunization Programs:
- Advocate for inclusion in national immunization programs for widespread access.
- Collaborate with policymakers to ensure equitable vaccine coverage.
- Promotion of Regular Screening:
- Emphasize the importance of cervical cancer screening for women over 30.
- Encourage routine Pap smears or HPV DNA tests for early detection.
- Physician Education:
- Provide comprehensive training on HPV vaccination and cervical cancer prevention.
- Equip healthcare professionals with updated guidelines and communication skills.
In conclusion, the article emphasizes the importance of proactive measures to prevent cervical cancer, particularly through HPV vaccination and screening. It underscores the role of healthcare professionals, policymakers, and community stakeholders in addressing the challenges and ensuring equitable access to preventive interventions.
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Rare Diseases Care in India: Progress, Challenges, and Opportunities
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Rare Diseases Definition
Mains level: Burden of Rare Diseases and Policy Interventions
In the news
- World Rare Diseases Day (February 29) was recently celebrated.
What are Rare Diseases?
- Global Perspective: Rare diseases are defined by the World Health Organization (WHO) as often debilitating lifelong diseases or disorders with a prevalence of 1 or less, per 1,000 population.
- National Context: While India lacks a standardized definition, the Organisation of Rare Diseases – India suggests defining a disease as rare if it affects 1 in 5,000 people or less.
Rare Diseases: Key Facts and Figures
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National Policy on Rare Diseases, 2021: Highlights
- Comprehensive Approach: This Policy offers a holistic framework encompassing prevention, management, and treatment strategies tailored to the unique needs of patients.
- Financial Support: Recognizing the financial burden on patients, the policy aims to lower the exorbitant costs of treatment through targeted interventions and support mechanisms.
- Research Focus: Emphasizing indigenous research, the policy lays the foundation for bolstering research initiatives in the field of rare diseases, fostering innovation and discovery.
Other Initiatives in India
- National Hospital-Based Registry: A pivotal component of the policy, the establishment of a national registry of rare diseases promises to provide invaluable epidemiological data, informing targeted interventions and resource allocation.
- Early Screening and Prevention: The creation of Nidan Kendras aims to enhance early detection and prevention efforts, crucial for improving patient outcomes and reducing disease burden.
- Capacity Building: Strengthening secondary and tertiary health facilities at Centres of Excellence underscores the commitment to enhancing healthcare infrastructure and service delivery.
Challenges and Imperatives
- Defining Rare Diseases: Despite significant progress, India lacks a standardized definition of rare diseases, necessitating clarity to guide policy and resource allocation effectively.
- Funding Utilization: Concerns arise over the underutilization of allocated funds, highlighting the urgency to streamline resource allocation and enhance accountability mechanisms.
- Patient Advocacy: Rare diseases patient advocacy groups play a pivotal role in advocating for timely access to treatment and sustainable funding support, urging policymakers and healthcare providers to prioritize patient-centric initiatives.
Way Forward
- Sustainable Funding: Ensuring sustainable funding support for rare diseases treatment is paramount to safeguarding patient well-being and fostering equitable access to care.
- National Registry Implementation: Accelerating the establishment of a hospital-based national registry is imperative to harness the power of data-driven decision-making and advance rare diseases research.
- Multidisciplinary Care: The creation of comprehensive care centers, coupled with initiatives to support caregivers, represents a crucial step towards enhancing patient outcomes and fostering a supportive healthcare ecosystem.
Conclusion
- As India commemorates World Rare Diseases Day, it stands at a pivotal juncture in its journey towards rare diseases care and advocacy.
- By embracing a collaborative and patient-centric approach, India can surmount existing challenges, paving the way for a future where every individual affected by a rare disease receives the care and support they deserve.
Try this PYQ from CSP 2014:
Consider the following diseases
- Diphtheria
- Chickenpox
- Smallpox
Which of the above diseases has/have been eradicated in India?
(a) 1 and 2 only
(b) 3 only
(c) 1, 2 and 3
(d) None
Post your responses here.
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Story of ASHAs: Navigating Challenges in Public Health
Note4Students
From UPSC perspective, the following things are important :
Prelims level: ASHA
Mains level: NA
Introduction
- ASHAs, or Accredited Social Health Activists, have emerged as pivotal figures in India’s public health landscape, embodying the promise of compassionate care and community advocacy.
Who are the ASHA workers?
- Inception: Established in 2002 in Chhattisgarh, ASHAs were envisioned as community health workers, modeled after the ‘Mitanins’, to bridge the gap between the health system and local populations. Initiated in 2005-06 as part of the National Rural Health Mission (NRHM); Expanded to urban settings since 2013 via the National Urban Health Mission.
- Number: Around 10.4 lakhs employed across India. The highest numbers are in populous states like Uttar Pradesh and Bihar.
- Geographical Distribution: One ASHA per 1,000 people in rural areas, adjusted to one per habitation in tribal, hilly, and desert regions.
- Global Recognition: Awarded by the World Health Organization (WHO) in 2013.
- Functions and Responsibilities: Register newborns, pregnant women, and deaths; accompany patients to health centers; distribute medicines; conduct immunization drives; and report health statistics.
Criteria for selection of ASHA worker:
- For Rural:
- The prospective candidate must be a married, widowed or divorced female resident of the village she’s applying to work at.
- Must be aged between 25 and 45 years.
- Candidates must be literate. Preference is given to those with a 10th pass certificate. There are several interviews at the Anganwadi, block and district levels. The health committees maintain a thorough selection process.
- For Urban:
- The prospective candidates must be female residents of vulnerable clusters or slums within an urban setup.
- This slum or cluster must be identified by the City or District Health Society as priority zones for ASHA healthcare workers. The candidate should preferably be married, widowed, separated or divorced.
- Must be aged between 25 and 45 years.
- Candidates must be literate and must have fluency in the native language of the community.
Challenges Faced by ASHAs
[1] Work Challenges
- Overwork and Underpayment: ASHAs endure a “triple shift,” balancing household responsibilities, community outreach, and health center duties, often without adequate compensation or rest.
- Systemic Inequities: ASHAs experience power imbalances along gender and caste lines, compounded by their status as “volunteers,” leading to economic, physical, and psychological vulnerabilities.
- Social Stigma: Despite their crucial role in improving health outcomes, ASHAs often face social stigma and discrimination within their communities, hindering their effectiveness and well-being.
[2] Occupational Hazards
- Physical Strain: Irregular meals, inadequate sleep, and exposure to extreme weather conditions contribute to health issues like malnutrition, anaemia, and non-communicable diseases among ASHAs.
- Mental Health Challenges: The demanding nature of their work and limited social support expose ASHAs to high levels of stress, anxiety, and burnout, affecting their overall well-being and job satisfaction.
- Safety Concerns: ASHAs, particularly those working in remote or conflict-affected areas, face risks of harassment, violence, and assault while performing their duties, highlighting the need for enhanced security measures and support systems.
[3] Social and Economic Implications
- Economic Precarity: ASHAs’ honorariums serve as primary family income, yet delays in payment and out-of-pocket expenses exacerbate financial strain, perpetuating cycles of poverty and dependence.
- Gendered Burden: ASHAs, predominantly women, often bear the brunt of caregiving responsibilities within their households, leading to gender disparities in workload distribution and access to resources.
- Empowerment and Agency: Despite facing numerous challenges, ASHAs demonstrate resilience and agency in advocating for their rights, mobilizing communities, and demanding policy reforms to improve their working conditions and livelihoods.
Advocacy and Policy Recommendations
- Recognition and Fair Compensation: Advocate for institutional recognition, fair wages, and improved working conditions for ASHAs, aiming for them to become government employees with access to social security benefits and maternity support.
- Capacity Building: Support initiatives aimed at enhancing ASHA skills, knowledge, and confidence through targeted training and skill development programs.
- Community Engagement: Encourage local communities to recognize and appreciate the contributions of ASHAs, fostering stronger support, trust, and collaboration.
- Safety Measures: Enhance safety protocols and support systems for ASHAs, especially those working in remote or conflict-affected areas, to minimize risks of harassment, violence, and assault.
- Address Systemic Barriers: Tackle gender and caste-based inequalities experienced by ASHAs, promoting equal opportunities and access to resources.
- Financial Security: Ensure timely payments and reduce out-of-pocket expenses for ASHAs, mitigating financial strain and perpetual cycles of poverty.
Conclusion
- The plight of ASHAs reflects broader structural injustices within India’s healthcare sector, underscoring the urgent need for policy reforms and systemic support.
- As frontline warriors in public health, ASHAs deserve equitable treatment, recognition, and protection, essential for advancing both individual well-being and community health outcomes.
- Through collective advocacy, empowerment, and solidarity, ASHAs can continue to drive positive change and make lasting contributions to public health in India.
Try this PYQ from CSP 2012:
With reference to the National Rural Health Mission, which of the following are the jobs of ASHA, a trained community health worker?
- Accompanying women to the health facility for antenatal care checkups
- Using pregnancy test kits for early detection of pregnancy
- Providing information on nutrition and immunization
- Conducting the delivery of the baby
Select the correct answer using the codes given below:
- 1, 2 and 3 only
- 2 and 4 only
- 1 and 3 only
- 1, 2, 3 and 4
Post your answers here.
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Eradication of Guinea Worm Disease
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Guinea Worm Disease
Mains level: NA
Why in the News?
The imminent eradication of Guinea worm disease marks a major win for public health, showcasing the effectiveness of simple strategies in fighting diseases.
About Guinea Worm Disease
- Causes: Guinea worm disease, known since ancient times as the “fiery serpent,” is caused by the Guinea worm (Dracunculus medinensis), bringing painful blisters and severe symptoms to those affected.
- How It Spreads: People develop painful blisters, and when they come into contact with water, adult worms emerge, contaminating water sources and continuing the cycle of infection.
Symptoms and Impact
- Pain and Suffering: The disease causes intense pain, swelling, and ulcers, making it hard for people to go about their daily lives.
- Effects: Mostly affecting the legs and feet, Guinea worm disease worsens poverty and illness in areas where clean water and healthcare are scarce.
Success Story in India
- Beating the Disease: India successfully got rid of Guinea worm disease in the late 1990s by focusing on simple things like clean water and educating communities about health.
- Team Effort: India’s government, local health workers, and international partners worked together to achieve this victory.
Global Progress and Challenges
- Making Strides: Progress has been made globally, but challenges remain in places like Chad and the Central African Republic, where the disease is still a problem.
- New Hurdles: Finding Guinea worms in animals like dogs shows that the disease is tough and needs continued attention.
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Electoral season and restructuring the health system
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Na
Mains level: importance of prioritizing primary healthcare
Central Idea:
The article discusses the importance of health reform in India, highlighting the necessity for political parties to prioritize it in their manifestos. It emphasizes the need to strengthen primary healthcare systems, citing successful examples from other countries like Thailand, and proposes comprehensive reforms to address India’s healthcare challenges.
Key Highlights:
- Manifestos serve as important documents reflecting political parties’ priorities and commitments.
- Both BJP and Congress manifestos in 2014 and 2019 highlighted the importance of revamping the primary healthcare system, but with differing perspectives on healthcare delivery.
- Past initiatives like the National Rural Health Mission under the UPA and policy continuity under the NDA have made incremental progress but haven’t addressed fundamental healthcare system flaws.
- Comparison with countries like Thailand and Turkey underscores India’s need for more ambitious and effective healthcare reforms.
- The focus should shift towards strengthening primary and secondary healthcare infrastructure to address the majority of health needs effectively.
- Successful reform examples emphasize deliberate planning, strong local capacity building, and a focus on community outcomes.
- Challenges include political will, overcoming preoccupation with high-end hospitals, and implementing synchronized reforms at the grassroots level.
Key Challenges:
- Political reluctance to prioritize primary healthcare over high-end hospital infrastructure.
- Resistance to reforming entrenched healthcare delivery models and governance structures.
- Capacity building and resource allocation at the district level to implement reforms effectively.
- Varying levels of capability across states necessitate tailored approaches to reform implementation.
- Addressing lifestyle factors contributing to disease incidence and out-of-pocket healthcare expenses.
- Overcoming market failures and governance challenges in healthcare service provision.
Main Terms or key terms for answer writing:
- Primary healthcare
- Universal Health Coverage (UHC)
- Health reform
- Public-private partnerships (PPP)
- Human resources for health
- Social health insurance
- Medical curriculum reform
- Decentralization
- Operational flexibilities
- Accountability framework
Important Phrases for quality answers:
- “Reforming the very architecture of the health system”
- “Building a system ‘fit for purpose'”
- “Operational flexibilities within a proactive, accountability framework”
- “Imagination to design the process of reform”
- “Infusion of new institutional and organizational capacities”
- “Reducing demand for hospitalization”
- “Out-of-pocket expenditures”
Quotes that you can use for essay writing:
- “Manifestos are useful documents… enabling people to hold the elected party accountable.”
- “India’s strategy for UHC has hinged on purchasing services from a private sector operating on the inflationary a fee for service model…”
- “Can our political parties commit themselves to such a process in their manifestos? Or, is that a big ask?”
Useful Statements:
- “Twenty years is a long time… Thailand… achieved significant outcomes within half the time span.”
- “India has a long way to go… States such as Bihar still have one doctor serving per 20,000 population.”
- “Successful examples of such reform processes show deliberate intent executed to a plan.”
Examples and References for value addition in your mains answer:
- Thailand’s Universal Health Coverage implementation in 2000.
- Turkey’s Health Transformation Program in 2003.
- India’s National Rural Health Mission and National Medical Commission establishment.
Facts and Data:
- India’s maternal mortality is three times more than the global average.
- 95% of ailments and disease reduction can be handled at the primary and secondary level.
- India’s public spending on healthcare has hovered around an average of 1.2% of GDP.
Critical Analysis:
The article provides a critical analysis of past healthcare initiatives in India, highlighting their incremental nature and failure to address fundamental system flaws. It underscores the importance of prioritizing primary healthcare and comprehensive reform to achieve equitable, effective healthcare delivery.
Way Forward:
- Prioritize strengthening primary healthcare infrastructure.
- Implement comprehensive healthcare reforms addressing governance, human resources, and service delivery.
- Tailor reform strategies to suit varying state capabilities.
- Shift focus towards community outcomes and accountability.
- Address lifestyle factors contributing to healthcare burden.
- Overcome political reluctance and vested interests to achieve meaningful reform.
Answer the following question and write your answer in comment box
How can India learn from successful healthcare reform initiatives in other countries like Thailand and Turkey to address its own healthcare challenges effectively?
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Bubonic Plague is back: Should you be worried?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Bubonic Plague and its causes
Mains level: Rise of zoonotic diseases
Introduction
- Recent reports from Oregon, US, confirm the reemergence of bubonic plague, marking the first case since 2005.
- Notable historical instances include the Third Pandemic in the late 19th and early 20th centuries, originating in China and spreading worldwide, reaching India by 1896.
What is Bubonic Plague?
- Cause: Bubonic plague is caused by Yersinia pestis, a zoonotic bacterium primarily found in small animals and their fleas, capable of transmission to humans.
- Transmission: The World Health Organization (WHO) identifies three primary modes of transmission:
- Through infected vector fleas,
- Contact with infectious bodily fluids or materials, and
- Inhalation of respiratory droplets from pneumonic plague patients.
Symptoms and Forms
- Bubonic Plague: Characterized by fever, headache, swollen lymph nodes, and weakness, typically resulting from flea bites.
- Septicemic Plague: Occurs when the bacteria enter the bloodstream, leading to severe symptoms such as abdominal pain, shock, and skin discoloration.
- Pneumonic Plague: The most perilous form, causing rapid-onset pneumonia, and posing a high risk of fatality if left untreated, with potential person-to-person transmission.
Historical Impact of the Black Death
- Deadliest Outbreak: The Black Death, spanning from 1346 to 1353, decimated up to half of Europe’s population, leaving a profound and enduring impact on survivors.
- Genetic Legacy: Genetic mutations linked to increased survival during the Black Death era have been identified, albeit with potential implications for autoimmune diseases in modern populations.
- Social and Economic Ramifications: Historians attribute Europe’s rise to global dominance partly to the aftermath of the Black Death, shaping subsequent societal, economic, and cultural trajectories.
Contemporary Outlook and Mitigation
- Limited Spread: Medical experts allay fears of a Black Death resurgence, affirming the localized nature of the recent bubonic plague case and the low likelihood of widespread transmission.
- Modern Interventions: Advancements in antibiotics and healthcare infrastructure significantly mitigate the threat posed by bubonic plague, rendering it treatable and containing its potential impact.
- Global Surveillance: Vigilant monitoring and prompt treatment protocols contribute to managing sporadic plague cases reported worldwide, underscoring the importance of continued vigilance and preparedness.
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Derek O’Brien writes: How BJP government’s Data Fails Rekha, Kavita, and Mohan
Note4Students
From UPSC perspective, the following things are important :
Prelims level: interim budget session of Parliament
Mains level: gap between government rhetoric and ground realities, emphasizing the human impact of policy failures
Central Idea:
The article critiques the recent interim budget session of Parliament, highlighting the discrepancy between the government’s rhetoric and the lived realities of everyday Indians. Through the stories of Rekha, Kavita, and Mohan, it exposes the failure of government schemes like Ayushman Bharat, food subsidies, and employment initiatives to address the fundamental issues facing citizens.
Key Highlights:
- The government’s self-aggrandizing adjectives during the budget session are criticized for being unsubstantiated by facts.
- The article delves into the lives of ordinary Indians to reveal the truth behind government data.
- Through scenarios, it demonstrates how government schemes often fail to provide adequate healthcare, nutrition, and employment opportunities.
- The suspension of a senior professor behind a damning health report raises questions about intellectual honesty regarding data.
- The Global Hunger Index ranking and reports from international organizations highlight India’s challenges in food security.
- Unemployment rates and the plight of educated youth like Mohan illustrate the failures in job creation and protection.
Key Challenges:
- Inadequate investment in healthcare, leading to poor quality and inaccessible services for millions.
- Subsidized food options lack nutritional value, exacerbating hunger and malnutrition.
- Job scarcity and lack of protection for workers, pushing individuals to precarious employment or even dangerous situations abroad.
- Discrepancies between government claims and ground realities, highlighting issues of transparency and accountability.
Main Terms:
- Ayushman Bharat scheme
- NFHS (National Family Health Survey)
- Global Hunger Index
- Gig economy
- Unemployment rate
- Food subsidies
Important Phrases:
- “Data stored with government hospitals under the Ayushman Bharat scheme is riddled with errors.”
- “The suspension of the IIPS Director shortly after the release of the NFHS report.”
- “India ranked out of countries in the Global Hunger Index.”
- “Mohan finds himself among the percent of graduates under years of age who are unemployed.”
- “A packet of rice costs more while dal costs more than before.”
Quotes:
- “The voices of Kavita, Rekha, and Mohan did not find a place in the Prime Minister’s marathon monologue in Parliament.”
- “Every youth believes that they can cement their job position with hard work and skills.”
- “Reality gets worse for Indian women like Rekha.”
- “Three out of four Indians cannot afford a healthy diet.”
Anecdotes:
- Rekha’s struggle to access healthcare at a government hospital.
- Kavita’s dilemma between subsidized but low-nutrient food and higher quality groceries.
- Mohan’s choice between unemployment at home or precarious work abroad.
Useful Statements:
- “The numbers either misidentify the dead, incorrectly record surgery details or entirely leave out beneficiaries from the list.”
- “Half the country does not turn to government facilities in their time of need.”
- “A job in a war zone is his only option.”
- “Mohan has not found employment for months.”
Examples and References:
- Global Hunger Index ranking (India ranked out of countries).
- NFHS data highlighting issues in healthcare access.
- Mohan’s situation exemplifying unemployment among educated youth.
Facts and Data:
- India invests only percent of GDP in healthcare.
- Three out of four Indians cannot afford a healthy diet.
- percent of graduates under years of age are unemployed.
- A packet of rice costs more, while dal costs more than before.
Critical Analysis:
The article effectively exposes the gap between government rhetoric and ground realities, emphasizing the human impact of policy failures. By presenting concrete examples and data, it challenges the narrative of progress touted by the government. The suspension of the IIPS Director adds weight to concerns about data integrity and transparency. However, the article could benefit from more analysis on systemic issues contributing to these failures, such as corruption and inadequate social welfare policies.
Way Forward:
- Increase investment in healthcare to improve accessibility and quality of services.
- Reform food subsidy programs to ensure nutritious options for all citizens.
- Create more employment opportunities through targeted policies and investments in key sectors.
- Enhance transparency and accountability in data collection and reporting to address systemic issues.
- Prioritize the voices and needs of ordinary citizens in policymaking process
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Gender Disparities: Big Blindspot in India’s Health Policy
Note4Students
From UPSC perspective, the following things are important :
Prelims level: NA
Mains level: Gender Gaps in Healthcare
Introduction
- Despite comprising nearly half of India’s health workforce, women face significant barriers in reaching leadership positions within the healthcare sector, highlighting deep-rooted gender disparities in health policy and decision-making.
Understanding the Gender Gap
- Data revelations: Official data reveals that while women make up almost 50% of health workers in India, only 18% occupy leadership roles across various health panels, committees, hospitals, and ministries.
- Impact of Gender Disparity: The over-representation of men at the top of the health pyramid perpetuates inequalities in decision-making and policymaking, leading to skewed health systems that fail to address the diverse needs of the population.
Insights from Research
- Diversity Gaps: Recent research highlights the prevalence of diversity gaps in India’s National Health Committees, with an “over-concentration” of men, doctors, individuals from urban areas, and bureaucrats. This centralization of power risks excluding diverse perspectives and experiences, hindering the development of inclusive health policies.
- Impact on Policy Formulation: The lack of gender diversity in health committees affects policy outcomes, as decisions are often made from a narrow lens, overlooking the nuanced needs of marginalized groups. For instance, the absence of women in decision-making bodies may lead to inadequate consideration of gender-specific health issues such as access to nutritious food for women.
Challenges Faced by Women
- Professional Barriers: Women encounter various obstacles in advancing their careers in the health sector, including limited opportunities for promotion, unequal pay, and cultural expectations regarding gender roles.
- Underrepresentation in Leadership: Women are significantly underrepresented in medical leadership positions, both within health committees and healthcare institutions, further perpetuating gender disparities in decision-making and policy formulation.
Recommendations for Change
- Policy Interventions: Affirmative policies, such as reserving seats for women and marginalized groups in health committees, can help address gender disparities and promote inclusive decision-making.
- Structural Reforms: Structural changes within healthcare institutions, such as promoting flexible working arrangements and providing dedicated resources for women leaders, are essential to breaking down barriers to gender equality in leadership.
- Community Engagement: Involving directly affected communities in policy-making processes can ensure that health policies are responsive to the needs and priorities of the population, fostering greater inclusivity and accountability.
Conclusion
- Achieving gender equality in health leadership requires concerted efforts to address systemic barriers and promote inclusive decision-making.
- By prioritizing diversity and inclusivity in health policy, India can build more responsive and equitable health systems that serve the needs of all its citizens.
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ASHA and Anganwadi Workers/Helpers in Ayushman Bharat Scheme
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Ayushman Bharat Scheme, ASHA and Anganwadi Workers
Mains level: ASHA and Anganwadi Workers
Introduction
- Following the Centre’s decision to extend health coverage under the Ayushman Bharat Scheme to Accredited Social Health Activists (ASHAs) and Anganwadi workers and helpers, the Health Ministry has initiated the process of enrollment.
- The Health Ministry has received Aadhaar details of 23 lakh Anganwadi workers and helpers and over three lakh ASHA workers from various states.
About Ayushman Bharat Scheme
| Details | |
| Launch | 2018, Ministry of Health and Family Welfare (MoHFW) |
| Aim | Achieve Universal Health Coverage (UHC) by providing promotive, preventive, curative, palliative, and rehabilitative care. |
| Funding | Centrally Sponsored Scheme (expenditure shared between Central and State governments) |
| Coverage | Targets over 10 crore families (approximately 50 crore beneficiaries) based on SECC (Socio-Economic Caste Census) |
| Implementing Agency | National Health Authority (NHA) |
| Components |
|
| Coverage Details |
|
| Portability of Benefits | Benefits are portable across the country, allowing cashless treatment at any empanelled public or private hospital in India. |
| Digital Overture | Ayushman Bharat Digital Mission (ABDM): Launched in 2021 to provide Unique Digital Health IDs (UHID) for all Indian citizens, facilitating electronic access to health records. |
Significance of ASHA Program
- Workforce: As of December 31, 2023, there were over 13 lakh Anganwadi workers and over 10 lakh Anganwadi helpers in the country, along with 9.83 lakh ASHAs in position.
- Program Scale: India’s ASHA program is recognized as the world’s largest community volunteer program, operating across 35 states and union territories.
- Role of ASHAs: The ASHA program serves as a vital component of community healthcare, facilitating access to care and playing a crucial role in the prevention and management of COVID-19.
- Contribution Acknowledged: ASHAs have been recognized for their substantial contribution to improving access to care for communities and are integral to various community platforms under the National Health Mission.
Ayushman Bharat Scheme Impact
- Beneficiary Coverage: Currently, 55 crore individuals corresponding to 12 crore families are covered under the Ayushman Bharat scheme, with some states/UTs expanding the beneficiary base at their own cost.
- Enrollment and Hospital Admissions: The government has issued approximately 28.45 crore Ayushman cards, authorizing over 6.11 crore hospital admissions amounting to ₹78,188 crores.
- Hospital Empanelment: A total of 26,901 hospitals, including 11,813 private hospitals, have been empanelled under AB-PMJAY to provide healthcare services to scheme beneficiaries.
- Gender Equity: The scheme ensures gender equity in access to healthcare services, with women accounting for approximately 49% of Ayushman cards created and 48% of total authorized hospital admissions.
Back2Basics:
[1] Accredited Social Health Activists (ASHA)
| Details | |
| Launch Year | 2005-06 as part of the National Rural Health Mission.
Later extended to urban areas with the National Urban Health Mission in 2013. |
| Program Scope | Largest community health worker program globally, serving as health care facilitators, service providers, and health awareness generators. |
| Number of ASHAs | Over 10.52 Lakh ASHAs across all states/UTs (except Goa) as of June 2022. |
| Role | Provide maternal and child health services, family planning, and services under National Disease Control Programme. |
| Service Population | Serve populations of approximately 1,000 in rural areas and 2,000 in urban areas, with local adjustments based on workload. |
| Selection Criteria |
|
| Employment Classification | Considered honorary/volunteer positions rather than government workers. |
[2] Anganwadi Programme
| Details | |
| Initiation |
|
| Objective | To combat child hunger and malnutrition |
| Implementation | Centrally sponsored scheme implemented by States/UTs |
| Services Provided |
|
| Beneficiaries | Identified based on Aadhaar |
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Kyasanur Forest Disease (KFD): The Monkey Fever
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Kyasanur Forest Disease (KFD) and Other Zoonotic Diseases
Mains level: NA
Introduction
- Recent fatalities due to Kyasanur Forest Disease (KFD), known as monkey fever, in Karnataka have sparked concerns about the spread of this viral infection.
What is Kyasanur Forest Disease (KFD)?
- Origins and Identification: KFD is caused by the Kyasanur Forest disease virus (KFDV), a member of the Flaviviridae virus family. It was first identified in 1957 in Karnataka’s Kyasanur Forest.
- Incidence and Mortality: Between 400-500 human cases are reported annually, with an estimated case-fatality rate ranging from 3% to 5%.
Transmission and Spread
- Tick-Borne Transmission: Humans can contract KFD through tick bites or contact with infected animals, particularly sick or deceased monkeys.
- Limited Animal Role: While large animals like goats, cows, and sheep can become infected, they play a minor role in disease transmission. There’s no evidence of transmission through unpasteurized milk.
Signs and Symptoms
- Early Symptoms: The disease typically manifests with chills, fever, and headache after an incubation period of 3-8 days.
- Progression: Severe muscle pain, vomiting, gastrointestinal issues, and bleeding tendencies may develop within 3-4 days. Some patients experience neurological symptoms in the third week, including severe headaches and vision problems.
Diagnosis and Treatment
- Diagnostic Methods: Early diagnosis involves molecular detection through PCR or virus isolation from blood. Serologic testing using ELISA is conducted later.
- Treatment Approach: While no specific treatment exists, early hospitalization and supportive therapy, such as hydration maintenance, are crucial.
Prevention Strategies
- Vaccination: A vaccine for KFD is available and administered in endemic regions of India to prevent the disease.
- Preventive Measures: Insect repellents and protective clothing are recommended in tick-infested areas to minimize the risk of infection.
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Issues in Self-Reporting of Mental Illness
Note4Students
From UPSC perspective, the following things are important :
Prelims level: NA
Mains level: Mental Healthcare in India
Introduction
- Recent studies, including one by researchers from IIT Jodhpur, indicate alarmingly low rates of self-reporting for mental health problems in India.
Mental Health Under-Reporting in India
- NSS 2017-2018 Findings: The NSS data, based on self-reporting by over 550000 individuals, revealed mental illness self-reporting rates of less than 1%.
- Scale of Mental Illness: The 2017 NMHS conducted by NIMHANS estimated around 150 million individuals requiring treatment for mental illness in India.
- WHO Estimates: India bears a heavy burden with 2443 DALYs per 10,000 population and an age-adjusted suicide rate of 21.1 per 100,000.
- Suicide Trends: India’s contribution to global suicide deaths surged to 36% in 2016, with a concerning rise reported in 2021, especially among youth and middle-aged adults.
- National Mental Health Survey: Alarming rates of depression among teenagers and Substance Use Disorders (SUDs) prevalence of 22.4% among adults highlight the gravity of the situation.
Key Challenges
- Stigma and Awareness: Social stigma and poor awareness impede access to mental healthcare, leading to delayed treatment-seeking and social isolation.
- Out-of-Pocket Expenses: The IIT Jodhpur study highlighted significant out-of-pocket expenses, particularly in the private sector, for mental health services.
- Vulnerability Factors: Individuals with lower income and education levels are more vulnerable to mental disorders, exacerbating their socioeconomic challenges.
- Socioeconomic Divide: Individuals with higher incomes were more likely to report health problems, indicating a socioeconomic disparity.
- Budget and Infrastructure: Inadequate budget allocation, lack of insurance coverage, and insufficient infrastructure pose hurdles to mental healthcare delivery.
- Shortage of Professionals: India grapples with a severe shortage of mental health professionals, with only 3 psychiatrists per million people.
Government Initiatives
- Mental Healthcare Act, 2016: Aims to safeguard the rights of individuals with mental illnesses, enhance access to mental healthcare, and decriminalize suicide attempts.
- National Mental Health Policy, 2014: Prioritizes universal access to mental healthcare and endeavors to mitigate risk factors linked to mental health issues.
Way Forward
- Combat Stigma: Launch nationwide campaigns to shift societal attitudes towards mental illness.
- Enhance Awareness: Integrate mental health education into curricula and disseminate resources in local languages.
- Improve Coordination: Strengthen collaboration between central and state governments for effective policy implementation.
- Innovative Solutions: Explore tele-mental health services, bolster support for NGOs, and foster community engagement to address resource shortages.
- Multisectoral Approach: Embrace a life-course perspective on mental health promotion and enforce legal frameworks.
- Enhance Mental Health Ecosystem: Define quality metrics, recognize mental health advocates, and ensure affordability and accessibility of care.
- Embrace Traditional Healing: Explore complementary medicines like Yoga and Ayurveda for mental health treatment.
Conclusion
- By prioritizing mental healthcare and fostering collaboration across sectors, India can build a resilient mental health ecosystem that promotes well-being and supports individuals in need.
- Embracing traditional healing practices alongside modern interventions can offer holistic solutions, paving the way for a mentally healthier nation.
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An Uttar Pradesh model to tackle malnutrition
Note4Students
From UPSC perspective, the following things are important :
Prelims level: United Nations World Food Programme
Mains level: women's empowerment and nutrition
Central Idea:
The article highlights the success of a decentralized approach to tackling malnutrition in Uttar Pradesh by empowering women through community-based micro-enterprises. This initiative, led by self-help groups, focuses on producing fortified and nutritious foods for pregnant/breastfeeding mothers and children, distributed via the Integrated Child Development Services (ICDS) programme.
Key Highlights:
- Collaborative effort between the Department of Women and Child Development and the Uttar Pradesh State Rural Livelihood Mission.
- Decentralized production of take-home rations by women’s enterprises.
- Positive impact on livelihoods with over 4,000 women engaged in 204 self-help group micro-enterprises.
- Re-formulation of take-home rations to enhance nutritional value and address monotony.
- Focus on strengthening demand through diverse and nutritious products.
- Innovation through app-based solutions and QR code tracking for supply chain management.
Key Challenges:
- Ensuring consistent quality and safety standards.
- Overcoming logistical challenges in decentralized production and distribution.
- Addressing potential resistance to change from centralized to decentralized models.
- Sustaining long-term engagement and empowerment of women.
Key Terms:
- Self-help groups
- Micro-enterprises
- Integrated Child Development Services (ICDS)
- Fortified foods
- Decentralized production
- Nutritional supplementation
- Livelihood opportunities
Key Phrases:
- Women’s empowerment for nutrition
- Decentralized model for take-home ration production
- Strengthening demand through diverse products
- Innovation and sustainability in food production
- Multi-stakeholder approach for effective solutions
Key Quotes:
- “Engaging women from the community to run the take-home ration production units is a game-changer.”
- “The State-wide expansion of micro-enterprises led by women confirms successful targeting and demonstrates how empowering women can bring about effective and sustainable processes.”
Key Examples and References:
- Collaboration between the Department of Women and Child Development and the Uttar Pradesh State Rural Livelihood Mission.
- Use of two pilot plants by the United Nations World Food Programme in Unnao and Fatehpur.
- Expansion to 202 production units across 43 districts, benefiting 12 million ICDS beneficiaries.
Key Statements:
- “This initiative presents an excellent opportunity for women to earn a livelihood and contribute to the local economy.”
- “The re-formulated take-home rations are nutritious and designed to support the health and well-being of children.”
Key Facts/Data:
- Over 4,000 women engaged in 204 self-help group micro-enterprises.
- Aim to generate an additional income of ₹8,000 a month for each woman.
- Products include sweet and savory options like aata besan halwa and daliya moong dal khichdi.
- Expansion to 202 production units across 43 districts, benefiting 12 million ICDS beneficiaries.
Critical Analysis:
- The initiative effectively addresses the intersection of women’s empowerment and nutrition, leveraging community resources for sustainable impact.
- Decentralized production and diverse product offerings enhance accessibility and acceptability.
- Challenges such as quality control and scalability need continuous monitoring and adaptation.
Way Forward:
- Continued support for women’s empowerment and capacity building.
- Strengthening of quality assurance mechanisms.
- Further research and innovation in product development and supply chain management.
- Collaboration with stakeholders for scaling up and sustainability.
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Populism does not help public health
Note4Students
From UPSC perspective, the following things are important :
Mains level: importance of evidence-based decision-making and long-term goals in public health policies
Central Idea:
The article highlights the need for a shift in the approach to public health management in democratic setups, emphasizing the importance of prioritizing preventive measures over immediate, politically-driven responses. It advocates for a separation of health-care decision-making from short-term political goals to ensure sustainable health strategies that address both immediate and future health needs.
Key Highlights:
- Silent victories in preventing diseases often go unnoticed in the pursuit of tangible achievements.
- Immediate response-focused initiatives divert attention from critical areas like sanitation, disease surveillance, and public health education.
- The case of dengue exemplifies the prioritization of emergency relief over long-term prevention strategies.
- The article stresses the importance of evidence-based decision-making and long-term goals in public health policies.
- Gaps in public health education and the influence of the pharmaceutical industry are recognized challenges.
- Disparities in achieving health policy targets, especially in nutrition programs, reveal gaps in public health efforts.
- Socio-economic factors like poverty, sanitation, and overcrowding contribute to health disparities in diseases like tuberculosis.
Key Terms/Phrases:
- Preventive health measures
- Vector bionomics
- Public health education
- Pharmaceutical industry influence
- Socio-economic factors
- Health policy targets
- Separation of powers approach
Key Quotes:
- “In a democratic setup, leaders often chase tangible achievements and overlook vital preventive efforts.”
- “Public health decisions should be based on scientific evidence and long-term goals, not electoral cycles.”
- “Behavioural change is key to managing public health challenges.”
- “Effective public health management should encompass preventive measures, policy formulation, community health, and environmental health.”
Key Statements:
- “Health care will benefit from being separated from political processes.”
- “Investments in nutrition programs have far-reaching implications for health and productivity.”
- “Public health is not just about treating diseases but preventing them.”
Key Examples and References:
- Dengue as an example of prioritizing immediate relief over long-term prevention.
- Disparity in achieving targets in the Prime Minister’s Overarching Scheme For Holistic Nourishment (POSHAN) Abhiyan Scheme.
- Disparity in TB cases between India and the United States due to socio-economic factors.
Key Facts/Data:
- 35.5% of children under five were stunted, and 32.1% were underweight in 2019-21.
- 58.6% to 67.1% increase in prevalence of anaemic children aged 6-59 months.
- India reported 21.4 lakh TB cases in 2021, an 18% increase from 2020.
Critical Analysis:
- The article effectively highlights the drawbacks of immediate, politically-driven health initiatives.
- Emphasizes the importance of evidence-based decision-making and long-term planning in public health.
- Recognizes gaps in public health education and the impact of socio-economic factors on health outcomes.
Way Forward:
- Advocate for a separation of health-care decision-making from short-term political goals.
- Strengthen public health education and adopt a multidisciplinary approach.
- Emphasize evidence-based decision-making and prioritize long-term preventive measures.
- Address socio-economic factors influencing health outcomes.
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Health Ministry announces new treatment regimen for Leprosy
Note4Students
From UPSC perspective, the following things are important :
Prelims level: New Leprosy Treatment Regimen
Mains level: Read the attached story
Introduction
- The Central government of India has given its approval for a new treatment regimen aimed at hastening the eradication of leprosy in the country.
- The move, based on the latest global scientific research and endorsed by the World Health Organization (WHO), seeks to transition from a two-drug regimen to a three-drug regimen for Pauci-Bacillary (PB) leprosy cases.
New Leprosy Treatment Regimen
- Objective: The primary goal is to halt the transmission of leprosy at the sub-national level by 2027, aligning with the UN’s Sustainable Development Goals, three years ahead of schedule.
- Transition from Two to Three Drugs: The Ministry of Health and Family Welfare has approved a shift from the existing two-drug regimen for six months to a three-drug regimen for Pauci-Bacillary (PB) cases.
- Scientific Basis: This decision is grounded in the latest globally accepted scientific research studies and evidence-based practices.
- WHO Endorsement: The World Health Organization (WHO) has committed to supply the revised drug regimen starting April 1, 2025, signifying international recognition and support for this approach.
Key Implementation Steps
- Three-Drug Regimen: The WHO-recommended treatment regimen includes dapsone, rifampicin, and clofazimine, collectively referred to as MDT. MDT is highly effective in killing the pathogen and curing the patient.
- Advance Requisitions: All States and Union Territories are instructed to submit their requisitions for anti-leprosy drugs a full year in advance to ensure a smooth transition.
- Unified Implementation Date: The revised classification of leprosy and the treatment regimen for both Pauci-Bacillary (PB) and multi-bacillary (MB) cases in India will come into effect simultaneously on April 1, 2025.
Understanding Leprosy
- Leprosy Overview: Leprosy is a chronic infectious disease caused by the Mycobacterium leprae bacteria, primarily affecting the skin and peripheral nerves.
- Transmission: It spreads through droplets from the nose and mouth during close contact with untreated cases.
- Curability: Leprosy is curable with multi-drug therapy (MDT).
Distinction between PB and MB Cases
- PB Cases: These individuals have fewer visible bacteria and show no signs of advanced disease in biopsies.
- MB Cases: They have visible bacteria and may exhibit more advanced disease in biopsies.
Significance of the New Regimen
- Eradication Target: The adoption of this new treatment regimen is expected to accelerate India’s progress towards leprosy eradication by 2027, reinforcing the country’s commitment to combat this disease.
- Previous Funding: The WHO has been providing free MDT, initially funded by the Nippon Foundation and later through an agreement with Novartis. This regimen is known as ‘Uniform MDT,’ simplifying administration and manufacturing processes.
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Re-evaluating the Use of Mosquitofish in India
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Mosquitofish
Mains level: Read the attached story
Introduction
- In recent months, several regions in India, including Andhra Pradesh, Odisha, and Punjab, have resorted to releasing mosquitofish into local water bodies as a means to combat mosquito-borne diseases.
- While this approach aims to address a pressing public health concern, it brings to light ecological challenges associated with the introduction of mosquitofish.
Understanding Mosquitofish
- Biological Control of Mosquitoes: Mosquitofish, particularly Gambusia affinis and Gambusia holbrooki, were introduced in freshwater ecosystems in the 1960s as an eco-friendly alternative to chemical pesticides for mosquito control.
- Widespread Distribution: Originally native to the U.S., these fish have become global inhabitants due to their adaptability and tolerance to environmental fluctuations.
- Unintended Consequences: Despite good intentions, the proliferation of mosquitofish has led to detrimental ecological and environmental effects.
Historical Use in India
- Early Introduction: Gambusia was first introduced in India in 1928 during British rule as a measure to combat malaria.
- Government and Non-Governmental Involvement: Various governmental organizations, such as the Indian Council of Medical Research (ICMR) and the National Institute of Malaria Research (NIMR), as well as local municipal corporations and health departments, were entrusted with introducing mosquitofish.
- Widespread Distribution: Gambusia species are now established in multiple habitats across India.
Ecological Impact
- Invasive Alien Species: Mosquitofish are among the hundred most detrimental invasive alien species worldwide, leading to the displacement and extinction of native fauna.
- Threat to Biodiversity: They exhibit voracious feeding habits and aggressive behavior, posing a threat to native fish, amphibians, and freshwater communities.
- Global Examples: Studies in Australia, New Zealand, and India have shown the harmful consequences of Gambusia presence, including the decline of endemic species and predation on native fish and frogs.
Sustainable Alternatives
- WHO Recommendations: The World Health Organization stopped recommending Gambusia as a mosquito control agent in 1982.
- Government Recognition: In 2018, the National Biodiversity Authority of the Government of India designated G. affinis and G. holbrooki as invasive alien species.
- Local Solutions: Collaborative efforts between mosquito biologists, entomologists, invasion ecologists, and fish taxonomists can identify native fish species capable of mosquito control.
- River Basin Approach: Authorities can compile lists of native fish species in each river basin that are effective in controlling mosquito larvae, offering an eco-friendly alternative to invasive species.
Conclusion
- The introduction of mosquitofish in India, once intended to combat mosquito-borne diseases, has led to ecological challenges and the disruption of native ecosystems.
- To mitigate the adverse effects and protect indigenous aquatic biodiversity, it is essential to discontinue the use of Gambusia and instead explore sustainable alternatives rooted in local solutions.
- By adopting a river basin approach and collaborating across disciplines, India can strike a balance between mosquito control and environmental preservation.
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Human Papillomavirus (HPV) and Cervical Cancer
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Cervical Cancer
Mains level: Read the attached story
Introduction
- This article sheds light on the significance of Cervical Cancer Awareness Month, the grim reality of cervical cancer in India, and the importance of prevention through knowledge, screening, and vaccination.
Cervical Cancer: Unveiling the Facts
- Prevalence in India: Cervical cancer ranks as the second-most common cancer among Indian women, with its origin in the cervix, the entrance to the uterus from the vagina.
- HPV Connection: Persistent infection by the human papillomavirus (HPV) is the primary cause of cervical cancer. HPV is a common virus that affects nearly all sexually active individuals, often without any symptoms. While the immune system typically clears the virus, high-risk strains can lead to cancer.
- India’s Alarming Stats: India bears a heavy burden, accounting for nearly a quarter of global cervical cancer deaths. Every year, approximately 1.25 lakh women are diagnosed with cervical cancer, and tragically, around 75,000 lose their lives to this disease.
Global Efforts and India’s Progress
- WHO’s Elimination Strategy: In 2022, the World Health Organization (WHO) launched a strategy to eliminate cervical cancer as a public health concern worldwide. The strategy emphasizes three pillars: vaccination, screening, and treatment.
- Positive Trends in India: India may not meet the 2030 goals outlined by WHO, but there is a glimmer of hope. Incidence rates are declining, possibly attributed to factors like sexual hygiene, pregnancy age, contraception use, and individual immune status.
- Comprehensive Approach: Experts stress the need for a multi-pronged approach, including awareness programs, vaccination drives, regular screenings, and education to combat stigma.
Screening Methods and Challenges
- Pap Smear vs. HPV DNA Testing: Traditionally, the pap smear was the gold standard for cervical cancer screening. However, it has limitations, such as the need for cytologists and low awareness, especially in rural areas.
- Advancements in Screening: Today, HPV DNA testing is recommended as the primary screening method. It involves testing cervical cells for high-risk HPV strains. This method is more reliable and less prone to errors.
- Empowering Self-Sampling: Studies suggest that self-sampling for cervical cancer screening, where patients collect their samples, can be as effective as physician-collected samples. Offering this option can enhance screening accessibility.
Vital Role of Vaccination
- HPV Vaccine Controversy: India faced controversy in the past regarding the HPV vaccine’s safety. However, cervical cancer is preventable, and the vaccine targets HPV serotypes 16&18, responsible for 70% of cervical cancers.
- Single-Dose Effectiveness: Recent recommendations from the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) highlight the effectiveness of even a single dose of the HPV vaccine, crucial for countries with low population coverage.
- India’s Vaccination Efforts: Two vaccines, Merck’s Gardasil and Serum Institute of India’s Cervavac, are available in India. Expanding production and introducing the vaccine into national programs are essential steps.
Government Initiatives and Challenges
- State-Level Success: Sikkim set a positive example by introducing free HPV vaccination, achieving high coverage rates among girls aged 9 to 14.
- Slow National Rollout: The Central government’s plan for a nationwide HPV vaccination program faced delays. Despite recent reports suggesting a rollout in phases, the Union Health Ministry has yet to make a final decision.
- Global Perspective: While 100 countries have integrated the HPV vaccine into their national schedules, achieving high coverage remains a challenge, particularly in poorer nations.
Encouraging Early Action
- Optimal Age for Vaccination: Vaccination is recommended for girls aged 9 to 15, providing maximum protection. However, it can benefit adults up to the age of 45.
- Combatting Hesitation: Effective communication and education are essential to address vaccine hesitancy and dispel misconceptions.
- A Global Endeavor: The International Agency for Research on Cancer stresses the importance of scaling up screening programs, expanding HPV vaccination coverage, and increasing access to affordable treatment to meet WHO’s 2030 targets.
What You Can Do
- Stay Informed: Educate yourself and others about HPV and cervical cancer.
- Prioritize Screening: Consult your healthcare provider for cervical cancer screening, especially if you haven’t done so before.
- Consider Vaccination: Discuss the HPV vaccine with your healthcare provider and make an informed choice for yourself or your loved ones.
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ICMR to revisit current National Essential Diagnostics List (NEDL)
Note4Students
From UPSC perspective, the following things are important :
Prelims level: NEDL
Mains level: Read the attached story
Introduction
- The Indian Council of Medical Research (ICMR) has initiated the revision of the National Essential Diagnostics List (NEDL), acknowledging the evolving healthcare landscape since its first release in 2019.
- This move aims to optimize the availability of essential diagnostic tests across all tiers of healthcare facilities in India.
What is NEDL?
- Inception: The NEDL extends and builds upon initiatives like the Free Diagnostics Service Initiative (FDI) under which was launched in July 2015 under National Health Mission (NHM).
- Comprehensive List: The NEDL is designed to cater to all levels of healthcare, including village-level healthcare, primary care, secondary care, and tertiary care facilities.
- Scope of Tests: The NEDL focuses on diagnostic tests essential for diseases with significant burdens, such as vector-borne diseases (Malaria, Dengue, Filariasis, Chikungunya, Japanese encephalitis), as well as Leptospirosis, Brucellosis, Tuberculosis, Hepatitis (A, B, C, and E), HIV, and Syphilis. Specific tests are marked as desirable, recommended for regions or states with high disease prevalence.
- In Vitro Diagnostics (IVD): Alongside diagnostic tests, the NEDL recommends corresponding In Vitro Diagnostics (IVD) products, which are tests conducted on samples like blood or tissue taken from the human body.
- Regulatory Guidance: The NEDL includes a comprehensive guidance document on the “Regulatory framework for diagnostics: National and International.”
- Human Resources: It also recommends the allocation of human resources, such as ASHA workers, lab technicians, and pathologists, tailored to the proposed list of diagnostics for different healthcare levels.
Significance of NEDL
- Quality Assurance: The availability of quality-assured diagnostics enhances the optimal utilization of the Essential Medicine List (EML).
- SDG Achievement: Implementation of the NEDL contributes to the realization of Sustainable Development Goal (SDG) 3.8, aiming for Universal Health Coverage (UHC).
- Enhanced Healthcare: The NEDL facilitates evidence-based healthcare, improving patient outcomes, reducing out-of-pocket expenses, and ensuring the effective use of public health facilities. It aids in disease burden assessment, trend analysis, surveillance, outbreak identification, and addressing antimicrobial resistance.
- Standardization and R&D: The NEDL encourages the standardization of technology and diagnostic services, fostering research and development (R&D) for innovative diagnostics, ultimately leading to cost reduction.
Revisiting the List: Careful Consideration Process
- Disease Burden Analysis: The inclusion of diagnostic tests in the NEDL is based on rigorous assessments of disease burden data across India’s diverse states.
- Alignment with National Programs: Tests align with national health programs to address specific health needs.
- Adherence to Standards: The NEDL adheres to Indian public health standards and considers the necessary resources, infrastructure, and personnel required at each healthcare facility.
Factors to Consider
- Essential Test Criteria: Stakeholders are encouraged to propose tests that meet specific criteria:
-
- Priority for healthcare needs
- Alignment with disease prevalence and public health significance
- Demonstrated efficacy, accuracy, and cost-effectiveness
- Impact on Disease Management: Tests should focus on conditions with high disease burdens and substantial public health relevance. The introduction of these tests should significantly enhance disease diagnosis and management.
- Appropriate Utilization: Any proposed addition to the NEDL must align with the availability of equipment, infrastructure, and qualified personnel, by the Indian Public Health Standards of 2022.
Conclusion
- The revision of India’s National Essential Diagnostics List is a crucial step towards ensuring that essential diagnostic tests are accessible at all healthcare levels.
- By aligning with disease burden data and adhering to stringent criteria, India aims to enhance its public health infrastructure, making diagnostics an integral part of healthcare delivery.
- The involvement of stakeholders ensures a comprehensive and effective approach to meet the evolving healthcare needs of the nation.
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Global Surgery: Why access to essential Surgery is important?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Global Surgery
Mains level: Read the attached story
Introduction
- Global surgery, despite its critical importance, often remains in the shadows of global health initiatives.
- This is particularly evident in South Asia, where the world’s largest population lacking access to essential surgery resides.
Why discuss this?
- Global surgery aims to address this disparity by focusing on equitable access to emergency and essential surgical care, encompassing a range of procedures.
- While 2015 marked a turning point in recognizing the significance of global surgery, this field’s history goes back several decades.
What is Global Surgery?
- Equitable Access: Global surgery prioritizes providing equitable access to emergency and essential surgical care, predominantly in low- and middle-income countries (LMICs), but also in under-served populations within high-income countries (HICs).
- Scope of Surgery: It encompasses essential and emergency surgeries, including surgery, obstetrics, trauma, and anaesthesia (SOTA).
Emergence of Global Surgery
- Annus Mirabilis of 2015: This year marked a pivotal moment in recognizing the global significance of surgical care.
- Influential Reports: The Disease Control Priorities Network (DCPN) report sponsored by the World Bank and The Lancet Commission on Global Surgery (LCoGS) played key roles.
- WHO Resolution 68.15: The World Health Organization Declaration on Safe Surgery highlighted the essential role of surgical systems in achieving universal health coverage.
Magnitude of the Problem
- Access Disparities: Over 70% of the global population, around five billion people, lack timely access to safe and affordable surgical care.
- Regional Disparities: Access gaps are most severe in low- and lower-middle-income countries (LLMICs), with 99% and 96% of people facing disparities, compared to 24% in HICs.
- South Asia’s Challenge: Over 1.6 billion people, over 98% of South Asia’s population, lack access to safe and affordable SOTA care.
- Disease Burden: In 2010, surgically treatable conditions caused around 17 million deaths, surpassing the combined mortality burden of HIV/AIDS, tuberculosis, and malaria.
- Economic Impact: The cumulative projected loss to global GDP due to insufficient surgical care could reach $20.7 trillion by 2030.
Current Efforts and Neglect
- Neglect in Policies: Surgical care often receives little attention in international and national policies.
- Limited Research Focus: Research in global surgery is underrepresented compared to global health.
- Funding Neglect: Funding for surgery is significantly lower than for other health sectors.
- Research Funding Disparity: Research funding for surgery-related projects is scarce compared to other health fields.
Way Forward
- Cost-Effectiveness: Global surgery has demonstrated that emergency and essential surgical care is cost-effective and cost-beneficial.
- Policy Commitment: Many countries have initiated National Surgical, Obstetrics, and Anaesthesia Plans (NSOAPs), demonstrating political and policy commitment.
- Positive Initiatives: Several South Asian countries have launched initiatives to expand surgical access.
- Research and Innovation: Prioritizing research, policy support, and sustainable financing are key to addressing global surgery challenges.
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Kerala’s Operation AMRITH to combat Antimicrobial Resistance
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Operation AMRITH
Mains level: Not Much
Introduction
- The Kerala Drug Control Department launched Operation Amrith (Antimicrobial Resistance Intervention For Total Health), a significant initiative to curb the overuse of antibiotics in the state.
Operation AMRITH
- Objective: The initiative aims to optimize antibiotic use by preventing over-the-counter (OTC) sales and ensuring compliance with prescription requirements.
- Pharmacy Regulations: Pharmacies are required to maintain accurate records of antibiotic sales and display notices stating that antibiotics will not be sold without a doctor’s prescription.
- Public Participation: The initiative encourages public involvement by allowing individuals to report pharmacies that sell antibiotics without a prescription.
Enforcement and Compliance
- Surprise Raids: The program includes conducting surprise checks in retail medical shops to detect OTC sales of antibiotics.
- Toll-Free Complaint Number: A toll-free number (18004253182) is provided for the public to lodge complaints against medical shops violating the rules.
- Immediate Action: Complaints are swiftly transferred to relevant zonal offices for verification, followed by immediate departmental action upon confirmation of violations.
Background and Context
- Kerala’s AMR Strategy: Kerala was the first state in India to develop a state action plan on AMR, the Kerala Anti-Microbial Resistance Strategic Action Plan (KARSAP), in 2018.
- Multi-Sectoral Approach: The plan, aligned with India’s National Action Plan on AMR, addresses human, animal, and environmental aspects of AMR containment.
- Support and Collaboration: The plan was developed with contributions from the Centre for Science and Environment and involves various state departments in its implementation.
- Surveillance Networks: The Kerala Antimicrobial Resistance Surveillance Network (KARS-NET) monitors AMR in humans, while an integrated plan covers non-human sector surveillance.
- AMR Laboratory: The Kerala State Pollution Control Board (KSPCB) inaugurated an AMR laboratory for environmental surveillance in August 2023.
- PROUD Initiative: The Programme on Removal of Unused Drugs (PROUD) is a drug take-back program piloted in Thiruvananthapuram for the proper disposal of unused antibiotics.
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Private: Diminishing Dietary Diversity amidst Biodiversity Emphasis
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Read the attached story
Mains level: NA
Introduction
- Despite the global emphasis on biodiversity, the world’s diet has become increasingly homogenous, with staples like rice, wheat, maize, and sugar constituting over half of the global calorie intake.
- Supermarkets mirror this trend, offering a limited selection of vegetables, reflecting a decline in “dietary diversity.”
Dietary Diversity and Issues
- Nutritional Quality: A diverse diet, encompassing various food groups, enhances nutrition. However, the prevalence of monoculture (growing a single crop extensively) diminishes “agricultural biodiversity.”
- Environmental Cost: Importing diverse food groups from distant regions is expensive and environmentally taxing.
Contributors to Nutritional Variety in India
- Small-Scale Farming and Agroforestry: Smallholder farmers, shepherds, and tribal communities practicing agroforestry significantly contribute to India’s nutritional diversity.
- Regional Varieties: India boasts a wide array of local vegetables and crops, varying regionally, provided by these small-scale cultivators.
Examples of Nutrient-Rich Local Varieties
- South India: Leafy greens like Green Amaranth (Tamil, kuppi keerai; Hindi, junglee chaulayi) and Leucas (Tamil, thumbai; Sanskrit, Drona pushpi), rich in iron and calcium; starchy tubers like East Indian arrowroot (Tamil, kuva or ararut-kizhargu; Hindi, tikhur), beneficial for digestion.
- Central India: Edible flowers and oil-rich seeds from the Madhuca or Indian butter tree (Tamil, illupai; Hindi, mahua); Khejri pods (Tamil, parambai) used in local cuisine and combating desertification.
- Northeast India: Indigenous Jhum cultivation, growing diverse crops on the same land, offering dietary variety but declining in practice.
Jhum Cultivation: A Diverse Agricultural Practice
- Contrast to Modern Agriculture: Jhum cultivation, practiced in Northeast India, involves growing multiple food crops together, offering dietary diversity but losing popularity.
- Decline in Practice: Research indicates a significant reduction in Jhum cultivation areas, with a shift towards monoculture crops like areca nut, black pepper, and rubber.
Consumer Influence and Choices
- Role of Consumer Preferences: Consumer tastes significantly impact the availability and cultivation of diverse, wild food varieties.
- Encouraging Diversity: Incorporating lesser-known fruits like wood apples (velam pazham) and Jamuns (nagai) into diets can enhance nutritional quality and support small growers.
Conclusion
- Need for Awareness: Recognizing the importance of dietary diversity is crucial for nutrition, environmental sustainability, and supporting small-scale agriculture.
- Promoting Local Varieties: Embracing local, diverse food options can enrich diets and contribute to preserving agricultural biodiversity, aligning with global efforts to emphasize biodiversity.
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The blood management system needs a fresh infusion
Note4Students
From UPSC perspective, the following things are important :
Prelims level: The World Health Organization's report on global disparities in blood collection.
Mains level: public-private partnerships to improve blood collection and distribution
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Proposed Health Tax on Sugar and High-Calorie Foods in India
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Health Tax
Mains level: Read the attached story
Central Idea
- Public health researchers recommend a health tax of 20% to 30% on sugar, sugar-sweetened beverages (SSBs), and high-fat, salt, and sugar (HFSS) products, in addition to the existing GST.
- The recommendation stems from a UNICEF-funded project, aiming to influence policies to reduce sugar consumption.
Study Insights and Recommendations
- Targeting Bulk Consumers: The study suggests taxing bulk consumers like confectionery manufacturers, rather than household sugar purchases.
- Definition of Sugar: The study includes all forms of refined, unrefined sugar, and gur (brown cane sugar) used by manufacturers.
- Impact on Manufacturers: Manufacturers, who buy up to 55% of India’s annual sugar production, are expected to be more price-sensitive than households.
Tax Implications and Demand Reduction
- Niti Aayog’s Interest: Niti Aayog is exploring the impact of health taxes and warning labels on food products to promote healthy eating in India.
- Current and Proposed Tax Rates: Sugar is currently taxed at 18% GST. The proposed additional tax could raise the total tax to 38-48%.
- Price Elasticity Metric: The study uses ‘Price Elasticity’ to estimate demand reduction. A 10% price increase could lead to a 2% demand reduction for households and a 13-18% reduction for manufacturers.
- Health Tax on Beverages and HFSS Products: A 10-30% health tax on SSBs could decrease demand by 7-30%, while a similar tax on HFSS products might lead to a 5-24% decline.
Government Revenue and Public Health Impact
- Increase in Tax Revenues: Additional taxes could boost government revenues by 12-200% across different scenarios.
- Current Tax Rates on Products: Sugar attracts 18% GST, SSBs 28% GST plus 12% cess, and HFSS products 12% GST.
- Public Health Benefits: Higher taxes on unhealthy foods could reduce obesity, diabetes, cardiovascular diseases, and certain cancers.
India’s Sugar Consumption and Health Risks
- India’s Sugar Intake: India is the world’s largest sugar consumer, with an average consumption of 25 kg per person per year, exceeding WHO recommendations.
- Rise in Sugar-Related Health Issues: There has been a significant increase in the sale of aerated drinks and HFSS food products, contributing to obesity and diabetes.
Taxation and Reformulation
- Encouraging Product Reformulation: The proposed tax rate is linked to sugar volume, encouraging manufacturers to reduce sugar content in products.
- Taxing Sugar Replacements: The study also recommends taxing artificial sweeteners to prevent manufacturers from switching to cheaper, unhealthy alternatives.
Global Precedents and Outcomes
- Health Tax Implementation Worldwide: Over 70 countries, including Mexico, Chile, and South Africa, have implemented health taxes on sugar and related products.
- Positive Outcomes in Mexico: In Mexico, the taxation on SSBs led to decreased consumption of taxed beverages and a reduction in mean BMI among younger age groups.
Conclusion
- Potential for Health Improvement: Imposing a health tax on sugar and related products could significantly contribute to public health improvement in India.
- Consideration of Economic Factors: The success of such a policy will depend on balancing health benefits with economic impacts on consumers and manufacturers.
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A call for disability inclusion that must be heeded
Note4Students
From UPSC perspective, the following things are important :
Prelims level: na
Mains level: neuropsychiatric disorders
Central idea
Dr. Ennapadam S. Krishnamoorthy advocates for prioritizing rehabilitation services globally, emphasizing their crucial role in treating neuropsychiatric disorders across the lifespan. He highlights the need for awareness, collaboration, and innovative solutions to address the significant burden of disabilities and enhance the quality of life for affected individuals.
Key Highlights:
- Dr. Ennapadam S. Krishnamoorthy emphasizes the importance of transformative solutions for persons with neuropsychiatric disorders, spanning childhood to old age.
- The focus is on enhancing activities of daily life and quality of life for individuals affected by various neuropsychiatric conditions.
- Rehabilitation services are crucial, with 2.41 billion individuals globally requiring rehabilitation according to the WHO’s Global Burden of Disease study.
Key Challenges:
- Rehabilitation is often seen as a disability-specific service, leading to under-prioritization despite its significant societal benefits.
- Lack of awareness in the community that disablement can be treated and, in some cases, reversed.
- The need for a shift in perception among medical professionals to recognize rehabilitation as an essential service.
Key Terms:
- Neuropsychiatric disorders
- Transformative solutions
- Rehabilitation
- Non-invasive brain stimulation (NIBS)
- Repetitive Transcranial Magnetic Stimulation (rTMS)
- Functional Magnetic Stimulation (FMS)
- Transcranial electrical stimulation (TES)
- Transcutaneous auricular vagus nerve stimulation (tA-VNS)
Key Phrases:
- “Rehabilitation needs are plentiful with a global burden of 2.41 billion individuals.”
- “Neurology and psychiatry are closely linked, requiring a continuum of care.”
- “Scientific advances, such as NIBS procedures, offer promising avenues for treatment.”
Key Quotes:
- “Disablement does not need to be endured; it can be treated, even reversed, in a proportion of cases.”
- “Rehabilitation services need to be multidisciplinary, multicomponent, and holistic.”
Key Statements:
- “Rehabilitation services are traditionally under-resourced despite individual and societal benefits.”
- “There is a need to build awareness that disablement can be treated.”
Key Examples and References:
- Repetitive Transcranial Magnetic Stimulation (rTMS) as a mainstream treatment for depression and obsessive-compulsive disorder.
- Functional Magnetic Stimulation (FMS) for pain, spasticity, and other neurological symptoms.
- Transcranial electrical stimulation (TES) showing success in improving memory, cognition, mood, and various neurological conditions.
- Transcutaneous auricular vagus nerve stimulation (tA-VNS) being investigated for depression, migraine, and dysautonomia.
Key Facts:
- 2.41 billion individuals globally had conditions benefiting from rehabilitation in 2019.
- The number of individuals requiring rehabilitation increased by 63% from 1990 to 2019.
Key Data:
- 317 million individuals affected by neuropsychiatric disorders in childhood.
- 167 million adolescents and 970 million people affected globally by mental health conditions.
Critical Analysis:
- Lack of prioritization and resources for rehabilitation despite a significant global burden.
- The necessity for a paradigm shift in perceiving rehabilitation as essential for a broad spectrum of neurological and mental health problems.
Way Forward:
- Increase awareness about the treatability of disabilities.
- Promote collaboration between governments, public and private sectors to find innovative solutions for persons with disabilities.
- Enhance training and development opportunities for rehabilitation professionals.
- Advocate for a multidisciplinary, holistic approach to rehabilitation services.
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Decriminalising Medical Negligence: Views from both sides of the bed
Note4Students
From UPSC perspective, the following things are important :
Prelims level: NA
Mains level: Medical Negligence and its impact on the marginalized people
Central Idea
- A women recently died from septic shock after a surgery in Jamshedpur, leading her brother to allege medical negligence due to unauthorized surgeon substitution and lack of postoperative care.
- The case has ignited discussions on the legal and ethical aspects of medical negligence in India, amidst proposed changes to exempt doctors from criminal prosecution.
Understanding Medical Negligence
- Definition and Impact: Medical negligence involves a breach of duty by healthcare professionals, leading to patient harm or death.
- Legal Framework: Currently, under Section 106(1) of the Bharatiya Nyaya (Second) Sanhita (BNSS), doctors face potential imprisonment and fines if convicted of negligence, though proposed changes might alter this.
Recent Developments and Legal Provisions
- Recent Announcement: MHA proposed exempting doctors from criminal prosecution in negligence cases, sparking debate and concern among various stakeholders.
- Constitutional Rights: The proposed changes have to be balanced against constitutional protections like Article 20(3) and Article 21, which safeguard against self-incrimination and ensure the right to life and liberty.
Role of the Indian Medical Association (IMA)
- IMA’s Stance: The IMA has advocated for exempting doctors from criminal prosecution for negligence, citing the increasing harassment and detrimental impact on patient care.
- Concerns Raised: The IMA also highlighted the high number of medical negligence cases filed against doctors and the economic losses due to violence against healthcare professionals.
Ethical and Societal Implications
- Power Dynamics: Critics argue that exempting doctors from criminal prosecution might exacerbate power imbalances in the doctor-patient relationship and lead to increased medical malpractice.
- Marginalized Populations at Risk: There’s concern that such exemptions could disproportionately affect vulnerable groups, including women, queer, transgender individuals, and rural residents.
Legal and Ethical Conundrums
- Good Faith Clause: BNSS clauses provide some protection for acts done in good faith, but the distinction between negligence and accident remains unclear.
- Bioethicists’ Perspective: Experts emphasize the need for a balanced approach that considers both healthcare professionals’ challenges and patients’ rights and safety.
Way Forward
- Nationwide Dialogue: The IMA plans to engage in discussions with the government and public to advocate for their position.
- Need for Comprehensive Data: Critics like Geet suggest conducting a nationwide survey to understand the scope of medical negligence and inform policy decisions.
- Legal Recourse for Patients: Ensuring that patients have access to legal recourse and justice is crucial to maintaining trust in the healthcare system and preventing violence against doctors.
Conclusion
- Complex Decision-Making: Exempting doctors from criminal prosecution for medical negligence is a multifaceted issue requiring careful consideration of legal, ethical, and societal factors.
- Ensuring Justice and Quality Care: Any policy changes must strive to protect patients’ rights while also considering the challenges faced by medical professionals, ensuring that the healthcare system remains just, accountable, and focused on delivering high-quality care. Top of Form
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The quest for ‘happiness’ in the Viksit Bharat odyssey
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Global Innovation Index, Rule of Law Index, Poverty Index
Mains level: Viksit Bharat
Central idea
The article calls for a reimagining of India’s development strategy, shifting from an economic-centric model to prioritizing happiness and well-being. It critiques the current focus on GDP, highlighting the need for comprehensive social indicators in the development narrative. The central idea is to envision a “Happy India-Developed India” by 2047, where happiness becomes the central pursuit, transcending conventional economic measures.
Key Highlights:
- Viksit Bharat Launch: The launch of Viksit Bharat aims to make India a developed nation by its 100th Independence year in 2047.
- Economic Overemphasis: Critics argue that Viksit Bharat places excessive emphasis on economic development, overlooking other crucial aspects.
- Happiness as Central Pursuit: The author suggests reimagining the theme as ‘Happy India-Developed India,’ focusing on happiness as a central pursuit for meaningful development.
- Happiness Metrics: The World Happiness Report measures happiness through variables like GDP per capita, life expectancy, generosity, social support, freedom, and perception of corruption.
- Social Connections and Well-being: Countries like Finland and Denmark, ranked highest in happiness, emphasize social connections and support systems, contributing to well-being.
Key Challenges:
- Economic-Centric Development: The challenge lies in shifting the development narrative from an economic-centric model to one that prioritizes happiness and well-being.
- Social Disruption: The current economic-focused development model may lead to social disruption, imbalances, and contradictions.
- Disregard for Social Indicators: The conventional focus on GDP fails to consider crucial social indicators, neglecting human and social aspects of development.
Key Terms and Phrases:
- Viksit Bharat: The development initiative launched with the goal of making India a developed nation by 2047.
- World Happiness Report: An annual report measuring happiness using multiple variables and indicators.
- Human Development Index (HDI): An index considering life expectancy, educational attainment, and income level.
- Green Index: A World Bank-developed index measuring a nation’s wealth based on produced assets, natural resources, and human resources.
- Social Development Index: Introduced by the UN Research Institute for Social Development, it includes 16 core indicators.
- Global Innovation Index, Rule of Law Index, Poverty Index, Corruption Perceptions Index, Gender Equality Index, and World Press Freedom Index: Various indices significant for comprehensive national development.
Key Quotes:
- “Without achieving happiness, development has no meaning.”
- “Happiness ought to be the central pursuit in this journey.”
- “The nations have developed, but people are not happy.”
Critical Analysis: The article critically examines the conventional economic-focused development model and advocates for a paradigm shift towards happiness-centric development. It emphasizes the inadequacy of GDP-centric measures and highlights the importance of considering social indicators for a more inclusive and balanced development approach.
Way Forward: The way forward involves reimagining the development narrative, giving importance to happiness metrics, and incorporating a broader set of indicators such as the Human Development Index, Green Index, and others. Prioritizing social connections, well-being, and happiness in development strategies will contribute to a more holistic and sustainable vision for Viksit Bharat@2047.
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Loneliness in India: A Deepening Public Health Concern
Note4Students
From UPSC perspective, the following things are important :
Prelims level: NA
Mains level: Mental Health Issues
Central Idea
- The World Health Organization (WHO) recently declared loneliness a significant global health threat, with an estimated 10% of adolescents and 25% of older people affected worldwide.
- Despite being a collectivistic society with over 140 billion people, loneliness in India remains relatively understudied and unacknowledged as a public health and social issue.
Understanding Loneliness
- Definition: Loneliness is defined as the unpleasant experience due to a deficiency in one’s network of social relations, either quantitatively or qualitatively.
- Health Impact: Comparable to smoking 15 cigarettes a day, loneliness can lead to severe mental and physical health issues, including heart disease, depression, and decreased longevity.
Data and Trends in India
- Historical Data: Studies from the early 1990s to recent years show varying rates of loneliness, with a notable increase in loneliness among the elderly and the highly educated.
- Pandemic Effect: COVID-19 and subsequent lockdowns have exacerbated loneliness, particularly among young people and those living alone.
Disparities and Challenges
- Higher Among Educated Youth: Young, highly educated individuals face disproportionately higher rates of unemployment and loneliness, indicating a structural issue in the Indian economy.
- Cultural Stigma: In India, loneliness is often dismissed as a phase or a state of mind, and discussing mental health is stigmatized, making it challenging to address the issue effectively.
Public Health Implications
- Rising Disease Burden: Loneliness contributes to an increased risk of various diseases, potentially inflaming India’s already rising communicable and non-communicable disease burden.
- Inadequate Healthcare Infrastructure: India’s healthcare system struggles with inadequate staff, infrastructure, and budgetary allocation, further complicating the response to the loneliness epidemic.
The Indian Experience of Loneliness
- Cultural Differences: Unlike Western countries, India’s collectivistic culture and socioeconomic barriers present unique challenges in understanding and addressing loneliness.
- Marginalized Communities: Loneliness disproportionately affects marginalized identities, and addressing it requires understanding the intersection of social inequity and mental health.
Addressing Loneliness as a Structural Problem
- Need for Targeted Interventions: Recognizing loneliness as a distinct condition can help develop interventions tailored to India’s cultural context.
- Community-Based Solutions: Addressing loneliness may require community-focused strategies that respond to structural inequities rather than solely clinical approaches.
Conclusion
- National-Level Surveys: Conducting comprehensive surveys in local languages can help understand the true scale of loneliness in India’s diverse population.
- Holistic Approach: Combating loneliness in India requires a multifaceted approach that includes improving mental health literacy, enhancing healthcare infrastructure, and addressing social inequalities.
- Continuous Engagement: As loneliness gains recognition as a public health issue, India must continuously adapt its strategies to effectively support those affected by this silent epidemic.
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Ethics and Compensation in Controlled Human Infection Studies (CHIS)
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Controlled Human Infection Studies (CHIS)
Mains level: Not Much
Central Idea
- A recent paper from August 2023 discusses the ethical and financial aspects of Controlled Human Infection Studies (CHIS), where participants are deliberately infected with pathogens.
- The paper argues that $20,000 for a six-month hepatitis C virus challenge study in the U.S. is reasonable, based on participant experiences and responses from potential participants.
Ethical Considerations in CHIS
- Contentious Issues: One major ethical concern in CHIS is the potential for disproportionate payment, which could be seen as an inducement for participation.
- ICMR’s Bioethics Unit Stance: Emphasizes altruism in CHIS participation, suggesting compensation should cover lost wages, incidental expenses, time, and effort.
Views on Altruism and Compensation
- Jake D Eberts’ Perspective: Disagrees with the ICMR’s emphasis on altruism, arguing that monetary motivation, if accompanied by informed consent and risk understanding, isn’t inherently negative.
- Compensation in Past Studies: Eberts received $7,350 for a Shigella study and less than $5,000 for a Zika study. He advocates for higher compensation in CHIS in the U.S.
Compensation Models and Ethical Frameworks
- Dr. Anna Durbin and Dr. Wilbur H. Chen’s Approaches: Compensation based on time, specimen collection, and regional study pay standards. Dr. Chen uses a Wage-Payment model, aligning compensation with unskilled labor wages in somewhat risky jobs.
- Compensation Calculation: For the Shigella study, compensation totaled $7,350, based on various factors like visit duration, risk level, and activities completed.
Differing Opinions on CHIS Compensation
- Paul Zimmer-Harwood’s Experience: Participated in malaria and COVID-19 CHIS, with compensation based on study duration, visits, and inconvenience, not risk.
- COVID-19 CHIS Concerns: Dr. Chen questions the rationale for COVID-19 CHIS, citing the absence of effective therapies and the risk of Long COVID.
Participant Perspectives and Decisions
- Paul’s Decision-Making: Chose to participate in the COVID-19 CHIS due to low perceived risk, previous infection, and vaccination status. Compensation was higher but proportional to study demands.
- Risk Assessment: Paul viewed the risks as acceptable compared to the potential scientific contributions, emphasizing that his decision was informed and measured.
Conclusion
- Complex Ethical Landscape: CHIS presents a nuanced ethical landscape where compensation, risk, and participant motivation must be carefully balanced.
- Importance of Informed Consent: Ensuring participants are fully informed and understand the risks is crucial in maintaining ethical standards in CHIS.
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Essential Services Maintenance Act (ESMA) and Its Implications
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Essential Services Maintenance Act (ESMA)
Mains level: Not Much
Central Idea
- The Odisha Government invoked its Essential Services (Maintenance) Act (ESMA) prohibiting strikes by paramedical staff, including nurses, pharmacists and technicians to ensure that medical services are not disrupted.
About Essential Services Maintenance Act (ESMA)
- Description: The Essential Services Maintenance Act (ESMA) is a significant piece of legislation enacted by the Parliament in 1968.
- Constitutional Placement: It falls under list no. 33 in the 7th schedule under the concurrent list of the Indian Constitution.
- Purpose: ESMA is primarily used by states to manage strikes by employees, especially in essential services.
- Essential Services: The Act empowers the government to designate any economic activity or service as ‘essential’, where disruption would impact the normal life of people.
Provisions and Powers under ESMA
- Police Authority: The Act grants police the authority to arrest protestors without a warrant if they violate the provisions of ESMA.
- State-Specific Provisions: Each Indian state has its unique version and provisions of the ESMA.
Right to Strike in Context
- Worker’s Basic Right: Striking is a fundamental means for workers to legitimately promote and defend their economic and social interests.
- Legal Status: While the right to protest is a fundamental right under Article 19 of the Indian Constitution, the right to strike is a legal right with certain restrictions.
- Industrial Dispute Act 1947: This act outlines the legal framework and restrictions for strikes, especially in public sectors and essential services.
- Restrictions in Specific Sectors: Strikes are particularly restricted for public sector employees, banking, oil, metropolitan transport, and education sectors under state jurisdiction.
International Labor Organization (ILO) and the Right to Strike
- ILO’s Stance: The ILO’s Committee on Freedom of Association has established principles regarding the right to strike.
- Essential Services Definition: Essential services are those whose interruption could endanger the life, safety, or health of part or all of the population.
- Examples of Essential Services: The committee identifies sectors like hospitals, electricity, water supply, telephone services, and air traffic control as essential services.
- Restriction on Strikes: Employees in these essential services are generally not permitted to strike.
Problems and Criticisms of ESMA
- Irresponsible Use: The Act has been criticized for its sometimes irresponsible and unwise implementation.
- Suppression of Democratic Rights: ESMA is seen as monopolizing power and suppressing the democratic rights of stakeholders, particularly the right to protest or strike.
- Government’s Overpowering Role: Critics argue that ESMA dangerously skews the balance in industrial relations towards the government in the public sector.
Conclusion
- Debate on ESMA’s Role: The Essential Services Maintenance Act remains a contentious topic, balancing the need for uninterrupted essential services with the rights of workers to strike.
- Need for Responsible Implementation: Responsible and democratic application of ESMA is crucial to maintain this balance.
- Ongoing Discussions: The Act continues to spark debate about the extent of government power and the protection of workers’ rights in essential sectors.
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Invisible Indians – sex workers, bar dancers, trans men and women – and lessons for AIDS epidemic
Note4Students
From UPSC perspective, the following things are important :
Prelims level: World AIDS Day
Mains level: resilience of sex workers, bar dancers, and trans individuals
Central idea
The article on World AIDS Day sheds light on the neglected lives of Mumbai’s marginalized communities, emphasizing lessons from the HIV epidemic. It calls for grassroots engagement, holistic healthcare solutions, and dignity-centered public health strategies.
Key Highlights:
- Forgotten Narratives: Reflecting on the lives of marginalized communities in Mumbai on World AIDS Day.
- Overlooked Wisdom: Emphasizing the resilience of sex workers, bar dancers, and trans individuals.
- Lessons from the Epidemic: Drawing insights from the HIV epidemic and its impact on these communities.
Key Challenges:
- Information Gap: Sub-standard public awareness efforts leading to misinformation.
- Access Barriers: Discrimination preventing vulnerable communities from accessing healthcare.
- Top-Down Struggles: Ineffectiveness of top-down approaches in understanding diverse high-risk communities.
Key Terms:
- Grassroots Engagement: Involving local communities in decision-making and solutions.
- Holistic Solutions: Addressing issues comprehensively, considering social, economic, and cultural contexts.
- Stigma and Discrimination: Negative attitudes and actions directed towards marginalized groups.
Key Phrases:
- “Forgotten Narratives“: Bringing attention to the overlooked stories of marginalized communities.
- “Grassroots Wisdom”: Advocating for effective health interventions through community involvement.
- “Holistic Approach”: Moving beyond traditional health services for comprehensive solutions.
Key Examples and References:
- Walks in Mumbai’s Shadows: Personal anecdotes from journeys with marginalized groups.
- Voices of Resilience: Quotes sharing insights on life, disease, and discrimination.
- Epidemic Lessons: Reference to valuable knowledge gained during the HIV epidemic.
Key Facts:
- Call for Collective Action: Emphasizing the need for public trust and stakeholder involvement.
- Investment in Health: Recognizing the commitment of poor and vulnerable populations to their well-being.
- Activism’s Role: Highlighting activism as essential for equitable and accessible healthcare.
| Key Quotes, Anecdotes, Key Statements for good marks |
| “Even the best strategies falter without grassroots engagement.” |
| “The key to ending an epidemic lay in uniting diverse high-risk groups, combating stigma and discrimination.” |
| “Conversations with these communities illuminated the multidimensional aspects of human sexuality, desire, and behavior change.” |
| “Every issue had human, economic, and social dimensions.” |
| “Activism is the kernel around which change can grow. In India, even today, marginalized groups face mistreatment, and it is activism that can make care equitable and accessible.” |
| “Health must come with dignity and empowerment.” |
| “They certainly gave me life lessons in self-respect, desire, and love.” |
Critical Analysis:
- Emotional Impact: Personal anecdotes and quotes enhance the emotional connection to the narrative.
- Advocacy for Change: Effectively advocates for a shift towards inclusive, grassroots-centered health strategies.
- Learnings from Marginalized: Stresses the importance of learning from marginalized communities for effective healthcare solutions.
Way Forward:
- Dignity-Centered Strategies: Calls for strategies prioritizing dignity, equity, and grassroots engagement.
- Community Learning: Emphasizes the value of understanding and incorporating lessons from marginalized communities in public health interventions.
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Mosquitofish: India’s Battle against Invasive Species
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Mosquitofish
Mains level: Read the attached story
Central Idea
- In recent months, Indian states such as Andhra Pradesh, Odisha, and Punjab have introduced mosquitofish to combat mosquito infestations.
- However, the unintended ecological consequences of introducing this invasive species have raised concerns.
Backgrounder: Vector Borne Diseases
- Global Mosquito-Borne Disease Prevalence: Mosquito-borne diseases affect over 150 countries and 500 million people worldwide.
- India’s Burden: India alone reports approximately 40 million cases of mosquito-borne diseases annually.
What is Mosquitofish?
- Introduction in the 1960s: In the 1960s, biological control methods were adopted to combat mosquitoes, including the introduction of mosquitofish (Gambusia species).
- Environmental Alternatives: These methods were considered environmentally friendly alternatives to chemical pesticides, which posed health and environmental risks.
- Global Proliferation: Mosquitofish, originally from the U.S., have now become widespread globally, adapting to various environments with adverse ecological impacts.
Mosquitofish in India
- Historical Introduction: In 1928, Gambusia was introduced in India during British rule, mainly for malaria control.
- Multiple Authorities Involved: Various governmental and private organizations, including the Indian Council of Medical Research (ICMR), National Institute of Malaria Research (NIMR), municipal corporations, and health departments, introduced mosquitofish across India.
Ecological Impact
- Invasive Alien Species: Mosquitofish are considered among the hundred most detrimental invasive alien species.
- Negative Effects: They prey on native fauna, leading to the extinction of native fish, amphibians, and freshwater communities.
- Examples from Other Countries: Australia and New Zealand have reported similar ecological harm due to introduced mosquitofish.
- WHO’s Stand: The World Health Organization stopped recommending Gambusia for mosquito control since 1982.
Current Situation and Recommendations
- Enforcement Measures: Stringent enforcement measures are essential to prevent further introduction of mosquitofish and mitigate past introductions’ consequences.
- Alternative Solutions: Collaboration between mosquito biologists, entomologists, invasion ecologists, and fish taxonomists is suggested to identify native fish species capable of controlling mosquito larvae.
- Local Solutions: Local alternatives should be favored over invasive species to preserve indigenous aquatic biodiversity and native species’ well-being.
- National Centre for Vector Borne Diseases Control (NCVBDC): The NCVBDC should remove its recommendation for the use of Gambusia and Poecilia (guppy) fishes for mosquito control.
Conclusion
- India faces a pressing ecological challenge with the unintended consequences of mosquitofish introduction.
- To safeguard the environment and native species, stringent enforcement and local solutions should replace invasive species in mosquito control efforts.
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Branded, generic and the missing ingredient of quality
Note4Students
From UPSC perspective, the following things are important :
Prelims level: The Hathi Committee
Mains level: Nexus between pharmaceutical companies and doctors
What is the news?
Following the Indian Medical Association’s protest, the NMC has withdrawn the order on ‘generic prescribing’ since August 23, 2023
Central idea
The article highlights challenges in India’s healthcare system, emphasizing the struggle between generic and brand prescriptions. It discusses the alleged nexus between pharmaceutical companies and doctors, quality assurance concerns, and the need for comprehensive measures to ensure affordable and reliable access to medicines. The withdrawal of the generic prescribing order reflects ongoing complexities in achieving universal healthcare goals.
Key Highlights:
- Over-the-Counter Medical Sales in India: Patients often seek second opinions from non-qualified individuals in medical shops, with queries ranging from medicine strength to potential side effects.
- Generic vs. Brand Names: The National Medical Council (NMC) directed doctors to prescribe generic names over brand names, emphasizing the cost factor and the affordability of generic names. The Hathi Committee in 1975 supported the gradual phasing out of brand names.
- Alleged Nexus and Ethical Commitment: An alleged nexus between pharmaceutical companies and doctors exists, but medical associations stress their ethical commitment to improving access to affordable medicines.
- Quality Assurance Concerns: Concerns about the quality of medicines persist, with a prevalence rate of 4.5% for spurious and 3.4% for “not standard quality” medicines. The need for 100% quality-tested drugs is crucial for patient safety.
- Government’s Role: The government is urged to ensure quality through Universal Health Coverage and private healthcare networks, with calls for periodic sampling, banning batches that fail quality tests, and taking punitive actions against manufacturers.
Challenges:
- Quality Assurance Implementation: Existing mechanisms for quality assurance are not earnestly implemented, raising concerns about the reliability of the system.
- Enforcement of Generic Prescription: The moral dilemma in enforcing generic prescription without concrete evidence of standard quality poses a challenge in the healthcare system.
- Availability of Essential Medicines: The low availability rate of essential medicines, especially pediatric medicines, hampers the effective treatment of patients.
- Unscientific Combinations: The presence of unscientific combinations of medicines in the retail market adds complexity to the pharmaceutical landscape.
Analysis:
- Role of the Chemist: Concerns revolve around the chemist or less knowledgeable salesperson determining the brand, potentially based on profit motives, impacting the choice of medicines.
- Withdrawal of Generic Prescription Order: The withdrawal of the NMC order on generic prescribing, following the Indian Medical Association’s protest, reflects the ongoing challenges in healthcare policy.
| Case study to improve answer quality
The Tamil Nadu Medical Services Corporation Limited’s practice, where all supplied medicines are kept under quarantine stock till double blinded samples are cleared in quality testing by government and private sector laboratories, is worth replicating. |
Key Data:
- Prevalence of Spurious and NSQ Medicines: National drug surveys in the last 10 years indicate prevalence rates of 4.5% for spurious and 3.4% for “not standard quality” medicines, highlighting the need for stricter quality control.
- Availability of Essential Pediatric Medicines: A study in Chhattisgarh in 2010 found only a 17% availability rate of essential pediatric medicines, indicating a significant gap in accessibility.
Way Forward:
- Government Assurance and Evidence: The government should provide concrete evidence of the standard quality of medicines before enforcing generic prescriptions, ensuring patient safety.
- Comprehensive Measures: Implementing comprehensive measures, such as limiting profit margins for wholesale and retail agents, is crucial for creating a transparent and fair pharmaceutical ecosystem.
- Janaushadhi Kendras Expansion: Expanding the network of Janaushadhi kendras is essential to improve accessibility to affordable medicines and promote their widespread availability.
- Monitoring Implementation: Ensuring proper implementation and monitoring of policies for free medicines and diagnostics under Universal Health Care is vital for the success of healthcare initiatives.
- Addressing Profit Motives: Addressing profit motives influencing the choice of medicines by chemists and salespersons is essential for a patient-centric healthcare system.
Conclusion:
The withdrawal of the generic prescribing order is seen as a step back in achieving universal access to affordable generic medicines. Addressing quality concerns, ensuring availability, and monitoring implementation are crucial for a successful healthcare system.
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Remission of diabetes, desirable, but not essential
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Prediabetes
Mains level: Holistic Diabetes Management
Central idea
The article highlights the importance of using precise terms like “remission” rather than “reversal” in discussing diabetes. It introduces the ABCDE criteria for potential remission, emphasizing factors like A1c, BMI, and duration. The author advocates a disciplined approach (ABCD: A1c, Blood Pressure, Cholesterol, Discipline) for a healthy life, addressing India’s substantial diabetes challenges.
Key Highlights:
- Redefining ‘Reversal’: Dr. V. Mohan demystifies the trend of claiming ‘diabetes reversal,’ emphasizing the more accurate term ‘remission.’
- Remission: Temporary relief or improvement from diabetes without a permanent cure.
- ABCDE Criteria for Remission: Identification of crucial factors—A1c, BMI, C-Peptide, Duration, and Enthusiasm—that influence the likelihood of remission in type 2 diabetes.
- A1c: Glycated hemoglobin, a measure of average blood sugar levels over the past three months.
- BMI: Body Mass Index, a measure indicating body fat based on weight and height.
- C-Peptide: A marker for insulin secretion, indicating the body’s ability to produce insulin.
- Duration: Period of time since the onset of diabetes.
- Enthusiasm: Eagerness and commitment towards achieving remission.
- Legacy Effect: Recognizing the enduring benefits of achieving even short-term remission in diabetes and its role in preventing complications.
- Legacy Effect: Long-lasting positive impact resulting from past actions or conditions.
- Lifestyle Discipline: Advocating a disciplined lifestyle, with A1c below 7%, controlled blood pressure, and cholesterol as key components for a healthy life with diabetes.
Challenges:
- Deceptive Claims: Cautioning against misleading claims by commercial entities promoting diabetes reversal.
- Individual Variations: Highlighting the diverse likelihoods of achieving remission among individuals with type 2 diabetes.
- Post-Remission Severity: Noting the common occurrence of increased diabetes severity upon its recurrence post-remission.
- Post-Remission Severity: Worsening of diabetes conditions after a period of temporary relief.
- Long-term Remission Challenges: Acknowledging the difficulty for a majority in achieving and sustaining long-term remission.
Key Phrases:
- ABCDE Benchmark: Proposing the ABCDE criteria as a pivotal benchmark for assessing the potential for remission in type 2 diabetes.
- Short-Term Remission Benefits: Underlining the lasting benefits, both physical and preventive, derived from short-term diabetes remission.
- Disciplined Lifestyle Advocacy: Advocating for a disciplined lifestyle encompassing A1c control, blood pressure regulation, and cholesterol management.
- Remission Duration Impact: Recognizing that even temporary remission contributes significantly to safeguarding against diabetes-related complications.
Analysis:
- Holistic Diabetes Management: Dr. Mohan stresses the importance of holistic diabetes management that extends beyond the pursuit of remission.
- Holistic Management: Comprehensive and integrated approach addressing various aspects of diabetes care.
- Remission Realities: Acknowledging the challenge for many individuals to achieve and sustain long-term remission in type 2 diabetes.
- Guidelines Adherence: Reinforcing the significance of adhering to ABCD guidelines for a healthy life despite diabetes.
- Balancing Expectations: Encouraging a balanced perspective on diabetes management, considering the varied responses to remission efforts.
Key Data:
- Diabetes Landscape: A snapshot of diabetes prevalence in India, with 101 million people diagnosed and 136 million in the prediabetes stage.
- Diabetes Prevalence: The proportion of the population affected by diabetes.
- Prediabetes Management: Recognizing the potential for delaying the onset of diabetes through lifestyle modifications in individuals with prediabetes.
- Prediabetes: A condition preceding diabetes, indicating higher-than-normal blood sugar levels.
Key Facts:
- Complications Risk: Highlighting the risks of sub-optimal diabetes control, contributing to severe complications.
- Expert Insight Impact: Dr. Mohan’s insights, drawn from extensive experience, underscore the potential for a healthy life despite diabetes.
- National Health Objective: Reinforcing the national health objective of achieving a ‘diabetes complications-free India.
Way Forward:
- World Diabetes Day Pledge: Urging a renewed commitment on World Diabetes Day to prevent diabetes complications and promote overall well-being.
- Dream of Complications-Free India: Aspiring toward realizing a ‘diabetes complications-free India’ by navigating existing challenges with determination and awareness.
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Hypertension Care: Insights from India’s Healthcare Landscape
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Hypertension
Mains level: Not Much
Central Idea
- An analysis of recent National Family Health Survey data, as published in the journal JAMA, has revealed substantial disparities in the prevalence, diagnosis, treatment, and control of hypertension within Indian states and districts.
- These disparities underscore the need for targeted and decentralized solutions to address the complexities of hypertension care across the nation.
What is Hypertension?
- Hypertension, commonly known as high blood pressure, is a medical condition in which the force of blood against the walls of the arteries is consistently too high.
- Blood pressure is measured in millimetres of mercury (mm Hg) and is expressed as two numbers: systolic pressure over diastolic pressure.
- The systolic pressure represents the force when the heart contracts, while the diastolic pressure represents the force when the heart is at rest between beats.
- Normal blood pressure is typically around 120/80 mm Hg. Hypertension is diagnosed when blood pressure consistently measures at or above 130/80 mm Hg.
- However, different organizations may have slightly different guidelines for defining hypertension.
Key Findings of the Study
- National-Level Observations: The national-level data reveals a common trend – a significant proportion of individuals with hypertension remain undiagnosed, and even among those diagnosed, many do not initiate treatment. Moreover, among those who commence treatment, few achieve adequate blood pressure control.
- Inter-State Variation: The study notes that while the prevalence of hypertension is comparable in southern states, it is notably higher than the national average, with 29.9% of the population in these states affected compared to 26.8% nationally.
- District-Level Disparities: The study highlights substantial variations within states. For instance, in Meghalaya, the prevalence of hypertension differs significantly across Garo Hills, Jaintia Hills, and Khasi Hills districts, affecting the diagnosis rates. A similar scenario is observed in Karnataka’s Chikmagalur, Shimoga, Udupi, and Chitradurga districts.
Impact of Demographics and Education
- Gender and Age: Despite hypertension being more prevalent in men, the data surprisingly reveals that women are more likely to be diagnosed, receive treatment, and achieve blood pressure control.
- Socio-Economic Status: Individuals in the wealthiest quintile demonstrate higher rates of prevalence, diagnosis, treatment initiation, and control.
- Education Level: Completion of schooling correlates with better rates of diagnosis, treatment, and control compared to those with no schooling or up to Class 11.
Significance of Inter-State and Inter-District Variability
- Resource Allocation: District-level data can guide state governments in allocating resources efficiently. It helps identify districts with a high prevalence of hypertension that may require increased screening and diagnostic facilities or better accessibility to medicines.
- Continuum of Care: Managing chronic conditions like hypertension requires a distinct healthcare approach. Ensuring regular availability of medicines, digitization of records for follow-ups, and the establishment of accessible treatment centers are critical components of an effective continuum of care.
Controlling Hypertension in India
- WHO’s Call to Action: The World Health Organization (WHO) emphasizes the potential to avert nearly 4.6 million deaths in India by 2040 if half of hypertensive individuals can control their blood pressure.
- Government Initiative: India launched a comprehensive initiative in 2023 to treat 75 million people with hypertension or diabetes by 2025. This endeavor extends beyond infrastructure expansion to active screening, treatment initiation, medication accessibility, and follow-up mechanisms.
Conclusion
- India’s quest to bridge the gaps in hypertension care demands a multifaceted approach.
- The district-level insights offered by this study can guide policymakers in crafting targeted solutions, ultimately enhancing the continuum of care for hypertension and contributing to better public health outcomes.
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Salt Consumption and Health: Striking a Delicate Balance
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Salt and its Heath Hazards
Mains level: Rising burden of NCDs in India
Central Idea
- Salt is an essential component of our diet, adding flavor to our food and serving vital bodily functions.
- However, excessive salt intake can lead to health issues, including high blood pressure.
Salt Intake in India
- In India, a recent national survey revealed that men consume 8.9 grams, while women intake 7.1 grams of salt daily (Prashant Mathur et al., Scientific Reports, 2023).
- While the World Health Organization recommends a daily salt intake of 5 grams, the global average is much higher at 10.8 grams.
Salt and Health Implications
- Diverse Health Effects: Extensive research in animals and human surveys consistently link high salt consumption to kidney, brain, vascular, and immune system diseases. Conditions such as kidney stones and osteoporosis are associated with excessive sodium intake.
- Global Impact: Excessive salt intake contributes to approximately five million deaths worldwide annually, underscoring the global health impact of salt-related health issues.
The Yanomami Example
- The Yanomami people, living in the Amazon rainforest, follow a foraging lifestyle and consume a diet primarily composed of Cassava, plantains, fruit, fish, and occasionally tapir.
- Interestingly, they use peppers for flavor but do not use salt.
- Their daily salt intake is less than one gram, yet they maintain excellent health and fitness.
Salt and Obesity Connection
- Balancing Act: While our bodies require salt for essential functions, excessive salt consumption can lead to health problems, including obesity.
- Metabolic Impact: High salt intake impairs metabolism and increases the size of adipocytes, the cells that store fat, contributing to obesity.
- Dietary Preferences: There is a connection between a preference for high-fat and salty foods. Experiments with mice showed that those exposed to high-fat diets during gestation preferred salty water.
Reducing Salt Intake and Blood Pressure
- Population Studies: Reducing salt intake by five to eight grams daily can lead to a 4 mmHg drop in systolic blood pressure and a lower risk of cardiovascular disease, as demonstrated in population studies.
- Clinical Trials: Antihypertensive drugs, which lower blood pressure, show similar results, with an average reduction of 5 mmHg.
- Salt Alternatives: Replacing normal salt with a mixture of 75% sodium chloride and 25% potassium chloride reduced systolic blood pressure by 3.3 mmHg in a Chinese population study.
- Caution for Elderly: Reducing salt intake may pose risks for elderly adults, particularly if they are taking blood pressure medication, as it could lead to hypotension and falls.
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How do some Cancer Cells survive Chemotherapy?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Lamin B Receptor (LBR), Chemotherapy
Mains level: NA
Central Idea
- Researchers at the Netherlands Cancer Institute have conducted a recent study to investigate drug resistance in cancer cells, focusing on resistance to a drug known as Taxol.
- It studied Chemotherapy and cancer relapse, particularly when a small number of cancer cells resist treatment and remain dormant, potentially leading to a resurgence of the disease.
Chemotherapy and its limitations
- Cancer cells are characterized by uncontrolled and rapid division.
- Chemotherapeutic drugs aim to halt this proliferation, often triggering programmed cell death, known as apoptosis, in response to halted cell division.
- However, this approach also damages healthy dividing cells, leading to adverse side effects.
Fine-Tuning Cancer Treatment
- Oncologists face the challenge of finding an effective drug dose that eliminates cancer cells while minimizing unbearable side effects for patients.
- One approach has been the development of antibody-drug conjugates (ADCs) that target specific proteins found mainly on cancer cells, sparing non-cancerous cells.
Unraveling Drug Resistance
- P-gp Protein: Some cancer cells escape drug treatments by overexpressing a protein called P-gp (permeability glycoprotein), which acts as a pump, expelling toxic compounds, including chemotherapeutic agents.
- ABCB1 Gene: The production of P-gp is controlled by the ABCB1 gene, and cells that produce excessive P-gp can flush out chemotherapy drugs, preventing them from accumulating at levels needed to trigger apoptosis.
Role of Cellular Location
- Recent Findings: The study examined the sensitivity of cells to Taxol and identified that the location of the ABCB1 gene within the cell’s nucleus plays a crucial role.
- Nuclear Envelope: In sensitive cells, the ABCB1 gene is located close to the nuclear envelope. In resistant cells, the gene has detached from the envelope and moved further inside the nucleus, resulting in a 100-fold increase in ABCB1 gene-related RNA.
Key Protein: Lamin B Receptor (LBR)
- LBR’s Influence: Researchers discovered that the presence or absence of a protein called Lamin B Receptor (LBR) affects the location of the ABCB1 gene.
- Depletion of LBR: When LBR is depleted, cells can activate the ABCB1 gene when exposed to Taxol. However, the absence of the LBR gene itself does not immediately increase ABCB1 expression, indicating the involvement of additional factors.
- Diverse Responses: Different cancer types exhibit varying responses to LBR depletion, highlighting the complex mechanisms governing gene expression and silencing.
- Analogy: A simple analogy illustrates the diversity: Different bathrooms offer various options for drying clothes, and cancer cell types rely on different mechanisms to tether genes to the nuclear envelope.
Significance
- These findings emphasize the need for further research into the diverse ways cancer cells express or suppress genes.
- Understanding drug resistance mechanisms opens avenues for developing strategies to maintain the potency of anti-cancer drugs while minimizing side effects, ultimately benefiting patients on their path to recovery.
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Egypt attains WHO ‘Gold Tier’ status in Hepatitis C Elimination
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Hepatitis
Mains level: Read the attached story
Central Idea
- Egypt has become the first country to achieve the World Health Organization’s “gold tier” status on the path to elimination of Hepatitis C.
About Hepatitis
| Hepatitis A | Hepatitis B | Hepatitis C | |
| Causative Virus | Hepatitis A Virus (HAV) | Hepatitis B Virus (HBV) | Hepatitis C Virus (HCV) |
| Transmission | Fecal-oral route (contaminated food/water) | Blood and body fluids (unsafe sex, sharing needles) | Blood-to-blood contact (sharing needles, transfusions) |
| Vaccine Available | Yes | Yes | Yes |
| Chronic Infection | No (usually acute) | Yes (can become chronic) | Yes (often becomes chronic) |
| Symptoms | Mild flu-like symptoms, jaundice | Variable, from none to severe symptoms | Often asymptomatic, but can lead to liver damage |
| Chronic Complications | None | Cirrhosis, liver cancer | Cirrhosis, liver cancer |
| Preventable by Vaccine | Yes | Yes | No |
| Treatment | Supportive care | Antiviral medications | Antiviral medications |
Egypt’s “Gold Tier” Status
- Stringent Criteria: To reach the “gold tier,” Egypt fulfilled specific criteria, including ensuring 100% blood and injection safety, providing a minimum of 150 needles/syringes annually for people who inject drugs, diagnosing over 80% of individuals with chronic hepatitis C virus (HCV), treating over 70% of diagnosed HCV patients, and establishing a surveillance program for hepatitis sequelae, including liver cancer.
- Exemplary Results: Egypt has diagnosed 87% of its hepatitis C patients and provided curative treatment to 93% of those diagnosed, surpassing the WHO’s gold tier targets.
How did Egypt achieve this?
- “100 Million Healthy Lives” Initiative: Egypt’s ambitious initiative led to a substantial reduction in hepatitis C prevalence, from 10% in 2016 to 5% in 2018 and an estimated less than 1% in 2019, as reported by the Africa CDC.
- Leadership Role: Egypt extends support to other African countries, aiming to replicate its success in hepatitis C elimination, including enhancing access to affordable treatment.
Try this PYQ:
Which one of the following statements is not correct?
(a) Hepatitis B virus is transmitted much like HIV.
(b) Hepatitis B, unlike Hepatitis C, does not have a vaccine.
(c) Globally, the number of people infected with Hepatitis B and C viruses are several times more than those infected with HIV.
(d) Some of those infected with Hepatitis B and C viruses do not show the symptoms for many years.
Post your answers here.
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India seeks inclusion of Traditional Medicine on WHO’s ICD List
Note4Students
From UPSC perspective, the following things are important :
Prelims level: International Classification of Diseases (ICD)
Mains level: NA
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.
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Threat posed by cardiovascular diseases (CVD)
Note4Students
From UPSC perspective, the following things are important :
Prelims level: World Heart Day
Mains level: World Heart Day, Rising burden of Cardio vascular diseases, efforts and challenges
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.
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Mental health and the floundering informal worker
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Key findings
Mains level: Mental health: A universal human right
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:
- Promotional: Aimed at augmenting income.
- Preventive: Intended to forestall economic distress.
- 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.
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Ageing World: Addressing Mental Health Challenges in the Elderly
Note4Students
From UPSC perspective, the following things are important :
Prelims level: UNFPA report on Ageing
Mains level: Elderly woes in India
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
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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.
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India’s diabetes crisis
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Diabetes and related facts
Mains level: India's Diabetes stress, Factors behind, exploitative marketing, measures
What’s the news?
- In June 2023, a study conducted by the Madras Diabetes Research Foundation in collaboration with the ICMR and the Union Health Ministry revealed alarming statistics about India’s diabetes crisis.
Central idea
- According to the study, 11.4% of India’s population, approximately 10.13 crore people, are living with diabetes. According to the WHO, a major reason for this is the consumption of unhealthy, ultra-processed foods and beverages. These statistics demand immediate attention and concrete actions to address the root causes of this public health crisis.
Key findings of the study
- Living with diabetes: 4% of India’s population, or 10.13 crore people, are living with diabetes.
- Pre-diabetic: 3% of the population, or an additional 13.6 crore people, are pre-diabetic.
- Obese Population: 6% of the population would be considered obese as per the BMI measure.
The consumption of ultra-processed foods: a significant contributor
- Contents of Ultra-Processed Foods:
- Ultra-processed foods encompass a wide range of products, including carbonated drinks, instant cereals, chips, fruit-flavored drinks, instant noodles, cookies, ice cream, bakery items, energy bars, sweetened yogurts, pizzas, processed meat products, and powdered infant formulas.
- These items are often characterized by their convenience and long shelf life.
- Increased Risk of Diabetes with Scientific Evidence:
- A concerning statistic reveals that a mere 10% increase in daily consumption of ultra-processed food is associated with a 15% higher risk of type-2 diabetes among adults.
- These foods are often high in sugar, fat, and salt, all of which contribute to insulin resistance and elevated blood sugar levels.
- Impact on Weight Gain:
- Ultra-processed foods are engineered to be hyper-palatable. They often contain combinations of sugars, fats, and artificial additives that stimulate the appetite and lead to overconsumption.
- This excessive calorie intake can result in weight gain, a known risk factor for type 2 diabetes.
- Structural Alteration:
- When food undergoes extensive processing, its original structure is often destroyed. Cosmetic additives, colors, and flavors are added to enhance taste and appeal.
- This altered structure and excessive processing can disrupt the body’s natural regulation of hunger and satiety, leading individuals to eat more and gain weight.
- Association with Cardiovascular Risks:
- The negative effects of ultra-processed foods extend beyond diabetes. Obesity and diabetes are key risk factors for heart disease and premature mortality.
- Research indicates that those who consume more than four servings of ultra-processed foods per day face a significantly higher risk of cardiovascular mortality compared to those who consume fewer than two servings per day.
- A similar trend is observed for all-cause mortality.
Exploitative marketing practices
- Shifting Focus to Low- and Middle-Income Countries:
- In many high-income countries, the sale of sugar-sweetened beverages has declined over the past two decades due to growing awareness of their health impacts.
- To compensate for this loss of sales, food companies have shifted their attention to low- and middle-income countries, where there may be less stringent regulations and a growing consumer base.
- Aggressive Marketing and Advertising:
- These companies invest substantial amounts of money in marketing and advertising ultra-processed food and beverages in countries like India.
- These aggressive marketing campaigns often target vulnerable populations, including children and the emerging middle class.
- Techniques like the use of cartoon characters, incentives, gifts, and celebrity endorsements are employed to make these products more appealing.
- Blaming Individuals vs. Addressing Systemic Issues:
- The food industry tends to place blame on individuals, suggesting that personal choices are responsible for unhealthy dietary habits.
- However, the environment created by aggressive marketing and the easy accessibility of ultra-processed foods play a significant role in shaping these choices.
- Impact on Public Health:
- The consequences of these marketing strategies are severe. They contribute to a deepening public health crisis, with diabetes being a ticking time bomb.
- Sugar-sweetened beverages, in particular, are highlighted as a major source of added sugar in diets, putting people at a higher risk of type 2 diabetes and other health issues.
The need for regulatory intervention
- Industry Opposition: The food industry resists marketing restrictions, citing economic concerns and portraying themselves as stakeholders.
- False Promises: Some industry initiatives, like ‘Eat Right,’ may appear health-focused but could divert attention from unhealthy product impacts.
- Impact on Regulation: Industry partnerships can hinder strong regulatory policies aimed at reducing ultra-processed food consumption.
- Role of Regulatory Authorities: Lackluster responses and industry dominance in regulatory bodies may impede effective public health regulations.
- Complementary Efforts: While exercise is essential, it should complement regulatory policies addressing marketing and warning labels on unhealthy foods.
- Balancing Interests: Governments must prioritize citizens’ health, striking a balance between industry interests and public well-being when implementing evidence-based, transparent regulations.
Strategy to safeguard: Mandatory Provisions
- To protect the public from the manipulative strategies of the food industry, the government must establish a legal framework or even an ordinance under Article 123 of the Constitution.
- This framework should focus on reducing or halting the consumption of ultra-processed foods and could include:
- Defining ‘healthy food’
- Implementing warning labels on unhealthy food
- Imposing restrictions on the promotion and marketing tactics of unhealthy food and beverages
- Raising public awareness about the risks associated with consuming such foods
Global Examples
- Several countries, including South Africa, Norway, and Mexico, have recently taken similar actions to regulate food labeling and marketing.
- The Indian government has the opportunity to demonstrate its commitment to public health by enacting similar laws.
- Much like the Infant Milk Substitutes, Feeding Bottles, and Infant Foods Act, which successfully regulated commercial baby food, this proposed legislation could make significant strides in curbing the consumption of unhealthy foods and beverages.
Conclusion
- India stands at a critical juncture in its battle against diabetes and a food industry that prioritizes profits over public health. The time has come for the government to implement robust regulations. By taking decisive action, India can protect the well-being of its citizens and set a precedent for responsible food regulation in the global context.
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Bridging Gender Gaps in Cancer Care: The Lancet Commission Report
Note4Students
From UPSC perspective, the following things are important :
Prelims level: NA
Mains level: Gender Gaps in Cancer
Central Idea
- The Lancet Commission report ‘Women, Power and Cancer’ spotlights the gender disparities in cancer care that persist in India.
Women dying of Cancer: Alarming Statistics
- The report emphasizes that approximately 6.9 million cancer-related deaths among Indian women were preventable, and 4.03 million were treatable.
- It revealed that a staggering 63% of premature cancer-related deaths in Indian women could have been prevented through risk reduction, screening, and early diagnosis.
- 37% could have been averted through timely and optimal treatment.
Understanding the Gender Gap
- Cancer Incidence and Mortality: Despite men being at a higher risk of certain cancers affecting both genders, women continue to face a significant burden of cancer incidence and mortality. Globally, women account for 48% of new cancer cases and 44% of cancer-related deaths. This happens even though some of the cancers in women, such as breast and cervical cancers, are highly preventable and treatable.
- Root Causes: The report attributes this gender gap in cancer outcomes to several factors, including limited access to timely and appropriate care due to disparities in knowledge, decision-making power, and financial resources. Women, irrespective of their socioeconomic status, often lack the necessary information and autonomy for informed decision-making in healthcare.
- Financial Strain: Additionally, women are more likely than men to experience financial devastation due to cancer-related expenses, compounding the challenges they face.
Challenges in Cancer Care for Women
- Underrepresentation: The report underscores that women are underrepresented in leadership roles in the field of cancer care. They are also susceptible to gender-based discrimination and harassment, making it a complex environment for women to thrive.
- Unrecognized Contributions: Shockingly, women constitute the largest unpaid workforce in cancer care, with their contributions estimated to be worth approximately 3.66% of India’s national health expenditure.
Expert Insights
- Healthcare-Seeking Behavior: A healthcare expert highlights the impact of gendered healthcare-seeking behavior. Women, particularly in disadvantaged sections of society, tend to exhibit lower healthcare-seeking behavior, impacting their overall health outcomes.
- Societal Changes: Beyond medical knowledge, societal changes are crucial. Women often hesitate to consult medical professionals for conditions like breast or cervical cancer, leading to delays in diagnosis and treatment.
Significance of Screening
- Preventable and Treatable Cancers: Breast and cervical cancers, two of the most common cancers in women, are highly preventable and treatable. Experts emphasize the importance of regular screenings.
- Early Detection: Self-examination of breasts, annual clinical examinations by a medical professional, and mammography for women over 40 can aid in early breast cancer detection. For cervical cancer, regular screenings can identify pre-cancerous growth and the presence of the human papillomavirus.
Government Interventions
- Awareness Campaigns: Experts underscore the need for government-led awareness campaigns to promote cancer prevention and early detection, similar to those for other health initiatives.
- Vaccination Programs: The government’s initiative to include vaccination programs for young girls is a positive step in reducing cancer incidence.
- Primary Health Centers: Experts highlight the potential for primary health centers to play a more significant role in cancer diagnosis and early treatment, particularly for cervical cancer.
Recommendations from the Report
- Data Collection: Regularly collecting gender and social demographic data for cancer health statistics is crucial.
- Policy Development: Developing, strengthening, and enforcing policies that reduce known cancer risks is essential.
- Equitable Access: The report calls for equitable access to cancer research resources, leadership roles, and funding opportunities for women, addressing the gender imbalance in cancer care and research.
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India’s Kidney Crisis
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Laws related to organ transplantation in India
Mains level: India's kidney crisis, challenges in procurement, transplant laws and Need for reforms
What’s the news?
- India faces a grave crisis in its healthcare landscape, particularly concerning the shortage of kidneys for transplantation.
Central idea
- India is grappling with a severe kidney crisis, marked by an alarming demand-supply gap in kidney transplantation. While kidney transplantation is the most effective treatment for end-stage renal disease (ESRD), India’s regulatory framework presents formidable obstacles to innovative kidney exchange methods.
India’s Kidney Crisis
- In 2022, over two lakh patients required kidney transplants, but only about 7,500 transplants, a mere 3.4%, were performed.
- This alarming disparity can be attributed to the high prevalence of chronic kidney disease (CKD) in India, which affects approximately 17% of the population.
- CKD often progresses to end-stage renal disease (ESRD), for which kidney transplantation is the most effective treatment in terms of quality of life, patient convenience, life expectancy, and cost-effectiveness.
- However, India lags far behind developed countries like the United States, which performs about 20% of the needed kidney transplants.
- Importantly, this gap is not solely due to a lack of medical facilities but is largely influenced by stringent regulations in India.
Current kidney procurement methods in India
- Deceased Donors:
- Obtaining kidneys from deceased donors is one of the primary methods in India.
- However, this method faces challenges due to low donation rates, specific conditions required for the nature of death, and the infrastructure needed to collect and store organs.
- Families’ willingness to donate organs after a loved one’s death remains relatively low.
- Living Relatives or Friends:
- Another method for obtaining kidneys is through living relatives or friends.
- Patients can request a kidney donation from a willing living individual who is a compatible match.
- This approach requires compatibility in terms of blood type and tissue type, which can be a significant obstacle. It also involves complex emotional and ethical considerations.
Challenges related to kidney procurement methods in India
- Regulatory Barriers: Stringent regulations in India hinder innovative kidney exchange methods, such as kidney swaps and kidney chains. These regulations limit the participation of non-near-relatives in kidney swaps, and altruistic donations for kidney chains are often illegal.
- Lack of Kidney Chains: Kidney chains, a method involving a series of altruistic donations, are nearly non-existent in India due to legal restrictions. In most Indian states, it is illegal to donate a kidney out of altruism.
- Black Market for Kidneys: The stringent regulations around kidney exchange have led to the emergence of black markets for kidneys in India. The reference to selling a kidney is a mainstream expression, indicating the prevalence of such illegal operations.
The need for regulatory reform
- Stringent Regulations: Current regulations impede innovative kidney exchange methods, hindering non-near-relatives’ participation and banning altruistic donations in many states.
- Missed Opportunities: India has missed chances to expand kidney supply through effective methods like kidney swaps and chains due to legal barriers.
- Disparity in Regulations: Inconsistent regulations between swap transplants and direct donations raise questions about fairness.
- Lack of Coordination: India lacks a national coordinating authority, making it difficult to create diverse donor-recipient pools.
- Black Market Concerns: Stringent regulations have led to a black market for kidneys, endangering those involved.
Key reforms so far
- Transplantation of Human Organs and Tissues Act 1994: This legislation laid the foundation for organ transplantation in India by recognizing the possibility of transplants from brain-stem death.
- 2011 Amendment: In 2011, an amendment legalized swap transplants and initiated a national organ transplant program in India. This represented a significant step toward expanding transplantation options.
- Reforms in February 2023: The government introduced reforms in February 2023, offering more flexibility in age and domicile requirements for organ registration. While noteworthy, the article suggests that these reforms fall short of addressing the core issue of inadequate kidney supply.
Lessons for India to transform its own organ transplantation landscape
- Altruistic Donations: Emulate countries like the US and the Netherlands in legalizing and encouraging altruistic kidney donations to expand the donor pool.
- National Registries: Follow Spain and the UK by establishing national-level registries for kidney chains and swaps to streamline coordination.
- International Collaboration: Explore international partnerships as seen in Spain to broaden the donor and recipient network.
- Continuous Improvement: Commit to ongoing regulatory enhancements, inspired by the success of the United States in facilitating kidney swaps and chains.
- Patient-Centric Approach: Prioritize patient-centered policies, drawing from global models, to improve patient access and quality of life.
Conclusion
- Reforming India’s kidney transplant laws is not only a matter of urgency but also a humanitarian imperative. Along with the domestic reforms, learning from global best practices is the key to addressing this critical issue and ensuring a brighter future for kidney transplant recipients in India.
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Challenges and Opportunities of India’s Aging Population
Note4Students
From UPSC perspective, the following things are important :
Prelims level: India's Aging Population
Mains level: Not Much
Central Idea
- Projected Demographic Shift: By 2050, the percentage of elderly individuals in India is expected to double, reaching over 20% of the total population, as per the UN Population Fund, India (UNFPA) in its 2023 India Ageing Report.
- Rapid Expansion: India is experiencing a remarkable decadal growth rate in its elderly population, currently estimated at 41%.
- Changing Dynamics: This demographic shift raises the possibility that by 2046, the elderly population may surpass the number of children (aged 0 to 15 years) in the country.
Economic Disparities among the Elderly
- Poverty Prevalence: More than 40% of India’s elderly population belongs to the poorest wealth quintile, with nearly 18.7% of them living without any source of income.
- Quality of Life Impact: Such high levels of poverty can significantly affect their quality of life and their access to healthcare services.
Understanding the Aging Population
- Rapid Growth in the 80+ Age Group: The report predicts a staggering 279% growth rate in the population of individuals aged 80 and above between 2022 and 2050.
- Gender Disparities: There is a predominance of widowed and highly dependent elderly women in this age group, a trend observed in several nations.
- Regional Variations: Life expectancy at 60 and 80 varies across states and union territories, with women generally having higher life expectancies, raising concerns about their social and economic well-being.
- Regional Disparities: States like Rajasthan, Haryana, Gujarat, Uttarakhand, Kerala, Himachal Pradesh, and the Union Territory of J&K have women with life expectancies exceeding 20 years at age 60, highlighting the need for tailored support.
Changing Sex Ratios among the Elderly
- Steady Increase: The sex ratio (females per 1,000 males) among the elderly has been steadily rising since 1991, in contrast to the stagnation in the general population’s sex ratio.
- Regional Variations: The northeast and east show an increased sex ratio among the elderly, but it remains below 1,000, indicating a male predominance. In contrast, central India saw a remarkable shift, with women outperforming men in survival after the age of 60.
Gendered Poverty in Old Age
- Inherent Gender Bias: Poverty in old age is inherently gendered, with older women more likely to be widowed, living alone, lacking personal income, and relying on family support.
- Feminization and Ruralization: The major challenges facing India’s aging population include the feminization and ruralization of the elderly. Policies must address these specific needs.
Inter-State Variations in Elderly Population
- Diverse Demographic Transition: Significant inter-state variation exists in the levels and growth of the elderly population, reflecting differing stages and rates of demographic transition.
- Regional Differences: States in the southern and select northern regions have a higher share of the elderly population, a gap expected to widen by 2036. In contrast, states with higher fertility rates, like Bihar and Uttar Pradesh, will see an increase in the elderly population share but will remain below the national average.
- Ageing Index: Central and northeastern regions are characterized by a younger demographic as indicated by the aging index.
Response to Elderly Needs during the Pandemic
- Inadequate State Aid: The report reviews the government and state authorities’ response to the needs of elderly people during the COVID-19 pandemic, highlighting that while most received state aid, it was insufficient.
- Only NGOs to rescue: Accessible public healthcare facilities were lacking, with NGOs and CBOs being the primary sources of help.
- Call for Preparedness: The report recommends a special focus on older persons in disaster-preparedness plans moving forward.
Enhancing Data Collection and Support
- Data Deficiency: The report underscores the lack of credible data on various issues related to the elderly in India and calls for the inclusion of questions concerning older persons in upcoming data collection exercises.
- Policy Recommendations: Suggestions include increasing awareness about elderly schemes, regulating Old Age Homes, and promoting in-situ aging.
- Community Engagement: Encouraging the creation of elderly self-help groups and emphasizing multigenerational households as well as short-term care facilities.
Promising Roadmap and Valuable Resource
- Government Acknowledgment: Social Justice Dept. termed the report a “valuable roadmap”. It emphasized its importance as a resource for scholars, policymakers, program managers, and all stakeholders involved in elder care.
- Data Sources: The report draws from various sources, including the 2011 Census, the 2017-18 Longitudinal Ageing Survey in India (LASI), population projections, and reports from the Government of India and the World Population Projection 2022.
Way forward
The report advocates for policies that enhance the well-being of India’s aging population-
- Foster community support
- Multigenerational living, and
- In-situ aging
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Challenge of Non-Communicable Disease in India
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Burden of Non-communicable diseases
Mains level: India's progress in healthcare progress, NCD challenges and potential of AI
What’s the news?
- India, with its emerging leadership in global issues, faces the challenge of rising NCDs, including diabetes and heart diseases. The healthcare industry calls for collaboration to address this crisis, highlighting India’s progress in healthcare, its role as a Medical Value Travel hub, and its potential in AI-driven healthcare innovations.
Central idea
- In recent years, India has emerged as a prominent voice on the global stage, leading the way in critical areas such as climate change, electrification, manufacturing, and space exploration. India’s achievements include successfully landing a mission near the moon’s south pole and a successful G-20 presidency. However, as India aims to become a global leader, it must confront a looming health crisis of NCDs.
What are Non-Communicable Diseases (NCDs)?
- NCDs are also known as chronic diseases, which are not caused by infectious agents and are not transmissible from person to person.
- NCDs are long-lasting and progress slowly, typically taking years to manifest symptoms.
- Examples of NCDs include cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes.
- These diseases are often caused by modifiable risk factors such as an unhealthy diet, a lack of physical activity, tobacco and alcohol use, and environmental factors.
- NCDs are a major cause of morbidity and mortality worldwide, accounting for around 70% of all deaths.
India’s NCD challenge
- Diabetes and Hypertension Prevalence: India is facing a high prevalence of NCDs, particularly diabetes and hypertension, which affect millions of people.
- Youth Health Issues: The burden of NCDs is increasingly affecting India’s youth, leading to heart attacks, cancer, respiratory problems, depression, and more.
- Economic Consequences: If unchecked, India’s NCD burden could lead to an economic cost of nearly $4 trillion by 2030. This poses a significant roadblock to India’s development and is compared to an age tax on the country’s demographic dividend.
India’s healthcare progress
- Improved Health Metrics: India has witnessed notable improvements in key health metrics.
- Infant Mortality: India has witnessed a remarkable improvement in infant mortality rates, which have decreased by four times from previous levels.
- Maternal Mortality: Maternal mortality rates have shown remarkable progress as well, decreasing by seven times from earlier rates.
- Average Life Expectancy: The average life expectancy of an Indian has increased by nearly 30%, rising from 55 years to over 70 years, reflecting the overall improvement in healthcare and quality of life in the country.
- World-Class Healthcare Infrastructure: India is described as having world-class healthcare infrastructure. Investments have been made in modern hospitals, clinics, and medical facilities to provide high-quality healthcare services.
- Clinical Excellence: India is noted for its pool of highly skilled clinical talent. These healthcare professionals are capable of delivering best-in-class clinical outcomes and providing healthcare services at a scale and cost that are favorable compared to the global average.
India as a Medical Value Travel (MVT) hub
- Global MVT Hub: India has emerged as a prominent global destination for MVT, attracting patients from around the world, particularly in specialized medical fields such as oncology, orthopedics, and robotic surgery.
- Advanced Medical Technology: India has invested in state-of-the-art medical technology and facilities, including the introduction of proton beam therapy for cancer treatment, positioning itself as a regional leader in cancer care.
- Highly Skilled Healthcare Professionals: India has a highly skilled and trained workforce of healthcare professionals known for their expertise in complex procedures, including joint replacements, spinal surgeries, and robotic-assisted surgeries.
- Minimally Invasive Techniques: Many medical procedures in India are conducted using minimally invasive techniques, attracting patients seeking precise and less invasive treatments.
- Cost-Effective Care: India offers cost-effective healthcare services, making it an attractive destination for patients seeking high-quality medical care at competitive prices.
- Growth Potential: India’s MVT sector has significant growth potential, capable of creating employment opportunities and contributing to foreign exchange earnings.
India’s potential for harnessing Artificial Intelligence (AI) to transform the healthcare sector
- AI in Healthcare Transformation: AI is rapidly reshaping healthcare worldwide, and India is poised to play a leading role in this transformation. India has a wealth of talented data scientists, engineers, and healthcare professionals capable of driving innovation in AI-driven healthcare solutions.
- Diagnostic Advancements: AI can significantly impact diagnostics by enhancing accuracy and efficiency in medical diagnoses. AI-powered tools can lead to faster treatment decisions and improved patient outcomes. Moreover, AI can aid in predicting disease outbreaks, analyzing healthcare data, optimizing treatment plans, expediting healthcare procedures, and revolutionizing drug discovery.
- India’s Progress in AI: India has already made strides in the application of AI in healthcare. However, to maintain and strengthen its leadership position, India must continue to invest in research and development, encourage collaborations between academia and industry, and create an ecosystem that fosters innovation.
- Economic Potential: The AI expenditure in the country is expected to reach $11.78 billion by 2025 and could contribute $1 trillion to India’s economy by 2035.
Way forward
- AI-Driven Healthcare Transformation: India should fully embrace the transformative potential of AI in healthcare. This involves integrating AI-powered solutions for diagnostics, treatment optimization, and healthcare procedures.
- Investment in R&D: India should continue and increase investment in research and development to drive healthcare innovation. Funding and supporting research initiatives will be crucial for advancements in healthcare technology.
- Collaboration Between Academia and Industry: Strengthening partnerships between academic institutions and the healthcare industry is essential. These collaborations can expedite the application of research findings to practical healthcare solutions.
- Nurturing an Innovation Ecosystem: India should create an ecosystem conducive to healthcare innovation. This includes supporting healthcare startups, offering incentives for innovation, and facilitating the growth of healthcare technology companies.
- Economic Potential of AI: Recognizing the economic potential of AI in healthcare, India should actively invest in AI-driven healthcare solutions. The expected growth in AI expenditure presents an opportunity to contribute significantly to the country’s economy.
- Community Health Focus: Prioritizing community health is essential. Initiatives aimed at improving public health, creating awareness about preventive measures, and addressing healthcare disparities should be emphasized.
- Public-Private Collaboration: Collaboration between the public and private sectors is critical. Joint efforts can lead to infrastructure development, the promotion of medical tourism, and the establishment of international healthcare accreditation bodies.
- Leadership in NCD Prevention: India should take a leading role in addressing non-communicable diseases (NCDs). Comprehensive strategies, including prevention, early detection, and effective management, should be at the forefront of healthcare efforts.
Conclusion
- India stands at a critical juncture in its healthcare journey. By reimagining its healthcare model, India can position itself as a global leader in medical value travel, a powerhouse in AI-driven healthcare solutions, and a trailblazer in combating NCDs. With concerted efforts and a commitment to excellence, India can forge a healthier and more prosperous future for generations to come, truly realizing its destiny as a global leader.
Also read:
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President launches Ayushman Bhav Campaign
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Ayushman Bhav Campaign
Mains level: Read the attached story
Central Idea
- The President of India, Mrs. Murmu, virtually launched the Ayushman Bhav campaign and the Ayushman Bhava portal.
Ayushman Bhav Campaign
- The Ayushman Bhav campaign aims to deliver healthcare services to the remotest corners of India, playing a pivotal role in achieving the campaign’s ambitious objectives.
- It is designed to ensure that every individual receives essential health services, aligning with the overarching goals of Ayushman Bhav.
- The campaign’s goals, include-
- Facilitating access to Ayushman cards
- Generating ABHA IDs
- Raising awareness about critical health schemes and disease conditions, such as non-communicable diseases, tuberculosis, and sickle cell disease.
Three Components of Ayushman Bhav:
- President highlighted the three integral components of Ayushman Bhav:
- Ayushman – Apke Dwar 3.0
- Ayushman Melas at Health and Wellness Centres (HWC) and Community Health Clinics (CHC)
- Ayushman Sabhas in every village and panchayat
- These components are expected to accelerate the delivery of healthcare services at grassroots levels, contributing to the creation of a healthier nation.
Back2Basics: Ayushman Bharat Scheme
| Launch Year | 2018 |
| Objective | Universal Health Coverage and Financial Protection |
| Components | 1. Pradhan Mantri Jan Arogya Yojana (PM-JAY)
2. Health and Wellness Centers (HWCs) |
| Target Beneficiaries | Economically disadvantaged families, rural populations, vulnerable communities |
| Coverage | Health insurance for eligible families, covering various medical expenses |
| Services Offered | Comprehensive healthcare services, including preventive, promotive, and curative care |
| Impact | Improved health indicators, reduced financial burden on beneficiaries, enhanced healthcare infrastructure |
| Vision | To make healthcare a fundamental right for all Indian citizens |
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Orphan Diseases in India
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Orphan Diseases
Mains level: NA
Central Idea
- Health discussions often revolve around common ailments, such as diabetes, which affect a significant portion of the population.
- However, amidst these well-known health issues, there are numerous rare/ orphan diseases that, though infrequent, can have devastating consequences for patients and their families.
What are Orphan Diseases?
- Rare diseases, often referred to as orphan diseases, are characterized by a low prevalence rate, typically affecting one person in a population of 10,000.
Challenges Posed
- Difficulty in Diagnosis: Rare diseases are challenging to diagnose, particularly for young medical practitioners who may have limited exposure to such cases. The rarity of these conditions means that many healthcare professionals may not have encountered them during their training.
- Lack of Research: Limited prevalence has historically resulted in insufficient research efforts. With fewer cases to study, there has been a lack of scientific understanding and effective treatments for many rare diseases.
- High Treatment Costs: While advances in medical research have led to the development of therapies for some rare diseases, the costs associated with these treatments are often exorbitant. From an Indian perspective, these costs can range from Rs. 1 million to Rs. 20 million per year, making them unaffordable for many.
Initiatives and Progress in India
- Increasing Awareness: Greater awareness of rare diseases and advancements in genomic technologies for diagnosis have begun to address these challenges. As awareness spreads, more cases are being identified and correctly diagnosed.
- Regulatory Incentives: Several countries, including India, have introduced regulatory incentives to encourage pharmaceutical companies to invest in research and development for neglected diseases. This has led to increased interest in orphan drugs.
- Patient-Driven Initiatives: Patient groups and organizations in India are actively contributing to rare disease research and treatment. One notable example is the Dystrophy Annihilation Research Trust (DART), which is conducting clinical trials for Duchenne’s muscular dystrophy.
- Government Initiatives: The government’s National Policy for Treatment of Rare Diseases is gradually making an impact. It aims to address rare diseases prevalent in India, such as cystic fibrosis, hemophilia, lysosomal storage disorders, and sickle-cell anaemia.
Lessons from Leprosy
- Incidence Reduction: Leprosy, once prevalent in India, is now considered a rare disease due to successful efforts in reducing its incidence.
- Research Benefits: Research on orphan diseases like leprosy can yield broader societal benefits. For instance, studies on synthetic antibiotics have shown a potential to curb the spread of leprosy to household relatives.
- Government Goals: Research findings may contribute to achieving the government’s objective of making India leprosy-free by 2027.
Conclusion
- Rare diseases present unique healthcare challenges that have long been neglected.
- However, recent progress in diagnosis, research, and patient-driven initiatives is gradually improving the landscape for rare disease patients in India.
- As awareness grows and regulatory support continues, there is hope for enhanced diagnosis, treatment options, and affordability, ultimately improving the lives of those affected by these conditions.
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Mercy Petitions in Bharatiya Nagarik Suraksha Sanhita (BNSS), 2023
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Mercy Petitions
Mains level: Not Much
Central Idea
- The Bharatiya Nagarik Suraksha Sanhita (BNSS) 2023 seeks to replace the Criminal Procedure Code (CrPC) and introduces significant changes to the mercy petition process for death sentence cases.
- These changes impact core aspects like justiciability, time limits, and the execution process.
Background on Mercy Petitions
- The Constitution granted the President (Article 72) and Governor (Article 161) the power to grant pardons or commute sentences.
- In the Supreme Court’s ruling in Maru Ram vs. Union of India (1981), it was established that the President must act based on the Council of Ministers’ advice in mercy petitions.
New Mercy Petition Provision in BNSS
- Under BNSS Section 473(1), convicts can file mercy petitions within 30 days after specific events.
- Convicts can petition the President or Governor based on dismissal of appeals or confirmation of sentences.
- For cases with multiple convicts, they all must file petitions within 60 days.
Centre’s Role in Mercy Petitions
- The Centre seeks the state government’s comments, reviews the case, and makes recommendations to the President within 60 days.
- No time limit is specified for the President’s decision.
Exclusion of Appeals against President’s Decision
- BNSS Section 473(7) states that the President’s decisions on mercy petitions are final.
- Courts cannot question or review the grounds for President’s pardons or commutations.
- Unlike the Shatrughan Chauhan vs. Union of India (2014) ruling that mandated a 14-day gap between the rejection of mercy petitions and execution, BNSS doesn’t mention such a provision.
Delay in Mercy Petition Disposal
- The Shatrughan Chauhan case highlighted the need to avoid undue delay in mercy petition disposal.
- BNSS lacks a time limit for the President to decide mercy pleas.
Conclusion
- The proposed BNSS’s alterations to mercy petitions raise concerns about transparency, judicial review, and the protection of prisoners’ rights.
- Balancing constitutional powers with timely justice remains a challenge in these proposed changes.
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Patient Safety and Neonatal Care: India’s Efforts and Challenges
Note4Students
From UPSC perspective, the following things are important :
Prelims level: NA
Mains level: Patient Safety Provisions
Central Idea
- The recent conviction of a former British nurse highlights the importance of patient safety in healthcare systems.
- While neonatal safety is not governed by exclusive rules, there are provisions to ensure the wellbeing of newborns and minimize potential risks.
Patient Safety Provisions in India
- Defining Patient Safety: Patient safety is defined as freedom from harm or potential harm associated with healthcare provision, according to the ‘National Patient Safety Implementation Framework (2018-2025).’
- Legal Protection: Patients in India are protected under various laws, including the Consumer Protection Act, Clinical Establishment Act, and mechanisms by the National Pharmaceutical Pricing Authority and Drugs Controller General of India to safeguard patients’ rights.
- Fragmented Laws: Patient safety is governed by a range of laws, from the Hippocratic Oath to clinical establishment regulations, reflecting a multifaceted approach to ensure safe healthcare practices.
Neonatal Safety and Care
- Proactive Measures: While no exclusive rules exist for neonatal care, provisions against issues like mix-ups and abductions are present. Deliberate harm is extremely rare and often linked to complex psychiatric illnesses.
- Comprehensive Provisions: Neonatal safety is ensured through comprehensive provisions that include staffing, equipment, infection control, parental involvement, training, and continuing medical education.
- Human Errors: In a country with a high birth rate, human errors may occur in neonatal care, but planned, deliberate harm remains an exceptional occurrence.
Neonatal Health Challenges
- Global Neonatal Deaths: Despite a decline in global neonatal deaths, newborns face the highest risk of death within the first 28 days of life. A significant proportion of under-five deaths occur during the newborn period.
- India’s Scenario: India’s infant mortality rate is gradually declining, but pre-term birth, complications during birth, infections, and birth defects remain major causes of neonatal deaths.
- Improving Neonatal Survival: Ensuring proper neonatal care and addressing the key challenges can contribute to reducing neonatal mortality rates and improving child health outcomes.
Promoting Neonatal Safety
- Midwife-Led Continuity of Care: Professional midwives providing midwife-led continuity of care (MLCC) significantly reduce the risk of neonatal and pre-term birth. This approach emphasizes the importance of skilled care during childbirth and the immediate postnatal period.
- Seeking Prompt Medical Care: Families are advised to seek prompt medical care in case of danger signs in newborns and to follow vaccination schedules for timely protection. This proactive approach helps prevent and manage potential health risks in neonates.
- Ensuring Proper Training: Proper training of healthcare providers, especially those in neonatal services, is crucial for maintaining high-quality care and adherence to safety standards.
Conclusion
- Patient safety and neonatal care form the foundation of a robust healthcare system.
- The challenges of neonatal care require ongoing attention, collaboration, and innovation to ensure the best outcomes for the youngest members of society.
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Somatic Genetic Variants: A genomic revolution hiding inside our cells
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Somatic genetic variants
Mains level: Not Much
Central Idea
- The human genome, comprising 23 pairs of chromosomes, is the blueprint of our genetic makeup inherited from our parents.
- The replication of this genetic information in nearly a trillion cells during development results in a complex mosaic of cellular diversity.
- Despite remarkable DNA replication accuracy, mutations still occur.
What are Somatic Genes?
- Somatic genetic variants, also known as somatic mutations or somatic alterations, are genetic changes that occur in the cells of an organism’s body (somatic cells) during its lifetime.
- These mutations are distinct from germline mutations, which are inherited from parents and are present in every cell of an individual’s body.
- Somatic mutations are acquired after conception and are not passed on to future generations.
- Somatic mutations can occur due to various factors, such as exposure to environmental mutagens (like radiation or chemicals), errors in DNA replication, and other cellular processes.
- These mutations can affect the DNA sequence of specific genes, leading to changes in protein production or function.
DNA Replication: The Copy-Paste Mechanism
- Genetic Inheritance: Ovum and sperm carry parental genetic blueprints, which combine after fertilization.
- Cell Division: The single fertilized cell, with 23 chromosomes, multiplies to form the human body’s trillions of cells.
- DNA Replication Accuracy: Proteins proofread and correct DNA during replication, resulting in an error rate of 0.64-0.78 mutations per billion base pairs per division.
Impact of Somatic Genetic Mutations
- Dependent on Timing: Errors occurring after birth but during development are somatic genetic mutations.
- Driver Mutations: Mutations that confer a fitness advantage to cells can lead to tumor formation and are called driver mutations.
- Cellular Mosaic: Human body is a mosaic of cells with subtle genomic differences, influenced by somatic genetic variants.
- Genetic Variants: Genetic variants within functional genome regions can affect protein encoding and regulation.
Somatic Variants and Physiological Processes
- Immune Cell Diversity: Immune cells undergo extensive somatic changes to create diverse antibodies recognise pathogens.
- Recent Knowledge Explosion: Technological advancements in sequencing individual cells have led to an explosion of data and knowledge on somatic variants.
- Cancer’s Role: Somatic genetic variants play a significant role in cancer development, aiding in early detection, diagnosis, and prognosis.
Cancer Mutational Signatures
- Mutational Signatures: Specific genetic variations and patterns are characteristic of certain cancers, enabling early detection.
- Blood-Based Detection: Technologies identify tumour DNA in blood to detect cancer early.
- Disease Progress Tracking: Cancer variations can be used to monitor disease progression and therapy response.
Somatic Variants in Genetic Diseases
- Genetic Diseases Origin: Many genetic disorders arise from somatic genetic variants, not inherited from parents.
- Disease Severity and Timing: The severity and distribution of genetic diseases depend on the timing of somatic mutations during development.
- Immune Disorders: Somatic changes can cause immune disorders and even beneficially reverse some genetic diseases.
SMaHT Network: Understanding Somatic Mosaicism
- Somatic Mosaicism: US has launched the ‘Somatic Mosaicism across Human Tissues’ (SMaHT) Network.
- Aims: SMaHT aims to discover somatic variants, develop tools for study, and improve analysis for biological and clinical insights.
- Investment and Research: The U.S. government has invested $140 million to study somatic variants in post-mortem samples.
Implications and Future Prospects
- Cellular Complexity: Studying somatic variants reveals the intricate diversity of cells and reshapes evolutionary understanding.
- Disease Management: Understanding somatic genetic changes can advance disease understanding and management.
- Innovative Approaches: Analyzing genes at the single-cell level paves the way for innovative disease approaches and insights into evolution.
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One Health Approach
Note4Students
From UPSC perspective, the following things are important :
Prelims level: One Health
Mains level: Read the attached story
Central Idea
- The global spotlight on the ‘One Health’ concept is illuminating India’s strides in integrating this paradigm to enhance its response to health challenges.
- While gaining recent recognition, the One Health approach finds its roots in history.
One Health Approach
- Holistic Vision: The One Health approach acknowledges the intricate linkages between the health of humans, animals, plants, and their shared environment.
- Historical Foundation: Early traces of One Health can be found in the teachings of Hippocrates and later articulated by 19th-century physician Rudolf Virchow, emphasizing unity in animal and human medicines.
Addressing Modern Health Challenges
- Environmental Impacts: Human growth, urbanization, and industrialization contribute to biodiversity and ecosystem disruption, fostering zoonotic diseases.
- Zoonotic Diseases: Roughly 60% of emerging diseases that affect humans are zoonotic, including Ebola, bird flu, and rabies.
- Key Concerns: The rise of antimicrobial resistance, vector-borne diseases, and food safety underscores the need for an integrated approach.
Power of One Health Strategy
- Resource Efficiency: One Health fosters coordination across governmental units, reducing resource demands and promoting cross-sectoral collaborations.
- Economic Benefits: One Health proves economically prudent, potentially saving billions when compared to pandemic management through non-One-Health strategies.
Recent One Health Endeavors in India
- COVID-19 Impact: The COVID-19 pandemic underscored the importance of the One Health approach.
- Indian Initiatives: India established a ‘Standing Committee on Zoonoses’ in 2006 and launched the ‘National One Health Mission’ for coordinated efforts.
The Transformation Process: Four Stages
- Stage 1: Communication: Setting up mechanisms for inter-ministerial communication and stakeholder engagement.
- Stage 2: Collaboration: Exchange of knowledge and expertise, defining roles in zoonoses management.
- Stage 3: Coordination: Long-term routine activities led by a dedicated agency for seamless collaboration.
- Stage 4: Integration: Developing synergies between sectors for streamlined resource sharing and coordinated initiatives.
Facilitating Collaborative Science
- Integrated Research: Beyond office-sharing, integrated research environments are crucial, allowing access to laboratories and biological samples.
- Sample Utilization: Efficient use of expensive and ethical biological samples, such as blood and tissue, enhances collaborative research outcomes.
Conclusion
- India’s embrace of the One Health approach reflects its commitment to holistic well-being.
- By recognizing the interconnectedness of humans, animals, plants, and the environment, India is laying the groundwork for comprehensive health strategies.
- With ongoing initiatives and a vision to seamlessly integrate resources and expertise, India aims to transform its health landscape, ensuring resilience against emerging challenges through a united and holistic approach.
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India launches Global Initiative on Digital Health (GIDH)
Note4Students
From UPSC perspective, the following things are important :
Prelims level: GIDH
Mains level: Not Much
Central Idea
- In a significant stride towards global healthcare innovation, the World Health Organization (WHO) and India’s G20 presidency have jointly unveiled the ‘Global Initiative on Digital Health’ (GIDH).
- The announcement was made at the Health Minister’s Meeting during the G20 Summit, hosted by the Indian Government.
What is GIDH?
- WHO and G20 Partnership: The WHO and India’s G20 presidency collaboratively introduced the ‘Global Initiative on Digital Health’ (GIDH).
- Strategy Implementation: GIDH functions as a WHO-managed platform, supporting the implementation of the ‘Global Strategy on Digital Health 2020–2025.’
- Transformation Acceleration: The WHO, as the strategy’s Secretariat, facilitates the global convergence of standards, best practices, and resources for expediting digital health system transformation.
Objectives of the GIDH Initiative
- Measurable Outcomes: GIDH aspires to unite nations and partners, aiming to achieve tangible results through concerted efforts.
- Prioritizing Investment Plans: The initiative seeks to establish focused investment plans for the transformation of digital health, driven by clear priorities.
- Enhancing Resource Transparency: GIDH works towards greater transparency in reporting digital health resources, ensuring effective resource allocation.
- Facilitating Global Collaboration: The initiative fosters the exchange of knowledge and collaboration among regions and countries to expedite progress.
- Comprehensive Governance: GIDH supports holistic government approaches to digital health governance within countries.
- Boosting Support: The initiative aims to enhance both technical and financial support for the implementation of the ‘Global Strategy on Digital Health 2020–2025’ and its forthcoming phase.
India’s Role and Vision
- Digital Health Innovation: India’s G-20 Health Minister emphasized India’s role in digital health innovation at the G-20 Health Ministers’ Meeting.
- National Digital Health Architecture: India’s efforts for a comprehensive digital health ecosystem, exemplified by the Ayushman Bharat Digital Mission (ABDM), were highlighted.
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Homeopathy and associated issues
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Integrated system of medicine, Homeopathy system of medicine etc
Mains level: India's path towards universal health care, challenges and measures
What’s the news?
- In a recent development, the ICMR and the Ministry of Ayush have agreed to enhance cooperation in health research related to integrated medicine.
Central idea
- The recent push to integrate AYUSH medicinal systems into mainstream health care to achieve universal health coverage and decolonize medicine is a commendable pluralistic approach. However, this endeavor must prioritize safety and efficacy standards for every participating system. Unfortunately, Homeopathy falls short of meeting these essential criteria.
What is an integrated system of medicine?
- An integrated system of medicine refers to an approach that combines elements from different healthcare systems or modalities, such as conventional medicine and traditional, complementary, or alternative medicine, with the goal of providing comprehensive and patient-centered care.
What Is Homeopathy?
- Homeopathy is a system of alternative medicine founded in the late 18th century by Samuel Heinemann, a German physician.
- Homeopathy is a medical system based on the belief that the body can cure itself. Those who practice it use tiny amounts of natural substances like plants and minerals. They believe these stimulate the healing process.
- This is based on the idea that a substance that causes symptoms in a healthy individual can stimulate the body’s natural healing response to overcome similar symptoms in an ill person.
Key principles of Homeopathy
- The Law of Similar: Homeopathy follows the principle that a substance that produces symptoms in a healthy person can be used to treat similar symptoms in a sick person.
- Minimum Dose: Homeopathic remedies are prepared through a process of dilution and potentization, which involves repeatedly diluting the original substance and shaking it vigorously. The belief is that this process enhances the remedy’s healing properties while minimizing any potential toxicity.
- Individualization: Homeopathy treats each person as a unique individual and tailors the treatment to address their specific symptoms and overall constitution.
- Totality of Symptoms: Rather than focusing solely on a specific disease or isolated symptoms, homeopathy takes into account the totality of a person’s physical, mental, and emotional symptoms to find an appropriate remedy.
Concerns over the efficacy and safety of Homeopathy
- Weak Evidence: The evidence supporting the efficacy of homeopathy is considered weak. The Nuremberg Salt Test (1835), a well-conducted double-blind randomized controlled trial, discredited homeopathy, attributing its claimed effects to imagination, self-deception, or potential fraud.
- Inconsistent Systematic Reviews: Multiple systematic reviews and meta-analyses have consistently shown that homeopathic treatments lack clinically significant effects across various ailments, population groups, study types, and treatment regimes.
- Unregistered Trials: Researchers found that more than half of the 193 homeopathic trials conducted in the last two decades were not registered. Surprisingly, unregistered trials showed some evidence of efficacy, while registered trials did not, casting doubt on the validity and reliability of the evidence.
- Lack of confidence: The World Health Organization (WHO) has issued warnings against using homeopathy for serious conditions such as HIV, tuberculosis, malaria, and infant flu and diarrhea. This indicates a lack of confidence in its effectiveness in treating such illnesses.
- Ineffectiveness for Serious Conditions: Evidence suggests that homeopathy may not work effectively in treating cancers and may not help reduce the adverse effects of cancer treatments.
- Potential Delay in Effective Treatment: One of the safety concerns related to homeopathy is its potential to delay the application of evidence-based clinical care for serious or life-threatening conditions. This delay can have detrimental effects on patients’ health outcomes.
Arguments in favor of Homeopathy
- Historical Usage: Supporters of homeopathy often highlight its long historical usage and widespread popularity, arguing that its effectiveness is demonstrated by its continued use over the centuries.
- Individualization of Treatment: Homeopathy emphasizes individualized treatment, tailoring remedies to address a person’s unique symptoms and overall constitution. This personalized approach is believed to be beneficial for patients who may not respond well to standardized treatments.
- Minimal Side Effects: Homeopathic remedies are highly diluted, which proponents claim minimizes side effects and makes them safe for use, even in sensitive patient populations.
- Holistic Approach: Advocates assert that homeopathy takes a holistic view of health, considering not only physical symptoms but also mental and emotional aspects of a person’s well-being.
- Anecdotal Testimonials: Supporters of homeopathy often provide anecdotal testimonials from patients who claim to have experienced positive outcomes from using homeopathic remedies. Supporters of homeopathy often cite testimonials from famous figures like Gandhi and Tagore to bolster its credibility.
Way forward: Key areas that India needs to focus on regarding Homeopathy
- Evidence-Based Medicine: India needs to prioritize evidence-based medicine across all healthcare systems, including homeopathy. Rigorous research, clinical trials, and systematic reviews should be conducted to evaluate the efficacy and safety of homoeopathic treatments.
- Integration and Pluralism: India should adopt a balanced approach to healthcare by integrating various medicinal systems, including allopatry and AYUSH, while ensuring that only evidence-based and effective practices are incorporated into mainstream healthcare.
- Regulatory Oversight: Strengthen regulatory bodies to oversee the practice of homeopathy and ensure adherence to quality standards and ethical guidelines. This will help maintain patient safety and foster trust in the healthcare system.
- Education and Awareness: Promote education and awareness among healthcare professionals and the public about the strengths and limitations of homeopathy. Informed decision-making and patient choice should be encouraged based on scientific evidence.
- Holistic Health Approach: Emphasize a holistic approach to healthcare that considers not only physical symptoms but also mental, emotional, and social aspects of health. This approach should be integrated into all medical systems, including homeopathy.
- Continuous Improvement: Continuously review and update the integration of homeopathy and other medical systems based on emerging evidence and changing healthcare needs. This iterative approach will lead to a more responsive and effective healthcare system.
Conclusion
- For India’s path towards universal health care, an evidence-based and ethics-driven medicine approach should be embraced, ensuring that only safe and effective treatments are integrated into mainstream healthcare practices.
Also read:
World Ayurveda Congress: Aligning traditional medicine with modern medicines
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Ayushman Bharat expose: How to nudge India’s public health infrastructure
Note4Students
From UPSC perspective, the following things are important :
Prelims level: PMJAY and schemes
Mains level: Government sponsored schemes, challenges, concerns and solutions
What’s the news?
- A recent report has revealed disturbing incidents of deception against poor patients at Safdarjung Hospital (‘Bypassing Ayushman Bharat, doctor at a top government hospital duped patients and made killings on implants).
Central Idea
- Designing a government-sponsored health insurance scheme for the poor presents significant challenges, including the issue of information asymmetry between doctors and patients, which may lead to the denial of benefits for the disadvantaged.
What is Ayushman Bharat?
- Pradhan Mantri Jan Aarogya Yojana (PMJAY), also known as Ayushman Bharat or the National Health Protection Scheme (NHPS), is a flagship government-sponsored health insurance scheme launched by the Government of India in September 2018. The primary aim of PMJAY is to provide financial protection and access to quality healthcare to economically vulnerable sections of society.
Key features
- Health Insurance Coverage: PMJAY provides health insurance coverage to eligible beneficiaries, especially those belonging to economically weaker sections (EWS) and low-income families. It aims to cover around 10 crore (100 million) families across India.
- Cashless and Paperless Treatment: Under PMJAY, eligible beneficiaries can avail of cashless and paperless treatment in empaneled public and private hospitals across the country. The scheme ensures that beneficiaries are not required to pay for the treatment at the time of hospitalization.
- Pre-Defined Medical Packages: The scheme offers a comprehensive set of pre-defined medical packages covering various medical and surgical treatments. These packages are designed to provide essential healthcare services, including diagnostics, medicines, and other treatments.
- Coverage for Pre-Existing Conditions: PMJAY provides coverage for pre-existing illnesses and health conditions from the date of enrollment. This ensures that beneficiaries with existing health conditions can also access healthcare services under the scheme.
- No Cap on Family Size: There is no restriction on the family size covered under PMJAY. All eligible family members can avail of the benefits of the scheme.
- Portability: PMJAY is portable across the country, meaning beneficiaries can avail of treatment in any empaneled hospital in any state or Union Territory, irrespective of their place of origin
- Identification of Beneficiaries: Beneficiaries under PMJAY are identified through the Socio-Economic Caste Census (SECC) data and are issued the Ayushman Bharat – PMJAY Golden Card, which serves as proof of eligibility.
- Online Verification: The scheme employs an online verification process to ensure seamless and efficient identification and validation of beneficiaries.
- Collaborative Effort: PMJAY is a joint collaboration between the central and state governments, and each state has the flexibility to implement the scheme based on its specific requirements.
The Incident of deceptive practices at Safdarjung Hospital
- Misleading Patients: The report reveals that certain doctors deceive patients by providing false information about delays in Ayushman Bharat Clearance. This deceptive tactic aims to divert patients towards private alternatives rather than enrolling them in the PMJAY scheme.
- Influence of Treating Doctors: The incident highlights the significant role of treating doctors in determining the medical package for patients and whether they are enrolled under the PMJAY scheme.
Concerns raised over the implementation of government-sponsored health insurance schemes
- Deceptive Practices: Misinformation about Ayushman Bharat Clearance delays is used as a tactic to divert patients towards private alternatives instead of enrolling them in the PMJAY. Such practices can deprive eligible patients of government-sponsored health insurance benefits and lead to potential financial exploitation.
- Doctor’s Influence: The treating doctors wield significant influence in determining the medical package for patients and their enrollment in the PMJAY scheme. This discretionary power can create an environment where some doctors prioritize their personal interests, such as financial gains from private channels, over the best interests of their patients.
- Lack of Active Interest: Although the time taken to settle claims was reasonable, the proportion of settled claims in public facilities was lower compared to private facilities. This points to potential issues in operational dynamics that may hinder the effective implementation of the scheme and limit its benefits for the poor.
- Inadequate Incentives: The financial incentives provided to doctors in public facilities under PMJAY may not be sufficiently attractive to encourage them to actively participate in the scheme. Some doctors may find greater financial gains through rent-seeking practices with private players, leading to a preference for private alternatives over the government-sponsored scheme.
- Limited Supporting Staff: The presence of limited supporting staff, such as Arogyamitras, responsible for registering patients under PMJAY, may impact the smooth implementation of the scheme. The Arogyamitras’ remuneration being linked to pre-authorizations rather than claim settlement may result in less emphasis on claim follow-up and documentation.
Way forward: Steps to improve operational dynamics
- Enhancing Doctor Incentives: Reviewing and revising the financial incentives provided to treating doctors could make the PMJAY scheme more attractive and encourage greater participation.
- Strengthening Arogyamitras’ Role: Linking the remuneration of Arogyamitras to the successful claim settlement and providing necessary support staff can incentivize them to be more proactive in claim documentation and follow-up.
- Streamlining the Claim Settlement Process: Simplifying and expediting the claim settlement process can encourage public facilities to actively participate in PMJAY, ensuring timely reimbursements and improving their financial viability.
- Increased Oversight: Implementing regular audits and stringent penalties for fraudulent practices can help curb deceptive activities and enhance transparency and accountability within public facilities.
Conclusion
- While the potential of PMJAY has been extensively discussed in the context of private hospitals, the operational dynamics within public facilities have received less attention. A collaborative effort involving doctors, Arogyamitras, and state governments can unleash the true potential of these schemes, contributing to improved health outcomes and greater inclusivity in healthcare services.
ALso read:
Digital Birth Certificates to streamline Official Documentation
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Controlled Human Infection Studies (CHIS) in India
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Controlled Human Infection Studies (CHIS)
Mains level: Read the attached story
Central Idea
- India has taken its first step towards introducing Controlled Human Infection Studies (CHIS), a research model widely used in other countries for vaccine and treatment development.
- The Indian Council of Medical Research’s (ICMR) Bioethics Unit has prepared a consensus policy statement open for public comment, addressing the need, benefits, and ethical challenges associated with CHIS.
What is Controlled Human Infection Studies (CHIS)?
- CHIS also known as human challenge trials, are scientific studies conducted to deliberately expose healthy human volunteers to infectious agents under controlled conditions.
- The primary objective of these studies is to gain a better understanding of the pathogens’ behavior, human immune response, and to test potential vaccines, treatments, or preventive measures against the infection.
Key points about Controlled Human Infection Studies (CHIS) include:
- Informed Consent: Volunteers participating in CHIS must provide informed consent, fully understanding the potential risks and benefits associated with their participation.
- Types of Pathogens: CHIS can be used to study various infectious agents, such as viruses (e.g., influenza, dengue, Zika), bacteria (e.g., cholera, typhoid), and parasites (e.g., malaria).
- Vaccine Development: CHIS plays a crucial role in vaccine development by providing controlled environments to assess the efficacy of candidate vaccines and their ability to induce protective immune responses.
- Controversy: The use of CHIS has sparked ethical debates about balancing potential risks to participants against potential benefits to public health.
Ethical Concerns Surrounding CHIS in India
- Delicate Ethical Balance: CHIS is considered ethically sensitive due to concerns about deliberate harm to participants, fair compensation, third-party risks, and withdrawal from the study, and involving vulnerable participants.
- Streamlined Ethics Review: ICMR acknowledges the need for a specialized ethics review process with additional oversight and safeguards to protect study participants.
- Deterrents and Unique Context: Technical, clinical, ethical, and legal challenges deterred India from adopting CHIS earlier, partly influenced by the nation’s unique socio-cultural context.
Potential Benefits of CHIS in India
- High Disease Burden: India faces a significant burden of morbidity and mortality from infectious diseases, contributing about 30% of the disease burden in the country.
- Novel Insights and Efficiency: CHIS offers unique insights into disease pathogenesis and enables accelerated and cost-effective outcomes with smaller sample sizes compared to large clinical trials.
- Social Value: CHIS can contribute to public health response, healthcare decision-making, policies, economic benefits, improved pandemic preparedness, and community empowerment.
Encouraging Collaboration and Expertise
- Complex Nature of CHIS: ICMR highlights the complexity of CHIS and suggests that collaborations between researchers, institutions, organizations, and countries may be necessary to ensure the right expertise is available.
- Crucial Role in Advancing Scientific Understanding: The ICMR Bioethics Unit’s consensus policy statement aims to address ethical concerns associated with CHIS, acknowledging its potential role in advancing the scientific understanding of infectious diseases and accelerating treatment strategies.
Public Consultation and Future Directions
- Open for Public Consultation: The ICMR’s consensus policy statement on CHIS is open for public consultation until August 16 to gather input from stakeholders and experts.
- Striving for Ethical Research: ICMR emphasizes its commitment to conduct CHIS in India while ensuring ethical principles are upheld and human participants are protected.
Conclusion
- The introduction of CHIS in India is a significant step towards advancing medical research and finding cost-effective solutions for infectious diseases.
- Public consultation and expert collaborations will help shape the future direction of CHIS research in India and contribute to scientific progress and improved healthcare outcomes.
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Is there a Rural Bias in National Surveys?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: National Statistical Organisation (NSO)
Mains level: Read the attached story
Central Idea
- The Centre has appointed a panel to review the methodology of the National Statistical Organisation (NSO).
- This step comes amid discussions regarding the accuracy of national surveys such as the National Sample Survey (NSS), National Family Health Survey (NFHS), and Periodic Labour Force Survey (PLFS).
About National Statistical Office (NSO)
Historical Background:
- The NSO was established in 1950 as the Central Statistical Office (CSO) under the Ministry of Planning.
- It was later renamed the National Sample Survey Office (NSSO) in 1970 and subsequently became the NSO in 2019.
- Over the years, it has evolved to become the primary statistical agency in India.
Organizational Structure:
- The NSO consists of several divisions and units responsible for different statistical functions.
- These include the Survey Design and Research Division, Field Operations Division, Data Processing Division, National Accounts Division, Price Statistics Division, and Social Statistics Division, among others.
Key organizations under NSO: Central Statistical Office (CSO)
- The CSO is a part of the NSO and focuses on macroeconomic statistics and national income accounting.
- It is responsible for producing key economic indicators such as the Gross Domestic Product (GDP), Index of Industrial Production (IIP), Consumer Price Index (CPI), and Wholesale Price Index (WPI).
Important Surveys Conducted:
- Population Census: The NSO conducts a decennial Population Census in collaboration with the Registrar General and Census Commissioner of India. The census collects data on population size, composition, and other demographic characteristics.
- National Sample Survey (NSS): The NSS is a large-scale household survey conducted by the NSO to collect data on various socio-economic aspects. It provides valuable information on employment, consumer expenditure, poverty, education, health, and other important indicators.
- Economic Census: The NSO conducts the Economic Census periodically to collect data on the number of business establishments, their distribution across sectors and regions, employment, and other relevant economic variables.
- Annual Survey of Industries (ASI): The ASI is conducted by the NSO to collect data on the performance and structure of the industrial sector in India. It covers various aspects such as employment, wages, production, and financial indicators.
- Agricultural Census: The NSO conducts the Agricultural Census periodically to collect comprehensive data on agricultural holdings, cropping patterns, land use, irrigation, livestock, and other relevant agricultural variables.
- Health and Morbidity Survey: The NSO conducts surveys on health and morbidity to gather data on healthcare utilization, access to healthcare services, prevalence of diseases, and other health-related indicators.
Why under review?
- Concerns about Methodology: Experts argue that the usage of outdated survey methodology in national surveys may have systematically underestimated India’s development.
- Narrower capture of data: The dynamic nature of the Indian economy over the last 30 years might not be adequately captured.
- Different Perspectives: While some experts believe there is no systematic underestimation of development by these surveys, they acknowledge the presence of errors that should be minimized.
- Role of National Data: Accurate national-level data is crucial for research, policymaking, and development planning.
Focus on NFHS Data
- Crucial development data: The National Family Health Survey provides vital data on health and family welfare indicators.
- Claims of Bias: Some experts suggest that national surveys, including NFHS, may exhibit a “rural bias” in representation, leading to an underestimation of India’s development.
- Issue of Error and Random Bias: While errors in population estimations have occurred in some rounds, they appear to be random rather than systematic.
Minimizing Errors in Data Collection
- Improving Response Rates: Efforts to increase response rates in both rural and urban areas can lead to more accurate data.
- Importance of Sample Weights: Proper assignment of sample weights can significantly improve the accuracy of estimations and correct any underrepresentation of rural or urban populations.
Recommendations for the Review Panel:
- Addressing Concerns: The review panel should focus on ensuring that the samples are adequately representative rather than proposing a complete overhaul of survey methodologies.
- Correcting Bias Where It Exists: While addressing any perceived biases, the panel should aim to eliminate bias where it genuinely exists without introducing new biases in policymaking and planning.
Conclusion
- Accurate data serves as the bedrock of progress and development in the country.
- Reviewing the methodology of national surveys is vital to ensure accurate and representative data for India’s development.
- Striking the right balance between addressing concerns and minimizing errors will lead to more informed decision-making and policy formulation.
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Tele-MANAS counsels 2 Lakh distressed people
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Tele-MANAS
Mains level: Mental health and telemedicine
Central Idea: The government-run national tele-mental health programme, Tele MANAS, has achieved a significant milestone by receiving over 2,00,000 calls from individuals across India since its launch in October 2022.
What is Tele-MANAS?
- Tele Mental Health Assistance and Networking across States (Tele-MANAS) initiative has been launched by the Ministry of Health & Family Welfare in October 2022.
- It aims to provide free tele-mental health services all over the country round the clock, particularly catering to people in remote or under-served areas.
Implementation of the scheme
- Counselling: The programme includes a network of 38 tele-mental health centres of excellence spread across 27 States and UTs working in over 20 languages.
- Helpline: A toll-free, 24/7 helpline number (14416) has been set up across the country allowing callers to select the language of choice for availing services. Service is also accessible at 1-800-91-4416.
Two-tier working
- Tele-MANAS will be organised in a two-tier system; Tier 1 comprises state Tele-MANAS cells which include trained counsellors and mental health specialists.
- Tier 2 will comprise specialists at District Mental Health Programme (DMHP)/Medical College resources for physical consultation and/or e-Sanjeevani for audio-visual consultation.
Call Demographics and Concerns
- Age Group: Two-thirds of the callers fall in the 18-45 years age group, while 12.5% belong to the 46-64 years age group, and 8% are below 18 years of age.
- Gender Distribution: Of the two lakh calls, 59.6% were made by male callers, and 40% by female callers.
- Top Concerns: The most common reasons for seeking help were general feelings of sadness (28.8%), sleep-related problems (27.6%), anxiety (20.4%), relationship issues (10%), aggression (9.2%), and low interest in activities (9.7%).
Expansion of the scheme
- The initial rollout providing basic support and counselling through a centralized Interactive Voice Response system (IVRS) is being customized for use across all States and UTs.
- It is being linked with other services like National teleconsultation, e-Sanjeevani, Ayushman Bharat, mental health professionals, health centres, and emergency psychiatric facilities for specialized care.
- This will not only help in providing immediate mental healthcare services but also facilitate a continuum of care.
- Eventually, this will include the entire spectrum of mental wellness and illness, and integrate all systems that provide mental health care.
Back2Basics: National Tele Mental Health Programme (NTMHP)
- The Indian Government announced the National Tele Mental Health Programme (NTMHP) in the Union Budget 2022-23.
- The National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru is the nodal centre for the programme.
- The programme sought to establish a digital mental health network that can address the mental health crisis in the wake of the COVID-19 pandemic.
- The pandemic has brought forth challenges to mental health, and the NTMHP aims to provide accessible and affordable mental health services to all.
- The programme will involve the use of digital platforms such as teleconsultations, chatbots, and mobile applications to deliver mental health services.
- The NTMHP will integrate with existing mental health services to provide a comprehensive and coordinated approach to mental healthcare.
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Crimean-Congo Haemorrhagic Fever (CCHF)
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Crimean-Congo Haemorrhagic Fever (CCHF)
Mains level: NA
Central Idea
- Europe is currently experiencing a heatwave and wildfires, leading to concerns about the spread of viruses that are typically not found in colder climates.
- The WHO has issued an alert regarding the Crimean-Congo haemorrhagic fever (CCHF), a potentially fatal infection transmitted by ticks.
What is CCHF?
- CCHF is a viral haemorrhagic fever primarily transmitted by ticks.
- It can also be contracted through contact with viraemic animal tissues during animal slaughter.
- CCHF outbreaks can lead to epidemics with a high case-fatality ratio (10-40%) and pose challenges for prevention and treatment.
Transmission and Hosts
- The virus exists in the tick family of insects.
- Animals such as cattle, goats, sheep, and hares serve as amplifying hosts for the virus.
- Humans can contract CCHF through contact with infected ticks or animal blood.
- The virus can also be transmitted between humans through contact with infectious blood or body fluids.
- Migratory birds can host ticks, allowing the virus to spread over long distances.
Symptoms and Treatment
- Common symptoms of CCHF include fever, muscle aches, dizziness, neck and back pain, headache, sore eyes, and sensitivity to light.
- Early symptoms may also include nausea, vomiting, diarrhea, abdominal pain, and sore throat, followed by mood swings and confusion.
- Later stages may involve sleepiness, depression, and lassitude.
- There is no vaccine available for CCHF in humans or animals, and treatment focuses on managing symptoms.
- The antiviral drug ribavirin has been used to treat CCHF infection with some apparent benefit.
Spread of CCHF in Europe
- CCHF is endemic to Africa, the Balkan countries, the Middle East, and parts of Asia.
- In 2016, Spain reported the first fatality from CCHF in Europe.
- Scientists warn that CCHF, which can have a fatality rate between 10% and 40%, is spreading northward and westward in Europe.
- Cases of CCHF have been reported in Spain, Russia, Turkey, and the UK.
Reasons for this spread
- Disrupted temperature patterns due to climate change are creating favorable conditions for pathogens.
- CCHF ticks are moving northward through Europe due to longer and drier summers caused by climate change.
- Climate change contributes to the spread of diseases by expanding tick habitats, altering water habitats, and facilitating the movement of animals and human interactions.
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India’s diabetes epidemic is making its widespread TB problem worse
Note4Students
From UPSC perspective, the following things are important :
Prelims level: DM and Tb related facts
Mains level: The dual burden of India, TB and Diabetes, Interconnection, challenges and treatment measures
What is the news?
- India has long grappled with two major epidemics: type 2 diabetes (diabetes mellitus, DM) and tuberculosis (TB). With a staggering 74.2 million people living with diabetes and 2.6 million new TB cases each year, it is crucial to understand the deep interconnection between these diseases.
Central Idea
- The diabetes mellitus (DM) and tuberculosis (TB) are closely interconnected in India, with DM increasing the risk and severity of TB, and TB co-infection worsening diabetes outcomes. Among people with TB, the prevalence of DM was found to be 25.3% while 24.5% were pre-diabetic. Which highlights the need for urgent action to address this dual burden and improve care coordination for individuals affected by both diseases.
What is type 2 diabetes?
- Type 2 diabetes, also known as diabetes mellitus (DM), is a chronic metabolic disorder characterized by high blood sugar levels.
- It is the most common form of diabetes and typically develops over time, often in adulthood.
- In type 2 diabetes, the body either becomes resistant to the effects of insulin (a hormone that helps regulate blood sugar levels) or does not produce enough insulin to maintain normal glucose levels.
What is tuberculosis (TB)?
- TB is an infectious disease caused by the bacterium Mycobacterium tuberculosis.
- It primarily affects the lungs but can also affect other parts of the body, such as the kidneys, spine, and brain.
- TB is transmitted through the air when an infected individual coughs, sneezes, or speaks, releasing tiny droplets containing the bacteria. When inhaled by others, these droplets can lead to infection
The interconnection and Impact of DM on TB
- Increased Risk of TB: People with DM have a higher risk of developing TB compared to those without DM. DM weakens the immune system and impairs the body’s ability to fight off infections, including TB.
- Increased TB Severity: When individuals with DM acquire TB infection, they tend to have a higher bacterial load, which means there are more TB bacteria in their bodies. This can result in more severe symptoms and complications associated with TB.
- Delayed Sputum Conversion:
- Sputum conversion refers to the transition from having TB bacteria detectable in the sputum (positive) to no longer having detectable bacteria (negative) after initiating treatment.
- Individuals with both TB and DM often experience delayed sputum conversion compared to those with TB alone.
- It means that it takes longer for the TB bacteria to be eliminated from their bodies, prolonging the infectious period and potentially increasing the risk of transmitting the disease to others.
- Altered Treatment Outcomes:
- TB treatment outcomes can be affected by the presence of DM. Individuals with both TB and DM may experience modified TB symptoms, radiological findings, and lung functioning compared to those with TB alone.
- Studies have shown that individuals with TB and DM have reduced lung functioning even after completing TB treatment.
- Respiratory Complications: Individuals with both TB and DM are more prone to experiencing respiratory complications related to TB. Respiratory complications can be a common cause of death in this population, highlighting the increased severity of TB when DM is present.
What measures India must take to combat the dual burden of DM and TB
- Integrated Care: Implement patient-centered care approaches that address the unique needs of individuals with both TB and DM, along with other comorbidities. This includes coordinated diagnosis and treatment, bidirectional screening, patient education, and support.
- Holistic Treatment Plans: Strengthen high-quality care for TB, DM, and associated comorbidities by developing holistic treatment plans. Prioritize individual programs for TB and DM and ensure their integration into healthcare services.
- Resilient Health Systems: Build and scale up resilient and integrated health systems by garnering increased commitment from stakeholders, formulating robust policy guidance, and mobilizing additional resources. These efforts will support the development of effective strategies to combat both diseases.
- Data-Driven Decision Making: Enhance the research literature on TB and DM interactions to enable better decision-making. Access to comprehensive data and ongoing studies will provide critical insights for improving patient care and raising awareness of the impact of these interconnected diseases
Conclusion
- The coexistence of diabetes mellitus and tuberculosis in India demands immediate attention. By adopting integrated care models, improving treatment outcomes, and strengthening health systems, we can effectively address the dual burden of DM and TB. It is essential for health professionals, policymakers, and communities to prioritize research, enhance collaboration, and work together to improve the lives of those affected by these intertwined epidemics.
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Don’t waste the wastewater
Note4Students
From UPSC perspective, the following things are important :
Prelims level: public health surveillance models
Mains level: wastewater surveillance and its benefits, public health surveillance mechanism, challenges and innovative models
What’s the news?
- A recent study published in The Lancet Global Health has reintroduced wastewater surveillance as a powerful strategy for public health surveillance.
Central idea
- In 1854, during a cholera outbreak in London, physician John Snow traced the epidemic to a contaminated water pump, highlighting the importance of disease prevention. Today, advancements in public health surveillance present new opportunities to detect outbreaks early. Wastewater surveillance, a cost-effective approach, has gained prominence in tracking diseases like poliovirus and SARS-CoV-2.
What is mean by Wastewater Surveillance?
- Wastewater surveillance refers to the monitoring and analysis of wastewater samples to gather information about the presence and spread of disease-causing agents, such as viruses or bacteria, within a community.
- It involves systematically sampling and testing wastewater from various sources, such as sewage systems or wastewater ponds. The samples are then analyzed in designated laboratories to identify specific markers or genetic fragments of pathogens.
Benefits of Wastewater Surveillance
- Early Outbreak Detection: Wastewater surveillance detects disease-causing agents before clinical cases are reported, enabling prompt response and containment measures.
- Community-Level Monitoring: Analyzing wastewater samples offers insights into overall community health, aiding in disease trend identification and targeted interventions.
- Cost-Effectiveness: Wastewater surveillance eliminates the need for individual samples, reducing costs associated with collection, testing, and analysis.
- Complementary to Clinical Data: Wastewater surveillance provides additional information beyond clinical data, capturing asymptomatic cases and enhancing disease prevalence understanding.
- Early Warning System: Specific genetic markers or pathogen fragments found in wastewater samples can serve as an alert for potential disease outbreaks.
- Surveillance in Resource-Limited Areas: Wastewater surveillance helps monitor disease occurrence in areas with limited access to healthcare facilities, enabling prioritized resource allocation.
- Evidence-Based Decision Making: Integrating wastewater surveillance data with other sources informs data-driven decisions for disease control, resource allocation, and targeted interventions.
Challenges in India’s public health surveillance system
- Uneven Coverage: The public health surveillance system in India does not provide uniform coverage across the country. Rural and remote areas often lack adequate surveillance infrastructure and resources, resulting in limited data collection and monitoring capabilities in these regions.
- Fragmented and Siloed Efforts: Disease surveillance efforts in India are often fragmented and focused on specific diseases or health conditions. This siloed approach makes it difficult to detect and respond to emerging health threats comprehensively.
- Inadequate Data Sharing: In India, there are challenges in sharing data between different levels of government and across departments, hindering the seamless flow of information necessary for early detection and response.
- Limited Diagnostic and Laboratory Capacity: India’s public health laboratory infrastructure and diagnostic capacity need significant improvements. Inadequate resources, outdated equipment, and a shortage of trained personnel can hamper timely and accurate testing.
- Underreporting and Data Quality Issues: Underreporting of diseases and inconsistent data quality pose significant challenges in India’s public health surveillance system.
- Limited Use of Advanced Technologies: The adoption of advanced technologies, such as real-time data analytics, machine learning, and artificial intelligence, is limited in India’s public health surveillance system.
How India can enhance its epidemiological capabilities?
- Incorporate Wastewater Surveillance into Reporting: Efforts should be made to incorporate wastewater surveillance data into existing surveillance reporting systems.
- Integration with Ayushman Bharat Digital Mission: The Ayushman Bharat Digital Mission, which aims to create a seamless online platform for healthcare services, offers an opportunity for the integration of wastewater surveillance.
- Strengthen Public Health Laboratory Networks: Efforts should be made to strengthen public health laboratory networks by incorporating the testing of wastewater samples into surveillance reporting. This can be achieved by providing the necessary resources, equipment, and trained personnel to conduct wastewater testing.
- Training of Public Health Professionals: Public health professionals should receive training not only in traditional epidemiological methods but also in the management and interpretation of data derived from wastewater surveillance.
- Data Management and Analysis: Develop robust data management systems to collect, store, and analyze wastewater surveillance data. This may involve creating dedicated databases or integrating wastewater surveillance data into existing surveillance information systems.
Need for Political backing and adequate funding for the successful integration of wastewater surveillance
- India’s Commitment to Public Health Surveillance: India has already demonstrated its commitment to public health surveillance and resource mobilization. It is essential for political leaders to recognize the potential of wastewater surveillance as an effective tool for disease monitoring and response.
- Niti Aayog’s Vision: The integration of wastewater surveillance aligns with Niti Aayog’s vision. Political leaders can provide strategic guidance and policy support to ensure the inclusion of wastewater surveillance in the national public health agenda
- International Platforms and Leadership: India’s leadership at international platforms like the G20 provides an opportunity to elevate the significance of innovative approaches to disease surveillance, including wastewater surveillance. Political leaders can leverage these platforms to advocate for enhanced public health surveillance and secure international commitments and support.
- Resource Allocation: Adequate funding is essential to implement wastewater surveillance effectively. Political leaders should allocate sufficient resources to build and strengthen laboratory networks, develop wastewater sampling infrastructure, and train public health professionals in data analysis and interpretation.
- Public-Private Partnerships: Political leaders can facilitate partnerships between the public and private sectors to enhance funding for wastewater surveillance.
Conclusion
- The inclusion of wastewater surveillance in India’s public health infrastructure holds great promise for enhancing disease prevention and control. Through strategic leadership, India has the potential to set a precedent in integrated public health surveillance, creating a model that prioritizes proactive measures, timely response, and a resilient healthcare system.
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Leptospirosis: A disease that surges in monsoons
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Leptospirosis
Mains level: Not Much
Central Idea
- Leptospirosis has emerged as an important infectious disease in the world today.
- It is a potentially fatal zoonotic bacterial disease that tends to have large outbreaks after heavy rainfall or flooding.
What is Leptospirosis?
- Leptospirosis is a zoonotic bacterial disease that poses a significant global health threat, particularly after heavy rainfall or flooding.
- It affects millions of people annually, with a high mortality rate, and its burden is expected to increase in the future.
- The disease is caused by the bacterium Leptospira interrogans, primarily transmitted from animals to humans.
Disease Transmission and Risk Factors
- Disease transmission: Leptospira is shed in the urine of infected animals, contaminating soil and water.
- Carriers: Both wild and domestic animals, including rodents, cattle, pigs, and dogs, can transmit the disease.
- Human exposure: Direct contact with animal urine or indirectly through contaminated soil and water poses a risk.
- Occupational hazards: Agricultural workers, animal handlers, and those in sanitary services are at an increased risk.
- Recreational activities: Engaging in water-based activities in contaminated lakes and rivers can also raise the risk.
Symptoms and Misdiagnosis
- Range of symptoms: Leptospirosis symptoms vary from mild flu-like illness to life-threatening conditions affecting multiple organs.
- Misdiagnosis challenges: Symptoms mimic other diseases like dengue, malaria, and hepatitis, leading to underreporting and limited awareness.
- Limited access to diagnostics: Lack of reliable diagnostic tools hinders accurate disease detection.
- Lack of environmental surveillance: Insufficient monitoring of the environment contributes to underestimating the disease burden.
Misconceptions and Preventive Measures
- Reservoir hosts: Rats are not the sole cause; various animals act as reservoir hosts.
- Environmental factors: Humidity and extreme weather events like floods increase the risk of exposure.
- Sanitary conditions: Poor waste management, high density of stray animals, and inadequate sanitation facilities contribute to the disease spread.
- Prevention strategies: Adopting a ‘One Health’ approach involving humans, animals, and the environment is crucial.
- Personal protective equipment: People working with animals or in flooded areas should use gloves and boots.
- Animal health and prevention: Ensuring sanitary animal-keeping conditions reduces the risk of leptospirosis transmission.
- Health education and awareness: Promoting proper hygiene practices, educating about the disease, and improving health literacy are essential preventive measures.
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Aspartame: the Carcinogenic additive in Diet Cola
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Aspartame
Mains level: Not Much
Central Idea
- The cancer research arm of the World Health Organization (WHO) is reportedly considering listing aspartame, a popular sugar substitute ‘Aspartame’ as “possibly carcinogenic to humans.”
- This potential listing by the International Agency for Research on Cancer (IARC) has generated controversy as it contradicts previous studies that found no evidence linking aspartame to cancer.
What is Aspartame?
- Aspartame is widely used as an artificial sweetener in various food and beverage products.
- It is made from the dipeptide of two amino acids, L-aspartic acid and L-phenylalanine.
- It is approximately 200 times sweeter than table sugar and is commonly used in diet soft drinks, sugar-free gum, and other sugar-free products.
- It is favored by those seeking to reduce calorie intake or manage diabetes.
Safety Record and Regulatory Approvals
- Aspartame has undergone extensive studies over 40 years, with over 100 studies finding no evidence of harm caused by its consumption.
- The US Food and Drug Administration (FDA) has permitted its use in food since 1981, and it has been reviewed multiple times for safety.
- The European Food Safety Authority (EFSA), as well as national regulators in various countries, also deem aspartame safe for consumption.
- However, individuals with phenylketonuria (PKU), a rare genetic disorder, should avoid aspartame due to the presence of phenylalanine.
Controversies and Impact of WHOs Listings
- Past IARC rulings have raised concerns, led to lawsuits, and influenced manufacturers to seek alternatives due to public confusion.
- The potential listing of aspartame as “possibly carcinogenic” by the IARC contradicts previous scientific consensus on its safety.
- Critics argue that IARC assessments can be confusing to the public and may create unnecessary fear and misinformation.
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Centre planning new Bill on Stray Dog Issue
Note4Students
From UPSC perspective, the following things are important :
Prelims level: NA
Mains level: Stray dog attack incidences
Centre Idea:
- The Centre will soon formulate a law on the issue of stray dogs, Union Minister Parshottam Rupala said.
Stray Dog Menace in India
- Cities have witnessed a sharp increase in the stray dog population, which as per the official 2019 livestock census stood at 1.5 crore.
- However, independent estimates peg the number to be around 6.2 crore.
- The number of dog bites has simultaneously doubled between 2012 and 2020.
- Experts agree there may be a correlation between urbanisation and solid waste production, made visible due to the mismanagement of waste disposal.
- Tepid animal birth control programmes and insufficient rescue centres, in conjunction with poor waste management, result in a proliferation of street animals in India.
Reasons behind
- Poor waste management: Inadequate waste disposal facilities and the mismanagement of solid waste often lead to the congregation of stray dogs around garbage dumps and landfills, where they scavenge for food.
- Unplanned urbanization: The population boom in Indian cities has led to a sharp increase in the stray dog population. Rapid urbanization has led to the creation of slums and unmanaged solid waste, which attract dogs.
- Lack of food and shelter: The availability of food and shelter determines the carrying capacity of a city. In the absence of these facilities, free-ranging dogs become scavengers that forage around for food, eventually gravitating towards exposed garbage dumping sites.
- Territoriality: Stray dogs often become territorial and aggressive about public spaces where they are fed, leading to increased attacks on humans.
- Improper sterilization and rescue centres: Tepid animal birth control programmes and insufficient rescue centres, in conjunction with poor waste management, result in a proliferation of street animals in India.
Food wastage in India
- A population boom in Indian cities has contributed to a staggering rise in solid waste production. Indian cities generate more than 150000 metric tonnes of urban solid waste every day.
- According to a 2021 UNEP report, an estimated 931 million tonnes of food available to consumers ended up in households, restaurants, vendors and other food service retailers’ bins in 2019.
- Indian homes on average also generated 50 kg of food waste per person.
- The presence of free-roaming dogs in urban areas is determined by the “carrying capacity” of a city, which is the availability of food and shelter.
Urban Stray Dogs and Waste Disposal
- Food and shelter: The wastage food often serves as a source of food for hunger-stricken, free-roaming dogs that move towards densely-populated areas in cities, such as urban slums which are usually located next to dumping sites.
- Sanitation assists food hunt: In the absence of proper sanitation and waste disposal facilities, stray dogs become scavengers that forage for food around exposed garbage dumping sites.
Impact of Unplanned and Unregulated Urban Development
- ABC Program: Under Animal Birth Control (ABC) program, municipal bodies trap, sterilize, and release dogs to slow down the dog population. This approach aims to control the number of strays while avoiding the inhumane practice of killing them.
- Rabies Control Measures: Another anchor of India’s response is rabies control measures, including vaccination drives. Rabies is a fatal disease that can be transmitted to humans through dog bites. Thus, preventing rabies is essential in addressing the issue of stray dogs.
- Informal Measures: These include mass killing of dogs in states like Kerala, which is a controversial practice as it is often inhumane and does not address the root causes of the issue. Other measures include imposing bans on the entry of stray dogs in colonies or feeding them in public.
Why address stray dog attacks issue?
- Adds Vulnerability to the poor: The disproportionate burden of dog bites may also fall on people in urban slums, which are usually located in close proximity to dumping sites.
- Exposes harsher realities: The rise in such attacks speak to core issues of lack of serviced affordable urban housing for all, lack of safe livelihood options and improper solid waste management”.
Empathizing the strays
- Abandoned, not strayed: Stray dogs are sentient social beings capable of feeling pain, fear, and joy. Urban living patterns have largely impacted their abandonment.
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