Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

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: 

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.

  • Preventive Measures: A healthy diet coupled with regular physical activity can prevent 80% of Type 2 diabetes cases and significantly reduce the burden of heart disease and high blood pressure.
  • Nutrition for Mother and Child: Proper nutrition from conception to the age of 2 years is crucial for optimal growth and development, preventing undernutrition, micronutrient deficiencies, and obesity in both mothers and children.
  • Suggested general dietary principles: The guidelines recommend getting required nutrients from at least eight food groups, including vegetables, leafy vegetables, roots and tubers, dairy, nuts, and oils.
  • Group-Specific Guidelines:
  1. Pregnant women: Small frequent meals for those experiencing nausea and vomiting. It recommends the consumption of lots of fruit and vegetables, especially those high in iron and folate content.
  2. Infants and children: For the first six months, infants should only be breastfed, and must not be given honey, glucose, or diluted milk. After the age of 6 months, complementary foods must be included.
  3. Elderly: The elderly should consume foods rich in proteins, calcium, micronutrients, and fiber. Apart from pulses and cereals — with at least one-third as whole grains — at least 200-400 ml of low-fat milk or milk products, a fist full of nuts and oilseeds, and 400-500g of vegetables and fruit should be consumed.

Key concerns as per the National Institute of Nutrition (NIN):

  • Rising Noncommunicable Diseases (NCDs) Among Adolescents and Children: Due to poor dietary habits led to diseases like cardiovascular disease, cancers, and diabetes are increasingly affecting adolescents and even children in India.
  • Focus on Healthy Dietary Habits: The guidelines emphasize the importance of reducing salt intake and avoiding highly processed foods like packaged snacks, cookies, and sugary treats, which are linked to unhealthy diets and disease burden.
  • High Prevalence of Lifestyle Conditions: The Comprehensive National Nutrition Survey 2019 highlights a concerning prevalence of lifestyle-related conditions even among children, including overweight or obesity, diabetes, pre-diabetes, and abnormal cholesterol levels.
  • Cholesterol Levels: The survey indicates high levels of bad cholesterol (LDL and triglycerides) in children aged 5-9 and pre-teens and teens aged 10-19, along with low levels of good cholesterol in a significant portion of children and adolescents.

Other concerns related to the “Dual nutrition challenge”

  • Incidence of micronutrient (zinc, iron, vitamins) deficiencies ranged from 13% to 30% of children between ages 1 and 19. But still, the prevalence of anemia is at 40.6%, 23.5%, and 28.4% in children under age 5, ages 5-9, and 10-19 respectively.
  • However severe forms of undernutrition such as marasmus (a deficiency of macronutrients such as carbohydrates and proteins) and kwashiorkor (deficiency of proteins) have disappeared from the country.

Conclusion: Implementing these guidelines effectively can significantly contribute to achieving Sustainable Development Goal (SDG) targets, particularly SDG 2 (Zero Hunger), SDG 3 (Good Health and Well-being), and SDG 12 (Responsible Consumption and Production).

Mains PYQ: 

Q How far do you agree with the view that the focus on the lack of availability of food as the main cause of hunger takes the attention away from ineffective human development policies in India? (15M) UPSC 2018

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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:
  1. The presence of these antibodies is detected through an agglutination reaction.
  2. The test involves serial dilution of the patient’s serum.
  3. 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

https://www.nimh.nih.gov/health/topics/schizophrenia#:~:text=What%20is%20schizophrenia%3F,for%20their%20family%20and%20friends

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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:

  1. 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.
  2. 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)
  3. 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:
      • 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)
  • Diagnostic Tests: Diagnosis of pulmonary hypertension typically involves a combination of medical history review, physical examination, and diagnostic tests, including:
      • Echocardiogram (ECG)
      • Right heart catheterization
      • Pulmonary function tests
      • Chest X-ray
      • CT scan or MRI of the chest
      • Blood tests
  • Treatment: Treatment for pulmonary hypertension aims to relieve symptoms, improve quality of life, and slow disease progression. Treatment options may include:
    • 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:

  • India Hypertension Control Initiative (IHCI) (2017): It was launched to strengthen the hypertension component of National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) in primary care public sector facilities in India
  • 75/25 initiative (2023): Union Health Ministry announced the initiative- 75 million people with hypertension and diabetes to be put on Standard Care by 2025, through the Primary Health Centres (PHCs).

 

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.

  • Commencement Year: 1954
  • Objective: To provide comprehensive health coverage to Central Government Employees (Allopathy/Homoeopathy)
  • Present change: The rates of the Central Government Health Scheme (CGHS) for general surgery have been revised since February 2024.

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 
      • 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.
  • Weak implementation
    • 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:
  1. 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.
  2. 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.
  3. 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

  • 1818: Establishment of the Oriental Life Insurance Company in Calcutta marked the beginning of the life insurance business in India. The company faced failure in 1834.
  • 1829: Madras Equitable started conducting life insurance operations in the Madras Presidency.
  • 1870: Enactment of the British Insurance Act. Establishment of insurance companies like Bombay Mutual (1871), Oriental (1874), and Empire of India (1897) in the Bombay Presidency during this era, dominated by British firms.
  • 1914: Commencement of publishing insurance company returns by the government of India.
  • 1912: Introduction of the Indian Life Assurance Companies Act, the first legislation regulating life insurance.
  • 1928: Enactment of the Indian Insurance Companies Act to gather statistical information about insurance business.
  • 1938: Consolidation and amendment of insurance legislation with the Insurance Act, 1938, introducing comprehensive provisions to regulate insurers’ activities.
  • 1950: The Insurance Amendment Act abolished principal agencies amid allegations of unfair trade practices. The GoI decided to nationalize the insurance industry in response to high competition levels.
  • 1956: The Life Insurance Corporation of India (LIC) was established under the Life Insurance Corporation Act, of 1956, consolidating the life insurance business in India under a single entity. LIC took over the assets and liabilities of around 245 private life insurers and provident societies.

 

PYQ:

[2012] Consider the following:

  1. Hotels and restaurants
  2. Motor transport undertakings
  3. Newspaper establishments
  4. Private medical institutions

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
  1. Ayushman Bharat
  2. Incepted in National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC)
Launch Year 2018
Components
  1. Health and Wellness Centres (HWCs)
  2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
  • Offers a sum insured of Rs. 5 lakh per family for secondary and tertiary care
  • Provides cashless and paperless access to services at any empanelled hospital across India
  • Portable scheme, allowing beneficiaries to avail treatment at any PM-JAY empanelled hospital
Coverage
  • 3 days pre-hospitalisation and 15 days post-hospitalisation
  • Includes diagnostic care and expenses on medicines
  • No restriction on family size, age, or gender
  • Covers all pre-existing conditions from day one
Beneficiaries Identified through Socio-Economic Caste Census (SECC) data
Funding
  • Shared funding: 60:40 for states and UTs with legislature, 90:10 in Northeast states and J&K,
  • Himachal Pradesh, and Uttarakhand, 100% central funding for UTs without legislature
Nodal Agency National Health Authority (NHA)

  • Autonomous entity under the Society Registration Act, 1860
  • Responsible for effective implementation of PM-JAY in alliance with state governments

State Health Agency (SHA)

  • Apex body of the State Government responsible for the implementation of AB PM-JAY in the State

 

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)

 https://www.indiatoday.in/health/story/rise-in-c-section-deliveries-despite-decrease-in-pregnancy-complications-iit-madras-study-2521773-2024-04-01

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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.
  • 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.
  1. Normal: Values below 5.7% are considered
  2. Pre-diabetes: 5.7% to 6.4%
  3. 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?

  1. Collecting DNA samples from air in a habitat at one go
  2. Understanding the genetic makeup of avian species of a habitat
  3. Using air-borne devices to collect blood samples from moving animals
  4. 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:

  1. It is used in the diagnosis of Sickle Cell Disease.
  2. It measures the percentage of red blood cells coated with sugar.
  3. It is recommended for individuals over 30 years.

How many of the given statements is/are correct?

  1. One
  2. Two
  3. Three
  4. 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 Disease

Symptoms of Lyme disease depend on the stage of the condition.

(1) Stage 1

  • The early symptoms of Lyme disease begin to appear within 3 to 30 days after a tick bite.
  • In this stage, the disease has a limited set of symptoms that includes rash, fever, headache, muscle aches etc. and hence is called early localised disease.

(2) Stage 2

  • Stage 2 is often more serious and widespread. It is called early disseminated disease.
  • Symptoms include more rashes on other parts of the body, neck pain or stiffness, muscle weakness on one or both sides of the face etc.

(3) Stage 3

  • In the United States, the most common condition of this stage is arthritis in large joints, particularly the knees.
  • Pain, swelling or stiffness may last for a long time. Or the symptoms may come and go.
  • Stage 3 symptoms usually begin 2 to 12 months after a tick bite.

 


Try this PYQ from CSE Prelims 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

 

Post your answers here.
1
Please leave a feedback on thisx

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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
  • Burkina Faso, Cameroon, the Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Sudan, Uganda, and Tanzania.
  • These countries collectively account for over 70% of the global malaria burden.
Pledges
  • Effective tackling of malaria threat in Africa, leading better and investing more money in fighting malaria, using new technology for data, etc.
  • Investing more in health infrastructure, personnel, and programs, collaborating across sectors, forming partnerships for funding, research, and innovation.
  • Showing strong commitment to quickly reducing malaria deaths and holding each other and their countries accountable for the commitments.

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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:

  • Polyacrylamide: Possible acrylamide contamination.
  • PTFE: Possible PFOA contamination.
  • Petrolatum: Possible PAH contamination.
  • Formaldehyde: A known carcinogen.
  • Paraformaldehyde: A type of formaldehyde.
  • Methylene glycol: A form of formaldehyde

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

health centres

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.
    1. In Himachal Pradesh, functional health centres serve 83% of the population.
    2. Chhattisgarh has shown a radical expansion in the public provision of healthcare, with increased facilities, medicines, and staff presence.
    3. 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.
    1. The share of health expenditure in the Union Budget increased drastically.
    2. The National Health Mission’s share shrank from 69% to 44%, while allocations for the Ayushmann Bharat program and new AIIMS hospitals surged.
    3. 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 

 

Cervical Cancer: Symptoms, Diagnosis & Treatment

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

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

  • India issued its first National Policy on Rare Diseases in March 2021, offering comprehensive strategies for prevention and management.
  • Less than 5% of rare diseases have therapies available in India, yet they affect nearly 1/5th of the population.
  • The Union Government allocated ₹50 lakh per patient for rare diseases treatment, but only approximately 49% of the allocated funds have been utilized.
  • There are approximately 7,000-8,000 rare diseases in India, with new diseases continually being identified and reported.

 

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

  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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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?

  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 the baby

Select the correct answer using the codes given below:

  1. 1, 2 and 3 only
  2. 2 and 4 only
  3. 1 and 3 only
  4. 1, 2, 3 and 4

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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

Guinea Worm Disease

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

 

Healthcare Reforms in India: A Compelling Need Today - India CSR

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

Bubonic Plague

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:
  1. Through infected vector fleas,
  2. Contact with infectious bodily fluids or materials, and
  3. 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

What is an Interim Budget - Oneindia News

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

asha

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
  1. Health and Wellness Centres (HWC) providing primary care services.
  2. Pradhan Mantri Jan Arogya Yojana (PM-JAY) offering health cover of Rs. 5 lakhs per family per year.
Coverage Details
  • Covers secondary and tertiary care hospitalization.
  • Includes pre-hospitalization and post-hospitalization expenses.
  • No restrictions on family size, age, or gender.
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
  • Primarily women residents of the village, preferably aged 25 to 45.
  • Literacy preferred and relaxed standards for tribal, hilly, or desert areas.
Employment Classification Considered honorary/volunteer positions rather than government workers.

 

[2] Anganwadi Programme

Details
Initiation
  • Started by the Government of India in 1975
  • Part of the Integrated Child Development Services (ICDS)
Objective To combat child hunger and malnutrition
Implementation Centrally sponsored scheme implemented by States/UTs
Services Provided
  1. Supplementary nutrition
  2. Pre-school non-formal education
  3. Immunization
  4. Health check-up
  5. Nutrition and health education
  6. Referral services
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

Kyasanur Forest Disease

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

An Uttar Pradesh model to tackle malnutrition - The Hindu

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

Centre asks states to create diverse public health cadre | Latest News India  - Hindustan Times

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

Leprosy

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

Mosquitofish

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:
    1. Priority for healthcare needs
    2. Alignment with disease prevalence and public health significance
    3. 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

Global Surgery

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

In defence of Syed Ahmad Afzal's 'Laal Rang' – Cafe Dissensus Everyday

Central Idea:

The article emphasizes the importance of addressing global disparities in blood collection and management for a resilient health system. It highlights the need for public-private partnerships, dispelling myths around blood donation, and implementing innovative models like the hub and spoke system to ensure equitable access to safe blood and its products.

 

Key Highlights:

  • Global disparities in blood collection pose a challenge to healthcare systems worldwide.
  • Shortages in blood units impact critical healthcare services, risking lives and affecting surgeries and transplants.
  • The hub and spoke model, involving high-volume blood banks and smaller centers, can optimize blood distribution and reduce wastage.

Seeing red: Randeep Hooda is out for blood in Laal Rang

Case study to fetch good marks 

“Lal Rang,” starring Randeep Hooda, unfolds the life-threatening impact of blood shortages in a small town, where individuals resort to illegal blood trade out of desperation. The movie underscores the urgent need for systemic improvements, showcasing the potential role of public-private partnerships and awareness campaigns.

Key Challenges:

  • Global inequities in blood collection, with low-income countries receiving a disproportionately small share.
  • Persistent shortage of blood units in countries like India, affecting healthcare services and putting lives at risk.
  • Misconceptions around voluntary blood donation hinder efforts to address shortages.

Key Terms:

  • Public-Private Partnerships (PPP)
  • Hub and Spoke Model
  • Blood Management Ecosystem
  • Voluntary Blood Donation
  • Global Disparities

 

Key Phrases:

  • “Innovative models for blood collection and distribution.”
  • “Optimizing utilization through the hub and spoke model.”
  • “Dispelling myths around voluntary blood donation.”

 

Key Quotes:

  • “The hub and spoke model is one such innovative method where high-volume blood banks act as a hub for smaller blood centers.”
  • “Over the course of three years, a surplus of 30 lakh blood units and related products were discarded due to expiration, degradation, and infections.”

 

Key Examples and References:

  • The World Health Organization’s report on global disparities in blood collection.
  • Data points in Parliament revealing the discard of blood units over three years.
  • The study by Savitribai Phule Pune University highlighting the impact of blood shortages on accident victims.

 

Key Statements:

  • “As we leave the COVID-19 pandemic behind us, the health paradigm must be prepared accordingly, with a focus on blood management.”
  • “Proactive engagement from the industry and active citizen participation are pivotal aspects of this concerted effort.”

 

Key Facts:

  • India faced a shortage of over six lakh blood units in 2019-20 despite improvements in the blood management ecosystem.
  • The hub and spoke model can address critical gaps in blood availability, especially in resource-constrained settings.
  • A surplus of 30 lakh blood units and related products were discarded over three years due to various reasons.

 

Critical Analysis:

The article critically examines the global disparities in blood collection and the impact of shortages on healthcare services. It emphasizes the need for innovative solutions like the hub and spoke model while addressing misconceptions around voluntary blood donation.

 

Way Forward:

  • Strengthen public-private partnerships to improve blood collection and distribution.
  • Implement the hub and spoke model to optimize blood utilization and reduce wastage.
  • Conduct targeted awareness campaigns to dispel myths and encourage voluntary blood donation.

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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

NeuroAIDS: Neuropsychiatric Disorders. | Download Table

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

Medical Negligence

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

Huge Disparities in Children's Well-Being Across India, says Report |  NewsClick

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

chis

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

Overview: Living Conditions of Sex-Workers in India — Ylcube

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.

Experts Warn of a Return of the AIDS 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

Mosquitofish

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 are Generic Medicines and why are they affordable?

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

Preventing Diabetes Complications & Health Problems

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

hypertension

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

cancer

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:
    1. Promotional: Aimed at augmenting income.
    2. Preventive: Intended to forestall economic distress.
    3. Protective: Designed to ensure relief from external shocks.
  • The Code on Social Security 2020: It is necessary to revisit the Code on Social Security 2020, highlighting that it doesn’t explicitly state the goal of universalizing social security in India, particularly for informal workers.

Way Forward: Improving Mental Health Care

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

Alignment with Sustainable Development Goals (SDGs)

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

Conclusion

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

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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

Elderly

Central Idea

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

Why discuss this?

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

Misconceptions about Ageing and Mental Health

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

Social Challenges Faced by the Elderly

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

Psychological Aspects of Ageing

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

Mental Health Challenges

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

Case Study: SCARF Partnership

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

Preserving Cultural Traditions

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

Way forward

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

Conclusion

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

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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:
  1. Defining ‘healthy food’
  2. Implementing warning labels on unhealthy food
  3. Imposing restrictions on the promotion and marketing tactics of unhealthy food and beverages
  4. 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.

Also read:

Is India a Diabetes capital of the world?

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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

women 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.

Also read:

Organ transplant rules In India: A Significant Step

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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

aging population

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:

India’s Rising Burden of Diabetes: Urgent Actions Needed

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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-
  1. Facilitating access to Ayushman cards
  2. Generating ABHA IDs
  3. 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:
  1. Ayushman – Apke Dwar 3.0
  2. Ayushman Melas at Health and Wellness Centres (HWC) and Community Health Clinics (CHC)
  3. 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

somatic gene

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

one health

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

chis

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:

  1. Informed Consent: Volunteers participating in CHIS must provide informed consent, fully understanding the potential risks and benefits associated with their participation.
  2. 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).
  3. 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.
  4. 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

survey

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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

manas

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

cchf

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

diabetes

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

diabetes

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.

Also read for more details:

Is India a Diabetes capital of the world?

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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.

Wastewater

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

lepto

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

aspartame

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

dog

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.
  • Subjected to abuse: They are often victims of neglect, abuse, and abandonment, and are forced to survive in harsh conditions on the streets.
  • Neglected community guardians: Stray dogs can serve as community guardians by alerting us to potential dangers and can also provide emotional support to humans.

Way forward

  • Improve waste management: Efficient management of solid waste can help reduce the availability of food for stray dogs and limit their population growth.
  • Increase vaccination and sterilization: ABC and vaccination programs should be implemented in a more organized and efficient manner to control the stray dog population and the spread of rabies.
  • Encourage responsible feeding practices: Regulating feeding around bakeries and restaurants and improving waste management in public spaces can reduce the carrying capacity of the environment for stray dogs and minimize the congregation of dogs in certain areas.
  • Develop national policy: There is a need for a comprehensive national policy that addresses the issue of stray dogs and their management in a more systematic and humane manner.
  • Stop gruesome brutality: Stopping brutality towards dogs is a crucial step towards creating a more compassionate and just management of stray dogs menace.

 

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Mental Health in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Mental health Disorders and Associated Initiatives

Mains level: Prevalence of Mental Health Disorders in India, challenges and gaps in support system and Way forward

Mental Health

Central Idea

  • India is grappling with a significant mental health crisis, with an estimated 6%-7% of the population affected by mental disorders. The COVID-19 pandemic further exacerbated the situation, leading to increased stress levels across social segments. Unfortunately, most cases of mental illness remain untreated due to ignorance and social stigma, leaving patients and their families to suffer in silence.

The Prevalence of Mental Health Issues in India

  • National Mental Health Survey (2016): According to this survey conducted by the National Institute of Mental Health and Neurosciences (NIMHANS), approximately 13.7% of India’s population (around 150 million individuals) was estimated to be in need of active mental health interventions. This survey covered a wide range of mental health disorders, including depression, anxiety disorders, substance use disorders, and psychosis.
  • World Health Organization (WHO) Report (2017): The WHO reported that India has one of the highest rates of major depression in the world, with over 5% of the population affected by this disorder. The report also highlighted that the prevalence of anxiety disorders in India was around 3.8%.
  • Global Burden of Disease Study (2017): This study estimated that mental health disorders accounted for 9.9% of the total disease burden in India. It encompassed a broad range of mental disorders, including depression, anxiety, bipolar disorder, schizophrenia, and substance use disorders.
  • National Health Mission (NHM) Estimates: NHM estimates suggest that 6%-7% of India’s population suffers from mental disorders. This aligns with the prevalence rates reported in other studies.

Causes for Caregiver Stress

  • Physical and Emotional Caregiving: Caregivers are responsible for providing physical and emotional support to individuals with mental health disorders. The demanding nature of caregiving tasks, such as managing medications, attending to personal care needs, and addressing emotional distress, can contribute to caregiver stress.
  • Social Isolation: Caregivers often experience social isolation as they may have limited time for social interactions and leisure activities. The focus on caregiving can lead to a decreased social support network and feelings of loneliness.
  • Financial Difficulties: Mental health disorders can place a financial burden on families. The cost of treatment, medications, therapy sessions, and other related expenses can be significant. Caregivers may face financial strain, which adds to their stress levels.
  • Troublesome Behavior of the Patient: Behavioral issues associated with mental health disorders, such as aggression, mood swings, and self-harm, can be challenging for caregivers to manage. Dealing with these behaviors on a daily basis can contribute to high levels of stress.
  • Non-Adherence to Treatment: Many individuals with mental health disorders may struggle with adhering to treatment plans, such as taking medication regularly or attending therapy sessions. Non-adherence to treatment can be frustrating for caregivers, as it hampers the progress and well-being of the patient, leading to increased caregiver stress.
  • Primary Caregiver Burden: In larger families, the responsibility of caregiving may be shared among family members. However, with reducing family sizes and changing social dynamics, the primary caregiver burden often falls on one individual, such as the spouse. This increased responsibility and lack of support can contribute to caregiver stress.
  • Balancing Multiple Roles: Women caregivers, in particular, may face challenges in balancing caregiving responsibilities with other roles such as careers, child-rearing, and household chores. The juggling of multiple roles without sufficient support can lead to increased stress levels.

The Need for Structured Interventions

  • Education and Awareness: Structured interventions can provide caregivers with comprehensive education and awareness about mental health disorders. This includes understanding the nature of the illness, its symptoms, treatment options, and available resources. Education empowers caregivers with the knowledge needed to better support their loved ones and navigate the challenges associated with mental health disorders.
  • Role Clarity and Responsibilities: Structured interventions help caregivers clarify their roles and responsibilities in providing care for individuals with mental health disorders. This clarity reduces confusion and uncertainty, allowing caregivers to have a better sense of control and confidence in their caregiving abilities.
  • Coping Skills and Stress Management: Caregiving can be emotionally and physically demanding, leading to high levels of stress. Structured interventions can equip caregivers with coping skills and stress management techniques to better handle the challenges they face. This may include strategies for self-care, relaxation techniques, problem-solving skills, and setting boundaries to prevent burnout.
  • Peer Support and Networking: Structured interventions often incorporate peer support and networking opportunities. Caregivers can connect with others who are going through similar experiences, fostering a sense of belonging and reducing feelings of isolation. Sharing experiences, exchanging advice, and receiving support from peers can be invaluable in coping with caregiver stress.
  • Access to Counseling and Helplines: Structured interventions can provide caregivers with access to professional counseling services and helplines. These services offer a safe and confidential space for caregivers to express their concerns, seek guidance, and receive emotional support. Counseling can help caregivers process their emotions, manage caregiver stress, and develop effective coping strategies.
  • Psychoeducation and Skill Building: Structured interventions often include psychoeducational sessions and skill-building workshops for caregivers. These sessions cover various topics such as understanding the condition, recognizing early warning signs of relapse, learning about available therapies and their effectiveness, managing treatment-related expenses, and identifying and implementing effective coping mechanisms.
  • Family Counselling and Involvement: Involving the entire family in structured interventions can foster a supportive environment for the individual with a mental health disorder. Family counselling sessions can enhance communication, understanding, and cooperation within the family, leading to better overall outcomes for the individual’s mental health.

Challenges and Gaps in Support Systems

  • Lack of Trained Specialists: One of the major challenges is the shortage of trained mental health specialists, such as psychiatrists and clinical psychologists. India has a low ratio of psychiatrists and psychologists per population, making it difficult to provide adequate support and interventions for caregivers.
  • Cost-Effective Intervention Implementation: Implementing cost-effective intervention models for caregiver support is hindered by the lack of trained specialists. The shortage of mental health professionals makes it challenging to scale up and deliver structured interventions that are accessible and affordable for caregivers.
  • Insufficient Budget Allocation: The are concerns about insufficient budget allocation for mental health patients. Inadequate funding for mental health services further exacerbates the challenges in developing and implementing interventions specifically designed to support caregivers.
  • Limited Insurance Coverage: Mental illnesses are often excluded from the list of ailments covered by leading medical insurers in India. While government schemes like Ayushman Bharat provide coverage for mental disorders, coverage by private insurers remains limited. This lack of comprehensive insurance coverage creates a gap in financial support for caregivers seeking mental health services.
  • Expensive Private Mental Health Institutions: Private mental health institutions may provide services, but their costs can be prohibitively expensive for many individuals and families. This restricts access to quality mental health care and support for caregivers who may not be able to afford the high costs associated with private institutions.
  • Inadequate Support for Caregivers: The current counselling services provided to caregivers upon request are not sufficient. Many caregivers may not be aware of their own emotional strain or may not proactively seek support due to various reasons, such as lack of awareness, stigma, or personal barriers.

Mental Health

Gaps in Insurance Coverage for Mental Health Disorders

  • Exclusion from Leading Medical Insurers: The mental illnesses are excluded from the list of ailments covered by leading medical insurers in India. This means that individuals seeking treatment for mental health conditions may not receive adequate insurance coverage or reimbursement for their expenses.
  • Mental Healthcare Act 2017: The Mental Healthcare Act 2017 aimed to rectify this issue by mandating that mental disorders should be treated on par with physical disorders for insurance coverage. However, it suggests that private insurers still have limited coverage for mental health disorders, indicating a gap between the mandate and its implementation.
  • Government Schemes and Public Sector Insurance: While government schemes like Ayushman Bharat provide coverage for mental disorders, the article mentions that coverage by private insurers remains limited. This implies that individuals relying on private insurance may face challenges in obtaining comprehensive coverage for mental health conditions.
  • Affordability and Accessibility: The private mental health institutions may provide services but at a higher cost, making them financially burdensome for many individuals and families. The lack of comprehensive insurance coverage further restricts access to affordable mental health care, exacerbating the affordability and accessibility challenges

Way Forward

  • Structured Intervention Programs: Introducing structured intervention programs specifically aimed at educating and supporting caregivers are essential. These programs should provide information about mental health disorders, caregiver roles and responsibilities, coping mechanisms, and resources for assistance.
  • Comprehensive Treatment Approach: There is need of a comprehensive treatment approach that involves healthcare professionals, informal caregivers, and psychosocial interventions. This collaborative approach recognizes the crucial role of caregivers and their involvement in the treatment process.
  • Early Support for Caregivers: Studies in developed countries have shown that providing support to family caregivers at the onset of the psychiatric illness of their loved ones is crucial. Early intervention and support can enhance caregiver well-being and improve patient treatment participation.
  • Intervention Models: Successful intervention models include cognitive-behavioral therapy, psychoeducational skill building, family counseling, and peer support. These models focus on providing caregivers with practical skills, knowledge, and emotional support to effectively manage caregiver responsibilities and cope with the challenges they face.
  • Addressing Systemic Gaps: There are evident gaps in the healthcare system, including the shortage of trained specialists and insufficient budget allocation for mental health patients. Addressing these systemic gaps is crucial for developing and implementing effective caregiver support programs.
  • Insurance Coverage: Expanding insurance coverage for mental disorders, as mandated by the Mental Healthcare Act 2017, is essential. Private insurers should also be encouraged to provide comprehensive coverage for mental health conditions to ensure financial support for caregivers seeking mental health services.
  • Non-Governmental Organizations (NGOs) and Community Movements: There is need to acknowledge the work of NGOs and community movements engaged in community support for mental illness and caregivers. Scaling up their efforts and ensuring collaboration with healthcare professionals can help bridge the existing gaps in caregiver support

Conclusion

  • Recognizing and addressing the caregiver burden is imperative in India’s mental health landscape. Structured interventions that educate and support caregivers are crucial for improving their well-being and promoting patient treatment participation. Moreover, bridging the gaps in healthcare infrastructure, sufficient trained specialists, and expanding insurance coverage for mental disorders are essential steps toward providing comprehensive care for psychiatric patients and their caregivers.

Also read:

Its high time to focus on Mental Health

 

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What is Medicines Patent Pool (MPP)?

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Medicines Patent Pool (MPP)

Mains level: Not Much

medicine

Central Idea

  • The Medicines Patent Pool (MPP) has entered into sub-licence agreements with Indian and Indonesian companies to produce generic versions of the cancer drug Nilotinib.
  • Nilotinib is used in the treatment of chronic myeloid leukaemia, a type of blood cancer.

What is Medicines Patent Pool (MPP)?

  • Mission and Purpose: The MPP is a United Nations-backed organization focused on increasing access to life-saving medicines for low- and middle-income countries.
  • Addressing IPR: The MPP works to overcome barriers related to intellectual property rights and patents that limit the availability and affordability of essential medicines.
  • Voluntary Licensing Agreements: The MPP negotiates voluntary licensing agreements with pharmaceutical companies to allow the production of generic versions of patented medicines.
  • Production of Affordable Generics: By securing licenses, the MPP enables qualified manufacturers in low- and middle-income countries to produce and distribute affordable generic medicines.

Need for MPP

  • Collaborative Approach: The MPP collaborates with governments, non-profit organizations, civil society groups, and pharmaceutical companies to address global health challenges and promote access to medicines.
  • Focus on Priority Diseases: The MPP’s efforts are particularly significant in diseases like HIV/AIDS, tuberculosis, hepatitis C, and other priority areas where access to affordable medications is crucial.
  • Sustainable Supply of Generic Medicines: Through licensing agreements, the MPP ensures a sustainable supply of quality-assured generic medicines, promoting market competition and expanding treatment options.
  • Improving Health Outcomes: The MPP’s work reduces the burden of high drug costs and enhances access to life-saving treatments, ultimately improving health outcomes and saving lives.
  • Benefit for Low- and Middle-Income Countries: The MPP’s initiatives directly benefit patients in low- and middle-income countries by increasing access to affordable medicines and reducing disparities in healthcare.

Recent agreements signed

  • Licence Agreement with Novartis: In October 2022, the MPP signed a licence agreement with Novartis Pharma AG, the Switzerland-based pharmaceutical corporation that holds the patent for Nilotinib.
  • First Sub-Licence Agreements: The recent sub-licence agreements with Indian companies Eugia, Hetero, and Dr. Reddy’s Laboratories, along with the Indonesian firm BrightGene, mark the first such agreements for a cancer treatment drug by the MPP.

Benefits

  • Generic Versions of Nilotinib: The licensed manufacturers can produce generic versions of Nilotinib.
  • Manufacturing: The selected manufacturers have the rights to manufacture generic Nilotinib in India and seven middle-income countries.
  • Supply in 44 Territories: The non-exclusive licence agreement allows for the supply of generic Nilotinib in 44 territories covered by the agreement, subject to local regulatory authorisation.
  • Affordable Treatment Option: Charles Gore, the executive director of the MPP, states that the production of generic Nilotinib will provide an affordable treatment option for people diagnosed with chronic myeloid leukaemia in the covered countries.
  • Increasing Access to Cancer Medication: The MPP’s initiative aims to improve access to essential cancer medications by reducing costs and increasing availability.

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India’s Rising Burden of Diabetes: Urgent Actions Needed

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Diabetes

Mains level: Rising burden of NCDs in India

diabetes

Central Idea: A recent study by ICMR has raised concerns about the emerging crisis of diabetes in India and the urgent need for effective strategies to tackle this escalating issue.

What is Diabetes?

Type 1 Diabetes Type 2 Diabetes
Prevalence Generally diagnosed in children and young adults Usually diagnosed in adults, but can occur at any age
Autoimmune Autoimmune condition, immune system attacks pancreas Not autoimmune, insulin resistance or impaired insulin production
Insulin Dependence Requires insulin injections or insulin pump May be managed with lifestyle changes, oral medication, or insulin
Onset Sudden onset Gradual onset
Causes Genetic predisposition and environmental factors Genetic and lifestyle factors, including obesity
Body Weight Often normal or underweight Often overweight or obese
Insulin Production Little to no insulin production Insulin resistance or inadequate insulin production
Treatment Insulin therapy, blood sugar monitoring Lifestyle changes, oral medication, insulin therapy if needed
Complications Higher risk of diabetic ketoacidosis Higher risk of heart disease, stroke, and other complications
Lifestyle Factors Cannot be prevented or reversed Can be prevented or managed through lifestyle changes
Prevention No known prevention strategies Focus on healthy lifestyle, weight management

 

Burden of Diabetes in India

  • The results of the largest long-term study on metabolic factors in the Indian subcontinent, known as the ICMR-InDiab study, were recently published in The Lancet.
  • This study, conducted between 2008 and 2020, aimed to estimate India’s burden of chronic non-communicable diseases (NCDs).

Key Findings

The study revealed alarming statistics regarding diabetes in India:

  1. Approximately 11% of the population has diabetes.
  2. Another 15.3% of the population is in the pre-diabetic stage.
  3. This translates to an estimated 101.3 million diabetics and 136 million individuals in the pre-diabetic stage.
  4. Urban areas have a higher prevalence (16.4%) compared to rural areas (8.9%).

These numbers underscore the need for immediate attention to prevent the further rise of diabetes and manage its complications effectively.

Reasons for India’s Rising Burden

India’s escalating burden of diabetes can be attributed to several factors:

  • Genetic Predisposition: Indians have a higher genetic susceptibility to diabetes.
  • Changing Lifestyles: Urbanization, sedentary habits, and unhealthy dietary patterns contribute to increased obesity and diabetes risk.
  • Obesity Epidemic: Rising obesity rates in India are a major risk factor for diabetes.
  • Socioeconomic Factors: Limited access to healthcare, lack of awareness, and resource constraints hinder diabetes management.
  • Urban-Rural Divide: Diabetes is no longer limited to urban areas, as rural regions also experience a growing prevalence.
  • Delayed Diagnosis and Treatment: Late diagnosis and treatment initiation impede effective disease management.

Addressing India’s Rising Burden of Diabetes

To combat this crisis, key interventions include:

  • Prevention and Health Promotion: Encouraging healthy lifestyles and stress reduction.
  • Early Detection and Diagnosis: Promoting awareness and implementing screening programs.
  • Access to Quality Healthcare: Improving healthcare infrastructure and ensuring equitable access.
  • Education and Awareness: Public health campaigns to raise awareness and encourage lifestyle modifications.
  • Policy Interventions: Implementing policies for healthy environments and regulating unhealthy products.

Conclusion

  • India is facing a significant health crisis with the rising burden of diabetes.
  • It is imperative to prioritize diabetes prevention and management to ensure a healthier future for the nation.

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The story behind the Ban on 14 FDC Drugs

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Fixed dose combination (FDC) Drug

Mains level: Not Much

fdc drug ban

Central Idea: Exploring the recent ban on 14 fixed dose combination drugs in India and its rationale.

What are FDC Drugs?

  • Definition: FDC drugs are combinations of active ingredients in a fixed ratio, commonly used in a single pill or syrup.
  • Benefits offered: FDCs can reduce pill burden, improve adherence to therapy, and lower costs.
  • Risks associated: Certain combinations can be pharmacologically incompatible, have abuse potential, and contribute to antibiotic resistance.

Issue of Irrational FDCs

  • Licensed FDCs: FDCs introduced for the first time require prior approval, while many older FDCs were licensed without proper scrutiny.
  • Lack of safety: Lack of evidence on safety and efficacy led to the categorization of many licensed FDCs as irrational.
  • Legal challenges: A ban on 344 FDCs in 2016 was stayed by the Delhi High Court, prompting further review and subsequent ban on 329 FDCs in 2018.

Government Action and Expert Review

  • Referral to Drugs Technical Advisory Board: The Supreme Court entrusted the review of FDC drugs to the government’s expert body.
  • Ban on 14 Pre-1988 FDCs: An expert committee recommended banning certain FDCs licensed before 1988.
  • Balancing Prior Approvals and Inquiry: The Supreme Court excluded 15 FDCs licensed prior to 1988 from the ban but allowed for an inquiry.

Implications of the Ban

  • Impact on Drug Availability: The ban affects approximately 40-50 brands used for cough, fever, pain, and common infections.
  • Support from Pediatricians: Many pediatricians welcome the ban, citing harmful combinations in FDC drugs.
  • Call for Additional Scrutiny: Calls to consider banning Nimesulide for single-dose use due to liver risks.

Cautions Regarding Cough Syrups

  • Conflicting Effects of Ingredients: Experts highlight how ingredients in cough syrups may work against each other, reducing their efficacy.
  • Limited Evidence on Cough Syrups: Weak evidence suggests cough syrups may not significantly reduce cough duration.
  • Caution for Cough Suppressants: Prescription-only use is advised, particularly for individuals with underlying lung conditions.

Socioeconomic impact of the Ban

  • Economic Savings and Improved Quality of Life: The ban may lead to cost savings and enhanced well-being for individuals.
  • Importance of Safe Drinking Water: Access to clean drinking water is crucial for public health and overall quality of life.
  • Evidence-Based Decision-Making: Ensuring the safety and effectiveness of medical treatments through research and evaluation.
  • Addressing Emerging Health Challenges: Continuous monitoring and research are necessary to tackle evolving health risks.
  • Optimizing Healthcare Practices: Ongoing efforts to improve healthcare systems and practices for better patient outcomes.

Conclusion

  • The recent ban on 14 fixed dose combination (FDC) drugs in India highlights the government’s commitment to ensuring the safety and efficacy of pharmaceutical products.

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Addressing Antimicrobial Resistance (AMR) in the Pandemic Treaty

Note4Students

From UPSC perspective, the following things are important :

Prelims level: AMR, Pandemic Treaty

Mains level: Not Much

antimicrobial resistance amr

Central Idea

  • Pandemic Treaty: The latest version of the draft Pandemic Instrument, also known as the “pandemic treaty,” was shared with Member States at the World Health Assembly.
  • Removal of AMR Mentions: It became apparent that all mentions of addressing antimicrobial resistance in the Pandemic Instrument were at risk of removal.

What is AMR?

  • Antimicrobial resistance (AMR) is the development of resistance in microorganisms to drugs that were once effective against them.
  • Microorganisms, including bacteria, fungi, viruses, and parasites, can become “immune” to medications used to kill or control them.
  • Misuse or overuse of antibiotics can contribute to the development of AMR.

About the Pandemic Treaty

  • Initiation of Work: Work on the Pandemic Instrument began in December 2021.
  • Objective: The instrument aims to protect nations and communities from future pandemic emergencies under the WHO’s Constitution.

Importance of Addressing Antimicrobial Resistance (AMR)

  • Calls for Inclusion: Civil society and experts, including the Global Leaders Group on Antimicrobial Resistance, have emphasized the inclusion of AMR in the Pandemic Instrument.
  • Not Limited to Viruses: Not all pandemics in the past or future are caused by viruses, with bacterial pandemics like plague and cholera being devastating examples.
  • Impact of Bacterial Infections: Bacterial infections cause one in eight deaths globally and contribute to the rise of drug-resistant infections.

Need for Comprehensive Pandemic Preparedness

  • Wider Range of Threats: Planning and developing effective tools to respond to a broader range of pandemic threats, beyond viruses, is crucial.
  • Secondary Bacterial Infections: Even in viral pandemics like COVID-19, secondary bacterial infections become a serious issue, requiring effective antibiotics.

Concerns over Potential Removal of AMR Measures

  • Risk to Future Pandemics: The removal of AMR measures from the Pandemic Instrument could hinder efforts to protect people from future pandemics.
  • At-Risk Measures: Measures at risk of removal include better access to safe water, infection prevention and control, integrated surveillance, and antimicrobial stewardship.

Strengthening the Pandemic Instrument to Address AMR

  • Inclusion of AMR Measures: Measures to address AMR can be easily incorporated into the Pandemic Instrument.
  • Recommendations for Inclusion: Recommendations include addressing bacterial pathogens, tracking viral and bacterial threats, and harmonizing AMR stewardship rules.

Efforts to Highlight AMR in the Pandemic Instrument

  • Involvement of Specialized Organizations: Civil society and research organizations participated in the WHO’s Intergovernmental Negotiating Body, providing analysis on AMR in the draft.
  • Publication of Special Edition: Leading academic researchers and experts published a special edition outlining the importance of addressing AMR in the Pandemic Instrument.

Current State and Next Steps

  • Concerns over Removal: Insertions related to AMR are at risk of removal after closed-door negotiations by Member States.
  • Importance of the Pandemic Instrument: The instrument is vital for mitigating AMR and safeguarding antimicrobials for treating secondary infections in pandemics.
  • Global Political Action: Collaboration and collective efforts are needed to address AMR and support the conservation and equitable distribution of safe and effective antimicrobials.

Safeguarding Antimicrobials for Future Pandemic Response

  • Undermining Goals: Missing the opportunity to address AMR in the Pandemic Instrument undermines its broader goals of protecting nations and communities.
  • Core Role of Antimicrobials: Antimicrobials are essential resources for responding to pandemics and must be protected.
  • Call for Strengthened Measures: Member States should strengthen measures to safeguard antimicrobials and support actions for conserving their effectiveness within the instrument.

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WHO’s advisory on Non-Sugar Sweeteners

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Non-Sugar Sweeteners

Mains level: Read the attached story

sweet

Central Idea: The World Health Organization (WHO) issued new guidelines advising against the use of non-sugar sweeteners (NSS) as a healthy alternative to sugar.

What are Non-Sugar Sweeteners?

  • NSS are low or no-calorie alternatives to sugar, including aspartame, saccharin, stevia, and others.
  • They are marketed for weight loss and controlling blood glucose in individuals with diabetes.

WHO’s Finding

  • The WHO analyzed 283 studies on NSS intake in adults and children.
  • Higher intake of NSS was associated with a 76% increase in obesity risk and a 0.14 kg/m2 increase in BMI.
  • No evidence of long-term benefits on reducing body fat was found, and long-term use of NSS may increase the risk of Type 2 diabetes, cardiovascular diseases, chronic kidney disease, and cancer.
  • WHO suggests that NSS should not be used for weight control or reducing the risk of diet-related non-communicable diseases.

Concerns and Recommendations

  • India has a high obesity rate and a significant number of people with pre-diabetes.
  • Lifestyle-related Type 2 diabetes is increasing among young individuals.
  • WHO recommends focusing on a balanced diet and minimally processed, unsweetened foods and beverages.

What lies ahead?

  • WHO’s conditional guideline requires further discussions among policymakers before adoption as national policy.
  • Efforts should be made to educate youngsters about taste preferences and healthy eating habits.
  • Doctors can now provide more confident guidance to patients regarding NSS consumption.

 

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India nears milestone with first indigenous Dengue Vaccine

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Dengue

Mains level: Not Much

dengue

Central Idea: Serum Institute of India and Panacea Biotec have applied to the ICMR’s call for Expression of Interest for collaborative Phase-III clinical trials for an indigenous dengue vaccine.

What is Dengue?

Details
Transmission Primarily transmitted through the bite of infected Aedes mosquitoes
Virus and Serotypes Dengue virus belonging to the Flaviviridae family

Four distinct serotypes: DENV-1, DENV-2, DENV-3, and DENV-4

Symptoms High fever, severe headache, joint and muscle pain, rash, pain behind the eyes, mild bleeding
Severe Dengue Progression to severe dengue can cause plasma leakage, bleeding, organ impairment
Geographic Distribution Endemic in more than 100 countries, particularly in tropical and subtropical regions
Incidence and Global Impact 100-400 million dengue infections occur annually globally, affecting healthcare systems and economies
Vector and Breeding Sites Aedes aegypti mosquito breeds in stagnant water containers found near human dwellings
Treatment No specific antiviral treatment available; supportive care, rest, fluid intake, symptom management
Prevention and Control Reduce mosquito breeding sites, proper water storage, cleaning of water containers, use of insecticides

 

Dengue Virus Disease and Global Impact

  • Dengue virus disease causes significant morbidity and mortality worldwide, with 2 to 2.5 lakh (200,000 to 250,000) cases reported annually in India.
  • The global incidence of dengue has increased dramatically, with over half of the world’s population at risk.
  • The World Health Organization (WHO) has identified dengue as one of the top ten global health threats in 2019.
  • Currently, there is no specific treatment for dengue, highlighting the urgent need for effective vaccines.

Desirable Characteristics of a Dengue Vaccine

The ICMR highlights the desirable characteristics of a dengue vaccine, including a-

  • Favorable safety profile
  • Protection against all four serotypes of dengue
  • Reduced risk of severe disease and death
  • Induction of a sustained immune response and
  • Effectiveness regardless of previous sero-status and age

 

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India’s G20 Presidency: Strengthening Global Health Governance for Safer and Equitable World

Note4Students

From UPSC perspective, the following things are important :

Prelims level: NA

Mains level: Universal Health Coverage, challenges and India's G20 presidency

Health

Central Idea

  • India’s G20 presidency is gaining momentum, with a focus on harnessing shared responsibilities and collaborative governance to enhance global safety from pandemics. It seeks to bridge the gap between the Global North and Global South, recognizing the inclusive memberships of G20 and other plurilateral arrangements that span the global community.

Importance of Health as a global public good

  • Interconnectedness: In today’s interconnected world, diseases can quickly spread across borders, transcending geographical boundaries. The health of individuals and communities in one part of the world can have direct implications for others. Therefore, addressing health issues becomes a shared responsibility for all nations.
  • Impact on Global Stability: Health crises, such as pandemics, can have severe social, economic, and political consequences. They can disrupt economies, strain healthcare systems, and cause social unrest. By ensuring health as a global public good, we contribute to global stability, sustainable development, and peaceful coexistence.
  • Humanitarian Imperative: Health is a fundamental human right. Everyone deserves access to quality healthcare and the opportunity to lead a healthy life. Treating health as a global public good ensures equitable access to healthcare services, regardless of an individual’s nationality or socioeconomic status.
  • Economic Productivity: Healthy populations are essential for economic productivity and growth. By investing in health as a global public good, we can create conditions for individuals to thrive, contribute to their communities, and participate actively in economic activities.
  • Prevention and Preparedness: Addressing health as a global public good requires proactive measures to prevent and prepare for health emergencies. By investing in disease surveillance, research, and robust healthcare systems globally, we can better detect and respond to outbreaks, mitigating their impact and saving lives.
  • Collaboration and Knowledge Sharing: Recognizing health as a global public good encourages collaboration among nations. By sharing knowledge, best practices, and resources, countries can collectively work towards improving public health outcomes, fostering innovation, and finding solutions to complex health challenges.
  • Achieving Sustainable Development Goals: Health is intricately linked to several Sustainable Development Goals (SDGs), including good health and well-being (SDG 3), poverty eradication (SDG 1), and gender equality (SDG 5). Treating health as a global public good support the achievement of these interconnected goals, leading to a more equitable and sustainable world.

India’s response to Covid-19: Whole-of-society and whole-of-government approach

  • Early Measures and Nationwide Lockdown: India implemented one of the world’s largest and strictest nationwide lockdowns in March 2020 to contain the spread of the virus. This decision aimed to break the chain of transmission and provide time to strengthen healthcare infrastructure.
  • Testing and Surveillance: India significantly ramped up its testing capacity, expanding the network of testing laboratories across the country. The government implemented various testing strategies, including rapid antigen tests and RT-PCR tests, to detect and track Covid-19 cases.
  • Healthcare Infrastructure: To bolster healthcare infrastructure, the government initiated several measures such as establishing dedicated Covid-19 hospitals, increasing the number of ICU beds, ventilators, and oxygen supply, and mobilizing healthcare professionals to regions facing surges in cases.
  • Vaccine Development and Rollout: India played a crucial role in vaccine development, with its indigenous vaccine candidates receiving regulatory approval. The country launched an ambitious vaccination drive, prioritizing healthcare workers, frontline workers, and vulnerable populations. India also contributed to global vaccine supply through the export of vaccines under the Vaccine Maitri initiative.
  • Economic Relief Measures: Recognizing the socioeconomic impact of the pandemic, the government introduced economic relief measures, including financial assistance, direct benefit transfers, and welfare schemes to support vulnerable sections of society affected by lockdowns and job losses.
  • Collaborations and International Aid: India engaged in international collaborations, sharing its experiences and expertise, and cooperating with other countries in areas such as research, drug repurposing, and knowledge exchange. The country also received international assistance in the form of medical supplies and equipment.
  • Focus on Healthcare Infrastructure and Research: The government emphasized strengthening healthcare infrastructure, investing in research and development, and promoting indigenous manufacturing of medical equipment and supplies. Efforts were made to enhance testing capacity, develop innovative solutions, and support research on therapies and diagnostics.
  • Communication and Awareness: The government and health authorities prioritized public communication and awareness campaigns to disseminate accurate information, promote preventive measures, and combat misinformation related to the virus.

Health

What is Universal Health Coverage (UHC) by 2030?

  • UHC 2030 is a global movement and partnership that aims to accelerate progress towards achieving Universal Health Coverage (UHC) by the year 2030.
  • UHC 2030 is a collaborative initiative led by multiple stakeholders, including governments, international organizations, civil society, and the private sector, with the goal of ensuring that all individuals and communities have access to essential healthcare services without suffering financial hardship.
  • UHC 2030 builds upon the commitment made by United Nations member states in 2015 through the Sustainable Development Goals (SDGs).

Challenges in achieving UHC by 2030?

  • Financing: Adequate and sustainable financing is crucial for UHC. Many countries struggle with limited healthcare budgets, inefficient resource allocation, and inadequate public financing. Mobilizing sufficient funds to cover the costs of expanding healthcare services and ensuring financial protection for all individuals can be a significant challenge.
  • Health Workforce: The availability, distribution, and quality of healthcare professionals pose challenges to UHC. Many countries face shortages of skilled healthcare workers, particularly in rural and remote areas. Strengthening the health workforce, ensuring equitable distribution, and improving their training and retention are critical for delivering quality healthcare services.
  • Health Infrastructure: Insufficient and inadequate healthcare infrastructure, including facilities, equipment, and technologies, can hinder the achievement of UHC. Many regions, especially in low-income countries, lack the necessary healthcare infrastructure to provide essential services to all populations. Investments in infrastructure development and strengthening are required to expand access and ensure quality care.
  • Inequities and Vulnerable Populations: UHC aims to address health inequities and reach vulnerable and marginalized populations. However, socioeconomic disparities, gender inequalities, and discrimination can hinder equitable access to healthcare services. Special attention is needed to address these inequities and ensure that UHC benefits all individuals, irrespective of their social or economic status.
  • Health Information Systems: Establishing robust health information systems is essential for effective UHC implementation. However, many countries face challenges in data collection, management, and utilization. Strengthening health information systems, including electronic health records and data analytics, is crucial for monitoring progress, making informed decisions, and improving service delivery.
  • Political Will and Governance: UHC requires strong political commitment and effective governance. Political will at the national level is necessary to prioritize UHC, allocate resources, and implement necessary policy reforms. Ensuring transparency, accountability, and efficient governance mechanisms are crucial to prevent corruption, ensure equitable service delivery, and maintain public trust.
  • Changing Disease Patterns: The evolving burden of diseases, including the rise of non-communicable diseases, poses challenges to UHC. Chronic conditions require long-term management and specialized care, placing additional strain on healthcare systems. Adapting healthcare delivery models and integrating prevention and control strategies for these diseases are essential components of UHC.
  • Global Health Security: Public health emergencies and global health security threats, as witnessed during the Covid-19 pandemic, can disrupt healthcare systems and hinder progress towards UHC. Strengthening health emergency preparedness and response capacities is vital to mitigate the impact of outbreaks and ensure continuity of healthcare services.

health

How India’s G20 presidency: Significant role in achieving UHC by 2030

  • Knowledge Sharing and Best Practices: As the G20 president, India can facilitate the sharing of knowledge and best practices among member countries. This includes sharing successful UHC models, innovative healthcare delivery approaches, and strategies to overcome challenges. By promoting knowledge exchange, countries can learn from each other’s experiences and accelerate progress towards UHC.
  • Advocacy for UHC: India can use its platform as G20 president to advocate for UHC as a global priority. Through diplomatic channels and international forums, India can emphasize the importance of UHC in achieving sustainable development and equitable healthcare access. This advocacy can encourage other G20 member countries to prioritize UHC and align their policies and actions accordingly.
  • Collaboration with Global Health Organizations: India’s G20 presidency can facilitate collaboration with global health organizations such as the World Health Organization (WHO), World Bank, and other relevant entities. By working closely with these organizations, India can contribute to the development and implementation of strategies and initiatives that support UHC, including capacity building, technical assistance, and funding mechanisms.
  • Promoting Innovative Financing Mechanisms: India can explore and promote innovative financing mechanisms for UHC. This includes advocating for increased public investment in healthcare, exploring public-private partnerships, and encouraging the development of social health insurance schemes. By identifying and sharing successful financing models, India can provide valuable insights to other G20 countries on sustainable funding for UHC.
  • Strengthening Primary Healthcare Systems: India’s G20 presidency can focus on strengthening primary healthcare systems, which are integral to UHC. This involves enhancing access to quality primary healthcare services, addressing health workforce shortages, improving infrastructure, and promoting preventive and promotive healthcare measures. Sharing India’s experiences and initiatives in primary healthcare can inspire other countries to invest in this essential aspect of UHC.
  • Leveraging Digital Health Technologies: India has made significant strides in adopting digital health technologies, and its G20 presidency can highlight the potential of these technologies in advancing UHC. By sharing digital health success stories and facilitating collaborations in areas such as telemedicine, health information systems, and mobile health applications, India can accelerate the adoption of digital solutions for healthcare access and delivery.
  • South-South Cooperation: India’s G20 presidency can promote South-South cooperation and collaboration among G20 member countries and other nations from the Global South. By fostering partnerships, sharing experiences, and supporting capacity-building efforts, India can facilitate collective progress towards UHC in regions that face similar challenges.

Conclusion

  • India’s G20 presidency aims to leverage collaborative governance and shared responsibilities to create a safer world from pandemics. India’s engagement with Japan’s G7 presidency and the focus on resilient, equitable, and sustainable UHC and global health architecture development further demonstrate shared responsibilities and the commitment to addressing public health emergencies. Through collective efforts, we can heal our planet, foster harmony within our global family, and offer hope for a better future.

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Govt. program for Non-Communicable Diseases renamed

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Non-Communicable Diseases (NCDs)

Mains level: Govt policies and actions against NCDs

disease

Central Idea: The article discusses the decision by the Indian Ministry of Health and Family Welfare to rename and expand its program for the control and prevention of non-communicable diseases (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, cancers, chronic respiratory diseases, and diabetes.
  • These diseases are often caused by modifiable risk factors such as unhealthy diet, 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 globally.

Why in news?

  • The addition of many new diseases and health initiatives have prompted the Indian government to expand and rename its NCD program.

Renaming of the NCD Program and Portal

  • The Ministry has renamed the NPCDCS as the “National Programme for Prevention & Control of Non-Communicable Diseases [NP-NCD].”
  • The application or software named Comprehensive Primary Healthcare Non-Communicable Disease (CPHC NCD IT) will now be renamed “National NCD Portal.”
  • The Ministry communicated this decision to the States on May 3, 2023, through a one-page letter and asked them to adhere to the changes.

Implementation and future action

  • The NPCDCS is implemented under the National Health Mission across India.
  • The letter addressed to Principal Secretaries and Health Secretaries of all States and Union Territories advised the government to use the new names for the scheme and portal in all their future references and correspondences with the Indian government.
  • Under NPCDCS, 677 NCD district-level clinics, 187 District Cardiac Care Units, 266 District Day Care Centres and 5,392 NCD Community Health Centre-level clinics have been set up.

Burden of NCDs in India

  • The study ‘India: Health of the Nation’s States – The India State-Level Disease Burden Initiative in 2017’ by the ICMR estimated that the proportion of deaths due to NCDs in India has increased from 37.9% in 1990 to 61.8% in 2016.
  • The four major NCDs are:
  1. Cardiovascular diseases (CVDs)
  2. Cancers
  3. Chronic respiratory diseases (CRDs) and
  4. Diabetes
  • The study shared four behavioural risk factors – unhealthy diet, lack of physical activity, and the use of tobacco and alcohol.

Solutions to mitigate NCD burden

  • Promote healthy lifestyle: Encourage people to adopt healthy lifestyle habits such as regular physical activity, balanced and nutritious diet, avoiding tobacco and alcohol, and getting enough sleep.
  • Increase awareness and education: Increase awareness among the public about the risk factors of NCDs and educate them about ways to prevent these diseases.
  • Improve healthcare infrastructure: Increase access to healthcare facilities, especially in rural and remote areas, to ensure early detection, treatment, and management of NCDs.
  • Implement policies and regulations: Implement policies and regulations that promote healthy living, such as increasing taxes on tobacco and alcohol products, and regulating the marketing of unhealthy food products.
  • Foster public-private partnerships: Foster partnerships between the government, private sector, and civil society organizations to work collaboratively towards preventing and managing NCDs.
  • Increase research and innovation: Increase research and innovation in the prevention, early detection, and treatment of NCDs to develop new and effective interventions.

 

 

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India’s One Health Approach to Tackle Future Pandemics

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Global Health Security Index, PM ABHIM and related schemes and facts

Mains level: India's One health approach

One Health

Central Idea

  • The Covid-19 pandemic exposed weaknesses in the world’s health systems, including countries ranked high in the Global Health Security Index. It has also provided an opportunity to build stronger health systems to prevent and respond to future pandemics. India’s One Health approach aims to address the health of people, animals, and ecosystems together in order to prevent, prepare, and respond to pandemics.

One Health

What is PM Ayushman Bharat Health Infrastructure Mission (PM ABHIM)? 

  • PM ABHIM is being rolled out as India’s largest scheme to scale up health infrastructure.
  • It is aimed at ensuring a robust public health infrastructure in both urban and rural areas, capable of responding to public health emergencies or disease outbreaks.
  • Key features:
  • Health and Wellness Centres: In a bid to increase accessibility it will provide support to 17,788 rural HWC in 10 ‘high focus’ states and establish 11,024 urban HWC across the country.
  • Exclusive Critical Care Hospital Blocks: It will ensure access to critical care services in all districts of the country with over five lakh population through ‘Exclusive Critical Care Hospital Blocks’.
  • Integrated public health labs: It will also be set up in all districts, giving people access to “a full range of diagnostic services” through a network of laboratories across the country.
  • Disease surveillance system: The mission also aims to establish an IT-enabled disease surveillance system through a network of surveillance laboratories at block, district, regional and national levels.
  • Integrated Health Information Portal: All the public health labs will be connected through this Portal, which will be expanded to all states and UTs, the PMO said.

Facts for prelims

What is Global Health Security Index?

  • The Global Health Security Index is a tool developed to assess a country’s preparedness and ability to respond to outbreaks, pandemics, and other public health emergencies.
  • It was developed by the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security, in collaboration with The Economist Intelligence Unit (EIU).
  • The Index ranks 195 countries based on their level of preparedness across six categories: 1. Prevention, 2. Detection and reporting, 3. Rapid response, 4. Health system, 5. Compliance with international norms, and 6. Risk environment.
  • The Index aims to identify gaps in preparedness and encourage countries to take action to strengthen their health security systems, particularly in the face of global health threats such as pandemics.
  • The first edition of the Index was published in 2019, and it has since been updated to reflect the evolving global health landscape.
  • Global Health Security Index 2021: India ranked 66th.

One Health

What is mean by One health?

  • One Health is an interdisciplinary approach that recognizes the interconnectedness of human, animal, and environmental health.
  • It emphasizes the need for collaboration between various sectors, including public health, veterinary medicine, environmental science, and others, to achieve optimal health outcomes for all.

key components of India’s One Health approach

  • Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM): The flagship program launched in October 2021 aims to prevent, prepare, and respond to pandemics. It seeks to fill the gaps in health systems at the national and state levels.
  • National Institute for One Health: The foundation for the institute was laid recently in Nagpur. It will identify hotspots for endemic and emerging zoonotic diseases to contain their spread early on.
  • Creation of a network of institutions for genomic surveillance: During the COVID-19 pandemic, India created a formidable network of institutions that can identify new pathogens. This can now be complemented with wider testing of wastewater and samples from incoming ships and aircraft.
  • Coordination between ministries: Several ministries, including health, animal husbandry, forests, and biotechnology, have been brought under the Principal Scientific Advisor to address overlapping mandates and improve coordination.
  • Expansion of research laboratories: India is expanding its network of research laboratories, which primarily focused on influenza, to cover all respiratory viruses of unknown origin.
  • Partnerships between research bodies and manufacturers: Indian manufacturers produced vaccines, test kits, therapeutics, masks and other items at very competitive prices, both for India and other countries. The partnerships between research bodies and manufacturers will need to be sustained and enhanced to make India a global hub in the biopharma sector.
  • Clinical trial network: The clinical trial network set up under the National Biopharma Mission is a positive step toward improving access to affordable new vaccines and drugs in India and around the world.
  • Ayushman Bharat Digital Health Mission: The mission can facilitate the bringing of private hospitals and clinics under a common platform and placing data in the public domain to augment surveillance in vulnerable areas.
  • Municipal corporations mandated to provide early alerts: Municipal corporations have been mandated to identify the most vulnerable areas and provide early alerts. For this to be successful, strong partnerships with communities, dairy cooperatives, and the poultry industry will be needed to identify new infections.

What are the potential advantages of the One Health approach?

  • Holistic approach: The One Health approach looks at the interconnectedness of human, animal, and environmental health. By taking a holistic approach, it enables a better understanding of the complex interconnections between human, animal, and environmental health, and can lead to more effective interventions and solutions
  • Early disease detection: The One Health approach emphasizes the importance of early disease detection in animals, which can serve as an early warning system for potential human outbreaks. This approach can help prevent the spread of diseases and reduce the risk of pandemics.
  • Better disease surveillance: The One Health approach facilitates better disease surveillance by enabling the sharing of information and resources between different sectors, including human health, animal health, and environmental health.
  • More effective responses: The One Health approach can lead to more effective responses to outbreaks by facilitating collaboration between different sectors and stakeholders, and ensuring a coordinated response.
  • Improved animal health: The One Health approach recognizes the importance of animal health and welfare, and can lead to improved animal health through better disease control and prevention measures.
  • Better environmental management: The One Health approach also recognizes the importance of environmental management and conservation, and can lead to more sustainable environmental practices that benefit both human and animal health.

One Health

Conclusion

  • India’s One Health approach is a positive step towards addressing the health of people, animals, and ecosystems together. The country’s efforts to tackle future pandemics are commendable, and the success of these efforts will be critical. The rise of new pathogens, zoonotic diseases, and antibiotic resistance highlights the need for a comprehensive approach to prevent future pandemics. India’s efforts to build stronger health systems, prevent pandemics, and respond to outbreaks will help protect its citizens and set an example for the world.

Mains Question

Q. What do you understand by mean One Health? Discuss the advantages of One health approach the efforts of India in this direction.

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Latest National Health Account figures on India’s Healthcare Sector

Note4Students

From UPSC perspective, the following things are important :

Prelims level: National Health Account (NHA) estimates

Mains level: Read the attached story

national health

Central idea: The National Health Account Estimates 2019-20 report shows an increase in government spending and a decline in out-of-pocket expenditure on healthcare.

About National Health Account (NHA) estimates

  • The NHA estimates for India 2019-20 is the seventh consecutive report prepared by the National Health Systems Resource Centre (NHSRC).
  • NHSRC was designated as National Health Accounts Technical Secretariat (NHATS) in 2014 by the Union Health Ministry.
  • The NHA estimates use an accounting framework based on the internationally accepted standard of System of Health Accounts, 2011 developed by the WHO.
  • India now has a continuous series of NHA estimates from 2013-14 to 2019-20, making the estimates comparable internationally.
  • The estimates enable policymakers to monitor progress in different health financing indicators of the country.

health

Key highlights

Description

Government spending as % of GDP
  • Increased from 1.13% (FY 2015) to 1.35% (FY 2020)
  • Per capita health spending of the government has also increased from Rs 1,108 in FY 2015 to Rs 2,014 in FY 2020.
  • Govt share in total healthcare spending has increased from 29% in 2015 to 41.4% in 2020
Declining out-of-pocket expenditure
  • Proportion of total healthcare spending that comes from people’s pockets has decreased from 62.6% in 2015 to 47.1% in 2020
  • Govt aims to further reduce out-of-pocket expenditure by investing in public health and insurance
  • To reduce the financial burden of healthcare on individuals and increase the utilization of healthcare services
Government spending on primary healthcare
  • Increased from 51.3% in 2015 to 55.9% in 2020.
  • Govt. invested in creating 1.5 lakh health and wellness centres that can screen people for cancers, diabetes, and eye disease.
Increase in social security expenditure
  • Increased from 5.7% of total healthcare spending in 2015 to 9.3% in 2020.
  • Suggests that the government is investing more in social welfare programs.
Increase in spending on insurance
  • Privately purchased health insurance increased from 3.9% of total health expenditure in 2015 to 7.72% in 2020
  • Govt. financed health insurance spending also went up from 3.8% in 2015 to 6.37% in 2020
Health spending by states
  • Only two big states and three smaller ones have crossed the target of 8% of their budget going towards healthcare as set by the National Health Policy 2017.

 

Key issues

  • Marginal increase: Activists are concerned about the marginal increase in government spending.
  • Global laggard: This increase in government health expenditure as a percentage of GDP also takes into account capital spending, which puts India in 164th place out of 184 countries in terms of government health spending.
  • No proportional increase: Total spending on health as a proportion of GDP has been going down, from 3.9% in 2015 to 3.3% in 2020, indicating a decline in consumption of healthcare services.

Conclusion

  • Overall, the report shows that government spending on healthcare has been increasing, while out-of-pocket expenditure has been declining.
  • There is a need to invest in public health and insurance and increase the contribution of states towards healthcare.

 

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[pib] Cabinet approves the Policy for the Medical Devices Sector

Note4Students

From UPSC perspective, the following things are important :

Prelims level: NA

Mains level: National Medical Devices Policy, 2023

medical device

Central idea: The Union Cabinet, chaired by Hon’ble Prime Minister, approved the National Medical Devices Policy, 2023.

National Medical Devices Policy, 2023

  • The Policy, 2023 aims to facilitate an orderly growth of the medical device sector to meet the public health objectives of access, affordability, quality, and innovation.
  • The policy lays down a roadmap for accelerated growth of the medical devices sector to achieve various missions.

Objectives

  • The policy aims to make the industry competitive, self-reliant, resilient, and innovative.
  • It focuses on meeting the healthcare needs of not only India but also the world.
  • It aims to accelerate the growth of the medical devices sector.
  • It takes a patient-centric approach to meet the evolving healthcare needs of patients.
  • It provides support and directions to the medical devices industry to achieve these goals.

Strategies to Promote Medical Device Sector

The medical devices sector will be facilitated and guided through a set of strategies that cover six broad areas of policy interventions:

Key measures and actions

1. Regulatory Streamlining Enhance ease of doing research and business, balance patient safety with product innovation, create a Single Window Clearance System for licensing of medical devices, enhance the role of Indian Standards like BIS, and design a coherent pricing regulation.
2. Enabling Infrastructure Establish and strengthen large medical device parks and clusters equipped with world-class common infrastructure facilities in proximity to economic zones with requisite logistics connectivity.
3. Facilitating R&D and Innovation Promote research and development in India, establish centres of excellence in academic and research institutions, innovation hubs, and support for startups.
4. Attracting Investments in the Sector Encourage private investments, funding from venture capitalists, and public-private partnerships, in addition to existing schemes and interventions like Make in India, Ayushman Bharat program, Heal-in-India, and Start-up mission.
5. Human Resources Development Ensure a steady supply of skilled workforce across the value chain by leveraging available resources in the Ministry of Skill Development and Entrepreneurship, supporting dedicated multidisciplinary courses for medical devices in existing institutions, and developing partnerships with foreign academic/industry organizations to develop medical technologies.
6. Brand Positioning and Awareness Creation Create a dedicated Export Promotion Council for the sector under the Department, initiate studies and projects for learning from best global practices of manufacturing and skilling system, promote more forums to bring together various stakeholders for sharing knowledge, and build strong networks across the sector.

 

Medical devices sector in India: A quick recap

  • The medical devices sector in India is an essential and integral part of the Indian healthcare sector.
  • The sector has contributed significantly to the domestic and global battle against the COVID-19 pandemic through the large-scale production of medical devices & diagnostic kits.

Growth potential in India

  • The market size of the medical devices sector in India is estimated to be $11 billion (approximately, ₹ 90,000 Cr) in 2020, and its share in the global medical device market is estimated to be 1.5%.
  • The Indian medical devices sector has enormous potential to become self-reliant and contribute towards the goal of universal health care.

Current initiatives in this sector

  • The Government of India has initiated the implementation of the PLI Scheme for medical devices.
  • It supports for setting up of four Medical devices Parks in the States of Himachal Pradesh, Madhya Pradesh, Tamil Nadu, and Uttar Pradesh.

 

 

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Preparedness and Resilience for Emerging Threats (PRET) Initiative

Note4Students

From UPSC perspective, the following things are important :

Prelims level: PRET Initiaitve

Mains level: Not Much

pret

Central Idea: The World Health Organization (WHO) has launched a PRET initiative to be better prepared for future outbreaks of a similar scale and devastation as the COVID-19 pandemic.

What is PRET Initiative?

  • The Preparedness and Resilience for Emerging Threats (PRET) initiative is launched by the WHO to prepare for future outbreaks of a similar scale and devastation as the COVID-19 pandemic.
  • It is aimed at providing guidance on integrated planning for responding to any respiratory pathogen such as influenza or coronaviruses.
  • The current focus of PRET is on respiratory viruses, but work is already underway to assess what should be the next group of pathogens to be mitigated under this initiative.
  • It can serve to operationalize the objectives and provisions of the Pandemic Accord, which is currently being negotiated by WHO Member States.

Three-pronged approach of PRET

  • The three-pronged approach includes-
  1. Updating preparedness plans
  2. Increasing connectivity among stakeholders in pandemic preparedness planning, and
  3. Dedicating sustained investments, financing, and monitoring of pandemic preparedness.
  • The approach has a special focus on bridging the gaps highlighted during the COVID-19 pandemic and ensuring community engagement and equity are at the centre of preparedness and response efforts.

 

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Malaria soon to be a notifiable disease across India

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Malaria

Mains level: Read the attached story

malaria

Malaria is all set to become a notifiable disease across India, which will require cases to be reported to government authorities by law.

About Malaria

Description
Definition A potentially life-threatening disease caused by parasites that are transmitted through the bite of infected female Anopheles mosquitoes
Causes Four species of plasmodium parasites, namely plasmodium vivax, plasmodium falciparum, plasmodium malariae, and plasmodium ovale
Spread Bite of infected female Anopheles mosquitoes
Symptoms Fever, chills, headache, muscle pain, fatigue, nausea, vomiting
Diagnosis Blood test
Treatment Antimalarial drugs
Prevention Insecticide-treated bed nets, indoor residual spraying, wearing protective clothing, using mosquito repellent, avoiding mosquito bites
Vaccine RTS,S/AS01 (Mosquirix)

 

Why in news?

  • The move is part of India’s vision to become malaria-free by 2027 and to eliminate the disease by 2030.

Menace of malaria in India

  • In India, 80% of malaria cases occur among 20% of its population living in the 200 high-risk districts of Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Odisha, West Bengal and the seven north-eastern states.
  • With only fewer than half of those infected reaching a clinic or hospital, the cases and deaths are much higher than recorded.

What is Notifiable Disease?

  • A notifiable disease is a disease that is required by law to be reported to government authorities.
  • In India, the Ministry of Health and Family Welfare maintains a list of notifiable diseases under the National Health Mission.
  • This is done to track the spread of the disease and to take necessary measures to control and prevent its spread.
  • Reporting notifiable diseases is important for public health surveillance and response to outbreaks.

Malaria as a Notifiable Disease

  • Malaria is currently a notifiable disease in 33 states and Union Territories in India.
  • Bihar, Andaman and Nicobar Islands, and Meghalaya are in the process of putting malaria in the notifiable disease category.

Other measures to curb malaria

  • Malaria Elimination Programme: The government has launched the National Framework for Malaria Elimination in India 2016-2030 to eliminate malaria from the country by 2030.
  • Joint Action Plan: The Health Ministry has initiated a joint action plan with the Ministry of Tribal Affairs for malaria elimination in tribal areas. This plan aims to bring down malaria cases to zero in tribal areas, which are among the most vulnerable to the disease.
  • HIP-Malaria Portal: The Ministry has ensured the availability of near-real-time data monitoring through an integrated health information platform and periodic regional review meetings to keep a check on malaria growth across India.

Vaccines developed so far

  • The WHO has approved the rollout of two first-generation malaria vaccines, RTS,S and R21, in high-transmission African countries.
  • Bharat Biotech, an Indian company, has been licensed to manufacture the RTS,S vaccine, with adjuvant provided by GSK.
  • The R21 vaccine, developed by scientists at Oxford University, has shown promising results in phase 2 clinical studies and has been approved by regulatory authorities in Ghana and Nigeria.
  • Scientists at the International Centre for Genetic Engineering and Biotechnology (ICGEB) in New Delhi have developed and produced two experimental blood-stage malaria vaccines, with Phase I clinical trials completed for one of them.

 

 

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India’s population to edge ahead of China’s by mid-2023: UN

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Freedom of speech and reasonable restrictions

Mains level: Global population trends

population

Central idea: India is set to overtake China as the world’s most populous country by mid-2023, according to data released by the United Nations.

State of World Population Report

  • The report is an annual report published by the United Nations Population Fund (UNFPA), which provides a global overview of population trends and issues.
  • The report covers a wide range of topics related to the population, such as fertility, mortality, migration, family planning, and gender equality.
  • It also includes analysis and recommendations for policymakers and governments to address population challenges and promote sustainable development.
  • The report is widely regarded as a key reference for researchers, policymakers, and international organizations working on population and development issues.

population

Highlights of the 2023 report

Facts

Data

World Population (2022) 8 billion
Most populous regions Eastern and Southeastern Asia, Central and Southern Asia
World Population Growth Rate (since 2020) Less than 1%
Fertility Rate (replacement level) 2.1 children per woman
Population aged 65 years or above (2050) 16%
Persons aged 65 years and above (2050) More than double that of 5-year-olds and same as 12-year-olds
Regions with fertility rate at or below 2.1 60%
Top countries accounting for global population increase by 2050 DR Congo, Egypt, Ethiopia, India, Nigeria, Pakistan, Philippines, Tanzania

 

Population anxieties in India

Facts
India’s population India is now the most populous country in the world, having overtaken China in population, with 1,428.6 million people.
Age distribution 68% of India’s population belongs to the 15-64 years category, and 26% in the 10-24 years group, making India one of the youngest countries in the world.
Fertility rate National Family Health 5 Survey (2019-21) found that India attained a Total Fertility Rate of 2.0 for the first time, less than the replacement level of 2.1, falling from 2.2 in NFHS 4 (2015-16).
Life expectancy Life expectancy for men in India is 71 years, the same as the global life expectancy, while it is marginally lower for women at 74 years.
Population growth India’s population growth rate has decreased from 2.3% in 1972 to less than 1% now.
Demographic dividend With 68% of its population as youth, and working population, India could have one of the largest workforces in the world, giving it a global advantage.

 

Way forward

The UNFPA report strongly recommended that governments introduce policies with gender equality and rights at their heart to address changing demographics. These recommendations include:

  • Parental leave programs: Introducing parental leave programs that provide paid leave to both mothers and fathers after the birth or adoption of a child. This can help promote gender equality in the workplace and support families in raising children.
  • Child tax credits: Providing tax credits or financial support to families with children to help them meet the costs of raising children. This can help address child poverty and support families in providing for their children’s basic needs.
  • Policies to promote gender equality at workplace: Implementing policies and practices that promote gender equality in the workplace, such as equal pay for equal work, flexible work arrangements, and anti-discrimination policies.
  • Universal access to sexual and reproductive health and rights: Ensuring that all people have access to comprehensive sexual and reproductive health services, including family planning, maternal health services, etc. This can help prevent unintended pregnancies, reduce maternal mortality, and promote the health and well-being of individuals and families.

 

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Healthcare: Need For Compassionate Leadership

Note4Students

From UPSC perspective, the following things are important :

Prelims level: NA

Mains level: Role of compassion in healthcare

Central Idea

  • India’s rapid strides in health and healthcare with the help of a digital boom and the Ayushman Bharat Digital Mission, and the need for compassionate leadership to ensure respectful healthcare.

India’s healthcare sector

  • India’s healthcare sector has shown improvement in multiple metrics due to the push for healthcare digitization, infrastructure, coverage, and other inputs.
  • However, healthcare is not just about the treatment of diseases or the availability of infrastructure but also about the overall wellness of the person.
  • Respectful healthcare that is available, affordable, accessible, and compassionate is a determinant of the quality of care.

Importance of Compassionate leadership

  • Respectful and compassionate healthcare is essential: Healthcare is a perpetually evolving, stressful, and high-risk industry that puts a vast burden on healthcare providers. It is essential to navigate and manage the situation compassionately to deliver respectful care.
  • Compassion is a beating heart if healthcare: Compassionate leadership is required to build this type of healthcare system, as it is the quiet, beating heart of the entire healthcare system.

Curriculum for compassionate healthcare

  • Compassionate curriculum is very necessary: To integrate compassion into the healthcare system at every stage, it is necessary to build a curriculum and deliver it to those responsible for administering healthcare respectfully.
  • Curriculum with Dalai Lama’s vision rolled out in Bihar: An eight-stage curriculum, developed by Emory University, that furthers the Dalai Lama’s vision of educating both heart and mind for the greater good of humanity is being rolled out in Bihar.
  • Impact: To date, 1,200 healthcare providers across 20 districts have been impacted by the vital components of the cognitive-based compassion training, creating compassionate leaders at every level.

Institutionalizing compassionate healthcare

  • Institutionalizing will bring in real change: While the curriculum is a quantum leap towards building compassionate leadership, institutionalizing it will bring in real change.
  • Adopting at each level: Every academic institution and every department mandated with the responsibility to deliver health-related learning should develop and adopt compassion-based curricula.
  • Building capacity: State and regional health institutions must also be built with the capacity to deliver compassionate leadership. Partnerships with established academia and development sector organizations can enable the organizing of master coaches and master facilitators, thereby creating public goods that can be delivered by all.

Strengthening internal systems

  • Making compassion intrinsic to the ethos: All healthcare providers are expected to carry out a wide range of tasks within the system, which often leads to burnout and impacts patient experience adversely. It is vital to strengthen systems internally to make respect and compassion intrinsic to the ethos.
  • Building a network: Building a network of compassionate practitioners in every state, district and block hospital is crucial to fan the winds of change by starting with self-compassion first and then moving to compassion for others.
  • Valuing and measuring organizational culture: Valuing and measuring organizational culture is just as critical as patient outcomes. Developing sound metrics to measure culture and employee satisfaction, self-compassion, and compassion for the team assumes greater significance to building an institution whose foundation is compassion.

Conclusion

  • Respectful healthcare is already mentioned in the National Health Mission (NHM) guidelines, and such guidelines need to be the warp and weft of every policy and every guideline developed by public health authorities to improve patient experience. Compassionate leadership can truly realize India’s historically known values of compassion and bring alive the words of Hippocrates, the father of medicine, “Wherever the art of medicine is loved, there is also a love of humanity”.

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Sodium Intake Target: Challenge of Cardiovascular Disease and Hypertension

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Related facts

Mains level: Sodium Intake, and burden of Hypertension and cardio vascular diseases

Sodium

Central Idea

  • The WHO recently published the ‘Global Report on Sodium Intake Reduction’ which sheds light on the progress of its 194 member states towards reducing population sodium intake by 30% by 2025. Regrettably, progress has been lethargic, with only a few countries making considerable headway towards the objective. Consequently, there is a proposal to extend the deadline to 2030.

The target of reducing population sodium intake

  • The target of reducing population sodium intake by 30% by 2025 was set by the World Health Organization (WHO) in its Global Action Plan for the Prevention and Control of Noncommunicable Diseases in 2013.
  • The plan aims to reduce premature deaths from non-communicable diseases, including cardiovascular diseases, by 25% by 2025, and to achieve a 30% reduction in the mean population intake of salt/sodium.
  • The target of reducing population sodium intake is aimed at reducing the burden of hypertension, which is a major risk factor for cardiovascular disease.

Why reducing sodium intake is essential for India?

  • Reduced sodium intake and decreased blood pressure: There is a strong correlation between reduced sodium intake and decreased blood pressure, leading to a decrease in stroke and myocardial infarction incidence. Lowering sodium intake by 1 gram per day leads to a 5 mm Hg reduction in systolic blood pressure, as per a study in The BMJ.
  • Cardiovascular disease: Elevated BP is a critical risk factor for cardiovascular disease, which is the leading cause of mortality worldwide. It contributed to 54% of strokes and 47% of coronary heart diseases globally in 2001.
  • Economic impact of cardiovascular disease on LMICs: Cardiovascular disease has a staggering economic impact on LMICs, estimated at $3.7 trillion between 2011 and 2025 due to premature mortality and disability. This represents 2% of the GDP of LMICs. The Indian economy alone faces losses surpassing $2 trillion between 2012 and 2030 due to cardiovascular disease, highlighting the need for effective interventions to mitigate the economic and health consequences of the disease in LMICs.

Sodium

How cardiovascular disease and hypertension pose significant challenges in India?

  1. Cardiovascular diseases as primary cause of mortality and morbidity:
  • As per data from the Registrar General of India, WHO, and the Global Burden of Disease Study, cardiovascular diseases have emerged as the primary cause of mortality and morbidity. Data from the Registrar General of India, WHO, and the Global Burden of Disease Study
  • Age-adjusted cardiovascular disease mortality rate increased by 31% in the last 25 years
  • Hypertension as leading risk factor for such diseases in India
  1. Prevalence of hypertension in India:
  • More prevalent among men aged 15 and above compared to women
  • More common in southern states, particularly Kerala, while Punjab and Uttarakhand in the north also report high incidence rates
  1. Pre-hypertensive population in India
  • Defined by systolic blood pressure levels of 120-139 mmHg or diastolic blood pressure levels of 80-89 mmHg
  • 5% of women and 49.2% of men at the national level
  • Significant risks of cardiovascular disease, stroke, and premature mortality for Indians with BP readings between 130 and 139/80-89 mmHg
  • Many Indians classified as pre-hypertensive are now included in the newly defined stage-I hypertension by the American guidelines.
  1. Circulatory system diseases: The 2020 Report on Medical Certification of the Cause of Death shows that circulatory system diseases account for 32.1% of all documented deaths, with hypertension being a major risk factor.

Global Efforts to Reduce Sodium Intake

  • The WHO aims to reduce population sodium intake by 30% by 2025
  • Only a few countries have made considerable progress towards the objective
  • India’s score of 2 on the WHO sodium score signifies the need for more rigorous efforts to address the health concern

Sodium

Government Initiatives

  • Voluntary programmes: The Union government has initiated several voluntary programmes aimed at encouraging Indians to decrease their sodium consumption
  • Eat Right India: The FSSAI has implemented the Eat Right India movement, which strives to transform the nation’s food system to ensure secure, healthy, and sustainable nutrition for all citizens
  • Aaj Se Thoda Kam: FSSAI launched a social media campaign called Aaj Se Thoda Kam.

Urgent Need for a Comprehensive National Strategy

  • Despite of awareness efforts, the average Indian’s sodium intake remains alarmingly high. Evidence shows an average daily consumption of approximately 11 grams.
  • India needs a comprehensive national strategy to curb salt consumption
  • Collaboration between State and Union governments is essential to combat hypertension, often caused by excessive sodium intake

Conclusion

  • The excessive consumption of salt can lead to severe health consequences, and India has a pressing need to reduce its sodium intake. While the government has initiated several voluntary programs, these have fallen short of the goal. India needs a comprehensive national strategy, engaging consumers, industry, and the government, to curb salt consumption. Collaboration between State and Union governments is essential to combat hypertension, often caused by excessive sodium intake.

Mains Question

Q. Reducing population sodium intake is a critical step towards preventing and controlling non- cardiovascular diseases and hypertension. Comment.

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Autism Spectrum Disorders: Prevalence in India and Way Ahead

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Autism

Mains level: Autism spectrum disorders, Prevalence in India and way ahead

Central Idea

  • In India, the prevalence of autism spectrum disorders (ASD) is a widely debated issue due to a lack of systematic estimates. Most estimates have been derived from studies based on school children, revealing that over one crore Indians may be on the autism spectrum. However, there are notable cultural differences in diagnosing autism between countries, which highlights the need to assess the prevalence of autism spectrum disorders specifically in the Indian context.

What is Autism?

  • Spectrum disorder: Autism, also known as Autism Spectrum Disorder (ASD), is a neurodevelopmental disorder that affects communication, social interaction, and behaviour. It is called a spectrum disorder because the symptoms and severity can vary widely between individuals.
  • Common symptoms: Some common symptoms of autism include difficulty with social interactions, such as maintaining eye contact or understanding nonverbal cues, delayed speech and language development, repetitive behaviors, and sensory sensitivities.
  • Cause: Autism is believed to be caused by a combination of genetic and environmental factors, but the exact cause is not yet fully understood.
  • Cure: There is currently no cure for autism, but early interventions and therapies can help individuals with autism lead fulfilling and independent lives.

Prevalence of Autism in India

  • Lack of systematic estimates: Autism is a global issue and affects individuals of all cultures, ethnicities, and socioeconomic backgrounds. However, there is a lack of systematic estimates of autism prevalence in India.
  • Methos failed: Researchers have attempted to estimate prevalence through government hospitals, but this method failed due to the absence of central medical registries.
  • Conservative estimates: As a result, prevalence was estimated through school-based assessments. According to conservative estimates, well over one crore Indians are on the autism spectrum. This highlights the need for further research and attention to address the prevalence of ASD in India.
  • Cultural Differences and Diagnosis of Autism:
  • Notable cultural differences exist in the diagnosis of autism spectrum disorder. In the US and UK, the majority of children with autism spectrum diagnosis are verbal, with average or higher IQ, and attending mainstream schools.
  • However, in India, a significant majority of children with a clinical diagnosis of autism also have intellectual disability and limited verbal ability. This difference is driven by sociological factors, such as access to appropriate clinical expertise, provisions for inclusion in mainstream schools, and availability of medical insurance coverage.

Challenges in Assessing Autism

  • Assessment tools: Assessment of autism spectrum disorder is primarily behavioral, and most widely used autism assessment tools are not available in Indian languages.
  • Indigenous autism assessment tools challenges: There has been a rise in the development of indigenous autism assessment tools. Despite the development of these tools, it can be challenging to compare across different assessment measures.

Demand and Supply in India

  • Shortage of mental health professionals: Most autism assessment tools need to be administered by specialist mental health professionals. However, there is a significant shortage of mental health professionals in India, with less than 10,000 psychiatrists, a majority of whom are concentrated in big cities.
  • Delay is costly: Delay in interventions can be costly for neurodevelopmental conditions such as autism.
  • Demand and supply gap need to be met: This gap between demand and supply cannot be met directly by specialists alone, and parallel efforts to widen the reach of diagnostic and intervention services through involving non-specialists is required. Emerging evidence suggests the feasibility of involving non-specialists in autism identification and intervention through digital technology and training programs.

Way ahead: Need for an All-India Program

  • National program on autism: The need of the hour is to develop a national program on autism in India that links researchers, clinicians, service providers to the end-users in the autism community.
  • Essential components: This program needs to have three essential components that are joined up: assessment, intervention, and awareness.
  • Assessment: Research is needed to develop appropriate assessments and design efficient implementation pathways.
  • Intervention: Clinical and support service workforce needs to be expanded by training non-specialists such that a stepped-care model can be rolled out effectively across the nation.
  • Awareness: Large-scale initiatives need to be launched to build public awareness that can reduce the stigma associated with autism and related conditions.

Conclusion

  • There are challenges in diagnosing and assessing autism in India which highlights the need for a comprehensive and coordinated effort to address them. By expanding the clinical and support service workforce, training non-specialists, and developing appropriate assessments and interventions, India can improve outcomes for those on the autism spectrum and reduce the stigma associated with the condition. This national program needs to be informed by consultation with different stakeholders, with a primary focus on end-users within the Indian autism community.

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Duty exemption for drugs for Rare Diseases

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Rare Diseases

Mains level: Not Much

rare

Central idea: The Centre has exempted all drugs and food for special medical purposes, imported for personal use, for the treatment of rare diseases listed under the National Policy for Rare Diseases 2021 from basic customs duty.

What are Rare Diseases?

  • Rare diseases are those medical conditions that affect a small percentage of the population.
  • In India, a disease is considered rare if it affects less than 1 in 2,000 people.
  • These diseases are often genetic and are chronic, degenerative, and life-threatening.
  • There are over 7,000 known rare diseases, and it is estimated that about 70 million people in India are affected by them.
  • Many of these diseases do not have a cure, and the treatment can be expensive and difficult to access.

Need for duty exemption

  • This decision has been taken to help reduce the burden of the cost of treatment for patients and families.
  • The drugs and food required for the treatment of these rare diseases are often expensive and need to be imported.
  • This exemption will result in substantial cost savings and provide much-needed relief to patients with rare diseases.

Key medicines under this exemption

  • The central government has fully exempted Pembrolizumab (Keytruda), a drug used in the treatment of various types of cancer, from basic customs duty.
  • Previously, the GST rate for Keytruda was cut to 5 per cent from 12 per cent in a meeting held in September 2021 by the GST Council.
  • Life-saving drugs Zolgensma and Viltepso used in the treatment of spinal muscular atrophy were exempted from GST when imported for personal use.

How the new duty exemption works?

  • The exemption has been granted by the Central Board of Indirect Taxes and Customs (CBIC) by substituting “Drugs, Medicines or Food for Special Medical Purposes (FSMP)” instead of “drugs or medicines”.
  • To avail of this exemption, the individual importer has to produce a certificate from the central or state director health services or district medical officer/civil surgeon of the district.

How are life-saving medicines taxed?

  • Drugs/medicines generally attract basic customs duty of 10 per cent, while some categories of lifesaving drugs/vaccines attract a concessional rate of 5 per cent or nil.
  • In its meeting in September 2021, the GST Council had reduced tax rates for several life-saving drugs.

 


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Healthcare: Remarkable Progress But The Gaps Needs to be Addressed

Note4Students

From UPSC perspective, the following things are important :

Prelims level: NA

Mains level: Healthcare progress and challenges

Central Idea

  • The Indian healthcare system has overcome many challenges and has made significant progress, but there are still many tough health challenges that need to be addressed. There is need to bridge the gap between the services available in metropolitan and Tier-II and Tier-III cities, provide healthcare insurance to the unorganised middle class, and use Artificial Intelligence and digital technology to improve healthcare services.

Overcoming past challenges

  • The Indian healthcare system has overcome seemingly insurmountable problems, including high maternal and infant mortality rates, and low hospital delivery rates.
  • The National Family Health Survey (NFHS-5) results show that even in the so-called BIMARU states, hospital deliveries have soared to 89 per cent.

Current Health Challenges

  • Five interrelated challenges: The current macro picture shows at least five interrelated challenges that are pervading the population, including non-communicable diseases (NCDs), obesity, and chronic respiratory diseases.
  • NCDs: The proportion of deaths due to NCDs has increased from around 38 per cent in 1990 to 62 per cent in 2016.
  • Obesity: Obesity has increased from 19 per cent to 23 per cent between NFHS-4 and NFHS-5. Awareness about leading healthy lives will save millions from illness and decelerate premature death.

Current state of healthcare in India

  1. Infrastructure:
  • The state of infrastructure matters. Since 2018, governments at the Centre as well as the state have been trying to bolster primary healthcare by establishing health and wellness centres.
  • But there are still huge variations between states, and some states have better arrangements than others. States must step up efforts to improve infrastructure in the healthcare sector.
  1. Bridging the gap in hospital services:
  • In urban areas, the challenge is to bridge the gap in hospital services between large urban agglomerations and Tier-II and Tier-III cities.
  • Large hospital chains provide only 4-5 per cent of the beds in the private sector.
  • Standalone hospitals and nursing homes provide 95 per cent of private hospital beds but are unable to provide multi-specialty, leave alone tertiary and quaternary care.
  • The gaps between services available in the metros and big cities and in districts must be bridged.
  1. Health Insurance Coverage:
  • Low health insurance penetration and the very high personal outgo on healthcare remain a challenge.
  • But over the past three years, more than four crore Indians have bought health insurance.
  • From 2018, the Ayushman Bharat insurance scheme for 10 crore poor families has been undertaken to provide insurance against hospitalisation for up to Rs 5 lakh per year per family.
  • Nearly 74 per cent of Indians are either covered or eligible for health insurance coverage.
  1. Use of Artificial Intelligence and digital technology:
  • An emerging concern is the use of Artificial Intelligence (AI) and digital technology to improve healthcare services.
  • Surgery assisted by robots, the use of genetic codes, clinical decision support systems, and telemedicine can help in making healthcare more accessible and efficient.

Conclusion

  • India has shown how the impossible can be achieved, but the healthcare system needs to overcome various challenges to fully redeem its advantage of having the youngest population. The government needs to step up efforts in improving infrastructure, bridging the gap in hospital services, and providing health insurance coverage for the unorganized middle class. It is also essential to regulate the use of AI and digital technology in the healthcare sector to ensure accountability and prevent malpractice.

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Healthcare: Public Health and The Insurance Funding

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Various Insurance Schemes

Mains level: Insurance based healthcare funding, benefits and drawbacks

Central Idea

  • The Tamil Nadu public health model has achieved success in improving healthcare outcomes and maintaining equity in healthcare delivery. However, the shift in healthcare funding to insurance companies has brought both benefits and drawbacks to the public healthcare system.

The key features of the Tamil Nadu public health model

  • Primary Healthcare: The Tamil Nadu public health model is based on a strong emphasis on primary healthcare, which is the first point of contact for patients seeking medical attention. Primary healthcare centres provide basic healthcare services and preventive care, which are critical to reducing the burden of disease.
  • Public Health Infrastructure: The state has a well-established public health infrastructure, including a network of primary healthcare centres, secondary and tertiary care hospitals, and medical colleges. The state government has also invested in health infrastructure, including sanitation facilities, water supply, and waste management.
  • Health Insurance: The Tamil Nadu government has implemented a comprehensive health insurance scheme, the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS), which provides free healthcare services to families living below the poverty line and low-income groups.
  • Human Resource Development: The state government has also focused on developing human resources in healthcare. It has set up a large number of nursing and paramedical institutions to train healthcare professionals.
  • Health Awareness: The Tamil Nadu government has launched various health awareness campaigns to educate people about health issues, including communicable and non-communicable diseases. The government has also launched campaigns to promote healthy lifestyle choices, such as a balanced diet and regular exercise.
  • Partnership with NGOs: The government has partnered with non-governmental organizations (NGOs) to implement various health programs. These partnerships have helped in the effective delivery of healthcare services in remote and rural areas of the state.
  • Innovations: Tamil Nadu has implemented several innovative approaches in healthcare, such as telemedicine, which enables patients to receive medical consultation and treatment remotely using technology. The state has also established mobile clinics to provide healthcare services to people living in remote areas.

Benefits of Decentralization

  • Improved access to healthcare: Decentralization can help to improve access to healthcare services, particularly in rural or remote areas. By empowering local communities and healthcare providers to make decisions about healthcare delivery, services can be tailored to meet the specific needs of the population.
  • Better quality of care: Decentralization can lead to better quality of care by enabling healthcare providers to respond more quickly and effectively to the needs of their patients. It can also promote innovation and experimentation in healthcare delivery, leading to new and improved approaches to patient care.
  • Increased accountability: Decentralization can increase accountability in healthcare delivery by empowering local communities and healthcare providers to monitor and evaluate the quality of care. This can help to identify and address problems in healthcare delivery, leading to improved outcomes for patients.
  • Cost savings: Decentralization can lead to cost savings in healthcare delivery by reducing the administrative costs associated with centralized decision-making and management. It can also promote greater efficiency in healthcare delivery, leading to reduced waste and duplication of services.

Insurance Funding in healthcare

  • Insurance funding in healthcare refers to the use of insurance mechanisms to finance healthcare services. This involves pooling financial resources from individuals or groups through insurance schemes, which are then used to pay for healthcare services.
  • Insurance funding can help to mitigate the financial risks associated with healthcare, and ensure that individuals have access to the care they need without incurring excessive costs.

Drawbacks of Insurance Funding

  • Shifted focus: The focus on indemnity and negotiations with insurance companies has shifted the focus of hospitals from patient care to claiming money.
  • Compromised quality of service: The appointment of contractual employees with meager pay has created a divide between permanent high-paid staff and temporary low-salaried staff, leading to a compromise in the quality of service.

Facts for prelims

Type of Insurance Funding Description
Private health insurance Purchased by individuals or employers to cover healthcare costs. Coverage, cost, and benefits vary widely and may be offered by commercial insurers, nonprofit organizations, or government programs
Public health insurance Provided by government-run programs, typically funded through taxes or other government revenues. Coverage is provided to eligible individuals based on criteria such as age, income, or medical need. Pradhan Mantri Jan Arogya Yojana (PMJAY) is a government-funded health insurance program that provides free health coverage to economically disadvantaged families across India.
Social health insurance A hybrid model that combines elements of private and public insurance. Individuals and employers contribute to a national insurance fund that is used to pay for healthcare services, typically managed by a government agency but delivered by private providers
Employer-sponsored insurance Private insurance provided by employers to their employees, often mandatory in many countries. Employers are required to provide a certain level of coverage to their employees.

Conclusion

  • While insurance funding has brought benefits, it has also created challenges, including the erosion of compassion among health professionals and a diversion of funds from public to private hospitals. It is necessary to strike a balance between decentralization, insurance funding, and preserving the fundamental principles of equity, compassion, and excellence in care to maintain the success of Tamil Nadu’s public healthcare system.

Mains Question

Q. Highlight the benefits of decentralization in healthcare delivery. Analyse the benefits and drawbacks of insurance funding in India?


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ICMR releases Ethical Guidelines for AI usage in Healthcare

Note4Students

From UPSC perspective, the following things are important :

Prelims level: AI in healthcare

Mains level: Read the attached story

health

The Indian Council of Medical Research (ICMR) has recently released the first-ever set of ethical guidelines for the application of artificial intelligence (AI) in biomedical research and healthcare.

Ethical Guidelines for AI usage in Healthcare

  • The guidelines aim to create “an ethics framework which can assist in the development, deployment, and adoption of AI-based solutions” in specific fields.
  • Through this initiative, the ICMR aims to make “AI-assisted platforms available for the benefit of the largest section of common people with safety and highest precision possible”.
  • It seeks to address emerging ethical challenges when it comes to AI in biomedical research and healthcare delivery.

Key features

  • Effective and safe development, deployment, and adoption of AI-based technologies: The guidelines provide an ethical framework that can assist in the development, deployment, and adoption of AI-based solutions in healthcare and biomedical research.
  • Accountability in case of errors: As AI technologies are further developed and applied in clinical decision making, the guidelines call for processes that discuss accountability in case of errors for safeguarding and protection.
  • Patient-centric ethical principles: The guidelines outline 10 key patient-centric ethical principles for AI application in the health sector, including accountability and liability, autonomy, data privacy, collaboration, risk minimisation and safety, accessibility and equity, optimisation of data quality, non-discrimination and fairness, validity and trustworthiness.
  • Human oversight: The autonomy principle ensures human oversight of the functioning and performance of the AI system.
  • Consent and informed decision making: The guidelines call for the attainment of consent of the patient who must also be informed of the physical, psychological and social risks involved before initiating any process.
  • Safety and risk minimisation: The safety and risk minimisation principle is aimed at preventing “unintended or deliberate misuse”, anonymised data delinked from global technology to avoid cyber attacks, and a favourable benefit-risk assessment by an ethical committee among a host of other areas.
  • Accessibility, equity and inclusiveness: The guidelines acknowledge that the deployment of AI technology assumes widespread availability of appropriate infrastructure and thus aims to bridge the digital divide.
  • Relevant stakeholder involvement: The guidelines outline a brief for relevant stakeholders including researchers, clinicians/hospitals/public health system, patients, ethics committee, government regulators, and the industry.
  • Standard practices: The guidelines call for each step of the development process to follow standard practices to make the AI-based solutions technically sound, ethically justified, and applicable to a large number of individuals with equity and fairness.
  • Ethical review process: The ethical review process for AI in health comes under the domain of the ethics committee which assesses several factors including data source, quality, safety, anonymization, and/or data piracy, data selection biases, participant protection, payment of compensation, possibility of stigmatisation among others.

Policy moves for streamlining AI in Healthcare

  • India already offers streamlining of AI technologies in various sectors, including healthcare, through the National Health Policy (2017), National Digital Health Blueprint (NDHB 2019), and Digital Information Security in Healthcare Act (2018) proposed by the Health Ministry.
  • These initiatives pave the way for the establishment of the National Data Health Authority and other health information exchanges.

Potential applications of AI in healthcare

Artificial Intelligence (AI) has revolutionized the healthcare industry by enabling various applications. These applications include:

  • Diagnosis and screening: AI can be used to identify diseases from medical images like X-rays, CT scans, and MRIs.
  • Therapeutics: AI can assist in the development of personalised medicines by analyzing a patient’s genetic makeup.
  • Preventive treatments: AI can predict the risk of developing a disease, helping healthcare professionals to take preventive measures.
  • Clinical decision-making: AI can analyze large amounts of data to assist healthcare professionals in making treatment decisions.
  • Public health surveillance: AI can be used to monitor disease outbreaks and inform public health policies.
  • Complex data analysis: AI can analyze large amounts of data from multiple sources to identify patterns and inform healthcare decision-making.
  • Predicting disease outcomes: AI can predict disease outcomes based on patient data, enabling early
  • Behavioural and mental healthcare: AI can help diagnose and treat mental health conditions.
  • Health management systems: AI can assist in managing patient records, appointment scheduling and reminders, and medication management.

Various challenges for imbibing

  • Data privacy and security: With the use of AI in healthcare, there is a significant amount of personal and sensitive data is collected. This data needs to be kept secure and protected from potential cyber-attacks.
  • Regulatory and ethical issues: AI technology is still in its early stages of development and there are no clear guidelines or regulations in place for its use in healthcare. There are also ethical considerations, such as accountability, transparency, and bias that need to be addressed.
  • High cost involved: The implementation of AI in healthcare requires significant investment in terms of infrastructure, software, and training. This cost can be a major challenge for healthcare organizations, especially in developing countries.
  • Integration with existing systems: AI systems need to be integrated with existing healthcare systems and processes. This can be challenging, especially in cases where the existing systems are outdated or incompatible with AI technology.
  • Lack of trust and acceptance: AI technology is still relatively new in healthcare and there is a lack of trust and acceptance among healthcare professionals and patients. This can be a major hurdle in the widespread adoption of AI in healthcare.

Threats posed by AI to healthcare

  • Data privacy and security: The use of AI in healthcare requires the collection and analysis of vast amounts of personal health data, which could be at risk of being stolen or misused.
  • Bias and discrimination: There is a risk that AI algorithms could perpetuate existing biases and inequalities in healthcare, such as racial or gender bias.
  • Lack of transparency: Some AI models are complex and difficult to understand, which can make it difficult to explain the reasoning behind a particular decision.
  • Medical errors: AI systems can make errors if they are trained on biased or incomplete data, or if they are used inappropriately.
  • Ethical concerns: There are several ethical concerns associated with the use of AI in healthcare, including the potential for AI to replace human doctors, the impact on patient autonomy, and the implications for informed consent.

Way forward

  • Develop a national AI strategy for healthcare: This strategy should include policies for data sharing, privacy, and security, as well as guidelines for the ethical and responsible use of AI.
  • Invest in AI research and development: The government should invest in research and development of AI technologies that can help address the challenges in healthcare.
  • Promote collaboration between stakeholders: Collaboration between stakeholders such as healthcare providers, researchers, government agencies, and industry can help accelerate the development and adoption of AI technologies in healthcare.
  • Train healthcare professionals in AI: The government can work with academic institutions and the industry to create training programs and certifications for healthcare professionals.
  • Address regulatory challenges: The government should work to address regulatory challenges related to the use of AI in healthcare.
  • Focus on affordability and accessibility: This can be achieved by promoting innovation, encouraging competition, and ensuring that AI technologies are integrated into existing healthcare infrastructure.

 

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Rajasthan becomes first state to guarantee Right to Health

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Right to Health

Mains level: Read the attached story

health

The Rajasthan Assembly passed the Right to Health (RTH), even as doctors continued their protest against the Bill, demanding its complete withdrawal.

Right to Health (RTH): A conceptual insight

  • RTH is a fundamental human right that guarantees everyone the right to enjoy the highest attainable standard of physical and mental health.
  • It is recognized as a crucial element of the right to an adequate standard of living and is enshrined in international human rights law.

Scope of RTH

  • RTH covers various health-related issues, including-
  1. Access to healthcare services, clean water and sanitation, adequate nutrition, healthy living and working conditions, health education, and disease prevention.
  2. Accessible, affordable, and quality healthcare services,
  3. Eliminating barriers to healthcare access
  4. Informed consent to medical treatment and accessing information about their health.

What is the Rajasthan Right to Health Bill?

  • Free treatment: RTH gives every resident of the state the right to avail free Out Patient Department (OPD) services and In Patient Department (IPD) services at all public health facilities and select private facilities.
  • Wider scope of healthcare: Free healthcare services will include consultation, drugs, diagnostics, emergency transport, procedures, and emergency care. However, there are conditions specified in the rules that will be formulated.
  • Free emergency treatment: Residents are entitled to emergency treatment and care without prepayment of fees or charges.
  • No delay in treatment: Hospitals cannot delay treatment on grounds of police clearance in medico-legal cases.
  • State reimbursement of charges: After emergency care and stabilisation, if patients do not pay requisite charges, healthcare providers can receive proper reimbursement from the state government.

Existing schemes in Rajasthan

  • The flagship Chiranjeevi Health Insurance Scheme provides free treatment up to Rs 10 lakh, which has been increased to Rs 25 lakh in the latest budget.
  • The Rajasthan Government Health Scheme covers government employees, ministers, current and former MLAs, etc.
  • The Nishulk Nirogi Rajasthan scheme provides free OPD and IPD services in government hospitals and covers about 1,600 medicines, 928 surgicals, and 185 sutures.
  • The Free Test scheme provides up to 90 free tests in government hospitals and has benefited 2.93 crore persons between March-December 2022.

Need for the RTH Scheme

  • The state prioritizes healthcare and wants Rajasthan to be a great example of good health.
  • The Health Minister has received many complaints about private hospitals asking for money from patients who have the Chiranjeevi card.
  • So, they are bringing in a new law to stop this.
  • The new law will make sure that future governments follow it and provide free healthcare to everyone.

Controversy with the RTH Law: Emergency Care Provisions

  • Emergency care was a contentious issue in the RTH.
  • The clause states that people have the right to emergency treatment and care for accidental emergency, emergency due to snake bite/animal bite and any other emergency decided by the State Health Authority under prescribed emergency circumstances.
  • Emergency treatment and care can be availed without prepayment of requisite fee or charges.
  • Public or private health institutions qualified to provide such care or treatment according to their level of health care can offer emergency care.

Issues raised by healthcare professionals

  • Existing burden of schemes: Doctors are protesting against the RTH because they question the need for it when there are already schemes like Chiranjeevi that cover most of the population.
  • Specialization concerns: They are also objecting to certain clauses, such as defining “emergency” and being compelled to treat patients outside their specialty as part of an emergency.
  • Unnecessary obligations: The Bill empowers patients to choose the source of obtaining medicines or tests at all healthcare establishments, which means that hospitals cannot insist on in-house medicines or tests.

Way forward

  • Given the contentious nature of the Bill, it is important for all stakeholders to come to the table and engage in constructive dialogue to resolve the issues at hand.
  • It should involve liaison between government, doctors, patient advocacy groups, and other relevant stakeholders to discuss the concerns raised by all parties and identify potential solutions.
  • This could be followed by a revision of the Bill, incorporating feedback and suggestions from all stakeholders, and a renewed effort to build consensus and support for the legislation.
  • Additionally, greater efforts could be made to improve transparency and accountability in the healthcare system, with a focus on educating patients about their rights.

 


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Rising Cancer Cases in India And Economic Burden

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Cancer and Innovative Treatment and therapies

Mains level: Rising Cancer and economic burden

Central Idea

  • Cancer cases in India are predicted to cross the 15 lakh mark by 2025, highlighting concerns about the economic burden of expensive cancer treatments and the accessibility of affordable healthcare for patients.

Cancer

  • Cancer is a group of diseases that arise when cells in the body begin to grow and divide uncontrollably, leading to the formation of tumors.
  • Normally, cells in the body grow, divide, and die in an orderly fashion, but in cancer, this process goes awry, leading to the accumulation of abnormal cells that can form a mass or tumor.
  • There are many different types of cancer, which can affect any part of the body. Some cancers, such as leukemia, do not form tumors but still involve the uncontrolled growth of abnormal cells.
  • Symptoms of cancer can vary depending on the type and location of the cancer, but common signs include unexplained weight loss, fatigue, pain, and changes in the skin or the appearance of a lump or mass.

Economic Burden of Cancer Treatment

  1. Inaccessible and Increasing Costs:
  • The average medical expenditure per hospitalization case for cancer treatment was ₹68,259 in urban areas, according to the NSS 2017-18 report.
  • A Parliamentary Standing Committee report expressed concern about the inaccessible and increasing cost of cancer treatment.
  1. Regulatory Challenges:
  • While anti-cancer medicine costs can be regulated, the cost of radiotherapy cannot, as it has not been declared an essential service.
  • Insurance Coverage and Out-of-Pocket Expenses.
  1. Impact on Patients:
  • Cancer often strikes around the retirement age, leading to mounting debt burdens.
  • The average hospital stay for 14.1% of cancer patients is more than 30 days, further increasing bills.

Insurance Coverage and Out-of-Pocket Expenses

  1. Poor Insurance Penetration: More than 80% of hospital bills are paid out of pocket, as per the NSS 2017-18 report.
  2. Ayushman Bharat Limitations: The Committee observed that the Ayushman Bharat insurance scheme launched in 2018 does not cover entire prescriptions, latest cancer therapies, or many diagnostic tests.
  3. State-Specific Insurance Schemes: The Committee suggested a convergence of State and Central schemes, as some State-specific insurance schemes have been highly beneficial.

State-wise Variation in Cancer Treatment Expenditure

  • State-wise average medical expenditure per hospitalization case for cancer treatment in government hospitals varies, with the lowest in Tamil Nadu and Telangana, and the highest in northern and north-eastern India.

Facts for Prelims: CAR T-cell therapy

  • Unlike chemotherapy or immunotherapy, which require mass-produced injectable or oral medication, CAR T-cell therapies use a patient’s own cells.
  • The treatment involves modifying a patient’s own T-cells, which are a type of immune cell, in a laboratory to target and attack cancer cells.
  • CAR stands for chimeric antigen receptor, which refers to the genetically engineered receptor that is added to the patient’s T-cells.
  • The patient’s T-cells are collected and genetically modified in a laboratory to express the CAR.
  • The modified T-cells are then infused back into the patient’s body, where they can seek out and destroy cancer cells that express the antigen targeted by the CAR.
  • The cells are even more specific than targeted agents and directly activate the patient’s immune system against cancer, making the treatment more clinically effective.
  • This is why they’re called living drugs.
  • CAR T-cell therapy has shown promising results in treating certain types of blood cancers, including leukemia and lymphoma.

Conclusion

  • The rising number of cancer cases in India underscores the need to address the economic burden of expensive cancer treatments and improve the accessibility of affordable healthcare for patients. Converging State and Central insurance schemes, expanding insurance coverage, and exploring ways to regulate treatment costs are essential steps to ensure that patients can access life-saving treatments without facing insurmountable financial challenges.

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Universal Health Coverage (UHC) Must be Affordable to All

Note4Students

From UPSC perspective, the following things are important :

Prelims level: NA

Mains level: Primary Health care and Universal Health care

Central Idea

  • The Universal Health Coverage (UHC) and its implementation in India raises the question of whether we believe in health as a basic human right, which India’s Constitution guarantees under the right to life. The UHC should encompass primary, secondary, and tertiary care for all who need it at an affordable cost without discrimination.

The Definition of Health

  • The definition of health according to the World Health Organization (WHO), which includes mental and social well-being and happiness beyond physical fitness, and an absence of disease and disability.
  • We cannot achieve health in its wider definition without addressing health determinants, which necessitates an intersectoral convergence beyond medical and health departments.

Difference between Primary health care (PHC) and Universal health care (UHC)

  • The main difference between PHC and UHC is that PHC is a level of care within the health care system, while UHC is a broader goal of ensuring access to health care for all individuals.
  • PHC is typically provided at the primary care level, while UHC includes all levels of care, from primary to secondary and tertiary care.
  • PHC is focused on basic health care services and health promotion, while UHC aims to provide comprehensive health care services to all individuals.

Health for All by 2000

  • The slogan Health for All by 2000 proposed by Halfdan Mahler and endorsed by the World Health Assembly in 1977. It argues that universal health care/coverage (UHC) was implied as early as 1977.
  • India committed itself to the ‘Health for All’ goal by 2000 through its National Health Policy 1983.

International Conference on PHC

  • The International Conference on Primary Health Care, at Alma Ata, 1978, which listed eight components of minimum care for all citizens.
  • Components included: It mandated all health promotion activities and the prevention of diseases, including vaccinations and treatment of minor illnesses and accidents, to be free for all using government resources, especially for the poor.
  • Components excluded: Chronic diseases, including mental illnesses, and their investigations and treatment were almost excluded from primary health care. When it came to secondary and tertiary care, it was left to the individual to seek it from a limited number of public hospitals or from the private sector by paying from their own pockets.

Concerns around The Astana Declaration

  • The Astana declaration of 2018, which calls for partnership with the private sector. However the commercial private sector, which contributes to alcohol, tobacco, ultra-processed foods, and industrial and automobile pollution, is well established.
  • The Astana declaration never addressed poverty, unemployment, and poor livelihood, but eulogizes quality PHC only as the cornerstone for Universal Health Coverage and ignores broader Universal Health Care.

Conclusion

  • Every individual has a right to be healed and not have complications, disability, and death. That right is guaranteed only by individualism in public health, the new global approach to UHC, where nobody is left uncounted and uncared for. The Alma Ata declaration of primary health care can be left behind as a beautiful edifice of past concepts, and we should move forward with a newer concept of UHC.

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What is ‘e-Sanjeevani App’?

Note4Students

From UPSC perspective, the following things are important :

Prelims level: E-Sanjeevani App

Mains level: Telemedicine

sanjeevani

The eSanjeevani app was featured in Prime Minister’s “Mann Ki Baat” address as part of the government’s efforts to promote digital healthcare in the country.

What is the e-Sanjeevani app?

  • E-Sanjeevani is a browser-based platform-independent application that allows for both ‘doctor-to-doctor’ and ‘patient-to-doctor’ teleconsultations.
  • During the Covid pandemic, the union health ministry launched the e-Sanjeevani telemedicine services to ensure that health consultations reach people even in remote villages.
  • At the time of its launch, the union health ministry stated that it was a doctor-to-doctor telemedicine service that would provide general and specialised health care in rural areas.

How does e-Sanjeevani work?

  • The e-Sanjeevani service establishes a virtual link between the beneficiary and doctor or specialist at the hub, which will be a tertiary healthcare facility.
  • This network’s spoke would be a paramedic or generalist at a health and wellness centre.
  • It allows for real-time virtual consultations between doctors and specialists at the hub and the beneficiary (via paramedics) at the spoke.
  • The e-prescription generated at the conclusion of the session is used to obtain medications.

What is the reach of e-Sanjeevani?

  • Sanjeevani HWC is currently operational in approximately 50,000 health and wellness centres across the country.
  • As PM Modi stated in ‘Mann Ki Baat’, the number of tele-consultants using the e-Sanjeevani app has now surpassed 10 crore.
  • Health minister has stated that 100.11 million patients were served at 115,234 Health and Wellness Centres (as spokes) via 15,731 hubs and 1,152 online OPDs staffed by 2,29,057 telemedicine-trained medical specialists and super-specialists.
  • More than 57% of e-Sanjeevani beneficiaries are women, with only about 12% being senior citizens, according to union health ministry.

 

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Understanding India’s Mental Healthcare Act, 2017

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Mental Healthcare Act, 2017

Mains level: Not Much

mental

Central idea: The article discusses the challenges faced in implementing India’s Mental Healthcare Act, 2017 and the need for better mental healthcare services in the country.

Mental Healthcare Act, 2017

The Mental Healthcare Act, 2017 is a comprehensive legislation that provides for the protection and promotion of the rights of people with mental illness.  Some of the key features of the Act are:

  • Decriminalization of suicide: The Act decriminalizes suicide and prohibits the use of inhuman and degrading treatment towards those who attempt suicide.
  • Advance directives: The Act allows individuals to make advance directives, specifying the type of treatment they would like to receive in the event of a mental health issue.
  • Informed consent: The Act mandates that patients have the right to give or refuse consent to treatment, and to be informed about the benefits, side effects, and alternatives of the treatment.
  • Mental health review boards: The Act establishes Mental Health Review Boards at the national and state levels to oversee the implementation of the Act and protect the rights of people with mental illness.
  • Prohibition of inhuman treatment: The Act prohibits the use of inhuman treatment methods, including chaining, electroconvulsive therapy (ECT) without anaesthesia, and solitary confinement.
  • Right to access mental healthcare: The Act guarantees the right to access mental healthcare services, and mandates the establishment of mental health services in every district.
  • Protection of rights and dignity: The Act aims to protect the rights and dignity of people with mental illness, and prohibits discrimination and stigmatization on the basis of mental illness.
  • Establishment of a Central Mental Health Authority: The Act establishes a Central Mental Health Authority to regulate mental health services in the country.

NHRC flags alert

  • Pity over healthcare institution: The National Human Rights Commission (NHRC) in a report flagged the “inhuman and deplorable” condition of all 46 government-run mental healthcare institutions across the country.
  • Prolonged hospitalization: The report notes that the facilities are “illegally” keeping patients long after their recovery, in what is an “infringement of the human rights of mentally ill patients”.
  • Need for Assessment: These observations were made after visits to all operational government facilities, to assess the implementation of the Mental Healthcare Act, 2017 (MHA).

Major issue: Lack of implementation

  • Despite the act’s provisions, mental health institutions in India have been plagued by a lack of adequate infrastructure, staff, and training.
  • Patients have reported human rights violations, including abuse, neglect, and violence.

Need for effective implementation

  • The Mental Healthcare Act needs effective implementation and oversight to ensure that patients receive the care and treatment they need with dignity and respect.
  • This requires increased investment in mental health infrastructure, including facilities, staff, and training.

Way forward

  • Ensuring proper implementation of the Act: There is a need for proper implementation of this act across the country, with a focus on ensuring the rights and dignity of patients in mental healthcare institutions.
  • Increasing awareness: Awareness needs to be raised about the Act, and the rights of mental healthcare patients among the general public, healthcare professionals, and law enforcement agencies.
  • Providing training and capacity building: Healthcare professionals, including doctors, nurses, and caregivers, need to be trained and equipped with the skills and knowledge to provide quality care and support to mental healthcare patients.
  • Strengthening mental healthcare infrastructure: There is a need to strengthen the infrastructure and facilities in mental healthcare institutions, including better staffing, improved physical facilities, and access to quality medication.
  • Encouraging community-based care: Community-based care for mental health patients can help reduce the burden on mental healthcare institutions and provide a more supportive environment for patients.
  • Promoting human rights: There is a need for greater emphasis on the human rights of mental healthcare patients, including the right to dignity, privacy, and freedom from discrimination and abuse.

 

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Its high time to focus on Mental Health

Note4Students

From UPSC perspective, the following things are important :

Prelims level: NA

Mains level: Mental health problems and solutions

Mental

Context

  • Suicides rates in India are amongst the highest when compared to other countries at the same socio-economic level. According to WHO, India’s suicide rate in 2019, at 12.9/1,00,000, was higher than the regional average of 10.2 and the global average of 9.0. Suicide has become the leading cause of death among those aged 15–29 in India.

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Background: Mental Health

  • While every precious life lost through suicide is one too many, it represents only the tip of the mental health iceberg in the country, particularly among young adults. Women tend to suffer more.
  • Across the world, the prevalence of some mental health disorders is consistently higher among women as compared to men.

Mental

Prevalence of Mental ill-health

  • The pandemic has further exacerbated the problem: Globally, it might have increased the prevalence of depression by 28 per cent and anxiety by 26 per cent in just one year between 2020 and 2021, according to a study published in Lancet.
  • Increased among younger age groups: Again, the large increases have been noted among younger age groups, stemming from uncertainty and fear about the virus, financial and job losses, grief, increased childcare burdens, in addition to school closures and social isolation.
  • Use of social media exacerbating the stress: Increased use of certain kinds of social media is also exacerbating stress for young people. Social media detracts from face-to-face relationships, which are healthier, and reduces investment in meaningful activities. More importantly, it erodes self-esteem through unfavourable social comparison.

Mental

Socio-economic implications of Mental ill-health

  • People living in poverty are at greater risks: Mental ill health is a leading cause of disability globally and is closely linked to poverty in a vicious cycle of disadvantage. People living in poverty are at greater risk of experiencing such conditions.
  • People experiencing mental health problems likely to fall in poverty: On the other hand, people experiencing severe mental health conditions are more likely to fall into poverty through loss of employment and increased health expenditure.
  • Stigma and discrimination: Stigma and discrimination often further undermine their social support structures. This reinforces the vicious cycle of poverty and mental ill-health.
  • Higher income inequality has high prevalence of ill mental ill health: Not surprisingly, countries with greater income inequalities and social polarization have been found to have a higher prevalence.

Mental

Approach to protect, promote and care for the mental health of people?

  • Killing the deep stigma surrounding mental health issues: The first step should be killing the deep stigma which prevents patients from seeking timely treatment and makes them feel shameful, isolated and weak. Stigma festers in the dark and scatters in the light. We need a mission to cut through this darkness and shine a light.
  • Making Mental health an integral part of public health programme: There is need to make mental health an integral part of the public health programme to reduce stress, promote a healthy lifestyle, screen and identify high-risk groups and strengthen interventions like counselling services. Special emphasis will need to be given to schools.
  • Paying attention to highly vulnerable: In addition, we should pay special attention to groups that are highly vulnerable because of the issues such as victims of domestic or sexual violence, unemployed youth, marginal farmers, armed forces personnel and personnel working under difficult conditions.
  • Creating a strong infrastructure for mental health care and treatment: Lack of effective treatment and stigma feed into each other. Currently, only 20-30 per cent of people with such disorders receive adequate treatment.
  • Mental health services should be made affordable for all: Improved coverage without corresponding financial protection will lead to inequitable service uptake and outcomes. All government health assurance schemes, including Ayushman Bharat, should cover the widest possible range.

Why is the wide treatment gap?

  • One major reason for a wide treatment gap is the problem of inadequate resources.
  • Less than two per cent of the government health budget, which itself is the lowest among all G20 countries, is devoted to mental health issues.
  • There is a severe shortage of professionals, with the number of psychiatrists in the country being less than those in New York City, according to one estimate.
  • Substantial investments will be needed to address the gaps in the health infrastructure and human resources.
  • Currently, most private health insurance covers only a restricted number of mental health conditions. Similarly, the list of essential medicines includes only a limited number of WHO-prescribed medications.

Mental

Conclusion

  • We need an urgent and well-resourced whole of society approach to protecting, promoting and caring for the mental health of our people, like we did for the Covid pandemic. Brock Chisholm, the first Director General of WHO, famously said, “there is no health without mental health”.

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Norovirus Cases detected in Kerala

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Norovirus

Mains level: Not Much

norovirus

The Kerala Health Department confirmed two cases of the gastrointestinal infection norovirus in class 1 students in Ernakulam district.

What is Norovirus?

  • Norovirus is an important cause of acute non-bacterial gastroenteritis in children as well as adults worldwide.
  • It leads to diarrhoea, vomiting, nausea, and abdominal pain. Being a diarrhoeal disease, it can lead to dehydration, so drinking plenty of fluids is recommended.
  • The virus was first discovered in connection with an outbreak of acute diarrhoeal disease in Norwalk, Ohio, in 1968 and was called the Norwalk Virus.
  • Later, several stomach flu viruses closely linked to the Norwalk virus were found and together, these are now called Noroviruses.
  • Many stomach flu outbreaks typically in cruise ships have been traced to NoV.

How deadly is this?

  • Norovirus is not new; it has been circulating among humans for over 50 years and is thought to be one of the primary causes of gastroenteritis.
  • The virus is estimated to kill 200,000 persons globally every year, with most deaths occurring among those below the age of five years and those over the age of 65 years.
  • The virus is capable of surviving low temperatures, and outbreaks tend to be more common during the winter and in colder countries — that is why it is sometimes referred to as “winter vomiting disease”.

What is the incidence of infection in India?

  • Cases of norovirus are not as common in India as in many other places — at the same time.
  • The infection has been reported in previous years as well, mainly from Southern India, and especially from Kerala.
  • A 2021 study from Hyderabad reported that norovirus was detected in 10.3% samples of children who came in with acute gastroenteritis.

Can norovirus infection cause a large-scale outbreak?

  • Even though more cases of norovirus are being detected, experts say that this is unlikely to lead to a large-scale outbreak.
  • There is no epidemiological study to co-relate of these cases.

 

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Mental Health Problem and effective policy

Note4Students

From UPSC perspective, the following things are important :

Prelims level: NA

Mains level: Strategy for better mental health policy

Mental Health

Context

  • The fifth Global Mental Health Summit, co-sponsored by over half a dozen organisations engaged with mental health, was held in Chennai to discuss mental health in the context of human rights, ethics and justice. Highlighting the importance of mental health, it gave a call for action against the continued neglect by society at large and the governments at central and state levels, in particular.

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Findings of national mental health survey

  • The National Mental Health Survey (NMHS): The latest National Mental Health Survey (NMHS) conducted by National Institute of Mental Health and Neuro Sciences (NIMHANS) in collaboration with the Ministry of Health and Family Welfare and WHO, was published in 2016.
  • Prevalence of mental disorder: According to the survey, the prevalence of mental disorders among adults in India is around 10.6%. The most common disorders were anxiety disorders (7.3%) and mood disorders (4.5%).
  • Higher among women than men: The survey also found that the prevalence of mental disorders was higher among women than men, and that the majority of people with mental disorders did not receive any treatment.
  • Prevalence of mental disorders is higher in urban areas: It also found that the prevalence of mental disorders was higher in urban areas than in rural areas, and that there was a higher prevalence of mental disorders among people with lower levels of education and income.
  • Gap in treatment coverage for people with mental disorder : The survey highlighted that there is a significant gap in treatment coverage for people with mental disorders, and that the majority of people with mental disorders do not receive any treatment.
  • Plan for mental health: The survey has provided an important information for Indian government and mental health professional to plan and implement mental health programs and policies in the country.

Mental Health

What constitutes good policy making on mental health?

  • Policy should be based on research and findings: Policies should be based on sound research and evidence from scientific studies. This helps to ensure that policies are effective in addressing mental health issues and are not based on assumptions or stereotypes.
  • Active engagement of stakeholders: Policy making should involve a wide range of stakeholders, including people with lived experience of mental health issues, mental health professionals, and representatives from relevant government departments and non-governmental organizations.
  • A comprehensive and integrated approach: Mental health policies should be comprehensive and address a wide range of issues, including prevention, early intervention, treatment, and recovery. They should also be integrated with other policies, such as those related to education, housing, and employment.
  • Ensure easy access to mental health care: policies should ensure that people have access to appropriate and affordable mental health care, including both medication and psychosocial therapies.
  • Public awareness and Sensitization : policies should ensure that people with mental health issues are treated with dignity and respect, and that their human rights are protected.

Case study: How India tackled HIV/AIDS?

  • Active surveillance system: The need for crafting strategic interventions based on epidemiological evidence from an active surveillance system.
  • Modelling different options: The importance of modelling different options of addressing the wide array of interventions required in different geographies, among different target groups, to provide the data related to cost effectiveness as well as efficacy of the interventions required for scaling up.
  • Proactive advocacy of systemic issues among all influencers: The proactive advocacy of systemic issues among all influencers the media, judiciary, politicians, police and other intersectoral departments whose programmes and activities have had a direct bearing on the key populations being worked on.
  • Community engagement: The use of peer leaders and civil society that was allocated over 25 per cent of the budget. Though a central sector programme was fully funded by the central government, every intervention was formulated with active participation and dialogue among the states and constituencies of local leaders.

Mental Health

Strategy for better implementation of mental health policy

  • Clear goals and objectives: Having clear and measurable goals and objectives can help to ensure that policies are implemented effectively and that progress can be tracked.
  • Training and capacity building: Providing training and capacity building for mental health professionals, as well as for other relevant stakeholders such as community leaders, can help to ensure that policies are implemented effectively.
  • Community engagement: Involving communities in the planning and implementation of mental health policies can help to ensure that policies are responsive to the specific needs and priorities of local populations.
  • Monitoring and evaluation: Regularly monitoring and evaluating the implementation of policies can help to identify any barriers or challenges, and make adjustments as necessary.
  • Multi-sectoral approach: Adopting a multi-sectoral approach that involves collaboration between different sectors, such as health, education, social welfare, housing, and employment can help to ensure that policies are implemented in a coordinated and effective manner.
  • Policy flexibility: Policies should be flexible enough to adapt to changing circumstances, and be responsive to feedback and suggestions from the community and stakeholders.

latest research in mental health domain

  • The growing recognition of the importance of early intervention in mental health: Research has shown that early intervention can prevent mental health issues from becoming more severe, and can help individuals to recover more quickly.
  • The use of technology in mental health: There has been an increase in the use of technology, such as mobile apps, virtual reality, and teletherapy, to deliver mental health care. Studies have shown that these technologies can be effective in improving mental health outcomes.
  • The impact of the COVID-19 pandemic on mental health: The pandemic has had a significant impact on mental health, and research has been conducted to understand the extent of the impact and to develop strategies to mitigate it.
  • Advancements in brain imaging and genetics: Researchers are using brain imaging techniques and genetic studies to gain a better understanding of the underlying causes of mental disorders and to develop more effective treatments.
  • The use of personalized medicine in mental health: There is growing interest in the use of personalized medicine, which involves using genetic and other information to tailor treatment to the individual patient, to improve mental health outcomes.
  • The benefits of nature-based interventions for mental health: Studies have shown that spending time in nature can have a positive impact on mental health, including reducing symptoms of stress, anxiety, and depression.
  • The importance of social determinants of mental health: Research has highlighted the importance of social determinants such as poverty, education, and social support in mental health.
  • The importance of addressing mental health in the workplace: Studies have highlighted the impact of workplace stress and burnout on mental health and the importance of workplace interventions to promote mental well-being.

Do you know Neuralink?

  • Neuralink is a gadget that will be surgically inserted into the brain using robotics. In this procedure, a chipset called the link is implanted in the skull.
  • Neuralink can be used to operate encephalopathy. It can also be used as a connection between the human brain and technology which means people with paralysis can easily operate their phones and computer directly with their brain.

Mental Health

Conclusion

  • Mental health problems and not related to age of persons. From children to old age all can suffer from this menace. Government of the must formulated, implement the effective, resulted oriented mental health policy as earliest as possible

Mains Question

Q. What factors need to be taken care while drafting sound mental health policy? Suggest a strategy for better implementation of metal health policy.

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Digital healthcare Services

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Ayushman Bharat, UHC, ABHA etc

Mains level: Digital public goods, Success of Ayushman Bharat and India's G20 presidency.

healthcare

Context

  • India leveraged information and communications technologies (ICTs) during the pandemic. Digital health solutions played a crucial role in bridging the gap in healthcare delivery as systems moved online to accommodate contactless care.

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India’s spectacular demonstration of digital public good (DPG) so far

  • Aadhar and UPI are like the building blocks of DPG: India has demonstrated its digital prowess by building digital public goods the digital identity system Aadhaar, the DPGs built on top of Aadhaar and the Unified Payments Interface.
  • Aadhar for PDS and UPI for payments: While Aadhaar has become central to India’s public service delivery architecture, UPI has transformed how payments are made.
  • One of the largest internet users: Our digital public infrastructure has reached the last mile, enabled by 1.2 billion wireless connections and 800 million internet users.
  • Some examples of DPGs developed during the pandemic: For instance, the Covid Vaccine Intelligence Network (CoWIN) and the Aarogya Setu application. CoWIN propelled India to adopt a completely digital approach to its vaccination strategy. Aarogya Setu provided real-time data on active cases and containment zones to help citizens assess risk in their areas.
  • Increasing use of Telemedicine platforms: Telemedicine platforms saw a steep increase in user acquisitions, as 85 per cent of physicians used teleconsultations during the pandemic, underscoring the need to better incorporate cutting-edge digital technologies into healthcare services.

Acknowledging the current need?

  • Although the impact of the pandemic on health services put the spotlight on the benefits of digital innovation and technology-enabled solutions, private entities, health technology players, and the public sector have been driving digitisation in the sector for some time now.
  • It has become clear that a comprehensive digital healthcare ecosystem is necessary to bring together existing siloed efforts and move toward proactive, holistic, and citizen-centric healthcare.

Government efforts in this direction?

  • Shared public goods for healthcare: Recognising this need, the government has created shared public goods for healthcare and developed a framework for a nationwide digital health system. This brought healthcare to a turning point in India.
  • Ayushman Bharat Digital Mission (ABDM): The PM launched the Ayushman Bharat Digital Mission on September 27, 2021, under the aegis of the National Health Authority. Within a year of its launch, ABDM has established a robust framework to provide accessible, affordable, and equitable healthcare through digital highways. The ABDM has implemented vital building blocks to unite all stakeholders in the digital healthcare ecosystem.
  • The Ayushman Bharat Health Account (ABHA): ABHA creates a standard identifier for patients across healthcare providers. With the ABHA and its associated Personal Health Record (PHR) app, citizens can link, store, and share their health records to access healthcare services with autonomy and consent. With more than 300 million ABHAs and 50 million health records linked, the mission is growing at a massive rate.
  • The Health Facility Registry (HFR) and the Health Professional Registries (HPR) for central digital health information: HFR and HPR accounts provide verified digital identities to large and small public and private health facilities and professionals. This enables them to connect to a central digital ecosystem while serving as a single source for verified healthcare provider-related information. HFR and HPR improve the discovery of healthcare facilities and help health professionals build an online presence and offer services more effectively. The
  • Drug registry for centralised repository of approved drugs: It is a crucial building block designed to create a single, up-to-date, centralised repository of all approved drugs across all systems of medicine.
  • Unified Health Interface (UHI) enables a connect between healthcare providers with end users: It aims to strengthen the health sector by enabling all healthcare service providers and end-user applications to interact with each other on its network. This will provide a seamless experience for service discovery, appointment booking, teleconsultations, ambulance access, and more. The UHI is based on open network protocols and can address the current challenge of different digital solutions being unable to communicate with each other.

What the government is planning next in this domain?

  • To give UHI the necessary push, the government is repurposing Aarogya Setu and CoWIN: Aarogya Setu is being transformed into a general health and wellness application. At the same time, CoWIN will be plugged with a lite Hospital Management Information System (HMIS) for small clinics, to bring digitisation to the masses.
  • Addressing well the patient registration process at the hospital counters: Another use-case of ABDM is scan and share, which uses a QR code-based token system to manage queues at hospital counters. It uses the foundational elements of ABHA and PHR to streamline the outpatient registration process in large hospitals
  • Expanding healthcare digital initiative worldwide: The government is also planning to expand its digital initiatives in the healthcare sector with Heal by India, making India’s healthcare professionals’ services available worldwide.
  • Platform for organ donation: Additionally, a platform is being developed to automate the allocation of deceased organ and tissue donations, making the process faster and more transparent.

Way ahead

  • Digitise insurance claim settlement process: With the implementation of digital solutions, the next step is to digitise and automate the insurance claim settlement process through the Health Claim Exchange platform.
  • Making claim settlement process inexpensive and transparent: There is need to make claim-related information verifiable, auditable, traceable and interoperable among various entities, enabling claim processing to become inexpensive, transparent and carried out in real time.
  • Bringing together global efforts for digital health: India assumes the G20 presidency this year. The G20 Global Initiative on Digital Health calls for the creation of an institutional framework for a connected health ecosystem to bring together global efforts for digital health.
  • Accelerating UHC by scaling up the technologies: It also calls for the scaling-up of technologies such as global DPGs to accelerate Universal Health Coverage.

Conclusion

  • The ABDM has proven to be a valuable asset and its adoption across states has been accelerated by the National Health Authority. It aims to build the foundation for a sustainable digital public infrastructure for health, enabling India to achieve universal health coverage. The mission embodies G20’s theme of “Vasudhaiva Kutumbakam” or “One Earth. One Family. One Future”

Mains question

Q. India has demonstrated spectacular success in digital public goods, specifically in Digital health. Discuss how the government efforts are taking shape in this direction and suggest a way ahead in short.

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Naegleria fowleri: The Brain-eating Amoeba

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Naegleria fowleri

Mains level: Not Much

naegleria

South Korea reported its first case of infection from Naegleria fowleri or “brain-eating amoeba”.

What is Naegleria fowleri (Amoeba)?

  • Amoeba is a type of cell or unicellular organism with the ability to alter its shape, primarily by extending and retracting pseudopods.
  • Naegleria is an amoeba, a single-celled organism, and only one of its species, called Naegleria fowleri, can infect humans.
  • It was first discovered in Australia in 1965 and is commonly found in warm freshwater bodies, such as hot springs, rivers and lakes.
  • So far, Naegleria fowleri has been found in all continents and declared as the cause of PAM in over 16 countries, including India.

How does it infect humans?

  • The amoeba enters the human body through the nose and then travels up to the brain.
  • This can usually happen when someone goes for a swim, or dive or even when they dip their head in a freshwater body.
  • In some cases, it was found that people got infected when they cleaned their nostrils with contaminated water/ vapour/ or aerosol droplets.
  • Once Naegleria fowleri goes to the brain, it destroys brain tissues and causes a dangerous infection known as primary amebic meningoencephalitis (PAM).

What are the symptoms of PAM?

  • The CDC says the first signs of PAM start showing within one to 12 days after the infection.
  • In the initial stages, they might be similar to symptoms of meningitis, which are headache, nausea and fever.
  • In the later stages, one can suffer from a stiff neck, seizures, hallucinations, and even coma.
  • The infection spreads rapidly and on average causes death within about five days.

How its spread is linked to climate change?

  • With the rising global temperatures, the chances of getting Naegleria fowleri infection will go up as the amoeba mainly thrives in warm freshwater bodies.
  • The organism best grows in high temperatures up to 46°C and sometimes can survive at even higher temperatures.
  • Various recent studies have found that excess atmospheric carbon dioxide has led to an increase in the temperature of lakes and rivers.
  • These conditions provide a more favourable environment for the amoeba to grow.

 

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India’s G20 Presidency: Healthcare should be a central agenda

Note4Students

From UPSC perspective, the following things are important :

Prelims level: NA

Mains level: Linking PHC with UHC, India's G20 presidency and healthcare agenda

Healthcare

Context

  • Health needs to be a central agenda for the G20 2023. It has been one of the priority areas for G20 deliberations since 2017, when the first meet of health ministers of G20 countries was organised by the German presidency. The G20 now has health finance in its financial stream and health systems development in the Sherpa stream.

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Background: Prioritizing Health

  • An annual G20 meeting of health ministers and a joint health and finance task force reflects the seriousness the subject has gained.
  • The Berlin Declaration 2017 of the G20 health ministers provided a composite approach focusing on pandemic preparedness, health system strengthening and tackling antimicrobial resistance.
  • The Covid-19 pandemic gave added urgency to pandemic preparedness and the Indonesian presidency in 2022 made it the major focus. The Indian presidency needs to advance these agendas.

resolution

Global community engagement to strengthen Health systems

  • Universal Health Coverage (UHC): The concept of UHC was born in the 2000s to prevent catastrophic medical expenditures due to secondary and tertiary level hospital services by universalizing health insurance coverage.
  • UHC as a strategy to ensure healthcare for all: The UHC has been the big global approach for health systems strengthening since 2010, also adopted in 2015 as the strategy for Sustainable Development Goal-3 on ensuring healthcare for all at all ages.
  • Limited impact of UHC: However, the limited impact of this narrow strategy was soon evident, with expenditures on outdoor services becoming catastrophic for poor households and preventing access to necessary healthcare and medicines, while many unnecessary/irrational medical interventions were being undertaken.

What are the new approaches developed to strengthen healthcare system?

  • Highlighted the need to prioritise primary healthcare (PHC): In 2018, the Astana Conference organised by WHO and UNICEF put out a declaration stating that primary healthcare (PHC) is essential for fulfilling the UHC objectives.
  • Combined UHC- PHC approach: In 2019, the UN General Assembly adopted the combined UHC-PHC approach as a political declaration.
  • World bank report on benefits of PHC services during pandemic: The World Bank published a report in 2021, “Walking the Talk: Reimagining Primary Health Care After COVID-19”. The dominant hospital-centred medical system is becoming unaffordable even for the high-income countries, as apparent during the 2008 recession and subsequently.

What is PHC-with-UHC approach?

  • It means strengthening primary level care linked to non-medical preventive action (food security and safety, safe water and air, healthy workspaces, and so on)
  • It works through whole-of-society and whole-of-government approaches, and extending the “PHC principles” to secondary and tertiary care services.
  • This could be the most cost-effective systems design the comprehensive game changer that global health care requires.

What is to be strengthened, what initiatives can be applied and how?

  • Making health central to development in all sectors: Health in all policies, one health (linking animal and human health for tackling antimicrobial resistance and zoonotic diseases), planetary health, pandemic preparedness.
  • Health systems strengthening: Designing PHC-with-UHC for diverse contexts. Conceptualised as a continuum of care from self-care in households to community services, to primary level para-medical services and first contact with a doctor, services provided as close to homes as possible, affordable and easily deliverable.
  • Appropriate technologies to be adopted as a norm: By strengthening health technology assessment, ethics of healthcare, equitable access to pharmaceutical products and vaccines, integrative health systems using plural knowledge systems rationally.
  • Health and healthcare from the perspective of the marginalised: Gendered health care needs, Health care of indigenous peoples globally, occupational health, mental health and wellbeing, healthy ageing.
  • Easy access to health knowledge for all: decolonization and democratization of health knowledge, with interests and perspectives of low-middle-income countries (LMICs), prevention and patient-centred healthcare.

Healthcare

India’s G20 Presidency: An opportunity to contribute and make inclusive healthcare system

  • India has several pioneering initiatives that can contribute to the PHC-with-UHC discussion:
  • National Health mission and dedicated health facilities: Lessons from the National Health Mission for strengthening public health delivery; the HIV-control programme’s successful involvement of affected persons/communities and a complex well-managed service structure.
  • Democratized health knowledge: Pluralism of health knowledge systems, each independently supported within the national health system.
  • Certified Health personnel: Health personnel such as the ASHAs, mid-level health providers and wellness centres, traditional community healthcare providers with voluntary quality certification;
  • R&D and widely acknowledged pharmaceutical capacity: Research designed for validation of traditional systems; pharmaceutical and vaccines production capacity;
  • Digital health as an example: Developments in digital health; social insurance schemes and people’s hospital models by civil society.

resolution

Conclusion

  • What is required is the drafting of PHC-with-UHC (a PHC 2.0) with a broad global consensus and commitment to a more sustainable and people-empowering health system. Pursuing such an agenda would involve much dialogue within countries, regions and globally. India should use its presidency to draft a model policy focusing on primary healthcare that commits to a universal, affordable, inclusive and just healthcare system

Mains Question

Q. What is Primary HealthCare and Universal healthcare integrated approach? What steps are necessary to further strengthen sustainable healthcare system? Discuss how India can contribute to it under its G20 presidency?

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Students suicides: A mismatch between rising aspirations, shrinking opportunities

Note4Students

From UPSC perspective, the following things are important :

Prelims level: NA

Mains level: Addressing the issues of Students pressure, suicides, reasons and way ahead

suicides

Context

  • Three students committed suicide within 12 hours in Rajasthan’s Kota, which is regarded as the education and coaching hub of India. Known for producing IITians, doctors and engineers, Kota has been in the news for the last few years because of the students’ suicides and depression they suffer.

What is Suicide?

  • Suicide is the act of intentionally causing one’s own death.
  • Mental and physical disorders, substance abuse, anxiety and depression are risk factors.
  • Some suicides are impulsive acts due to stress (such as from financial or academic difficulties), relationship problems (such as breakups or divorces), or harassment and bullying.
  • Despite being entirely preventable, India has been increasingly losing individuals to suicide.

suicides

The National Crime Records Bureau’s Accidental Deaths and Suicide in India report 2021.

  • The report released this year shows that the number of students’ deaths by suicide rose by 4.5 per cent in 2021.
  • Maharashtra bearing the highest toll with 1,834 deaths, followed by Madhya Pradesh with 1,308, and Tamil Nadu with 1,246.
  • According to the report, student suicides have been rising steadily for the last five years.
  • According to a 2012 Lancet report, suicide rates in India are highest in the 15-29 age group the youth population.
  • According to the National Crime Record Bureau (NCRB), in 2020, a student took their own life every 42 minutes; that is, every day, more than 34 students died by suicide.

suicides

What are the reasons behind these alarming stats of student’s suicide in India?

  • Education is for livelihood more than knowledge: Education in India has been viewed as a gateway to employment and livelihood rather than to knowledge.
  • Pressure to get into government jobs or highly paid private sector: Many students and their families dream of the coveted ‘sarkari naukri’ (government job) to escape the precarious social, caste and class predicaments they find themselves in.
  • Limited educational infrastructure: The failure of the Union government to improve the country’s educational infrastructure means that exam-oriented coaching had become the norm.
  • Coaching centres as prisons for many students: Cashing in on the ‘hope for a better future,’ coaching centres emerged as one of the predominant industries in the education sector. However, these centres are now being seen as prisons for the many youngsters who join them; where their bodies, souls and dreams are tamed.
  • Number of factors marginalising students who are already vulnerable: Students from marginalised sections are pushed further to the margins through a number of factors, such as the lack of English-medium education; private institutions charging high fees; poor quality education in government-run schools and institutes; ever-growing economic inequality; graduates not having the adequate skills to secure jobs; and caste discrimination.
  • Social ideology of success and failure: The rise of neoliberalism as an economic and social ideology has pushed the youth to blame themselves for their failure to secure their ‘dream job’ while the government continues to shirk its basic responsibility.
  • Flawed neoliberal agenda for failure and success: The neo-liberal agenda keeps propagating the belief that it is not that hard to find success if one works hard enough, normalising the notion that the youth should blame themselves for their ‘failures’.

suicides

What are various solutions have been proposed?

  • The myth of the Indian family being supportive also need to be called out: Family, being the primary social unit of the society, shapes the aspirations and dreams of the youth. Family should be supportive in true sense.
  • Deeper introspection is needed instead of make shift solutions: Deeper introspection on structural aspects of the education system is the need of the hour. Instead, we take pride in coming up with Jugaad (makeshift solutions) to manage affairs peripherally, without dealing with the root of problem.
  • Easing pressure in the students: Others have suggested like the guidelines issued by the Board of Intermediate Education in Andhra Pradesh in 2017 to ease the pressure on students, including yoga and physical exercise classes and maintaining a healthy student-teacher ratio.
  • Realising today’s realities and making changes: It is painfully evident that the failure to address the larger issue of a punishing education system that is simply not designed to support young minds or prepare them for today’s economic realities continues.
  • Collective responsibility: Not only family plays a significant role in students life, even the society has a huge influence. We as a society should realise true essence of life and not confine students into success and failure tags. Instead support them empathically in realising their true potential.

Did you know this solution? What any sensitive person will think of this?

  • Some suggested bordering on the ludicrous, like the Indian Institute of Science’s reported move last year to replace ceiling fans in hostel rooms with those that are wall-mounted.

Conclusion

  • Scholars have long linked farmers’ suicides to India’s agrarian crisis; it is time that civil society starts looking at students’ suicides as an indicator of a grave crisis of the country’s educational structure, including the institutional structure, curriculum, and the like. The combination of a large population of young people with rising aspirations and an economy with shrinking opportunities has created a public health crisis that requires urgent attention.

Mains Question

Q. There has been a steady increase in student suicides in India over the past few years. What are the reasons and suggest what should be done?

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Curbing individualism in public health

Note4Students

From UPSC perspective, the following things are important :

Prelims level: NA

Mains level: Issues in public health management

public

Context

  • A failure to examine and interpret public health problems from a population perspective is leading to ineffective and unsustainable solutions as far as complex public health problems are concerned. There is a strong tendency in public health to prioritise individual-oriented interventions over societal oriented population-based approaches, also known as individualism in public health.

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What are the problems in public health approach?

  • Micronutrient supplementation at Individualistic level instead sustainable approach at public level: Problems such as undernutrition, for which individualist solutions such as micronutrient supplementation and food fortification have been proposed as solutions in lieu of sustainable approaches such as a strengthening of the Public Distribution System, supplementary nutrition programmes, and the health services.
  • Diagnosis and treatment than the solutions that modify health behaviours: Similar is the case with chronic disease control, wherein early diagnosis and treatment is the most popular solution, with little scope for solutions that can modify health behaviours (through organised community action).

Recent evidences that show individualism is preferred over population-based approach

  1. Pradhan Mantri Jan Arogya Yojana (PMJAY): A nationwide publicly-funded insurance scheme, the Pradhan Mantri Jan Arogya Yojana (PMJAY) falls under Ayushman Bharat. It is the largest health insurance scheme in the country covering hospitalisation expenses for a family for ₹5 lakh a year. The goal is to ensure ‘free’ curative care services for all kinds of hospitalisation services so that there is no financial burden to the beneficiary.
  • Approach needed: What is not talked about in the entire scheme is the need for hospitalisation services per year for any population.
  • Approach preferred: Instead, every individual is given an assurance that if there is a need for hospitalisation expenses, the scheme will cover the expenses, highlighting the risk/probability of every individual facing hospitalisation in a year.
  • Individualistic response: This is an individualistic response to the problem of hospitalisation expenditure faced by populations. This becomes obvious when one examines the data on annual hospitalisation across populations.
  1. vaccination for COVID-19 unlike other vaccinations: It was evident that a COVID-19 vaccine cannot prevent people from getting the disease but only reduce hospitalisation and deaths in the event of contracting COVID-19.
  • Approach needed: To effectively manage COVID-19, what was needed was to have primary, secondary, and tertiary health-care facilities to manage the above proportion of cases. This is what a population-based approach to epidemic would be focusing on.
  • Approach preferred: Instead, by focusing on a vaccination programme for the entire population, it is again an assurance and a promise to every individual that even if you get COVID-19, you will not need hospitalisation and not die. Even after the entire crisis, not much is talked about in terms of the grossly inadequate health-care infrastructure to ensure the necessary primary, secondary and tertiary care services for COVID-19 patients, in turn leading to many casualties.
  • Individualistic response: The entire focus has been on the success story that every individual is protected from hospitalisation and death achieved through vaccine coverage. Most of the deaths due to COVID-19 are a reflection of the failure to offer ventilator and ICU support services to the 1%-2% in desperate need of it. Curative care provisioning is never planned at an individual level as epidemiologically, every individual will not necessarily need curative care every time. The morbidity profile of a population across age groups is an important criterion used to plan the curative care needs of a population.

What the data on population hospitalization suggests?

  • Episode of hospitalization a year: Data from the National Sample Survey Organisation (75th round) show that on an average, only 3% of the total population in India had an episode of hospitalisation in a year (from 1% for Assam to 4% for Goa and 10% for Kerala the need also a function of availability). The proportion hovers around 3%-5% across most Indian States.
  • Population based healthcare planning is necessary: This is population-based health-care planning. Instead, giving an assurance to every individual without ensuring the necessary health-care services to the population is not really helping in a crisis.

Determinants of individualistic approach

  • Misconception in philosophy of public health: The dominance of biomedical knowledge and philosophy in the field of public health with a misconception that what is done at an individual level, when done at a population level, becomes public health. This is despite the contrasting philosophy and approaches of clinical medicine and public health and the evidence that support the latter and must be based on population characteristics and economic resources.
  • Visibility impact and mistake of judging a population’s characteristics: Health effects are more visible and appear convincing at the individual level, wherein improvements at the population level will be clear only after population-level analysis; this needs a certain level of expertise and orientation about society an important skill required for public health practitioners.
  • Market’s role and the effect of consumerism in public health practice: The beneficiaries for a programme become the maximum when 100% of the population is targeted. Instead of making efforts to supply evidence of the actual prevalence of public health problems, market forces would prefer to cast a wide net and cover 100% of beneficiaries. Propagating individualism has always been a characteristic feature of a consumerist society as every individual can then be a potential ‘customer’ in the face of risk and susceptibility.

public

Conclusion

  • The need of the hour is population-level planning, which means, population as a single unit needs to be considered. All forms of individualistic approaches in public health need to be resisted to safeguard its original principles of practice, viz. population, prevention, and social justice.

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The depopulation alert

Note4Students

From UPSC perspective, the following things are important :

Prelims level: NA

Mains level: Population and population decline trend

depopulation

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Context

  • Recently, when the world population touched eight billion, several headlines focused on how India was the largest contributor to the last billion and is set to surpass China as the world’s most populous nation by 2023. But missing in this conversation is the real threat of depopulation that parts of India too face, and the country’s complete lack of preparedness to deal with it.

Note: “The population and Population decline are continuously in the headlines which makes the population and associated topics important for the upcoming Mains Examinations.”

India’s Population trend

  • The total population of India currently stands at 1.37 billion which is 17.5% of the world population.
  • Between 1992 and 2015, India’s Total fertility rate (TFR) had fallen by 35% from 3.4 to 2.2.
  • Young people (15-29 age years) form 27.2% of the population in 2021. This made India enter the Demographic dividend stage.
  • The percentage of the elderly population has been increasing from 6.8% in 1991 to 9.2% in 2016.

What is depopulation?

  • The depopulation decline (also sometimes called population decline, underpopulation, or population collapse) in humans is a reduction in a human population size.
  • Over the long term, stretching from prehistory to the present, Earth’s total human population has continued to grow; however, current projections suggest that this long-term trend of steady population growth may be coming to an end.

depopulation

The depopulation discussion and the missing links

  • Falling fertility rate and discussing reversal: Demographers, policy experts and politicians in countries such as Japan, South Korea and Europe, which are experiencing falling fertility and nearing the inflection point of population declines, are beginning to talk about what the future holds and whether reversal is possible.
  • The missing key elements in the conversation: Talking about equitable sharing of housework; access to subsidized childcare that allows women to have families as well as a career; and lowered barriers to immigration to enable entry to working-age people from countries which aren’t yet in population decline is missing.

Fertility in India

  • Falling fertility rate: It is now well-established that fertility in India is falling along expected lines as a direct result of rising incomes and greater female access to health and education. India’s total fertility rate is now below the replacement rate of fertility.
  • Many states are on the verge of population decline: Parts of India have not only achieved replacement fertility, but have been below the replacement rate for so long that they are at the cusp of real declines in population. Kerala, which achieved replacement fertility in 1998, and Tamil Nadu, which achieved this in 2000, are examples.
  • Decline in working age population: In the next four years, both Tamil Nadu and Kerala will see the first absolute declines in their working-age populations in their histories. With falling mortality (barring the pandemic), the total population of these States will continue to grow for the next few decades, which means that fewer working-age people must support more elderly people than ever before.

What is Replacement Level Fertility (RLF)?

  • Replacement level fertility is the level of fertility at which a population exactly replaces itself from one generation to the next.
  • In simpler terms, it denotes the fertility number required to maintain the same population number of a country over a given period of time.
  • In developed countries, replacement level fertility can be taken as requiring an average of 2.1 children per woman.
  • In countries with high infant and child mortality rates, however, the average number of births may need to be much higher.
  • RLF will lead to zero population growth only if mortality rates remain constant and migration has no effect.

A depopulating future and the challenges

  • Invisible trend because infuse of migrants: Access to working-age persons notably different from the situation in other States with low fertility. For instance, Delhi and Karnataka which are both net recipients of migrants, and will not confront population decline in the near future.
  • A skewed sex ratio remains a danger: As the latest round of the NFHS showed, families with at least one son are less likely to want more children than families with just one daughter.
  • Difference in education: The stark differences between northern and southern States in terms of basic literacy as well as enrolment in higher education, including in technical fields, will mean that workers from the southern States are not automatically replaceable.

Conclusion

  • With decades of focus on lowering fertility, the conversation in India is stuck in a rut. It is for the southern States to break away from this outmoded, data-free rhetoric and join the global conversation on depopulation. India’s cannot ignore the depopulation in the name of migration to meet its current labour needs.

Mains question

Q. What is depopulation, which has been a hot topic in recent times? Where do you see India in global population trends? Discuss.

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Union Health Ministry rolls out India’s 1st Suicide Prevention Policy

Note4Students

From UPSC perspective, the following things are important :

Prelims level: NA

Mains level: National Suicide Prevention Strategy

The Ministry of Health and Family Welfare announced a National Suicide Prevention Strategy, the first of its kind in the country.

What is Suicide?

  • Suicide is the act of intentionally causing one’s own death.
  • Mental and physical disorders, substance abuse, anxiety and depression are risk factors.
  • Some suicides are impulsive acts due to stress (such as from financial or academic difficulties), relationship problems (such as breakups or divorces), or harassment and bullying.
  • Despite being entirely preventable, India has been increasingly losing individuals to suicide.

Why need such strategy?

Ans. Suicides in India

  • The burden of deaths by suicide has increased in India — by 7.2 per cent from 2020 — with a total of 1,64,033 people dying by suicide in 2021.
  • In India, more than one lakh lives are lost every year to suicide, and it is the top killer in the 15-29 years category.
  • In the past three years, the suicide rate has increased from 10.2 to 11.3 per 1,00,000 population, the document records.
  • The most common reasons for suicide include family problems and illnesses, which account for 34% and 18% of all suicide-related deaths.
  • The report follows a 2021 Lancet study that noted “India reports the highest number of suicide deaths in the world”.

About the National Suicide Prevention Strategy

The NSPS puts a time-bound action plan and multi-sectoral collaborations to achieve reduction in suicide mortality by 10% by 2030.  The strategy broadly seeks to establish-

  1. Effective surveillance mechanisms for suicide within the next three years,
  2. Establish psychiatric outpatient departments that will provide suicide prevention services through the District Mental Health Programme in all districts within the next five years, and
  3. Integrate a mental well-being curriculum in all educational institutions within the next eight years.

The strategy also envisages:

  1. Developing guidelines for responsible media reporting of suicides and
  2. Restricting access to means of suicide

Significance of the strategy

  • The most important thing is that the government has acknowledged that suicide is a problem.
  • We now have a well-conceived plan involving multi-sectoral collaborations, because the only way a strategy would work would be to involve various sectors.
  • The strategy should now be passed on to the States for them to develop locally relevant action plans; and then cascade to the district, primary health and community levels.

Why suicide is such a big issue?

  • More youth committing: For the youth of the country (15-29 years), among whom 1/3rd of all suicides take place.
  • Performance pressure: Data suggests that one student dies by suicide every 55 minutes, and 1,129 suicides among children below 18 years of age in 2020 were due to failure in examinations.
  • Farm distress: This is followed by farmer’s suicide and the gendered variance observed these days.
  • Gendered variances: More women are committing suicides these days.

Way forward

suicide

  • Holistic approach: Promoting national and sectoral research into the reasons for suicide mortality and its rise, and making culturally and economically appropriate suggestions to help mitigate the problem is critical.
  • Counselling by mass-media: During times of distress, media must promote health-seeking behaviour, correct information and counter the possible myths related to suicide.
  • Evidence-based interventions: Keep in mind the needs of the most vulnerable and marginalized populations, like women and young individuals, providing the required support systems can reduce the number of lives lost and build a healthier response system.

 

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Is India a Diabetes capital of the world?

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Basics-Diabetes, Insulin, glucose. etc

Mains level: India's Diabetes stress, Measures

Diabetes

Context

  • India is often referred to as the ‘Diabetes Capital of the World as it accounts for 17%percent of the total number of diabetes patients in the world. There are currently close to 80 million people with diabetes in India and this number is expected to increase to 135 million by 2045. World Diabetes day is observed on 14 November.

What is Diabetes?

  • Diabetes is a chronic (long-lasting) health condition that affects how our body turns food into energy.
  • Diabetes is a metabolic disorder in which the body has high sugar levels for prolonged periods of time.
  • The lack of insulin causes a form of diabetes.
  • Type-I Diabetes: It is a medical condition that is caused due to insufficient production and secretion of insulin from the pancreas. Type 1 diabetes is thought to be caused by an autoimmune reaction (the body attacks itself by mistake). This reaction stops your body from making insulin. Approximately 5-10% of the people who have diabetes have type 1
  • Type-2 diabetes: With type 2 diabetes, your body doesn’t use insulin well and can’t keep blood sugar at normal levels. About 90-95% of people with diabetes have type 2.

Diabetes

Type-2 diabetes in brief 

  • Long term Condition: It is long-term (chronic) condition which results in too much sugar circulating in the bloodstreams and poor response of insulin. Eventually, high blood sugar levels can lead to disorders of the circulatory, nervous and immune systems. Type 2 diabetes is an impairment in the way the body regulates and uses sugar (glucose) as a fuel. It is a defective response of Insulin
  • More common in adults: Type 2 is more common in older adults, but the increase in the number of children with obesity has led to more cases of type 2 diabetes in younger people.
  • Slow signs and symptoms: Signs and symptoms of type 2 diabetes often develop slowly. Symptoms include, Increased thirst, Frequent urination, Increased hunger, Unintended weight loss, Fatigue, Blurred vision, Slow-healing sores, Frequent infections etc. It develops over many years and is usually diagnosed in adults (but more and more in children, teens, and young adults).
  • Cure for Type-2: There’s no cure for type 2 diabetes, but losing weight, eating well and exercising can help you manage the disease. If diet and exercise aren’t enough to manage your blood sugar, you may also need diabetes medications or insulin therapy.

What is insulin?

  • Insulin is a hormone produced by the pancreas.
  • Insulin regulates the movement of sugar into your cells.
  • Blood glucose levels tightly controlled by insulin.
  • When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level

Diabetes

The prevalence of diabetes in India

  • People living with Diabetes in India: There are an estimated 77 million people with diabetes in India. Which means one in every 10 adults in India has diabetes. Half of those who have high blood sugar levels are unaware. Even among those who have been diagnosed with diabetes, only half of them have their blood sugar level under control.
  • Rapid increase in younger population: According ICMR report, the prevalence of diabetes in India has increased by 64 percent over the quarter-century. prevalence among the younger population has also increased above 10%.
  • Children impacting more: Worryingly, in India, a large number of children are also impacted by diabetes. Children are developing obesity and metabolic syndrome early because of the change in diets to more processed and fast foods.
  • Projected Estimation: About 98 million Indians could have diabetes by 2030, these projections come from the International Diabetes Federation and the Global Burden of Disease project.
  • Children impacting more: Worryingly, in India, a large number of children are also impacted by diabetes. Children are developing obesity and metabolic syndrome early because of the change in diets to more processed and fast foods.

Why Indians are more prone to diabetes?

  • Lifestyle changes: The current exponential rise of diabetes in India is mainly attributed to lifestyle changes. The rapid change in dietary patterns, physical inactivity, and increased body weight, especially the accumulation of abdominal fat, are some of the primary reasons for increased prevalence.
  • Ethnically more prone: Ethnically, Indians seem to be more prone to diabetes as compared to the Caucasians, although the precise mechanisms are not well known. we Indians have a greater degree of insulin resistance which means our cells do not respond to the hormone insulin. And when compared to Europeans, our blood insulin levels also tend to rise higher and more persistently when we eat carbohydrates.
  • Greater genetic predisposition: The epidemic increase in diabetes in India along with various studies on migrant and native Indians clearly indicate that Indians have an increased predilection to diabetes which could well be due to a greater genetic predisposition to diabetes in Indians.
  • Decrease in traditional diets: At the same time, the increased ‘westernization’, especially in the metros and the larger cities, has led to a drastic change in our dietary pattens. Indian diets have always been carbohydrate-heavy and now the reliance on refined sugars, processed food in the form of quick bites and fuss-free cooking and trans fatty acids are creating havoc.
  • Mechanization of day-to-day work: With the increasing availability of machines to do our work, there’s also a substantial drop in day-to-day activities.
  • Consumption of high calorie food and lack of physical activities: Obesity, especially central obesity and increased visceral fat due to physical inactivity, and consumption of a high-calorie/high-fat and high sugar diets, thus become major contributing factors.
  • Rapid urbanization: Currently, India is undergoing a rapid epidemiological transition with increased urbanization. The current urbanization rate is 35% compared to 15% in the 1950’s and this could have major implications on the present and future disease patterns in India with particular reference to diabetes and coronary artery disease.
  • Rural-urban migration: The rural migration to urban areas and associated stress plays a significant role in lifestyle change.

Diabetes

Ways to manage Increasing Diabetes in India

  • Aggressive Screening procedures: Indians need an upstream approach or prioritizing protection of the population as a whole, beginning with women and children. This can be done with aggressive screening procedures. “Anybody above 18, with a clear-cut risk like family history, weight issues and young women with polycystic ovarian syndrome (PCOS) should be tested. All Indians above 30 should be screened.
  • Timely diagnosis and right management: Medical experts feel that timely detection and right management can go a long way in helping patients lead a normal life.
  • Diet discipline for children: For children, Doctors recommends a serious diet discipline. “Only healthy meals are the option that remains. Tutor the tastebuds of the young and stop their access to fast foods. There can be supportive policy measures making healthy fruits and vegetables accessible in a cost-effective manner to all instead of plain carbs. The mid-day meal or tiffin needs to be looked at thoughtfully and to make it healthy.
  • Promoting physical activities: “The overall decline in physical activity has had devastating impacts on our metabolism,” while agreeing with the 30-minute a day exercise and activity schedule, sounds a note of caution. The recent scientific evidence suggests even five minutes of walk after any meal provides some protection.
  • Adopting healthy Lifestyle: Though a chronic medical condition, Diabetes can be curbed at the initial level by introducing lifestyle changes. Experts suggests, reduce stress; sleep on time and for minimum of seven hours, maintaining ideal body weight, regular physical activity stop smoking, stopping/ minimum alcohol intake and get early treatment for any pre-existing or co-morbid health condition such as hypertension.
  • Regular check-ups: Regular visits to the doctor are important to assess sugar control and assessment/ prevention of complications related to the disease.

Conclusion

  • With the country having the highest number of diabetic patients in the world, the sugar disease is posing an enormous health problem to our country today. According to a World Health Organization (WHO) fact sheet on diabetes, an estimated 3.4 million deaths are caused due to high blood sugar in the world.

Mains Question

Q. Diabetes is increasing alarmingly across all age groups in India. Discuss the reasons and suggest measures to manage epidemic of diabetes if it is not curable?

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Role of Private Sector in Ayushman Bharat Digital Mission

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Ayushman Bharat Digital Mission

Mains level: Issues with interoperability of Private Sector under Ayushman Bharat Digital Mission

 Ayushman Bharat Digital Mission

Context

  • On 27 September, 2021, Prime Minister Narendra Modi announced the rollout of the Ayushman Bharat Digital Mission with the aim of integrating the different and disparate digital health systems that exist into a National Digital Health Ecosystem.

What is Ayushman Bharat Digital Mission (ABDM)?

  • The ABDM currently has five main components:
  • Ayushman Bharat Health Account (ABHA) number: A unique health identification number,
  • Healthcare Professionals Registry (HPR): A repository of healthcare professionals across both modern and traditional systems of medicine,
  • Health Facility Registry (HFR): A repository of both public and private health facilities, including hospitals, clinics, diagnostic laboratories, and pharmacies,
  • Unified Health Interface (UHI): An open protocol for digital health services linking patients with healthcare providers,
  • ABHA Mobile App: An app allowing an individual to carry electronic health records.

 Ayushman Bharat Digital Mission

Analyzing the future of India’s health care system

  • Digitization push of Government: To achieve the Sustainable Development Goals and targets of universal health coverage, the Indian government has expended significant efforts to promote the digitization of the healthcare sector to make health accessible, affordable, and equitably distributed.
  • Citizens and doctors can access the health registry: The two registries would ostensibly create a database of India’s healthcare institutions and professionals that citizens would be able to access.
  • Digital health card: The ABHA number and the application allow citizens to securely identify themselves and carry their health records to any healthcare facility.
  • Targeted health care services: And lastly, the UHI would facilitate greater access to and delivery of healthcare services.
  • Huge data for research: All of this activity has and will generate a tremendous quantity of data, which will be crucial for research, innovation, and policymaking.

Importance of private sector in health sector

  • Mixed health care system: India has a mixed healthcare system, which means that it has both public and private healthcare providers. Without significant participation from the private healthcare providers, the ABDM’s ability to achieve its objectives will be limited.
  • 81% doctors are private: This is because private healthcare infrastructure accounts for nearly 62 per cent of all of India’s health infrastructure and the private sector also provides 81 per cent of the doctors in India.
  • Preference to private healthcare: Both rural and urban population in India seem to prefer seeking treatment from the private sector. Only 33 per cent of the rural and 26 per cent of the urban population depend on the public sector for healthcare.

 Ayushman Bharat Digital Mission

Why Private health care are opting out of ABDM?

  • Voluntary participation in ABDM: The voluntary nature of participation in the ABDM has led to a significant portion of private healthcare providers opting to not participate in the universal programme nor integrate into the UHI.
  • High cos