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Subject: Health

  • [7th June 2024] The Hindu Op-ed: Health regulations need a base-to-top approach

    [7th June 2024] The Hindu Op-ed: Health regulations need a base-to-top approach

    PYQ Relevance

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

    Q In order to enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss. (UPSC IAS/2020)

    Mentors comment: In the last week of May, a tragic fire at a private neonatal care nursing home in New Delhi shocked everyone. Political parties started blaming each other, and the media exaggerated by incorrectly claiming that many nursing homes in Delhi operate without a license. Despite the intense media coverage, the incident has been largely forgotten, leaving the grieving parents behind. Instead of focusing on who to blame, it’s important to recognize that such tragedies are usually the result of systemic failures—in this case, the failure of health-care regulations.

    Let’s learn–

    Why in the news?

    Health regulations are crucial, but their implementation in India needs to be thoughtful and carefully balanced.

    Regulation and standards in the Indian health care system

    • Excessive and Complex Regulations: Some states have over 50 approvals required under multiple regulations for each healthcare facility, creating a bureaucratic burden. Despite the complexity, there is a perception among officials that the private health sector is under-regulated.
    • Unrealistic Standards: Many healthcare quality standards set by the government, such as those in the Clinical Establishments (Registration and Regulation) Act, 2010, and the Indian Public Health Standards (IPHS), are considered unrealistic and difficult to implement. Only a small percentage of government primary healthcare facilities meet these standards despite their aspirational goals.

    Mixed health-care system in India 

    • Diverse Healthcare Providers: India’s healthcare system includes both government and private sector providers, ranging from single-doctor clinics and small nursing homes to large corporate hospitals, each serving different population segments.
    • Dominance of Private Sector: The private sector delivers approximately 70% of outpatient services and 50% of inpatient services, indicating a significant reliance on private facilities for health care by the Indian population.
    • Regulatory and Quality Challenges: There are disparities in regulation enforcement and quality standards between the private and government sectors, with issues such as approval delays, cost of compliance, and ensuring consistent quality care across diverse facilities.

    Challenges related to mixed health-care system

    • Regulatory Disparities: Uneven enforcement of regulations between private and government health facilities. Overzealous regulation of private facilities while government facilities face fewer consequences for similar infractions.
    • Approval Delays: Sluggish approval processes for private facilities, causing operational delays and financial strain. Long waiting periods for renewal applications, even when submitted well in advance.
    • Cost and Accessibility: High cost of services in large corporate hospitals compared to smaller clinics and nursing homes. Limited accessibility of government facilities for certain populations, despite being free or low-cost.
    • Differential Standards: Impractical to hold small clinics and nursing homes to the same standards as large hospitals. Need for a tiered approach to regulation, with essential and desirable standards based on facility type.
    • Financial Burden: High cost of compliance with regulations for smaller facilities, potentially making health services unaffordable for patients. The a need for government subsidies or funding to help smaller providers meet regulatory standards without increasing costs for patients.
    • Stakeholder Involvement: Insufficient involvement of health-care providers, facility owners, and community members in the formulation of regulations. Lack of representation from various types of facilities in regulatory processes.
    • Public Perception and Trust: Political rhetoric and sensational media coverage undermining trust in health-care providers. Potential for increased violence against health-care providers due to public mistrust.
    • Infrastructure and Safety: Inconsistent emphasis on essential safety measures like fire safety across facilities. Need for equitable implementation of safety standards in all healthcare buildings.

    Affordable care is one need

    • Role of Small Providers: Single doctor clinics and small nursing homes are crucial for providing initial access and health services, particularly for middle-income and low-income populations. These smaller providers deliver a significant portion of health services at a lower cost compared to large corporate hospitals.
    • Supportive Regulations: There is a need for regulations that support small providers to keep healthcare costs low and affordable. Guidelines should be practical and implementable, harmonizing multiple regulations and simplifying the application process with timely approval.
    • Differential Approach: Regulations should recognize the different capabilities of various health facilities. Smaller clinics and nursing homes should not be held to the same standards as large hospitals to avoid escalating costs that could be transferred to patients. Essential and desirable regulatory points should be established, with regular self-assessments and inspections to ensure compliance.
    • Government subsidies and funding should be considered to help smaller facilities adhere to necessary regulations without increasing costs for patients.

    Why do we need to Focus on the primary caregivers?

    • Accessibility and Affordability: Single-doctor clinics and small nursing homes provide essential health services at a lower cost, making health care more accessible and affordable for middle-income and low-income populations.
    • Primary Care Foundation: Promoting primary care helps manage health issues early, reducing the burden on secondary and tertiary care facilities and supporting the goals of the National Health Policy, 2017, for people-centric, accessible, and affordable health services.
    • Sustainable Support: Simplified, fair, and collaborative regulatory processes, along with government subsidies, can help primary-care providers operate effectively, ensuring quality and safety without escalating costs for patients.

    Conclusion: Primary health care is crucial for achieving the SDG goal of universal health coverage by providing accessible, affordable, and quality health services, thus reducing the burden on higher-level care facilities and promoting overall health equity.

  • India and the ‘managed care’ promise

    PYQ Relevance

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

    Q The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC IAS/2022)

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

    Let’s learn_ _ 

    Why in the news?

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

    What is a Managed Care Organization?

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

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

    Evolution of MCOs in the United States:

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

    Evolution of MCOs in India:

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

    Challenges in India:

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

    Prospective Solutions and Remaining Issues:

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

     NITI Aayog Report:

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

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

  • Women often outlive men but in poorer health: what new Lancet study says

    Why in the news?

    Over 30 years, a study examining 20 diseases revealed minimal advancements in narrowing the disparity between genders as per “the Lancet Public Health Journal”.

    What does the New Lancet report say?

    • On Health Disparities: The study highlights that women tend to suffer more from lower back pain, depression, and headaches, while men have shorter life expectancies due to higher rates of road accidents, cardiovascular diseases, and, recently, COVID-19.
    • On Health Burden: Women spend more time in poor health, while men are more likely to die prematurely from severe conditions.
    • Overall Global Analysis: The analysis examines differences in the 20 leading causes of illness and death globally, considering all ages and regions.

    What Causes the Differences in Diseases Between Women and Men? (Observations)

    • Biological Factors:
        • Hormonal Differences: Hormonal fluctuations in women, such as during menstrual cycles, pregnancy, and menopause, can influence susceptibility to certain conditions like migraines, depression, and autoimmune diseases.
        • Genetic Variations: Variations in genes and genetic predispositions may contribute to differences in disease susceptibility and severity between sexes.
        • Anatomical Variances: Physiological differences, such as in skeletal structure and hormonal regulation, can affect the manifestation of certain diseases like lower back pain and reproductive disorders.
    • Societal and Gender Norms:
        • Healthcare-Seeking: Societal norms and gender roles may influence healthcare-seeking behaviors, with men often less likely to seek medical attention for mental health issues due to perceived notions of masculinity.
        • Occupational Hazards: Occupational differences between genders can lead to varying exposures to health risks, with certain professions associated with higher rates of injury or exposure to harmful substances.
        • Socioeconomic Factors: Disparities in socioeconomic status can impact disease prevalence and outcomes differently for women and men.
    • Healthcare System Bias:
        • Diagnostic Bias: Gender biases in healthcare may result in underdiagnosis or misdiagnosis of certain conditions in women, leading to delays in treatment and poorer health outcomes.
        • Treatment Disparities: Differences in treatment approaches and responses may exist between sexes, with women sometimes receiving less aggressive treatment for cardiovascular diseases or being undertreated for pain conditions.
        • Research Bias: Historically, medical research has often focused on male subjects, leading to a lack of understanding of how diseases manifest and progress differently in women.
    • No Improvement in Care for Women Over Time
      • Stable Gender Gap: Despite overall health improvements, the disparity between male and female health conditions remains stable.
      • Conditions Affecting Women: Conditions like lower back pain and depressive disorders have shown little to no decrease over time compared to male-dominated conditions.
      • Reproductive Focus: Global health systems have historically focused on women’s reproductive health, neglecting other significant health issues affecting women.

    What Needs to Be Done (Way Forward)

    • Better Data Collection: Governments should consistently collect and categorize health data by sex and gender to better understand and address health disparities.
    • Targeted Health Interventions: Specific health interventions should be developed and implemented based on detailed sex and gender data.
    • Increased Funding: More financial resources should be allocated to underfunded conditions that disproportionately affect women, such as mental health.
    • Addressing Healthcare Bias: Efforts should be made to eliminate biases in healthcare to ensure women receive appropriate and timely treatment for their conditions.

    Mains PYQ: 

    Q Can the vicious cycle of gender inequality, poverty and malnutrition be broken through microfinancing of women SHGs? Explain with examples. (UPSC IAS/2021)

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

    Why in the news?

    A global report highlights a significant rise in unhealthy food consumption in India, surpassing intake of vegetables, fruits, and other nutritious foods.

    • Global Food Policy Report 2024: Food Systems for Healthy Diets and Nutrition was released by “the International Food Policy Research Institute (IFPRI)”.

    About CGIAR:

    • CGIAR (formerly the Consultative Group on International Agricultural Research) is a global partnership uniting organizations engaged in research for a food-secure future.
    • Focus: Its mission focuses on reducing poverty, enhancing food and nutrition security, and improving natural resources and ecosystem services.CGIAR conducts research and partners with other organizations to transform global food systems and ensure equitable access to sustainable, healthy diets.

    Emerging Trends in India:

     

    • Increase in consumption of unhealthy food: There is a significant increase in the consumption of unhealthy foods such as salty or fried snacks compared to nutritious options like vegetables and fruits. About 38% of the population consumes unhealthy foods, while only 28% consume all five recommended food groups.

    The consumption of processed foods and ready-made convenience foods is rising. From 2011 to 2021, malnutrition in India increased from 15.4% to 16.6%.The prevalence of overweight adults rose from 12.9% in 2006 to 16.4% in 2016.

    Processed food consumption is on the rise in India 

    South Asian Highlights

    • Processed Food Consumption: Increasing intake of processed foods like chocolates, salty snacks, beverages, and ready-made meals in India and other South Asian countries.
    • Malnutrition Rates: High levels of undernutrition and micronutrient deficiencies coexist with rising rates of overweight, obesity, and diet-related noncommunicable diseases (NCDs).
    • Food Budget Trends: Packaged food spending in India’s household food budgets nearly doubled from 6.5% to 12% between 2015 and 2019.

    Issue of Double Malnutrition:

    • Double malnutrition refers to the coexistence of undernutrition and micronutrient deficiencies with overweight and obesity, or diet-related noncommunicable diseases (NCDs).
    • High levels of undernutrition (stunting and wasting) and micronutrient deficiencies persist even as overweight and obesity rates increase.
    • More than two billion people, especially in Africa and South Asia, cannot afford a healthy diet.

    Dietary Guidelines by ICMR:

    • The Indian Council of Medical Research (ICMR) released 17 dietary guidelines to promote healthy eating.
    • Guidelines emphasize reading food labels to make informed choices and minimizing the consumption of high-fat, sugar, salt, and ultra-processed foods.
    • The guidelines highlight the importance of diverse diets over cereal-centric agriculture and food policies.
    • ICMR advises against the misleading information often presented on packaged foods.

    Way forward:

    • Strengthen Nutritional Policies: Develop and enforce policies that promote the consumption of nutritious foods. Implement taxes on unhealthy foods and subsidies for fruits, vegetables, and other micronutrient-rich foods.
    • Regulate Processed Foods: Implement strict regulations on the marketing of unhealthy foods, especially targeting children.

    Mains PYQ:

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

  • [17th May 2024] The Hindu Op-ed: Health advice to take with no pinch of Salt

    PYQ Relevance:

    [2022] The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? 

    [2020]  Critically examine the role of WHO in providing global health security during the Covid-19 pandemic.

    Note4Students: 

    Prelims: NA 

    Mains:  Hypertension, WHO’s HEARTS Strategy, India’s Hypertension Control Initiative (IHCI)

    Mentor’s Comment: Hypertension, a major but overlooked risk factor for heart attacks and strokes, causes 10.8 million preventable deaths annually, surpassing risks like tobacco use and high blood sugar. The WHO’s 2023 report reveals that 1.3 billion adults globally have hypertension, with 46% unaware of their condition. In India, 311 million adults suffer from hypertension, triple the number with diabetes.

    Let’s learn___

    Why in the News?

    Over the past three years, the COVID-19 vaccine has attracted significant public attention as a potential risk factor for blood clot formation, leading to sudden cardiac arrest.

    What is Hypertension?

    Hypertension (high blood pressure) is when the pressure in your blood vessels is too high (140/90 mmHg or higher).
    It is common but can be serious if not treated.
    Eating a healthier diet with less salt, exercising regularly and taking medication can help lower blood pressure.

    WHO Report on Hypertension

    • 2023 WHO Report: In 2023, the World Health Organization (WHO) released its first-ever report on hypertension titled “Global Report on Hypertension: The Race against a Silent Killer.”
    • Silent Killer: Hypertension is often called a silent killer because people are usually unaware of their high blood pressure until they develop complications.
    • Leading Cause of Death: High blood pressure causes more deaths than other leading risk factors, such as tobacco use and high blood sugar.
    • Rising Numbers: The number of adults with hypertension nearly doubled since 1990 to reach 1.3 billion.
    • Awareness and Control: Globally, an estimated 46% of adults with hypertension are unaware of their condition, and less than half (42%) are diagnosed and treated. Only one in five adults (21%) with hypertension has it under control.

    Hypertension in India

    • Prevalence in India: The Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study estimates that in India, 311 million people (or one in every three adults) have hypertension.
    • Comparison with Diabetes: In India, adults with hypertension are threefold of the estimated 101 million people living with diabetes.

    Dietary Salt and Hypertension

    • Impact of Excess Salt: Excess dietary salt intake (five grams or more per day) is a key risk factor for hypertension and contributed to two million cardiovascular disease deaths in 2019.
    • Benefits of Reducing Salt Intake: Research shows that reducing salt intake can reduce cardiovascular disease risks by 30% and mortality by 20%.
    • Salt Consumption in India: Indian adults consume on average eight to 11 grams of salt per day, which is approximately twice the WHO-recommended daily intake.
    • Deaths Due to High Salt Intake: High salt intake is responsible for an estimated 175,000 deaths in India.

    Hypertension across Socio-Economic Groups

    • Universal Impact: Hypertension affects all socio-economic groups.
    • Health Camps Findings: A Delhi-based NGO, Foundation for People-centric Health Systems, conducted 50 health camps in five localities of Delhi and Gurugram from October 2023 to March 2024, screening and treating around 12,000 people.
    • Detection in Low-Income Groups: Many were women, migrant workers, and rickshaws and taxi drivers from low-income groups. A large number were found to have diabetes and hypertension, with most cases detected for the first time in these camps, indicating gaps in awareness, detection, and treatment.
    Back2Basics: India’s Hypertension Control Initiative (2021):

    Objective: India aims to put 75 million people with hypertension and/or diabetes on standard care by 2025.

    Initiation and Expansion: The IHCI, a collaborative project of ICMR, Ministry of Health and Family Welfare/Directorate General of Health Services, WHO India, and other partners, was initiated in November 2017 in 25 districts across five states and expanded to 140-plus districts of India in 2023.

    Strategies: IHCI follows five simple and scalable strategies implemented through primary health care:

    -Simplified drug and dose-specific treatment protocols for primary-care settings.
    -Strengthening the drug supply chain by including protocol-based drugs in the State essential drug list, forecasting drugs based on morbidity, and ensuring adequate budget allocation in annual plans.
    -Team-based and decentralized care.
    -Patient-centric measures such as dispensing 30 days of medicine during each patient visit.
    -Use of information systems for program monitoring.

    Programmatic Learnings from IHCI

    • Access and Utilization: Nearly six years of IHCI implementation has resulted in two major learnings:
      • Simple treatment protocols with fewer drugs, reliable drug supply, linking patients to facilities closer to home for follow-up, and engaging teams increase access and utilization of health services from government facilities.
      • Simplified program monitoring makes performance assessment quantifiable and actionable.
    • Recognition: The IHCI won the 2022 UN Interagency Task Force and WHO Special Programme on Primary Health Care Award.

    Future Goals and Prevention

    • Global Goals: Seventy-six million cardiovascular deaths and 450 million disability-adjusted life years (DALYs) could be avoided if countries achieve 50% population hypertension control by 2050.
    • India’s Targets: An estimated 4.6 million deaths can be prevented in India by 2040 if half the hypertensive population has its blood pressure under control, helping to achieve targets under the National Health Policy and global commitments like universal health coverage.

    Way Forward

    • Raise Awareness: Educate the public about the risks and long-term adverse impacts of untreated hypertension. High blood pressure can affect multiple organs, including the heart, kidneys, brain, and eyes.
    • Scale Up Evidence-Based Interventions: Expand successful programs like IHCI. Use strategies and lessons from such experiences to design interventions for other lifestyle diseases like diabetes and chronic kidney diseases.
    • Focus on Non-Modifiable Risk Factors: Address non-modifiable risk factors such as family history, age over 65 years, and pre-existing comorbidities like diabetes and/or kidney disease. Focus on healthy adults with known non-modifiable risk factors.
    • Reduce Dietary Salt Consumption: Implement strategies like “SHAKE the salt habit” under WHO’s HEARTS strategy:
      • Surveillance to measure and monitor salt use.
      • Harness industry to promote and reformulate foods with less salt.
      • Adopt standard labelling and marketing.
      • Educate and communicate to empower individuals to eat less salt.
      • Support environments that promote healthy eating.

    Conclusion: As hypertension continues to exact a heavy toll on global health, concerted efforts are needed to raise awareness, implement evidence-based interventions, and promote healthier lifestyles. By prioritizing hypertension control initiatives and fostering a culture of preventive healthcare, we can mitigate the devastating impact of this silent killer on communities worldwide.

    With inputs from:

    https://www.thehindu.com/opinion/lead/health-advice-to-take-with-no-pinch-of-salt/article68183434.ece

  • The impact of 50 years of vaccination on children worldwide 

    Why in the News?

    On the occasion of World Immunisation Week observed from 24th to 30th April, the Indian Academy of Paediatrics has launched a campaign to focus on routine immunization as the ‘Birth Right’ of a Child.

    About Measles Vaccination

    • This vaccine protects against 3 diseases: Measles, Mumps, and Rubella (MMR).
    • Centre for Disease Control and Prevention (CDC) recommends children get two doses of MMR vaccine, starting with the first dose at 12 -15 months of age, and the second dose at 4-6 years of age. Teens and adults should also be up to date on their MMR vaccination.

    Indian Government Initiatives:

    • World Immunization Week: The Indian Academy of Paediatrics (IAP) launched a campaign during World Immunisation Week (April 24-30) focusing on routine immunization as a fundamental right of every child. IAP urged the government to expedite the introduction of the HPV vaccine and typhoid conjugate vaccine to address significant public health burdens.
    • Vaccination made within the country:
      • DTP Vaccine: 93% of surviving infants received the third dose of the DTP vaccine.
      • Measles Vaccine: 90% of infants received the second dose of the measles vaccine. The measles vaccine has been the most significant in reducing infant mortality, accounting for 60% of lives saved through immunisation since 1974.
      • Present issues include inequitable distribution of vaccines, inability to reach 90% coverage, human resource gaps, and financing problems. In 2022, 33 million children missed a measles vaccine dose, with 22 million missing the first dose and 11 million missing the second dose.

    Impacts of Immunisation Globally:

    • Lives Saved: Immunisation efforts have saved an estimated 154 million lives globally over the past 50 years, equating to six lives every minute of every year.
    • Infant Mortality Reduction: 101 million of the lives saved were infants. Vaccination against 14 diseases has reduced infant deaths by 40% globally and by over 50% in Africa.
    • Diseases Targeted: Vaccines have contributed to reducing deaths from diseases like Diphtheria, Haemophilus Influenzae Type B, Hepatitis B, Japanese Encephalitis, Measles, Meningitis A, Pertussis, invasive Pneumococcal disease, Polio, Rotavirus, Rubella, Tetanus, Tuberculosis, and Yellow fever.

    Conclusion: Immunisation saves lives, reduces infant mortality, and prevents outbreaks by protecting against infectious diseases, ensuring healthier communities, and securing a better future for children worldwide.

    Mains PYQ:

    Q What is the basic principle behind vaccine development? How do vaccines work? What approaches were adopted by the Indian vaccine manufacturers to produce COVID-19 vaccines? (UPSC IAS/2022)

  • Niti Aayog report finds ‘huge gap’ in cancer screening at Ayushman centres

    Why in the news? 

    Ayushman Bharat insurance scheme reached 5.47 crore users, but cancer screening at Health and Wellness Centers (HWCs) faces significant gaps, reports NITI Aayog.

    Objective of Ayushman Bharat Scheme:

    • Besides providing a Rs 5-lakh insurance cover, the scheme aimed to upgrade primary health centers to HWCs, offering annual screening for Non-Communicable Diseases (NCDs) including oral, breast, and cervical cancers for individuals aged 30 years or older.

    Coverage of Ayushman Bharat Scheme: 

    • Over 5.47 crore users have utilized the Ayushman Bharat insurance scheme, making it the world’s largest medical insurance scheme.

    The ‘huge gap’ in cancer screening at Ayushman Bharat Health and Wellness Centres (HWCs):

    • NITI Aayog Report Findings: A report from NITI Aayog, based on visits to HWCs in 13 states, highlights a significant gap in cancer screening services.
    • Limited NCD Screening: Although NCD screening is underway in most HWCs, yearly screening is largely absent, with less than 10% of facilities completing a single round of NCD screening.

    Reason behind the ‘huge gap’ in cancer screening at Ayushman Bharat Health and Wellness Centres (HWCs):

    • Methods of Screening: Official protocol mandates distinct screening methods for oral, cervical, and breast cancers. However, implementation of these methods faces challenges.
    • Lack of Awareness and Capacities: The gap in cancer screening is attributed to low awareness levels and lack of capacities among healthcare providers.
    •  Implementation fell short: Auxiliary Nurse and Midwife (ANMs), medical officers, and staff nurses were supposed to be trained in cancer screening methods, but implementation fell short.
    • Suboptimal Screening Activities: Screening for breast cancer relies on beneficiary education for self-examination, while cervical cancer screening remains to be operationalized. Oral cancer screening is performed on a case-by-case basis.
    • Infrastructure and Basic Devices: HWCs generally adhere to infrastructure standards, with basic devices and medicines available free-of-cost. However, the focus remains on improving cancer screening services to align with the government’s prevention and early detection efforts.

    Way forward: 

    • Awareness Campaigns: Launch comprehensive awareness campaigns to educate the public about the importance of cancer screening and early detection. This can involve community outreach programs, workshops, and informational sessions.
    • Utilize Technology: Integrate technology solutions such as telemedicine and mobile applications to facilitate easier access to screening services, especially in remote areas. Digital platforms can also aid in data management and monitoring of screening activities.
    • Performance Monitoring: Implement robust monitoring and evaluation mechanisms to track the implementation of cancer screening programs at HWCs.

    Mains PYQ: 

    Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain.

  • Meeting Nutrition challenge: What new guidelines prescribe?

    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

  • The unseen effects of Climate Change on Mental Health

    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

  • [8 May 2024] The Hindu Op-ed: A dignified peaceful passing is everyone’s right

    Mains PYQ Relevance: 

    Q) Appropriate local community-level healthcare intervention is a prerequisite to achieving ‘Health for All’ in India. Explain. (UPSC IAS/2018)
    Q) To enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss. (UPSC IAS/2020)

    Note4Students: 

    Prelims: Right to life; Right to health; Right to die with dignity;

    Mains: Judicial Intervention in Health Care sector;

    Mentor comments: Death is inevitable, the one certainty in life. When the time comes, and if you have an incurable disease, how would you like to go? Would you prefer your bed in your home, with your loved ones around you? Or would you prefer being all alone in an Intensive Care Unit (ICU) with a tube in every orifice, hooked to machines that measure the functioning of every vital organ in your body, with each malfunctioning organ supported artificially? When facing an incurable illness, the choice between passing away at home surrounded by loved ones or in an ICU on life support is deeply personal (Right to Privacy). Some prefer the comfort and intimacy of home, while others seek every medical intervention, even if alone. There have been long debates on euthanasia and Palliative care for old people to protect their rights. Courts, through various decisions, have recognized the right to die with dignity as a fundamental right and an integral part of the right to life under Article 21.

    Let’s learn

    —

    Why in the News?

    Ronald Reagan, the 40th President of the USA, died at 93 in his home surrounded by his family members (2004). However, India’s former PM Atal Bihari Vajpayee died (2018), nine years after a stroke that had left him non-ambulant. 

    • Hence, communicating end-of-life wishes is crucial to ensure one’s final moments align with their values.

    What is the difference between Life support System and Palliative Care?

    Life support SystemPalliative Care System
    What is it?It aims to prolong life by artificially maintaining vital bodily functions.It focuses on improving quality of life by relieving symptoms, pain, and distress, regardless of prognosis.
    Treatment It involves invasive medical interventions like ventilators, dialysis, and feeding tubes.It emphasizes comfort-oriented, non-curative treatments to alleviate suffering.
    GoalsTo sustain life, even if it means prolonging the dying process.To enhance quality of life and provide comfort, even if it means foregoing life-prolonging treatments.
    TimingUsed in critical, end-stage illness when curative treatment is no longer possible.Can be provided at any stage of a serious illness, even alongside curative treatments.

    End-of-Life Practices: West vs. India

    • West Scenario: Advance directives for common, terminally ill allowed Natural Death by withdrawing life support.
    • Europe Scenario: Only 10.3% die on life support, others shifted to Palliative Care.
    • Indian Scenario:
      • 70% of incurable patients die on life support in ICUs, alone.
      • The remaining 30% die through “Left Against Medical Advice” – ethically questionable. A survey in Pune showed 83% prefer to die at home.
    What is the LAMA/DAMA Practice?

    Left Against Medical Advice/Discharged Against Medical Advice (LAMA/DAMA) refers to a patient leaving the hospital against the advice and recommendation of their treating healthcare providers.

    Its Causes:  Financial constraints, Belief in alternative therapies, Dissatisfaction with care, Terminal/advanced illness, and Lack of understanding about the treatment process. It adversely affects patient outcomes, increasing the risk of mortality and the need for readmission.

    The practice is considered ethically questionable, as it represents unplanned treatment limitations without a formal shift to palliative care.

    Challenges in Indian Context:

    • ICU Routinisation: 
      • Society has a mistaken belief in prolonging life at all costs and accepts ICU death as normal 
      • In recent years, a lack of adherence to ethical principles and routinization of intensive care deaths has become more common.
    • Lack of Legal Clarity:
      • Lack of death literacy and inability to make informed decisions plays a major setback in Indian Society.
      • Further, the absence of a Legal Framework for End-of-life Care in India creates wider challenges for hospital staff and patients.
      • The term “Passive Euthanasia” is considered a misnomer by ICMR. Withholding or withdrawing life support in futility is not euthanasia but allowing natural death.

    Initiatives taken on Palliative Care and Living Wills:

    • By WHO:
      • WHO defines health as “physical, social, and mental well-being” beyond just the absence of disease.
      • World Health Day (April 7) has passed and the theme for 2024 was “My health, my right”. 
    • By India (through Judicial intervention):
      • SC in 2018 recognized passive euthanasia and the ‘Right to die with dignity’ as a fundamental right subject to guidelines.
        • India’s Supreme Court (three-member Bench) ruled that the ‘Right to Health’ includes the ‘Right to palliative care’.
      • SC verdict of 2023 recognizes advance medical directives and withdrawal of life support in futility cases.

    Conclusion: The Lancet Commission Report 2022 speaks on the Value of Death and that modern society has become death-illiterate. Therefore, it is much required to bring awareness in our Indian Society on the value system of “dignified death”.