About 25% of men and women in India were overweight or obese in 2019-21, a 4% increase from 2015-16. Obesity is more common among women in South Indian states, Delhi, and Punjab, but it is rising faster among men.
What is the definition of “overweight” and “obese” based on BMI measurements in the National Family Health Survey?
Overweight: BMI between 25.0 and 29.9. Example: A person who is 1.65 m (5’5″) tall and weighs 70 kg would have a BMI of 25.7, categorizing them as overweight.
Obese: BMI of 30.0 or above. Example: A person who is 1.70 m (5’7″) tall and weighs 90 kg would have a BMI of 31.1, classifying them as obese.
Calculation Formula: BMI = Weight (kg) ÷ (Height in meters)². Example: If a person is 1.60 m tall and weighs 60 kg, their BMI would be: BMI=601.6×1.6=23.4\text{BMI} = \frac{60}{1.6 \times 1.6} = 23.4BMI=1.6×1.660=23.4 (Healthy range).
When did the share of overweight and obese individuals in India significantly increase?
Period of Increase (2015-16 to 2019-21): The National Family Health Survey (NFHS-5) recorded a significant rise in the share of overweight and obese individuals between 2015-16 (NFHS-4) and 2019-21 (NFHS-5).
Increase in Overweight Individuals: Women: Increased from 15.5% in 2015-16 to 17.6% in 2019-21 (a rise of 2.1 percentage points). Men: Increased from 15.9% in 2015-16 to 18.9% in 2019-21 (a rise of 3 percentage points).
Example: In Delhi, the proportion of overweight men and women was among the highest in the country during 2019-21.
Increase in Obese Individuals: Women: Increased from 5.1% in 2015-16 to 6.4% in 2019-21. Men: Increased from 3% in 2015-16 to 4% in 2019-21. Example:Punjab recorded one of the sharpest increases in obesity among women during this period.
Which Indian states reported the highest increase in obesity levels?
Northern States with Sharp Increases: Delhi and Punjab recorded the highest increase in obesity levels for both men and women between 2015-16 and 2019-21. Example: Delhi had the largest proportion of obese and overweight men in the country by 2019-21.
Southern States with Persistent High Obesity Rates: Tamil Nadu, Kerala, Andhra Pradesh, Telangana, and Karnataka consistently reported high obesity levels, with a notable rise over the survey period. Example: In Kerala, a significant portion of the population—both men and women—crossed the obesity threshold by 2019-21.
States with Accelerated Growth in Obesity: States in the South and North-West witnessed faster increases in obesity, reflecting a shift toward unhealthy dietary habits like increased consumption of fried foods and aerated drinks. Example:Punjab experienced a sharp increase in the share of obese women, making it one of the top states for rising obesity.
What are the steps taken by the Indian government?
Public Awareness Campaigns: The government promotes healthy lifestyle choices through initiatives like “Eat Right India” and “Fit India Movement” to encourage balanced diets and physical activity. Example: In Mann Ki Baat, Prime Minister advised reducing oil consumption by 10% monthly to combat obesity.
School-Based Interventions: Implement nutrition guidelines in midday meal programs and banjunk food in and around school premises to promote healthy eating habits among children. Example: The Food Safety and Standards Authority of India (FSSAI) issued regulations to restrict high-fat, salt, and sugar (HFSS) food sales in schools.
Policy and Regulation of Processed Foods: Introducing front-of-pack labeling for processed and packaged foods to inform consumers about high sugar, salt, and fat content. Example:FSSAI’s Eat Right Logo helps consumers identify healthier food options.
Lifestyle Disease Control Programs: The National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) targets obesity, diabetes, and hypertension through screening and lifestyle modification programs. Example:Community health workers under Ayushman Bharat conduct health screenings for BMI and other risk factors.
Promotion of Traditional Wellness Practices: Encouraging the adoption of Yoga and Ayurveda through programs like International Yoga Day to promote holistic health and weight management. Example: The AYUSH Ministry organizes free Yoga sessions to spread awareness about natural ways to maintain healthy BMI levels.
Way forward:
Strengthen Multi-Sectoral Collaboration: Enhance coordination between health, education, and food regulatory bodies to implement comprehensive obesity prevention programs. Example: Integrate nutrition education in school curricula and expand community-based health screenings.
Promote Sustainable Food Systems: Encourage the availability of affordable, nutritious foods and regulate ultra-processed foods through taxation and clear labeling. Example: Introduce subsidies for healthy food options and enforce strict advertising regulations for unhealthy products.
Mains PYQ:
Q The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC IAS/2022)
Recently, the Budget has acknowledged health care as a cornerstone of national growth and development.
What are India’s steps towards healthcare transformation in Budget 2025-26?
Increased Healthcare Spending: The budget includes a substantial allocation of ₹99,859 crore to the healthcare sector, marking a 9.8% increase from the previous fiscal year.
Expansion of Medical Education: The budget allocates resources to add 10,000 new seats in medical colleges across India in FY26, with plans to add 75,000 seats over the next five years. This expansion aims to address the rising demand for skilled healthcare professionals.
Strengthening Healthcare Infrastructure: There is an increase of ₹1,000 crore allocation under the PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), which aims to strengthen health infrastructure at all levels.
Digital Health Focus: The budget emphasizes the expansion of digital health portfolios, including telemedicine and AI-driven diagnostic solutions, to bridge care gaps and offer efficient healthcare solutions to underserved regions.
Promoting Medical Tourism: With the launch of the ‘Heal in India’ initiative, the budget aims to position India as a top medical tourism destination by introducing on-arrival visas for international patients and streamlining visa norms.
Healthcare Coverage for Gig Workers: The budget extends Ayushman Bharat coverage to one crore gig workers, recognizing their contribution to the new-age services economy.
Support for AI in Healthcare: The budget announces the establishment of India’s Centre of Excellence for AI, and the expansion of the Atal Tinkering Labs (ATL) initiative, will further propel research within the Indian healthcare sector.
What would be the implications of Customs duty exemptions?
Cost Reduction: The budget includes a full exemption of customs duty on 36 life-saving drugs used to treat cancer, rare diseases, and other severe chronic conditions. This measure will significantly reduce the cost of these essential medications, making them more accessible to patients, especially those from economically disadvantaged backgrounds.
Improved Access to Medications: The exemption extends to specific drugs under Patient Assistance Programs run by pharmaceutical companies, along with adding 37 new medicines and 13 new patient assistance programs by next year. This will improve access to critical medications for patients, particularly those with chronic conditions.
What are the objectives of synergy – ‘Heal in India’?
Promote Medical Tourism: The ‘Heal in India’ initiative aims to promote medical tourism by simplifying visa procedures for international patients.
Establish India as a Global Healthcare Destination: By enhancing hospital infrastructure and streamlining visa processes, India is poised to become the preferred medical destination for international patients.
What are the challenges in India?
Inadequate Infrastructure: India faces a shortage of healthcare infrastructure, particularly in rural areas, leading to unequal access to services.
For example, India has only 0.9 beds per 1000 population, with only 30% of these beds located in rural areas. This is significantly lower than the WHO’s suggested norm of 3.5 beds per 1000 population.
The underdeveloped state of roads and railways, along with erratic power supply, further complicates the establishment of rural health facilities.
Financial Barriers: A significant portion of the population faces affordability issues, with many households bearing healthcare expenses out-of-pocket.
For instance, a large proportion of the Indian population lacks health insurance coverage, exacerbating the financial burden and limiting access to necessary healthcare services.
High costs of intensive care units (ICUs), averaging ₹60,000-90,000 per day, are beyond the reach of most Indians.
Shortage of Healthcare Professionals: There is a shortage of trained healthcare professionals, including doctors, nurses, and specialists.
For example, shortages of surgeons, obstetricians and gynaecologists, general physicians, and paediatricians range from 74.2% to 81.6% of the required strength in Community Health Centers (CHCs). The doctor-patient ratio is significantly low, especially in rural areas.
Way forward:
Strengthen Rural Healthcare Infrastructure – Increase investments in rural hospitals, improve transport and power infrastructure, and incentivize private sector participation to bridge accessibility gaps.
Expand Medical Workforce & Insurance Coverage – Enhance training programs for doctors and nurses, increase medical seats, and extend affordable health insurance schemes to reduce out-of-pocket expenses for low-income groups.
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)
The Ministry of Labour and Employment’s 2024 report indicates that all States and Union Territories must complete harmonization and pre-publication of draft rules for new Labour Codes by March 31, 2025, allowing for mental health provisions.
How does social inequality impact mental health access and outcomes?
Disparity in Access to Care: Social inequality leads to significant disparities in access to mental health care services. Individuals from lower socio-economic backgrounds, particularly blue-collar workers, often face barriers such as lack of awareness, stigma, and inadequate healthcare infrastructure, resulting in a treatment gap of 70% to 92% for mental disorders in India.
Workplace Conditions: Blue-collar workers frequently endure demanding jobs with poor working conditions, job insecurity, and inadequate pay, which can exacerbate mental health issues. These conditions contribute to higher rates of stress and mental disorders among this demographic compared to their white-collar counterparts.
Limited Legislative Protections: The existing labor laws primarily focus on physical safety and do not adequately address mental health concerns. This legislative gap perpetuates the marginalization of blue-collar workers in accessing mental health resources and support.
What legislative and policy changes are necessary to promote inclusivity in mental health care?
Rights-Based Framework: Establishing a rights and duty-based legislative framework that mandates employers to ensure both physical and mental well-being is crucial. This framework should include clear definitions of occupational diseases that encompass mental health issues arising from work conditions.
Inclusion of Mental Health in Labor Codes: The upcoming labor codes should explicitly incorporate provisions for mental health, creating a liability-based framework for employers to prioritize the mental well-being of their employees. This includes recognizing stress-related conditions as occupational hazards eligible for compensation.
Awareness and Accessibility Initiatives: Legislative measures should mandate employers to promote awareness of available mental health resources, such as helplines and support programs like Tele Manas, ensuring that blue-collar workers are informed and encouraged to seek help without stigma.
What are the steps taken by the government?
Implementation of National Mental Health Policies: The Indian government has implemented policies such as the National Mental Health Policy (2014), which emphasizes the integration of mental health services into primary healthcare.
Launch of Mental Health Initiatives and Helplines: Initiatives like Tele Manas, a government-run mental health support service, have been introduced to provide confidential telephonic counselling for individuals.
Increased Mental Health Awareness through Education and Campaigns: Programs like the “Mental Health Awareness Campaign” and partnerships with organizations like WHO have aimed to educate the public about mental health.
How can societal attitudes towards mental health be transformed to reduce stigma? (Way forward)
Education and Awareness Campaigns: Raising awareness through national and local campaigns can help normalize mental health discussions. For example, the “It’s Okay to Not Be Okay” campaign in India aimed at addressing mental health issues in the workplace.
Media Representation and Positive Portrayal: The media plays a significant role in shaping public attitudes. Portraying individuals with mental health issues as strong, resilient, and capable of leading successful lives can help shift negative perceptions. For instance, Bollywood movies like “Dear Zindagi”.
Involvement of Influential Figures: Public figures such as celebrities, politicians, and community leaders can be instrumental in reducing stigma by sharing their personal mental health stories. When Virat Kohli, an Indian cricketer, spoke openly about struggling with mental health issues, it made a powerful impact and encouraged others.
Mains PYQ:
Q ”Economic growth in the recent past has been led by increase in labour productivity.” Explain this statement. Suggest the growth pattern that will lead to creation of more jobs without compromising labour productivity. (UPSC IAS/2022)
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? (CS Mains 2018)
Mentor’s Comment: UPSC Mains has always focused on the main cause of hunger (2018) and poverty and hunger in India(2019).
India’s White Revolution made it the world’s top milk producer, but now the focus should shift to ensuring milk reaches the most vulnerable. Milk is an important source of protein and calcium, especially for children. However, there are significant differences in milk consumption across income groups and regions. Addressing these gaps is crucial for better health outcomes.
Today’s editorial discusses how milk should be accessible to everyone in India and highlights the differences in milk availability. It looks at how these issues are connected to topics in GS Paper 1, 2, and 3, such as social inequalities, health, and policy solutions.
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Let’s learn!
Why in the News?
The challenge is making sure that the most vulnerable people have fair access to milk, while also controlling how much milk is consumed by wealthier people.
What is the disparity in milk consumption?
Income-Based Disparities: Households in the top-income decile consume 3-4 times more milk per capita compared to those in the lowest-income decile. Despite increases in milk consumption among lower-income groups, the poorest 30% account for just 18% of India’s milk.
Urban vs. Rural and Regional Disparities: Urban households consume ~30% more milk per capita than rural households, despite rural areas being the main milk producers.
Additionally, northern states like Rajasthan, Punjab, and Haryana have higher consumption (333g-421g), while eastern states like Chhattisgarh, Odisha, and West Bengal have much lower consumption (75g-171g).
Social Group Disparities: Scheduled Tribe households consume 4 litres less milk per capita annually compared to general category households, highlighting social and economic inequalities in milk access.
What are the nutritional implications of milk consumption in India?
Protein Source: Milk is a rich source of high-quality protein. In India, it contributes significantly to daily protein intake, especially for children and adults in rural areas. According to the National Family Health Survey (NFHS), over 70% of children in India consume milk, making it a key protein source.
Calcium and Bone Health: Milk provides essential calcium, which is vital for bone health. Around 67% of Indian households consume milk, helping to prevent calcium deficiency, particularly in growing children and elderly populations, which can lead to conditions like osteoporosis.
Micronutrients and Vitamin D: Milk is also a good source of vitamins such as B12 and D, essential for immune function and energy production. The National Institute of Nutrition (NIN) states that milk helps in reducing vitamin D deficiency, which is prevalent in India due to limited sunlight exposure.
How can policy interventions address disparities in milk production and access?
Enhancing Milk Provision: Increase milk availability for vulnerable populations through government schemes like the Pradhan Mantri Poshan Shakti Nirman (POSHAN) and Integrated Child Development Services. States can collaborate with nutrition institutes to align milk products with local dietary preferences.
Financial Support: Boost financial allocations for existing schemes to ensure adequate milk provision, especially in states where such programs have been discontinued due to budget constraints.
Nutritional Awareness Campaigns: Conduct awareness campaigns focusing on the benefits of milk consumption, targeting women through various community channels. This can help improve dietary diversity within households.
What strategies can be implemented to promote sustainable dairy practices?
Healthy Consumption Awareness: Develop partnerships with healthcare professionals and media to promote balanced diets and moderation in dairy consumption among affluent groups.
For example, Campaigns similar to the UK’s Change4Life initiative could serve as effective models for India.
Investing in Dairy Infrastructure: The government should continue investing in dairy infrastructure, including animal health care and fodder availability, to ensure sustainable production practices while improving yields.
Community Engagement: Engage local communities in sustainable practices through education and training programs aimed at improving animal husbandry practices and enhancing productivity without compromising environmental sustainability.
What are the steps taken by the government?
Rashtriya Gokul Mission: This initiative focuses on enhancing the genetic quality of bovine animals through the identification and use of high-quality bulls for breeding, in-vitro fertilization (IVF) technology, and genomic selection. It aims to improve milk production by covering millions of livestock and providing better healthcare services for animals.
National Dairy Plan (NDP): The NDP supports the establishment of dairy cooperatives and processing facilities to enhance milk marketing and value addition. It includes financial assistance for creating dairy processing infrastructure, thereby improving the overall efficiency and competitiveness of the dairy sector.
Kisan Credit Card (KCC) Facility: This scheme offers credit support to farmers for various agricultural activities, including dairy farming. By providing financial assistance, the KCC aims to empower smallholder farmers to invest in their livestock and improve milk production capabilities.
Way forward:
Increase Access for Vulnerable Groups: Expand milk distribution through government schemes (e.g., POSHAN and ICDS) and ensure adequate funding to cover vulnerable populations.
Regional and Social Equity: Implement targeted interventions to reduce regional, income, and social disparities in milk access, such as milk coupons or subsidies for underserved areas.
The Union Cabinet has approved the extension of the National Health Mission (NHM) for an additional five years(2025 to 2030).
What are the new Components of the NHM and initiatives launched?
Digital Health Initiatives: The U-WIN platform was launched in January 2023 to improve vaccination tracking for pregnant women, infants, and children, expanding to 65 districts across 36 states/UTs by the end of FY 2023-24.
Expanded Healthcare Programs: NHM has overseen the launch of initiatives such as the National Sickle Cell Anaemia Elimination Mission and the Measles-Rubella Elimination Campaign, enhancing disease control efforts.
Strengthening Human Resources: The NHM has focused on increasing healthcare personnel, engaging over 1.2 million additional healthcare workers across various roles since its last extension.
What are the key achievements of the National Health Mission during its previous tenure?
Reduction in Maternal and Child Mortality:
Maternal Mortality Ratio (MMR): Declined from 130 per lakh live births in 2014-16 to 97 per lakh in 2018-20 (25% reduction).
Under-5 Mortality Rate: Decreased from 45 per 1,000 live births in 2014 to 32 in 2020 (75% decline).
Infant Mortality Rate (IMR): Reduced from 39 per 1,000 live births in 2014 to 28 in 2020. India is on track to achieve the SDG targets for maternal, child, and infant mortality before 2030.
Healthcare Workforce Expansion: The NHM facilitated the engagement of approximately 2.69 lakh additional healthcare workers in 2021-22 alone, contributing to improved healthcare delivery.
Disease Control Improvements: Enhanced surveillance and control measures for diseases like tuberculosis have led to a decrease in incidence rates, contributing to overall public health improvements.
What are the financial implications and commitments associated with the NHM’s extension?
Budgetary Allocation and Funding Structure: The National Health Mission (NHM) continues based on recommendations from the Expenditure Finance Committee (EFC) and fixed spending limits. While the mission has been extended, its budget is reviewed regularly to ensure efficient use of resources.
For funding, most states share costs with the central government in a 60:40 ratio, while northeastern and hilly states follow a 90:10 pattern. This setup ensures states have enough funds to implement health programs effectively.
Performance-Based Funding: The NHM rewards states with additional funds for improving key health outcomes like maternal and child health. This encourages states to enhance their healthcare systems.
Local committees, such as Rogi Kalyan Samitis (RKS), also receive untied funds, giving them the flexibility to directly address patient needs and improve services.
Commitment to Health Targets: By 2025, the NHM aimed to achieve specific health goals, including reducing the Maternal Mortality Ratio (MMR) to 90, the Infant Mortality Rate (IMR) to 23, and the Under-5 Mortality Rate (U5MR) to 23. Achieving these targets will require consistent investment in health infrastructure, workforce training, and community programs.
The government is also focused on tackling broader factors affecting health, such as nutrition and disease prevention while improving access to healthcare for disadvantaged groups.
What are the challenges?
Infrastructure Deficiencies: Many Primary Health Centres (PHCs) lack essential diagnostic tools, medical equipment, and sanitation facilities. PHCs in remote areas of Bihar and Uttar Pradesh often face electricity and water supply shortages, limiting their ability to deliver quality care.
Shortage and Distribution of Healthcare Workforce: Despite adding 1.2 million healthcare workers, there remains a shortage of specialists such as gynaecologists, anaesthetists, and paediatricians in rural areas. Rajasthan and Madhya Pradesh struggle to staff CHCs with specialized doctors.
Financial Constraints and Inefficient Fund Utilization: Delays in fund disbursement and underutilization of allocated budgets hinder the implementation of key initiatives. Northeastern states like Nagaland and Manipur faced challenges in utilizing NHM funds due to inadequate financial planning and monitoring mechanisms.
Way forward:
Infrastructure and Workforce Enhancement: Strengthen PHC and CHC infrastructure with essential facilities and ensure equitable distribution of healthcare specialists through targeted incentives, training, and deployment programs in underserved areas.
Efficient Fund Utilization: Streamline fund disbursement processes, enhance financial planning, and implement robust monitoring mechanisms to ensure optimal use of allocated budgets, particularly in resource-constrained regions.
Mains PYQ:
Q “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. (UPSC IAS/2021)
Recently, Maharashtra Food and Drugs Administration has allowed homeopathic doctors, who completed a course in modern medicine to prescribe allopathic medicines.
What is the difference between Homeopathy and Allopathy?
Homeopathy uses natural substances in tiny doses to help the body heal, while allopathy uses medicines or treatments to directly fight or treat diseases based on science and evidence.
What is crosspathy?
Crosspathy refers to practitioners from one medical system (e.g., homoeopathy) treating patients with medicines from another system (e.g., allopathy).
Why did the Maharashtra FDA issue a directive allowing homoeopathic practitioners to prescribe allopathic medicines?
Addressing Doctor Shortage: The directive aimed to tackle the severe shortage of doctors, particularly in rural areas, where there is a lack of healthcare professionals, especially specialists.
Expanding Healthcare Access: By allowing certified homoeopathic practitioners to prescribe allopathic medicines, the Maharashtra FDA sought to expand healthcare services and make treatment more accessible to patients in underserved regions.
Promoting Integrative Medicine: The directive is part of a broader initiative to promote integrative or integrated medicine, where different medical systems, such as homoeopathy and allopathy, are used to complement each other in patient care.
What is the Supreme Court’s stance on ‘crosspathy’?
The Supreme Court (SC) has consistently held that cross-system practice (practicing medicine from a system one is not qualified for) is a form of medical negligence.
Poonam Verma vs Ashwin Patel (1996) – A homoeopath was held liable for prescribing allopathic medicines that resulted in a patient’s death.
Crosspathy is only allowed where state governments have specifically authorized it through special orders.
What are the challenges faced by govt?
Doctor Shortage: India faces a significant shortage of doctors, especially in rural areas, where the Health Dynamics of India 2022-23 report highlights an 80% deficit of specialists in community health centres. As of June 2022, there were 13.08 lakh allopathic doctors and 5.65 lakh AYUSH practitioners, indicating an insufficient number of qualified professionals to meet healthcare demands.
Integration of AYUSH Practitioners: While AYUSH practitioners could potentially fill healthcare gaps, there is no systematic approach to integrating them effectively, which could lead to poor outcomes.
Risk to Patients: Allowing unqualified practitioners to prescribe allopathic medicines could result in medical errors and negligence, raising concerns about patient safety.
Opposition from Professional Bodies: Organizations like the Indian Medical Association (IMA) strongly oppose crosspathy, questioning its legality and the risks posed to patients.
Regulatory Uncertainty: Lack of clarity on who has the authority to issue such directives and manage cross-system practice leads to legal and administrative challenges.
Way forward:
Clear Regulatory Framework: Establish clear guidelines and regulations for integrating different medical systems to ensure patient safety and effective healthcare delivery, with proper qualifications for practitioners.
Address Doctor Shortage Strategically: Focus on training and deploying more allopathic doctors, especially in rural areas, while ensuring AYUSH practitioners are properly integrated into the healthcare system through structured programs.
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)
The Global Burden of Diseases Study (GBD) 2021 shows that India’s fertility rate has dropped significantly, from 6.18 children per woman in the 1950s to 1.9 children per woman in 2021.
What has a GBD Report shown about the total fertility rate in India?
Declining Fertility Rates: India’s TFR has dramatically decreased from 6.18 in the 1950s to 1.9 in 2021, which is below the replacement level of 2.1 necessary for population stability.
Future Projections: The report projects that India’s TFR could further decline to 1.04 by 2100, indicating a potential average of less than one child per woman.
Socio-Economic Concerns: This steep decline in fertility has raised alarms regarding political and socio-economic impacts, particularly in southern states, where there are fears of losing parliamentary representation due to demographic shifts post-delimitation in 2026.
Why are fertility levels declining in India?
Early Adoption of Family Planning Policies: Southern states like Tamil Nadu and Andhra Pradesh rigorously implemented family planning policies introduced in the 1950s, leading to a significant decline in fertility rates. For example, Andhra Pradesh currently has a Total Fertility Rate (TFR) of 1.5, comparable to Nordic countries like Sweden.
Higher Female Literacy and Workforce Participation: Increased educational attainment among women has empowered them to delay marriage and childbirth. This is evident in Kerala, where high literacy rates have contributed to the state achieving replacement-level fertility as early as 1988.
Changing Societal Norms: Cultural shifts have led to late marriages and smaller families. For instance, women in southern states increasingly prioritize careers and financial independence over traditional roles, contributing to lower fertility rates.
Urbanization and Economic Pressures: Urban lifestyles and rising costs of living discourage larger families. States like Tamil Nadu and Karnataka have seen fertility rates drop to 1.4 and 1.6 respectively due to urbanization and modern aspirations.
Why are the southern States worried?
Ageing Population: Southern states like Kerala, Tamil Nadu, and Andhra Pradesh have fertility rates that have fallen below the replacement level of 2.1 children per woman. This decline leads to an increasing proportion of elderly individuals in the population, which is projected to rise significantly.
For instance, Kerala’s population aged 60 and above is expected to increase from 13% in 2011 to 23% by 2036. This demographic shift results in a smaller working-age population, which can strain economic productivity and increase demands for pensions and healthcare services.
Political Representation: The upcoming delimitation of parliamentary constituencies, based on population figures from the 2031 Census, raises fears that southern states may lose parliamentary seats due to their slower population growth.
This potential reduction in representation could diminish their political influence at the national level, especially compared to more populous northern states like Uttar Pradesh and Bihar.
Economic Strain: With a declining workforce contributing less to the economy through taxes and social security, southern states face challenges similar to those observed in countries with ageing populations, such as Japan and China.
Migration Issues: As birth rates decline, southern states may increasingly rely on internal migration from northern states to fill labour shortages. However, this reliance could create further socio-economic disparities between regions.
Way forward:
Equitable Resource Distribution: Implement policies ensuring equitable representation and resource allocation in parliamentary seats post-delimitation to address regional disparities without penalizing states with successful population control measures.
Support for Ageing Populations: Develop robust social security systems, healthcare infrastructure, and incentives for elder care while promoting skill development and migration-friendly policies to mitigate workforce shortages in southern states.
Mains PYQ:
Q Discuss the main objectives of Population Education and point out the measures to achieve them in India in detail. (UPSC IAS/2021)
The HPV vaccine works best if given before coming into contact with the virus. It is recommended for children aged 12 to 13 and for people who are more likely to get HPV.
What are the health benefits of including the HPV vaccine in the national immunization program?
Prevention of Cervical Cancer: The HPV vaccine can prevent over 90% of cervical cancers caused by HPV, significantly reducing incidence rates and mortality associated with this disease.
Broader Cancer Protection: Vaccination also protects against other HPV-related cancers, including those of the vagina, vulva, penis, anus, and oropharynx, promoting overall public health.
Cost-Effectiveness: Early vaccination can lead to long-term savings in healthcare costs by reducing the need for cancer treatments and associated healthcare services.
Equity and Accessibility: Making the HPV vaccine part of the national immunization program would enhance accessibility for all demographics, particularly in low- and middle-income regions where cervical cancer rates are disproportionately high.
What are the economic implications of integrating the HPV vaccine into the national immunization program?
Healthcare Savings: By preventing cervical cancer, the integration of the HPV vaccine into the national immunization program can lead to substantial reductions in treatment costs and hospitalizations related to advanced cancer stages.
Increased Productivity: Healthier populations contribute to economic productivity as fewer individuals suffer from debilitating illnesses that impede work and social engagement.
Investment in Public Health: Allocating resources for HPV vaccination can enhance public health infrastructure and create a more robust healthcare system capable of addressing other health issues.
What are the barriers to HPV vaccination?
High Vaccine Costs: The prohibitive cost of HPV vaccines like Gardasil and Cervarix limits their accessibility for many Indian families. Although the indigenous vaccine, CERVAVAC, offers a more affordable alternative, affordability remains a key barrier to widespread vaccination.
Low Awareness Levels: A significant lack of awareness about HPV and its link to cervical cancer results in poor understanding of the vaccine’s benefits, contributing to low acceptance and coverage rates.
Cultural and Social Stigma: Cultural taboos around sexual health and reproductive issues discourage parents from vaccinating children, particularly girls, due to misconceptions about the vaccine’s necessity or fears of promoting promiscuity.
Gender Bias in Vaccination Efforts: The focus on HPV as a women-centric infection leads to insufficient promotion of vaccination among boys and young men, perpetuating gender disparities in healthcare and reducing overall campaign effectiveness.
Policy and Budgetary Constraints: Despite recommendations for including the HPV vaccine in national immunization programs, delays caused by budgetary limitations and competing health priorities hinder its integration and accessibility.
What strategies can be employed to overcome barriers to HPV vaccination uptake? (Way forward)
Awareness Campaigns: Implementing educational initiatives to inform communities about the benefits and safety of the HPV vaccine can help dispel myths and cultural stigmas surrounding vaccination.
Subsidizing Costs: Reducing the financial burden through government subsidies or integrating the vaccine into public health programs can improve accessibility for lower-income populations.
Engaging Healthcare Providers: Training healthcare professionals to communicate the importance of HPV vaccination effectively can encourage more patients to get vaccinated, particularly among hesitant parents and young adults.
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)
Q) Does the Rights of Persons with Disabilities Act, 2016 ensure effective mechanisms for empowerment and inclusion of the intended beneficiaries in the society? Discuss (UPSC CSE 2017) Q)The Rights of Persons with Disabilities Act, 2016 remains only a legal document without intense sensitisation of government functionaries and citizens regarding disability. Comment. (UPSC CSE 2022)
Mentor’s Comment: UPSC mains have always focused on Rights of Persons with Disabilities Act, 2016 (2022), and ‘Morals of Welfare State’ in (2021).
PwDs (Persons with Disabilities) face stigma, discrimination, and neglect, due to prejudice and socio-psychological and cultural reasons, despite the Constitutional guarantee of equality of all citizens. Only about 35.29% of children with disabilities have access to schools, and approximately 55% of disabled individuals in India are illiterate, which severely limits their employment opportunities and social participation.
Today’s editorial emphasizes the urgent need for accessibility rules that are grounded in fundamental principles. This content can be used for representing a framework that is not only comprehensive but also clear and actionable, ensuring that all individuals, regardless of their abilities, can access services and environments effectively.
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Let’s learn!
Why in the News?
The Supreme Court, in the case of Rajive Raturi v. Union of India (2024), ruled that Rule 15 of the Rights of Persons with Disabilities (RPwD) Rules, 2017, violates the Rights of Persons with Disabilities Act, 2016.
The Court found that Rule 15 was written in a discretionary manner, contrasting with the mandatory language of relevant sections in the Act, which obligate the government to ensure accessibility.
Significance of the Present Ruling:
• The present Rajive Raturi v. Union of India (2024) ruling is crucial as Rule 15 underpins various accessibility guidelines from different ministries, such as housing and transportation. • By declaring Rule 15 ultra vires, the Court effectively nullified the statutory authority of the existing guidelines and mandated the government to establish minimum mandatory accessibility requirements within three months. Rule 15 of the Act states that the appropriate government shall designate one or more authorities to mobilize the community and create social awareness to support persons with disabilities in the exercise of their legal capacity. • The judgment highlights a significant oversight in how accessibility guidelines have been developed without a unified framework, calling for a shift towards principle-based rules that ensure comprehensive and inclusive access for all individuals.
What are the provisions under the Rights of Persons with Disabilities Act, 2016?
• The Act aims to ensure that all PwDs can lead their lives with dignity, without discrimination and with equal opportunities. • It was enacted to give effect to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) of 2007, to which India is a signatory. The key provisions of the Act are as follows: • PwD refers to a person with long term physical, mental, intellectual or sensory impairment which, in interaction with barriers, hinders his full and effective participation in society equally with others. • It recognises 21 types of disabilities including acid attack victims, intellectual disability, mental illness, etc. • State governments are responsible for ensuring PwDs enjoy the right to equality, life with dignity and respect. It ensures their protection from abuse, cruelty, inhuman treatment, violence and exploitation, etc. Other rights include the right to home and family, reproductive right, accessibility in voting, the right to own or inherit property. • It refers to a person with at least 40% of a specified disability, whether defined in measurable terms or not as certified by the relevant authority. • If a PwD cannot make legally binding decisions even with support, a limited guardian may be appointed. The District Court or designated authority may also grant total support to the person if needed. • The Act mandates the government to formulate necessary programmes to safeguard the rights of PwDs for an adequate standard of living to enable them to live independently or in the community.
How is the idea of Accessibility pursued?
Accessibility is recognized as a fundamental right under the UN Convention on the Rights of Persons with Disabilities. It establishes standardized accessibility measures that must be integrated from the outset in various environments.
Reasonable accommodation, on the other hand, acts as a facilitator of equality by addressing specific challenges faced by individuals in particular contexts. It tailors solutions to meet unique needs, ensuring that all individuals can participate fully.
Both concepts are interdependent; accessibility lays the groundwork, while reasonable accommodation provides necessary adjustments for those who still encounter barriers.
The notion of accessibility is dynamic, evolving with technological advancements such as Artificial Intelligence and the Internet of Things. This evolution necessitates continuous updates to digital accessibility tools to enhance inclusivity.
The Rajive Raturi case emphasized that existing guidelines often set long-term goals without immediate minimum standards. A phased approach is needed, where accessibility thresholds are gradually raised over time, similar to Canada’s roadmap for achieving full accessibility by 2040.
What are the barriers to Accessibility?
Definition: The RPwD Act defines barriers broadly, including both tangible (infrastructure) and intangible (attitudinal) obstacles. Recognizing attitudinal barriers is crucial for fostering a more inclusive society.
As societal understanding of disability evolves, so too must the parameters for accessibility. This includes acknowledging that disability can arise from various situations beyond permanent impairments, such as temporary injuries or age-related challenges.
Universal Design Principles: The concept of universal design has expanded to encompass not just PwDs but all vulnerable groups, including women, children, and the elderly. This shift reflects a broader understanding that disability is not merely an individual limitation but often a result of environmental factors.
What is the significance of compliance with Social Audit under the RPwD Act?
Section 48 of the Rights of Persons with Disabilities (RPwD) Act, 2016 mandates that both Central and State governments conduct regular social audits of all general schemes and programs to ensure they meet the needs of persons with disabilities (PwDs).
• Accountability: Social audits help identify bottlenecks in the delivery of services, assess the effectiveness of assistance technologies provided to PwDs, and adapt to their changing needs. • Service Improvement: By evaluating existing schemes, social audits can lead to better device provision and more effective support systems for individuals with disabilities.
What are the challenges in Implementation?
Lack of Standardized Guidelines: Currently, there are no clear guidelines under the RPwD Rules regarding the scope and methodology for conducting social audits. This absence leads to inconsistencies between the Centre and States, a lack of awareness among stakeholders, and insufficient training for auditors.
For instance, a sporting complex has multiple guidelines for accessibility from the Ministry of Urban Affairs and Housing, Sports, Transport, and others.
Need for Clarity: Establishing clear operational guidelines for social audits is essential to effectively identify evolving disability-related challenges and implement targeted interventions.
Way Forward: There is a need for a principled approach to accessibility that transcends mere compliance with regulations. By ensuring that accessibility rules are clear, inclusive, and well-enforced, society can move towards a more equitable environment where everyone has the opportunity to participate fully.
This structured approach will not only benefit individuals with disabilities but will also enhance user experience for all members of society.
Non-communicable diseases (NCDs) like heart disease, stroke, diabetes, and cancer are rising sharply in India which causing a heavy financial burden. In 2022, NCDs accounted for 65% of all deaths.
Why should India shift its focus from curative to preventive healthcare?
Improved Health Outcomes: Preventive healthcare allows for early detection and management of health issues, which can lead to better overall health, a higher quality of life, and potentially increased lifespan.
Early diagnosis helps mitigate serious complications associated with chronic diseases like diabetes, heart disease, and cancer.
Cost Savings: Investing in preventive care can significantly reduce healthcare costs. By preventing illnesses or catching them early, individuals can avoid expensive treatments and hospitalizations.
Reduced Burden on Healthcare Systems: With a proactive approach to health, the pressure on India’s already strained healthcare infrastructure can be alleviated. Preventive care can help manage the rising incidence of non-communicable diseases (NCDs), which accounted for about 65% of deaths in 2022.
Economic Productivity: A healthier population contributes to increased productivity. Chronic illnesses often lead to absenteeism and reduced work capacity, which can negatively impact economic growth.
Addressing Rising Disease Burden: The growing prevalence of NCDs in India necessitates a shift toward preventive measures. With many individuals facing disease burdens earlier in life, focusing on prevention can help manage these conditions more effectively and sustainably.
How can India effectively shift its focus from curative to preventive healthcare?
Strengthening Early Intervention: Enhancing the capabilities of Ayushman Health and Wellness Centres to facilitate targeted screenings and early interventions is crucial. This can involve using data analytics to identify high-risk populations and provide tailored preventive care services.
Encouraging Regular Screenings: Promoting regular health screenings, especially for individuals aged 40-60, can help identify conditions early. Collaborating with private health providers and insurers to offer subsidized screening programs can make preventive care more accessible.
Policy Incentives: Revising tax deductions for preventive health checks can incentivize individuals to prioritize their health. Increasing the limit from ₹5,000 to ₹15,000 under Section 80D of the Income Tax Act can encourage more people to undergo comprehensive health assessments.
What role do technology and innovation play in enhancing preventive healthcare accessibility?
AI and Digital Health Solutions: The integration of AI-enabled imaging modalities and telemedicine can enhance the accessibility of preventive healthcare services. These technologies can facilitate lower-cost screenings and improve diagnostic accuracy, especially in underserved areas.
Health Data Management: The National Digital Health Mission (NDHM) can play a pivotal role in managing health data effectively, enabling better tracking of health trends and facilitating targeted interventions based on population health analytics.
Wearable Health Devices: The use of wearable devices for monitoring vital signs and health metrics can empower individuals to take proactive steps in managing their health, leading to earlier detection of potential health issues.
What are the expected economic and health outcomes of prioritizing preventive care?
Reduced Healthcare Costs: By prioritizing preventive care, India could significantly lower the overall financial burden on individuals and the healthcare system.
Early diagnosis and intervention can prevent the escalation of diseases that require expensive treatments.
Improved Health Outcomes: A focus on preventive healthcare is likely to lead to better health outcomes, including reduced morbidity and mortality rates associated with non-communicable diseases (NCDs). This shift can enhance the quality of life for many individuals.
Economic Resilience: Investing in preventive healthcare can contribute to economic stability by reducing productivity losses associated with chronic diseases. A healthier population is more productive, which can drive economic growth and reduce the financial strain on households.
Way forward:
Expand Preventive Care Infrastructure: Strengthen health centers with early screening capabilities, utilize data analytics to identify high-risk groups, and collaborate with private providers to offer affordable preventive services.
Incentivize Preventive Health Practices: Revise tax benefits for health check-ups and promote the use of technology, such as wearable devices and telemedicine, to increase accessibility and awareness of preventive healthcare.
Mains PYQ:
Q The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC IAS/2022)
