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Subject: Social Justice

  • Health Expenditure at 1.84% of GDP

    Why in the News?

    The Union government has steadily increased its spending on healthcare, with the expenditure rising to 1.84% of GDP in 2021-22, up from 1.15% in 2013-14.

    Overview of India’s Health Expenditure

    • India has shown a consistent increase in government spending on healthcare, reflecting a growing commitment to improving the public healthcare system.
    • As of 2021-22, government health expenditure (GHE) rose to 1.84% of GDP, up from 1.15% in 2013-14, and is on track to meet the National Health Policy 2017 target of 2.5% of GDP by 2025.
    • The rise in health expenditure has been particularly significant post–COVID-19, with a 37% increase in government spending from 2020-21 to 2021-22.
    • This has led to better healthcare accessibility, reduced financial burden on individuals, and greater focus on strengthening healthcare infrastructure.

    What is Total Health Expenditure?

    • Total Health Expenditure (THE) refers to the sum of all current and capital expenditures incurred by the government, private sector, and external sources for healthcare purposes in a given period.
    • This includes:
      • Current Health Expenditure (CHE): Ongoing spending on healthcare services, such as hospitals, doctor visits, and medical supplies.
      • Capital Expenditure: Investments in healthcare infrastructure, such as building hospitals or purchasing medical equipment.
    • In 2020-21, India’s THE was estimated at â‚č7,39,327 crores, constituting 3.73% of GDP, with a per capita expenditure of â‚č5,436.
    • In 2021-22, this figure increased to â‚č9,04,461 crores, representing 3.83% of GDP, reflecting a proactive government response to healthcare challenges and pandemic management.

    Reasons for Reduced Out-of-Pocket Expenditure (OOPE)

    The reduction in OOPE can be attributed to:

    • Increased government health spending, making healthcare more affordable.
    • Expansion of public health services, including vaccination and preventive care.
    • Growth in government-funded health insurance and social security programs, reducing reliance on personal funds.
    • Health initiatives like Ayushman Bharat have eased the financial burden.
    • Improved public healthcare access and financial protection have reduced hardship for low- and middle-income families.

    PYQ:

    [2021] “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse.

     

  • [12th March 2025] The Hindu Op-ed: Building compassion into the health-care structure 

    PYQ Relevance:

    Q)  Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. (UPSC CSE 2021)

     

    Mentor’s Comment: UPSC mains have always focused on the moral imperative of a Welfare State, primary health structure (2021) and Appropriate local community-level healthcare intervention (2018).

    On February 7, 2025, the WHO released the “Compassion and Primary Health Care” report, emphasizing compassion as a transformative force in health care. Based on my interactions with medical pioneers and global advocacy efforts, including the 74th World Health Assembly, I am encouraged to see growing recognition of compassion’s vital role in improving health care worldwide.

    Today’s editorial highlights the importance of compassionate health care, offering valuable insights for GS Papers, particularly in policy-making and ethics discussions.

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    Let’s learn!

    Why in the News?

    Compassionate health care should guide the actions of industry leaders, hospitals, and health-care organizations.

    What is the key message of the WHO report “Compassion and Primary Health Care”?

    • Compassion as a Transformative Force: The report highlights compassion as a core value in improving primary health care outcomes. Example: A cancer patient’s recovery improves significantly when doctors spend an extra 40 seconds expressing support, as found in a Johns Hopkins study.
    • Improved Patient Outcomes through Compassion: Compassionate care leads to faster recovery, shorter hospital stays, and reduced patient anxiety.Example: Stanford University’s CCARE research found that patients treated with compassion experience quicker healing and fewer complications.
    • Benefits for Health-Care Providers: Compassion reduces stress, prevents burnout, and increases job satisfaction for medical professionals. Example: Nurses who engage in compassionate care report stronger patient relationships and improved emotional well-being.
    • Distinguishing Compassion from Empathy and Sympathy: Compassion involves mindful problem-solving while maintaining emotional stability, unlike empathy, which may cause emotional fatigue. Example: A compassionate doctor can acknowledge a patient’s suffering while staying emotionally balanced to provide sustained care.
    • Global Call for Compassionate Health Systems: The report urges policymakers to integrate compassion into health systems and decision-making processes. Example: The WHO calls for training programs to equip health workers with compassionate communication skills across nations.

    Why is compassion considered beneficial for both patients and health-care providers?

    • Faster Recovery and Better Patient Outcomes: Compassionate care leads to quicker recovery, reduced pain, and shorter hospital stays for patients. Example: A Johns Hopkins study found that when doctors express solidarity (e.g., saying, “We are in this together”), patient anxiety decreases, improving their healing process.
    • Enhanced Patient Trust and Satisfaction: Patients feel heard, valued, and safe when treated with compassion, which strengthens their trust in the healthcare system. Example: Cancer patients who receive compassionate communication are more compliant with treatment and express higher satisfaction with care.
    • Reduced Stress and Burnout for Health-Care Providers: Compassion reduces emotional exhaustion and prevents burnout by fostering emotional resilience. Example: Nurses trained in compassionate care report lower stress levels and improved emotional well-being.
    • Stronger Patient-Provider Relationships: Compassion fosters deeper connections, improving communication and shared decision-making between patients and healthcare providers. Example: Physicians who practice compassionate care build long-term patient trust, leading to better health outcomes and loyalty.
    • Increased Job Satisfaction and Professional Fulfillment: Compassion enhances job satisfaction by giving healthcare providers a sense of purpose and fulfillment. Example: Doctors who engage in compassionate interactions report feeling more connected to their profession and experience greater personal reward.

    How does compassion differ from sympathy, empathy, and kindness in the context of health care?

    • Compassion: Compassion is the ability to recognize a patient’s suffering and actively take steps to alleviate it. It involves an emotional connection combined with a willingness to help. Example: A nurse notices that a terminally ill patient is in pain despite receiving standard treatment. She advocates for a change in medication to improve the patient’s comfort while offering emotional support to the family.
    • Sympathy: Sympathy is feeling sorrow or concern for someone’s suffering but without deeply sharing their emotional experience. Example: A doctor expresses condolences to a patient’s family after delivering bad news but does not necessarily feel the pain personally.
    • Empathy: Empathy is the ability to understand and share the feelings of another person by mentally putting oneself in their position. Example: A physician listens to a patient with chronic pain, acknowledges the emotional toll, and adjusts treatment plans accordingly while providing reassurance.

    What are the steps taken by the government? 

    • Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY): Provides free health coverage to economically vulnerable families. Example: Over 50 crore beneficiaries are eligible for â‚č5 lakh annual health coverage per family for secondary and tertiary care, reducing financial burdens and ensuring accessible healthcare.
    • National Health Mission (NHM): Strengthens rural and urban healthcare infrastructure and ensures equitable healthcare access. Example: Under NHM, initiatives like Janani Shishu Suraksha Karyakram (JSSK) provide free maternal care during pregnancy, delivery, and postnatal services, ensuring compassionate care for mothers and newborns.
    • Tele-MANAS (Tele Mental Health Assistance and Networking Across States): Provides free tele-mental health services to address rising mental health concerns. Example: Launched in 2022, this initiative provides 24/7 mental health support, helping patients access timely counseling and care, especially in rural areas.
    • Pradhan Mantri National Dialysis Program (PMNDP): Provides free dialysis services to patients with chronic kidney disease. Example: More than 12 lakh dialysis sessions are provided annually across 800+ districts, reducing the financial and emotional stress on patients and their families.
    • Health and Wellness Centers (HWCs): Deliver comprehensive primary healthcare closer to communities. Example: Over 1.6 lakh HWCs have been established nationwide, offering preventive care, maternal health services, and non-communicable disease screenings, fostering compassionate and inclusive healthcare.

    Way forward: 

    • Integrate Compassion Training in Medical Education: Include structured programs to develop compassionate communication and patient-centered care skills for all healthcare professionals, ensuring empathy and emotional resilience.
    • Strengthen Policy Frameworks for Compassionate Care: Implement guidelines that prioritize compassion in healthcare delivery, with regular assessments and incentives to encourage patient-centered, humane practices across public health systems.

  • [8th March 2025] The Hindu Op-ed: What ails Pre-Clinical PG Courses?

    PYQ Relevance:

    Q) Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC CSE 2018)

     

    Mentor’s Comment: UPSC mains have always focused on the ‘Health for All’ (2018) and primary health structure is a necessary precondition (2021).

    No students enrolled in postgraduate (PG) medical pre-clinical courses like anatomy, biochemistry, physiology, forensic medicine, microbiology, and pharmacology at Vydehi Institute of Medical Sciences and Research Centre (VIMS), Bengaluru, until the second round of PG-NEET counselling.

    Today’s editorial discusses the issues related to postgraduate medical seats. This content would help in GS Paper 2 and 3 in the mains paper.

    _

    Let’s learn!

    Why in the News?

    Many postgraduate medical seats are vacant this year because students are choosing pre-clinical courses.

    Why are postgraduate medical students reluctant to choose pre-clinical courses in Karnataka?

    • Lack of Job Opportunities: Pre-clinical graduates cannot practice as doctors and are limited to working in laboratories, diagnostic centers, or as faculty. Example: Despite reducing tuition fees and offering job guarantees, private institutions like the Vydehi Institute of Medical Sciences struggle to fill pre-clinical seats due to limited employment avenues.
    • Lower Salary Compared to Clinical Courses: Pre-clinical roles offer significantly lower remuneration than clinical practice, making them financially unattractive. Example: A clinical doctor can earn a higher salary working in hospitals or private practice, while pre-clinical graduates face salary stagnation in academic or lab-based roles.
    • Limited Career Progression and Mobility: Clinical course graduates have the flexibility to work globally and in various healthcare sectors, while pre-clinical graduates are restricted to teaching or research roles. Example: An MD in General Medicine can practice as a physician anywhere, whereas an MD in Anatomy primarily qualifies for academic positions.
    • High Capital Requirement for Self-Employment: Establishing independent diagnostic centers requires significant investment, which deters pre-clinical graduates from entrepreneurial ventures. Example: Diagnostic centers with advanced technology demand substantial startup costs, making it challenging for pre-clinical graduates to become self-employed.
    • Persistent Seat Vacancies Reflect Low Demand: Consistent under-enrollment over the years signals a long-term disinterest in these courses. Example: In 2024-25, only 6 out of 104 MD Anatomy seats were filled in Karnataka, despite five rounds of counselling and reduced cut-off percentages.

    What is the trend of student enrollment in PG medical courses at the all-India level?

    • Substantial Increase in PG Medical Seats: The number of PG medical seats has risen from 31,185 before 2014 to 70,645 by the 2023-24 academic year, marking a 127% increase.
    • Growth in Medical Colleges: The total number of medical colleges has expanded by 82%, from 387 before 2014 to 704 in 2023. This expansion has contributed to the increased availability of both undergraduate (UG) and PG medical seats.
    • Rising Demand for Medical Education: The number of candidates aspiring to study MBBS grew from 16 lakh in 2019 to 24 lakh in 2024, reflecting a heightened interest in medical education.
    • Improved UG to PG Seat Ratio: The ratio of UG to PG medical seats improved from 2.1:1 in 2018-19 to 1.9:1 in 2022-23, indicating better alignment between the number of medical graduates and available PG training opportunities.
    • Emerging Challenges: Despite the increase in seats, challenges such as geographic disparities in seat distribution and concerns about the quality of education persist.
      • For example,  Karnataka has the highest number of PG medical seats, totaling 5,984, with a significant contribution from private institutions, but States like Arunachal Pradesh, Dadra and Nagar Haveli, Mizoram, and Nagaland currently do not offer PG medical seats.

    What is the significance of pre-clinical courses? 

    • Foundation for Advanced Medical Practice: Pre-clinical courses (Anatomy, Physiology, Biochemistry) provide the scientific basis for understanding human biology and disease mechanisms. Example: The COVID-19 pandemic highlighted the importance of biochemistry in vaccine development and understanding viral behavior.
    • Essential for Medical Education and Training: These courses are crucial for training future doctors, ensuring they understand the human body before clinical practice. Example: Medical schools worldwide adopted virtual anatomy labs during the pandemic, enhancing remote learning and maintaining education continuity.
    • Innovation in Diagnostic and Therapeutic Techniques: Pre-clinical research drives advancements in diagnostic tools and medical treatments. Example: Advances in physiology have contributed to wearable health devices like continuous glucose monitors for diabetic patients.

    How has the National Medical Commission (NMC) addressed the issue of unfilled PG medical seats in Karnataka?

    • Reduction of NEET-PG Cut-off Scores: In an unprecedented move, the NEET-PG 2023 cut-off was reduced to zero, making all candidates who appeared for the exam eligible for PG medical programs. This decision aimed to expand the pool of eligible candidates and fill vacant seats across various specialties.
    • Guidelines for Interstate Posting Under District Residency Programme: The NMC issued directives emphasizing strict adherence to the Post-Graduate Medical Education Regulations, 2023.
      • These guidelines facilitate the interstate posting of PG medical students under the District Residency Programme, ensuring a more even distribution of medical professionals and addressing regional disparities in seat occupancy.
    • Monitoring and Rectifying Seat Allocation Discrepancies: The NMC has been proactive in addressing discrepancies between its records and those of state authorities. For instance, admissions to 23 PG medical seats in Bengaluru were put on hold due to mismatches between NMC and Directorate of Medical Education (DME) lists. Such actions ensure that seat allocations are transparent and accurate.
    • Annual Increase of PG Seats: The NMC has facilitated the process for medical institutions to apply for an increase in PG seats for the academic year 2025-26. By inviting applications and setting clear guidelines, the commission aims to enhance the availability of PG medical seats, thereby reducing the likelihood of vacancies.

    Way forward: 

    • Enhance Pre-Clinical Career Prospects: Introduce incentives like research grants, industry collaborations, and fellowship programs to improve career progression and salary prospects for pre-clinical graduates.
    • Targeted Seat Distribution and Quality Monitoring: Implement region-specific seat allocation policies and strengthen regulatory oversight to ensure quality education and equitable access across underserved states.

  • Women in South India, Delhi, Punjab have higher levels of obesity 

    Why in the News?

    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) Ă· (Height in meters)ÂČ. 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 ban junk 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)

  • A green signal for India to assert its health leadership

    Why in the News?

    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 â‚č99,859 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 â‚č1,000 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 â‚č60,000-90,000 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)

  • Eliminating elitism in mental health

    Why in the News?

    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)

  • [30th January 2025] The Hindu Op-ed: Bridge the milk divide for a nutritionally secure India

    PYQ Relevance:

    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.

  • Union cabinet extends National Health Mission for another 5 years

    Why in the News?

    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)

  • Is the government encouraging ‘crosspathy’?

    Why in the News?

    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)

  • Why are fertility levels declining in India?

    Why in the News?

    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.

    Why are fertility levels declining in India?

    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)