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Subject: Social Justice

  • The story behind the Ban on 14 FDC Drugs

    fdc drug ban

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

    What are FDC Drugs?

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

    Issue of Irrational FDCs

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

    Government Action and Expert Review

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

    Implications of the Ban

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

    Cautions Regarding Cough Syrups

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

    Socioeconomic impact of the Ban

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

    Conclusion

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

  • National Exit Test (NExT) for Medical Grads

    next

    Central Idea: The NExT examination, a common qualifying criterion for final-year undergraduate medical students will be introduced in the year 2024.

    National Exit Test (NExT)

    • Objective: The examination aims to bring uniformity in evaluation across the country, ensuring minimum common standards of education and training for medical graduates.
    • Two-Part Examination: The NExT exam will consist of two parts: NExT 1, which will be a theoretical examination, and NExT 2, which will include practical, clinical, and oral examinations covering seven clinical subjects or disciplines.
    • Mock Test: A mock test may be conducted to familiarize students with the procedure and alleviate any anxiety before the official examination is rolled out.

    National Medical Commission and Application of NExT

    • Role of NMC: The NMC is responsible for implementing the NExT examination and ensuring a common standard for medical education in the country.
    • Applicability: The NExT examination will also apply to institutes of national importance, including the All India Institutes of Medical Sciences (AIIMS), to maintain uniformity in medical education.

    Significance

    • Quality professionals: The NExT examination is seen as a means to ensure quality and produce well-trained Indian medical graduates.
    • Expert Perspectives: Experts in the medical field have welcomed the move, emphasizing the importance of uniform examination standards and the opportunity for interns to focus on their clinical training.

  • Addressing Antimicrobial Resistance (AMR) in the Pandemic Treaty

    antimicrobial resistance amr

    Central Idea

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

    What is AMR?

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

    About the Pandemic Treaty

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

    Importance of Addressing Antimicrobial Resistance (AMR)

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

    Need for Comprehensive Pandemic Preparedness

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

    Concerns over Potential Removal of AMR Measures

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

    Strengthening the Pandemic Instrument to Address AMR

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

    Efforts to Highlight AMR in the Pandemic Instrument

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

    Current State and Next Steps

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

    Safeguarding Antimicrobials for Future Pandemic Response

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

  • Why is India rethinking its Anaemia Policy?

    Central Idea

    • Anaemia questions are excluded from National Family Health Survey (NFHS-6) due to concerns about accuracy, emphasizing the need for precise estimates to address India’s growing anaemia burden.
    • NFHS-5 data reveals a significant increase in anaemia prevalence in India, underscoring the urgency of accurate estimates to effectively tackle this public health challenge.

    National Family Health Survey (NFHS)

    • NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
    • Three rounds of the survey have been conducted since the first survey in 1992-93.
    • The International Institute for Population Sciences (IIPS) Mumbai, is the nodal agency, responsible for providing coordination and technical guidance for the survey.
    • IIPS collaborates with a number of Field Organizations (FO) for survey implementation.
    • The survey provides state and national information for India on fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health etc.

    Each successive round of the NFHS has had two specific goals:

    1.      To provide essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies for policy and programme purposes, and

    2.      To provide information on important emerging health and family welfare issues.

     Anaemia: A bigger menace

    • Anaemia is characterized by low red blood cells or haemoglobin levels, leading to symptoms like fatigue and weakness.
    • Iron deficiency is the primary cause, but deficiencies in folate, vitamins B12, and A also contribute.
    • Addressing nutritional deficiencies is crucial for prevention and treatment.

    Shift to DABS-I for Anaemia Assessment

    • The Health Ministry shifted anaemia assessment to Diet and Biomarkers Survey in India (DABS-I) for more accurate prevalence estimates.
    • DABS-I is a comprehensive dietary survey collecting individual data to assess food and nutrient adequacy nationwide.

    Reasons for Methodology Change

    • Concerns of Over-Diagnosis: Using WHO cut-offs may not suit the Indian population due to various factors that influence anaemia.
    • Inadequacy of WHO Cut-Offs: Country-specific cut-offs are needed as the WHO’s haemoglobin cut-offs may not reflect the Indian anaemia situation accurately.
    • Differences in Blood Sampling Methods: Venous blood sampling is more accurate than the capillary blood sampling used in previous surveys.

    Role of DABS-I Dietary Survey

    • DABS-I collects detailed dietary intake data to understand nutritional patterns and deficiencies contributing to anaemia.
    • It provides information on nutrient composition in foods from different regions, aiding targeted interventions.

    Prevalence of Anaemia in India

    • High Burden: Anaemia is a significant public health concern in India, with a high prevalence across different population groups.
    • Anaemia among Women: Data from national surveys indicate that a considerable percentage of women in India, particularly those in the reproductive age group, are affected by anaemia.
    • Anaemia among Children: Anaemia is also prevalent among children in India, with a substantial proportion experiencing this condition at a young age.

    Causes and Risk Factors

    • Nutritional Deficiencies: Iron deficiency is the primary cause of anaemia in India. Inadequate intake and absorption of iron, along with deficiencies in other key nutrients, contribute to the problem.
    • Socioeconomic Factors: Factors such as poverty, limited access to nutritious food, and inadequate healthcare contribute to the high prevalence of anaemia in certain socioeconomically disadvantaged populations.
    • Infections and Diseases: Certain infections, such as malaria and helminthiasis, and chronic diseases like kidney disease and cancer, can increase the risk of developing anaemia.

    Impact on Health and Well-being

    • Physical Symptoms: Anaemia can cause a range of physical symptoms, including fatigue, weakness, shortness of breath, and impaired cognitive function.
    • Maternal and Child Health: Anaemia in pregnant women increases the risk of complications during pregnancy and childbirth. It can also lead to low birth weight and developmental issues in infants.
    • Impaired Growth and Development: Anaemia among children can hinder their growth, development, and overall well-being. It may affect cognitive function, school performance, and future productivity.

    Government Initiatives and interventions

    • National Nutrition Programs: The Government of India has implemented various programs, such as the National Iron+ Initiative and the Pradhan Mantri Matru Vandana Yojana, to address anaemia and improve maternal and child health.
    • Supplementation and Fortification: Iron and other micronutrient supplementation programs, along with food fortification initiatives, aim to enhance iron intake and combat anaemia.
    • Awareness and Education: Public awareness campaigns and educational programs focus on promoting nutrition, especially among vulnerable groups, and raising awareness about the importance of addressing anaemia.

    Challenges and Future Directions

    • Access to Healthcare and Nutritious Food: Improving access to quality healthcare services, affordable nutritious food, and clean drinking water is crucial in addressing anaemia in India.
    • Multisectoral Collaboration: Addressing anaemia requires collaboration across various sectors, including healthcare, nutrition, education, and social welfare, to develop comprehensive strategies and interventions.
    • Monitoring and Evaluation: Regular monitoring and evaluation of anaemia prevalence, intervention effectiveness, and progress towards targets are essential to track improvements and identify areas that require further attention.

  • Mandatory Anti-Tobacco Warnings on OTT Platforms

    tobacco

    Central Idea

    • Over-the-top (OTT) streaming platforms must display anti-tobacco warnings similar to those seen in movies screened in theatres and on TV.
    • The requirement is based on a Union Health Ministry notification that amends the rules under the Cigarettes and Other Tobacco Products Act (COTPA), 2004.

    What is COTPA, 2004?

    Description
    Purpose Regulate production, sale, distribution, and consumption of tobacco products
    Prohibition of Smoking in Public Places Smoking prohibited in public areas like offices, restaurants, parks, public transport, etc.
    Health Warnings on Tobacco Products Mandatory display of health warnings on cigarette packages and other tobacco products
    Ban on Advertisement and Promotion Prohibition on direct and indirect advertising of tobacco products
    Prohibition on Sale to Minors Selling tobacco products to individuals below 18 years of age is strictly prohibited
    Packaging and Labelling Requirements Health warnings and pictorial representations of harmful effects on cigarette packages
    Powers of Enforcement Authorities empowered to enforce the act, conduct inspections, and seize contraband products

    New requirements for Anti-Tobacco Warnings

    • Publishers of online curated content displaying tobacco products or their use must show anti-tobacco health spots at the beginning and middle of the program.
    • When tobacco products or their use are displayed during the program, an anti-tobacco health warning must be prominently displayed as a static message at the bottom of the screen.
    • The warning message should be legible and readable, with black font on a white background.
    • The specified warnings are ‘Tobacco causes cancer’ or ‘Tobacco kills.’
    • Health spots, warnings, and audio-visual disclaimers should be in the same language as used in the show.

    Negative health impacts of tobacco

    • Cancer: Tobacco use is the leading cause of preventable cancer. It can cause cancer of the lungs, mouth, throat, larynx, pancreas, bladder, kidney, and cervix.
    • Respiratory diseases: It may cause chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. It can also worsen asthma symptoms.
    • Cardiovascular diseases: Consumption increases the risk of heart attack, stroke, and other cardiovascular diseases. It damages blood vessels and increases the risk of blood clots.
    • Reproductive health: Tobacco use can lead to infertility, premature birth, and low birth weight in babies.

    Socio-economic impact

    (1) On an individual level:

    • Decreased productivity: Smoking-related illnesses can result in absenteeism from work, decreased work performance, and increased medical expenses.
    • Decreased life expectancy: Tobacco consumption can lead to decreased life expectancy, which reduces the overall productive years of an individual.

    (2) On a societal level:

    • Healthcare cost: Tobacco consumption can lead to decreased economic development due to the increased burden of healthcare costs and decreased productivity.
    • Increased social expenditure: According to a study conducted by the World Health Organization (WHO), tobacco-related illnesses cost India about $22.4 billion in healthcare costs and lost productivity annually

    Why tobacco isn’t completely banned?

    • Revenue loss: The industry contributes a significant amount of tax revenue to the government. Banning tobacco would result in the loss of these tax revenues, which are used for various public welfare programs and initiatives.
    • Economic Impact: The tobacco industry provides employment to a large number of people, especially in the agricultural sector, where tobacco farming is prevalent.
    • Not a psychotropic substance: While the harmful effects of tobacco are well-documented, banning a legal product entirely requires careful consideration and legal processes.
    • Regulatory approach: Instead of a complete ban, the Indian government has adopted a regulatory approach to control tobacco use.

    Way forward

    • Strengthen tobacco control laws: Review and enhance existing laws to effectively reduce tobacco consumption.
    • Conduct public awareness campaigns: Educate the public about the health risks of tobacco use and the benefits of quitting.
    • Expand access to tobacco cessation programs: Increase availability of affordable and effective programs to support individuals who want to quit tobacco.
    • Implement sin taxes on tobacco products: Increase taxes to discourage consumption, especially among price-sensitive populations.
    • Enforce smoke-free environments: Strictly implement smoke-free laws in public places, workplaces, and public transport.
    • Support tobacco farmers: Provide alternative livelihood options and assistance for farmers transitioning away from tobacco farming.
    • Conduct research and surveillance: Invest in data collection and analysis to inform evidence-based policies and interventions.
    • Collaborate with international organizations: Partner with global entities like WHO to leverage expertise and resources in tobacco control.

     

     

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  • Iron Fortification: Health Risks of Excessive Iron Intake

    iron

    Central Idea

    • Iron is an essential mineral for bodily functions, but excessive intake can be harmful.
    • Fortification of food with iron is a suggested method for treating iron deficiency anemia.
    • Excess consumption of fortified foods or simultaneous consumption of multiple fortified foods can lead to excessive iron intake.

    What is Iron Fortification?

    • Iron fortification refers to the process of adding iron to food products to increase their iron content.
    • It is done using various forms of iron, such as iron salts or iron powders, which are added to the food during processing.
    • It is a public health strategy employed to address iron deficiency, particularly in populations where inadequate iron intake is prevalent.
    • The goal is to provide a significant portion of the recommended daily iron intake through fortified foods, contributing to the prevention and treatment of iron deficiency anaemia.

    Implications for Iron Overload

    • Comorbidities: Iron overload conditions, such as thalassemia, hemochromatosis, and chronic liver disease, have impaired iron excretion mechanisms.
    • Blooding events: Iron absorption is balanced by steady and minimal excretion, except during bleeding events.
    • Menstrual bleeding: Women can excrete iron through menstrual bleeding, while men are less capable of iron excretion.
    • Oxidative stress: Increased iron intake can lead to oxidative stress, cellular damage, and impaired mitochondrial function.
    • Heart ailments: High serum ferritin levels (a marker of iron storage) are associated with an increased risk of chronic diseases such as high fasting serum glucose, high total cholesterol, high triglycerides, and hypertension.
    • Liver damage: Very high amounts of iron can activate hepatic stellate cells and cause excessive deposition of extracellular matrix in the liver. Prolonged liver iron overload can lead to liver fibrosis and cirrhosis.

    Challenges and consequences

    • Minimal absorption: Only a small percentage of ingested iron from fortified foods is absorbed, with the rest passing through the intestine.
    • Digestive issues: Unabsorbed iron can cause inflammation in the gastrointestinal lining and disrupt the colonic microbiota, leading to abdominal discomfort and gastrointestinal issues.
    • Issues with nutrition absorption: Excessive iron in the gastrointestinal tract can impair the absorption of other essential minerals like zinc and copper and potentially result in other deficiencies.

    Way Forward

    • Implement individualized strategies for iron intake rather than mandatory fortification programs to avoid unsupervised high iron intake across diverse populations.
    • Ensure thorough monitoring and detection of adverse events related to iron intake.
    • Precision in public health approaches is necessary to prevent the risk of iron overload and potential long-term chronic illnesses associated with excess iron.
    • Evaluate the specific dietary iron needs of different population segments to avoid unnecessary excess iron consumption.

     

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  • Highlights of the Joint Malnutrition Estimates (JME)

    Central Idea

    • According to the Joint Malnutrition Estimates (JME) by UNICEF, WHO, and the World Bank, India has shown a reduction in stunting among children under five.

    Such reports (including NFHS) are credible sources of information to substantiate your answers in Mains answer writing ….

    What is Stunting and Wasting?

      Stunting Wasting
    Definition Impaired growth and development due to chronic malnutrition. Rapid weight loss and muscle wasting in a short period.
    Measurement Height-for-age comparison against standardized growth reference. Weight-for-height comparison against standardized growth reference.
    Causes Insufficient intake of essential nutrients, frequent infections, poor maternal health. Inadequate caloric intake, poor feeding practices, infectious diseases.
    Effects Irreversible consequences, reduced cognitive development, increased disease vulnerability. Increased morbidity and mortality, severe malnutrition.
    Time Frame Long-term condition Short-term condition
    Overall Nutritional Status Reflects chronic malnutrition Represents acute malnutrition
    Focus Impacts growth and development Impacts weight and muscle mass

     

    Decline in Child Stunting in India

    • The prevalence of stunting in India dropped from 41.6% in 2012 to 31.7% in 2022, with 1.6 crore fewer stunted children recorded.
    • India’s share of the global burden of stunting declined from 30% to 25% in the past decade.

    Concerns over Wasting

    • Wasting remains a concern in India, with an overall prevalence of 18.7% in 2022.
    • India contributes 49% to the global burden of wasting, reflecting the severity of this malnutrition indicator.
    • Two-thirds of wasting cases in India may be attributed to maternal malnutrition, leading to low birth weight for height.

    Rise in Obesity

    • The prevalence of obesity in India increased marginally from 2.2% in 2012 to 2.8% in 2022.
    • India’s obesity classification remains low compared to the global prevalence of 5.6%.
    • Obesity contributes to 8.8% of the global burden, with 31.8 lakh obese children in India.

    Way Forward

    • The JME report highlights the need for accelerated efforts to achieve global nutrition targets.
    • India’s progress aligns with the National Family Health Survey (NFHS) data, indicating a reduction in stunting.
    • More research is needed to understand the complexities of wasting, particularly its links to maternal malnutrition.
    • Continued focus on addressing malnutrition, access to health services, and maternal nutrition is crucial for further improvement.
    • Learning more about wasting and its determinants will be essential for tailored interventions in India and Asia.

     

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  • Debate over Fortified Rice

    fortified rice

    Central Idea

    • The Union Food Ministry refuted the allegations made by the Opposition regarding the distribution of Fortified Rice through fair price shops.

    What is Fortified Rice?

    • Fortified rice refers to the process of enhancing regular rice with essential nutrients to address nutritional deficiencies in populations that heavily rely on rice as a staple food.
    • These added nutrients aim to improve the nutritional value of rice and combat specific deficiencies prevalent in certain regions or population groups.
    • The fortification process involves coating the rice grains with a nutrient-rich powder or premix.
    • The specific nutrients added to fortified rice can vary, but commonly include:
    1. Iron: Iron is often added to fortified rice to address iron deficiency anaemia, a widespread nutritional problem globally.
    2. Vitamins: Essential vitamins such as vitamin A, vitamin B-complex (including thiamine, riboflavin, niacin, and folic acid), and vitamin D may be included in fortified rice to address specific vitamin deficiencies prevalent in target populations.
    3. Minerals: Other minerals like zinc, calcium, and iodine may be incorporated into fortified rice, depending on the specific nutritional needs and deficiencies of the target population.

    Need for fortification

    • Data from the National Family Health Survey 2019-21 shows that 57 per cent of women in the reproductive age group (15-49) are deficient in iron.
    • Moreover, studies have shown that about a fifth of the children (0-5 years) who do not have access to a nutritious and diversified diet suffer from vitamin-A deficiency.
    • Vitamin D deficiency has been termed a silent epidemic.

    Advantages offered

    • Health: Fortified staple foods will contain natural or near-natural levels of micro-nutrients, which may not necessarily be the case with supplements.
    • Taste: It provides nutrition without any change in the characteristics of food or the course of our meals.
    • Nutrition: If consumed on a regular and frequent basis, fortified foods will maintain body stores of nutrients more efficiently and more effectively than will intermittently supplement.
    • Economy: The overall costs of fortification are extremely low; the price increase is approximately 1 to 2 percent of the total food value.
    • Society: It upholds everyone’s right to have access to safe and nutritious food, consistent with the right to adequate food and the fundamental right of everyone to be free from hunger.

    Issues with fortified food

    • Against nature: Fortification and enrichment upset nature’s packaging. Our body does not absorb individual nutrients added to processed foods as efficiently compared to nutrients naturally occurring.
    • Bioavailability: Supplements added to foods are less bioavailable. Bioavailability refers to the proportion of a nutrient your body is able to absorb and use.
    • Immunity issues: They lack immune-boosting substances.
    • Over-nutrition: Fortified foods and supplements can pose specific risks for people who are taking prescription medications, including decreased absorption of other micro-nutrients, treatment failure, and increased mortality risk.

    Possible health hazard

    • Thalassemia, sickle cell anaemia and malaria are conditions where there is already excess iron in the body, whereas TB patients are unable to absorb iron.
    • Consumption of iron-fortified foods among patients of these diseases can reduce immunity and functionality of organs.

    Ministry’s justification of Fortified Rice

    • The Ministry cited various studies to support the assertion that consumption of fortified rice leads to a significant improvement in haemoglobin levels and a reduction in the prevalence of anaemia.
    • Rice fortification has been adopted by seven countries, including the U.S., since 1958, highlighting its effectiveness as a public health intervention.
    • Ongoing evaluation, conducted by NITI Aayog in collaboration with the Indian Council of Medical Research, is being carried out to assess the impact and effectiveness of fortified rice.
    • Evaluation studies focusing on pilot districts are currently underway to gather comprehensive data and insights.

    Way Forward

    • Collaborative efforts between the Ministry, NITI Aayog, and other relevant institutions should be prioritized to conduct a thorough and independent evaluation of the fortified rice program.
    • Transparent communication of evaluation results and findings is crucial to foster trust and address any potential shortcomings or areas of improvement.
    • Incorporating feedback and recommendations from stakeholders will be valuable in enhancing the implementation and impact of the fortified rice distribution program.
    • Continuous monitoring and assessment of the program’s effectiveness should be a priority, enabling necessary adjustments and improvements to be made in a timely manner.

     

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  • Arsenic Contamination in India

    arsenic

    Central Idea: A recent peer-reviewed study suggests that even low levels of arsenic consumption can affect cognitive function in children, adolescents, and young adults.

    Arsenic Contamination

    • Arsenic is a highly toxic element naturally present in the environment.
    • Contaminated water, particularly groundwater, is a major source of arsenic exposure.
    • Long-term arsenic exposure can lead to various health issues, including cancer, skin lesions, cardiovascular disease, and negative impacts on cognitive development.

    Menace in India

    • Arsenic contamination in groundwater is one of the most crippling issues in the drinking water scenario of India.
    • According to the latest report of the Central Ground Water Board (CGWB), 21 states across the country have pockets with arsenic levels higher than the BIS stipulated permissible limit of 0.01 milligram per litre (mg/l).
    • The states along the Ganga-Brahmaputra-Meghna (GBM) river basin — Uttar Pradesh, Bihar, Jharkhand, West Bengal and Assam — are the worst affected by this human-amplified geogenic occurrence.
    • In India, arsenic contamination was first officially confirmed in West Bengal in 1983.
    • Close to four decades after its detection, the scenario has worsened.
    • About 9.6 million people in West Bengal, 1.6 million in Assam, 1.2 million in Bihar, 0.5 million in Uttar Pradesh and 0.013 million in Jharkhand are at immediate risk from arsenic contamination in groundwater.

    Key findings of the recent study

    (1) Arsenic impact on behaviour

    • The study found that individuals exposed to arsenic had reduced grey matter and weaker connections within key regions of the brain associated with cognitive functions.
    • Chronic exposure to arsenic could have significant consequences at a population level, leading to increased school failures, diminished economic productivity, and higher risks of criminal and antisocial behavior.

    (2) Arsenic Exposure and Socioeconomic Factors

    • As previous studies have shown, arsenic exposure is particularly harmful to the poor.
    • The recent study reaffirms that economically and nutritionally disadvantaged individuals experience greater cognitive impairment from arsenic exposure.
    • The impact of arsenic on impairing cognition is more pronounced at a collective level rather than at an individual level.

    Government Initiatives to address Arsenic Contamination

    • Governments in Bihar and West Bengal have taken steps to address arsenic contamination since the 1990s.
    • Strategies include promoting piped water access, installing arsenic removal plants, and encouraging groundwater extraction from deeper aquifers with lower arsenic levels.
    • The goal is to minimize arsenic exposure and mitigate its health impacts in affected regions.

    Possible solutions

    Some of the management options include

    • Uses of surface water sources
    • Exploring and harnessing alternate arsenic-free aquifer
    • Removal of arsenic from groundwater using arsenic treatment plants/filters
    • Adopting rainwater harvesting/ watershed management practices.

     

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  • Trend of unnecessary Hysterectomies

    hyster

    Central Idea: The Health Ministry in India is concerned about the high incidence of unnecessary hysterectomies, particularly among poor, less-educated women in rural areas.

    Why in news?

    • The Supreme Court has directed States and Union Territories to implement health guidelines formulated by the Centre to monitor and prevent unnecessary hysterectomies.

    What is Hysterectomy?

    • Hysterectomy is a surgical procedure to remove the uterus, and sometimes surrounding organs and tissues.
    • It can be classified as a partial hysterectomy (removal of the uterus), total hysterectomy (removal of the uterus and cervix), or radical hysterectomy (removal of the uterus, cervix, part of the vagina, and surrounding tissues).
    • The procedure can be performed through the vagina or through an incision in the abdomen.

    Issues with such surgery

    • Overuse and unnecessary procedures: Hysterectomy can be performed without exploring alternative treatments.
    • Psychological and emotional impact: The procedure may lead to feelings of loss and changes in body image.
    • Surgical risks and complications: Hysterectomy carries risks such as infection and damage to surrounding organs.
    • Long-term health effects: Removal of the uterus may have impacts on hormones and bone health.
    • Patient autonomy and informed consent: Patients should be fully informed about the procedure and involved in decision-making.
    • Access and equity: Disparities in access to healthcare may contribute to overuse, particularly among marginalized communities.

    Concerns and Petition

    A public interest litigation (PIL) highlighted the occurrence of unnecessary hysterectomies in the states of Bihar, Chhattisgarh, and Rajasthan under government healthcare schemes.

    • Marginalized women were targeted: Women from marginalized communities, such as Scheduled Castes, Scheduled Tribes, and Other Backward Communities, were disproportionately affected.
    • Misuse and Insurance Fraud: Healthcare institutions were found to be misusing hysterectomies to claim high insurance fees from the government under various health insurance schemes.

    Key issue: Violation of Fundamental Rights

    • The recent judgement acknowledges that rising hysterectomy rates among young women in India deviate from trends observed in developed countries.
    • It recognizes the violation of fundamental rights, stating that unnecessary hysterectomies infringe upon the right to health and the right to life under Article 21 of the Constitution.

    Government action and guidelines

    • The Health Ministry has closely monitored the issue of hysterectomies and requested States to share data on hysterectomy cases before and after the implementation of guidelines.
    • Compulsory audits for all hysterectomies are advised, similar to those conducted for maternal mortality, in both public and private healthcare institutions.
    • In 2022, the Health Ministry issued guidelines to prevent unnecessary hysterectomies and urged States to comply with them.

     

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