Subject: Social Justice

Context

• The death of a 12-year-old girl in Pathanamthitta has sharpened the focus on the rising number of rabies cases and the growing population of stray dogs in Kerala

What is rabies?

• The rabies virus attacks the central nervous system of the host, and in humans, it can cause a range of debilitating symptoms including states of anxiety and confusion, partial paralysis, agitation, hallucinations, and, in its final phases, a symptom called “hydrophobia,” or a fear of water.

What are rabies caused by?

• Rabies is a preventable viral disease most often transmitted through the bite of a rabid animal. The rabies virus infects the central nervous system of mammals, ultimately causing disease in the brain and death.

Can rabies person survive?

• Once clinical signs of rabies appear, the disease is nearly always fatal, and treatment is typically supportive. Less than 20 cases of human survival from clinical rabies have been documented.

How long can a human live with rabies?

• Death usually occurs 2 to 10 days after first symptoms. Survival is almost unknown once symptoms have presented, even with intensive care.

Facts on rabies

• What animal has the most rabies?
• Bats
• Wild animals accounted for 92.7% of reported cases of rabies in 2018. Bats were the most frequently reported rabid wildlife species (33% of all animal cases during 2018), followed by raccoons (30.3%), skunks (20.3%), and foxes (7.2%).

What is the issue?                                  

• There is a blame game over the rising rabies cases: With the rabies deaths causing panic and reports of residents killing stray dogs through poisoning and strangulation, there is a blame game over the rising canine population and rabies cases. Some legal experts blame it on conflicts in the Prevention of Cruelty to Animals Act, 1960 and the Animal Birth Control (Dogs) Rules, 2001; others point to the flawed implementation of birth control measures.
• Legal battle over the issue in the Supreme Court: Canine culling campaigners and advocates of animal rights are also engaged in a protracted legal battle over the issue in the Supreme Court. V.K. Biju, a lawyer of the Supreme Court, who brought the issue of the “stray dog menace” before the apex court, contends that the root cause is the enactment of the Rules, which according to him, were passed in contravention of the parent Act, the Prevention of Cruelty to Animals Act.
• Existence of stray dogs has adversely affected the fundamental rights of citizens: Biju says that while the Act stands for the “destruction” of stray dogs, the rules are against the “destruction” of stray dogs, including the rabies affected ones, besides providing specific protection of stray dogs. In his submission before the Supreme Court, he argues that the existence of stray dogs has adversely affected the fundamental rights of citizens, i.e. the right to life and free movement.
• The quashing of the Rules to make India free of stray dogs: In his writ petition filed before the apex court, Biju has sought orders for the strict implementation of the Act and the quashing of the Rules to make India free of stray dogs.
• Animal rights campaigners are apprehensive: In the light of this, animal rights campaigners are apprehensive over the campaign to cull dogs to check rabies.

How can we prevent rabies in animals?

1. First, visit your veterinarian with your pet on a regular basis and keep rabies vaccinations up-to-date for all cats, ferrets, and dogs.
2. Second, maintain control of your pets by keeping cats and ferrets indoors and keeping dogs under direct supervision.
3. Third, spay or neuter your pets to help reduce the number of unwanted pets that may not be properly cared for or vaccinated regularly.
4. Finally, call animal control to remove all stray animals from your neighbourhood since these animals may be unvaccinated or ill.

How can we prevent rabies in humans?

• Leave all wildlife alone.
• Know the risk: contact with infected bats is the leading cause of rabies deaths in people followed by exposure to rabid dogs while traveling internationally.
• Wash animal bites or scratches immediately with soap and water.
• If you are bitten, scratched, or unsure, talk to a healthcare provider about whether you need postexposure prophylaxis. Rabies in people is 100% preventable through prompt appropriate medical care.
• Vaccinate your pets to protect them and your family.

Initiatives by Government to curb Neglected Tropical Diseases

National Rabies Control Programme: This programme is being restructured as Integrated National Rabies Control Programme under ‘One Health Approach’, with a aim to provide vaccination to stray dogs and free vaccines through Government hospitals.

Way forward

• Think globally, act locally. Study and adopt global ‘best-practices’ after customising them to local needs.
• Apply integrated approach. Follow a holistic strategy.
• Ensure efficient and effective collaboration across various government departments.
• Partner with Civil Society Organisations (especially with WASH – Water, Sanitation and Hygiene – sector) for ground-level implementation and monitoring.

Mains question

Q. What is rabies? What ethical challenges are involved in culling of stray dogs? Explain the control measures for the same.

 

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Context

• The recent National Family Health Survey (NFHS-5) data shows anaemia rates increased from 53 per cent to 57 per cent in women and 58 per cent to 67 per cent in children in 2019-21.

Definition of anaemia

• The WHO defines anaemia as a condition where the number of red blood cells or the haemoglobin concentration within them is lower than normal. This compromises immunity and impedes cognitive development.

Why anaemia is a concern?

• Adverse effects of anaemia affect all age groups lower physical and cognitive growth and alertness among children and adolescents, and lesser capacity to learn and play, directly impacting their future potential as productive citizens.
• Anaemia among adolescent girls (59.1 per cent) advances to maternal anaemiaand is a major cause of maternal and infant mortality and general morbidity and ill health in a community.

What causes anaemia?

• Imbalanced diet: Cereal-centric diets, with relatively less consumption of iron-rich food groups like meat, fish, eggs, and dark green leafy vegetables (DGLF), can be associated with higher levels of anaemia.
• Underlying factors: High levels of anaemia are also often associated with underlying factors like poor water quality and sanitation conditions that can adversely impact iron absorption in the body.
• Iron deficiency is major cause: A diet that does not contain enough iron, folic acid, or vitamin B12 is a common cause of anaemia.
• Some other conditions: That may lead to anaemia include pregnancy, heavy periods, blood disorders or cancer, inherited disorders, and infectious diseases.

Why is anaemia so high in the country?

• Low vitamin intake: Iron-deficiency and vitamin B12-deficiency anaemia are the two common types of anaemia in India.
• High population and nutrition deprivation: Among women, iron deficiency prevalence is higher than men due to menstrual iron losses and the high iron demands of a growing foetus during pregnancies.
• Overemphasis on cereals: Lack of millets in the diet due to overdependence on rice and wheat, insufficient consumption of green and leafy vegetables could be the reasons behind the high prevalence of anaemia in India.

What is Iron fortification?

• Iron fortification of food is a methodology utilized worldwide to address iron deficiency. Iron fortification programs usually involve mandatory, centralized mass fortification of staple foods, such as wheat flour.

Why need iron fortification?

• Iron deficiency anaemia is due to insufficient iron.
• Without enough iron, the body can’t produce enough of a substance in red blood cells that enables them to carry oxygen (haemoglobin).
• Severe anaemia during pregnancy increases risk of premature birth, having a low birth weight baby and postpartum depression. Some studies also show an increased risk of infant death immediately before or after birth.

Success story / value addition

• Nepal’s success story to improve maternal anaemia by national action plan .

Anaemia Mukt Bharat

• The scheme aims to reduce the prevalence of anaemia in India.
• It provides bi weekly iron Folic acid supplementation to all under five children through Asha workers.
• Also, it provides biannual Deworming for children and adolescents. The scheme also establishes institutional mechanisms for advanced research in anaemia.
• It also focuses on non-nutritional causes of anaemia.

We need to focus on the following interventions

• Prophylactic Iron and Folic Acid supplementation.
• Intensified year-round Behaviour Change Communication Campaign (Solid Body, Smart Mind).
• Appropriate infant and young child feeding practices.
• Increase in intake of iron-rich food through diet diversity/quantity/frequency and/or fortified foods with focus on harnessing locally available resources.
• Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents
• Mandatory provision of Iron and Folic Acid fortified foods in government-funded public health programmes

Way forward

• India’s nutrition programmes must undergo a periodic review.
• The Integrated Child Development Services (ICDS), which is perceived as the guardian of the nation’s nutritional well-being must reassess itself and address critical intervention gaps, both conceptually and programmatically, and produce rapid outcomes.
• The nutritional deficit which ought to be considered an indicator of great concern is generally ignored by policymakers and experts. Unless this is addressed, rapid improvement in nutritional indicators cannot happen.

Conclusion

• When a person is anaemic, the capacity of his blood cells to carry oxygen decreases. This reduces the productivity of the person which in turn affects the economy of the country. Therefore, it is highly important to cover Anaemia under National Health Mission.

Mains question

Q. “Every second adolescent girl has anaemia. Every second woman of reproductive age is anaemic”. In this context do you think Women’s empowerment will not have any meaning without tackling anaemia? Discuss.

 

 

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Context

• Doctor shortages are creating hurdles in health emergency response

What is the crux of the article in simple words?

• Medical qualification and expertise is necessary to deliver quality health services by medical professionals unlike by general health care workers who lack competency.

What is public health?

• Public health has been defined as “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals”.

Why there is need of qualification?

• Lack of training: Health workers have no training in public health; they are grassroots-level service providers. Asking them to be part of public health cadre trivialises the profession of public health.
• Separate profession: It is important to understand that public health is a separate profession with a specific set of competencies.

What are 4 pillars of public health?

• Academics: Academics refers to a good understanding of evidence generation and synthesis by having a good grounding in epidemiology and biostatistics. These competencies are also critical for monitoring and evaluating programmes, conducting surveillance, and interpreting data and routine reporting.
• Activism: Public health is inherently linked to ‘social change’ and an element of activism is core to public health. Public health requires social mobilisation at the grassroots level by understanding community needs, community organisation, etc. This requires grounding in social and behavioural sciences.
• Administration: Administration refers to administering health systems at different levels from a primary health centre to the district, State, and national level. This includes implementing and managing health programmes, addressing human resource issues, supply and logistical issues, etc. It includes microplanning of programme delivery, team building, leadership as well as financial management to some extent.
• Advocacy: In public health, there is little that one can do at an individual level; there must be communication with key stakeholders to change the status quo at different levels of government. This requires clear enunciation of the need, analysis of alternative set of actions and the cost of implementation or non-implementation. Good communication and negotiation skills are critical to perform this function. The related subjects are health policy, health economics, health advocacy and global health.

What are the hurdles in absorbing others as public health professionals?

• Lack of skill: Many doctors and other health professionals work at the grassroots level and develop a good sense of public health due to their inclination. But they do not become public health professionals as they may not have the necessary skills. Nevertheless, they are valuable.
• Lack of critical expertise: Clinicians with training in epidemiology and biostatistics would not qualify to be public health professionals as they lack not only other essential and critical expertise but also an appropriate perspective.
• Compromise on quality:

Current challenges faced by public healthcare in India

• Deficiency: The doctor-patient ratio of 1:1655 in India as against WHO norm of 1:1000 clearly shows the deficit of MBBS. While the government is working towards a solution and targeting to reach the required ratio, there is a need to relook at the overall medical education.
• Post pandemic scenario: The lag in formal medical education has come up evidently post-pandemic when the nation saw the medical fraternity struggling to fill the doctor deficit.
• Limited government seats: The number of seats available for medical education in India is far less than the number of aspirants who leave school with the dream of becoming doctors.
• Lack of skills: Though the institutes are managing to hire professors and lecturers, there is a lack of technical skills. Finding faculties in clinical and non-clinical disciplines is difficult and there are very few faculty development programs for upskilling the existing lot.
• Lack of infrastructure: The gap in digital learning infrastructure is currently the biggest challenge the sector is facing. There is an urgent need to adopt technology and have resources available to facilitate e-learning.
• Lack of research and innovation: The medical research and innovation needs an added push as there haven’t been many ground-breaking research here. The education system needs to focus more on increasing the quality of research. Additionally since industry academia partnership is not available, hence innovation also takes a back-seat.

Conclusion

• By establishing new medical colleges, the government can increase student intake as well as enhance equitable access to public health as separate profession. This will attract the best and the brightest people into this discipline, which is very important for the nation’s health. This is one lesson that we should learn from the pandemic.

Mains question

Q. What do you understand by public health? Do you think it is a separate profession requiring a specific set of competencies? Examine.

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Context

• People’s participation in the ‘TB-Mukt India’ campaign can help eliminate the disease by 2025.

What is TB?

• A potentially serious infectious bacterial disease that mainly affects the lungs.

How TB is caused?

• Tuberculosis (TB) is caused by a type of bacterium called Mycobacterium tuberculosis. It’s spread when a person with active TB disease in their lungs coughs or sneezes and someone else inhales the expelled droplets, which contain TB bacteria.

What does TB do to humans?

• It mainly affects the lungs, but it can affect any part of the body, including the tummy (abdomen), glands, bones and nervous system.

How long has the TB infected us?

• TB is as old as humanity itself, infecting us for at least 5,000 years. The infecting agent, a bacterium, was identified way back in 1882, by Robert Koch, signalling one of the landmark discoveries which laid the foundation of modern medicine

Is TB painful?

• If TB affects your joints, you may develop pain that feels like arthritis. If TB affects your bladder, it may hurt to go to the bathroom and there may be blood in your urine. TB of the spine can cause back pain and leg paralysis. TB of the brain can cause headaches and nausea.

Can we get TB if vaccinated?

• BCG is a vaccine for TB. This vaccine is not widely used in the United States, but it is often given to infants and small children in other countries where TB is common. The BCG vaccine is not very good at protecting adults against TB. We can still get TB infection or TB disease even if you were vaccinated with BCG.

When do TB symptoms start?

 

• TB disease usually develops slowly, and it may take several weeks before you notice you’re unwell. Your symptoms might not begin until months or even years after you were initially infected. Sometimes the infection does not cause any symptoms. This is known as latent TB.

Is TB curable permanently?

• TB can usually be completely cured by the person with TB taking a combination of TB drugs. The only time that TB may not be curable is when the person has drug resistant TB.

What are drug-resistant tuberculosis?

• Drug-resistant tuberculosis (DR-TB) is a form of antimicrobial resistance that is difficult and costly to treat. It is caused by TB bacteria that are resistant to at least one of the first-line existing TB medications, resulting in fewer treatment options and increasing mortality rates.

Risk factors for TB include

• Poverty
• HIV infection.
• Being in jail or prison (where close contact can spread infection)
• Substance abuse.
• Taking medication that weakens the immune system.
• Kidney disease and diabetes.

TB statistic for mains

We are home to 1 in 4 of the world’s TB patients.

Over 2.5 million Indians are infected.

Government initiatives

• Nikshay Poshan Yojana: in which TB patients receive Rs 500 every month while on treatment was launched. Nikshay Poshan Yojana ensure that the patients have economic support and nutrition during the required period.
• TB Harega Desh Jeetega Campaign: was launched to accelerate the efforts to end TB by 2025. The campaign aims to initiate preventive and promotive health approaches.
• Community-led approach: By applying “multi-sectoral and community-led” approach, the government is building a national movement to end TB by 2025.
• Ni-kshay Mitra: Any individual or organisation can register as Ni-kshay Mitra on the Ni-kshay 2.0 portal to support people affected by the disease. The initiative intends to provide essential nutritional and social support to people with TB and root out stigma and discrimination against them.

Some positive suggestions to eliminate TB

• Sincere efforts need to be made to make our health systems more accessible and reliable.
• It also required to ensure that those seeking care trust the healthcare system and get the appropriate care for completing treatment.
• There is a need to create more labs, point of care tests, an assured drug pipeline, access to new drugs.
• The government should also ensure counselling and support for those affected.
• Every patient who is diagnosed late and does not receive timely treatment continues to infect others.
• To break this cycle, government machinery at the field level should work with communities and provide free diagnosis and treatment to every affected individual.

Conclusion

• We have ignored TB for too long. It’s time we acknowledge the magnitude of the disease, and work harder at offering individuals equitable healthcare access and resources that the disease warrants.

Mains question

Q. Do you think we can eliminate TB by 2025? Discuss the roadmap and give some affirmative actions to be taken by government.

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Context

• How to deal with mental wellness challenges in the uniformed forces

What is stress?

• Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stress is your body’s reaction to a challenge or demand.

What is mental wellness?

• Mental wellness encompasses emotional, psychological, and social well-being. It influences cognition, perception, and behaviour. It also determines how an individual handles stress, interpersonal relationships, and decision-making.

Why is Mental Health Important?

• Mental health is more important now than ever before; it impacts every area of our lives. The importance of good mental health ripples into everything we do, think, or say.

Reasons for Persistence of Mental Illness

• Stigma to seek help: The staggering figures are void of millions of others directly, or indirectly impacted by the challenge and those who face deep-rooted stigma, many times rendering them unable to seek help.
• Lack of awareness: This growing challenge in dealing with mental health issues is further compounded by a lack of information and awareness, self-diagnosis, and stigma.
• Psycho-social factors: Institutions like gender, race and ethnicity, are also responsible for mental health conditions.
• Post-Treatment gap: There is a need for proper rehabilitation of the mentally ill persons post/her treatment which is currently not present.
• Rise in Severity: Mental health problems tend to increase during economic downturns, therefore special attention is needed during times of economic distress.

Ongoing challenges in mental wellness regime

• There is a need to expand understanding of the full scope of what uniformed Services and other mental health experts can achieve.
• Stigma regarding mental health both domestically and around the world remains strong.
• There is a lack of trained personnel and healthcare and public health systems in many areas of the world.
• Training needs are broad and reach beyond direct patient care, especially regarding cultural competence, crisis communication, and consultation.
• There is a need for expanded support for the value of multi-professional and multi-organizational integration and collaboration.

Government Policy initiatives

• National Mental Health Program (NMHP): To address the huge burden of mental disorders and shortage of qualified professionals in the field of mental health, the government has been implementing the NMHP since 1982.
• Mental HealthCare Act 2017: It guarantees every affected person access to mental healthcare and treatment from services run or funded by the government.
• Rights of Persons with Disabilities Act, 2017: The Act acknowledges mental illness as a disability and seeks to enhance the Rights and Entitlements of the Disabled and provide an effective mechanism for ensuring their empowerment and inclusion in the society
• Manodarpan Initiative: An initiative under Atmanirbhar Bharat Abhiyan aims to provide psycho-social support to students for their mental health and well-being.

What needs to be done?

• Open dialogue: The practice of open dialogue, a therapeutic practice that originated in Finland, runs through many programmes in the Guidance. This approach trains the therapist in de-escalation of distress and breaks power differentials that allow for free expression.
• Increase investment: With emphasis on social care components such as work force participation, pensions and housing, increased investments in health and social care seem imperative.
• Network of services: For those homeless and who opt not to enter mental health establishments, we can provide a network of services ranging from soup kitchens at vantage points to mobile mental health and social care clinics.

Conclusion

• Persons with mental health conditions need a responsive care system that inspires hope and participation without which their lives are empty. We should endeavour to provide them with such a responsive care system.

Mains question

Q. Mental disorders are now among the top leading causes of health burden worldwide, with no evidence of global reduction since 1990. Examine.

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