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Subject: Social Justice

  • India ranked 101 in Global Hunger Index (GHI)

    The Global Hunger Index 2021 has ranked India at 101 positions out of a total 116 countries.

    Note the parameters over which the GHI is based and their weightage composition.

    Global Hunger Index (GHI)

    • The Global Hunger Index is a peer-reviewed annual report, jointly published by Concern Worldwide and Welthungerhilfe.
    • It determines hunger on a 100-point scale, where 0 is the best possible score (no hunger) and 100 is the worst.
    • It is designed to comprehensively measure and track hunger at the global, regional, and country levels.
    • The aim of the GHI is to trigger action to reduce hunger around the world.

    For each country in the list, the GHI looks at four indicators:

    1. Undernourishment (which reflects inadequate food availability): calculated by the share of the population that is undernourished (that is, whose caloric intake is insufficient)
    2. Child Wasting (which reflects acute undernutrition): calculated by the share of children under the age of five who are wasted (that is, those who have low weight for their height)
    3. Child Stunting (which reflects chronic undernutrition): calculated by the share of children under the age of five who are stunted (that is, those who have low height for their age)
    4. Child Mortality (which reflects both inadequate nutrition and unhealthy environment): calculated by the mortality rate of children under the age of five

    India’s (poor) performance

    • India is among the 31 countries where hunger has been identified as serious.
    • Only 15 countries fare worse than India.
    • Some of these include Afghanistan (103), Nigeria (103), Congo (105), Mozambique (106), Sierra Leone (106), Timor-Leste (108), Haiti (109), Liberia (110), Madagascar (111) and Somalia (116).
    • India was also behind most of the neighbouring countries.
    • Pakistan was placed at 92 rank, Nepal at 76 and Bangladesh also at 76.

    Reasons for such poor performance

    • Poor maternal health: Mothers are too young, too short, too thin and too undernourished themselves, before they get pregnant, during pregnancy, and then after giving birth, during breast-feeding.
    • Poor sanitation: Poor sanitation, leading to diarrhoea, is another major cause of child wasting and stunting.
    • Food insecurity: Low dietary diversity in India is also a key factor in child malnutrition.
    • Poverty: Almost 50 million households in India are dependent on these small and marginal holdings.
    • Livelihood loss: The rural livelihoods loss after COVID and lack of income opportunities other than the farm sector have contributed heavily to the growing joblessness in rural areas.

    Issues over credibility of GHI

    • India has ranked among many African countries while it is among the top 10 food-producing countries in the world.

     

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  • On Digital Health ID, proceed with caution

    Much recently, the Prime Minister had launched the Digital Health ID project (DHID), generating debate on issues related to the use of technology in a broken health system.

    Explained: Digital Health ID

    Good intents of the DHID

    • The key objective of DHID is to improve the quality, access and affordability of health services by making the service delivery “quicker, less expensive and more robust”.
    • The ambition is undoubtedly high. Given that health systems are highly complex, the DHID would hardly be able to address some of the issues plaguing it.

    Why need DHID?

    (a) Record maintenance

    • The use of technology for record maintenance is not just inevitable but necessary. Its time has certainly come.
    • A decade ago, the process to shift towards electronic medical records was initiated in the private sector.
    • It met with limited success, despite the strong positives.
    • With DHID, the burden of storing and carrying health records for every visit to the doctor is minimised.

    (b) Better tracking of medical history

    • The doctor has instant access to the patient’s case history –the treatment undertaken, where and with what outcomes — enabling more accurate diagnosis and treatment.
    • As the DHID enables portability across geography and healthcare providers, it also helps reduce re-testing or repeating problems every time a patient consults a new doctor.
    • That’s a huge gain, impacting the quality of care and enhancing patient satisfaction and confidence.

    (c) Better Diagnosis

    • DHID can have a transformative impact in promoting ecosystems that function as paperless facilities.
    • Paperless hospitals can promote early diagnosis before the patient reaches the doctor after spending long hours in queue.
    • The doctor can already go through the patient’s record and the pharmacist can make the drugs available by the time the patient reached its counter.

    (d) Promoting medical research

    • Digitisation of medical records is another important positive, given the problems related to space and retrieving huge databases.
    • Well organised repositories that enable easy access to records can stimulate much-needed research on medical devices and drugs.
    • This storehouse of patient data can be valuable for clinical and operational research.

    Given our population, would this be an idealistic expectation?

    • We need to conduct pilot studies to assess the use of technology for streamlining patient flows and medical records and thereby increase efficiencies across different typologies of hospitals and facilities.
    • While technology helps smoothen processes and enhance patient experience, there is a cost attached.
    • Investments have to be made upfront and results should not be expected overnight.

    Issues with DHID

    (a) A costly affair

    • In the immediate short run, DHID will increase administrative costs by about 20 per cent, due to the capital investment in data infrastructure.
    • Over the long run, the additional cost to healthcare is expected to be about 2 per cent.
    • Any scaling up of this reform would require extensive fiscal subsidies and more importantly providing techno-logistical support to both government and private hospitals.

    (b) Privacy concerns

    • Most important is the issue of privacy, the high possibility of hacking and breach of confidentiality.
    • The possibility of privacy being violated increases with the centralisation of all information.
    • Though it is said that the patient is the owner of the information, how many of us deny access, as a matter of routine, when we download apps or programmes that seek access to all our records?
    • How far is this “consent” practical for an illiterate, vulnerable patient desperate to get well?
    • So, taking refuge behind a technical statement that access is contingent on patient consent is unconvincing.

    Ground situation in India

    • Inherently unaffordable healthcare: The costs in the Indian context can be high and that should lead to a careful assessment of the project.
    • Digital divide: Such a scenario is not inconceivable and in the case of health, may cause immense hardship to the most marginalised sections of our population.
    • Infrastructure gap: A large majority of facilities do not have the required physical infrastructure — electricity, accommodation, trained personnel.
    • Usual nature of technical glitches: Cards getting corrupted, servers being down, computers crashing or hanging, and power outages are common in India.
    • Conformity over data synchronization: The inability to synchronise biometric data with ID cards has resulted in large-scale exclusions of the poor from welfare projects.
    • Accuracy of records: Besides, the efficacy of the DHID hinges on the assumption that every visit and every drug consumed by the patient is faithfully and accurately recorded.
    • Increased workload on Medical Professionals: Moreover, while electronic mapping of providers may enable patients to spot a less busy doctor near their location, it is simplistic to assume that the patient will go there.

    Plugging the existing gaps

    • Patient preference for a doctor is dependent upon perception and trust. Likewise, teleconsultations need a huge backend infrastructure and organisation.
    • Teleconsulting has certainly helped patients access medical advice for managing minor ailments, getting prescriptions on the phone and even getting drugs delivered home.
    • But in handling chronic diseases that necessitate continuity of care, teleconsultations have been problematic and cannot be substituted for actual physical examination.
    • Continuity of care is central to good outcomes in inpatient management of chronic diseases.
    • The one serious shortcoming of using teleconsultation for such management is the high attrition rate of doctors within the context of an overall shortage of doctors.
    • Technology can be of little use in the absence of doctors and basic infrastructure.

    Way forward

    • What is needed is building very robust firewalls and trust.
    • Seeing the frequency with which Aadhaar cards have been breached, it is not unreasonable to be concerned with this issue and the implications it has at the family and societal levels.
    • For this reason, instead of a big bang approach, it is better to go slow and steady.
    • That’s the only way to ensure that a good policy does not die along the way due to poor implementation.

     

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  • What are the concerns of digital health mission?

    The Ayushman Bharat Digital Mission (ABDM), was recently launched by the PM.

    About Ayushman Bharat Digital Mission

    • The pilot project of the National Digital Health Mission was announced by PM Modi during his Independence Day speech from the Red Fort on August 15, 2020.
    • The mission will enable access and exchange of longitudinal health records of citizens with their consent.
    • This will ensure ease of doing business for doctors and hospitals and healthcare service providers.

    The key components of the project include

    • Health ID for every citizen that will also work as their health account, to which personal health records can be linked and viewed with the help of a mobile application,
    • Healthcare Professionals Registry (HPR)
    • Healthcare Facilities Registries (HFR) that will act as a repository of all healthcare providers across both modern and traditional systems of medicine

    How will it work?

    • In order to be a part of the ABDM, citizens will have to create a unique health ID – a randomly generated 14-digit identification number.
    • The ID will give the user unique identification, authentication and will be a repository of all health records of a person.
    • The ID can also be made by self-registration on the portal, downloading the ABMD Health Records app on one’s mobile or at a participating health facility.
    • The beneficiary will also set up a Personal Health Records (PHR) address for the issue of consent, and for future sharing of health records.

    Major privacy issues involved

    • Informed Consent: The citizen’s consent is vital for all access. A beneficiary’s consent is vital to ensure that information is released.
    • Data leakages issue: Personalised data collected at multiple levels are a “sitting gold mine” for insurance companies, international researchers, and pharma companies.
    • Digital divide: Other experts add that lack of access to technology, poverty, and lack of understanding of the language in a vast and diverse country like India are problems that need to be looked into.
    • Data Migration: The data migration and inter-State transfer are still faced with multiple errors and shortcomings in addition to concerns of data security.

    Other challenges

    • Existing digitalization is yet incomplete: India has been unable to standardise the coverage and quality of the existing digital cards like One Nation One Ration card, PM-JAY card, Aadhaar card, etc., for accessibility of services and entitlements.
    • Lack of healthcare facilities: The defence of data security by expressed informed consent doesn’t work in a country that is plagued by the acute shortage of healthcare professionals to inform the client fully.
    • Lack of finance: With the minuscule spending of 1.3% of the GDP on the healthcare sector, India will be unable to ensure the quality and uniform access to healthcare that it hoped to bring about.

  • Antimalarial drug resistance in India

    In recent years there is increasing evidence for the failure of artemisinin-based combination therapy for falciparum malaria either alone or with partner drugs.

    What is Malaria?

    • Malaria is caused by the bite of the female Anopheles mosquito if the mosquito itself is infected with a malarial parasite.
    • There are five kinds of malarial parasites — Plasmodium falciparum, Plasmodium vivax (the commonest ones), Plasmodium malariae, Plasmodium ovale and Plasmodium knowlesi.
    • Therefore, to say that someone has contracted the Plasmodium ovale type of malaria means that the person has been infected by that particular parasite.

    Burden of Malaria in India

    • In 2018, the National Vector-borne Disease Control Programme (NVBDCP) estimated that approximately 5 lakh people suffered from malaria.
    • 63% of the cases were of Plasmodium falciparum.
    • The recent World Malaria Report 2020 said cases in India dropped from about 20 million in 2000 to about 5.6 million in 2019.

    Treatment of Malaria

    • Malaria is treated with prescription drugs to kill the parasite. Chloroquine is the preferred treatment for any parasite that is sensitive to the drug.
    • In most malaria-endemic countries including India, Artemisinin-based antimalarial drugs are the first-line choice for malaria treatment.
    • This is especially against Plasmodium falciparum parasite which is responsible for almost all malaria-related deaths in the world.

    Why in news now?

    • There are reports of artemisinin resistance in East Africa and is a matter of great concern as this is the only drug that has saved several lives across the globe.
    • In India, after the failure of chloroquine to treat P. falciparum malaria successfully, artemisinin-based combination therapy was initially introduced in 2008.
    • Currently, several combinations of artemisinin derivatives are registered in India.

    Artemisinin-based combination therapy failure in India

    • In 2019, a report from Eastern India indicated the presence of two mutations in P. falciparum cases treated with artemisinin that linked to its presence of resistance.
    • Again in 2021, artemisinin-based combination therapy failure was reported from Central India where the partner drug SP showed triple mutations with artemisinin wild type.
    • This means the failure of artemisinin-based combination therapy may not be solely linked to artemisinin. Here it is needed to change the partner drug as has been done in NE states in 2013.

    History of drug resistance

    • In the 1950s chloroquine resistance came to light.
    • Both chloroquine and pyrimethamine resistance originated from Southeast Asia following their migration to India and then on to Africa with disastrous consequences.
    • Similarly, artemisinin resistance developed from the six Southeast Asian countries and migrated to other continents, as is reported in India and Africa.
    • It would not be out of context that artemisinin is following the same path as has been seen with chloroquine.
    • Now, the time has come to carry out Molecular Malaria Surveillance to find out the drug-resistant variants so that corrective measures can be undertaken in time to avert any consequences.
    • Some experts even advocate using triple artemisinin-based combination therapies where the partner drug is less effective.

    Try this PYQ:

    Widespread resistance of malarial parasite to drugs like chloroquine has prompted attempts to develop a malarial vaccine to combat malaria.

    Why is it difficult to develop an effective malaria vaccine?

    (a) Malaria is caused by several species of Plasmodium

    (b) Man does not develop immunity to malaria during natural infection

    (c) Vaccines can be developed only against bacteria

    (d) Man is only an intermediate host and not the definitive host

     

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  • Explained: Digital Health ID

    The PM has recently launched the flagship Ayushman Bharat Digital Mission (ABDM) which involves the creation not just a unique digital health ID for every citizen.

    Ayushman Bharat Digital Mission

    What is the unique health ID?

    • If a person wants to be part of the ABDM, she must create a health ID, which is a randomly generated 14-digit number.
    • The ID will be broadly used for three purposes: unique identification, authentication, and threading of the beneficiary’s health records, only with their informed consent, across multiple systems and stakeholders.

    Why is this initiative significant?

    • The initiative has the potential to “increase the ease of living” along with “simplifying the procedures in hospitals”.
    • At present, the use of digital health ID in hospitals is currently limited to only one hospital or to a single group, and mostly concentrated in large private chains.
    • The new initiative will bring the entire ecosystem on a single platform.
    • The system also makes it easier to find doctors and specialists nearest to you.
    • Currently, many patients rely on recommendations from family and friends for medical consultation, but now the new platform will tell the patient who to reach out to, and who is the nearest.
    • Also, labs and drug stores will be easily identified for better tests using the new platform.

    How can one get it?

    • One can get a health ID by self-registration on the portal or by downloading the ABMD Health Records app on one’s mobile.
    • Additionally, one can also request the creation of a health ID at a participating health facility.
    • Health facilities may include government or private hospitals, community health centres, and wellness centres of the government across India.
    • The beneficiary will also have to set up a Personal Health Records (PHR) address for consent management, and for future sharing of health records.

    What is a PHR address?

    • It is a simple self-declared username, which the beneficiary is required to sign into a Health Information Exchange and Consent Manager (HIE-CM).
    • Each health ID will require linkage to a consent manager to enable sharing of health records data.
    • An HIE-CM is an application that enables sharing and linking of personal health records for a user.
    • At present, one can use the health ID to sign up on the HIE-CM; the National Health Authority (NHA), however, says multiple consent managers are likely to be available for patients to choose from in the near future.

    What does one need to register for a health ID?

    • Currently, ABDM supports health ID creation via mobile or Aadhaar.
    • The official website states that ABDM will soon roll out features that will support health ID creation with a PAN card or a driving licence.
    • For health ID creation through mobile or Aadhaar, the beneficiary will be asked to share details on name, year of birth, gender, address, mobile number/Aadhaar.

    Is Aadhaar mandatory?

    Ans. No, it is voluntary.

    • One can use one’s mobile number for registration, without Aadhaar.
    • If the beneficiary chooses the option of using her Aadhaar number, an OTP will be sent to the mobile number linked to the Aadhaar.
    • However, if she has not linked it to her mobile, the beneficiary has to visit the nearest facility and opt for biometric authentication using Aadhaar number.
    • After successful authentication, she will get her health ID at the participating facility.

    Are personal health records secure?

    • The NHA says ABDM does not store any of the beneficiary health records.
    • The records are stored with healthcare information providers as per their “retention policies”.
    • They are “shared” over the ABDM network “with encryption mechanisms” only after the beneficiary express consent.

    Can one delete my health ID and exit the platform?

    Ans. Yes, the NHA says ABDM, supports such a feature.  Two options are available: a user can permanently delete or temporarily deactivate her health ID.

    • On deletion, the unique health ID will be permanently deleted, along with all demographic details.
    • The beneficiary will not be able to retrieve any information tagged to that health ID in the future, and will never be able to access ABDM applications or any health records over the ABDM network with the deleted ID.
    • On deactivation, the beneficiary will lose access to all ABDM applications only for the period of deactivation.
    • Until she reactivates her health ID, she will not be able to share the ID at any health facility or share health records over the ABDM network.

    What facilities are available to beneficiaries?

    • Users can access personal digital health records right from admission through treatment and discharge.
    • One can access and link his/her personal health records with your health ID to create a longitudinal health history.

    What other features will be rolled out?

    • Upcoming new features will enable access to verified doctors across the country.
    • The beneficiary can create a health ID for her child, and digital health records right from birth.
    • Third, she can add a nominee to access her health ID and view or help manage the personal health records.
    • Also, there will be much inclusive access, with the health ID available to people who don’t have phones, using assisted methods.

    How do private players get associated with a government digital ID?

    • The NHA has launched the NDHM Sandbox: a digital architecture that allows helps private players to be part of the National Digital Health Ecosystem as health information providers or health information users.
    • The private player sends a request to NHA to test its system with the Sandbox environment.
    • The NHA then gives the private player a key to access the Sandbox environment and the health ID application programming interface (API).
    • The private player then has to create a Sandbox health ID, integrate its software with the API; and register the software to test link records and process health data consent requests.
    • Once the system is tested, the system will ask for a demo to the NHA to move forward. After a successful demo, the NHA certifies and empanels the private hospital.

    Now try this PYQ:

    Consider the following statements:

    1. Aadhaar metadata cannot be stored for more than three months.
    2. State cannot enter into any contract with private corporations for sharing of Aadhaar data.
    3. Aadhaar is mandatory for obtaining insurance products.
    4. Aadhaar is mandatory for getting benefits funded out of the Consolidated Fund of India.

    Which of the statements given above is/are correct?

    (a) 1 and 4 only

    (b) 2 and 4 only

    (c) 3 only

    (d) 1, 2 and 3 only

     

    [wpdiscuz-feedback id=”3o1iiih1nf” question=”Please leave a feedback on this” opened=”1″]Post your answers here.[/wpdiscuz-feedback]

     

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  • Ayushman Bharat Digital Mission

    The PM has launched the Ayushman Bharat Digital Mission to provide a digital Health ID to people which will contain their health records.

    Ayushman Bharat Digital Mission

    • The pilot project of the National Digital Health Mission was announced by PM Modi during his Independence Day speech from the Red Fort on August 15, 2020.
    • The mission will enable access and exchange of longitudinal health records of citizens with their consent.
    • This will ensure ease of doing business for doctors and hospitals and healthcare service providers.

    The key components of the project include

    • Health ID for every citizen that will also work as their health account, to which personal health records can be linked and viewed with the help of a mobile application,
    • Healthcare Professionals Registry (HPR)
    • Healthcare Facilities Registries (HFR) that will act as a repository of all healthcare providers across both modern and traditional systems of medicine

    What makes this special?

    • The mission will create integration within the digital health ecosystem, similar to the role played by the Unified Payments Interface (UPI) in revolutionising payments.
    • Citizens will only be a click-away from accessing healthcare facilities.

     

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  • Disease surveillance system

    Context

    A well-functioning system can reduce the impact of diseases and outbreaks.

    Importance of disease surveillance system

    • Successful tackling of cholera in 1854 in London by use of the health statistics and death registration data from the General Registrar Office (GRO) started the beginning of a new era in epidemiology.
    • Importance of data: The application of principles of epidemiology is possible through systematic collection and timely analysis, and dissemination of data on the diseases.
    • This is to initiate action to either prevent or stop further spread, a process termed as disease surveillance.
    • Subsequently, the high-income countries invested in disease surveillance systems but low- and middle-income countries used limited resources for medical care.
    • Then, in the second half of the Twentieth century, as part of the global efforts for smallpox eradication and then to tackle many emerging and re-emerging diseases, many countries recognised the importance and started to invest in and strengthen the diseases surveillance system.
    • These efforts received a further boost with the emergence of Avian flu in 1997 and the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002-04.

    Surveillance in India

    • The Government of India launched the National Surveillance Programme for Communicable Diseases in 1997.
    • However, this initiative remained rudimentary.
    • In wake of the SARS outbreak, in 2004, India launched the Integrated Disease Surveillance Project (IDSP).
    • The focus under the IDSP was to increase government funding for disease surveillance, strengthen laboratory capacity, train the health workforce and have at least one trained epidemiologist in every district of India.

    Issues with surveillance: Interstate variation

    • Variation among states: The disease surveillance system and health data recording and reporting systems are key tools in epidemiology.
    • In the fourth round of serosurvey, Kerala and Maharashtra States could identify one in every six and 12 infections, respectively; while in States such as Madhya Pradesh, Uttar Pradesh and Bihar, only one in every 100 COVID-19 infections could be detected.
    • This points towards a weak disease surveillance system.
    • In a well-functioning disease surveillance system, an increase in cases of any illness would be identified very quickly.
    • While Kerala is picking the maximum COVID-19 cases; it could pick the first case of the Nipah virus in early September 2021. 
    • On the contrary, cases of dengue, malaria, leptospirosis and scrub typhus received attention only when more than three dozen deaths were reported and health facilities in multiple districts of Uttar Pradesh, began to be overwhelmed.

    Way forward

    • A review of the IDSP in 2015, conducted jointly by the Ministry of Health and Family Welfare, the Government of India and World Health Organization India had made a few concrete recommendations to strengthen disease surveillance systems.
    • These included increasing financial resource allocation, ensuring an adequate number of trained human resources, strengthening laboratories, and zoonosis, influenza and vaccine-preventable diseases surveillance.
    • Increase allocation: The government resources allocated to preventive and promotive health services and disease surveillance need to be increased by the Union and State governments.
    • Trained workforce: The workforce in the primary healthcare system in both rural and urban areas needs to be retrained in disease surveillance and public health actions.
    • The vacancies of surveillance staff at all levels need to be urgently filled in.
    • Capacity increase: The laboratory capacity for COVID-19 needs to be planned and repurposed to increase the ability to conduct testing for other public health challenges and infections.
    • The interconnectedness of human and animal health: The emerging outbreaks of zoonotic diseases, be it the Nipah virus in Kerala or avian flu in other States as well as scrub typhus in Uttar Pradesh, are a reminder of the interconnectedness of human and animal health.
    • The ‘One Health’ approach has to be promoted beyond policy discourses and made functional on the ground.
    • Strengthening registration system: There has to be a dedicated focus on strengthening the civil registration and vital statistics (CRVS) systems and medical certification of cause of death (MCCD).
    • Coordination: It is also time to ensure coordinated actions between the State government and municipal corporation to develop joint action plans and assume responsibility for public health and disease surveillance.
    • The allocation made by the 15th Finance Commission to corporations for health should be used to activate this process.

    Consider the question “Examine the measure for disease surveillance in India? How it can help reduce the impact of the diseases?”

    Conclusion

    We cannot prevent every single outbreak but with a well-functioning disease surveillance system and with the application of principles of epidemiology, we can reduce their impact.

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  • Front-of-pack labelling of Food Stuffs

    Seven years, four committees and two draft regulations later, India still does not have a clear labelling system to warn consumers about harmful levels of fat, salt and sugar in processed foods.

    Context

    • According to the Food Safety and Standards (Packaging and Labelling) Regulations, 2011, every pre-packed processed food product sold in the country must be labelled with nutritional information.
    • To ensure that consumers are able to easily see and interpret the nutritional information on food packets, an expert committee was established by the Food Safety and Standards Authority of India (FSSAI).
    • The committee, set up following an order of the Delhi High Court which was hearing a public interest petition seeking a ban on the sale of junk food in and around schools.

    Why label nutritional information?

    • This helps the consumer know everything about the food they buy and make an informed decision about what and how much to eat.
    • Such information is particularly crucial because the packaged food contain ultra-processed foods that are high in fat, salt or sugar and low in fibre and other essential micronutrients.
    • On the one hand, these foods cause malnutrition.
    • On the other hand they are linked strongly with obesity and diet-related non-communicable diseases, such as Type-2 diabetes, hypertension, heart ailments and certain cancers, like that of the colon.
    • All these increase the risk of premature death.

    Issues with labelling in India

    • Most products provide information in English understanding which can be daunting for a vast number of people in India.

    What is FoP labelling?

    • The front-of-pack (FoP) labelling system has long been listed as one of the global best practices to nudge consumers into healthy food choices.
    • It works just the way cigarette packets are labelled with images to discourage consumption.
    • Countries such as Chile, Brazil and Israel have laws to push the packaged food industry to adopt FoP labelling.
    • They have used FoP labelling as a measure to fight obesity and NCDs.

    FoP labelling in India

    • The system is yet to be implemented in India even seven years after it was first proposed by FSSAI.
    • The fact is, makers of packaged foods are also a powerful lot, with strong business acumen.
    • While companies in other countries have acceded to the FoP labelling laws, they are unwilling to do so in India — a country experiencing a dietary shift.

    Why must we have FoP labels?

    • Countries are working to find ways to nudge consumers into healthy food choices and to contain the growing crisis of obesity and diet-related non-communicable diseases (NCDs).
    • It is a crisis that increasingly impacts children and also exacerbates novel coronavirus disease (COVID-19) symptoms. Front-of-pack (FoP) labelling is definitely an effective tool in this effort.

    India definitely needs ‘warning labels’ on front-of-pack, but this must be a symbol-based label with no text and numbers. This is because:

    (1) Junk foods have high levels of unhealthy nutrients

    • There is strong evidence that sugar, salt and fat in junk foods are addictive, like nicotine in tobacco.
    • FoP ‘warning’ labels have helped reduce cigarette consumption. It is time we adopted the same for junk foods.

    (2) Warning labels are easy to notice and understand

    • They do not confuse consumers with mixed messages.
    • Their distinct shape, colour and size make them noticeable in the otherwise cluttered and colourful packaging.
    • With one label for one nutrient, it becomes easier to know if a product is high in more than one nutrient.

    (3) Warning labels are the global best practice now

    • At least seven countries have adopted warning labels in the past five years. These include Chile, Peru, Mexico, Israel and Uruguay.
    • Low- and middle-income mothers have shown profound changes in attitudes towards food purchases as they now understand the nutritional content of packaged foods.
    • Even children can read the labels and take an informed decision. This has also forced food companies to reduce the amount of sugar and sodium in foods and beverages.

    (4) They are best suited for India

    • Warning labels are best suited for India as they do not include numbers unlike many other FoP labels.
    • In fact, warning labels that are symbol-based, like that of Israel, can transcend the barriers of literacy and language in India.

    (5) FSSAI has experience of successfully implementing symbol-based FoP labels

    • Its “green filled circle in green outlined square” logo to depict vegetarian food has been hugely successful in informing consumers.
    • In recent years, FSSAI also has made similar laws to depict fortification (+F logo) and organic food (a green-coloured tick for Jaivik Bharat logo).

    Way forward

    • FoP labels must include information on nutrients that make food injurious to health.
    • This should be distinct from the details on the back-of-pack. FoP labels should aim to inform the consumer, while the back-of-pack label serves the purpose of scientific compliance and enforcement.
    • FoP labels should have information on ‘total sugar’ and not ‘added sugar’. There is no analytical laboratory method to differentiate ‘added sugar’ from total sugar and quantify it.

     

  • Outpatient Opioid Assisted Treatment Centres

    The state government in Punjab is banking on Outpatient Opioid Assisted Treatment Centres (OOAT) to curb the drug menace in the state.

    What are the OOAT Centres?

    • The move to set up OOAT centres in Punjab began in October 2017.
    • The centres administer de-addiction medicine, a combination of buprenorphine and naloxone, to the opioid-dependent people registering there.
    • Administered in the form of a pill, the treatment is primarily for addicts of opioid drugs, including heroin, poppy husk and opium.
    • There are such private and state-run centres in Punjab.

    Why is the Punjab government planning?

    • Punjab is planning to open OOAT linked extension centres and clinics in rural areas to broaden the outreach of this treatment.
    • The idea is that patients get medicine nearer their place of residence.
    • It will also reduce pressure on existing OOAT centres which cater to patients from far-off places.

    Administering medicine at OOAT Centres

    The patients are broadly put into three categories or phases.

    • In the induction phase, the newly-registered patients are administered medicine at the OOAT centres for a week or two to manage withdrawal symptoms in the presence of the doctor and counselor.
    • In the second, stabilization, phase, which extends between two to four months.
    • The patient is put on watch for taking any opioid-based “super-imposed” illicit drug and accordingly maximum tolerated dose is administered to nullify the kick of the “super-imposed” drug.
    • In the third, maintenance, phase, the patient is given take-home medicine and it continues for a year and a half before an assessment is done to see whether the medicine can be tapered off.

    Why is Punjab banking so much on OOAT therapy?

    There are two major approaches to wean away opioid-dependent persons.

    • One is the abstinence approach and another alternate medication approach.
    • There are more chances of relapse in an abstinence-based approach as compared to alternate medication for de-addiction.
    • In the abstinence approach, it would have taken years to rehabilitate patients by admitting them to facilities and there would have been increased chances of relapse.
    • On the other hand, the alternate medication approach has been acknowledged as better in various scientific studies worldwide.

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  • The nutrition-hygiene link

    Context

    A recent UNICEF report stated that nearly 12 lakh children could die in low-income countries in the next six months due to a decrease in routine health services and an increase in wasting. Nearly three lakh such children would be from India.

    Problem of nutrition in India and factors responsible for it

    • The National Family Health Survey (NFHS 5) indicates that since the onset of the pandemic, acute undernourishment in children below the age of five has worsened.
    • According to the latest data, 37.9 per cent of children under five are stunted, and 20.8 per cent are wasted — a form of malnutrition in which children are too thin for their height.
    • Comparison with other countries: This is much higher than in other developing countries where, on average, 25 per cent of children suffer from stunting and 8.9 per cent are wasted.
    • Factors: Inadequate dietary intake is the most direct cause of undernutrition.
    • Several other factors also affect nutritional outcomes, such as contaminated drinking water, poor sanitation, and unhygienic living conditions.
    • According to the World Health Organisation, 50 per cent of all mal- and under-nutrition can be traced to diarrhoea and intestinal worm infections.
    • Nutrition and water, sanitation, and hygiene (WASH) are intricately linked, and changes in one tend, directly or indirectly, to affect the other.
    • Poor hygiene and sanitation in developing countries lead to a sub-clinical condition called “environmental enteropathy” in children.
    • Environmental enteropathy is a disorder of the intestine which prevents the proper absorption of nutrients, rendering them effectively useless.
    • Childhood diarrhoea is a major public health problem in low- and middle-income countries, leading to high mortality in children under five.
    • According to NFHS 4, approximately 9 percent of children under five years of age in India experience diarrhoeal disease.

    Way forward

    • Investment in WASH: The link between WASH and nutrition suggests that greater attention to, and investments in, WASH are a sure-shot way of bolstering the country’s nutritional status.
    • Addressing nutrition sanitation problems together: Both WASH and nutrition must be addressed together through a lens of holistic, sustainable community engagement to enable long-term impact.
    • One of the first instances of the link between WASH and nutrition appeared in the Convention on the Rights of the Child in 1989, which urges states to ensure “adequate nutritious foods and clean drinking water” to combat disease and malnutrition.
    • Safe drinking water, proper sanitation, and hygiene can significantly reduce diarrhoeal and nutritional deaths.
    • Multistructural approach: What we require is a coordinated, multisectoral approach among the health, water, sanitation, and hygiene bodies, not to mention strong community engagement.
    • WHO has estimated that access to proper water, hygiene, and sanitation can prevent the deaths of at least 8,60,000 children a year caused by undernutrition.

    Conclusion

    At the end of the day, all sides are working towards a common goal: A safe and healthy population and the hope that the 75th year of Independence becomes a watershed moment in India’s journey.

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