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Subject: Social Justice

  • India’s burden of heart diseases

    According to the Global Burden of Disease, nearly a quarter (24.8 per cent) of all deaths in India is due to cardiovascular diseases (CVDs).

    The fastest-growing economy has some perils. In this newscard, you will get to see how CVDs are a legacy of economic growth.

    Global Burden of Disease (GBD) Report

    • The GBD is a comprehensive regional and global research program of disease burden that assesses mortality and disability from major diseases, injuries, and risk factors.
    • GBD is a collaboration of over 3600 researchers from 145 countries.
    • It is based out of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and funded by the Bill and Melinda Gates Foundation.

    Indian burden of CVDs

    • About a third of the senior citizens have been diagnosed with hypertension, 5.2% with chronic heart disease and 2.7% with stroke
    • Even an analysis of the medical certification of cause of death (MCCD) reports points to an increase in the proportion of deaths due to CVD. It went from 20.4 per cent in 1990 to 27.1 per cent in 2004.
    • According to MCCD report, 2018, CVDs accounted for more than half (57%) of the total deaths in the age group of 25–69 years.
    • Case fatality due to CVD in low-income countries, including India, appears to be much higher than in middle and high-income countries.
    • In India, for example, the mean age at which people get the first myocardial infarction is 53 years, which is about 10 years earlier than their counterparts in developed countries.
    • About a third (32 per cent) of the senior citizens have been diagnosed with hypertension, 5.2 per cent were diagnosed with chronic heart disease and 2.7 per cent with stroke.

    Women are more vulnerable

    • Numerous studies have also pointed out that CVD remains the number-one threat to women’s health as more women than men die annually due to these diseases.
    • A Harvard study shows low high-density lipoproteins and high triglycerides appear are the main factors that increase the chances of death from cardiovascular disease in women over age 65.
    • As per the LASI report, gender differences were evident in cross-state variations.
    • CVD among men was higher in Kerala (45 per cent), Goa (44 per cent), Andaman and Nicobar (41 per cent) and lower in Chhattisgarh (15 per cent), Meghalaya (16 per cent), Nagaland (17 per cent).

    Why CVDs are prevalent in India?

    • Epidemiological evidence suggests that CVD is associated with behavioural factors such as smoking, alcohol use, low physical activity, and insufficient vegetable and fruit intake.
    • In the Indian context, poverty, maternal malnutrition, and early life changes enhance an individual’s risk of CVDs.
    • Rural to urban migration that happens in distress leads to over-crowded and unclean environments in urban slums.
    • Problems of inadequate housing, indoor pollution, infectious diseases, inappropriate diet, stress and smoking crop up as a result.

    Need of the hour

    • CVD-risk prevention is one of the important priorities among India’s sustainable development goals.
    • In an earlier estimate, WHO had said with India’s present CVD burden, the country would lose $237 billion from the loss of productivity and spending on healthcare over 10 years (2005–2015).
    • This is because the diseases affect the country’s working population.

    Way ahead

    • The government should devise an approach that can improve the efficiency of care and health system preparedness to curb the CVD epidemic currently sweeping India.
    • Attempts in direction to preserve the traditional lifestyle are also necessary.

  • [pib] Longitudinal Ageing Study of India (LASI)

    The Union Minister for Health & Family Welfare has released INDIA REPORT on Longitudinal Ageing Study of India (LASI) Wave-1.

    Discuss various issues pertaining to old-age care in India.

    Longitudinal Ageing Study of India (LASI)

    • LASI is a full–scale national survey of scientific investigation of the health, economic, and social determinants and consequences of population ageing in India.
    • The LASI, Wave 1 covered a baseline sample of 72,250 individuals aged 45 and above till the oldest-old persons aged 75 and above from all States and UTs of India (excluding Sikkim).
    • It is India’s first and the world’s largest ever survey that provides a longitudinal database for designing policies and programmes for the older population in the broad domains of social, health, and economic well-being.
    • The evidence from LASI will be used to further strengthen and broaden the scope of National Programme for Health Care of the Elderly.
    • It would also help in establishing a range of preventive and health care programmes for older population and most vulnerable among them.

    Why need such survey?

    • In 2011 census, the 60+ population accounted for 8.6% of India’s population, accounting for 103 million elderly people.
    • Growing at around 3% annually, the number of elderly age population will rise to 319 million in 2050.
    • 75% of the elderly people suffer from one or the other chronic disease.
    • 40% of the elderly people have one or the other disability and 20% have issues related to mental health.
    • This report will provide base for national and state level programmes and policies for elderly population.

  • Need to focus on the well-being of the child from womb to first five years

    The article analyses the data of NHFS-5 and try to factors responsible for the outcomes.

    Analysing health and nutrition of child through NHFS-5

    • The recently released fifth round of the National Family Health Survey (NFHS-5) provide insights into some dimensions of micro-development performance before COVID struck.
    • The latest round only has data for 17 states and five Union territories.
    • Madhya Pradesh, Uttar Pradesh, Punjab, Rajasthan and Tamil Nadu are notable exclusions.
    • Many of the child-related outcomes are also determined by state-level implementation, therefore neither success nor failure can be attributed to state or the centre alone.

    Let’s understand the data

    • The NFHS has 42 indicators related to child’s health and nutrition.
    • Indicators fall into nine categories and each of these can be divided into outcomes and inputs.
    • For example, neonatal, infant and under-5 mortality rates can be thought of as outcomes.
    • Similarly, all the nutrition indicators —stunting, wastage, excess wastage, underweight and overweight can also be classified as outcomes.
    • In contrast, the post-natal care indicators relating to visits made by health workers and the extent and nature of feeding for the child can be classified as inputs.

    Outcomes of the survey

    • On the front of wasting (weight for height of children) these is an improvement because even though the gains were marginal, they reversed a negative trend between 2005 and 2015. 
    • India continues to be successful in preventing child deaths, but the health and nutrition of the surviving, living child has deteriorated, somewhat worryingly.
    • India continued to make progress in preventing child-related deaths (neonatal, infants and under-5).
    • The pace of improvement in child mortality slowed down relative to the previous 10 years (Fig.1).
    • Figure 2 shows the six indicators where outcomes have deteriorated. These all relate to what happens after survival:
    • The health (anaemia, diarrhoea, and acute respiratory illness (ARI)) and nutrition (stunting, and overweight) of the child deteriorated between 2015 and 2019.
    • The absolute deterioration in health and nutrition indicators must be seen against the fact that they reversed the historic trends of steady improvements.

    What explains the outcomes

    • Implementation capacity of individual states probably played an important role.
    • Sector-specific factors such as changing diets are also implicated.
    • A broader deterioration in outcomes hints at the likelihood of a common factor, namely the macro-economic growth environment, which determines employment, incomes and opportunities.
    • At the least, it is safe to conjecture that some of these outcomes are inconsistent with the narrative of a rapidly growing economy.

    Conclusion

    As discussed in Chapter 5 of the Economic Survey of 2015-16, perhaps the next big welfare initiative of the government should be a mission-mode focus on the well-being of the early child (and of course the mother), from the womb to the first five years, which research shows is critical for realising its long run potential as an individual.

  • FSSAI slashes limit for Trans Fats level in food

    The Food Safety and Standards Authority of India (FSSAI) has capped the amount of trans fatty acids (TFA) in oils and fats to 3% for 2021 and 2% by 2022 from the current permissible limit of 5%.

    New FSSAI norms

    • FSSAI has acted in response to the amendment to the Food Safety and Standards (Prohibition and Restriction on Sales) Regulations.
    • The country’s food regulatory body notified the amendment on December 29, more than a year after it issued a draft on the subject for consultation with stakeholders.
    • The revised regulation applies to edible refined oils, vanaspati (partially hydrogenated oils), margarine, bakery shortenings, and other mediums of cooking such as vegetable fat spreads and mixed fat spreads.
    • It was in 2011 that India first passed a regulation that set a TFA limit of 10% in oils and fats, which was further reduced to 5% in 2015.

    What are Trans Fats?

    • Artificial Trans fats are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid.
    • Since they are easy to use, inexpensive to produce and last a long time, and give foods a desirable taste and texture, they are still widely used despite their harmful effects being well-known.

    Why such a regulation?

    • Trans fats are associated with increased risk of heart attacks and death from coronary heart disease.
    • As per the WHO, approximately 5.4 lakh deaths take place each year globally because of intake of industrially-produced trans-fatty acids.
    • The WHO has also called for global elimination of trans fats by 2023.

  • Burden of Anaemia in India

    Indian women and children are overwhelmingly anaemic, according to the National Family Health Survey (NFHS) 2019-20 released this month, and the condition is the most prevalent in the Himalayan cold desert.

    Anaemia is the condition of having a lower-than-normal number of red blood cells or a quantity of haemoglobin. How widespread is it in India?

    What is Anaemia?

    • The condition of having a lower-than-normal number of red blood cells or a quantity of haemoglobin. It can make one feel tired, cold, dizzy, and irritable, and short of breath, among other symptoms.
    • 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.

    How widespread is anaemia in our country?

    • In Phase I of the NHFS, result factsheets have been released for 22 states and UTs.
    • In a majority of these states and UTs, more than half the children and women were found to be anaemic.
    • In 15 of these 22 states and UTs, more than half the children are anaemic. Similarly, more than 50 percent of women are anaemic in 14 of these states and UTs.
    • The proportion of anaemic children and women is comparatively lower in Lakshadweep, Kerala, Meghalaya, Manipur, Mizoram, and Nagaland.
    • However, it is higher in Ladakh, Gujarat, J&K, and West Bengal, among others.
    • Anaemia among men was less than 30 percent in a majority of these states and UTs.

    What was the methodology used?

    • NFHS used the capillary blood of the respondents for the estimation of anaemia. For children, haemoglobin of fewer than 11 grams per decilitre (g/dl) indicated anaemia.
    • For non-pregnant and pregnant women, it was less than 12 g/dl and 11g/dl respectively, and for men, it was less than 13 g/dl.
    • Among children, the prevalence was adjusted for altitude and among adults, it was adjusted for altitude and smoking status.

    Why is anaemia so high in the country?

    • Iron-deficiency and vitamin B12-deficiency anaemia are the two common types of anaemia in India.
    • 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.
    • 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 about the cold desert region of the western Himalaya?

    • In the union territory of Ladakh, a whopping 92.5 per cent children, 92.8 per cent women, and around 76 per cent men are anaemic in the given age groups, as per the survey.
    • The high prevalence in this region could be due to the short supply of fresh vegetables and fruits during the long winter each year.
    • Crops here are generally only grown in summer and during winter; residents fail to get a regular supply of green vegetables and fresh produce from outside, due to restricted connectivity in harsh weather.
    • However, there could be other factors as well and the causes of anaemia here are yet to be scientifically ascertained.

  • Global Alliance for Vaccines and Immunization (GAVI)

    Union Health Minister has been nominated by the Global Alliance for Vaccines and Immunisation (GAVI) as a member of the GAVI Board.

    Q.The Covid-19 pandemic has exposed the limitations of global cooperation. Critically analyse.

    GAVI

    • GAVI is a public-private global health partnership with the goal of increasing access to immunization in poor countries.
    • GAVI has observer status at the World Health Assembly.
    • GAVI has been praised for being innovative, effective, and less bureaucratic than multilateral government institutions like the WHO.
    • Members: the WHO, UNICEF, the World Bank, the vaccine industry in both industrialized and developing countries, and the Bill & Melinda Gates Foundation among others.
    • GAVI programs can often produce quantified, politically appealing, easy-to-explain results within an election cycle, which is appealing to parties locked in an election cycle.

    Its function

    • It currently supports the immunization of almost half the world’s children, giving it the power to negotiate better prices for the world’s poorest countries and remove the commercial risks of manufacturers.
    • It also provides funding to strengthen health systems and train health workers across the developing world.

    Significance of India’s membership

    • The GAVI Board is responsible for the strategic direction and policymaking oversees the operations of the Vaccine Alliance and monitors program implementation.
    • With membership drawn from a range of partner organizations, as well as experts from the private sector, the Board provides a forum for balanced strategic decision making, innovation, and partner collaboration.

  • [pib] PM-JAY SEHAT

    The Prime Minister has launched Ayushman Bharat PM-JAY SEHAT to extend coverage to all residents of Jammu & Kashmir.

    Q.Discuss various challenges in ensuring Universal Healthcare in India. (150W)

    PM-JAY SEHAT

    • The full form of SEHAT is social, endeavor for health, and telemedicine. Under this scheme, the SEHAT card will be distributed to all the eligible beneficiaries.
    • All the eligible beneficiaries of Jammu and Kashmir can apply for the Scheme through common service center operators
    • Around 1 crore beneficiaries will cover under this scheme. All the eligible citizens of Jammu and Kashmir will get cashless treatment up to Rs 5 lakh under the Scheme.

  • Dominance of Private healthcare in India & Related issues

    • Lack of resources such as 1:1,700, doctor: citizen ratio, well below the minimum ratio of 1:1,000 stipulated by WHO.

    • Rural areas and smaller towns of India are the worst sufferers, where even basic health services remain inaccessible, many cases were reported where ward boys and alone found running the primary healthcare center.

    • Inadequate government spending on healthcare and lack of access to health insurance to a large section of society.

    • The quality of public health services in India continues to remain below expectations which hamper the economic growth of the country.

    • Government’s inability to build sufficient capacity and infrastructure, difficulty in reaching out to poor and vulnerable groups.

    • An undersized skilled workforce and the absence of upgraded technology is a major challenge in the health sector.

  • [pib] Vision 2035: Public Health Surveillance in India

    NITI Aayog today released a white paper: Vision 2035: Public Health Surveillance (PHS) in India.

    Q.Discuss the role of Public Health Surveillance in the success of Ayushman Bharat Abhiyan.

    Vision 2035 for PHS

    • It is a continuation of the work on health systems strengthening.
    • It contributes by suggesting mainstreaming of surveillance by making individual electronic health records the basis for surveillance.
    • Public health surveillance (PHS) is an important function that cuts across primary, secondary, and tertiary levels of care. Surveillance is ‘Information for Action’.

    Let’s have a look at the executive summary of the vision document:

    PHS in India

    • Surveillance is an important Public Health function.
    • It is an essential action for disease detection, prevention, and control. Surveillance is ‘Information for Action’.

    Why need PHS?

    • Multiple disease outbreaks have prompted India to proactively respond with prevention and control measures. These actions are based on information from public health surveillance.
    • India was able to achieve many successes in the past. Smallpox was eradicated and polio was eliminated.
    • India has been able to reduce HIV incidence and deaths and advance and accelerate TB elimination efforts.
    • These successes are a result of effective community-based, facility-based, and health system-based surveillance.
    • The COVID19 pandemic has further challenged the country. India rapidly ramped up its diagnostic capabilities and aligned its digital technology expertise.
    • This ensured that there was a comprehensive tracking of the pandemic.

    Highlights of the vision document

    • It builds on initiatives such as the Integrated Health Information Platform of the Integrated Disease Surveillance Program.
    • It aligns with the citizen-centricity highlighted in the National Health Policy 2017 and the National Digital Health Blueprint.
    • It encourages the use of mobile and digital platforms and point of care devices and diagnostics for amalgamation of data capture and analyses.
    • It highlights the importance of capitalizing on initiatives such as the Clinical Establishments Act to enhance private sector involvement in surveillance.
    • It points out the importance of a cohesive and coordinated effort of apex institutions including the National Centre for Disease Control, the ICMR, and others.

    Gap areas in India’s PHS that could be addressed

    • India can create a skilled and strong health workforce dedicated to surveillance activities.
    • Non-communicable disease, reproductive and child health, occupational and environmental health and injury could be integrated into public health surveillance.
    • Morbidity data from health information systems could be merged with mortality data from vital statistics registration.
    • An amalgamation of plant, animal, and environmental surveillance in a One-Health approach.
    • PHS could be integrated within India’s three-tiered health system.
    • Citizen-centric and community-based surveillance, and use of point of care devices and self-care diagnostics could be enhanced.
    • To establish linkages across the three-tiered health system, referral networks could be expanded for diagnoses and care.

    Moving ahead

    • Establish a governance framework that is inclusive of political, policy, technical, and managerial leadership at the national and state level.
    • Identify broad disease categories that will be included under PHS.
    • Enhance surveillance of non-communicable diseases and conditions in a step-wise manner.
    • Prioritize diseases that can be targeted for elimination as a public health problem, regularly.
    • Improve core support functions, core functions, and system attributes for surveillance at all levels; national, state, district, and block.
    • Establish mechanisms to streamline data sharing, capture, analysis, and dissemination for action.
    • Encourage innovations at every step-in surveillance activity.

  • India needs to rethink its nutrition agenda

    Poor nutritional outcomes in NFHS-5 show that a piecemeal approach does not work.

    Nutrition-related data released by NFHS-5

    • The Ministry of Health and Family Welfare has released data fact sheets for 22 States and Union Territories (UTs) based on the findings of Phase I of the National Family Health Survey-5 (NFHS-5).
    • The 22 States/ UTs don’t include some major States such as Tamil Nadu, Rajasthan, Punjab, Uttar Pradesh, Jharkhand, Odisha and Madhya Pradesh.

    Practice Question: The latest findings from the National Family Health Survey data shows a sign of worry. Suggest the policy measures required to tackle the health and nutrition-related issues in India.

    Worrying findings

    • There is an increase in the prevalence of severe acute malnutrition in 16 States/UTs (compared to NFHS-4 conducted in 2015-16). Kerala and Karnataka are the only two big states where there is some decline.
    • The percentage of children under five who are underweight has also increased in 16 out of the 22 States/UTs.
    • Anaemia levels among children as well as adult women have increased in most of the States with a decline in anaemia among children being seen only in four States/UTs.
    • There is also an increase in the prevalence of other indicators such as adult malnutrition in many States/ UTs.
    • Most States/UTs also see an increase in overweight/obesity prevalence among children and adults shows the inadequacy of diets in India both in terms of quality and quantity.
    • The data report an increase in childhood stunting (an indicator of chronic under-nutrition and considered a sensitive indicator of overall well-being) in 13 of the 22 States/UTs.
    • Poshan Abhiyaan, one of the flagship programmes of the PM, launched in 2017, aimed at achieving a 2% reduction in childhood stunting per year.

    Economic growth vs health indicators

    • There is an increase in the prevalence of childhood stunting in the country during the period 2015-16 to 2019-20.
    • This calls for serious introspection on not just the direct programmes in place to address the problem of child malnutrition but also the overall model of economic growth that the country has embarked upon.
    • The World Health Organization calls stunting “a marker of inequalities in human development”.
    • Over the last three decades, India has experienced high rates of economic growth. But this period has also seen increasing inequality, greater informalisation of the labour force, and reducing employment elasticities of growth.
    • Currently, India is witnessing a slowdown in economic growth, stagnant rural wages and highest levels of unemployment. This is reflected in the rising number of reported starvation deaths from different parts of the country.
    • The situation has become even worse due to the pandemic and lockdown-induced economic distress.
    • Field surveys such as the recent ‘Hunger Watch’ are already showing massive levels of food insecurity and decline in food consumption, especially among the poor and vulnerable households.
    • All of this calls for urgent action with commitment towards addressing the issue of malnutrition.

    Social protection schemes and their impact on nutrition indicators

    • Social protection schemes and public programmes such as the Mahatma Gandhi National Rural Employment Guarantee Scheme, the Public Distribution System, the Integrated Child Development Scheme (ICDS), and school meals have contributed to a reduction in absolute poverty as well as previous improvements in nutrition indicators.
    • However, there are continuous attempts to weaken these mechanisms through underfunding and general neglect.
    • Only about 32.5% of the funds released for Poshan Abhiyaan from 2017-18 onwards had been utilized.
    • There are some improvements seen in determinants of malnutrition such as access to sanitation, clean cooking fuels and women’s status – a reduction in spousal violence and greater access of women to bank accounts.

    A piecemeal approach

    • The overall poor nutritional outcomes show that a piecemeal approach addressing some aspects does not work.
    • Direct interventions such as supplementary nutrition (of good quality including eggs, fruits, etc.), growth monitoring, and behaviour change communication through the ICDS and school meals must be strengthened and given more resources.
    • Universal maternity entitlements and child care services to enable exclusive breastfeeding, appropriate infant and young child feeding as well as towards recognizing women’s unpaid work burdens have been on the agenda for long, but not much progress has been made on these.
    • The linkages between agriculture and nutrition both through what foods are produced and available as well as what kinds of livelihoods are generated in farming are also important.

    Conclusion

    • The basic determinants of malnutrition – household food security, access to basic health services and equitable gender relations – cannot be ignored any longer.
    • An employment-centred growth strategy which includes the universal provision of basic services for education, health, food and social security is imperative.
    • There have been many indications in our country that business as usual is not sustainable anymore.
    • It is hoped that the experience of the pandemic, as well as the results of NFHS-5, serve as a wake-up call for a serious rethinking of issues related to nutrition and accord these issues priority.