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Subject: Social Justice

  • AYUSH Health-Wellness Centres

    What is the news: The Union Cabinet has approved the inclusion of AYUSH Health and Wellness Centre (AYUSH HWC) component of Ayushman Bharat in the National AYUSH Mission (NAM).

    • A total of 12,500 Ayush health and wellness centres throughout the country will be operationalised within a period of five years.
    • The implementation of the proposal will establish a holistic wellness model based on Ayush principles and practices focusing on preventive promotive, curative, rehabilitative and palliative healthcare by integration with the existing public health care system.

    Why such a move?

    • The move is aimed at establishing a holistic wellness model based on AYUSH principles and practices focusing on preventive, promotive, curative, rehabilitative and palliative healthcare by integration with the existing public health care system.
    • The National Health Policy 2017 has advocated mainstreaming the potential of AYUSH systems (Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sows-rigpa and Homoeopathy) within a pluralistic system of Integrative healthcare.
    • The vision of the proposal is to establish a holistic wellness model based on AYUSH principles and practices, to empower masses for ‘self care’ to reduce the disease burden and out of pocket expenditure and to provide informed choice of the needy public.

    What is National AYUSH Mission (NAM)?

    • Department of AYUSH, Ministry of Health and Family Welfare, Government of India has launched National AYUSH Mission (NAM) during 12th Plan for im­plementing through States/UTs.
    • The basic objective of NAM is to promote AYUSH medical systems through cost effective AYUSH services, strengthening of educational systems, facilitate the enforcement of quality control of ASU &H drugs and sustainable availability of ASU & H raw-materials.
    • It envisages flexibility of implementation of the programmes which will lead to substantial participation of the State Governments/UT.
    • The NAM contemplates establishment of a National Mission as well as corresponding Missions in the State level.

  • Need for re-orientation

    Context

    State universities will have to deliver more to the State where they are located

    Status of the state universities in India

    • Significance of state universities: Out of about a thousand higher education institutions (HEIs) that are authorised to award degrees in India, about 400 are state public universities.
      • These state universities produce over 90% of our graduates (including those from the colleges affiliated to them) and contribute to about one-third of the research publications from this country.
    • Poor quality: That their quality and performance is poor in most cases is accepted as a given today.
      • It is evidenced by their poor performance in institutional rankings,
      • the poor employment status of their students,
      • rather poor quality of their publications,
      • negligible presence in national-level policy/decision-making bodies,
      • poor track record in receiving national awards and recognition, poor share in research funding and so on.
    • Stated reasons for poor performance– Commonly stated reasons for these observations include government/political interference in the management of the university, lack of autonomy, poor governance structures, corruption, poor quality of teachers, outdated curricula, plagiarism, poor infrastructure and facilities, overcrowding, evils of the “affiliation” system and poor linkages with alumni and industry.
      • Symptoms of the problem: While many of these observations are no doubt valid, they appear to be only the symptoms and consequences of some deeper malaise and not the underlying cause.

    Core causative factors for the poor state of state universities

    • Lack of support: State universities are not supported the way Central universities are supported by the Central government as well as given patronage by the section of society.
      • It is as though State-level players do not have much stake in the stability and performance of the State university system.
      • What could be the reason for lack of support? One reason why State-level players do not feel compelled to back the State university system more strongly could be that the latter does not commit itself to anything that may be of particular interest and value to the State where the university is located.
    • What could be the solution? In order to receive much more funding and support from the State system then, State universities would have to commit to delivering lots more to the State and its people where they are located.
      • New vision and programmes: They must come up with a new vision and programmes specifically addressing the needs of the State, its industry, economy and society, and on the basis of it make the State-level players commit to providing full ownership and support to them.

    Conclusion

    The initiative to start a larger dialogue on the future of our State universities would have to be taken primarily by the academic community of these institutions.

  • Get a step ahead of the virus

    Context

    The COVID-19 pandemic has repercussions beyond the biomedical sector — it impinges on industry, transport, finance, banking and education sectors. All of them must act in unison.

    Virus different from its nearest relative

    • Comparison with SARS and MERS: The rapid spread of the zoonotic (transmitted from animal-to-human) coronavirus infection in Wuhan in China — several hundreds every day — in December 2019 and January 2020 was a clear signal that COVID-19 is drastically different from its nearest relative viz.-
      • the Severe Acute Respiratory Syndrome (SARS) coronavirus,
      • and its distant relative, the Middle-East Respiratory Syndrome (MERS) coronavirus.
      • The former spread slowly among humans in 2002-2003. It was checked globally within nine months by screening passengers and quarantining travellers from infected countries.
      • There have been no cases since July 2003. MERS coronavirus is, by and large, an inefficient spreader — it has been confined to the Middle-East.
    • How COVID-19 is different? COVID-19 has assumed a pandemic form.
      • In less than three months, it has reached more than 180 countries and claimed more than 10,000 lives.
      • The disease has claimed more people in Italy than in the country of its origin.
      • Travel bans, screening travellers and quarantines are necessary to slow the spread of COVID-19.
      • However, there is a limit to the utility of these measures.
    • Community transmission: When the infection becomes widespread, screening procedures will become inefficient — the virus will spread stealthily.
      • Indigenous transmission — the virus spreading within communities — has begun in many countries.
      • This is typical of viruses that spread from human to human through the respiratory system.

    How India’s health management systems deals with the disease burden?

    • Medicine consists of three components —
      • universal healthcare,
      • public health, and
      • research to constantly contextualise solutions to local problems.
    • Reaction after falling ill: Many of us in India believe that disease is a matter of fate or karma and disease prevention is not always in human hands — we only react after falling ill.
    • No focus on prevention and control: Therapeutics and surgeries — healthcare interventions — are valued much, but not disease prevention and control.
    • Cultural beliefs matter: Attitudes and cultural beliefs do matter. If victims are somehow regarded as responsible for their maladies, universal healthcare is perceived as an optional service — not mandatory.

    Good reasons to change the attitude

    • There are good reasons for such thinking to change.
    • Every person who contracts a communicable disease stands the risk of spreading it to others.
    • Prevention of disease is states’ duty: At the same time, the state, too, is responsible for the spread of diseases by not mitigating the environmental and social risk factors or determinants. Prevention of disease is the state’s duty.
    • Investment in health and its implications: Healthy people create wealth. For example, every year, uncontrolled tuberculosis drains India’s economy of the equivalent of the GDP of roughly 2 million people.
      • Investment in health, therefore, can have implications for the country’s economy.
      • But Indians have never really demanded an effective public health system.
      • Healthcare has never become a political slogan. That’s one reason for the sorry state of India’s public health system.
    • Absence of effective public health system: The country does have international obligations to control TB, malaria and leprosy, and eliminate polio.
      • Ad hoc measures: In the absence of an effective public health system, the country has depended on fulfilling these obligations through ad hoc measures that are targeted towards one disease.
      • Need for robust health system: Robust public health systems are needed to prevent typhoid, cholera, dysentery, leptospirosis, brucellosis, water-born hepatitis and influenza.
    • Overburdened healthcare system with communicable disease: The absence of an effective preventive element means that healthcare services in the public sector are over-burdened with uncontrolled communicable diseases.
      • The entry of the private sector: This encourages private sector healthcare providers to step in, which brings in problems related to unregulated profits.
      • Questions are often raised over the quality of service.
      • COVID-19 could compound the systems problems: Moreover, uncontrolled communicable diseases vie with the non-communicable ones for the healthcare provider’s attention. The COVID-19 outbreak could compound the system’s problems.

    One step ahead of the virus

    • SARS and Nipah in Kerala: The SARS and Nipah virus outbreak in Kerala in 2018 were crises that required short bursts of professional activity. Our healthcare systems coped with them.
      • But endemic diseases, even influenza, that has a vaccine, require sustained interventions.
    • Test for the country’s healthcare system: Herein lies the test for the country’s healthcare system.
      • It has often been seen that the system is not able to sustain its initial momentum.
      • There is a possibility that COVID-19 could follow the path taken by the HINI influenza – after the epidemic died down, the disease became endemic.
      • The country’s healthcare system has to prepare for that. In other words, it has to be one step ahead of the virus.

    Way forward

    • Equipping district hospitals: Every district hospital must be equipped to diagnose infections caused by serious communicable diseases — these affect the lungs, brain, liver and kidneys.
      • The system should also ensure that healthcare personnel do not get infected.
    • Allocate 5% of GDP to health budget: The country needs to allocate 5 per cent of the GDP to the health budget to have a health management system that can take care of public health emergencies such as the COVID-19 outbreak — and its aftermath.
    • Unified control machinery: A unified command and control machinery, under the prime minister’s guidance, to control the spread of COVID-19 is overdue by at least six weeks in the country.
    • Define the tasks of various authorities: The tasks of the Directorate-General of Health Services, National Centre for Disease Control, Indian Council of Medical Research, National Health Mission and state health ministries must be clearly defined.
    • The mechanism for coordination: Most importantly, a mechanism for coordination between these agencies should be set up to deal with the COVID-19 threat.

    Conclusion

    The COVID-19 pandemic has repercussions beyond the biomedical sector — it impinges on industry, transport, finance, banking and education sectors. All of them must act in unison.

  • Smart-locking India

    Context

    Currently, India has entered Stage 2 of the COVID 19 epidemic, but can we do something urgently to halt it before Stages 3 and 4, and prevent it from becoming another China or Italy? Let’s look at what COVID 19 is doing globally and what it has already done in India.

    Nature and characteristics of COVID-19

    • It belongs to a simple family of cold viruses: Coronavirus 19, which emerged from China but has now spread globally, belongs to a simple family of common cold viruses which look innocent and harmless, unlike the sinister flu.
    • Footprints of similar epidemics: It has footprints of two similar epidemics: SARS (2002) and MERS (2012) apart from Ebola, which were contained well globally in the last two decades.
    • They are the group of viruses: Coronaviruses are large groups of viruses seen in humans as well as animals like camels, bats, cats, and even cattle, which India should take note of.
      • The current COVID 19 appears to be a bat-originated beta variant of the coronavirus.
      • Who is the most vulnerable? The human COVID disease is fatal predominantly in elderly or vulnerable groups, such as people with a chronic disease like hypertension, diabetes, cancer or people with suppressed immune systems.
    • How it is spread? It is spread via airborne droplets (sneeze or cough) or contact with the surface. It is possible that a person can get COVID-19 by touching a surface or an object that has the virus on it and then touching their own nose, eyes or mouth.

    Susceptibility and the measures needed to contain the spread

    • Mode of spread: The way virus spreads creates vulnerability and susceptibility of the spread of the virus through airborne droplets and contact surfaces — which are now, therefore, targets of public hygiene for preventing the spread.
    • Why India is more vulnerable? We are vulnerable due to the large population constantly travelling and working: This needs immediate containment to halt the virus spread. We are a ticking time bomb now with less than 30 days to explode in Stage 3, which will be the virus getting deeper into communities, and which will then be impossible to contain.
    • Poor public hygiene in India: Public hygiene in India is poor despite the “Swachh Bharat (Clean India)” movements. We need to have legislation with a penalty to stop spitting in public as well as private spaces.
    • Past performance: India has done very well to contain both SARS and the novel Nipah viral spread very well.

    Should India shut down the cities?

    • From China to global spread: The COVID 19 virus possibly came from the Wuhan epicentre of central China. Subsequent it assumed a large enough proportion to be called a pandemic. It rapidly transitioned across different geographies of the world including Korea, Japan, Iran, Italy and others for the WHO to declare it as a pandemic.
    • Neighbouring countries shutting down the cities: neighbouring countries like Thailand and Singapore shut down their major cities and towns for a few weeks to stop it from moving onto the next stages.
    • Should India shut down the cities? The big question today is, should the Indian government and the state governments stop the virus spread from Stage 2 to 3 by totally shutting down cities and towns when the economy is already fragile and on the brink?
    • From cluster to community spread: India had its first case diagnosed on January 30, from a student who returned from China. Later, it had a very slow spread despite the global transit involved. Such individual cases will become small clusters.
      • These clusters will then spread to communities.
    • We must halt the community-wide spread: Currently, we have just moved from case to clusters, but we must halt the community-wide spread.
    • Biphasic or dual-phase infection: COVID 19 usually follows what is known as a biphasic or dual-phase infection, which means the virus persists and causes a different set of symptoms than observed in the initial bout.
      • Also, sometimes, the recovered person can relapse.
    • The possibility of “super spreader”: Currently, the cases and clusters in India are simple spreaders which means an infected person with normal infectivity.
      • What is it? But COVID 19 can also have a “super spreader”, which means an infected person with high infectivity who can infect hundreds in no time.
    • This was reportedly seen in Wuhan where a fringe group spread the virus via a place of worship in Korea, infecting almost 51 cases.
    • India saw a mini spurt of cases on March 4, and then again between March 10 and 13, when cases jumped from 23 to 35, yet no super spreader was present.
    • We need to halt transition from stage 2 to stage 3: Now we have almost crossed a hundred cases and we must be vigilant.
      • As we enter Stage 2, we will now see a geometric jump in the number of cases which will put us at risk of rapidly transitioning from Stage 2 to 3 like Italy, which we need to halt urgently.

    Conclusion

    The ICMR has rightly advised the government to go into partial shutdown but is it too little too late now? It’s time to halt COVID 19 by smartly locking the country at home so that we can have a better tomorrow. This needs a political will which we currently have.

  • A tale of two bugs

    Context

    India needs to take TB at the same level of seriousness at which it is dealing with the Covid-19.

    Contrast and between the response

    • Tuberculosis in India: Indians will still have to contend with other deadly respiratory tract infections which spread via airborne transmission. We will still have to contend with one particular bug which kills millions of us and which has been around for millennia. Tuberculosis.
      • But all comparisons between COVID-19 and TB end with the superficial observation that they are both deadly respiratory tract infections.
    • Speedy tackling of COVID-19: COVID-19 began its march through humankind barely half a year ago and, in record time, scientists have identified the virus and hundreds of millions of dollars have been allocated to controlling its spread, developing vaccines (at last count, more than a dozen candidates) and testing medication regimens for those infected.
    • Waning of the epidemic: While the virus has spread to over 100 countries, the epidemic already shows signs of waning in the Asian countries where it hit first and hardest.

    Response to the TB

    • How long has the TB infected us? On the other hand, 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.
    • How was the response to TB? The subsequent response to this disease, which was infamously called the White Plague and was a leading cause of death globally at the start of the 20th century, is similar to what we see today for COVID-19, but played out over decades rather than months.
      • Measures taken: TB was made a notifiable disease, campaigns were launched to prohibit spitting and containment policies, including sequestering infected persons, were implemented.
    • The first vaccine was produced over a hundred years ago, and the first curative treatments available by the 1950s.
    • Divide between rich and poor in TB infections: TB was largely beaten in the rich world, not only because of these medical miracles but also thanks to the dramatic reduction in poverty and improvement in living standards.
      • There is compelling evidence that addressing these social determinants was even more impactful than medical interventions in the war against TB.
    • The disease of squalor: TB has always been, and this is even more true now than ever before, a disease of poverty and squalor. And no country is more affected than India.
    • Every TB statistic is grim:
      • We are home to 1 in 4 of the world’s TB patients.
      • Over 2.5 million Indians are infected.
      • In 2018, over 4,00,000 Indians died of the disease.
      • To put this in stark perspective, more people died of TB in India last week than the entire global death toll of COVID-19 to date.
      • Contrast with the response to COVID-19: Given our urgent, energetic and multifaceted response to the latter Covid-19, one is left wondering why we have failed so miserably for another bug, particularly one which has been around for so long, which has been exquisitely studied and characterised, which is preventable and treatable, and which most of the world has conquered.

    Why TB has not been given such attention?

    • It is because those who suffer from TB are not likely to be boarding international flights or passing through swanky airports to attend conferences.
    • It is because TB infects people in slower tides, slow enough for industries to replace the sick with healthier recruits without endangering the bottom line.
    • It is because TB does not threaten the turbines that keep the global economy throbbing.
    • It is because TB no longer poses a threat to rich and powerful countries.
    • It is because those who have TB live on the margins and have little political influence.
    • It is because TB control requires society to address the squalid environments, which shroud the daily lives of hundreds of millions of Indians.
    • It is because TB is a medieval scourge that reminds us of our shameful failure to realise a just, humane and dignified life for all our people.

    Conclusion

    If there is one lesson from COVID-19, it is that India, and the global community, has the political will, technical capacity and financial resources to act in a committed and concerted way to control infectious diseases. It needs to marshal these assets to eradicate TB, the most pernicious and pervasive infection of all, both through addressing its social determinants and scaling up effective biomedical interventions. But, for this to happen, we will have to be as concerned about the health needs of those who travel by foot and bicycle as we do for those who board cruise ships and international flights.

     

     

  • Positive response

    Context

    Cooperation between the Centre and the States in dealing with the threat of the virus is commendable.

    Hope in dealing with the pandemic and India’s response to the pandemic

    • What is the best response?  World Health Organisation declared it a pandemic, Secretary-General offered hope: “If countries detect, test, treat, isolate, trace, and mobilise their people in the response, those with a handful of cases can prevent those cases becoming clusters, and those clusters becoming community transmission.”
    • The advantage with India: India, with 70-odd cases, has the advantage, and commendably, the central and state governments have reacted rapidly to the developing pandemic
    • Equally importantly, they have set aside the acrimony over the CAA-NRC question and pulled together, without the need for external urging.
      • Because everyone realises that COVID-19 is everyone’s problem.
    • Steps taken by the government: No visas are being issued, screening is in progress, health education messaging is visible, public gatherings are sharply reduced and there is no sign of the wearying political blame game which generally besets such challenges.

    No room for complacency

    • Display of political will: The secretary-general has also cautioned that while many nations can avoid the pandemic, the operative verb is not “can” but “will”. The Indian response has displayed political will, but there is no room for complacency.
    • Fear of the unknown: This is the first coronavirus to reach pandemic levels. For at least 18 months, no vaccine can be market-ready. At least until the summer, there will be insufficient information about the behaviour of the organism in the wild. Wisely, Homo sapiens fears the unknown.
    • Caution is the best prescription: Until we learn more about the nature of the beast, abundant caution is the only credible prescription.
      • Isolation at the focus of the response: At present, the focus of the response is isolation (including self-isolation) and the maintenance of sanitation barriers. Schools have been closing down, some workplaces are screening staff, and people are discouraged from leaving home without a compelling reason.
      • However, outside the controlled conditions in homes and hospitals, maintaining the patency of the sanitation barrier requires extraordinary vigilance and self-control.

    Status of healthcare infrastructure

    • The readiness of healthcare facilities: In the case of breaches — a few oversights or accidents are inevitable — the readiness of healthcare facilities would become a serious factor in controlling mortality.
    • Variation in states’ preparedness: The quality of the states’ level of preparedness and the quality of health services varies. While Kerala efficiently controlled the Nipa virus, Uttar Pradesh, the most populous state, has failed to contain annual outbreaks of Acute Encephalitis Syndrome for over a decade.
      • And the capital’s initial failure in the face of seasonal waves of lethal mosquito-borne diseases cannot be forgotten.
    • Rural cluster-most vulnerable: How much less protected would a rural cluster be, serviced by a poorly equipped primary health centre?

    Conclusion

    If community transmission becomes commonplace, it would become a difficult battle. Hence, the sanitation barrier remains the most reliable epidemiological response. If the government has to resurrect primordial provisions from the era of bubonic plagues to keep it patent, so be it.

  • Explained: Epidemic Diseases Act, 1897

    Till today, at least 60 COVID-19 cases have been confirmed in India. So it was decided in a Cabinet Secretary meeting that States and UTs should invoke provisions of Section 2 of Epidemic Diseases Act, 1897, so that Health Ministry advisories are enforceable.

    History of the 1897 Epidemic Diseases Act

    • The Epidemic Diseases Act is routinely enforced across the country for dealing with outbreaks of diseases such as swine flu, dengue, and cholera.
    • The colonial government introduced the Act to tackle the epidemic of bubonic plague that had spread in the erstwhile Bombay Presidency in the 1890s.
    • Using powers conferred by the Act, colonies authorities would search suspected plague cases in homes and among passengers, with forcible segregations, evacuations, and demolitions of infected places.
    • Historians have criticised the Act for its potential for abuse.
    • In 1897, the year the law was enforced, Lokmanya Tilak was punished with 18 months’ rigorous imprisonment after his newspapers Kesari and Mahratta admonished imperial authorities for their handling of the plague epidemic.

    Provisions of the 1897 Epidemic Diseases Act

    • The Act is one of the shortest Acts in India, comprising just four sections. It aims to provide for the better prevention of the spread of Dangerous Epidemic Diseases.
    • The then Governor-General of colonial India had conferred special powers upon the local authorities to implement the measures necessary for the control of epidemics.
    • Although, the act does define or give a description of a “dangerous epidemic disease”.

    Its various sections can be summarized as under:

    • The first section describes all the title and extent, the second part explains all the special powers given to the state government and centre to take special measures and regulations to contain the spread of disease.
    • The second section has a special subsection 2A empowers the central government to take steps to prevent the spread of an epidemic, especially allowing the government to inspect any ship arriving or leaving any post and the power to detain any person intending to sail or arriving in the country.
    • The third section describes the penalties for violating the regulations in accordance with Section 188 of the IPC. Section 3 states, “Six months’ imprisonment or 1,000 rupees fine or both could be charged out to the person who disobeys this Act.”
    • The fourth and the last section deals with legal protection to implementing officers acting under the Act.

    Examples of implementation

    The act has been invoked several times since independence. Few recent incidents include-

    • In 2018, the district collector of Gujarat’s Vadodara issued a notification under the Act declaring a town as cholera-affected.
    • In 2009, to tackle the swine flu outbreak in Pune, Section 2 powers were used to open screening centres in civic hospitals across the city, and swine flu was declared a notifiable disease.

  • [pib] Regulating Content of Trans-Fat in Oils and Fats

     

     

    The limit of trans-fats to be not more than 5% is prescribed under Food Safety and Standards (Food Products Standards and Food Additives) Regulations, 2011 for vanaspati, bakery shortenings, bakery and industrial margarine and interesterified vegetable fats/oils.

    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 this move?

    • Studies have recently shown that 60,000 deaths occur every year due to cardiovascular diseases, which in turn are caused due to high consumption of trans fats.
    • Since the impact of trans fats on human health is increasing exponentially, it is very important to create awareness about them.

    Standards for Trans-fats

    • A draft notification to limit trans-fat to be not more than 2% by weight of the total oils/fats present in the processed food products in which edible oils and fats are used as an ingredient on and from 1st January, 2022 was issued on 28.08.2019. 
    • Standards prescribed under various regulations of FSSAI are enforced to check that they comply with the standards laid down under Food Safety and Standards Act, 2006, and the rules and regulations made thereunder.
    • In cases where the food samples are found to be non-conforming, recourse is taken to penal provisions under Chapter IX of the Food Safety and Standards Act, 2006.

  • Tracking the big three

    Context

    The article focuses on the top three Sustainable Development Goals (SDGs) of the United Nations, namely poverty elimination, zero hunger, and good health and well-being by 2030.

    India’s record on extreme poverty, hunger and health

    • Decline in extreme poverty: The World Bank’s estimates of extreme poverty- measured as $1.9/per capita/per day at purchasing power parity of 2011- show a secular decline in India from 45.9 per cent to 13.4 per cent between 1993 and 2015.
    • Elimination of extreme poverty 2030: If the overall growth process continues as has been the case since, say, 2000 onwards, India may succeed in eliminating extreme poverty by 2030, if not earlier.
    • Zero hunger by 2030: Given the overflowing stock of food grains with the government, and a National Food Security Act (NFSA) that subsidises grains to the tune of more than 90 per cent of its cost to 67 per cent of the population, there is no reason to believe that India can also not attain the goal of zero hunger before 2030.
    • Health- a real challenge: The real challenge for India, is to achieve the third goal of good health and well-being by 2030. India’s performance in this regard, so far, has not been satisfactory. as per the National Family Health Survey (NFHS 2015-16)-
      • In 2015-16, almost 38.4 per cent of India’s children under the age of five years were stunted.
      • 8 per cent were underweight.
      • 21 per cent suffered from wasting (low weight for height).
      • The situation in some states like Bihar, Jharkhand and Uttar Pradesh is even worse.
    • Global Hunger Index ranking of India: No wonder, the Global Hunger Index (GHI) ranks India at 102 out of 117 countries in terms of the severity of hunger in 2019.

    What are the various targets set on the nutrition problem?

    • Target on reducing the problems of underweight children: The National Nutrition Strategy, 2017, aims to reduce the prevalence of underweight children (0-3 years) by three percentage points every year by 2022 from NFHS 2015-16 estimates.
      • Why this is an ambitious target? This is an ambitious target given the decadal decline in underweight children from 42.5 per cent in 2005-06 to 35.8 per cent in 2015-16 amounts to less than 1 per cent decline per year.
    • Targets set in National Nutrition Mission: Similar targets have been set by the National Nutrition Mission (renamed as POSHAN Abhiyaan), 2017.
      • To reduce stunting by 2 per cent.
      • Under-nutrition by 2 per cent.
      • Anaemia (among young children, women and adolescent girls) by 3 per cent.
      • Low birth weight by 2 per cent.

    Four areas India needs to focus to achieve the set targets

    • India has to focus on four key areas:  If India has to make a significant dent on malnutrition by 2030.
    • First- Mother’s education.
      • Multiplier effect: It is one of the most important factors that have a positive multiplier effect on child care and access to healthcare facilities.
      • Increases awareness: It also increases awareness about the nutrient-rich diet, personal hygiene, etc. This can also help contain the family size in poor, malnourished families.
      • Thus, a high priority to female literacy, in a mission mode through liberal scholarships for the girl child, would go a long way towards tackling this problem.
    • Second- Access to improved sanitation and safe drinking water.
      • The Swachh Bharat Abhiyan and Jal Jeevan Mission would have positive outcomes in the coming years.
    • Third-shift in dietary pattern
      • Shift from cereals to more nutritious food: There is a need to shift dietary patterns from cereal dominance to the consumption of nutritious foods such as livestock products, fruits and vegetables, pulses, etc.
      • But they are generally costly and their consumption increases only by higher incomes and better education.
      • Diverting the food subsidy to nutritious foods: Diverting a part of the food subsidy on wheat and rice to more nutritious foods can help.
    • Fourth- Adoption of new agricultural technology
      • Adopt bio-fortifying cereals: India must adopt new agricultural technologies of bio-fortifying cereals, such as zinc-rich rice, wheat, iron-rich pearl millet, and so on.
      • The Indian Council of Agricultural Research (ICAR) has to work closely with the Harvest Plus programme of the Consultative Group of International Agricultural Research (CGIAR) to make it a win-win situation for curtailing malnutrition in Indian children at a much faster pace — and, at a much lower cost than would be achieved under a business as usual scenario.

    Examples from the world

    • Right public policies make the difference: Global experience shows that with the right public policies focusing on agriculture, improved sanitation, and women’s education, one can have much better health and well-being for its citizens, especially children.
    • China’s example: In China, it was agriculture and economic growth that significantly reduced the rates of stunting and wasting among the population and lifted millions of people out of hunger, poverty and malnutrition.
    • Brazil and Ethiopia example: According to FAO, Brazil and Ethiopia have transformed their food systems: They have targeted their investments in agricultural R&D and social protection programmes to reduce hunger in the country.

    Conclusion

    Despite India’s improvement in child nutrition rates since 2005-06, it is way behind the progress experienced by China and many other countries. According to the Global Nutrition Report, 2016, at the present rates of decline, India will achieve the current stunting rates of China by 2055. India can certainly do better, but only if it focuses on this issue.

  • State lethargy amidst cough syrup poisoning

    Context

    A few days ago, 12 children died in Udhampur district of Jammu due to poisoned cough syrup (Coldbest-PC).

    Fourth mass glycol poisoning

    • What was the cause of the poisoning? A team of doctors at the Post Graduate Institute of Medical Education & Research, Chandigarh, attributed the deaths to the presence of diethylene glycol in the cough syrup.
    • What is Diethylene glycol? It is an anti-freezing agent that causes acute renal failure in the human body followed by paralysis, breathing difficulties and ultimately death.
    • This is the fourth mass glycol poisoning event in India that has been caused due to a pharmaceutical drug.

    Measures required and example from the US

    • Preventing further deaths: The immediate concern for doctors, pharmacists and the drug regulators should be to prevent any more deaths.
      • The only way to do so is to account for each and every bottle of the poisoned syrup that has ever been sold in the Indian market and stop patients from consuming this drug any further.
    • The US example in such case: United States Food and Drug Administration (USFDA), in 1937, when the United States faced a similar situation with glycol poisoning.
      • Tracking down every bottle: Entire field force of inspectors and chemists were assigned to the task of tracking down every single bottle of the drug.
      • Even if a patient claimed to have thrown out the bottle, the investigators scoured the street until they found the discarded bottle.
      • This effort was accompanied by a publicity blitz over radio and television.
    • What is being done in India? We do not see such public health measures being undertaken here.
      • Seriousness not communicated to the pubic: Authorities are simply not communicating the seriousness of the issue to the general public.
      • A general statement: At most, the authorities in Himachal Pradesh (H.P.), who are responsible for oversight of the manufacturer of this syrup, have made general statements that they have ordered the withdrawal of the drug from all the other States where it was marketed.
      • Lack of transparency: There is no transparency in the recall process and information about recalls and batch numbers is not being communicated through authoritative channels.
      • No public announcement by the DCGI: There is no public announcement by the Drug Controller General of India (DCGI), which is responsible for overall regulation of the entire Indian market.
      • The suspect product, although manufactured in H.P., has been sold across the country.
      • The website of the DCGI, which is supposed to communicate drug alerts and product recalls, has no mention of Coldbest-PC as being dangerous as of this writing.

    Need for the recall policy

    • No rules or binding guidelines on recall: One of the key reasons why the DCGI and state drug authorities have been so sloppy is because unlike other countries, India has not notified any binding guidelines or rules on recalling dangerous drugs from the market.
    • Warnings to the DGCI on lack of framework: The 59th report of the Parliamentary Standing Committee on Health as well as the World Health Organization (in its national regulatory assessment) had warned the DCGI on the lack of a national recall framework in India.
      • A set of recall guidelines was drafted in 2012 but never notified into law.

    Conclusion

    The drug regulator needs to take the urgent steps to avoid the repeat of such tragedies in the future and formulate a policy on the drug recall at the earliest.