Sunday, December 13, 2015

[Editorial # 12] Heal Thyself


Yet again, the Lancet has cut deep. For the second time this year, the premier medical publication has sniffed at the Indian government for being inattentive to public health. In September, it had published data suggesting that India would miss the target of less than 42 child deaths in the under-five category per 1,000 live births by the end of 2015.
Now, it has pulled up the Narendra Modi government for defaulting on its election promise of universal health coverage. The public health debate tends to concern the containment of communicable and non-communicable diseases, but the journal has moved the focus to the costs associated with managing them. And since the study was piloted by seasoned Indian researchers led by Vikram Patel and K. Srinath Reddy, its findings cannot be easily dismissed.

The Lancet paper, “Assuring Health Coverage for All in India”, ranks India lowest among the BRICS countries for its failure to contain out-of- pocket expenses for healthcare, which further impoverish the poor while denying them value. Indeed, India bears a disproportionate share of the global burden of disease, and this has not been falling as expected in recent years. On the other hand, the budgetary allocation for health has fallen by 0.5 per cent of the GDP over the last decade, roughly speaking. Given the inflationary surges seen after the meltdown of 2008, the real decline in allocation may be even steeper than the numbers suggest. The obvious remedies are to increase public spending while regulating private enterprise in order to deny it windfall gains at the expense of the common good. In addition, primary care must be given primal importance and some imagination is needed to close the gap between demand and supply of medical staff where it is needed most, in rural areas.

In the literature, public health is one of the components of the idea of “common security”, which developed the concept of security beyond the traditional ambit of military and geopolitical concerns. However, the problem is as easily stated in terms of the more readily accessible idea of national security: A nation with a population featuring high morbidity and mortality due to preventable factors is at risk. Neither can it actualise its full potential, nor can it compete effectively with its peers in the global marketplace. Surprisingly, for decades, this simple truth has not been adequately reflected in policy.


Questions:

1. What are communicable and non-communicable diseases? Give examples.

2. Which disease is responsible for claiming higher number of deaths in India?

3. What is understood by Public Health Infrastructure? Do we have such infrastructure in place in India? If yes then throw some light on its structure.

4. What is out of pocket expenditure on health? Have you ever availed the facilities of healthcare on government's expenditure? If not then why?

5. What is IMR, MMR, U5MR,CBR,CDR in the context of healthcare? What are their values with respect to India?

6. What is Lancet?

7. Which government is responsible for public health -local, state or central ?

8. What percentage of GDP does India spend on healthcare?

9. Where is the nearest public health care facility near your place of stay?

10. Suppose you are coming back from a friend's place late at night. While returning, you see an old man lying by the road side. You are a concerned citizen of India. You approach the old man only to find that he is  bleeding profusely and is lying unconscious. You are alone and there is no one on that street as well. You are travelling on a four wheeler.  Under these circumstances what would be the action taken by you? Justify your answer.

7 comments:

  1. Communicable diseases are those that spread from one individual to another or from an animal to a human being through airborne viruses, bacteria , blood and other bodily fluids. They are also referred to as infectious or contagious diseases. These range from the common cold to more severe diseases such as hepatitis, influenza, polio, Malaria, HIV/AIDS, and tuberculosis. Non-communicable disease(NCD) is a medical condition or disease that is non-infectious or cannot be transmitted from one person to another. These are usually chronic illnesses that persist for long periods of time and progress slowly, although they can also result in rapid or sudden deaths for example , heart disease, strokes, cancer, osteoporosis, kidney failure, diabetes, Alzheimer's disease, cataracts and autoimmune diseases. Non communicable disease can be distinguished from communicable ones only by their non-infectious and non-transmissible nature and not by duration , since some communicable diseases like HIV/AIDS persist for long periods of time and progress very slowly.

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  2. Non-communicable diseases are a leading cause of death worldwide, accounting for more than 65% of deaths as of 2012. Non-communicable diseases have also assumed massive proportions in India. In the 1990's malaria, tuberculosis and pneumonia were leading killers whereas in the present scenario, heart disease particularly Ischaemic Heart Disease has emerged as the top killer. In addition lung disease, cancer, strokes, pulmonary disease and diabetes constitute the top killer diseases in India.

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  3. Ischaemic Heart Disease is the top killer disease in India and the world and accounts for the highest number of deaths. It is also known as Coronary Artery Disease and is a condition in which supply of blood to the heart becomes restricted as a result of the blockage of the arteries ad blood vessels due to deposition of fatty layers of cholesterol.

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  4. Public health infrastructure refers to the basic health services and facilities established and maintained by the government in order to safeguard and enhance public health and well-being. It not only includes tangible infrastructure such as hospitals, medical facilities, laboratories and medical equipment, but also includes the knowledge capacity and the workforce skill of the doctors , nurses and other medical professionals as well as the research and development capabilities and quality of the medical institutions and educational facilities. The Public Health Infrastructure in India consists of the Primary Health Care centers are the basic health centres usually serving in rural areas at the level of panchayats, the community health centres which are the basic health units present in the urban areas, the taluk level hospitals controlled by the state governments and serving at the taluk level, District hospitals, government medical colleges and All India Institutes of Medical Sciences in increasing order of facilities, area served, capacity and specialization.

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  5. The Primary Health Centers are also known as Public Health Centres and they are state-owned rural healthcare facilities. They are essentially single physician facilities which are theoretically equipped with minor surgical facilities as well. The main functions of these primary health centres are as follows : infant immunization programs and vaccination programs which are fully subsidized at these centres, birth control procedures for example vasectomies and tubectomies. The experience with the latter has however been very dismal, with inexperienced and inadequately qualified doctors conducting these procedures leading to several death from infections . Anti-epidemic programs and emergencies for example snake bites. However the mainstay od the primary health centres has been the maternal and pregnancy related services that it offers which include pre-natal and post-natal care. In-fact although several of these primary health care centres have become defunct and barely provide all the requisite services, they have mainly become centres for maternal and neonatal healthcare. The primary health centres , to a large extent function well below their intended potential. This means that in several cases, patients from rural areas must travel long distances to urban hospitals for even simple procedures which in fact the PHCs are supposed to be equipped to deal with. This results in unnecessary loss of life due to the inefficient maintenance and operation of these PHCs . Reluctance of medical professional to work in rurak areas citing lack of requisite remuneration does not help the matter either. These professionals must be provided with incentives to serve at the PHCs , in order to provide the rural populace with essential medical services , in the light of their inabaility to access more sophistaicated urban medical infrastructure. Providing the citizens ith good health and medical care are the primary duties of a state. For this purpose, the government must take serious steps to revitalize the PHCs as they constitute crucial medical infrastructure for those who can least afford any other alternatives.

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  6. This is an opinion, but I feel that when talking about public health facilities and hygiene, instilling a civic sense in the public is at least as important as budgetary expenditure. It's ironic that, 4,500 years ago, public utilities and private hygiene facilities (toilets and indoor bathing facilities), were in better shape in Harappa than they are in the present-day Pakistani village. If people in the Bronze Age, without access to modern technology, knowledge of epidemiology, or disposable income, could build and maintain a hygienic sewer system, then it is clearly more a matter of cultural inertia than anything else. If the people of Mawlynnong village in Meghalaya have anything to demonstrate, it's that hygiene and public sanitation are intrinsically tied to the people's sense of civic responsibility. It's not enough to build free toilets here and there: research needs to go towards hygienic, low-tech sanitation solutions (e.g. collecting, segregating, and recycling solon waste). Moreover, the value of sanitary practices needs to be inculcated from childhood onwards. We need to lead by example. Any idea why there's a big, stinking pile of garbage near Juicy's? It's because not a single person walking by gave a moment's consideration to the sanitary implications of dumping their crap on the street. This applies to public urination and defacation as well. We need to consider out-of-the-box strategies: From personal observation, I've noticed that walls inscribed with religious inscriptions tend not to be urinated on. If people value faith over hygienic considerations, then perhaps a few stylised religious inscriptions wouldn't be out of place on the walls as a part of the push for art in urban spaces: preaching about hygiene is one thing, but for results, you need to engage people in the contexts they are comfortable with. Hygiene needs to acquire greater relevance in our cultural discourse. Just a thought :)

    ReplyDelete
  7. This is an opinion, but I feel that when talking about public health facilities and hygiene, instilling a civic sense in the public is at least as important as budgetary expenditure. It's ironic that, 4,500 years ago, public utilities and private hygiene facilities (toilets and indoor bathing facilities), were in better shape in Harappa than they are in the present-day Pakistani village. If people in the Bronze Age, without access to modern technology, knowledge of epidemiology, or disposable income, could build and maintain a hygienic sewer system, then it is clearly more a matter of cultural inertia than anything else. If the people of Mawlynnong village in Meghalaya have anything to demonstrate, it's that hygiene and public sanitation are intrinsically tied to the people's sense of civic responsibility. It's not enough to build free toilets here and there: research needs to go towards hygienic, low-tech sanitation solutions (e.g. collecting, segregating, and recycling solon waste). Moreover, the value of sanitary practices needs to be inculcated from childhood onwards. We need to lead by example. Any idea why there's a big, stinking pile of garbage near Juicy's? It's because not a single person walking by gave a moment's consideration to the sanitary implications of dumping their crap on the street. This applies to public urination and defacation as well. We need to consider out-of-the-box strategies: From personal observation, I've noticed that walls inscribed with religious inscriptions tend not to be urinated on. If people value faith over hygienic considerations, then perhaps a few stylised religious inscriptions wouldn't be out of place on the walls as a part of the push for art in urban spaces: preaching about hygiene is one thing, but for results, you need to engage people in the contexts they are comfortable with. Hygiene needs to acquire greater relevance in our cultural discourse. Just a thought :)

    ReplyDelete