Mapping illness (Indian Express Editorial)
In 2013, a World Bank report, The Global Burden of Disease, Generating Evidence, Guiding Policy-South Asia, suggested that India was going through an epidemiological transition.
- Major national surveys, such as the National Family Health Survey and the Annual Health Survey, have provided valuable data on key health indicators, and several states have generated data on non-communicable diseases such as diabetes and heart ailments.
- The World Bank report argued that non-communicable disease, like heart ailments, diabetics and chronic respiratory afflictions were “increasingly causing more premature mortality and disabilities in India compared to the communicable diseases.
- However, a comprehensive assessment of every major disease across the states of the country, providing estimates over an extended period, has eluded policymakers.
- The India State Level Disease Burden Report, released recently to fill this gap.
About India State Level Disease Burden Report:
- This is the first time burden of disease has been studied at state-level.
- Till now only national-level data was available, masking varying disease patterns in states.
- The study used multiple data sources to map State-level disease burden from 333 disease conditions and injuries, and 83 risk factors for each State from 1990 to 2016.
- The report, a product of a two-year long study undertaken by the Indian Council of Medical Research, Public Health Foundation of India and the Institute for Health Metrics and Evaluation in collaboration with the Ministry of Health and Family Welfare.
- The report poses some good news for the country’s policymakers and many challenges for them.
Key highlights of the report:
1- On Non-Communicable diseases:
- The study has found that every State in India has a higher burden from non-communicable disease and injuries than from infectious disease.
- The contribution of non-communicable diseases to health loss fuelled by unhealthy diets, high blood pressure, and blood sugar- has doubled in India over the past two decades.
- Air pollution and tobacco smoking continue to be major contributors to health loss.
- The report provides the first comprehensive set of state-level disease burden data, risk factors estimates, and trends for each state in India, is expected to inform health planning with a view towards reducing health inequalities among States.
- Lifestyle diseases like heart and chronic respiratory diseases now kill more people than communicable ones like tubercolosis or diarrhoea in every state in India, including the most backward.
- The least developed states that recently transitioned are having to grapple with having a higher burden of NCDs while they continue to have a high burden of infectious and maternal child diseases, the report pointed out.
2- On Communicable diseases:
- The report pointed out that communicable diseases constitute almost two-thirds of the disease burden in India.
- The report studies the period from 1990 to 2016 and shows that communicable diseases constitute almost two-thirds of the disease burden in India from a little over a third in 1990. Despite the transition, which is associated with development, malnutrition remains the single top risk for health loss.
- Malnutrition is still the single largest risk factor responsible for 15% of the total disease burden in India in 2016.
- The leading individual cause of death in India in 2016 was inchaemic heart disease.
- The proportion of all deaths in India due to communicable, maternal, neonatal and nutritional diseases reduced from 53.6% in 1990 to 27.5% in 2016, while those due to non-communicable disease increased from 37.9% to 61.8%, and those due to injuries changed from 8.5% to 10.7%.
3- On Life Expectancy:
- The Life expectancy at birth jumping from 59.7 years in 1990 to 70.3 years in 2016 for females, and from 58.3 years to 66.9 years for males.
- Although Life expectancy at birth has improved at the national level, inequalities between states continue – ranging from 66.8 years in Uttar Pradesh to 78.7 years in Kerala for females, and 63.6 years in Assam to 73.8 years in Kerala for males in 2016
4- On Diarrhoea, TB among top causes of death:
- The disease burden due to child and maternal malnutrition in India was 12 times higher per person than in China in 2016.
- Kerala had the lowest burden due to this risk among the Indian states, but even this was 2.7 times higher per person than in China.
- The leading individual cause of death in India in 2016 was inchaemic heart disease, the death rate from which was twice as much as the next leading cause.
- But there were wide variations with the highest death rate among the states from this disease being 12 times the lowest.
5- On Non-communicable diseases (NDC):
- The other non-communicable diseases (NCD) in the top 10 individual causes of death included chronic obstructive pulmonary disease (COPD), stroke, diabetes, and chronic kidney disease.
- Communicable diseases such as diarrhoeal diseases, lower respiratory infections, and tuberculosis, and road injuries and suicides were also in the top 10 causes of death. The death rates from diarrhoeal diseases and tuberculosis were also higher in the least developed states and had a 12-fold and seven-fold variation in rates, respectively, between states.
- Contribution of non-communicable diseases to health loss had doubled in the past two decades. While air pollution and tobacco continue to be major contributors to health loss, the extent of these risk factors varies considerably across states.
- The report presents a two-pronged challenge for policymakers.
- The large-scale variation in the disease patterns across the country means that one health policy and uniform health-related schemes are unlikely to work in all the states.
- The persistence of communicable diseases and malnutrition means that efforts to tackle these maladies have to be scaled up.
- Kerala had the lowest disease burden due to malnutrition in India, but even that was 2.7 times higher per person than in China.
- The study upturns the widespread perception that states performing well on economic yardsticks are also doing well on health indicators.
- Kerala, Tamil Nadu, Maharashtra, Gujarat, Goa and Punjab have become hubs of non-communicable diseases, while communicable diseases and malnutrition continue to dog people in most parts of the country — Jharkhand, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Odisha and Uttarakhand being the worst affected.
State wise data:
- The first group to make the transition in 1986 included Kerala, Tamil Nadu, Goa, Himachal Pradesh and Punjab. The last group to do so, accounting for the highest number of people (588 million), made the transition almost a quarter of a century later, in 2010. This group included Bihar, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Jharkhand, Rajasthan and Odisha. India as a country made the transition in 2003.
- Though life expectancy at birth has improved at the national level, inequalities between states continue – ranging from 66.8 years in Uttar Pradesh to 78.7 years in Kerala for females, and 63.6 years in Assam to 73.8 years in Kerala for males in 2016.
- The biggest change is seen in the overall disease pattern in the country.
- In 1990, 61% of the total disease burden in India was attributed to communicable, maternal, neonatal, and nutritional diseases.
- This figure has dropped to 33% in 2016. At the same time, the contribution of non-communicable diseases (heart disease, cancers, respiratory diseases, neurological disorders) has risen to 55% from 30% in 1990. Kerala, Goa, and Tamil Nadu have the largest dominance of non-communicable diseases and injuries while they are relatively lower in Bihar, Jharkhand, Uttar Pradesh and Rajasthan.
- The proportion of all deaths in India due to communicable, maternal, neonatal and nutritional diseases reduced from 53.6% in 1990 to 27.5% in 2016, while those due to non-communicable diseases increased from 37.9% to 61.8%, and those due to injuries changed from 8.5% to 10.7%.
What is communicable disease?
- Communicable, or infectious diseases, are caused by microorganisms such as bacteria, viruses, parasites and fungi that can be spread, directly or indirectly, from one person to another. Some are transmitted through bites from insects while others are caused by ingesting contaminated food or water.
- A variety of disease-producing bacteria and viruses are carried in the mouth, nose, throat and respiratory tract. Conditions such as leprosy, tuberculosis (TB) and different strains of influenza (flu) can be spread by coughing, sneezing, and saliva or mucus on unwashed hands.
- Sexually transmitted infections (STIs) such as HIV and viral hepatitis are spread through the exposure to infected bodily fluids such as blood, vaginal secretions and semen. Hepatitis is a significant concern in the African Region and the majority of people living with hepatitis B and C are unaware of their infections.
- Insects play a significant role in the transmission of disease. Bites from Anopheles mosquitoes transmits malaria parasites that can wreak havoc on high-risk populations such as children under age 5 and pregnant women. Yellow fever has also seen resurgence due to reduced vaccination efforts. Many neglected tropical diseases are caused by unsafe water, poor housing conditions and poor sanitation in the Region.
What is non-communicable disease?
- Noncommunicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behaviours factors.
- The main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.
- NCDs disproportionately affect people in low- and middle-income countries where more than three quarters of global NCD deaths – 31 million
A plan for Asia(Indian Express Editorial)
In Manila, PM signalled commitment to a rules-based order. India must bridge gap between promise and performance
- Senior officials from the United States, Japan, India, and Australia met on the sidelines of the Association of Southeast Asian Nations and East Asia Summits to discuss regional and global cooperation.
- The meeting brought forward the fact that without a plan to advance economic integration with East Asia, the gap between India’s strategic promise and its performance will continue to grow and undermine Delhi’s political credibility.
What is the purpose of the meeting?
- The objective of the meeting has been covered under “free and open Indo-Pacific”.
- The meeting addressed seven core themes: the rules-based order in Asia, freedom of navigation and overflight in the maritime commons, respect for international law, enhancing connectivity, maritime security, the North Korean threat and nonproliferation, and terrorism.
What were the national statements issued by the four governments?
- Following the meeting, the U.S. Department of State, the Indian Ministry of External Affairs, the Australian Department of Foreign Affairs and Trade, and the Japanese Ministry of Foreign Affairs each released statements outlining what was discussed.
- All four statements emphasized that the convergence of visions and shared interests underpinned the quadrilateral.
- The statements, however, were far from identical and a close reading reveals varying priorities within the quadrilateral.
- The Australian and the U.S. statements touched on all seven of the issues highlighted under the aegis of a “free and open Indo-Pacific.”
- Japan’s statement omitted any mention of enhancing “connectivity,” which, for India and the United States, has come to mean offering an alternative vision to China’s ambitious Belt and Road Initiative.
China as a hurdle for “free and open Indo-Pacific”:
- The rise of China, the expansion of its military capabilities and Beijing’s assertiveness on territorial disputes has ended the prolonged tranquility in the region.
- China’s pressure on its neighbours is weakening the unity of the ASEAN.
- The country is also limiting the options of most countries in the region.
What is the way forward?
- The Indian Ministry of Defence neither has the time nor inclination to think positively about military diplomacy in East Asia.
- Without a plan to advance economic integration with East Asia, the gap between India’s strategic promise and its performance will continue to grow and undermine Delhi’s political credibility.
- Succeeding in the sustainment of a “free and open Indo-Pacific” will require much work and coordination among these four countries.
- The Quad needs to offer smaller states in the region an attractive set of reasons to value the status quo regional architecture and a rules-based order compared to China’s competing vision
- France and India have a “special and specific” interest in the Indian Ocean, and would prefer to conduct their exchanges across the Indo-Pacific bilaterally.
- The cooperation is growing in the Indian Ocean, where both India and France have focal positions.
- Both the countries are in a process of forming a defence and security partnership in the Indo-Pacific.
- This new cooperation will deal in counter-terrorism, defence hardware, nuclear energy, and space cooperation during the upcoming visit of Foreign Minister Jean-Yves Le Drian to India.
- France is the only western country with large territory in the Indian Ocean Region (IOR) including the Reunion Islands, spanning about two million square kilometres of an Exclusive Economic Zone (EEZ).
- France has a population of one million French Citizens in the region, including about 30% of Indian origin.
- The French navy maintains bases in the UAE, Djibouti as well as in Reunion, with a total of 20,000 forces permanently based in the IOR.
- France is India’s oldest strategic partner, and has conducted India’s first international ‘Varuna’ joint naval exercises since 1983.
An itinerary in search of a strategy: on Trump’s East Asia tour(The Hindu Opinion)
- Donald Trump’s statements and Twitter posts through his 12-day visit, five-nation tour of Asia, decodes a new American strategy towards the region that can be challenging.
- His main aim surrounds around resistance to China’s unrestrained ambitions in ‘freedom of navigation’ and censure of ‘predatory’ economic practices used along with America’s commitment to democracy, human rights, and free trade.
- Mr. Trump’s desire to be friends with the ruler of North Korea, the emerging picture appears confusing, if not bizarre.
- Mr. Trump overview of the “terrific” tour and how he enjoyed the unprecedented reception in Beijing was baffling.
- The cheery on the cake was the business deals — he put the figure at $300 billion and hoped that it would exceed $1 trillion in the coming months, though the actual numbers remain unclear.
- The security partnerships with these Asian partners have also been enhanced.
Words of Trump
“Those days are over,” he declared. He was there “to offer a renewed partnership with America,” the basis of which would be “bilateral trade agreements with any Indo-Pacific nation that wants to be our partner and that will abide by the principles of fair and reciprocal trade… I call it the Indo-Pacific dream.”
What does he mean?
- The U.S. has trade deficits with all the five countries that Mr. Trump visited, putting China, Japan, South Korea and Vietnam in the same basket on this count.
- America offers these countries technology, capital and access to its market.
- America offers a security guarantee and a predictable world order based on multilateral trade and security pacts.
- The rise of China has added additional optimism for neighbouring countries. The friction between China and its neighbours heightened as Beijing’s ambitions grew after the 2008 financial crisis.
- Vietnam, Philippines, Japan, and South Korea started to gravitate more towards the U.S., which was itself alarmed by the assertiveness of China.
- The Obama administration announced the Pivot to Asia strategy in response.
- Barack Obama wanted to open the Asian markets for American companies, but there was a broader blue print issue but Mr. Trump has knocked it down to a one-point agenda: buy our goods and services.
- His statement that countries in the “region [should] be strong, independent, and prosperous, in control of their own destinies, and satellites to no one,” is a call for ending multilateralism which looked as Amercian disinterest.
- Mr. Trump also told his Asian hosts that they were free to pursue their interests solo, as he would pursue his, hinting that America could cut a deal with China on its own, regardless of its potential impact on other countries.
- China is the biggest trading partner of South Korea, Japan and Vietnam. Speaking after Mr. Trump at APEC, Mr. Xi presented a case for multilateralism and open trade. China is also willing to offer technology, capital and market access, on its terms under the Belt and Road Initiative.
- Mr. Trump asked them all to join hands with the U.S. in stopping North Korea’s nuclear adventurism and collaterally asked Japan, Vietnam and South Korea to buy “his weapons”.
- Mr. Trump’s “Indo-Pacific dream” may not appear to be much of a dream for most countries in the region as conflicts in Asia, in the west and the east, could appear to be good opportunities for profit from the realtor’s perspective.
After the tsunami: how the ‘Quad’ was born(The Hindu Opinion)
- India’s full capabilities came as a surprise to the world the Indo-Pacific during Tsunami crisis as India had naval capabilities of scale to move in urgently further leading to the formation of QUAD.
How did it start?
- The shocking death toll from the tsunami led to a call from Sri Lankan President Mahinda Rajapaksa to Indian envoy Nirupama Rao made it clear that island nation needed urgent humanitarian assistance.
- For India, it was time to show that the Indian Ocean was in fact India’s domain, and India committed in an unparalleled manner to the effort.
- India within twelve hours was in Colombo with its Indian naval helicopters and relief material.
- Two Indian naval ships were in Galle and Trincomalee, while three others were despatched to Male within next two days.
- INS Khukri and INS Nirupak, were converted into hospital ships and sent to the worst hit-country, Indonesia.
- In all, about 32 Indian ships and 5,500 troops were involved in the international relief effort.
The formation of Quad
- In December 2004, the then U.S. President George W. Bush announced that India, the U.S., Japan and Australia would set up an international coalition to rescue those trapped in the waters, rush relief, and rehabilitate those made homeless, and to restore power, connectivity lines as well as infrastructure like ports and roads.
- By mid-January the coalition handed over charge to the UN, it led to the birth of a new framework: the Quadrilateral, or Quad.
- Japanese Prime Minister Shinzo Abe was the first to voice his long-standing idea of an “arc of prosperity and freedom with QUAD.
- The plan for a meeting of the Quad was formed with the then Prime Minister Manmohan Singh visited Tokyo in December 2006.
- Contrary to public perception, Australia wasn’t the first to object. The U.S. felt that angering China with the Quadrilateral would hamper larger strategic efforts under way, including the move for sanctions against Iran in the UN Security Council, and the six-nation talks on North Korea.
- Zimbabwe is under the control of the military after its army chief warned President Robert Mugabe against purging the ruling party’s senior ranks.
- Armoured personnel carriers and troops were deployed onto roads leading towards Harare on Tuesday, a day after army chief General Constantino Chiwenga warned the military may intervene after Mugabe fired Mnangagwa last week.
- There is a climax of a power struggle between liberation-era figures loyal to ousted vice president Emmerson Mnangagwa and forces faithful to First Lady Grace Mugabe, who is seen as vying to succeed her 93-year-old husband.
- Zimbabwean soldiers and armoured vehicles blocked roads to the main government offices, Parliament and the courts in central Harare
- Mr. Mugabe’s wife Grace had supposedly been vying to succeed Mr. Mugabe.
- Soldiers were deployed across Harare on November 14 and they seized the state broadcaster after the ZANU-PF party accused the head of the military of treason, prompting frenzied speculation of a coup.
- Mr. Mugabe has led Zimbabwe for the last 37 years.
Indian Constitution and Polity:
Rajasthan conversion Bill returned by Centre(The Hindu)
The Religious Freedom Bill passed by the Rajasthan Assembly in 2008, aimed at banning forcible religious conversions, was returned by the Union government as it deviated from the national policy.
- According to the Rajasthan government, the Bill was sent back for “further clarifications”.
- The Bill, called Rajasthan Dharma Swatantraya Bill, 2008, is now under the consideration of the Union home ministry.
- The state government is making attempts to get the President’s nod for the Bill that has been pending since 2008, the year it was passed.
- The state government recently filed an affidavit in the court in response to a notice on a habeas corpus writ petition seeking production of 22-year-old girl, who has converted from her religion and married a Muslim man.
- The court had asked whether there was any law or procedure in force in Rajasthan that governed concersions.
The Religious Freedom Bill:
- The Bill defined “conversion” as “renouncing one’s own religion and adopting another” through “fraudulent means” or any other “fraudulent contrivance.”
- The Bill has provisions for prison terms of up to five years.
- It also contains a clause for cancellation of registration of organizations held guilty of abetting conversions.
- According to the Religious Freedom Bill, In the case of forcible conversion, forgery or fraud, the accused will be sentenced to one to three years and fine of Rs 25 thousand will be imposed.
- Changing the religion of a person who is less than 18 years of age or children of a woman or SC-ST category will have a sentence of 2 to 5 years and a fine of up to Rs 50 thousand.
- The registration of organizations which are found to be working illegally in religion can be canceled.
- The collector can give permission for religious conversion only after investigating the matter.
- If a person returns to the original religion, then he will not have to inform the District Magistrate. Returning to the original religion will not be considered as a crime.
- The religious conversion of a child below 18 years of age cannot be allowed.
Money can’t always buy votes(The Hindu, Opinion)
- There is a widely held belief that voters in India, especially the poor, sell their votes in exchange for cash or other briberies.
- Thus, the supply of cash and consumption of liquor increases during elections remains unexplained.
What does recent research says about briberies during election?
- Recent research says that spending of money was not reflected in the vote count.
- The candidate who spent the most came nowhere near winning the seat, while the candidate who won a landslide victory did so with limited spending.
- Thus, distribution of money is seen as an uncertain investment and a leap of faith on the part of the candidate.
What is the reason behind such briberies in India?
Cash to support a campaign:
- Parties have weak organisations at the local level and face heavy institutional constraints.
- Thus, money acts as a substitute for the organisation as cash is used to engage vote mobilisers or local individuals who will seek votes for a party and/or candidate.
A cheaper move:
- Given the size of constituencies, a candidate requires an army of workers during the campaign period which ends up being quite expensive.
- To avoid this, candidates spend huge sums of money on cash, liquor and gifts that they hand out to their middlemen.
Money signals access to powerful networks:
- Money allows candidates to mobilize supporters who in turn can pull a crowd together.
- The display of money during elections is socially approved in certain ways, is a political necessity, and is born of cultural expectations.
Sweet Success(Indian Express Editorial)
- West Bengal has been awarded the Geographical Indication (GI) for “Banglar Rasogolla” (Bengal rasogolla).
- In the backdrop, Odisha claims the origin of the sweet.
What is the debate between Odisha and West Bengal about?
- For long there has been a tussle between Odisha and West Bengal about the origins of the Rasagulla.
- The battle between Odisha and West Bengal began in the year 2015 when it was pointed out that the origin of the sweet rosagolla existed for about 600 years and that it was originated in Puri.
- In response to this, the West Bengal government quoted 19th century history to claim that rosogolla was invented by Nabin Chandra Das, a popular sweetmeat maker in the year 1868.
- Finally, the debate has been settled in favour of West Bengal.
- The decision has been made under the GI Act that authenticates products to either geographical locations or to communities or societies.
What is the Geographical Indications of Goods (Registration and Protection) Act, 1999?
- GI Act is an Act of the Parliament of India for protection of geographical indications in India.
- India, as a member of the World Trade Organization (WTO), enacted the Act to comply with the Agreement on Trade-Related Aspects of Intellectual Property Rights.
- The GI tag ensures that none other than those registered as authorised users (or at least those residing inside the geographic territory) are allowed to use the popular product name.
What is a Geographical indication?
- A geographical indication (GI) is a name or sign used on products which corresponds to a specific geographical location or origin (e.g. a town, region, or country).
- The use of a geographical indication may act as a certification that the product possesses certain qualities, is made according to traditional methods, or enjoys a certain reputation, due to its geographical origin.
- India and developing countries scored an important victory at the climate change conference as key demands on ‘pre-2020 actions’ was agreed
What is the significance of ‘pre-2020 actions?
- The ultimate objective of the United Nations Framework Convention on Climate Change is to prevent dangerous human interference with the climate system.
- Developing countries agreed to craft Nationally Appropriate Mitigation Actions (NAMAs) that are in line with their national development objectives.
- Through NAMAs, developing countries aim to reduce their emissions below business as usual by 2020.
What is the significance of Nationally Appropriate Mitigation Action?
- Nationally Appropriate Mitigation Action (NAMA) refers to a set of policies and actions that countries undertake as part of a commitment to reduce greenhouse gas emissions.
- It also emphasizes financial assistance from developed countries to developing countries to reduce emissions.
What was the primary agenda of the conference?
- The 23rd session of the Conference of Parties (CoP23) focused on preparing the rule book for implementation of the Paris Agreement as India, China and Iran took the floor at the opening plenary to raise the issue of vast inadequacy of climate actions in the run up to 2020
- It was agreed that the next two climate conferences, in 2018 and 2019, will have special ‘stock-taking’ sessions on the ‘pre-2020 actions’ being taken by different countries.
- ‘Pre-2020 actions’ would also be included for discussion in another scheduled review meeting at next year’s conference
- Countries have to assess whether all the climate actions they are planning to take was commensurate to keeping the global temperatures from rising beyond 1.5 or 2 degrees Celsius from pre-industrial times
What was the outcome at Bonn?
- The breakthrough came on a day that heads of states and ministers gathered in Bonn to give the final touches to decisions that would be taken here. In the last two days, countries have also reached separate agreements on issues related to agriculture, loss and damages, integration of gender in climate policy.
- All these agreements, including the one reached on ‘pre-2020 actions’, would be reflected in the final decisions to be adopted at the end of Bonn meeting.
- A number of other issues, including those related to finance, and preparation of the rulebook for the Paris Agreement, are still under discussions.