- A recent incident in the US brings forward the question of accountability of a child’s health care needs clarity.
- Charlie Gard was born with a serious mitochondrial disorder that led to the wasting of his muscles and brain and there is no definitive treatment.
- Charlie Gard’s parents wanted to take him to the United States where an experimental therapy of nucleosides would have been attempted, with an estimated 10% chance of benefit.
- But the doctors held out no hope of survival and felt that the boy should be allowed to die with dignity.
- The parents wanted to try out the experimental therapy and repeatedly took the hospital to court.
- But they failed to convince British courts and the European Court of Human Rights which deferred to the hospital’s assessment.
- The U.S. Congress intervened to grant extraordinary citizenship to Charlie so that he could travel for treatment but the British court did not permit his release from the hospital.
- Last week, the parents finally gave up after the American expert said that the latest scan ruled out any possible benefit at this stage.
- In countries with high levels of treatment coverage under a system of universal health coverage (UHC), this cost is covered in part or full.
- In many countries it is not, especially when the cost of the procedure is high.
- In the Indian context, costly treatments that can provide high returns of longevity and functionality for children are obtained through occasional philanthropy or limited coverage social insurance schemes funded by the government.
- But these do not remove the barriers of access and affordability.
- The court decided on behalf of the baby after hearing all the parties.
- The public opinion mostly supported the parents while the legal verdict upheld the medical recommendation.
- The key message that emerged is that society has the final responsibility to protect the child’s interests, however determined.
- China has settled most of the land boundary issues with most neighboring countries.
- But it still has issues with India and Bhutan and only only reciprocal withdrawal by India and China can ease the Doklam stand-off.
- Bhutan maintains that Doklam is in Bhutanese territory; but China claims the territory.
- However, China is committed through the bilateral agreements of 1988 and 1998 with Bhutan to respect the status quo and not to change the status quo unilaterally.
- China’s actions are in direct violation of agreements with Bhutan and India.
- China is changing the tri-junction unilaterally in violation of such agreements.
- The Chinese are trying to bring down the tri-junction point to Geymochen ridge line between the Siliguri corridor and the Chumbi Valley, which would have hit security.
- There have been 24 rounds of border negotiations between Bhutan and China.
- On June 29, 2017, Bhutan requested China to restore the status quo as of June 16, 2017.
- Any change in the status quo will hurt Bhutan first as it will lose a very strategic territory and it will lose access to India through the Siliguri corridor.
- For Bhutan too there are vital strategic interests involved in any compromise.
Bilateral ties between China and India:
- China is becoming increasingly assertive in pursuit of its global and regional goals. As for example:
- The Belt and Road project aimed at China trying to put together a continental and maritime domain where China is the lead player.
- This is apart from the fact that the project affects Indian sovereignty as it passes through Pakistan-occupied Kashmir.
- But the rise of China is also taking place simultaneously with the rise of India.
- With China’s want to be the pre-eminent power, India too would like to see a multipolar world. That is the contradiction.
- India-China ties also have positive aspect and there will be an uncertain mix of cooperation and competition and how India manages the relationship will be a big challenge.
- India needs to persist with the present approach that the border areas remain peaceful and the country needs to ensure that there is requisite deterrence available on the ground to discourage China.
The very popular 85% price reduction in cardiac stents may create political capital, but it could run a nascent industry into the ground.
- The recent price cap on stents is also being seen as a measure to address the burden of heart disease in the country.
- The nature of the stents price-cap raises questions about the efficacy of such strategies
- The government has made some serious commitments to improving health indicators and tackling disease in the country.
- The drive to eradicate multiple diseases and tame Kala-azar and filariasis by 2017, leprosy by 1018, measles by 2020 and tuberculosis by 2025 are all noble cause.
- IMR (infant mortality rate) is projected to come down from 39 in 2014 to 28 per 1,000 live births in 2019 and MMR (maternal mortality rate) from 167 in 2011-13 to 100 per 100,000 live births by 2018.
Many factors come in the way of formulating sound public policies:
- Policymakers are often required to take decisions with very little reliable information, let alone evidence.
- Policymakers find themselves on shaky ground because many economists who advise them do not fully factor in the significance of history, culture and context.
- To improve knowledge, policymakers often commission evaluations. They commonly tend to use two criteria to assess the quality of the evaluation report.
- The first is to match the findings with their own understanding of ground reality. If the findings coincide reasonably well, then it is a good report.
- The second is simply political expediency. If the report matches current ideology, it is kosher.
- The National Pharmaceutical Pricing Authority (NPPA) put a price ceiling on cardiac stent.
- Many countries are, like India, struggling with a complex set of economic and ethical challenges in healthcare financing.
- The very popular 85% price reduction in cardiac stent may create political capital, but it could run a nascent industry to the ground as device companies realize that the freedom of choice of what products to sell is not available to them.
- On the one hand, the NPPA decided that all stents are the same, and on the other, it did not allow them to withdraw commercially unviable products. This is reflective of the dichotomy in healthcare decision-making, and makes the government look like a “big brother”.
- To a great extent, the device-makers have themselves to blame.
- This needs to be addressed as the government starts looking at implementing similar price controls on other devices.
India would do well to adopt a comprehensive health technology assessment that is a multidisciplinary process that handles and analyses information on medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner. It would be a better approach to informed decision making on funding decisions leading to efficient access and use of technology.
The Central Government criticized for taking conflicting position on whether or not Indian citizen enjoy a fundamental right to privacy under the Constitution.
The Chronological order
- In the Aadhaar case, the government has argued against the existence of a fundamental right to privacy despite more than 40 years of jurisprudence developed by the court holding it to be so.
- The government has taken the opposite position in the Whatsapp case: Arguing that personal data, and consequently privacy, is an extension of life and personal liberty guaranteed under Article 21 of the Constitution. This is but one in a series of ironies that have punctuated the government’s positions.
- Back in 2011, when the Ministry of Law and Justice referred the question of the continuing operation of the Aadhaar project without a law, the opinion was that the right to privacy is a fundamental right under Article 21.
- This position was repeated in the government’s counter-affidavits filed in the Aadhaar petitions before the Supreme Court between 2012 and 2014.
- In 2015, the central government began to argue against a fundamental right to privacy. Around the same time, its arguments in the criminal defamation case were grounded on the fundamental right to privacy.
- There, it succeeded in its attempt to save Section 499 of the IPC that provided for defamation as a criminal offence from being struck down as being in violation of the right to free speech.
The arguments over Aadhaar
- In Aadhaar, the government’s tendency to take self-contradicting positions is not limited to the right to privacy.
- It has been argued for Aadhaar as a project of inclusion on the one hand, even as, on the other hand, all the statistics claimed in support of the project seek to prove exclusion or “savings”.
- It has also been argued that the Aadhaar project has given millions of Indians an identity and made them visible to the state even as it defends its porous verification procedures saying that only 0.03 per cent of the enrollees were without prior identity documents.
- Following several incidents of “data leaks” where government websites were shown to be leaking personal information, including Aadhaar numbers of people, the UIDAI is reported to have played down the dangers of such leaks.
- The Act prescribes a punishment of imprisonment up to three years for such supposedly innocuous disclosure.
- It has been argued that basic demographic and biometric data collected by private enrolment agencies is not so sensitive as to have any personal security implications.
- At the same time, UIDAI had been turning down Right to Information (RTI) requests on the sanctity of UIDAI data on a legal exemption that relates to the sovereignty and integrity of India and national security.
- There has been an implied acknowledgement of the danger of storing one’s religion in a database such as Aadhaar’s when the Act included a specific prohibition on that.
- The law sanctions the storage of one’s name and fathers’ name which together can be used to determine religion with near certainty.
- Such records are by no means in-depth. Some of these inconsistencies are subtle, but others like the government’s position on the fundamental right to privacy are less so.
- Even on pure questions of law, one hopes that dispassionate and consistent reason, rather than convenience in the context of a specific case determines its positions before the court. More so when citizens’ fundamental rights are involved.
US study has added climate change as another significant factor that is driving farmer to suicide.
- Climate change may have led to over 59,000 farmer suicides over the last three decades in India, argues a research report from the University of California, Berkeley in US.
- The study was carried out by using the data from all States and Union Territories.
- India’s average temperature is expected to increase by 3 degree C by 2050
Consequences of climate change:
- The increase in temperature during the cropping season reduces crop yields, resulting in increased suicides, according to a study published in the journal Proceedings of the National Academy of Sciences.
- A study published by the University of California, Berkeley researchers attributes 59,000 farmer suicides in India to rising temperatures.
- Researchers say that a warmer climate reduces crop yields, aggravates distress
- Even a 1 degree C increase in temperature of above 20 degree C in a single day during the crop growing season results in about 70 suicides on average.
- The researchers found that drought apparently does not seem to have any effect on suicide rates.
- The study was carried out using data for all States and Union Territories.
- It has several limitations, though, including the fact that it has not looked at other factors that could have contributed to suicides
- The study did not find any adaptive behavior to prevent suicides in response to climate change.
- Endorsing the temperature crop yield link, agricultural scientist Prof. M.S. Swaminathan said, “The effect of increased temperature on crop yield is real. In the late 1980s we found that when the temperature increases by 1-1.5 degree C the duration of the crop reduces by one month.
- An increase in rainfall by 1 cm during the growing season leads to a decrease of about 0.8 deaths per 100,000, thus lowering the suicide rate by 7% on average
- The lead researcher Tamma Carleton says in the paper published in PNAS online (Proceedings of the National Academy of Science) that the suicide rates in India have virtually doubled since the 1980s.
- The Berkeley researchers analysed data sourced from the National Crime Records Bureau (NCRB) for the period 1967-2013
Causes of suicide:
- The crop losses due to heat damage because additional burden on farming households and this at times lead to suicides.
- The effect of climate variation reveals that past growing season temperature strongly influences suicide rates in the following years up to about five years.
- Financial distresses, lack of timely help and crop failure have often been blamed for the spiraling numbers in farm suicides in India.
- The researchers evaluated crop yield data from all the states and union territories.
- District level yield data from 13 states was intensely studied to guage the response to climate change factors.
- The researcher found a dip in annual yields with a rise in temperature and increase in suicides.
- The effect of climate variation reveals that past growing season temperature strongly influences suicide rates in the following years up to about five years.
- The study says South India, which is generally hotter, has higher famer suicide rate.
- The States where the yields are more affected by high temperature are also the states which report higher suicide rates.
- Maharashtra, Karnataka, Tamil Nadu, and Andhra Pradesh not only show severe suicide responses to temperature but crop yield is also more negatively affected by higher temperature
India must undertake anticipatory research using genetic checkmating for potential changes in climate such as changes in precipitation, and temperature.
Most farmers swim in a turbulent sea of risks against which they have almost no protection.
One way to reduce price risk is through price deficiency payment, which has been advocated by Niti Aayog
- The economist at HSBC showed in a recent report that the fall in inflation has increased the real debt burden of farmers, which has risen faster than real income in recent years.
- Price risk is the most important factor affecting Indian agriculture. A bumper crop can pull down prices in wholesale markets.
- The bountiful rain of 2016 resulted in record farm output.
- Farmers are reported to have not been able to even recover the cost for some crops.
- The prospects of rural monsoon pushed up rural wages.
Problems of Indian agriculture:
- The production in the months ahead is deeply dependent on whether conditions.
- The opportunities for risk mitigation are minimal.
- Even a round of unseasonal rain can destroy standing crop
- Irrigation can offer some respite-but not to the extent of completely removing production risks
- The successive governments have taken steps to reduce the risk faced by farmers.
- The Minimum support prices (MSP) was originally conceived as a way to mitigate risk through guaranteed prices. But later it degenerated into a tool to buy the political support of large farmers.
- Crop insurance will not benefit farmers as desired if the compensation is not paid in time, as they will need the money for sowing in the next season.
There are other issues as well. For example, gross margin in the MSP recommendations by the Commission for Agricultural Costs and Prices looks higher on the basis of “actual paid out cost plus imputed value of family labour”, which does not account for foregone interest and rental for owned capital and land.
- The government in 2016 launched the Pradhan Mantri Fasal Bima Yojna, as a potential game changer.
- In 2016, the government encouraged farmers to produce pulses because of rising prices, part of the protein inflation that the Reserve Bank of India used to be obsessed with
- A more robust mechanism is needed to mitigate the price risk.
- The standard cobweb model in microeconomics helps us understand why production decisions based on limited information lead to wild swings in prices every year.
- One way to reduce price risk is through price deficiency payment, which has been advocated by Niti Aayog.
- In price deficiency payment, farmers can be compensated through direct benefit transfer if prices fall below a predetermined threshold level.
- Farmers should be register with relevant details at the nearest mandi.
- A deeper derivative market in agriculture commodities will also help farmers in hedging against price risks.
- The government should avoid its Pavlovian response of banning trading whenever price rise.
- Protecting consumer interest in general is the right thing to do for any government.
- In areas where markets don’t function freely, it needs to strike a balance between the interest of both the producer and the consumer.
- The actual impact of higher remunerative farm prices can be contained by making markets more efficient and removing middlemen from the system.
- Building a common agriculture market is also necessary.
Policy should focus not just on higher production but also on helping farmers manage risks. Government should do well to remove inefficiency in the system. Government policy should focus not just on higher production but also on helping farmers manage risks.
Manufacturing activity in July slowed to 47.9, the lowest level since February 2009, according to the Nikkei Manufacturing Purchasing Managers’ Index, due almost entirely to the introduction of Goods and services Tax on July 1.
- The reading was lower than the 59.9 noticed in June.
- A score above 50 implies an expansion of activity while one below 50 denotes a contraction.
Survey pointed out the following points:
- PMI survey data indicated that the introduction of goods and services tax (GST) weighted heavily on the Indian manufacturing industry in July.
- New orders and output decreased for the first time since the demonetization related downturn recorded in December last year, with rates of contraction the steepest since February 2009 in both cases.
- According to Indian manufacturers, highest tax rates sparked greater cost burdens in July.
- However, the pace at which input costs rose was moderate and much weaker than its long-run average.
- The report also found that the one year outlook for output remained positive in July due to company’s expectation that greater clarity on GST would bolster growth.