Medical education

Cut medical education cost, MCI board told (The Tribune: 20181129)

https://www.tribuneindia.com/news/nation/cut-medical-education-cost-mci-board-told/690666.html

Health Ministry concerned as some varsities charging a whopping Rs 20 lakh a yearfor MBBS

The government has asked India’s apex medical education regulator, the Medical Council of

India Board of Governors, to find ways of reducing the humungous cost of medical education

in the country.

The Health Ministry has flagged the high cost of MBBS fees being charged in private sector,

especially by deemed universities, calling for urgent engagement with stakeholders to check

this trend and cut down on costs.

DAILY NEWS BULLETINLEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE Day

Thursday 20181129

Top sources in the Health Ministry confirmed to The Tribune that the cost of medical education

was a major unresolved issue before the erstwhile MCI, which the government had to dissolve

on September 26 owing to its lack of cooperation on medical education reforms.

“The erstwhile MCI refused to look at fees being charged by colleges and universities for

MBBS and PG courses. They said it was not part of their mandate under Indian Medical

Council Act, 1956,” a Health Ministry official said.

The IMC Act 1956 is silent on fees to be charged by medical colleges although the government

maintained that the cost of medical education should naturally constitute the mandate of the

MCI, which is the apex medical education regulator and a torch bearer of medical ethics.

The Ministry has evidence of a range of deemed universities offering MBBS courses for a

whopping Rs 20 lakh a year. “What would such a student think of when he or she gets out of

the system and starts practising? The high cost of medical education in Indian private sector is

leading to malpractices. A student who has paid through the nose to study medicine is

vulnerable to compromising medical ethics to recover huge costs. Students naturally avail of

education loans to pay that kind of fees,” a Ministry source aware of the developments said.

There is also a sense that the mechanism of fee regulation in other state colleges by a committee

chaired by HC judge is not working well and there are huge variations in the cost of medical

education.

One way to reduce costs is by increasing the size of Indian medical classrooms. Under MCI

regulations for MBBS, a classroom cannot have more than 250 students. “This can change.

One classroom can have many more students. One professor can reach the entire class with

gadgets and life size tutorial screens,” an official said.

Hepatitis B oral vaccine

Hepatitis B oral vaccine project moves a little closer to completion (TheIndian Express: 20181129)

https://indianexpress.com/article/cities/delhi/hepatitis-b-oral-vaccine-project-moves-a-little-closer-to-completion-5469809/

The AIIMS team which developed the vaccine two years ago, is generating data for approvalfor human trials (File Photo)

Two years after researchers at the All India Institute of Medical Sciences (AIIMS) developedan oral vaccine for hepatitis B, the project has moved an inch closer to completion, with the

team generating data to get approval for human trials. The vaccine has already been testedsuccessfully on mice and guinea pigs. Approval for human trials has to be given by the DirectorController General of India (DCGI).

The research, funded by the Department of Biotechnology, was published in the journal,Vaccine, in 2016 and is expected to see the light of day by 2021. In India, as per latest estimates,40 million people are chronically infected by hepatitis B.

“The process is already on. We are now generating data to apply to the DCGI. We will then beable to conduct human trials… After getting approval, it may take two-three years to be fullycompleted. If we receive positive results through human trials, the vaccine will replaceinjections,” Dr Amit Dinda, professor, department of pathology, AIIMS, told The IndianExpress.

Currently, immunisation against hepatitis B requires injectable vaccines, with the first boostershot after one month, and the second after six months. Once the vaccine is prepared, it will becompletely safe, cost-effective and help in mass immunisation.

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After validating and assessing the project for around two years, academicians at the medicalinstitute are hoping to look for a commercial firm to support the research project. “The processis on and hopefully we will enter into a partnership with a commercial firm by 2019,” addedDr Dinda.

During the research, the team developed nano-particles loaded with antigen protein segments.Experts feel that the use of nanocarrier for oral delivery of antigen may help it escape the acidenvironment of the stomach.“If everything falls into place, this is going to be a major discoveryin the field of medicine. This vaccine is easily injectable and reduces the need for cold storageof medicines. It is like a dry powder and will also do away with the risk of blood-borneinfections such as HIV,” said Dr Dinda.

As per the World Health Organisation, hepatitis B is a viral infection that attacks the liver andcan cause both acute and chronic diseases. The virus is transmitted through contact with bloodor other body fluids of an infected person. A vaccine against hepatitis B has been availablesince 1982.The vaccine is 95% effective in preventing infection and development of chronicdisease and liver cancer.

HomeCitiesDelhiHepatitis B Oral Vaccine Project Moves A Little Closer To Completion

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Healthcare

A prescription for the future (The Hindu: 20181129)

https://www.thehindu.com/opinion/op-ed/prescription-for-the-future/article25608216.ece

While using cutting-edge technology, we need to find ways to continuously lower the cost ofhealthcare

The world as we know it is changing so fast and so much. Global mega-trends only reinforcethis fact. The Internet has taken over our lives, smartphone penetration is growing rapidly,demographics are evolving. For the first time, in 2019, millennials (born between 1981 and1996), who feel fully at home in a digital world, will overtake the population of baby boomers.There are dramatic lifestyle and behavioural changes occurring every day, with strongimplications for the future of our planet and its inhabitants.

Impactful changes

Healthcare is no stranger to change — in fact, the most impactful transformations in humanlife have happened in healthcare. Time’s cover three years ago showed the picture of a childwith the headline, “This baby could live to be 142 years old”. That is the extent of thebreakthrough in longevity that modern medicine has been able to achieve. Healthcare in Indiatoo has been transformed over the last three decades, and as members of this industry, we canbe proud of how far we’ve come in terms of improved indices on life expectancy, infantmortality, maternal deaths and quality of outcomes.

But we cannot rest on these achievements now, because the pace of change is still scorching,and is fundamentally altering disease patterns, patient risk profiles and their expectations.Information technology and biotechnology are twin engines, with immense potential totransform the mechanics of care delivery, the outcomes we can achieve and, above all, the liveswe can touch and save.

There are several examples of the kinds of impact technology and biotechnology can make onhealthcare. Telemedicine has already brought healthcare to the remotest corners of the country.The use of artificial intelligence for preventive and predictive health analytics can stronglysupport clinical diagnosis with evidence-based guidance, and also prevent disease. From thevirtual reality (VR) of 3D-printing, we are now moving towards augmented reality (AR), bywhich, for example, every piece of node in a malignant melanoma can be completely removed,thereby eliminating the risk of the cancer spreading to any other part of the body.Biotechnology, cell biology and genetics are opening up whole new paradigms ofunderstanding of human life and disease, and have made personalised medicine a way of life.

Largest health scheme

So, the outlook is clear: those in healthcare who wish for status quo and for the comfort of thefamiliar run the risk of becoming irrelevant. And that goes for countries too. India needs torapidly adapt to, embrace and drive change if it wishes to stay relevant in the global healthcareorder.

India’s change imperative has become even more pronounced with the launch of the PradhanMantri Jan Arogya Yojana Abhiyan, or National Health Protection Mission (NHPM), underthe ambit of Ayushman Bharat. This major shift in approach to public health addresses thehealthcare needs of over 500 million Indians in the first stage through what is probably theworld’s largest public health-for-all insurance scheme. The vast scale of the programmerequires reimagining an innovative model which will transform healthcare delivery in thecountry. By leapfrogging through smart adoption of technology and using emerging platformssuch as Blockchain, significant improvements are possible in healthcare operations and costs.

The private health sector is committed to support this programme, and ensure its success,because we are beneficiaries of society’s social licence to operate, and it is our responsibilityto make sure this programme reaches the most vulnerable and the under-privileged, for whomit is intended. At the same time, we have a solemn responsibility to ensure that the sector issustainable in the long term. For India to grow, healthcare as an engine of the economy needsto flourish. And the private sector, which has contributed over 80% of the bed additions in thelast decade, needs to earn healthy rates of return on investment to continue capital investmentin infrastructure, technology upgrades, and to have the ability to acquire top clinical talent,which can lead to differentiated outcomes. In our quest to achieve low-cost healthcare, we mustnot inhibit our potential for growth, nor isolate ourselves from exciting global developments.

The way forward

The prescription is clear. We need to achieve a balance between staying at the cutting edge ofclinical protocols, technology and innovation and continue to deliver world-class care, whilefinding increasingly efficient ways of operating to continuously lower the cost of care and bringit within the reach of those who cannot afford it. This is a difficult balance to achieve, but notimpossible. And when accomplished, India would have found an answer that can be an examplefor the rest of the world to emulate.

With clarity and focus, we can create a blueprint for the legacy we wish to build and set thetrajectory for Indian healthcare for the next several decades. The decisions we make today aredecisions we make for our children, a future we will create for them. Will they lead healthierlives than we do? Will they approve of our choices and actions? Are we building an inclusiveand sustainable world for them? We have it in our hands to shape the winds of change we facetoday into the aero-dynamics that will definitively propel our collective destinies forward.

Suneeta Reddy is Managing Director, Apollo Hospitals Group

First gene-edited babies

First gene-edited babies claimed in China (The Tribune: 20181129)

https://www.tribuneindia.com/news/health/first-gene-edited-babies-claimed-in-china/689191.html

A Chinese researcher claims that he helped make the world’s first genetically edited babies—twin girls born this month whose DNA, he said, he altered with a powerful new tool capableof rewriting the very blueprint of life.

If true, it would be a profound leap of science and ethics.

A US scientist said he took part in the work in China, but this kind of gene editing is bannedin the United States because the DNA changes can pass to future generations and it risksharming other genes.

Many mainstream scientists think it’s too unsafe to try, and some denounced the Chinese reportas human experimentation.

The researcher, He Jiankui of Shenzhen, said he altered embryos for seven couples duringfertility treatments, with one pregnancy resulting thus far.

He said his goal was not to cure or prevent an inherited disease, but to try to bestow a trait thatfew people naturally have—an ability to resist possible future infection with HIV, the AIDSvirus.

He said the parents involved declined to be identified or interviewed, and he would not saywhere they lived or where the work was done.

There is no independent confirmation of He’s claim, and it has not been published in a journal,where it would be vetted by other experts. He revealed it on Monday in Hong Kong to one ofthe organisers of an international conference on gene editing that is set to begin on Tuesday,and earlier in exclusive interviews with The Associated Press.

“I feel a strong responsibility that it’s not just to make a first, but also make it an example,” Hetold the AP.

“Society will decide what to do next” in terms of allowing or forbidding such science. Somescientists were astounded to hear of the claim and strongly condemned it.

It’s “unconscionable...an experiment on human beings that is not morally or ethicallydefensible,” said Dr Kiran Musunuru, a University of Pennsylvania gene editing expert andeditor of a genetics journal.

“This is far too premature,” said Dr Eric Topol, who heads the Scripps Research TranslationalInstitute in California. “We’re dealing with the operating instructions of a human being. It’s abig deal.”

However, one famed geneticist, Harvard University’s George Church, defended attemptinggene editing for HIV, which he called “a major and growing public health threat”. “I think thisis justifiable,” Church said of that goal.

In recent years scientists have discovered a relatively easy way to edit genes, the strands ofDNA that govern the body. The tool, called CRISPR-cas9, makes it possible to operate onDNA to supply a needed gene or disable one that’s causing problems.

It’s only recently been tried in adults to treat deadly diseases, and the changes are confined tothat person. Editing sperm, eggs or embryos is different—the changes can be inherited. In the

US, it’s not allowed except for lab research. China outlaws human cloning but not specificallygene editing.

He Jiankui, who goes by “JK”, studied at Rice and Stanford universities in the US beforereturning to his homeland to open a lab at Southern University of Science and Technology ofChina in Shenzhen, where he also has two genetics companies.

The US scientist who worked with him on this project after He returned to China was physicsand bioengineering professor Michael Deem, who was his adviser at Rice in Houston.

Deem also holds what he called “a small stake” in—and is on the scientific advisory boardsof—He’s two companies.

The Chinese researcher said he practised editing mice, monkey and human embryos in the labfor several years and had applied for patents on his methods.

He said he chose to try embryo gene editing for HIV because these infections are a big problemin China. He sought to disable a gene called CCR5 that forms a protein doorway that allowsHIV, the virus that causes AIDS, to enter a cell.

All of the men in the project had HIV and all of the women did not, but the gene editing wasnot aimed at preventing the small risk of transmission, He said.

The fathers had their infections deeply suppressed by standard HIV medicines and there aresimple ways to keep them from infecting offspring that do not involve altering genes.

Instead, the appeal was to offer couples affected by HIV a chance to have a child that might beprotected from a similar fate.

He recruited couples through a Beijing-based AIDS advocacy group called Baihualin.

Its leader, known by the pseudonym “Bai Hua”, told the AP that it’s not uncommon for peoplewith HIV to lose jobs or have trouble getting medical care if their infections are revealed.

Here is how He described the work:

The gene editing occurred during IVF, or lab dish fertilisation. First, sperm was “washed” toseparate it from semen, the fluid where HIV can lurk. A single sperm was placed into a singleegg to create an embryo. Then the gene editing tool was added.

When the embryos were 3 to 5 days old, a few cells were removed and checked for editing.Couples could choose whether to use edited or unedited embryos for pregnancy attempts. Inall, 16 of 22 embryos were edited, and 11 embryos were used in six implant attempts beforethe twin pregnancy was achieved, He said.

Tests suggest that one twin had both copies of the intended gene altered and the other twin hadjust one altered, with no evidence of harm to other genes, He said. People with one copy of thegene can still get HIV, although some very limited research suggests their health might declinemore slowly once they do.

Several scientists reviewed materials that He provided to the AP and said tests so far areinsufficient to say the editing worked or to rule out harm.

They also noted evidence that the editing was incomplete and that at least one twin appears tobe a patchwork of cells with various changes.

“It’s almost like not editing at all” if only some of certain cells were altered, because HIVinfection can still occur, Church said. AP

Drug

Drug to reduce brain bleeding, stroke risk identified (The Tribune:20181129)

https://www.tribuneindia.com/news/health/drug-to-reduce-brain-bleeding-stroke-risk-identified/689779.html

Scientists have identified a drug, already approved for use in patients to treat urea-relateddisorders that could reduce brain bleeding and risk of strokes.

Brain bleeding, caused by a defect in a gene called collagen IV, can cause strokes.

Mutations in collagen IV genes cause a genetic form of eye, kidney and vascular disease whichaffects the blood vessels in the brain and can cause brain bleeding, even in childhood.

The researchers, from the University of Manchester and University of Edinburgh in the UK,studied mice that have a similar defect in the collagen IV gene and develop the same diseaseas patients.

Using sodium phenyl butyric acid they were able to reduce brain bleeding, according to thestudy published in the journal Human Molecular Genetics.

However, the treatment did not treat either the eye or kidney disease associated with thesegenetic defects.

Researchers believe that for future treatments, patients with these mutations will need to bedivided into groups based on their symptoms and medical history, and the mechanism thatcauses the disease.

This precision medicine approach will allow for better, more targeted treatment for patients,they said.

While these genetic forms of the disease are rare, the same gene has also been implicated incommon forms of brain bleeding in the general population, potentially increasing the numberof people that may ultimately benefit from this work.

Further research is now required to understand how these mutations cause the disease in thedifferent tissues so that strategies for treating all the clinical symptoms, including the eye andkidney disease, can be developed.

Specific treatments that target brain bleeding, including common diseases such ashaemorrhagic stroke that accounts for 15 per cent of adult stroke, are currently lacking.

Researchers now hope these new insights will be able to lead to new treatment opportunitiesfor patients with these conditions.

"There are no treatments for diseases due to collagen IV mutations and brain bleeding. Thiswork has identified a potential treatment strategy in mice and is the first step in translating thisto patients," said Tom Van Agtmael, from the University of Glasgow.

"It will also help to identify for which patients this strategy may be effective and for whichpatients it is not recommended or may be counter-indicative. This personalised approach tomedicine will be important to develop the most effective future treatments," said Agtmael. —PTI

Air pollution

Indians lose over four years of their lives to air pollution: Study (TheTribune: 20181129)

https://www.tribuneindia.com/news/health/indians-lose-over-four-years-of-their-lives-to-air-pollution-study/689215.html

People in India would live an average 4.3 years longer if the country met the global guidelinesfor particulate pollution, according to a study which found that effect of pollution on lifeexpectancy is worse than HIV/AIDS, cigarette smoking, and even terrorism.

According to the new Air Quality Life Index (AQLI), developed by researchers at Universityof Chicago in the US, particulate air pollution cuts global average life expectancy by 1.8 yearsper person.

The AQLI establishes particulate pollution as the single greatest threat to human healthglobally, with its effect on life expectancy exceeding that of devastating communicablediseases such as tuberculosis and HIV/AIDS, behavioural killers like cigarette smoking, andeven war.

Critically, the AQLI reports these results in tangible terms that are relatable for most people.

"Around the world today, people are breathing air that represents a serious risk to their health.But the way this risk is communicated is very often opaque and confusing, translating airpollution concentrations into colors, like red, brown, orange and green," said MichaelGreenstone, a professor at Energy Policy Institute at the University of Chicago (EPIC).

"My colleagues and I developed the AQLI, where the 'L' stands for 'life,' to address theseshortcomings. It takes particulate air pollution concentrations and converts them into perhapsthe most important metric that exists: life expectancy," he said.

The AQLI is based on a pair of studies that quantify the causal relationship between long-termhuman exposure to particulate pollution and life expectancy.

Seventy-five per cent of the global population, or 5.5 billion people, live in areas whereparticulate pollution exceeds the WHO guideline.

The AQLI reveals that India and China, which make up 36 per cent of the world's population,account for 73 per cent of all years of life lost due to particulate pollution.

On average, people in India would live 4.3 years longer if the country met the WHO guideline-- expanding the average life expectancy at birth there from 69 to 73 years.

In the US, about a third of the population lives in areas not in compliance with the WHOguideline. Those living in the country's most polluted counties could expect to live up to oneyear longer if pollution met the WHO guideline.

Globally, the AQLI reveals that particulate pollution reduces average life expectancy by 1.8years, making it the greatest global threat to human health.

By comparison, first-hand cigarette smoke leads to a reduction in global average lifeexpectancy of about 1.6 years. Other risks to human health have even smaller effects: Alcoholand drugs reduce life expectancy by 11 months; unsafe water and sanitation take off 7 months;and HIV/AIDS, 4 months.

Conflict and terrorism take off 22 days. So, the impact of particulate pollution on lifeexpectancy is comparable to that of smoking, twice that of alcohol and drug use, three timesthat of unsafe water, five times that of HIV/AIDS, and more than 25 times that of conflict andterrorism.

“While people can stop smoking and take steps to protect themselves from diseases, there islittle they can individually do to protect themselves from the air they breathe," Greenstone said.

“The AQLI tells citizens and policymakers how particulate pollution is affecting them and theircommunities and reveals the benefits of policies to reduce particulate pollution," he said. PTI

Dementia risk

MRI scans may predict dementia risk before symptoms appear (TheTribune: 20181129)

https://www.tribuneindia.com/news/health/mri-scans-may-predict-dementia-risk-before-symptoms-appear/689208.html

MRI brain scans can help predict whether a person will develop dementia in the next threeyears, before the symptoms of the disorder appear, scientists have found.

In a study, researchers from Washington University and University of California San Franciscoin the US used magnetic resonance imaging (MRI) brain scans to predict dementia with 89 percent accuracy.

The findings suggest that doctors may one day be able to use widely available tests to tellpeople their risk of developing dementia before symptoms arise.

“Right now it’s hard to say whether an older person with normal cognition or mild cognitiveimpairment is likely to develop dementia,” said Cyrus A Raji, an assistant professor atWashington University.

“We showed that a single MRI scan can predict dementia on average 2.6 years before memoryloss is clinically detectable, which could help doctors advise and care for their patients,” saidRaji.

Although there are no drugs available yet to prevent or delay the onset of Alzheimer’s disease,identifying those at high risk of developing dementia within the next few years could still bebeneficial, the researchers said.

People could make decisions on their financial and living arrangements while they are still infull control of their faculties.

Researchers analysed MRI scans for physical signs of impending cognitive decline.

They used a technique called diffusion tensor imaging to assess the health of the brain’s whitematter, which encompasses the cables that enable different parts of the brain to talk to oneanother.

“Diffusion tensor imaging is a way of measuring the movement of water molecules along whitematter tracts,” Raji said.

“If water molecules are not moving normally it suggests underlying damage to white tracts thatcan underlie problems with cognition,” he said.

Using information from the Alzheimer’s Disease Neuroimaging Initiative--a multisitecollaboration that pools data, funding and expertise to improve clinical trials for Alzheimer’sdisease--researchers identified 10 people whose cognitive skills declined over a two-yearperiod and matched them by age and sex with 10 people whose thinking skills held steady.

The average age of people in both groups was 73. Then, the researchers analysed diffusiontensor MRI scans taken just before the two-year period for all 20 people.

The researchers found that people who went on to experience cognitive decline hadsignificantly more signs of damage to their white matter.

The researchers repeated their analysis in a separate sample of 61 people, using a more refinedmeasure of white matter integrity.

With this new analysis, they were able to predict cognitive decline with 89 per cent accuracywhen looking at the whole brain. When the researchers focused on specific parts of the brainmost likely to show damage, the accuracy rose to 95 per cent.

“We could tell that the individuals who went on to develop dementia have these differences ondiffusion MRI, compared with scans of cognitively normal people whose memory and thinkingskills remained intact,” Raji said. PTI

Global warming

Global warming increasing death, disease risk (The Tribune: 20181129)

https://www.tribuneindia.com/news/health/global-warming-increasing-death-disease-risk/690279.html

Climate change is putting an increasing proportion of the global population at risk of heat-related death and diseases, and causing significant loss of work hours in vulnerable areas likeIndia, sub-Saharan Africa, and South America, according to a study published in The Lancetjournal.

The rising vulnerability to the heat-related risks of climate change is mirrored by increasedexposure to higher temperatures.

Despite a mean global temperature increase of 0.3 degrees Celsius between 1986 and 2017, theaverage temperature increase people were exposed was more than double this (0.8 degreesCelsius).

With the pace of climate change outweighing the urgency of the response, the report providescause for concern.

However, researchers also note promising trends in key areas for health, including the phase-out of coal, the deployment of healthier, cleaner modes of transport, and health systemadaptation.

Present day changes in heat waves and labour capacity provide early warning of thecompounded and overwhelming impact on public health that is expected if temperaturescontinue to rise," said Hilary Graham from The University of York in UK.

"Trends in the impacts of climate change, exposures and vulnerabilities show unacceptablyhigh risk for health now and in the future," said Graham.

"The lack of progress in reducing emissions and building adaptive capacity threatens lives andhealth systems and must be addressed to avoid disruption to core public health infrastructureand overwhelming health services," she said.

"Despite delays, some sectors are embarking on a low-carbon transition, which is a promisingsign. It is clear that the nature and scale of the response to climate change will be thedetermining factor in shaping the health of nations for centuries to come," said Graham.

The annual report tracks 41 indicators across five areas: climate change impacts, exposures,and vulnerability; adaptation, planning, and resilience for health; mitigation actions and healthco-benefits; finance and economics; and public and political engagement.

The indicators include weather-related disasters, food security, clean fuel use, meatconsumption, air pollution and the number of scientific research articles about climate andhealth.

As a result of increasing temperatures caused by climate change, vulnerable populations (adultsover 65 years old, people living in cities, and people with cardiovascular diseases, diabetes,and chronic respiratory diseases) are exposed to heat stress, increasing their risk ofcardiovascular disease, and kidney disease.

In 2017, over 157 million vulnerable people over the age of 65 were exposed to heatwaves,and 18 million more people compared to 2016.

Europe and the eastern Mediterranean are more vulnerable than Africa and Southeast Asia,most likely due to ageing populations living in cities — 42 per cent of Europeans and 43 percent of people in the eastern Mediterranean are aged over 65 and vulnerable to heat exposure,compared with 38 per cent in Africa and 34 per cent in Southeast Asia.

However, as the prevalence of NCDs increases in low- and middle-income countries, thevulnerability of these populations also increases — particularly in southeast Asia wherevulnerability to heat exposure has increased by 3.5 per cent since 1990.

Maternity benefits

Without maternity benefits (The Hindu: 20181129)

https://www.thehindu.com/opinion/op-ed/without-maternity-benefits/article25616970.ece

The government’s maternity benefit programme must be implemented better and comply withthe Food Security Act

Yashoda Devi was five months pregnant with her third child when we met her in Jharkhand inJune. She was in extreme pain. The doctor had told her that she was very weak and had advisedher to improve her nutritional intake. But Ms. Devi did not have money to follow the doctor’sadvice.

Not serving its purpose

Ms. Devi was one of the 98 women we interviewed in the course of a small survey in 12 villagesspread across two blocks of Jharkhand: Manika in Latehar district and Khunti in Khunti district.We enquired about the financial and physical hardships experienced by the respondents duringpregnancy and delivery, and also studied the implementation of the Pradhan Mantri MatruVandana Yojana (PMMVY), a maternity benefit programme, nearly one year after it wasofficially launched.

Under the National Food Security Act (NFSA) of 2013, every pregnant woman is entitled tomaternity benefits of ₹6,000, unless she is already receiving similar benefits as a government employee or under other laws. The PMMVY was announced by Prime Minister Narendra Modion December 31, 2016. Unfortunately, it violates the NFSA in several ways. First, the benefitshave been reduced from ₹6,000 to ₹5,000 per child. Second, they are now restricted to the first living child. Third, they are further restricted to women above the age of 18 years.

The scheme largely defeats the purpose it is supposed to serve: according to a recent analysis,it excludes more than half of all pregnancies because first-order births account for only 43% ofall births in India. In our sample, less than half of the women met the PMMVY eligibilitycriteria. Among those who were eligible, a little over half had applied for maternity benefits.

The application process is cumbersome and exclusionary: a separate form has to be filled,signed and submitted for each of the three instalments, along with a copy of the applicant’smother-child protection card, her Aadhaar card, her husband’s Aadhaar card, and the details ofa bank account linked to her Aadhaar number. The compulsory linking of the applicant’s bankaccount with Aadhaar often causes problems. Further, the PMMVY provides little assistanceto women who lose their baby, because the successive payments are made only if thecorresponding conditionalities are met.

Many hardships

The worst form of hardship reported by pregnant women in our sample, among those relatedto lack of funds, was the inability to improve their nutritional intake or even to eat properlyduring pregnancy.

Ms. Devi, during and before her second pregnancy, was working in someone else’s field whereshe was paid in kind (5 kg of grain per day). This time, as she was in pain, she was unable towork for wages during her pregnancy. This reduced the family’s income, already strained bythe last delivery’s debts when they had to spend more than ₹12,000 by borrowing and selling assets. Ms. Devi said that if she had received maternity benefits under the PMMVY, she couldhave used the money to take care of her health and eat nutritious food as advised by the doctor.Like her, 42% of respondents in the sub-sample of women who were working for wages beforepregnancy with an average wage of ₹126 per day of work could not work during their pregnancy and earned zero wages. In our sample, on average, respondents spent ₹8,272 on their deliveries alone. Half of the respondents who had spent money during delivery or pregnancysaid that they had to borrow money to meet the expenses. It was also common for the familiesof the respondents to sell assets or migrate to cover these costs. The PMMVY could help protectpoor families from these financial contingencies.

The provision for maternity entitlements in the NFSA is very important for women who arenot employed in the formal sector. The PMMVY, however, undermines this provision due tothe dilution of the entitled amount and the exclusion criteria. Even in this restricted form, thescheme is yet to reach eligible women as the implementation record has been dismal till date.In our sample, 30 women had applied for maternity benefits, but none of them had actuallyreceived any PMMVY money. No doubt some women did receive PMMVY benefits in bothdistricts by June (this was confirmed by the block offices), but the numbers were so small thatnone of them emerged in our sample. The scheme seems to be achieving very little for now, inJharkhand at least. There is an urgent need for better implementation as well as for complianceof the scheme with the NFSA. Maternity benefits should be raised to ₹6,000 per child at least, for all pregnancies and not just the first living child.

Heatwave exposure

Lancet urges response to heatwave exposure surge (The Hindu: 20181129)

https://www.thehindu.com/sci-tech/health/lancet-urges-response-to-heatwave-exposure-surge/article25617310.ece

Indians faced almost 60 mn heatwave exposure events in 2016, says journal

Indian policy makers must take a series of initiatives to mitigate the increased risks to health,and the loss of labour hours due to a surge in exposure to heatwave events in the country overthe 2012-2016 period, the Lancet Countdown 2018 report recommends.

From 2014-2017, the average length of heatwaves in India ranged from 3-4 days compared tothe global average of 0.8-1.8 days, and Indians were exposed to almost 60 million heatwaveexposure events in 2016, a jump of about 40 million from 2012, the report released Thursdayshowed.

Heatwaves are associated with increased rates of heat stress and heat stroke, worsening heartfailure and acute kidney injury from dehydration. Children, the elderly and those with pre-existing morbidities are particularly vulnerable.

Almost 153 billion hours of labour were lost globally in 2017 due to heat, an increase of 62billion hours from the year 2000.

Observing that a recent report “places India amongst the countries who most experience highsocial and economic costs from climate change”, the study makes several recommendations.These include identifying “heat hot-spots” through appropriate tracking of meteorological dataand promoting “timely development and implementation of local Heat Action Plans withstrategic inter-agency co-ordination, and a response which targets the most vulnerable groups.”

The report prepared jointly with the Public Health Foundation of India also urges a review ofexisting occupational health standards, labour laws and sectoral regulations for worker safetyin relation to climatic conditions.

The India Meteorological Department had reported that from 1901 to 2007, there was anincrease of more than 0.5°C in mean temperature, with considerable geographic variation, andclimate forecasts by research groups project a 2.2-5.5°C rise in temperatures in northern,central and western India by the end of the 21st century.

The number of hours of labour lost also jumped between 2000-2017 across India, the Lancetsaid.

Farm labour vulnerable

For the agriculture sector alone, this rose to about 60,000 million hours in 2017, from about40,000 million hours in 2000. Overall, across sectors India lost almost 75,000 million hours oflabour in 2017, from about 43,000 million hours in 2000.

The agriculture sector was more vulnerable compared to the industrial and service sectorsbecause workers there were more likely to be exposed to heat.

The findings are significant for India as agriculture makes up 18% of the country’s GDP andemploys almost half the population. A recent World Bank report on South Asia’s hotspotspredicted a 2.8% erosion of the country’s GDP by 2050, accompanied by a fall in livingstandards due to changes in temperature, rainfall and precipitation patterns.

If the average global temperature rose by more than one degree Celsius from the present, Indiacould “annually” expect conditions like the 2015 heat wave that killed at least 2,000, accordingto the ‘Special Report on Global Warming of 1.5°C,’ commissioned by the IntergovernmentalPanel on Climate Change (IPCC), last month.

Next week, the Conference of Parties — a compact of about 190 countries signatory to the UNtreaties to address global warming — is set to begin talks in Katowice, Poland, to iron out a‘rule book’ to implement the Paris Agreement of 2015. The agreement was a landmark accord,in which countries agreed to strengthen the global response to the threat of climate change bylimiting the global temperature rise this century to well below 2°C above pre-industrial levelsand to pursue efforts to limit the temperature increase even further to 1.5°C.

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