Health Matters

A population count and many allied issues 

This week in health, we discuss population, urban health, elderly care, climate change impacts and more

This week began with the marking of World Population Day, on July 11, a day that has an obvious significance for the world’s most populated country. But beyond the numbers of 1.7 billion in 2064 and 1.53 billion 2100, there are multiple other strands to India’s population story: what happens to the health of cities when greater numbers of people migrate from rural to urban areas? What happens to the health of our elderly, projected to number 347 million by 2050? What happens to the health of the climate, the adverse effects of which are already being felt through extreme weather events? 

A number of our stories this week attempt to explore these and other questions: in A pathway for the most populous nation, S. Irudaya Rajan and U. S. Mishra write that this year’s theme was ‘women’s sexual and reproductive health and reproductive rights’. While there has been reasonable progress in three decades — women have greater access to modern contraceptives today and maternal deaths have declined considerably since 2000 — there are still unequal results across regions. It is unacceptable, they say, that each day, 800 women die globally from preventable causes relating to pregnancy and childbirth, with a disproportionate share of these deaths occurring in developing countries.  

They also point to the need to encourage the emergence of new cities, in order to release pressure on existing mega cities. And another crucial aspect the authors bring up is that the most populous country of the world does not have a realistic count of its population. Until India conducts its census, we will only have estimates – the lack of reliable data was also underscored by The Lancet in April this year, as you may recall.  

Speaking of contraception, over 4,000 women in Karnataka have chosen to use newer contraceptive methods for healthy birth spacing since September last year, writes Afshan Yasmeen. To ensure healthy birth spacing, the National Family Planning programme introduced two new contraceptive options: subdermal single rod implants and subcutaneous injectables, last year. Four districts from Karnataka — Bengaluru, Bidar, Mysuru, and Yadgir — are among the 40 districts in 10 States where the new options were introduced in the first phase. The Health Department is now all set to extend the new options in six more districts in Karnataka, she reports. 

Where does the population vs people dichotomy become apparent? In the adverse effects of climate change which do not recognise national boundaries, S. Ramasundaram, writes in A case of people versus population. With 11% of its people still below the poverty line, India will continue to accord priority to economic growth over climate change mitigation measures. That responsibility lies majorly with the OECD countries, and now increasingly with China, he says. 

What do the changing dynamics of the demographic shift signify? Paramita Majumdar and Nitin Kumar explore this in India’s demographic journey of hits and misses. Three components: fertility, mortality, and migration, play a pivotal role in shaping India’s demographic landscape. India has made significant strides in reducing its fertility; there has been a significant drop in the mortality rate and the average life expectancy of Indians has increased over time. With this, India is experiencing a demographic shift, towards an ageing population, and this issue, the authors write, requires a long-term plan — focusing on geriatric care and providing social security benefits. Another significant point they make is about women’s labour force participation, which is straggling; women’s notable absence from political representation and their unending plight within society, they say, are the silent issues that can sabotage India’s path to achieving the sustainable development goals by the target year of 2030. 

While this year’s theme focuses on women, let’s also take a look at a subject involving men that’s not often spoken about: male infertility. This issue, Priyanka Parte says in Breaking the taboo around men’s reproductive health, remains stigmatised, shrouded in silence and surrounded with misconceptions. Male infertility accounts for 50% of all infertility cases in the country. Factors that can affect fertility include stress, hormonal imbalances; genetic, anatomical and epigenetic factors, or even exposure to certain infections. External factors such as environmental pollution and an indiscriminate use of pesticides on crops, plastics, and plasticisers and lifestyle factors such as diets, sleep patterns, work schedules, and consumption of alcohol and tobacco can also play a part. As is the case with many other health conditions, creating awareness is key; there is an urgent need for open and informed discussions on reproductive health and as always, good lifestyle practices can play a critical, preventative role. 

From population issues to children’s issues isn’t much of a leap, and in concerning news on that front, the United Nations has said that global childhood vaccination levels have stalled, leaving millions more children un- or under-vaccinated than before the pandemic, warning of dangerous coverage gaps, enabling outbreaks of diseases like measles. Not only has progress stalled, it said, but the number of so-called zero-dose children, who have not received a single jab, rose to 14.5 million last year from 13.9 million in 2022. 

Even more concerning is that more than half of the world’s unvaccinated children live in 31 countries with fragile, conflict-affected settings, where they are especially vulnerable to contracting preventable diseases, due to lacking access to security, nutrition and health services. 

And while concern mounts about the rise in vaccine-preventable diseases, two infectious diseases are spreading fast in India – multiple States have now reported outbreaks of dengue, while the Zika virus cases continue to slowly climb, even as the monsoon continues, and the task of eliminating mosquito breeding sources becomes more challenging. We have two explainers for you this week on these two diseases: both transmitted by the bite of the Aedes mosquitoes and both with some similar symptoms – do read this piece on Why dengue cases are on the rise | Explained and my piece on the need to improve surveillance and vector control for Zika, to have all your FAQs on these two infections answered. 

Research has always been the mainstay of medicine, but unethical research practices risk casting a shadow upon an institute as a whole. In 12 papers from CSIR’s Indian Institute of Toxicology Research retracted, R. Prasad documents the case of papers co-authored by scientist Ashok Pandey, being retracted from Elsevier’s journal, Bioresource Technology. The common reason cited in the retraction notice of most papers is that Dr. Pandey handled the review of the initial submission of the manuscript and wanted the authors to make some revisions. When the revised manuscript was submitted, Dr. Pandey’s name was added as a co-author without providing any justification for adding his name. While the unethical behaviour of Dr. Pandey is clear, what is not clear is how the publisher and the journal continued to involve Dr. Pandey as the editor-in-chief despite his compromising of the editorial process and breaching the journal’s policies since at least 2016, the writer points out. 

And while we’re on the subject of research, do read this piece by S. Vijay Kumar, who writes that amidst shortage of human cadavers for academic and research purposes in medical colleges across the country, the Union Ministry of Health has appealed to States/Union Territories to encourage people to donate dead bodies in the event of deaths happening outside hospitals.

Circling back to current news, ahead of the presentation of the full Union Budget on July 23, Kannuru Sujatha Rao, India’s former Health Secretary, calls for Double health budget, lower out-of-pocket spends. India’s health system is at a crossroads as it needs to, without any further procrastination, build capacity in all States, particularly the northern States, to cope with the dual burden of disease – communicable and non-communicable diseases. Tackling both requires a health system that is swift and nimble but also steady and solid. Getting the right balance is the key: the right mix of skills and competencies, technology, infrastructure and supervisory systems. All this, as she crucially points out, needs money. 

Here’s a key update on tuberculosis: former Director General of the Indian Council of Medical Research and former WHO Chief Scientist Soumya Swaminathan has been appointed as the Principal Adviser at the Union Ministry of Health and Family Welfare for the National Tuberculosis Elimination Programme. 

For our tailpiece this week, and since we’re on a population theme, do read this piece by D P Kasbekar, Scientists found a bacteria tricked a wasp to get rid of its males on a new study that reports that Wolbachia bacteria have manipulated the wasp Encarsia formosa, to entirely get rid of the male of its species! 

This week, we also bring you selection of stories on nutrition, exercise and the prevention of diabetes: 

Reshma Mirshad and Vijay Viswanathan write: Weight loss is among the ‘best routes to diabetes remission, explaining how successful diabetes remission could relieve healthcare systems. 

A.M. Jigeesh writes on makhana or foxnut cultivation in Bihar –  foxnuts are in demand as a ‘super snack’ but its producers earn very little of this health food pie.  

This podcast explores a recent study in the Lancet that revealed close to half of all Indians are not exercising enough.  

A piece on a study by researchersfrom NIMHANS that illustrates the use of a statistical quality control methodology in the development of an acute stroke intervention programme. 

Continuing our coverage of the NEET fiasco, here is T.G. Sitharam on the way forward for the National Testing Agency. 

And finally, Vasudevan Mukunth traces the history of the EEG, in 100 years of the electroencephalography in medicine.