(In the weekly Health Matters newsletter, Ramya Kannan writes about getting to good health, and staying there. You can subscribe here to get the newsletter in your inbox.)
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In a leaner and meaner Health Matters newsletter this week, we look at a slimmer selection of health stories from the past week, the key news events and explainers, theme-based clusters on health and related issues.
Now, did you not know that consuming foods that are sweet, and carbohydrate-dense, increases the chances of developing diabetes. Strange but true, apparently, the clinical world has always considered this controversial. There were some who set their store by the impact Glycaemic Index (GI - the body’s response through blood sugar after a meal) and Glycaemic Load (GL - GI * amount of food consumed) on a person’s health, but then, there was insufficient evidence to back it. And what is health science but entirely driven by evidence. So a bunch of people decided to find the evidence for it.
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Our report on the recent paper in the Lancet lists the broad findings — key of which was of course that both GI and GL have a marked association with developing diabetes, particularly in persons with a higher Body Mass Index, and with family history of diabetes. A total of 1,27,594 adults aged 35–70 years without known diabetes from 20 high-income, middle-income, and low-income countries, had enrolled as part of the Prospective Urban and Rural Epidemiology (PURE) study. Their diet was assessed at baseline using country-specific food frequency questionnaires. The GI and GL were estimated on the basis of the intake of seven categories of carbohydrate-containing foods.
With antimicrobial resistance gaining ground across the world, this modest initiative, next generation of medics leading the fight against AMR, has its own certain place in the sun. First, on Antimicrobial Resistance (AMR) itself. A 2022 paper in the Lancet revealed that AMR infections alone caused 1.27 million deaths in 2019. Additionally, there were an estimated 4·95 million deaths associated with bacterial AMR in the same period, meaning that AMR might have been present but the underlying disease might have caused death. The paper noted, antimicrobial resistance (AMR) poses a major threat to human health around the world. Previous publications have estimated the effect of AMR on incidence, deaths, hospital length of stay, and health-care costs for specific pathogen–drug combinations in select locations.
As the WHO says, AMR occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death. AMR is a natural process that happens over time through genetic changes in pathogens. Its emergence and spread is accelerated by human activity, mainly the misuse and overuse of antimicrobials to treat, prevent or control infections in humans, animals and plants. The misuse and overuse of antimicrobials in humans, animals and plants are the main drivers in the development of drug-resistant pathogens.
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It is in this context that the efforts undertaken by a young bunch of medicos in association with seniors in the profession, with experience in dealing with AMR in ICUs is significant. The idea is to train the youth about the dangers of over-prescribing or issuing unnecessary antimicrobials to patients, in order to right the wrongs that have been going on for decades. It was initiated by Rotary Medicrew, a significant medical student association worldwide, and the AMR Declaration Trust, an NGO with expertise in dealing with AMR, to broadcast widely a message on dealing with antimicrobial resistance and to literally saturate different medical and allied groups with information about the importance of talking about and preventing antimicrobial assistance in the community and hospitals. It aims to empower medical students with the knowledge and tools to tackle this global health challenge, involving the expertise of an NGO and a significant medical student organisation worldwide. In addition, the idea is also to take the message of AMR awareness to the people, building compliance among the people to drug regimens. Starting with a webinar, introducing the concept to doctors, young and old, the initiative has hived off into a WhatsApp group that allows for real time discussion of cases, and solutions to the problem of AMR itself.
In the same context, do read this report as well: Urgent action needed to combat antimicrobial resistance.
The significance of observing April 7 as World Health Day, on the theme ‘My Health, My Right’ (article by Saima Wazed), was recorded by The Hindu, with a curated package of articles on the opinion pages, touching on various aspects of healthcare on the occasion. But as the doubting Thomases ask, do these international days, observing them, rather, make any difference to the larger scheme of things? No doubt, one swallow does not a summer make, and what’s one day in the global mosaic? And yet, as far as awareness generation goes, any such international day helps in raising the profile of the disease, or cause, and wedging the thought in the minds of the public.
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K. Madan Gopal, Suneela Garg and K.S. Uplabdh Gopal write on an important issue in health in the country: Shaping India’s path to inclusive health care. India is diverse and has wide socioeconomic gaps. Thus this predicament strikes a chord. Access to health care in rural areas is significantly less than in metropolitan areas. Social and economic barriers exacerbate this disparity.
True health equity addresses the root causes of health inequities such as poverty, discrimination, limited access to high-quality education, a healthy diet, clean water, fresh air, and housing, and merely grants equal access to health care.
Psychiatrist Lakshmi Vijayakumar dwells on the complex topic of youth suicide in India, with ‘gone too soon’. The National Crime Records Bureau (NCRB) reports that 1.71 lakh people died by suicide in 2022. The suicide rate has increased to 12.4 per 1,00,000 — the highest rate ever recorded in India. But these figures are underestimated due to an inadequate registration system, the lack of medical certification of death, stigma and other factors. Unfortunately, 41% of all suicides are by young people below the age of 30. Suicide is the leading cause of mortality for young women in India. A young Indian dies by suicide every eight minutes, which is a loss to family, society, the economy and future of the country. Suicide in the young is a major public health problem in India, she writes. Hit the link for more on the subject.
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Also, Aruna Bhattacharya in ‘Implementing universal health coverage’ asks: How should access to health be envisaged? Given that health is a state subject and the UHC policy is envisaged at the national level, there is a need for discourses on implementation. She makes the case that the discourse on health as a human right must be seen as the possibility that every citizen has to achieve health and wellness as part of their rights to access to public health.
Meanwhile Abhay Shukla and Pratap C. Reddy discuss the multiple dimensions of private healthcare on the same page. The former argues that private healthcare needs reform in public interest. Pointing to the recent COVID-19 pandemic, he says strengthening public health services and regulating private healthcare providers is essential. In the Indian context, no initiative for reforming the health sector will be complete without touching upon private healthcare, which accounts for around 70% of healthcare utilisation in the country. The latter makes the case for prioritising health for a sustainable future and ruminates on the need for health infrastructure and using tech to aid doctors in the new age.
In our tailpiece section, Sridhar Sivasubbu and Vinod Scaria write on a fascinating line of emergent research how genetics is revealing skin colour biology is more than skin-deep. Beauty is not skin deep, certainly, now even science says it. Researchers at the University of Pennsylvania used genome editing and chromosomal conformational capture to identify the regulators of a number of genes involved in skin pigmentation. They also identified a new gene, CYB561A3, that regulates skin pigmentation. This work expanded the repertoire of genes we know to be involved in the processes driving pigmentation diversity.
From the Health page
For more health articles for the week, click on the links below:
Bindu Shajan Perappadan writes about how E-commerce sites were told to classify food items correctly.
Nihal Sahu says the implementation of living wills lags in India.
Vijaita Singh marks this development: Centre to separately record parents’ religion during registration of childbirth.
Serena Josephine M. records at a time of yet another country-wide shortage of TB drugs, the Tamil Nadu initiative through local purchases to manage the situation.
World’s most powerful MRI scans the first images of the human brain, reaching a new level of precision that hopefully, will shed more light on our mysterious minds — and the illnesses that haunt them.
For many more health stories, head to our health page, and subscribe to the health newsletter, here.