The Health Budget- A Damp Squib
Health and education are purportedly the key
priorities of the Union Budget this year. The plaudits and bouquets have
been pouring in about the High Level Expert Group of the Planning
Commission’s utopian proposal to provide Universal Health Care through
the creation of an Integrated National Health Care System. Margaret
Chan, Director General of the WHO was effusive in her praise of the
proposals to deliver Universal Health Care in India declaring it a
"historic time" for India. But Finance Minister Pranab Mukherjee
announced only an incremental increase of Rs 2700 crore in the
allocation of the National Rural Health Mission. He also has touched on
the planned launch of a National Urban Health Mission and improvements
to some government medical colleges for better tertiary medical care.
There is also a 10% increase in plan outlay for the alternative systems
of medicine including Ayurveda, Yoga, Unani, Siddhi and Homeopathy and a
10% increase in the plan outlay for the Department of Health Research.
The committee had asked for an increase in health spending from 1 to 6%
of the GDP and 15% of tax revenues. (21 March 2012 The Hindu, 28
March 2012 The Hindu, 16 March 2012 www.moneycontrol.com, Reddy KS, et
al Towards achievement of universal health care in India by 2020: a call
to action Lancet 2011; 377: 760–68).
Saying No to Nestle
The Centre has asked the State Governments to
prohibit all health and educational institutes from availing any offers
from baby food companies. Strict action may be taken against the
organizers of such programs as well those attending these functions,
according to a directive issued to the State governments by the Ministry
of Women and Child Development, asking them to take immediate steps to
ensure that the practice of breastfeeding is protected in the interest
of the healthy growth of the children. According to Section 9 (2) of the
Infant Milk Substitute, Feeding Bottles and Infants Foods (Regulation of
production, supply and distribution) Act, 1992 "no producer, supplier or
distributor shall offer or give any contribution or pecuniary benefit to
a health worker or any association of health workers, including funding
of seminar, meeting, conferences, educational courses, contest,
fellowship, research work or sponsorship. Recent reports of these
guidelines being flouted by various baby food manufacturers including
Nestle by organizing workshops and seminars have roused the ire of the
government. An order could also be issued to authorize Class-1 officer
of each State to monitor the compliance of IMS Act in each district
where a complaint in writing may be made to the court (18 March 2012,
The Hindu).
Cancer Deaths In India
A recent paper by Jha, et al. from the Centre
for Global Health Research, University of Toronto published in the
Lancet gives a panoramic view of the causes of cancer deaths in India.
5,56,400 people died of cancer in India in 2010. Seventy one percent
were between 30 -69 years of age. Cancer accounted for 8% of total male
deaths and 12% of total female deaths. In men the commonest cancers were
oral (23%), stomach (12.6%) and lung (11.4%). In women it was cervical
cancer (17%) followed by breast cancer (10.2%). Tobacco related cancers
accounted for 42% of men with cancer and 18.3% of women with cancer.
There were significant differences in cancer deaths between states.
States with a higher Muslim population like Kashmir and Assam had much
lower cervical cancer incidence probably related to lower HPV
transmission due to circumcision. Increasing deaths due to breast cancer
may be related to early menarche and late pregnancies. Tobacco control
may yet be the best cancer vaccine and Jha recommends huge tax hikes on
tobacco which have yielded good results in other countries like France,
Mexico and Philippines. (29 March 2012, The Hindu; The Lancet Early
Online Publication 28 March 2012).
Artemesin Resistant Malaria
Western Cambodia has long reported falciparum
resistant to artemesinin. Now a new paper in the Lancet documents that
this scourge is fast spreading to the Western border of Thailand.
Researchers analyzed 6 hourly parasite counts in patients with
hyperparasitemic (>4% parasitized RBC’s) falciparum malaria over the
last 10 years. They found that parasite clearance half lives in patients
given oral artesunate containing regimens increased from 2.6 hours in
2001 to 3.7 hours in 2010. The proportion of slow clearing infections
(half-life > 6.2 hours) increased from 0.6% in 2001 to 20% in 2010. At
this rate it is predicted that resistance rates in Thailand will reach
rates of Cambodia in 2-6 years. These are alarm bells for India and we
need to sit up and take action (The Lancet Early Online Publication 5
April 2012).