Indian Society and Social Issues: March 2024 UPSC Current Affairs | Current Affairs & Hindu Analysis: Daily, Weekly & Monthly PDF Download

Levels and Trends in Child Mortality

Why in News?

The United Nations Inter-agency Group for Child Mortality Estimation recently released a report titled "Levels and Trends in Child Mortality," revealing a significant decrease in the annual number of global under-five deaths from 9.9 million in 2000 to 4.9 million in 2022.

Key Highlights of the Report

Historic Low in Child Mortality:

• The annual under-five deaths reduced to 4.9 million in 2022, marking a substantial achievement in global efforts.
• Global under-five mortality rate (U5MR) also halved since 2000.
• Sustained commitment from stakeholders like governments, organizations, and communities drove this decline.

Persistent High Death Toll:

• Despite progress, the death toll among children, adolescents, and youth remains high.
• In 2022, 2.3 million under-five deaths occurred within the first month of life, and 2.6 million between ages 1 and 59 months.
• Additionally, 2.1 million children, adolescents, and youth aged 5–24 died that year.

Magnitude of Lives Lost:

• Between 2000 and 2022, the world lost 221 million children, adolescents, and youth.
• Neonatal deaths accounted for 72 million, with under-five deaths increasing in the neonatal period from 41% in 2000 to 47% in 2022.

Inequality in Survival Chances:

• Survival chances vary based on factors like geographical location and socio-economic status, highlighting persistent disparities.

Regional Disparities:

• While global rates decline, regional disparities persist, with sub-Saharan Africa bearing the brunt.
• Many countries are likely to miss the UN-mandated Sustainable Development Goal (SDG) targets.

Recommendations:

• Some low- and lower-middle-income countries have exceeded global declines, emphasizing the importance of investments in maternal and child health.
• Sustained action, even in resource-constrained settings, can save lives.

What can be done to Curb Child Mortality?

• Increase Access to Family Planning Services: Comprehensive family planning services can prevent unintended pregnancies, reducing risks of preterm births and stillbirths.
• Improve Antepartum Services: Enhancing antenatal care with regular health check-ups and iron folic acid supplementation for pregnant mothers can improve maternal and foetal health.
• Identification and Management of Risk Factors: Effective screening programs for conditions like hypertension and infections during pregnancy can mitigate adverse outcomes.
• Improve Data Recording and Reporting: Enhanced data collection systems and standardized reporting methods are crucial for understanding and addressing the problem effectively.
• Implement Surveillance Guidelines: Timely reporting and analysis of maternal and perinatal deaths can inform policies and interventions.

Challenges Faced by the Gig Workers

Why in News?

A recent study conducted by the People’s Association in Grassroots Action and Movements and the Indian Federation of App-based Transport Workers sheds light on the challenges faced by gig workers, including app-based cab and delivery drivers/persons in India.

Key Highlights of the Study

Long Working Hours:

• Nearly a third of app-based cab drivers work over 14 hours daily, with over 83% working more than 10 hours and 60% exceeding 12 hours.
• Over 60% of drivers from Scheduled Castes (SC) and Scheduled Tribes (ST) work over 14 hours daily, exacerbating social disparities.

Low Pay:

• More than 43% of gig workers earn less than Rs 500 a day or Rs 15,000 a month after expenses.
• Around 34% of app-based delivery persons earn less than Rs 10,000 a month, contributing to social inequalities.

Financial Strain:

• 72% of cab drivers and 76% of delivery persons struggle with expenses, with 68% of cab drivers' expenses exceeding earnings, potentially leading to debt.

Unsatisfactory Compensation:

• Over 80% of app-based cab drivers are dissatisfied with company fares, while over 73% of delivery persons are unhappy with their rates.
• Employers reportedly deduct between 31-40% of commission rates per ride, higher than officially claimed figures.

Work Conditions:

• Demanding work hours lead to physical exhaustion and increased risk of accidents, especially due to stringent delivery policies.
• Many workers struggle to take regular days off, with less than 37% belonging to a union.

Issues with Platforms:

• Workers face challenges like ID deactivation and customer misbehavior, hindering their effectiveness.
• A majority report negative impacts from customer behavior.

Recommendations

• The report suggests regulations for fair and transparent payment structures, ensuring gig workers are not underpaid or exploited.
• Payment of a minimum wage and prohibition of indefinite ID blocking are recommended.
• Platforms should address worker demands and provide stronger social security.

Who are Gig Workers?

• Gig workers are individuals who work temporarily and flexibly, often for multiple clients or companies, performing tasks or providing services.
• They are typically independent contractors, allowing more control over their work.

Why is it Essential to Provide Social Security Benefits to Gig Workers?

• Economic Security: Lack of job security in the gig sector necessitates social security benefits like unemployment insurance and retirement savings.
• More Productive Workforce: Providing health benefits ensures a healthier workforce, improving productivity.
• Equity in Opportunities: Social security benefits level the playing field and protect gig workers from exploitation.
• Long-term Financial Security: Retirement plans reduce the risk of financial hardship in the future.

Main Challenges in Providing Social Security Benefits to Gig Workers

• Classification and Excess Flexibility: Determining company obligations and designing flexible benefits is complex.
• Funding and Cost Distribution: Identifying funding mechanisms is challenging in a self-employed workforce.
• Coordination and Data Sharing: Coordinating data among platforms and agencies is crucial but difficult.
• Education and Awareness: Raising awareness about entitlements is a challenge.

What can be done to Ensure Social Security of Gig Workers?

Implementing Code on Social Security, 2020:

• Although the Code on Social Security, 2020, contains provisions for gig workers, the rules are yet to be framed by the States and not much has moved in terms of instituting the Board. These should thus be taken up expeditiously by the government.

Adopt International Examples:

• The UK has instituted a model by categorising gig workers as “workers,” which is a category between employees and the self-employed.
• This secures them a minimum wage, paid holidays, retirement benefit plans, and health insurance.
• Similarly, in Indonesia, they are entitled to accident, health, and death insurance.

Expanding Employer Responsibilities:

• Strong support for gig workers should come from the gig companies that themselves benefit from this agile and low-cost work arrangement.
• The practice of classifying gig workers as self-employed or independent contractors needs to be eliminated.
• Companies must be provided equal benefits as that of a regular employee.

Government Support:

• The government should invest in systematically increasing exports in high-skill gig work such as in the education, financial advisory, legal, medicine or customer management sectors; by making it easier for Indian gig workers to access global markets.
• Also, it would require collaboration between governments, gig platforms, and labour organisations to establish fair and transparent mechanisms for sharing the responsibility of providing social security benefits.

Snakebite Envenoming

Why in News?

The Ministry of Health and Family Welfare recently introduced a National Action Plan for Prevention and Control of Snakebite Envenoming (NAP-SE) within the framework of the 'One Health' approach.

What is the National Action Plan for Prevention and Control of Snakebite Envenoming (NAP-SE)?

About:

• The NAP-SE serves as a comprehensive framework for managing, preventing, and controlling snakebite envenoming in India.
• Aligned with global objectives to reduce snakebite-related deaths by half, it delineates strategic components and stakeholder roles.
• It acts as a guiding document for states/UTs and stakeholders to tailor action plans specific to their needs, focusing on systematic risk reduction through various measures.

Aim:

• To halve snakebite-related deaths and disabilities by 2030.
• To progressively decrease morbidity, mortality, and associated complications in humans due to snakebites.

Strategic Actions:

• Human Health: Ensuring availability of anti-snake venom in all health facilities, enhancing surveillance, and strengthening emergency care services.
• Wildlife Health: Promoting awareness, antivenom distribution, research, and wildlife management.
• Animal and Agriculture Component: Preventing snakebites in livestock, fostering community engagement, and other related measures.

What is Snakebite Envenoming (SE)?

About

• SE is classified as a High-Priority Neglected Tropical Disease by the WHO.
• It results from venom injection following snake bites and poses a significant health risk in rural areas of tropical regions.
• Long-term complications include deformities, amputations, visual impairment, and psychological distress.

Prevalence

• India accounts for around half of global snakebite deaths, with an estimated 3-4 million snake bites annually.
• Actual burden is underreported, with only a small proportion seeking medical help.
• 'Big four' snakes cause around 90% of bites in India.

WHO’s Roadmap for SE

• WHO aims to reduce snakebite deaths and disabilities by 2030.
• Initiatives include increasing antivenom manufacturers, creating a global antivenom stockpile, and integrating snakebite treatment into national health plans.

Indian Initiatives

• Indian Council of Medical Research (ICMR) initiated awareness and capacity-building efforts since 2013.
• India ratified a National Action Plan in 2015, aligning with WHO and UN frameworks.

Abortion

Why in News?

French lawmakers have overwhelmingly passed a bill to embed abortion rights in France's constitution, making it the sole country to explicitly safeguard a woman’s right to voluntarily terminate pregnancy.

The approved bill amends Article 34 of the French Constitution, explicitly stating that “the law determines the conditions by which the freedom of women to have recourse to an abortion, which is guaranteed.”

• The initiative responds to global concerns about declining abortion rights, notably highlighted by the US Supreme Court's 2022 decision in Roe v. Wade.

What is Abortion?

About:

• Abortion is the deliberate termination of a pregnancy, typically performed during the first 28 weeks of gestation. It can be achieved through various medical procedures or medications, depending on the stage of pregnancy and the preferences of the individual seeking abortion.
• Abortion can be a highly contentious and debated topic, often involving ethical, moral, religious, and legal considerations.

Proponents:

• Proponents of abortion rights argue that it is a fundamental reproductive right that allows individuals to make choices about their own bodies, health, and future.
• They emphasise the importance of access to safe and legal abortion services in preventing unwanted pregnancies, protecting women's health, and supporting reproductive autonomy.

Opponents:

• Opponents of abortion, often referred to as "pro-life," believe that abortion is morally wrong and should be restricted or prohibited entirely.
• They typically argue that life begins at conception and that terminating a pregnancy is equivalent to taking a human life, thus violating the rights of the unborn foetus.

Legal Provisions Related to Abortion in India:

• Until the 1960s, abortion was prohibited in India, and violating this led to imprisonment or fines under Section 312 of the Indian Penal Code.
• The Shantilal Shah Committee was set up in the mid-1960s to investigate the need for abortion regulations.
• Based on its findings, the Medical Termination of Pregnancy (MTP) Act, 1971 was enacted, allowing safe and legal abortions, safeguarding women's health, and reducing maternal mortality.
• The Supreme Court recognized martial rape as a ground for abortion, even though marital rape itself is not recognized, in a progressive move for women's reproductive rights.
• The MTP Act, 1971, allows abortion up to 20 weeks of gestation, with the consent of the woman and on the advice of one registered medical practitioner (RMP). However, the law was updated in 2002 and 2021.
• The MTP Amendment Act, 2021 permits abortion from 20 to 24 weeks of gestation for specific cases like rape survivors, with approval from two doctors.
• It sets up state level Medical Boards to decide if a pregnancy may be terminated after 24 weeks in cases of substantial fetal abnormalities.
• It extends the failure of contraceptive clauses to unmarried women (initially only married women), allowing them to seek abortion services on grounds of their choice, irrespective of their marital status.
• Consent requirements vary based on age and mental state, ensuring medical practitioner oversight.
• The Constitution of India, which guarantees the right to life and personal liberty to all citizens under Article 21. This right has been interpreted by the Supreme Court of India to include the right to reproductive choice and autonomy for women.

What are the Concerns Related to Abortion?

Cases of Unsafe Abortions:

• Unsafe abortions are the third leading cause of maternal mortality in India, and close to 8 women die from causes related to unsafe abortions each day, according to the United Nations Population Fund (UNFPA)'s State of the World Population Report 2022.
• The women outside marriages and in poor families are left with no choice but to use unsafe or illegal ways to abort unwanted pregnancies.

Preference for a Male Child:

• The selective abortion of female foetuses is most common where male children are valued over female children, especially in parts of East Asia and South Asia (particularly in countries such as China, India and Pakistan).

Shortage of Medical Expert in Rural India:

• According to a 2018 study in the Lancet, 15.6 million abortions were accessed every year in India as of 2015.
• The MTP Act requires abortion to be performed only by doctors with specialisation in gynaecology or obstetrics.
• However, the Ministry of Health and Family Welfare’s 2019-20 report on Rural Health Statistics indicates that there is a 70% shortage of obstetrician-gynaecologists in rural India.

Way Forward

• Efforts should be made to ensure that women have access to safe and legal abortion services without facing unnecessary barriers or stigma.
• This may involve expanding the availability of abortion services in both urban and rural areas, training healthcare providers to offer comprehensive reproductive health services, and raising awareness about women's rights under the MTP Act.
• Medical practitioners play a vital role in ensuring women's access to safe abortion services.
• Policies should be designed to support healthcare providers in delivering high-quality, non-judgmental care to women seeking abortion services, while also addressing any ethical or legal concerns they may have.

Enhancing Accessibility for Persons with Disabilities

Why in News?

Central Public Works Department (CPWD) Focuses on Enhancing Accessibility for Persons with Disabilities (PwDs)

Understanding the Rights of Persons with Disabilities (RPwDs) Act, 2016

Background:

• The RPwDs Act, 2016, aligns with the United Nations Convention on the Rights of Persons with Disabilities, adopted by India in 2007.
• It supersedes the Persons with Disabilities (Equal Opportunity, Protection of Rights and Full Participation) Act, 1995.
• According to the 2011 Census, India has approximately 26.8 million persons with disabilities, accounting for 2.21% of the total population.
• The National Sample Survey Office (NSSO) estimates the disability incidence in India at 2.2%.
• NSSO's 76th round in 2019 reports a yearly disability incidence of 86 per 1,00,000 people.

Expanded Definition of Disability:

• The RPwD Act, 2016, broadens the scope, recognizing 21 types of disabilities, with provision for the Central Government to include more.

Rights and Entitlements:

• Governments tasked with ensuring equal rights for persons with disabilities.
• Reserved quotas in higher education (minimum 5%), government jobs (minimum 4%), and land allocation (minimum 5%) for those with benchmark disabilities and high support needs.
• Free education guaranteed for children with benchmark disabilities aged 6 to 18.
• Mandate for inclusive education in government-funded and recognized educational institutions.
• Emphasis on enhancing accessibility in public infrastructure and facilities.

Mandates for Public Buildings:

• Rule 15 of the Rights of Persons with Disabilities Rules, 2017, mandates the establishment of accessibility guidelines for public buildings.
• Recent amendments require compliance with the 2021 harmonized guidelines.
• Guidelines cover various accessibility features such as ramps, grab rails, lifts, and accessible toilets.
• All building plans must align with these guidelines, with existing buildings mandated to undergo retrofitting within five years.

Other Empowerment Initiatives for the Disabled

• Unique Disability Identification Portal
• DeenDayal Disabled Rehabilitation Scheme
• Assistance to Disabled Persons for Purchase/Fitting of Aids and Appliances
• National Fellowship for Students with Disabilities
• Divya Kala Mela 2023
• Accessible India Campaign

Concerns Regarding Accessibility in Public Buildings

• Lack of Effective Implementation: Reports suggest inadequate implementation of both 2016 and 2021 accessibility guidelines.
• Non-Adoption by States: No state has yet incorporated the harmonized guidelines into their building by-laws.
• Awareness and Accountability Issues: Lack of awareness and accountability among engineers responsible for implementing accessibility standards.
• Underutilization of Funds: Despite available funds for retrofitting, many states and cities have not utilized them, indicating a lack of prioritization.
• Clarity Issues with CPWD Memo: Lack of clarity in the CPWD memo may result in resource wastage, further hindering effective implementation.

World Poverty Clock

Why in News?

According to the latest data from the World Poverty Clock, India has successfully reduced the proportion of its population living in 'extreme poverty' to below 3%. It signifies a substantial step towards accomplishing the first of the 17 Sustainable Development Goals (SDGs) set by the United Nations, with the target year of 2030.

Understanding the Key Findings of the World Poverty Clock

Overview:

• The World Poverty Clock monitors real-time poverty estimates until 2030 for nearly all nations, tracking progress toward ending extreme poverty.
• It categorizes people in extreme poverty by age, gender, and rural or urban residency, capturing both those escaping poverty and those entering it every second.
• The escape rate indicates the current pace of poverty reduction globally.
• Supported by the International Fund for Agricultural Development (IFAD) and Germany's Federal Ministry for Economic Cooperation and Development.

Methodology and Main Discoveries:

• Poverty rates are calculated based on income levels, with the poverty threshold set at USD 2.15 per day.
• The USD 2.15-a-day poverty line, akin to national poverty lines in some of the poorest countries, is commonly termed the extreme poverty line.
• It is utilized to track progress toward the World Bank's objective of reducing the proportion of people living in extreme poverty to less than 3% by 2030.
• India's population in extreme poverty decreased to about 3.44 crore in 2024 from 4.69 crore in 2022, constituting 2.4% of the total population.
• These figures support the CEO of NITI Aayog's assertion that less than 5% of Indians are expected to be below the poverty line, with extreme destitution nearly eradicated, based on the Household Consumption Expenditure Survey (HCES), 2022-23.

Other Global Goals:

• SDG target 1.1 strives for global poverty eradication by 2030, aiming for all countries, regions, and demographic groups to achieve zero poverty using the same international poverty line.

Recent NITI Aayog Paper on Poverty:

• A recent discussion paper by NITI Aayog unveiled a significant reduction in multidimensional poverty in India, declining from 29.17% in 2013-14 to 11.28% in 2022-23.
• This led to 24.82 crore individuals escaping multidimensional poverty over the 9-year period.
• The paper analyzed multidimensional poverty trends in India from 2005-06 to 2022-23, utilizing National Family Health Survey (NFHS) data and projection methods for years lacking NFHS data.

Women, Business and the Law 2024

Why in News?

Recently, the World Bank (WB) Group has released a report titled-Women, Business and the Law 2024, presenting in-depth analysis of the challenges obstructing women’s entry into the global workforce, hindering their ability to contribute to prosperity for themselves, their families and their communities.

What is Women Business and Law 2024 Report?

• Its indexes align areas of the law and public policy instruments with the economic decisions that women make throughout their lives and careers, identifying where and in what areas women continue to face hurdles.
• Indicators: It has 10 indicators- Safety, Mobility, Workplace, Pay, Child Care, Marriage, Parenthood, Entrepreneurship, Assets, and Pension.
• Safety from violence and access to childcare services are very crucial indicators.

What are the Key Highlights of the Report?

Scores Among OECD High-Income Economies:

• Eleven OECD high-income economies achieved scores of 90 or higher, with Italy leading at 95, followed by New Zealand and Portugal at 92.5.
• Conversely, over 37 economies provide women with less than half of the legal rights enjoyed by men, impacting around half a billion women. Notably, high-income economies have an average score of 75.4.

Scores Across Income Groups:

• Upper-middle-income economies closely follow with an average score of 66.8.
• The disparity in scores between the highest- and lowest-scoring economies is most pronounced in high-income economies, with a significant difference of 75 points.

Women Enjoy Fewer Legal Rights than Men:

• Women globally only have access to 64% of the legal protections available to men, considering legal disparities involving violence and childcare, which is lower than the previous estimate of 77%.

Gap Between Legal Reforms and Actual Outcomes for Women:

• Despite the enactment of laws promoting gender equality in many countries, there exists a substantial gap between these laws and women's actual experiences.
• While 98 economies have laws mandating equal pay for equal work for women, only 35 have implemented pay-transparency measures to address the wage gap.

Poor Performances by Countries:

• Togo stands out among Sub-Saharan economies, providing women approximately 77% of the rights available to men, surpassing other countries in the continent.
• However, Togo has only established 27% of the necessary systems for full implementation, which is the average rate for Sub-Saharan economies.

Categories of Legal Equal-Opportunity Reforms:

• Governments in 2023 prioritized advancing legal reforms in three categories: Pay, Parental Rights, and workplace protections.
• However, most countries performed poorly in the newly tracked categories of access to childcare and women’s safety.

Women’s Safety:

• Women's safety remains a significant concern, with the global average score at just 36.
• Women have access to only a third of the necessary legal protections against domestic violence, sexual harassment, child marriage, and femicide.

Childcare:

• Women spend 2.4 more hours daily on unpaid care work than men, primarily on childcare.
• Only 78 economies provide financial or tax support for parents with young children, and fewer than a third have quality standards for childcare services.

Significant Obstacles for Women:

• In entrepreneurship, only one in five economies includes gender-sensitive criteria in public procurement processes, limiting women's participation in a USD 10-trillion-a-year economic opportunity.
• Women earn 77 cents for every USD 1 paid to men, and retirement ages differ in 62 economies, leading to smaller pension benefits and greater financial insecurity for women in old age.

How did India Perform in Women, Business and the Law 2024 Report?

• India’s rank has marginally improved to 113, with a score of 74.4%. While the country’s score has remained constant since 2021, its ranking witnessed a decline from 122 in 2021 to 125 in 2022 and further to 126 in the 2023 index.
• Indian women have just 60% of the legal rights compared to men, slightly below the global average of 64.2%.
• However, India outperformed its South Asian counterparts, where women have only 45.9% of the legal protections enjoyed by men.
• When it comes to constraints on freedom of movement and constraints related to marriage, India got a full score.
• India receives one of its lowest scores in the indicator evaluating laws impacting women’s pay.
• To enhance this aspect India could explore measures such as mandating equal pay for equivalent work, permitting women to work at night on par with men and enabling women to engage in industrial jobs on an equal footing with men.
• When it comes to supportive frameworks, India scored higher than both the global and South Asian averages.

What are the Recommendations of the Report?

• Eliminating discriminatory laws and practices hindering women from working or initiating businesses could result in a more than 20% increase in global gross domestic product.
• It has the potential to double the rate of global growth in the upcoming decade.
• Effective implementation of equal-opportunity laws depends on an adequate supporting framework, including strong enforcement mechanisms, a system for tracking gender-related pay disparities, and the availability of healthcare services for women who survive violence.
• It is more urgent than ever to accelerate efforts to reform laws and enact public policies that empower women to work and start and grow businesses.
• Increasing women's economic participation is the key to amplifying their voices and shaping decisions that affect them directly.

Growing Obesity in India

Why in News?

A recent research paper featured in The Lancet has highlighted the concerning rise in obesity rates among children, adolescents, and adults globally over the past several decades. This extensive study was carried out by the NCD Risk Factor Collaboration (NCD-RisC) in partnership with the World Health Organization (WHO). The research examined body mass index (BMI) trends to analyze the changes in obesity and underweight prevalence worldwide from 1990 to 2022.

What are the Key Highlights of the Study?

Obesity:

• According to The Lancet, in 2022, India had 12.5 million overweight children aged 5-19, a significant increase from 0.4 million in 1990, with 7.3 million boys and 5.2 million girls affected.
• India ranked 174th globally in terms of obesity prevalence for both boys and girls in 2022.
• Among adults, obesity rates rose from 1.2% to 9.8% in women and from 0.5% to 5.4% in men from 1990 to 2022.

Undernutrition:

• India faces a high prevalence of undernutrition, leading to a significant "double burden" of Malnutrition.
• 13.7% of women and 12.5% of men were underweight.
• Thinness prevalence in Indian girls was the highest globally at 20.3%, and the second highest in boys at 21.7%.

Global:

• The global population of obese individuals has surpassed one billion, with 159 million children and adolescents, and 879 million adults affected in 2022.
• The combined burden of underweight and obesity has risen in most countries, primarily driven by obesity increases, while underweight and thinness persist in South Asia and parts of Africa.
• Island nations in the Caribbean Polynesia and Micronesia, along with countries in the Middle East and North Africa, had the highest combined prevalence of underweight and obesity in 2022.
• Polynesia, Micronesia, and the Caribbean, along with Chile and Qatar for boys, had the highest combined prevalence of thinness and obesity.
• Some South Asian countries like India and Pakistan had high combined prevalence despite a decline in thinness.

Factors Contributing to Obesity:

• Women are more susceptible to weight gain due to time constraints on exercise and prioritization of family nutrition over their own.
• Household responsibilities often lead to less sleep for women.
• Availability and affordability of unhealthy junk food compared to nutritious options contribute to rising obesity rates, even among low-income individuals in regions like Tamil Nadu, Punjab, and Goa.

What are India’s Initiatives Related to Nutrition?

• Eat Right Mela
• Fit India Movement
• Eat Right Station Certification
• Mission Poshan 2.0
• Mid-Day Meal Scheme
• Poshan Vatikas
• Anganwadi
• Integrated Child Development Services (ICDS) Scheme
• Pradhan Mantri Matru Vandana Yojana (PMMVY)

Way Forward

• Addressing Obesity and Underweight: It is essential not to view obesity and underweight in isolation, as their transition can occur rapidly, leaving their combined burden unchanged or even higher.
• Focus on Nutrition Enhancement Programs: Emphasis should be placed on initiatives promoting healthy nutrition, including targeted cash transfers, food subsidies or vouchers for nutritious foods, provision of free healthy school meals, and primary care-based nutritional interventions.
• Urgent Need for Weight Loss Support: There is an urgent need to support weight loss efforts in individuals with obesity.
• Prevention and Management Emphasis: Prevention and management efforts are crucial, especially considering the decreasing age of onset of obesity, which prolongs the duration of exposure to its health risks.

Hepatitis B: A Public Health Concern In India

Why in News?

A recent report from Sir Ganga Ram Hospital, New Delhi, underscores the inadequate public awareness and knowledge concerning Hepatitis B, a potentially life-threatening condition leading to liver cirrhosis and cancer, within India.

What is Hepatitis?

Overview:

• Hepatitis denotes liver inflammation, characterized by irritation or swelling of liver cells due to various factors.
• It can manifest as either acute, presenting symptoms like jaundice, fever, and vomiting, or chronic, lasting over six months without apparent symptoms.

Symptoms:

• While some infected individuals may remain asymptomatic, common symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice.

Causes:

• Hepatitis is primarily caused by hepatotropic viruses such as A, B, C, D, and E, although other viruses like varicella may also induce the disease.
• SARS-CoV-2, the virus responsible for Covid-19, can also cause liver damage.
• Additional causes include drug and alcohol abuse, fatty liver hepatitis, or autoimmune responses targeting the liver.

Types of Hepatitis

• Hepatitis A Virus (HAV): Transmitted through contaminated food or water, HAV can be prevented with a vaccine, with most individuals achieving full recovery and lifelong immunity.
• Hepatitis B Virus (HBV): HBV can lead to acute or chronic liver disease and is preventable with vaccines.
• Hepatitis C Virus (HCV): HCV causes both acute and chronic hepatitis and is primarily transmitted through unsafe healthcare, blood transfusions, injection drug use, and certain sexual practices.
• Hepatitis D Virus (HDV): HDV depends on HBV for replication and poses a severe risk to liver health, with limited treatment options.
• Hepatitis E Virus (HEV): Prevalent in East and South Asia, HEV is transmitted through contaminated water, with ongoing research for vaccines worldwide.

Government Initiatives to Tackle Hepatitis

• National Viral Hepatitis Control Program: Aims to eliminate viral hepatitis as a public health threat in India by 2030.
• India's Universal Immunization Programme (UIP): Offers free vaccination against various diseases, including Hepatitis B.

Global Initiatives

• WHO’s Global Hepatitis Strategy
• Coalition for Global Hepatitis Elimination (CGHE)
• Global Hepatitis Programme

Rare Disease Day 2024

Why in News?

Recently, Rare Disease Day was commemorated on the final day of February. This international observance aims to raise awareness about rare diseases and their significant impact on patients and their families.

What is Rare Disease Day?

• Rare Disease Day is a globally coordinated movement dedicated to advocating for equity in social opportunity, healthcare, and access to diagnosis and therapies for individuals with rare diseases.
• The theme for Rare Disease Day 2024 is "Share Your Colours," which emphasizes collaboration and support.
• It was established in 2008 and observed annually on 28th February (or 29 in leap years). Rare Disease Day is coordinated by the European Organisation for Rare Diseases (EURORDIS) and over 65 national alliance patient organization partners.
• It serves as a focal point for advocacy work on local, national, and international levels, engaging individuals, families, caregivers, healthcare professionals, researchers, policymakers, industry representatives, and the general public.

What is a Rare Disease?

About:

• Rare diseases are loosely defined as occurring infrequently in the population, with prevalence varying between nations.
• The World Health Organization defines rare diseases as often debilitating lifelong conditions with a prevalence of 1 or less per 1000 population.
• Different countries have their own definitions; for instance, the US considers diseases affecting fewer than 200,000 patients rare, while the European Union sets the limit at no more than 5 in 10,000 people.
• India currently does not have a standard definition, but the Organisation of Rare Diseases India (ORDI) has suggested that a disease is to be defined as rare if it affects 1 in 5,000 people or less.

Global Rare Diseases Burden:

• 300 million people worldwide are affected by rare diseases.
• Rare diseases affect approximately 3.5% to 5.9% of the population.
• 72% of rare diseases are genetic, with over 7000 characterized by diverse disorders and symptoms.
• 75% of rare diseases affect children. 70% of rare diseases have their onset during childhood.

Characteristics and Impact of Rare Diseases:

• Rare diseases present with a broad diversity of disorders and symptoms, varying not only between diseases but also among patients with the same disease.
• The chronic, progressive, degenerative, and often life-threatening nature of rare diseases significantly affects patients' quality of life.
• Lack of effective cures exacerbates the pain and suffering endured by patients and their families.

Challenges Faced by Individuals with Rare Diseases:

• Delayed diagnosis due to lack of scientific knowledge and quality information.
• Inequalities in access to treatment and care leading to social and financial burdens.
• Common symptoms can mask underlying rare diseases, leading to initial misdiagnosis.
• According to EURORDIS, 5 years is the time it takes on average for rare disease patients to get a diagnosis.
• 70% of people with rare diseases wait more than 1 year to get a confirmed diagnosis after coming to medical attention.
• Physicians' lack of awareness and training in interpreting rare disease signs and symptoms contributes to diagnostic challenges.

What is the Landscape of Rare Diseases in India?

Impact:

• India represents one-third of global rare disease cases, encompassing over 450 identified diseases.
• Despite this significant prevalence, rare diseases remain largely overlooked in India, with limited awareness, diagnosis, and drug development.
• Over 8 to 10 crore Indians are estimated to suffer from rare diseases, with over 75% being children.

Challenges in Policy and Implementation:

• The Ministry of Health and Family Welfare formulated a national policy for rare diseases in 2017 but withdrew it in 2018 due to implementation challenges.
• The revised first National Policy for Rare Diseases (NPRD) was announced in 2021, but problems persist, including the absence of a clear definition for rare diseases.

Treatment Accessibility and Funding:

• Less than 50% of identified rare diseases in India are treatable, with approved treatments available for only about 20 diseases.
• Access to approved treatments is limited to designated Centres of Excellence (CoEs), which are few (12) in number, unevenly distributed, and often lack coordination.
• The NPRD guidelines provide limited financial assistance per patient, insufficient for lifelong management and therapy of chronic rare diseases.

Challenges in Fund Utilization:

• Budget allocations for rare diseases have increased but remain low, with Rs 93 crore allocated for 2023-2024.
• Confusion and disparities in fund utilization among CoEs highlight inefficiencies in resource allocation.
• A staggering 51.3% of allocated funds remain unutilized, despite patients urgently needing treatment.
• Some CoEs struggle with underutilization of allocated funds, while others exhaust their budgets quickly, leading to unequal access to treatment.
• For instance, Mumbai exhausted all its funds while treating only 20 out of 107 patients, Delhi utilized less than 20% of its funds.
• The burden of funding treatment often falls on patients and their families, with governmental support falling short.
• Patients and advocacy groups call for sustainable funding from both the central and state governments to support rare disease treatment.
• Sustainable funding is crucial for patients, especially those who have exhausted their allotted funds and are struggling to continue treatment.

Way Forward

• Establish a uniform definition of rare diseases to ensure clarity and consistency in policy implementation.
• Augment budget allocations specifically earmarked for rare diseases to bolster drug development, therapy, and research endeavors.
• Widen the network of Centres of Excellence (CoEs) catering to rare diseases and facilitate improved coordination among them.
• Establish satellite centers affiliated with CoEs to enhance accessibility and outreach in underserved regions.
• Promote responsible allocation of funds to maximize efficacy and mitigate discrepancies in fund utilization.
• Create a national registry for rare diseases to document and elucidate the roster of rare diseases, alongside establishing a centralized laboratory for rare disease detection.
• Offer incentives to domestic pharmaceutical manufacturers through the Production-Linked Incentive Scheme to stimulate the production of cost-effective drugs.
• Implement the Comprehensive Rare Disease Care (CRDC) model, which aims to bridge the gap for patients and families affected by genetic anomalies.
• The CRDC model delineates a technical and administrative blueprint for hospitals to follow.
• Ensure economical access to medications for rare diseases by reducing taxes on commercially available drugs, thus broadening access for patients.