Civilsdaily

Subject: Indian Society

  • [13 May 2024] The Hindu Op-ed: A well-intentioned study and a demographic myth

    PYQ Relevance:

    Mains: 

    Q Analyse the salience of ‘sect’ in Indian society vis-a-vis caste, region, and religion.(UPSC IAS/2022)
    Q Discuss the main objectives of Population Education and point out the measures to achieve them in India in detail. (UPSC IAS/2021)
    Q “Empowering women is the key to controlling the population growth.” Discuss. (UPSC IAS/2019)

    Prelims:
    India is regarded as a country With a “Demographic Dividend” This is due to (UPSC IAS/2011)
    (a) Its high population in the age group below 15 years
    (b) Its high population in the age group of 15-64 years
    (c) Its high population in the age group above 65 years
    (d) Its high total population

    Note4Students: 

    Prelims:  Population Trends; Minorities; 

    Mains: Society; Minorities; Religious demography; Effects of Policies and Programs on Demographics;

    Mentor comment: The recent report ‘Share of Religious Minorities: A Cross-Country Analysis (1950-2015)’ conducted by the Economic Advisory Council analyzes the demographic changes in the religious composition of Indian Society as well as across 167 countries from 1950 to 2015. It focuses on the shifting shares of majority and minority religious groups, highlighting trends such as the decline in the Hindu population and the growth of the Muslim population in India. The study emphasizes the importance of understanding these changes as indicators of relative well-being within a country. We need to study this analysis as it is based on the premise that any change in minority populations is influenced by policies related to defining and treating minorities in our country.

    Let’s learn

    _

    Why in the News? 

    The recent working paper titled ‘Share of Religious Minorities: A Cross-Country Analysis (1950-2015)’ by the Economic Advisory Council to the Prime Minister (EAC-PM), has major observations on Indian religious demographics.

    Key highlights made by EAC-PM Report:

    The paper is based on the baseline year as 1950, because this was the time around when the International Human Rights Framework was introduced under the aegis of the newly created United Nations.
    Considering the global trends of declining majority, India too has witnessed a reduction in the share of the majority religious denomination by 7.82%.
    According to the Report, the Hindu population decreased by 7.82% (1950-2015), while that of Muslims increased by 43.15%, suggesting a conducive environment in the country to foster diversity.
    The share of the Christian population rose from 2.24% to 2.36% — an increase of 5.38% between 1950 and 2015.
    While the share of the Sikh population increased from 1.24% in 1950 to 1.85% in 2015 — a 6.58% rise in their share, the share of the Parsi population in India witnessed a stark 85% decline, reducing from 0.03% share in 1950 to 0.004% in 2015.

    South Asian Trends:

    Within the neighborhood, the share of the majority religious denomination has increased and minority populations have shrunk alarmingly across countries like Bangladesh, Pakistan, Sri Lanka, Bhutan, and Afghanistan. Minority populations from across the neighborhood come to India during times of duress.

    The present controversy over the EAC-PM Report:

    • The PM-EAC report on religious minorities in India has sparked debate due to its timing, outdated data, and selective focus. 
      • For example, firstly, it does not highlight the nearly 1,520% increase in share in the total population of Buddhists, for every one Muslim, five Hindus were born during this period.
      • Secondly, the Hindu population has tripled, and the Total Fertility Rate (TFR) of Muslim women saw a drop of 2.05 against Hindu women’s TFR by 1.36, making it controversial. 
    • Despite concerns raised by some, the demographers do not see that the Hindus are losing their majority status, given the historical context and current demographic patterns.
      • For example, when Hindus could retain their majority status during the 800 years of so-called Mughal rule, they cannot be in danger today.

    Present rhetoric and challenges:

    • Need to have a broader outlook: Focusing solely on Total Fertility Rates to assess a group’s status overlooks broader factors like education and socioeconomic conditions. 
    • Need to survey Public Participation: The representation of a particular religious group in the state’s power structure is a crucial indicator of its well-being.
      • The Finance Minister recently highlighted the growth of the Muslim population as a positive sign, emphasizing that Indian Muslims enjoy more rights compared to minorities in some Muslim-majority countries. 
    • India is set to become the country with the largest Hindu and Muslim populations by 2050, showcasing the diversity and coexistence within the nation.

    What does the Population Data say?

    • Stabilizing of the Minorities: The data on the decline in Muslim women’s fertility rates, as seen in Census data, indicates a positive trend toward stabilization. (according to the United Nations Population Fund)
      • Demographers predict that by the end of the century, Muslims may constitute around 18.8% of India’s population, with Hindus maintaining a significant majority at 74.7%. 
    • Regional Variations: Various states have already achieved fertility rates below replacement levels, signaling a broader trend of population stabilization.
      • While the Population Regulation Bill in 2019 or the Population (Control) Bill in 2021 has been introduced, some demographers generally emphasize the importance of addressing population dynamics through education, healthcare, and socioeconomic development.
    • Lack of Data-evidences: Claims of alarming Muslim population growth in certain regions like Assam lack substantial evidence, with data showing different growth patterns across states.
      • Illegal Muslim infiltration from Bangladesh is generally said to be responsible for the demographic change since the 1970s in Assam.

    Are Coercive Methods Counter-productive?

    • International Norms and the Indian Government stance: Being a signatory to international covenants such as the International Covenant on Civil and Political Rights (ICCPR), India has to abide by the international norms on population control. 
    • The United Nations Human Rights Committee has categorically mandated that state parties to ICCPR cannot adopt policies that are compulsory, coercive, or discriminatory. 
    • Even the National Population Policy, of 2000 focused on more relevant socio-cultural factors such as age at marriage, age at birth, girl education, maternal and child health, and voluntary and informed consent over coercive methods.

    Conclusion: To address concerns about population growth, efforts should concentrate on improving education and economic opportunities for all communities, including Muslims, rather than resorting to coercive measures.

    https://www.thehindu.com/opinion/lead/a-well-intentioned-study-and-a-demographic-myth/article68168538.ece

    https://www.thehindu.com/news/national/hindu-population-falls-1950-2015-eac-pm-paper/article68156830.ece

  • Reservation within Constitutional bounds

    Why in the news?

    There’s a big argument between political parties about reservation. The BJP said some exaggerated things about the Congress wanting a caste census, suggesting it’s connected to religion.

    Current debates on Reservation and Sub-categorization:

    • Constitutional Provisions: The Constituent Assembly opposed reservation solely based on religion, and the Constitution guarantees prohibition of discrimination based on religion under Articles 15 and 16.
    • History of Sub-categorization in Karnataka: In Karnataka, all Muslim communities are included within the OBC quota, forming the basis for the BJP’s current campaign.
      • Sub-categorization for Muslims within the OBC quota has existed in Karnataka since 1995.
      • The H. D. Deve Gowda-led government introduced it but was later removed by the Basavaraj Bommai-led government. However, the status quo continues after court observation.
    • Reservation for Muslim and Christian Communities: Socially and educationally backward Muslim and Christian communities are provided reservations under the OBC/MBC category in various states, including Karnataka, Kerala, Tamil Nadu, and Andhra Pradesh.
    • Constitutional Language and SC/ST Communities: The Constitution specifies that for SCs, the person should profess Hinduism, Sikhism, or Buddhism, but no such requirement exists for STs.
    • Congress Manifesto Promise: The Congress has promised in its manifesto to work towards removing the 50% cap placed on reservations, suggesting a potential shift in reservation policy if they come into power.

    Affirmative action as per Constitution:

    • Constitutional Provisions: Articles 15 and 16 of the Constitution ensure equality to all citizens in actions by the state, including admissions to educational institutions and public employment.
      • They also enable the state to make special provisions for advancing socially and educationally backward classes, including OBC, SC, and ST.
    • Classification of Backward Classes: OBC is a collective term for socially and educationally backward castes, with some states also classifying certain castes as Most Backward Classes (MBC). Reservation percentages vary from state to state.
    • Indra Sawhney Case (1992): Supreme Court upheld 27% reservation for OBC. Caste is considered a determinant of class in the Indian context, and backwardness cannot be determined solely on economic criteria.
      • A cap of 50% was fixed for reservations unless there were exceptional circumstances.
    • Total reservation stood at 49.5% for OBC (27%), SC (15%), and ST (7.5%)—creamy layer exclusion from OBC reservation, with an income limit currently at ₹8 lakhs per annum.
      • Exclusion of children of certain government officials from the reservation.
    • Janhit Abhiyan Case (2022): The court upheld the constitutional validity of the reservation for Economically Weaker Sections (EWS). Economic criteria could be a reservation basis, according to the court’s majority opinion.

    Affirmative Actions Globally:

    • In the U.S., there is ‘affirmative action’ that consists of government-approved and voluntary private programs granting special consideration to racial minorities like African Americans and Latin Americans.
      • In Fair Admissions vs Harvard case (2023), the U.S. Supreme Court, however, ruled that race-based affirmative action programs in college admissions violate the equal protection clause of the U.S. Constitution.
    • In the U.K., the law enables voluntary ‘positive action’ which allows employers to combat the under-representation of disadvantaged groups.
    • France does not have any affirmative action based on race or ethnicity. It provides educational measures designed to increase opportunities for low-income students.

    Way Forward: 

    • Need for Sub-categorization: The Rohini Commission was set up to provide recommendations on sub-categorization among OBC castes, as a significant portion of reserved jobs and seats have been garnered by a small percentage of OBC castes/sub-castes. Similar issues of concentration of benefits persist in the SC and ST categories.
    • Inclusion of Dalit Christians and Muslims: Dalit Christians and Muslims also suffer from discrimination and lack of opportunities. There is a need to extend reservation benefits to these communities and address their marginalization.

    Mains PYQ:

    Q Whether National Commission for Scheduled Castes (NCSC) can enforce the implementation of constitutional reservation for the Scheduled Castes in the religious minority institutions? Examine.(UPSC IAS/2018)

  • Niti Aayog report finds ‘huge gap’ in cancer screening at Ayushman centres

    Why in the news? 

    Ayushman Bharat insurance scheme reached 5.47 crore users, but cancer screening at Health and Wellness Centers (HWCs) faces significant gaps, reports NITI Aayog.

    Objective of Ayushman Bharat Scheme:

    • Besides providing a Rs 5-lakh insurance cover, the scheme aimed to upgrade primary health centers to HWCs, offering annual screening for Non-Communicable Diseases (NCDs) including oral, breast, and cervical cancers for individuals aged 30 years or older.

    Coverage of Ayushman Bharat Scheme: 

    • Over 5.47 crore users have utilized the Ayushman Bharat insurance scheme, making it the world’s largest medical insurance scheme.

    The ‘huge gap’ in cancer screening at Ayushman Bharat Health and Wellness Centres (HWCs):

    • NITI Aayog Report Findings: A report from NITI Aayog, based on visits to HWCs in 13 states, highlights a significant gap in cancer screening services.
    • Limited NCD Screening: Although NCD screening is underway in most HWCs, yearly screening is largely absent, with less than 10% of facilities completing a single round of NCD screening.

    Reason behind the ‘huge gap’ in cancer screening at Ayushman Bharat Health and Wellness Centres (HWCs):

    • Methods of Screening: Official protocol mandates distinct screening methods for oral, cervical, and breast cancers. However, implementation of these methods faces challenges.
    • Lack of Awareness and Capacities: The gap in cancer screening is attributed to low awareness levels and lack of capacities among healthcare providers.
    •  Implementation fell short: Auxiliary Nurse and Midwife (ANMs), medical officers, and staff nurses were supposed to be trained in cancer screening methods, but implementation fell short.
    • Suboptimal Screening Activities: Screening for breast cancer relies on beneficiary education for self-examination, while cervical cancer screening remains to be operationalized. Oral cancer screening is performed on a case-by-case basis.
    • Infrastructure and Basic Devices: HWCs generally adhere to infrastructure standards, with basic devices and medicines available free-of-cost. However, the focus remains on improving cancer screening services to align with the government’s prevention and early detection efforts.

    Way forward: 

    • Awareness Campaigns: Launch comprehensive awareness campaigns to educate the public about the importance of cancer screening and early detection. This can involve community outreach programs, workshops, and informational sessions.
    • Utilize Technology: Integrate technology solutions such as telemedicine and mobile applications to facilitate easier access to screening services, especially in remote areas. Digital platforms can also aid in data management and monitoring of screening activities.
    • Performance Monitoring: Implement robust monitoring and evaluation mechanisms to track the implementation of cancer screening programs at HWCs.

    Mains PYQ: 

    Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain.

  • Meeting Nutrition challenge: What new guidelines prescribe?

    Why in the news? 

    According to the National Institute of Nutrition (NIN), approximately 56.4% of India’s overall disease burden is linked to poor dietary habits.

    Guidelines by the National Institute of Nutrition (NIN): 

    The NIN, operating under the Indian Council of Medical Research (ICMR), has issued comprehensive guidelines on nutrition for vulnerable groups, including pregnant and lactating women, children, and the elderly.

    • Preventive Measures: A healthy diet coupled with regular physical activity can prevent 80% of Type 2 diabetes cases and significantly reduce the burden of heart disease and high blood pressure.
    • Nutrition for Mother and Child: Proper nutrition from conception to the age of 2 years is crucial for optimal growth and development, preventing undernutrition, micronutrient deficiencies, and obesity in both mothers and children.
    • Suggested general dietary principles: The guidelines recommend getting required nutrients from at least eight food groups, including vegetables, leafy vegetables, roots and tubers, dairy, nuts, and oils.
    • Group-Specific Guidelines:
    1. Pregnant women: Small frequent meals for those experiencing nausea and vomiting. It recommends the consumption of lots of fruit and vegetables, especially those high in iron and folate content.
    2. Infants and children: For the first six months, infants should only be breastfed, and must not be given honey, glucose, or diluted milk. After the age of 6 months, complementary foods must be included.
    3. Elderly: The elderly should consume foods rich in proteins, calcium, micronutrients, and fiber. Apart from pulses and cereals — with at least one-third as whole grains — at least 200-400 ml of low-fat milk or milk products, a fist full of nuts and oilseeds, and 400-500g of vegetables and fruit should be consumed.

    Key concerns as per the National Institute of Nutrition (NIN):

    • Rising Noncommunicable Diseases (NCDs) Among Adolescents and Children: Due to poor dietary habits led to diseases like cardiovascular disease, cancers, and diabetes are increasingly affecting adolescents and even children in India.
    • Focus on Healthy Dietary Habits: The guidelines emphasize the importance of reducing salt intake and avoiding highly processed foods like packaged snacks, cookies, and sugary treats, which are linked to unhealthy diets and disease burden.
    • High Prevalence of Lifestyle Conditions: The Comprehensive National Nutrition Survey 2019 highlights a concerning prevalence of lifestyle-related conditions even among children, including overweight or obesity, diabetes, pre-diabetes, and abnormal cholesterol levels.
    • Cholesterol Levels: The survey indicates high levels of bad cholesterol (LDL and triglycerides) in children aged 5-9 and pre-teens and teens aged 10-19, along with low levels of good cholesterol in a significant portion of children and adolescents.

    Other concerns related to the “Dual nutrition challenge”

    • Incidence of micronutrient (zinc, iron, vitamins) deficiencies ranged from 13% to 30% of children between ages 1 and 19. But still, the prevalence of anemia is at 40.6%, 23.5%, and 28.4% in children under age 5, ages 5-9, and 10-19 respectively.
    • However severe forms of undernutrition such as marasmus (a deficiency of macronutrients such as carbohydrates and proteins) and kwashiorkor (deficiency of proteins) have disappeared from the country.

    Conclusion: Implementing these guidelines effectively can significantly contribute to achieving Sustainable Development Goal (SDG) targets, particularly SDG 2 (Zero Hunger), SDG 3 (Good Health and Well-being), and SDG 12 (Responsible Consumption and Production).

    Mains PYQ: 

    Q How far do you agree with the view that the focus on the lack of availability of food as the main cause of hunger takes the attention away from ineffective human development policies in India? (15M) UPSC 2018

  • The unseen effects of Climate Change on Mental Health

    Why in the News? 

    Studies show that individuals with schizophrenia are more likely to experience fatal effects from extreme heat compared to those with kidney or heart problems as per Geo Health report.

    What is schizophrenia? 

    As per the National Institute of Mental Health, Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which can be distressing for them and their family and friends.

    Effects of Extreme Heat  as per the Geo Health Report:

    • Schizophrenia Heat-Related Deaths: GeoHealth in 2023 revealed that an extreme heat event in British Columbia in 2021 led to more fatalities among individuals with schizophrenia compared to those with kidney and heart diseases.
    • Mental Health Conditions: People with mental health conditions, including schizophrenia, anxiety, and bipolar disorder, were identified as being at higher risk of succumbing to heat-related deaths during extreme heat events.
    • Impact of Extreme Heat Event: British Columbia experienced an eight-day extreme heat event in 2021, with temperatures soaring as high as 40 degrees celsius, significantly above the average temperature of around 20 degrees celsius. The region recorded approximately 740 excess deaths during this heat wave.
      • Researchers analyzed the data based on various medical conditions, including heart disease, schizophrenia, chronic kidney disease, dementia, depression, Parkinson’s disease, and osteoporosis.
    • Higher Risk of Schizophrenia: Contrary to expectations, the study reported a 200% increase in the prevalence of schizophrenia diagnoses during the extreme heat event in 2021 compared to a summer without recorded heat waves.

     Key challenges for treating Schizophrenia:

    • Dysfunction of the Hypothalamus: The dysfunction of the hypothalamus, a structure deep in the brain responsible for maintaining bodily homeostasis, may contribute to increased vulnerability to heat stress among individuals with schizophrenia.
    • Impact of Antipsychotic Medications: Certain antipsychotic medications prescribed for schizophrenia can interfere with the functioning of the hypothalamus, potentially raising body temperature. This side effect, when combined with high ambient temperatures, can lead to fatal outcomes.
    • Psychotic Symptoms and Anosognosia (unable to be aware of the symptoms): Individuals with schizophrenia often experience psychotic symptoms such as hallucinations, delusions, disorganized thinking, and memory loss. The anosognosia, a condition where individuals are unaware of their illness can further complicate treatment efforts.

    Way Forward:

    • Enhanced Monitoring and Support Systems: Implement enhanced monitoring and support systems for individuals with schizophrenia during extreme heat events.
    • Education and Awareness Campaigns: Conduct education and awareness campaigns to inform individuals with schizophrenia and their caregivers about the risks of heat-related distress and the importance of staying cool and hydrated during extreme heat events.
    • Tailored Treatment Plans: Develop tailored treatment plans for individuals with schizophrenia that take into account the potential impact of antipsychotic medications on body temperature regulation.

    Mains PYQ 

    Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)

    With inputs from:

    https://agupubs.onlinelibrary.wiley.com/doi/10.1029/2022GH000729

    https://www.nimh.nih.gov/health/topics/schizophrenia#:~:text=What%20is%20schizophrenia%3F,for%20their%20family%20and%20friends

  • [8 May 2024] The Hindu Op-ed: A dignified peaceful passing is everyone’s right

    Mains PYQ Relevance: 

    Q) Appropriate local community-level healthcare intervention is a prerequisite to achieving ‘Health for All’ in India. Explain. (UPSC IAS/2018)
    Q) To enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss. (UPSC IAS/2020)

    Note4Students: 

    Prelims: Right to life; Right to health; Right to die with dignity;

    Mains: Judicial Intervention in Health Care sector;

    Mentor comments: Death is inevitable, the one certainty in life. When the time comes, and if you have an incurable disease, how would you like to go? Would you prefer your bed in your home, with your loved ones around you? Or would you prefer being all alone in an Intensive Care Unit (ICU) with a tube in every orifice, hooked to machines that measure the functioning of every vital organ in your body, with each malfunctioning organ supported artificially? When facing an incurable illness, the choice between passing away at home surrounded by loved ones or in an ICU on life support is deeply personal (Right to Privacy). Some prefer the comfort and intimacy of home, while others seek every medical intervention, even if alone. There have been long debates on euthanasia and Palliative care for old people to protect their rights. Courts, through various decisions, have recognized the right to die with dignity as a fundamental right and an integral part of the right to life under Article 21.

    Let’s learn

    —

    Why in the News?

    Ronald Reagan, the 40th President of the USA, died at 93 in his home surrounded by his family members (2004). However, India’s former PM Atal Bihari Vajpayee died (2018), nine years after a stroke that had left him non-ambulant. 

    • Hence, communicating end-of-life wishes is crucial to ensure one’s final moments align with their values.

    What is the difference between Life support System and Palliative Care?

    Life support SystemPalliative Care System
    What is it?It aims to prolong life by artificially maintaining vital bodily functions.It focuses on improving quality of life by relieving symptoms, pain, and distress, regardless of prognosis.
    Treatment It involves invasive medical interventions like ventilators, dialysis, and feeding tubes.It emphasizes comfort-oriented, non-curative treatments to alleviate suffering.
    GoalsTo sustain life, even if it means prolonging the dying process.To enhance quality of life and provide comfort, even if it means foregoing life-prolonging treatments.
    TimingUsed in critical, end-stage illness when curative treatment is no longer possible.Can be provided at any stage of a serious illness, even alongside curative treatments.

    End-of-Life Practices: West vs. India

    • West Scenario: Advance directives for common, terminally ill allowed Natural Death by withdrawing life support.
    • Europe Scenario: Only 10.3% die on life support, others shifted to Palliative Care.
    • Indian Scenario:
      • 70% of incurable patients die on life support in ICUs, alone.
      • The remaining 30% die through “Left Against Medical Advice” – ethically questionable. A survey in Pune showed 83% prefer to die at home.
    What is the LAMA/DAMA Practice?

    Left Against Medical Advice/Discharged Against Medical Advice (LAMA/DAMA) refers to a patient leaving the hospital against the advice and recommendation of their treating healthcare providers.

    Its Causes:  Financial constraints, Belief in alternative therapies, Dissatisfaction with care, Terminal/advanced illness, and Lack of understanding about the treatment process. It adversely affects patient outcomes, increasing the risk of mortality and the need for readmission.

    The practice is considered ethically questionable, as it represents unplanned treatment limitations without a formal shift to palliative care.

    Challenges in Indian Context:

    • ICU Routinisation: 
      • Society has a mistaken belief in prolonging life at all costs and accepts ICU death as normal 
      • In recent years, a lack of adherence to ethical principles and routinization of intensive care deaths has become more common.
    • Lack of Legal Clarity:
      • Lack of death literacy and inability to make informed decisions plays a major setback in Indian Society.
      • Further, the absence of a Legal Framework for End-of-life Care in India creates wider challenges for hospital staff and patients.
      • The term “Passive Euthanasia” is considered a misnomer by ICMR. Withholding or withdrawing life support in futility is not euthanasia but allowing natural death.

    Initiatives taken on Palliative Care and Living Wills:

    • By WHO:
      • WHO defines health as “physical, social, and mental well-being” beyond just the absence of disease.
      • World Health Day (April 7) has passed and the theme for 2024 was “My health, my right”. 
    • By India (through Judicial intervention):
      • SC in 2018 recognized passive euthanasia and the ‘Right to die with dignity’ as a fundamental right subject to guidelines.
        • India’s Supreme Court (three-member Bench) ruled that the ‘Right to Health’ includes the ‘Right to palliative care’.
      • SC verdict of 2023 recognizes advance medical directives and withdrawal of life support in futility cases.

    Conclusion: The Lancet Commission Report 2022 speaks on the Value of Death and that modern society has become death-illiterate. Therefore, it is much required to bring awareness in our Indian Society on the value system of “dignified death”.

  • Why Youth Unemployment is India’s biggest challenge?

    Why in the News?

    The India Employment Report (IER) 2024, brought out by the Institute for Human Development (IHD) and the International Labour Organisation (ILO), has attracted widespread attention.

    • The analysis compares four years — 2000, 2012, 2019, and 2022 — which capture the changes over the past 22 years.

    Positives in the IER Report, 2024:

    • Employment Quality Improvement: The report highlights a robust improvement in employment conditions as indicated by the Employment Condition Index, with an increase in non-farm employment and a decline in agriculture employment, suggesting structural transformation in the economy.
    • Female Workforce Participation: There has been a significant increase in the female workforce participation rate, albeit mainly in the agricultural sector and in own-account and unpaid family work. The Female workforce participation (FWFP) rate from 24.5% in 2019 to 37.0% in 2023.
    • Labour Market Resilience Amidst COVID: Despite the global slowdown induced by the pandemic, the labor market in India bounced back well, with wages of casual workers increasing, leading to a reduction in extreme poverty and deprivation.
    • Unemployment Trends: Unemployment and underemployment rates increased until 2018 but have declined thereafter. The unemployment rate has declined from 6 percent in 2018 to 3.2 percent in 2023.

    Challenges as per the IER Report, 2024:

    • Emerging Employment Challenges: Challenges include a skewed employment pattern towards agriculture, increasing capital and skill-intensive production processes, low women’s participation, and rising educated youth unemployment.
    • Youth Unemployment Focus: The report emphasizes youth unemployment as a principal challenge, especially among educated youth, who account for a significant portion of total unemployment.
    • Informal Employment: Despite improvements, the majority of jobs remain informal and of lower productivity, with over 90% of employment being informal and 83% in the informal sector.

    Way Forward 

    • Policy Recommendations: Policy measures suggested include making production more employment-intensive, improving job quality, addressing labor market inequalities, enhancing skills training, and generating reliable statistics to better understand labor market dynamics.
    • Demographic Advantage: India is likely to have a demographic advantage for the next decade, and policy measures are recommended to leverage this advantage for robust economic growth.

    Mains PYQ:

    Q Besides the welfare schemes, India needs deft management of inflation and unemployment to serve the poor and the underprivileged sections of the society. Discuss.(UPSC IAS/2022)

  • Make the poor richer without making the rich poorer

    Why in the News? 

    Since the Congress Party released its Election Manifesto ’Nyay Patra’, the word ‘redistribution’ has dominated the election discourse.

    Arguments against the redistribution of wealth:

    • Against the fair mean: Wealth redistribution stems from a ‘zero-sum’ thought to reduce economic disparity. However, this approach conflates the process of acquiring wealth with the outcome, potentially penalizing even those who acquired their wealth through fair means.
    • Hindrance to Economic Growth: Implementing confrontational policies to make the rich poorer can hinder investments and trigger capital flight, which is essential for economic growth. Economic growth is necessary for increasing the overall economic pie and improving prosperity for all.

    Measures needed to reduce Inequality:

    • On Wealth and Inheritance Taxes: Wealth and inheritance taxes are seen as potentially punitive measures that may not effectively address economic inequality. The government needs to focus on fixing systemic issues rather than penalizing the wealthy.
    • On Policies: Economic growth is emphasized as crucial for addressing inequality. Policies should prioritize investment and avoid hindrances that might deter capital flow.
    • Job Creation and Labour Market Policies: Jobless growth and imbalance in capital-labour relations contribute to inequality. Labor market-focused policy incentives, such as employment-linked schemes and promoting labor-intensive activities, are proposed to rebalance this skew.
    • Overhaul of the taxation structure: The taxation system is criticized for burdening the poor and middle class disproportionately compared to corporations. There’s a call for an overhaul of the taxation structure to ensure fairness and simplicity, with a focus on lowering the tax burden for the common person.
    • Social Welfare Programs: Social welfare programs are deemed essential to provide a safety net for the poor until they can benefit from economic growth. Funding for such programs can come from a combination of faster growth, efficient tax collection, and welfare delivery mechanisms.

    Steps taken by the Government:

    • For addressing Social Inequality
        • Deen Dayal Upadhyaya Grameen Kaushalya Yojana (DDU-GKY) and Deendayal Antyodaya Yojana- National Urban Livelihoods Mission (DAY-NULM): These schemes aim to create additional employment opportunities in both rural and urban areas.
        • Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA): This scheme provides a legal guarantee for 100 days of employment per year to rural households
        • Pradhan Mantri Awas Yojana: This scheme provides affordable housing to the urban and rural poor
    • For improving Financial Inclusion
        • Atal Pension Yojana: This pension scheme targets the unorganized sector and private sector employees without pension benefits
        • Pradhan Mantri Jan Dhan Yojana: This scheme aims to provide universal access to banking facilities for all households
    • For enhancing Access to Basic Necessities
      • Pradhan Mantri Ujjwala Yojana: This scheme provides LPG connections to women from Below Poverty Line (BPL) households
      • Swachh Bharat Mission: This program focuses on providing toilets for every household and cleaning India’s cities and villages

    Conclusion: The Indian government implements schemes to reduce inequality. For example targeting financial inclusion, health protection, and economic development to reduce inequality. Beneficiaries include rural and urban poor, low-income families, and women from Below Poverty Line households.

    Mains PYQ:

    Q Can the vicious cycle of gender inequality, poverty, and malnutrition be broken through the microfinancing of women SHGs? Explain with examples. (UPSC IAS/2021)

  • Recognize ‘this leave’ as a woman’s right

    Why in the news?

    The DMK’s 2024 election manifesto in Tamil Nadu pledges to advocate for a law mandating menstrual leave for women, promoting gender equality and women’s welfare.

    Tracking Regional Progress:

    • Indian States:
        • The Kerala Sahitya Academy published work, Kerala in 19th Century, mentions that Kerala was the first (in the Cochin State) to recognize the need for “ period leave” for students and allowed it during examinations in 1912.
        • Kerala, in January 2023, introduced menstrual and maternity leave to all students above the age of 18.
        • Bihar, in 1992, allowed government employees two-day menstrual leave.
    • Asian Countries: 
      • Japan introduced menstrual leave in 1947, Indonesia in 1948, and South Korea. Taiwan and Vietnam have also implemented paid leave. But concerning the Asian countries, the progress made by the western world, except in Sweden and Spain, is still abysmal.

    Global Scenario:

    • International Labour Organisation report, in 2003, asked nations to recognise menstrual leave.
    • The World Health Organization recognised a non-governmental organisation driven World Menstrual Hygiene Day on May 28 from 2014.
    • India’s new code on Social Security, 2020, passed by Parliament, which consolidated existing labour laws (yet to be notified), has not included the aspect of menstrual leave in its code.

    Evidence related to impact:

    Women laborers in the sugarcane fields of Maharashtra and agricultural laborers in Telangana have been documented to have hysterectomies as menstrual-related absences could endanger their livelihoods.

    Legal Initiatives in India:

    • Bill in Tamil Nadu: In December 2021, S. Jothimani, Congress Member of Parliament (MP) from Tamil Nadu, had introduced a Private Member Bill named, ‘Right to Menstrual Hygiene and Paid Leave Bill, 2019’, which sought to bring menstrual leave into the ambit of the rights of a woman.
    • Bill in Arunachal Pradesh: Congress MP from Arunachal Pradesh, introduced a private member Bill on menstrual leave in 2017 (the Menstruation Benefit Bill, 2017).
    • Bill in Kerala: Shashi Tharoor, Congress MP from Kerala, introducing a similar Bill named The Women’s Sexual, Reproductive and Menstrual Rights Bill, 2018.
    • The Supreme Court of India, early in 2023, refused to entertain a public interest litigation in Shailendra Mani Tripathi vs Union of India which sought direction to the state on menstrual leave; it thought that it is in the policy domain of the government. 

    Way Forward: 

    • Legislation and Policy Implementation: Advocate for the passage of bills at both the state and national levels that mandate menstrual leave for women. Additionally, ensure effective implementation and enforcement of these policies to guarantee that women can avail themselves of their entitled leave without fear of discrimination or repercussions.
    • Awareness and Education: Launch comprehensive awareness campaigns to remove shame of menstruation and promote understanding of its biological, social, and cultural aspects.

    Mains PYQ 

    Q Women empowerment in India needs gender budgeting. What are requirements and status of gender budgeting in the Indian context?

  • Inequality can no longer be ignored

    Why in the news?

    The Congress’s party’s election manifesto, the Nyay Patra, has triggered a debate on inequality, concentration of wealth and the measures to address these.

    The reason behind the inequality in India:

      • Taxation Disparities: India’s tax-GDP ratio is comparatively low, standing at 17% as opposed to 25% in Brazil, indicating room for improvement in revenue generation. The taxation structure in India leans towards indirect taxes, which contribute significantly (about two-thirds) to overall tax revenue collection.
      • Regressive Taxation Structure: India’s tax system is described as regressive, indicating that it disproportionately impacts low-income individuals compared to high-income individuals. Indirect taxes, which are a significant component of overall tax revenue, tend to burden lower-income groups more than higher-income groups.
      • Lack in Tax Progressivity: There are concerns about the lack of progressivity in India’s direct tax regime, where higher-profit companies enjoy relatively lower effective tax rates compared to lower-profit companies.

    Welfare spending is low

      • Low Spending on Welfare and Social Sector: India’s expenditure on welfare and the social sector is significantly lower compared to other countries. Public spending on health remains low, approximately 1.3% of GDP, falling short of the National Health Policy (NHP) target of 2.5% of GDP by 2025.
      • Eventual decline Budget Allocations: Major budgetary allocations for programs like the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), education, and budgets for children have either declined as a proportion of total expenditure or GDP.

    Way forward

    • Revenue Mobilization and Spending Priorities: There’s a pressing need to improve revenue mobilization progressively, ensuring that the burden of taxation is distributed fairly and equitably.
      • Simultaneously, increasing spending on areas that directly affect the lives of the poor is crucial. This includes healthcare, education, social protection programs, and employment generation schemes like MGNREGA.
    • Achieving Policy Targets: Meeting targets set by policies like the NHP requires a concerted effort to ramp up healthcare spending in line with national goals.

    Mains PYQ 

    Q) Despite the consistent experience of high growth, India still goes with the lowest indicators of human development. Examine the issues that make balanced and inclusive development elusive.  (UPSC IAS/2019)

    Q) Critically discuss the objectives of Bhoodan and Gramdan movements initiated by Acharya Vinoba Bhave and their success.  (UPSC IAS/2013)

  • Towards a less poor and more equal country

    Why in the news? 

    In March, World Inequality Lab, a Global Research Center focused on inequality and public policies, published in a paper titled, ‘Income and Wealth Inequality in India, 1922-2023: The Rise of the Billionaire Raj’. 

    Income and wealth inequality as per the World Inequality Lab: 

    • Income Inequality: In 2022-23, the top 1% of Indians received 22.6% of the national income, the highest in a century. The top 0.1% earned nearly 10% of the national income. Wealth inequality was also stark, with the top 1% holding 40.1% of the wealth in 2022-23, the highest since 1961.
    • Wealth Inequality Trends: Wealth concentration increased significantly between 1961 and 2023. The top 10% held 65% of the wealth in 2022-23, up from 45% in 1961. The bottom 50% and middle 40% saw declines in their share of wealth.
    • Comparison with Other Countries: India’s wealth inequality, while not as extreme as in Brazil and South Africa, increased threefold between 1961 and 2023. India’s income inequality is among the highest globally, surpassing South Africa, Brazil, and the U.S.
    • Impact of 1991 Economic Reforms: Inequality increased notably after the 1991 economic reforms in India. Growth in China has been broad-based compared to India, resulting in lesser income inequality despite higher growth rates in China.

    Present Dilemma in Human Development:

    • The Human Development Report (HDR) 2023-2024 ranked India 134 out of 193 countries. 
    • India is now the fifth-largest economy but it still ranks lower than Sri Lanka, Bhutan, and Bangladesh in human development. Its economic growth has not translated into growth in human development.

    Measures to Improve Human Development:

    • Investment in Education: Ensure access to quality education for all, from primary to higher levels. Focus on improving educational infrastructure, teacher training, and curriculum development.
    • Healthcare Access and Quality: Expand access to affordable and quality healthcare services, including preventive, primary, and specialized care. Invest in healthcare infrastructure, medical personnel, and technology.
    • Poverty Reduction: Implement social welfare programs to provide basic needs such as food, shelter, and clothing to the disadvantaged. Promote inclusive economic growth to create employment opportunities and increase household incomes.

    Conclusion: The Indian government has taken several steps including the creation and organization of women’s self-help groups, sending civil servants to areas with poor levels of human development,  and implementing land reforms. However, a major necessity of raising awareness is through an organic approach.

     

    Mains PYQ 

    Q Despite the consistent experience of high growth, India still goes with the lowest indicators of human development. Examine the issues that make balanced and inclusive development elusive (UPSC IAS/2019)

     

  • Urbanization, no liberating force for Dalits

    Why in the News?

    The Indian cities have failed with the aspirations and expectations of the Dalit liberation movement in urbanization.

    View of Ambedkar and  Jyotirao Phule on Urbanisation:

    • Urbanization as an Opportunity for Dalit Liberation: Both Ambedkar and Jyotirao Phule saw urbanization as an opportunity for Dalit liberation. They believed that the systems of caste oppression that were prevalent in Indian villages would weaken in cities.
    • City Life as Liberating and Liberal: Phule admired city life for its liberal atmosphere and the opportunity it provided him to earn a living. Similarly, Ambedkar saw cities as places where one could become anonymous, breaking free from the constraints of caste-based identities.
    • Transition from Caste to Class: Cities offered the potential for individuals to transition from a caste-based order to a class-based order. In cities, one’s status would be determined more by their accumulation of resources or capital rather than their caste background.

    Why Urbanisation is not a liberating force for Dalits?

    • Extension of Caste in City: The logic of purity-pollution extends to the broader urban environment, where Dalits carry the stigma of their ghettoized identity into public spaces. This perpetuates the association of Dalit identity with impurity and reinforces caste-based discrimination.
    • Meat as impure by the State: Governments impose Brahminical regulations on public spaces, reinforcing the perception of meat as impure. For example, it includes Regulations on meat shops and bans on meat-based street food in certain areas, often justified by citing religious sentiments.
    • Secular and Religious Spaces: The state’s regulations to maintain purity in both secular and religious public spaces, even extending to what pedestrians can visually encounter.
    • Poor Sanitation: A large-scale study also found that public services and access to Municipal Infrastructure such as clean drinking water are the worst in Dalit and Muslim ghettos
    • Issue of Sacrifice Zone: Research in sacrifice zones regions marked for severe environmental pollution such as landfills shows that such areas are overwhelmingly inhabited by Dalits and Muslims.
    • Statistics: A recent report by the ‘Housing and Land Rights Network’ on forced evictions in India also shows that Dalits and Muslims are the most impacted by slum demolition drives.

    Suggestive Measures:

    • Community Empowerment: Empower Dalit and Muslim communities through grassroots initiatives, community organizations, and advocacy groups.
    • Awareness and Sensitization: Conduct awareness campaigns and sensitization programs aimed at challenging caste-based stereotypes and prejudices in urban society.
    • Infrastructure Development: Prioritize investment in infrastructure development in Dalit and Muslim ghettos to improve access to basic amenities such as clean water, sanitation, healthcare, and education.

    Conclusion: Urbanization hasn’t fulfilled Dalit liberation hopes. Ambedkar and Phule envisioned cities as liberating, but caste persists. Measures include community empowerment, awareness campaigns, and infrastructure development to combat discrimination and improve living conditions.

  • Data for better education, a brighter future for students

    PYQ Relevance:

    Mains: 

    Q National Education Policy 2020 isin conformity with the Sustainable Development Goal-4 (2030). It intends to restructure and reorient education system in India. Critically examine the statement.(UPSC IAS/2020)

    Q The quality of higher education in India requires major improvement to make it internationally competitive. Do you think that the entry of foreign educational institutions would help improve the quality of technical and higher education in the country. Discuss.(UPSC IAS/2015)

    Mentore comment: The release of the Annual Status of Education Report (ASER) 2023 in mid-January has once again drawn significant attention, following a tradition dating back to 2005, with exceptions during the COVID-19 years. Among the multitude of insights provided by the report, particular focus has been placed on the foundational skills of 14-18 year olds, which has garnered headlines. While the learning outcomes data raises concerns, it is imperative for practitioners and policymakers to delve deeper into the data to extract actionable insights aimed at enhancing education and overall outcomes for India’s adolescents and youth.

    Why in the news? 

     The Annual Status of Education Report (ASER) 2023 was released in mid-January this year.

     Foundational learning trajectories as per ASER 2023 Beyond Basics survey  

    • District level Representation: The survey was conducted in 28 rural districts across 26 states, providing insights into the activities, abilities, and aspirations of 14-18 year olds at the district level, though not nationally representative.
    • Literacy : Overall, 26% of 14-18 year olds cannot read a standard two level text in their regional language, reflecting concerning literacy levels.  
    • Distribution of Children without Basic Reading Skills: Among 14-18 year olds without basic reading skills, 57% are enrolled in standard 10 or below, while 28% are not enrolled in any educational institution. This suggests a need for targeted interventions and efforts to encourage school attendance.

    Challenges in Reading Improvement: 

    • Many children who struggle with reading may face ridicule and embarrassment, leading to disengagement with reading. The availability of reading materials, including beyond textbooks, is crucial for developing reading habits and abilities.

    Children and careers

    • Educational Aspirations: More than 60% of surveyed adolescents aim to obtain a college education, with a higher percentage of girls aspiring for higher education compared to boys.
    • Work Aspirations: One in five respondents had not seriously considered their future careers. Among those who had, joining the police or defense forces was prominent for boys, while becoming a teacher or doctor was prominent for girls.
    • Perceptions of Vocational Education: Vocational education faced negative perceptions in some areas, seen as a fallback option for those unable to secure white-collar jobs. However, in Solan, Himachal Pradesh, context-driven vocational courses such as tourism and hotel management gained aspirational value, encouraging students to aspire for related professions with the support of on-the-job training and readily available career information.

    Challenges related to careers 

    • Need for Support and Mentorship: Youth require support, mentorship, and inspiration to evaluate their aspirations, identify alternative prospects, and prepare for their chosen paths.
    • Lack of Familiarity with Professions: Nearly half of the surveyed adolescents with work aspirations do not personally know anyone working in their desired profession, indicating a need for greater exposure and guidance.

     Digita literacy as per ASER 2023 report

    • Smartphone Ownership: Boys in the 14-18 age group are more than twice as likely to own smartphones compared to girls, with 43.7% of males owning smartphones compared to 19.8% of females
    • Digital Literacy: Girls are less likely to know how to use smartphones or computers compared to boys, with males outperforming females in tasks like using email, Google Maps, and other digital functions
    • Educational Usage: While about two-thirds of youth use smartphones for educational purposes, there is a notable emphasis on entertainment and social media over educational activities, indicating a need to leverage digital technology for educational purposes
    • Gender Gaps: The gender gap extends to online safety awareness, with boys being more familiar with safety settings than girls, highlighting the need for comprehensive strategies to address the digital gender divide

    Suggestive measures to address the identified issues:

    • Improving Foundational Learning: Encourage school attendance by addressing the needs of 14-18 year olds without basic reading skills, with a particular emphasis on those not enrolled in any educational institution.
    • Role of Community Libraries: Ensure effective management of community libraries and engage committed individuals to cultivate a culture of reading and support readers of all ages and abilities.
    • Educational and Career Aspirations: Address the lack of familiarity with professions by offering exposure opportunities and guidance to help youth make informed career choices.
    • Digital Literacy and Gender Gaps:  Promote educational usage of smartphones by leveraging digital technology for educational purposes and bridging the gender gap in online safety awareness.
    • Addressing Vocational Education Perceptions: Encourage context-driven vocational courses that align with local aspirations and provide on-the-job training and career information to support career choices.

    Conclusion 

    To address literacy and career challenges, prioritize targeted interventions to improve educational access and support, enhance digital literacy among girls, promote vocational education, and leverage digital technology for educational purposes, bridging gender gaps.

     

     

  • On Unemployment in Indian States

    Why in the news? 

    A recent report by the International Labour Organization (ILO) and the Institute for Human Development (IHD) revealed that two out of every three unemployed individuals were young graduates.

    Unemployment across Indian States: 

    • Highest Unemployment Rate: At almost 10%, Goa’s unemployment rate is more than three times the national average of 3.17%.
      • Four of the top five states with high unemployment rates (Goa, Kerala, Haryana, and Punjab) are comparatively richer states.
    • Lower Unemployment Rates: Maharashtra and Gujarat, which are rich states in western India, experience unemployment rates far less than the national average.
    • Unemployment in Northern and Southern states: All northern states (Jammu and Kashmir, Punjab, Haryana, Uttarakhand, and Himachal Pradesh) and most southern states have unemployment rates higher than the national average, except Karnataka.
    • Unemployment below the National Average: Out of the 27 states considered, 12 states have unemployment rates less than the national average.
    • Lower unemployment rates in poorer states: Except for Maharashtra and Gujarat, most states with unemployment rates lower than the national average also have per capita incomes lesser than the national average.

    What is the Relationship between Urbanisation and Unemployment? (ILO observations)

    • Relationship between Self-employment and Unemployment: The trend line shows a downward slope, indicating a negative relationship between self-employment and unemployment.
    • Informal self-employment mainly in Agriculture and Rural Economy: A significant portion of informal self-employment is in agriculture and the rural sector.

    • Relationship between Labor Force and Unemployment: Figure 3 illustrates a positive relationship between the urban share of the labor force and the unemployment rate. Highly urbanized states tend to have higher unemployment rates (Positive relationship).
    • High Unemployment and Urbanized states: States like Goa and Kerala, which are highly urbanized, experience high unemployment rates. This is attributed to the limited scope for informal jobs in urban settings compared to rural agriculture, which acts as a reserve for absorbing surplus labor.
    • Limited Informal Sectors: Although informal sectors exist and thrive in urban settings, they have limited capacity to absorb job-seekers compared to rural agriculture.
    • Exceptions states: Gujarat and Maharashtra, despite being highly urbanized, have lower unemployment rates compared to states like Uttar Pradesh and Madhya Pradesh.

    Nexus between Education and Employment:

    • Highly educated labor force and unemployment: Kerala, with a highly educated labor force (30% of graduates), faces high unemployment.
      • In contrast, Gujarat and Maharashtra have lower proportions of graduates in their labor force (14% and 20% respectively) and experience lower unemployment rates despite being richer and urbanized.
    • High unemployment among graduates: Graduates may lack the skills required for the growing modern sector, highlighting the need for improved teaching infrastructure and standards.
      • Graduates aspire to high-wage jobs that match their skills, leading to unemployment if the modern sector doesn’t expand enough to absorb them.

    Conclusion: Addressing youth unemployment necessitates improving education quality to match job market demands, fostering skill development for the modern sector, promoting entrepreneurship, and enhancing rural employment opportunities. Policy interventions should target these areas for inclusive growth and employment generation.

  • The advent of a holistic approach to ‘one health’

    Why in the news? 

    In the past, we have seen that there is interdependence between humans, animals, and the environment has been made increasingly evident with the emergence of pandemics such as COVID-19.

    • It is not just humans who are affected by pandemics but also livestock — an example being the outbreak of lumpy skin disease that has spread across countries.

    Why an integrated idea like the ‘One Health’ Mission is needed?

    One Health is an interdisciplinary approach that recognizes the interconnectedness of human health, animal health, and environmental health. It emphasizes collaboration across various sectors, including medicine, veterinary science, ecology, and public health, to address health challenges comprehensively.

    Key features of National One Health Mission:

    • Intersectoral Collaboration: The mission aims to coordinate, support, and integrate all existing One Health initiatives in the country, including the Ministries of Health and Family Welfare, Fisheries, Animal Husbandry and Dairying, Environment, and Science and Technology
    • Integrated Disease Surveillance: The mission implements integrated disease surveillance within and across human, animal, and environmental sectors to address communicable diseases, including zoonotic diseases, and improve overall pandemic preparedness and integrated disease control.
    • Consolidation of data: The mission creates an integrated, science-based environment where researchers from various disciplines can use laboratories as necessary and generate requisite inputs for One Health Science, including databases and models with a consolidated approach of ecologists, field biologists, epidemiologists, and other scientists.

     Challenges in National One Health Mission

    • Limited Database: There have been limited efforts to develop databases and models with a consolidated approach of ecologists, field biologists, epidemiologists, and other scientists to understand and respond to the drivers that threaten health and optimize the effectiveness of public health systems in achieving these goals within each sector.
    • Lack of Awareness and Understanding: The lack of awareness and understanding of the One Health concept among stakeholders hinders collaborative efforts required to address complex public health issues
    • Funding Constraints: Funding constraints are a significant barrier to implementing One Health interventions, especially in low- and middle-income countries that may need more resources to invest in One Health initiatives

    Conclusion: To address challenges in the National One Health Mission, efforts must focus on enhancing data collection, raising awareness among the stakeholders, and securing adequate funding. These measures are essential for effective implementation and holistic health management.

  • Implementing Universal Health Coverage

    Why in the news?

    On the eve of World Health Day (7th April), many countries aim to implement UHC (Universal Health Coverage) in the same way as India introduced its National Health Policy, in 2017. However, there exist challenges in India too for implementing it.

    Background:

    • On December 12, 2012, the UN General Assembly unanimously endorsed a resolution urging countries to accelerate progress towards UHC.
    • In India, the high-level expert group report, submitted to the Planning Commission in 2011, outlined a government intent to increase public financing for health to 2.5% of India’s GDP during the 12th Plan (2012-17).

    BACK2BASICS:

    About National Health Policy, 2017:

    It aims to achieve Universal Health Coverage and deliver quality healthcare services to all at an affordable cost. It focuses on improving health status through preventive, promotive, curative, palliative, and rehabilitative services with an emphasis on quality.

     

    What are the challenges in the Implementation of UHC in India? 

    • Federal Issue: Health is a state subject in India, but UHC policy is envisaged at the national level. This can lead to challenges in coordination between the central government and state governments.
      • While the Directive Principles of State Policy provide a basis for the right to health, the absence of a specific constitutional guarantee may create challenges in ensuring consistent and enforceable healthcare rights.
    • Migrant Population and Urban Slums:  Due to issues such as overcrowding, poor sanitation, and limited infrastructure, a significant portion of the population living in urban slums face issues with the availability and accessibility of Primary Health Services is hard to provide.
    • Lack of Finance: Implementing UHC requires significant financial resources. Reducing out-of-pocket expenditure and strengthening primary healthcare services necessitate substantial investments, which may strain government budgets and require innovative financing mechanisms to ensure sustainability.
    • Lack of Healthcare Infrastructure and Human Resources:  India faces shortages in both infrastructure and human resources, particularly in rural and underserved areas, which hinders efforts to improve healthcare accessibility and quality.
    • The vicious cycle of poverty: The vicious cycle of poverty and poor health perpetuates inequality in various spheres of life which eventually leads to the accessibility of health services.

    Suggestive Measures:

    • Addressing Urban Migrants’ Health Needs: Establishing mobile healthcare units or clinics that can reach migrant communities in urban and peri-urban areas, providing essential primary healthcare services.
    • Reducing Out-of-Pocket Expenditure: Simplifying the reimbursement process by digitizing healthcare payment systems and integrating them with government identification or mobile banking platforms to facilitate easy reimbursement for medical expenses.
    • Creating Inclusive Health Systems: Introducing multilingual and culturally sensitive health information materials and services to bridge language barriers and ensure accessibility for diverse urban populations.
    • Implementing Community-Based Primary Healthcare: Establishing community health centers or clinics in urban and peri-urban areas staffed by trained community health workers who can provide basic healthcare services and referrals.

    Conclusion: Building Constitutional backing, enhancing coordination, and federal with fiscal consensus with adequate infrastructure in addressing urban health needs can improve the reach of the Universal Health Program in India.

    Mains PYQ

    Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)

  • [8 April 2024] The Hindu Op-ed: Shaping India’s path to inclusive Health Care

    [8 April 2024] The Hindu Op-ed: Shaping India’s path to inclusive Health Care

    PYQ Relevance:

    Mains: 
    Q) Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC CSE 2015) 
    Q) The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC CSE 2022) 

    Prelims:
    With reference to National Rural Health Mission, which of the following are the jobs of Asha, a trained community health worker?  (UPSC CSE 2012) 
    1) Accompanying women to the health facility for antenatal care checkups
    2) Using pregnancy test kits for early detection of pregnancy
    3) Providing information on nutrition and immunization
    4) Conducting the delivery of babySelect the correct answer using the codes given below:
    (a) 1, 2 and 3 only
    (b) 2 and 4 only
    (c) 1 and 3 only
    (d) 1, 2, 3 and 4

    Note4Students: 

    Prelims: National Health Policy; Ayushman Bharat;

    Mains: Health Issues in India; Universal Health Coverage;

    Mentor comments: Indian Health Policies since Independence have neglected diverse perspectives critical for public health systems at the local level. This diversity impacts the nature of policies made, “because we are looking only from a certain lens”. Recently, with the passage of World Health Day 2024, WHO promoted the idea that ‘Health Equity’ is a source of optimism for millions of people, going beyond social justice or legislative change. Now the issue is with the theme of World Health Day ‘my health – my right’. How should access to health be envisaged? Given that health is a state subject (Seventh Schedule) and the ‘Universal Health Coverage’ policy is envisaged at the National level, there is a need for discourses on implementation. 

    Let’s learn. 

    —

    Why in the News?

    The World Health Organization (WHO) has declared health to be a fundamental human right. 

    • India’s ‘Health Equity’ issues require a comprehensive approach that goes beyond improvements in healthcare facilities.
    About World Health Day 2024:

    World Health Day (April 7) unites every country around ‘Health Equity’, an essential topic at the heart of global health and justice. 

    Theme for 2024: “My Health, My Right”.Although over 140 nations recognize health as a Constitutional right, the WHO Council on the ‘Economics of Health for All’ reported that more than half the world’s population needs complete access to essential health services. 

    There is an alarming gap in Indian health-care access, which was highlighted especially during the COVID-19 epidemic, environmental crises, and growing socio-economic gaps. 

    What is meant by Health Equity?

    ‘Health Equity’ ensures that every person has an equal opportunity to achieve their highest health potential, no matter what their circumstances. 

    WHO’s idea behind Health Equity – Ensuring Everyone’s Right to Health:

    • Aim: To eliminate unfair and preventable health disparities among different social and economic categories.
    • Significance:
      • Builds Equality: True health equity addresses the root causes of health inequities, such as poverty, discrimination, and limited access to resources.
      • Universal Coverage: Pandemics, climate change, and sociopolitical unrest exacerbate health inequities, particularly in diverse countries like India.
    What does the Indian Statistics say?

    1) 2011 Census: 

    Infectious diseases, such as tuberculosis, are 1.5 times more common in slums due to overcrowding and poor sanitation as compared to non-slum areas, according to the Indian Council of Medical Research. Disparities across caste and gender are profound. 

    2)National Family Health Survey (NFHS)-5 (2019-21) 

    Minorities: SCs and STs experience higher child mortality and lower immunization rates. 59% of women in the lowest wealth quintile suffer from anemia, demonstrating the intersection of caste, gender, and economic status in health outcomes.Non-communicable diseases (NCDs) account for more than 60% of all fatalities in India. The economic effect of NCDs could surpass $6 trillion by 2030.

    3)Public Health Foundation of India:
    Shortage of Doctors: The WHO data indicates that there are only 0.8 doctors per 1,000 people, which is below the advised ratio. Even though over 75% of Health-care professionals work in metropolitan regions, which only account for 27% of the population, the shortage is particularly severe in rural areas. 
    • Limitations in India:
      • Diversity: The road to health equity is fraught with difficulties, ranging from deeply ingrained social injustices to global systemic health concerns, particularly in multicultural countries such as India.
      • Comprehensive Planning: Achieving health equity requires a comprehensive approach beyond legislative reform, addressing socioeconomic determinants of health.
      • Collaboration and Coordination: Realizing health potential demands collective effort by governments, communities, and individuals to remove barriers.
      • Accessibility: Health equity includes targeting marginalized and vulnerable groups, climate change disproportionately impacting low-income and vulnerable people, and conflicts disrupting healthcare provision.

    Initiatives Taken by Government:

    • Ayushman Bharat Initiative: This initiative provides free health coverage to the bottom 40% economically, demonstrating a commitment to reducing health disparities.
    • National Health Mission (NHM): It includes both the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), thus reducing the healthcare gap between rural and urban India. It expands its access by strengthening infrastructure and providing essential services to vulnerable populations.

    Way Forward:

    • Requires a Comprehensive Approach: To move India towards Universal Health Coverage and a more equitable future, the government, civil society, healthcare providers, and communities need to work together.
    • Tap Organizations Together: Organizations (Non-Governmental organizations and Civic Societies) with a strong local presence are essential for health equity. They actively participate in every phase, from planning to evaluation, to guarantee the relevance and effectiveness of health programs. 
    • Successful collaborations: Need for open communication, respect for one another, and common goals because this can strongly emphasize empowering communities, sharing knowledge, and building capacity. For Example, WHO, the Global Fund and Gavi support health initiatives.
    • Building R&D: Research institutes and academic institutions offer crucial insights into health inequalities and the efficacy of interventions, assisting in creating evidence-based practices and policies supported by scientific studies.

  • [pib] Ayushman Bharat Health Accounts (ABHA)

    Why in the news?

    This newscard is an excerpt from an explainer published in the PIB.

    Ayushman Bharat Health Accounts (ABHA)

    • ABHA, an integral part of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), serves as a link for all health records of an individual.
    • It is a sub-component of the Ayushman Bharat Digital Mission launched in September 2021.
    • It is a 14-digit id employed to uniquely identify individuals, verify their identity, and connect their health records (with their consent) across various systems and stakeholders.

    Features of ABHA

    • Cashless Transactions: ABHA enables cashless transactions for eligible beneficiaries, reducing the financial burden during medical emergencies.
    • Electronic Health Records (EHR): It integrates electronic health records, facilitating storage, and retrieval of patient information for streamlined healthcare delivery.
    • Portability: ABHA accounts are portable across various healthcare providers under the Ayushman Bharat scheme, ensuring seamless access to services.
    • Real-time Monitoring: Incorporating real-time monitoring mechanisms to track fund utilization, ABHA ensures efficient allocation and prevents misuse.

    Various Components

    • Beneficiary Identification: ABHA involves the identification and registration of eligible beneficiaries under the Ayushman Bharat scheme, assigning a unique health identification number (UHID).
    • Funds Management: It manages the allocation and disbursement of funds for healthcare services, ensuring prompt and secure transfers.
    • Claim Settlement: ABHA processes and settles claims submitted by healthcare providers, verifying authenticity, and disbursing payments.
    • Audit and Oversight: Incorporating audit mechanisms to monitor fund utilization, ABHA ensures compliance with regulations and maintains system integrity.

    Back2Basics: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

    Details
    Umbrella Scheme
    1. Ayushman Bharat
    2. Incepted in National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC)
    Launch Year 2018
    Components
    1. Health and Wellness Centres (HWCs)
    2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)
    Pradhan Mantri Jan Arogya Yojana (PM-JAY)
    • Offers a sum insured of Rs. 5 lakh per family for secondary and tertiary care
    • Provides cashless and paperless access to services at any empanelled hospital across India
    • Portable scheme, allowing beneficiaries to avail treatment at any PM-JAY empanelled hospital
    Coverage
    • 3 days pre-hospitalisation and 15 days post-hospitalisation
    • Includes diagnostic care and expenses on medicines
    • No restriction on family size, age, or gender
    • Covers all pre-existing conditions from day one
    Beneficiaries Identified through Socio-Economic Caste Census (SECC) data
    Funding
    • Shared funding: 60:40 for states and UTs with legislature, 90:10 in Northeast states and J&K,
    • Himachal Pradesh, and Uttarakhand, 100% central funding for UTs without legislature
    Nodal Agency National Health Authority (NHA)

    • Autonomous entity under the Society Registration Act, 1860
    • Responsible for effective implementation of PM-JAY in alliance with state governments

    State Health Agency (SHA)

    • Apex body of the State Government responsible for the implementation of AB PM-JAY in the State

     

    PYQ:

    2021:

    “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse.

     

    Practice MCQ:

    Consider the following statements about the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY):

    1.    3 days pre-hospitalisation and 15 days post-hospitalisation.

    2.    Includes diagnostic care and expenses on medicines.

    3.    No restriction on family size, age, or gender.

    4.    Beneficiaries are identified from national family health survey.

    How many of the above discussed features is/are correct?

    (a) One

    (b) Two

    (c) Three

    (d) Four

  • Two States: a comparison on access to life-saving C-sections

    Why in the News?

    The study released by IIT Madras highlights the concerns related to high rates of C-section deliveries among women in Tamil Nadu, particularly in private hospitals.

    • This indicates the necessity for corrective measures to address the situation.

    What is a Caesarean section? 

    It is also known as C-section or cesarean delivery, which is the surgical procedure by which one or more babies are delivered through an incision in the mother’s abdomen.

    It is often performed because vaginal delivery would put the mother or child at risk.

     

    Changes in the share of births delivered by C-sections in public and private sector hospitals in India, Tamil Nadu, and Chhattisgarh between 2015-16 and 2019-21.

    • High C-section Rate in Public Hospitals: In public sector hospitals in Tamil Nadu, nearly 40% of women underwent C-sections during 2019-21.
    • High C-section Rate in Private Hospitals: Close to 64% of women underwent C-sections in private sector hospitals in Tamil Nadu during 2019-21, which is significantly higher than both the national average of around 50% and Chhattisgarh’s rate of 59%.
    • Higher than the National Average: The rate of C-section deliveries in Tamil Nadu’s public sector hospitals is substantially higher than the national average, which is approximately 16%. Additionally, it surpasses the rate in Chhattisgarh, where it stands at 10%.

    Reasons behind the increase in C-section rates despite a decrease in pregnancy complications:

    • Regional Disparities: In Chhattisgarh, the likelihood of a woman undergoing a C-section in a private hospital is ten times higher than in a public hospital. This suggests potential disparities in access to high-quality healthcare services between public and private sectors, with implications for maternal health outcomes.
    • Socioeconomic Factors: The study assumes that poorer households opt for public hospitals while richer households prefer private ones for deliveries. This socioeconomic divide may contribute to inequitable access to healthcare services at the national level.
    • Higher Likelihood in Private Health Facilities: Women delivering in private health facilities are more likely to undergo C-sections compared to those in public facilities, with a notable disparity observed in Chhattisgarh.
    • Maternal Age and Weight Status: Factors such as maternal age (35-49) and overweight status increase the likelihood of C-section delivery.
    • High gap between Poor and Rich: In India, the gap in C-section prevalence between the poor and non-poor narrowed in private facilities, but Tamil Nadu exhibited a concerning trend where a higher percentage of the poor underwent C-sections compared to the non-poor.

    Recommendations by the World Health Organization (WHO): Cesarean delivery rates should ideally not exceed 10-15% to achieve the lowest maternal and neonatal mortality rates. When C-section rates go beyond 10%, there is no significant decrease in maternal mortality. In 2021, global C-section rates surpassed 20%, and they are projected to increase to 30% by 2030.

    Conclusion: Access to C-sections in Tamil Nadu shows disparities, with high rates in both public and private hospitals. Addressing regional, and socioeconomic factors and adhering to WHO recommendations are crucial for equitable maternal healthcare.

    PYQ Mains 

    Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)

     https://www.indiatoday.in/health/story/rise-in-c-section-deliveries-despite-decrease-in-pregnancy-complications-iit-madras-study-2521773-2024-04-01

  • Hate Speech: Interpreting Section 153A IPC

    What is the news?

    • The Supreme Court reiterated that to constitute an offence under Section 153A of the Indian Penal Code (IPC), the essential ingredient is to create a sense of enmity and disharmony amongst two or more groups or communities.
    • Quite often, politicians are arrested under section 153 A of IPC for alleged hate speech.

    Section 153A of the Indian Penal Code (IPC)

    • Section 153A of the IPC deals with the offence of promoting enmity between different groups on grounds of religion, race, place of birth, residence, language, etc.
    • The primary is to prevent the promotion of disharmony or feelings of enmity, hatred, or ill-will between different groups in society.
    • It was enacted in 1898 and was not in the original penal code.

    Prohibited Acts:

    The section prohibits several acts:

    1. Engaging in activities that promote or attempt to promote feelings of enmity or hatred between different religious, racial, linguistic, or regional groups.
    2. Committing acts prejudicial to the maintenance of harmony between different groups or communities.
    3. Doing anything that disturbs or disrupts public tranquillity or creates unrest among various groups.

    Essential Elements:

    To constitute an offence under Section 153A, the following essential elements must be established:

    1. Promotion of enmity or hatred between different groups.
    2. Such promotion must be based on religion, race, place of birth, residence, language, etc.
    3. The intention behind the act must be to disrupt public tranquillity or to create disharmony among groups.

    Punishment:

    • Jail Term: Any individual found guilty of committing an offence under Section 153A may be punished with imprisonment for a term which may extend to 3 years, or with a fine, or with both.
    • Cognizable and Non-Bailable: The offence is a cognizable offence and the punishment for the same may extend to three years, or with fine, or with both. Further, the offence is non-bailable in nature, wherein the accused is tried by the magistrate of the first class.
    • Burden of Proof: It lies with the prosecution to demonstrate that the accused’s words, actions, or conduct were aimed at promoting enmity or hatred between different groups based on the specified grounds.

    PYQ:

    2014: What do understand by the concept “freedom of speech and expression”? Does it cover hate speech also? Why do the films in India stand on a slightly different plane from other forms of expression? Discuss.

     

    2022: With reference to India, consider the following statements:

    1. When a prisoner makes out a sufficient case, parole cannot be denied to such prisoner because it becomes a matter of his/her right.
    2. State Governments have their own Prisoners Release on Parole Rules.

    Which of the statements given above is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2

     

    Practice MCQ:

    Q.The Section 153A of the Indian Penal Code (IPC) essentially deals with:

    1. Fake News
    2. Hate Speech
    3. Protest without permission
    4. Encroachment