healthcare

In the news: The response to the Chan Zuckerberg plan to end disease, a stronger gutkha ban and more

This week’s wrap of health news across India.

Chan Zuckerberg Science: Is it feasible and is it a good idea?

Facebook founder and CEO Mark Zuckerberg and his pediatrician wife Priscilla Chan announced last week that they were pledging $3 billion of their fortune over the next ten years "to cure, prevent or manage all disease within our children's lifetime." Yes, that is not a particular disease but all disease.

The announcement has been met with mixed reactions. Some have called it a great and bold initiative and welcomed any contribution towards better health for people around the world. Most have pointed out that $3 billion is a pittance compared to the amount of money being spent on many public and private health programmes around the world, none of which have such audacious ambition. For example, the annual health budget of the National Institutes of Health in the United States that goes towards research if disease, treatment and development of vaccines is about 11 times that of the Chan Zuckerberg commitment for ten years at $32 billion.

The Chan Zuckerberg plan revolves around funding fundamental breakthroughs in medicine to target the four types of disease that cause the most death in the world – heart disease, cancer, neurological diseases and infectious diseases.

While some wonder whether the plan stems from hubris or one-upmanship of other billionaire philanthropists, The UK’s Telegraph points out that is all disease is cured in the next 80 years, it will put a huge strain on resources. “Without any deaths to offset all the births, we would have to make room on earth for an extra 208,400 people a day, or 76,066,000 a year – and that’s before those babies grow old enough to reproduce themselves,” said writer Jemima Lewis, making the point that we should aim to eliminate diseases that kills people much too young, or much too painfully but we need the diseases of old age.

Supreme Court reinforces gutkha ban

The Supreme Court on Friday came down heavily on companies circumventing the gutkha ban by selling pan masala and tobacco in separate pouches by reiterating the prohibition on sale of food products having tobacco and nicotine as its ingredients. The court directed authorities like the Food Safety and Standards Authority of India to endure the end of sales of all forms of chewable tobacco and nicotine.

A plea in the Supreme Court by senior advocate Gopal Subramaniam, who is amicus curiae in a batch of petitions related to the gutkha ban, pointed out that chewing tobacco manufacturers contended that the regulations restrained them only from selling gutkha, which is raw betel nut mixed with tobacco. So, instead various companies had started selling pan masala and tobacco in separate but often conjoined sachets, instead of the ready mixes.

India’s new family planning mission

The Ministry of Health and Family Welfare has announced a new scheme to promote family planning called Mission Parivar Vikas. The mission will be targeted at 145 districts in Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand and Assam – states that account for 44% of the country’s population.

India is the second most populous country after China and is set to have the highest population by 2022. India’s population, and therefore health, goal is to redice the Total Fertility Rate or the average number of children per woman to 2.1 by 2025. The Total Fertility Rate in the 145 districts covered t be covered in the new plan is more than or equal to 3.

The announcement of Mission Parivar Vikas comes just days after a study in the Lancet ranked India at 143 out of 188 countries in terms of progress in health. Family planning, as an effort to control population, is one of the United Nation’s health goals under the newly adopted Sustainable Development Goals.

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Relying on the power of habits to solve India’s mammoth sanitation problem

Adopting three simple habits can help maximise the benefits of existing sanitation infrastructure.

India’s sanitation problem is well documented – the country was recently declared as having the highest number of people living without basic sanitation facilities. Sanitation encompasses all conditions relating to public health - especially sewage disposal and access to clean drinking water. Due to associated losses in productivity caused by sickness, increased healthcare costs and increased mortality, India recorded a loss of 5.2% of its GDP to poor sanitation in 2015. As tremendous as the economic losses are, the on-ground, human consequences of poor sanitation are grim - about one in 10 deaths, according to the World Bank.

Poor sanitation contributes to about 10% of the world’s disease burden and is linked to even those diseases that may not present any correlation at first. For example, while lack of nutrition is a direct cause of anaemia, poor sanitation can contribute to the problem by causing intestinal diseases which prevent people from absorbing nutrition from their food. In fact, a study found a correlation between improved sanitation and reduced prevalence of anaemia in 14 Indian states. Diarrhoeal diseases, the most well-known consequence of poor sanitation, are the third largest cause of child mortality in India. They are also linked to undernutrition and stunting in children - 38% of Indian children exhibit stunted growth. Improved sanitation can also help reduce prevalence of neglected tropical diseases (NTDs). Though not a cause of high mortality rate, NTDs impair physical and cognitive development, contribute to mother and child illness and death and affect overall productivity. NTDs caused by parasitic worms - such as hookworms, whipworms etc. - infect millions every year and spread through open defecation. Improving toilet access and access to clean drinking water can significantly boost disease control programmes for diarrhoea, NTDs and other correlated conditions.

Unfortunately, with about 732 million people who have no access to toilets, India currently accounts for more than half of the world population that defecates in the open. India also accounts for the largest rural population living without access to clean water. Only 16% of India’s rural population is currently served by piped water.

However, there is cause for optimism. In the three years of Swachh Bharat Abhiyan, the country’s sanitation coverage has risen from 39% to 65% and eight states and Union Territories have been declared open defecation free. But lasting change cannot be ensured by the proliferation of sanitation infrastructure alone. Ensuring the usage of toilets is as important as building them, more so due to the cultural preference for open defecation in rural India.

According to the World Bank, hygiene promotion is essential to realise the potential of infrastructure investments in sanitation. Behavioural intervention is most successful when it targets few behaviours with the most potential for impact. An area of public health where behavioural training has made an impact is WASH - water, sanitation and hygiene - a key issue of UN Sustainable Development Goal 6. Compliance to WASH practices has the potential to reduce illness and death, poverty and improve overall socio-economic development. The UN has even marked observance days for each - World Water Day for water (22 March), World Toilet Day for sanitation (19 November) and Global Handwashing Day for hygiene (15 October).

At its simplest, the benefits of WASH can be availed through three simple habits that safeguard against disease - washing hands before eating, drinking clean water and using a clean toilet. Handwashing and use of toilets are some of the most important behavioural interventions that keep diarrhoeal diseases from spreading, while clean drinking water is essential to prevent water-borne diseases and adverse health effects of toxic contaminants. In India, Hindustan Unilever Limited launched the Swachh Aadat Swachh Bharat initiative, a WASH behaviour change programme, to complement the Swachh Bharat Abhiyan. Through its on-ground behaviour change model, SASB seeks to promote the three basic WASH habits to create long-lasting personal hygiene compliance among the populations it serves.

This touching film made as a part of SASB’s awareness campaign shows how lack of knowledge of basic hygiene practices means children miss out on developmental milestones due to preventable diseases.

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SASB created the Swachhata curriculum, a textbook to encourage adoption of personal hygiene among school going children. It makes use of conceptual learning to teach primary school students about cleanliness, germs and clean habits in an engaging manner. Swachh Basti is an extensive urban outreach programme for sensitising urban slum residents about WASH habits through demos, skits and etc. in partnership with key local stakeholders such as doctors, anganwadi workers and support groups. In Ghatkopar, Mumbai, HUL built the first-of-its-kind Suvidha Centre - an urban water, hygiene and sanitation community centre. It provides toilets, handwashing and shower facilities, safe drinking water and state-of-the-art laundry operations at an affordable cost to about 1,500 residents of the area.

HUL’s factory workers also act as Swachhata Doots, or messengers of change who teach the three habits of WASH in their own villages. This mobile-led rural behaviour change communication model also provides a volunteering opportunity to those who are busy but wish to make a difference. A toolkit especially designed for this purpose helps volunteers approach, explain and teach people in their immediate vicinity - their drivers, cooks, domestic helps etc. - about the three simple habits for better hygiene. This helps cast the net of awareness wider as regular interaction is conducive to habit formation. To learn more about their volunteering programme, click here. To learn more about the Swachh Aadat Swachh Bharat initiative, click here.

This article was produced by the Scroll marketing team on behalf of Hindustan Unilever and not by the Scroll editorial team.