The World Health Organisation (WHO) has recently released a list of “Ten threats to global health in 2019”.
What are the highlights and where does India stand?
Air pollution, climate change - This is the gravest risk, with 9 out of 10 people breathing polluted air across the world.
With 18% of the world’s population, India sees a disproportionately high 26% of the global premature deaths and disease burden due to air pollution.
Over half the 12.4 lakh deaths in India attributable to air pollution in 2017 were of individuals of age under 70, as per the India State-Level Disease Burden Initiative report.
The average life expectancy in India would have been 1.7 years higher if air pollution levels were lower than the minimum level causing health loss.
Noncommunicable diseases -Noncommunicable diseases (NCD) such as diabetes, cancer, and heart disease kill 41 million every year.
This is over 70% of deaths worldwide, including 15 million premature deaths of people in 30-69 age group.
India, notably, remains the “diabetes capital of the world”.
India’s current estimated cancer burden - over 1.5 million new cases - is predicted to nearly double in 20 years.
Global influenza pandemic -WHO has warned of another influenza pandemic in the world.
But global defences are only as effective as the weakest link in any country’s health emergency preparedness and response system.
Fragile, vulnerable settings - More than 22% of the global population live in places where prolonged crises and weak health services leave them without access to basic care.
[The crisis situation includes a combination of challenges such as drought, famine, conflict, and population displacement.]
In India, the massive distress in farm sector has engendered waves of internal migration for work.
This migrant population often live in unhygienic conditions with very little access to basic care.
The Rohingya migration crisis unfolding in Bangladesh could send ripples into India.
Moreover, natural calamities routinely bring health crises in their wake. E.g. the recent Kerala floods were followed by a leptospirosis outbreak
Antimicrobial resistance - Antimicrobial resistance (AMR) is what a pathogen develops upon non-lethal exposure to a drug.
It usually happens when patients do not complete the full dosage prescribed.
It is also a result of rampant over-the-counter sale of medications without the prescription of a registered medical practitioner.
This threatens to send the world back to a time when treating infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis were impossible.
India, China, and the Russian Federation accounted for 47% of the global incidence of MDR (Multi-drug-resistant)/RR (rifampicin resistant) TB in 2016.
India now has an AMR policy but implementation is poor.
Primary healthcare - WHO has highlighted that many countries did not have adequate primary healthcare facilities.
In India, only about 5,000-odd centres are estimated to be functioning currently, and there is high vacancy of doctors too.
The primary care arm of Ayushman Bharat, with a proposed 1,53,000 health and wellness centres, has received less attention.
Vaccine hesitancy - The reluctance to vaccinate despite the availability of vaccines threatens to reverse the progress made in tackling vaccine-preventable diseases.
Vaccination currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.
The Delhi High Court's recent ruling on parental consent in vaccination has the threat of adversely impacting vaccination drives.
Dengue - Dengue is endemic to India, and its season in countries like Bangladesh and India is lengthening significantly.
In 2018, Bangladesh saw the highest number of deaths in almost two decades.
The disease is spreading to less tropical and more temperate countries such as Nepal.
WHO estimates 40% of the world is at risk of dengue, with around 390 million infections annually.
HIV - The epidemic continues to rage, with nearly a million people every year dying of HIV/AIDS.
India has now launched a test and treat policy, and made HIV treatment the right of every individual who needs it.
The HIV/AIDS Act, 2018 makes access to anti-retroviral therapy (ART) an actionable legal right for Indians living with HIV/AIDS (about 21 lakh).
Also, India is a stakeholder in the WHO’s 90-90-90 target for HIV elimination.
[By 2020, diagnose 90% of all HIV-positive persons, provide ART for 90% of those diagnosed, and achieve viral suppression for 90% of those treated]
Ebola, other pathogens - Several Indian states battled Zika in 2018, and at least 17 people died of Nipah infection in parts of Kerala.
While India has been spared Ebola so far, the WHO prioritises research & development for several haemorrhagic fevers, Zika, Nipah, and SARS.
