{"id":34861,"date":"2018-10-31T14:11:22","date_gmt":"2018-10-31T08:41:22","guid":{"rendered":"https:\/\/blog.forumias.com\/?p=34861"},"modified":"2018-10-31T14:11:22","modified_gmt":"2018-10-31T08:41:22","slug":"falling-off-the-health-care-radar","status":"publish","type":"post","link":"https:\/\/forumias.com\/blog\/falling-off-the-health-care-radar\/","title":{"rendered":"Falling off the health-care radar:"},"content":{"rendered":"<p><a href=\"http:\/\/www.thehindu.com\/todays-paper\/tp-opinion\/falling-off-the-health-care-radar\/article19765879.ece\"><span style=\"font-weight: 400;\">Falling off the health-care radar<\/span><\/a><span style=\"font-weight: 400;\">:<\/span><\/p>\n<p><b>Overview<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The article discusses the problems with National Health Policy (NHP), and dealing and managing the non-communicable diseases (NCDs).<\/span><\/li>\n<\/ul>\n<p><b>What are the issues with National Health Policy?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The <\/span><b>National Health Policy (NHP), 2017<\/b><span style=\"font-weight: 400;\"> is unable to see the wood for the trees.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Life and death questions are dealt with perfunctorily or simply overlooked.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">For example, it overlooks the rapid rise in the share of the old (60 years or more), and associated morbidities, especially sharply rising non-communicable diseases (NCDs) and disabilities.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">With rising age, numerous physiological changes occur and the risk of chronic diseases rises.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The co-occurrence of chronic diseases and disability elevates the risk of mortality.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The recent report, <\/span><b>Caring for Our Elders: Early Responses, India Ageing Report \u2013 2017 (UNFPA)<\/b><span style=\"font-weight: 400;\">, complements the NHP by focussing on the vulnerability of the aged to NCDs, recent policy initiatives and the role of non-governmental organisations in building self-help groups and other community networks.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">While all this is valuable, it fails to make a distinction between the aged in general and those suffering from chronic conditions. It matters as many suffering from chronic conditions and disabilities may find it Nor are the important questions of the impact of these networks and their reliability discussed except in a piecemeal manner.<\/span><\/li>\n<\/ul>\n<p><b>Is the health system well-equipped to deal with surging NCDs?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The health system is ill-equipped to deal with surging NCDs; nor is the staff well trained to treat\/advise the aged suffering from dementia or frailty, and for early diagnosis and management of conditions such as hypertension.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The quality of medical care is abysmal, and hospitalisation costs are exorbitant and impoverishing.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Health insurance covers a fraction of medical expenses incurred.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">However, many of these chronic conditions such as hypertension can be prevented or delayed by engaging in healthy behaviours. Supportive families and community networks often make a significant difference.<\/span><\/li>\n<\/ul>\n<p><b>India Human Development Survey (IHDS): Analysis<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Based on the <\/span><b>India Human Development Survey (IHDS) 2015<\/b><span style=\"font-weight: 400;\">, among aged males and females (over 60 years)\u00b8 the proportions of those suffering from NCDs nearly doubled during 2005-12, accounting for about a third of the respective populations in 2012.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">More females than males suffered from these diseases.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The proportions were higher among those over 70, and these doubled in the age groups 60-70 years and over 70.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">A vast majority of those with NCDs had access to medical advice and treatment and the proportion remained unchanged during 2005-12.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">As there is considerable heterogeneity in providers of medical help \u2014 from qualified doctors to faith healers and quacks \u2014 and a sharp deterioration in the quality of medical services, it is not surprising that the proportions suffering from NCDs have shot up despite high access.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Access to government health insurance nearly doubled but remained low as barriers for the aged remain pervasive. In any case, the proportion of medical expenses covered was measly.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The IHDS also provides data on inter-caste and village conflicts, with the proportion of those suffering from NCDs living in villages that experienced inter-caste or other conflicts more than doubling during 2005-2012. Lack of social harmony induces helplessness, disruption of medical supplies and network support.<\/span><\/li>\n<\/ul>\n<p><b>Loneliness and immunity: Risk factor for NCDs <\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Loneliness is a perceived isolation that manifests in the distressing feeling that accompanies discrepancies between one\u2019s desired and actual social relationships.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The link between loneliness and mortality is mediated by unhealthy behaviors and morbidity.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Research shows that loneliness increases vascular resistance and diminishes immunity.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Whether related to or unrelated to loneliness, a high risk factor for NCDs is daily consumption of alcohol, especially local brews.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Daily consumption of alcohol among the aged with NCDs rose more than twice over the period 2005-2012.<\/span><\/li>\n<\/ul>\n<p><b>What is the role of networking?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Another measure is the proportion of those married and widowed.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">However, children often play an important role in elderly support with the caveat that filial piety shows signs of diminishing.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">An important point is that today, \u2018women are increasingly filling other roles, which provides them with greater security in older age.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">But these shifts also limit the capacity of women and families to provide care for older people who need it\u2019.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">That social networks are effective in providing support to the aged is far from axiomatic as there are questions of size of a network, whether it is proximal or non-proximal and whether there is social harmony.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">If social networks are instrumental in bonding together in periods of personal crises, this could compensate for a lack of family support, e.g. widows living alone, and help alleviate morbidity.<\/span><\/li>\n<\/ul>\n<p><b>What does the World Report on Ageing and Health 2015 say?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The <\/span><b>World Report on Ageing and Health 2015 (WHO)<\/b><span style=\"font-weight: 400;\"> is emphatic about what is known as ageing in place.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">That is the ability of older people to live in their own home and community safely, independently, and comfortably, regardless of age, income or level of intrinsic capacity.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">This reinforces the case that solutions to those with chronic diseases lie within but also outside health systems.<\/span><\/li>\n<\/ul>\n<p><b>Conclusion: Policy perspective<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">From a policy perspective, health systems have to be configured to deal with not one NCD but multiple NCDs to manage them better.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The impact of multimorbidity on an old person\u2019s capacity, health-care utilization and the costs of care are significantly larger than the summed effects of each.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Besides, the reconfigured medical system must be complemented by stronger family ties and social networks.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">This is not as Utopian as it may seem as examples of such complementarities abound.<\/span><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Falling off the health-care radar: Overview The article discusses the problems with National Health Policy (NHP), and dealing and managing the non-communicable diseases (NCDs). What are the issues with National Health Policy? The National Health Policy (NHP), 2017 is unable to see the wood for the trees. Life and death questions are dealt with perfunctorily&hellip; <a class=\"more-link\" href=\"https:\/\/forumias.com\/blog\/falling-off-the-health-care-radar\/\">Continue reading <span class=\"screen-reader-text\">Falling off the health-care radar:<\/span><\/a><\/p>\n","protected":false},"author":61,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"footnotes":""},"categories":[555],"tags":[],"class_list":["post-34861","post","type-post","status-publish","format-standard","hentry","category-test-1","entry"],"jetpack_featured_media_url":"","views":{"total":0,"cached_at":"","cached_date":1704859846},"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts\/34861","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/users\/61"}],"replies":[{"embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/comments?post=34861"}],"version-history":[{"count":0,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts\/34861\/revisions"}],"wp:attachment":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/media?parent=34861"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/categories?post=34861"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/tags?post=34861"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}