1
INDIA
Is India doing marvellously well, or is it failing terribly? Total Population (in Billions)
1.21 2011 1.028 in 2001
G-20
10
$436
th largest economy in the world
averate annual income per capita in Uttar Pradesh
3
rd largest by purchasing power parity (PPP)
29.5%
of population below poverty line RSBY helpline
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The Economy of India is the 10th largest in the world by nominal GDP, 3rd largest by purchasing power parity (PPP). The country is one of the G-20 major economies, a member of BRICS and a developing economy among the top 20 global traders acc. to the WTO.
$294
averate annual income per capita Poverty line 2014 in Bihar
Rs 32 in villages
Rs 47 in cities Poverty rates in India’s poorest states are three to four times higher than those in the more advanced states. While India’s average annual per capita income was Tamil Nadu $1,410 in 2011 – placing it among the poorest of the world’s middle-income countries – it was just $436 in Uttar Pradesh (which has more people than Brazil) and only $294 in Bihar, one of India’s poorest states. The HDI is the rdfor highest for Kerala (0.625) followed by Punjab (0.569) and the lowest Orissa (0.442), Bihar (0.447) and Chhattisgarh (0.449).[3] most developed
3
in India
Perhaps no other country in the world offers such a rich diversity of religious, caste, ethnic, and linguistic identities as it is found in India. Forward castes • Other Backward Castes (OBC) • Dalits (Scheduled Castes) • Adivasis (Scheduled Tribes) • Muslims • Other minority religions (Christians, Sikhs, Buddhists, Jains)
Right to Education Act
India has made education free and compulsory for children ages 6–14. The vast majority of children are enrolled in government schools, especially in rural areas. But most children from elite households—the rich, the political class, government employees and the growing middle class—are sent to private schools. In many instances, boys are sent to private schools, and girls to free government schools. To reduce these trends towards segregation, India passed the Right of Children to Free and Compulsory Education Act in 2009. It requires private schools to admit at least 25% of students from socially disadvantaged and low-income households[4].
In comparison: Bangladesh, Bhutan, India, Nepal, Pakistan, Sri Lanka [1] World Trade Organization, World Trade Report 2013 [2] World Bank: India Country Overview 2013 [3] http://www.scribd.com/doc/252233423/Inequality-Adjusted-Human-Development-Index-for-Indias-State1#scribd [4]Source: Government of India 2009; Supreme Court of India 2012.
2
RURAL LIFE
Rural residents have lower incomes; their children stay in school shorter; when sick they have less access to medical care
800
2/3 Mio
have no toilets
people live in villages
121 33%
of all farm households have less than
0.4
Mio Agricultural Holdings
93
Mio small marginal Farmer
with a landshare of
44%
are indepted
47%
Total farm suicides
296,438 Maharashtra, richest state, crosses 60,000. [3]
higher,' says P Sainath.[4]
4.1
Mio Members
2 Tumbler System In more than
50%
A national survey in 2006 found that in more than half of rural communities, Dalits were not permitted to enter non-Dalit homes, to use the same laundry man or barber as non-Dalits, to go into the places of worship, nor to share food or water or dishes with non-Dalits. [2] The system, reported mostly in southern districts of TN, is prevalent in tea shops in many hamlets in Pollachi. In many stalls, tea is served in disposable plastic cups to Dalit villagers, whereas for customers belonging to the so-called upper castes, it is served in a glass. Worse, some tea shops in villages, have come up with an innovative two tumbler system to deceive authorities in case of a surprise inspection.
of children are malnourished
Poverty line 2014
Rs 32 in villages
'Suicide rates among Indian farmers were a chilling 47 per cent higher than they were for the rest of the population in 2011. In some of the states worst hit by the agrarian crisis, they were well over 100 per cent
Launched by the Government of Kerala in 1998 for wiping out absolute poverty from the State through concerted community action under the leadership of Local Self Governments, Kudumbashree is today one of the largest women-empowering projects in the country. The programme has 41 lakh members and covers more than 50% of the households in Kerala.
of communities are dalits not allowed inside houses
Hectares of land
50%
KudumbashreeEmpowering women
645
scheduled tribes[3]
“At the tea stalls in these villages, separate tumblers for Dalits are identified by dots marked in green or yellow at the bottom. In some cases, there is a cut mark on the top edge of the tumbler for Dalits,� [4]
The tribal population
constitutes 8.6% of the nation's total population, over 104 million people, are recognised as socially and economically vulnerable. Their lifestyles and food habits are different from that of their rural neighbours. They depend on minor forest produce and manual labour for livelihood. They may not have adequate income. Their food consumption pattern is dependent on the vagaries of nature and varies from extreme deprivation (in the lean seasons) to high intakes (in the post-harvest period). [2]K Marimuthu, president, Makkal Viduthalai Munnani, a local outfit which fights for the rights of Dalits. http://ibnlive.in.com/news/2tumbler-system-in-a-new-avatar-in-pollachi/182901-60-118.htm
HEALTH
3
Without good nutrition, neither communicable nor non-communicable diseases can be controlled.
Malnutrition is the worst form of noncommunicable disease and is an important risk factor for chronic diseases at a later date.
55%
Child Sex Ratio
Sex Ratio
Life expectancy of
1000 940
64/67
1000 914
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males
years (m/f)
have no toilets
males
Infant mortality rate of
46
females In 2011
females
per 1000 live births
Anaemic
Proportional mortality (% of total deaths, all ages, both sexes)* Injuries 12%
Cardiovascular diseases 26%
12% Communicabel, maternal, perinatal and nutritional conditions
28%
26%
56% women
Poor sanitation — and open defecation in particular — low social status of women, can account for a large part of the international variation in height, including that between India and sub-Saharan Africa. It is largely girls, especially those younger, who face the height disadvantage.
59%
Of children under 5 are stunted
7% Cancers 7% 13% Chronic respiratory 12% diseases 13% 2%
Other NCD 12%
Diabetes 2%
Total deaths: 9,816,000 NCDs are estimated to account for
60%
2,500
Premature mortality due to NCDs The probability of dying between ages 30 and 70 years from the 4 main NCDs is 26% Number of deaths, under 70 years Number of deaths, under 70 years Males Females 2,500 Number of deaths (thousands)
Number of deaths (thousands)
of total deaths
2,000 1,500 1,000 500 0 2000
2002
2004
2006
2008
2010
[1] Inequality- adjusted Human Development Index for India’s States, © UNDP India 2011
Cancer
Diabetes
2,000 1,500 1,000 500 0
2012
Cardiovascular Diseases
2000
2002
2004
2006
Chronic Respiratory Disease
2008
2010
Other NCDs
2012
[4]Farmers’ suicide rates soar above the rest by P. Sainath, The Hindu, May 18, 2013
HEALTHCARE
4 More than
Private sector
40%
80 %
of hospitalized people have to borrow money
of outpatient and 60% of inpatient care
Basic social securIty /Health Public expenditure
1.5% of GDP in India.
Only in Tamil Nadu the total health budget increased 3.6 times between 1993/94 and 2005/6
Need for hospital beds, scans and ambulances, addressed by women, are strongly related to pregnancy and child birth.
Hospital costs
58 %
of annual expenditure for Indian Households
OUT OF POCKET expenditure for private healtcare, more than
71 %
in private Household
Public spending on Health is one of the lowest in the world
The public expenditure on health in India is recorded one of the lowest amongst the developed as well as South East Asian countries, except Pakistan. The low per capita income country like Sri Lanka’s spends more public fund in health than India. The quantum of public spending on health, in per capita term, also recorded low in India. While, even some developing countries like, Nepal and Bangladesh (who’s per capita GDP almost less than half of India’s GDP) managed high public spending on heath out of their GDP than India. The low level of public expenditure has resulted in government failure in providing adequate public health infrastructure. The availability of health facilities in India is comparatively much lower (about 1:1000 ‐ bed: population ratio) than the developed nations, about 7:1000 (WHS, 2009). This probably forces the less privileged to seek unregulated private healthcare with significant adverse impact on out‐of‐pocket (OOP) expenditure. The burden on household out‐of‐pocket expenditure is accounted very high ranging from 71 per cent to 75 per cent . [1] Within India, healthcare services in the country vary substantially between states, regions and societies. These differences in healthcare provision translate to differences in various health indicators, including: Life Expectancy at Birth (LEB) and Infant Mortality Rate (IMR) .
The state of Tamil Nadu, located in the South of India, is one of the foremost states in terms of overall development. The state has the highest number (10.56%) of business enterprises in India (Provisional Results of Economic Census 2005). Tamil Nadu has also done very well in terms of human development among the better performing states in terms of health indicators Tamil Nadu had among the lowest percentage of the hospitalized falling into poverty from medical costs in 1995–96 – less than the national average.
Health care is main cause of poverty in India
“It is a paradox. Health care is supposed to make people well, productive and robust. But it is the reason for poverty in India, because of failing value system in health care sector,” The Hindu, March 17, 2015 The private sector has expanded rapidly in cities, towns and rural villages since the 1980s, and now accounts for 80% of outpatient and 60% of inpatient care. The most serious issue is a huge shortage in manpower in the public sector that provides healthcare to the poorer segments of the population. Indians who are hospitalized tend to spend 58% of their total annual expenditures on healthcare. More than 40% of hospitalized people in India manage to cover expenses by borrowing money or selling assets to cover expenses. Consequently, many hospitalized people are likely to fall into poverty. There is a great financial risk that hinders the poor from accessing private healthcare. [2]
Accessibility, Availability and Affordability
Lack of management, especially emergency care and short length of duty for doctors in the government – led Primary Health Centres, leads to low quality treatment and hasty and careless diagnosis. Due to a lack of explanation about diseases, physical problems, and medicines from doctors, patients are likely to lack knowledge about medicines and rely on heavy dosage medicines to seek quick recovery. It could be necessary for medical providers to explain usage of medicines and procedure of treatment in order to build awareness among patients. Primary Health Centers in village are mostly not offering any X-ray, ECG scan, ultrasounds, and so on. So most villagers have to visit nearby towns to avail of these facilities. The need for hospital beds, scans and ambulances, addressed by women, are strongly related to pregnancy and child birth. Accessibility would be even less of a concern for villagers if there were clinics or hospitals in the village that offered the aforementioned facilities Despite it being an illegal medical practice, unqualified doctors (‘quacks’) seem to exist and often meet villagers’ needs with 24-hour access and affordable medicines.[3] [1]ISID-PHFI Collaborative,Research Programme ISID, Working Paper Series CHANGING PATTERN OF PUBLIC EXPENDITURE ON HEALTH IN INDIA, Issues and Challenges http://111.93.33.222/pdf/wp154.pdf [2]http://www.ictph.org.in/gip-2009/paper-6-background.html [3 ]Exploring Gaps in the Existing Healthcare System in Rural Tamil Nadu, www.ictph.org.in
53
NUTRITION I.
"Estimates of general undernourishment - what is sometimes called protein-energy malnutrition - are nearly twice as high in India as in Sub-Saharan Africa." - Amartya Sen, Nobel Prize Winner
1/3
rd of the world’s hungry live in India.
Anaemic
56% 79% women
More than
Anaemic
(married)
of children age 6-35 months
77
million people have pre-diabetes
Vitamin D deficiency
70% –100%
in the general population
Iron deficiency anaemia (IDA)
70Mio
India is home
in the general population
The UN Food and Agriculture Organisation (FAO) defines hunger as the consumption of fewer than 1,800 kilocalories a day -- the minimum required to live a healthy and productive life.
“Higher growth rates in India has not been translated into hunger reduction,” [1]
The high incidence of hunger is despite India having enough foodgrain, indicating a failure in reaching the deprived or abject low levels of incomes for a vast segment of population. China's economy, which is four times bigger than India's, has made remarkable progress in reducing hunger.
MN deficiency is referred to as the hidden hunger
since often times it is not an obvious killer or crippler, but extracts heavy human and economic cost. Though anthropometric deficits are attributed to protein calorie malnutrition, MN deficiencies contribute significantly, because MNs are needed forutilisation of proteins and calories and to fight infection s from a young age. These anaemic girls face debilitating exhaustion. Their ability to learn is severely compromised. They struggle to get through daily chores, like caring for younger siblings or working on family farms. They may be getting through the day, but they aren’t getting the quality of life they deserve – now or in the future. If they do make the decision to have children when they’re older, anaemia puts these young women at a higher risk of death due to post-partum hemorrhage.[2]
3rd
Highest no. of obese people
Obesity has reached epidemic proportions in in the world after India in the 21st century, with morbid obesity the USA and China affecting 5% of the country's population. A high BMI is associated with higher blood pressure and risk of hypertension, higher total cholesterol, LDL cholesterol and triglyceride levels and lower HDL cholesterol levels. The overall risk of coronary heart disease and stroke, therefore, increases substantially with weight gain and obesity . Gall bladder disease and the incidence of clinically symptomatic gallstones are positively related to BMI.[3]
Unequal status tells on women’s nutrition While much of the earlier discussions, including influential work by Nobel laureate Amartya Sen, focussed on food availability and consumption, there has been a growing acknowledgement, including by Dr. Sen himself, that food consumption alone does not explain the scale of India’s under-nutrition.
Younger daughters-in-law in rural families have shorter children on average
There is new evidence that the unequal social status of women could play a significant — and as yet ignored — role in explaining India’s “inexplicably” high under-nutrition levels.. .[4] [1]Ashok Gulati, Director Asia, International Food Policy Research Institute (IFPRI) said after the release of the 2010 Global Hunger Index (GHI) [2]http://www.theguardian.com/global-development-professionals-network/2014/nov/10/anaemia-epidemic-we-are-neglecting-adolescent-girls-nutrition [3]World Health Organization; Obesity and Overweight. Available from http://www.who.int; 2005. [4]http://www.thehindu.com/news/national/unequal-status-tells-on-womens-nutrition/ article5004409.ece [5] http://infochangeindia.org/poverty/news/hunger-haunts-shining-india.html?Itemid=
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63
NUTRITION II.
Under-nutrition is more prevalent in rural areas, again mainly due to low socio-economic status. How much and what people eat Caste determines spending on food. and what work they do
37%
of rural households below the poverty line in 1993-94
70%
Of preschool children consume less than
50%
RDA of iron, vitamin A and riboflavin
Cereal-pulse based Indian diets
are qualitatively deficient in micronutrients particularly iron, calcium, vitamin A, riboflavin and folic acid (hidden hunger), due to low intake of income-elastic protective foods such as pulses, vegetables particularly green leafy vegetables (GLV), fruits, and foods of animal origin. In recent years, there has been substantial erosion of area under cultivation of coarse grains and millets and share of these nutritious grains in total cereals produced and consumed.
MICRO-NUTRIENT SECURITY FOR INDIA – PRIORITIES FOR RESEARCH AND ACTION Indian National Science Academy Bahadurshah Zafar Marg New Delhi-
MN intake
Basically there are four types of approaches to augment MN intake.
1) Pharmaceutical supplements, 2) Food fortification 3) Biofortification 4) Foodfortification (dietary diversification).
Micronutrient SupplementationNational Nutritional Anaemia Control Programme (NACP)In this programme supplements containing 100 mg of elemental iron + 500 μg folicacid are given to pregnant women for 100 days during pregnancy; 20 mg elementaliron and 100 μg folic acid are given daily to preschool children for 100 days in the year.9,10. Recently adolescent girls have also been included as part of the life cycle approach with same dose as pregnant women...
differs significantly by
caste
Inadequate intake of micronutrients such as zinc, vitamin D, calcium and vitamin B12
99%
of the 1000 Adivasi households from 40 villages in the two states, experienced chronic hunger
Higher prevalence of undernutrition in tribal population
99% of the 1000 Adivasi households from 40 villages in the two states, who comprised the total sample, experienced chronic hunger (unable to get two square meals, or at least one square meal and one poor/partial meal, on even one day in the week prior to the survey). Almost as many (24.1 per cent) had lived in conditions of semi-starvation during the previous month. Higher prevalence of undernutrition in tribal population is due to poverty and consequent undernutrition lack of awareness about, access to and utilisation of the available nutrition supplementation programmes; social barriers preventing the utilisation of available nutrition supplementation programme and services. poor environmental sanitation and lack of safe drinking water, leading to increased morbidity from water-borne infections; environmental conditions that favour vector-borne diseases; lack of access to health care facilities resulting in increased severity and /or duration of illnesses. [4]
Public Distribution System (PDS) India has a much disputed Public Distribution System, which distributes subsidized food and non-food items to India's poor. Major commodities distributed include staple food grains, such as wheat, rice, sugar, and kerosene, through a network of public distribution shops. India runs the world's largest free-meal programme for school-going children. Source: MICRO-NUTRIENT SECURITY FOR INDIA – PRIORITIES FOR RESEARCH AND ACTION Indian National Science Academy, Bahadurshah Zafar Marg, New Delhihttp://infochangeindia.org/poverty/news/hunger-haunts-shining-india.html?Itemid= The Economic Times, October 12, 2010 Hindustan Times, October 12, 2010 http://www.csmonitor.com, October 12, 2010 AFP, October 12, 2010 http://www.bbc.co.uk, October 2010 [4]http://wcd.nic.in/research/nti1947/7.10%20Tribals%20pr%204.2.pdf
73
AYURVEDA
Vedic medicine, considered one of the oldest systems of medicine in the world, was developed in India during the period 2000-1000 B.C. 2000 BC
1500-1000 BC
Rigveda is the oldest Atharvaveda described recorded document more plants and regarding use introduced basic of plants as Ayurveda concepts medicine in was derived from the India, Vedas, the compendium of ancient Indian knowledge
Ayurveda describes the beneficial, nonbeneficial, happy and unhappy aspects of life. Health is defined as the state of equilibrium of dosha (humours), agni (digestive juices, enzymes and hormones), dhatu (tissues) and the normal excretion of mala (waste materials), along with a happy state of atma (soul), indriya (sensory and motor organs), and manas (mind). Ayurveda is a Sanskrit word derived from ayuh (life) and veda (knowledge), and is also known as the “science of life”.
As per Charak Samhita, the main aim of Ayurveda has been described as "Ayurveda not merely being a system of medicine, but a way of life". Its objective is to accomplish physical, mental, social and spiritual well-being by adopting preventive and promotive approaches as well as treating disease with a holistic approach. The Ayurvedic concepts of physiology, pathology, diagnosis, medicine and therapeutics are based on the doctrine of tridoshas: vata, pitta and kapha. They are designated as doshas because of their capacity to vitiate other doshas and also as dhatus as they support the body. The doshas are present in every cell and move through every channel of the body.
About 15000-20000 plants have good medicinal value India with its ecological,geographical and climatic diversities is perhaps the richest nation with a vast herbal medicinal wealth. In india the therapeutic use of herbs dates back to the vedic period. The Rigveda has documented about 67 medicinal plants, Yajurveda 81 species and Atharvaveda 290 species. [2]
The western system of medicine was introduced into India by the British in the
19th century.
65 %
of India's rural population uses Ayurveda and herbal medicine for their primary health care[1]
Milestones in the development of Ayurveda
Ayurveda was derived from the Vedas, the compendium of ancient Indian knowledge. The Atharvaveda, or “fourth Veda” (1500-1000 BC) also mentions many medicinal plants and concepts from Ayurveda. The Charaka Samhita (1000 BC) and Sushruta Samhita (1000 BC) are the original texts of Ayurveda. The western system of medicine was introduced into India by the British in the 19th century. In 1827, classes in Ayurvedic medicine began at the Government Sanskrit College, Calcutta. A five-year degree course in Ayurvedic medicine and surgery was offered at Banaras Hindu University from 1927. In 1970, the Ayurvedic formulary of India (1.2) was published in two volumes by the Government of India. It contains over 600 compound Ayurvedic formulations. In 1999, Part I of the Ayurvedic pharmacopoeia of India (3) was published by the Government of India. To date, five volumes have been published. [3]
Training of practitioners of Ayurvedic medicine
Under the Central Council of Indian Medicine (CCIM), the regulatory body for education, the Bachelor of Ayurvedic Medicine and Surgery (BAMS) is awarded to all candidates who successfully complete a five-and-a-half year course including a one-year internship. A postgraduate MD (Ay.)/MS (Ay.) degree is awarded to successful candidates by a recognized educational institution after three years’ specialization in various divisions of Ayurveda. [4] Source: [1]Accord. to WHO 2003, http://apps.who.int/gb/archive/pdf_files/WHA56/ea5618.pdf [2] http://www.liveayurved.com/medicnal-plants-and-their-uses.shtml [3][4]Benchmarks for trainingin traditional / complementary and alternative medicine. Benchmarks for Training in Ayurveda, WHO 2010