Health

Center continues National Health Mission

Context: The Ministry of Health and Family Welfare has recently announced that India has achieved the National Health Policy (NHP) target of a maternal mortality rate (MMR) of 100 deaths per one lakh live births. The Ministry has announced the continuation of the National Health Mission, stating its achievements in healthcare.

Relevance of the Topic: Prelims and Mains: National Health Mission and its Relevance.

National Health Mission

National Health Mission (NHM) was launched in 2013 by subsuming National Rural Health Mission (launched in 2005) and National Urban Health Mission (launched in 2013).
Initiative of: Ministry of Health and Family Welfare
Aim: Achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs.
Main programmatic components include:
- Health System Strengthening
- Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A),
- Communicable and Non-Communicable Diseases

Targets under National Health Mission:

Reduce MMR to 1/1000 live births (100/1 lakh live births)
Reduce IMR to 25/1000 live births
Reduce TFR to 2.1
Prevention and reduction of anaemia in women aged 15–49 years
Reduce annual incidence and mortality from Tuberculosis by half
Reduce Leprosy to <1/10000 population and incidence to zero in all districts
Annual Malaria Incidence to be <1/1000
Less than 1 percent microfilaria prevalence in all districts
Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks
Prevent and reduce mortality from communicable & non-communicable diseases
Reduce household out-of-pocket expenditure on total health care expenditure

Key features of National Health Mission:

Comprehensive primary healthcare: Establishment of Health and Wellness centers to provide preventive, promotive, curative and palliative care service.
Maternal and child healthcare: Programs like Janani Suraksha Yojana and Janani Shishu Suraksha Karyakram to promote institutional deliveries and reduce maternal and infant mortality.
National Disease Control Programs with integrated management of communicable and non-communicable diseases. E.g.; National Vector Borne Disease Control Program.
Free drugs and diagnostics provision under Free Drugs Service Initiative.
Strengthening Rural healthcare by establishing Sub-centers and Community Health Centers in rural areas for accessible and affordable healthcare.
Community participation by formation of Village Health Sanitation and Nutrition Committees to engage local communities in health planning.

Achievements under National Health Mission:

Maternal Mortality Rate has declined from 130 per lakh live births in 2014-16 to 97 per lakh in 2018-20 (marking a 25% reduction).
The Under-5 Mortality Rate has decreased from 45 per 1,000 live births in 2014 to 32 in 2020 (75% reduction compared to global reduction)
Infant Mortality Rate has declined from 39 per 1,000 live births in 2014 to 28 in 2020.
Total Fertility Rate has decreased from 2.3 in 2015 to 2.0 in 2020, as per National Family Health Survey (NFHS-5).
Under the National Tuberculosis Elimination Programme (NTEP), the incidence of tuberculosis has reduced from 237 per 1,00,000 population in 2015 to 195 in 2023. The mortality rate has decreased from 28 to 22 in the same period.
Kala-azar elimination efforts have been successful, with 100% of endemic blocks achieving the target of less than one case per 10,000 population by the end of 2023.
Measles-Rubella Elimination Campaign, under the Intensified Mission Indradhanush 5.0, vaccinated over 34 crore children, achieving a 97.98% coverage.
National Sickle Cell Anemia Elimination Mission, launched in 2023, has screened over 2.61 crore individuals in tribal areas, working towards its elimination by 2047.
Malaria surveillance has increased and malaria deaths have decreased.

New Initiatives under NHM:

U-WIN platform (2023) aids in timely administration of vaccines and real-time vaccination tracking to pregnant women, infants, and children across India.
The number of operational Ayushman Arogya Mandir (AAM) centers has increased to 1,72,148 by the end of FY 2023-24.
Mobile medical units have expanded (over 1400 MMUs) to ensure healthcare access in remote and underserved areas.
Bharat Health Initiative for Sahyog Hita and Maitri (BHISHM): advanced mobile modular kits designed to offer rapid, first-line medical care during disasters or public health emergencies.
Certification of public health facilities under the National Quality Assurance Standards.

Also Read: National Health Mission

These improvements indicate that India is on track to meet its SDG targets for maternal, child, and infant mortality well ahead of 2030.

Maternity Benefits in India

Context: Despite legal provisions under the National Food Security Act (NFSA) 2013, implementation of maternity benefits has been inadequate. PM Matru Vandana Yojana (PMMVY), also has been restrictive and ineffective.

Relevance of the Topic: Mains: Maternity Benefit initiatives-Issues, Way forward

Maternity Benefit Initiatives in India

National Food Security Act (NFSA) 2013: Entitles all pregnant women (except those in the formal sector) to ₹6,000 per child.
PM Matru Vandana Yojana (PMMVY): Initially introduced in 2017, restricts benefits to one child per family, later extended to a second child (if a girl).
Maternity Benefits Act 1961 (amended 2017): Provides 26 weeks of paid maternity leave in the formal sector, compared to only ₹5,000 in the informal sector under PMMVY.

Issues with PMMVY Implementation

Violation of NFSA provisions:
- PMMVY provides only ₹5,000 instead of ₹6,000.
- Limiting benefits to one child (or two in case of a girl) contradicts NFSA's universal entitlement.
Shrinking Coverage:
- Effective coverage peaked at 36% in 2019-20 and crashed to 9% in 2023-24.
- Budgetary allocation for PMMVY fell to ₹870 crore in 2023-24, about one-third of the allocation five years ago.
- Required budget to cover 90% of births at ₹6,000 per child: ₹12,000 crore.
Lack of Transparency:
- The Ministry of Women and Child Development does not proactively disclose PMMVY data.
- Basic statistics on beneficiaries and disbursement rates are absent from public records.
Administrative and Technical challenges:
- Frequent software issues disrupted disbursements in 2023-24.
- Aadhar-linked payments and digital application processes create exclusionary barriers.
Comparison with State Schemes:
- Tamil Nadu: Offers ₹18,000 per child, with 84% coverage in 2023-24.
- Odisha: Provides ₹10,000 per child, covering 64% of births in 2021-22.
- PMMVY (all-India): Coverage fell below 10% in 2023-24.

Way Forward

Universal Coverage: Restore NFSA-mandated ₹6,000 benefit for every pregnancy.
Increase budget allocation: Align PMMVY spending with estimated needs.
Transparent implementation: Publish real-time data on applications, approvals, and disbursements.
Simplified disbursement process: Reduce bureaucratic and technological hurdles.
Indexation to inflation: Adjust maternity benefits in line with rising living costs.

Revamped scheme aligned with NFSA provisions is essential to ensure better maternal and child health outcomes. Strengthening maternity benefits is a social investment that benefits not just women, but the entire society.

Faecal bacteria levels surpass safe limits at Maha Kumbh: CPCB

Context: As per the recent report by the Central Pollution Control Board (CPCB) to the National Green Tribunal, the multiple spots in Prayagraj (where the Maha Kumbh Mela is underway), Uttar Pradesh have failed to meet primary bathing standards due to high levels of faecal coliform in water.

Relevance of the Topic: Prelims: Key facts about faecal coliform bacteria.

Major Highlights:

According to the CPCB, faecal coliform —a key indicator of sewage contamination— have exceeded the permissible limit of 2,500 units per 100 ml in various spots in Prayagraj.
The high levels of faecal bacteria in the waters pose significant risks of waterborne diseases, while excessive organic pollution threatens aquatic life and overall river health.

What is faecal coliform bacteria?

Coliform is a group of bacteria commonly found in the intestines of warm-blooded animals and humans. Faecal coliform bacteria is present in human or animal wastes.
While not all coliform bacteria are harmful, presence of faecal coliform bacteria in water suggests contamination from sewage or animal waste.
- They are commonly used as indicators of potential contamination in water.
- Their presence suggests that the water may also contain other harmful pathogens, such as viruses, parasites, or other bacteria (Salmonella, and E. coli), that originate from faecal matter.

Implications:

Health risks: The pathogens can enter the body via the mouth, nose and ears. Exposure to such contaminated water can lead to a range of health issues, including:
- Nausea, gastrointestinal infections, vomiting, diarrhoea.
- Skin rashes and eye irritations.
- Serious conditions like typhoid and hepatitis A.
- Respiratory issues due to inhaling water droplets containing bacteria.
Individuals with low immune systems, the elderly, and children are most vulnerable.

New Definition for Obesity

Context: The Lancet medical journal has proposed a new definition and method for diagnosing obesity, beyond simply looking at a person’s Body Mass Index (BMI).

Relevance of the Topic: Prelims: Basic idea of new definition for Obesity; Body Mass Index (BMI).

How is obesity measured at present?

Globally, the standard method of determining obesity employs Body Mass Index (BMI) cut-offs, as the sole determinant.
BMI is calculated by dividing a person’s body mass (weight) in kilograms by the square of their height measured in metres.
Global BMI cut-offs: A person with-
- BMI of less than 18.5 is considered to be underweight.
- BMI between 18.5 and 24.9 is considered to be normal.
- BMI between 25 and 29.9 is considered to be overweight.
- BMI over 30 is considered to be obese.

Why has the BMI method been criticised?

Relying solely on BMI cut-offs leads to both over-diagnosis and under-diagnosis of obesity.
- People with excess body fat may not always have a BMI of more than 30. But they may suffer the health consequences of obesity.
- People with high muscle mass may have a BMI of more than 30 while being extremely healthy.
E.g., In India many seemingly lean people with a BMI of less than 30 have abdominal fat that can affect the functioning of various organs.
- Indians get diabetes, hypertension, heart diseases and other consequences of obesity, even at lower BMI. This is because they have higher body fat percentages and central obesity as compared to Western counterparts.
- In India, BMI cut-offs were revised. BMI between 23 to 24.9 is deemed overweight and BMI of more than 25 indicates obesity.

What is the new proposed definition of Obesity?

Lancet Commission defines clinical obesity as a chronic illness that results in alteration in organ functions, regardless of other conditions a person might have.
The new definition takes into account physical parameters such as height, weight, waist circumference, muscle mass, and functioning of various organs.
Clinical obesity cannot be self-diagnosed. A physician will have to check for all kinds of signs and symptoms, such as:
- breathlessness, wheezing, sleep apnoea, high triglyceride levels, metabolic dysfunctions, non-alcoholic fatty liver disease.
- changes in reproductive system, heart failure, chronic fatigue, and knee and joint pain, physical activity of individuals etc.
Pre-clinical obesity: The new definition does away with the overweight category, and adds a category called pre-clinical obesity- where a person has excess body fat, but no associated ongoing illness.

How is body size calculated for this evaluation?

Lancet Commission suggests looking at any two of the following four parameters for evaluating body size:
- BMI
- Waist circumference
- Waist-to-hip ratio
- Waist-to height ratio
Doctors may also use methods such as Dexa scan to directly measure body fat.

New definition for Indians:

Indian guidelines will use the classifications of stage 1 and stage 2 obesity, instead of pre-clinical and clinical obesity.
- Stage 1 obesity: BMI of more than 23 — waist circumference and waist-to-height ratio is optional for this group — but do not have symptoms that show limitations in day to day activities.
- Stage 2 obesity: BMI of more than 23 and individual meets one more physical parameter of obesity (such as waist circumference and waist-to-height ratio), and suffer from obesity-associated limitations, co-morbid diseases.

Latest development in Obesity treatment:

Drugs like Ozempic, Wegovy, Zepbound are developed to deal with clinical obesity. They belong to a class of drugs known as glucagon-like peptide-1 receptor agonists (GLP-1RAs), which mimic a hormone (GLP-1) in the body that helps control insulin and blood glucose levels and promotes feelings of satiety. However, they are not free from complications.

Exercise helps Neurons to Grow

Context: A recent study by engineers at the Massachusetts Institute of Technology (MIT) has revealed that exercise may also stimulate the growth of neurons through its physical and biochemical effects.

Relevance of the Topic: Prelims: Basic idea of the experiment (developing exercise-based therapies to repair nerves).

Background:

Regular exercise strengthens our muscles, improves cardiovascular health, helps to maintain a healthy body weight, and is an effective stress buster.
Conventional concept of nerve-muscle interaction emphasises the nerve’s control over the muscles.
However, the researchers started to wonder if the reciprocal could be true: i.e., if stimulating muscles (exercise) could encourage the formation of nerves.

Impact of Exercise on Neurons

Researchers established a hint of a biochemical connection between muscle activity and neural growth.
The Experiment:
- The researchers grew small sheets of muscular tissues made from mouse muscle cells.
- Using genetic modification techniques, the team was able to contract the muscular tissue, when flash light was stimulated on it.
- Then the samples of the fluids (containing myokines like growth factors, RNA, and other proteins) surrounding the muscle were collected.
  - Myokines are proteins secreted by muscles, which are crucial for neural growth.
  - Myokines are secreted nearly all the time, but they are produced more during exercise.
- The myokine solution was transferred to a separate dish containing motor neurons. The motor neurons were grown from stem cells derived from mice.
  - Motor nerves are found in the spinal cord that control muscles involved in voluntary movement.
- After the motor neurons were exposed to the myokine mixture, they began to grow quickly: about four-times faster than neurons that did not receive the biochemical solution.
The result suggested exercise did not only stimulate neuronal growth: it also enhanced the maturity of neurons and their functional abilities.

Significance of the Research

Nerve Injury treatment: Explore the possibility of using targeted muscle stimulation to regenerate and grow neurons in a clinical setting. Develop reparative therapies for nerve injuries.
Neuro-degenerative disorders: Opens avenues for developing therapies to cure neurodegenerative disorders (like amyotrophic lateral sclerosis) by activating the muscles surrounding them.

Sudden Cardiac Deaths in Athletes

Context: Instances of sudden cardiac death (SCD) in athletes, while rare, remain a significant concern that requires careful attention and preventive measures.

Relevance of the Topic: Key facts about Sudden Cardiac Death & Cardiovascular diseases (CVDs).

What is Sudden Cardiac Death (SCD)?

The most common cause of SCD is sudden cardiac arrest (SCA), characterised by an unexpected circulatory arrest (a condition where blood circulation suddenly stops) typically due to cardiac arrhythmia, occurring within an hour of symptom onset.
- Sudden cardiac arrest (SCA) is the sudden loss of all heart activity due to an irregular heart rhythm.
- Breathing stops, the person becomes unconscious. Without immediate treatment, sudden cardiac arrest can lead to death.
It is concerning as it causes sudden death in a structurally normal heart with no other explanation and a history consistent with cardiac-related death.

- A cardiac arrhythmia is an irregular heartbeat. It occurs when the electrical signals that tell the heart to beat don't work properly. The heart may beat too fast or too slow. Or the pattern of the heartbeat may be inconsistent.

-A heart arrhythmia may feel like a fluttering, pounding or racing heartbeat. Some heart arrhythmias are harmless. Others may cause life-threatening symptoms.

Risk Factors:

The risk factors for SCA and SCD include:
- Coronary artery disease - Narrowing or blockage of coronary arteries (due to plaque/cholesterol buildup in these arteries), which supply oxygen-rich blood to the heart.
- Hypertrophic cardiomyopathy- A disease in which the heart muscle becomes thickened, also called hypertrophied. The thickened heart muscle can make it harder for the heart to pump blood.
- Arrhythmias - An irregular heartbeat.
- A genetic predisposition
- Pre-existing heart conditions
- Weight issues
- High-intensity exercise without proper training
- History of smoking
- Increased ambient temperature.

Exercise and Cardiovascular Health:

Exercise is a vital tool for promoting health and well-being. It improves cardiovascular risk factors like lipid levels, hypertension, insulin sensitivity, and weight.
Multiple studies have established a positive correlation between moderate aerobic exercise and reduced risk of coronary artery disease.

Guidelines to Prevent Sudden Cardiac Death (SCD) in Athletes:

According to International Olympic Committee recommendations, pre-participation screening and periodic health evaluation are the only ways to reduce the incidence of cardiovascular accidents and other injuries in athletes.
The World Athletics Health and Science Department, based on IOC guidelines, recommends a pre-participation medical evaluation (PPME) at the start of the season for athletes in competitive sports.
A study conducted on the benefits of pre-participation screening and periodic health evaluation demonstrated a drop in the incidence of SCD by 90% in young athletes.

Challenges:

Concerns with Athletes: During vigorous physical activity by athletes, there is a substantial increase in sympathetic nervous system activity. This surge can trigger arrhythmias and potentially lead to sudden cardiac arrest.
Pre-participation screening and periodic health evaluation may not be possible in mass endurance events where the majority of participants are recreational athletes. Despite screening, sudden cardiac arrest may be challenging to predict.

Way Forward

Prompt and appropriate resuscitation - Evidence points to excellent survival rates after arrest when appropriate resuscitation is started promptly (for every minute delay, there is a 7% decreased chance of survival.) Personnel trained in CPR and access to defibrillators on the route and at sports venues are crucial in reducing the incidence of sudden cardiac death.
Periodic health evaluations - As athletes, competitive or recreational, it is important to have periodic health evaluations. The ECG needs to be read by a trained physician who is aware of the physiological and structural adaptations in the heart of an athlete.
Correct medical information should be provided honestly by the athletes during their screening.
Workouts under trained coach - The risk of sudden cardiac death is higher in those with pre-existing conditions, and hence it is important that exercise be carried out under supervision or with the help of a trained coach.

Cardiovascular diseases (CVDs):

CVDs are a group of disorders of the heart and blood vessels, including:

Coronary heart disease: It happens when the heart's blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries.
Cerebrovascular disease: It is an umbrella term for conditions that impact the blood vessels in the brain. It may cause a reduction of blood flow to your brain (ischemia) or bleeding (haemorrhage) in a part of your brain.
Peripheral arterial disease: A condition where the arteries that supply blood to the legs or arms narrow or become blocked.
Rheumatic heart disease: Rheumatic heart disease is a condition where the heart valves have been permanently damaged by rheumatic fever.
Congenital heart disease: It is one or more problems with the heart's structure that are present at birth.
Deep vein thrombosis: A condition when a blood clot (thrombus) forms in one or more of the deep veins in the body, usually in the legs.
Pulmonary embolism: A condition that arises when a blood clot that blocks and stops blood flow to an artery in the lung.

Osteoporosis: Explained

Context: Winter poses additional risks for Osteoporosis sufferers, with cold weather exacerbating bone and joint issues. A 2019 study revealed that India was the highest contributor to osteoporosis fracture-related deaths and disabilities worldwide.

Relevance of the Topic: Prelims: Key facts about Osteoporosis.

About Osteoporosis

Osteoporosis literally means "porous bone”. It is a bone disease that causes a loss of bone density and leads to the weakening of bones.
- Bone is a living tissue that is constantly being broken down and replaced.
- When viewed under a microscope a healthy bone looks like a honeycomb.
- When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than in healthy bone.
- Osteoporotic bones lose density or mass and contain abnormal tissue structures.
Impact: For people with osteoporosis bone loss outpaces the growth of new bone. Bones become porous (less dense), brittle and the fracture can occur with a minor fall, bump or sudden movement. It also causes changes in posture and the person stoops.
Risk Factors:
- Age, gender, low body weight, smoking, excessive alcohol consumption, and a family history of the disease.
- Individuals with low physical activity after the age of 40 or a history of fractures are also at higher risk.
Occurrence: The prevalence of osteoporosis occurs more with ageing. The prevalence of osteoporosis in elderly females is slightly higher than in males as Estrogen, a hormone in women that protects bones, decreases sharply when women reach menopause.
- Projected data shows that at least 46 million women in India currently live with post-menopausal osteoporosis.
Diagnosis: Bone mineral density scan (DEXA) helps healthcare providers detect osteoporosis by measuring how much Calcium and other minerals are present in an area of a bone.
Prevention: Nutritional intake of adequate Calcium, Protein, and Vitamin D and regular exercise.

Concerns

High prevalence: Owing to the large elderly population and prevalence of micronutrient deficiencies, particularly in women, and the lack of physical exercise, there is a high index of suspicion/occurrence of osteoporosis in India.
Knowledge Gap: There are no large-scale studies on osteoporosis in India and enormous gaps in knowledge about osteoporosis, even among doctors.
Infrastructural Gap: Most of the Indian population does not have access to DEXA or bone mineral density scan. A study found that in India, there are only 0.26 DEXA machines per million of the population.

Way Forward

Adequate Calcium intake, Sunlight exposure and Vitamin D levels, regular physical activity, and avoiding smoking and excessive alcohol consumption are essential for preventing bone loss in young adults.

Universal Health Coverage (UHC)

Context: Universal Health Coverage (UHC) is essential for ensuring that all individuals in India can access quality healthcare without facing financial hardship. Public spending on health plays a crucial role in achieving this goal.

Relevance of the Topic: Mains: Issues relating to development and management of services relating to Health.

Universal Health Coverage:

Health is a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity.
The concept of Universal Health Coverage covers three key elements — access, quality, and financial protection.
India is committed to achieving Universal Health care for all by 2030, which is fundamental to achieving the other Sustainable Development Goals.

Extent of Public Spending on Health in India:

Total Health Expenditure (THE) for India is estimated to be around 3.3% of GDP and ₹4,863 per capita.
Share of Out-of-Pocket Expenditure (OOPE) in Total Health Expenditure declined from 62.6% in 2014-15 to 47.1% in 2019-20.
Share of Government Health Expenditure in Total Health Expenditure increases from 29% (2014-15) to 41.4% (2019-20).
Government Health Expenditure’s share in the country's total GDP increases from 1.13% (2014-15) to 1.35% (2019-20).

Extent of Public Spending on Health in India 2

Despite the significant increase in government expenditure on Health, it is still way below the target of National Health Policy (2017)- 2.5% of GDP.

Need for Government Health Expenditure:

Preventive Healthcare: Unlike private Health expenditure, public spending invests heavily on preventive health care services like Immunization and Nutrition which ultimately reduces the expenditure burden on curative Healthcare.
Reduce Catastrophic Expenditure: In a country like India whose workforce is predominantly concentrated in the informal sector and devoid of social security net, there is more probability for incidence of catastrophic health expenditure on its population. Hence, significant public spending on health is necessary to reduce catastrophic health expenditure and incidence of poverty as a result of it.
Limitations of Private Participation:
- Affordability: Since private institutions require heavy investment in infrastructure, advanced equipment and quality professionals, health services are not affordable. This causes heavy out-of-pocket expenditure by households, especially in secondary & tertiary care.
- Issues in Private insurance: Adverse selection (asymmetric information between buyer and insurer) and moral hazard (reckless attitude of insured consumers), lead to higher pay-out by insurance companies. This cost is adjusted by increasing premium prices, which makes health insurance less attractive for the majority of Indians.
- Issues with private participation in public-funded health protection schemes:
  - Supply-induced demand: When patients are protected under schemes like PMJAY, private hospitals can resort to over-prescription of medication, non-standardised tests, and a longer duration of therapy to generate additional revenue.
  - High cost of premium due to 18% GST burden.
  - Low-reimbursement tariffs set by the government deter genuine private hospitals to be part of such schemes.
- Overpriced drugs: Private firms have invested heavily in R&D for new drugs, especially for secondary and tertiary care; hence, the price of patented drugs is passed on to consumers.

Conclusion: Private participation can only complement but can not replace public spending on Health to achieve the goal of Universal Health Coverage. To move India towards UHC, the government, civil society, health-care providers, and communities need to work together.

AIIMS devises new Breast Cancer Detection Tool

Context: The All India Institute of Medical Science (AIIMS) in New Delhi has recently unveiled an AI-based solution to assist in the early detection of Breast Cancer.

Relevance of The Topic: Prelims: Key facts about Breast Cancer; New AI Cancer Detection Tool

What is Breast Cancer?

Breast cancer results from abnormal growth in breast cells which form tumours.
- Breast cancer cells begin inside the milk ducts and/or the milk-producing lobules of the breast. The cells can spread into nearby breast tissue and create tumours.
- The earliest form (in situ) is not life-threatening if detected in early stages.
- In later cases, invasive cancers can spread to nearby lymph nodes or other organs (metastasize). Metastasis can be life-threatening and fatal.
Females at highest risk: Approximately 99% of breast cancers occur in women and 0.5–1% of breast cancers occur in men.
Treatment: Chemotherapy, radiation therapy, surgical removal of breasts etc.
Prevalence in India: Breast Cancer is the most common cancer in women in India. India ranks highest in the number of estimated breast cancer deaths (98,337) for the year 2022 among females.

Risk Factors:

Certain factors increase the risk of breast cancer, they include-

Increasing age (females over 40 years).
Lifestyle factors: Obesity, harmful use of alcohol, tobacco use, history of radiation exposure etc.
Genetic factors: The risks of developing breast cancer are markedly increased in people who inherit mutated BRCA1 or BRCA2 genes.
- BRCA1 or BRCA2 are tumour suppressor genes present in both males and females. They produce proteins that repair DNA and are responsible for the stability of genetic material.
- Mutations in these genes increase the chances of breast cancer, ovarian cancer, prostate cancer and pancreatic cancer.

About New AI Cancer Detection Tool:

The All India Institute Of Medical Science (AIIMS) in New Delhi has recently unveiled an AI-based solution that assists with the early detection of Breast Cancer.
Aim: Improving early breast cancer detection and reducing mortality by identifying breast cancer patterns specific to Indian women.
The project is part of the Indian government’s flagship scheme to establish three Centres of Excellence (CoE) in AI, focusing on healthcare, agriculture, and sustainable cities.

How will the AI model work?

The AI model will first scan a five-year database of women tested for breast cancer at some medical institutions (presently pilot study- AIIMS Delhi, NCI Jhajjar and PGI Chandigarh) regardless if they were tested negative or had developed cancer.
For identifying Indian risk factors for breast cancer, ASHA workers will collect data (after detailed conversations with families about their personal health status and family history of diseases) which will be fed into the AI tool.
After analysing the data, the AI tool will predict the risk of developing breast cancer by combining a patient’s general test results with their lifestyle and family history data.
- It will extract common risk factors and then recommend mammograms (specialised X-rays to check for signs of breast cancer) for women it thinks are cancer-prone.
- It will also help codify what constitutes a no-risk category.

Benefits of AI Cancer detection Tool:

Facilitate early screening: AI-trained systems can recognise complex features in mammograms that indicate cancer, thus picking up even the smallest signs.
Data-profiling based on risk factors: AI can interpret the data pool and identify which women may need mammograms while reassuring others with low-risk profiles.
Reduce cost: The AI-trained systems would not require a radiologist, help reduce the amount of manual work involved in screening which can lower costs.
Facilitate cancer detection in remote areas: The tool can provide advanced breast cancer screening, even in remote areas where there is a shortage of trained radiologists.

Presently, a pilot project has been initiated. If the AI tool is found to be effective, then an economic assessment will be conducted on the cost required to scale this up pan-India and take it up for licensing.

Why Centre wants states to make snakebites notifiable disease?

Context: The Union Health Ministry has urged states to make snakebites a notifiable disease.

Relevance of the Topic: Prelims- Notifiable diseases; Some basic facts about Snakebites.

Major Highlights:

Snakebites are a major public health challenge in the country. Some three to four million cases of snakebites are reported every year, and an estimated 58,000 persons die because of them annually.
Earlier in 2024, the Central government launched the National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE) with the aim of halving snakebite deaths by 2030. NAPSE recommended that snakebites should be made a notifiable disease.

Which types of diseases are considered notifiable?

Notifiable disease is a disease that is legally required to be reported to the government by both private and public hospitals.
State governments are responsible to declare a disease as a notifiable disease, and the list of notifiable diseases differs from state to state.
- Registered medical practitioners must notify such diseases, typically in a standard form within three days, or notify verbally via phone within 24 hours if urgent.
- Every government hospital, private hospital, laboratory, and clinic will have to report cases of the disease to the local government authorities.
- Any failure to report a notifiable disease is a criminal offence and the state government can take necessary actions against defaulters.
Usually, diseases are declared notifiable if they:
- Have the potential to cause an outbreak
- Leads to significant mortality
- Require rapid investigation and public health action.
Notifiable diseases in India: Cholera, diphtheria, encephalitis, leprosy, meningitis, pertussis (whooping cough), plague, tuberculosis, AIDS, hepatitis, measles, yellow fever, malaria, dengue.

Why is snakebite considered a ‘disease’?

Snakebites can lead to acute medical emergencies that require immediate care. They can cause severe paralysis that can prevent breathing, can lead to a fatal haemorrhage, and damage different tissues.
Snakebites need to be treated with antivenoms to prevent death and severe symptoms.

Which snakes can be fatal?

There are more than 310 species of snakes in India — 66 of them are venomous and 42 are mildly venomous.
Almost 90% of snakebites in the country are caused by the ‘Big Four’ — the Indian cobra, common krait, Russell’s viper, and saw-scaled viper.
- The commercially available polyvalent antivenom contains venom from all four species, and is effective against 80% of snakebites.
Most snakebites happen in densely populated, low-altitude, agricultural areas in states including Bihar, Jharkhand, Madhya Pradesh, Odisha, Uttar Pradesh, Andhra Pradesh, Telangana, Rajasthan, and Gujarat.

Why does the Centre want snakebites to be made notifiable?

To strengthen snakebite surveillance:
- Making snakebites notifiable is expected to lead to proper surveillance, and to help determine the precise numbers of snakebite cases and deaths across India.
- The government can then use this information to effectively manage, prevent, and control cases of snakebites.
- Adequate antivenoms can be provided to various regions, and proper training can be imparted in areas where snakebites are frequent.

What are the challenges of treating snakebites?

Inadequate Treatment:
- Snakebite victims either do not reach a healthcare centre in time or many reach out to faith-based healers instead.
- In many cases, staff at healthcare centres are not adequately trained in treating snakebites.
- Tests for confirming snakebites are also not available.
Limitations of Anti-venoms:
- The venom used to make the antivenom in India mostly comes from snakes caught by the Irula tribe, who live in Tamil Nadu, Karnataka, and Kerala. However, venom from the same type of snake can vary depending on the region, making the antivenom less effective in other areas.
- Commercially available antivenom does not work against some local snake species. E.g., green pit viper in the Northeast.
- Antivenoms themselves can cause various reactions.
Challenges in Venom collection:
- Experts have suggested setting up zonal venom collection banks across the country to develop antivenoms that can cover the regional differences. However, The Wild Life (Protection) Act, 1972, limits access to snakes, making it difficult to set up such banks.

Note:

Researchers are now developing artificially produced antibodies that can help neutralise the toxins across various snake species. They are also looking at artificially designed peptides to fight the toxin.

India needs Right to Disconnect

Context: Recently, Australia has announced “Right to Disconnect”; it allows employees to refuse to monitor, read, or respond to work-related communications outside of their scheduled working hours. Parliamentarian Shashi Tharoor has remarked that “inhumanity at the workplace must be legislated out of existence.” It is to be noted that India does not have specific laws recognising the right to disconnect from work.

Relevance of the Topic: Mains: Conceptual understanding of ‘Right to Disconnect’.

Issues and concerns regarding ‘Right to Disconnect’

A recent report by The Hindu reported that Indians in professional jobs, like auditing, Information Technology, and media, work more than 55 hours a week.
According to a study by ADP Research Institute, 49% of Indian workers said workplace stress negatively impacts their mental health.
It has been observed that employees physically leave the office, but they do not leave their work. They remain attached by a kind of electronic leash.

Constitutional and Legal Provisions in India:

Article 38 of the Constitution mandates that “the State shall strive to promote the welfare of the people”.
Article 39(e) of the Directive Principles of State Policy directs the state to direct its policy towards securing the strength and health of its workers.
Article 43 directs that the conditions of work must ensure a decent standard of life and full enjoyment of leisure and cultural opportunities.
Vishakha v State of Rajasthan (1997): The Supreme Court ruled that sexual harassment at the workplace violates fundamental rights, recognised the right to dignity at the workplace, and issued guidelines to ensure that there is a safe working environment for women and gender equality.
Praveen Pradhan v. State of Uttaranchal (2012): High Court of Uttarakhand held that “under the pretext of administrative control and discipline, a superior officer cannot be left to enjoy extreme liberty to make the intense humiliation and scolding inhumanly in front of all the subordinate staff members for a little lapse.”
Ravindra Kumar Dhariwal v. Union of India (2021): The Court read Article 14 to include ideas of inclusive equality to reasonably accommodate persons with disabilities, an employer must consider an employee’s individual differences and capabilities.

International Examples:

France: The Labour Chamber of the French Supreme Court ruled in 2001 that an employee is under no obligation to work from home or take home files and working tools.
Portugal: Portugal has a Right to Disconnect law, which makes it illegal for employers to contact employees outside working hours, except in emergencies.
Spain: Public workers and employees have the right to switch off devices in order to guarantee that, outside of legal or conventionally established working hours, their time off, leave and holidays are respected, in addition to their personal and family privacy, with the aim of promoting a good work-life balance”.
Australia: Australian Parliament passed the Fair Work Legislation Amendment, which gave employees the right to disconnect from work outside of working hours.
Ireland: Ireland has also recognised the right to disconnect for employees.

Suggestions and Way Forward:

Research by Harvard Business Review shows that working prolonged hours causes stress, coronary heart diseases, and impacts overall health. There is a widespread belief that overworked human beings bring in productivity, however research by the University of Oxford found a conclusive link between happiness (ensured by work life balance) and productivity.
Thus, a more nuanced approach, recognising the importance of hard work, ambition, and sustained productivity, while also ensuring a healthy and motivated workforce is needed.
- Employers can promote vacations, flexible working hours, promoting mental health and counselling, managerial restraint to respect personal time.
In 2018, MP Supriya Sule introduced a Private Member Bill in the Lok Sabha, delineating the right to disconnect from work after working hours. The bill included the provision of a penalty of 1% of the total remuneration of all employees to be paid by companies for noncompliance with its provisions; this bill can be brought back as a government bill to deal with this issue.

Immunotherapy for Cancer Treatment

Context: Despite decades of scientific progress the treatment of cancer remains a formidable challenge. However, research in recent years has brought new ways to combat the disease.

Relevance of The Topic: Prelims- Key facts about technologies for cancer treatment.

What is Cancer?

Cancer is a condition of uncontrolled cell growth and division in any part of the body. Cancer occurs when some disruption in the DNA in a normal cell interferes with the cell’s ability to regulate cell division.

DNA disruption can be caused by mutation due to certain chemicals or sources of high energy (Sun, X-rays, Nuclear radiation), infection by some viruses and due to certain environmental and lifestyle factors.

Potential of Immunotherapy for Cancer Treatment:

Immunotherapy is a type of biological therapy that uses a person's own immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells.

Some important types of Immunotherapy for Cancer Treatment, include:

1. CAR-T Cell Therapy:

Chimeric antigen receptor (CAR) T-cell therapy is a type of cell-based gene therapy which involves altering the genes inside T-cells (a type of white blood cell) to help them attack cancer cells. In the therapy, T-cells are harvested from the patient’s blood.
- Researchers modify these cells in the laboratory so that they express specific proteins on their surface known as chimeric antigen receptors (CAR).
- These cells are then grown and multiplied in the laboratory and then inserted back into the patient. This genetic modification allows CAR T-cells to effectively bind to the cancer cells and destroy them.
Presently, CAR T-cell therapy has been approved for leukaemia (cancer arising from the cells that produce white blood cells) and lymphoma (arising from the lymphatic system).

2. Monoclonal antibodies:

Monoclonal antibodies are immune system proteins created in the lab (artificial antibodies) that are designed to bind to specific targets on cancer cells.
Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system.

3. Cancer vaccines/ Injecting induced non-classical monocytes (I-NCMs):

Northwestern University research showed that injecting a specific type of white blood cell (induced non-classical monocytes) into mice was effective in combating cancer.
- These specialised WBCs (I-NCMs) can be generated/activated through severe infections like COVID-19 or by using certain chemicals.
- Once activated, I-NCMs are able to leave blood vessels and migrate to tumours, where they launch an attack on cancer cells.
Mechanism (just for your curiosity):
- I-NCMs possess a unique receptor (CCR2) which acts like a specialised antenna to detect signals emitted by certain types of cancer cells or inflamed tissues. These signals guide I-NCMs to the infection site, where they launch an attack.
- At the infection site, they recruit other immune cells callednatural killer (NK) cells, which are effective at destroying cancer cells.
  - Natural killer cells are a vital component of the immune system.
  - NK cells directly target and eliminate abnormal-appearing cells, such as cancer cells or virus-infected cells.

However, not all cancers respond to immunotherapy, and even when treatments show initial success, cancer cells can adapt and develop resistance.

Important Technologies for Cancer Treatment:

S.No.	Technology	Details
1.	Chemotherapy	Involves administration of drugs that interfere with cell division to slow down the growth of tumours. Limitations: These drugs can disrupt the cell division of normal cells too, causing complications.
2.	Radiation Therapy	Radiation therapy directs high-energy radiation at the part of the body where a tumour is located. Limitations: The radiation process is not perfect and the nearby tissues are often harmed.
3.	Image-guided Radiation Therapy	Form of radiation therapy that uses imaging techniques to precisely locate and treat cancerous tissue. Allows for higher doses of radiation to be delivered to tumour while minimising exposure to surrounding healthy tissues.
4.	Proton Therapy	Type of radiation therapy that uses high-energy proton beams to destroy cancerous cells.Particularly useful to treat tumours located in sensitive areas (brain, eyes and spinal cord) where traditional radiation therapy can cause severe side effects.
5.	Precision Medicine	Uses genomic information (genetic profile of their tumour) to personalise treatment for cancer patients.
6.	Immunotherapy	i. CAR-T Cell Therapy ii. Utilising Monoclonal Antibodies iii. Injecting Cancer Vaccines

Government Initiatives for Cancer Treatment:

National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke is a flagship program under the National Health Mission. Launched in 2010, it aims to prevent and control major non-communicable diseases, including cancer.
National Cancer Registry Programme (1982) under the Indian Council of Medical Research collects and maintains data on cancer incidence across the country.
National Cancer Grid is a network of major cancer centres across India that collaborate to standardise cancer care to improve the quality of cancer treatment.
National Cancer Institute at Jhajjar, Haryana has been established as a centre of excellence for cancer treatment and research.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana includes coverage for cancer treatment to over 10 crore families.
Production Linked Incentive (PLI) scheme launched in 2020 for domestic manufacturing of oncology equipment and other medical devices.

National Health Mission

Targets under National Health Mission:

Key features of National Health Mission:

Achievements under National Health Mission:

New Initiatives under NHM:

Maternity Benefit Initiatives in India

Issues with PMMVY Implementation

Way Forward

What is faecal coliform bacteria?

Implications:

How is obesity measured at present?

Why has the BMI method been criticised?

What is the new proposed definition of Obesity?

How is body size calculated for this evaluation?

New definition for Indians:

Latest development in Obesity treatment:

Impact of Exercise on Neurons

Significance of the Research

What is Sudden Cardiac Death (SCD)?

Risk Factors:

Exercise and Cardiovascular Health:

Guidelines to Prevent Sudden Cardiac Death (SCD) in Athletes:

Challenges:

Way Forward

About Osteoporosis

Concerns

Way Forward

Universal Health Coverage:

Extent of Public Spending on Health in India:

Need for Government Health Expenditure:

What is Breast Cancer?

Risk Factors:

About New AI Cancer Detection Tool:

How will the AI model work?

Benefits of AI Cancer detection Tool:

Which types of diseases are considered notifiable?

Why is snakebite considered a ‘disease’?

Which snakes can be fatal?

Why does the Centre want snakebites to be made notifiable?

What are the challenges of treating snakebites?

Issues and concerns regarding ‘Right to Disconnect’

Constitutional and Legal Provisions in India:

International Examples:

Suggestions and Way Forward:

What is Cancer?

Potential of Immunotherapy for Cancer Treatment:

1. CAR-T Cell Therapy:

2. Monoclonal antibodies:

3. Cancer vaccines/ Injecting induced non-classical monocytes (I-NCMs):

Important Technologies for Cancer Treatment:

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