Nov 14th 2024 Editorial

1. Cardiovascular Kidney Metabolic Syndrome: A Modern Epidemic

Introduction

  • Definition: Cardiovascular Kidney Metabolic (CKM) syndrome is a complex interplay between obesity, cardiovascular disease, and chronic kidney disease.
  • Link to Globalisation: The rapid adoption of urban lifestyles, driven by globalisation, has led to sedentary habits, unhealthy diets, and a surge in lifestyle diseases.
  • Significance: CKM syndrome highlights the need for integrated healthcare systems to address the rising burden of non-communicable diseases (NCDs).

 

  1. Rising Burden of CKM Syndrome in India
  • Tamil Nadu as a Case Study:
    • Achievements: Strong public health framework with better-than-national average indicators for infant mortality, maternal mortality, and infectious diseases.
    • Challenge: According to the Global Burden of Disease (GBD) report:
      • NCDs cause 69% of premature deaths and 68% of disabilities.
    • Contributors: Obesity, hypertension, and diabetes as highlighted in surveys like the Tamil Nadu STEPS and National Family Health Survey (NFHS-5).

 

  1. Economic Impact
  • Healthcare Costs:
    • Tamil Nadu spends ₹1,200 crore annually on insurance claims, with coronary angioplasty and dialysis being the most common.
    • The private sector contributes significantly to rising health expenditures.
  • Productivity Loss: Premature deaths and disabilities caused by NCDs disrupt the economy.

 

  1. Need for Integrated Healthcare
  • Current Gaps:
    • Treatment is focused on individual diseases rather than the syndrome as a whole.
  • Recommendations:
    • Integrated clinics for managing obesity, diabetes, and cardiovascular and kidney diseases collectively.
    • Policies emphasizing preventive care, such as antenatal nutrition and regular screenings.

 

  1. Role of Food Security and Nutrition
  • Rice and Obesity:
    • High glycemic index of rice distributed through the Public Distribution System (PDS) has contributed to obesity.
    • Recommendations: Replacing polished rice in PDS with alternatives such as low-sodium salt or whole grains.
  • Pilot Interventions:
    • Introducing low-sodium salt in PDS to reduce hypertension rates.

 

  1. Globalisation and Lifestyle
  • Work Culture: Long working hours and irregular shifts increase stress and disrupt metabolism.
  • Dietary Patterns: Globalisation-induced diets rich in salt, sugar, and fats have worsened public health.
  • Need for Balance: Promoting healthier work environments and policies encouraging better lifestyle choices.

 

Conclusion

The CKM syndrome underscores the pressing need for a holistic public health approach to combat lifestyle disorders. Policies integrating preventive care, accessible nutrition, and awareness about globalisation-induced health challenges are crucial. Tamil Nadu’s proactive measures can serve as a model for other states in India.

 

Mains Practice Question

Q. Cardiovascular Kidney Metabolic (CKM) syndrome is emerging as a significant public health challenge in India. Discuss the factors contributing to its rise and suggest integrated policy measures to tackle it.

 

2. The Impact of PMUY in Jammu and Kashmir: Promoting Clean Fuel Adoption

Introduction

  • Context: Despite significant efforts to promote clean cooking fuels, over 681 million Indians still rely on solid fuels, causing severe health and environmental challenges.
  • Scheme Overview: The Pradhan Mantri Ujjwala Yojana (PMUY) aims to provide subsidized LPG connections to poor households, improving health outcomes and reducing environmental degradation.
  • Study in J&K: A primary survey conducted across 820 households in 48 villages of Kulgam and Rajouri districts highlights PMUY’s impact and challenges in the region.

 

  1. Adoption of LPG in Rural J&K
  • LPG Penetration:
    • 07% of surveyed households have official LPG connections, with 68% under PMUY.
    • 41% of households, especially in hilly regions like Rajouri, lack LPG access, and 10.53% rely on unofficial connections.
  • Fuel Stacking:
    • 92% of households still maintain traditional chulhas.
    • 85% use both LPG and solid fuels, reflecting cultural attachment and affordability issues.
  • Consumption Patterns:
    • Average LPG consumption: 3.56 cylinders per household in six months.
    • Kulgam: Higher adoption by PMUY beneficiaries (3.54 cylinders) compared to non-beneficiaries (3.21).
    • Rajouri: Lower adoption by PMUY beneficiaries than general consumers.

 

  1. Health Benefits
  • Reduction in Indoor Air Pollution:
    • PMUY adoption significantly reduced respiratory issues among women.
    • For BPL households:
      • Coughing: Reduced from 24% in non-beneficiaries to 21% in beneficiaries.
      • Similar trends observed for chest infections and headaches.
    • AAY households reported even greater improvements.
  • Role of Education and Appliances:
    • Households with educated members and appliances like rice cookers reported better health outcomes.
    • Example: Coughing incidence dropped to 20% in PMUY households with rice cookers.

 

  1. Barriers to Exclusive LPG Usage
  • Lack of Awareness:
    • 47% of households unaware of the health risks of solid fuels.
    • Limited communication channels: 64% without TV and 33% of cooks without mobile phones.
  • Financial Constraints:
    • High cost of LPG refills forces households to resort to cheaper solid fuels.
    • Fuel stacking remains widespread (85% of households).

 

  1. Recommendations for Improving LPG Adoption
  • Enhancing Awareness: Targeted campaigns to educate households on health and environmental benefits of LPG.
  • Improving Accessibility: Expanding LPG distribution networks in rural and hilly regions.
  • Financial Support: Subsidies for refills to make LPG usage more affordable.
  • Promoting Modern Cooking Appliances: Encouraging adoption of rice cookers and other appliances to reduce dependency on solid fuels.

 

Conclusion

PMUY has significantly increased LPG access in Jammu and Kashmir, improving health outcomes and reducing reliance on solid fuels. However, challenges like fuel stacking, limited awareness, and financial constraints hinder its full potential. A multi-pronged approach focusing on awareness, affordability, and accessibility is essential to achieve the scheme’s objectives of universal clean cooking fuel adoption.

 

Mains Practice Question

Q. The Pradhan Mantri Ujjwala Yojana (PMUY) has been instrumental in promoting clean cooking fuels in rural India. Discuss its impact and challenges in achieving exclusive LPG adoption, with special reference to Jammu and Kashmir.

 

3. The Perfect Cocktail of Layered Discrimination: Delimitation in India

Introduction

  • Context: Delimitation—the recalibration of Lok Sabha seats as per population—is a politically sensitive and complex issue. Its suspension since 1976 reflects its explosive potential to disrupt India’s federal structure.
  • Crossroad for India: The impending delimitation in 2026 presents a dilemma: uphold federal principles or risk tilting the balance towards a majoritarian and centralised system.
  • Federalism at Stake: India’s federalism, rooted in its diversity of languages, cultures, and historical ethno-linguistic homelands, is integral to its constitutional framework and unity.

Delimitation: Constitutional Mandate and Historical Context

  • Article 82: Mandates recalibration of Lok Sabha seats based on the Census.
  • Historical Freezes:
    • 1976: Indira Gandhi’s government suspended delimitation until 2001 to avoid penalising States successful in population control.
    • 2001: Vajpayee’s government extended the freeze to 2026 for similar reasons.
  • Current Scenario: The Narendra Modi government has hinted at revisiting delimitation before 2029 elections, reigniting debates about its implications.

 

Potential Threats Posed by Delimitation

  1. Disproportionate Representation
  • Demographic Disparities:
    • Non-Hindi States (e.g., Kerala, Tamil Nadu): Total Fertility Rate (TFR) < 2.1 (replacement level).
    • Hindi Heartland States (e.g., UP, Bihar): TFR ~3.5, significantly higher.
  • Impact on Lok Sabha Seats:
    • Southern States: Proportion of seats may drop from 25% to 17%.
    • Hindi States: Seat share could increase from 40% to 60%.
  • Stakeholder Index Skew: Hindi States will dominate decision-making in the Union, marginalising non-Hindi States.

 

  1. Economic Disparities
  • Tax Contributions vs. Receipts:
    • Southern and Western States contribute disproportionately to the national GDP and direct taxes (e.g., Karnataka, Tamil Nadu).
    • Hindi States receive 250%-350% more funds than their contribution.
  • 16th Finance Commission: Use of the 2011 Census for fund allocation exacerbates biases against developed States.

 

  1. Cultural and Political Alienation
  • Ethno-Linguistic Imbalance:
    • Hindi-speaking population has grown from 36% (1947) to nearly 43%.
    • Non-Hindi linguistic groups (e.g., Tamil, Kannada, Bengali) face declining population proportions, reducing their influence in the Union.
  • Majoritarianism Risk:
    • Delimitation rewards States with high population growth but poor governance and penalises progressive States with population control.

 

  1. Federal Erosion
  • Unity in Diversity: India’s federal structure is underpinned by equitable representation of all States. Delimitation risks centralising power in Hindi-majority regions, threatening the spirit of cooperative federalism.
  • Historical Comparison: India’s uniqueness lies in its federal plurality, unlike China or Russia’s majoritarianism.

 

Possible Solutions

  1. Extend the Freeze:
    • Continue the precedent set by Indira Gandhi and Vajpayee, postponing delimitation for another 25 years.
    • Rationale: Avoid immediate disruptions while exploring long-term solutions.

 

  1. Permanent Freeze:
    • Lock the current seat distribution across States.
    • Rationale: Maintain status quo to ensure federal balance and prevent demographic-driven domination.

 

  1. Delimitation with Federal Reforms:
    • Rebalance powers between the Centre and States:
      • Abolish the Concurrent List in favour of an expanded State List.
      • Transfer residual powers to States.
      • Retain defence, external affairs, and currency at the Union level.
    • Rationale: Decentralisation could counterbalance the majoritarian implications of delimitation.

 

  1. Proportional Increase in Lok Sabha Seats:
    • Maintain the current State-wise seat ratio but increase the total number of seats proportionally.
    • Rationale: Offset representational deficits without penalising population-controlled States.

 

Conclusion

Delimitation is not merely a technical exercise but a question of India’s constitutional ethos. It demands a nuanced approach that balances demographic equity with federal integrity. The risk of eroding India’s federal structure and fostering ethno-linguistic tensions is too grave to ignore. A federal compact that combines decentralisation with proportional representation can preserve India’s unique experiment in pluralistic democracy.

 

Mains Practice Question:

Q. “Delimitation poses a serious threat to India’s federal structure.” Critically examine the challenges and suggest a balanced approach to address the issue.

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