Health Action Sustainable Development Goals April 2019. ISSN: 0970-471X

Vol 32 No.4 April 2019
A National Monthly from HAFA
Universal HealthCare
& Sustainable Development Goals

A HAFA
National
Monthly Universal Health Coverage: An “essential
launch pad” for realizing Sustainable
Development Goals in India
Dr Abhay Kudale
Millennium Development Goals: Improvement
in many fields
17 Sustainable Development Goals
“Achieve Gender Equality & Empower All
Women & Girls” : Sustainable Development
Goal (SDG) 5
Dr Vibhuti Patel
Universal Healthcare & Sustainable
Development Goals
Dr Arvinder Singh Napal
Impact of Climate Change on Mosquito-
Transmitted Diseases in India
Ratna Joseph
Counselling Skills for a Dietitian
Aparna Kuna, K. Bhagya Lakshmi
Fostering School Health Services
For Betterment of Our Nation
S.Saranya
Health Bits
Contents
MANAGING EDITOR
Rev. Dr. Mathew Abraham C.Ss.R, MD
EDITORIAL DIRECTOR
Rev. Dr. Joby Kavungal, RCJ
EDITOR
N. Vasudevan Nair
CIRCULATION & EDITORIAL OFFICER
T. K. Rajendran
DESIGN
M. S. Nanda Kishore, George Paul
EDITORIAL BOARD
Sr. Anne Ponnattil
Ravi Duggal
Dr. Amarender Reddy
Dr. M V Ramana Rao
Dr. Ravi D’Souza
Dr. Subbanna Jonnalagada
Dr. Nevin Charles Wilson
EDITORIAL ADVISORY COMMITTEE
Dr. S. Ram Murthy
Dr. P. Sangram
Dr. Gopala Krishna
Dr. Venugopal Gouri
Dr. P. V. Sharada
M. C. Thomas
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“ Take time for all things:
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Thought for
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Benjamin Franklin
Vol 32 No. 4 April 2019
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EDITORIAL
Universal HealthCare
& Sustainable Development Goals
Millennium Development Goals (MDGs) were adopted by the UN General
Assembly in 2000. Now, as a follow-up, Sustainable Development Goals (SDGs)
have been chosen from January 2016 to ensure prosperity, peace, health and wellness
across the globe. After a three-year-long worldwide consultation, 17 goals and 169
targets were formally accepted by the UN member-states with the time-frame of
2030.
The Goals aim at ending poverty, inequality and tackling climate change.
Articulated in 230 indicators, they will stimulate, align and accomplish action and
would guide the global policy makers’ decisions over the 15-year period. The SDG
agenda has three dimensions – economic, social and environmental. Health is a core
factor. The concept of Universal Health Care (UHC) plays a fundamentally important
role in promoting equitable access to health. Endorsed by WHO in 2005, UHC is
now primed for a leading role in meeting SDG targets.
Three years down the line, in India, steps have already been initiated to help
facilitate its implementation. The National Institution for Transforming India (NITI
Aayog) has been entrusted with the role of coordinating the SDG Agenda. NITI
Aayog is expected to act proactively to fructify the goals and targets by maintaining
high standards of quality.
The cover story section comprises Universal Health Coverage: An “essential
launch pad” for realizing Sustainable Development Goals in India; Millennium
Development Goals: Improvement in many fields; 17 Sustainable Development
Goals; “Achieve Gender Equality & Empower All Women & Girls”: Sustainable
Development Goal (SDG) 5; Universal Healthcare & Sustainable Development
Goals; and Impact of Climate Change on Mosquito-Transmitted Diseases in India.
Happy Reading!
Rev. Dr. Mathew Abraham, C.Ss.R, MD
Managing Editor
1HEALTH ACTION | APRIL 2019

Sustainable Development Goals (SDGs), widely
accepted and considered as an agenda for global action,
is a Charter for People and Planet in the 21st Century.
It serves as an opportunity for governments and the
international community to renew their commitment
to improving health as a central component of
development. There are 17 Goals and 169 Targets
which demonstrate the scale and ambition of this new
Universal Agenda. The Goals define the priority areas
of action.
Goal 3 aims to ensure healthy lives and promote
wellbeing for all at all ages, with target 3.8 on universal
health coverage (UHC), emphasizing the importance
of all people and communities having access to quality
healthcare services without risking financial hardship.
These healthcare services include those targeting
individuals such as curative care and population-based
services, like health promotion. UHC is an integrated,
efficient approach to improve health outcomes. It’s
aspirational, but there is growing global and national
commitment to UHC. It reflects the healthcare sector’s
inherent responsibility to provide universal and
equitable access to healthcare services for ensuring
improved health outcomes. UHC links to other sectors,
and enables healthy, sustainable development. UHC is a
recommitment to healthcare as a human right. Further,
UHC has been regarded as the only comprehensive
approach that embraces the whole healthcare system
and puts rights and equity at the centre of its vision.
Specifically, UHC emphasizes universal access to
comprehensive, high-quality prevention, treatment and
care. It includes clear, specific and concrete healthcare
goals which include accelerating progress on the
unfinished Millennium Development Goals agenda and
incorporating Non-communicable diseases agenda.
UHC is a catalyst for change, more efficient and aims
at equitable government spending which would yield
a more efficient and accountable healthcare system.
UHC ensures greater access to healthcare services,
financial protection and a sustainable, healthier and
more productive society.
COVER STORY
Universal Health Coverage
An “essential launch pad” for realizing
Sustainable Development Goals in India
Dr Abhay Kudale
2 HEALTH ACTION | APRIL 2019

Financing Strategies of UHC
The World Health Organization (WHO) has
identified four key financing strategies to achieve UHC
-- increasing taxation efficiency, increasing government
budget for health, innovation in financing for health
and increasing development assistance for health.
Unfortunately, all of these measures fall beyond the
control of Ministry of Health (MOH) and less likely to
be influenced by its efforts alone. The MOH needs to
be more assertive in its demand for health budget and
should use evidence-driven investment case-scenarios to
justify higher budgetary allocations. Evidence suggests
that tax revenue is a key determinant in the progress
towards UHC in low- and middle-income countries
(LMICs). To generate an additional $9.86 public
healthcare spending per capita, the tax revenue needs
to increase by $100 per-capita. Not only financing
and institutionalization are critical for achieving
UHC, but also measuring progress towards UHC
is equally important. The three core dimensions of
UHC proposed by the WHO are “the proportion of a
population covered by existing healthcare systems, the
range of healthcare services available to a population,
and the extent of financial risk-protection available to
local populations”. Achieving UHC is an important
objective for all countries to attain equitable and
sustainable healthcare outcomes and improve the well-
being of individuals and communities.
Six Pathways
The WHO report from the High-level Commission
on Health Employment and Economic Growth states
that the contribution to economic growth can happen
through six inter-related pathways.
The first pathway is through investment in health
which contributes to an increase in life-expectancy
and healthier workers, contributing to increase in
economic productivity. The second pathway is through
promoting economic output. The health sector adds
direct economic value by expanding the number of
jobs, investing in infrastructure projects and purchasing
supplies needed for healthcare delivery. Third pathway
is through enhancing social protection. Investing in
decent jobs in the healthcare sector contributes to
enhancing social protection systems, for example in
case of sickness, disability, unemployment and old
age, as well as financial protection against loss of
income, out-of-pocket payments and catastrophic
health expenditures. Social protection, in turn promotes
sustainable pro-poor economic growth. The fourth
pathway is linked to social cohesion. Equal societies are
more economically productive ones. The fifth pathway
is promoting innovation and diversification. Scientific
and social innovations in this sector are likely to further
support economic growth in the future. The sixth and
last pathway is by protecting and promoting human
security. Strong healthcare systems perform better in the
detection, prevention and control of infectious disease
outbreaks, protecting individual and global health
security for peace, development, and economic growth.
Investments in the healthcare sector to support
UHC will boost economic growth in line with SDG 8
(promote sustained, inclusive and sustainable economic
growth, full and productive employment and decent
work for all). The expectation is that the healthcare
sector’s contribution to SDG 8, by protecting and
promoting human security, will be significant.
Indian Scenario: SDGs and UHC
The Government of India is strongly committed to
Agenda 2030, including the Sustainable Development
Goals. The Hon’ble Prime Minister of India in his
statement at the Sustainable Development Summit in
New York on 25 September 2015 strongly affirmed
India’s commitment to Agenda 2020 and the SDGs.
He drew attention to the fact that we live in “an age
of unprecedented prosperity, but also unspeakable
deprivation around the world” and pointed out that
“much of India’s development agenda is mirrored in
the Sustainable Development Goals”. Further, he has
reiterated the importance of the SDGs at the global
level, such as at G-20 meetings. The Parliament of
India has taken exemplary initiatives to propel the
SDG agenda forward. It is widely agreed that India will
play a leading role in determining the relative success
or failure of the SDGs, as it is the second and most
populous county in the world. India is already making
significant strides towards the attainment of SDGs.
Progressive realization of UHC is also one of the
key features of SDGs. India’s commitment towards
achieving UHC is clearly reflected in policies and
institutional mechanism, which are directed towards
increasing coverage and access to healthcare services.
To address the policy challenges and fill critical gaps
in achieving UHC, the National Health Policy (NHP)-
2017 has been approved by the Union Cabinet. The
NHP aims to deliver quality healthcare services at
affordable cost for the achievement of UHC. It also
envisages increasing public health expenditure to 2.5
per cent of the GDP to achieve its intended objectives.
ABNHPM
To translate its vision of the NHP-2017 into reality,
the Government of India has approved Centrally-
Sponsored Ayushman Bharat-National Health
Protection Mission (ABNHPM). It is the world’s largest

government-funded healthcare scheme in terms of
coverage. More than 10 crore households and 50 crore
people will be included in the scheme for Rs 5 lakh
per year insurance that will be provided for secondary
and tertiary healthcare. IT-enabled, free and cashless
in-patient healthcare will be provided to the people
enrolled in ABNHPM. It is expected to increase health
insurance coverage in India from the current 34% (43.7
crore people) to 50% (60.2 crore people) as per IRDAI
and CRISIL. ABNHPM is also expected to create an
additional 200,000 jobs along with increase in the
number of public hospitals in Tier 2 and Tier 3 cities,
and improve public healthcare services.
Further, the press note on ABNHPM suggests that
the scheme is expected to have a major impact on the
reduction of out-of-pocket expenditure on ground of
“(i) increased benefit cover to nearly 40 per cent of
the population (poorest and vulnerable), (ii) covering
almost all secondary and many tertiary hospitalizations
(except a negative list), and (iii) coverage of 5 lakh
for each family, (no restriction of family size)”. As
per the National Health Agency (NHA), the apex
body for implementation of ABNHPM, no enrolment
or payment of premium is necessary for households
to be a part of it. Households have already been
chosen as per the Socio-Economic Caste Census
(SECC), 2011 database. The scheme will be merged
with existing similar state schemes with a 60:40
contribution by Centre and States respectively. 28
States and Union Territories are already a part of
ABNHPM. The ABNHPM has another component of
Health and Wellness Centers which are supposed to
be instrumental in provision of comprehensive primary
healthcare to rural masses. These 1.5 lakh centres
will bring the health care system closer to the homes
of people, providing comprehensive care, including
noncommunicable diseases and maternal and child
health services. The government centres will provide
free essential drugs and diagnostic services. Rs. 1200
crore has been allocated for this flagship programme.
Public-Private-Partnership
ABNHPM is the world’s largest and most ambitious
healthcare protection program and is the harbinger of
change in India’s healthcare system. Poverty due to
healthcare on account of out-of-pocket expenses was
the sore point in India’s health system and in trying
to tackle this, the most deprived portion of India’s
population has obtained crucial and timely support.
In most UHC discussions so far in India, the private
healthcare sector was seriously ignored and neglected
and mostly seen as something that needed to be just
regulated. Private sector accounts for more than 70% of
healthcare services in India and as such, the government
will fare much better in making the private sector
significant and an important partner in its journey
towards UHC. In this, ABNHPM takes a step towards
involving the private sector towards achieving its
healthcare goals. NITI Aayog must be commended for
promoting public-private partnerships in healthcare and
for steering ABNHPM in this direction. NITI Aayog is
mandated with the task of coordinating work on SDGs
and UHC by adopting a synergistic approach, involving
central ministries, States/Union territories, civil society
organizations, academia and business sector to help
achieve India’s SDG targets.
India has committed to achieve UHC as a signatory
to the globally-agreed upon Sustainable Development
Goals as well as through the NHP 2017. In the journey
towards UHC, ABNHPM appears to be a balanced
approach, which combines provision of comprehensive
primary healthcare through health and wellness centres
and facilitating access to secondary and tertiary level
health care services. Although, ABNHPM would
help India move towards UHC, this needs to be
supplemented by other much required initiatives such as
following one-health, health-in-all-policies-initiatives,
intersectoral coordination and convergence. The
platform created with the initiation of ABNHPM in
the near future needs to be exploited in a mission mode
by launching several healthcare-system- strengthening
initiatives and approaches. n
(Faculty, Interdisciplinary School of Health Sciences,
Savitribai Phule Pune University, E-mail: amkudale@
unipune.ac.in; The author acknowledges various
references which are available on request.)
Sustainable Development
Goals (SDGs), widely accepted and
considered as an agenda for global
action, is a Charter for People and
Planet in the 21st Century. It serves
as an opportunity for governments
and the international community to
renew their commitment to improving
health as a central component of
development. There are 17 Goals
and 169 Targets which demonstrate
the scale and ambition of this new
Universal Agenda. The Goals define
the priority areas of action.

COVER STORY
At the Millennium Summit in 2000, world leaders
adopted eight Millennium Development Goals (MDGs)
to be achieved within 15 years. In 2015, the UN took
stock on the basis of data from several UN organisations.
Its main conclusions were published in the final MDG
report of 2015.
Goal 1: Eradicate Extreme Poverty and Hunger
Extreme poverty declined significantly in the two
decades before 2015. In 1990, nearly half of the people
in developing countries lived on less than $ 1.25 a day.
By 2015, that share was down to 14%. Globally, the
number of people living in extreme poverty declined by
more than half, falling from 1.9 billion in 1990 to 836
million in 2015. The share of under-nourished people
was almost halved – from 23.3% in 1992 to 12.9%
in 2016. The number of people in the working middle
class – whose purchasing power per person is above four
dollars – almost tripled between 1991 and 2015.
Goal 2: Achieve Universal Primary Education
The net enrolment rate for primary schools reached
91% for all developing countries, up from 83% in
2000. Around the world, about 100 million children of
primary-school age did not go to school in 2000. That
number dropped to an estimated 57 million in 2015. The
greatest improvements occurred in sub-Saharan Africa.
Goal 3: Promote Gender Equality and Empower
Women
In 2015, many more girls were in school than 15 years
earlier. As a whole, the developing regions succeeded in
eliminating gender disparity in primary, secondary and
tertiary education. In Southern Asia, only 74 girls were
enrolled in primary school for every 100 boys in 1990.
By 2015, 103 girls were enrolled for every 100 boys.
Goal 4: Reduce Child Mortality
The global under-five mortality rate went down by
more than half, dropping from 90 to 43 deaths per
1,000 live births from 1990 to 2015. The number of
globally reported measles cases was reduced by 67% in
this period. In 2013, about 84% of children worldwide
received at least one dose of measles-containing vaccine.
The respective figure for 2000 was 73%.
Goal 5: Improve Maternal Health
From 1990 to 2015, the maternal mortality declined
by 45% worldwide. Globally, more than 71% of births
were assisted by skilled health personnel in 2014, an
increase from 59% in 1990.
Goal 6: Combat HIV/AIDS, Malaria and Other
Diseases
The number of new HIV infections fell by
approximately 40% between 2000 and 2013. In June
2014, 13.6 million people living with HIV were receiving
antiretroviral therapy (ART) internationally, a huge
increase from just 800,000 in 2003. ART averted 7.6
million deaths from AIDS between 1995 and 2013. Over
6.2 million malaria deaths were prevented between 2000
and 2015, primarily of children under five years of age
in sub-Saharan Africa. The global malaria incidence rate
fell by an estimated 37% and the mortality rate by 58%.
Between 2000 and 2013, tuberculosis prevention and
treatment interventions saved an estimated 37 million
lives. The tuberculosis mortality rate fell by 45% and
the prevalence rate by 41% between 1990 and 2013.
Goal 7: Ensure Environmental Sustainability
Terrestrial and marine-protected areas in many regions
have increased substantially since 1990. In Latin America
and the Caribbean, coverage of terrestrial protected
areas rose from 8.8% to 23.4% between 1990 and
2014. In 2015, 91% of the world population had safe
drinking water, compared with 76% in 1990. While 147
countries met the drinking water target, 95 countries
met the sanitation target, and 77 countries met both.
Goal 8: Develop A Global Partnership for
Development
Rich nations’ official development assistance (ODA)
increased by two-thirds in real terms from 2000 to
2014, reaching $135.2 billion. In 2014, Denmark,
Luxembourg, Norway, Sweden and the United Kingdom
exceeded the UN target of spending 0.7% of gross
national income on ODA. n
D+C, Volume 45, 9th October 2018
Millennium Development Goals
Improvement in many fields

COVER STORY
After the world leaders met with a great deal
of energy deliberating threadbare for adopting
Sustainable Development Goals (SDGs) in September
last year, it was concluded that the implementation of
SDGs is not only ambitious but a Hurclean task than
the Millennium Development Goals (MDGs), covering
a broad range of interconnected issues, from economic
growth to social issues to global public goods. The
whole exercise needs every country to judiciously
prioritise, and adapt the goals and targets in accordance
with local challenges, capacities and resources available.
India is no exception.
Explained below are each of the 17 Sustainable
Developments Goals:
Goal 1:
End poverty in all its forms
everywhere
ŠŠ Globally, the number of people
living in extreme poverty has
declined by more than half from
1.9 billion in 1990. However,
836 million people still live
in extreme poverty. About one in five persons in
developing regions lives on less than $1.25 per day.
ŠŠ Southern Asia and sub-Saharan Africa are home
to the overwhelming majority of people living in
extreme poverty.
ŠŠ High poverty rates are often found in small, fragile
and conflict-affected countries.
ŠŠ One in four children under age five in the world has
inadequate height for his or her age.
ŠŠ The all-India Poverty Head Count Ratio (PHCR) has
been brought down from 47% in 1990 to 21% in
2011-2012, nearly halved.
Goal 2:
End hunger, achieve food
security and improved nutrition
and promote sustainable
agriculture
ŠŠ Globally, the proportion of
undernourished people in the
developing regions has fallen
by almost half since 1990,
from 23.3% in 1990-1992 to 12.9% in 2014-2016.
However, one in nine people in the world today (795
million) are still undernourished.
ŠŠ The vast majority of the world’s hungry people
live in developing countries, where 12.9% of the
population is undernourished.
ŠŠ Asia is the continent with the hungriest people –
two-thirds of the total. The percentage in southern
Asia has fallen in recent years, but in western Asia it
has increased slightly.
ŠŠ Sub-Saharan Africa is the region with the highest
prevalence (percentage of population) of hunger.
About one person in four there is undernourished.
ŠŠ Poor nutrition causes nearly half (45%) of deaths in
children under five – 3.1 million children each year.
ŠŠ One in four of the world’s children suffer stunted
growth. In developing countries, the proportion rises
to one in three.
ŠŠ 66 million primary school-age children in developing
countries attend classes hungry, with 23 million in
Africa alone.
ŠŠ Agriculture is the single largest employer in the
world, providing livelihoods for 40% of today’s
global population. It is the largest source of income
and jobs for poor rural households.
ŠŠ 500 million small farms worldwide, most still rain-
fed, provide up to 80% of food consumed in a large
part of the developing world. Investing in small
holder farmers is an important way to increase food
security and nutrition for the poorest, as well as food
production for local and global markets.

ŠŠ In 1990, 53% of all Indian children were
malnourished. In 2015, malnourishment declined to
40%.
Goal 3:
Ensure healthy lives and
promote well-being for all at all
ages
Child health
ŠŠ 17,000 fewer children die each
day than in 1990, but more than six million children
still die before their fifth birthday each year.
ŠŠ Since 2000, measles vaccines have averted nearly
15.6 million deaths.
ŠŠ Despite global progress, an increasing proportion of
child deaths are in sub-Saharan Africa and Southern
Asia. Four out of every five deaths of children under
age five occur in these regions.
ŠŠ India’s Under-Five Mortality (U5MR) declined from
125 per 1,000 live births in 1990 to 49 per 1,000 live
births in 2013.
Maternal health
ŠŠ Globally, maternal mortality has fallen by almost
50% since 1990.
ŠŠ In Eastern Asia, Northern Africa and Southern
Asia, maternal mortality has declined by around
two-thirds. But, the maternal mortality ratio – the
proportion of mothers that do not survive childbirth
compared to those who do – in developing regions is
still 14 times higher than in the developed regions.
ŠŠ Only half of women in developing regions receive the
recommended amount of health care.
ŠŠ From a Maternal Mortality Rate (MMR) of 437 per
100,000 live births in 1990-91, India came down to
167 in 2009. Delivery in institutional facilities has
risen from 26% in 1992-93 to 72% in 2009.
HIV/AIDS
ŠŠ By 2014, there were 13.6 million people accessing
antiretroviral therapy, an increase from just 800,000
in 2003.
ŠŠ New HIV infections in 2013 were estimated at 2.1
million, which was 38% lower than in 2001.
ŠŠ At the end of 2013, there were an estimated 35
million people living with HIV.
ŠŠ At the end of 2013, 240,000 children were newly
infected with HIV.
ŠŠ India has made significant strides in reducing the
prevalence of HIV and AIDS across different types
of high-risk categories. Adult prevalence has come
down from 0.45 percent in 2002 to 0.27 in 2011.
Goal 4:
Ensure inclusive and equitable
quality education and promote
lifelong learning opportunities
for all
ŠŠ Enrollment in primary education
in developing countries has
reached 91%, but 57 million children remain out of
school.
ŠŠ More than half of children who have not enrolled in
school live in sub-Saharan Africa.
ŠŠ An estimated 50% of out-of-school children of
primary school age live in conflict-affected areas.
Children in the poorest households are 4 times as
likely to be out of school as children in the richest
households.
ŠŠ The world has achieved equality in primary
education between girls and boys, but few countries
have achieved that target at all levels of education.
ŠŠ Among youth aged 15 to 24, the literacy rate has
improved globally from 83 per cent to 91 per cent
between 1990 and 2015.
ŠŠ India has made significant progress in universalizing
primary education. Enrollment and completion
rates of girls in primary school have improved as
are elementary completion rates. The net enrollment
ratio in primary education (for both sexes) is
88%(2013-14). At the national level, male and
female youth literacy rate is 94% and 92%.
Goal 5:
Achieve gender equality and
empower all women and girls
ŠŠ In Southern Asia, only 74 girls
were enrolled in primary school
for every 100 boys in 1990. By
2012, the enrolment ratios were
the same for girls and for boys.
ŠŠ In sub-Saharan Africa, Oceania and Western Asia,
girls still face barriers to entering both primary and
secondary school.
ŠŠ Women in Northern Africa hold less than one in five
paid jobs in the non-agricultural sector.
ŠŠ In 46 countries, women now hold more than 30% of
seats in national parliament in at least one chamber.
ŠŠ India is on track to achieve gender parity at all
education levels, having already achieved it at the
primary level. The ratio of female literacy to male
literacy for 15- 24 year olds is 0.91.
ŠŠ As of August 2015, in India the proportion of seats
in National Parliament held by women is only 12%
against the target of 50%

Goal 6:
Ensure availability and
sustainable management of
water and sanitation for all
ŠŠ In 2015, 91% of the global
population was using an
improved drinking water source,
compared to 76% in 1990.
However, 2.5 billion people lack access to basic
sanitation services, such as toilets or latrines.
ŠŠ Each day, an average of 5,000 children die due to
preventable water and sanitation-related diseases.
ŠŠ Hydropower is the most important and widely-
used renewable source of energy and as of 2011,
represented 16% of total electricity production
worldwide.
ŠŠ Approximately 70% of all available water is used for
irrigation.
ŠŠ Floods account for 15% of all deaths related to
natural disasters.
ŠŠ The overall proportion of households in India having
access to improved water sources increased from
68% in 1992-93 to 90.6 percent in 2011-12.
ŠŠ In 2012, 59% households in rural areas and 8%
in urban India did not have access to improved
sanitation facilities. Almost 600 million people in
India defecate in the open, the highest number in the
world.
Goal 7:
Ensure access to affordable,
reliable, sustainable and
modern energy for all
ŠŠ 1.3 billion people – one in five
globally – still lack access to
modern electricity.
ŠŠ 3 billion people rely on wood,
coal, charcoal or animal waste for cooking and
heating.
ŠŠ Energy is the dominant contributor to climate
change, accounting for around 60% of total global
greenhouse gas emissions.
ŠŠ Energy from renewable resources – wind, water,
solar, biomass and geothermal energy – is
inexhaustible and clean. Renewable energy currently
constitutes 15% of the global energy mix.
ŠŠ The total installed capacity for electricity generation
in India has registered a compound annual growth
rate of 7% (2013-14).
ŠŠ The total installed capacity of grid interactive
renewable power has been showing a growth rate of
over 12% (2013-14).
Goal 8:
Promote sustained, inclusive
and sustainable economic
growth, full and productive
employment and decent work
for all
ŠŠ Global unemployment increased
from 170 million in 2007 to nearly 202 million in
2012, of which about 75 million are young women
and men.
ŠŠ Nearly 2.2 billion people live below the US$2
poverty line and poverty eradication is only possible
through stable and well-paid jobs.
ŠŠ 470 million jobs are needed globally for new entrants
to the labour market between 2016 and 2030.
ŠŠ Small and medium-sized enterprises that engage in
industrial processing and manufacturing are the most
critical for the early stages of industrialization and
are typically the largest job creators. They make up
over 90% of business worldwide and account for
between 50-60% of employment.
ŠŠ The unemployment rate in India is estimated to
be approximately 5% at All India level (2013-14).
India’s labour force is set to grow by more than 8
million per year.
Goal 9:
Build resilient infrastructure,
promote inclusive and
sustainable industrialization
and foster innovation
ŠŠ About 2.6 billion people in the
developing world are facing
difficulties in accessing electricity
full time.
ŠŠ 2.5 billion people worldwide lack access to basic
sanitation and almost 800 million people lack access
to water, many hundreds of millions of them in sub-
Saharan Africa and South Asia.
ŠŠ 1 to 1.5 million people do not have access to reliable
phone service.
ŠŠ For many African countries, particularly the lower-
income countries, infrastructure constraints affect
company productivity by around 40%.
ŠŠ Manufacturing is an important employer, accounting
for around 470 million jobs worldwide in 2009 – or
around 16% of the world’s workforce of 2.9 billion.
It is estimated that there were more than half a
billion jobs in manufacturing in 2013.
ŠŠ Industrialization’s job multiplication effect has
a positive impact on society. Every one job in
manufacturing creates 2.2 jobs in other sectors.
ŠŠ In developing countries, barely 30% of agricultural
production undergoes industrial processing. In high-

income countries, 98% is processed. This suggests
that there are great opportunities for developing
countries in agribusiness.
ŠŠ India’s growth rate averaged at 7.25% in the last 5
years.
ŠŠ India’s CO2 emissions per capita are 1.67 (metric
tons), one of the lowest in the world, the global
average being around 4-5(metric tons). In 2010, per
capita annual electricity consumption was 626 kwH
compared to the global average of 2977 kwH.
Goal 10:
Reduce inequality within and
among countries
ŠŠ On average – and taking into
account population size –
income inequality increased by
11% in developing countries
between 1990 and 2010.
ŠŠ A significant majority of households in developing
countries – more than 75% – are living today in
societies where income is more unequally distributed
than it was in the 1990s.
ŠŠ Children in the poorest 20% of the population are
still up to three times more likely to die before their
fifth birthday than children in the richest quintiles.
ŠŠ Social protection has been significantly extended
globally, yet persons with disabilities are up to five
times more likely than average to incur catastrophic
health expenditures.
ŠŠ Despite overall declines in maternal mortality in
the majority of developing countries, women in
rural areas are still up to three times more likely to
die while giving birth than women living in urban
centres.
ŠŠ The Gini Coefficient of income inequality for India
has risen from 33.4% in 2004 to 33.6% in 2011.
Goal 11:
Make cities and human
settlements inclusive, safe,
resilient and sustainable
ŠŠ Half of humanity – 3.5 billion
people – lives in cities today. By
2030, almost 60% of the world’s
population will live in urban
areas.
ŠŠ 828 million people live in slums today and the
number keeps rising.
ŠŠ The world’s cities occupy just 2% of the Earth’s land,
but account for 60 – 80% of energy consumption
and 75% of carbon emissions. Rapid urbanization
is exerting pressure on fresh water supplies, sewage,
the living environment, and public health. But the
high density of cities can bring efficiency gains and
technological innovation while reducing resource and
energy consumption.
ŠŠ Cities have the potential to either dissipate the
distribution of energy or optimise their efficiency by
reducing energy consumption and adopting green
– energy systems. For instance, Rizhao, China has
turned itself into a solar – powered city; in its central
districts, 99% of households already use solar water
heaters.
ŠŠ 68% of India’s total population lives in rural areas
(2013-14).
ŠŠ By 2030, India is expected to be home to 6 mega-
cities with populations above 10 million. Currently
17% of India’s urban population lives in slums.
Goal 12:
Ensure sustainable consumption
and production patterns
ŠŠ 1.3 billion tonnes of food are
wasted every year.
ŠŠ If people worldwide switched to
energy-efficient lightbulbs, the
world would save US$120 billion annually.
ŠŠ Should the global population reach 9.6 billion by
2050, the equivalent of almost three planets could be
required to provide the natural resources needed to
sustain current lifestyles.
ŠŠ More than 1 billion people still do not have access to
fresh water.
ŠŠ India is the fourth largest GHG emitter, responsible
for 5.3% of global emissions. India has committed
to reduce the emissions intensity of its GDP by 20 to
25% by 2020.
Goal 13:
Take urgent action to combat
climate change and its impacts
ŠŠ The greenhouse gas emissions
from human activities are driving
climate change and continue
to rise. They are now at their
highest levels in history. Global
emissions of carbon dioxide have increased by almost
50% since 1990.
ŠŠ The atmospheric concentrations of carbon dioxide,
methane, and nitrous oxide have increased to levels
unprecedented in at least the last 800,000 years.
Carbon dioxide concentrations have increased by
40% since pre-industrial times, primarily from fossil
fuel emissions and secondarily from net land use
change emissions. The ocean has absorbed about
30% of the emitted anthropogenic carbon dioxide,
causing ocean acidification.

ŠŠ Each of the last three decades has been successively
warmer at the Earth’s surface than any preceding
decade since 1850. In the Northern Hemisphere,
1983-2012 was likely the warmest 30-year period of
the last 1,400 years.
ŠŠ From 1880 to 2012, average global temperature
increased by 0.85°C. Without action, the world’s
average surface temperature is projected to rise over
the 21st century and is likely to surpass 3 degrees
Celsius this century – with some areas of the world,
including in the tropics and subtropics, expected to
warm even more. The poorest and most vulnerable
people are being affected the most.
ŠŠ The rate of sea level rise since the mid-19th century
has been larger than the mean rate during the
previous two millennia. Over the period 1901 to
2010, global mean sea level rose by 0.19 [0.17 to
0.21] meters.
ŠŠ From 1901 to 2010, the global average sea level rose
by 19 cm as oceans expanded due to warming and
melted ice. The Arctic’s sea ice extent has shrunk in
every successive decade since 1979, with 1.07 million
km² of ice loss every decade.
ŠŠ It is still possible, using an array of technological
measures and changes in behaviour, to limit the
increase in global mean temperature to two degrees
Celsius above pre-industrial levels.
ŠŠ There are multiple mitigation pathways to achieve
the substantial emissions reductions over the next
few decades necessary to limit, with a greater than
66% chance, the warming to 2ºC – the goal set
by governments. However, delaying additional
mitigation to 2030 will substantially increase the
technological, economic, social and institutional
challenges associated with limiting the warming
over the 21 century to below 2 ºC relative to pre-
industrial levels.
ŠŠ India has committed to reduce the emissions intensity
of its GDP by 20 to 25% by 2020.
Goal 14:
Conserve and sustainably use
the oceans, seas and marine
resources for sustainable
development
ŠŠ Oceans cover three-quarters of
the Earth’s surface, contain 97%
of the Earth’s water, and represent 99% of the living
space on the planet by volume.
ŠŠ Globally, the market value of marine and coastal
resources and industries is estimated at $3 trillion per
year or about 5% of global GDP.
ŠŠ Globally, the levels of capture fisheries are near the
ocean’s productive capacity, with catches on the
order of 80 million tons.
ŠŠ Oceans contain nearly 200,000 identified species, but
actual numbers may lie in the millions.
ŠŠ Oceans absorb about 30% of carbon dioxide
produced by humans, buffering the impacts of global
warming.
ŠŠ Oceans serve as the world’s largest source of protein,
with more than 3 billion people depending on the
oceans as their primary source.
ŠŠ Marine fisheries directly or indirectly employ over
200 million people.
ŠŠ Subsidies for fishing are contributing to the rapid
depletion of many fish species and are preventing
efforts to save and restore global fisheries and related
jobs, causing ocean fisheries to generate US$ 50
billion less per year.
ŠŠ As much as 40% of world oceans are heavily affected
by human activities, including pollution, depleted
fisheries, and loss of coastal habitats.
ŠŠ There are some 120 species of marine mammal to
be found in the world, and a fourth of these may be
found in India and adjacent countries. More than 1
million people in 3651 villages of India situated along
the coast are employed in marine capture fisheries.
Goal 15:
Protect, restore and promote
sustainable use of terrestrial
ecosystems, sustainably manage
forests, combat desertification,
halt and reverse land
degradation and halt biodiversity loss
ŠŠ Thirteen million hectares of forests are being lost
every year.
ŠŠ Around 1.6 billion people depend on forests for their
livelihood. This includes some 70 million indigenous
people. Forests are home to more than 80% of all
terrestrial species of animals, plants and insects.
ŠŠ 2.6 billion people depend directly on agriculture, but
52% of the land used for agriculture is moderately or
severely affected by soil degradation.
ŠŠ Due to drought and desertification each year, 12
million hectares are lost (23 hectares per minute),
where 20 million tons of grain could have been
grown.
ŠŠ Of the 8,300 animal breeds known, 8% are extinct
and 22% are at risk of extinction.
ŠŠ As many as 80% of people living in rural areas in
developing countries rely on traditional plant-based
medicines for basic healthcare.
ŠŠ Forest cover in India has increased to 21.23% - an
increase of 5871 sq. km, and protected areas cover to
about 4.8% of the country’s total land area.
ŠŠ India is among the early movers on the Nagoya
protocol and is committed to the Aichi targets on
conserving biodiversity.
ŠŠ India has 8% of the world’s biodiversity with many
species that are not found anywhere else in the world.

Goal 16:
Promote peaceful and inclusive
societies for sustainable
development, provide access
to justice for all and build
effective, accountable and
inclusive institutions at all
levels
ŠŠ The number of refugees of concern to the United
Nations High Commissioner for Refugees (UNHCR)
stood at 13 million in mid-2014, up from a year
earlier.
ŠŠ Corruption, bribery, theft and tax evasion cost some
US $1.26 trillion for developing countries per year.
ŠŠ The rate of children leaving primary school in
conflict-affected countries reached 50% in 2011,
which amounts to 28.5 million children.
ŠŠ In India, more than 20% of all pupils and one-third
of all Scheduled Tribe students drop out before
finishing primary education.
Goal 17:
Strengthen the means of
implementation and revitalize
the global partnership for
sustainable development
ŠŠ Official development assistance
(ODA) stood at approximately
$135 billion in 2014.
ŠŠ In 2014, 79% of imports from developing countries
entered developed countries duty-free.
ŠŠ The debt burden on developing countries remains
stable at about 3% of export revenue.
ŠŠ The number of internet users in Africa almost
doubled in the past four years.
ŠŠ As of 2015, 95% of the world’s population is
covered by a mobile-cellular signal.
ŠŠ 30% of the world’s youth are digital natives, active
online for at least five years.
ŠŠ Internet penetration has grown from just over 6% of
the world’s population in 2000 to 43% in 2015.
ŠŠ But more than four billion people do not use the
Internet, and 90% of them are from the developing
world.
ŠŠ India has the second highest number of Internet users
in the world, however, Internet penetration in the
country is under 20%. n
(Health Action, January 2017)
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COVER STORY
The Sustainable Development Goals (SDGs-
2015-2030) are a derivative of the Millennium
Development Goals (2000-2015), which spell out
the following values: freedom, equality, solidarity,
tolerance, respect for nature, and shared responsibility.
They are a clarion call of 189 governments, on behalf
of their citizens, to “free our fellow men, women and
children from the abject and dehumanizing conditions
of extreme poverty, to which more than a billion of
them are currently subjected”.
The SDGs are benchmarks of development progress
based on such fundamental values as freedom, equity,
human rights, peace and security. SDGs can be achieved
if all actors work together -- heads of nation states,
civil society organizations, international financial
institutions, global trade bodies and the UN system
-- and do their part. Poor countries have pledged
to govern better, and invest in their people through
health care and education. Rich countries must stick
to their pledge to support the poor countries through
aid, debt relief, and fairer and just trade. Only if there
is commitment on the part of the rich as well as poor
countries to fulfil these promises, all the SDGs could
be achieved and distributive justice, gender justice and
social justice can be realised.
Gender concerns in SDGs
As per the World Economic Forum, India stands at
114 amongst 142 countries in terms of Gender Gap
Index. All goals are expected to mainstream SDG 5
that aims to “achieve gender equality and empower all
women and girls”. All the 17 SDGs and 169 Targets
Sustainable Development Goal (SDG) 5
Dr Vibhuti Patel
are mandated a special focus on gender and challenge
discrimination against women by focusing on school
education, ensuring that more women become literate,
guaranteeing more voice and representation in public
policy and decision-making-political participation,
providing improved job prospects- 36 % Work
Participation Rate, food and nutrition security, support
to women farmers.
Indian Women & SDGs
The SDGs explicitly acknowledge that gender -- what
a given society believes about the appropriate roles and
activities of men and women, and the behaviours that
result from these beliefs -- can have a major impact on
development, helping to promote it in some cases while
seriously retarding it in others. SDG 5 (out of 8) is
calling for an end to disparities between boys and girls
at all levels of education. There is general agreement
that education is vital to development, and ensuring
that girls as well as boys have full opportunities for
schooling will help improve lives in countless ways.
Child Sex Ratio
Mid-decade census has revealed further decline in
the child sex ratio in several parts of India. In the
urban centers, deficit of girls has been rising due to
pre-birth elimination. In spite of demand of women’s
groups and recommendations of the Eleventh Five Year
Plan to revisit the two-child norm laws, several state
governments continue to victimize the victim, namely
poor, dalit, tribal and Muslim women and unborn girls
(as the norm has resulted into intensified sex-selective
abortions).
“Achieve Gender Equality &
Empower All Women & Girls”

Reproductive and Child Health
Evaluation of Chiranjivi Scheme to halt maternal
mortality has revealed that the public private
partnership (PPP) in this scheme allows private
practitioners milk tax-payers’ money without giving
necessary relief to pregnant women. Only in cases of
normal delivery, the private practitioner admits women
for delivery and in case of complicated delivery, the
women concerned are sent to over-crowed public
hospitals. In NRHM, ASHAs are not paid even
minimum wages and are paid a “honorarium”.
Smart Cities
The Union Budget, 2017-18 has given priority
to formation of 100 smart cities in terms of high
allocation for physical infrastructure, IT-based and
cyber- technology-based governance. Smart cities
have to be safe cities. Town planners, policy- makers
and budget experts need to do gender budgeting to
ensure women-friendly civic infrastructure- water,
sanitation, health care, safe transport, public toilets,
help lines, skill development for crisis management and,
safety at work place. While making budgets for social
defense services, consideration must be given to safety
of girls and women in schools and colleges in terms
of prevention of child sexual abuse through public
education and counseling facilities, separate toilets for
girls and boys in schools, legal literacy on POCSO Act,
2012 and Prevention of Sexual Harassment Workplace
Act, 2013. Provision must be made to have special cells
in the police department to take action against display
of pornographic images, SMS messages, cybercrimes
that victimize young girls at public places or in public
transport- buses, local trains, rickshaws and taxis.
There is a need to integrate safety of women as a
major concern in flagship centrally- sponsored schemes
such as Jawahar Lal Nehru Urban Renewal Mission
(JNNURM), PMSSY, NUHM which are supposed to
have 30% of funds as Women’s Component.
Predicament of Women-Farmers
Women-farmers and cultivators are the backbone
of agricultural production in India. Majority of
agricultural labourers are women. In the agricultural
sector also the allocation at Rs.20400 crore is lower as
compared to the year 2014-15 in which the allocation
was Rs.22309 crore. The current budget makes a non-
plan allocation of Rs.15000 crore to the Ministry of
Agriculture to transfer funds to compensate commercial
banks for providing subsidized credit to agriculture.
The budget permits 100 per cent FDI in rural markets.
This will affect women small and marginal farmers
hard. Entry of corporate sector into agrarian marketing
has already made condition of farmers precarious
as a result of their monopsonistic control where
large number of poor sellers face handful of buyers.
Desperate farmers will have to resort to distress selling
of their products to the multinational corporations.
Several states in our country are facing severe drought
resulting in agrarian unemployment. In this context,
increase of MGNAREGA allocation by 7.7% is highly
inadequate. The government of India should initiate
Mahila Haats at the block level in rural areas so that
women farmers can directly sell their products to
buyers.
Violence against Women and Girls
At the country-level, most initiatives to address
violence have been legislative. Although the legislation
varies, it typically includes a combination of protective
or restraining orders and penalties for offenders. As
with property rights, a formidable challenge is often the
enforcement of existing laws. Procedural barriers and
traditional attitudes of law enforcement and judicial
officials undermine the effectiveness of existing anti-
violence laws. Training programmes for judicial and
law-enforcement personnel often go a long way to
change such attitudes. Beyond training programmes, the
establishment of female-staffed police stations has been
effective in making them more accessible to women.
For the women who have experienced violence, a range
of medical, psychological, legal, educational, and other
support services is necessary. To prevent violence,
improving women’s education levels and economic
opportunities has been found to be a protective
factor. The interventions noted above to improve
women’s economic opportunities thus become even
more important. Ultimately, however, the threshold of
acceptability of violence against women needs to be
shifted upwards. To do that requires a massive media
and public education campaign.
National Mission for Empowerment of
Women (NMEW)
The Gender Budget Statement has increased NMEW’s
allocation to 50 crore which is double as compared
to the previous year. The budget has not taken
serious consideration with respect to violence against
women that has escalated manifold. While schemes to
combat trafficking and empowering adolescent girls
have received increased funds, the schemes meant
for implementation of PCPNDT Act, and Protection
of Women from Domestic Violence Act have not
received much allocation. Corpus of Rs. 3000 crores
under Nirbhaya Fund has largely remained unutilized.
On March 8, 2016, the Union Budget 2015-16 had
allocated Rs. 653 crore for Scheme for Safety of Women
in Public Road Transport with an objective to ensure
safety of women and girl child in public transport by
monitoring location of public road transport vehicles to
provide immediate assistance in minimum response time
to the victims in distress. The proposed scheme under
the “Nirbhaya Fund” envisages setting up of a National
Emergency Response System with a control room
under the overall control of Ministry of Home Affairs,
which will receive alerts from distressed women and

take action on it. Under the scheme for giving grants to
states for setting up driving schools, preference is given
to proposals for driving school for women. Similarly,
‘Beti Padhao, Beti Bachao’ scheme was announced with
the goal of improving efficiency in delivery services for
women. Proposals submitted by different ministries,
local self-government bodies and state governments
under these schemes are gathering dust and funds have
remained largely unutilized.
Water
The audit report of Comptroller and Auditor-
General of India (CAG) on Accelerated Rural Water
Supply (ARWS) has made a shocking revelation that
despite recurrent bouts of water-borne diseases across
the country, all states are ignoring drinking water
quality. Most of the state governments did not conduct
water quality tests during 2008-09. Poor urban, rural,
tribal women’s major survival struggle revolves around
safe drinking water. Leaving supply of safe drinking
water to private players has increased the hardship of
common women.
Budgetary Allocation for Water Supply & Sanitation
that affects women’s life greatly as consumers,
and unpaid and partially paid-workers does not
mention facilities for women. This has perpetuated
‘unproductive female workload of fetching water from
long distance: “Water-sheds in the country need to be
contoured on the Geographical Information Systems
(GIS) platform. Using space technology for mapping
of aquifers, a five-year plan needs to be drawn up for
creating sustainable water sources within reasonable
reach of rural habitation.” (Rajaram, 2007).
Energy Expenditure of Women
Reproductive responsibility and domestic duties
demand major time and energy of women. In the
rural and tribal areas, collection of fuel, fodder, water,
looking after the livestock, kitchen-gardening demand
a great deal of time and energy from women and girls.
The 11th Plan document has acknowledged the fact,
but in reality nothing significant is done in terms of
priority given to alternative to bio-fuels that causes
smoke-related illnesses, availability of safe drinking
water; child care facilities and adequate public transport
for women that would reduce their drudgery.
Social Security for Women in Informal Sector
Unorganized Workers’ Social Security Act, 2008, has
hardly made any difference in the lives of millions of
poor women in the unorganized sector due to non-
implementation of the Act. In the labour market, a
bizarre scenario is created where girl children are
trafficked for sex trade, domestic work and slave
labour is employed in occupationally hazardous
condition, sexploitation has become the norm in the
informal labour markets, domestic work/ servitude
go unchallenged; young women workers in Special
Economic Zone are hired and fired as per the whims
of employers and are paid miserable wages. Ninety
percent of women are not getting the benefits of
maternity benefits. Design of Maternity Benefit Scheme
must be critically examined and specific details should
be provided for its judicious implementation and
officers concerned who are guilty of non-performance
must be made accountable and punished.
Elderly Women
Half-Way Homes and Elderly Women’s Homes
must be provided in every district. Pension Scheme
for old, and disabled women is implemented only in
4 or 5 states such as Kerala, Gujarat, Andhra Pradesh
and Tamil Nadu. Panchayati Raj Institutions (PRIs)
must be motivated to provide an extensive data base
on 60 + women in their areas. For widows or elderly
women, creation of community-based half way homes,
fully equipped with counseling facilities, temporary
shelter, get-to-gather, drop-in-centre, skill building/ up
gradation and technical training, is a far more humane
way of providing social security rather than doling out
money that gets snatched from them by the bullies or
wicked relatives.
NREGA
Trade unions and women’s rights orgasnisations from
M.P., Punjab and Bihar have repeatedly conveyed that
even under NREGA pay disparities are reported by
women. Though NAREGA provided job to 56, 29,822
women in 2007-08 (GOI, 2009), they are assigned the
most unskilled and low-paying tasks. Development
economists and feminists have demanded that NREGA
For the women who
have experienced violence, a range
of medical, psychological, legal,
educational, and other support services
is necessary. To prevent violence,
improving women’s education levels
and economic opportunities has been
found to be a protective factor. The
interventions noted above to improve
women’s economic opportunities
thus become even more important.
Ultimately, however, the threshold of
acceptability of violence against women
needs to be shifted upwards. To do that
requires a massive media and public
education campaign.

be turned into an Earn-While-You-Learn plan through
Public Private Partnership (PPP) model that creates
an on-the-job training-module aimed at upgrading
skills of women working at the sites. National Skill
Development Mission (NSDM) plans to add 1 crore
workers to the non-agricultural sector through skill
training. It must respect 30 % women’s component
of the total employment opportunities. Human
(here, Women) capital formation is a must for value
addition among women employed in NREGA. Central
Employment Guarantee Council that is supposed to be
an independent watchdog for NREGA must be made
accountable for gender sensitive implementation of
NREGS.
JNNURM
Vocational Training for Women must be an inbuilt
component of JNNRUM. Support services such as
crèche, working women’s hostel, schools, ICDS centers,
and ITIs must converge to make an effective utilization
of infrastructure.
Self-Help Groups (SHGs)
Provision of loans at 4 % interest rate is implemented
only in A.P. Federations of SHGs for women are
pressurizing other state governments also to provide
loans at differential rate of interest. 71% women
workers are in agriculture and women form 39% of
total agricultural workers, who demand the women
component plan in PRIs. There is an urgent need
for a paradigm shift from micro-credit to livelihood
finance, comprising a comprehensive package of
support services including insurance for life, health,
crops and livestock: infrastructure finance for roads,
power, market, telecom etc. and investment in human
development; agriculture and business development
services including productivity enhancement, local value
addition, alternate market linkages etc. and institutional
development services (forming and strengthening
various producers’ organisations, such as SHGs, water
user associations, forest protection committees, credit
and commodity cooperatives, empowering Panchayats
through capacity building and knowledge centers etc.).
A network of capacity-building institutions
should be set up to strengthen and develop SHGs to
undertake the various functions into which they are
expanding, including Training of Trainers (ToT), and
to nurture and mentor them during the process. Milk
cooperatives must be run and managed by women. The
local authorities should facilitate meeting of SHGs of
women with the bank managers, lead bank officers and
National Bank for Agriculture and rural Development
(NABARD) officers. There should be reservation of
10% of authorized shopping areas for SHGs of women.
Women’s SHGs with primitive accumulation of capital
should charge 2% or below 2 % rate of interest. The
SHGs that manage to acquire Swarna Jayanti Gram
Swarojgar Yojana (SGSY) loans should reduce the rate
of interest to 1.5 %. Female-headed households (single,
divorced, deserted and widows) should get special
consideration while granting loans.
Women’s Component Plan (WCP)
Gender audit of Scheduled Caste Plan (SCP), Tribal
Sub Plan (TSP) and financial allocation of Ministry
of Minority Affairs is urgently required. So far, only
proclamations are made by the state governments but
except for Kerala, none of the states have implemented
WCP in all development-oriented schemes and
programmes. For example, in the Union Budget, 2009-
10, there is Need to Emphasize Women’s Component
in mega schemes on education, health, MGNREGS,
Bharat Nirman, AIDS Control Progeamme, Skill
Development Fund, Animal Husbandry, Dairying
and Fisheries Programme and funds of Department
of Agricultural Research and Education. These
development- oriented activities where massive financial
allocation is made need to specify women’s component,
at least 30% of the total budgetary allocation within
the overall financial provision. Reservation of seats for
girls must be ensured for Skill Development institutes
and Model Schools for which sizable allocation is made
in the budget.
Women’s Rights Education
No effort is made by the state or professional bodies
for employers’ education about basic human rights
of women workers. Supreme Court directive as per
Vishakha Judgment concerning safety of women at
workplace is still not implemented by most of the
private sector employers and media barons.
Utilization of Financial Allocation for Pro-
Women Schemes
Only 3-4 states are taking advantage of the financial
allocation for Swadhar, working women’s hostel, short
stay homes for women in difficult circumstances and
UJJAWALA: A Comprehensive Scheme for Prevention
of Trafficking and Rescue, Rehabilitation and Re-
integration of Victims of Trafficking and Commercial
Sexual Exploitation. What are the bottlenecks?
Implementation of crèche scheme is far from
satisfactory.
It is encouraging to note that the proposal to reserve
50% of seats for women in PRIs was cleared by the
cabinet on 27-8-09. But fund flow to PRIs has not been
streamlined even after separate budgetary allocation
for PRIs made in the current budget. How many states
have provided women’s component in Panchayat funds?
Is it utilized judiciously for women’s practical and
strategic needs?
All state governments must be made to work towards
fulfillment of longstanding demands of women’s groups
that provisions be made in the composite programmes

under education, health and rural development sectors
to target them specifically at girls/women as the
principal beneficiaries and disaggregated within the
total allocation, and restrictions are placed on their re-
appropriation for other purposes.
Road and Rail Transport for Women
India is undergoing U-shape phenomenon so far as
women’s work participation is concerned (Sudarshan
and Bhattacharya, 2009). There has been a continuous
increase in the work participation of women in the
Indian economy. Most of the working women in urban
and rural areas travel in overcrowded buses and trains.
In the transport sector, top priority needs to be given for
women special buses and trains in all cities. For women
street-vendors, seat-less buses and special luggage
compartments in trains need to be provided.
Implementation of Legislations
Promise of the EFYP to allocate funds for
Implementation of PCPNDT ACT, 2002 and DV Act
has remained unfulfilled in most of the states; and
marginally fulfilled in some states such as A.P., Kerala,
Karnataka and Tamil Nadu.
No progress is made in providing audit of land
and housing rights of women by any ministry- Urban
Development, Rural Development, Tribal Development,
Panchayati Raj institutions (PRIs) and Urban local self-
Government bodies.
Minority Women
After consistent highlighting of the findings of
Rajendra Sachar Committee Report, 2007 on
deplorable socio-economic status of majority of
Muslims in India, special budgetary allocation for
socially excluded minority communities is made. In sub-
plan for minorities where allocation of Rs. 513 crore
is made in Budget Estimates, no specific allocations
are made for minority women and women headed
households by Ministry of Minority Affairs. Inadequate
allocation for crucial schemes affecting survival
struggles of women such as Rajiv Gandhi National
Creche Scheme for Children of Working Mothers (Rs.
Rs. 56.50 crore), Working Women’s Hostel (Rs. 5
crore), Swadhar (Rs. 15 crore), Rescue of Victims of
Trafficking (Rs. 10 crore), Conditional cash transfer for
Girl Child (for the 1st time introduced and allocation of
Rs. 15 crore made) need to be corrected.
SDG 5 must direct efforts of the state and
non-state actors to provide structures,
mechanisms, funds and functionaries to ensure
women’s betterment:
ŠŠ Working-women’s hostels, night shelters for homeless
women, crèches, cheap eating facilities, public toilets
ŠŠ Women-friendly and SAFE public transport- local
trains, Metro, buses
ŠŠ Subsidized housing for single/ deserted/ divorced/
widowed women
ŠŠ Strengthening of PDS and nutritional mid-day meals
ŠŠ Abolition of user fees for BPL population, one
stop crisis centre in public hospital for women/girls
survivors of violence linked with shelter homes
ŠŠ Skill training centres for women and tailor made
courses
ŠŠ Safe, efficient and cheap public transport-bus, train,
metro
ŠŠ Safe drinking water in the community centres
ŠŠ Occupational health & safety of recycling workers/
rag pickers
ŠŠ Proper electrification in the communities
ŠŠ Multipurpose Community Centres, half way homes
for elderly and mentally disturbed women
Conclusion
Overall, the Convention to Eliminate All Forms of
Discrimination against Women (CEDAW) provides
a useful international mechanism to hold countries
accountable for meeting SDG 5. The SDG campaign
offers an opportunity to attend to the unfinished
business of development by fulfilling the promises
made by world leaders to reduce poverty, end hunger,
improve health and eliminate illiteracy. Gender
inequality fuels many of these ubiquitous challenges
and is exacerbated by them. Conversely, gender equality
and the empowerment of women can secure sustainable
future of women themselves, their households, and the
communities in which they live. n
(Chairperson and Professor, Advanced Centre for
Women’s Studies, School of Development Studies,
Tata Institute of Social Sciences, Deonar,
Mumbai-400088 Email: vibhuti.patel@tiss.edu;
The author acknowledges various references
which are available on request.)
Rich countries must stick
to their pledge to support the poor
countries through aid, debt relief, and
fairer and just trade. Only if there is
commitment on the part of the rich
as well as poor countries to fulfil
these promises, all the SDGs could
be achieved and distributive justice,
gender justice and social justice can be
realised.

COVER STORY
The year 2016 marked the end of the era of
millennium development goals (MDGs). The MDGs
paved the way for sustainable development goals
(SDGs) that the world will strive to achieve over the
next fifteen years. It is an opportune moment to reflect
on the successes and lessons learnt from the MDG
era, and the possible way forward for achieving the
ambitious and inclusive agenda of SDGs in the health
sector.
Sustainable development goal 3 stresses “Ensure
healthy lives and promote well- being for all at all
ages”.
It has the following targets and indicators:
ŠŠ To reduce maternal mortality ratio to less than 70.
ŠŠ To reduce infant mortality rate to less than 12 per
1000 live birth.
ŠŠ End epidemics of AIDS, Tuberculosis and Malaria.
Combat hepatitis, water-borne diseases and other
communicable diseases.
ŠŠ Reduce mortality from non-communicable diseases
through prevention and treatment and promoting
well-being.
ŠŠ Strengthen the prevention and treatment of
substance-abuse.
ŠŠ Halve the number of global deaths and injuries from
road traffic accidents.
ŠŠ Ensure universal health coverage, access to quality
sexual & reproductive health care services including
family planning.
ŠŠ Achieve universal health coverage, access to quality
essential healthcare services and access to safe,
effective, quality and affordable essential medicines
and vaccines for all.
ŠŠ Substantially reduce the number of deaths and
illnesses from hazardous chemicals and air, water &
soil contamination and pollution.
Lessons learnt
When MDGs were decided, there was high level
political commitment, globally and nationally. Every
effort was made to achieve the goals. To understand
the real progress and challenges, there is a need to
disaggregate data by gender, economic status and
geographical area. We know that nations require a
healthy population to prosper. When people fall sick,
high out-of-pocket expenditures on healthcare lead
to financial hardship and diminish the ability of the
population to contribute to the economy. In India,
nearly 60 million people fall into poverty just paying
for health care.
Another lesson learnt is that MDGs did not detect
and capture the importance of prevention and
easy response to disease threats. The growing non-
communicable disease (NCD) epidemic could be
prevented by reducing lifestyle risk-factors, specifically
tobacco-use, food-intake, inactivity and alcohol-
consumption.
Universal
Healthcare &
Sustainable
Development Goals
Dr Arvinder Singh Napal

Lastly, it is not only about ‘more money for health
but also more health for money’. The MDGs focused
on addressing specific diseases and symptoms which led
to fragmentation, duplication and inefficiencies in the
healthcare system. WHO estimates that nearly 20-30%
of health resources are wasted.
Present scenario
We are concerned about one goal on health (SDG3)
which aims “To ensure healthy lives and promote well-
being for all at all ages”.
The 13 broad targets under this goal are in tune with
the current global epidemiological reality. Besides the
unfinished MDG agenda of reducing maternal and child
mortality and tackling NCDs, substance abuse and
effects of environment hazards on health. This goal is
interlinked with other SDGs related to poverty, gender
equality, education, food security, water sanitation etc.
The universal health coverage (UHC), a programme
of the present government, can act as the anchor to
guide and achieve SDG goals in health.
The way forward
India can progress towards sustainable development
in health if it follows the following five steps:
ŠŠ Health must be high on the national and state
agenda, as it is the cornerstone for economic
growth of the nation. This requires high political
commitment and collective long-term efforts by
ministries beyond the Ministry of Health to invest in
health. The proposal in India’s draft National Health
Policy 2015 to raise public expenditure to 2.5 % of
the GDP by 2020 is commendable.
ŠŠ India should invest in Public Health and finish the
MDG agenda through further improvements in
maternal and child health, confronting neglected
tropical diseases, eliminating malaria and
increasing the fight against tuberculosis. For all
these challenges, it is clear what needs to be done;
programs and interventions need to be taken up to
scale, with a central emphasis on equity and quality
of services.
ŠŠ Accelerate the implementation of universal health
coverage. UHC is important to prevent people
slipping into poverty due to ill health and to ensure
everyone in need has access to good quality health
services. To complement tax-revenue-based health
financing, incremental expansion of prepayment
and risk-pooling mechanism such as social health
insurance are worth considering. UHC is at the
core of SDGs and in the interest of people and
governments.
ŠŠ Build robust healthcare system in all aspects and
strengthen both the rural and urban components,
with comprehensive primary health care as its centre.
Given the magnitude of the private sector in India,
more effective engagement with private healthcare
providers is vital. Appropriate contracting modality,
which is an important feature under the social health
insurance or RSSY, can be worked out and private
sector can be instrumental in complementing the
public sector as demonstrated by different country
experiences, including Thailand and Philippines.
Finally, develop a strong system for monitoring,
evaluation and accountability. It is absolutely essential
to regularly review and analyze the progress made for
feeding into policy decisions and revising strategies
based on the challenges.
Conclusion
In conclusion, the SDGs have the potential to create
a world where no one is left behind. The SDGs also
make it possible to achieve what the WHO constitution
mandates: ‘attainment by all people of the highest
possible level of health’.
India did fine in achieving almost all millennium
development goals. It has promised to achieve all SDGs
by 2030. We should closely monitor SDG3 which deals
with healthcare so that we don’t fall behind on targets.
Civil society can play the role of a facilitator as well as
monitor the cause. n
(The author is working in the public health care sector
for the last 20 years. He is closely associated with
nursing training institutes. Email: gadssldh@gmail.com)
We know that nations require a healthy
population to prosper. When people fall
sick, high out-of-pocket expenditures on
healthcare lead to financial hardship and
diminish the ability of the population to
contribute to the economy. In India, nearly
60 million people fall into poverty just
paying for health care.

Climate Change may refer to ‘a change in average
weather conditions or in the time variation of weather
within the context of longer-term average conditions’
as defined by World Meteorological Organization
(WMO). It can be 30 years or a longer term. Climate
change is caused by factors such as biotic processes,
variations in solar radiation received by Earth, plate
tectonics and volcanic eruptions. Certain human
activities have been identified as primary causes of
ongoing climate change, often referred to as global
warming. There is no general agreement in scientific
media or policy documents on the precise term to be
used to refer to anthropogenic forced change, as either
“global warming” or “climate change”.
Factors that can shape climate are called ‘climate
forcing’ or “forcing mechanisms” which can be either
“internal” or “external”. Internal forcing mechanisms
are natural processes within the climate system itself as
thermohaline circulation. External forcing mechanisms
can be either anthropogenic (caused by humans such
as increased emissions of greenhouse gases and dust)
or natural as changes in solar output, the earth’s orbit,
volcanic eruptions. Over the last 50 years, human
activities, particularly burning of fossil fuels have
released sufficient quantities of Carbon dioxide (CO2
)
and other greenhouse gases to trap additional heat in
the lower atmosphere and affect the global climate
change. In the last 100 years, the world has warmed
by approximately 0.75oC and in the last 25 years, the
rate of global warming has accelerated over 0.18oC per
decade. Sea levels are rising, glaciers are melting and
precipitation patterns are changing, extreme weather
events are becoming more intense and frequent.
Climate change affects social and environmental
determinants of health and important among them are
extreme heat, natural disasters and variable rainfall
patterns and infection patterns.
Impact of Climate Change
on Mosquito-Transmitted
Diseases in India
Ratna Joseph
Human disease vectors
Climate change leads to the alteration in geographical
distribution of various human diseases and their vectors
in terms of migration to cooler climates and higher
elevations. These migration events could in some
cases lead to increased disease transmission, however
extinction events may also be expected which could
possibly decrease the number of vectors in a given area.
Temperature alone can have an effect on vector-biting
rates, reproductive cycles and survival rates. It has been
suggested that an increase in global temperature may
lessen the potential for seasonally lower temperatures
which cyclically decrease vector populations. Humidity
and rainfall also have an effect on vector population
dynamics and temperature affects the survival of the
pathogens carried by vectors.
The following variables in anthropo-ecosystem of
vector-borne diseases are affected due to global climate
change, which may lead to focal outbreaks or even
epidemics in new areas.
ŠŠ Infection sub-system
ŠŠ Environmental sub-system
ŠŠ Demographic sub-system
ŠŠ Social aggregation sub-system
ŠŠ Health action sub-system.
COVER STORY

Vectors, Pathogens & Hosts which survive and
reproduce within a range of optimal climatic conditions
such as temperature, relative humidity and precipitation
are the most important, while sea level elevation, wind
and light duration are also crucial. Major determinants
of vector-borne disease transmission include vector-
survival and reproduction; vector-biting rate; and
pathogen’s incubation rate within the vector. There
are 5 important categories to be focussed to study the
relationships between climatic conditions and vector-
borne disease transmission:
ŠŠ Changes in vector biology and bionomics in relation
to climate change
ŠŠ Biochemical and physiological adaptations of vectors
and pathogens
ŠŠ Causes & associations between climate variability
and disease occurrence
ŠŠ Indicators of existing, emerging and re-emerging
disease impacts
ŠŠ Predictive models to estimate the future burden of
disease under projected climate changes.
Mosquito-transmitted Diseases
Climate change parameters that are most often
considered for their impact on mosquitoes are
temperature, rainfall and humidity, but others such
as atmospheric particle pollution and wind can also
have an impact. Primary changes in such parameters,
caused principally through the increased emission of
greenhouse gases into the atmosphere, can alter the
bionomics of mosquito vectors and therefore the rates
of transmission of mosquito transmitted diseases.
These primary changes in global climate can produce
further alterations in the biosphere and geosphere that
can additionally affect mosquito vector bionomics.
Prominent among such secondary changes are the
global distribution and characteristics of plants and
animals including disease vectors, the frequency and
Some recent natural disasters in India due to Global Climate Change.
Year Disaster Worst affected area Fatality & Damage
2001 Earthquake Gujarat state 13,805 persons died & 63,00,000 people affected
2002 Heat wave Southern parts of India Over 1000 persons died
2004 Tsunami Kerala, Tamil Nadu, Andhra Pradesh, 10,749 persons died, 5,640 persons missing,
Pondicherry states and Andaman & 27,00,000 people affected and 11,827 hectare of
Nicobar islands crops damaged
2005 Floods Jammu & Kashmir state 1400 persons died
2005 Floods Maharashtra state 1,094 persons died, 167 persons injured,
54 persons missing
2008 Cyclone Tamil Nadu state 204 persons died
2008 Floods Bihar state 527 persons died, 33,00,000 people affected &
2,23,000 houses damaged
2009 Floods Andhra Pradesh and Karnataka states 300 persons died
2010 Cloud burst Jammu & Kashmir state 257 persons died
2010 Storm Eastern India Over 140 persons died
2011 Earthquake Sikkim state 75 persons died
2012 Cold wave Northern & Eastern India 92 persons died
2013 Floods/Land slides Uttarakhand & Himachal Pradesh states Over 5,700 persons died
2014 Floods Jammu & Kashmir state Over 500 persons died
2014 Cyclone Andhra Pradesh state Over 125 persons died
2015 Floods Gujarat state Over 70 persons died
2015 Floods Tami Nadu state Over 500 persons died and over
18,00,000 were displaced
2017 Floods Gujarat state Over 200 persons died
2017 Floods West Bengal state Over 100 persons died
2018 Cyclone Tamil Nadu, Puducherry states Over 63 persons died
2018 Dust Storms Uttar Pradesh state Over 125 persons died
2018 Floods Kerala state Over 445 persons died
Source: NVBDCP, Govt. of India.

severity of extreme weather
events and a global rise in
sea levels.
In general, climate
plays an important role
in the seasonal pattern or
temporal distribution of
diseases that are carried
and transmitted through
mosquitoes, because they
often thrive in particular
climatic conditions. For
example, warm and wet
environments are excellent places for mosquitoes to
breed, if those breeding mosquitoes happen to be
the species that can transmit disease and if there is
an infected population in the region, the disease is
more likely to spread in that area. According to the
IPCC Fourth Assessment Report, climate change has
already altered the distribution of some disease-causing
mosquitoes and there are evidences that the geographic
range of mosquitoes that carry disease has changed
in response to climate change. While future climate
change is expected to continue to alter the distribution
of disease vectors, it is important to recognize that there
are several other factors such as changes in land use,
population density and human behaviour that can also
change the distribution of mosquitoes as well as the
extent of disease.
The rate of spread of a mosquito transmitted disease
in non-immune population can be represented in a
simple form by the Ross–MacDonald equation.
ma2αβpn
Ro
= --------------
r[−loge(p)]
Ro
= number of secondary infections generated from a
single infected human in a non-immune population
m = ratio of the number of vector mosquitoes to the
number of humans
a = average number of human blood meals taken by a
mosquito
α = probability of transmission of pathogen from an
infected human to mosquito
β= probability of transmission of pathogen from an
infective mosquito to a non-immune human
p = daily probability of survival of the vector mosquito
n = duration in days from infection to infective, which is
also termed the ‘extrinsic incubation’ period
r = recovery rate in humans (inverse of the average
duration of infectiousness in days)
Malaria
Malaria is of great public health concern and seems
likely to be the important mosquito-transmitted disease,
most sensitive to long-term climate change. Change
in sea-surface temperature affects the El-Nino Southern
Oscillation (ENSO) cycle and causes drought (El-Nino)
in some places and heavy rain (La-Nina) in others.
Recent analyses have shown that the Malaria epidemic
risk increases around five-fold in the year after an El-
Nino event. Further, the seasonal duration of Malaria
would increase manyfold in currently endemic areas.
Malaria varies seasonally in highly endemic areas and
the link between Malaria and extreme climatic events
has long been studied in India. Early last Century,
the river-irrigated Punjab region experienced periodic
Malaria epidemics due to excessive monsoon rainfall
and high humidity was identified as major influence,
enhancing mosquito breeding and survival. Thar
Desert, north-western Rajasthan where Malaria
dominated by Plasmodium falciparum, exacerbated
during past Two decades. The Malaria modelling
shows that, small temperature increases can greatly
affect transmission potential. The rise in minimum
temperature, consequent to global warming is poised
to substantial increase in number of Malaria cases
trnsmitted by Anopheles minimus mosquito in Assam,
India and spread to areas hitherto Malaria low-risk at
higher latitudes and altitudes.
Filariasis
Filariasis is one of the six major tropical diseases
recognized by World Health Organization (WHO) and
it is estimated that 2/3rd of global filariasis is in India
and China. In India, more than 45 crore people are
living where Filariaisis is endemic, of which 33 crore
Rural and 12 crore Urban population are at risk of
infection. At present more than 5 crore people are
Mosquito
Genera
Preferred
Breeding Habitat
Transmitted
Diseases
Causative Agent
Distribution in
India
Anopheles
Culex
Aedes
Mansonia
Fresh waters
Dirty waters
Water containers
Water with
hydrophytes
Malaria
Filariasis, JE
Chikungunya,
Dengue, Zika
Filariasis
Plasmodium spp.
Wuchereria, JE
Virus
Chikungunya,
Dengue, Zika
Virus
Brugia
All over India
All over India
All over India
Kerala
Major Mosquito-transmitted diseases in India.

suffering from disease in which, about 2 crore with
‘overt physical disabilities’ and the remaining about
3 crore with ‘microfilaraemic’. Uttar Pradesh, Bihar,
Andhra Pradesh, Telangana, Kerala, Odisha, Tamil
Nadu, Gujarat and Maharashtra states are highly
endemic for ‘Bancroftian’ Filariasis and Kerala is the
only endemic state for ‘Brugian’ Filariasis. According
to National Vector-Borne Disease Control Programme
(NVBDCP), the disease had dramatically spread over
Urban areas of India and now it is equally prevalent in
Rural areas also.
The strategies employed to achieve the goals of
elimination are implementing integrated therapy,
intensified disease management and preventive
chemotherapy with repeated community-based
mass drug administration (MDA). Climatic change
impacts like vegetation phenology, changes in
temperature or precipitation and identifying vectors are
researched intensively, but impact on parasitological,
entomological and migration challenges have been
overlooked. To improve health impacts of climate
change, better universal health coverage and sustainable
control, further studies are required. Observed changes
in temperature, rainfall and humidity that are expected
to occur under different climate change scenarios will
affect the biology and ecology of vectors, hosts and
consequently the risk of disease transmission.
Filarial infection is determined by the number of
infective bites, which can either be the result of high
intensity over a short period of time or constant
bites over a long period of time. Incubation period
from infection to the development of adult worms is
about 1 year, but the first symptoms (Fever) may not
occur until ‘microfilariae’ are produced or worms die
(Lymphatic obstruction). Since many infective bites
are required to produce infection in humans, there is
a need for continuous supply of infective mosquitoes.
The development cycle in the mosquito is 11-21 days
(mean 15 days) and an infected person can continue
to produce microfilariae for more than 10 years,
although the maximum output is in the first 3 years.
Various points in which, environmental conditions
have an impact on disease burden and control can be
implemented are:
ŠŠ Reduction of the number of adult worms (Worm
burden)
ŠŠ Decreasing the number of ‘microfilariae’ in human
host (Chemotherapy)
ŠŠ Decreasing the mosquito density (Vector abundance)
ŠŠ Reduction of the mosquito’s expectation of life (Life
span)
ŠŠ Reduction of the number of infective bites by
mosquitoes (Infection rate)
ŠŠ Alteration of the mosquito biting time (Vector
bionomics).
Any change in environmental conditions (whether
through climate change or other changes like
behaviour) has the potential to affect the relationship of
the above parameters between pathogens, vectors and
hosts.
Dengue / Chikungunya
Although Dengue fever has been known to exist in
India for over a century, outbreaks have since been
reported from different parts of the country and since
early 1960s, more than 50 outbreaks of Dengue fever
were reported in different parts of country. Dengue
transmission is seasonal in most countries including
India and epidemics have been documented during
the period, which usually correspond with warm
rainy season, when density of vector mosquito is
very high. However, outbreaks also occur during dry
season when widespread storage of water results in
tremendous increase in vector population. Dengue
fever is an acute, febrile illness caused by Flavivirus
which has 4 serotypes: DEN-1, DEN-2, DEN-3 and
DEN-4 respectively. All 4 Dengue virus serotypes
have been isolated frequently from humans and less
often from mosquitoes. Infection with one serotype
provides life-long homologous immunity but does
not provide protection against other serotypes, thus
people may acquire multiple Dengue infections. Aedes
species are widely distributed in our country and
Dengue, primarily an Urban disease until 1970s, is now
increasingly causing outbreaks in rural areas also.
Aedes mosquito, vector of Dengue/Chikungunya is
highly sensitive to climatic conditions. Studies suggest
that climate change could expose an additional 2
billion people worldwide to Dengue transmission by
2080. The effect of future climate change on the rates
of Dengue / Chikungunya transmission is complex.
On the one hand, areas with higher rainfall and higher
temperatures can expect higher rates of Dengue /
Chikungunya transmission because the mosquitoes
thrive in warm, moist environments. However, while
it seems somewhat counter-intuitive, rates of Dengue
/ Chikungunya transmission may actually increase in
regions that are projected to become more prone to
drought. Sylvaitc and mountainous environments of
Kerala state in southern peninsular India, Dengue /
Chikungunya emerged as new infections and continued
to effect. This is because the Aedes mosquitoes which
carry Dengue / Chikungunya breed in containers used
for household water storage and because the need for
such water storage containers will increase in areas
projected to be more prone to drought as climate
continues to change. Thus there may likely be more
habitats for Dengue / Chikungunya vectors in areas
projected to become drier and seasonal breeding has
also been found in tree holes and unused wells in the
country.

Dengue Situation in India
In India, major epidemic of Chikungunya fever was
reported in Kolkata during 1963, Pondicherry, Chennai,
Tamil Nadu, Andhra Pradesh, Madhya Pradesh and
Maharashtra and in 1973 in Barsi, Maharashtra during
1965, and again in Maharashtra during 1973. Thereafter,
sporadic cases also continued to be recorded especially in
Maharasthra state during 1983 and 2000. The states
affected by Chikungunya recently are Kerala, Andhra
Pradesh, Tamil Nadu, Karnataka, Maharasthra, Madhya
Pradesh, Gujarat, Rajasthan, Delhi, Pondicherry, Goa
and A&N Islands. While mutations to Chikungunya
virus are responsible for some portion of the re-
emergence, Chikungunya epidemiology is closely tied
with weather patterns in Southeast Asia. Extrapolation
of this regional pattern, combined with known climate
factors impacting the spread of Malaria and Dengue,
summate to a dark picture of climate change and the
spread of Chikunguunya disease in Asia and Africa.
Chikungunya collates current data regarding its spread
in which climate change plays an important part.
Other Arboviral Diseases
Most Arboviruses are RNA Viruses that circulate in
environment and do not infect humans in general, but
some infect occasionally and cause mild illness, while
others are of great clinical importance causing large
epidemics and deaths. Some of the important Arboviruses
other than Dengue/Chikungunya transmitted by
mosquitoes in India are Japanese Encephalitis, Sindbis
and Chandipura. Important factors in transmission of
these infections are: Susceptibility of host to infection;
Breeding habitats near human settlements and other
hosts; Biology & Bionomics; Longevity and their
abundance; and Ecological factors including ‘biocenosis’.
Improved infrastructure and socio-economic factors
along with basic diagnostics, healthcare & prevention
can decrease the risk of transmission and mortality.
Similarly, an increase in precipitation and temperature
may lead to higher density of mosquitoes responsible
for Arboviral infections and an increased transmission
rates. It is therefore suggested that efforts to control
the spread of Arbovirus in the wake of climate change
may be less effective than those directed towards other
mosquito transmitted diseases. Mosquitoes thrive in
weather conditions of heat, precipitation and humidity
and expand their range and accelerate their lifecycles,
boosting their ability to carry such diseases to infect
humans.
Effects of Climate Change and Spread of Zika
Virus.
The World Health Organization recently declared
mosquito transmitted Zika virus to be a “public health
emergency of international concern” (PHEIC) as the
disease linked to thousands of birth defects in Brazil and
Puerto Rico continues to spread rapidly. Zika outbreak
erupted after an extraordinarily hot and rainy El-Nino
summer with severe flooding that was predicted by
the IPCC as a development related to global warming.
Although it’s a combination of reasons that explains
the current Zika virus outbreak, including movement
of people and interruption of mosquito eradication
campaigns, there are reasons that aspects of climate
change, warmer wetter weather and flooding, may be
contributing to the crisis.
In India, cases of Zika virus disease were reported in
Bhagalpur area of Ahmedabad, Gujarat during May,
2017. At the same time an outbreak of Zika virus
disease occcured in Krishnagiri district of Tamil Nadu.
Recently Zika virus disease was reported from Jaipur,
Rajasthan during October, 2018.
Global climate change can potentially increase
the transmission of mosquito-borne diseases such as
Malaria, Lymphatic Filariasis, Dengue/Chikungunya/
Zika and other Arboviral infections in many parts
of the World. These predictions are based on the
effects of changing temperature, rainfall and humidity

on mosquito breeding
and survival. More
rapid development of
ingested pathogens in
mosquitoes leads to more
frequent blood feeds at
moderately higher ambient
temperatures. Greater
attention therefore needs to
be devoted for monitoring
disease incidence and
pre-imaginal development
of vector mosquitoes
in artificial and natural
habitats. Application
of appropriate counter-
measures can greatly reduce
the potential for increased
transmission of mosquito
transmitted diseases
consequent to climate
change.
Developing tools and
strategies for adaptation to
climate change, systematic
review for risk management
strategies for climate
change effects on mosquito
transmitted diseases,
building research capacity,
sharing knowledge are the
need of the hour in India.
World Health
Organization pleads for
Advocacy to raise awareness
that climate change is a
fundamental threat to
human health in terms
of anthropo-ecosystem.
Partnerships, to coordinate
with partner agencies
to ensure that health is
properly represented in
the climate change agenda.
Science and evidence, to
coordinate on the links
between climate change
and mosquito transmitted
diseases to develop research
priorities. Health system
strengthening, to assist
those areas to assess their health vulnerabilities and
build capacity to reduce mosquito-transmitted disease
burden. Identification of vulnerable areas for vector
/ disease specific regional maps, development of
robust predictive model for climate change, improved
surveillance and monitoring system will be of
immense value in prevention and control of mosquito-
transmitted diseases in India. Improved infrastructure
and development of an Integrated Environmental
1 Andhra Pradesh 16972 4925 108 1 37
2 Arunachal Pradesh 1546 18 0 5 5
3 Assam 5281 5024 41 604 2077
4 Bihar 4020 1854 1251 74 189
5 Chhattisgarh 140727 444 - - -
6 Goa 653 235 48 0 1
7 Gujarat 38588 4753 1363 - -
8 Haryana 5696 4550 6 4 4
9 Himachal Pradesh 96 452 0 0 0
10 Jammu & Kashmir 226 488 0 0 0
11 Jharkhand 94114 710 17 29 272
12 Karnataka 7381 17844 3511 26 332
13 Kerala 1192 19994 74 1 7
14 Madhya Pradesh 47541 2666 858 - -
15 Maharashtra 17710 7829 1438 27 143
16 Manipur 80 193 0 186 1125
17 Meghalaya 16454 52 45 48 160
18 Mizoram 5715 136 0 0 0
19 Nagaland 394 357 0 10 36
20 Odisha 347860 4158 - 79 1228
21 Punjab 805 15398 201 1 1
22 Rajasthan 10607 8427 1612 - -
23 Sikkim 14 312 8 0 0
24 Tamil Nadu 5444 23294 131 127 1358
25 Telangana 2688 5369 58 11 136
26 Tripura 7051 127 64 90 323
27 Uttarakhand 508 849 0 - -
28 Uttar Pradesh 32345 3092 103 693 4724
29 West Bengal 31265 37746 577 165 1514
30 A&N Islands 505 18 17 0 0
31 Chandigarh 114 1125 54 0 0
32 D&N Haveli 290 2064 0 0 0
33 Daman & Diu 38 59 0 0 0
34 Delhi 577 9271 940 - -
35 Lakshadweep 1 0 0 0 0
36 Puducherry 60 4568 23 0 0
Total 844558 188401 12548 2181 13672
No. of confirmed cases
Chikun-
gunya
Japanese
Encephalitis
Acute Encephalitic
Syndrome
DengueMalariaState / UT
Sl.
No
Burden of Mosquito-transmitted Diseases in India - 2017
Management Plans (IEMP) for stratification will be
useful to combat mosquito-transmitted diseases in
changing climatic conditions. n
(Public Health Entomologist, Deputy-Director (Retired)
Health & Family Welfare Department,
Government of India, Andhra Pradesh.
Email: ratna.joseph1956@gmail.com.
which are available on request)

A registered dietitian / clinical nutritionist / medical
nutrition therapist is an expert in the multifaceted field
of food and nutrition, who knows well about food
composition and understands the various economic,
social, psychological, and physiological factors that
influence food choices, and the relationship of these
factors to health and diseases. She / he is the health
care professional uniquely qualified for the role of a
nutrition communicator, who is a skilled listener and a
translator of theoretical information and abstract ideas
into concrete actions and practical skills for clients.
What are counselling skills?
To better understand and advance the process
of nutrition counselling, dietetic professionals and
researchers have characterized the role of the dietitian,
delineated the process of nutrition counselling, and
identified essential nutrition counselling skills, since the
last five decades. Counselling skills are a necessity for
dietitians to build trust and rapport with their patients,
to comply with nutrition therapies and to improve their
dietary behaviors.
Counseling skills include both verbal and non-verbal
communication. Verbal communication includes
actively listening to patients, using clear language and
limiting the use of nutrition / medical jargon, expressing
compassion, empathy and understanding, and being
able to communicate cross-culturally. Non-verbal
communication involves using body language, physical
gestures, eye contact and facial expressions. If verbal
and non-verbal communication are lacking or absent,
the patient may not be motivated to comply with
nutrition therapies and change their dietary behaviors.
Compliance among patients to comply with nutrition
Counselling Skills for a Dietitian
Aparna Kuna1, K. Bhagya Lakshmi 2
therapies and ultimately change patient’s dietary
behaviors is a critical endeavor, which can be fruitful
only with good communication skills.
Since nutrition counselling is a conversation or
dialogue between the dietitian and client, the dietitian
needs the following communication skills in order to
facilitate change:
Attending
Attending refers to the ways in which dietitians
can be “with” their clients, both physically and
psychologically. Effective attending allows clients to
share their world with the dietitian and also puts them
in a position to listen carefully to what their clients
are saying. Adopting a bodily posture and eye contact
that indicates involvement with client helps the client
to speak openly. Try creating a relaxed or natural
environment with the client and listen carefully to what
their clients are saying or not saying.
Listening
Listening refers to the ability of dietitians to capture
and understand the messages clients communicate
as they tell their stories, whether those messages are
transmitted verbally or nonverbally. Active listening
involves the following skills:
ŠŠ It is very important to listen to and understand the
client’s verbal messages. The dietitian has to listen to
the mix of experiences, behaviour and feelings the
client uses to describe his or her problems associated
with diet and health. Also “hear” what the client is
not saying (nonverbal messages).
ŠŠ Dietitians should learn how to listen to and read
nonverbal messages such as bodily behaviour, facial
DIET - COUNSELLING

expressions, voice-related behaviour, observable
physiological responses, general appearance, and
physical appearance. They also need to learn how
to “read” these messages without distorting or over
interpreting them.
ŠŠ The dietitian should listen to the whole person in
the context of his or her social settings. Empathic
listening involves attending, observing and listening
in such a way that the they develop an understanding
of the client’s food habits, and their eating patterns.
Basic empathy
ŠŠ Basic empathy involves listening to clients,
understanding them and their concerns to the best
possible level, and communicating this understanding
to them in such a way that they might understand
themselves more fully and act as guided by the
nutritionist.
ŠŠ A diet counsellor must temporarily forget about
his or her own frame of reference and try to see the
client’s world and the way the client sees him or
herself. This will help formulate best possible and
individualized dietary guidelines to the client.
Probing or questioning
Probing involves statements and questions from the
dietitian, that enable clients to explore more fully any
relevant issue about their dietary patterns. Probes can
take the form of statements, questions, requests, single
word or phrases and non-verbal prompts. Probes or
questions serve the following purposes:
ŠŠ Help clients to remain focussed on relevant and
important issues related to diet and disease.
ŠŠ Help clients to move forward in the dietary practices
and therapeutic process
ŠŠ Help clients understand their dietary patterns and
their problem situations to follow dietary regimens
as advised.
While probing or questioning, the following have
to be practiced:
ŠŠ Use questions with caution.
ŠŠ Don’t ask too many questions.
ŠŠ Don’t ask a question if the answer is not of any
importance.
ŠŠ Although close-ended questions have their place,
avoid asking too many close-ended questions that
begin with “does”, “did”, or “is”.
ŠŠ Ask open-ended questions ie., questions that require
more than a simple yes or no answer.
ŠŠ Start sentences with: “how”, “tell me about”, or
“what”. Open-ended questions are non-threatening
and they encourage description.
Summarizing
It is always useful for the diet counsellor to
summarize what was said in a session so as to provide
a focus to what was previously discussed, and so
as to challenge the client to move forward with the
prescribed dietary practices. Summaries are helpful
under the following circumstances:
ŠŠ At the beginning of a new diet counselling session,
summary can give direction to clients who do not
know where to start; it can prevent clients from
merely repeating what they have already said, and it
can direct a client to move forward.
ŠŠ When a session seems to be going nowhere, a
summary may help to focus the client.
ŠŠ When a client gets stuck, a summary may help
to move the client forward, so that he or she can
investigate other aspects of diet and health.
Integrating communication skills
Communication skills should be integrated in a
natural way in the counselling process. Skilled dietitians
continually attend and listen, and use a mix of empathy
and probes to help the client to come to grips with their
problems. Which communication skills will be used and
how they will be used, depends on the client’s need and
the health condition.
Communication is an essential dietetic practice
competency. The goal of client-RD relationship is
a mutual understanding of client-centred nutrition
services, to communicate and effectively implement
dietary changes for a positive health outcome. Effective
communication include establishing rapport, speaking
clearly, listening, having empathy and knowing how
to give and receive feedback and making sure clients
understand dietary treatment options for reported
health issues. It is also important to have awareness
of how much information a client can handle. This
requires identifying barriers in communication by
listening to clients and carefully observing how they
react to a given volume of information. Communication
skills along with dietetic knowledge and skills, attitudes,
values, and goals, all contribute to the quality of dietary
treatment. These elements influence how well a dietitian
encodes thoughts, feelings, emotions, and attitudes into
messages adaptable by the client for a change in dietary
practice. n
(1Sr. Scientist, MFPI – Quality Control Laboratory,
PJTS Agricultural University
2Sr. Scientist, KVK – Amudalavalasa, ANGR
Agricultural University. Email: aparnakuna@gmail.
com)

HEALTH - PROMOTING SCHOOLS
Good health is essential for learning and cognitive
ability. Ensuring good health to children of school age
can boost attendance and educational achievement.
Schools play a vital role in developing and supporting
children as they grow and learn. Every teacher, parent,
administrator and school staff member wants to
see students succeed in school, and establish skills,
knowledge and readiness they will need as adults.
The World Health Organisation (WHO) defined a
health promoting school as one that is constantly
strengthening its capacity as a healthy setting for living,
learning and working. Such schools foster healthy and
learning environment.
What is meant by School Health Service?
School Health Service is the comprehensive i.e.
integrated preventive, promotive, curative, rehabilitative
services to the school children and teachers and all the
supportive staff. It provides remedial measures and
referral services when they are needed.
Historical Background
The beginning of school health services in India
dates back to 1909, when for the first time medical
examination of school children was carried out
in Baroda city. The Bhore Committee in 1946,
reported that school health services were practically
nonexistent in India, and where they existed, they
were in under-developed state. In 1953, the secondary
education committee emphasized the need for medical
examination of pupils and school feeding programmes.
Fostering School
Health Services
For Betterment of Our Nation
S.Saranya
In 1960, the Govt. of India constituted a school
health committee to assess the standards of health
and nutrition of school children. The committee
submitted its report in 1961, which included very useful
recommendations. During the five year plans, many
state governments have provided for school health, and
school feeding programmes. In spite of these efforts to
improve school health, it must be stated that in India, as
in other developing countries, the school health services
provided are hardly more than a token service because
of shortage of recourses and insufficient facilities
Need for School Health Services
Since a school brings large numbers of students and
staff together, a system must be in place to deal with
health issues of the school children. Especially young
students may not be able to assume this responsibility
themselves. Since schools are where children spend a
significant portion of their time, schools are seen by
many observers as the logical site for services that are
based on public health principles of population-based
prevention.
Further, school health services can be a rich source
of data for studying the relation between health status
and learning capacity, and for assessing unmet needs
and monitoring the health status of children and
adolescents.
Given the above needs and benefits, a basic health
services programme must be in place in all schools.
The role of the school in providing access to primary
care is a particularly difficult and critical issue.

Since schools are a public system whereas health
care is predominately private, there appears to be a
fundamental mismatch between the two systems. Many
students already have their own source of primary care,
but a significant and growing segment of the student
population does not. Those students without access to
primary care are usually poor and are often at greatest
risk of academic failure.
Objectives
ŠŠ Prevention of illness as well as promotion of health
and wellbeing of the students
ŠŠ Early detection and care of students with health
problems
ŠŠ Development of healthy attitudes and healthy
behaviors by students
ŠŠ Ensuring a healthy environment for children at
school
ŠŠ Prevention of communicable diseases at school.
School Health and Nutrition (SHN)
Interventions
Healthy children learn better. SHN interventions
have been shown to improve not only children’s health
and nutrition, but also their learning potential and life
choices both in the short and long-term. Over the past
few decades, the success of child survival programmes
and the expansion of education coverage has resulted
in a greater number of children reaching school age and
a higher number of these children attending a primary
school.
However, disease and malnutrition are still a major
burden among this age group. Children who begin
school with the worst health status, have the most to
gain from health and nutrition programmes. They also
have the most to gain educationally, since they show
the greatest improvement in cognition as a result of
health intervention. These school health programmes
particularly benefit the poor and disadvantaged and
these children are increasingly accesible through schools
as a result of universal education strategies.
School-based health programmes can be amongst
the most cost-effective of public health interventions;
promoting learning, and simultaneously reducing
absenteeism, they can also be used as leverage for
existing investments in schools and teachers.
It is now widely recognised that SHN programmes
are an important instrument in enabling children to
attend school. As such, they are recognized as making
a significant contribution towards countries’ efforts to
achieve Education for All (EFA) and the Sustainable
Development Goals.
WHO’s Global School Health Initiative
WHO’s Global School Health Initiative, launched
in 1995, seeks to mobilise and strengthen health
promotion and education activities at the local,
national, regional and global levels. The Initiative is
designed to improve the health of students, school
personnel, families and other members of the
community through schools.
The goal of WHO’s Global School Health Initiative
is to increase the number of schools that can truly
be called “Health-Promoting Schools”. Although
definitions will vary, depending on need and
circumstance, a Health-Promoting School can be
characterised as a school constantly strengthening its
capacity as a healthy setting for living, learning and
working.
The general direction of WHO’s Global School
Health Initiative is guided by the Ottawa Charter for
Health Promotion (1986); the;Jakarta Declaration
of the Fourth International Conference on Health
Promotion(1997); and the WHO’s Expert Committee
Recommendation on Comprehensive School Health
Education and Promotion (1995).
Strategies
ŠŠ Research to improve school health programmes
ŠŠ Building capacity to advocate for improved school
health programmes:
ŠŠ Strengthening national capacities:
ŠŠ Creating networks and alliances for the development
of health-promoting schools
Coordinated School Health (CSH)
Is a strategy developed and recommended by the
Centers for Disease Control and Prevention (CDC).
CSH is not a temporary fix for your school’s physical
education or health department. It focuses on
comprehensive, school-wide improvement of your
students’ health and well-being, and it fosters an
environment of learning
The CDC’s eight components of Coordinated School
Health are as follows:
Health education
Health education encompasses many topics, including
alcohol and drug abuse, personal health and wellness,
The World Health Organisation
(WHO) defined a health promoting school
as one that is constantly strengthening
its capacity as a healthy setting for living,
learning and working. Such schools foster
healthy and learning environment.

mental and emotional health, sexual health, and of
course, healthy eating and nutrition. Students learn
how to make health-promoting decisions and why
those decisions are important. Our partner, Healthy
Lifestyle Choices, is a non-profit organization dedicated
to helping youth and families make these important
decisions.
Physical education
Physical education is much more than physical
activity; the educational aspect is integral to long-term
physical health. Students engage in activities that help
them become more knowledgeable and aware of their
physical well-being, as well as focus on acquiring new
skills and improving existing ones.
Plus, many secondary skills are learned through
this process: leadership, teamwork, communication,
strategy, critical thinking, and many more.
Health services
To foster a truly health-conscious environment in
your school, you need to include health services that
focus on preventing illness by promoting sanitary
conditions and access to emergency care for injury.
Moreover, the more education you can give students
on the ways to remain disease and injury free, the more
complete your plan will be.
Nutrition services
Nutritious food options help maintain healthy
lifestyles. By replacing unhealthy food options with
healthy, locally sourced foods in your school’s nutrition
program, you’re helping your students learn about
healthy eating—a skill they can bring home and spread
to their own families.
Following certain guidelines, like the U.S. Dietary
Guidelines for Americans, is a good place for your
nutrition services to start. Our partner, Healthy Kids
Challenge, also offers tons of great information about
how to help kids make healthy choices.
Depending on your area, the availability of nutritious
food could be limited. Talk to SPARK representatives
for guidance on how to implement nutrition services in
your school.
Counselling, psychological, and social services
Complete well-being includes more than physical
and nutritional health. In this case, counseling,
psychological, and social services are meant to improve
students’ mental, emotional, and social health, and
provide trusted professionals that are there to guide
students.
These services also help to prevent and recognize
certain disorders that relate to health and wellness,
including eating disorders and physical ailments that
would normally go untreated.
Healthy and safe school environment
A healthy school environment means many things:
starting with the physical property, as in ensuring your
school’s building and grounds are free of dangerous
elements (biological, physical, or otherwise); and ending
with the social environment within that building,
including the health culture perpetuated by your
student body.
Since it’s often difficult for school administrators to
get a grasp on what needs to change in order to create
that health-conscious culture, our SPARK educators
provide excellent resources.
Health promotion for staff
You can’t change your culture without also improving
the ability of your role models to demonstrate healthy
lifestyles to your students. By focusing on staff wellness,
you’ll ensure your teachers are not only passing their
experiences on to their students, but that your teachers
are also reaping the benefits of a healthy lifestyle.
And the healthier your employees are, the lower your
overall health care costs will be. This is potentially a
budgetary golden egg; not only will your staff members
be healthier, but you can use those health care savings
to improve other areas of your organization.
Family/community involvement
You can engage your students in health-conscious
activities during the school day, but there will be little
positive change if the parents aren’t also educated on
the benefits of living a healthy lifestyle.
The same goes with the community as a whole; there
are some great ways to get your community’s leaders
involved in construction of safe walkways, bike lanes,
and playgrounds for kids and parents alike to enjoy.
With family/community involvement, students (and
their families and friends) practise healthy lifestyle
techniques that will increase their quality of life. n
(Lecturer, Kasturba Gandhi Nursing College,
SBV University, Pudhucherry.
Email: saranyasivapragash@gmail.com;
which are available on request)
In spite of these efforts to
improve school health, it must be stated
that in India, as in other developing
countries, the school health services
provided are hardly more than a token
service because of shortage of recourses
and insufficient facilities

Aspirin: risks
outweigh
benefits
According to a British
study published in the
Journal of the American
Medical Association, the
small benefit in reducing
the risk of heart attack
and stroke by taking daily
aspirin is offset by an
equal increase in the risk
of serious bleeding.
To assess the role of
aspirin in preventing
cardiovascular events
and bleeding in people
without cardiovascular
diseases, the researchers
analysed 13 randomised
clinical trials with
more than 1,64,225
participants, aged 53 to
74.
Taking aspirin was
associated with an 11
per cent lower risk of
cardiovascular events.
But, the risk for a major
bleeding event increased
by 43 per cent.
Aspirin decreased the
absolute risk of heart
attack, stroke or death
from heart disease by
0.38 per cent. But, it
increased the absolute
risk of major bleeding by
0.47 per cent.
The Week, 24, February, 2019
In the green of
health
The heart-shaped
leaves of Giloy (Tinospora
cordifolia) found in almost
every Indian backyard is
a wonder from the plant
kingdom. Commonly
known as the heart-
shaped moonseed, it is
used extensively to treat
fever, diabetes, urinary
tract disorders, anaemia,
jaundice, asthma, cardiac
disorders etc. It has
also been called the
Indian Quinine since it
is used to treat hepatitis,
splenomegaly and
syphilis. It is often used
in ayurveda, unani and
other medicinal purposes.
The biochemical
substances found in
Giloy are steroids,
flavonoids, alkaloids and
carbohydrates.
The Indian Express, 27, January,
2019
Stay active
Older adults who were
physically active, either
by exercising or just doing
daily housework, kept
their minds sharp, even if
their brains showed signs
of lesions or other markers
linked to Alzheimer’s
disease or dementia,
according to findings of
a study published in the
journal Neurology.
The study included
454 older adults, 191
of whom had dementia.
The participants had
physical exams and tests
of memory and thinking
skills every year for 20
years. All of them agreed
to donate their brains
for research after death.
The average age at
death was 91. About two
years before death, each
participant was asked to
wear a wrist-worn device
called an accelerometer,
which measured every
single movement round
the clock, including
walking around the house
and exercise routines.
Participants who
moved around the most
had better thinking and
memory skills. Those who
had better motor skills
(that help with movement
and coordination) also
had better thinking and
memory skills.
For every standard
deviation of increase
in physical activity
and motor skills, the
participants were 31 per
cent and 55 per cent
less likely to develop
dementia, respectively.
The link between higher
activity and better
thinking skills remained
consistent even in people
who had dementia.
Less sleep
damages brain:
Study
Sleep deprivation
may increase the risk of
developing Alzheimer’s
disease by raising the
levels of tau proteins in
the brain associated with
the neurodegenerative
disease. Researchers
found sleeplessness
accelerates the spread
through the brain of
toxic clumps of tau – a
harbinger of brain damage

and decisive step along
the path to dementia.
The findings in Science
indicate lack of sleep
alone helps drive the
disease, and suggests
that good sleep habits
may help preserve brain
health. The interesting
thing here is that factors
such as sleep may
alter speed of disease
progression, said David
Holtzman, a Washington
University professor.
The New Indian Express, 29,
January, 2019
Soft killer
Drinking soft drinks
while exercising or
working outside in hot
weather may increase
the risk of kidney
disease, according to a
study published in the
American Journal of
Physiology – Regulatory,
Integrative and
Comparative Physiology.
The researchers
studied 12 healthy
adults, average age 24,
in a laboratory setting
that mimicked working
at an agricultural
site on a really hot
day. The participants
completed 30 minutes
on the treadmill followed
by 15 minutes of
lifting, dexterity and
sledgehammer swinging
activities. While resting
for 15 minutes after
their exercise, they drank
16 ounces of either a
high-fructose, caffeinated
soft drink or water. They
repeated the cycle three
more times for a total of
four hours.
The researchers
measured the
participants’ core body
temperature, heart rate,
blood pressure, body
weight and markers of
kidney injury before,
immediately after, and
24 hours after each
session. A week later, the
volunteers repeated the
four-hour session once
again. But, those who had
soft drinks in the previous
trial received water and
vice versa.
The participants had
higher levels of creatinine
in the blood and a lower
glomerular filtration
rate—both markers for
kidney injury—after
the soft drink trial, but
not when they drank
water. They also had
higher blood levels of
vasopressin, an anti-
diuretic hormone that
raises blood pressure,
and they were slightly
dehydrated after the soft
drink trial.
Counting makes
exercise-
intensity simple
Walking cadence is
a reliable measure of
exercise intensity and
can be used to set
‘simple steps-per-minute,
guidelines for moderate
and vigorous intensity,
according to a study in
the US. The researchers
also concluded that for
adults, between the ages
21 and 40, walking about
100 steps per minute
constitutes moderate
intensity, while vigorous
walking begins at about
130 steps per minute.
The research offers
walkers a concrete way to
track their activity level
without relying on exercise
devices or complicated
calculations about oxygen
consumption or heart rate.
The study also sought to
establish the relationship
between walking cadence
(steps per minute) and
intensity (metabolic rate)
across the adult lifespan,
from ages 21 to 85.
Using the study’s initial
results for younger adults,
walkers can simply count
their steps to determine
their approximate exercise
intensity. Counting steps
for 15 seconds and
multiplying by four, for
example, will determine
steps per minute. The
findings appear in the
International Journal of
Behavioural Nutrition and
Physical Activity.
The Hindu, 03, February, 2019
Sleep like a baby
Babies fall asleep faster
when they are rocked
to sleep. A Swiss study
published in Current
Biology suggests that
rocking motion helps
adults sleep better, too. It
also boosts memory.
The study included 18
healthy young adults who
spent three nights in a
sleep lab. The first night
was meant to get them
used to sleeping there.
The second night, the
participants slept on a
gently rocking bed and
on the third night, they
slept on an identical bed
that was not moving. The
participants fell asleep

faster while rocking. Once
asleep, they also spent
more time in non-rapid
eye movement sleep,
woke up fewer times and
slept more deeply. To
find out if better sleep
influenced memory,
participants studied word
pairs. The researchers
then measured how
accurately they recalled
those paired words in an
evening session compared
to the next morning.
People did better on the
morning test when they
were rocked during sleep.
Additionally, the studies
found that continuous
rocking motion helped
to synchronise brain
activities that are
important in both sleep
and memory.
Eco-diets are
healthier
After examining
the carbon footprint
of what more than
16,000 Americans eat
in a day, researchers
have identified that
more climate-friendly
diets are also healthier,
according to a study. For
the study, published in
the American Journal
of Clinical Nutrition,
researchers built an
extensive database of the
greenhouse gas emissions
related to the production
of foods and linked it to a
large federal survey that
asked people what they
ate over a 24-hour period.
They ranked diets by the
amount of greenhouse
gas emissions per 1,000
calories consumed and
divided them into five
equal groups.
January, 2019
Deadly bacteria
lurking in your
cash
Tests conducted by
researchers at London
Metropolitan University
have found that our notes
and coins are riddled
with 19 different types of
bacteria, including two
potentially life-threatening
bacteria, staphylococcus
aureus (MRSA) and
enterococcus faecium
(VRE), both known to be
resistant to antibiotics
and difficult to treat.
The money also
contained the airborne
bacteria listeria. People
who are sick and have
compromised immune
systems are the most
vulnerable.
“If you are visiting
people in hospital who
might be vulnerable
to infection, you could
unknowingly transfer
bacteria off your cash,
which is resistant
to antibiotics,” the
researchers cautioned.
“One of the most
shocking discoveries
was finding so many
microorganisms thriving
on metal, and element
on which you would
not normally expect to
see germs. The bugs
have adapted to their
environment, resulting
in coins becoming a
breeding ground for
harmful bacteria”.
The researchers
recommend washing
hands after handling
money to prevent the
spread of these deadly
bacteria. Using cards and
smartphones for payments
could also be a better
option.
The Week, 04, November 2018
Snarky
colleagues can
impact sleep
A co-worker’s rude
behaviour can affect
not only an employee’s
sleep but also his/her
partner’s, according to
a study conducted by
Portland State University
and University of Illinois.
Such employees find it
hard to fall asleep or may
wake up in the middle of
the night. For the study,
the team involved 305
working couples.
February, 2019

READERS
SPEAK
Forthcoming Themes
(The order is subject to change)
Readers are invited to write on the themes of their choice
• Iatrogenic diseases
• Plastics and health
• Emergency and trauma medicine
• Sleep disorders
• Migrant health
• Burns
• Genetically modified foods
• Deafness and hearing loss
• Helminthiasis (worms)
• Hypertension
• Road traffic accidents
• The new MBBS curriculum
• Artificial intelligence and health care
Kudos to the editorial team
An immensely useful issue
Editorials are excellent
Dr M Hemamalini,
MSc (N) MSc (Phy) PhD
Chennai-45, Tamil Nadu
Vinod
Hyderabad, Telangana
EVS Naidu, BA.,BL.,
Nellore, Andhra Pradesh
Kudos to the editorial team for
the amazing work being done
every month! Let me also thank
the team for readily publishing
our articles.
The March issue is immensely
useful. Very informative. It is
useful material for holding health
campaigns. It is a fact that most
people do not know how valuable
a physical activity is. Those who
happen to read this issue will know
more about physical activity and
exercise. It will certainly help them
to maintain their health. Keep up
the good work!
I closely read the editorial every month. They are excellent, provide
complete information with statistics on various health issues. No doubt,
the magazine is a treasure trove of health information. It can be used
by individuals and institutions. Being the head of an NGO (President,
DRUSS), I know how useful it is for non-governmental organisations in the
field of health. It covers a wide spectrum of health topics. Being a regular
reader; I recommend it for various health institutions and NGOs.
I feel proud in being a subscriber to the magazine for so long. You may
continue the good work!

ISSN NO 0970 - 471 X Registration No. H/SD/165/2018-2020
RNI No. 44961/88
Date of Publishing: 28th of every month
Date of Posting: 30th of every month
For more details, advertising and subscriptions, contact:
The Catholic Health Association of India,
157/6, Staff Road, Gunrock Enclave,
Secunderabad - 500 009, Telangana, India
Tel: +91-40-27848293, 27848457
Fax: +91-40-27811982
Email: directorgeneral@chai-india.org
Web: www.chai-india.org
75 Years
of Service to the Nation
21 Million
people being cared for
by the network
3500+
Member Institutions
in the network
76000+
Health Professionals
in the network
5 Medical
Colleges
in the network
Vol 32 No.4 April 2019

Health Action Sustainable Development Goals April 2019. ISSN: 0970-471X

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Health Action Sustainable Development Goals April 2019. ISSN: 0970-471X