GH 101 Final Assignment
-Abhishek Bandyopadhyay
Quiz Section AS
Student Number 1736063
SECTION 1
India is sort of a mixed bag when it comes to its stance on policies of public health. Public opinion on public and private healthcare sectors varies significantly between states, with almost all states leaning heavily towards favoring private care despite the high out-of-pocket costs and extremely shady health insurance policies. Among the many reasons for doing so, the main one at the national level is poor quality of care in the public sector, with more than 57% of households pointing to this as the reason for a preference for private health care(https://dhsprogram.com/pubs/pdf/FRIND3/FRIND3-Vol1AndVol2.pdf)
The focus of my research will be on the prevalence and incidence of Respiratory diseases (acute, chronic, infectious and non-infectious) in the Northwest region of India, particularly the states of Haryana, Punjab and Delhi. From the provided GBD Tool, respiratory illnesses span across all 3 categories, and together constitute around 15-16% of all deaths occurring across the country per annum. A major contributor to these statistics is the northwestern region itself.

SECTION 2
STAFF More opportunities for women in all fields of work, study and research. Measurement of sex ratio 1) Family planning awareness programs, 2) free mandatory education programs for women till 12th grade. 1)Change in sex ratio, and also 2) changes in proportion of women represented in all fields.           STUFF 1)Increase in immunizations administered; 2) Improvement in basic sanitation and hygiene standards. Incidence of cases of those immunizable and preventable diseases 1) Increase awareness and break down myths regarding immunization; 2) Drives and fundraisers organized by schoolchildren. Prevalence of new cases of those diseases.           SPACE Increase in infrastructure, quality and number of health service providing centers. Number of hospitals/clinic/health centers per unit area. 1) Do surveys in areas with low health center density, figure out what kind of healthcare is needed at those regions, and 2) increase budget for health infrastructure at those focus areas. Measure changes in health center density, also measure prevalence of problem illnesses.           SYSTEMS Providing health services in underserved and “backward” areas Incidence of “poverty”-related communicable and non-communicable diseases like diarrhea, cholera, TB, malaria etc. State Urban Health Missions for extending health services to urban areas, especially urban slums. Prevalence of those “poverty”-related communicable and non-communicable diseases .           SECTION 3
STAFF: One of the root underlying causes of disease is lack of education among women in Haryana about their own rights and well-being, especially for low-income families. Hence, making education compulsory and free FOR WOMEN AND GIRLS ONLY will help provide them with a voice in the community, a voice which should have been there from the very beginning. Reversing the current sex ratio, which is horribly skewed in favor of males, will also go a long way in addressing these problems of understaffing and disproportionate representation in health centers.

STUFF: To combat the drop in total number of immunizations done, awareness programs may be undertaken to dispel myths about vaccines and increase awareness of its benefits. Involving schoolchildren in programs to bring about improvements in living conditions for the poor is crucial not only for the present, but also in shaping young minds to care for each other in the future as well.

SPACE: There is a severe lack of healthcare providing centers in remote areas. Increasing health center density in these areas as well as making access easier by creating proper transport routes would be extremely beneficial. This would require support from the state-level PWD (Public Works Department) and the state Government.

SYSTEMS: Increase provision of better health services to so-called “backward” regions of the community, which include the slums and remote areas. State Urban and Rural Health Missions should be created to focus on these objectives, and these bodies would have a diverse representation of various communities, but have the majority be members of the low-income and underserved communities.

SECTIONS 4 and 5
The key political player in the Government of Haryana today (and even the central Government of India) is the “Bharatiya Janata Party” or the BJP. As such, India is currently in a highly charged political atmosphere with strong pro-Hindu sentiments, which has lead, often, to anti- Islam feelings among the general public. From a public health perspective, the Government has undertaken quite a few initiatives to combat causes of respiratory disease like silicosis and tuberculosis.
As per the Anderson Memorandum (called “Trade Reforms in India”, dated Nov. 30, 1990) submitted to Government of India by the World Bank, the following series of policy measures launched by the Indian government were part of the $500 million twofold SAP approved in December 1991 and closed in December 19932-V:
•Devaluation of rupee by 23%.

•Opening more areas for private domestic and foreign investment.

•Sick public-sector units to be closed.

•Reforms of the financial sector by allowing in private banks.

•Liberal import and export policy.

•Amendments to the existing laws and regulations to support reforms.

•Market-friendly approach and less government intervention.

There is a significant deficit in the size of the health workforce in India. Physician and nurse/midwife density is consistently 25-30% below WHO-recommended levels, although net numbers have been steadily climbing in the past decade2-VI. The northern part of India has contributed 7-10% of the total cases of COPD from the early 60’s to the late 90’s2-VII.
A majority of the monetary aid is external, from organizations like the GFATM, which has provided $337 million between 2014 to 2017 as aid committed to fighting tuberculosis2-VIII. India has also formed partnership programs with USAID to improve self-sustainability and even herself extend aid to fellow countries, as agreed upon in a U.S.-India Joint Statement signed in June 2016, which enables the U.S. and India to work as partners across Africa and Asia to reduce the effects of climate change and socio-political unrest on public health, promote food security and ensure continued regional integration and stability2-IX. Initiatives by the local Governments include National Urban and National Rural Health Missions, which aim to increase public awareness and choose to combat the disease from a preventative rather than simply a curative angle2-VII.

SECTION 6
With a population of more than 1.2 billion, India is home to one-sixth of the world’s population. This has a very strong positive correlation to the large gaps in the living standards of low and high-income communities. The BPL (Below Poverty Line) percentage currently stands at 38% for rural areas and 25% for urban areas, and this is a considerably larger proportion of poor citizens than expected. Presence of such a high population is also indicative of poor family planning awareness, as well as failure to meet basic levels of sanitation and hygiene. Family values are important in Indian culture, and multi-generational patriarchal joint families have been the norm in India, though nuclear families are becoming common in urban areas. 30.7% of India’s children under the age of five are underweight2-XI. According to a Food and Agriculture Organization report in 2015, 15% of the population is undernourished (Barillas, 2013) 2-XII. The “Mid-Day Meal” scheme attempts to lower these rates. A major underlying factor of this is the large disparity between the rich and poor sections of society. Although the total GDP is above ten trillion dollars, a Gini coefficient of 33.9 means almost all that wealth is in the hands of a few 2-IX. This factor goes hand in hand with the significant levels of corruption seen in past governments. Most public healthcare serves rural areas; the poor quality is attributed to health professionals’ unwillingness to practice with such subpar infrastructure. As a result, most public healthcare depends on inexperienced and unmotivated undergraduate students who are required to spend 2-4 years in public healthcare clinics as part of their M.B.B.S. graduation requirement.

India has shown itself to be quite a formidable force in the fight against the global burden of disease when she puts her mind to it. Certain issues like internal disunity and corruption within the government as well as the middlemen involved in the transfer of external aid resources to the government need to be addressed for effective disbursement and utilization of that aid. However, India is trying and, provided she maintains or increases her level of commitment to these issues, will stay on the path towards a brighter, healthier future.

SECTION 7 2-XIII
The given GBD comparison screenshot is a tree map that shows the proportion of deaths across all age and sex demographics in India for the year 2016.

Sources are listed below: –
1..Scholarly sources:
•Singla, N., Satyanarayana, S., Sachdeva, K. S., Van den Bergh, R., Reid, T., Tayler-Smith, K., ; … Sarin, R. (2014). Impact of Introducing the Line Probe Assay on Time to Treatment Initiation of MDR-TB in Delhi, India. Plos ONE, 9(7), 1-5. doi:10.1371/journal.pone.0102989
•Prakash, B., Puri, M. M., Kumar, L., Malik, A., ; Behera, D. (2014). Correlation of quality of life and activities of daily living with disease stage in patients with COPD. International Journal Of Medicine ; Public Health, 4(3), 275-279. doi:10.4103/2230-8598.137716
2. Websites and PDF links:-
I)National Tobacco Control Program: http://haryanahealth.nic.in/menudesc.aspx?page=93II)Revised National Tuberculosis Control Program: http://haryanahealth.nic.in/menudesc.aspx?Page=86III)2016 Annual Health Department Report: http://haryanahealth.nic.in/userfiles/file/pdf/Annual_Reports/AnnualReport_2016.pdfIV)Haryana Silicosis Rehabilitation Policy, Labor Department, Govt. of Haryana: https://hrylabour.gov.in/staticdocs/labourpolicies/Haryana%20Silicosis%20Rehabilitation%20Policy%20(English).pdfV)SAPs in India, World Bank: http://lnweb90.worldbank.org/oed/oeddoclib.nsf/DocUNIDViewForJavaSearch/0586CC45A28A2749852567F5005D8C89VI)Rate of healthcare professionals per 1000 people in India (2016): http://apps.who.int/gho/data/node.main.A1444VII)Epidemiology of COPD in India (2012): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3378191/pdf/jtd-04-03-298.pdfVIII)Audit Report Global Fund Grants to the Republic of India; GF-OIG-16-023 5 October 2016 Geneva, Switzerland: https://www.theglobalfund.org/media/2664/oig_gf-oig-16-023_report_en.pdf?u=636488964600000000IX) County Profile- India, USAID: https://www.usaid.gov/sites/default/files/documents/1861/INDIA_COUNTRY_PROFILE.pdfX) Haryana: Disease Burden Profile, 1990 to 2016:
file:///C:/Users/gudlu/Desktop/Haryana_-_Disease_Burden_Profile1.pdfXI)Improving Efficiency of Health Care System in Multiple States (UNDP, India): http://www.in.undp.org/content/india/en/home/operations/projects/health/improving-efficiency-of-health-care-system-in-multiple-states.htmlXII)The Global Fund- India- Country Overview:
https://www.theglobalfund.org/en/portfolio/country/?loc=IND;k=7c973abd-19b9-486b-956a-8ddeb7dd3f58XIII) Global Burden of Disease comparison mapping tool: https://vizhub.healthdata.org/gbd-compare/