Editorial 1 : Health sector can’t ignore green gains from telemedicine: study
Context
A study by researchers at the L.V. Prasad Eye Institute (LVPEI), Hyderabad, has found that around 70-80% of people who visit an eye hospital can benefit from tele-consultations because their problems aren’t serious enough to require attention at a hospital.
Telemedicine
- Telemedicine is the use of information and communications technologies (ICT) within the realm of healthcare.
- The applications of telemedicine can be categorised according to type of interaction (clinician-to-patient or clinician-to-clinician) or timing (asynchronous or synchronous).
- Asynchronous involves sending pre-recorded information between individuals, whereas synchronous is real-time data transmission.
- The data may be transmitted via a variety of media, such as audio, video or text.
- The reported advantages include lower financial costs, high patient satisfaction, better rural access, decreased waiting times and fewer missed appointment.
- The main disadvantages are erosion of the clinician–patient relationship and concerns around quality of care.
- In terms of clinician–patient relationship, this concern arises particularly from elderly patients and healthcare providers themselves; however, acceptance has been shown to be increasing.
- Studies in high-income countries have shown that telemedicine is a patient-friendly and also environment-friendly.
- Vehicular emissions are a major contributor to local pollution and global warming.
- In India, about 88% of the carbon dioxide emissions come from road traffic.
- According to one analysis, India’s healthcare sector emitted 74 million tonnes of carbon dioxide in 2014, or around 3% of India’s total emissions of the gas that year.
- Every healthcare system should work towards carbon neutrality that is why Teleophthalmology is an efficient and effective tool that can help the eye health sector to achieve that goal.
The teleophthalmology process
- In a teleophthalmology session, a patient remotely consults with an ophthalmologist over an internet-based video chat.
- The teleconsultation is mediated through a smartphone app or facilitated by a technician at a primary healthcare centre.
- If the patient uses an app, they can book an appointment with a doctor, have an online consultation, and receive an e-prescription through the app.
- This system is primarily designed for follow-up patients, so they do not have to travel to a tertiary hospital for subsequent visits after treatment.
- Most Indians live in rural areas while most doctors operate from urban locations. This leads to a gap in health care access. Teleconsultations bridge this gap.
- By helping to defer travel, we can also save a significant amount of carbon emissions. All we need is a stable internet connection.
Conclusion
- Therefore telemedicine could play a valuable role in the transition to a net carbon-zero healthcare system.
- Further research is necessary to understand how to implement telemedicine within specific contexts of specialty and geographic region in order to maximise clinical and environmental benefits.
Editorial 2 : The climate crisis is not gender neutral
Introduction
The climate crisis is already here and does not impact everyone equally. Women and girls experience disproportionately high health risks, especially in situations of poverty, and due to existing roles, responsibilities and cultural norms.
Climate change not gender neutral
- According to the United Nations Development Programme (UNDP), women and children are 14 times more likely than men to die in a disaster.
- The Supreme Court of India has just ruled that people have a right to be free from the adverse effects of climate change, and the right to a clean environment is already recognised as a fundamental right within the ambit of the right to life.
- Agriculture is the most important livelihood source for women in India, particularly in rural India.
- Climate-driven crop yield reductions increase food insecurity, adversely impacting poor households that already suffer higher nutritional deficiencies.
- Within small and marginal landholding households, while men face social stigma due to unpaid loans (leading to migration, emotional distress, and sometimes even suicide), women experience higher domestic work burdens, worse health, and greater intimate partner violence.
- The National Family Health Survey (NFHS) 4 and 5 data showed that women living in drought-prone districts were more underweight, experienced more intimate partner violence and had a higher prevalence of girl marriages.
- For women, the increasing food and nutritional insecurity, work burdens and income uncertainties lead not only to poor physical health, but also impact their mental health and emotional well-being.
Extreme events and gender-based violence
- A report from the Council on Energy, Environment and Water (CEEW) in 2021 found that 75% of Indian districts are vulnerable to hydromet disasters (floods, droughts and cyclones).
- Also, extreme weather events and subsequent changes in water cycle patterns severely impact access to safe drinking water, which increases the drudgery and reduces time for productive work and health care of women and girls.
- Prolonged heatwaves is particularly dangerous for pregnant women (increasing the risk of preterm birth and eclampsia), young children, and the elderly.
- Similarly, exposure to pollutants in the air affects women’s health, causing respiratory and cardiovascular disease, and also the unborn child, impairing its physical and cognitive growth.
- One of the most worrying aspects of air pollution is its impact on the growing brain.
- For every 10 micrograms per cubic meter increase in PM2.5, the risk of lung cancer increases by 9%, the risk of cardiovascular deaths on the same day by 3%, and stroke by 8%. For dementia, the risk increased by 4% for 2 micrograms increase in annual PM2.5.
On heatwaves and water shortage
- There are areas where immediate action is needed.
- First, we should reduce the impact of prolonged heat on priority groups (outdoor workers, pregnant women, infants and young children and the elderly).
- Urban local bodies, municipal corporations and district authorities in all vulnerable districts need to have a plan and provide training and resources to key implementers.
- Heat wave warnings, change of timings for outdoor work and schools, cooling rooms in health facilities, public drinking water facilities, and immediate treatment of those with heat stroke will minimize deaths.
- In addition, urban planning to improve tree cover, minimising concrete, increasing green-blue spaces and designing housing that is better able to withstand heat are longer-term actions.
- Using geographic information systems, the panchayat could map key water sources, identify vulnerabilities and climate hazards and develop a local plan to improve water access by directing government schemes and resources.
- Devolution of powers and finances and investing in building the capacity of panchayat and SHG members can be India’s way of demonstrating how to build resilience in a community-led and participatory way.
- Finally, a gender lens needs to be applied to all State-action plans on climate change.
Way forward
The National Action Plan on Climate Change (NAPCC) and State Action Plan on Climate Change (SAPCC) needs to implement gender-transformative strategies, ensuring a comprehensive and equitable approach to climate adaptation.