Topic 1 summer warming
Introduction: According to the India Meteorological Department (IMD), 2023 was the second warmest year in India in 122 years — the warmest ever recorded was 2016. The IMD predicts that most of India is likely to experience both above-normal maximum and minimum temperatures in April, May, and June.
Which states/regions are going to experience heatwaves?
- States or regions most prone to increased heatwaves include Gujarat, Maharashtra, North Karnataka, Rajasthan, Madhya Pradesh, North Chhattisgarh, Odisha, and Andhra Pradesh.
- A high of 45.2 degrees Celsius was reported from parts of Raichur district, Karnataka, on April 6, with seven people from different villages suffering mild heat strokes.
Rise in heat waves days in India
- The nature of the rising threats from heatwaves can be gauged from an EnviStats-IMD analysis which noted that the total average number of heatwave days annually has been increasing each decade; from 90 in 1990-99 to 94 in 2000-09, and to 139 in 2010-2019.
- The total annual average heatwave days increased from 42 in 2020 to 190 in 2022.
Heat wave-related mortalities in India
- Mortality statistics on account of heatwaves are reported by several agencies and those often do not agree on the exact numbers.
- While the IMD reported 10,545 deaths between 2000 and 2020, the National Disaster Management Authority (NDMA) put it at 17,767 and the National Crime Records Bureau (NCRB) reported 20,615.
- The National Programme on Climate Change and Human Health (NPCCHH) has initiated a reporting platform for heat-related illnesses (HRIs).
- For the record, the NDMA reported the number of deaths as only four in 2020.
- EnviStats-India reported 27 deaths in 2020 and none in 2021.
- However, in response to an unstarred question in the Lok Sabha, the Minister of Earth Sciences reported 1,274 heat-related deaths in 2019 followed by 530 in 2020 and 374 in 2021.
Trends from mortality data
- Notwithstanding these differences, there is apparent unanimity on three aspects.
- One, the actual number of deaths is likely to be higher than those reported;
- two, deaths peaked around 2015-16 and,
- three, they have been on the decline since.
- These trends are to be seen in the backdrop of two more statistics:
- the number of heatwave-affected states increased from nine in 2015 to 23 in 2019 and
- the number of average heatwave days recorded in this period increased nearly five-fold, from 7.4 to 32.2.
- This underscores heat as a growing public health challenge.
Case study: co-morbidities related heat wave death in Ballia and Deoria District in Uttar Pradesh
- The cases of Ballia and Deoria districts in Uttar Pradesh are worth recounting.
- These district hospitals witnessed sharp spikes in admissions from certain areas and recorded 150 deaths in five days during the week of June 15-22, 2023.
- These were not medically certified as heat-related deaths but district officials confirmed that most were aged above 60 years and suffered from co-morbidities that “may have aggravated due to the heatwave”.
- The state-level investigation concluded that heatstroke could have been “contributory” to the deaths but not “causative”.
- Environmental analysts noted that temperatures at that time were about 45 degrees Celsius, with a relative humidity of 30-50 per cent — that meant, it would “feel like” more than 60 degrees Celsius. This is unquestionably life-threatening.
The under-reporting of heat wave related deaths
- Environmental health experts draw attention to the fact that non-biomedical external factors are often missed on death certificates leading to inaccuracies in cause-of-death reporting or estimations.
- The classic example is lightning strikes where the direct cause may be a falling tree branch or a fire but the indirect cause — the lightning strike — that triggered a cascade of events culminating in mortality does not find mention.
- The US National Association of Medical Examiners defines “heat-related death” as a death in which “exposure to high ambient temperature either caused the death or significantly contributed to it”.
European method can be used to correct misreporting/under-reporting of heat wave deaths
- A standard method to estimate deaths occurring on account of these situations is recording and mapping excess deaths during the specified period.
- It is now agreed that over 70,000 excess deaths occurred across 16 countries with a combined population of about 400 million in Europe during the exceptionally hot summer of 2003.
- An epidemiological analysis of the Eurostat mortality database published in July 2023 quantified heat-related mortality burden during the summer of 2022, the hottest season in Europe so far.
- The number of heat-related deaths estimated for 35 countries between May 30 and September 4 is 61,672.
- These countries have a combined population of 543 million, a little less than half of India’s.
- Among them, those around the Mediterranean Sea experienced the highest mortalities — Italy, Greece, Spain, and Portugal.
- Despite the experience of 2003 and with most countries institutionalising adaptation measures, the magnitude of heat-related deaths underscores the enormity of the challenge.
India’s preparation to tackle heat wave disaster in 2024
- The union Health minister reviewed public health preparedness for the management of HRIs on April 3.
- Updated Heat Action Plans are available in 23 states and about 100 districts have initiated awareness campaigns.
- Those at the greatest risk include children, pregnant women and the elderly; those with pre-existing conditions such as diabetes and heart disease; those who are socially isolated and the poor.
Conclusion: In theory, all or most all heat-related deaths and illnesses are preventable while in practice, gauging the public health impact of extreme temperatures is difficult. As the summer season intensifies, the state and civil society will be tasked with watching out for the extra-vulnerable.
Topic 2 : Hepatitis warning
Introduction: A WHO report has flagged the seriousness of India’s Hepatitis challenge. India is called the Hepatitis capital of the world. Despite a national programme to eliminate Hepatitis, India is seeing a huge burden of this disease.
The number of reported and unreported Hepatitis patients in India
- With nearly 3 crore Hepatitis B patients and more than 50 lakh Hepatitis C patients, the country’s burden of these liver diseases is the second highest in the world.
- They claimed more than a lakh lives in 2022.
- Even more worrying is that a very small fraction of the infected come under the diagnostic ambit.
- Less than 30 per cent of Hepatitis C cases are detected; the figure for Hepatitis B is less than 3 per cent.
National Viral Hepatitis Control Programme (NVHCP)
- It aims to eliminate Hepatitis C by 2030 and “achieve significant reduction in morbidity and mortality associated with Hepatitis B” by that year.
- The WHO report is a warning that the country has much work to do to attain this target.
- However, the global health agency has also struck a note of optimism: “Course correction between 2024 and 2026 can bring NVHCP on track”.
About Hepatitis
- Hepatitis refers to an inflammatory condition of the liver.
- It is commonly the result of a viral infection, but there are other possible causes of hepatitis.
- These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol.
- Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue.
- The liver is a vital organ that processes nutrients, filters the blood, and fights infections.
- When the liver is inflamed or damaged, its function can be affected.
- Hepatitis B and C are spread through contact with contaminated blood.
Hepatitis B: Symptoms and cures
- Hepatitis B can lead to the scarring of liver tissues and increase the risk of cancer.
- Diagnosis is complicated — carriers can harbour the virus for years without appearing to be diseased.
- They can infect others even when they do not show symptoms — these often show up only when the pathogen takes an aggressive form.
- There is no cure, though treatment can help manage symptoms to an extent.
- The NVHCP, initiated in 2018, provides free testing and medication.
- However, the WHO report indicates that the programme hasn’t touched most patients.
- Rigorous adoption of blood screening protocols in the past 20 years has substantially reduced the risks from transfusion.
- Most of the Hepatitis B infections in the country are today passed on from mother to child.
- Vaccination can prevent the disease but the highest immunity is conferred when the child is administered a jab just after birth.
- In India, less than 50 per cent infants get vaccinated this early.
- This is largely to do with the low rate of institutionalised births in large parts of the country.
- Informing community healthcare workers with vaccination protocols could increase the efficacy of the immunisation regime.
Hepatitis C cures
- Hepatitis C is far easier to treat.
- Anti-virals can cure the disease and prevent long-term liver damage.
Conclusion:
According to WHO, treatment costs in India are amongst the lowest in the world. But 70 per cent patients eluding the diagnostic network speaks of a healthcare deficit that must be addressed immediately. Whether it’s containing viral diseases like hepatitis or bacterial infections like TB, there can be no shortcuts to expanding the country’s medical facilities.