Editorial 1: Cancer in India: A status report
Recent Context:
- According to recently published report by the American Cancer Society, deaths due to cancer have declined by 33% in the United States since 1991
- The attribute of success goes to early detection, lower rates of smoking, and improvements in cancer treatment.
- This trend is yet to be reflected in India. Even with improvements in treatment, both the incidence of cancer and mortality continue to rise in the country.
The finding of report related to cancer cases:
- The findings in the US, journal A Cancer Journal for Clinicians, record
- a steep reduction of 65% in the rates of cervical cancer in women in their early 20s between 2012 and 2019, the first cohort to receive the human papillomavirus vaccine (HPV) vaccine.
- Doctors confirmed that the rates of cervical and smoking-related cancers have gone down in India as well; however, the incidence of lung and breast cancers has increased.
- Better screening and treatment centres, and more comprehensive linkages between screening centres and hospitals are essential to reduce cancer mortality in the country.
What is the incidence of cancer and mortality in India currently?
- As per data from the National Cancer Registry of the Indian Council of Medical Research (ICMR) An estimated 14.6 lakh new cancer cases were detected in 2022, up from 14.2 lakh in 2021 and 13.9 lakh in 2020.
- Deaths due to cancer increased to an estimated 8.08 lakh in 2022 from 7.9 lakh in 2021 and the incidence of all cancers is estimated to increase to 15.7 lakh by 2025, according to the data.
- One in nine Indians will develop cancer during their lifetime, according to an ICMR study using data from population-based cancer registries.
- One in 68 men will develop lung cancer and one in 29 women will develop breast cancer, according to the study.
- The incidence of cancer is higher among women — 103.6 per 100,000 in 2020 compared to 94.1 among men. Among men, the most common cancers were of the lung, mouth, prostate, tongue, and stomach; for women, they were breast, cervix, ovary, uterus, lung
Why are some cancers on the decline and others continue to rise?
- The incidence of cervical cancer has dropped in India over the last 50 years from 45 to 10 per 100,000 population, Prof G K Rath a former head of the AIIMS National Cancer Institute in Jhajjar, said.
- “At the same time, there is an increase in rates of breast cancer, especially in urban centres.
- Rates of cervical cancer have declined because of later marriages, fewer children, better hygiene, and vaccination.
- And the incidence of breast cancer has gone up because of the same reasons — later age of marriage, having the first child at a later age, not breastfeeding, and a high protein diet,”
- Unlike cervical cancer, which can be prevented with HPV vaccination — with vaccines becoming cheaper, the government plans a campaign soon — there is no specific intervention for breast cancers other than screening because what causes it is unknown.
- The rates of tobacco-related cancers — oral, oesophageal — cancers are also coming down. This is largely due to tobacco laws that have brought down smoking in public places
- Lung cancers, however, remain a cause for concern. “Lung cancer is caused not only by smoking. For example, lung cancer rates are high in Arunachal Pradesh because they light fires indoors in winter. We see lung cancers in women in Bihar because they have spent years cooking on chullahs. And with the kind of air we are breathing in Delhi, we will see the impact in the next 10 years,
Have there been improvements in cancer treatments?
- Yes, “The cure rate for various cancers is rising. And we do see individuals who have completely beaten cancer.
- The cure rate for pancreatic cancer has doubled from 3% 50 years ago to 6%.
- For prostate cancer, it has gone up from 60% to 100%. And for breast cancer it has improved from 50% to 90% with newer treatments.
- But in order to reduce mortality, we have to ensure people get diagnosed early on and receive timely treatment
What must be done to bring down overall mortality like in the US?
- The first intervention has to be screening.
- Screening for the three most common types of cancer — breast, cervical, and oral has already started through the government’s upgraded health and wellness centres.
- This, coupled with other government programmes, has meant people are reaching hospitals sooner.
- “I used to have a 80/20 rule — 80% of patients present to the hospital late, of whom 20% are curable, and 20% of patients present early, of whom 80% are curable.
- Over the last 10 years, this has become 70/30 — now 30% of patients are presenting early to hospitals
- Cervical, breast, and oral cancers account for 34% of cancers in India, so screening for them is good; however, it has to be more focused in order to achieve mortality gains,
- Dual stain testing is the best tool for screening for cervical cancer, while a low-dose CT in those with a history of smoking is the best for lung cancer.
Conclusion:
- There is need for raising the awareness among the people so that they come for screening and early detection and curation of cancer related cases.
- There are several programmes of the government that are working independently which are needed to be coordinated so that once a person is screened, they do reach a hospital.
- Along with government should also increase its budget for R&D, infrastructure creation, adoption of technologies related to cancer and availability of cancer related drugs at affordable cost.
Editorial 2: Election Commission’s initiative to enfranchise migrant voters is a step in the right direction
Recent Context:
- Recently, Election Commission (EC) announced that it is ready to pilot remote voting for domestic migrants, so they don’t have to travel back to their home states to vote.
- It is regarded as on of the EC’s acknowledgement of migration-based disenfranchisement
- EC has developed a prototype for a Multi-Constituency Remote Electronic Voting Machine (RVM) that can handle multiple constituencies from a single remote polling booth.
Background:
- One of the significant features of India’s electoral record has been its progressive betterment on two major counts
- in registering eligible citizens as electors and
- achieving increased participation of electors in voting.
- While only 17 per cent were registered and 45 per cent of them turned out to vote in 1951 in India’s first general election, in 2019, India’s latest general election, over 91 per cent of its eligible citizens were registered with 67 per cent of them coming out to vote, which is the highest voter turnout in the nation’s history.
- It is, however, worrying that one-third third eligible voter who counts 30 crore people, do not vote.
- Among the many reasons, including urban apathy and geographical constraints, one prominent reason is the inability of internal migrants to vote for different reasons.
Committee formed by the Election commission to address migrants’ issues related to election:
- Election Commission had earlier formed a “Committee of Officers on Domestic Migrants” to address this issue.
- The Committee’s report submitted in 2016 suggested a solution in the form of “remote voting”
- EC invited representatives from all recognised national and state political parties to discuss the legal, administrative, and statutory changes to resolve the issue. The discussion took place in the presence of a technical expert committee.
- Earlier also, major decision about the voting system was the introduction of Voter Verifiable Paper Audit Trail (VVPAT), with the consensus of all political parties in 2010.
Why do migrants voting rights to be recognised?
- Indian Constitution guarantees freedom of movement to every citizen and freedom to reside in any part of the country.
- However, migrant workers, especially circular or short-term migrants, constituting tens of millions of citizens are deprived from right to vote due to absence in own constituency.
- As, the issue of disenfranchisement faced by migrant workers is not one arising out of deliberate denial of the right to vote, but for lack of access to vote.
- The Supreme Court, in a series of cases, has conclusively interpreted the freedom to access the vote as within the ambit of Article 19(1)(a).
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According to the 2011 Census, the number of internal migrants stands at 450 million, a 45 per cent surge from the 2001 census.
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- The root cause of the migrant voters’ issue is that the individual’s inalienable right vote is conditioned by a rather strict residency qualification.
- As a consequence, it tends to disenfranchise the migrant population. In the survey report, ‘Political inclusion of Seasonal Migrant Workers in India: Perceptions, Realities and Challenges’ by Aajeevika Bureau, it was found that “close to 60 per cent of respondents had missed voting in elections at least once because they were away from home seeking livelihood options”.
- In the 2019 Lok Sabha polls, major sender states such as Bihar and UP had among the lowest voter turnout rates at 57.33 per cent and 59.21 per cent respectively, while the national average was 67.4 per cent.
- Although electoral laws let people register at their place of “ordinary residence”, most face difficulties to get residence proof. Moreover, many migrant voters may not be as intensively involved in the political affairs and interests in their host locations as they are in their home locations
Way forward / What is the way out?
- Section 60(c) of the Representation of People Act, 1951 empowers the Election Commission of India, in consultation with the government, to notify “classes” of voters who are unable to vote in person at their constituencies owing to their physical or social circumstances.
- Once notified, the voters are eligible for the ETPB system (Electronically Transmitted Postal Ballot System).
- In the 2019 general elections, the ETPB system was accessed by 18 lakh defence personnel across the country.
- In 2019, in the backdrop of a PIL before the Supreme Court, a bill was floated to extend a similar remote voting possibility to over 10 million adult NRIs in order to “boost their participation in nation-building”.
- In the 2019 Lok Sabha elections, more than 28 lakh votes were received via postal ballots.
- In the existing system, remote voting within the constituency by voting via postal ballot is available to senior citizens, people with disabilities, and Covid-affected personnel.
- The postal ballot voting outside the constituency is available only to service voters, persons on election duty and persons on preventive detention.
- The Indian migrant worker too deserves the secured right to have access to vote through some mechanism.
- The Election Commission has proposed the use of remote voting for migrant workers wherein a modified version of the existing model of M3 EVMs will be placed at remote polling stations.
- In fact, the Electronic Corporation of India Ltd. has already developed a prototype of a Multi-constituency Remote EVM (RVM) — a modified version of the existing EVM which can handle 72 constituencies in a single remote polling booth.
- Therefore, it is positive steps of Election commission to increase the participation of eligible votes who migrated for their livelihood.
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The technology: allowing voters from multiple constituencies to vote using the same machine
This will also be displayed privately, on the BUOD in the RVM’s RBU. The voter will then vote and each vote will be stored constituency-wise in the control unit of the voting machine. |
