World Health Study Shows Pakistan Doing Better Than India

[Riaz Haq]

Pakistan ranks in the middle among 15 similar countries compared by the
Global Burden of Disease Study 2010 (GBD 2010).  Other countries in this group include India, Djibouti, Kyrgyzstan, Laos, Moldova, Mongolia, Nicaragua, Palestine, Papua New Guinea, Philippines, Solomon Island, Uzbekistan, Vietnam and Yemen.

Source: Global Burden of Disease (GBD) Study

 The study is  is a collaborative
project of nearly 500 researchers in 50 countries led by the Institute
for Health Metrics and Evaluation (IHME) at the University of
Washington. The Institute describes it as " the largest systematic scientific effort in history to quantify
levels and trends of health loss due to diseases, injuries, and risk
factors. GBD serves as a global public good to inform evidence-based policymaking and health systems design".

In terms of the number of years of life lost (YLLs) due to premature death in Pakistan, the study found that lower respiratory infections,
neonatal encephalopathy (birth asphyxia and birth trauma), and
diarrheal diseases were the highest ranking causes in 2010.
Of the 25 most important causes of burden, as measured by
disability-adjusted life years (DALYs), diarrheal diseases showed
the largest decrease, falling by 35% from 1990 to 2010.
The leading risk factor in Pakistan is household air pollution
from solid fuels. Interpersonal violence, including crime and terrorism, is ranked 20th on a list of  71 causes of premature mortality in Pakistan.

Leading Mortality Causes in Pakistan

Recent research shows that there are potentially far reaching negative consequences for nations carrying high levels of disease burdens causing lower average intelligence among their current and future generations.

World IQ Map

Published by the University of New Mexico and reported by Newsweek, new research shows that there is a link between lower IQs and prevalence of infectious diseases. Comparing data on national “disease burdens” (life years lost due to infectious diseases or DALYs) with average intelligence scores, the authors found a striking inverse correlation—around 67 percent. They also found that the cognitive ability is rising in some countries than in others, and IQ scores have risen as nations develop—a phenomenon known as the “Flynn effect.”



According to the UNM study's author Christopher Eppig and his colleagues, the human brain is the “most costly organ in the human body.” The Newsweek article adds that the "brainpower gobbles up close to 90 percent of a newborn’s energy. It stands to reason, then, that if something interferes with energy intake while the brain is growing, the impact could be serious and longlasting. And for vast swaths of the globe, the biggest threat to a child’s body—and hence brain—is parasitic infection. These illnesses threaten brain development in several ways. They can directly attack live tissue, which the body must then strain to replace. They can invade the digestive tract and block nutritional uptake. They can hijack the body’s cells for their own reproduction. And then there’s the energy diverted to the immune system to fight the infection. Out of all the parasites, the diarrheal ones may be the gravest threat—they can prevent the body from getting any nutrients at all".

Looking at the situation in South Asia, it appears from the WHO data that Pakistan is doing a bit better than India in 12 out of 14 disease groups ranging from diarrhea to heart disease to intentional injuries, and it is equal for the remaining two (Malaria and Asthma).

Another detailed WHO report on World Health Statistics for 2010 assesses and compares its member nations on the basis of nine criteria including mortality and burden of disease, cause-specific mortality, selected infectious diseases, health service coverage, risk factors, health workforce-infrastructure, health expenditures and demographic and socioeconomic statistics. It shows that both India and Pakistan have some serious challenges to overcome to have any chance of meeting health-related Millennium Development Goals (MDGs 4, 5 and 6).


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South Asia Slipping in Human Development

[Riaz Haq]

An excerpt from the HDR 2013 report summary mentioning Pakistan is as follows:

More than four-fifths of these developing countries increased their trade to output ratio between 1990 and 2012. Among the exceptions in the subgroup that also made substantial improvement in HDI value are Indonesia, Pakistan and Venezuela, three large countries that are considered global players in world markets, exporting or importing from at least 80 economies. Two smaller countries whose trade
to output ratio declined (Mauritius and Panama) continue to trade at levels much higher than would be expected for countries at comparable income levels.

Here's a Business Standard report on HDI 2013 in South Asia:

Of 187 countries, India's Human Development Index (HDI), essentially a composite measure of health, education and income, rank stands at 136, on a par with Africa's Equatorial Guinea and just above Cambodia and Laos in Southeast Asia. Even over a longer period (between 2000 and 2012), it registered average annual HDI growth of 1.50 per cent, lower than Pakistan's (1.74 per cent).

Viewed in the context of the BRICs grouping (Brazil, Russia, India and China), India's standing is much below its peers - China is ranked 101st, Russia 55th and Brazil 85th. In fact, India remains squarely stuck at the bottom end of the second-lowest category in the report -Medium Human Development - even as neighbour Sri Lanka (99) moves a step higher towards becoming a "high human development" nation.

A closer look at India's performance reveals more inadequacies, especially in education. Though the country's life expectancy at birth, mean years of schooling and per capita GNI are comparable to peers, India's "expected years of schooling" is significantly below others, including Vietnam, Bhutan and even Swaziland.

Gender inequality
India is no easy country for women. The Human Development Report's Gender Inequality Index, which assesses gender-based inequalities based on reproductive health, empowerment and economic activity, ranks India 132nd out of 148 countries, below Bangladesh (111) and Pakistan (123).

"26.6 per cent of adult women have a secondary or higher level of education, compared to 50.4 per cent of their male counterparts (in India)," said an explanatory note. "Female participation in the labour market is 29 per cent, compared with 80.7 per cent for men."

Difficult future?
Though the report recognises key initiatives undertaken in India in recent years - particularly reforms in the education system, the direct cash transfer programme, a rise in social sector spending, public-private-partnerships across sectors and growing connectivity -vital concerns remain.

"India has the most projected child deaths over 2010-2015, about 7.9 million, accounting for nearly half the deaths among children under five in Asia," the report said. "China has more people than India, but is projected to have less than a quarter (1.7 million) the number of child deaths over 2010-2015."

India also has to contend with a substantial, uneducated population, possibly partly counteracting the country's feted demographic dividend. "Despite the recent expansion in basic schooling and impressive growth in better educated Indians, the proportion of the adult population with no education will decline only slowly," the report predicted.

"Even under an optimistic fast-track scenario, which assumes education expansion similar to Korea's, India's education distribution in 2050 will still be highly unequal, with a sizeable group of uneducated (mostly elderly) adults."

http://www.business-standard.com/article/economy-policy/un-report-b...

[Riaz Haq]

India world’s leprosy epicentre, despite its ‘elimination’ in 2005
Leprosy cases with severe deformities have increased by 50% increase in the past six years, indicating that many cases of the curable disease are being detected late. This rising trend of late diognosis is a cause for concern, especially after the government had declared leprosy had been eliminated from India in 2005. WHO norms say leprosy is eliminated if the prevalence of the disease is less than one case per 10,000 people.
According to the WHO, 60% of the 2,12,000 people detected with leprosy globally in 2015 were from India. WHO norms say leprosy is eliminated if the prevalence of the disease is less than one case per 10,000 population. In 2005, India achieved statistical elimination of leprosy with a national prevalence rate of 0.96. The prevalence rate declined to 0.66 in 2015-16. The next step is eradicating the disease, when not a single case is reported.

http://www.hindustantimes.com/india-news/india-world-s-leprosy-epic...


From the early 1960s on, Pfau helped lead the Marie Adelaide Leprosy Centre, transforming what was once a tiny makeshift dispensary into the hub for a system of 157 medical centers across the country, often in remote regions. With the partnership of the Pakistani government, Pfau developed the country's National Leprosy Control Programme and extended her efforts to include treatments for blindness and tuberculosis.

"We are like a Pakistani marriage," Pfau told the BBC of her occasionally strained collaboration with state officials. "It was an arranged marriage because it was necessary. We always and only fought with each other. But we never could go in for divorce because we had too many children."

But that partnership paid dividends. By 1996, the World Health Organization declared that leprosy had been controlled in Pakistan. The country's Dawn newspaper reports that last year, just 531 patients were in treatment for leprosy nationwide — down from 19,398 in the early 1980s.

For her efforts, Pfau earned the country's second-highest civilian honor, the Hilal-e-Imtiaz, in 1979. And she ultimately came to enjoy a celebrity in Pakistan on par with another nun known the world over for her work with the sick and the poor: Mother Teresa.

http://www.npr.org/sections/thetwo-way/2017/08/10/542588725/ruth-pf...

[Riaz Haq]

World #SnakeDay: #India is the #Snakebite Capital of the World with one million reported snakebites every year that kill ~60,000 and leave 1.5 lakh to 2 lakh #Indians permanently disabled. There's deteriorating quality, rising costs of antivenom. #disease https://weather.com/en-IN/india/biodiversity/news/2022-07-16-world-...

Poor waste management practices in our cities lead to a thriving rodent population, which in turn leads to a thriving population of snakes, albeit those of just commensal species such as cobras, rat snakes, Russell’s vipers and a few others. Still, the urban residents have little to fear when it comes to snakebites.

The story in rural India is vastly different — akin to two diametrically opposite ‘Indias’ within the same geographic boundary. Our country leads the world in snakebite figures, deaths from snakebite, and even cases of loss of life function.

Now, on the occasion of World Snake Day — observed annually on July 16 to increase awareness about the different species of snake all around the world — we attempt to understand the ground reality of human-snake conflict in India.

India records over 10 lakh snakebites every single year, which kill ~60,000 individuals and leave another 1.5 lakh to 2 lakh people with permanent disabilities. Studies have demonstrated that 94% of the victims are farmers, most of which belong to the most economically productive age groups.

These are staggering figures for a disease that the World Health Organisation (WHO) rightly calls a ‘Neglected Tropical Disease’. However, they are only an unfortunate fraction when compared to the number of snakes that are cruelly and brutally killed in conflict every day across the country.

One cannot help but wonder how India, one of the first countries in the world to develop antivenom over a century ago, remains frozen in time when it comes to safeguarding its citizens from snakebite. A myriad of problems surround the issue of human-snake conflict, and very few have attempted to address it, unlike the conflicts with mega-fauna such as tigers, elephants, bears and others.

Challenges that coil the human-snake conflict in India
The complexity of snakebite begins with the very fact that India, as a tropical country, is blessed with a diversity of snakes rivalled by few others. Among more than 300 species of snakes found in the country, nearly 50 are venomous, of which 18-20 are medically significant — meaning they can cause loss of life or morbidity in their victims if untreated.

Despite these many medically significant species, the lone antivenom available in India only targets the four most commonly found venomous species. This effectively ignores those parts of the country where none of these four species are found. Further, for nearly a decade now, it has been common knowledge that the venom of snakes, even within the same species, varies by region significantly enough to render the antivenom ineffective in several places.

Snake venom, produced at the lone source in the country, has been severely critiqued for its deteriorating quality and increasing costs by the antivenom manufacturers. In turn, herpetologists and venom research scientists have long been urging the pharmaceuticals to upgrade their own processes for the manufacture of antivenom, which will need significantly lower quantities of venom and at least addresses the issue of costs of venom.

Beyond all of these issues, the major hurdle at the hospital stage for the victim, is the lack of availability of antivenom, and the fact that snakebite is a medico-legal case which hoists far more bureaucratic hoops for a victim and their family to jump through. If one were to bypass these hurdles still, they are often faced with a medical fraternity that is so poorly equipped to treat snakebites that victims are often shuttled between hospitals, only for several to succumb in transit.