1. Sustainable Health for All.
2. One nation one election
1. Sustainable Health for All.
Theme : Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
TABLE OF CONTENT
(b) Some Facts on Health and Diseases
(c) Prevalence of Non-Communicable Diseases
(d) Health for All
(e) Challenges in the Health Sector
Universal Health Care is seen as a route to building robust, responsive and efficient health systems capable of addressing growing inequalities in healthcare demands along with shielding populations from spiraling healthcare and medicine costs.
Some Facts on Health and Diseases :
Non communicable diseases (NCDs) lead to the death of 41 million people globally each year. This is more than 70% of all deaths in the world.
77% of NCDs deaths are in middle and low income countries.
India’s per capita public expenditure on health is just Rs. 1,657 in nominal terms, as compared to Rs. 5,000 in Sri Lanka and Rs 3,500 in Indonesia.
India has 7 doctors for 10,000 Population, as compared to 9.5 in Malaysia, 11.5 in Philippines, 12.2 in Vietnam and 18.3 in Singapore.
Doctor to population ratio in India is 1:1,404 in urban areas and 1:11,000 in rural areas, against the WHO recommended ratio of 1:1,000.
Also, WHO recommends 44.5 health workers per 10,000 population to achieve the Sustainable Development Goals (SDGs). India has only half of it.
According to WHO, between the years 1990 and 2015, under-nutrition or malnutrition is the major cause of death in 45% of all deaths among children aged below 5 years.
The proportion of underweight children in developing countries has declined from 28% to 16% in 2015. However, in India, about 47% of the children were underweight in 2013.
Similarly, the prevalence of Stunting is almost 34.7% in Indian children.
Mental Health: As per the mental health survey 2016, lifetime prevalence of mental illness in India is 13.7%. Over 15 Crore patients need active intervention.
28% of the global suicides occur in India.
Global Hunger Index 2020: India ranked 94 among 107 countries. India was classified in the ‘serious hunger’ category.
Prevalence of Non-Communicable Diseases :
- Non Communicable Diseases (NCDs): A NCD is a disease which is not transmitted from one person to another directly. They are mostly genetic or lifestyle diseases. For e.g., diseases like Diabetes, hypertension, Parkinson’s disease, kidney diseases, heart diseases are examples of NCDs. Out of these, 4 categories viz. cardiovascular diseases, cancers, respiratory diseases and diabetes account for almost 80% of all premature deaths.
- Diseases of the Rich: Unlike the communicable diseases which are more prevalent in the poor, NCDs are mostly limited to the richer class of society. This is because communicable diseases are mostly spread because of the inability to access hygienic food, pure water and clean surroundings. NCDs, on the other hand, are majorly attributed to genetic factors or a consequence of the fast-paced life without adequate concern for health.
- Reasons for the spread of NCDs: Major causes for the spread of the NCDs are attributed to:
- Fast-paced life: A wave of urbanization is underway in the country. This is characterized by high paying jobs in the urban areas. Such a lifestyle does not leave adequate time for leisure activities, leading to stress induced diseases in the individual.
- Job targets: Again, the high paying jobs have strict targets and a fear of job loss, if these targets are not met. This also leads to stress, sometimes deteriorating to depression and other mental issues, if the performance of the individual is not up to the expectations.
- Insufficient Physical activity: At the same time, it is seen that contemporary jobs are much more focuses on brain activity, with physical activities taking a back seat. Coupled with insufficient time for physical exercise or gym training, it has the potential to increase the vulnerability towards NCDs.
- Unhealthy junk food: Spread of globalization has led to the adaptation of food habits from different cultures in the country. Experts have called this the McDonaldization and Coca-colonization of the world. Though knowledge and appreciation of cultures is a positive effect, it has also promoted uptake of unhealthy junk foods, leading to the spread of NCDs in the community.
- Smoking: Usage of tobacco is another major cause of the spread of NCDs. Usage of tobacco has spread in the form of chewing in rural areas and smoking in urban areas. ? Pollution: The spread of respiratory diseases can be attributed to the use of unclean fuel in rural areas as well as an increase in air pollution across the cities of the country. In fact, media reports have also attributed the increase in the incidence of cancer to the spread of plastic pollution in the country. Though medical science is yet to conclusively establish the cause of cancer in humans.
- Epidemiological transition: Studies have pointed to the epidemiological transition in the prevalence of NCDs in the country. A study in the medical journal Lancet has found that 7% of the population of India had diabetes, with 10-15% of the population showing early signs of diabetes viz. increase in blood sugar levels. The study has concluded that the states with high GDP have more prevalence of diabetes.
Health for All :
- History of International Cooperation: Health sector has been accorded top priority by the United Nations, manifested in the Alma Ata Declaration in 1978 which defines health as ‘state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity’.
- The Article 3 of the Universal Declaration of Human Rights (UDHR) provides that everyone has the ‘right to life, liberty and security of person’. This is extended by the Supreme Court of India by stating that the right to life includes the right to food and health.
- Thailand: It has introduced universal health care without any charge for everyone since 2002. As per the recent reports, 77% of all hospital beds in Thailand are in the public sector.
- Cuba: It has a compulsory service for the doctors and nurses for at least 3 years in the rural areas. Also, there is a sustained drive to get all the old people with cataracts operated on in the public hospitals. Cuba has also started a radical drive to fund the primary healthcare system.
Challenges in the Health Sector :
- Retreat of the State: Critics have blamed the spread of capitalism for the retreat of the State from the welfare functions like subsidized education and universal health coverage. This has led to a general decline in the coverage of the public health system for the population, especially in the rural areas. For instance, the doctor to population ratio in rural India is 1:11,000 as compared to the WHO recommended ratio of 1:1,000.
- Low Health Expenditure: The burden of a huge population in the country is compounded by a meager health expenditure of 1.26% of the GDP. This is low even when compared to the south Asian standards, with countries like Bangladesh and Pakistan, spending almost 3% of their GDP on healthcare. Countries like Thailand increased their public health expenditure from 1.7% (2001) of the GDP to 2.7% (2008) in a span of 7 years.
- Demand and Supply Mismatch: The Medical Education system is unable to keep up with the increase in the demand for qualified professionals including doctors, trained nurses and para-medical healthcare personnel. In India, there are only 7 doctors per 10,000 population, as compared to 12.2 in Vietnam and 18.3 in Singapore.
- Inadequate coverage of the health insurance: The challenges of the ailing public health system in India are exacerbated by the minuscule insurance coverage. In 2019, India’s life insurance penetration stood at around 2.82%. Non-life insurance coverage (like health insurance) is also quite low, at 0.94%.
- Increase in Out of Pocket Expenditure: Retreat of the state, minuscule insurance penetration and rise in the incidence of diseases have led to an increase in the out of pocket health expenditure in India. In fact, catastrophic health expenditure is considered the most frequent cause of households slipping below the Poverty Line in India.
- Malpractices by the Medical Professional: Multiple media reports have pointed to the absence of government doctors in the duty hours due to their commitments to private clinics and hospitals. At the same time, even private doctors have been accused of colluding with the diagnostic services to recommend unnecessary tests to the patients.
2. One nation one election
Theme : Functions and responsibilities of the Union and the States, issues and challenges pertaining to the federal structure, devolution of powers and finances up to local levels and challenges therein. Salient features of the Representation of People’s Act.
TABLE OF CONTENT
(b) What is the Model Code of Conduct?
(c) Status of Simultaneous elections in India
(d) Arguments for why Simultaneous elections is a good idea
(e) Arguments for why the present system should continue
There has been an Increasing discussion on conducting One Election throughout.
What is the Model Code of Conduct?
- It is a set of guidelines issued by the Election Commission to ensure fairness in the elections conducted to the Central and State legislature.
- The code was observed first in the 1960 elections.
- It is a voluntary code which has been agreed upon by the political parties themselves to ensure free and fair elections. However, it is enforced by the Election Commission.
Status of Simultaneous elections in India :
- Till 1967, the country had simultaneous elections at the Centre and in all the state assemblies except Nagaland and Pondicherry.
- However, the premature dissolution of Lok Sabha in 1971 led to the lack of synchronization in the elections at the Centre and State assemblies.
- Again, the premature dissolution of Lok Sabha in 1998 and 1999, apart from the loss of confidence in state governments and passing of No-Confidence motions has contributed to staggered elections in India. The imposition of President Rule has also exacerbated the situation.
Arguments for why Simultaneous elections is a good idea :
- Cost to the Exchequer: Multiple elections at different times leads to a huge cost to the exchequer in the form of lost time, labor and financial costs. There are significant costs involved in the conducting of elections including the movement of security personnel, diversion of state machinery towards presiding over the elections and other similar costs.
- Administrative Disturbance: Staggered elections lead to diversion of officials towards election duty. This also extends to the other requirements of the Election Commission like the official vehicles, buildings etc. Similarly, the teachers and other functionaries must leave their primary occupation in abeyance, leading to gaps in the social development of the community.
- Policy Paralysis: A significant casualty of the multiple elections is Development. Since the government is prohibited from announcing any new development schemes after the enforcement of the Model Code of Conduct (see inset), no new projects can be taken up. This is especially problematic once the elections start spreading over to multiple elections every year or even twice a year.
- Political Opportunism: Multiple elections mean that the government cannot take decisions in the national interest, due to the fear of losing elections in the respective states. This usually translates to a lack of long-term vision of the developmental policy and security paradigm of the country. Again, the critics have lamented the diversion of funds from the security needs to the welfare provisions, mostly in the nature of appeasement, affecting the long-term needs of the armed forces.
- Election Expenditure: The staggered elections not only lead to heavy expenditure by the State but also the political parties. The costs involved in printing election paraphernalia, movement of star campaigners and other miscellaneous costs must be borne by the parties. This enhances the need for donations to the political parties, leading to the industry-politician nexus and breeding corruption in the State.
- Missing Leadership: Again, frequent elections lead to focus on winning the elections rather than the development of the nation, for the Ministers of the government. This leads to a political vacuum and absence of guidance for the bureaucracy, again, hampering development in the country.
Arguments for why the present system should continue :
- Constitutional Amendments: The present system is envisaged by the Constitution and would require multiple amendments to effect any significant change. For e.g., for the first-time synchronization, there needs to be an amendment to the Article 83 of the Constitution which envisages a term of five years for the Lok Sabha. It is important to note that the Constitution does not allow for the extension of the term of Lok Sabha except in the case of Proclamation of Emergency (National Emergency).
- Difficult to Maintain Synchronization: It is difficult to maintain simultaneous elections in a democracy. Even if we can achieve simultaneous elections at the Centre and in all states by prolonging and shortening the tenures of the Lok Sabha and the respective State Assemblies, it would be difficult to maintain such a situation for long. As soon as any government loses confidence in its assembly, again the system will fall into disarray.
- No-Confidence Motion: The lower house has been envisaged to keep a check on the government through various instruments given in the Constitution like the No-confidence motion or the Censure motion or the devices invented by the Parliament for the purpose like the Zero hour. However, to maintain simultaneous elections, there would be a need to modify the Constitution by removing such motions which can dissolve the Lok Sabha without completing its term.
- Constructive Vote of Confidence: An alternative to the motion of No-confidence is the Constructive Vote of Confidence which is the norm in the German parliament. In this system, a vote of No-Confidence is moved only with a vote of Confidence in the successor. Therefore, the government cannot be dissolved without electing another one in its place.
- Against the Principles of Democracy: The present system has been consciously chosen by our forefathers to uphold the will of democracy by providing for regular elections so that people can express their will through the right to vote. However, modifying the election system would mean tampering with the power of people to express their democratic will.
- Accountability: Again, regular elections mean that the government is under an obligation to listen to the will of the people lest it loses the elections in one state or the other. However, if the government is assured of a fixed tenure without any fear of recall, it might lead to autocratic tendencies, where the ministers exercise their powers, at least initially, as per their whims and fancies, and conduct political welfare in the latter part of the tenure to influence the voters.
- Costs don’t matter: Experts contend that there are certain functions where the costs are immaterial. For e.g. ensuring food security or law and order in the territory is the primary function of the government, irrespective of the costs incurred in such an endeavor. Similarly, ensuring the continuation of democracy in the country is independent of the associated costs.
- Disadvantage to Regional parties: Many experts have pointed out that in case of simultaneous elections to the Centre and the States, the voter is much influenced by the national issues rather than the local problems. Therefore, it is inherently disadvantageous for the regional parties as it diminishes their chances to perform well.