A budget that addresses the ‘medical poverty trap’ is the need of the hour

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Government should introduce limit of 8 lakh for EWS for insurance cover

New Delhi, 31 January 2019: Statistics indicate that about 55 million Indians were pushed into poverty in a single year because of having to fund their own healthcare. Another 38 million of them fell below the poverty line due to spending on medicines alone, as per a study published in the British Medical Journal. Health expenditure is considered catastrophic if it constitutes more than 10% of overall household consumption or income.

There is an urgent need to reduce health inequity in India. This has been addressed in the National Health Policy 2017 as a key policy principle, which states Reducing inequity would mean affirmative action to reach the poorest. It would mean minimizing disparity on account of gender, poverty, caste, disability, other forms of social exclusion and geographical barriers. It would imply greater investments and financial protection for the poor who suffer the largest burden of disease.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “With the Union Budget 2019 to be announced in just a short while from now, all attention will be on what policies have been put in place to ensure universal, accessible, and affordable healthcare. It is not just medical care but also social factors that play an important role in determining a person’s health status. These factors are also responsible for the gaps in health among various strata of people. Lack of availability and accessibility to resources that improve health among the socially disadvantaged groups are major factors contributing to health inequity in the country. Though there has been progress in the efforts to make healthcare accessible to the poor, there still exist inequities. Many people are pushed below poverty line on account of the high medical expenses in what has been termed as ‘the medical poverty trap’.”

Among the 10 social determinants of health, social gradient has been deemed to be the strongest predictor of health and wellbeing. It is measured by variables such as income, education, occupation or housing. The lower the socioeconomic position, the higher the risk of poor health.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “The Ayushman Bharat scheme, which provides up to Rs 5 lakh cover, is one step towards ensuring the Right to Health and access to healthcare. This year, the constitutional amendment bill providing for 10% reservation to the economically weaker sections of the General Category was notified. These are in a bracket of less than 8 lakh annual income. Only by reducing the health inequity, can the goal of universal health coverage be realized. In the budget to be announced, the government must bring this limit of 8 lakh to the definition of EWS for the purpose of ESI, health subsidy, and Ayushman Bharat subsidy. Those above this bracket should be able to buy their insurance on their own.”

A common budget allocated for various health programmes will ensure more intersectoral cooperation and knowledge sharing. This will also avoid any overlap in programmes in these ministries to a large extent and result in saving of financial outflow. All in all, we look forward to a budget that focuses on overall health and wellness thereby contributing to better productivity. Positive policies that will make healthcare more simple, affordable and accessible to common people are the need of the hour.

Anger management: An anger episode may trigger an acute heart attack within 2 hours

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Emotionally stressful events, and more specifically, anger, immediately precede and appear to trigger the onset of acute myocardial infarction (MI) and other cardiovascular events.

Outbursts of anger increase the risk of acute myocardial infarction, acute coronary syndrome, ischemic stroke, ruptured intracranial aneurysm and ventricular arrhythmia. This was corroborated by a systematic review and meta-analysis published in the European Heart Journal, which found a higher risk of cardiovascular events in the 2h after outbursts of anger (Eur Heart J. 2014 Jun 1;35(21):1404-10).

An earlier study from Deaconess Hospital, Harvard Medical School published in the journal Circulation in 1995 had shown that episodes of anger are capable of triggering the onset of acute myocardial infarction and that that this risk may be reduced by the use of aspirin (Circulation. 1995 Oct 1;92(7):1720-5). More than 1600 patients were studied, of which 39 were found to have episodes of anger in the 2 hours before the onset of MI. The relative risk of MI in the 2 hours after an episode of anger was 2.3. This risk was mitigated by aspirin. Compared to nonusers, patients who were taking aspirin regularly had a significantly lower relative risk; 1.4 vs 2.9, respectively.

These studies caution that heart patients on aspirin should continue to take aspirin to prevent anger-induced heart attack or stroke.

The description of anger comes in mythology as one of the five vices which need to be controlled to acquire spirituality. The description of anger in mythology is as under:

Lord Shiva is also shown wearing a snake in his neck with hood directed inwards. Shiva is also said to have a blue neck or Neelkanth indicating that to control anger one should neutrilise then anger continuously (matted hairs) with cool mind (Moon) using positive flow of thoughts (ganga) with ego controlled (naag)
Bhagavad Gita talks about anger in great details and tells that anger is as a result of unfulfilled of desires. As per Bhagavad Gita lust leads to anger and anger leads to ego.
As per Lord Shiva, anger can be expressive and or suppressive. Expressive anger can lead to rupture of arterial blockage and suppressive anger can lead to arterial blockage. The best answer described by Lord Shiva is to manage and control the anger.
Two forms of Goddess Durga and Kali also indicate when to get angry.
As per mythology, one should learn to control anger but it also talks about allowable spiritual anger when it is done for the benefit of the mankind.
The period of Uttarayana has started, which is the phase of a positive state of mind. But even then people with angry temperament, especially heart patients on aspirin should not miss their daily aspirin dose.

It is equally important to learn to manage one’s anger.

As per Shiva Puran, anger management is described under Neelkanth role of Lord Shiva. The blue color means slow poison (one of them being anger) which is kept in the neck. It indicates that anger should not be expressed or suppressed but should be managed. Management involves continuously (Jatadhari) with cool mind (Moon), one should direct positive thoughts (Ganga) towards the reason for anger keeping the ego under control (Naag) with head directed in.
As per Bhagwad Gita, anger is always resulting of non-fulfillment of desires. Therefore, one must act at the levels of desires.
As per Marshal Rosenberg, indulging in non-violent communication helps in managing anger.
Drugs like SSRI used in modern medicine, primarily focus on reducing irritability and chronic anger. They may take as long as 10 weeks to act. Aspirin is also recommended in people with un-managed anger to prevent occurrence of heart attack.
Anger recall is as bad as anger itself, which can be expressive or suppressive. Both are dangerous. Expressive anger causes plaque to rupture leading to heart attack or MI, while suppressive anger causes chronic sympathetic overactivity that helps plaque formation.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

India needs more awareness generation and removal of stigma around HIV/AIDS

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Mother-to-child transmission of the disease can only be prevented through targeted efforts

New Delhi, 30 January 2019: About 80 adolescents will be dying of AIDS every day globally by 2030 if progress in preventing transmission is not accelerated, according to a report by the UNICEF. The report mentions that the current trends indicate that AIDS-related deaths and new infections are slowing, but the downward trajectory is not happening fast enough. Programmes to treat the virus and prevent it from spreading among older children are nowhere near where they should be.

Currently, three million persons 19 years and younger, are infected with HIV worldwide. Two million new infections could be averted by 2030, if global targets are met — this means providing adequate access to HIV prevention, care and treatment services, and testing and diagnosis. Many infected children and adolescents are unaware of their illness, and even when tested HIV-positive, rarely adhere to proper treatment.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “The HIV virus remains concealed in the reservoir cells; for this reason, the HIV infection, which is in remission with antiretroviral drugs (ART), becomes active again as soon as ART is discontinued. Killing these latent reservoirs is therefore essential to achieving cure. Scientists are better equipped today, both with knowledge and technology, which raises hopes of finding a cure. HIV/AIDS also continues to affect the Indian population despite various mass awareness campaigns, availability of various state-of-the-art medical interventions, and evolving technology. A large part of this is also due to the social stigma that our society has associated with the disease. This is also one reason why people avoid routine checkups. There is an urgent need to educate the masses about the various disease prevention measures along with the fact that people with HIV can live a normal life.”

The UNICEF report cites a global target reduction in the number of HIV-infected children by 2030 to 1.4 million. However, the projected number of 1.9 million, shows that the world is off-track by around 500,000.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “HIV can spread from an infected woman to her child during pregnancy and childbirth. It can also be passed from a mother to her child through breastfeeding. All pregnant mothers should get HIV test done. Antiretroviral therapy (ART) should be started at the earliest to prevent HIV transmission to sexual or drug using partner/s or from the mother to the infant during pregnancy or breastfeeding.”

Some other facts

  • ABC for safe sex: Abstain, Be faithful to your partner and if you cannot, use Condoms.
  • Drinking alcohol or taking drugs interferes with judgment. Even those who understand the risks of AIDS and the importance of safer sex may become careless after drinking or using drugs.
  • People with STIs should seek prompt treatment and avoid sexual intercourse or practice safe sex.
  • Used infected razor blades, knives or tools that cut or pierce the skin also carry some risk of spreading HIV.

·         HIV-positive people may remain asymptomatic but can still pass on the virus to others.

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