National Health Policy 2017 approved by Cabinet

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Focus on Preventive and Promotive Health Care & Universal access to good quality health care services
The Health Ministry has formulated the National Health Policy 2017, after a gap of 14 years, to address the current and emerging challenges necessitated by the changing socio-economic and epidemiological landscapes since the last National Health Policy was framed in 2002. The Cabinet has approved the National Health Policy 2017.

The policy informs and prioritizes the role of the Government in shaping health systems in all its dimensions investment in health, organization and financing of healthcare services, prevention of diseases and promotion of good health through cross-sectoral action, access to technologies, developing human resources, encouraging medical pluralism, building the knowledge base required for better health, financial protection strategies and regulation and progressive assurance for health.

The roadmap of this new Policy is predicated on public spending and provisioning of a public healthcare system that is comprehensive, integrated and accessible to all. The Policy seeks to reach everyone in a comprehensive integrated way to move towards wellness. It aims at achieving universal health coverage and delivering quality health care services to all at affordable cost.

The policy is patient centric and empowers the patient for resolution of all their problems. The policy, has at its centre, the person, who seeks and needs medical care.

The policy also looks at reforms in the existing regulatory systems both for easing manufacturing of drugs and devices, to promote Make in India, as also for reforming medical education.

The policy envisages a time-bound Implementation Framework with clear deliverables and milestones to achieve the policy goals.

It also seeks to ensure improved access and affordability of quality secondary and tertiary care services through a combination of public hospitals and strategic purchasing in healthcare deficit areas from accredited non-governmental healthcare providers, achieve significant reduction in out of pocket expenditure due to healthcare costs, reinforce trust in public healthcare system and influence operation and growth of private healthcare industry as well as medical technologies in alignment with public health goals.

The policy emphasizes reorienting and strengthening the Public Health Institutions across the country, so as to provide universal access to free drugs, diagnostics and other essential healthcare.

• The broad principles of the Policy are centered on professionalism, integrity and ethics, equity, affordability, universality, patient-centered and quality of care, accountability and pluralism.

• The main objective of the National Health Policy 2017 is to achieve the highest possible level of good health and well-being, through a preventive and promotive health care orientation in all developmental policies, and to achieve universal access to good quality health care services without anyone having to face financial hardship as a consequence.

• The policy seeks to move away from Sick- Care to Wellness, with thrust on prevention and health promotion.
• It envisages providing larger package of assured comprehensive primary health care through the ‘Health and Wellness Centers’ and denotes important change from very selective to comprehensive primary health care package which includes care for major NCDs, mental health, geriatric health care, palliative care and rehabilitative care services.
• It advocates allocating major proportion (two-thirds or more) of resources to primary care followed by secondary and tertiary care.
• It also aspires to provide at the district level most of the secondary care which is currently provided at a medical college hospital.
• In order to provide access and financial protection at secondary and tertiary care levels, NHP 2017 proposes free drugs, free diagnostics and free emergency care services in all public hospitals.
• National Health Policy 2017 affirms commitment to pre-emptive care (aimed at pre-empting the occurrence of diseases) to achieve optimum levels of child and adolescent health. It envisages school health programmes as a major focus area as also health and hygiene being made a part of the school curriculum.

• The policy looks at stronger partnership with the private sector and advocates a positive and proactive engagement with the private sector for critical gap filling towards achieving national goals. It envisages private sector collaboration for strategic purchasing, capacity building, skill development programmes, awareness generation, developing sustainable networks for community to strengthen mental health services, and disaster management.
The policy also advocates financial and non-incentives for encouraging the private sector participation.
• The policy proposes raising public health expenditure to 2.5% of the GDP in a time bound manner.
• It aims to ensure availability of 2 beds per 1000 population distributed in a manner to enable access within golden hour.
• The Policy advocates a progressively incremental assurance-based approach.
• The policy envisages a three dimensional integration of AYUSH systems encompassing cross referrals, co-location and integrative practices across systems of medicines. This has a huge potential for effective prevention and therapy that is safe and cost-effective.
• Yoga would be introduced much more widely in school and work places as part of promotion of good health.
• It seeks to strengthen the health surveillance system and establish registries for diseases of public health importance, by 2020.
• It also seeks to align other policies for medical devices and equipment with public health goals.
• Under a ‘giving back to society’ initiative, the new Health Policy supports voluntary service in rural and under-served areas on pro-bono basis by recognized healthcare professionals.
• It also advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system and proposes establishment of National Digital Health Authority (NDHA) to regulate, develop and deploy digital health across the continuum of care.
• The Policy has also assigned specific quantitative targets aimed at reduction of disease prevalence/incidence under 3 broad components viz.
a) Health status and programme impact,
b) Health system performance and
c) Health systems strengthening, aligned to the policy objectives.
Some key targets that the policy seeks to achieve are -
• Life Expectancy and healthy life
a. Increase Life Expectancy at birth from 67.5 to 70 by 2025.
b. Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease and its trends by major categories by 2022.
c. Reduction of TFR to 2.1 at national and sub-national level by 2025.
• Mortality by Age and/ or cause
a. Reduce Under-Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020.
b. Reduce infant mortality rate to 28 by 2019.
c. Reduce neo-natal mortality to 16 and still birth rate to “single digit” by 2025.
• Reduction of disease prevalence/ incidence
a. Achieve global target of 2020 which is also termed as target of 90:90:90, for HIV/AIDS i. e,- 90% of all people living with HIV know their HIV status, – 90% of all people diagnosed with HIV infection receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression.
b. Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017.
c. To achieve and maintain a cure rate of >85% in new sputum positive patients for TB and reduce incidence of new cases, to reach elimination status by 2025.
d. To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one third from current levels.
e. To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.
(Source: Press Information Bureau, 16th March, 2017)

Dr KK Aggarwal
National President IMA and HCFI

Air pollution increases risk of childhood obesity and diabetes

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There is increasing evidence for the role of environment in pathogenesis in many diseases. Children below 5 years of age and adults older than 50 years are most at risk. A global assessment of the burden of disease from environmental risks by the WHO has shown that 23% of global deaths and 26% of deaths among children under five are due to modifiable environmental factors. The harmful effects of air pollution on respiratory health are well-known to us and well-established. Air pollution has been linked to many non communicable diseases such as cardiovascular diseases, obesity, cancers and type 2 diabetes.

A new study has again underscored the dire need for a healthier environment. This study has suggested that exposure to ambient air pollution may contribute to development of type 2 diabetes through direct effects on insulin sensitivity and β-cell function. The study reported in the January 2017 issue of the journal Diabetes investigated whether exposure to elevated concentrations of nitrogen dioxide (NO2) and particulate matter (PM 2.5) had adverse effects on longitudinal measures of insulin sensitivity, β-cell function, and obesity in children at high risk for developing diabetes.

Although this was not a cause and effect study, an association between air pollution and risk of obesity and type 2 diabetes in children was observed in the study.

• Higher NO2 and PM2.5 were associated with a faster decline as well as a lower insulin sensitivity at age 18 independent of adiposity.
• NO2 exposure negatively affected β-cell function evidenced by a faster decline in disposition index (DI) and a lower DI at age 18.
• Higher NO2 and PM2.5 exposures over follow-up were also associated with a higher BMI at age 18.

(Source: WHO, Diabetes 2017 Jan; db161416. https://doi.org/10.2337/db16-1416)

Regular eye checkup essential for all patients with diabetes

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Diabetic retinopathy is the major cause of blindness in patients with diabetes mellitus. But, it is largely a preventable or avoidable cause of blindness. Poor glycemic control, high blood pressure and high cholesterol levels increase the risk of developing diabetic retinopathy.

In most patients, diabetic retinopathy to begin with is usually asymptomatic or may cause only very mild symptoms. Hence, many people with diabetes remain unaware until the disease is at a very advanced stage, when it is too late for treatment. Vision that has been lost cannot be restored.

Hence, regular screening of patients with diabetes to detect retinopathy and early intervention is very important to prevent visual impairment and blindness.

The American Diabetes Association (ADA) 2016 Standards of Medical Care in Diabetes recommend optimal glycemic control including blood pressure and serum lipid control to reduce the risk or slow the progression of diabetic retinopathy. For screening, the ADA recommends as follows:

· “Patients with type 1 diabetes should have an initial dilated and comprehensive eye examination within 5 years after the diagnosis of diabetes.
· Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis as they may have had years of undiagnosed diabetes.
· If there is no evidence of retinopathy for one or more annual eye exams, then exams every 2 years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal examinations for patients with type 1 or type 2 diabetes should be repeated at least annually by an ophthalmologist or optometrist. If retinopathy is progressing or sight-threatening, then examinations will be required more frequently.”

Diabetic retinopathy is included in the list of eye diseases that can be prevented and treated if detected early under ‘VISION 2020: The Right to Sight’ global joint initiative of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB). The initiative aims to “Intensify and accelerate prevention of blindness activities so as to achieve the goal of eliminating avoidable blindness by 2020.”

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