Category: Healthcare IT

Packaging sells and also kills !


We heard the famous marketing quote that , ‘ packaging sells’, but the story for most of the India’s middle class, who eat on roadside eateries is somewhat different , and the new message is ‘packaging kills’ , and more so, when food gets garnished with lead and other hazardous chemicals !

India is a foodie nation, and with the rising middle class, our eating habits are changing. There is an increasing tendency to eat food outside, and India, predominantly being a middle class nation, our preference is for road side eateries and small or mid size restaurants. But what goes unnoticed is; the newspapers used in packing food items, or the printed material on tea bags, and the potential dangers associated with them.

It is a fact, that the newspapers are printed with ink that is dissolved on it with the help of chemical solvents. Studies have shown that printing ink from newspapers can easily gets into foods wrapped or served in them and this is dangerous for health. The solvents used in ink are potentially carcinogenic.

Also, newspapers and cardboard boxes used for packaged foods are made of recycled paper, which may be contaminated with harmful chemicals like di-isobutyl phthalate and di-n-butyl phthalate that can cause digestive problems and also lead to severe toxicity.

It is a fact that the recycled paper used has printing ink residues. These un-cleaned residues have found to contain hormone disruptors like benzophenones and mineral oils which can interfere with reproductive cycle of women.

Through the print based packaging, there is an exposure to organic chemicals called aryl amines, such as benzidine, Naphthylamine and 4-Aminobiphenyl, which are associated with high risks of bladder and lung cancer. Apart from these, printing inks also contain colorants, pigments, binders, additives and photo-initiators, which have harmful effects.
It is also believed, that the mineral oil-based printing inks for newspapers contain mineral oils, which consists of various types of hydrocarbon molecules that can exist as Mineral Oil Saturated Hydrocarbons (MOSH) and Mineral Oil Aromatic Hydrocarbons (MOAH). These hydrocarbons usually convert into gases by evaporation that eventually penetrates food items.
Newspapers are usually produced by a system called offset-web printing, which requires a certain consistency of the ink (it needs to be very thick) and a particular means of drying. For the former, mineral oils (petroleum-based) and solvents such as methanol, benzene and toluene are used; and for the latter, heavy metal (Cobalt)-based drying agents are used. None of these should be used in food packaging, as they are also classified as harmful and can be dangerous for health if consumed.
According to the FAO / WHO, Joint Expert Committee on Food Additives, the safe upper limit for the MOSH in foodstuffs is 0.6mg/kg. Older people, teenagers, children and people with compromised vital organs and immune system are at a greater risk of acquiring cancer-related health complications.
Another problem lies in the plastic bags used in takeaways. These bags are made of polyethylene (polythene) and the principal potential ‘migrant’ agent is ethylene. There are a number of potential additives to polythene, such as anti-static agents, ultra-violet protection and flame-retardants. These additives can be very dangerous if they find way into the takeaway food, which usually happens.
According to an article in the British Medical Journal, ‘Food packaging and migration of food contact materials: will epidemiologists rise to the neotoxic challenge? J. Epidemiol’ by Muncke J, et al. (Feb 2014), scientists say that most food contact materials (FCMs) are not inert. Chemicals contained in the FCM, such as monomers, additives, processing aids or reaction by-products, can diffuse into foods and this chemical diffusion is accelerated by warm temperature, and in India, the temperatures can touch as high as 45 degrees Celsius.
The scientists believe that FCMs are a significant source of chemical food contamination. As a result, humans consuming packaged or processed foods are chronically exposed to synthetic chemicals throughout their lives.
Formaldehyde, another known carcinogen, is widely present at low levels in plastic bottles made of polyethylene terephthalate. Other chemicals known to disrupt hormone production and used in food and drink packaging include; Bisphenol A, tributyltin, triclosan and phthalates.
There is an increase in the use of tea bags, and while using teabags, sometimes people squeeze the teabag using the label at the end of the loop. This can leak the ink from the label. I would recommend that the guidelines be framed and implemented to warn people of the same and prevent this practice
I also suggest that based on the facts available, it might be worthwhile banning the use of plastics, recycled materials and newspapers for food packing.

The FSSAI must act immediately and frame guidelines to control wrapping of fried foods in newspapers, banning the use of plastic bags for takeaways, and other practices that are harmful.
Further, it must mandate the use of ‘food packaging grade’ butter paper or aluminum foil for packaging food. We need to act on this without losing any further time
DISCLAIMER: The views expressed are solely of the author and ETHealthworld.com do not necessarily subscribe to it. ETHealthworld.com shall not be responsible for any damage caused to any person/organisation directly or indirectly.

About Rajendra Pratap Gupta

Rajendra Pratap Gupta is a global healthcare leader and a revered public policy expert, and is the author of the Healthcare best selling book,  ‘ Healthcare Reforms in India – Making up for the lost decades’ . @rajendragupta

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Time to start the work on the new National Health Policy


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 Rajendra Pratap Gupta

President & Member

Board of Directors

October 27, 2013

Shri Keshav Desiraju

Secretary to the Government of India

Ministry of Health & Family Welfare

Nirman Bhawan, New Delhi – 110108.

 

Reference: Need for a National Health Policy – NHP

Dear Shri Keshav ji,

I am writing on behalf of the Disease Management Association of India – The Population Health Improvement Alliance. We have been proactively taking up issues with regards to healthcare policy & reforms in India.

On February 01, 2013, when you were appointed as the Health Secretary, people involved with the health sector felt happy that the nation had got its best health secretary!  Expectations are running high!

This communiqué is about the need for setting up a team to draft the National Health Policy. Since the last National Health Policy was drafted more than 10 years ago in 2002, a lot of things have changed, like;

  • NRHM was launched in 2005 as a flagship program focused on rural health
  • RSBY was launched
  • Pandemic outbreaks like H1N1 (Swine Flu) have been a surprise and have shaken the world
  • Rise of MDR – T.B.
  • Increase in the incidence of chronic diseases & the issues related to child health
  • Occupational hazards
  • High IMR/MMR & MDGs deadline approaching in 2015

Besides, a lot of other developments have taken place, like;

  • UID –Aadhaar number for the entire population have been initiated
  • Emergence of mHealth & telemedicine
  • Newer technological interventions for diagnostics and treatment
  • Emergence of Big Data Analytics
  • Also that, India is focusing on transitioning the healthcare system to Universal Coverage
  • Emergence of innovative concepts, like Disease Management, ACOs (Accountable Care Organizations), HMOs (Health Management Organizations)  & Meaningful use.
  • Emergence of the prominent role of civil society organizations in healthcare delivery
  • Role of social media

The 12th five year plan has often been referred to as the plan for health, and I believe, that it is the right time to set up a committee to draft the new National Health Policy by 2015. Even if the committee is set up in early 2014, it will take at least a year to do the survey and complete the policy and so, most likely, the NHP would be tabled by 2015 and would cover a period of next 10 years (2015-2025).

We are sure that you will consider our request seriously and initiate the process for the new National Health Policy

With best wishes and with warm regards

Sd/-

Rajendra Pratap Gupta

CC:

Dr.Manmohan Singh, Prime Minister, Government of India.

Shri. Ghulam Nabi Azad, Union Minister for Health & Family Welfare

Dr.Syeda Hameed, Member, Planning Commission, Government of India

Chairperson, UPA

Presidents of all the National Political Parties

Food Security Bill – Another bill for poor and dollars for congress


Please ask the Hon’ble PM to give a statement on a scheme similar to the Food security bill launched with much fanfare in 1975 to reduce malnutrition . This scheme was called the Integrated Child Development Scheme (ICDS) . It has been around for the past 38 years and now again another bill to remove malnutrition ?  Despite this scheme being around for about four decades, the scenario is as mentioned below ;

It is a matter of serious concern that the mean per capita consumption of calories has never crossed the minimum threshold  for intake ( 2400 Kcal in rural and 2100 Kcal in urban areas), and still about 3/4th of the households do not consumer the minimum calorific intake (Dr.D.K.Taneja, 2013, p. 21)

Protein Energy Malnutrition (PEM) most commonly prevalent in India . 45.3 percent of children under 3 years are under weight as per NFHS -3.  Also, as per NFHS-3 , 33 percent of adult women and 28.1 percent of adult men have below normal BMI (Dr.D.K.Taneja, 2013, p. 301)

According to the information procured from the Ministry of Women and Child development via RTI through their letter dated 25 July 2013 ( F. No. 10-1/2011-CD.II(Pt.II)

Total money spend in 11th plan on ICDS was Rs.43829.53 Crore

Total money spent in 2012-13 is 15701.50 crore

During the 12th Five Year Plan, a total approved allocation of Rs. 1,23,580 crore has been made for the scheme. Any additional requirement of funds under ICDS Scheme can be met through Supplementary Demands for Grants and savings. ( Source http://pib.nic.in/newsite/erelease.aspx?relid=93731 )

I think food security bill means  ‘another bill for the poor and dollars for the congress’ .

This bill might be another money-making scheme in the name of aam aadmi .. Already, all the FM channels have been bombarded with advertisements for the Food security bill making the intentions of congress very clear that this is a poll gimmick

Rajendra Pratap Gupta

http://www.commonmansblog.com

Healthcare policies for a political party


On 5th April, 2013,  was invited to lead the discussions on a healthcare policy meeting of a fast emerging political party

The following discussion points i put forth for the kind consideration of the committee ;

Three key components for reform:

Systems

Service

Staff

Key challenges :

longevity of life

Expenses as budgetary allocation

Timely and quality interventions

Preventive promotive and curative health care

Child health

Chronic diseases

Rural health

Technological interventions

Role of pharmacists and nurses

Private community  partnership-sector

Outcomes with patient satisfaction

Health is not a standalone topic

Four pillars of public health . Hygiene , water , sanitation and nutrition

Protocols & treatment guidelines

Soft skills

Tax on unhealthy products and foods

Challenge is huge country , diverse population , demographics and poor infrastructure .

Why doctors don’t go to rural india ? Poor infrastructure for families and staying locally  coupled with no infrastructure for operations in rural

Several solutions few execution is the problem

Following inputs were given in the format the party needed ( Point wise );

Primary care :

1. Rural healthcare centres be accessible 24 X 7 using technology – Health Helplines

2. Mobile applications on phones connected to ASHA workers etc

3. Clinic on Ambulance model

4. 75 % of the funding of healthcare should go to Primary care

Refer the article on primary care

Child Health 

1. Incorporate health in school curriculum from class IV onwards

2. Pictorial charts and audio-visual films to teach hygiene and health

3. Health parameters be reported in annual and six monthly report cards

4. Junk foods be banned in and around school premises

5. Calorific and nutritional value be written on every packaged food items in relation to RDCA

6. 3 % of the curriculum marks be allocated to health of the student

7. Health & Hygiene be included in school curriculum as an exam based paper from class 4th onwards

Health IT 

1. All programs must be backed by an IT backbone

2. Mobile health record ( PHR ) as an alternative to electronic health record be linked to Aadhaar card

3. Reporting , surveillance and monitoring all programs through live data reporting at the taluka, district and national level

4. Standards and protocols for  all the treatments be issued , so that the AAM AADMI is not fleeced by unscrupulous people in the name of healthcare / treatment

5. All village sub centres be connected via telemedicine and mobile healthcare

6. At least 2 % of the healthcare budgets be spent on Healthcare IT

Chronic diseases 

1. Mass screenings be made available through pharmacies across the nation for diabetes , hypertension & obesity

2. Disease Management Programs be launched for all chronic diseases

3. mobile health be used for chronic disease management

4. Those with habits of smoking and drinking should have a higher co-pay to seek universal healthcare benefits ,  so that the healthy should not subsidise the ‘irresponsible’ sick people

5. Companies spending on wellness should be given incentives

Public health :

1. Focus on healths should be centred on wellness and not just on treatment

2. 75 % of the health budget should be spent on prevention and promotion

3. Corporate and five-star hospitals in urban india / metros should be taxed (levied  5% surcharge )  to subsidise the healthcare delivery in rural India

4. Set up the epidemiological data

We should change the slogan from ‘Health for all’ to ‘All for Health’

12th Five Year Plan – DMAI


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Rajendra Pratap Gupta

President & Member

Board of Directors

March 09, 2012

Via e-mail / Speed-Post

Dr. Manmohan Singh,

Prime Minister

Government of India

Shri Ghulam Nabi Azad,

Union Minister for Health & Family Welfare

Government of India.

Subject: Strategic Considerations for Healthcare in the 12th five year plan

 

Dear Dr. Singh & Shri Ghulam Nabi Azad ji,

I am writing this note on behalf of DMAI – Disease Management Association of India.

Disease Management Association of India (DMAI – The Population Health Improvement Alliance) is formed by leaders from the Global Healthcare fraternity, to bring all the stake- holders of healthcare on one platform (Both the public & the Private sector). DMAI has been successful in establishing an intellectual pool of top healthcare leaders to become an enabler in building a robust healthcare system in India. India is on the verge of building its healthcare system, and it has a long way to go. DMAI is building the resource – knowledge pool to contribute & convert ‘Ideas’ into ‘Reality’ for healthcare in India. DMAI is the only not-for-profit organization focused on population health improvement in India.

Earlier in 2009, I have authored the comprehensive healthcare reforms agenda for India, and this has been appreciated by political and policy-making leadership at the highest level. Further, the healthcare reforms agenda  (detailed agenda is available at the DMAI website http://www.dmai.org.in/Healthcare_Reforms_Agenda.pdf) has been incorporated in the healthcare planning in the state of Chhattisgarh.

Further, DMAI has given inputs to various government bodies, as sought from time to time on:

Re-structuring of ICDS

NCD Policy

Re-structuring the 12th Five year plan for healthcare

Formation of NCHRH

Inputs in the high level UN summit for NCD’s (DMAI was an official invitee to the UN)

DMAI has raised important issues w.r.t. The Mental Health Act 2010, banning of Junk food in schools, reservations in airlines and railways for critically ill and in times of medical emergencies, radical changes in Jan Aushadhi scheme, healthcare reforms in J & K, Protocols and treatment guidelines for all major acute and chronic illnesses; besides other issues. Details available on www.dmai.org.in

12th five year plan is being talked of as the ‘Plan for Health’, and through this note, DMAI wishes to bring a few important issues before the policy makers for debate and appropriate action:

Quality of Healthcare: Last year, I was nominated to the five member Healthcare committee of the Quality Council of India. Since then, I have been discussing with all the stakeholders in healthcare, including the patient groups, about how to improve the quality of healthcare in India.

Action:  It must be made mandatory for all healthcare providers (Care Givers), to submit the Patient / treatment outcomes data e.g. for hospitals (including admissions, no. Of night stays, re-admissions, infection rates, deaths, referrals, etc.) to the government every year without fail. Also, getting similar data for doctors, clinicians etc. should also be looked at. This data could be maintained under the Quality Council of India (QCI) or an entity under QCI, funded jointly by the government and private players or, as an independent organization. This organization must analyze the data and post it on the website, so as to enable the patients to make an informed choice when it comes to choosing the doctors / hospitals or the caregivers. This will be the first step in bringing transparency in healthcare and a major boost to improving quality in healthcare. A hospital stay costs an average of $236 per day in India, $655 per day in France and an average of $3,949 per day in the US, according to a report — 2011 Comparative Price Report Medical and Hospital Fees by Country – released by the International Federation of Health Plans.  After paying USD 236 (Approximately Rs. 11328.00 / day (USD 1= INR 48), what does the patient get in return?  . We believe that by implementing this reporting by caregivers, the caregivers would work harder to improve their performance in terms of outcomes for treatment and, in a way, it will lead to ‘Pay for Performance’.  Patient would be able to make choices based on whosoever provides the best care!

Also, all the hospitals / care givers must ensure appropriate patient follow-up and feed back mechanism, and the government must devise an institutional mechanism to collect the data on success rate of treatments and examine the reasons for failure so that the quality of healthcare delivered can be improved.

This must be done by setting up the National Institute for Research in Healthcare Quality Improvement.

This institute must focus on coming out with annual reports on improving the quality of healthcare in all the states, as the healthcare issues vary from state to state. We have seen that recently, West Bengal has been home to dozens of child deaths in major government hospitals.

But as of now, there is no investigating body for healthcare to look into these issues, and the crime investigating agencies (Police) lack the necessary qualifications & skills to carry out any meaningful investigation and suggest remedial steps for such incidents. It is the time to correct this by setting a dedicated national body for such incidents.

USA has moved towards ACO’s (Accountable Care Organizations); and it is high time that India sets up the guidelines for all healthcare delivery organizations to become self-regulated ACO’s

Recently, DMAI was actively involved in doing the biggest Healthcare camp in Ajmer (the constituency of Shri Sachin Pilot), and examined over 50,000 (according to some media estimates, approximately 71,000 people). The people were given free diagnostic tests & medicines only due to active participation & support from the private sector. It is high time that the government acknowledges that the private sector has a pivotal role to play if the ‘Healthcare for all- Universal Healthcare’, has to move beyond ‘mike & paper’! Private sector has always shown commitment by providing resources for ‘pilots’ and ‘Free camps’, but we must not forget that, ‘Charity is as deep as the pocket’! It would be a win-win, if the government starts with launching the mass screening program with the private sector, re-launching the ‘Jan Aushadhi’ scheme with the private sector & implementing mass scale telemedicine / mHealth projects with the private sector

I was an invitee to the meeting called by the Hon’ble Health Minister /WHO on 23/ 24th August 2011 at Delhi, and was also involved in the writing of the document called ‘Delhi call to action’.  I recall, that the Hon’ble Minister made an announcement to screen 200 million people for diabetes and hypertension by March 2012. I have learned through reliable sources that this mass screening plan, that was to start with 100 districts was reduced to 10 districts and finally to slums of two districts, and the results were not encouraging! In a way, even 10 % of the target of 200 million (2 crores) has not been achieved. This reminds me of the Sir Joseph Bhore Committee report in 1946, which talked about Universal Healthcare.

Also of the National Health Policy (NHP) 1983, which talked about ‘Health for All’ by 2000 AD’.

Both these committees failed to deliver Universal Healthcare. So, essentially, even after 65 years, ‘Healthcare for all’ has just remained a ‘concept’ & a mere ‘talking point’.

In the current plan – 2012, we are again talking about the same thing ‘Healthcare for all’. This time, we have a high level committee and the wordings have changed to ‘Universal Healthcare’. Doubling of budgets for healthcare will not be able to address the healthcare problems facing the nation, till we ‘double our understanding’ of the real issues and the solutions and give up the parochial approach to remedy the ills in our system!

It is clear that the government lacks an execution plan, and also that; ‘execution’ has never been the forte of the government. It is high time that government puts “PPPr”- Private Public Performance based rewards partnership in place like the NHAI and then only releases the budget for the 12th five-year plan.

It is time to learn from what you did in UID! A person from the private sector has already issued 30 million Aadhaar cards, and this has already become the biggest biometric program in the world. Can we not learn from UID and implement in MOHFW ?

We need a ‘Professional’ CIIO (Chief Innovation & Information Officer) in the Ministry of Health, who will bring the necessary capabilities in the ministry to make a difference in the ‘Health for All’.

Free insurance & Free medicines: This scheme is a ‘Killer Combination’.  ‘Social healthcare’ has failed miserably in the western world, and we seem to have not picked up the lessons but are hell bent on ‘Importing failures’ of the west into the Indian healthcare system. As I mentioned in the 2009- ‘Healthcare reforms agenda’, I will re-iterate that we need a ‘Co-pay’ model for healthcare delivery.  Except the BPL families, all others must have’Co-Pay’ component in the healthcare services even if it is a token of 5-10 % of the total healthcare cost borne by the government. Co-Pay must go up with the income slabs!

Rajiv Aarogyashree scheme (highly publicized scheme of Andhra Pradesh), is now widely talked of as a ‘failure’, and the government is not in a position to pay the empanelled facilities for the ‘free treatment’ that has been a part of the popular scheme

It is time to re-look at ‘Free universal healthcare schemes’. If the government examines the free healthcare schemes currently offered all over the world, it would think twice about free healthcare!.

Free medicines scheme: During my visits to Rajasthan (medicines are given free in Rajasthan government hospitals), I was made to re-think about this scheme

This scheme has created a peculiar situation for doctors.  Doctors are told that the family member is suffering from cold, cough or backache, and s/he is asked to give the medicine!

When the doctors request to examine the patient as to check if it is dry cough, TB induced cough etc., the response that the family members give is, ‘ When the medicines are provided free by the government, then why do you ask so many questions?

If the doctor refuses to give medicines, political pressure is applied and the doctors are harassed! Doctors have been reduced to ‘compounders’, and are just dispensing medicines rather than treating patients, because of the ‘free medicine scheme’!  Even in the USA, we have seen scams where ‘dummy patients’ were created under Medicaid, and reimbursements taken from the government in the name of ‘diabetic patients’. India will witness large-scale organized frauds if such a scheme is rolled out without adequate checks and controls.

When it comes to medicines, I must request the government to monitor the pharma industry closely, as the customer is not getting the benefit of ‘low prices’ (read as- schemes that are offered by the industry to the distributors).  Just for the sake of information, I am quoting two examples:

Panegra is available at an MRP of Rs. 124.00 and the scheme offered by the manufacturing company is- seven strips free on purchase of one strip! Still the end consumer buys the medicine on MRP!  The manufacturer distributor – retailer nexus swallows the entire margin.

Another example is that of Cifran, priced at Rs.58.80 and the scheme offered by the manufacturing company is – one strip free on buying two strips. But, such benefits are never passed on to the ignorant end customer- patient. Similarly, 1000’s of products are available with such ‘deals’ but the patient does not get the benefit.

Government must take decisive action against such pharma companies. The two companies quoted here are just for reference and most of the companies are indulging in these practices

Also, the government must give a big push for mobile healthcare (mHealth & Telemedicine). CDAC Mohali (a government body) has developed a great application for telemedicine, and DMAI used that service during the mega healthcare camp at Ajmer, in collaboration with PGI, Chandigarh. It is time to promote such institutes and organizations.

May be, it would be worth having a joint working group between the ‘Ministry of Communications & IT’ and ‘Ministry of Health & Family Welfare’, to explore the commercially deployable models of telemedicine & mHealth

It is the right time to train all our nurses & pharmacists in healthcare counseling through online training modules and create a special cadre of healthcare counselors for chronic diseases.

It is the right time to set the Patient Charter for Healthcare, which includes the patient’s rights and responsibilities. DMAI is driving an initiative to come out with a ‘Patient Charter’ under the leadership of Dr.Aniruddha Malpani.

These changes are required if we wish to make an impact on the healthcare delivery system.

Currently, there is a big gap between ground realities, policy formulation & execution framework. We need radical changes in our thinking to create an ‘Inclusive Healthcare Ecosystem’. It is better that immediate steps are taken to correct the loopholes so that Healthcare for all can become a reality without compromising on the quality of care.

DMAI would be willing to volunteer with its knowledge pool and resources should the policy makers need the same

Yours in good health

 Rajendra Pratap Gupta

CC:

Mrs.Sonia Gandhi

Shri Nitin Gadkari

Dr.Manmohan Singh,

Dr.Murli Manohar Joshi, Chairman, Parliamentary Accounts Committee

Minister for Communication & IT, GOI

Montek Singh Ahluwalia

Dr.Syeda Hameed.

Shri L.K.Advani

Smt. Sushma Swaraj

Shri Sudip Bandyopadhyay

Sam Pitroda

Rahul Gandhi

Sitaram Yechury

Secy, Health & Family Welfare, GOI

DGHS, MOHFW,GOI.

Dr. K. Srinath Reddy

Dr.Girdhar Gyani, QCI.

Dr.V.K. Singh, QCI

Board of Directors – DMAI


Right to Primary & Preventive Care


August 10th , 2011

Dr.Manmohan Singh

Prime Minister

Government of India

7, Race Course , New Delhi 110001

Subject: Right to Primary & Preventive Care

Dear Dr.Singh,

 

Greetings from the Disease Management Association of India – DMAI, The Population Health Improvement Alliance .

 

DMAI – The Population Health Improvement Alliance is a not-for-profit organization formed by global healthcare leaders. It is the only civil society organization in India dedicated to chronic disease management in the country, with an objective of overall population health improvement .In the past three years , DMAI has worked at both International level and within India to address the issue of India’s healthcare challenges,  with the support of  patient groups , Industry & policy makers , and wishes to put on record the continuous support DMAI has received from policy makers and the industry .

 

Your government has been behind some key initiatives like

 

Right to information Act

Right to Education

Right to Work / Employment

Right to Food

 

I wish to draw your kind attention to consider enacting, the ‘Right to Primary & Preventive care’ for all citizens of this country, before it gets too late !

 

The nation is burdened by ‘a catastrophic disaster in slow motion’, moving towards it in the form of a huge population suffering from Life threatening diseases / disorders ( LTD’s ) or Debilitating Chronic Disorders- ( DCD’s ); what is today called the NCD’s ( Non communicable diseases ) .

 

We are already facing an acute shortage of both, hard infrastructure and soft infrastructure in healthcare delivery , and with our current ‘Baby Boomers’ becoming ‘Patient Boomers’ in the next 15-25 years , we could lose our competitiveness & productivity by over 50 % . India  in 2025 , with over 1.40 Billion population and with over 600 million LTD / DCD patients

would be a burden for the human race if we fail to adopt the Right to Primary & Preventive care, as the basic right for all citizens .

 

I must also state an electoral reason to accomplish this very important act . It is not just the US that fought the last elections on issue of Healthcare reform , but back home,  Andhra Pradesh and Assam are examples of how healthcare schemes can be a deciding factor for the public to choose who will run their government and so, lets get this ‘Right to Primary & Preventive care’ implemented at the earliest possible.  My detailed note on healthcare reforms agenda available at the DMAI website ( www.dmai.org.in ) , has the details of what could be potentially done in this area . It has to be multi-sectoral and inter ministerial effort & I am sure that this act with vast social & economic implications will be the best thing to do in healthcare !

 

Also, to keep you posted , I am working on the Chronic Care Bill & the Child Health bill . If all goes as per plan , the draft of these documents will be submitted to the policy makers by end of September 2011

 

Hoping for a positive response from a responsible government on the ‘Right to Primary & Preventive care !

 

We remain at your disposal for any help / assistance that you might need on this matter of great national interest

 

Yours Sincerely

Rajendra Pratap Gupta

president@dmai.org.in

 

H.E. Ban Ki Moon, Secretary General , United Nations

H.E. Joseph Diess , President of the UN General Assembly

Hon’ble Deputy Secretary General of the UN General Assembly

Ms. Margaret Chan, Director General, WHO

Shri Ghulam Nabi Azad , Hon’ble Ministry of Health & Family Welfare, GOI

Dr.K. Srinath Reddy , President , PHFI

Dr.Syeda Hameed, Planning Commission , GOI

Sri Sudip Bandopadhyay, MOS- H&FW

Shri K.Chandramouli, Secretary , H&FW , GOI.

K.Desiraju, Additional Secretary , Government of India.

Dr.Sudhir Gupta , CMO, NCD’s. MOHFW.

Board Of Directors , Disease Management Association of India – DMAI , The Population Health Improvement Alliance .

UN Summit on Chronic Diseases in September 2011


July 11 , 2011.

Dr.Manmohan Singh

Prime Minister

Government of India

7, Race Course , New Delhi 110001

Subject: UN High-Level Summit on Non-Communicable Diseases, September 2011

Dear Dr.Singh,

In the above quoted reference , and in continuation to the letter I wrote to you on 8th June 2011; I am connecting with you on my return from the UN session on NCD’s

On 16th June 2011  , on the invitation from the United Nations, I participated  in the informal interactive civil society hearing  & delivered an address at the UN General Assembly Hall . The session was presided by the President of the UN General Assembly , Mr.Joseph Diess

My view was also quoted in the closing remarks by Sir George Alleyne , UN Special Envoy to the Caribbean .

This September, you and your fellow political leaders will have a once-in-a-generation opportunity to halt a global epidemic that is killing and disabling millions of people, impoverishing families and undermining economic progress. The United Nations High-Level Summit on Non-Communicable Diseases (NCDs) is a chance for the Government of India to play a leading global role in confronting this major threat to health, prosperity and security of all of us and future generations.

I wish to assure you of the full support of our organization for the High-Level Summit in September 2011.  We campaigned for such a Summit because the NCD epidemic has reached such proportions that it now constitutes a major risk to global prosperity, development and political stability.

Together the four major NCDs – diabetes, cancer, heart disease and chronic respiratory disease – are the world’s number one killer. It is estimated that some 35 million people die from NCDs each year, and 14 million of these deaths could be averted or delayed.

Recently , Our Hon’ble Health Minister quoted; that every ten seconds two new cases of  diabetes are reported . Further , 14 % people in Bangalore were found to be diabetic , 21 percent had  high blood pressure and 13 % had both diabetes and hypertension. DMAI had conducted the first Health Risk Assessment study in 2009 , and our findings showed that  other NCD’s pose a threat of similar magnitude . We found that 44 % males & 42 % females were Obese , 18 % males and 8 % females were suffering from Hypertension ,  21 % males and 11 % females were suffering from Diabetes , 7% males and 6 % females were suffering from respiratory ailments .

Overall average occurrence across occupations was found to be thus :

Obesity 44 % , Diabetes  20 %, Hypertension 16 % & , alarmingly 7 % of the students suffered from Hypertension

India’s biggest enemy is taking the shape of a multiple headed monster i.e. Chronic diseases .We must be proactive in keeping India prepared for victory against our biggest enemy, Non- Communicable diseases. If we win the war against chronic diseases, rest of the enemies could be easily defeated, but if we lose the war against chronic diseases, we would certainly lose the war against all other enemies

The right word for NCD’s is ‘Irreversible diseases’ or ‘debilitating chronic disorders- DCD’s’ or ‘Life threatening disorders – LTD’s ’ . As a first step, let us address the diseases with the seriousness they need  ! Let’s change the name from NCD’s to LTD’s or DCD’s. Through the same note , I call upon the UN & WHO to redefine the terminology for addressing these disorders .

Dr.Singh , I must highlight you the points of discussions that we had at this special session at the UN on chronic diseases .

President of the General Assembly emphasized the need for a global response to the challenge of non-communicable diseases (NCDs). NCD prevention and control should not be seen as competing with other development and health priorities, and solutions must be integrated with existing initiatives

The Deputy Secretary-General noted that NCDs are a threat to societal well-being, taking

their greatest toll in developing countries. This is an issue that the United Nations is taking very seriously to ensure that there is a global response to the broader social and economic impact of NCDs. Praising the work and commitment of those present at the hearing, who are at the frontline of the fight against NCDs, she encouraged them to learn from and link with those working on other key health development issues – HIV/AIDS, and maternal and child health.

The World Health Organization’s Assistant Director-General for Non communicable Diseases and Mental Health cited key evidence on the scale, distribution and impact of the global NCD epidemic. Reviewing the key achievements of the past decade, he noted the important role that civil society had played in progress of management of chronic diseases to date

The Director-General of the King Hussein Cancer Foundation, Princess Dina Mired of Jordan,

emphasized the need for everybody to be unified in their efforts to get NCDs on the global

agenda and receive the attention they deserve

The first roundtable addressed the health, social and economic scale of the NCD challenge.

There is a fundamental right to good health that is being undermined by the globalization of

NCD risk factors and an insufficient action to date. Thus, a human rights-based approach to

NCD prevention and control is warranted. The global response to NCDs needs to address the

developmental and political aspects of the drivers of the main NCDs, and this will require

collective action – no individual country will be able to deal with the problem alone. Much greater progress can, and must be made in preventing and controlling the NCD epidemic to prevent unnecessary suffering and premature deaths.

Speakers emphasized the need for urgent national and global action as NCDs are increasingly frustrating social and economic development. Some countries already suffer the ‘double burden’ of communicable and non-communicable diseases as well as under- and over nutrition, sometimes in the same household. Health systems in all countries will not be able to cope with the projected burden of NCDs and governments need to be clear that the cost of intervening is much less than the cost of inaction. The economic burden of NCDs is already substantial and will become staggering over the next two decades. Economic policy makers need to better understand that NCDs pose a significant economic threat as they can be expensive to treat, require long-term management and undermine the labour contribution to production. There is also a substantial opportunity cost as the money spent on treating preventable diseases could be spent on other priorities.

Speakers stressed that the economic impact of NCDs is felt disproportionately among the poor and many individuals and families are already tipped into poverty by these diseases; thus NCDs are also a social justice issue. This will only worsen if NCDs are not prioritized in countries’ health and development plans. Health systems strengthening must address the need for social insurance to reduce the potential for ‘catastrophic’ expenditure by individuals who suffer from an NCD.

Given the complexity of the factors driving the NCD epidemic, speakers underscored the need for a response that is ‘whole-of-government’, multi sectoral and spans the life-course.

Both prevention and control are essential, and there is much that can be done by more systematically applying existing knowledge. There are highly cost-effective population and individual interventions for the four main NCD key risk factors – tobacco use, poor diet, inadequate physical activity and harmful use of alcohol – and these should be prioritized.

Focusing on the ‘best buys’ should not be at the expense of the broader range of approaches that is needed to effectively reduce the impact of these risk factors. Speakers noted that this includes the need to consider the broader social, environmental and economic determinants of health, which strongly shape health-related choices and decisions made by communities, families and individuals. Likewise, the cultural, religious and social context should be considered in implementing effective interventions.

Many speakers highlighted the need for a response that is integrated – not competing – with existing initiatives, improving health systems for all conditions regardless of their origin.

There is great potential for synergy with existing health development priorities, including those in the MDGs. The important role of health professionals in both prevention and control was highlighted by speakers. A holistic approach is required that addresses the needs of people and doesn’t treat diseases in isolation. In this sense, other non-communicable conditions such as mental health and substance abuse and oral health disorders should be considered in the health system response to NCDs.

The leadership role of governments was highlighted, which should include a commitment to developing and implementing a national NCD action plan and committing to ‘health in all policies’. It was repeatedly emphasized that all key stakeholders need to be involved in the response, but it was noted that clarity of roles is essential to ensure that potential conflicts of interest are appropriately managed and it was proposed that frameworks be developed to assist countries to do so. It was noted that there are some industrial influences that are in conflict with not just health and social goals but also the goals of other industry and private sector actors; all stakeholders have an interest in dealing with these negative influences.

Speakers agreed on the need for ongoing and improved surveillance of NCDs, their risk factors and outcomes. This will be needed to monitor progress, guide policy decisions and research priorities, and provide information on the effectiveness of different interventions.

There was strong endorsement of the need for a clear monitoring and accountability framework as part of the global response to NCDs, with measurable indicators that countries can report against.

Finally, it was noted that success is possible, and there are many examples of significant and rapid progress in addressing NCDs. Now is the time to scale up collective action on NCDs, and the opportunity must not be lost to avoid the growing negative social and economic consequences of the NCD epidemic.

The second roundtable examined effective ways to address the NCD epidemic. Much is known about effective interventions at both the population and individual levels to both prevent and control NCDs.

These include tobacco control as set out in the Framework Convention on Tobacco Control; reducing the sugar, salt, trans-fats and saturated fats content of processed food; improved diets; increased physical activity; effective policies and programmes to reduce the harmful use of alcohol; and providing low-cost high-quality essential medicines and technologies.

For example, chapters four and five of the WHO Global Status Report on non communicable diseases 2010 summarize the ‘best buys’ in NCD prevention and control http://www.who.int/nmh/publications/ncd_report2010/en/index.html

There is little contention about the evidence for the most cost-effective interventions, and the challenge is thus primarily one of ensuring their proper implementation. It was agreed that NCDs are a societal problem, so a range of government departments and societal actors need to be involved in the response. An effective mechanism to achieve this should be a priority for every country. There is an important role for civil society and civil society should be given a formal role in both the development and implementation of each country’s response.

Speakers highlighted that premature deaths from NCDs are largely preventable, and prevention is central to a more effective NCD response at both national and global levels.

Many primary and secondary preventive interventions are highly cost-effective and there are existing tools to support their implementation, including agreed international codes, strategies and Conventions.

Full implementation of the World Health Organization Framework Convention on Tobacco Control (FCTC) was cited by many speakers as being a top priority for action, due to the domination of tobacco-related premature deaths across the NCDs – currently six million per year. The FCTC is now widely ratified by both developing and developed countries, but more can and should be done to support its full implementation in developing countries.

NCD prevention and control should be grounded in a life-course approach, given the fatal and early childhood origins of some NCDs. Children are an important focus for interventions, with the growing impact of risk factors such as obesity on children and adolescents and the opportunity afforded to reach them through schools. Likewise, women are an important target for interventions as child bearers and, frequently, as the ‘gatekeepers’ for food, physical activity and health services for families. Speakers also emphasized the importance of prevention and effective treatment across the life-course, including into older age where much of the burden or diseases falls.

Speakers agreed on the need for an effective health system, which has benefits for all areas of health, not just NCDs. Primary care is the key healthcare setting for cost-effective NCD prevention and control. An important learning from HIV/AIDS is the need for better integration of prevention and treatment services across disease areas – so-called ‘horizontal’ and ‘diagonal’ approaches. In support of this, one participant proposed ’15 by 15′ – namely that by 2015, 15% of funding in all ‘vertical’ programs should be earmarked for strengthening ‘horizontal’ health systems activities. In low-income countries, such approaches should also address the endemic NCDs that affect the so-called ‘bottom billion’, for example sickle cell anemia and rheumatic heart disease, as well as palliative care.

Speakers referred to the roles that civil society organizations can play in NCD prevention and control. There is a significant opportunity to use information and communication technologies to promote health awareness and increase empowerment of individuals and communities to reduce their exposure to NCD risk factors and supporting self care.

Many speakers emphasized that access to essential medicines and technologies for prevention and treatment of NCDs is critical. The cost of the essential medicines is low, and these should be included in readily available ‘packages’ of essential care; this will require increasing manufacturing capacity of essential drugs to ensure quick access to high quality generic pharmaceuticals. The specific need for better access to adequate pain relief, especially morphine, as part of palliative care was raised by several speakers. It was noted that late presentation is all too common in developing countries, partly because of a lack of universal social insurance, as well as lack of awareness; both need to be addressed to avoid unnecessary suffering and premature deaths. Patient and ‘survivor’ groups should be engaged in policy and implementation and can play a significant role in influencing the public, politicians and the media with their stories.

Speakers noted that governments need to set the pace for change and utilize their power to ensure appropriate regulation to achieve public health goals. This may require regulation at both national and international levels to address significant health threats such as the obesity epidemic, for example to support the effective implementation of standards on marketing of unhealthy foods to children and agreed targets for salt reduction. Children and the public should be protected from commercial marketing that encourages unhealthy actions and, exposed to educational messages in schools and in their communities that encourage healthy action. The use of social media to deliver such messages needs to be greatly expanded. The role of physical activity was raised by a number of speakers. The benefits of physical activity are wider than NCD prevention and national and local policies should create an environment that encourages and supports people to be physically active.

Regarding the resources required to prevent and control NCDs, speakers noted that the majority of funding for health comes from within countries, and States need to mobilize their own resources. Health needs to be a higher priority for government spending, and NCDs a higher priority in health spending – this is the only way that funding will be sustainable in the long term. Likewise, current spending on NCD prevention and control needs to be carefully scrutinized to ensure the best possible value for money. NCD prevention and control should also be considered in decisions about ODA for health, in particular through integration with existing health development priorities. In addition, innovative funding mechanisms will need to be explored.

Many speakers emphasized that one important source of funding for NCD prevention and control is through increasing taxation of tobacco products. Tobacco taxation is also irrefutably one of the most effective ways to decrease tobacco consumption, particularly among young people, and is fundamental to an effective tobacco control programme.

Speakers endorsed the need to build capacity and capability to address NCDs among health professionals. This will require concerted efforts to revised training curricula, dealing with ‘brain drain’ of trained professionals from low income to higher income countries, and greatly strengthening research capacity in developing countries to monitor trends and evaluate interventions.

 The final roundtable examined ways to scale up action at the global level to collectively address NCD prevention and control. The full range of stakeholders, including all those present at the debate, was identified as been essential to a more effective response. It is vital to carefully examine previous international experiences to draw out the key lessons.

The value of international instruments such as the FCTC was emphasized, and it was noted that other such instruments may be needed in the future to support effective international action.

Speakers provided specific examples of enabling mechanisms to support global cooperation, including a ‘clearing house’ function to facilitate knowledge sharing, a global forum, and bilateral and multilateral partnerships to support technology and knowledge transfer.

The need for appropriate monitoring and accountability was reiterated, noting that accountability is a national responsibility that can be supported by appropriate international monitoring.

It was acknowledged that the funding environment is currently challenging, but there is much that can be done with existing funding. At the national level, there are opportunities to generate or ‘free up’ resources, for example through taxation of tobacco, alcohol and foods high in fat or sugar, and reprioritizing spending on ineffective and expensive health care interventions. Reducing donor ‘silos’ will help to ensure that health development occurs in a much more integrated way that will benefit NCDs as well as other priority areas. There is a need to expand the donor base, and opportunities to do so through linking with other related issues such as climate change.

International federations of NGOs, private sector and other organizations have a useful role to play in promoting global cooperation. Representatives of the research-based pharmaceutical industry and the food and non-alcoholic beverage industries outlined pledges they have made to contribute to NCD prevention and control. There is potential to expand new partnerships, for example with the sporting goods industries to promote physical activity. The private sector can bring a range of capabilities to support NCD prevention and control; for example, its global reach, and experience with global brands and global marketing campaigns. With respect to NGOs, speakers identified the value of greater collaboration, which has been realized over the past two years. This has greatly enhanced their ability to mobilize resources, advocate and generate social and political momentum. This collaboration will need to be further developed to support and monitor the implementation of the outcome document that is to be adopted in September.

 Sir George Alleyne, Director Emeritus of the Pan American Health Organization,summarized many of the key points canvassed during the day’s discussions. He noted a strong degree of coherence in the day’s discussion and agreement on the need to act urgently, while acknowledging the different views within and between the different stakeholder groups on some key issues. Underscoring the need to use proven tools and the value of strong partnerships within the UN and across broader society, Sir George urged all stakeholders to work together for the global public good of reduced suffering and early deaths from NCDs. He echoed the comments of many speakers on the need to integrate NCD prevention and control with action on other key health priorities, notably HIV/AIDS and maternal and child health.

In concluding, Sir George Alleyne exhorted participants to increase their efforts to stimulate political action on NCDs. Civil Society has the resources and passion to overcome the apparent inertia and it must use its unique ability to ‘agitate’ for change. The wider public needs to be informed of the size of the problem and of the consequences of inaction. He emphasized that the High-level Meeting is an important milestone but that sustained action will be needed beyond September.

In closing, the President of the General Assembly emphasized that, as with other key health and development issues, all stakeholders need to act collectively to address the global challenge of non-communicable diseases. He noted that the global community can act decisively and effectively on important global health issues, and we must learn from these prior experiences. It is in our common interest to act now.

Thanking all those who participated in the hearing, the President noted his optimism that the  High-level Meeting and the subsequent response will make a real difference to the global NCD epidemic. This optimism had been strengthened by quality of the discussion and range of ideas canvassed during the hearing and the obvious energy and sense of purpose from all stakeholder groups.

Principal conclusions

 The key conclusions of the hearing include the following:

Countries should move urgently to prevent and control NCDs to alleviate the significant social, economic and health impact these diseases are having, which is now compromising development gains. The last decade has seen some progress at the global level in NCD prevention and control and it is clear that concerted action and leadership by governments can result in significant and rapid progress. However, efforts need to be greatly scaled up to avert unsustainable increases in the costs of treating NCDs, which no country can afford.

There is a strong consensus that NCDs are a development issue and urgently need to be afforded greater priority in national health and development plans, and a higher priority in government funding decision. NCDs also need to be incorporated into the global development agenda in ways that complement rather than compete with existing health development priorities, and innovative funding mechanisms need to be rapidly identified and implemented.

The complex drivers of NCDs require multi-stakeholder action, and countries should put in place a mechanism to engage all the sectors needed for an effective response. Governments should ‘set the pace’ of the response and must show political courage and leadership.

Addressing the key risk factors for NCDs will require involvement of government, communities, civil society, non-government organizations, academia and the private sector. It is important that potential conflicts of interest are appropriately managed so that effective action is not compromised.

NCDs disproportionately affect the poor at global and, in many cases, national levels and lead to ‘catastrophic’ expenditure that forces people below the poverty line. Universal social insurance schemes are essential to avoid this and their implementation should be a priority, with attendant benefits for health care that go beyond just NCDs.

Countries should prioritize the implementation of the most cost-effective population and individual level interventions to prevent NCDs, some of which are in fact cost saving, to ensure they are getting the best value for money from existing expenditure. These interventions should be the priority for new spending on NCD prevention and control.

A renewed commitment to full implementation of the FCTC is essential to prevent a huge burden of suffering and many millions of premature deaths among working age people.

Countries should honour their commitment not just to full implementation nationally, but to international cooperation to support low-income countries to implement the FCTC.

Countries should continue to strengthen NCD surveillance and monitoring to inform and guide NCD policy and action at both national and international levels.

The health system response to NCDs must be fully integrated with programmes that address other key health issues, to ensure that services are delivered around the needs of the people who use them. Access to high-quality and affordable essential medicines is an essential component, and the implantation of programmes to deliver them effectively in low resource settings.

The outcome document for the High-level Meeting must have clear objectives and measurable indicators, supported by a monitoring and evaluation function, to support national accountability for scaling up NCD prevention and control. Civil society organizations should play a role in independently monitoring and reporting on progress.

It is essential the Heads of State and Government attend the High-level Meeting, to ensure that there is the high-level political commitment to scale up NCD prevention and control.

Countries should consider including NGOs on their delegations to the High-level Meeting, as they can bring technical expertise, can help to mobilize political support, and will be essential actors in implementing the agreed outcomes of the High-level Meeting.

Health workers are key to an effective national response to NCDS, but many are not trained to prevent, detect and manage NCDs. Training curricula should be reviewed to ensure that health workers receive relevant training in both NCD prevention and control.

Governments should look to tobacco taxation as a key way of raising revenue to prevent and control NCDs – in addition, this is a highly effective way to reduce smoking rates, particularly among young people.

DMAI – The Population Health Improvement Alliance asks you to attend the UN Summit and in person and make this a high priority for the Ministry of Health & Family Welfare . We are also calling for the establishment of a NCDs partnership to lead multi- sectoral and coordinated action, and a UN Decade of Action on NCDs to implement the commitments governments will make at the UN Summit in New York

DMAI – The Population Health Improvement Alliance would be pleased to provide your office with any further information in preparation for the UN Summit.

NCDs have the power to affect us all. Increasingly NCD’s strike people in younger age groups, including children, threatening international economic progress. But we are not powerless.

We have achievable cost-effective solutions. We need political leadership now to make them a reality. Please be a champion for NCDs by attending the UN Summit in September and safeguard the health and prosperity of future generations in India

We sincerely hope that the country will take leadership and set an example for the world on how to manage chronic diseases through early interventions

DMAI – The Population Health Improvement Alliance Recommends that:

Indian government establishes an NGO-Private Healthcare Players – Government  Alliance . An  India NCDs Alliance , linked to WHO, to coordinate follow up action with member states, other UN and multilateral agencies, foundations, NGOs and private sector

  • We must look at enacting a Chronic Care bill 2011 in the parliament in the winter session that addresses this biggest healthcare challenge (NCD’s) .
  • Create a high level committee for creating an actionable plan for identification , enrolment and treatment of chronically ill populations or move them under a primary prevention plan for people at the risk of chronic diseases . This plan should be implemented on ground before end of this year
  • As written in my comprehensive healthcare reforms document  in 2009, we must set up a CDR ( Central Disease Registry ). Details available at www.dmai.org.in .
  • Come out with protocols for the treatment of chronic diseases
  • Come out with mandatory guidelines for work force wellness
  • Enforce child health guidelines in all primary schools & dietary guidelines . Please refer DMAI’s note on Healthy Foods & An Appeal at www.dmai.org.in for details
  • Include general & basic information on nutrition and physical activity in school curriculum from class VI onwards . Have a compulsory paper on health & Wellness for  class 10th exam for all educational boards in India
  • Adopt an open minded and outcome driven approach of roping in private healthcare players to improve preventive care & treatment of identified populations
  • Include preventive checks and health clubs ( Gyms & Yoga ) under tax benefits
  • Levy additional premium on insurance policies for smokers to dissuade them from smoking
  • Launch a nationwide campaign for creating awareness on avoiding and managing chronic diseases
  • Encourage and implement the use of mHealth for timely access & affordability

 Post my return from UN session , I had discussions with leading pharmaceutical companies as to how to get their support and involvement in this major pan India efforts. All the

Companies  I have talked to are willing to work with the government on the way  to address the issue of chronic diseases . I believe that we must involve the companies in our outreach efforts and form a long term partnership with the pharmaceutical companies

Finally , I must state that success will depend on the development of strategic partnerships, ensuring there are explicit and measurable targets, and governments providing the necessary political leadership. I would be grateful for your consideration of the following in order to ensure a successful Summit in September:

  • Support the strong participation of civil society in the Summit. We request that civil society representatives be included in the official government delegation to the Summit.
  • Invest in the consultation process leading up to the Summit to ensure that the meeting produces an outcomes document with strong recommendations and a concrete plan of international action, as outlined in the NCD Alliance 10 Outcomes Document Priorities. This should include:
  • Language on the NCD Alliance’s 10 Priority Outcomes, based on previously agreed upon language.
  • Acknowledgement of the health, social and economic burden of NCDs in the world, particularly in low- and middle-income countries.
  • An increase in international development funds and technical assistance to NCD prevention and control, including support for international instruments such as the Framework Convention on Tobacco control.
  • Measures that address the availability and affordability of quality medicines and technologies to ensure that people living with NCDs can access life-saving treatments.
  • Agreement to global accountability monitoring, reporting, and follow-up mechanisms.

DMAI – The Population Health Improvement Alliance is a not-for-profit organization formed by global healthcare leaders , and the only civil society organization in India dedicated to the management of chronic disease management in India .  In the past three years , DMAI has worked at both International level and within India to address the issue of chronic diseases with the support of  patient groups , Industry & policy makers , and wishes to put on record the continuous support DMAI has received from policy makers and the industry . We wish to expand this association further to address the issue of NCD’s together in form of a ‘PPPP’ – Profitable Private public partnerships .  I personally believe , that if the first “P” – Profit is missing from PPP We would just be restricted to pilot stage. We should not shy from adding the additional  “P” – Profits , so that the industry is incentivized to align its goals to government, and work together in a sustainable and profitable manner with performance that is measurable and with positive outcomes 

I think without profit , government cannot demand performance ; and without performance, private players should not expect profit . So profit has a pivotal role in the success of PPPP

To show our support for this summit , we have put the sub-theme ‘Management of Chronic Diseases using technology’ at the International Telemedicine Congress (www.telemedicon11.com ) that I am chairing from 11-13 November 2011 at Mumbai, India.

We would very much appreciate the opportunity to share perspectives on the meeting with you or one of your colleagues. At your earliest convenience, please let me know your availability in the coming weeks.

We look forward to your personal participation with a team of civil society organizations at the High-Level UN Summit in September, & I am sure that your thoughts will be really helpful for the summit and will set an example for others to follow . We wish you and the UN a successful summit .

Yours sincerely,

Rajendra Pratap Gupta

President & Member of the Board

Disease Management Association of India

Member – Healthcare , QCI. Government of India

P.N. : Details of the work done by DMAI in managing chronic diseases is available at the website www.dmai.org.in

Encl: Message at the UN delivered on 16th June 2011.

CC:

H.E. Ban Ki Moon, Secretary General , United Nations

H.E. Joseph Diess , President of the UN General Assembly

Hon’ble Deputy Secretary General of the UN General Assembly

Ms. Margaret Chan, Director General, WHO

Shri Ghulam Nabi Azad , Hon’ble Ministry of Health & Family Welfare, GOI

Dr.K. Srinath Reddy , President , PHFI

Minister of State for Health & Family Welfare , GOI

Dr.Syeda Hameed, Planning Commission , GOI

Shri K.Chandramouli, Secretary , H&FW , GOI

Board Of Directors , Disease Management Association of India – DMAI , The Population Health Improvement Alliance .

Address of the President of DMAI – The Population Health Improvement Alliance at the UN on 16th June 2011

Venue : UN General Assembly Hall , United Nations , New York.

Chaired by Mr. Joseph Deiss , President of the UN General Assembly .

Dear Friends ,

I am honored to be here , &  have few key points  for the special high level, two-day session that UN will convene in September 2011 for addressing the issue of chronic diseases.

I appreciate the point that UN session talks about local issues across regions . I would further suggest the United Nations that , if we want the governments to act on its recommendations , we must go beyond local i.e. get micro . My experience in public policy makes me believe that governments do appreciate and act on recommendations that are local but also focus on micro issues .

We have mega goals but  our actions have to be micro and we must suggest inputs that are local and at  micro level,  for execution.

Also, let us  accept the fact that for this generation , we are late, and we have already missed the bus . What I would not like is, that our next generation sits in the same UN General Assembly hall after 40 years , and discusses the same issues related to chronic diseases , and says that ‘our earlier generation behaved irresponsibly and did nothing for us ! ’. So the time has come for us to distinguish the ‘Urgent’ & ‘Important’ . Urgent is that we must fix the issues related to the chronic diseases now , but it is more Important  that we plan to build a healthier next generation . So my expectation from the UN is,  that  there will be a dedicated session related to Child health at the UN General Assembly in September .

Also that,  the technology is becoming all-pervasive and we must use this UN session to promote the use of  mHealth to address the issue of chronic diseases . I am expecting that the UN general assembly will dedicate a session to mHealth, and how it can help in the delivery of care for chronic diseases.

Lastly , I would like to run a quick survey on ABCDE of  Chronic Diseases / Healthcare . Where,  A stands for – Asthma/ Arthritis , B stands for Blood Pressure , C stands for CVD / Cancer , D stands for Diabetes & E stands for Epilepsy / Elderly patients ( as 84 % of all the elderly patients are on one or more medications)

If anyone of you or your immediate family members have any of these ABCDE , please raise hands .

The response is unbelievable ! I have made a point . It is not about the 5 or 10 % prevalence rate of chronic diseases. We have just now had the visual proof of the prevalence of chronic diseases , and it is much higher than the figures that we read often .

It’s time to act now .

Thank you.

Rajendra Pratap Gupta

Recording of the speech is available at www.un.org/webcasts