Why in news?

The World Health Organisation (WHO) has recently released a list of “Ten threats to global health in 2019”.

What are the highlights and where does India stand?

• Air pollution, climate change - This is the gravest risk, with 9 out of 10 people breathing polluted air across the world.
• With 18% of the world’s population, India sees a disproportionately high 26% of the global premature deaths and disease burden due to air pollution.
• Over half the 12.4 lakh deaths in India attributable to air pollution in 2017 were of individuals of age under 70, as per the India State-Level Disease Burden Initiative report.
• The average life expectancy in India would have been 1.7 years higher if air pollution levels were lower than the minimum level causing health loss.
• Noncommunicable diseases - Noncommunicable diseases (NCD) such as diabetes, cancer, and heart disease kill 41 million every year.
• This is over 70% of deaths worldwide, including 15 million premature deaths of people in 30-69 age group.
• India, notably, remains the “diabetes capital of the world”.
• India’s current estimated cancer burden - over 1.5 million new cases - is predicted to nearly double in 20 years.
• Global influenza pandemic - WHO has warned of another influenza pandemic in the world.
• But global defences are only as effective as the weakest link in any country’s health emergency preparedness and response system.
• Fragile, vulnerable settings - More than 22% of the global population live in places where prolonged crises and weak health services leave them without access to basic care.
• [The crisis situation includes a combination of challenges such as drought, famine, conflict, and population displacement.]
• In India, the massive distress in farm sector has engendered waves of internal migration for work.
• This migrant population often live in unhygienic conditions with very little access to basic care.
• The Rohingya migration crisis unfolding in Bangladesh could send ripples into India.
• Moreover, natural calamities routinely bring health crises in their wake. E.g. the recent Kerala floods were followed by a leptospirosis outbreak
• Antimicrobial resistance - Antimicrobial resistance (AMR) is what a pathogen develops upon non-lethal exposure to a drug.
• It usually happens when patients do not complete the full dosage prescribed.
• It is also a result of rampant over-the-counter sale of medications without the prescription of a registered medical practitioner.
• This threatens to send the world back to a time when treating infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis were impossible.
• India, China, and the Russian Federation accounted for 47% of the global incidence of MDR (Multi-drug-resistant)/RR (rifampicin resistant) TB in 2016.
• India now has an AMR policy but implementation is poor.
• Primary healthcare - WHO has highlighted that many countries did not have adequate primary healthcare facilities.
• In India, only about 5,000-odd centres are estimated to be functioning currently, and there is high vacancy of doctors too.
• The primary care arm of Ayushman Bharat, with a proposed 1,53,000 health and wellness centres, has received less attention.
• Vaccine hesitancy - The reluctance to vaccinate despite the availability of vaccines threatens to reverse the progress made in tackling vaccine-preventable diseases.
• Vaccination currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.
• The Delhi High Court's recent ruling on parental consent in vaccination has the threat of adversely impacting vaccination drives.
• Dengue - Dengue is endemic to India, and its season in countries like Bangladesh and India is lengthening significantly.
• In 2018, Bangladesh saw the highest number of deaths in almost two decades.
• The disease is spreading to less tropical and more temperate countries such as Nepal.
• WHO estimates 40% of the world is at risk of dengue, with around 390 million infections annually.
• HIV - The epidemic continues to rage, with nearly a million people every year dying of HIV/AIDS.
• India has now launched a test and treat policy, and made HIV treatment the right of every individual who needs it.
• The HIV/AIDS Act, 2018 makes access to anti-retroviral therapy (ART) an actionable legal right for Indians living with HIV/AIDS (about 21 lakh).
• Also, India is a stakeholder in the WHO’s 90-90-90 target for HIV elimination.
• [By 2020, diagnose 90% of all HIV-positive persons, provide ART for 90% of those diagnosed, and achieve viral suppression for 90% of those treated]
• Ebola, other pathogens - Several Indian states battled Zika in 2018, and at least 17 people died of Nipah infection in parts of Kerala.
• While India has been spared Ebola so far, the WHO prioritises research & development for several haemorrhagic fevers, Zika, Nipah, and SARS.