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Cancer in India

GS- II >>Social Justice>> Health

Context: Free cancer care alone won’t help India fight cancer.

About the Cancer:

• Cancer is a condition characterised by the uncontrolled growth and dissemination of certain cells within the body. It has the potential to originate in virtually any part of the human body, a complex organism composed of trillions of cells.
• Under normal circumstances, human cells undergo growth and replication through a regulated mechanism known as cell division, generating new cells to meet the body’s requirements.
• As cells age or incur damage, they undergo a natural process of death, with new cells assuming their role. However, there are instances where this orderly progression is disrupted, leading to the abnormal proliferation of damaged cells beyond the normal limits.

Causes of cancer:

• Genetic factors: Some individuals inherit genetic mutations from their parents that increase their susceptibility to certain types of cancer.
• These inherited mutations can be present in genes involved in cell growth, DNA repair, and tumor suppression.
• Environmental exposures:
• Carcinogens: Carcinogens can be found in various environments and include chemicals, pollutants, and radiation. Examples include asbestos, benzene, formaldehyde, radon, and certain industrial chemicals.
• Lifestyle choices:
• Tobacco use: Smoking and the use of smokeless tobacco are major contributors to various cancers, especially lung, mouth, throat, and pancreatic cancer.
• Dietary habits: Diets high in processed foods, red and processed meats, and low in fibres have been associated with an increased risk of certain cancers, such as colorectal cancer.
• Alcohol consumption: Excessive alcohol consumption is linked to an elevated risk of liver, breast, oesophageal, and other cancers.
• Physical inactivity: Lack of regular physical activity is associated with an increased risk of several types of cancer, including breast and colon cancer.
• Viral infections: Some viral infections are linked to an increased risk of cancer. Examples include human papillomavirus (HPV) and cervical cancer, hepatitis B and C viruses and liver cancer, and certain lymphomas.
• Radiation exposure: Exposure to ionising radiation, whether from medical sources (E.g., X-rays) or environmental sources, can increase the risk of cancer. However, the risk depends on the dose and duration of exposure.

Disease burden In India:

• According to the 2020 WHO ranking on cancer burden, India ranks at the third position after China and the US, respectively, in terms of new yearly cancer incidence being reported.
• An estimated 14.6 lakh new cancer cases were detected in 2022, up from 14.2 lakh in 2021 and 13.9 lakh in 2020, as per data from the National Cancer Registry of the Indian Council of Medical Research (ICMR) presented in Parliament.
• Deaths due to cancer increased to an estimated 8.08 lakh in 2022 from 7.9 lakh in 2021 and 7.7 lakh in 2020.
• The incidence of all cancers is estimated to increase to 15.7 lakh by 2025, according to the data. However, the real incidence of cancer is conservatively estimated to be 1.5 to 3 times higher than the reported incidence from cancer registries.
• One in nine Indians will develop cancer during their lifetime, according to an ICMR study using data from population-based cancer registries.
• The incidence of cancer is higher among women — 103.6 per 100,000 in 2020 compared to 94.1 among men.
• Among men, the most common cancers were of the lung, mouth, prostate, tongue, and stomach; for women, they were breast, cervix, ovary, uterus, lung.

National Initiatives:

• National Cancer Control Programme (NCCP) was launched to combat cancer comprehensively. It focuses on prevention, early detection, diagnosis, treatment, palliative care, and rehabilitation.
• It was launched in 1975, and now has become a part of NPCDCS.
• National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS):
• The NPCDCS is a flagship program under the National Health Mission. Launched in 2010, it aims to prevent and control major non-communicable diseases, including cancer.
• Under NPCDCS, NCD Cells are being established at National, State and District levels for programme management, and NCD Clinics are being set up at District and CHC levels, to provide services for early diagnosis, treatment and follow-up for common NCDs.
• National Cancer Registry Programme (1982): NCRP, under the Indian Council of Medical Research (ICMR), collects and maintains data on cancer incidence across the country.
• National Cancer Grid (NCG): NCG is a network of major cancer centres across India that collaborate to standardise cancer care and share best practices. This initiative helps improve the quality of cancer treatment and facilitates research and training.
• Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY): PMJAY provides financial protection for over 100 million families (10 crore) against catastrophic health expenses. This includes coverage for cancer treatment, making it more accessible and affordable.
• Government has introduced Production Linked Incentive (PLI) scheme for domestic manufacturing of oncology equipment and other medical devices in 2020 with an outlay of Rs 3,420 crores offering incentive of 5% on incremental sales of goods manufactured in India.

Challenges:

• Inadequate health infrastructure: The healthcare infrastructure for cancer care, including diagnostic facilities and treatment centres, is often insufficient, particularly in rural and remote areas.
• Along with it, low rates of information on screening importance, methods, and even self-practising.
• Vacancy of ~2 to 9% female ANMs at HWCs mainly due to shortfall in Gujarat, Himachal Pradesh, Rajasthan, Tripura, and Kerala. Similarly, shortfall of 4% MOs exists in centers at Orissa, Karnataka, and Chhattisgarh.
• Comprehensive Cancer Centres (CCCs) are available only in 175 districts with each CCC covering a population of ~3 million.
• Low penetration of radiotherapy treatment (RT) facilities in India with 0.4 RT per million against the WHO norm of 1 RT per million.
• Implementation issues: Gaps in implementation of the NPCDCS program and lack of adequate workforce, technology, or equipment to enable specialists at CHCs and District hospitals to make a diagnosis.
• As part of a survey done by GoI, 27% CHCs and 13% of DHs had not implemented NPCDCS till 2017-2018.
• Long-pending dues of hospitals empanelled under PM-JAY makes it unsustainable for these hospitals to continue offering cancer treatment.
• Lack of comprehensive insurance coverage by retail health insurance players.

Way forward:

• Ensure adequate focus and budget allocation for cancer detection, the disease should be dealt with separately and not merged with other lifestyle diseases, such as diabetes and cardiovascular diseases.
• Deploy female ANM/ staff nurse or female MO/CHO at each HWC so that women feel safe and confident while attending breast and cervical cancer screenings.
• Include various types of necessary diagnostic tests under the AB-PMJAY so that timely detection of cancer can improve the cancer mortality rate.
• Conduct effective roll-out of low-cost indigenous HPV vaccine ‘Cervavac’ through mass vaccination drives leveraging experience.
• Drawing learnings from the latest Arogya Setu and CoWIN experience and leveraging the ongoing initiatives under the NDHM.
• To create a single health identity (Health ID/ AB ID), implement a standard platform to undertake screening and track a patient till treatment linked to the Health ID/ AB ID/Aadhar ID of population.

Studies and research on low-cost early detection methods for cancers such as lung, gastrointestinal and prostrate are critical to be evaluated for assessing their impact on downstaging the disease and consequently improving outcomes.

Source: www.thehindu.com

India- Australia Bi-lateral Relations

GS- II >>International Relations>> Bi-lateral Relations

Context: Defence Minister Rajnath Singh and Australian Deputy Prime Minister Richard Marles discussed enhanced cooperation in information exchange and Maritime Domain Awareness (MDA) during the second India-Australia 2+2 Ministerial Dialogue, which also involved External Affairs Minister S Jaishankar.

About the background of India-Australia relations:

• Overview: India and Australia share commonalities as vibrant democracies with secular, multicultural societies.
• The relationship has strengthened since India’s economic reforms in the 1990s, spanning trade, energy, science, technology, education, and defence.
• Historical Contacts: Commercial ties between India and Australia date back to the 18th century, with India playing a vital role in supporting the young Australian colony.
• India was a crucial source of food and provisions for Australia in the 19th century. Diplomatic offices, including the Consulate General of India in Sydney and Melbourne, were established in the mid-20th century.
• Diplomatic Relations: Diplomatic ties between India and Australia were initiated in the pre-Independence era, marked by the establishment of the India Trade Office in Sydney in 1941.
• Strategic Partnership: In 2009, India and Australia elevated their relationship to a ‘Strategic Partnership’ and later to a ‘Comprehensive Strategic Partnership’ (CSP) in 2020. The CSP involves regular ‘2+2’ meetings between Foreign and Defence Ministers.
• Economic and Trade Relations: Australia’s India Economic Strategy to 2035, commissioned in 2018, aims to strengthen economic ties.
• Bilateral trade, with India as the 8th largest partner, witnessed a deficit of $8.5 billion in FY22. The Economic Co-operation and Trade Agreement (ECTA), signed in April 2022, targets doubling trade to $50 billion.
• Civil Nuclear Cooperation: The Civil Nuclear Cooperation Agreement signed in 2014 facilitates substantial energy trade between India and Australia.
• Defence Collaboration: Defence cooperation expanded after PM Modi’s 2014 visit, covering research, development, and industry engagement.
• Agreements like Mutual Logistics Support (MLSA) and cooperation in Defence Science and Technology were finalized. Bilateral naval exercise ‘AUSINDEX’ commenced in 2015, showcasing joint maritime capabilities.
• Cultural Artifact Repatriation: India and Australia have successfully repatriated several cultural artifacts in recent years, including the Bronze Idol of Nataraja and Dwarpala stone sculptures, reflecting a commitment to preserving cultural heritage.
• Indian community in Australia: India is a major source of skilled immigrants, with a growing population of Indian students, reaching approximately 105,000 in Australian universities. In 2020, India became the second-largest migrant group in Australia after England.

India-Australia 2+2 Ministerial Dialogue:

• Dialogue overview: Defence Minister Rajnath Singh and External Affairs Minister S Jaishankar held the second India-Australia 2+2 Ministerial Dialogue.
• Key agendas: Discussions focused on deepening bilateral ties in defence, security, trade, investment, critical minerals, energy, and people-to-people linkages. Regional and global issues were also part of the agenda.
• Military history connection: Acknowledgment of the longstanding military relations, highlighting instances of Australian soldiers fighting alongside Indian troops, including at Gallipoli.
• Crucial for the region: Emphasis on India being central and crucial to the region, working towards a peaceful, stable, and prosperous environment with respect for sovereignty.
• Bilateral achievements: Mention of collaborative efforts in economic ties, trade, investment, climate initiatives, and people-to-people links, with a commitment to furthering cooperation.
• Open discussions: Open discussions on recent Indo-Pacific strategic developments, West Asia dynamics, and even sharing a light moment about the recent cricket match.

Significance of Australia:

• Indo-Pacific stability: Both India and Australia advocate for a free, open, and prosperous Indo-Pacific, evident in their active participation in the QUAD grouping, aimed at addressing regional challenges, particularly in response to China’s actions.
• Gateway to Pacific countries: Strengthening cooperation provides India enhanced access to Pacific Island nations, leveraging Australia’s influence over countries like Kiribati and Solomon Islands.
• Indian diaspora influence: The sizable Indian diaspora in Australia, constituting 2.8% of the population, underscores the importance of collaborative efforts to ensure their well-being and development, fostering stronger ties.
• Geo-strategic collaboration: Australia’s geographical proximity to the Indian Ocean makes active engagement crucial for India’s strategic positioning. Collaboration is sought for India’s strength in the Indian Ocean and support for initiatives like NSG membership and UNSC reforms.
• Energy security via LNG: Australia’s secure and long-term LNG supply offers India a strategic opportunity to diversify its energy sources, reducing dependence on the Middle East.
• Balancing China and defying coercion: Both countries recognize and respond to China’s ambitions in the Indo-Pacific, with Australia actively seeking to balance and restrain China. India is seen as a pivotal partner in countering China’s economic coercion and regional dominance.

Challenges in India-Australia relations:

• Shifting dynamics: Deterioration of Australia-China ties mirrored India’s challenges. Led to forging a Comprehensive Strategic Partnership in 2020.
• Quad cooperation: Quad (India, Australia, Japan, U.S.) pivotal in current geopolitics. Joint statements and expanded agendas foster closer alignment.
• Economic challenges: Economic ties limited; coal exports dominate. Plans for Indian-controlled global supply chains face setbacks.
• Security cooperation hurdles: India’s reliance on Russian weapons hinders deeper cooperation. India’s stance on Ukraine adds complexity to strategic alignment.
• Trade Agreement and Technology: Negotiating full free trade agreement faces hurdles. Divergent approaches to technology policies pose challenges.
• Cognitive dissonance: Promotion of India as a vibrant liberal democracy faces challenges. Trivialization and avoidance strategies in political discourse.
• Future outlook: Relationship no longer neglected but faces ongoing complexities. Divergences in geopolitical and economic interests persist.

Way forward:

• Enhancing economic competitiveness: To compete effectively, India must enhance competitiveness. Notable competition from countries with existing FTAs with Australia.
• Mitigating religious polarization: Addressing religious polarization crucial for internal harmony. Similar to concerns raised by India about religious tensions in Australia.
• Diplomatic outreach for tax reform: Actively engage diplomatically to ensure Australia amends tax laws. Focus on preventing taxation of offshore income from Indian technical services.
• Promoting Science & Tech collaboration: Leverage existing collaborations for mutual benefit in innovation. Align with Australia’s National Innovation and Science Agenda.
• Space cooperation opportunities: Explore collaborations in the commercial space sector. India well-positioned to support Australia’s space initiatives.
• Strategic dialogue on shared interests: Regular strategic discussions crucial for addressing shared concerns. Prioritize collaboration on issues related to China, Pakistan, Afghanistan, terrorism, and maritime security.
• Bilateral security declaration: Formalize security commitments through a bilateral declaration. Reciprocal engagement as a priority maritime partner urged by Australia.

Source: indianexpress.com