Madhumita Dobe

Health promotion for prevention and control of non-communicable diseases: Unfinished agenda

The magnitude of Non Communicable diseases demands urgent attention. Common, preventable risk factors underlie most NCDs. These include behavioural risk factors and metabolic risk factors. The prevalence of these, varies between income groups and differs with gender. Majority of events occur in individuals with modest elevations of multiple risks rather than with significant elevation of a single risk factor. The need of the hour is to adopt a process which addresses the upstream determinants through enabling people, to increase control over their health and its determinants, thereby promoting and sustaining good health The answer lies in Health Promotion which involves changing behaviour at multiple levels. In order to change, there is need to understand and apply the models which have been widely used to empower people to make healthy choices. These include the Health Belief, Self-Efficacy, Social Learning and Self-empowerment models.Changing behaviour, however, is a process, not an event. Different strategies are most effective at different Stages of Change. The contextual determinants of health and health behaviour also significantly influence the risks of NCDs.Till date, there has been limited focus on these issues. We urgently, need a close look at policies and their impact on health. With increasing burden of NCDs, the Health Sector will face strain on services delivery and budgets. Special policies and programs are necessary for the disadvantaged poor to address their differential vulnerabilities and risks. The unfinished agenda of NCD prevention and control needs to be addressed urgently with an integrated comprehensive framework of Health Promotion.

Viewpoint: The role of sanitation in malnutrition – A science and policy controversy in India

Over the past decade, India’s economic growth has been remarkable – yet almost half of India’s children under 5 remain stunted. The National Food Security Bill is the country’s response to this critical situation. Studies reveal that Indian children are chronically undernourished, not only because of lack of food but also because of recurring gastrointestinal infections. The stunting problem revolves more around lack of sanitation than food insecurity. Despite acknowledging that malnutrition is ‘complex and multidimensional’, government action has consisted largely of nutritional interventions and subsidized food. Although improvements in sanitation would be the most effective way to reduce excessively high levels of chronic undernutrition and stunting, a review of policy formulation and implementation reveals deficits and disconnects with available scientific evidence. It is time to change these mistaken assumptions and focus on improving access and use of safe sanitation facilities to achieve India’s nutritional goals.

Personal vis-a-vis social responsibility for disparities in health status: An issue of justice

Health inequities are disparities which can be avoided through rational actions on the part of policymakers. Such inequalities are unnecessary and unjust and may exist between and within nations, societies, and population groups. Social determinants such as wealth, income, occupation, education, gender, and racial/ethnic groups are the principal drivers of this inequality since they determine the health risks and preventive behaviors, access to, and affordability of health care. Within this framework, there is a debate on assigning a personal responsibility factor over and above societal responsibility to issues of ill health. One school of philosophy argues that when individuals are worse-off than others for no fault of their own, it is unjust, as opposed to health disparities that arise due to avoidable personal choices such as smoking and drug addiction for which there should (can) be a personal responsibility. Opposing thoughts have pointed out that the relative socioeconomic position of an individual dictates how his/her life may progress from education to working conditions and aging, susceptibility to diseases and infirmity, and the consequences thereof. The existence of a social gradient in health outcomes across populations throughout the world is a testimony to this truth. It has been emphasized that assuming personal responsibility for health in public policy-making can only have a peripheral place. Instead, the concept of individual responsibility should be promoted as a positive concept of enabling people to gain control over the determinants of health through conscious, informed, and healthy choices.

Determinants of menstrual hygiene among school going adolescent girls in a rural area of West Bengal

Background: Menstrual hygiene is a neglected issue in rural India. Lack of menstrual hygiene in adolescent girls can make them susceptible to various morbidities, for example, reproductive tract infection and urinary tract infection and their long-term consequences, for example, cervical cancer, infertility, and ectopic pregnancy. This study aims to find out the determinants of menstrual hygiene among the school going adolescent girls in a rural area of West Bengal. Objectives: To elicit the menstrual hygiene practices among the study population and to find out the association of poor menstrual hygiene practices with sociodemographic factors, such as age, occupation and education of the parents, housing, and presence of sanitary toilet. Materials and Methods: A descriptive, cross-sectional study was conducted among 307 school going adolescent girls of 12–17 years age group in a rural area of West Bengal. Results: Majority of the students in both schools (62.9%) were Hindu, general caste (54.1%) and belonged to nuclear family (69.7%). Most of the parents in both schools had completed their education up to primary level. Bivariate analyses were done, and the significant factors predicting good menstrual hygiene were entered into the multivariable logistic regression model. It revealed that good menstrual hygiene was more among those whose mothers were educated (adjusted odds ratios [AOR] 2.3 [1.06–5.01]), and who were homemakers (AOR 2.3 [1.06–5.01]). Conclusions: Menstrual hygiene among the study population was found to be poor. The improving education level of the mothers can go a long way in improving menstrual hygiene practice.

Viewpoint: The role of sanitation in malnutrition |[ndash]| A science and policy controversy in India

Over the past decade, India’s economic growth has been remarkable – yet almost half of India’s children under 5 remain stunted. The National Food Security Bill is the country’s response to this critical situation. Studies reveal that Indian children are chronically undernourished, not only because of lack of food but also because of recurring gastrointestinal infections. The stunting problem revolves more around lack of sanitation than food insecurity. Despite acknowledging that malnutrition is ‘complex and multidimensional’, government action has consisted largely of nutritional interventions and subsidized food. Although improvements in sanitation would be the most effective way to reduce excessively high levels of chronic undernutrition and stunting, a review of policy formulation and implementation reveals deficits and disconnects with available scientific evidence. It is time to change these mistaken assumptions and focus on improving access and use of safe sanitation facilities to achieve India’s nutritional goals.